Tending The Wind

The qì of the five phases manifest in the body as densely as an organ or as rarified as a thought. Terms like “liver” and “intuition” are a means of making distinctions between the different types of qì within a phase, but these are not ideal or isolated forms. Nor is a form of qì to be separated from its function; the “liver” is both the fleshy liver and the act of doing what the liver does (to liver, or the act of liver-ing). The qì of an organ is its dynamic way of being – its moment by moment structure and behavior. To perform acupuncture along an organ’s meridian is to influence the nature and emergence of its being. Acupuncture along the liver meridian can be aimed at its physical attributes (such as its store of blood), its physical activities (such as its role in regulating movement), or its mental/emotional attributes and activities (such as the capacity to feel anger, or the ability to visualize one’s future and actuate a plan). These are all attributes of the Wood phase as expressed in the organism. But instead of saying anger belongs to “Wood-as-manifest-in-the-person” we just say it belongs to the liver.

Each phase is associated with two organs, one yīn (solid) and one yáng (hollow). Each organ has a pair of meridians that flow bilaterally, both through the body and on its surface where the qì can be influenced by needling. The yīn organs produce, transform, regulate, and store. Yáng ones receive, break down, and transport. (There are some organs, not directly related to the five phases, which are yáng in form but yīn in function – hollow organs that store vital substances. These “Curious Organs” include the uterus, blood vessels, brain, and bones and marrow. The gall bladder is considered both a Wood phase yáng organ, and a Curious Organ.) Not all anatomical organs as Westerners know them are named in Chinese medicine (such as the glands and nerves), nor do Chinese organ functions always match the physiology of recognized Western organs. The broad behavioral patterns associated with Chinese organs must be emphasized over their individual anatomy. The fleshy organs are simply space-time locations with the highest probability and density of a certain type of qì. The same type of qì can also be found at other locations in varying degrees. This also applies to some of the functional cross-over between yīn and yáng organ pairs.

Each organ pair has a relationship, via its phase, with resonant aspects of the natural environment. Thus the liver and gall bladder are strongly affected by wind, the color green, the season spring, and foods that taste sour. Some of these are also mirrored in the pathology of these organs, such as vomit with green bile or seizures that look like the limbs of the body being whisked about by a strong wind. Each organ pair also has an affinity for corresponding mental and emotional aspects, all related by phase resonance. (Please see the table (HTML, or PDF) at the end of this chapter for a full list of phase correspondences.) In the cycle of life, the vitality of one phase directly affects the next and indirectly affects all the others; these phase interactions can be used to predict and trace back sequences of organ pathology.

The five phases are broad categories; there is some variation regarding the specific details of organ function and pathology among different authors. Part of this variation comes from whether that author took a Confucian approach (viewing the organs as members of an orderly society whose disease is the result of a lack of order and propriety) or a Daoist approach (viewing the organs as each having their own inner nature whose disease is the result of stresses and behaviors not in harmony with that nature). And part of the variation among authors, with regard to applying Naturalist philosophy to the body, comes from how different people experience the natural world. The metaphors of nature are open to interpretation – not a problem for the Daoist who relies more on experience and personal transformation, but a big problem for the Confucian who relies more on education and examinations. The earliest texts emphasize that only those who understand the metaphors of the natural environment can heal the body’s landscape. This is the approach that has been most effective in my own practice, and the one used in this work. It affords a natural and easy way to understand Chinese physiology.

WOOD (Mù, pictograph of a tree: tree, wood.) The natural tendency of trees and plants is to grow upward and spread outward. Liver qì tends to expand upward and outward, giving the body upright strength and the mental confidence to move out into the world. Trees move gracefully in the breeze, their swaying a necessary stimulus for healthy roots, trunk, and branches. The liver ensures the even and smooth flow of qì in the body. This affects all processes, enabling smooth digestion, graceful movement, and an even disposition. If qì is constrained (literally tree in a box) liver anger rises. Chronic constraint causes depression. (The character for “emotion” is feeling that bites the heart. “Anger” is a slave’s heart.) The liver’s importance in movement is manifest in the tendons, ligaments, and the small muscles around joints; these move wildly, like branches in a strong wind, during seizures. Trees store sap, their nutritive fluid; healthier trees produce better quality sap. The liver stores blood, and contributes to its nutritive quality. Liver blood that is deficient in either quantity or quality results in dry and brittle nails and tendons, menstrual problems, poor vision, and dull hair and skin color. Mentally, those who don’t feel nurtured by good liver blood are timid and indecisive. (From a scientific standpoint, the liver actually has tremendous blood storage capacity, serving as a capacitance reservoir, and is able to compensate for a 25% loss of blood during moderate hemorrhage. The liver also stores and metabolizes a host of nutrients, and transforms many toxins.) Leaves and petals provide color. The liver provides good color to the body, and gives the eyes their ability to see the various colors and shades. Outer vision is complemented by the inner vision of meditation and dreams. It is said that blood returns to the liver during sleep and deficient blood causes abnormal dreaming. (The liver’s blood reservoir is in fact affected by posture.)

The gall bladder is the only five phase yáng organ that doesn’t hold or transport food. Instead, it stores a refined substance (bile) and aids the liver in regulating the sinews and formulating decisions – the liver involved in planning (the ability to see ahead) and the gall bladder involved in discerning and clarifying the course of action. The texts don’t say much about bile, but the gall bladder is valued for its discernment, judgment, and clear decisions. There is a connection with bile’s function as a detergent and its ability to separate fat globules into more manageable sizes for digestion. As a metaphor, this ability to separate a mass of information into manageable pieces is a form of discernment. Once the objects in our field of vision have been clarified, decisive action is possible.

FIRE (Hǔo, pictograph of rising flames: fire, flame.) Fire is warming. The heart warms the body as blood circulates through its vessels. The heart itself actually develops as a specialized vessel. Vibrant circulation ensures activity and life. Fire produces light. The heart stores shén – the light of awareness, and the spiritual vitality of the body. Shén gathers best when the heart is free of desires, like an empty vessel. As the heart circulates blood, it also circulates shén, giving different types of awareness to each organ pair. The awareness of the liver is hún; that of the lungs is pò, and so forth. Shén in the heart itself typically refers to conscious awareness, which must receive and act upon all the other types. The heart is thus said to act as the emperor of the body. Shén is reflected in the face and facial expressions. Fire consumes its fodder. The emotion of the heart is xǐ, which is typically translated as joy. However, many authors note that the pictograph really implies the pleasure derived from eating. Xǐ in the etymological dictionary is translated as happiness, or to like. If we like something we may consume too much of it, and overindulgence in sensual pleasures is said to damage the heart. Similarly, too much excitement about what we like is said to “scatter the shén” and cause mental distraction. An unquenchable desire may lead to obsession, greed, jealousy, neediness and dependence. Liking oneself excessively causes vanity and avoidance of personal responsibility.

The small intestine receives “ground and fermented” food from the stomach, proceeding with the real work of digestive breakdown. The ancient texts say the small intestine separates the pure from the impure, offering the pure to the spleen for assimilation/absorption and sending the impure to the large intestine for further processing. (With the help of bile from the gall bladder and enzymes from the pancreas, the small intestine does break down and separate ingested food into that which is absorbed and that which is expelled. This is a type of decision, and it could be argued that the small intestine rather than the gall bladder has the final say in making decisions – guided by the heart’s shén and aided by bile-enhanced discernment. Enzymatic action in the small intestine may be viewed as a form of fire, cooking the food and exposing its qualities.)

EARTH (Tǔ, pictograph of object rising through the earth: earth, dirt, soil, ground, land.) Good soil ensures healthy plants and nutritious crops. The spleen and stomach are the foundation for nutrient energy assimilation in the body. Their health lays the ground for all the other organs. The sand, silt, and clay that give soil its essential properties are made from the weathering of rocks. Weathering occurs by both physical erosion and chemical dissolution (primarily by mildly acidic rainwater). The majority of caves are made by acidic dissolution, also resulting in underground drainage systems. Caves have traditionally been used as storage and burial sites. The stomach is said to be the warehouse for grain and water, receiving food, and beginning the “rotting and ripening” process. The stomach may be compared to a cave where the rotting of dead organisms begins. The same physical and chemical weathering that wear down the rock are applied metaphorically to the food that is “ground and fermented” in the stomach. This mixture then begins its journey downward.

Soil is extremely porous, about half its volume being interconnected spaces. These passages contain water, air, and dissolved substances. Porosity is very important to soil quality, with the best soil neither leaching water and nutrients too easily (sand), nor retaining them too tightly (clay). Water is sucked into microscopic pores and held by adsorption on soil particles. The movement of the stomach is said to be downward (heavier food pieces) and that of the spleen is upward (lighter food distillations). The imagery is that of gravitational movement down subterranean byways and the largest openings of the soil, and of upward capillary movement into the smaller soil pores. The upward movement of the spleen is described as a “suctioning” effect, and its functions include the assimilation of nutrients from food and water and their distribution to other organs. This suggests the physiology of nutrient assimilation both from the intestines and into cells, which is why the spleen is treated in situations as diverse as diarrhea and diabetes. Insulin is required for cell assimilation of glucose, and it may be that the endocrine (hormonal) pancreas is better treated through the spleen, while the exocrine (digestive) pancreas is better treated through the small intestine.

The Chinese spleen is the toughest organ for Westerners to relate to, since the anatomic spleen neither absorbs food nor has any ductwork connecting to the stomach. Instead, it houses red blood cells (helping young ones to mature, destroying old ones, and releasing caches of them during exercise or acute blood loss) and white blood cells (exposing red blood cells to the immune system). It is notable, however, that the above functions rely heavily on the spleen’s variably porous pathways. Its unique vascular structure makes three functional compartments: areas of fast blood flow (comparable to the capillaries in muscles), areas of intermediate flow (holding the ready cache of red blood cells), and areas of slow flow (where the ability of red blood cells to deform and squeeze through narrow passageways is key to maturation and destruction). The porous nature of the spleen mirrors the porous nature of soil. It is the most physical expression of a phase that also includes other activities related to the properties of soil.

Boulders and dirt provide the lay of the land, and define its surface contours. The spleen is associated with healthy muscle tone, which provides the surface contours of the body. A weak spleen results in weak and atrophied muscles. Earth lines streams and rivers, holding their flow. The spleen is said to hold blood within the vessels; a weak spleen may result in slow hemorrhage. Lack of holding and upward suctioning results in organ prolapse. Mentally, it affects our ability to extract and hold meaning from information. And thinking about things too much causes worry, the emotion of the spleen. Waterlogged soil can’t support life due to lack of aeration; nutrient and gas flow get bogged down in the pores. The spleen is responsible for preventing accumulation of “dampness” (sludgy fluid). Dampness has a slippery and sticky quality (like wet clay) and manifests as edema, mucus coating on the stool, sluggish vitality, or slow thinking with an inability to express meaningful ideas.

METAL (Jīn, pictograph of nuggets in the earth with the phonetic “now/current/this”: gold, metals, money.) The phonetic meaning “now” is a combination of “union” and “contact” which may add special meaning to the nuggets. The difference between rocks (Earth) and minerals (Metal) is that rocks are combinations of different minerals, while minerals themselves are pure. The lungs have much to do with purity in Chinese medicine. They are said to receive the pure qì from air and nutrients and carry these to the heart to be mixed into blood. They eliminate “dirty” qì via exhalation and, through the large intestine, defecation. They maintain physical purity, but also purity of mind and spirit. It is the Metal aspect of a being that knows its own inner nature (dé) most clearly, and can reflect this to the outside world. Thus the lungs are said to serve as advisor to the heart, ensuring that what is allowed into one’s personal space is appropriate, and that what gets expressed to the world is one’s personal truth. A physical example of Metal’s role in purity is the immune system. A mental example is one’s ability to maintain an unpopular but personally appropriate path. Metal is hard but malleable. The lungs are associated with the hardness of the bones, and the protective yet pliable nature of the skin. Malleability requires a water-like quality, and the lungs are sensitive to dryness. The lungs also assist the circulation of water through the triple heater; respiratory movements increase water transfer through connective tissues, and may aid their electrical conductivity. The same metal can be formed and reformed into different shapes. One theme of Metal is constancy regardless of form. The same běn (original, basic, personal) qì of a being can manifest in a myriad different ways depending on context (location, time, etc.), but all those manifestations come from and must reflect the qualities of their origin. This origin, however, is not static, and changes like the Dào in response to its experiences.

The lungs have an intimate relationship with both the physical and the ethereal, serving as the interface between the two. They hold the same secret that the fox shares with the Little Prince: “L’essentiel est invisible pour les yeux.” That which is essential is invisible to the eyes. What is of real value can’t be measured. (Interestingly, autumn was the season when Chinese merchants traditionally recalibrated their scales.) It’s easy to see why the lungs are associated with the emotion grief, as we lament those who’ve gone beyond our immediate perception. The lungs are said to house pò (corporeal spirit), which may be best understood as inherent body awareness. Pò is often translated as the basic body instincts, like the drive to breathe and eat, and the ability to feel basic sensations like pain. Viewed in light of the lungs’ function as an interface between that which is easily perceived and that which is not, pò also includes those subtle “gut feelings” about things not identified by the other types of awareness. The lungs are able to bring the most subtle influences to our attention. They also provide awareness of what some spiritual traditions call the “I Am” – the vast unlimited aspect of a being that spans all space and time.

The lungs’ Chinese functions and their connection to Metal can be appreciated by studying iron. Iron is the most abundant metal in the universe, the earth, and the body. Of all metals, it is the most easily magnetized. Iron is important to the earth’s magnetic field, and is essential in the form of magnetite to many species’ ability to sense magnetic fields and use them for navigation. The human brain also contains magnetite, though its significance is unknown (but would tie into the lungs’ role in sensing subtle forms of energy). Iron is very malleable with a high tensile strength, but is very reactive chemically, corroding rapidly in moist air; it is called the vulnerable metal (and, by coincidence, the lungs are called the delicate organ). Its unusually easy alternation between its ferrous (oxygen-poor) and ferric (oxygen-rich) states has earned it the title breather among metals. Hence its importance in bringing oxygen from the lungs to the tissues, and carrying waste carbon dioxide from the tissues back to the lungs, aiding the respiration of every cell in the body. Iron also has crucial roles in the maintenance of a healthy immune system, cellular energy production, DNA synthesis, and production of thyroid hormone, connective tissues, and several brain neurotransmitters. Iron is recognized in homeopathy as an element that allows the soul to assert itself in the physical world. There is some similarity between homeopathy’s vital force and pò.

WATER (Shǔi, pictograph of streams flowing together: water.) Water is the basis of life. Water covers 75% of the earth’s surface and composes 70% of the physical body. It is essential for all biological processes. Water is said to be the first material substance to emerge from the Dào, assisting the processes of emergence and change for the rest of nature. In the body, the kidneys assist the spark of life at mìngmén to make all the other organ systems. They are the home of original yīn and yáng, and they store jīng. The character for jīng is composed of rice/kernel + a plant rising from the ground (new growth) + a red mineral inside a mine or furnace (cinnabar). “Rice” is on the left; “new growth” is over “cinnabar” on the right. (Cinnabar is 86.2% mercury and 13.8% sulfur, from which pure mercury is easily obtained. Mercury had special importance in Chinese alchemy practices because of its similarity to water, being the only liquid metal at room temperature.) Jīng suggests the alchemical process of transforming nutrients into new growth. It is the capacity for substantial transformation. When used as a noun, jīng suggests a refined liquid-like substance that holds transformative capacity. Jīng substances include saliva, blood, bone marrow, brain and spinal cord (another kind of marrow in Chinese medicine), and sexual fluids.

Water is a unique substance, well suited to representing the above concepts. H2O is a polar molecule, having a partial positive charge at the hydrogens and a partial negative charge at the oxygen (yīn and yáng). Attraction between these partial charges creates many of the properties of water that make it so well suited for life. Water is dense, with a high surface tension that gives it capillary action as it carries nutrients through the roots of trees and the tiny blood vessels of the body. Water is called the universal solvent because it can dissolve most substances except non-polar fats and oils; giving up the old form is the first step in creating the new. Water is the only substance found in all three physical states (solid, liquid, gas) at naturally occurring temperatures, holding within itself the ever-changing nature of the Dào. It can also absorb and store a lot of heat before vaporizing, enabling it to carry warmth through the body. And water is crucial for folding enzymes into their functional state, giving proper form to the catalysts of all change in the body. Since water is involved in both dissolution and creation it represents the flow of life in all stages.

Because the kidneys hold the first differentiated form of qì (original yīn and yáng) and jīng (transformative capacity created by the dynamic interaction of yīn and yáng), they are said to govern all transformative processes in the body – especially those involved with development and reproduction. Deficient kidney jīng can cause stunted growth in the young, and as jīng wanes with age we lose the ability to reproduce. For any transformation to be useful and for development to be orderly, jīng must operate with a purpose. This is provided by zhì, the shén of the kidneys. Zhì shows a plant growing from the heart, and is commonly translated as will, aspiration, or ambition. It is the goal we have in mind as we change from the old to the new. This requires concentration, and of course the physical kidneys concentrate water.

Kidney jīng is said to make marrow, which includes bone marrow and the brain and spinal cord. Bone marrow supports the body (contributing to strong bones and vital blood) while brain “marrow” supports the mind (contributing to sensory perception and intelligence). When jīng is deficient, the bones are brittle and the mind is dull. (The brain may be best understood as the organ that transforms sensory perception into the five types of shén. It relies on both the heart and the kidneys to function.) The kidneys actually do produce a hormone (erythropoietin) that induces production of red blood cells by the bone marrow, and they make the active form of vitamin D which affects bone density and mental health.

The emotion of the kidneys is fear, whose character is also translated as dread and the verb to terrify. Change can be scary and dissolution (death) can be petrifying, literally freezing us in an icy grip. But just as water carries dissolved minerals to a new destination, Water holds the knowledge of Metal – that our true nature in its purest state is not measurable, but is held within all manifest forms.

Oceans are the ultimate destination for all other forms of water. Their surface currents are caused by wind, but the grand ocean currents so important to life on earth are caused by shifts in water density. Density is determined by temperature and salinity. The kidneys are called the ocean of the body, receiving water from all the other organs and governing the overall flow of body water. They separate the “clear” from the “turbid,” sending the latter out through the bladder and recycling the former. The kidneys in fact depend on salinity gradients to preserve water and concentrate urine. They serve a crucial role in regulating blood pressure. The kidneys’ ability to preserve water and sodium also impacts both the volume and density of intracellular and extracellular fluids; density gradients between these two spaces set the stage for currents important to cellular metabolism and communication. This flow is also affected by temperature.

Salinity is lowest in rainwater and streams, with mineral density increasing as rivers empty into oceans. The kidneys are said to draw the breath (Metal) down, concentrating it into the abdomen. This form of concentration roots the ethereal into physical form. Shortness of breath may result if the kidneys can’t “grasp the qì.”

These five phases – Wood, Fire, Earth, Metal and Water – provide the basis for discerning patterns of disharmony in the patient. Phase organs and functions create an intricate web of behaviors and interactions that the practitioner must understand and help to harmonize. As healing progresses and core issues surface, functional patterns shift, so acupuncture point and herb selection requires adjustment through the course of treatment.