Traditional Chinese Medicine Theory

(Zi Wu Liu Zhu)

Concept
In Traditional Chinese Medicine, Midnight-noon Ebb-flow theory is also called Zi Wu Liu Zhu (
). The flowing and ebbing of Qi and Xue along different meridians (Jingluo) is believed to
be related to the designated days and hours in terms of the heavenly stems and earthly
branches().
Zi (midnight) and Wu (midday) reflect the growth and decline of Yin and Yang. In reference to
the 24 hour cycle, in the Zi time (23-1) the Yin Qi reachers its most extreme. After that the Yin Qi
begins to decline and the Yang Qi starts to increase. At the Wu time the Yang Qi is at its most
extreme, after that it begins to decline, and the Yin Qi starts to increase. Thus the Zi and Wu
represent the pivotal points of the growth and decline of the day and night, and Yin and Yang.
The original meaning of** "Liu Zhu" (ebb and flow) is the circulation of the water system. It's
dissipating and it's gathering together. Zi Wu Liu Zhu** describes the circulation of Qi and Xue in
the Jing Mai. It explains that the physiological functions of the body will follow the diurnal rhythm
and vary according to the changing of time.

Circulation
In the Yuan Dynasty, Hua Bo Ren said "The Jing Mai serve as pathways for Qi and Xue and so
circulate the Yin and Yang and nourish the whole body. Starting in the Middle Jiao and form there
pouring into the Hand Tai Yin and Hand Yang Ming, the Qi belongs to the 'Ping Dan' time, like the
dew drops that fall at dawn. The Qi flows day and night, reaches the end and then starts again."
The Ping Dan time here refers to the Yin time (the 3rd of the Earthly Branches, 3-5am).

In the Yin time (3rd) the Qi and Xue will exit the Middle Jiao and flow and pour into the
Hand Tai Yin Lung channel.
In the Mao time (4th), Qi and Xue will flow and pour into the Hang Yang Ming Large
Intestine channel.

In the Chen time (5th), iQi and Xue will flow and pour into the Foot Yang Ming Stomach
channel.

In the Ji time (6th), Qi and Xue will flow and pour into the Foot Tai Yin Spleen channel.

In the Wu time (7th), Qi and Xue will flow and pour into the Hand Shao Yin Heart channel.

In the Wei time (8th), Qi and Xue will flow and pour into the Hand Tai Tang Small Intestine
channel.

In the Shen time (9th), Qi and Xue will flow and pour into the Foot Tai Yang Bladder
channel.

In the You time (10th), Qi and Xue will flow and pour into the Foot Shao Yin Kidney
channel.

In the Shu time (11th), Qi and Xue will flow and pour into the Hand Yue Yin Pericardium
channel.

In the Hai time (12th), Qi and Xue will flow and pour into the Hand Shao Yang Sanjiao
channel.

In the Zi time (1st), Qi and Xue will flow and pour into the Foot Shao Yang Gall Bladder
channel.

In the Chou time (2rd), Qi and Xue will flow and pour into the Foot Jue Yin Liver channel.

And then Qi and Xue will return to the Lung channel.

The Qi and Xue flow in every channel for a period of two hours, and just like the tides of the sea,
will ebb and flow, reaching a high point followed by a low point, entering every channel at its time
of fullness, and leaving it at the time of emptiness.

Function
Zi Wu Liu Zhu in Traditional Chinese Medicine can help in diagnosis, in prevention of disease, and
especially to choose the most auspicious time to treat the patient. Because of this, in the past few
years a new direction in the study of medicine has evolvedwhen to select the treatment time.
Many scholars outside China have performed trials investigating left heart failure due to
hypertension. It has been found it mostly occurs between 11pm-1am. When patient is given a
suitable amount of vasodilators and a small amount of diuretics at 10 pm, this can prevent left heart
failure.

Midnight-moon Ebb-flow

Concept of the seven emotions ()

The seven emotions refer to seven emotional activities including joy, anger, worry, anxiety, sadness,
fear and fright. They are external manifestations of the functional activities of viscera. Normally, the
seven emotions dont cause diseases and only when the emotional stimulations are too abrupt,
violent, and prolonged and beyond one's adaptability or when there is diminished adaptability due
to imbalanced yin-yang, qi and blood of viscera, can they turn into pathogenic factors, thus causing
diseases. This is what is called "internal injury due to seven emotions."

The six climatic factors are pathogenic wind, pathogenic cold,

pathogenic summer-heat, pathogenic dampness,
pathogenic dryness and pathogenic heat (fire). ()
Wind, cold, summer-heat, dampness, dryness and heat (fire) are six kinds of natural climatic factors
known as "six qi". Human beings living in the natural world constantly contact with these natural
factors. Under normal condition, the human body can adapt to the changes of climate which are
indispensable to the existence of human beings. If the harmonious relationship between human
beings and nature is broken, the body is unable to adapt itself to the changes of the climate, leading
to the occurrence of disease. Under such condition, the six natural climatic factors become
pathogenic factors.
The six climatic factors are characterized by the following features in causing disease:
(1) The cause of disease by the six climatic factors is usually related to seasonal changes of living
conditions.
(2) The six climatic factors may singly or collectively attack people. For example, pathogenic wind
may combine with cold, dampness, dryness and heat to attack people and lead to wind-cold
syndrome, wind-dampness syndrome, wind-dryness syndrome and wind-heat syndrome.
(3) The nature of the diseases caused by the six climatic factors may be the same as or different
from that of the six climatic factors. For example, invasion of pathogenic cold may deepen
internally to transform into heat and so do accumulation of pathogenic dampness. Sometimes the
nature of the disease caused by various pathogenic factors may vary due to the differences in
constitution, which is called "secondary transformation". For example, frequent abundance of yang
or frequent deficiency of yin may transform into heat after the invasion of exogenous pathogenic
factors; frequent abundance of yin or frequent deficiency of yang may transform into cold after
invasion of exogenous pathogenic factors; frequent abundance of dampness or deficiency of the
spleen may lead to transformation of dampness, etc.
(4) The six climatic factors usually invade people from the skin into the muscles or from the mouth
and nose into the lung and the defensive qi. That is why external syndromes tend to appear at the
early stage of disease caused by the six climatic factors and gradually transmit to the internal.
Besides, clinically there are some diseases due to dysfunction of the viscera that appear similar to
the pathological changes caused by pathogenic wind, pathogenic cold, pathogenic dampness,
pathogenic dryness and pathogenic heat (fire), known as "five endogenous pathogenic factors", such
as endogenous wind, endogenous cold, endogenous dampness, endogenous dryness and endogenous
heat (fire) which are not directly caused by, but can result from, the six exogenous climatic factors.
For example, attack by exogenous pathogenic wind can stir the endogenous pathogenic wind and
exogenous pathogenic dampness can induce endogenous pathogenic dampness.

Improper diet
Improper diet is also named

Diet is indispensable to human existence and is the main route for human being to obtain nutrient
substances from the natural world. However, the intake of food has to follow certain rules. If the
diet is improper, it may impair the body and become pathogenic factors.
Improper diet includes three aspects: starvation and overeating, unhygienic food and food partiality.

Starvation and overeating

Starvation refers to two different things: prolonged lack of food and protracted insufficient intake of
food.
Prolonged lack of food cannot provide the body with enough nutrient substance, leading to
insufficient production of qi and blood and sudden decline of the viscera functions with the
manifestations of dizziness and lassitude of the four limbs or even death in severe cases. Protracted
insufficient intake of food will lead to malnutrition, deficiency of qi and blood, weakness of the
body, susceptibility to invasion of pathogenic factors and various diseases.
Overeating means two different things: crapulence and protracted excessive intake of food.
Crapulence impairs the spleen and stomach because the food taken is beyond the normal functions
of the spleen and stomach to digest, transport and transform, leading to gastric and abdominal
distension and fullness, eructation wrth fetid and acid odor, anorexia, vomiting and diarrhea, etc. In
severe cases the intestinal and gastric vessels and collaterals will be impaired, causing abdominal
pain or hemorrhoid bleeding, etc. Protracted excessive intake of food will bring on superutrition,
delayed transformation of qi and failure of the nutrients of food and water to transform into qi and
blood. Instead, the nutrients of food and water turn into phlegm and accumulate in the body to
hinder the flow of qi and blood, leading to obesity, dizziness, palpitation and chest oppression; or
transforming dampness into heat to invade the vessels and causing abscess, carbuncle, sores and
ulcers, etc.

Unhygienic diet
This refers to eating unclean food, such as taking food gone bad, polluted by pestilent evils,
parasites or mistaken intake of poisonous food. Ingestion of food that has gone bad can cause
gastric and abdominal pain, nausea and vomiting, diarrhea with borborygmus or dysentery. Taking
food polluted by parasites can cause various verminosises, usually manifested as occasional
abdominal pain, addiction of singular things, emaciation with sallow complexion etc. If food
contaminated by epidemic toxin is taken, infectious diseases will occur. If food polluted by
poisonous things or poisonous food is taken, food poisoning will occur.

Diet predilection
This refers to the phenomenon that diseases can start due to the liking of foods with certain tastes or
specially eating certain foods, including predilection for cold or hot food, or predilection for one of
the five tastes or predilection for alcohol.

1. Predilection for cold or heat

Excessive intake of cold food can impair the yang qi of the spleen and stomach, cold-dampness is
thus produced internally, producing symptoms of abdominal pain and diarrhea. Partiality to spicyhot food can impair the stomach yin due to the accumulation of heat in stomach and intestines,
causing thirst, halitosis, abdominal distention and pain and constipation etc.
2. Predilection for the five tastes
Acid, bitter, sweet, pungent and salt tastes correspond to five viscera to some extent. Acid taste first
enters the liver, bitter the heart, sweet the spleen, pungent the lungs and salt the kidney. Long time
of preferring food with a certain taste can cause the preponderance of its corresponding viscera, thus
causing disharmony among viscera.
3. Predilection for alcohol
Liquors are cereal nutrients and hot in nature. Proper drinking can dredge blood vessels and relax
tendons. Overdrinking can impair the spleen and stomach and produce internal dampness-heat.
Clinical manifestations include abdominal fullness and distention, anorexia, bitter and greasy taste
in the mouth, thick and greasy tongue coating ect .
4. Predilection for one type of food
It refers to a long period of special taking of some foods or not taking some foods, or lack of certain
food. This can cause diseases due to excess or lack of some foods. For example, long time of
excessive ingesting rich foods can lead to production of phlegm and transformation of heat, causing
obesity, vertigo, stroke and consumptive thirst and so on. Prolonged lack of taking some nutrients
(such as vitamine A, calcium and iodin) can cause night blindness, rachitis, goiter and tumor.

Zang Xiang Theory

Zang Xiang Theory is also named

Zang Xiang, is also known as the visceral manifestation. It is first appeared in the chapter of six
Sections of Discussions on Visceral Manifestation in Su Wen. According to the explanation in some
Chinese medical classics, "Zang" refers to interior organs which are stored inside the human body.
"Xiang" has three levels of explanations: 1. Real zang-organs: such as skin, muscle and bones. 2.
physiological functions of human body revealed by zang, fu-organs, meridians, qi, blood, essence
named as breath, vessel pulse and changes of expressions.3. Natural phenomena interconnected to
human organs functions of essence, qi and blood, for instance, sun, moon, four seasons and climate
changing. In Nei Jing (Canon of classification) compiled by Zhang Jingyue, for example, it was
recorded that "Xiang means image". The viscera are stored inside the body and the image is
manifested outwardly. For this reason, it is called "visceral manifestation". That is why zang xiang
is sometimes translated as "viscera and their manifestations".

Origins
The theory of visceral manifestation advanced on the basis of several aspects of as following:
1. The knowledge of anatomy accumulated in ancient times. In Ling Shu, for instance, it says,
"After death, the body may be dissected and the texture of the zang-organs, the size of the
fu-organs, the capacity of the intestines, the length of the arteries, the condition of the blood
can all be observed... " From anatomy's point of view, such a proper understanding of the
human body laid concrete foundation for the theory of visceral manifestation in morphology.
2. The long-term observation of the human physiological functions and pathological changes.
For example, catching cold may produce such symptoms as stuffy nose, running nose and
cough, ancient people got to know there is a close relationship between the skin and hair as
well as the nose and lung.
3. Medical practice in which certain physiological functions were disproved analyzed in the
light of pathological phenomena and curative effect. For example, eye disorders are mostly
cured by treating the liver, ancient people eventually reached the conclusion that "the liver
opens into the eyes".

Zang Xiang Theory

The theory of the visceral manifestation studies the physiological functions and pathological
changes of viscera and their relations. It plays an important role in building the theoretical system of
TCM and is significant for expounding the physiology and pathology for the human body and for
guiding clinical practice.

Zang xiang with five elements

Viscera, basis for the theory of visceral manifestation, is a collective term of internal organs which,
according to their physiological functions, can be classified into three major categories: The fivezang organs, including the heart, liver, spleen, lung and kidney; the six fu-organs, including the
gallbladder, stomach, small intestine, large intestine, bladder and triple energizer; and the
extraordinary fu-organs, including the brain, marrow, bone, vessel, gallbladder and uterus.
The common function of the five zang-organs is to transform and store essence; while that of the six
fu-organs is to receive, transport and transform water and food. The extraordinary fu-organs, as a
kind of fu-organs, differing from the six fu-organs in shape and physiological functions, are
relativity hermetic organs and do not contact with water and food directly. The six fu-organs are in
charge of transporting and transforming foods, so they can be solid but not full. The reason is that
the stomach becomes full and the intestines remain empty when the food is taken into the stomach;
the intestines become solid and the stomach empty when food is transported downward.

Characteristics of the theory

Holism which focusing on the five Zang-organs is the reflection of the overall concept in theory of
zang-xiang, it believes that the human body is an extremely complex organic whole, indivisible
parts of the human body coordinate with each other, physiologically, interlink with each other in the
metabolism and interaction in the pathological changes.
This wholeness of body embodied in three main areas: one is that the five Zang-organs, six Fu
organs, body and the five sense organs constitute five functional systems through the connection of
meridians, qi and blood.
The second one is the restraint, reinforce of five elements between five functional systems of which
maintain life activities as a whole.
In the midst of five functions systems, five Zang-organs store the essence, guide the gasification, is
in central position; functions of six Fu organs are subordinate from five organs; essence stored by
Chi Heng fu-organs is also derived from the five Zang-organs.
The five Zang-organs function forgetful, other organs of the human body to function properly, the
body can be strong.
Vigorous and healthy as the five Zang-organs are, other organs of the human body can function
properly and the body being strong.

Significance for differentiation between zang-organs and the

fu-organs
The significance for differentiation between zang-organs and fu-organs is not only for explaining
their physiological functions, but also for guiding clinical practice. For instance, the disorders are
zang-organs are of deficiency type in most cases, while the disorders of fu-organs are of excess type
mainly. The related fu-organs can be purged for the treatment of the excess type of zang-organs
disorders, and the zang-organ can be nourished for the treatment of the excess type of fu-organs
disorders. These therapeutic principles are still of great significance for now.

zang-organs

Influences on TCM
The theory of visceral manifestation is mainly characterized by the concept of organic holism.
According to the theory, the zang-organs pertain to yin and the fu-organs pertain to yang. Each
zang-organ is internally and externally related to a certain fu-organ. For instance, heart is internally
and externally related to the small intestine, the lung to the large intestine, the spleen to the
stomach, the liver to the gallbladder, the kidney to the bladder and the pericardium to the triple
energizer. These internal and external relations are deduced on the basis of the interconnection
between meridians.
The physiological functions are closely related to mental and emotional activities. Spirit,
consciousness and thinking reflect the functions of the brain, which is already mentioned in Nei
Jing. However, the theory of visceral manifestation holds that spirit, consciousness and thinking are
also closely related to physiological functions of the five zang-organs, which controlled the whole
body, so the brain also depends on the five zang-organs to perform physiological functions. As we
can seen, the balance of the five zang-organs physiological functions is the core of maintainance of
related constant of internal environment of human body.
The above analysis shows that the theory of visceral manifestation, though based on ancient
anatomy, was established mainly by means of observation according to the idea that "viscera inside
the body must manifest themselves externally." Therefore, the result of the observation and analysis
was inevitably beyond the viscera in human anatomy. That is why TCM has developed such a
unique system for physiology and pathology.

Meridians
Meridians is also named Collaterals, Channel, Jing Luo, ,

The twelve meridians control human life, yet they are the place where disease can live. If disease
starts in the meridians, the physician can use the meridians to treat the root cause of disease.
Nei Jing (Classic Chinese text, 475-221 BC)
Meridians and collaterals are the essential component parts of human body structure. The
circulation of qi, blood and body fluid, the visceral functions as well as their correlations all depend
on the transmitting and regulating functions .f meridians to integrate the human body into an
organic whole.
The theory of meridians, which is taken as an important component of the theoretical system of
traditional Chinese medicine, concentrates on the study of the distributions, physiological functions,
pathological changes of the meridians as well as their relationships with the viscera, body
constituents, sense organs and orifices, qi, blood and body fluid.
Physicians in the past dynasties ceaselessly contributed their clinical experience to the supplement
and enrichment of the theory of meridians since it formed in Huangdi Neijing. The theory of
meridians supplementary to the theory of visceral manifestations, qi, blood and body fluid, has been
the theoretical basis explaining the physiological activities and pathological changes of the human
body and provides important guiding principles for clinical specialties, particularly for acupuncture,
moxibustion, massage and Qigong.

Concept of meridians
Meridian is a general term for meridians and collaterals. It serves as the pathway for the
transportation of qi and blood throughout the body, thus connecting the viscera with extremities, the
interior with the exterior as well as the upper with the lower. Meridians are the main trunks running
longitudinally within the body, most of which run deeply inside and follow certain routes.
Collaterals are the branches of meridians running reticular over the body. They run deeply or
superficially within the body, most of which run in the shallow region and some often give a visible
appearance on the surface of the body. The interconnection of meridians with collaterals throughout
the body integrates the viscera, limbs and orifices, muscles and tendons into an organic whole, thus
ensuring the normal performance of body activities.

Formation of the theory of meridians

1. Elicitation from the pathological and anatomical knowledge
By the method of direct observation, ancient people gained a degree of knowledge about blood
vessels, muscles and tendons, bones, viscera as well as the interrelationships between them, thus
providing a basis for the formation of the theory of meridians.
2. Deduction of the pathological phenomena over the body
In clinical practice, it has been found that certain visceral disorders may be manifested on the
corresponding superficial area of the body, where some pathological phenomena may occur, such as
tenderness, nodes, rashes, and changes of luster.

When one viscus becomes diseased, pressing the corresponding superficial area of the body may
relieve the pain inside. Hereby, it is inferred that there are special routes associating these acupoints,
which serves as another basis for the formation of the theory.
3. Observation and deduction on induction and transmission phenomena of acupuncture and
moxibustion
If the needles are accurately inserted into the right acupoints, the patient will feel a feeling of
soreness, numbness, heaviness and distention, which is also called"needling sensation" or "Deqi"
(arrival of qi) and may also transmit along certain routes to distant areas. When performing the
technique of health preservation in Qigong, practitioners who concentrate their mind on Dantian
point (the central area below the umbilicus), usually have a sense of qi flowing along certain routes.
Such kind of sense and transmission is one important basis for the formation of the theory of
meridians.
4. Summarization of the therapeutic effects of acupoints
When trying to summarize and analyze the main therapeutic effects of acupoints, ancient people
found that acupoints with similar functions usually rank in the same route in a regular order.
So it is presumed that the acupoints are connected with each other through some particular routes,
which shows the great importance to the formation of the concept of meridians.

Composition of meridians
The system of meridian is composed of meridians, collaterals and their subsidiary parts.

1. Main meridians
Main meridians, being the trunk of meridian, may be classified into three categories: regular
meridians, extra meridians and divergent meridians.
A. Twelve regular meridians
Twelve regular meridians, also collectively termed as "the twelve main meridians", include three
yin meridians of hand, three yin meridians of foot, three yang meridians of hand and three yang
meridians of foot. These twelve meridians act as the main pathways in which qi and blood circulate
throughout the body. They start and terminate at given sites, circulate along fixed routes, convergent
in definite orders, distribute and flow with certain rules and are directly connected with certain
viscera.
B. Eight extra meridians
The eight extra meridians refer to eight important vessels different from the twelve main meridians,
included the governor vessel, conception vessel, Thoroughfare vessel, belt vessel, yin heel vessel,
yang Heel vessel, yin link vessel and yang link vessel. They perform the function of governing,
connecting and regulating the twelve regular meridians.

C. Twelve divergent meridians

The branches stemming from the twelve main meridians are referred to as the twelve divergent
meridians, which respectively start from the limbs, run deep into the viscera, and emerge from the
shallow regions on the neck. The divergent meridians of yang meridians separating from the
meridians proper run inside the body arid return to the meridians proper while the divergent
meridians of yin meridians separating from the yin meridians proper run inside the body and finally
join the yang meridians to which they are interiorly and exteriorly related. The function of the
twelve divergent meridians is to strengthen the connection between two meridians in interior and
exterior relation.

2. Collaterals
The collaterals are the branches of the main meridians, including the connecting collaterals,
superficial collaterals and tertiary collaterals.
A. Fifteen connecting collaterals
The connecting collaterals are larger and major collaterals, which separate from the twelve
meridians, as well as the governor and conception vessel respectively. Together with the large
splenic collateral, they are so called "the fifteen main collaterals";. The function of them is to
strengthen the connection of the exteriorly-interiorly related meridians on the body surface.
B. Superficial collaterals
The superficial collaterals are those running through the superficial area of the body.
C. Tertiary collaterals
The tertiary collaterals refer to the smallest and thinnest branches of the whole body.

3. Subsidiary parts of the meridian system

The subsidiary parts of the meridian system refer to the parts that connect the twelve main
meridians with the superficial and muscular portions of the body, including twelve muscle regions
and cutaneous region.
A. Muscles along twelve meridians
Muscles along twelve meridians, one of the subsidiary parts of the twelve main meridians, refer to a
system where qi of the twelve main meridians "retains, accumulates, scatters and links"; in the
muscles and joints, and serve to communicate the extremities with bones and control the
movements of the joints.
B. Twelve cutaneous regions
The twelve cutaneous regions are the twelve superficial areas of the body on which the functions of
the twelve main meridians are reflected, and also the sites where qi of the twelve main meridians
scatters.

Twelve Standard Meridians

Each meridian is a Yin-Yang pair, meaning each Yin organ is paired with its corresponding Yang
organ.

Yin (Arm) Meridians

o Taiyin Lung Meridian of Hand () (LU)
o

Shaoyin Heart Meridian of Hand () (HT)

Jueyin Pericardium Meridian of Hand () (PC)

Yang (Arm) Meridians

o

Shaoyang Sanjiao Meridian of Hand () (TE)

Taiyang Small Intestine Meridian of Hand () (SI)

Yangming Large Intestine Meridian of Hand () (LI)

Yin (Leg) Meridians

o

Taiyin Spleen Meridian of Foot () (SP)

Shaoyin Kidney Meridian of Foot () (KI)

Jueyin Liver Meridian of Foot () (LR)

Yang (Leg) Meridians

o

Shaoyang Gall Bladder Meridian of Foot () (GB)

Taiyang Bladder Meridian of Foot () (BL)

Yangming Stomach Meridian of Foot () (ST)

Eight Extra Meridians

The eight extraordinary meridians are different to the standard twelve organs meridians in that they
are considered to be storage vessels or reservoirs of energy. They are not associated directly with
Zang fu or internal organs.

Conception Vessel () (Ren Mai) (CV)

Governor Vessel () (Du Mai) (GV)

Thoroughfare Vessel () (Chong Mai)

Belt Vessel () (Dai Mai)

Yin Link Vessel () (Yin Wei Mai)

Yang Link Vessel () (Yang Wei Mai)

Yin Heel Vessel () (Yin Qiao Mai)

Yang Heel Vessel () (Yang Qiao Mai)