On Chinese Medicine: The Five Xng

Stephan Beyer, Singing to the Plants

BACKGROUND
European philosophy has long been dominated by questions of epistemology: what do we know? how do we know it? how can we
justify our claims to knowledge? Chinese philosophy perhaps because of its origins in practical political thought has been
dominated instead by questions of change: why is there change rather than stability? what is the relationship between change and
human action? are there patterns of change that we can detect and use to our advantage?
The concept of the wxng was proposed by the philosopher Zou Yan (f. c. 350-270 BCE) as one answer to that last
question.
The character w is the numeral fve. The folk etymology of the character xng sees it as depicting a man walking, putting frst
his left foot forward and then his right (Rochat, 2009, p. 76). But the character was originally a pictogram depicting a street
intersection, as can be seen in some of its earlier forms (, 2014, Etymology, para. 1):
Oracle bone scriptBronze inscriptions Large seal script Small seal script
The term xng represents a cluster of concepts that includes go, walk, move, travel, and circulate. By extension, it means behavior,
conduct, practice; as a transitive verb, it means guide, lead, conduct. The Bih tng a record of debates among leading
Confucian scholars at the court of the emperor Han Zhang Di beginning in 79 CE asks why the fve xng are called by
that name, and answers with a typical Chinese etymology: they are called , it says, because heaven s conducts, moves, puts
in motion their q (quoted in Rochat, 2009, p. 67).
Whatever xng may be in this context, there are fve of them, all tangible, natural materials wood m , fre hu , earth t ,
metal jn , and water shu . The term xng has been variously translated into English as element, phase, agent, movement,
process, and stage. All of these are attempts to capture, in one way or another, the idea that the xng are simultaneously substances
and processes; indeed, one awkward translation calls them process-classifcations (Chen, 1996, p. 200); another calls them material
forces (Yao, 2000, p.82).
The Chinese were certainly not interested, as were the ancient Greeks, in discovering the ultimate constituents of the material world,
or seeking to penetrate the world of appearances to some ultimate reality beyond it. Rather, as Benjamin Schwartz (1985, pp. 358-
360) puts it, the Chinese were concerned with accepting the world as they found it, correlating the realities of ordinary experience, and
interrelating the manifold world of experience into a meaningful and patterned whole.
Why fve? Perhaps so that they can be counted on the fngers; perhaps because there are four directions and a center. We do know
that the Confucian texts are full of fves fve excellences, fve talents, the fve qualities of the sage, fve colors, fve notes, fve duties
(Rochat, 2009, pp. 35-36).
The concept of the fve xng ranges from the concrete to the abstract. All the xng appear in another list, that of the six treasuries or
storehouses lif water, fre, metal, wood, and soil, to which is added grain that constitute the substantial necessities for
human civilization, and for which the government is responsible. Thus, in the Shjng , the legendary king Y the Great is
reported to have counseled:
Virtue is seen in the goodness of the government, and the government is tested by its nourishing of the people. There are water, fre,
metal, wood, soil, and grain these must be duly regulated; there are the rectifcation of the peoples virtues, the conveniences of life,
and the securing of abundant means of sustentation these must be harmoniously attended to (quoted in Geiss, 1988, p. 403 n. 1;
Unschuld, 2010, p. 59).
Here there is little doubt that the fve xng, along with grain, are material objects of use and consumption.
On the other hand, for Zou Yan these fve xng were primarily a conceptual tool for understanding history specifcally, the
succession of dynasties. He called them by the abstract expression wd , meaning the fve virtues or powers. The term d is
here the same as that found in Laozis Dodjng .
There is a further level of abstraction. In the Hngfn Great Plan chapter of the Shjng we read: Water is said to soak
and descend; fre is said to blaze and ascend; wood is said to be curved or straight; metal is said to conform and solidify; earth is said
to take seed and give harvest (Ho, 2000, p. 170; Chen, 1996, p. 200; Wang, 2012, p. 37; Rochat, 2009, p. 27).
I think the proper reading here is not so much that water soaks and descends as that whatever soaks and descends is in some way
water. In other words, all stream-like processes of fowing or continuity are under the sign of water, and are connected to each other
in a variety of ways, most importantly by occupying the place of water in the cycles of generation and inhibition.
The same is true for the other xng. Blazing and ascending are properties of all combustion processes, including metaphorical
combustion warmth, passion, impulse, spirit, the fre in the heart. The properties of wood that allow it to be curved or straightened
align it with all the processes of shaping, cutting, and making birth, ideation, creativity, expression. The qualities of earth that allow
planting and harvest embrace stability, regularity, centeredness, nourishment, productivity. Metal poured in a mold frst conforms and
then hardens; so do all things that adapt, comply, and become frm (see Chen, 1996, p. 201; Tierra, 1998, p. 31; Zhu & Wang, 2010,
p. 30).
THE ASSOCIATIONS
Each of the fve xng has a number of such associated concepts, extending from the transparent to the puzzling. Wood, for example, is
associated with the liver gn and gall bladder dn , with springtime and the eyes, with anger and the time from 1:00 am to 3:00
am, with leeks, chickens, and plums. And there are a lot of such associations. Warren (2002, pp. 27-28) lists fourteen for each xng;
Tierra (1998, pp. 29-30) lists twenty-fve.
Some of these associations are fairly clear. Wood the character m also means tree is considered to represent growth,
germination, expansion, spreading out. It is therefore associated with springtime, when temperatures increase and the weather is
windy, when trees and grass turn green, when fruit is sour and not yet ripe.
Thus at least in China, situated in the northern temperate zone wood is associated with springtime, wind, germination, growth,
green, and sour tastes (Liu, 1988, p. 49). Or perhaps wood is associated with a sour taste because decaying wood has a sour taste
(Ho, 2000, p. 170); or perhaps because wood opens up, clears the way, gets rid of obstacles, just as does an acid, which has a sour
taste (Rochat, 2009, p. 94). Clearly there is a lot of room here for creativity.
Such associations become important in Chinese medicine. The basic features of water are coldness, downward motion, moistness,
and contraction, and those of fre are heat, dryness, upward motion, and meltability. Thus, in Chinese medicine, the kidney shn
and urinary bladder pnggung are associated with winter, cold, north, and water, and the heart xn is associated with
summer, heat, south, and fre (Lo, 1986, p. 221).
But many medical associations are less transparent and more dependent on specifcally Chinese medical concepts. For example, why
is the liver associated with wood? Because, we are told, the liver prefers a moist environment, its qi likes to ascend, and, when
diseased, it produces symptoms of the wind pathogen, such as tremors and convulsions (Liu, 1988, p. 49). Or again: because, we are
told, just as wood can bend or straighten, and the leaves and branches of a tree are free, growing, and movable, the liver prefers free
movement and dislikes being prohibited, and functions to promote the free fow of qi (Zhu & Wang, 2010, p. 38). Even more: the liver
connects to the gall bladder, controls the tendons, opens into the eyes, and manifests in the nails. Therefore, since the liver is
associated with wood, then the gall bladder, tendons, eyes, and nails are associated with wood as well (Zhu & Wang, 2010, p. 32).
The following table (see Warren, 2002, pp. 27-28; Tierra, 1998, pp. 29-30) lists some of the more common associations of the
fve xng.
Wood Fire Earth Metal Water
Planet Jupiter Mars Saturn Venus Mercury
Direction East South Center West North
Color Green White Yellow Red Black
Season Spring Summer Late Summer Autumn Winter
Pathogen Wind Heat Dampness Dryness Cold
Zng Liver Heart,
pericardium
Spleen Lungs Kidney
F Gall bladder Small intestine, Stomach Large intestine Bladder
triple warmer
Sense Sight Speech Taste Smell Hearing
Body part Muscles/ tendons Blood vessels Flesh Skin Bones
Manifestation Nails Complexion Lips Body hair Head hair
Orifce Eyes Tongue Mouth Nose Ears, anus,
urethra
Fluid Tears Perspiration Saliva Mucus Urine
Sound Crying Laughter Singing Sobbing Groaning
Emotion Anger Happiness Worry Sorrow Fear
Smell Rancid Scorche Fragrant Rotten Putrid
Taste Sour Bitter Sweet Pungent Salty
THE CYCLES
Background
It is probably to Zou Yan that we owe the idea that the fve xng succeed each other in a regular sequence; he explains dynastic
succession by associating each dynasty with a xng a power or virtue that by necessity overcomes that of the previous dynasty.
He wrote:
Each of the fve virtues is followed by one that it cannot conquer. The dynasty of Shn was ruled by the virtue of earth, the Xi !
dynasty by the virtue of wood, the Shng " dynasty by the virtue of metal, and the Zhu # dynasty by the virtue of fre (quoted in Ho,
2000, p. 16; Chen, 1996, p. 202).
This idea was apparently opposed by the Mhist $% logicians and perhaps also by Sunzi &' who believed that one xng
succeeded another not by some natural progression but because of greater quantity: That fre melts wood is because there is much
fre; that metal uses up charcoal is because there is much metal (Zhang, 2002, pp. 99-100; Chen, 1996, p. 202).
But Zou Yans ideas were tremendously popular among the rulers of the Warring States period. In contrast to the rebufs given to
Confucius and Mencius, Zou Yan was received respectfully by the rulers of Ling (, Zho ), and Yn *; the Shiji +, devotes three
times more space to describing Zou Yans theories and activities than it gives to Mencius or Xunzi (Harper, 1999, p. 824).
The generation and inhibition cycles of the fve xng
Perhaps one of the reasons for this popularity was that a regular succession of xng allowed both prediction and manipulation. When
a new dynasty is going to rise, Heaven exhibits auspicious signs to the people, Zou Yan writes. Following fre that is, the Zhu
dynasty there comes water. Heaven will show when the time will come for the qi of water to dominate. Then the color will have to
be black; afairs will have to be placed under the sign of water (quoted in Ho, 2000, p. 16).
This theory that the Zhu dynasty, for example, had a natural and inevitable propensity to replace the Shng dynasty, just as fre
overcomes metal led Qn Shhung -./, the frst emperor of the Qn, to defne his dynasty as water, with its inevitable propensity
to overcome fre. It also led to important debates in the succeeding Hn dynasty as to whether it should be water, thus displacing
Qn as the legitimate successor to Zhu, or should be earth, thus naturally overcoming Qn (Wang, 2012, p. 39).
The Generation Cycle
The wxng doctrine describes two primary cycles, a generation or creation shng 0 cycle and an inhibition or overcoming k 1
cycle. These cycles are also called, respectively, mutual generation xingshng 20 and mutual inhibition xingk 21.
The generation cycle is considered the mother-child cycle. A naturalistic description of the cycle is that water causes trees to grow, the
wood feeds the fre, the fre leaves an earthen ash, the earth gives birth to metal ore, and metal becomes liquid when it melts (see
Tierra, 1998, p. 30). So water generates wood, wood generates fre, fre generates earth, earth generates metal, and metal generates
water. Water is the mother of wood; earth is the child of fre (Wang, 2012, p. 38).
The Inhibition Cycle
The inhibition cycle is considered the grandmother-grandchild cycle; in the traditional Chinese household, it was the grandparents who
were responsible for the discipline and control of the grandchildren (Tierra, 1998, p. 30). Here water inhibits fre, fre inhibits metal,
metal inhibits wood, wood inhibits earth, and earth inhibits water (Wang, 2012, p. 38).
The Hungd nijng swn 3456 gives a naturalistic rationale for the inhibiting cycle: When wood meets metal it is felled;
when fre meets water it is extinguished; when earth meets wood it is penetrated; when metal meets fre it is destroyed; when water
meets earth it is interrupted in its fow. These transformations can be applied to the myriad things (Ni, 1995, p. 101; Rochat, 2009, p.
85). In other words, a metal axe chops down a tree; water extinguishes a fre; tree roots penetrate the ground; fre melts metal; an
earthen dam constrains the stream.
The Bih tng gives a more abstract rationale: The mass overcomes the stray, so water overcomes fre. The fne overcomes the
solid, so fre overcomes metal. The hard overcomes the soft, so metal overcomes wood. The compact overcomes the loose, so wood
overcomes earth. The full overcomes the empty, so earth overcomes water (quoted in Rochat, 2009, p. 72).
Feedback loops
If we look just at the two cycles outlined above, it looks as though the relationships of generation and inhibition among the fve xng are
all unidirectional: wood generates fre, but fre does not generate wood; earth inhibits water, but water does not inhibit earth. But, as
Liu Yanchi (1988, pp. 53-56) points out, these two cycles operate simultaneously, and thus create a feedback mechanism.
These feedback loops help to maintain homeostasis. For example, fre is inhibited by water and generates earth; earth then inhibits
water. This feedback loop prevents water from overly inhibiting fre. Similarly, fre is generated by wood and generates earth; earth can
inhibit water, preventing water from overly generating wood. This feedback loop prevents wood from overly generating fre. Such loops
are called mutual control xingzh 27 (Ho, 2000, p. 20; Wang, 2012, p. 38; Liu, 1988, pp. 53-56).
These loops can become complex. Here is one example: Metal inhibits wood but at the same time generates water; the water then
generates more metal, preventing its overinhibition. Here is another: When exuberant fre overly inhibits metal, metal becomes too
weak to inhibit wood. Wood then becomes exuberant and overly inhibits earth. Earth is then unable to inhibit water, so water becomes
exuberant and brings fre back to normal. Such loops are called mutual transforming xinghu 28 (Ho, 2000, p. 20; Wang, 2012, p.
38; Liu, 1988, pp. 53-56).
Disorders of inhibition
There are two ways that the inhibition cycle can go wrong. These are called, respectively, overinhibition gu k 91 or bullying chng
:, and counterinhibition fn k ;1 or insult w < (Lo, 1986, p. 221; Zhu & Wang, 2010, pp. 34-35).
Overinhibition or bullying can occur just as in a Chinese household either because the grandmother is too strong or the
grandchild is too weak. In the frst case, for example, overly excessive water may overinhibit fre, resulting in fre insufciency. This is
called water overinhibits fre. In the second case, water may not be excessive but fre may be insufcient, so that water becomes
relatively excessive, resulting in an even greater fre insufciency. This is called water overinhibits fre when fre is defcient.
In counterinhibition or insult the grandchild is so strong that it inhibits the grandmother, as when a forest fre burns so fercely that the
water poured on it evaporates, or when a raging food overwhelms and destroys an earthen dam. For example, wood should be
inhibited by metal; but if wood is especially strong, it may not only fail to be inhibited by metal but may counterinhibit it. This is called
wood counterinhibits metal. Or again: if metal is particularly weak, then not only may it fail to inhibit wood but may be counterinhibited
by it. This is called metal counterinhibited by wood when metal is weak.
Both overinhibition and counterinhibition can occur at the same time. If wood is excessively strong it may both overinhibit earth and
counterinhibit metal; if metal is excessively weak, it may be both counterinhibited by wood and overinhibited by fre (Zhu & Wang,
2010, pp. 34-35)
MEDICAL APPLICATIONS
Diagnosis
The fve xng by time of day
As outlined above, each of the fve xng is associated with two or, in the case of fre, four of the zngf =>. Thus each of the
zngf is in a dual relationship of generation and inhibition; it both has and is a mother and grandmother. For example, the kidney is
correlated with water, and the liver is correlated with wood; because water generates wood, the kidney is the mother of the liver.
Similarly, the heart is correlated with fre; because water inhibits fre, the kidney is the grandmother of the heart.
Wxng theory can therefore contribute to medical diagnosis in two ways. First, an excess or defciency of one of the xng may
produce observable behavioral efects. A person with excessive wood, for example, will have a shouting, angry tone of voice, while a
person with defcient wood may appear timid and repressed. Such behavior points to an imbalance in the liver, the zng associated
with wood. In the same way, inappropriately happy or manic behavior points to excessive fre, while depression points to a fre
defciency in either case indicating a possible disharmony in the heart, the zng associated with fre (Tierra, 1998, p. 31).
Second, each of the fve xng is associated with a particular body type. People with a wood constitution, for example, have tall thin
bodies, broad shoulders, and straight backs; they are hard workers, but with a tendency to worry and think too much; their voices are
generally gentle and smooth. Therefore an urgent or hurried tone of voice in a patient with a wood constitution may be indicative of
pathological changes in the phonic organs and, by extension, the liver (Qiao, 2008, pp. 25, 164).
Treatment
Acupuncture and herbs
These associations also underlie several sorts of medical intervention. For example, if one of the zngf is defcient, it can be
nourished indirectly by nourishing its mother. Here is an example. Zhao Jingyi and Li Xuemei (1998, pp. 203-210) describe the case of
a 45-year-old woman who had been sufering for some time from depression, insomnia, and general body pain upon awakening.
These symptoms could be mild or severe. Four days earlier the condition had become acute, and so she sought medical attention.
Her insomnia and dream-disturbed sleep indicated that the site of the disorder was the heart. But why was the heart disturbed? Her
physical discomfort, tight muscles, and swelling and soreness indicated impaired circulation of qi and blood. Further inquiry revealed
poor appetite, excessive saliva, tasteless sensation in the mouth, and soft and loose stools all pointing to an impairment in the
transformative and transportive functions of the spleen p ?.
Spleen-wood is the mother of heart-fre. It is the source of production for qi and blood, and functions to replenish and nourish the
heart. So the underlying cause of the acute sleep-disturbance symptoms was in fact a spleen defciency depriving the heart of its
nourishment.
The treatment therefore focused frst on tonifying and strengthening the spleen and nourishing the blood, and only then on nourishing
the heart and calming the spirit. If the spleen defciency could be improved, the source of production for the qi and blood would
become richer. The qi and blood could then easily be replenished, and the heart would be nourished and become calm.
Qgng
Qgng practices can be used in the same way for example, the practice known as the six-syllable formula liz ju @A or the
six-syllable method liz f @B. Each of these six syllables is held to be able, under the right circumstances, to normalize the zng
or f with which it is associated nourish the liver, replenish the heart, moisten the lung, strengthen the spleen (Bi, Sun, Guo, Cao,
Zhang, & Zhang, 1988, pp. 110-120). There are several diferent versions of these correlations and several diferent versions of just
what each syllable does (see generally Despeux, 2006).
As we have seen, a defciency in one of the xng may result from overinhibition by an excessive grandmother. For example, a liver
defciency may be due to excessive lung metal overinhibiting liver wood; in this case, the lungs can be settled and moistened by
uttering the syllable SI C. A heart defciency may be due to excessive kidney water overinhibiting heart fre; in this case, the kidneys
can be strengthened and made tranquil by uttering the syllable CHUI D. A kidney defciency may be due to excessive spleen earth
overinhibiting kidney water; in this case, the spleen can be cultivated and strengthened by uttering the syllable HU E.
It is also possible to use feedback loops. So, where a spleen earth defciency is due to overinhibition by excessive liver wood, there
are two therapeutic strategies. The liver can be leveled and nourished by uttering the syllable XU F. Or especially if the direct
strategy fails the heart fre can be supplemented by uttering the syllable HE G, thus inhibiting the excessive liver wood. This is
called releasing the child in an excessive syndrome (Liu, 2013, pp. 49, 181)
Psychotherapy
Each of the fve xng is associated with an emotion or state of mind. Fire is associated with happiness x H, earth with thought s I,
metal with sorrow bi J, water with fear kng K, and wood with anger n L (Rossi, 2002, p. 30).
There are conditions of excessive emotion that may require medical intervention depression, mania, panic, rage. One approach is
medical. Each emotion is associated with a specifc zng. An excess of that emotion may injure the associated zng or, conversely,
may result from a disharmony of that zng. For example, anger is associated with the liver; excess anger can injure the liver, or a liver
disharmony may result in excess anger (Ross, 1985, p. 187). Thus a condition of excessive anger may be susceptible to treatment of
the underlying liver disharmony.
Zhang Zihe M'N (1156-1228 CE) was a radical physician whose attacking school of medicine emphasized driving out toxins with
diaphoretics, emetics, and purgatives. He saw in the inhibition cycle a psychotherapeutic tool that could be used to treat excessive
emotions.
He wrote that the physician should treat anger with sorrow, moving the patient with sad and painful stories; treat depression with
happiness, entertaining the patient with jokes and wisecracks; treat mania with fear, frightening the patient with talk of bad luck and
death; treat thinking with anger, provoking the patient with insult and insolence; and treat fear with thinking, diverting the patient toward
another subject (Xu, 2012, p. 319; Rossi, 2002, p. 31; Liu, 2013, p. 50).
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