Professor Wu Boping, head of the research library at the Beijing Academy of TCM discusses the engendering and restraining (sheng and ke) relationship among the five phases and gives his recommended herbal formulae in cases where 'disharmonious relationships' occur. He cites four case histories: dizziness, cough and dyspnoea, abdominal pain, and palpitations. Translated by Chao Baixiao.
The term, five phases (wu xing), was first recorded in an ancient Chinese work Shangshu - hong fang in which the natures of the five phases are interpreted in the following way: water moistens and descends, fire flames upward, wood bends and straightens, metal works towards transformation and earth sows and reaps, and the nature of moistening and descending is connected with saltiness, flaming upward with bitterness, bending and straightening with sourness, working towards transformation with acridity and sowing and reaping with sweetness. After that, the five phases were carefully discussed and frequently used in many ancient books such as the Bai Hu Tong and the Huainanzi. Five phase theory, therefore, became a fundamental aspect of traditional Chinese thought and culture. Traditional Chinese medicine, as an integral part of ancient Chinese culture, absorbed the five phases in the formation of its own theories and further enriched and developed it in the light of extensive clinical practice.
In Chinese medicine, five phase theory is widely applied to explaining the relationships between climate, geography, the constitution and emotions of a patient, disease factors, pathomechanisms, the nature of medicinal substances, and so on. In this paper we will discuss mainly the clinical application of the engendering and restraining (sheng and ke) relationship among the five phases. A good grasp of five phase theory is essential in order to develop and extend one's diagnostic and clinical skills as a concept of Chinese philosophy.
Engendering and restraining among the five phases is used in Chinese medicine on the basis of specific relationships between the zang fu and their anatomical and functional correspondences. Under normal circumstances each zang fu entertains a good relationship with other zang fu so as to maintain a dynamic equilibrium. This 'healthy' relationship is called the normal engendering and restraining between the zang fu If this harmonious engendering and restraining relationship breaks down, disharmonious relationships such as 'insufficient engendering', 'insufficient restraining' or 'over restraining and engendering' may emerge. In such situations five phase theory may usefully be adopted as the principal approach in differentiation and treatment. In the following we will provide detailed examples of the approach.
(1) If the child is vacuous (xu), supplement the mother This condition arises in the case of insufficient engendering; that is, the child's vacuity is caused by its mother's vacuity. For instance, long term vacuity or depletion of the kidney may cause vacuity of the liver. This is referred to as 'water failing to moisten wood,' and should be treated mainly by supplementing kidney-water. If, on the other hand, vacuity of the kidney is due to liver vacuity, this is called 'child stealing the mother's qi' and is treated by supplementing the liver and kidney simultaneously.
(2) In case of repletion (shi), drain the child This condition is caused by excessive strength of one organ which leads to a replete condition in its mother organ. For example, heart fire can lead to effulgent liver fire. In such a case it would be appropriate to use the method of clearing the liver by draining fire.
(3) Effulgence is treated by repressing This condition is usually caused by excessive restraining. For example, when liver-wood is exuberant it tends to restrain the spleen and stomach. This situation is called 'wood restraining earth.' It is treated by coursing the liver and harmonising the stomach. The opposite condition is the situation where the free coursing function of the liver is affected by effulgent earth, i.e. a spleen-stomach stagnation leading to abnormal up-bearing and down-bearing of liver qi. This situation is called 'overwhelming.' It is treated by moving the spleen and harmonising the stomach in order to regulate the liver qi.
(4) Hypofunction is treated by supporting This condition is usually caused by insufficient restraining. For instance, a hypofunction of liver-wood may affect the movement and transformation of spleen-stomach. This is called wood failing to restrain earth, and is treated by regulating and nourishing the liver, and possibly also supporting the spleen.
I will now present four typical cases listing which herbal treatment is carried out following the principles of five phase theory.
Case 1 Dizziness: water failing to engender wood Chi is a 61 year old man with a weak constitution. He complained that he had suffered from dizziness for about 2 years. This had been accompanied by tremor of his hands, as well as heat in the palms and soles of his feet. He also had tinnitus and deafness. His pulse was rapid, wiry and fine. This patient was diagnosed as 'water failing to moisten wood.' Depleted kidney-water was failing to enrich the liver-wood. This resulted in liver blood vacuity and internal wind, manifesting as dizziness. Accordingly it was treated with the method of enriching water and moistening wood. The basic prescription used was Zuo Gui Yin:
Radix Rehmanniae Glutinosae Conquitae (shu di huang) 10g Radix Rehmanniae Glutinosae (sheng di huang) 10g Radix Dioscoreae Oppositae (shan yao) 10g Fructus Evodiae Rutaecarpae (wu zhu yu) 10g Fructus Lycii Chinensis (gou qi zi) 10g no Latin name (hong li zi) 10g Radix Paeoniae Lactiflorae (bai shao) 10g Rhizoma Gastrodiae Elatae (tian ma) 6g Fructus Ligustri Lucidi (nu zhen zi) 10g Herba Ecliptae Prostratae (han lian cao) 6g
The patient's dizziness was greatly relieved after taking this medicine for 15 days.
Notes: In this case the mother-son relationship was indicated and it was treated mainly by enriching the yin and essence of the kidney, and at the same time supplementing the liver blood so that the liver wind was extinguished.
Case 2 Cough and Dyspnoea: earth failing to engender metal Mr Yu, male, aged 56 years. He had had weak digestion since his youth. Over the last 5 to 6 years he often felt tired, short of breath and had frequent coughing and dyspnoea with thin phlegm. He suffered from a feeling of stuffiness and fullness in the chest and abdomen. The pulse was weak at the cun position and floating at the guan position. The cough and dyspnea tended to be especially bad when he suffered from dyspepsia. This condition was diagnosed as 'earth failing to engender metal.' A weak spleen led to accumulation and stagnation of fluid return which, over time, transformed into phlegm, causing cough and dyspnea. It was treated with the method of 'banking earth and engendering metal.' Modified Shen Ling Bai Zhu Wan was used as follows:
The above herbs were mixed and ground into powder. The powder was filled into capsules of 0.3g each. The patient took 4 capsules 3 times daily, for about 60 days (1 course). After 2 courses of treatment the cough and dyspnea were greatly reduced. The patient became more energetic and put on 7.5 kilograms in weight.
The situation of earth failing to engender metal arose because the spleen-stomach was too weak to enrich the lung. Since the movement and transformation of the spleen was insufficient, phlegm-damp was brought about and then obstructed the lung, leading to cough and dyspnea. Spleen vacuity appeared first while the symptoms of the lung emerged later. If treatment was only given to the lung by supplementing lung qi it would cause a congestion of phlegm in the lung. This would manifest as distension and fullness in the chest. If we just dispelled the phlegm-damp, it might give rise to a depletion of centre qi and the root condition might be aggravated. Therefore, the root was treated by regulating the spleen-stomach with balanced but not over sweet and warm herbs. Simultaneously, some herbs were used to nourish the lung in order to transform the phlegm.
Case 3 Abdominal pain: wood overwhelming earth Wang, female, aged 36 years. This patient complained of depression and irascibility, headache and a sensation of pressure in the head, painful distension in the chest and lateral costal region, poor appetite, belching and acid regurgitation. Her pulse was rising, especially at the left guan position. At the right guan position, instead, it felt slightly deep and weak. The sides of her tongue were red, with a thin yellow fur. The condition was diagnosed as abdominal pain caused by wood overwhelming earth. Because the liver qi was exuberant it overwhelmed spleen-earth. The method of coursing the liver and harmonising the stomach was applied and a prescription composed on the basis of Tiao Qi Tang and Zuo Jin Wan.
Radix Bupleuri (chai hu) 5g Pericarpium Citri Reticulatae (chen pi) 6g Herba Agastaches Seu Pogostemi (huo xiang) 6g Fructus Citri Seu Ponciri (prepared zhi qiao) 10g Lignum Aquilariae (chen xiang) 2g (made into powder and taken with water or with the decoction) Fructus Evodiae Rutaecarpae (wu zhu yu) 2g Rhizoma Cyperi Rotundi (xiang fu) 10g Radix Scutellariae Baicalensis (huang qin) 6g Fructus Meliae Toosendan (chuan lian zi) 6g Pericarpium Citri Reticulatae Viride (qing pi) 6g Fructus Seu Semen Amomi (sha ren) 3g Rhizoma Corydalis Yanhusuo (yan hu suo) 10g Rhizoma Atractrylodis Macrocephalae (prepared bai zhu) 10g
After taking these herbs for 7 days, all the symptoms disappeared.
Note: In this case of wood overwhelming earth, exuberant liver qi impaired the harmonious down bearing function of the stomach. Therefore, the treatment was applied to regulating and down-bearing the hyperactive liver qi, combined with herbs for harmonising the stomach and rectifying qi.
Case 4 Palpitations: water overwhelming fire Yan, female, aged 54 years. This patient had suffered from swelling of the eyes, face and lower limbs, and from aching, heaviness and lack of strength in the lower back. Since her recent menopause she easily felt flustered, had palpitations and became easily frightened. She often imagined that someone might come to attack her. She became so vexed and restless that she could not sit still reading or watching TV. She also started to suffer from nocturia. The pulse was weak at the two guan positions but skipping at the two cun positions. The tongue was pale, moist and enlarged. This condition was diagnosed as water overwhelming fire, or 'water qi intimidating the heart'. Exuberant kidney-water formed due to vacuity of kidney yang. This is also called debilitation of the ming men fire, failing to restrict water. In the treatment, therefore, the method of warming the kidney and disinhibiting water, strengthening the heart and boosting fire was adopted. Modified Zhen Wu Tang, Gui Zhi Jia Gui Tang and Ling Gui Zhu Gan Tang were prescribed as follows:
Radix Aconiti Carmichaeli Praeparata (prepared fu zi) 5g Ramulus Cinnamomi Cassiae (gui zhi) 6g Radix Glycyrrhizae Uralensis (prepared gan cao) 6g Fructus Schisandrae Chinensis (wu wei zi) 5g White Radix Ginseng (bai shen) 6g Rhizoma Atractylodis Macrocephalae (prepared bai zhu) 10g Radix Paeoniae Lactiflorae (prepared bai shao) 10g Herba Epimedii (xian ling pi) 6g Radix Stephaniae Tetrandrae (fang ji) 10g Sclerotium Poriae Cocos (fu ling) 10g Radix Morindae Officinalis (ba ji tian) 6g Herba Asari Cum Radice (xi xin) 2g
After taking the herbs for 7 days, the swelling of the eyes, face and lower limbs disappeared and the palpitation was ameliorated. Nocturia became less frequent, so that the patient managed to sleep more calmly. She gradually became energetic, her behaviour returning to normal. One month later, the patient had recovered completely.
Note: In this case, the patient was an elderly woman whose kidney yang was insufficient. This led to water damp stagnation and invasion of heart-fire. The yang of both heart and kidney became obstructed by the yin water pathogen. In the light of five phase theory, the method of warming kidney-water and boosting heart-fire was adopted.
The cases presented above are merely intended as examples of the clinical application of engendering and restraining five phase theory. The examples selected are of quite simple conditions and do not exhaust the clinical applicability of this method of diagnosis and treatment. Furthermore, in this paper we just selected the examples of 'disease in the mother affecting the child' and of 'overwhelming.' The examples of 'child stealing the mother's qi ' and of 'rebellion' were not used.
It is thus clear that the engendering and restraining of the five phases is a very useful theory in the clinical application of Chinese medicine. However, one must remember that five phase theory may not be used indiscriminately. There are not always engendering-restraining relationships when two or more zang fu have some symptoms at the same time, in which case five phase theory should be used very carefully so as not to affect the scientific features of Chinese medicine.
This paper came from several decades of my own clinical experience. If there are some mistakes in it, I sincerely hope they will be pointed out and will be discussed.
Wu Boping Wu Boping was born in 1935 in Shanghai. He graduated from the first class of the Beijing College of TCM and later worked in Urumqi, Hangzhou and Beijing. He is Professor at the Beijing Academy of TCM, where he was head of the research library. From 1988-90 he carried out field research on the treatment of AIDS in Tanzania and is now one of the leading experts in the treatment of AIDS by TCM. Professor Wu is well known in the UK from a number of seminars and lectures he presented in 1994-5.
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