Each can learn from the other: Yang can
benet from the long-term and thrifty perspective of Yin; Yin can
learn to focus,  express, and actualize energy more like Yang. Yang
needs Yin for its foundation, and Yin needs Yang for its fruition. Yang types tend to become Yin decie nt and Yin types tend to
become Yang decie nt. People who lack Yang have trouble rising
with the dawn and kindling their morning re. They crave sunlight,
warmth, and enjoy spring and summer. Since their own re is low,
they benet from outside stimulation that awakens, motivates, and
activates them. They might be likened to snakes and lizards, which
are dicult to arouse until after they have basked on a warm rock
in the sun. Someone who is Yang decient and lives in a cold
climate will be challenged to maintain circulation, digestion,
enthusiasm, and libido because their limited re is being used to
sustain basic survival. Yang easily becomes overextended by vibrating at a high
frequency, like the honeybee, engaging in incessant work and
activity. Neglecting sleep and nourishment increases the probability
of shortening an intense life. For someone more Yang who lives in a
hot, dry climate, it is a challe nge to avoid dehydration, restlessness,
and irritability. If Yin is decient over time, Yang becomes decient, and vice
versa. Not only do Yin and Yang balanc e each other, they mutually
create each other as well. When Yin is dissipated, Blood  and Moisture
are depleted and Yang Qi loses its source. A person becomes weak,
fatigued, and has a lowere d resistance to stress. When Yang is
decient, vital functions like respiration, digestion, and circulation
are retarded, and the body is unable to generate Blood  and tissue.Again, a person becomes weak and tired with a poor ability to heal
and recover from infection s or injuries. A deciency of one
ultimately becomes a deciency of the other. The stages of disease can also be understood according  to Yin-
Yang patterns. When a disease develops quickly, it is in the acute or
Yang stage. As the disease becom es chronic, it passes into the Yin
stage. Usually acute diseases aect the supercial functions or
surface of the body, where they encounter the rst line of defense,
the wei Qi. If the disease overwhelms the body’s resistance and
penetrates to deeper, second ary layers, the disease enters a Yin or
internal stage. Regardless of where the disease is located or how
long it has existed, it can be classied according to its eects. If the
symptoms are very extreme or severe, the disease is considered an
excess illness, and excess belongs to Yang. If the symptoms are mild
or diuse, it is a deciency syndrome, which belongs to Yin. (see larger image)
OceanofPDF.comReading the Patterns: DiagnosisCHAPTER FIVE
READING THE  PATTERNS : DIAGNOSIS  THE
DOCTOR  AS DETECTIVE , AS ARTIST
Illnesses may be identical but the persons suering from them
are dierent. The … emotio ns and the … excesses aecting
people are not the same. Some people may be strong and others
weak as far as their Qi or the condition of their body is
concerned.…  One’s nature may be tough or soft, one’s sinews
and bones may be rm or brittle  … there are patient s who
suer in their heart from grief, and others who enjoy happ iness. If one treats all those patients who appear to suer from one
identical illness with one and the same therapy, one may hit the
nature of the illness, but one’s approach may still be exactly
contraindicated by the inuences of Qi that determine the
condition of the individual patient’s body.…  Physicians
therefore must carefully take into account the dierences
among the people and only then decide whether the thera peutic
pattern they employ suits  … the individual constitution on the
basis of the criteria mentioned above. Unpublished translation of text by Hsu Ta-ch’un in  
1757, translated by Paul Unschuld and presented    
in a lecture at the International Acupuncture          
Symposium, San Francisco, March 30, 1987. DIAGNOSIS IS THE FIRST STEP IN MEDICAL PROBLEM-SOLVING, ITS TASK IS to
organize a complex set of variables and interpret the relationships
among them. Traditional Chinese categories, techniques, and
objectives dier from what we are used to in the West. The
categories are drawn from Yin-Yang  and Five-Phase  concepts, thetechniques do not rely on technology, and the objective is to
formulate a picture of healthy and distorted patterns of function
rather than named diseases related to a single cause. Like the detective, the doctor unravels mysteries and solves
problems by chasing leads , following hunches, and gathering
evidence. Information is collected, sifted, and classied according to
relevant categories, then interpreted to formulate a hypothesis. Examination uncovers the raw data, and diagnosis explains what,
how, and why events occur red in order to determine appropriate
therapy. Like the police artist who gathers bits of memory from witnesses
to sketch a composite drawing, so the doctor relies on history,
observation, and discussion. The artist incorporates the data into a
preconceived model of human form that shows how bones, muscles,
skin, and hair t together. With each new piece of information, the
drawing alters to more closely resemble the suspect. The doctor
employs the intuitive skills and logical techniques of both the artist
and detective, using theoretical constructs to organize and integrate
information. It usually takes more than one construct to describe reality. Diagnosis employs many distinct yet overlapping frames of
reference to establish the criteria and methods of assessment. Chinese medicine, like Western medicine, searches for causes. The
dierence is that in Chinese medicine, causes are really descriptions
of underlying relationships rather than descriptions of material
agents or pathogens. The Five Adverse Climates  and Emotions  are
often translated into English  as “causative factors,” yet they do not
represent material things like bacteria or viruses. Instead they
describe groups of symptoms  and subjective states. There is no way
to detect or verify these pathogenic inuences excep t by their
manifestations. These phenomena are classied within the broad
parameters of Yin-Yang  and Five-Phase Theory . Greater
dierentiation is elaborated through the more specic concepts of
Qi, Moisture , and Blood , the Eight Guiding Principles , and the
functional models of the Five Organ Networks .Each set of diagnostic parameters provides one dimensio n of the
total picture, the way cameras on a movie set record the same scene
from a dierent angle. Each method conrms and validates the
others. These points of view parallel each other and interact through
their mutual correspondence to the fundamental concepts of Yin-
Yang and Five-Phase Theory . Like the editing room in which the
footage is spliced together, a diagnosis becomes one person’s
seamless moving story. There are many possible combinations and permuta tions of
interacting variables. This chapter illustrates methods and
techniques of information gathering and the process by which a
complex array of symptoms, signs, and other characteristics is
interpreted. CATEGORIES OF  STRESS AND THE  GENESIS OF  DISEASE
Efrem studied in China at the Kunming Railway Workers Hospital in
the midst of an icy winter. Because it was almost as cold indoors as
out, he took notes wearing gloves, periodically wrapping  his hands
around a hot cup of tea. A tense and downhearted young man
walked into the hospital acupuncture clinic complaining of
numbness and immobility on the left side of his face. The left corner
of his mouth drooped, interfering with his speech. Terse and
reticent, he appeared unhappy as well as worried about his
condition. He reported that he had spent much of the previous day
riding his motorcycle, whipp ed about by the harsh cold wind. The
doctor placed  needles in points corresponding to the areas of
paralysis, warming the area with a lighted moxa stick. She also
inserted needles on the top of his feet in a point on the Liver
meridian. Efrem asked why she included these distal points. She
replied that the young man felt angry and depressed following a
disagreement with his family and had torn o on his motorcycle to
relieve his frustration. She felt that his emotional state had
predisposed him to being injured by the cold wind. Treating theLiver channel would help to loosen the Qi that had become blocked
by prolonged frustration and unhappiness. A disturbed emotional state, harsh weather, and imprudent
behavior comb ined to adversely aect the health of this young man
in Kunming. Generally, Chinese medicine recognizes emotions,
climate, and life-style as the primary sources of pathogenic stress. Sudden changes in weather or prolonged exposure can leave the
body vulnerable to attack by wind, heat, dampness, dryness, and
cold. Intense, persistent or suppressed emotional reactions such as
anger, joy, rumination, sorrow, or fear can cause a disruption of the
circulation of Qi and Blood . Misuse of the body through overwork,
overuse of the senses, or prolonged sitting, lying, or standing wastes
the Qi and injures the Blood . Overindulgence in or neglect of dietary
and sexual needs depletes Vital Essence . THE FIVE CLIMATES
The Five Climates  correspond to the cycle of the seasons. When a
person exhibit s internal response patterns analogous to external
climatic conditions, Chinese medicine postulates that a person has
that condition: that climate exists internally. Cold, for example,
makes things  contract. Contracted blood vessels constrict
circulation, chilling the body and producing a craving for warmth. When symptoms correspond to those produced by cold, Chinese
medicine describes a person as manifesting a condition called Cold,
regardless of whether actual exposure to external cold caused the
condition. An adverse intern al climate can be unrelated to outside
weather. An inhabitant of the Antarctic can manifest a condition of
Dampness  when the air is dry or Heat in the dead of a ercely cold
winter. Whenever specic “weather” starts to dominate the body milieu,
it can become a pathogenic stress. This may be both the source and
the outcome the root and the fruit, of imbalance. Usually a
multiplicity of factors contrib ute to the disease pattern in which oneexcess conditio n combines with another. There is not necessarily a
causal chain of events, but a circle o invariable associations. WIND
The nature of Wind  is movement that rises and falls unpredictably,
rustling and disturbing the location and direction of things. Because
spring is a time of sudden and rapid change, it is considered the
season of Wind . Both this season and climate correspond to the
Wood Phase . Of all the climatic forces that can engender disharmony, Wind  is
deemed the most virulent, as in “an ill wind that blows.” The
concept of Wind  refers not only to the movement of air, but to the
capricious, foreboding nature or shifting conditions; hence the
expressions “winds of war” and “blown away.” Being perched in a
tree as it’s shaken by gusts of gale-force wind conjures up an image
of instability, disequilibrium, and fright. Wind  can steal into the
body, just as it nds its way through the cracks and crevices of
doors and windows. It creates an intense draft, the nature of which
is to unsettle and disrupt surface and interior circulation. In the body, Wind  can manifest as jerky movement, dizziness,
uncoordination, or symptoms that migrate from one region of the
body to another, suddenly appearing and disappearin g without
apparent pattern. Wind  invading the surface of the body manifests
as soreness, itching, and sensitivity of the skin and muscles. The
latter occurs when circulation is obstructed by external attack. Disorders of external Wind  are the common cold and u,
characterized by dizziness and migratory pains in the joints,
muscles, and head. Diseases of internal Wind  are characterized by
labile emotion s, vertigo, tremors, headaches, seizures, strokes, and
the agitation of the Liver Qi by fever, deciency of Blood , or
emotional instability. Because of the ability of Wind  to penetrate the
body’s defensive perimeter, Wind  can create a portal through which
the other adverse climates— Dampness, Dryness, Cold, and Heat—
enter the body.HEAT
The nature of Heat is to accelera te metabolic activity, dilate blood
vessels, and activate circulation. Heat tends to rise and move out
toward the surface. Summ er is dominated by Heat, and both
correspond to the Fire Phase . When Heat becomes excessive, it generates conditions such as
inammation, rapid pulse, and fever. Inammation is characterized
by redness, swelling, and pain. Among other types of swelling and
pain, Heat is distinguish ed by the appearance of redness and the
feeling of increased warmth. In Chinese medicine it is not necessary
to have a fever recorded on a thermometer to establish the presence
of excess Heat somewhere in the body. Hot conditions are often
associated with thirst, dryness, constipation, dicult urination,
agitation, a desire for cold, and an aversion to warm foods, drinks,
and climate. The tendency for Heat to move toward the surface is illustrated by
perspiration, the manifestation of Yang Heat released or discharged
through the skin. This may be due to increased metabolic activity
from exercise, feverish disea ses, or the ingestion of warm or spicy
foods. When Heat invades the surface, it may also show up as skin
eruptions such as red rashes, welts, sores, ulcers, boils, and acne. A redde ned appearance of the face, neck, and eyes reects the
rising tendency of Heat, often occurring in association with intense
emotional states such as anger, happiness, or embarrassment. A
person “red-fa ced” with embarrassment, “livid [or purple] with
rage,” “hot under the collar,” and so on manifests the ascension of
internal Heat. Certain B vitamins, thyroid hormone, sugar, coee, adrenaline,
spicy food, alcohol, and amphetamines all produce Heat. If someone
already has excess Heat, these substances may exacerbate the
condition and encourage the accompanying symptoms. DAMPNESSThe nature of Dampness  is to sink and accumulate, like a stagnant
swamp. Dampness  is characterized by an abnormal buildup of uids
or excess secretions. It appears as swelling and a sense of fullness
and heaviness, locally or throughout the body. Because of its
tendency to collect and coagulate, Dampness  easily causes stagnation
and obstruction of circulation. Late summer is dominated by
humidity or Dampness  and corresponds to the languid and sultry
Earth Phase . During this period of relative inactivity, the air is
motionless, the water is still, the atmosphere is heavy. Whether
there is signicant humidity  in the air or not, feelings that are
sluggish, apath etic, dull, or torpid provide evidence of the inuence
of Dampness . Dampness on the surface of the body shows up as oily skin, sticky
perspiration, subcutaneous edema, and swelling around the joints. Internally, Dampness  is indicated by the appea rance of phlegm,
abundant discharge of mucus, water retention, and edema of the
abdomen and extremities. Heaviness of the head and limbs, dull
pains, and lethargy characterize Dampness . Dairy produc ts, starchy
and glutinous foods, steroids, birth control pills, and watery fruits
and vegetables generate Dampness . Dampness  rarely appears by itself. It is usually accompanied by
Cold, Heat, or Wind . When Dampness  combines with Cold there is
constricted circulation, aversion to Cold, stiness and soreness of the
muscles and joints, and fatigue. When Dampness  combines with Heat there may be red, painful
swellings, thick purulent discharge, blisters as in herpes or shingles,
and inammations such as cystitis, jaundice, and bronchitis. Any
sore, abscess, or ulcer with pus or uid indicates Dampness  or Damp
Heat Sugar, alcohol, and fatty or fried foods create Damp Heat . Dampness  combined with Wind  produces swellings that appear,
disappear, and migrate (such as hives, swollen lymph nodes,
accumulation of air and uid in the stomach or intestines), bubbly
phlegm, and itching, oozing sores and ulcers. In severe cases Wind
and Dampness  can together obstruct the brain and sense organs,
producing seizures, strokes, and other neurologic disorderscharacterized by clumsiness, uncoordination, disequilibr ium as in
vertigo, and muddled, fuzzy thinking. DRYNESS
The nature of Dryness  is to wither and shrivel. Dryness  damages
uids and is manifested by symptoms of dehydration. Brittle hair
and nails, cracked and wrinkled skin and mucous membranes,
irritated eyes, dry stool and constipation, lack of perspiration, and
scanty urine occur with Dryness. Dryness  dominates autumn, the
season associated with the Metal Phase . External Dryness  usually occurs in hot or windy weather. However,
internal Dryness  occurs when body uids are damaged or lost due to
other factors. Heat, profu se perspiration, prolonged diarrhea,
excessive urina tion, and loss of blood may all lead to Dryness . Hot,
spicy foods, stimulants, diuretics, antihistamines, and other
astringent medications that dry secretions and arrest discharges can
result in Dryness. Dryness  in turn can generate irritation,
inammation, and Heat due to a lack of lubrication and moisture. In
conditions of weakness and deciency, loss of blood and uids will
lead to internal Dryness . Another consequence of Dryness  due to
decient Blood  or Moisture  is the appearance of internal Wind
experienced as dizziness and disturbances of vision and hearing. This may arise in conditions like anemia. COLD
The nature of Cold is to slow things down by chilling them. Cold
depresses metabolism and retards circulation. Winter is dominated
by Cold, and both correspond to the Water Phase . When Cold attacks the surface, the skin and muscles contract with
shivering and goose bumps. This is accompanied by fever if the
body’s defensive Yang energy is mobilized to repel the invader. This
protective response may accompany any of the Adverse Climates  that
frequently appear in combination with each other.Cold can also arise internally from either a deciency of metab olic
heat (Yang) or the ingesti on of an exces s of food, liquid, or medicine
that is considered to be Cold. The concept of Cold includes that
which has been refrigerated and is thermally cold as well as foods
that are categorized as having a Cold nature. Prolonged stress,
illness, lack of proper nutrition, or repeated exposure to cold climate
or substances can lead to a depletion of Yang. In this case, Cold
overcomes Heat and Yin overcomes Yang. Refrigerated or raw foods and chilled drinks are Cold. Ice cream
and iced drinks are particularly damaging to the Yang energy. Because of their ability to counteract inammation and fever,
medicines such as antibiotics and aspirin have a Cold nature. Antacids counteract stomach inammation and are also considered
Cold medicines. The stomach depends on the power of digestive Fire to break
down and process food. These Cold medic ines weaken and
undermine digestive function because of their ability to dissipate
heat. The repeated administration of antibiotics to children damages
their already sensitive and underdeveloped digestive systems, which
leads to innumerable problems in their later childhood and
adulthood. The most common consequence is weakness of the
immune system, manifested as allergies. The resulting deciency
and Coldness  set the stage  for disorders such as asthma, colitis,
arthritis, eczema, and candidiasis. Accompanying the aversion to cold is a desire for heat and a
craving for warm foods and liquids. There is a feeling of weariness
and debility as well. Retarded circulation also leads to a stagnation
of Blood  and Moisture , which may congeal or harden into clots,
lumps, or masses associated with xed and localized tenderness and
pain. THE FIVE EMOTIONS
Just as climate s exist within the seasons, emotions are primal forces
within the human psyche. All of us experience times of anger, joy,rumination, sorrow, and fear during the course of our everyday
lives. These emotions are often appropriate. It is natural to feel mad
when thwarted, happy when fullled, pensive when attention is
focused inward, sad over loss, and alarmed in the face of danger. When any one state, however, dominates our internal experience or
outward behavior, it interfe res with the conduct of daily life and
disrupts the smooth ow of Qi. The Five Emotions  are associated with the Five Phases . In excess,
these emotions generate imbalance. Anger  causes energy to rise—it
tends to are up and lash out with sudden explosivenes s, like the
windy storms of spring, unpredictable and intense. Joy causes
energy to disperse—it tends to dissipate and be lost. Being overcome
by joy can leave a person giddy and weak like the inten se heat of
summer, exhausted and drained. Rumination  causes  energy  to slow
down—sluggish movement tends toward stagnation, leaving one
lazy and inert, like the oppressive humidity of late summer, slow
and torpid. Sorrow  causes energy to stop—it tends to constrict and
close down. Imprisoned by grief, one is cut o from life; like the
drying leaves of autumn, feelings wither and motivation crumples. Fear causes energy to sink—the bottom falls out. When survival is
threatened, one becomes petried with fright and loses control. As
in the perilous cold of winter, people feel frozen with fear. The emotions are immaterial yet palpable. Although—or  because
—they are experienced deeply, they are dicult to dene and
categorize. Nevertheless they have profound and tangible eects. In
Chinese medicine they are considered one of the major inuences
upon health and disease. Wind  and Anger  particularly injure the
Liver, Heat and Joy the Heart , Dampness  and Rumination  the Spleen,
Dryness  and Sorrow  the Lung, and Cold and Fear the Kidney . ANGER
When Anger  predominates, a person becomes easily upset by
frustrations and obstacles, unable to appropriately restrai n feelings. This person is volatile, engaging in erratic and impulsive behavior.He vacillates between riveted interest and subdued indierence. These unstable emotions and unpredictable actions result in the
uneven circula tion of Qi and Blood , creating a generalized state of
tension. This kind of person often leads a double life. Usually he
exerts tremend ous self-discip line in order to maintain self-control
and composure . But when the stress builds, or when he relaxes and
loosens his inhibitions, he is likely to explode in rage or indulge in
thoughtless, rash behavior. At work he may be dedicated, outgoing,
and resourceful, but on the weekends after a few drinks he may “y
o the handle” and “go through the roof.” He is prone to ailments
such as ulcers, hemorrhoids, and migraine headaches. JOY
When the pleasure principle is the main focus of a person’s life, she
becomes unable to retain her reserve of energy. She seeks
gratication at every turn and becomes jaded, drive n to seek
continuously more stimulation. She appears fun-loving and romantic
but in fact is unable to sustain her interest and excitement without
external props and other people’s attention. She dislikes being alone. By herself she feels lifeless;  in company she comes alive. She is
prone to free-oating anxiety, insomnia, despair. Her easy
excitability manifests as giggling, talkativeness, giddiness, and
garrulousness. This type of person dissipates her energy by burning
the candle at both ends. When she’s not up, she’s down. When she’s
not lled with excitement, she’s empty and hopeless. The high level
of activity causes accelerated metabolism which may take the form
of hypoglyce mia, anorex ia, or schizophrenia. These are
manifestations of Heat. However, the presence of Heat is not
accompanied by light or clarity. In fact, this person is often
confused, bewildered, and apprehensive. RUMINATIONWhen a person is overly pensive and contemplative, he can easily
become xated on worriso me thoughts and ideas. He is often
tormented by his overconce rn for details and becomes caught in
circular thinking from which  there is no escape. His approach to life
may become obsessive to the point that he is unable to have any
fresh thoughts or experiences. Secure but dull, safe yet sorry, he is
prone to apathy and boredo m. He may be construed as a stick-in-
the-mud. People can depend  on this type of person because he is
reliable, sympa thetic, and a good caretaker. Without the demands of
work or responsibility to others, he can become inert, dropping back
into the well-w orn trails of his own mind. In this state, his energy
becomes stagnant and leads to poor digestion, heaviness, and
abbiness. SORROW
When Sorrow  pervades, a person insulates and defends herself from
the pleasure of attachment and the pain of loss. She arranges her life
for the purpose of avoiding risk and the vagaries of passion. She can
become possessive, acquisitive, and domineering in an eort to
control her environment. Her striving for self-protection may keep
her too detached and inaccessible for true intimacy. She is pleasant
but cool. She has easy disdain for people she considers sloppy and
undisciplined and is uncomfortable with displays of emotion. Her
life is designe d to keep her feelings in. She appears tight, well
mannered, and scrupulously put together. Without the ordered
arrangement of her daily life, this person becomes completely
vulnerable and threatened. Overcontrol is her theme and can
manifest as asthma, constipation, and frigidity. She wards o
excitement and feeling. FEAR
Fear arises when survival is threatened. A man who is in the grip of
Fear can think only of escape. His life is dominated by theexpectation of threat, so he isolates himself and hides from the
world. He becomes furtive and suspicious, relies on no one and
prefers to be left alone. He is the hermit, drifter, and loner. He
anticipates the worst, imagining calamity and disast er lurking
around every corner. He lives under a cloud of doom and gloom. Critical and cynical, he believes the world is fundamentally harsh,
unsafe, and unfriendly. Among other people he remains aloof. His
isolation may eventually cut him o from life, leaving him cold and
hard like stone, impenetrabl e and devoid of spirit. Because of this
hardening, he is prone to develop arthritis, deafness, and senility. METHODS OF  EXAMINATION:  OBSERVATIONS , QUESTIONS , PALPATIONS
Western diagnosis often involves evaluation of a battery of
laboratory tests and machine measurements. Chinese diagnosis
emphasizes methods that rely solely on the practitioner’s own sense
perceptions, judgment, intuition, and experience. The practitioner
inventories what he sees, hears, smells, and feels. He listens to the
patient’s feelings and complaints. He asks questions about activities
and events that cannot be observed directly. Using himself as the instrum ent, the doctor takes the measure of
the patient: focusing mind and perception upon the gestalt of
posture, statur e, emotional and behavioral expression; upon specic
attributes of the tongue, pulse, and complexion; and nally upon the
areas and quality of pain or discomfort, restriction or freedom of
movement, overall vigor and weakness. Like the Feng Shui adept who divines the currents of Wind  and
Water  that circulate  through the environment to place people in a
proper and benecial alignment to them, the doctor turns himself
into a divining  rod that reads the movements of Qi, Moisture , and
Blood , assessing whether the Five Organ Networks  are working
harmoniously. The patient reports on current physical, mental, and emotional
complaints, states, and attitudes. Patterns of sleepin g, eating,
eliminating, working, and relaxing, as well as responses to stress,needs, desires, and goals, are useful information. The doctor wants
to know not only the nature  of the problem, but the nature of the
patient. Patient and doctor work together, recapturing and re-creating
relevant history, noting tendencies, patterns, and cycles that might
be inuencing the present condition. Together, family health,
emotional, physical, and sexual development, childhood illness and
treatment, injury, trauma and its resolution or lack thereof, and
times of crisis and change all reveal the evolutionary stages leading
to the present state. Just as every cell in the human body contains in its DNA a
template of the entire organism, so in Chinese medicine any part of
the body (puls e, tongue, eye, ear) broadcasts information  about the
whole. Just as the genes contain all the information about the
potential form and develop ment of the person, any aspect of a
human being can become a window or lens for revealing the state of
the person. This applies not only to the physical body, but to the
thinking and feeling body as well. METHODS OF  DIAGNOSIS
To observe: complexion, eyes, tongue, nails, hair, gait,
stature, aect, quality of excretions, secretions
To listen and smell: sound of voice and breath; odor of
breath, skin, excretions, secretions
To question: current complaints, health history, family health
history, pattern s of sleep, appetite, weight, elimination, menses,
stress
To touch: texture, humidity, temperature, elasticity of skin;
strength and tone of muscles; exibility, range of motion of
joints; sensitivity of diagnostic points; radial pulse evaluationMAY I PLEASE  SEE YOUR TONGUE? Of all the possi ble methods of examination, two are considered most
useful and reliable: inspection of the body and coating of the
tongue, and palpation of the pulse at both wrists. The tongue is
characterized by its color, texture, moisture, size, and shape. A
healthy tongue  ts comfortably in the mouth and is smooth, moist,
bright, pink, and rm, with a thin white fur that covers the upper
surface. Changes in the body of the tongue generally reect long-term
dysfunction of the viscera, whereas changes in the fur reect short-
term disturbances of digestion, uid balance, and heat regulation. In acute conditions such as a cold or u, the tongue may be red at
the tip with a yellow or white fur that is thicker than normal. The
red tip indicates Heat and possibly fever, and the thickened fur
indicates an Adverse Climate  such as Cold or Dampness . An enlarged, pale, and abby  tongue with greasy or cheesy white
fur is associate d with deciency and Dampness  or excess Moisture . This is charact eristic of illnesses such as chronic bronchitis, colitis,
nephritis, or a weak and enlarged heart. The thick, wet quality of
the fur is a sign of excess Moisture  manifested as phlegm in
bronchitis, loose, watery stool in colitis, and edema of the feet and
hands in heart disease or nephritis. The tongue fur primarily mirrors the Qi of the Stomach . Quite
Yang, this Qi is referred to as the “digestive Fire,” the “smoke of the
Stomach .“ If the fur is yellow, there is an excess of Heat in the
Stomach , associated with stomach pain or acidity, constipation, and
a sore, dry mouth or throat. If the fur is thick and white like cottage
cheese, this reects an extreme accumulation of Cold and Dampness
usually associated with marked deciency of digestive Fire,
manifesting in nausea, bloating, lack of appetite, and loose bowels. The color and shape of the tongue body also reect the intrinsic
strength and functional capacity of the individual. If the tongue is
very red overall or in one area, this indicates the presence of fever
or inammatio n that is attacking the Organ Networks . The Heart,
Lung, and Liver are most vulnerable to damage by Heat, which showsup as redness on the tip and edges of the tongue. In prolonged
febrile or chronic inammatory illness, the entire tongue may
become deep red. In additio n, if the tongue looks dry or parched,
this indicates serious deplet ion of Moisture , manifested by scanty
urine, constipa tion, thirst, and dryness of the skin and mucous
membranes. In these situations the tongue may appear to be
shrunken and shriveled. Tongue Zones
Kidney  zone: organs and functions below the navel including
kidneys, adrenals, large intestine, small intestine, bladder, uterus,
ovaries, and testicles; reproduction, elimination, regeneration,
locomotion, vegetative metabolism.Spleen  zone: organs and functions between diaphragm and navel and
between right and left sides including stomach, spleen, pancreas,
transverse colon, lower portion of esophagus, duodenum;  digestion,
assimilation, anabolic metabolism. Liver zone: organs and functions in lateral areas of the body between
diaphragm and navel including diaphragm, liver, gallbladder,
spleen, hepatic and splenic exures of large intestine; digestion,
elimination, detoxication, catabolic metabolism, coordination. Lung and Heart  zones: organs and function s above the diaphragm
including, lungs, heart, diaphragm, esophagus, trachea, bronchi,
mouth, nasoph arynx, nose, ears, eyes, brain; respiration, circulation,
digestion, mentation, perception, communication. Pallor of the tongue usually  indicates chronic deciency of Qi,
Blood , and Moisture . When  this is severe, the tongue may take on a
purplish hue, indicating that deciency has led to stagna tion of the
Blood . This color appears in cases where there is Coldness  of the
body and limbs, tiredness, shortness of breath, and pain in the chest,
abdomen, or joints. The progress of illness is also disclosed by the tongue. As illness
improves, the quality of the fur and color of the tongue become
more normal. If the illness worsens, so will the tongu e and fur. Realistically it is common for individuals to have a complex tongue
picture showin g conicting conditions of Heat and Cold, excess and
deciency. For example, the tongue of a person with a chronic
peptic ulcer and acute inuenza might appear abby and pale,
reddened at the tip, with yellow fur in the center. This indicates the
intermingling of chronic interior deciency with acute exterior
excess. Each part of the tongue corresponds to the condition or state of an
Organ Network . To see the condition of the Heart Network  one looks
at the extreme tip of the tongue, whereas to gauge the state of the
Lung one looks near the tip. So a very red tipped tongue indicatesnot only the general presenc e of Heat, but Heat aecting these two
Networks . A tongue that is purplish indicates poor circulation,
particularly associated with the stagnation of Qi or Blood  in the
Liver. And greasy yellow fur in the center of the tongue reports
Damp Heat  in the Spleen  and Stomach . Many external factors can also aect the appearance of the
tongue, such as smoking, coee, alcohol, and the use of
pharmaceutical drugs. Under these conditions, the tongue may
reect the eect of these agents rather than give a true picture of
the underlying state. This is why the practitioner never relies on
only one method of diagnosis. MAY I PLEASE  FEEL YOUR PULSE? Pulse diagnosis is based on the principle that Qi and Blood  circulate
as a single entity. By feeling the movement of blood in the vessels,
the activity of Qi, Moisture , and Blood  is inferred. The pulse is
produced by the movement of blood in the arteries, but movement
is initiated by the force of Qi. The Chinese saying “Where  Qi goes,
Blood  ows” communicates this synergy of Qi and Blood . When Qi
and Blood  are disturbed, Moisture  may become abnormal as well.Palpating the Pulse
The practition er feels three positions on each wrist along the
radial artery. These positions correspond to metabolic zones known
as the Triple-Burner  or Three-Heater . The position closest to the
thumb corresp onds to the chest and upper body (the Heart  and
Lung). The middle position corresponds to the upper abdomen (the
Stomach, Spleen, Gallbladder , and Liver). The position farthest from
the wrist corresponds to the lower abdomen (the Kidney, Bladder,
Small Intestine , and Large Intestine ). The strength, rate, rhythm,  and size of the pulse express the
integrity of the Qi and Blood  and the functional activity of the Five
Organ Networks . A healthy pulse is regular, with four to ve beats
per cycle of respiration and a smooth, owing feeling as it rises and
falls. It is both elastic and resilient, evoking a sense of relaxed and
vigorous rhythm and harmony. As many as thirty-two pulse qualities are described in the classical
texts, each indicating a particular type of disturbance. For example,
if the pulse is “oating”—that is, it can be felt with light pressure
but fades away as the pressure increases—it indicates an AdverseClimate  (Wind, Cold, Heat, Dampness , or Dryness ) has penetrated the
surface from the outside. If the pulse is oating and rapid, or
oating and strong, this reects the inuence of these Adverse
Climates  in con ict with the vigorou s defensive Qi of the body. The
“sinking” pulse is its counterpart. It is perceived only with deeper
pressure and feels like a stone settling in water. Since it is relatively
hidden or buried, it indicate s that the problem exists at the deeper
internal level. Left
Heart : all organs and functions above the diaphragm, especially on
the left side of the body
Liver: all organs and functions between the diaphragm and the navel
especially in the lateral areas of the body
Kidney Yin: all organs and functions below the navel, especially in
the pelvic region on the left side of the lower abdomenHeart  
Inch Position:  
(Upper Burner): cun
Liver 
Bar Position  
(Middle Burner): guanKidney Yin  
Cubit Position  
(Lower Burner): che
Right
Lung: all organs and functions above the diaphragm, especia lly on
the right side of the body
Spleen : all organs and functions between the diaphragm and the
navel, especially in the central area of the abdomen
Kidney Yang: all organs and functions below the navel, especially in
the pelvic region on the right side of the lower abdomenLung 
Inch Position:  
(Upper Burner): cun
Spleen  
Bar Position  
(Middle Burner): guanKidney Yang  
Cubit Position  
(Lower Burner): che
The slow pulse suggests that Cold is retarding  movement,
manifesting in a lack of warmth, whereas the rapid pulse suggests
that the presence of Heat is accelerating  movement and activity. A
thin and forceless pulse is associated with weakness and a lack of
sucient Qi and Blood . A big, full pulse that “pounds” against the
ngers suggests excess and may be felt when too much Heat is found
in the Heart , Stomach, Liver, or Intestines . Generally, problems of a
Yin nature are indicated by a frail and weak pulse, while problems
of a Yang nature are indicated by a strong and full pulse. A given
individual may exhibit a full and forceful pulse in one position and a
soft and weak pulse in another, suggesting that one system is
hyperactive and another is underactive. Stagnation tends to produce
a tense and erratic pulse It can be generated by both conditions of
excess  or deciency. Heat  can be generated by a lack of Yin as well as
an excess of Yang or Fire. Most people are not diagno sed as having
problems of a purely Yin or Yang nature , and often more than one
Organ Network  is involved in their disorder. THE EIGHT GUIDING  PRINCIPLES
The Eight Principles  are four sets of polar categories that distinguish
between and interpret the data gathered by examination. These
include Yin-Yang, Cold-Heat, deciency-excess , and interior-exterior . They determine the relative nature, quality, and location of the Qi,
Moisture , and Blood  within the body as a whole and within each of
the Five Organ Networks . The energetic activity of the organism is determined by qualities
that distinguish between Heat and Cold. The locale of a disturbance
is judged by the presence of symptoms in the exterior  region
(aecting skin, hair, muscles, tendons, joints, peripheral bloodvessels, nerves , and meridians) or the interior  region  (aect ing the
visceral organs, deep vessels and nerves, brain, spinal cord, and
bones). The virulence of a pathology is compared with the inherent
strength of the body by the presence of symptoms and qualities that
indicate excess  or deciency . Excess  refers to noxious pathogenic inuences such as the Adverse
Climates  or Emotions  and abnormal accumulations of Qi, Moisture ,
and Blood. Deciency  refers  to a lack of the fundamental
constituents, Qi, Moisture , and Blood . Any condition can then be
summarized in terms of the relative dominance of Yin and Yang. (see larger image)(see larger image)  
Click  to download a PDF of Syndromes of Distress
Using the Eight Principles  enable s the practitioner to formulate
certain therapeutic objectives. Where Cold predominates, the body
must be warmed. Where excess  persists, it must be dispersed. When
the disease is internal , deep-acting remedies must be employed. Similarly, Heat is cooled, deciency  tonie d, and external  ailments
are treated with remedies that act on the surface.THE ACUPUNCTURIST AND THE  HERBALIST
Just like an irrigation engineer needs dierent data than a soil
analyst, the acupuncturist needs dierent information, or the same
information organized dierently, than the herbalist. Herbs are
classied by categories descr ibing the disruption of Qi, Moisture , and
Blood  corresponding to the Eight Principles  and Adverse Climates . For
example, the herb poria dispels Dampness ; angelica nourishes
decient Blood ; astragalus generates Qi; forsythia and
chrysanthemum clear Heat
Five-Phase Theory  is more critica l for acupuncture. It is not enough
to know that Dampness  or Heat need to be dispersed, or that
deciencies of Qi and Blood  need to be tonied. The acupuncturist
also needs to know which Organ Network  assumes primary
responsibility for the disru ption of Qi in order to treat the
appropriate channel. The methods of the acupuncturist emphasize
the direct manipulation of Qi within the Organ Networks . The properties of herbs are assimilated metabolically by the
internal organ s and then dispersed throughout the body as Qi,
Moisture , and Blood . There are particular herbs that clear Damp Heat
from the body. With acupuncture there is a dierent process—the
elimination of Damp Heat is accomplished by adjusting the
circulation of Qi of the Organ Networks  respon sible for distributing
and transforming Moisture  and generating heat. The Damp Heat is
not treated directly, but rather through the functional relationship
within and among Organ Networks . If the relatio nships among the
Organs  are harmonic, the pathologic condition resolves itself. Five-
Phase Theory  puts the relationship among Organ Networks  into
perspective. The doctor who practices both herbal medicine and
acupuncture gathers all the evidence and synthesizes and interprets
it, using both the Eight Principles  and Five-Phase  approaches. SAME SYMPTOM , DIFFERENT  DISORDERS
To use Five-Phase Theory  it is necessary to identify which Organ
Network  is disturbed. The evaluation identies where the symptomis located, when it occurs, whether anything makes it better or
worse, and what other events may have occurred just prior to or at
the same time as the sympto m. This information is interpreted via
lines of correspondence that link symptoms, timing, and
circumstances with Organ Networks . In the West, a symptom like a headache may be treated
universally with aspirin or Tylenol. This same headache needs
dierentiating in Chinese medicine. It’s like the many words in the
Eskimo language that describe varieties of “snow.” In Chinese
medicine a multiplicity of disease patterns produce what in Western
medicine is one named symptom or disease. For example, disturbance of the Liver Network  can produce
migraine or bilious headaches associated with nausea, vomiting, and
sensitivity to light and noise. These headaches may be provoked by
anger and occur more frequently in the spring. Disturbance of the
Stomach  and Intestines  may cause headaches associated with nasal
and sinus congestion, acidity, atulence, and constipation. This type
of headache may appear in the morning and improve in the evening. Especially in hot, humid weather, disturbances of the Spleen  and
Heart  may cause headaches associated with fatigue, dizziness,
perspiration, and anxiety. In winter, headaches associated with
backache, chilliness, and profuse urination may suggest a
disturbance of the Kidney . The headache could be a simple matter of
acute indigesti on or related to a complex and chronic problem such
as hypertension, asthma, allergies, or premenstrual syndrome. Treatment for someone’s headache will dier according to which
Organ Network  is disturbed. The same holds true for a “cough.” In Chinese medicine,  a cough
may be a deciency, excess, Cold, Heat, Damp , or Dry phenomenon,
characterized by the amount and type of phlegm. One type can
produce blood-tinged, clear, yellow, or green phlegm, another a
very small amount of clear, white phlegm or no phlegm  at all. A
productive cough can be further dierentiated by whether the
phlegm is thick, sticky, and dicult to expectorate or loose, clear,
and easy to expectorate. A nonproductive cough may beaccompanied by a feeling of dryness and thirst or a sense of
weakness and malaise. What dierentiates one cough from another is signicant,
alongside the idiosyncratic patterns that distinguish one person from
another. One diagnostic assessment evaluates the symp toms, the
other evaluates the general condition of the person who has them. The total relationship of person to symptoms forms the diagnostic
pattern. Each of the children described below complains of a
dierent type of cough:
Becca is hot and feverish, has diculty sleeping at night, and
craves lots of cold liquids. At night her head becomes damp with
perspiration and she throws o her covers. Her cough is
characterized by thick, dry, tenacious green phlegm. She has to
cough a lot to bring it up. David appears pale and listless. His hands and feet are cold and
clammy, and his arms and legs are sore. He craves warmth, wants to
be covered by lots of blankets, and desires warm drinks. He sleeps a
lot during the day and at night. His cough is characterized by easy
expectoration with large amounts of clear, colorless phlegm. Jenny no longer has a fever , but for several weeks she’s had a
hacking cough at night and seems tired and restless during the day. She complains that her throat is dry and scratchy, and her lips are
red and parched. Oered drinks, she shows no interest. When she
does cough, there is little phlegm and it is sometimes tinged with
blood. Alex had a cold several weeks earlier without a fever. He
recovered from the cold, but in the last few days he has a morning
cough with a rattle in his chest and loose bowel movements. He
seems sensitive to the cold, getting goose bumps easily, and he
requests an extra sweater. He has also lost his appetite. He easily
expectorates a lot of frothy gelatinous mucus, especially in the
morning. Here’s how a doctor of Chinese medicine would interpret the
condition and treat each of the four “coughs”:
Becca’s condition is generally characterized by Heat (fever, night
sweats, restles sness, and green phlegm) and excess  (thick phlegm,high fever, restlessness). Her diagnosis is an acute cough of the Heat
type. This requires a therapy that clears Heat, relieves thirst, calms
coughing, and loosens, phlegm. Since Becca has an excess  condition,
she can tolerate a strong treatment, and it’s unnecessary to attend to
strengthening the body (tonication). The primary goal for Becca is
to treat the symptoms. Along with David’s acute illness, his general condition is one of
weakness and fatigue. His cough is diagnosed as a Cold type
(chilliness, clear phlegm, craves warmth) accompanie d by the
underlying condition of deciency . In general, Cold types of cough
are treated by methods that stimulate circulation, perspiration, and
expectoration. Because of the signs of weakness, however, the
treatment should avoid overstimulation and be comple mented by
strengthening or tonifying therapy to replenish the Qi. Jenny’s cough is the kind that develops from a prolonged recovery
from an acute illness. Her lips are red and her throat is dry,
suggesting that her fever consumed essential body uids. Yet she is
not thirsty. This lack of thirst, combined with the presence of
fatigue, indicates that her body has been weakened and that she
does not have the energy to recover. Her cough is the decient-Heat
type. The Heat is no longer due to fever, but rather to dehydration,
deciency of Moisture , and the dissipation of Qi. Therapy for Jenny
will be directed primarily at restoring Moisture  and increasing Qi. Alex’s cough appeared after apparent recovery from a cold. This
suggests that in fact the cold was not completely cured, but rather
that the illness had penetrated to a deeper level in the body. The
combined symptoms of chilliness, loose stool, and loss of appetite
indicate weakened metabolism and resistance. When the metabolic
Fire is decient, the interior becomes Cold and Moisture  tends to
congeal. Alex’s  phlegm appears in the morning upon awakening, the
time of day the body’s metabolism is at its lowest ebb and the
external environment is the coolest. Treatment for Alex emphasizes
warming the body and stimu lating metabolism in order to eliminate
the Cold and dissipate the phlegm. Whereas for Becca and David the
treatment is directed primarily at eliminating the symptoms, forJenny and Alex the treatm ent is directed at restoring Qi and
strengthening the body. Diagnosis is thus the process of determining what, how, and why
particular events occur so that we’re informed about what to do. It
is a process of discovery in which decisions are made according to
dierent frames of reference and orders of complexity, from the
most general parameters of Yin-Yang  and Five Phases  down to the
very specic ones of Qi, Moisture, Blood, Eight Guiding Principles , and
Five Organ Networks : Is the condition one of Heat or Cold, belonging
to Metal  or Fire, aecti ng the Qi or the Blood , of the Spleen  or the
Liver? The craft of the clinician, like the detective and artist, is in
capturing the essence of the person and the nature of the disease
within the net of these descriptive and interpretive criteria. OceanofPDF.comFive Organ Networks: Traditional Chinese PhysiologyCHAPTER SIX
FIVE-PHASE THEORY : EVOLUTIONARY  STAGES OF
TRANSFORMATION
As a microcosm, human beings embody all the phases within
themselves. Within each thing is contained all things. In the
seed is the tree; in the tree is the forest.…  Life forms are
stations for the reception and transmission of forces, through
which all are nourished. Each thing exists to nourish all others
and, in return, to be nouri shed itself. In this manner, each
kingdom of nature serves to receive and transmit life.…  These
forces are not all material, but include subtle energies of … a
spiritual nature.…  In the inner world, a central sun is also the
source of life. The inner sun is our true self.…
Vasant Lad and David Frawley  
The Yoga of Herbs                     
THE URGE TO ORDER OUR PERCEPT IONS AND DEFINE THE WORLD IS AS old as
humankind itself. From observation and contemplation, we generate
symbols that reect our experience back to us, demystifying
existence by discovering and deciding how reality is organized. Chinese philos ophy does this through the notions of Tao, Yin-Yang ,
and the Five Phases . Tao is a compo site of everything, the intrinsic order of all things. The way we interact with Tao, with nature, is described by Yin-Yang
and the Five Phases . Chinese cosmology suggests that life’s
movement is like a spinning ball on a owing river, a tide of wind
and water, a vortex revolving while rhythmically contracting and
expanding ( Yin-Yang ) as we are carried along by the currents of Tao.The Yin-Yang  model symbo lizes the creation process through the
interaction of bipolar forces. Five-Phase Theory * further
dierentiates this dynamic into the relationship between ve
fundamental powers, partitioning the continuum of movement into
identiable stages. Five-Phase  thinki ng provides the basis for
describing the development of forms, systems, and events. It
postulates that everything in creation can be categorized within
these basic parameters: Wood, Fire, Earth, Metal , and Water . If Yin-Yang  is like shadow and sun in varying proportions, Five-
Phase  is like the rainbow spectrum. Shades of darkness and light
create the drama and inten sity, and the Five Phases  provide the
shape, character, and hue. Green, Red, Yellow, White , and Black
correspond to each of the Phases . Five aords a more complex  description of phenomena than two. Combining Yin-Yang  and Five-Phase  genera tes an even more intricate
system of two times ve, or ten. Any process that can be described
in terms of Yin-Yang  can be further dierentiate d into Five-Phase . Any of the Five Phases  can be further dierentiated into Yin-Yang . Each of the ve colors can be distinguished as bright and intense,
Yang, or pale and diuse, Yin. Just as Yin-Yang  can be used to describe the alternation between
sun and shade, heat and cold, dry and wet, so the Five Phases
represent the seasons of the earth, the stages of huma n life, the
waxing and waning of Yin and Yang. Just as day is Yang and night
Yin, so the dawn  is Wood , midday Fire, afternoon Earth , evening
Metal , and nighttim e Water. Five-Phase  and Yin-Yang  concepts
always illuminate and cast shadows upon each other.Five-Phase Yin-Yang Rhythms
The stages of transformation that dene all processes in nature can
be similarly described by the two interpenetrating paradig ms of Yin-
Yang and Five Phases . FIVE-PHASE  THEORY: A  HOLOGRAPHIC  MAP
The underlying assumption of Chinese philosophy is that the forces
that govern the cycles of change occurring in the external world are
duplicated within our human bodies and minds. Patterns  in nature
are recapitulated at every level of organization—from the rotation
of the planets to the behavio r of our internal organs. These ancient
Oriental ideas conform to what some modern thinkers call the“holographic paradigm”: the organization of the whole (nature) is
reected by each and every part (plants, animals, human beings). 2
Within the human being, the same forces that organize the
physical, senso ry, and perceptual life of the organism (soma) aect
the emotional, intellectual, and spiritual life of the person (psyche). Within this framework, the Five-Phase  model has a diverse range of
application. Using anthropologist Gregory Bateson’s phrase, it is a
“pattern which connects.” 3
A comp lex web of relationships was spun between the Five Phases
and human culture. Aairs of state and society were conducted
according to these principles. Proper times to plant and harvest,
advance and retreat in battle , wed and procreate, and the methods
of preserving health were prescribed by this system. The Five Phases
are an almanac of the human cycles of momentary and lifelong
change, a map that charts the course of process, a guide for
comprehending our unfolding. PHASES AS TRANSFORMATIVE  STAGES
The Five Phases  identify stages of transformation, patterns of
expansion and contraction, proliferation and withering. Each Phase
has an intrinsic primal energy, an ontological inuence that shapes
events. For example, human beings go through cycles in their lives
similar to the seasons in nature—beginning in birth and ending in
death, with stages of growth, maturity, and decay in between. Within the life cycle, the power of each Phase  can be observed. The Wood Phase  is seen in birth, new life bursting forth. The
newborn, at rst small and fragile like a tender green shoot,
mobilizes tremendous energy for swift growth. The baby moves
from the Yin phase of gesta tion, correspon ding to Water , to the Yang
phase of growth, correspond ing to Wood . The peak of this Yang
phase is reached in adulthood when we are in our prime. This
corresponds to Fire. Our “ripening,” the stage during which we
luxuriate in our maturity, corresponds to the Earth Phase . We revisit
Yin through degeneration and aging, which corresponds to Metal . Inour dying we return to the Yin state of dissolution, the Water Phase ,
and the emptiness from which we emerged. Five Phases With Earth in the Center
One representation of Earth  within the Five-Phase  model is as the
center or axis, the point of reference of the four cardinal directions,
the middle of the Middle Kingdom that was ancient China. Later on,
in an eort to align Yin-Yang  and Five-Phase Theory, Earth  came to
represent the time and space of transition from one stage to another,particularly the passage between the apex of Yang (Fire) and
ascendance of Yin (Metal ). For examp le, between summer and
autumn is late summer, between noon and dusk is late afternoon. Within this logic, Earth  was placed schematically along the circular
continuum between Fire and Metal . This diagram has become the
one conventionally used to describe the Five-Phase  relationships in
Chinese medicine. Just as the Five Phases  delineate transformations of the life cycle,
they also describe the proces s of our daily existence. Our awakening
is associated with Wood , and our movement toward a state of
complete wakefulness corresponds to Fire. Becoming sleepy
represents Metal , and the state of sleep itself corresponds to Water. Earth  represents the still point, the balance between the polar
movements, when neither one nor the other ascends. Our integrity
is based on the proportion and rhythm of each of the Five Phases
within us, regulating our waking and sleeping, activity  and rest,
arousal and inhibition. PHASES OF  PULSATION
The power, quality, and direction of each Phase can be observed in
any given internal process. In expanding the chest, for example, we
move out into our world,  and in contracting we gather our
resources, experiencing ourselves as contained within  our own
boundaries. Wood  is the Phase  of expansion , culminating in the
Phase  of Fire, which spreads energy across and away from the
surface (Yang). Metal  is the Phase  of contraction , culminating in the
Phase  of Water , which  consolidates energy at the core (Yin). Our
Wood  aspect leads us outward toward Fire, where we feel at one, a
part of it all; our Metal  aspect leads us inward toward Water , where
we recognize our separate and historical self. Our Earth Phase
stabilizes us so that we can handle the gyrations of our oscillatingprocess. Consciousness that exists beyond time, in the realm of
space, belongs to Fire. Our bodies, lineage, genes, and will to pass
from generation to generation through time belongs to Water . The
realm of action belongs to Wood , denition to Metal , and balance to
Earth . Familiarity with each of the Five Phases  acquaints us with the
individual waves within the common sea of our being. In tension with the great Yin Phase, Water , is the great Yang, Fire. Water  gives rise to the germination  of substance, and Fire gives rise
to the completion of materi alized form. The latent power of the
apple seed in the creation of the apple tree derives from Water . The
manifest power of the tree to mature and bear shiny red apples,
completing and fullling its potential, derives from Fire. Whereas
Metal  and Wood  represent stages of expans ion and contraction,
Water  and Fire represent stages of generation and completion. The lines of correspondence between the Five Phases  and human
experience divide the body into Five Organ Networks , each of which
corresponds to one Phase. These Organ Networks , echoing the nature
of each Phase , descr ibe the physiology and psychology of the
organism. By extrapolation people can be generally classied into
ve character types by matching healthy and distorted expressions
of the soma and psyche with the characteristics of each of the Five
Phases  and Organ Networks . Five-Phase Theory  is like a fugue, with ascending and descending
rhythms and recapitulations, repetitions, echoes, and variations on a
theme. Each Organ Network  is a living system, a melody, expressed
through the instrument of the soma and psyche. In the body,
dissonance manifests as physical symptoms and patterns of
dysfunction. In the psyche, bothersome traits, xations, and
dilemmas manifest as distortions of character and patterns of
distress. The function and interaction of the Five Organ Networks
establish the basis for understanding the ve character types.Phases of Pulsation
Symbolizing the organism as a sphere: Metal  (Yin) represents
contraction, movement inwar d toward the core. Water  (extreme Yin)
represents the core, the site of germination and creation. Wood
(Yang) represents expansion, movement outward toward the surface. Fire (extreme Yang) represents the surface, the site of culmination
and completion. Earth  represents the axis, the point of balance,
around which the forces of Yin-Yang  revolve and spin. FIVE ORGAN NETWORKS:  TRADITIONAL  CHINESE  PHYSIOLOGYTo maintain the abundant circulation of Qi and Blood  is to sustain
the material life of the organism, the integrity of mind and tissue. Each Organ Network  refers  to a complete set of functions—
physiological and psychological—rather than to a specic and
discrete physical structure xed in an anatomical locatio n. For this
reason they are referred to as Organ Networks  rather than simply
organs. Identied by the names of the Yin Organs , each paired
system consists of Liver-Gallbladder, Heart-Smal l Intestine, Spleen-
Stomach, Lung-Large Intestine , and Kidney-Bladder *
Yin corresponds to organs that store Qi. Here Qi means Essence—
the most rened state of material substance. The Yin organs are
more stable and constant, representing the more homeostatic
mechanisms that regulate pressure, temperature, distribution, and
metabolism. Constituting the body’s foundation, they’re both more
consequential and more vulnerable. Disease of these organs is
considered deeper and more critical. Yang corresponds to the organs
that transform matter. They are more active and unstable in
character because of their participation in the process of digestion
and elimination. As an aggregate of organs, tissues, channels, and physiologic
functions, each Network  is critical for the sustenance of life. Each
embodies a distinctive intellectual, emotional, and behav ioral style
as well as physiological correspondences. Each has its own
responsibilities (a job to do), a strategy (how to do the job), and a
character (a way of being, a personality) that reect the power of
each Phase .Five-Phase Organ Network Correspondences
Each Organ Network  refers  to a complete set of functions—
physiological and psychological—rather than to a specic and
discrete physical structure xed in an anatomical locatio n. For this
reason they are referred to as Organ Networks  rather than simply
organs. Each paired system is identied by the names of the Yin
Organs . The Liver stores the Blood  and regulates the even movement of Qi. The Heart  propel s the Blood  and is the seat of consciousness. The
Spleen  generates and distributes nourishment. The Lung receives and
disperses Qi. And the Kidney  stores the Vital Essence . Together the
Organ Networks  comprise the team that gets the work of the body
done. Through the division of labor, all tasks are accomplished.CIRCULATION OF  QI FROM  DAY THROUGH  NIGHT
Qi and Blood  circulate continuously in an orderly sequence from one
Organ Network  to the next throughout the day and night, accounting
for maximum and minimum periods of function. During the day, Qi
expands outward toward the surface of the body (Yang) and during
the night Qi retreats into the body’s core (Yin). Yang peaks at
midday, Yin at midnight. Every two-hour period during the day and
night clocks an alternating ebb and ow of Qi. One Organ  and its
associated channel lls, while another empties. For example, from
three to ve A.M., the Qi of the Lung reache s its peak, while the
Bladder  is at its lowes t ebb. At noon  the Heart  reaches its peak and
the Gallbladder  its ebb.Our Functional Shape: A Continuum of Organ Networks  as Yin-
Yang  Protoplasm
Our inner and outer shape is dened not only by cavities and
structures, but also by an alchemy of processes governed by the
functions of the Organ Networks  impelled by the inexorable ebb and
ow of Yin (Jing) and Yang (Shen) as Qi and Blood  pulse and stream
through the organism.The Rhythmic Circulation of Qi from Day through Night
Stomach peaks 7 A.M.–9 A.M.. 
Spleen peaks 9 A.M.–11 A.M.. 
Heart peaks 11 A.M.–1 P.M.. 
Small Intestine peaks 1 P.M.–3 P.M.. 
Urinary Bladder peaks 3 P.M.–5 P.M.. 
Kidney peaks 5 P.M.–7 P.M.. 
Pericardium peaks 7 P.M.–9 P.M.. 
Triple-Burner peaks 9 P.M.–11 P.M.. 
Gallbladder peaks 11 P.M.–1 A.M.. 
Liver peaks 1 A.M.–3 A.M.. Lung peaks 3 A.M.–5 A.M.. 
Large Intestine peaks 5 A.M.–7 A.M.. The Stomach  and Spleen  are at their peak function between seven
and eleven A.M. This is the time of optimal digestion and assimilation
and helps to explain why the rst meal of the day is so important
for maintaining adequate energy. The time of peak function for theLarge Intestine  occurs at ve to seven A.M., just prior to that of the
Stomach . This suggest s that the natural rhythm is to empty in
preparation for receiving.
_OceanofPDF.com_Between_Heaven_and_Earth_-_Harriet_Beinfield.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        Each can learn from the other: Yang can
benet from the long-term and thrifty perspective of Yin; Yin can
learn to focus,  express, and actualize energy more like Yang. Yang
needs Yin for its foundation, and Yin needs Yang for its fruition. Yang types tend to become Yin decie nt and Yin types tend to
become Yang decie nt. People who lack Yang have trouble rising
with the dawn and kindling their morning re. They crave sunlight,
warmth, and enjoy spring and summer. Since their own re is low,
they benet from outside stimulation that awakens, motivates, and
activates them. They might be likened to snakes and lizards, which
are dicult to arouse until after they have basked on a warm rock
in the sun. Someone who is Yang decient and lives in a cold
climate will be challenged to maintain circulation, digestion,
enthusiasm, and libido because their limited re is being used to
sustain basic survival. Yang easily becomes overextended by vibrating at a high
frequency, like the honeybee, engaging in incessant work and
activity. Neglecting sleep and nourishment increases the probability
of shortening an intense life. For someone more Yang who lives in a
hot, dry climate, it is a challe nge to avoid dehydration, restlessness,
and irritability. If Yin is decient over time, Yang becomes decient, and vice
versa. Not only do Yin and Yang balanc e each other, they mutually
create each other as well. When Yin is dissipated, Blood  and Moisture
are depleted and Yang Qi loses its source. A person becomes weak,
fatigued, and has a lowere d resistance to stress. When Yang is
decient, vital functions like respiration, digestion, and circulation
are retarded, and the body is unable to generate Blood  and tissue. Again, a person becomes weak and tired with a poor ability to heal
and recover from infection s or injuries. A deciency of one
ultimately becomes a deciency of the other. The stages of disease can also be understood according  to Yin-
Yang patterns. When a disease develops quickly, it is in the acute or
Yang stage. As the disease becom es chronic, it passes into the Yin
stage. Usually acute diseases aect the supercial functions or
surface of the body, where they encounter the rst line of defense,
the wei Qi. If the disease overwhelms the body’s resistance and
penetrates to deeper, second ary layers, the disease enters a Yin or
internal stage. Regardless of where the disease is located or how
long it has existed, it can be classied according to its eects. If the
symptoms are very extreme or severe, the disease is considered an
excess illness, and excess belongs to Yang. If the symptoms are mild
or diuse, it is a deciency syndrome, which belongs to Yin. (see larger image)
OceanofPDF. comReading the Patterns: DiagnosisCHAPTER FIVE
READING THE  PATTERNS : DIAGNOSIS  THE
DOCTOR  AS DETECTIVE, AS ARTIST
Illnesses may be identical but the persons suering from them
are dierent. The … emotio ns and the … excesses aecting
people are not the same. Some people may be strong and others
weak as far as their Qi or the condition of their body is
concerned. …  One’s nature may be tough or soft, one’s sinews
and bones may be rm or brittle  … there are patient s who
suer in their heart from grief, and others who enjoy happ iness. If one treats all those patients who appear to suer from one
identical illness with one and the same therapy, one may hit the
nature of the illness, but one’s approach may still be exactly
contraindicated by the inuences of Qi that determine the
condition of the individual patient’s body. …  Physicians
therefore must carefully take into account the dierences
among the people and only then decide whether the thera peutic
pattern they employ suits  … the individual constitution on the
basis of the criteria mentioned above. Unpublished translation of text by Hsu Ta-ch’un in  
1757, translated by Paul Unschuld and presented    
in a lecture at the International Acupuncture          
Symposium, San Francisco, March 30, 1987. DIAGNOSIS IS THE FIRST STEP IN MEDICAL PROBLEM-SOLVING, ITS TASK IS to
organize a complex set of variables and interpret the relationships
among them. Traditional Chinese categories, techniques, and
objectives dier from what we are used to in the West. The
categories are drawn from Yin-Yang  and Five-Phase  concepts, thetechniques do not rely on technology, and the objective is to
formulate a picture of healthy and distorted patterns of function
rather than named diseases related to a single cause. Like the detective, the doctor unravels mysteries and solves
problems by chasing leads, following hunches, and gathering
evidence. Information is collected, sifted, and classied according to
relevant categories, then interpreted to formulate a hypothesis. Examination uncovers the raw data, and diagnosis explains what,
how, and why events occur red in order to determine appropriate
therapy. Like the police artist who gathers bits of memory from witnesses
to sketch a composite drawing, so the doctor relies on history,
observation, and discussion. The artist incorporates the data into a
preconceived model of human form that shows how bones, muscles,
skin, and hair t together. With each new piece of information, the
drawing alters to more closely resemble the suspect. The doctor
employs the intuitive skills and logical techniques of both the artist
and detective, using theoretical constructs to organize and integrate
information. It usually takes more than one construct to describe reality. Diagnosis employs many distinct yet overlapping frames of
reference to establish the criteria and methods of assessment. Chinese medicine, like Western medicine, searches for causes. The
dierence is that in Chinese medicine, causes are really descriptions
of underlying relationships rather than descriptions of material
agents or pathogens. The Five Adverse Climates  and Emotions  are
often translated into English  as “causative factors,” yet they do not
represent material things like bacteria or viruses. Instead they
describe groups of symptoms  and subjective states. There is no way
to detect or verify these pathogenic inuences excep t by their
manifestations. These phenomena are classied within the broad
parameters of Yin-Yang  and Five-Phase Theory. Greater
dierentiation is elaborated through the more specic concepts of
Qi, Moisture, and Blood, the Eight Guiding Principles, and the
functional models of the Five Organ Networks. Each set of diagnostic parameters provides one dimensio n of the
total picture, the way cameras on a movie set record the same scene
from a dierent angle. Each method conrms and validates the
others. These points of view parallel each other and interact through
their mutual correspondence to the fundamental concepts of Yin-
Yang and Five-Phase Theory. Like the editing room in which the
footage is spliced together, a diagnosis becomes one person’s
seamless moving story. There are many possible combinations and permuta tions of
interacting variables. This chapter illustrates methods and
techniques of information gathering and the process by which a
complex array of symptoms, signs, and other characteristics is
interpreted. CATEGORIES OF  STRESS AND THE  GENESIS OF  DISEASE
Efrem studied in China at the Kunming Railway Workers Hospital in
the midst of an icy winter. Because it was almost as cold indoors as
out, he took notes wearing gloves, periodically wrapping  his hands
around a hot cup of tea. A tense and downhearted young man
walked into the hospital acupuncture clinic complaining of
numbness and immobility on the left side of his face. The left corner
of his mouth drooped, interfering with his speech. Terse and
reticent, he appeared unhappy as well as worried about his
condition. He reported that he had spent much of the previous day
riding his motorcycle, whipp ed about by the harsh cold wind. The
doctor placed  needles in points corresponding to the areas of
paralysis, warming the area with a lighted moxa stick. She also
inserted needles on the top of his feet in a point on the Liver
meridian. Efrem asked why she included these distal points. She
replied that the young man felt angry and depressed following a
disagreement with his family and had torn o on his motorcycle to
relieve his frustration. She felt that his emotional state had
predisposed him to being injured by the cold wind. Treating theLiver channel would help to loosen the Qi that had become blocked
by prolonged frustration and unhappiness. A disturbed emotional state, harsh weather, and imprudent
behavior comb ined to adversely aect the health of this young man
in Kunming. Generally, Chinese medicine recognizes emotions,
climate, and life-style as the primary sources of pathogenic stress. Sudden changes in weather or prolonged exposure can leave the
body vulnerable to attack by wind, heat, dampness, dryness, and
cold. Intense, persistent or suppressed emotional reactions such as
anger, joy, rumination, sorrow, or fear can cause a disruption of the
circulation of Qi and Blood. Misuse of the body through overwork,
overuse of the senses, or prolonged sitting, lying, or standing wastes
the Qi and injures the Blood. Overindulgence in or neglect of dietary
and sexual needs depletes Vital Essence. THE FIVE CLIMATES
The Five Climates  correspond to the cycle of the seasons. When a
person exhibit s internal response patterns analogous to external
climatic conditions, Chinese medicine postulates that a person has
that condition: that climate exists internally. Cold, for example,
makes things  contract. Contracted blood vessels constrict
circulation, chilling the body and producing a craving for warmth. When symptoms correspond to those produced by cold, Chinese
medicine describes a person as manifesting a condition called Cold,
regardless of whether actual exposure to external cold caused the
condition. An adverse intern al climate can be unrelated to outside
weather. An inhabitant of the Antarctic can manifest a condition of
Dampness  when the air is dry or Heat in the dead of a ercely cold
winter. Whenever specic “weather” starts to dominate the body milieu,
it can become a pathogenic stress. This may be both the source and
the outcome the root and the fruit, of imbalance. Usually a
multiplicity of factors contrib ute to the disease pattern in which oneexcess conditio n combines with another. There is not necessarily a
causal chain of events, but a circle o invariable associations. WIND
The nature of Wind  is movement that rises and falls unpredictably,
rustling and disturbing the location and direction of things. Because
spring is a time of sudden and rapid change, it is considered the
season of Wind. Both this season and climate correspond to the
Wood Phase. Of all the climatic forces that can engender disharmony, Wind  is
deemed the most virulent, as in “an ill wind that blows. ” The
concept of Wind  refers not only to the movement of air, but to the
capricious, foreboding nature or shifting conditions; hence the
expressions “winds of war” and “blown away. ” Being perched in a
tree as it’s shaken by gusts of gale-force wind conjures up an image
of instability, disequilibrium, and fright. Wind  can steal into the
body, just as it nds its way through the cracks and crevices of
doors and windows. It creates an intense draft, the nature of which
is to unsettle and disrupt surface and interior circulation. In the body, Wind  can manifest as jerky movement, dizziness,
uncoordination, or symptoms that migrate from one region of the
body to another, suddenly appearing and disappearin g without
apparent pattern. Wind  invading the surface of the body manifests
as soreness, itching, and sensitivity of the skin and muscles. The
latter occurs when circulation is obstructed by external attack. Disorders of external Wind  are the common cold and u,
characterized by dizziness and migratory pains in the joints,
muscles, and head. Diseases of internal Wind  are characterized by
labile emotion s, vertigo, tremors, headaches, seizures, strokes, and
the agitation of the Liver Qi by fever, deciency of Blood, or
emotional instability. Because of the ability of Wind  to penetrate the
body’s defensive perimeter, Wind  can create a portal through which
the other adverse climates— Dampness, Dryness, Cold, and Heat—
enter the body. HEAT
The nature of Heat is to accelera te metabolic activity, dilate blood
vessels, and activate circulation. Heat tends to rise and move out
toward the surface. Summ er is dominated by Heat, and both
correspond to the Fire Phase. When Heat becomes excessive, it generates conditions such as
inammation, rapid pulse, and fever. Inammation is characterized
by redness, swelling, and pain. Among other types of swelling and
pain, Heat is distinguish ed by the appearance of redness and the
feeling of increased warmth. In Chinese medicine it is not necessary
to have a fever recorded on a thermometer to establish the presence
of excess Heat somewhere in the body. Hot conditions are often
associated with thirst, dryness, constipation, dicult urination,
agitation, a desire for cold, and an aversion to warm foods, drinks,
and climate. The tendency for Heat to move toward the surface is illustrated by
perspiration, the manifestation of Yang Heat released or discharged
through the skin. This may be due to increased metabolic activity
from exercise, feverish disea ses, or the ingestion of warm or spicy
foods. When Heat invades the surface, it may also show up as skin
eruptions such as red rashes, welts, sores, ulcers, boils, and acne. A redde ned appearance of the face, neck, and eyes reects the
rising tendency of Heat, often occurring in association with intense
emotional states such as anger, happiness, or embarrassment. A
person “red-fa ced” with embarrassment, “livid [or purple] with
rage,” “hot under the collar,” and so on manifests the ascension of
internal Heat. Certain B vitamins, thyroid hormone, sugar, coee, adrenaline,
spicy food, alcohol, and amphetamines all produce Heat. If someone
already has excess Heat, these substances may exacerbate the
condition and encourage the accompanying symptoms. DAMPNESSThe nature of Dampness  is to sink and accumulate, like a stagnant
swamp. Dampness  is characterized by an abnormal buildup of uids
or excess secretions. It appears as swelling and a sense of fullness
and heaviness, locally or throughout the body. Because of its
tendency to collect and coagulate, Dampness  easily causes stagnation
and obstruction of circulation. Late summer is dominated by
humidity or Dampness  and corresponds to the languid and sultry
Earth Phase. During this period of relative inactivity, the air is
motionless, the water is still, the atmosphere is heavy. Whether
there is signicant humidity  in the air or not, feelings that are
sluggish, apath etic, dull, or torpid provide evidence of the inuence
of Dampness. Dampness on the surface of the body shows up as oily skin, sticky
perspiration, subcutaneous edema, and swelling around the joints. Internally, Dampness  is indicated by the appea rance of phlegm,
abundant discharge of mucus, water retention, and edema of the
abdomen and extremities. Heaviness of the head and limbs, dull
pains, and lethargy characterize Dampness. Dairy produc ts, starchy
and glutinous foods, steroids, birth control pills, and watery fruits
and vegetables generate Dampness. Dampness  rarely appears by itself. It is usually accompanied by
Cold, Heat, or Wind. When Dampness  combines with Cold there is
constricted circulation, aversion to Cold, stiness and soreness of the
muscles and joints, and fatigue. When Dampness  combines with Heat there may be red, painful
swellings, thick purulent discharge, blisters as in herpes or shingles,
and inammations such as cystitis, jaundice, and bronchitis. Any
sore, abscess, or ulcer with pus or uid indicates Dampness  or Damp
Heat Sugar, alcohol, and fatty or fried foods create Damp Heat. Dampness  combined with Wind  produces swellings that appear,
disappear, and migrate (such as hives, swollen lymph nodes,
accumulation of air and uid in the stomach or intestines), bubbly
phlegm, and itching, oozing sores and ulcers. In severe cases Wind
and Dampness  can together obstruct the brain and sense organs,
producing seizures, strokes, and other neurologic disorderscharacterized by clumsiness, uncoordination, disequilibr ium as in
vertigo, and muddled, fuzzy thinking. DRYNESS
The nature of Dryness  is to wither and shrivel. Dryness  damages
uids and is manifested by symptoms of dehydration. Brittle hair
and nails, cracked and wrinkled skin and mucous membranes,
irritated eyes, dry stool and constipation, lack of perspiration, and
scanty urine occur with Dryness. Dryness  dominates autumn, the
season associated with the Metal Phase. External Dryness  usually occurs in hot or windy weather. However,
internal Dryness  occurs when body uids are damaged or lost due to
other factors. Heat, profu se perspiration, prolonged diarrhea,
excessive urina tion, and loss of blood may all lead to Dryness. Hot,
spicy foods, stimulants, diuretics, antihistamines, and other
astringent medications that dry secretions and arrest discharges can
result in Dryness. Dryness  in turn can generate irritation,
inammation, and Heat due to a lack of lubrication and moisture. In
conditions of weakness and deciency, loss of blood and uids will
lead to internal Dryness. Another consequence of Dryness  due to
decient Blood  or Moisture  is the appearance of internal Wind
experienced as dizziness and disturbances of vision and hearing. This may arise in conditions like anemia. COLD
The nature of Cold is to slow things down by chilling them. Cold
depresses metabolism and retards circulation. Winter is dominated
by Cold, and both correspond to the Water Phase. When Cold attacks the surface, the skin and muscles contract with
shivering and goose bumps. This is accompanied by fever if the
body’s defensive Yang energy is mobilized to repel the invader. This
protective response may accompany any of the Adverse Climates  that
frequently appear in combination with each other. Cold can also arise internally from either a deciency of metab olic
heat (Yang) or the ingesti on of an exces s of food, liquid, or medicine
that is considered to be Cold. The concept of Cold includes that
which has been refrigerated and is thermally cold as well as foods
that are categorized as having a Cold nature. Prolonged stress,
illness, lack of proper nutrition, or repeated exposure to cold climate
or substances can lead to a depletion of Yang. In this case, Cold
overcomes Heat and Yin overcomes Yang. Refrigerated or raw foods and chilled drinks are Cold. Ice cream
and iced drinks are particularly damaging to the Yang energy. Because of their ability to counteract inammation and fever,
medicines such as antibiotics and aspirin have a Cold nature. Antacids counteract stomach inammation and are also considered
Cold medicines. The stomach depends on the power of digestive Fire to break
down and process food. These Cold medic ines weaken and
undermine digestive function because of their ability to dissipate
heat. The repeated administration of antibiotics to children damages
their already sensitive and underdeveloped digestive systems, which
leads to innumerable problems in their later childhood and
adulthood. The most common consequence is weakness of the
immune system, manifested as allergies. The resulting deciency
and Coldness  set the stage  for disorders such as asthma, colitis,
arthritis, eczema, and candidiasis. Accompanying the aversion to cold is a desire for heat and a
craving for warm foods and liquids. There is a feeling of weariness
and debility as well. Retarded circulation also leads to a stagnation
of Blood  and Moisture, which may congeal or harden into clots,
lumps, or masses associated with xed and localized tenderness and
pain. THE FIVE EMOTIONS
Just as climate s exist within the seasons, emotions are primal forces
within the human psyche. All of us experience times of anger, joy,rumination, sorrow, and fear during the course of our everyday
lives. These emotions are often appropriate. It is natural to feel mad
when thwarted, happy when fullled, pensive when attention is
focused inward, sad over loss, and alarmed in the face of danger. When any one state, however, dominates our internal experience or
outward behavior, it interfe res with the conduct of daily life and
disrupts the smooth ow of Qi. The Five Emotions  are associated with the Five Phases. In excess,
these emotions generate imbalance. Anger  causes energy to rise—it
tends to are up and lash out with sudden explosivenes s, like the
windy storms of spring, unpredictable and intense. Joy causes
energy to disperse—it tends to dissipate and be lost. Being overcome
by joy can leave a person giddy and weak like the inten se heat of
summer, exhausted and drained. Rumination  causes  energy  to slow
down—sluggish movement tends toward stagnation, leaving one
lazy and inert, like the oppressive humidity of late summer, slow
and torpid. Sorrow  causes energy to stop—it tends to constrict and
close down. Imprisoned by grief, one is cut o from life; like the
drying leaves of autumn, feelings wither and motivation crumples. Fear causes energy to sink—the bottom falls out. When survival is
threatened, one becomes petried with fright and loses control. As
in the perilous cold of winter, people feel frozen with fear. The emotions are immaterial yet palpable. Although—or  because
—they are experienced deeply, they are dicult to dene and
categorize. Nevertheless they have profound and tangible eects. In
Chinese medicine they are considered one of the major inuences
upon health and disease. Wind  and Anger  particularly injure the
Liver, Heat and Joy the Heart, Dampness  and Rumination  the Spleen,
Dryness  and Sorrow  the Lung, and Cold and Fear the Kidney. ANGER
When Anger  predominates, a person becomes easily upset by
frustrations and obstacles, unable to appropriately restrai n feelings. This person is volatile, engaging in erratic and impulsive behavior. He vacillates between riveted interest and subdued indierence. These unstable emotions and unpredictable actions result in the
uneven circula tion of Qi and Blood, creating a generalized state of
tension. This kind of person often leads a double life. Usually he
exerts tremend ous self-discip line in order to maintain self-control
and composure. But when the stress builds, or when he relaxes and
loosens his inhibitions, he is likely to explode in rage or indulge in
thoughtless, rash behavior. At work he may be dedicated, outgoing,
and resourceful, but on the weekends after a few drinks he may “y
o the handle” and “go through the roof. ” He is prone to ailments
such as ulcers, hemorrhoids, and migraine headaches. JOY
When the pleasure principle is the main focus of a person’s life, she
becomes unable to retain her reserve of energy. She seeks
gratication at every turn and becomes jaded, drive n to seek
continuously more stimulation. She appears fun-loving and romantic
but in fact is unable to sustain her interest and excitement without
external props and other people’s attention. She dislikes being alone. By herself she feels lifeless;  in company she comes alive. She is
prone to free-oating anxiety, insomnia, despair. Her easy
excitability manifests as giggling, talkativeness, giddiness, and
garrulousness. This type of person dissipates her energy by burning
the candle at both ends. When she’s not up, she’s down. When she’s
not lled with excitement, she’s empty and hopeless. The high level
of activity causes accelerated metabolism which may take the form
of hypoglyce mia, anorex ia, or schizophrenia. These are
manifestations of Heat. However, the presence of Heat is not
accompanied by light or clarity. In fact, this person is often
confused, bewildered, and apprehensive. RUMINATIONWhen a person is overly pensive and contemplative, he can easily
become xated on worriso me thoughts and ideas. He is often
tormented by his overconce rn for details and becomes caught in
circular thinking from which  there is no escape. His approach to life
may become obsessive to the point that he is unable to have any
fresh thoughts or experiences. Secure but dull, safe yet sorry, he is
prone to apathy and boredo m. He may be construed as a stick-in-
the-mud. People can depend  on this type of person because he is
reliable, sympa thetic, and a good caretaker. Without the demands of
work or responsibility to others, he can become inert, dropping back
into the well-w orn trails of his own mind. In this state, his energy
becomes stagnant and leads to poor digestion, heaviness, and
abbiness. SORROW
When Sorrow  pervades, a person insulates and defends herself from
the pleasure of attachment and the pain of loss. She arranges her life
for the purpose of avoiding risk and the vagaries of passion. She can
become possessive, acquisitive, and domineering in an eort to
control her environment. Her striving for self-protection may keep
her too detached and inaccessible for true intimacy. She is pleasant
but cool. She has easy disdain for people she considers sloppy and
undisciplined and is uncomfortable with displays of emotion. Her
life is designe d to keep her feelings in. She appears tight, well
mannered, and scrupulously put together. Without the ordered
arrangement of her daily life, this person becomes completely
vulnerable and threatened. Overcontrol is her theme and can
manifest as asthma, constipation, and frigidity. She wards o
excitement and feeling. FEAR
Fear arises when survival is threatened. A man who is in the grip of
Fear can think only of escape. His life is dominated by theexpectation of threat, so he isolates himself and hides from the
world. He becomes furtive and suspicious, relies on no one and
prefers to be left alone. He is the hermit, drifter, and loner. He
anticipates the worst, imagining calamity and disast er lurking
around every corner. He lives under a cloud of doom and gloom. Critical and cynical, he believes the world is fundamentally harsh,
unsafe, and unfriendly. Among other people he remains aloof. His
isolation may eventually cut him o from life, leaving him cold and
hard like stone, impenetrabl e and devoid of spirit. Because of this
hardening, he is prone to develop arthritis, deafness, and senility. METHODS OF  EXAMINATION:  OBSERVATIONS, QUESTIONS, PALPATIONS
Western diagnosis often involves evaluation of a battery of
laboratory tests and machine measurements. Chinese diagnosis
emphasizes methods that rely solely on the practitioner’s own sense
perceptions, judgment, intuition, and experience. The practitioner
inventories what he sees, hears, smells, and feels. He listens to the
patient’s feelings and complaints. He asks questions about activities
and events that cannot be observed directly. Using himself as the instrum ent, the doctor takes the measure of
the patient: focusing mind and perception upon the gestalt of
posture, statur e, emotional and behavioral expression; upon specic
attributes of the tongue, pulse, and complexion; and nally upon the
areas and quality of pain or discomfort, restriction or freedom of
movement, overall vigor and weakness. Like the Feng Shui adept who divines the currents of Wind  and
Water  that circulate  through the environment to place people in a
proper and benecial alignment to them, the doctor turns himself
into a divining  rod that reads the movements of Qi, Moisture, and
Blood, assessing whether the Five Organ Networks  are working
harmoniously. The patient reports on current physical, mental, and emotional
complaints, states, and attitudes. Patterns of sleepin g, eating,
eliminating, working, and relaxing, as well as responses to stress,needs, desires, and goals, are useful information. The doctor wants
to know not only the nature  of the problem, but the nature of the
patient. Patient and doctor work together, recapturing and re-creating
relevant history, noting tendencies, patterns, and cycles that might
be inuencing the present condition. Together, family health,
emotional, physical, and sexual development, childhood illness and
treatment, injury, trauma and its resolution or lack thereof, and
times of crisis and change all reveal the evolutionary stages leading
to the present state. Just as every cell in the human body contains in its DNA a
template of the entire organism, so in Chinese medicine any part of
the body (puls e, tongue, eye, ear) broadcasts information  about the
whole. Just as the genes contain all the information about the
potential form and develop ment of the person, any aspect of a
human being can become a window or lens for revealing the state of
the person. This applies not only to the physical body, but to the
thinking and feeling body as well. METHODS OF  DIAGNOSIS
To observe: complexion, eyes, tongue, nails, hair, gait,
stature, aect, quality of excretions, secretions
To listen and smell: sound of voice and breath; odor of
breath, skin, excretions, secretions
To question: current complaints, health history, family health
history, pattern s of sleep, appetite, weight, elimination, menses,
stress
To touch: texture, humidity, temperature, elasticity of skin;
strength and tone of muscles; exibility, range of motion of
joints; sensitivity of diagnostic points; radial pulse evaluationMAY I PLEASE  SEE YOUR TONGUE. Of all the possi ble methods of examination, two are considered most
useful and reliable: inspection of the body and coating of the
tongue, and palpation of the pulse at both wrists. The tongue is
characterized by its color, texture, moisture, size, and shape. A
healthy tongue  ts comfortably in the mouth and is smooth, moist,
bright, pink, and rm, with a thin white fur that covers the upper
surface. Changes in the body of the tongue generally reect long-term
dysfunction of the viscera, whereas changes in the fur reect short-
term disturbances of digestion, uid balance, and heat regulation. In acute conditions such as a cold or u, the tongue may be red at
the tip with a yellow or white fur that is thicker than normal. The
red tip indicates Heat and possibly fever, and the thickened fur
indicates an Adverse Climate  such as Cold or Dampness. An enlarged, pale, and abby  tongue with greasy or cheesy white
fur is associate d with deciency and Dampness  or excess Moisture. This is charact eristic of illnesses such as chronic bronchitis, colitis,
nephritis, or a weak and enlarged heart. The thick, wet quality of
the fur is a sign of excess Moisture  manifested as phlegm in
bronchitis, loose, watery stool in colitis, and edema of the feet and
hands in heart disease or nephritis. The tongue fur primarily mirrors the Qi of the Stomach. Quite
Yang, this Qi is referred to as the “digestive Fire,” the “smoke of the
Stomach. “ If the fur is yellow, there is an excess of Heat in the
Stomach, associated with stomach pain or acidity, constipation, and
a sore, dry mouth or throat. If the fur is thick and white like cottage
cheese, this reects an extreme accumulation of Cold and Dampness
usually associated with marked deciency of digestive Fire,
manifesting in nausea, bloating, lack of appetite, and loose bowels. The color and shape of the tongue body also reect the intrinsic
strength and functional capacity of the individual. If the tongue is
very red overall or in one area, this indicates the presence of fever
or inammatio n that is attacking the Organ Networks. The Heart,
Lung, and Liver are most vulnerable to damage by Heat, which showsup as redness on the tip and edges of the tongue. In prolonged
febrile or chronic inammatory illness, the entire tongue may
become deep red. In additio n, if the tongue looks dry or parched,
this indicates serious deplet ion of Moisture, manifested by scanty
urine, constipa tion, thirst, and dryness of the skin and mucous
membranes. In these situations the tongue may appear to be
shrunken and shriveled. Tongue Zones
Kidney  zone: organs and functions below the navel including
kidneys, adrenals, large intestine, small intestine, bladder, uterus,
ovaries, and testicles; reproduction, elimination, regeneration,
locomotion, vegetative metabolism. Spleen  zone: organs and functions between diaphragm and navel and
between right and left sides including stomach, spleen, pancreas,
transverse colon, lower portion of esophagus, duodenum;  digestion,
assimilation, anabolic metabolism. Liver zone: organs and functions in lateral areas of the body between
diaphragm and navel including diaphragm, liver, gallbladder,
spleen, hepatic and splenic exures of large intestine; digestion,
elimination, detoxication, catabolic metabolism, coordination. Lung and Heart  zones: organs and function s above the diaphragm
including, lungs, heart, diaphragm, esophagus, trachea, bronchi,
mouth, nasoph arynx, nose, ears, eyes, brain; respiration, circulation,
digestion, mentation, perception, communication. Pallor of the tongue usually  indicates chronic deciency of Qi,
Blood, and Moisture. When  this is severe, the tongue may take on a
purplish hue, indicating that deciency has led to stagna tion of the
Blood. This color appears in cases where there is Coldness  of the
body and limbs, tiredness, shortness of breath, and pain in the chest,
abdomen, or joints. The progress of illness is also disclosed by the tongue. As illness
improves, the quality of the fur and color of the tongue become
more normal. If the illness worsens, so will the tongu e and fur. Realistically it is common for individuals to have a complex tongue
picture showin g conicting conditions of Heat and Cold, excess and
deciency. For example, the tongue of a person with a chronic
peptic ulcer and acute inuenza might appear abby and pale,
reddened at the tip, with yellow fur in the center. This indicates the
intermingling of chronic interior deciency with acute exterior
excess. Each part of the tongue corresponds to the condition or state of an
Organ Network. To see the condition of the Heart Network  one looks
at the extreme tip of the tongue, whereas to gauge the state of the
Lung one looks near the tip. So a very red tipped tongue indicatesnot only the general presenc e of Heat, but Heat aecting these two
Networks. A tongue that is purplish indicates poor circulation,
particularly associated with the stagnation of Qi or Blood  in the
Liver. And greasy yellow fur in the center of the tongue reports
Damp Heat  in the Spleen  and Stomach. Many external factors can also aect the appearance of the
tongue, such as smoking, coee, alcohol, and the use of
pharmaceutical drugs. Under these conditions, the tongue may
reect the eect of these agents rather than give a true picture of
the underlying state. This is why the practitioner never relies on
only one method of diagnosis. MAY I PLEASE  FEEL YOUR PULSE. Pulse diagnosis is based on the principle that Qi and Blood  circulate
as a single entity. By feeling the movement of blood in the vessels,
the activity of Qi, Moisture, and Blood  is inferred. The pulse is
produced by the movement of blood in the arteries, but movement
is initiated by the force of Qi. The Chinese saying “Where  Qi goes,
Blood  ows” communicates this synergy of Qi and Blood. When Qi
and Blood  are disturbed, Moisture  may become abnormal as well. Palpating the Pulse
The practition er feels three positions on each wrist along the
radial artery. These positions correspond to metabolic zones known
as the Triple-Burner  or Three-Heater. The position closest to the
thumb corresp onds to the chest and upper body (the Heart  and
Lung). The middle position corresponds to the upper abdomen (the
Stomach, Spleen, Gallbladder, and Liver). The position farthest from
the wrist corresponds to the lower abdomen (the Kidney, Bladder,
Small Intestine, and Large Intestine ). The strength, rate, rhythm,  and size of the pulse express the
integrity of the Qi and Blood  and the functional activity of the Five
Organ Networks. A healthy pulse is regular, with four to ve beats
per cycle of respiration and a smooth, owing feeling as it rises and
falls. It is both elastic and resilient, evoking a sense of relaxed and
vigorous rhythm and harmony. As many as thirty-two pulse qualities are described in the classical
texts, each indicating a particular type of disturbance. For example,
if the pulse is “oating”—that is, it can be felt with light pressure
but fades away as the pressure increases—it indicates an AdverseClimate  (Wind, Cold, Heat, Dampness, or Dryness ) has penetrated the
surface from the outside. If the pulse is oating and rapid, or
oating and strong, this reects the inuence of these Adverse
Climates  in con ict with the vigorou s defensive Qi of the body. The
“sinking” pulse is its counterpart. It is perceived only with deeper
pressure and feels like a stone settling in water. Since it is relatively
hidden or buried, it indicate s that the problem exists at the deeper
internal level. Left
Heart : all organs and functions above the diaphragm, especially on
the left side of the body
Liver: all organs and functions between the diaphragm and the navel
especially in the lateral areas of the body
Kidney Yin: all organs and functions below the navel, especially in
the pelvic region on the left side of the lower abdomenHeart  
Inch Position:  
(Upper Burner): cun
Liver 
Bar Position  
(Middle Burner): guanKidney Yin  
Cubit Position  
(Lower Burner): che
Right
Lung: all organs and functions above the diaphragm, especia lly on
the right side of the body
Spleen : all organs and functions between the diaphragm and the
navel, especially in the central area of the abdomen
Kidney Yang: all organs and functions below the navel, especially in
the pelvic region on the right side of the lower abdomenLung 
Inch Position:  
(Upper Burner): cun
Spleen  
Bar Position  
(Middle Burner): guanKidney Yang  
Cubit Position  
(Lower Burner): che
The slow pulse suggests that Cold is retarding  movement,
manifesting in a lack of warmth, whereas the rapid pulse suggests
that the presence of Heat is accelerating  movement and activity. A
thin and forceless pulse is associated with weakness and a lack of
sucient Qi and Blood. A big, full pulse that “pounds” against the
ngers suggests excess and may be felt when too much Heat is found
in the Heart, Stomach, Liver, or Intestines. Generally, problems of a
Yin nature are indicated by a frail and weak pulse, while problems
of a Yang nature are indicated by a strong and full pulse. A given
individual may exhibit a full and forceful pulse in one position and a
soft and weak pulse in another, suggesting that one system is
hyperactive and another is underactive. Stagnation tends to produce
a tense and erratic pulse It can be generated by both conditions of
excess  or deciency. Heat  can be generated by a lack of Yin as well as
an excess of Yang or Fire. Most people are not diagno sed as having
problems of a purely Yin or Yang nature, and often more than one
Organ Network  is involved in their disorder. THE EIGHT GUIDING  PRINCIPLES
The Eight Principles  are four sets of polar categories that distinguish
between and interpret the data gathered by examination. These
include Yin-Yang, Cold-Heat, deciency-excess, and interior-exterior. They determine the relative nature, quality, and location of the Qi,
Moisture, and Blood  within the body as a whole and within each of
the Five Organ Networks. The energetic activity of the organism is determined by qualities
that distinguish between Heat and Cold. The locale of a disturbance
is judged by the presence of symptoms in the exterior  region
(aecting skin, hair, muscles, tendons, joints, peripheral bloodvessels, nerves, and meridians) or the interior  region  (aect ing the
visceral organs, deep vessels and nerves, brain, spinal cord, and
bones). The virulence of a pathology is compared with the inherent
strength of the body by the presence of symptoms and qualities that
indicate excess  or deciency. Excess  refers to noxious pathogenic inuences such as the Adverse
Climates  or Emotions  and abnormal accumulations of Qi, Moisture,
and Blood. Deciency  refers  to a lack of the fundamental
constituents, Qi, Moisture, and Blood. Any condition can then be
summarized in terms of the relative dominance of Yin and Yang. (see larger image)(see larger image)  
Click  to download a PDF of Syndromes of Distress
Using the Eight Principles  enable s the practitioner to formulate
certain therapeutic objectives. Where Cold predominates, the body
must be warmed. Where excess  persists, it must be dispersed. When
the disease is internal, deep-acting remedies must be employed. Similarly, Heat is cooled, deciency  tonie d, and external  ailments
are treated with remedies that act on the surface. THE ACUPUNCTURIST AND THE  HERBALIST
Just like an irrigation engineer needs dierent data than a soil
analyst, the acupuncturist needs dierent information, or the same
information organized dierently, than the herbalist. Herbs are
classied by categories descr ibing the disruption of Qi, Moisture, and
Blood  corresponding to the Eight Principles  and Adverse Climates. For
example, the herb poria dispels Dampness ; angelica nourishes
decient Blood ; astragalus generates Qi; forsythia and
chrysanthemum clear Heat
Five-Phase Theory  is more critica l for acupuncture. It is not enough
to know that Dampness  or Heat need to be dispersed, or that
deciencies of Qi and Blood  need to be tonied. The acupuncturist
also needs to know which Organ Network  assumes primary
responsibility for the disru ption of Qi in order to treat the
appropriate channel. The methods of the acupuncturist emphasize
the direct manipulation of Qi within the Organ Networks. The properties of herbs are assimilated metabolically by the
internal organ s and then dispersed throughout the body as Qi,
Moisture, and Blood. There are particular herbs that clear Damp Heat
from the body. With acupuncture there is a dierent process—the
elimination of Damp Heat is accomplished by adjusting the
circulation of Qi of the Organ Networks  respon sible for distributing
and transforming Moisture  and generating heat. The Damp Heat is
not treated directly, but rather through the functional relationship
within and among Organ Networks. If the relatio nships among the
Organs  are harmonic, the pathologic condition resolves itself. Five-
Phase Theory  puts the relationship among Organ Networks  into
perspective. The doctor who practices both herbal medicine and
acupuncture gathers all the evidence and synthesizes and interprets
it, using both the Eight Principles  and Five-Phase  approaches. SAME SYMPTOM, DIFFERENT  DISORDERS
To use Five-Phase Theory  it is necessary to identify which Organ
Network  is disturbed. The evaluation identies where the symptomis located, when it occurs, whether anything makes it better or
worse, and what other events may have occurred just prior to or at
the same time as the sympto m. This information is interpreted via
lines of correspondence that link symptoms, timing, and
circumstances with Organ Networks. In the West, a symptom like a headache may be treated
universally with aspirin or Tylenol. This same headache needs
dierentiating in Chinese medicine. It’s like the many words in the
Eskimo language that describe varieties of “snow. ” In Chinese
medicine a multiplicity of disease patterns produce what in Western
medicine is one named symptom or disease. For example, disturbance of the Liver Network  can produce
migraine or bilious headaches associated with nausea, vomiting, and
sensitivity to light and noise. These headaches may be provoked by
anger and occur more frequently in the spring. Disturbance of the
Stomach  and Intestines  may cause headaches associated with nasal
and sinus congestion, acidity, atulence, and constipation. This type
of headache may appear in the morning and improve in the evening. Especially in hot, humid weather, disturbances of the Spleen  and
Heart  may cause headaches associated with fatigue, dizziness,
perspiration, and anxiety. In winter, headaches associated with
backache, chilliness, and profuse urination may suggest a
disturbance of the Kidney. The headache could be a simple matter of
acute indigesti on or related to a complex and chronic problem such
as hypertension, asthma, allergies, or premenstrual syndrome. Treatment for someone’s headache will dier according to which
Organ Network  is disturbed. The same holds true for a “cough. ” In Chinese medicine,  a cough
may be a deciency, excess, Cold, Heat, Damp, or Dry phenomenon,
characterized by the amount and type of phlegm. One type can
produce blood-tinged, clear, yellow, or green phlegm, another a
very small amount of clear, white phlegm or no phlegm  at all. A
productive cough can be further dierentiated by whether the
phlegm is thick, sticky, and dicult to expectorate or loose, clear,
and easy to expectorate. A nonproductive cough may beaccompanied by a feeling of dryness and thirst or a sense of
weakness and malaise. What dierentiates one cough from another is signicant,
alongside the idiosyncratic patterns that distinguish one person from
another. One diagnostic assessment evaluates the symp toms, the
other evaluates the general condition of the person who has them. The total relationship of person to symptoms forms the diagnostic
pattern. Each of the children described below complains of a
dierent type of cough:
Becca is hot and feverish, has diculty sleeping at night, and
craves lots of cold liquids. At night her head becomes damp with
perspiration and she throws o her covers. Her cough is
characterized by thick, dry, tenacious green phlegm. She has to
cough a lot to bring it up. David appears pale and listless. His hands and feet are cold and
clammy, and his arms and legs are sore. He craves warmth, wants to
be covered by lots of blankets, and desires warm drinks. He sleeps a
lot during the day and at night. His cough is characterized by easy
expectoration with large amounts of clear, colorless phlegm. Jenny no longer has a fever, but for several weeks she’s had a
hacking cough at night and seems tired and restless during the day. She complains that her throat is dry and scratchy, and her lips are
red and parched. Oered drinks, she shows no interest. When she
does cough, there is little phlegm and it is sometimes tinged with
blood. Alex had a cold several weeks earlier without a fever. He
recovered from the cold, but in the last few days he has a morning
cough with a rattle in his chest and loose bowel movements. He
seems sensitive to the cold, getting goose bumps easily, and he
requests an extra sweater. He has also lost his appetite. He easily
expectorates a lot of frothy gelatinous mucus, especially in the
morning. Here’s how a doctor of Chinese medicine would interpret the
condition and treat each of the four “coughs”:
Becca’s condition is generally characterized by Heat (fever, night
sweats, restles sness, and green phlegm) and excess  (thick phlegm,high fever, restlessness). Her diagnosis is an acute cough of the Heat
type. This requires a therapy that clears Heat, relieves thirst, calms
coughing, and loosens, phlegm. Since Becca has an excess  condition,
she can tolerate a strong treatment, and it’s unnecessary to attend to
strengthening the body (tonication). The primary goal for Becca is
to treat the symptoms. Along with David’s acute illness, his general condition is one of
weakness and fatigue. His cough is diagnosed as a Cold type
(chilliness, clear phlegm, craves warmth) accompanie d by the
underlying condition of deciency. In general, Cold types of cough
are treated by methods that stimulate circulation, perspiration, and
expectoration. Because of the signs of weakness, however, the
treatment should avoid overstimulation and be comple mented by
strengthening or tonifying therapy to replenish the Qi. Jenny’s cough is the kind that develops from a prolonged recovery
from an acute illness. Her lips are red and her throat is dry,
suggesting that her fever consumed essential body uids. Yet she is
not thirsty. This lack of thirst, combined with the presence of
fatigue, indicates that her body has been weakened and that she
does not have the energy to recover. Her cough is the decient-Heat
type. The Heat is no longer due to fever, but rather to dehydration,
deciency of Moisture, and the dissipation of Qi. Therapy for Jenny
will be directed primarily at restoring Moisture  and increasing Qi. Alex’s cough appeared after apparent recovery from a cold. This
suggests that in fact the cold was not completely cured, but rather
that the illness had penetrated to a deeper level in the body. The
combined symptoms of chilliness, loose stool, and loss of appetite
indicate weakened metabolism and resistance. When the metabolic
Fire is decient, the interior becomes Cold and Moisture  tends to
congeal. Alex’s  phlegm appears in the morning upon awakening, the
time of day the body’s metabolism is at its lowest ebb and the
external environment is the coolest. Treatment for Alex emphasizes
warming the body and stimu lating metabolism in order to eliminate
the Cold and dissipate the phlegm. Whereas for Becca and David the
treatment is directed primarily at eliminating the symptoms, forJenny and Alex the treatm ent is directed at restoring Qi and
strengthening the body. Diagnosis is thus the process of determining what, how, and why
particular events occur so that we’re informed about what to do. It
is a process of discovery in which decisions are made according to
dierent frames of reference and orders of complexity, from the
most general parameters of Yin-Yang  and Five Phases  down to the
very specic ones of Qi, Moisture, Blood, Eight Guiding Principles, and
Five Organ Networks : Is the condition one of Heat or Cold, belonging
to Metal  or Fire, aecti ng the Qi or the Blood, of the Spleen  or the
Liver. The craft of the clinician, like the detective and artist, is in
capturing the essence of the person and the nature of the disease
within the net of these descriptive and interpretive criteria. OceanofPDF. comFive Organ Networks: Traditional Chinese PhysiologyCHAPTER SIX
FIVE-PHASE THEORY : EVOLUTIONARY  STAGES OF
TRANSFORMATION
As a microcosm, human beings embody all the phases within
themselves. Within each thing is contained all things. In the
seed is the tree; in the tree is the forest. …  Life forms are
stations for the reception and transmission of forces, through
which all are nourished. Each thing exists to nourish all others
and, in return, to be nouri shed itself. In this manner, each
kingdom of nature serves to receive and transmit life. …  These
forces are not all material, but include subtle energies of … a
spiritual nature. …  In the inner world, a central sun is also the
source of life. The inner sun is our true self. …
Vasant Lad and David Frawley  
The Yoga of Herbs                     
THE URGE TO ORDER OUR PERCEPT IONS AND DEFINE THE WORLD IS AS old as
humankind itself. From observation and contemplation, we generate
symbols that reect our experience back to us, demystifying
existence by discovering and deciding how reality is organized. Chinese philos ophy does this through the notions of Tao, Yin-Yang,
and the Five Phases. Tao is a compo site of everything, the intrinsic order of all things. The way we interact with Tao, with nature, is described by Yin-Yang
and the Five Phases. Chinese cosmology suggests that life’s
movement is like a spinning ball on a owing river, a tide of wind
and water, a vortex revolving while rhythmically contracting and
expanding ( Yin-Yang ) as we are carried along by the currents of Tao. The Yin-Yang  model symbo lizes the creation process through the
interaction of bipolar forces. Five-Phase Theory * further
dierentiates this dynamic into the relationship between ve
fundamental powers, partitioning the continuum of movement into
identiable stages. Five-Phase  thinki ng provides the basis for
describing the development of forms, systems, and events. It
postulates that everything in creation can be categorized within
these basic parameters: Wood, Fire, Earth, Metal, and Water. If Yin-Yang  is like shadow and sun in varying proportions, Five-
Phase  is like the rainbow spectrum. Shades of darkness and light
create the drama and inten sity, and the Five Phases  provide the
shape, character, and hue. Green, Red, Yellow, White, and Black
correspond to each of the Phases. Five aords a more complex  description of phenomena than two. Combining Yin-Yang  and Five-Phase  genera tes an even more intricate
system of two times ve, or ten. Any process that can be described
in terms of Yin-Yang  can be further dierentiate d into Five-Phase. Any of the Five Phases  can be further dierentiated into Yin-Yang. Each of the ve colors can be distinguished as bright and intense,
Yang, or pale and diuse, Yin. Just as Yin-Yang  can be used to describe the alternation between
sun and shade, heat and cold, dry and wet, so the Five Phases
represent the seasons of the earth, the stages of huma n life, the
waxing and waning of Yin and Yang. Just as day is Yang and night
Yin, so the dawn  is Wood, midday Fire, afternoon Earth, evening
Metal, and nighttim e Water. Five-Phase  and Yin-Yang  concepts
always illuminate and cast shadows upon each other. Five-Phase Yin-Yang Rhythms
The stages of transformation that dene all processes in nature can
be similarly described by the two interpenetrating paradig ms of Yin-
Yang and Five Phases. FIVE-PHASE  THEORY: A  HOLOGRAPHIC  MAP
The underlying assumption of Chinese philosophy is that the forces
that govern the cycles of change occurring in the external world are
duplicated within our human bodies and minds. Patterns  in nature
are recapitulated at every level of organization—from the rotation
of the planets to the behavio r of our internal organs. These ancient
Oriental ideas conform to what some modern thinkers call the“holographic paradigm”: the organization of the whole (nature) is
reected by each and every part (plants, animals, human beings). 2
Within the human being, the same forces that organize the
physical, senso ry, and perceptual life of the organism (soma) aect
the emotional, intellectual, and spiritual life of the person (psyche). Within this framework, the Five-Phase  model has a diverse range of
application. Using anthropologist Gregory Bateson’s phrase, it is a
“pattern which connects. ” 3
A comp lex web of relationships was spun between the Five Phases
and human culture. Aairs of state and society were conducted
according to these principles. Proper times to plant and harvest,
advance and retreat in battle, wed and procreate, and the methods
of preserving health were prescribed by this system. The Five Phases
are an almanac of the human cycles of momentary and lifelong
change, a map that charts the course of process, a guide for
comprehending our unfolding. PHASES AS TRANSFORMATIVE  STAGES
The Five Phases  identify stages of transformation, patterns of
expansion and contraction, proliferation and withering. Each Phase
has an intrinsic primal energy, an ontological inuence that shapes
events. For example, human beings go through cycles in their lives
similar to the seasons in nature—beginning in birth and ending in
death, with stages of growth, maturity, and decay in between. Within the life cycle, the power of each Phase  can be observed. The Wood Phase  is seen in birth, new life bursting forth. The
newborn, at rst small and fragile like a tender green shoot,
mobilizes tremendous energy for swift growth. The baby moves
from the Yin phase of gesta tion, correspon ding to Water, to the Yang
phase of growth, correspond ing to Wood. The peak of this Yang
phase is reached in adulthood when we are in our prime. This
corresponds to Fire. Our “ripening,” the stage during which we
luxuriate in our maturity, corresponds to the Earth Phase. We revisit
Yin through degeneration and aging, which corresponds to Metal. Inour dying we return to the Yin state of dissolution, the Water Phase,
and the emptiness from which we emerged. Five Phases With Earth in the Center
One representation of Earth  within the Five-Phase  model is as the
center or axis, the point of reference of the four cardinal directions,
the middle of the Middle Kingdom that was ancient China. Later on,
in an eort to align Yin-Yang  and Five-Phase Theory, Earth  came to
represent the time and space of transition from one stage to another,particularly the passage between the apex of Yang (Fire) and
ascendance of Yin (Metal ). For examp le, between summer and
autumn is late summer, between noon and dusk is late afternoon. Within this logic, Earth  was placed schematically along the circular
continuum between Fire and Metal. This diagram has become the
one conventionally used to describe the Five-Phase  relationships in
Chinese medicine. Just as the Five Phases  delineate transformations of the life cycle,
they also describe the proces s of our daily existence. Our awakening
is associated with Wood, and our movement toward a state of
complete wakefulness corresponds to Fire. Becoming sleepy
represents Metal, and the state of sleep itself corresponds to Water. Earth  represents the still point, the balance between the polar
movements, when neither one nor the other ascends. Our integrity
is based on the proportion and rhythm of each of the Five Phases
within us, regulating our waking and sleeping, activity  and rest,
arousal and inhibition. PHASES OF  PULSATION
The power, quality, and direction of each Phase can be observed in
any given internal process. In expanding the chest, for example, we
move out into our world,  and in contracting we gather our
resources, experiencing ourselves as contained within  our own
boundaries. Wood  is the Phase  of expansion, culminating in the
Phase  of Fire, which spreads energy across and away from the
surface (Yang). Metal  is the Phase  of contraction, culminating in the
Phase  of Water, which  consolidates energy at the core (Yin). Our
Wood  aspect leads us outward toward Fire, where we feel at one, a
part of it all; our Metal  aspect leads us inward toward Water, where
we recognize our separate and historical self. Our Earth Phase
stabilizes us so that we can handle the gyrations of our oscillatingprocess. Consciousness that exists beyond time, in the realm of
space, belongs to Fire. Our bodies, lineage, genes, and will to pass
from generation to generation through time belongs to Water. The
realm of action belongs to Wood, denition to Metal, and balance to
Earth. Familiarity with each of the Five Phases  acquaints us with the
individual waves within the common sea of our being. In tension with the great Yin Phase, Water, is the great Yang, Fire. Water  gives rise to the germination  of substance, and Fire gives rise
to the completion of materi alized form. The latent power of the
apple seed in the creation of the apple tree derives from Water. The
manifest power of the tree to mature and bear shiny red apples,
completing and fullling its potential, derives from Fire. Whereas
Metal  and Wood  represent stages of expans ion and contraction,
Water  and Fire represent stages of generation and completion. The lines of correspondence between the Five Phases  and human
experience divide the body into Five Organ Networks, each of which
corresponds to one Phase. These Organ Networks, echoing the nature
of each Phase, descr ibe the physiology and psychology of the
organism. By extrapolation people can be generally classied into
ve character types by matching healthy and distorted expressions
of the soma and psyche with the characteristics of each of the Five
Phases  and Organ Networks. Five-Phase Theory  is like a fugue, with ascending and descending
rhythms and recapitulations, repetitions, echoes, and variations on a
theme. Each Organ Network  is a living system, a melody, expressed
through the instrument of the soma and psyche. In the body,
dissonance manifests as physical symptoms and patterns of
dysfunction. In the psyche, bothersome traits, xations, and
dilemmas manifest as distortions of character and patterns of
distress. The function and interaction of the Five Organ Networks
establish the basis for understanding the ve character types. Phases of Pulsation
Symbolizing the organism as a sphere: Metal  (Yin) represents
contraction, movement inwar d toward the core. Water  (extreme Yin)
represents the core, the site of germination and creation. Wood
(Yang) represents expansion, movement outward toward the surface. Fire (extreme Yang) represents the surface, the site of culmination
and completion. Earth  represents the axis, the point of balance,
around which the forces of Yin-Yang  revolve and spin. FIVE ORGAN NETWORKS:  TRADITIONAL  CHINESE  PHYSIOLOGYTo maintain the abundant circulation of Qi and Blood  is to sustain
the material life of the organism, the integrity of mind and tissue. Each Organ Network  refers  to a complete set of functions—
physiological and psychological—rather than to a specic and
discrete physical structure xed in an anatomical locatio n. For this
reason they are referred to as Organ Networks  rather than simply
organs. Identied by the names of the Yin Organs, each paired
system consists of Liver-Gallbladder, Heart-Smal l Intestine, Spleen-
Stomach, Lung-Large Intestine, and Kidney-Bladder *
Yin corresponds to organs that store Qi. Here Qi means Essence—
the most rened state of material substance. The Yin organs are
more stable and constant, representing the more homeostatic
mechanisms that regulate pressure, temperature, distribution, and
metabolism. Constituting the body’s foundation, they’re both more
consequential and more vulnerable. Disease of these organs is
considered deeper and more critical. Yang corresponds to the organs
that transform matter. They are more active and unstable in
character because of their participation in the process of digestion
and elimination. As an aggregate of organs, tissues, channels, and physiologic
functions, each Network  is critical for the sustenance of life. Each
embodies a distinctive intellectual, emotional, and behav ioral style
as well as physiological correspondences. Each has its own
responsibilities (a job to do), a strategy (how to do the job), and a
character (a way of being, a personality) that reect the power of
each Phase. Five-Phase Organ Network Correspondences
Each Organ Network  refers  to a complete set of functions—
physiological and psychological—rather than to a specic and
discrete physical structure xed in an anatomical locatio n.
Diagnosis is the first step in medical problem-solving, and its task is to organize a complex set of variables and interpret the relationships among them.
What is the purpose of diagnosis in Chinese medicine?
The tongue is used as a diagnostic tool to infer the condition of the patient, and its appearance can indicate the presence of certain patterns or imbalances.
What is the significance of the tongue in diagnosis?
The practitioner uses their own senses to gather information, including observing the patient, listening to their complaints, and asking questions, and then synthesizes this information using their own judgment and intuition.
What is the role of the practitioner in diagnosis?
Yin-Yang is a fundamental concept in Chinese medicine, describing the cyclical and harmonious interplay between opposing forces, which are necessary for maintaining health and balance.
What is the concept of Yin-Yang in the context of Chinese medicine?
The Five Organ Networks correspond to the Five Phases, and understanding the relationships between them is crucial for diagnosis and treatment in Chinese medicine.
How do the Five Organ Networks relate to the Five Phases?