While historically the concepts of Yin-Yang and 5 phases come first, the model of the Six Qi represents the first fully detailed Chinese medical theory. Zhang Zhongjing details this system in the 3rd century A.C.E. text Shanghan lun, or Treatise on Cold Damage. This is not the first Chinese medical text, but it is the first to fully elaborate a method of diagnosis and treatment based on a theoretical system, in this case the Six Qi. Before there was TCM (Traditional Chinese Medicine), before there was Liver stagnation or Spleen deficiency, before there was wind cold invasion, there was the Six Qi. The system lays the foundation for what is referred to today as Classical Chinese Medicine. Classical Chinese Medicine is focused on the philosophy, diagnostic methods, and acupuncture and herbal treatments that are rooted in the ancient, classic texts of Chinese medicine. I have found this approach to be clinically diverse and effective, and it forms the basis of my own practice.
The system of the Six Qi is beautifully complex and can be discussed in many ways. Most obvious is its representation of the Six pernicious influences or climates – wind, heat, fire, damp, dry and cold. It also represents energetic layers of the body, described from most superficial to most deep (in this context it is often referred to as the Six Confirmations). These are Taiyang, Shaoyang, Yangming, Taiyin, Shaoyin, Jueyin.
Combining these, the Six Qi system reflects the effect upon the body of the penetration of external climate as it moves into deeper layers of the body. These layers are associated with acupuncture channels. It also represents the body’s response to the penetration of external climate. Finally, and perhaps most importantly, the system is a model for describing the location and movement of the body’s Yang Qi, or life force.
The Three outer layers reflect the opening movement of Yang Qi, broken down into the opening, closing and hinge movements. Likewise, the Three inner layers reflect the closing movement of Yang Qi, again described as opening, closing and hinge movements. Think of opening a door. There is an opening movement, a counterbalancing closing movement so it does not go too far, and a hinge around which these revolve. Likewise, there is a closing of the door, a counterbalancing opening movement, and the hinge.
The primary concern of Chinese medicine is to observe the movement of Yang Qi in the body, and to correct any imbalances in the same. This model describes an intricate and intimate relationship between the Qi in our bodies and the Qi of the climate around us. These are in fact one and the same. Shanghan, or cold damage, does not refer only to cold as in cold weather. It also suggests any damaging influence upon the body. The system is therefore not limited to illness from cold weather, but also from any climate or chronic condition which lingers and produces damage.
Six Qi in Clinical Practice: Shaoyang
Shaoyang, or lesser Yang, is the hinge for the opening movement of the Yang Qi. Taiyang opens, Yangming closes, and Shaoyang is the hinge around which this movement occurs. It reflects a neither fully external nor fully internal state, but rather one which is both external and internal, or half-external and half-internal. It resonates with ministerial fire in the body, the climate of fire or summer heat, the channels of the Gall Bladder and Triple Heater, and the lateral (side) aspect of the body.
Fire in the body when stored in the Kidneys is referred to as imperial fire, and belongs to Shaoyin. When it circulates through the body, via the Triple Heater, it is called ministerial fire and belongs to Shaoyang. Shaoyang symptoms reflect alternation, movement between an external and an internal state. Alternating hot and cold, and changing symptoms characterize Shaoyang disease. The basic prescription for Shaoyang disease is xiao chai hu tang, or minor bupleurum decoction. Most of my patients have taken this in some form at some point, and it is arguably the single most commonly prescribed herbal formula in the world. It is the basis for Cold Quell, Forsythia 18, Ease Pearls, and the Chinese patent remedy of the same name.
Ministerial fire out of balance reflects Yang Qi that is not rooted in the Kidneys. The opening and closing function of the body is damaged, as the hinge is not performing properly. When unable to open, this can lead to a propensity for accumulation of fire and dryness that deplete the Yang Qi when the climate is dry or hot. This can also occur when the body is internally overheated or dry due to physical overexertion, dehydration, excessive sweating, over-consumption of bitter and acrid foods, regular use of stimulants such as caffeine, and excessive sexual activity.
What Is the Opening and Closing Function of the Body?
What does it mean to open and to close? Life is characterized by movement, that movement is always cyclical, and it is the Yang Qi itself which is moving. Everything opens and closes. The sun rises and sets, the moon waxes and wanes, the eyes open and close. These are all the expression of the Yang Qi opening and rising, and then closing and sinking.
Chinese medicine is focused on understanding the method of disease, and applying treatment to address this. Rather than simply observing that a person has a cold, or neck pain, or constipation, or any other illness, Chinese medicine is concerned with what this implies in terms of external climatic factors, the energetic layers of the body, the organs and acupuncture channels, and the movement of Yang Qi. Opening and closing is one way to describe this. As a simple example, if a person has the flu and experiences chills and fever but no sweat, this can indicate that the Taiyang layer is closed due to the presence of external cold. For the practitioner, this indicates the need to apply acupuncture and herbal treatment to “open” or “resolve the exterior”. This results in a very different treatment than assuming the person has a virus and administering a non-specific treatment that may make the condition worse. Similarly, it allows the patient to understand that taking a warm bath, getting wrapped with blankets and breaking a sweat may help them to feel better quickly. The questions that people often have about whether to eat or not, whether to drink or not, whether to sweat or not, whether to apply hot or cold, can all be answered using the method of The Six Qi and understanding the opening and closing functions of the body.