The theory of five elements is used in TCM to classify the viscera and meridians into five categories and explain their characteristics according to the properties of the five elements, to analyze the relationships among the viscera, meridians and various physiological functions according to the inter-generation and inter-restriction of five elements, and to explain their interactions under pathological conditions according to the over- restriction and counter-restriction of five elements.
To Explain the Physiological Function of the Five Zang-Organs Each of the internal organs, according to the theory of five elements, per- tains to one of the five elements. So their physiological functions are illustrated by the characteristics of the five elements. For example, the liver prefers to grow freely and dislikes depression, and can regulate qi and blood as well as emotions, so it pertains to wood marked by growing, ascending, dispersing and free-reaching; the heart yang has the function of warming, so it pertains to fire marked by warming, heating and ascend- ing. The spleen, as the source of qi and blood, can transport and transform water and food into nutrients for the nourishment of the viscera, limbs and bones, so it pertains to earth marked by generating and supporting a myriad of things. The lung, characterized by purifying and descending,
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takes the downward action as the normal tendency, so it pertains to metal marked by clarifying, descending, and astringing. The kidney stores essence and controls water, so it pertains to water marked by moistening, descending and storing.
In addition to explaining the physiological functions of the five zang- organs, the theory of five elements is also used for analyzing the various structures, tissues and functions of the entire body by analogy and deduc- tion. At the same time, it is further extended to correlate the five orienta- tions, five seasons, five properties, five flavors and five colors in nature with the five zang-organs, six fu-organs, five sensory organs and five body constituents of the human body. In such a manner the internal environment and external environment of the body are connected into an entirety. Take the liver as an example, it says in Su Wen, “the east engenders wind, wind generates wood, wood produces sourness, sourness forms liver, liver con- trols eyes and gives birth to tendon, and tendon promotes heart.” That is how the east, spring, wind and sourness in nature are correlated with wood in five elements and liver, tendons and eyes in the human body, indicating the holistic concept of correspondence between man and nature.
To Explain the Inter-Connection Among the Five Zang-Organs
The functional activities of the five zang-organs are not isolated, but inter- connected. The attribution of the five zang-organs to the five elements is helpful for the discussion of the functional characteristics of the five zang-organs, as well as the intrinsic connection among the physiological functions of the viscera. The five elements are inter-generated and inter- restricted, so are the five zang-organs.
1. The Inter-Generation of the Five Zang-Organs
Liver promoting heart, or wood generating fire, means that the liver stores blood to nourish the heart. Heart promoting spleen, or fire generating earth, means that the heart yang warms the spleen earth so as to facilitate its transportation and transformation. Spleen promoting lung, or earth generating metal, means spleen qi disperses nutrients over the lung. Lung promoting kidney, or metal generating water, means the lung qi flows
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downward to regulate waterways and facilitate the kidney water. Kidney promoting liver, or water generating wood, means the kidney stores essence to nourish liver blood.
2. The inter-restriction of the five elements
Liver restraining spleen, or wood restricting earth, means the free flow of liver qi helps to unblock the stagnation of the spleen earth. Spleen retraining kidney, or earth restricting water, means the spleen transforms water and dampness to prevent kidney water from overflowing. Kidney restraining heart, or water restricting fire, means the upward flow of kidney water for curbing heart fire. Heart restraining lung, or fire restricting metal, means that the warmth of heart fire is helpful for the dispersion of lung qi and may prevent it from excessive descent. Lung restraining liver, or metal restricting wood, means lung qi moves downward to prevent over-ascent of the liver qi.
It should be pointed out that the physiological functions of the five zang- organs and their inter-generation and inter-restriction are illustrated through the characteristics of the five elements and their interactions. Despite all of these, the functions of the five zang-organs, and their relations, are very complicated. So the characteristics of the five elements cannot cover all the functions of the five zang-organs, nor can the interactions among the five elements explain all the intricate physiological relations among the five zang-organs. Therefore, when studying the intrinsic connection and regula- tory mechanism of the physiological functions of the viscera, we cannot confine our attention only to the inter-generation and inter-restriction of the five elements.
To Illustrate the Pathological Interaction Among the Five Zang-Organs
The theory of five elements is not only used to indicate the inter-connection among the viscera under physiological conditions, but also used to explain the interaction among the viscera under pathological circumstances. The disorder of one organ may be transmitted to another. This pathological interaction is called transmission, which is divided into two types: inter- generation transmission and inter-restriction transmission.
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1. Inter-generation transmission
This refers to the disorder of one organ that may be transmitted to another organ in the order of inter-generation of the five elements: from liver to heart, spleen, and lung, then to kidney, and finally to liver, again. In a specific disease, there are often such an inter-generation relationship between two organs, i.e., mutual transmission between the mother organ and the child organ, including “mother organ involving child organ” and “child organ involving mother organ.” Mother organ involving child organ refers to the transmission of disease from the mother organ to the child organ. For example, the kidney pertains to water and the liver to wood, so the kidney is the mother organ and the liver is the child organ; if the kid- ney disease involves the liver, this is regarded as mother organ involving child organ. A case in point is “water failing to nourish wood,” which is very common clinically. This is due to deficient kidney water that fails to nourish the liver yin, leading to yin deficiency of both the liver and the kidney as well as hyperactivity of liver yang, which is called “water fail- ing to nourish wood.” Child organ involving mother organ refers to the transmission of disease from the child organ to the mother organ. For example, the liver pertains to wood and the heart to fire, so the kidney is the mother organ and the liver is the child organ because wood produces fire; if the heart disease involves the liver, this is regarded as child organ involving mother organ. Blood deficiency of heart and liver or fire hyper- activity of heart and liver, which are very common clinically, are both classified into this category. This is due to that deficient heart blood fails to nourish the liver yin, leading to blood deficiency of the liver and heart, or due to that hyperactive heart fire involves the liver, leading to fire hyperactivity of both heart and liver.
2. Inter-restriction transmission
This refers to the disorder of one organ that may be transmitted to another organ in the order of inter-restriction of the five elements: from liver to spleen, from spleen to kidney, from kidney to heart, from heart to lung, and finally, from lung to liver. This usually takes place between two organs that are mutually restricted. Such a transmission is divided into two types: “ over- restriction” transmission in the normal order of inter-restriction of the five
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elements and “ counter-restriction” transmission in the reverse order of inter- restriction of the five elements.
Over-restriction means the excessive restraint of one element one another. There are mainly two reasons for over-restriction among the five zang-organs: one is due to that the restricting organ is so hyperactive that it restricts another organ excessively; the other is due to that the restricted organ is too weak to withstand the excessive inhibition of the restricting organs. For example, as far as the relation between the liver wood and spleen earth are concerned, there are mainly two types: “hyperactive wood over-restricts earth” (hyperactive liver over-restricts spleen) and “ deficiency of earth incurs over-restriction of wood” (deficiency of spleen incurs over- restriction of liver). It is generally called “hyperactive wood over-restricting earth” when the stagnation of liver qi impairs the transportation and trans- formation of the spleen and stomach, leading to fullness and distension in the chest and hypochondria, distending pain in the gastric and abdominal region, bitterness sensation in the mouth, acid regurgitation, belching, nau- sea, and loose stool, etc. By contrast, if the spleen and stomach are too weak to bear the restriction of the liver, leading to dizziness, lassitude, indiges- tion, belching, fullness and distension in the chest and hypochondria, dis- tending pain in the gastric and abdominal region, rugitus and diarrhea, this is called “deficiency of earth incurring over-restriction of wood.”
Counter-restriction means the reverse restraint of one element on another. There are mainly two reasons for counter-restriction among the five zang-organs: over-action and under-action. For instance, the lung- metal is supposed to restrict the liver-wood, but when the liver qi rises adversely and liver fire burns hyperactively, the lung metal will be coun- ter-restricted by liver wood instead of restricting it. This is called “hyper- active wood counter-restricting metal” or “hyperactive wood fire scorching metal.” Clinically there will be adverse rising of liver qi and hyperactive of liver fire due to sudden, intense anger, marked by irascibility, reddened complexion and eyes, fullness and distension in the chest and hypochon- dria, or even cough with dyspnea, sputum with blood and hemoptysis, etc. Counter-restriction due to under-action refers to the reverse inhibition on the organ that is supposed to be the restricting one by the organ that is supposed to be the restricted one due to the weakness of the former. For instance, if the spleen-earth cannot inhibit the kidney-water, there will be
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such symptoms as general edema. This is called “ deficiency of earth incurring counter-restriction by water.”
In a nutshell, the pathological interaction among the five zang-organs can be illustrated by the over-restriction, counter-restriction and mother- child relation of the five elements. If the disease transmits in the order of inter-generation, it is a relatively mild one when the mother organ involves the child organ; however, when the child organ involves the mother organ, it will be a relatively severe one. Contrarily, if the disease transmits in the order of inter-restriction, it is a relatively severe one when there is over- restriction and a milder one when there is counter-restriction. Nevertheless, the inter-generation and inter-restriction of the five elements cannot be used to explain all the complicated physiological relations among the five zang-organs, and similarly, the over-restriction, counter-restriction and mother-child relation of the five elements cannot be used to illustrate all the pathological interactions among the five zang-organs. So clinically we should proceed from practice so as to truly command the transmission patterns of disease.
Daily Exercises
1. How to describe the inter-generation and inter-restriction of the five elements?
2. What is transmission in the order of inter-generation? 3. What is transmission in the order of inter-restriction?
The Application of Five-Element Theory in TCM
For Diagnosis of Diseases
The human body is an organic entirety, the internal disorders of which must be manifested externally. The manifestations may be various. The abnormal changes of the functional activities of the viscera and their interrelations can be reflected on the corresponding tissues and organs of the superficies, marked by morbid changes in color, luster, voice, shape, and pulse. The five zang-organs have specific connections with the five colors, five sounds, and five flavors. Such a hierarchic classification of the five-zang system provides
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the theoretical foundation for the clinical diagnosis of diseases. Hence, dur- ing the clinical diagnosis, the information collected through the synthetic application of inspecting, listening and smelling, inquiring and pulse-taking can be used to deduce the disease conditions in the light of five-element attribution and the inter-generation, inter-restriction, over-restriction and counter-restriction of the five elements.
1. For inspection of the complexion
Each of the five zang-organs are associated with a certain type of color, i.e., the liver is associated with blue, heart with red, spleen with yellow, lung with white, and kidney with black. This is determined by the five- element attribution. So clinically the changes of facial color may indicate the disorder of a certain organ, e.g., facial colors such as blue, red, yellow, white and black are indicative of disorders in the liver, heart, spleen, lung and kidney, respectively. Besides, the changes in color can also be used to infer the transmission of diseases among the zang-organs. For example, if blue color is shown in spleen diseases, it is mostly due to “hyperactive wood over-restricting earth” or “over-restriction of wood due to defi- ciency of earth:” if black complexion is shown in heart diseases, it is mostly due to “water over-restricting fire.” The prognosis of diseases may be deduced from the inter-generation and inter-restriction among the five colors. When the facial color is inconsistent with the disease, this is called color-disease contradiction in which colors in an inter-generation relation- ship indicate a favorable prognosis while colors in a inter-restriction rela- tionship signify an unfavorable turn. For instance, liver disease with blue complexion, called correspondence between color and disease, is a com- mon manifestation. However, if the complexion turns black (water gener- ating wood) or red (wood generating fire), the prognosis is favorable although the color contradicts the disease because there are inter-genera- tion between the color and the disease. If the complexion turns yellow (wood restricting earth) or white (metal restricting wood), the prognosis is unfavorable because there are inter-restriction between the two. In favorable cases, color generating disease indicates the positive of fortune; whereas disease generating color signifies the negative of fortune.
In unfavorable diseases, color restricting disease indicates the negative of misfortune, whereas disease restricting color signifies the positive of
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misfortune. This is also applicable to other viscera. The diagnostic signifi- cance of five colors and their application in predicting disease prognosis according to the inter-generation and inter-restriction of the five elements bear certain theoretical and practical value. It is very common clinically that kidney deficiency leads to a black complexion and spleen deficiency results in a yellow one. Nevertheless, some deductions from this theory are not congruent with practical manifestations, so clinically this method should be used flexibly and be combined with the four major diagnostic methods so as to achieve a satisfactory therapeutic effect.
2. For inquiry of flavors
The abnormal changes of flavors are also pathological manifestations of the five zang-organs, so the organs in disorder can be deduced from the five-element attribution: sourness pertains to liver, bitterness to heart, sweetness to spleen, pungency to lung and saltiness to kidney. Therefore, sourness in the mouth indicates hyperactivity of liver fire (hyperactive liver fire invading stomach); bitterness in the mouth indicates relative exuberance of heart fire; sweetness in the mouth indicates obstruction of dampness in the spleen (or Pi Dan); pungency in the mouth indicates dis- order of the lung metal (unusual in the clinic); and saltiness in the mouth indicates deficiency of the kidney. The diagnostic significance of five flavors is much valued clinically. For example, if pathogenic dampness accumulates in the spleen and stomach and turbid qi flows upward to the mouth, there will be sweet and greasy flavor in the mouth; if heat accu- mulates in the liver and stomach and goes upward to the mouth, there will be sourness sensation in the mouth; if kidney yang is deficient with upward flowing of cold water, there will salty flavor in the mouth. There are also conditions in which the same abnormal flavor indicates more than one disease, e.g., bitterness in the mouth can be seen in up-flaming of heart fire, or up-flowing of gallbladder qi (because bile is bitter in flavor), or even all the fire-heat syndromes.
3. For combined diagnosis of color and pulse
Combined diagnosis of color and pulse refers to the judgment of progno- sis of diseases through the generation and inter-restriction between color
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and pulse. Generally speaking, liver disease with blue color and taut pulse is marked by correspondence between color and pulse; if there is floating pulse instead of the taut one, the prognosis will be unfavorable because the pulse restricts the color (metal restricts wood); if there is sinking pulse, the prognosis will be favorable because the pulse promotes the color (water generates wood). This is also applicable to other zang-organs. Despite its diagnostic significance, this method cannot replace the syn- thetic application of the four major diagnostic methods in the clinical judgment of prognosis for the reason that it is not invariably correct.
Daily Exercises
1. Explain why disordered viscera can be identified by examining the changes of facial color and luster?
2. What are the viscera pathological states of which can be indicated by the unusual changes of oral flavors?
3. What is combined diagnosis of color and pulse?
The Application of Five-Element Theory in TCM
For Treatment of Diseases
The application of the five-element theory in TCM is mainly reflected in directing visceral medication, controlling disease transmission, and deter-