On Chinese Medicine: The Five Xíng
European philosophy has long been dominated by questions of epistemology: what do we know? how do we know it? how can we justify our claims to knowledge? Chinese philosophy — perhaps because of its origins in practical political thought — has been dominated instead by questions of change: why is there change rather than stability? what is the relationship between change and human action? are there patterns of change that we can detect and use to our advantage?
The concept of the wŭxíng 五行 was proposed by the philosopher Zou Yan 鄒衍 (fl. c. 350-270 BCE) as one answer to that last question.
The character wŭ 五 is the numeral five. The folk etymology of the character xíng 行 sees it as depicting a man walking, putting first his left foot forward and then his right (Rochat, 2009, p. 76). But the character was originally a pictogram depicting a street intersection, as can be seen in some of its earlier forms (“行,” 2014, “Etymology,” para. 1):
|Oracle bone script||Bronze inscriptions||Large seal script||Small seal script|
The term xíng represents a cluster of concepts that includes go, walk, move, travel, and circulate. By extension, it means behavior, conduct, practice; as a transitive verb, it means guide, lead, conduct. The Báihǔ tōng 白虎通 — a record of debates among leading Confucian scholars at the court of the emperor Han Zhang Di 漢章帝 beginning in 79 CE — asks why the five xíng 行 are called by that name, and answers with a typical Chinese etymology: they are called 行, it says, because heaven 行s — conducts, moves, puts in motion — their qì (quoted in Rochat, 2009, p. 67).
Whatever xíng may be in this context, there are five of them, all tangible, natural materials — wood mù 木, fire huǒ 火, earth tǔ 土, metal jīn 金, and water shuǐ 水. The term xíng has been variously translated into English as element, phase, agent, movement, process, and stage. All of these are attempts to capture, in one way or another, the idea that the xíng are simultaneously substances and processes; indeed, one awkward translation calls them process-classifications (Chen, 1996, p. 200); another calls them material forces (Yao, 2000, p.82).
The Chinese were certainly not interested, as were the ancient Greeks, in discovering the ultimate constituents of the material world, or seeking to penetrate the world of appearances to some ultimate reality beyond it. Rather, as Benjamin Schwartz (1985, pp. 358-360) puts it, the Chinese were concerned with accepting the world as they found it, correlating the realities of ordinary experience, and interrelating the manifold world of experience into a meaningful and patterned whole.
Why five? Perhaps so that they can be counted on the fingers; perhaps because there are four directions and a center. We do know that the Confucian texts are full of fives — five excellences, five talents, the five qualities of the sage, five colors, five notes, five duties (Rochat, 2009, pp. 35-36).
The concept of the five xíng ranges from the concrete to the abstract. All the xíng appear in another list, that of the six treasuries or storehouses liùfǔ 六府 — water, fire, metal, wood, and soil, to which is added grain — that constitute the substantial necessities for human civilization, and for which the government is responsible. Thus, in the Shūjīng 書經, the legendary king Yü the Great 大禹 is reported to have counseled:
Virtue is seen in the goodness of the government, and the government is tested by its nourishing of the people. There are water, fire, metal, wood, soil, and grain — these must be duly regulated; there are the rectification of the people’s virtues, the conveniences of life, and the securing of abundant means of sustentation — these must be harmoniously attended to (quoted in Geiss, 1988, p. 403 n. 1; Unschuld, 2010, p. 59).
Here there is little doubt that the five xíng, along with grain, are material objects of use and consumption.
On the other hand, for Zou Yan these five xíng were primarily a conceptual tool for understanding history — specifically, the succession of dynasties. He called them by the abstract expression wŭdé 五德, meaning the five virtues or powers. The term dé 德 is here the same as that found in Laozi’s Dàodéjīng 道德經.
There is a further level of abstraction. In the Hóngfàn 洪範 “Great Plan” chapter of the Shūjīng 書經 we read: “Water is said to soak and descend; fire is said to blaze and ascend; wood is said to be curved or straight; metal is said to conform and solidify; earth is said to take seed and give harvest” (Ho, 2000, p. 170; Chen, 1996, p. 200; Wang, 2012, p. 37; Rochat, 2009, p. 27).
I think the proper reading here is not so much that water soaks and descends as that whatever soaks and descends is — in some way — water. In other words, all stream-like processes of flowing or continuity are under the sign of water, and are connected to each other in a variety of ways, most importantly by occupying the place of water in the cycles of generation and inhibition.
The same is true for the other xíng. Blazing and ascending are properties of all combustion processes, including metaphorical combustion — warmth, passion, impulse, spirit, the fire in the heart. The properties of wood that allow it to be curved or straightened align it with all the processes of shaping, cutting, and making — birth, ideation, creativity, expression. The qualities of earth that allow planting and harvest embrace stability, regularity, centeredness, nourishment, productivity. Metal poured in a mold first conforms and then hardens; so do all things that adapt, comply, and become firm (see Chen, 1996, p. 201; Tierra, 1998, p. 31; Zhu & Wang, 2010, p. 30).
Each of the five xíng has a number of such associated concepts, extending from the transparent to the puzzling. Wood, for example, is associated with the liver gān 肝 and gall bladder dǎn 胆, with springtime and the eyes, with anger and the time from 1:00 am to 3:00 am, with leeks, chickens, and plums. And there are a lot of such associations. Warren (2002, pp. 27-28) lists fourteen for each xíng; Tierra (1998, pp. 29-30) lists twenty-five.
Some of these associations are fairly clear. Wood — the character mù 木 also means “tree” — is considered to represent growth, germination, expansion, spreading out. It is therefore associated with springtime, when temperatures increase and the weather is windy, when trees and grass turn green, when fruit is sour and not yet ripe.
Thus — at least in China, situated in the northern temperate zone — wood is associated with springtime, wind, germination, growth, green, and sour tastes (Liu, 1988, p. 49). Or perhaps wood is associated with a sour taste because decaying wood has a sour taste (Ho, 2000, p. 170); or perhaps because wood opens up, clears the way, gets rid of obstacles, just as does an acid, which has a sour taste (Rochat, 2009, p. 94). Clearly there is a lot of room here for creativity.
Such associations become important in Chinese medicine. The basic features of water are coldness, downward motion, moistness, and contraction, and those of fire are heat, dryness, upward motion, and meltability. Thus, in Chinese medicine, the kidney shèn 腎 and urinary bladder pángguāng 膀胱 are associated with winter, cold, north, and water, and the heart xīn 心 is associated with summer, heat, south, and fire (Lo, 1986, p. 221).
But many medical associations are less transparent and more dependent on specifically Chinese medical concepts. For example, why is the liver associated with wood? Because, we are told, the liver prefers a moist environment, its qi likes to ascend, and, when diseased, it produces symptoms of the wind pathogen, such as tremors and convulsions (Liu, 1988, p. 49). Or again: because, we are told, just as wood can bend or straighten, and the leaves and branches of a tree are free, growing, and movable, the liver prefers free movement and dislikes being prohibited, and functions to promote the free flow of qi (Zhu & Wang, 2010, p. 38). Even more: the liver connects to the gall bladder, controls the tendons, opens into the eyes, and manifests in the nails. Therefore, since the liver is associated with wood, then the gall bladder, tendons, eyes, and nails are associated with wood as well (Zhu & Wang, 2010, p. 32).
The following table (see Warren, 2002, pp. 27-28; Tierra, 1998, pp. 29-30) lists some of the more common associations of the five xíng.
|Fŭ||Gall bladder||Small intestine,|
|Body part||Muscles/ tendons||Blood vessels||Flesh||Skin||Bones|
|Manifestation||Nails||Complexion||Lips||Body hair||Head hair|
It is probably to Zou Yan that we owe the idea that the five xíng succeed each other in a regular sequence; he explains dynastic succession by associating each dynasty with a xíng — a power or virtue — that by necessity overcomes that of the previous dynasty. He wrote:
Each of the five virtues is followed by one that it cannot conquer. The dynasty of Shùn 順 was ruled by the virtue of earth, the Xià 夏 dynasty by the virtue of wood, the Shāng 商 dynasty by the virtue of metal, and the Zhōu 周 dynasty by the virtue of fire (quoted in Ho, 2000, p. 16; Chen, 1996, p. 202).
This idea was apparently opposed by the Mòhist 墨家 logicians — and perhaps also by Sunzi 孫子 — who believed that one xíng succeeded another not by some natural progression but because of greater quantity: “That fire melts wood is because there is much fire; that metal uses up charcoal is because there is much metal” (Zhang, 2002, pp. 99-100; Chen, 1996, p. 202).
But Zou Yan’s ideas were tremendously popular among the rulers of the Warring States period. In contrast to the rebuffs given to Confucius and Mencius, Zou Yan was received respectfully by the rulers of Liáng 梁, Zhào 趙, and Yān 燕; the Shiji 史記 devotes three times more space to describing Zou Yan’s theories and activities than it gives to Mencius or Xunzi (Harper, 1999, p. 824).
Perhaps one of the reasons for this popularity was that a regular succession of xíng allowed both prediction and manipulation. “When a new dynasty is going to rise, Heaven exhibits auspicious signs to the people,” Zou Yan writes. “Following fire” — that is, the Zhōu dynasty — “there comes water. Heaven will show when the time will come for the qi of water to dominate. Then the color will have to be black; affairs will have to be placed under the sign of water” (quoted in Ho, 2000, p. 16).
This theory — that the Zhōu dynasty, for example, had a natural and inevitable propensity to replace the Shāng dynasty, just as fire overcomes metal — led Qín Shǐhuáng 秦始皇, the first emperor of the Qín, to define his dynasty as water, with its inevitable propensity to overcome fire. It also led to important debates in the succeeding Hàn 漢 dynasty as to whether it should be water, thus displacing Qín as the legitimate successor to Zhōu, or should be earth, thus naturally overcoming Qín (Wang, 2012, p. 39).
The Generation Cycle
The wŭxíng doctrine describes two primary cycles, a generation or creation shēng 生 cycle and an inhibition or overcoming kè 克 cycle. These cycles are also called, respectively, mutual generation xiāngshēng 相生 and mutual inhibition xiāngkè 相克.
The generation cycle is considered the mother-child cycle. A naturalistic description of the cycle is that water causes trees to grow, the wood feeds the fire, the fire leaves an earthen ash, the earth gives birth to metal ore, and metal becomes liquid when it melts (see Tierra, 1998, p. 30). So water generates wood, wood generates fire, fire generates earth, earth generates metal, and metal generates water. Water is the mother of wood; earth is the child of fire (Wang, 2012, p. 38).
The Inhibition Cycle
The inhibition cycle is considered the grandmother-grandchild cycle; in the traditional Chinese household, it was the grandparents who were responsible for the discipline and control of the grandchildren (Tierra, 1998, p. 30). Here water inhibits fire, fire inhibits metal, metal inhibits wood, wood inhibits earth, and earth inhibits water (Wang, 2012, p. 38).
The Huángdì nèijīng sùwèn 黃帝內經素問 gives a naturalistic rationale for the inhibiting cycle: “When wood meets metal it is felled; when fire meets water it is extinguished; when earth meets wood it is penetrated; when metal meets fire it is destroyed; when water meets earth it is interrupted in its flow. These transformations can be applied to the myriad things” (Ni, 1995, p. 101; Rochat, 2009, p. 85). In other words, a metal axe chops down a tree; water extinguishes a fire; tree roots penetrate the ground; fire melts metal; an earthen dam constrains the stream.
The Báihǔ tōng gives a more abstract rationale: “The mass overcomes the stray, so water overcomes fire. The fine overcomes the solid, so fire overcomes metal. The hard overcomes the soft, so metal overcomes wood. The compact overcomes the loose, so wood overcomes earth. The full overcomes the empty, so earth overcomes water” (quoted in Rochat, 2009, p. 72).
If we look just at the two cycles outlined above, it looks as though the relationships of generation and inhibition among the five xíng are all unidirectional: wood generates fire, but fire does not generate wood; earth inhibits water, but water does not inhibit earth. But, as Liu Yanchi (1988, pp. 53-56) points out, these two cycles operate simultaneously, and thus create a feedback mechanism.
These feedback loops help to maintain homeostasis. For example, fire is inhibited by water and generates earth; earth then inhibits water. This feedback loop prevents water from overly inhibiting fire. Similarly, fire is generated by wood and generates earth; earth can inhibit water, preventing water from overly generating wood. This feedback loop prevents wood from overly generating fire. Such loops are called mutual control xiāngzhì 相制 (Ho, 2000, p. 20; Wang, 2012, p. 38; Liu, 1988, pp. 53-56).
These loops can become complex. Here is one example: Metal inhibits wood but at the same time generates water; the water then generates more metal, preventing its overinhibition. Here is another: When exuberant fire overly inhibits metal, metal becomes too weak to inhibit wood. Wood then becomes exuberant and overly inhibits earth. Earth is then unable to inhibit water, so water becomes exuberant and brings fire back to normal. Such loops are called mutual transforming xiānghuà 相化 (Ho, 2000, p. 20; Wang, 2012, p. 38; Liu, 1988, pp. 53-56).
Disorders of inhibition
There are two ways that the inhibition cycle can go wrong. These are called, respectively, overinhibition guō kè 過克 or bullying chéng 乘, and counterinhibition fǎn kè 反克 or insult wŭ 侮 (Lo, 1986, p. 221; Zhu & Wang, 2010, pp. 34-35).
Overinhibition or bullying can occur — just as in a Chinese household — either because the grandmother is too strong or the grandchild is too weak. In the first case, for example, overly excessive water may overinhibit fire, resulting in fire insufficiency. This is called water overinhibits fire. In the second case, water may not be excessive but fire may be insufficient, so that water becomes relatively excessive, resulting in an even greater fire insufficiency. This is called water overinhibits fire when fire is deficient.
In counterinhibition or insult the grandchild is so strong that it inhibits the grandmother, as when a forest fire burns so fiercely that the water poured on it evaporates, or when a raging flood overwhelms and destroys an earthen dam. For example, wood should be inhibited by metal; but if wood is especially strong, it may not only fail to be inhibited by metal but may counterinhibit it. This is called wood counterinhibits metal. Or again: if metal is particularly weak, then not only may it fail to inhibit wood but may be counterinhibited by it. This is called metal counterinhibited by wood when metal is weak.
Both overinhibition and counterinhibition can occur at the same time. If wood is excessively strong it may both overinhibit earth and counterinhibit metal; if metal is excessively weak, it may be both counterinhibited by wood and overinhibited by fire (Zhu & Wang, 2010, pp. 34-35)
As outlined above, each of the five xíng is associated with two — or, in the case of fire, four — of the zàngfǔ 臟腑. Thus each of the zàngfǔ is in a dual relationship of generation and inhibition; it both has and is a mother and grandmother. For example, the kidney is correlated with water, and the liver is correlated with wood; because water generates wood, the kidney is the mother of the liver. Similarly, the heart is correlated with fire; because water inhibits fire, the kidney is the grandmother of the heart.
Wŭxíng theory can therefore contribute to medical diagnosis in two ways. First, an excess or deficiency of one of the xíng may produce observable behavioral effects. A person with excessive wood, for example, will have a shouting, angry tone of voice, while a person with deficient wood may appear timid and repressed. Such behavior points to an imbalance in the liver, the zàng associated with wood. In the same way, inappropriately happy or manic behavior points to excessive fire, while depression points to a fire deficiency — in either case indicating a possible disharmony in the heart, the zàng associated with fire (Tierra, 1998, p. 31).
Second, each of the five xíng is associated with a particular body type. People with a wood constitution, for example, have tall thin bodies, broad shoulders, and straight backs; they are hard workers, but with a tendency to worry and think too much; their voices are generally gentle and smooth. Therefore an urgent or hurried tone of voice in a patient with a wood constitution may be indicative of pathological changes in the phonic organs and, by extension, the liver (Qiao, 2008, pp. 25, 164).
Acupuncture and herbs
These associations also underlie several sorts of medical intervention. For example, if one of the zàngfǔ is deficient, it can be nourished indirectly by nourishing its mother. Here is an example. Zhao Jingyi and Li Xuemei (1998, pp. 203-210) describe the case of a 45-year-old woman who had been suffering for some time from depression, insomnia, and general body pain upon awakening. These symptoms could be mild or severe. Four days earlier the condition had become acute, and so she sought medical attention.
Her insomnia and dream-disturbed sleep indicated that the site of the disorder was the heart. But why was the heart disturbed? Her physical discomfort, tight muscles, and swelling and soreness indicated impaired circulation of qi and blood. Further inquiry revealed poor appetite, excessive saliva, tasteless sensation in the mouth, and soft and loose stools — all pointing to an impairment in the transformative and transportive functions of the spleen pí 脾.
Spleen-wood is the mother of heart-fire. It is the source of production for qi and blood, and functions to replenish and nourish the heart. So the underlying cause of the acute sleep-disturbance symptoms was in fact a spleen deficiency depriving the heart of its nourishment.
The treatment therefore focused first on tonifying and strengthening the spleen and nourishing the blood, and only then on nourishing the heart and calming the spirit. If the spleen deficiency could be improved, the source of production for the qi and blood would become richer. The qi and blood could then easily be replenished, and the heart would be nourished and become calm.
Qìgōng practices can be used in the same way — for example, the practice known as the six-syllable formula liùzì jué 六字訣 or the six-syllable method liùzì fǎ 六字法. Each of these six syllables is held to be able, under the right circumstances, to normalize the zàng or fǔ with which it is associated — nourish the liver, replenish the heart, moisten the lung, strengthen the spleen (Bi, Sun, Guo, Cao, Zhang, & Zhang, 1988, pp. 110-120). There are several different versions of these correlations and several different versions of just what each syllable does (see generally Despeux, 2006).
As we have seen, a deficiency in one of the xíng may result from overinhibition by an excessive grandmother. For example, a liver deficiency may be due to excessive lung metal overinhibiting liver wood; in this case, the lungs can be settled and moistened by uttering the syllable SI 呬. A heart deficiency may be due to excessive kidney water overinhibiting heart fire; in this case, the kidneys can be strengthened and made tranquil by uttering the syllable CHUI 吹. A kidney deficiency may be due to excessive spleen earth overinhibiting kidney water; in this case, the spleen can be cultivated and strengthened by uttering the syllable HU 呼.
It is also possible to use feedback loops. So, where a spleen earth deficiency is due to overinhibition by excessive liver wood, there are two therapeutic strategies. The liver can be leveled and nourished by uttering the syllable XU 噓. Or — especially if the direct strategy fails — the heart fire can be supplemented by uttering the syllable HE 呵, thus inhibiting the excessive liver wood. This is called releasing the child in an excessive syndrome (Liu, 2013, pp. 49, 181)
Each of the five xíng is associated with an emotion or state of mind. Fire is associated with happiness xĭ 禧, earth with thought sī 思, metal with sorrow bēi 悲, water with fear kŏng 恐, and wood with anger nù 怒 (Rossi, 2002, p. 30).
There are conditions of excessive emotion that may require medical intervention — depression, mania, panic, rage. One approach is medical. Each emotion is associated with a specific zàng. An excess of that emotion may injure the associated zàng or, conversely, may result from a disharmony of that zàng. For example, anger is associated with the liver; excess anger can injure the liver, or a liver disharmony may result in excess anger (Ross, 1985, p. 187). Thus a condition of excessive anger may be susceptible to treatment of the underlying liver disharmony.
Zhang Zihe 張子和 (1156-1228 CE) was a radical physician whose “attacking school” of medicine emphasized driving out toxins with diaphoretics, emetics, and purgatives. He saw in the inhibition cycle a psychotherapeutic tool that could be used to treat excessive emotions.
He wrote that the physician should treat anger with sorrow, moving the patient with sad and painful stories; treat depression with happiness, entertaining the patient with jokes and wisecracks; treat mania with fear, frightening the patient with talk of bad luck and death; treat thinking with anger, provoking the patient with insult and insolence; and treat fear with thinking, diverting the patient toward another subject (Xu, 2012, p. 319; Rossi, 2002, p. 31; Liu, 2013, p. 50).
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