Disclosing Central-Earth Splenic Theory Based Upon two TCM Five-Element Models

Having been practicing Traditional Chinese Medicine (TCM) in Taiwan for over 35 years, I found that TCM theory applying to the daily clinical practices is essential. During the last ten years, I have two books published on the subject of wu-yuen liu-qi (?) from HuangDi Neijing (?) which is the core concept of yin-yang [1,2]. In the Western world there was a far advance teaching about of wu-yuen liu-qi (?“Phase Energy”) written in his book by Porkert [3] and the topic of “the Five Evolutive Phases” (abbreviated E.P.; wu-hsing) was defined. The concept of E.P. has been using by our classical TCM ancestors for over one thousand years since the JinYuan dynasty and it is really old but useful. Actually, E.P. was documented originally in HuangDi Neijing Shu-Wen as a teaching of yin-yang-wu-hsing (?) by Huangdi’s teacher Gu Yu-Shu (???). Sometimes, we refer those doctrines to the seven chapters of yuen-qi of Shu-Wen (?).

It is essential to grasp the thoughts of original TCM and the theory of yin-yang-wu-hsing will be reacted as the foundation. It is crucial to learn TCM step-by-step by acquiring the basic principal of yin-yang and sometimes we refer it as basic TCM Kung Fu (?). It this paper, the basis of yin-yang will be elucidated by introducing two models of wu-hsing (??). Model II is the conventional model we familiar with which mainly focus on the activities of redundancy (?) and the deficiency (?). Model I the E.P. model seems to be new to most TCM learners which will be illustrated based on classical yuen-qi from Neijing. If someone wants to further their studies about the basis of yin-yang-wu-hsing in English, a good resource from Porkert’s books [3,4] will be fulfilled. 

A reminder about the core concept of yin-yang in TCM which was the knowledge claimed from the nature. Ancient Chinese philosophers obtained Yin-Yang by observing seasonal changes and simplified them into a yin-yang related system. The useful teaching from Neijing: “Human being nourished by qi available in nature, from premature to mature through yin-yang’s stimulations in the four seasons” (?”) told us about facts from nature. How does this four season’s simulation (?) work? The key point of this sentence was referred to contents of yin-yang given by the four seasons. Four seasons: Spring yang-in-yin (????), Summer yang-in-yang (?), Autumn yin-in-yang (?), Winter yin-in-yin (?) constructed our nature(Figure 6), these seasonal changes will be emerged rhythmically year-after-year. 

Nowadays, qi (?) which is the most popular subjects such as: Qi-Kung (?), Kung-Fu (?), Chinese Medicine (?), TaiChi (??), etc. What is qi really about in TCM? It was defined in Huangdi Neijing (?) exclusively. Neijing introduced the highest level of yin-yang which was discussed in my book [1, page 23] as follows: Yang as a functional activities is qi (?) and Yin as the shape of visceral organs is xing (?). Yang can be further subdivided to three levels of yin and three levels of yang (?). These different levels of the three-yin and three-yang can be considered as the standard units of qi. How can we measure qi? The solution is involved in these three levels of yin-yang. These knowledge and clinical applications of xing and qi may consider to be the upmost level of Neijing which indicated that all different kinds of TCM issues could be developed based upon them. 

Moving from theory to the clinical aspect, it is important to understand that all of universal subjects are in motion dynamically all the time. This sustains movement such as our living cells proceeds metabolism and the life cycle in the form of apoptosis. Any of these movement requires energy and this power is qi. The five visceral organs have their own functional activities, which are formed as a closed system, corresponding to each other freely. Wood, fire, earth, metal, water (Five Elements ?) is a symbolic entity and every beings can be grouped into these five attributes. Substitute the five visceral organs into this Five Elements will be liver as wood, heart as fire, spleen as earth, lung as metal and kidney as water. Visceral organs which may get another form from the five attributes: Emerging (?), Maturing (?), Transforming (?), Shrinkage (?), Consolidation (?) are evolved. This E-M-T-S-C axis gives the life-cycling idea of the five visceral organs by the perspective of yang-qi. Yang is energy and movement while yin is the substance and shape. Every yang may carry each yin moving around naturally is a teaching given by Taoism (?). Meanwhile, yin-yang always joins themselves together and cannot be separable. Therefore, neither single yang nor unique yin can be survived by itself alone (?). 

Our ancestor observed the phenomenological representation from the nature and discovered that the universe had the form of yin-yang thereafter made the Heaven-Earth-Human unity (?) possible and further topics will be elicited as follows.

The core concept of TCM is Yin-Yang and Five Circuits yin-yang-wu-hsing (?). I-Ching (?) is a book talking about yin-yang in way of multiple prospective achievement, while Neijing interest on medical approach only. The basis of yin-yang from I-Ching is emerged from nature which was disclosed by our wisest master: “Phenomenological representation of the nature by vision revealed of destiny, whilst wiseman undisclosed these representations” (?). These wisdoms were written down and published such as: Neijing (?), Hetu (?), Luoshu (?), Tai Chi (?), Eight Trigrams (?) etc. In TCM history, Classical TCM literatures such as Neijing Su-Wen talks about basic theories, Neijing Ling-Shu about acupuncture meridians and points, and Sheng Nong’ Herbal Book(?) about herbal medicine. All these biblical literature’s knowledge is come from nature and concerned with yin-yang. Some useful concepts, which are relevant to this topic, will be elucidated in the following paragraph.

Hetu? derived the idea of Central Earth (Figure 1)

 Figure 1: Hetu?? the oldest yin-yang diagram (> B.C. 2000).

Hetu used to be considered as the foundation of I-Ching. Legendarily, wiseman FuXi (?) made use of Hetu to draw the Eight-Trigram. In figure 1, we may consider 1,2,3,4 as pre-mature (? sheng), and 6,7,8,9 as mature (? cheng). In the middle of Hetu is the number of five, 1+5 give 6, 2+5 give 7 and so forth. This number of five gives the idea of center-earth in TCM because five represents the earth in Hetu. The idea from premature to mature, can be explained in this way: raw-rice become cook-rice with water and fire, wood is the raw material which becomes a form of table by wooden work of a carpenter whenever the process of water-fire, wooden-work is the idea given by this ‘five’. Since this five is resided in the center of Hetu and simulated as the central-earth splenic in TCM. 

Hereby, I want to emphasis that TCM always focus on the organ’s functional activities not the visceral organ itself. Why is it so important to understand? It is because most TCM students make the mistake of interpreting TCM visceral attributes as five anatomical organs. Someone may wonder that Chinese medicine lack of the knowledge of anatomy because TCM said that liver is located on the left. Actually, wood represents liver and wood is located on the left side of Hetu (Figure 1). Therefore, we said that liver is on the left, it does not mean the anatomical liver is on the left side. I noticed that nowadays most people think about Chinese medicine in the way of the modern anatomical and physiological views which is completely led astray from the teaching of TCM. Finally, should view TCM organs in two aspects: anatomical form and functional activity.

The Central-Earth form of the Five Evolutive Phases (Model I) (Figure 2)

 Figure 2.1: Five Elements the ancient model of I.

 Figure 2.2: Model I equivalent to model of figure 2.1.

Figure 2.1 is copied from a literature (Si-Zhen-Jue-Wei?) which was written by Lin zhi-han (?) in the Ching dynasty (A.D. 1790). Figures 2.1&2.2 are derived from Hetu (Figure 1). This Model I made use by Dr. Porkert to illustrate the energy changing in the course of time. Since Model I which is derived from nature and used to simulate the yin-yang transformation of the four seasons. Why is there a central-earth? Hot in summer and cold in winter, the four season is changing from time to time. This idea showed that the attribution of yin-yang is different during each season which is a result of equilibrium. Why is this equilibrium essential? For an example, it is crucial to understand that yang qi is needed more in baby then aging people. Whichever indicted that do not supply aging people with redundant yang energy because this redundancy yang-qi can hurt. Summarized in this example that the normal distribution of yin-yang should be examined carefully because the proportion may not be the same within different situation and/or condition.

The Conventional Five Elements Model (Model II) (Figure 3)

 Figure 3: Conventional Five-Element Model.

Dr. Porkert strongly disagreed to translate TCM wu-hsing (??) with the term of “Five Elements”. He concluded the wu-hsing should be called ‘production sequence’ which is relevant to the Five Evolutive Phases in terms of Sequence I to V. Coincidentally, he redefined this model as the Five Transformation Phases [4]. 

This Model II of the Five Elements is essential in TCM history. Porkert had discussed this topic explicitly in his book [4]. The idea of xiangsheng (??) is the sequence of production which follows the order of wood fire earth metal water while the sequence of suppression xiangke (?) follows: wood earth water fire metal. 

Model II should also be in the form of dynamic status and in motion. In nature, movement will be given by pressure gradient. This gradient is given by redundancy (?) and deficiency (?) naturally in universe. Water flows from high to low. Like breathing, atmospheric pressure changes in this way, when our chest expansion air inhaled (chamber pressure deficiency) and compression while air exhaled (redundancy). The Five Elements system owns the property of redundancy and deficiency which may make xiangsheng (?) and xiangke (?) possible. When Wood is in the status redundancy (either Wood strong or Earth weak), Earth will be insufficiently then Wood will come to inhibit Earth. Conclusively, the conventional Five Elements model can achieve its interactive goal by the property of redundancy and deficiency.

Prior to discuss this subject, I would like to clarify the importance of applying theory for practicing TCM. Theory concerns about the teaching in Neijing which instructs medical doctor how to think and postulate causal dysfunction of incoordination of our body. Theory cannot be acquired by empirical experience but teachings from Neijing. For acupuncture, I can tell you which acupoints can relieve pain off the patient immediately but you may not know the reason. Nevertheless, this kind of empirical practices is really useful too. Applying the theory of Neijing Ling-Shu (?) is a good way to practice acupuncture, you may accumulate treatment experiences and also can promote your skill by inventing new theory. An example of applying one of the theories of acupuncture will be elucidated as below section. 

The second example will give some insight of central-earth-splenic system in order to learn about the ancient thinking of yin-yang equilibrium. It is also a good example to understand qi moving around in our body and this splenic system supplies energy to the five visceral organs including spleen itself.

Acupuncture (Figure 4)

 Figure 4: Infrastructure of the twelve cardinal meridians (infta TCM).

The Twelve Cardinal Meridians (shier jingluo ?) is well known to every TCM doctor and acupuncturist (Figure 4). The infrastructure is drawn based on the fact of Qi moving in the meridians with sequences as shown. The body part with numbers on it which is started from inner arm head (above) foot(below) sequentially. It should started from the 1^st column Lu(yin) LI(yang) ST(yang) SP(yin) 2^nd HT(yin) SI(yang) BL(yang) KI(yin) 3^rd PC(yin) TE(yang) GB(yang) LR(yin) consecutively and back to the starting point Lu(yin)……etc. The common pathway will be stated as Inner (yin) Arm (yang) Outer (yang) Foot (yin) which good fit into column 1 to 3. Notice that Qi energy flows from inside to outside and from yin-yin to yang-yang alternatively. Most acupuncturist is familiar with this subject which is a very fundamental teaching in TCM.

Energetic conduits and sensitive points (Acupoint ??) is an essential teaching from Neijing [3] which will be further explained in this context. Pictorial drawn from Neijing SuWen chapter 56 and 63 will be summarized as follows (Figure 5): 

Su Wen chapter 63 (Pi-Bo-Lun ???) taught about the pathogen transmitted through skin, muscular, reticular conduits, meridian conduits, Six yang visceral organs (??), and scattering Gastro-Intestinal (G.I.) terminated subsequently. Energetic qi flows from exterior (? yang) to interior (? yin) through skin surface, terminated and scattered qi energy around the G.I. system. While Su Wen chapter 56 (?Maio-Ci-Lun) further taught about the pathogen transmitted inwardly/outwardly through the whole picture of reticular and cardinal conduits.

 Figure 5: Pictorial for Neijing Su-Wen.

As in figure 5, all meridians are conduits which come up with different forms of energy qi. Energetic qi used to flow from the inside meridians to the surface acupoints. Inversely, exterior pathogen may break through the barrier of the surface and penetrate into the internal meridians. That may lead to the effectiveness of acupuncture treating illness for internal diseases. This whole picture (Figure 5), which was written in SuWen, here is just an outline. The details should involve a lot of anatomical knowledge and qi theory of moving in/out of our body which are more advanced and complicated topics [5]. The concepts of in/out, up/down picture of Figure 5, advance reading on this subject is available [6]. Wei (?) and Ying (?) are two basic TCM subjects mention about qi move around. I reiterate that yin-yang will be the finale in all TCM subject matter. An example as in figure 5, there is a formula involving yang(?)/yin(?)such as: surface(?)/inside(?), Wei(?)/Ying(?), yang-meridian/yin-meridian, exterior(?)/interior(?), zhengqi(?)/pathogen(?), and qi(?)/structure(?). It is important to think TCM by acquiring theoretical teachings. 

To practice acupuncture, someone should learn the skill of acupuncture as well as knowledge of meridians, anyway differential diagnosis of Zheng (?) is most urgent. Knowing pathogenesis of Zheng which is the subject on causal effectiveness, people may achieve the newly emerged slogan “precision-TCM” (?). Practically, it is really true that acupuncture is effective for relieving most discomforts and treating diseases in the out-patient clinic and not just pain relieve.

Motivation of the Central-Earth-Splenic system [7]

From Model I of the Five Evolutive Phases, I would like to present a clinical usage as an example. Actually, it is a very useful and famous model in splenic theory which was written by Li Dong-Yuan (?A.D. 1120). There is a briefing on this doctrine and focus on the topic of Qi generation and movement. Qi is generated by the gastric-spleen couple with food-nutrients supplement. Remember that Model I comes from the doctrine of Hetu (?) which is the foundation of yin-yang in Chinese culture (Figure 1). 

Simulation of Qi Energy supplied (Figure 6): Li Dong-Yuan?intervened the Central-Earth (Gastric-Splenic) theory which based on the concept of Hetu. In Figure 6, this cycle represents the four seasons within one year. Yin-yang has had the property of vanished(?) and earned(?) which was shown as yang qi become more and more during winter to summer while diminished through summer to winter (?). Since, Stomach is Yang-Earth (?), Spleen is Yin-Earth (?). Clearly, the identity of central-earth, which contained in Model I, is both the Spleen-yin and Stomach-yang that is a pair of yin-yang too. The mission of central-earth splenic, which claims food supplement, further supplies energy to the rest of visceral organs (Liver, Heart, Lung, Kidney and Spleen). 

What is the nature can tell us about relating to central-earth theory? Within one year, there are 360 days which can be subdivided into four seasons containing 90 days in each section. In Neijing Su-Wen Chapter 29: “The spleen is located in the center which used to make use the four seasons to manage the other four visceral organs and each section subsided into 18 days so that it itself is not a season involved.” (?Figure 6) The idea of authority in the middle center which indict the supplement of qi is the teaching from Su Wen and further explanations of qi generation and degradation is an assessment through the five-element in Model I.

 Figure 6: The fiver evaluative phases established the central-earth system.

Every TCM doctor should know the digestive-axis documentation in Neijing that food is ingested into the stomach and food-energy vaporized to spleen which further convey to the lung. Therefore, vital energy generated from food to our visceral organs is accomplished. This concept was clearly defined in Su-Wen. Furthermore, yang qi is in charge of surface (?) while yin is the internal (?). Totally, there can be subdivided into six layers: three-yin (?) and three-yang (?) components. I have mentioned earlier in this paper that these three yin-yang sets are simulated to measurement of qi. 

If we understand the subject of central-earth splenic system then we know that qi used to move around in/out and up/down in our body [6]. Evaluate qi’s situation in our body which may use those two Five Elements Model again. When earth-splenic is in deficiency which is an insufficiency symptom-complex (xuzheng ?), based on Model II this splenic deficiency may be due to Liver inhibit Spleen or Spleen weakness by itself. Cause differently and then treatment will be different. Further question appeared, how do we know whether there is blockage in the qi pathway of up/down, or it is really a matter of splenic insufficiency? Pulse diagnosis is essential to make the judgement. Obviously, pulse diagnosis could not be obtained from learning pulse alone which is a matter of integrative of principle-method (li-fa ?). Again, the essential knowledge of TCM arteriology is yin-yang. Among the four-method of diagnosis, the most difficulty is pulse diagnosis because it takes time to learn, skillful and should grasp the equilibrium issues about yin-yang. In Su Wen it mentioned that: “Equilibrium is acquired through weighting the pulse which is located by the TCM radial aterial inch-point (?) while ‘live or die’ issue can be determined.” (?). This equilibrium issue belongs to the subject matter of balancing yin-yang which refers to a complete TCM assessment. Porkert said that “The radial pulse is the highest tribunal, so to speak, to which every diagnosis might be submitted for final approval [4].” I highly recommended that.

Nowadays, the Chinese society in Taiwan, people used to think of that TCM is very simple and easy by searching information acquired from the Google search-engine wherever they got everything. Sometimes, patient walked in my clinic and said that they are suffered from dampness of the spleen (shi ?). I told them that our body contained 70 percent of water and everyone should be in dampness environment. The point is how the spleen handle the metabolic water. Will it be so simple? A motto from Johann W. Goethe that “We know accurately only when we know little, with knowledge doubt increases.” It is also true that if someone practice TCM without TCM’s thinking while just memorize doctrines then they may never meet the need of “precision-TCM” (?). 

Even as knowledgeable as the Han-learning (?), Dr. Manfred Porkert in the 1950s of his early life, who mentioned that “I could indeed translate the Chinese words of the text but not the thoughts they expressed.” Obviously, he noticed that Chinese thought was his most difficult part in learning classical Chinese medicine. I have been teaching TCM in medical schools over thirty years and found that pure classical TCM thought is being forgotten in these days among most student. Hopefully, this paper may give some insights on the right path of learning TCM wherever to the Eastern or Western world.

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