《What Did the Ancient ChinesePhysicians Actually See?》Volume II BK22

Why did qi become “energy” in Western translation? What do yin and yang actually describe? Were Wood, Fire, Earth, Metal and Water really five elements? Volume II examines qi, yin-yang, the Five Phases and the relationship between humans and nature, asking where ancient observations meet modern science—and where important questions remain open.

BK22

What Did the Ancient ChinesePhysicians Actually See?

Volume II

AI Narration Edition

Fang Tianliang

 

 

Chapter Ten: How Was “Qi” Translated Into “Energy”?

—A French diplomat's translation choice, and how it shaped a century of Western understanding of “qi”

The previous chapter left us with a question: the ancients said “the qi has arrived” — so what, exactly, did they mean by “qi”?

This chapter is not yet in a hurry to answer that. First, a more basic question: when we say “qi,” are we even talking about one single thing?

1. A Translation Choice: Why Did Qi Become “Énergie”?

In 1901, a 22-year-old Frenchman named Georges Soulié de Morant arrived in China. Over the following eight years, he served in French consular posts as a diplomat and translator, with postings that took him to Shanghai, Kunming, and elsewhere. According to his own later recollection, during a cholera outbreak in Beijing he saw Chinese physicians treating patients with acupuncture, and this sparked his interest in the medicine. This story later became part of his personal legend; some details remain disputed today, so this book presents it as his own account, not as unqualified historical fact. Back in France, he threw himself into translation work, drawing on Ming-dynasty texts such as the Compendium of Acupuncture and Moxibustion, and steadily published articles and monographs. Between 1939 and 1941 his major work, L'Acuponcture Chinoise, appeared in two volumes, with a third completed just before his death. This book later came to be recognized as a foundational text in the Western history of acupuncture. In 1950, Professor E. Mériel of the University of Toulouse nominated him for the Nobel Prize in Physiology or Medicine, citing his “work on acupuncture” — this nomination can still be found today in the official Nobel archives. The following year, his qualifications to practice acupuncture were publicly challenged by peers, and he was accused of practicing medicine illegally. These two events occurring together say a great deal about his position in the French medical world of the time: substantial, and deeply contested.

In translating these texts, Soulié de Morant needed French equivalents for two core concepts. “Jingluo” (meridians) he rendered as méridien — meridian, line of longitude — a term that later entered English as “meridian” and remains, to this day, on the lips of acupuncturists worldwide. “Qi” he rendered as énergie — energy. Later histories of acupuncture and translation studies often describe this choice as an expedient translation made “for lack of a better word.” Whether this phrase can ultimately be traced to his own words remains uncertain, but one thing is clear: he systematically used énergie to express “qi” and méridien to describe the meridian system throughout his acupuncture writings — the two terms together formed the skeleton of his “energy theory,” and the first volume of his book was simply titled L'Energie (“Energy”).

The influence of this translation choice can hardly be overstated. Today, in both Chinese and English contexts, equating “qi” with some kind of “life energy” has become almost common sense. But this was, at first, simply one man's expedient solution, made a hundred years ago in the absence of a better option — later taken by a great many readers as an established, certain correspondence.

Two further details are worth adding, so this history is not told as a simple black-and-white story. First, Soulié de Morant actually revised part of his own view later in life, acknowledging that the vascular system itself carries “blood” and some life-sustaining substance to the whole body, without needing to assume a separate channel system, outside the blood vessels, dedicated to transporting “energy.” This revision has rarely been mentioned since. Second, some researchers have also questioned certain details of his early self-reported experiences and titles, suggesting some may have been exaggerated. This book draws no conclusion here — the episode itself can serve as a reminder: the reliability of a far-reaching translation choice is not necessarily proportional to how often it has been cited.

 

2. Back to the Original Texts: In Early Chinese Medical Contexts, “Qi” Never Meant Just One Thing

If “qi” is taken directly as a single thing that can be called “energy,” and one then returns to early Chinese medical texts, it becomes clear that the original texts were never arranged this way at all.

A passage in the “Evil Guests” chapter of the Lingshu places three kinds of “qi” side by side at once:

“When the five grains enter the stomach, their dregs, fluids, and ancestral qi divide into three channels: the ancestral qi gathers in the chest, emerges through the throat, threads through the heart vessel, and is bound up with the movement of breath; the nutritive qi secretes the essence of the fluids, pours into the vessels, transforms into blood, nourishing the four limbs, entering internally into the five viscera and six bowels, moving in accordance with a fixed timing; the defensive qi, being the fierce and swift portion of this qi, travels first among the four limbs, the flesh, and the skin, without ever resting.”

In plain language: once food enters the stomach, it divides into three streams — the dregs, the fluids, and the ancestral qi. The ancestral qi gathers in the chest, rises up through the throat, threads through the vessel of the heart, and is bound up with the movement of breathing. The nutritive qi is the portion secreted from the essence of the bodily fluids; it pours into the vessels, transforms into blood, nourishing the limbs outward and entering the five viscera and six bowels inward, moving according to a fixed rhythm in time. The defensive qi is described as the fiercer, more mobile portion of this qi, traveling among the four limbs, the flesh, and the skin, never resting.

Looking at this through modern eyes, a reader will naturally think of respiratory-circulatory function, nutrient transport and blood formation, and surface defense, respectively. This association is not unreasonable, and later chapters will follow this very thread in questioning modern instruments. But it must be said clearly here first: these are only possible correspondences that modern readers form for themselves after reading the classical text — one cannot turn this around and say the ancients were, at the time, already describing a modern respiratory-circulatory system, a metabolic system, or an immune system. The original text says only that ancestral qi “threads the heart vessel and moves with breathing,” that nutritive qi “transforms into blood, nourishes the four limbs, and enters the organs,” and that defensive qi “travels among the limbs, flesh, and skin” — these describe each one's pathway and rough function; they are not an instruction manual for some modern anatomical system.

In this passage, ancestral qi, nutritive qi, and defensive qi share a common source — all arising from the pure qi of food and breath — yet their pathways and functions differ, and the ancients never confused the three.

The “Eighth Difficulty” chapter of the Nanjing proposes a fourth kind: the “moving qi between the kidneys,” later often called “primordial qi” or “original qi”:

“All twelve meridians are tied to the source of life-generating qi. What is called the source of life-generating qi is the root of the twelve meridians — it is the moving qi between the kidneys. This is the foundation of the five viscera and six bowels, the root of the twelve meridians, the gate through which breathing passes, and the origin of the Triple Burner... Hence qi is the very root of a person; when the root is severed, the branches and leaves wither.”

In plain language: the twelve meridians are all connected to a single common root — the “source of life-generating qi,” namely the pulsing qi between the two kidneys. This is the foundation of the five viscera and six bowels, the root of the twelve meridians, the gate through which breathing passes, and the origin from which the Triple Burner operates... Qi is the very root of a person; once the root is cut, the branches and leaves wither as well.

Primordial qi operates on a different level entirely: not any single breath or any single delivery of nourishment, but the innate, foundational capital with which a person is born, sustaining the functioning of all the organs throughout life. In addition, early Chinese medical texts often speak separately of “lung qi,” “kidney qi,” and “spleen qi” — the functional state of a particular organ, also called “qi,” yet each managing its own separate affair, not to be confused with ancestral, nutritive, defensive, or primordial qi.

Taken together, these passages allow us to confirm at least one thing: “qi” is not a narrow word pointing to a single object. Within medical texts, depending on the qualifying term placed before it, it enters entirely different networks of relationships — ancestral qi, nutritive qi, defensive qi, and primordial qi each have their own origin, movement, and function; and there are also organ-specific states such as lung qi, kidney qi, and spleen qi, likewise called “qi,” yet each managing its own separate business. Set against the larger context of Chinese thought, the uses of “qi” extend far beyond the human body: the weather (*tianqi*), the qi of the earth, the qi of the four seasons, the six climatic qi, upright qi, and pathogenic qi all refer to completely different things. The question, then, may never have been “which single substance is qi,” but rather: what, exactly, are the ancients talking about in this particular sentence, with this particular use of the word “qi”?

 

3. What Happens If All These “Qi” Are Stuffed Into the Same English Word?

The English word “energy” has two faces. In everyday language, a person can say “I have no energy today,” simply meaning they feel run-down or lack strength. But once it enters modern physics, “energy” becomes a strictly defined physical quantity, measurable and interconvertible, with the unit of the joule — whether thermal, kinetic, or chemical energy, all of it can be converted onto the same scale for comparison.

This is exactly where the problem lies. Once “qi” had been translated as “energy” for a long time, readers could easily slide, without noticing, from the first sense to the second: if qi is “energy,” shouldn't it exist the way thermal or electrical energy does? Can it be measured? What is its unit? Does it flow along a “meridian”? A single translated word quietly added a question to the original text that the original text never necessarily raised.

“Qi” was never constructed the way physical “energy” was. Ancestral qi, nutritive qi, defensive qi, and primordial qi are the result of the ancients naming and classifying, separately, different phenomena they observed over long periods — breathing, the pulse, nutrition, surface defense, and organ function. There is no single, shared unit of measure among them that could allow conversion from one into another. Collapsing them all into the same word — whether the everyday sense of “energy” or its physics sense — is like translating the Chinese verbs for “run,” “walk,” “crawl,” and “swim” all into the single English word “move”: the sentence can still technically be read, but every distinction the original text took care to preserve has been flattened out entirely.

This does not mean “qi” cannot engage with modern physiology at all, nor that it is merely an abstract vocabulary the ancients used to describe physiological function. Within traditional medicine, and within the cultivation traditions adjacent to it, qi is often described as something capable of moving, gathering and dispersing, rising and falling, entering and exiting — something that can be perceived as a genuinely real presence, not merely a classificatory label. Exactly what material basis it might have, and whether it includes some layer that current instruments simply cannot yet measure directly, is another, much larger question — this book will not, at this point, prematurely rewrite the answer on the ancients' behalf as “energy,” nor prematurely rewrite it as “physiological function” or some specific modern indicator. What can be done for now is to break the question apart: what phenomena associated with ancestral qi can modern instruments detect? What about nutritive qi, defensive qi, and primordial qi, respectively?

So, from this chapter onward, this book will no longer translate “qi” wholesale as “energy,” nor will it make blanket substitutions such as “qi is ATP” or “qi is nerve electrical activity” — that would be doing exactly the same thing, quietly writing the ancients' answer for them using a different modern word. Every time the word “qi” appears, the first question will be: which one is this — ancestral, nutritive, defensive, primordial qi, or the qi of some particular organ?

 

4. What This Chapter Can Actually Confirm

First, the translation of “qi” into the English word “energy” can be traced to a specific historical thread: the Frenchman Georges Soulié de Morant, translating Chinese acupuncture texts in the 1930s and 1940s, systematically used énergie to express “qi” and méridien to express the meridian system. Later research has often described the choice of énergie as an expedient made “for lack of a better word”; this chapter cannot confirm with certainty whether that phrase traces directly back to his own words, but he did indeed build an “energy theory” on this foundation, and the two translated terms together became the default framework of Western acupuncture discourse.

Second, Soulié de Morant's experiences in China come mainly from his own account and the biographical tradition that followed, some details of which remain disputed today; this chapter presents them as his own account, not as unqualified historical fact. What can be confirmed is this: in 1950, Professor Mériel of the University of Toulouse nominated him for the Nobel Prize in Physiology or Medicine, citing his “work on acupuncture” — a nomination still on record in the official Nobel archives; and in 1951, his qualifications to practice acupuncture were publicly challenged by his peers. This book records both facts honestly, and does not avoid questioning the reliability of the historical record concerning him simply because his translation has had such far-reaching influence.

Third, the “Evil Guests” chapter of the Lingshu, within a single passage, describes ancestral qi (driving respiration, threading the heart vessel), nutritive qi (distributing nourishment, participating in blood formation), and defensive qi (defending the body's surface, following a daily rhythm) as three separate things with different functions. The “Eighth Difficulty” chapter of the Nanjing separately proposes primordial qi (the moving qi between the kidneys) as the root of the twelve meridians and the five viscera and six bowels. These texts themselves never treated “qi” as a single substance.

Fourth, “qi” is not a narrow word pointing to a single object: within medical texts, ancestral qi, nutritive qi, defensive qi, primordial qi, and the organ-specific forms of qi each have their own origin and function; set against the larger context of Chinese thought, the weather, the qi of the earth, the qi of the four seasons, upright qi, and pathogenic qi refer to entirely different things again. The English word “energy” itself has two faces — an everyday sense (spirit, vigor) and a physics sense (a strictly measurable, interconvertible physical quantity) — and once “qi” had been translated as “energy” for a long time, readers could easily slide, without noticing, from the first sense into the second, asking a question of the original text it never necessarily raised: whether qi ought to be measurable and interconvertible the way thermal or electrical energy is. Replacing several functionally distinct kinds of “qi” uniformly with the same modern term — whether “energy” or some specific physiological indicator — erases the distinctions the original text took care to preserve. The conversation should proceed layer by layer: first ask what ancestral qi corresponds to, then nutritive qi, then defensive qi, then primordial qi — rather than asking, all at once, “what is qi.”

The gaps that must be left standing are equally clear. Which details of Soulié de Morant's early experiences are solid and which may be exaggerated is now very difficult to verify item by item, and this chapter draws no conclusion on any specific allegation. Whether ancestral qi, nutritive qi, defensive qi, and primordial qi can each find a correspondence in modern physiology is likewise a question this chapter does not answer; nor does this chapter conclude whether they include some layer that current instruments cannot yet directly measure — these are questions the next chapter must address directly.

A man, in order to let foreign readers understand an unfamiliar medicine, chose a translation later repeatedly described as one made “for lack of a better word” — and that choice, over a hundred years, became common knowledge the world over.

Yet the original text the ancients themselves wrote down never, from the very start, treated these several kinds of “qi” as one and the same thing.

Sometimes, we believe we are studying an ancient concept, when in fact what we are studying is the English word a translator chose for that concept a hundred years ago.

The next question must separate these several kinds of “qi” and ask about them one at a time:

Blood, we are already able to measure. So what phenomena, respectively, do ancestral qi, nutritive qi, defensive qi, and primordial qi describe? Which of them can modern instruments detect, and which still cannot be matched to anything at all?

 

 

Chapter Eleven: Once “Qi” Is Taken Apart, What Have Modern Instruments Actually Detected?

—Starting from an unexpected discovery about “kidney-yang deficiency syndrome”: why would a cluster of ancient symptoms correspond to an entire endocrine axis?

The previous chapter left us with this: blood, we are already able to measure. So what phenomena, respectively, do ancestral qi, nutritive qi, defensive qi, and primordial qi describe? Which of them can modern instruments detect, and which still cannot be matched to anything at all?

This chapter begins with a true story from research, because it demonstrates something important: how to ask this question in a way that does not go wrong from the very start.

 

1. Diagnose First, Test Later: How the Material Basis of a “Pattern” Was Found

In the 1950s, Shen Zi-yin, a physician of Chinese medicine at Huashan Hospital, affiliated with Shanghai Medical College, saw a group of patients diagnosed, by traditional pattern-differentiation criteria, with “kidney-yang deficiency” — soreness and weakness in the lower back and knees, aversion to cold with cold limbs, and low spirits. This is a long-established cluster of symptoms within Chinese medicine, quite distinct from the Western-medicine “kidney” as a urinary organ. Shen Zi-yin wanted to know: behind this cluster of symptoms, was there some shared, underlying change that could be measured by modern means?

Rather than first guessing which modern indicator “kidney-yang deficiency” might equal, he did the reverse: he first grouped patients according to the traditional diagnostic criteria, and only then ran the various tests available at the time, to see which indicators consistently deviated from normal within the kidney-yang-deficiency group. He found that this group of patients had generally low levels of urinary 17-hydroxycorticosteroids — an indicator reflecting adrenal cortex function — and that this indicator could be restored after treatment with warming, yang-tonifying Chinese herbal medicine. This result was later independently reproduced in hospitals across seven Chinese provinces and cities, as well as in Japan, with consistent conclusions.

Shen Zi-yin did not stop there. He pressed further: was this reduced adrenal cortex function a problem of the adrenal gland itself, or was it governed by the pituitary gland and hypothalamus at a higher level? Through a full battery of neuroendocrine measurements across three groups — healthy controls, kidney-yang-deficient patients, and kidney-yin-deficient patients — he found that kidney-yang-deficient patients showed dysfunction at various points along the hypothalamic-pituitary-adrenal-cortical axis; subsequent research further found similar patterns of dysfunction in the thyroid axis and the gonadal axis. Taken together, he concluded that the principal locus of kidney-yang-deficiency syndrome likely lay at the level of the hypothalamus.

The significance of this story for this chapter lies not in the specific conclusion that “kidney-yang deficiency equals hypothalamic dysfunction” itself, but in the fact that it got something right methodologically: rather than first guessing what modern name “qi” or a given “pattern” ought to correspond to, he first fixed the traditional diagnostic criteria, and then let the data speak for itself. It also reminds us that the correspondence found is quite likely not one-to-one — not “kidney-yang deficiency equals a single indicator,” but a whole cluster of indicators, a pattern of dysfunction spanning multiple levels, that together correspond to a single traditional syndrome.

Carrying this method forward, this chapter will place ancestral qi, nutritive qi, defensive qi, and primordial qi, one by one, before modern instruments.

 

2. Write Down the Ancients' Predictions First, Then Turn On the Instruments

Chapter Ten already quoted the original texts; here, let us extract and rewrite the portion of each “qi” that can serve as a “prediction.”

Ancestral qi: the “Evil Guests” chapter of the Lingshu says it “gathers in the chest, emerges through the throat, threads the heart vessel, and moves with breathing.” From this sentence we can read a specific prediction: the strength of ancestral qi should change in step with the state of breathing and heartbeat.

Nutritive qi: the same passage says it “secretes the essence of the fluids, pours into the vessels, transforms into blood, nourishes the four limbs, enters the five viscera and six bowels, and moves in accordance with a fixed timing.” The prediction is: nutritive qi is related to the distribution of bodily fluids and the formation and circulation of blood, and follows some kind of rhythm in time.

Defensive qi: “being the fierce and swift portion of this qi, it travels first among the four limbs, the flesh, and the skin, without ever resting”; the “Construction and Defense” chapter of the Lingshu adds that it “travels through yin for twenty-five circuits and through yang for twenty-five circuits, dividing into day and night.” The prediction is: defensive qi is related to surface defense, and follows a clear day-night rhythm — traveling through the yang portion by day, shifting into the yin portion at night.

Primordial qi: the “Eighth Difficulty” chapter of the Nanjing calls it “the root of the twelve meridians,” “the foundation of the five viscera and six bowels,” and “the gate through which breathing passes,” and states, “qi is the very root of a person; when the root is severed, the branches and leaves wither.” The prediction is: this is a deeper, more global functional reserve; once it fails, the consequences should ripple through multiple systems throughout the body, rather than being confined to any single local function.

These four predictions are written out here in order to fix, before turning on any modern instrument, what the ancients thought ought to be observed — so as not to go looking for an explanation only after the data has already come in.

 

3. Turning On the Instruments: Four Lines, Four Different Degrees of Correspondence

Ancestral qi — degree of correspondence: direct, but only at the level of description. The prediction for ancestral qi points directly to breathing and heartbeat, and modern instruments for measuring these two things are extremely well developed: blood-oxygen saturation, respiratory rate, heart rate, and cardiac output are all routine clinical indicators. The correspondence here is quite direct — direct almost to the point of requiring no further validation: what the ancients described as “threading the heart vessel and moving with breathing” was, from the start, simply describing the two visible, palpable facts of breathing and heartbeat. But precisely because it is so direct, what this level of correspondence confirms is only the portion of the concept of “ancestral qi” closest to its literal wording — one cannot turn this around and say that the full meaning of the three characters “ancestral qi” has been exhausted by a few modern terms like “cardiorespiratory function.”

Primordial qi — degree of correspondence: one-to-many, with cross-institutional, reproduced evidence. The story in the previous section is already the most solid example along the line of primordial qi (or, more precisely, “kidney qi,” which is closely related to it). What it corresponds to is not a single indicator, but the hypothalamic-pituitary-adrenal-cortical axis, along with the thyroid and gonadal axes discovered later — a cluster of interconnected neuroendocrine dysfunctions distributed across multiple levels. This matches the prediction that primordial qi is “the foundation of the five viscera and six bowels”: when it fails, the consequences genuinely do ripple across the whole body and multiple systems, rather than showing up as a single isolated lab value.

Nutritive qi — degree of correspondence: weak evidence, less systematic research than the previous two. Nutritive qi is related to the distribution of nourishment and the formation of blood, yet this line is, in modern research, actually less well-characterized than ancestral or primordial qi. Indicators such as blood composition, digestive and absorptive function, and hemoglobin levels do touch on the literal description of “nutritive qi,” but there are currently few studies designed with the same rigor as Shen Zi-yin's work on kidney-yang deficiency, directly testing whether the concept of “nutritive qi” itself corresponds to a stable set of blood or metabolic indicators. Let us note this honestly here: the evidence is insufficient — not because there is no relationship, but because no one has yet carried out a sufficiently rigorous test.

Defensive qi — degree of correspondence: a clear prediction, but lacking dedicated testing. The statement that defensive qi “travels twenty-five circuits by day and twenty-five by night” translates, into modern language, into a specific prediction about circadian rhythm. Modern medicine does indeed have a great deal of research on the daily fluctuations of cortisol, melatonin, and immune-cell counts — these fluctuations are themselves well-established scientific facts. But there is, as yet, no dedicated study directly comparing the specific rhythmic pattern described by defensive-qi theory — “traveling through yang, then through yin” — against the actual measured rhythms of cortisol or immune cells, to test whether their phases align. This is not “a mismatch” — it is “a testable prediction that no one has yet seriously tested.”

 

4. Placing the Four Lines Side by Side

The four kinds of “qi” correspond to four entirely different situations: ancestral qi is a direct but surface-level overlap; primordial qi is an indirect, one-to-many relationship with cross-institutional, reproduced evidence; nutritive qi has weak evidence and awaits dedicated study; defensive qi has a clear prediction, yet no one has performed the test.

These four different situations are, in themselves, the most important finding of this chapter. If “qi” is treated as a single whole from the outset, and the question asked is simply “what modern indicator does qi correspond to,” the only possible answer is a vague one — either everything or nothing. Only once it is broken apart into these four lines does it become clear: in some places, ancient and modern observation genuinely point to the same thing; in others, only the surface wording resembles something, while the substance remains unexamined; and in yet others, the ancients left behind a very specific, in-principle testable prediction — a piece of testing work that, to this day, no one has actually carried out.

This also answers the reminder from Chapter Ten: do not quietly replace one old word with a new one. This chapter has not said “qi is the endocrine axis,” nor “qi is the circadian rhythm” — it has instead laid out four kinds of qi separately, each reporting its own state of evidence.

 

5. What This Chapter Can Actually Confirm

First, Shen Zi-yin's research on “kidney-yang-deficiency syndrome” adopted the method of “diagnose and group by traditional criteria first, then run modern tests,” and found that kidney-yang-deficient patients had low urinary 17-hydroxycorticosteroids, a result repeatedly reproduced across seven provinces and cities in China and in Japan; subsequent research further found dysfunction across the hypothalamic-pituitary-adrenal-cortical axis, as well as the thyroid and gonadal axes, concluding that the principal locus lay at the hypothalamus. What this research got right, methodologically, was not presupposing the correspondence, but letting the data present itself under a fixed diagnostic grouping.

Second, breaking apart the classical descriptions of ancestral, nutritive, defensive, and primordial qi into four separately testable predictions — ancestral qi corresponding to respiration and heartbeat, nutritive qi to nourishment and blood formation, defensive qi to circadian rhythm and surface defense, primordial qi to fundamental, whole-body function — is what makes a meaningful, item-by-item check possible, rather than vaguely asking “what does qi correspond to.”

Third, the four lines currently stand at very different states of evidence: the overlap between ancestral qi and cardiorespiratory indicators is direct but shallow; primordial qi (and the closely related kidney qi), in the research on kidney-yang-deficiency syndrome, has multi-system evidence reproduced across institutions; nutritive qi currently lacks rigorously designed dedicated research; defensive qi has a clear, specific, testable prediction about circadian rhythm, but to date no dedicated experiment has directly compared this prediction against modern rhythm data.

Fourth, these four different states of evidence cannot be compressed into a single line declaring either “qi has been scientifically proven” or “qi has no scientific basis whatsoever.” The honest statement is: some parts correspond clearly, some parts show a correspondence that only touches the surface, some parts lack sufficient evidence, and some parts remain untested blanks.

The gaps that must be left standing are equally clear. What this chapter offers regarding the correspondence between ancestral, nutritive, defensive, and primordial qi and modern indicators is the degree currently supported by the evidence, not a final conclusion; the lines of nutritive qi and defensive qi in particular need dedicated future research to fill the gaps. The conclusions from the kidney-yang-deficiency research are also limited to the patients captured by that particular set of traditional diagnostic criteria, and cannot be generalized into a complete answer for the larger concept of “primordial qi.”

Shen Zi-yin's story shows that, with the right method, a cluster of symptoms described two thousand years ago can correspond to an entire modern endocrine axis.

The four different situations of ancestral, nutritive, defensive, and primordial qi show that, beneath the single word “qi,” lie four answers at entirely different stages of progress.

The next question must move forward, leaving qi and blood behind, and enter another pair of terms even more prone to misunderstanding —

Are yin and yang a philosophy, or a set of testable regularities governing the human body?

 

 

Chapter Twelve: The Body Between Day and Night

—Why a man who shut himself in a cave for sixty-three days ended up speaking for “yin and yang”

The previous chapter left us with this question: are yin and yang a philosophy, or a set of testable regularities governing the human body?

This chapter will not yet discuss the taiji diagram, nor the history of philosophy. First, a story about a man and a cave.

 

1. The Man Who Shut Himself in a Cave

On July 16, 1962, the 23-year-old French speleologist Michel Siffre, carrying simple equipment, entered the Scarasson glacier cave in the Ligurian Alps, on the border between Italy and France. He intended to live inside for two months, with no clock, no calendar, and no sight of the sun. Between him and the team on the surface there was only a one-way telephone line — he could call up, but the surface team was under strict instruction never to tell him the time or the date. Every time he woke, ate, or prepared to sleep, he would make a call, so the surface team could record that moment as a data point for his own “internal clock.”

Sixty-three days later, when the surface team told him the experiment was over and he could leave the cave, the actual date was September 14 — yet Siffre himself firmly believed it should be August 20. His subjective sense of time had fallen behind the calendar by nearly a month. This experience later came to be known as a “free-running circadian rhythm”: once all external cues to time are cut off, the human body will still follow its own rhythm of sleeping and waking — only this internal rhythm no longer aligns perfectly with the Earth's 24-hour rotation.

Following this experiment, Siffre organized several more studies of the same kind; in 1972, he himself spent 205 days in Midnight Cave in Texas, in a study jointly funded by NASA and the French Ministry of Defense — the former concerned with how to schedule astronauts' sleep during long-duration spaceflight, the latter with how to schedule the routines of nuclear-submarine crews during long submerged patrols with no day-night alternation to see.

 

2. Later, Stricter Experiments Pulled the Number Back In

Told this far, Siffre's story is easily simplified into the line “the human internal biological clock runs on a 25-hour day.” This claim has circulated widely, but this chapter cannot simply write it down as fact, because later research found that the number had been overestimated.

The problem lay in the experimental conditions themselves: Siffre, and the subjects in many similar experiments that followed, could not see the sun, but they could control the artificial lighting inside the cave themselves — and the sleepier they became, the brighter they tended to turn up the lights, which had the effect of delaying sleep onset and quietly stretching out the “day.” In 1999, Charles Czeisler's team published a study in the journal Science, using strictly controlled lighting conditions, and measured the intrinsic human circadian period at an average of 24.18 hours — considerably shorter than the 25 hours estimated by the generation of cave experiments, and much closer to 24 hours.

This correction is not meant to diminish Siffre's contribution. Quite the opposite — it was precisely his experiments that first led the scientific community to take seriously the idea that the human body contains an internal biological clock, independent of the sun, capable of running on its own — which is exactly what made the later, more precise measurements possible. The story itself can be kept, but the specific number within the story needs to be corrected using later, more rigorous experiments.

 

3. Inside the Body, Day and Night Were Already Different

One need not go into a cave — everyday life already offers abundant evidence that the human body internally distinguishes day from night.

Cortisol is a hormone secreted by the adrenal glands; in most people, its concentration reaches a daily peak around the time of waking in the morning, then gradually declines, reaching its lowest point around midnight — a phenomenon known as the “cortisol awakening response.” Melatonin behaves oppositely: light suppresses its secretion, and once darkness falls, melatonin levels begin to rise, helping a person enter sleep, only to be suppressed again once it grows light. Core body temperature follows a similar daily rhythm, typically reaching its lowest point around four or five in the morning and its highest point in the early evening, with a daily fluctuation of nearly 1 degree Celsius. The sleep-wake rhythm itself is stubborn in the same way: anyone who has crossed several time zones knows that forcibly shifting one's bedtime by several hours does not make the body comply immediately — this is the source of “jet lag.”

Taken together, these facts point to the same conclusion: inside the human body, day and night — from hormone levels to body temperature to the tendency to sleep — are, quite genuinely, two different states. This is not a subjective feeling, but a physiological phenomenon that can be measured repeatedly and verified independently.

 

4. Two Thousand Years Ago, the Ancients Had Already Divided the Day Into Four Parts

Carrying these facts, if we look back at the Huangdi Neijing, we find a passage devoted to the yin and yang of day and night, with a division far more detailed than one might expect:

“Hence it is said: within yin there is yin, within yang there is yang. From dawn to midday is the yang of heaven, the yang within yang. From midday to dusk is still the yang of heaven, but the yin within yang. From nightfall to the crowing of the cock is the yin of heaven, the yin within yin. From the crowing of the cock to dawn is still the yin of heaven, but the yang within yin. And so man corresponds to this as well.”

In plain language: within yin and yang, there is a further division of yin and yang. From daybreak to noon, belonging to the yang of daytime, is “yang within yang”; from noon to dusk, still daytime, but belonging to “yin within yang”; from nightfall until before the cock crows, belonging to the yin of night, is “yin within yin”; from the cock's crow until daybreak, still night, yet belonging to “yang within yin.” Man corresponds to this pattern as well.

This passage does not stop at the crude statement “day is yang, night is yin” — it further slices the day into four segments, each marked by its own degree: yang qi is at its most vigorous around noon, and already beginning to withdraw by dusk; yin qi is at its most vigorous around midnight, and already beginning to weaken as dawn approaches. Set beside the physiological curves measured today, this way of dividing time runs in the same direction: cortisol does not surge instantly to its peak the moment it grows light, but climbs gradually around the time of waking; body temperature does not plunge to its lowest point the instant night falls, but only bottoms out in the deep of night, beginning to rise again before dawn. This layered description of “yin within yin, yang within yang” is describing exactly this kind of gradual change — not a switch flipped abruptly between day and night.

A cautious line must be drawn here: this classical passage is speaking of the time of day and hour, and its point ultimately concerns the timing of needling and medication — it is not describing modern concepts such as cortisol or melatonin. What can be confirmed is that the day-night rhythm the ancients observed aligns, in direction and in its rough segmentation, with the physiological rhythms measured by modern instruments; what cannot be confirmed is whether the ancients were already aware of some specific mechanism resembling hormonal fluctuation. Alignment in direction is not the same as identity of mechanism.

 

5. What This Chapter Can Actually Confirm

First, in 1962, Michel Siffre lived for 63 days in a cave completely isolated from all cues to time, proving that the human body possesses an internal rhythm, independent of the sun, capable of running on its own — a rhythm later called the “free-running circadian rhythm.” In 1972 he himself completed a further 205-day cave experiment, and the resulting research was used by American space agencies and the French military in scheduling the routines of astronauts and submarine crews.

Second, the period length of more than 24 hours estimated by early cave experiments was later corrected by better evidence: in 1999, the Czeisler team, under strictly controlled lighting conditions, measured the intrinsic human circadian rhythm at an average of 24.18 hours — shorter, and closer to 24 hours, than the figure estimated by the generation of cave experiments. This book preserves this correction as it stands, rather than omitting it simply because it makes for a less tidy story.

Third, the morning peak in cortisol, the nighttime rise in melatonin, the daily fluctuation of nearly 1 degree Celsius in core body temperature, and the resistance of the sleep-wake rhythm to time-zone shifts (jet lag) are all day-night physiological phenomena that have been repeatedly measured and independently verified in modern medicine.

Fourth, the “Discourse on the True Words in the Golden Chamber” chapter of the Suwen divides the day into four segments — “yang within yang,” “yin within yang,” “yin within yin,” and “yang within yin” — and this gradual, layered division aligns, in direction and rough rhythm, with the physiological curves of cortisol and body temperature measured today. This classical passage's point ultimately concerns the timing of needling and medication, not a description of modern hormone or temperature curves in the current sense; alignment in direction is not identity of the described mechanism.

The gaps that must be left standing are equally clear. Whether the ancients' division of day and night into yin and yang corresponds to other physiological indicators not yet mentioned here is not something this chapter has exhaustively examined. Beyond day and night, the ancients also used the pairing of yin and yang to describe many other kinds of opposing relationships — whether these can likewise be matched at the level of measurement is a question for the next chapter.

A man shut himself in a cave for sixty-three days, and measured out a genuine sense of time within the human body, independent of the sun.

Two thousand years earlier, a physician had already written the very same thing into the words “yang within yang, yang within yin.”

The next question must move one step further: beyond day and night, are yin and yang, as the ancients spoke of them, two separate things, or a language for describing relationships?

Yin and yang are not two things — so what, exactly, are they?

 

 

Chapter Thirteen: Yin and Yang Are Not Two Things

—Insulin and glucagon: if the ancients had seen these two hormones, would they have called this “yin and yang”?

The previous chapter left us with this: yin and yang are not two things — so what, exactly, are they?

This chapter begins with an unexpected experimental discovery.

 

1. One Hormone, Two Directions

In 1921, Frederick Banting, a surgeon at the University of Toronto in Canada, and his student Charles Best, extracted a substance from the pancreas of a dog and injected it into a diabetic dog, whose blood sugar dropped at once. This was insulin. On January 11, 1922, 14-year-old Leonard Thompson became the first patient to receive an insulin injection. In 1923, Banting received the Nobel Prize in Physiology or Medicine for this discovery, and split his prize money in half with Best — the Nobel committee had not included Best among the official laureates.

This story is already widely known, but few mention what happened next: the crude pancreatic extract Banting and Best first produced was not pure, and when injected into animals, blood sugar would sometimes rise briefly before falling. This anomalous “rise-then-fall” pattern prompted two other researchers, Charles Kimball and John Murlin, to re-examine these crude extracts in 1923, isolating another substance whose effect was exactly opposite to insulin's — it raised blood sugar. They named this substance “glucagon.”

Later research clarified further that these two hormones are secreted by two different types of cells within the same cluster of cells in the pancreas — the islets of Langerhans: insulin from the beta cells, glucagon from the alpha cells. After a meal, when blood sugar rises, insulin secretion increases, pushing blood sugar back down into the normal range; during fasting, when blood sugar falls, glucagon secretion increases, pulling blood sugar back up into the normal range. Two hormones, moving in two opposite directions, existing simultaneously within the same organ, each indispensable, together holding blood sugar within a relatively stable range.

 

2. Back to the Original Meaning of Yin and Yang: Not Two Things, But a Set of Relationships

Carrying the example of insulin and glucagon, if we look back at the Huangdi Neijing's definition of yin and yang, we find that the ancients, from the very start, were never speaking of two entities:

“Yin and yang are the way of heaven and earth, the guiding thread of the myriad things, the mother of all change, the root and origin of birth and death, the abode where the spirit-light resides.”

In plain language: yin and yang are the principle by which heaven and earth operate, the overarching framework and order of all things, the source of all change, the root of growth and death, the place where every law of nature comes to be revealed. This sentence does not say “yin is such-and-such a thing, yang is such-and-such a thing” — it defines yin and yang as a framework for describing “the way,” “the guiding thread,” and “change.”

The “Great Treatise on the Correspondence of Yin and Yang” chapter of the Suwen then unfolds several specific regularities within this framework.

Opposition with waxing and waning: “Yang generates, yin nourishes; yang reaps, yin stores.” Yang governs generation and outward growth, yin governs nourishment; yang governs reaping and withdrawal, yin governs storage — yin and yang do not change independently of one another; the movement of one is accompanied by a corresponding movement of the other.

Mutual rootedness: “Yin resides within, guarding what yang holds; yang moves without, serving what yin employs.” Yin remains quietly within, forming the basis on which yang can hold firm; yang moves about outside, serving as the means by which yin is deployed and put to use — the two depend on each other, and without either one, the other cannot stand alone. This statement applies perfectly to insulin and glucagon: without insulin to push blood sugar down, glucagon's effect of raising it would be meaningless; without glucagon to provide a floor, insulin alone might push blood sugar too low.

Transformation: “Extreme cold turns to heat, extreme heat turns to cold”; “extreme yin necessarily becomes yang, extreme yang necessarily becomes yin” — once a thing develops to its extreme, it transforms into its opposite.

Taken together, these three regularities sketch out a language of relationships: yin and yang describe several kinds of relational patterns — opposition, mutual rootedness, waxing and waning, transformation — rather than referring to two specific substances or entities. Insulin is not “yin,” and glucagon is not “yang” — this book will not resort to such simple labeling — but the relational structure between these two hormones — opposition, mutual rootedness, waxing as the other wanes — is genuinely the kind of phenomenon that the relational language of “yin and yang” was originally meant to describe.

 

3. Yang Good, Yin Bad? A Common but Mistaken Reduction

In everyday language, “yang” is often understood as positive, bright, and good, while “yin” is understood as negative, dark, and bad. This is the most common — and most easily reinforced — misreading of yin and yang, and the original text of the Huangdi Neijing itself argues directly against it:

“When yang dominates, the body grows hot, the pores close, breathing becomes coarse with hunching and arching of the back, sweat fails to come out yet the heat persists, the teeth grow dry and the mind grows agitated, the abdomen distends, and death follows — such a person can endure winter but not summer. When yin dominates, the body grows cold, sweat comes out unexpectedly, the body stays chilled, shivering with cold, and when the cold reaches its extreme the limbs go numb and reversed, the abdomen distends, and death follows likewise — such a person can endure summer but not winter.”

In plain language: an excess of yang qi brings bodily heat, closed pores, coarse and labored breathing, sweat that will not come even as the heat worsens, dry teeth, and an agitated mind — even, in extreme cases, abdominal distension and death; such a person can bear winter but not summer. An excess of yin qi brings bodily cold, unexpected sweating, chilled and shivering limbs, and, at its extreme, cold reversal of the limbs — likewise possibly ending in abdominal distension and death; such a person can bear summer but not winter.

This passage places “yang dominance” and “yin dominance” side by side, describing both as fatal pathological states, with neither one presented as “good.” Yin and yang describe a dynamic relationship that must be kept within an appropriate range — too much of either is illness, and neither side is inherently superior to the other. This connects directly with the relationship between insulin and glucagon as well: excess insulin secretion can cause hypoglycemia and even coma; excess glucagon can cause hyperglycemia — an excess of either hormone alone is dangerous, and a healthy state is one in which the two are dynamically adjusted and mutually constrained according to the body's needs.

 

4. Where This Resembles, and Does Not Resemble, the Modern Concept of “Homeostasis”

The mechanism by which insulin and glucagon wax and wane against each other to jointly maintain stable blood sugar has, in modern physiology, a dedicated name: homeostasis.

This word does not have a particularly long history. In 1865, the French physiologist Claude Bernard proposed the concept of the milieu intérieur — the “internal environment” — arguing that the body maintains a relatively stable internal environment that must be actively regulated. In 1926, the American physiologist Walter Cannon, of Harvard University, building on Bernard's foundation, coined the term “homeostasis,” and in his 1932 book The Wisdom of the Body systematically laid out the idea: the body's various stable states — blood sugar, temperature, the acid-base balance of bodily fluids — are never static, but are dynamically maintained within a normal range through sets of mechanisms that work in coordinated opposition to one another.

Placing the definition of homeostasis alongside yin and yang's “opposition, mutual rootedness, waxing and waning, transformation,” the structures do genuinely resemble each other: both describe a relationship in which forces pulling in opposite directions constrain one another, thereby maintaining overall stability. The interplay of insulin and glucagon could almost serve as a textbook case for homeostasis theory — and could almost equally serve as a textbook case for yin and yang's “opposition with mutual rootedness.”

But resemblance is not identity, and a few boundaries must be drawn here. First, homeostasis theory concerns a specific, numerically measurable variable — blood sugar has a normal range, body temperature has a normal range, and the task of the homeostatic mechanism is to keep that variable within that range. Yin and yang, by contrast, is a classificatory framework that can be applied to almost any pair of opposing relationships — day and night, hot and cold, interior and exterior, male and female, the organs, even the thickness or thinness of a medicine's flavor and qi can all be described through yin and yang — it does not commit in advance to any single, specific, measurable indicator. Second, every step of a homeostatic mechanism has a specific, traceable molecular basis — which cell secretes which hormone, acting on which receptor; yin and yang, as a relational language, does not itself provide description at this level — it states that “such a mutually constraining relationship exists,” without specifying “through which molecules, exactly, this relationship is realized.”

So the more accurate statement is this: the relational language of yin and yang and the modern theory of homeostasis are structurally similar in describing “maintaining overall stability by having opposing sides constrain one another”; but the scope of yin and yang is far broader than that of homeostasis, and the mechanisms provided by homeostasis theory are far more specific than those of yin and yang. Using a single case — such as insulin and glucagon — to illustrate this structural resemblance is entirely reasonable; declaring yin and yang, as a whole, to simply “be” the ancient version of homeostasis theory carelessly equates two frameworks of very different scope and precision.

 

5. What This Chapter Can Actually Confirm

First, in 1921 Banting and Best isolated insulin; in 1923, while purifying it, Kimball and Murlin separately isolated glucagon from the crude extract. The two are secreted respectively by the beta and alpha cells of the pancreatic islets, acting in opposite directions — insulin lowers blood sugar, glucagon raises it — and together maintain blood sugar within a stable range. This is a real, mechanistically well-understood physiological system of “a pair of opposing forces jointly maintaining overall stability.”

Second, the Huangdi Neijing's definition of yin and yang, in the “Great Treatise on the Correspondence of Yin and Yang,” was never, from the very beginning, a reference to two entities, but rather a relational language describing “the way,” “the guiding thread,” and “change,” unfolding specifically into the regularities of opposition (yang generates and yin nourishes, yang reaps and yin stores), mutual rootedness (yin resides within, guarding what yang holds; yang moves without, serving what yin employs), and transformation (extreme yin necessarily becomes yang, extreme yang necessarily becomes yin).

Third, the original text of the Huangdi Neijing explicitly describes both “yang dominance” and “yin dominance” as pathological states leading to death, placing them side by side with no ranking of one as superior to the other. Equating “yang” with good and “yin” with bad is a misreading of the original text, not what the original text itself meant.

Fourth, the modern concept of “homeostasis” — Bernard's 1865 proposal of the “internal environment,” Cannon's 1926 coinage of “homeostasis” — genuinely resembles the relational language of yin and yang in the structure of “maintaining overall stability through the mutual constraint of opposing sides”; but the scope of yin and yang is far broader than that of homeostasis, and the molecular mechanisms provided by homeostasis theory are far more specific than those of yin and yang. The resemblance holds only at the level of relational structure, and cannot be generalized into a claim that the two are one and the same thing.

The gaps that must be left standing are equally clear. This chapter uses only the single case of insulin and glucagon to show that the relational language of yin and yang can correspond structurally to the modern concept of homeostasis; this does not mean that every opposing relationship described by yin and yang can find an equally clear case in modern physiology — this book does not overextend the claim in that direction.

The ancients said that yin and yang are not two things, but a set of relationships.

Two hormones, one rising as the other falls, existing simultaneously within the same pancreas, gave this statement a concrete demonstration.

The next question must move forward, leaving yin and yang behind, and enter a theory with an even worse reputation, and even easier to get wrong —

Are wood, fire, earth, metal, and water really talking about five chemical elements?

 

 

Chapter Fourteen: Wood, Fire, Earth, Metal, and Water Are Not Five Chemical Elements

—A misunderstanding much like “qi” becoming “energy” — this time starting from the word “element”

The previous chapter left us with this question: are wood, fire, earth, metal, and water really talking about five chemical elements?

This chapter, too, begins with a story about translation — because this particular misunderstanding follows almost the same pattern as “qi” becoming “energy” in Chapter Ten.

 

1. A Missionary's Perceived “Resemblance”

In the seventeenth century, Jesuit missionaries who came to China, reading Chinese classical texts, encountered the term wuxing (“Five Phases” or “Five Agents”), composed of the five characters wood, fire, earth, metal, and water. They naturally thought of a framework more familiar to them: the ancient Greek theory of the “four elements” — earth, water, air, and fire, proposed by Empedocles and later systematized by Aristotle, held to be the constant, unchanging basic materials that made up everything in the world. The two theories had similar numbers of terms, and some of the names even overlapped (earth, water, fire), and so wuxing was translated as “Five Elements” — a rendering still very common today, especially in English-language textbooks of acupuncture and Chinese medicine.

Modern scholars who study this translation history call this correspondence a “false analogy”: the ancient Greek elements were constant, unchanging entities that made up all things while remaining unchanged themselves; the Chinese wuxing, in its literal meaning, is far closer to movement, change, and succession — a point that becomes very clear once we return to the earliest surviving text to use the term “wuxing.”

 

2. What “Xing” Originally Meant

The earliest text to systematically mention “wuxing” that survives today is the “Great Plan” (*Hongfan*) chapter of the Book of Documents, traditionally said to record words spoken by Jizi in answering King Wu of Zhou's questions on the way of governing:

“First, the Five Phases: the first is water, the second is fire, the third is wood, the fourth is metal, the fifth is earth. Water is said to moisten and descend; fire is said to blaze upward; wood is said to bend and straighten; metal is said to yield and be shaped; earth is said to allow sowing and reaping.”

In plain language: first, the Five Phases: first is water, second is fire, third is wood, fourth is metal, fifth is earth. The nature of water is to moisten and flow downward; the nature of fire is to blaze upward; the nature of wood is that it can be bent and can be straightened; the nature of metal is that it can be reshaped according to human will; the nature of earth is that it can be used for sowing and for harvesting.

This passage never says “what substance water is made of” — it says “how water moves, how it changes”: flowing downward and moistening is a tendency; blazing upward is likewise a tendency; being bendable and straightenable, being reshapeable by human will, being suitable for sowing and reaping — all of these describe characteristics and modes of behavior, not compositional makeup. These five characters were originally chosen to represent five representative modes of change and tendencies of action, not five basic materials. The character xing itself, in classical Chinese, at its most basic level means “to walk” or “to move” — and its use here points precisely to this layer of meaning: movement, change, succession.

 

3. In 1987, a Sinologist Proposed a Different Translation

This translation problem is not something this book raises for the first time. In 1987, the American sinologist Nathan Sivin formally proposed rendering wuxing as “Five Phases” rather than “Five Elements.” This suggestion was later accepted by a considerable portion of Western sinology, and has become the more common translation in academic writing.

The word “phase” also has a ready-made meaning in physics — water can exist as a solid, liquid, or gas, each a “phase,” describing precisely the different states and processes of transformation that the same substance takes on under different conditions, not several different constituent materials. Although this analogy, too, is imperfect, it at least points in the right direction: wood, fire, earth, metal, and water within wuxing are closer to five representative states, tendencies, and modes of transformation, than to five basic building blocks that construct the world.

This is not merely a matter of preferred phrasing within academic circles. If one takes it for granted, from the outset, that wuxing means “five elements,” it becomes easy to go on and ask “where is the wood element in the human body” or “can the metal element be tested for in the lab” — such questions belong to the framework of the Greek four-element theory, and are not the questions the original text of the Hongfan set out to answer.

 

4. If Not Elements, Then What? A Classification of “Modes of Change”

Once the assumption of “elements” is set aside, the question can be asked again: what, exactly, is wuxing classifying?

The answer is: it provides a system for classifying the various processes of change and mutual relationships observable in nature and in the human body. Wood represents the tendency of generation and free, unhindered growth; fire represents the tendency of rising and blazing heat; earth represents the tendency of transformation and support; metal represents the tendency of contraction and clearing away; water represents the tendency of moistening, descending, and storing. Later texts further summarized two kinds of relationships among these five tendencies: mutual generation (wood generates fire, fire generates earth, earth generates metal, metal generates water, water generates wood — one tendency creating the conditions for another to arise) and mutual overcoming (wood overcomes earth, earth overcomes water, water overcomes fire, fire overcomes metal, metal overcomes wood — one tendency exerting a restraining effect on another).

This network of generating and overcoming relationships is, in itself, a description of “how processes of change influence one another,” not “how substances react with one another.” Read as a framework for classifying and describing relationships of change, “metal overcomes wood” describes a certain type of restraining relationship — it does not mean that metal literally corrodes trees. Read as a chemical periodic table, the phrase becomes nonsensical. Use the right framework, and the question the ancients were actually asking becomes visible; use the wrong one, and every subsequent step of the discussion goes off course.

 

5. What This Chapter Can Actually Confirm

First, the translation of wuxing into the English “Five Elements” originated with seventeenth-century Jesuit missionaries in China, who, seeing a surface resemblance between China's wood, fire, earth, metal, water and the ancient Greek four-element theory of earth, water, air, and fire, produced an analogical translation. Modern scholars who study this history call this analogy a “false” one, because the Greek elements were constant, unchanging constituent materials, while the Chinese character xing itself points toward movement and change.

Second, the earliest surviving text to systematically record wuxing, the “Great Plan” chapter of the Book of Documents, uses the dynamic terms “moistens and descends,” “blazes upward,” “bends and straightens,” “yields and is shaped,” and “allows sowing and reaping” to describe the characteristics of water, fire, wood, metal, and earth, respectively — describing each one's behavioral tendency, not the substance of which it is composed.

Third, in 1987, the sinologist Nathan Sivin proposed retranslating wuxing as “Five Phases,” a rendering later adopted in a considerable body of academic writing, meant to remind readers that wuxing is first and foremost a classification of states and processes of change, not a list of basic materials.

Fourth, the mutual-generation and mutual-overcoming relationships among the wuxing describe the ways in which tendencies of change promote or restrain one another — this is a network of relationships, not a set of chemical equations. Reading wuxing through the framework of “elements” leads to questions the original text never intended to answer; reading it through the framework of “a classification of modes of change” allows one to see clearly what the ancients were actually saying.

The gaps that must be left standing are equally clear. This chapter has dealt only with the most basic misunderstanding — whether wuxing refers to chemical elements — and has not yet addressed how wuxing is specifically used to correspond to the body's organs and the seasons; that is a question for the next chapter. Whether the network of mutual generation and mutual overcoming itself has any predictive power, and whether it can be tested, this book likewise sets aside for later treatment and draws no conclusion on here.

A missionary, standing between two unfamiliar systems of classification, saw a surface resemblance, and chose a ready-made word.

The Hongfan, more than two thousand years earlier, had written down something concrete and observable instead: water seeping downward, fire burning upward.

The next question must move forward, placing this classification of tendencies of change onto the human body and the four seasons —

Why does spring belong to wood, and why does the liver belong to wood as well?

 

 

Chapter Fifteen: Why Does Spring Belong to Wood, and the Liver Belong to Wood as Well?

—History shows at least three different schemes of correspondence; the one we use today was only settled in the Han dynasty

The previous chapter left us with this question: why does spring belong to wood, and why does the liver belong to wood as well?

This chapter begins with something many people do not know: this correspondence was never, historically, the only one.

 

1. At Least Three Different Schemes

The scheme in common use in Chinese medicine today is: the liver belongs to wood, the heart to fire, the spleen to earth, the lungs to metal, the kidneys to water. But in texts from the pre-Qin period through the Han dynasty, the correspondence between the five organs and the Five Phases appears in at least three different versions.

The scheme in the Guanzi is: the spleen corresponds to wood, the lungs to water, the kidneys to metal, the liver to fire, the heart to earth — entirely different from today's. Within Han-dynasty classical scholarship, the “Old Text” school held: spleen-wood, lung-fire, heart-earth, liver-metal, kidney-water. The “New Text” school held the scheme still followed today: liver-wood, heart-fire, spleen-earth, lung-metal, kidney-water. The Huangdi Neijing adopted the New Text school's version, and later Chinese medicine followed suit.

In other words, the statement “the liver belongs to wood” was never uniquely settled from the very start — it was one of several competing schemes that ultimately won out and was adopted by the Huangdi Neijing. This is not this book seeking to belittle the theory, but to state honestly: it went through a process of selection; it was not something observed once, uncontested, and settled for all time.

 

2. An Adjustment to the Scheme, Entangled With Politics

The historian Gu Jiegang once carried out textual research suggesting that the change from “heart-earth” to “heart-fire” was very possibly connected to Wang Mang's reshaping of the “theory of cyclical dynastic virtues” during his usurpation of the Han throne — the assignment of organs to the Five Phases was not merely a medical question, but part of the argument for political legitimacy at the time. This piece of research remains open to discussion, and this book does not treat it as the sole settled conclusion, but it reminds us: the process by which the system of Five-Phase correspondence was established was mixed together with factors like political and scholarly rivalry — it was not completed independently, in some quiet observatory.

The scheme finally settled on by the New Text school does have a traceable inner logic: the liver governs free flow and favors an unhindered, expansive state, which resonates with wood's quality of “bending and straightening” and its tendency toward generation; the heart governs yang qi, and fire's nature is to blaze upward, which resonates with fire's upward, blazing quality; the spleen governs transformation and transportation, nourishing and generating all things, which resonates with earth's quality of bearing and nurturing; the lungs govern clearing and descending, favoring a state of purity and order, which resonates with metal's quality of contraction; the kidneys govern storage, favoring moistening and downward flow, which resonates with water's quality of moistening and flowing down. This is an internally consistent system of analogy — but internal consistency in an analogy is not the same as being an empirical regularity summarized from a large body of independent observation.

 

3. Was This Observed, or Constructed for the Sake of a Complete System?

Placing these facts together, the more honest answer is: both are true, and to a degree difficult to separate precisely.

The connection between the liver and emotion, and between free-flowing function and mood, and the connection between the spleen and stomach and digestive-transformative function, are the kind of observations that genuinely seem to come from long clinical experience. But cross-domain correspondences such as “the liver corresponds to spring” or “the heart corresponds to summer” were, to a great extent, systematically constructed only after the wuxing framework had already been established — built in order to let several independent classificatory systems (organs, seasons, the five colors, the five flavors, the five musical notes) nest together and form a single, complete network of relationships. Some independent clinical observations came first; afterward came a project of analogical construction, in pursuit of systematic completeness, weaving these observations together with classifications from other domains — these two processes, in the formation of wuxing theory, were very likely intertwined, rather than occurring in a clean sequence.

This judgment lays the groundwork for the question the next chapter must raise: if observation and analogical construction are tightly interwoven within a single theory, what standard should be used to test whether that theory has actually touched upon a genuine regularity of nature?

 

4. What This Chapter Can Actually Confirm

First, the correspondence between the five organs and the wuxing had, from the pre-Qin era through the Han dynasty, at least three distinct versions: the correspondence in the Guanzi, the correspondence of the “Old Text” classical school, and the correspondence of the “New Text” classical school. The New Text correspondence adopted by the Huangdi Neijing is the version that won out after competition among rivals, was written into the medical classics, and has been followed ever since — it was never the only scheme ever proposed.

Second, the historian Gu Jiegang proposed that the change from “the heart paired with earth” to “the heart paired with fire” may well be connected to the political need for Wang Mang, during his usurpation of the Han throne, to reshape the “theory of cyclical dynastic virtues.” This piece of textual research remains open to discussion, and this book records the existence of this view honestly, without treating it as the sole established conclusion.

Third, the New Text correspondence itself has an internal logic — the functional characteristics of the organs can be analogically matched to the respective properties of the wuxing; this analogy is internally consistent, but internal consistency is not the same as being an empirical regularity summarized from independent observation.

Fourth, some of the observations linking organs such as the liver and spleen to their corresponding functions may indeed reflect a long accumulation of clinical experience; but the systematic, cross-domain correspondence between organs and seasons, colors, and flavors is more likely to be an analogical construction built up after the wuxing framework had already been established, in pursuit of systematic completeness. The two are very likely intertwined, and this chapter makes no either-or judgment between them.

The gaps that must be left standing are equally clear. This chapter has not traced, item by item, the experiential origins of specific clinical observations such as “the liver governs free flow,” nor has it carried out further historical verification of Gu Jiegang's textual research — both lie beyond the scope of this chapter.

Of the three schemes, only one survived, and it was written into two thousand years of medical tradition.

This fact itself reminds us: the question to ask next is not “is this system complete enough,” but “can it be tested?”

If a theory can be reinterpreted, no matter what happens, as “consistent with wuxing,” does it still have any scientific meaning at all?

 

 

Chapter Sixteen: The Most Dangerous Thing About the Five Phases — It Can Explain Anything

—How Han-dynasty court historians filed every eclipse, flood, and insect plague under wuxing — and where the problem begins

The previous chapter left us with this question: if a theory can be reinterpreted, no matter what happens, as “consistent with wuxing,” does it still have any scientific meaning at all?

This chapter begins with a particular archive in the Book of Han.

 

1. An Archive That Can Absorb Anything

When the Eastern Han historian Ban Gu compiled the Book of Han, he devoted an entire dedicated volume — the “Treatise on the Five Phases” — to systematically recording every kind of anomaly that occurred throughout the Western Han: solar eclipses, earthquakes, floods, insect plagues, landslides, strange omens — and explained the cause of each one, item by item, using the logic of wuxing generation and overcoming, often linking it to some policy failure of the court, or some moral failing of the ruler, at the time.

What is most worth noting about this archive is not how many anomalous events it records, but its method of explanation: a flood can be explained by “an excess of water qi”; a drought can be explained by “a deficiency of water qi”; an insect plague can be explained by “metal qi overcoming wood”; a fire can equally be explained by “an excess of fire qi.” Almost any kind of natural anomaly can find a plausible reason within the framework of wuxing generation and overcoming.

This is exactly the question this chapter must raise head-on: if a theory can offer an explanation for any possible outcome, is it even capable of being disproven by any outcome at all?

 

2. A Standard for Judging Whether a Theory Is Good or Bad

In the twentieth century, the philosopher Karl Popper proposed a standard, later widely accepted by the scientific community: for a theory to count as a scientific theory, there must exist at least one imaginable observational outcome that, if it actually occurred, would prove the theory wrong. This standard is called “falsifiability.”

The example Popper himself used was Freudian psychoanalysis: whether a person behaves aggressively or in a repressed, restrained manner, the theory can explain either — the former as “the outward release of libido,” the latter as “the defense mechanisms at work.” That two diametrically opposite behaviors can both be accounted for by the same theory shows precisely that the theory excludes no possibility at all, and therefore, by Popper's standard, can hardly count as a testable scientific theory.

Applying this same measure to the mode of explanation in the “Treatise on the Five Phases” in the Book of Han, the problem is identical: a flood can be explained; a drought can equally be explained; an insect plague can be explained; and when the weather is favorable, that too can be explained as “the harmonious balance of the wuxing.” This explanatory system itself sets up no outcome of the form “if this happens, it proves this particular wuxing-based derivation to be wrong.” It functions more as a language of after-the-fact attribution than as a theory capable of making exclusive predictions before events occur.

 

3. Can the Five Phases Say, Before an Event Occurs, “If It Doesn't Turn Out This Way, I Am Wrong”?

Two things must be separated clearly here, rather than dismissed together in one sweep.

The first is wuxing functioning as a language for classifying and describing relationships of change — as the previous two chapters have discussed, at this level it provides an analogical framework that does not itself directly correspond to any falsifiable empirical proposition, much as saying “felines share certain common traits” is not itself a scientific hypothesis requiring falsification, but a mode of classification.

The second is wuxing being used to make a specific prediction — for instance, a physician reasoning from “the liver belongs to wood, and wood overcomes earth” to predict that a certain category of patients with spleen-and-stomach ailments will worsen in spring, or that patients with a certain “deficiency of metal qi” will show specific symptoms in autumn. This kind of specific prediction is, in principle, testable: write down the prediction in advance, then gather the data, and see whether the outcome matches the prediction.

This book draws a clear line here: if wuxing theory remains stuck at the level of after-the-fact attribution — finding some account to match, whatever the outcome — its scientific value must be reassessed; if it can be converted into specific, exclusive predictions that withstand independent testing, then that particular application deserves to be taken seriously. The “Treatise on the Five Phases” in the Book of Han falls into the former category, and this book does not defend it. But this does not mean that every specific clinical prediction based on wuxing falls into the same category — each must be tested individually, and the failure of the “Treatise” should not be allowed to condemn every specific application by association.

 

4. What This Chapter Can Actually Confirm

First, the “Treatise on the Five Phases” in the Book of Han systematically records the various natural anomalies of the Western Han dynasty, explaining each, item by item, through wuxing generation and overcoming; its mode of explanation covers an extremely wide range, such that almost any kind of anomalous phenomenon can be absorbed into this framework and given a plausible reason.

Second, the philosopher Popper's standard of “falsifiability” holds that a theory that cannot rule out any possible observational outcome can hardly count as a scientific theory testable by experience. Measured against this standard, the after-the-fact attribution found in the “Treatise on the Five Phases” belongs to an explanatory system lacking any capacity for exclusive prediction.

Third, wuxing functioning as a language for classifying relationships, and wuxing being used to make specific clinical predictions, are two different levels of question, and should not be conflated. The former is not, in itself, an empirical proposition requiring falsification; the latter can, in principle, be converted into specific, testable predictions.

Fourth, this book's position is: it does not defend the after-the-fact attribution of the “Treatise on the Five Phases,” but it does not, on that basis, declare that every specific clinical prediction based on wuxing is equally untestable — this requires designing tests case by case, rather than a single blanket affirmation or denial.

The gaps that must be left standing are equally clear. This chapter has neither listed nor tested any specific, contemporarily operable clinical prediction based on wuxing — that work is left for the later chapter, “Putting the Ancients' Theories to a Real Test,” to address formally.

The Han-dynasty court historians filed every natural disaster into an explanation drawn from wuxing generation and overcoming, fitting each one seamlessly into place, yet leaving behind not a single crack through which the theory might be overturned.

After this chapter, the questions concerning wuxing have been asked in full. The next question must move forward, leaving behind any one specific theory, to ask a larger question: why did the ancients keep looking up at the sky?

 

 

Chapter Seventeen: Why Does the Body Know What Time It Is?

—The brain has a dedicated timekeeping structure — and the liver and skin cells each have one of their own

The previous chapter closed the questions concerning the Five Phases. This chapter formally returns to the thread of “correspondence between heaven and man,” beginning with a specific question: how does the human body know what time it is?

 

1. A “Clock” Inside the Brain

In 1972, two independent research teams — one led by Robert Moore and Victor Eichler, the other by Charles Stephan and Irving Zucker — published, almost simultaneously, the discovery that destroying a small structure in the rat hypothalamus called the “suprachiasmatic nucleus” (SCN) caused the rhythm of cortisol secretion, drinking behavior, and activity levels to lose their circadian pattern entirely. This experiment was the first to prove that mammals possess a specific “master clock,” located at a particular site in the brain — the circadian rhythm is not some diffuse, centerless phenomenon spread throughout the body, but has an anatomical structure that can be located, destroyed, and even restored through transplantation.

At almost the same time, another line of investigation was advancing. In the early 1970s, Ronald Konopka and Seymour Benzer discovered, in fruit flies, that a mutation in a single gene could make the fly's circadian rhythm run faster, slower, or disappear entirely; they named this gene “period.” In 2017, Jeffrey Hall, Michael Rosbash, and Michael Young jointly received the Nobel Prize in Physiology or Medicine for further revealing how the period gene, through a molecular feedback loop, produces an oscillation of roughly 24 hours within the cell.

 

2. Not Just the Brain — Almost Every Cell Has Its Own “Clock”

If the story ended here, it would be easy to conclude that “only that one piece of tissue in the brain keeps time for the whole body” — but a 1998 study overturned this impression. The Swiss scientist Aurélio Balsalobre and colleagues found that ordinary fibroblast cells in a culture dish — cells with no apparent connection to any “biological clock” — began, after a brief soak in a high concentration of serum, to display days-long, regular oscillations in circadian gene expression. This showed that the molecular machinery producing circadian rhythm is not the exclusive property of the brain's suprachiasmatic nucleus — almost every cell in the body carries the same set of gene-oscillation “parts”; it is simply that, under ordinary circumstances, the SCN acts as a central hub, coordinating and synchronizing these scattered “clocks” throughout the body so they keep a consistent rhythm. Subsequent research further confirmed that peripheral tissues such as the liver, skin, and muscle each possess their own relatively independent “local clocks,” which are nonetheless drawn along by the central rhythm.

 

3. Two Thousand Years Ago, Chinese Physicians Also Drew a Chart of “Time-Divided” Activity

Carrying this modern framework of “central clock plus peripheral clocks,” if we look back at the traditional Chinese theory of the “Meridian Flow at the Hours” (*ziwu liuzhu*), an intriguing coincidence emerges. This theory divides a full day and night into twelve two-hour periods, each associated with a meridian said to be “on duty” — for instance, the Yin hour (3 to 5 a.m.) corresponds to the Lung meridian, the Mao hour (5 to 7 a.m.) to the Large Intestine meridian, and so on in sequence around all twelve meridians. Its core claim is: different organs and meridians each have their own period of “duty,” a time of relatively heightened function, at different points across the 24-hour day — rather than maintaining the same state around the clock.

This claim shares a logic with the modern discovery of “peripheral clocks”: different organs genuinely do have their own rhythmic curves; the liver's metabolic activity, the rate of skin-cell division, the strength of gastrointestinal peristalsis — none of these traces a flat, level line across the day, but rather rises and falls with its own peaks and troughs. What the “Meridian Flow at the Hours” theory got right, in direction, is the idea itself that different organs each keep their own timing; what it neither confirmed nor could confirm is whether the detailed timetable — which specific two-hour period corresponds to which specific meridian — can be matched, item by item, to the rhythmic curves measured at the molecular level today. This item-by-item verification has not, to date, been carried out by any rigorous modern study.

 

4. What This Chapter Can Actually Confirm

First, the 1972 experiments by two independent teams proved that the suprachiasmatic nucleus (SCN) in the mammalian brain is the central structure coordinating the body's circadian rhythms; destroying it causes multiple physiological rhythms to disappear simultaneously.

Second, a series of studies from the 1970s through 2017 — from the discovery of the period gene in fruit flies to the 2017 Nobel Prize recognizing its molecular mechanism — revealed a specific molecular mechanism underlying circadian rhythm, based on a gene-transcription negative-feedback loop.

Third, the 1998 study by Balsalobre and colleagues proved that this molecular oscillation mechanism is not unique to the suprachiasmatic nucleus; ordinary cultured fibroblasts, and, as subsequent research confirmed, peripheral tissues such as the liver and skin, each possess their own relatively independent “local clocks,” which require coordination and synchronization from the central rhythm.

Fourth, the traditional Chinese theory of “Meridian Flow at the Hours” claims that different meridians are “on duty” during different periods of the day — this general direction, that different organs each keep their own timing, aligns with the modern framework of “central clock plus peripheral clocks”; but the detailed timetable of which specific hour corresponds to which specific meridian has not, to date, been compared item by item, in any rigorous modern study, against the actual measured rhythmic curves of the organs.

The gaps that must be left standing are equally clear. This chapter has not undertaken the verification of the specific hourly divisions of “Meridian Flow at the Hours” — that remains work awaiting a dedicated experimental design, and this book will not draw a premature conclusion on its behalf.

A piece of tissue in the brain, found two thousand years later, was proven to be genuinely keeping time for the whole body.

Physicians two thousand years ago had likewise guessed that “different parts of the body each keep their own time,” yet left behind no timetable that could be checked item by item.

The direction was guessed correctly; the details remain suspended — this is exactly the situation the thread of “correspondence between heaven and man” will keep encountering going forward.

The next question must move forward: beyond day and night, do the seasons also change the body itself?

 

 

Chapter Eighteen: Why Are Winter and Summer Not the Same Body?

—A Cambridge University study found that nearly a quarter of human genes change their activity with the seasons

The previous chapter left us with this question: beyond day and night, do the seasons also change the body itself?

 

1. Nearly a Quarter of Genes Behave Differently in Winter and Summer

In 2015, a team led by Xaquin Castro Dopico at Cambridge University published a study in Nature Communications, examining the activity levels of more than 22,000 genes in white blood cells and adipose tissue, and found that more than 5,000 of them — roughly a quarter — showed expression levels that changed in a regular pattern with the seasons, some more active in winter, others more active in summer. Even more interestingly, the very same batch of pro-inflammatory genes was more active in the British winter, accompanied by a rise in inflammation-related markers such as the soluble IL-6 receptor and C-reactive protein; in Gambia, near the equator, the seasonal direction of change for the same genes was exactly reversed. The researchers suggested this might be connected to the fact that winter is precisely the season when cardiovascular disease, psychiatric illness, and autoimmune disease all tend to show higher rates of onset.

The significance of this study lies here: the effect of the seasons on the human body is not merely the surface-level sensation of “it's cold, so wear more clothes” — it reaches down to the level of gene expression, a real, precisely measurable physiological change.

 

2. Two Thousand Years Ago, Physicians Had Already Written Down Seasonal Lifestyle Advice

Carrying this discovery, if we look back at the “Great Treatise on Regulating the Spirit According to the Four Seasons” chapter of the Suwen, we find that the ancients had long since written out a “prescription” of routine and emotional regulation for each of the four seasons:

“In the three months of spring, called the period of unfolding and renewal... retire late and rise early, walk widely in the courtyard, let the hair hang loose and the body relax, so as to let the will grow... to go against this injures the liver. In the three months of summer, called the period of luxuriant flourishing... retire late and rise early, do not tire of the long daylight, do not let the will grow angry... to go against this injures the heart. In the three months of autumn, called the period of settling and evenness... retire early and rise early, rising with the rooster's crow, let the will be calm and at peace... to go against this injures the lungs. In the three months of winter, called the period of closing and storing... retire early and rise late, always waiting for the sunlight before rising, let the will seem hidden and concealed... to go against this injures the kidneys.”

In plain language: the three months of spring are a time when all things shed the old and renew themselves; one should retire late and rise early, walk frequently in the courtyard, let the hair hang loose and the body relax, allowing the will to grow along with spring's own generative force; to violate this pattern injures the liver. The three months of summer are a time when all things flourish luxuriantly; one should retire late and rise early, not resent the long daylight, and not allow oneself to grow angry; to violate this injures the heart. The three months of autumn are a time when all things settle and draw inward; one should retire early and rise early, letting the will remain calm and at peace; to violate this injures the lungs. The three months of winter are a time when all things close up and lie hidden; one should retire early and rise late, always waiting for the sun to appear before rising, letting the will remain as still as something concealed; to violate this injures the kidneys.

This passage is not vague literary sentiment. It offers specific, actionable advice — which season calls for retiring early, which for rising late, whether the emotions should be drawn inward or allowed to expand outward — and it explicitly links “violating this pattern” to “injuring a specific organ.”

 

3. Partial Alignment in Direction, No Alignment in Specific Mechanism

Placing the two side by side, what can be confirmed and what cannot must be stated separately.

Where the direction partially aligns: modern research confirms that winter genuinely is the season when cardiovascular disease, respiratory illness, and certain psychiatric conditions show higher rates of onset — this aligns, in broad direction, with the cautious attitude the “Four Seasons” chapter urges for winter, of “closing and storing” and “avoiding cold, seeking warmth.” The advice to adjust sleep timing with the seasons (retiring early and rising late in winter, retiring late and rising early in summer) is likewise not in conflict with the modern understanding that day length affects sleep rhythm.

Where confirmation is not possible, and forced correspondence is unnecessary: the “Four Seasons” chapter matches “injures the liver,” “injures the heart,” “injures the lungs,” and “injures the kidneys” one-to-one with the four seasons; this specific assignment of organs comes from the wuxing framework (Chapter Fifteen already discussed how this correspondence itself came to be formed), while the modern seasonal-gene research measures the overall trend of change across thousands of genes in white blood cells and adipose tissue, without specifically testing a claim as organ-specific as “does violating spring's routine specifically injure liver-function indicators.” Caution in the general seasonal direction — contracting and staying warm in winter, stretching out and venting in summer — is supported by modern evidence; but assigning this seasonal influence precisely to one specific organ currently lacks dedicated modern research to verify it item by item.

 

4. What This Chapter Can Actually Confirm

First, the 2015 Cambridge University study found that roughly a quarter of human gene-expression levels change in a regular pattern with the seasons, with pro-inflammatory genes more active in winter — a timing that coincides with the higher winter incidence of cardiovascular, psychiatric, and autoimmune disease; this pattern runs in opposite directions in the UK and in Gambia, suggesting that the seasonal effect on gene expression is tied to the climate and environment itself, not simply to day length.

Second, the “Great Treatise on Regulating the Spirit According to the Four Seasons” chapter of the Suwen gives specific advice on routine and emotional regulation for each of the four seasons, and links violation of this advice to injury of specific organs.

Third, modern research and the ancient text align in the broad direction that “the seasons genuinely and systematically affect the physiological state of the body”; but the ancients' specific claim of assigning seasonal influence precisely to a particular organ (spring injures the liver, summer injures the heart) has not been specifically tested by modern research, and this chapter does not judge it right or wrong.

The gaps that must be left standing are equally clear. The Cambridge team's study sample came mainly from populations in the UK and Gambia; whether it can represent the seasonal pattern of change in all regions and populations is not something this chapter overgeneralizes. The specific organ-season correspondence in the “Four Seasons” chapter requires dedicated modern research to verify item by item — this book has not carried out that work on its behalf.

A prescription for daily routine written two thousand years ago, and a twenty-first-century genomic study, are speaking to the same thing on the broad point that “the seasons systematically change the body.”

The finer line — which specific season injures which specific organ — has not yet been carefully checked by anyone.

The next question must move forward: how far should this line — the environment's influence on the body — reasonably extend, and at what point does it become overreach?

 

 

Chapter Nineteen: Where Should “Correspondence Between Heaven and Man” Stop?

—A necessary brake for the whole book

The previous chapter left us with this question: how far should the line of the environment's influence on the body reasonably extend, and at what point does it become overreach?

This chapter tells no new story. It does something more important first: draw a clear boundary between the evidence already confirmed in Chapters Twelve, Seventeen, and Eighteen, and another category of claim that is often lumped together with it.

 

1. Three Lines Already Backed by Evidence

Up to this point, the thread of “correspondence between heaven and man” has yielded only three conclusions genuinely backed by solid evidence:

First, light affects the body's internal biological clock. The suprachiasmatic nucleus, as the central clock, receives light signals from the retina and coordinates the rhythms of peripheral tissues throughout the body — this mechanistic pathway is clear, and the evidence is solid.

Second, circadian rhythm genuinely exists, and is expressed in specific, repeatedly measurable indicators such as cortisol, melatonin, and body temperature; this internal rhythm continues to run even when completely isolated from all external cues to time, only with a period slightly different from 24 hours.

Third, the seasons genuinely and systematically affect human gene expression, immune status, and the incidence of numerous diseases — this is supported by large-scale, reproducible modern research.

What these three lines share in common is this: they concern the relationship between specific, limited environmental variables — light, temperature, season — and specific, measurable physiological indicators, and this relationship can be repeatedly verified through experiments or epidemiological data.

 

2. Another Category of Claim Frequently Mixed In

But the phrase “correspondence between heaven and man” has historically also carried another category of claim, entirely different in nature: that the year of one's birth corresponds to a particular fate, that the movement of the stars corresponds to human fortune and misfortune, that solar and lunar eclipses foretell shifts in a dynasty's destiny. Chapter Sixteen already discussed how the “Treatise on the Five Phases” in the Book of Han explained every natural anomaly as an omen of human affairs — this category of claim likewise often appears under the very same banner of “correspondence between heaven and man.”

The fundamental difference between this category of claim and the three lines above is this: that light affects the biological clock can be tested or refuted through a designed controlled experiment; that “the position of a certain star determines a certain person's fate” is something for which no one can design an experiment specifying “if such-and-such an outcome is observed, this claim is proven wrong.” The former is a falsifiable empirical proposition; the latter is not.

 

3. Drawing a Clear Line

This book must draw a clear line here: a verifiable environment-body relationship, and an unverifiable claim of cosmic correspondence, cannot be discussed together, lumped under the single label of “correspondence between heaven and man.”

This does not mean the latter category of claim is “necessarily false” — this book has held, from Chapter One onward, to the principle that “content currently unverifiable is not to be hastily judged,” and that principle applies here as well. But “not hastily judging it false” does not mean “it may be blended together with an already-verified mechanism like light affecting the biological clock, borrowing the latter's scientific credibility to vouch for the former.” This kind of conflation is precisely where the phrase “correspondence between heaven and man” is most easily abused in popular circulation — using one genuine, verifiable scientific finding to lend credibility to another claim, of an entirely different nature, that cannot be verified at all.

This book's position on “correspondence between heaven and man,” as far as this chapter is concerned, extends only to the first category of claim: the verified relationships between specific, measurable environmental variables — light, temperature, season — and human physiological indicators. For claims of cosmic correspondence beyond this scope, this book neither declares them wrong, nor borrows the scientific evidence of earlier chapters to crown them.

 

4. What This Chapter Can Actually Confirm

First, the evidence this book has confirmed so far for “correspondence between heaven and man” is limited to three specific, verifiable relationships: the regulation of the biological clock by light, the existence of an internal circadian rhythm, and the systematic influence of the seasons on gene expression and disease incidence.

Second, another category of claim, likewise made under the name “correspondence between heaven and man,” involving astrology, fate, and omens of disaster, is fundamentally different in nature from the first three — such claims generally cannot be designed into falsifiable experiments or reproducibly verifiable observations, and therefore cannot claim the scientific credibility earned by the first three lines of evidence.

Third, this book explicitly refuses to discuss “a verifiable environment-body relationship” and “an unverifiable claim of cosmic correspondence” as though they were the same thing, even though the two have historically shared the same phrase, “correspondence between heaven and man.”

The gaps that must be left standing are equally clear. This chapter has not exhaustively catalogued every specific claim in ancient texts made under the name of “correspondence between heaven and man” — it has only drawn a standard of judgment; which category any particular claim falls into requires testing that claim on its own terms, and cannot be settled by the umbrella label of “correspondence between heaven and man” alone.

With the brake applied here, what needed to be confirmed and what needed to be clearly separated, along the thread of “correspondence between heaven and man,” have all been laid out plainly.

The next question must move forward, gathering everything confirmed across the preceding chapters of this book into a single, comprehensive test: what would happen if a physician from two thousand years ago walked into a modern hospital today?

 

 

Chapter Twenty: If the Ancients Had a Modern Medical Checkup

—A thought experiment: Chunyu Yi walks into today's hospital

The previous chapter left us with this question: what would happen if a physician from two thousand years ago walked into a modern hospital today?

This chapter must state honestly, from the start: what follows is a thought experiment, not history, and not a fictionalized historical scene — it simply borrows Chunyu Yi, who already appeared in Chapter Three, to string together everything confirmed in the previous nineteen chapters into an imagined medical checkup.

 

1. Checking In

Suppose Chunyu Yi, carrying his bundle of bamboo strips filled with “diagnostic records,” walked into a hospital today. A nurse has him get his blood pressure and temperature taken, blood drawn for testing, an electrocardiogram done, and then schedules him for an abdominal ultrasound and an overnight sleep study. How might he regard this entire procedure?

The blood-pressure cuff and thermometer would probably not strike him as unfamiliar. Chapter Three already described how he would “feel the pulse, observe the complexion, listen to the voice, and examine the form” — judging a patient's condition by feeling the strength, speed, and rhythm of the pulse by touch. Though the instruments are entirely different, this asks essentially the same question as a blood-pressure cuff measuring pressure within the vessels: the force and state of blood flowing through the vessels. The number given by a thermometer, too, corresponds directly to his basic judgments of “cold” and “heat.” He would likely regard these tests as doing what he was already doing, only with different tools and more precise numbers.

 

2. The Blood Test Results Come Back

The lab report lists dozens of indicators: hemoglobin, white-blood-cell count, blood glucose, liver and kidney function, electrolytes... Chunyu Yi would probably be utterly at a loss.

He would have no concept of “white blood cells,” but if told that “an elevated value here means the body is fighting off some kind of invasion,” he could very likely accept this — it runs in the same direction as the logic he used to judge “an abundance of pathogenic qi”: something existing within the body that must be fought and expelled, with the rising and falling of a number corresponding to the intensity of that struggle. Chapter Eleven already recorded that cortisol-related indicators in “kidney-yang-deficiency” patients can be detected by modern instruments and reproduced across institutions — if Chunyu Yi could grasp the principle behind “drawing blood for testing,” he would probably recognize this as exactly what he called “deficiency” or “excess,” simply measured in a different way.

But other indicators — a particular liver-function enzyme, a particular cytokine — he would have no corresponding conceptual framework for at all; he could neither say “this is what I call qi,” nor “this has nothing to do with what I know” — he could only acknowledge this as a territory he had never observed. This is exactly the point this whole book keeps emphasizing: the ancients' observations do not cover everything modern instruments can detect — the two maps do not contain one another.

 

3. The Electrocardiogram and the Sleep Study

The electrocardiogram traces out a curve, and the doctor points to a segment and tells him: “This is the heart contracting; this is the heart relaxing.” Chunyu Yi would probably immediately connect this with what he called the “pulse” — the beating of the heart was, from the start, one of the direct sources by which he judged the “pulse.” Chapter Nine already described how Hua Tuo, when needling, would have the patient report “where the sensation has traveled,” using the patient's feedback to judge whether the needling had taken effect; shown an electrocardiogram, Chunyu Yi would probably conclude that this is simply what he sensed by touch, now drawn out as a curve that can be checked and rechecked.

An overnight sleep study records his brainwaves, heart rate, and blood-oxygen changes throughout the night. Chapter Twelve already described how the human body possesses an internal circadian rhythm independent of the sun, with melatonin and cortisol each following their own daily curve. If told, “your body automatically secretes a substance at night that makes you want to sleep,” Chunyu Yi would likely find this fascinating — it runs in the same direction as the Huangdi Neijing's description of the daily rise and fall of yang qi, as in “at midday, yang qi is at its height; as the sun sets in the west, yang qi has already weakened” — but lacking the specific concept of “melatonin,” he could only say: “We are speaking of the same change; you have simply given it a name, and drawn it as a curve.”

4. The Checkup Is Over — How Would the Doctor Write the Diagnosis?

Once the checkup was complete, if Chunyu Yi were to write his own “diagnostic record,” he would probably retain his original framework — observing complexion, feeling the pulse, judging cold and heat, deficiency and excess — but he might add one further line: “Later generations have a method that can measure a person's form and verify these numbers with marvelous instruments; of what I myself have seen, six or seven parts in ten match — yet there is also that which I have never seen.” (This line is composed by this book on his behalf; it is not a historical source, and is used only to summarize the conclusion of this thought experiment.)

In this line, the proportion “six or seven parts in ten” is itself fictional and should not be taken as a genuine figure — what it is meant to express is this: a considerable portion of the ancients' observations can find a correspondence in modern instruments, but not all of them; and a considerable portion of what modern instruments detect is something the ancients had no concept at all to describe. Neither is the two entirely overlapping, nor entirely unrelated.

 

5. What This Chapter Can Actually Confirm

First, this chapter is an explicitly labeled thought experiment, not a historical record, and not a genuine speculation about the real Chunyu Yi — this chapter does not claim that Chunyu Yi actually said, or would actually say, these things.

Second, the material for the thought experiment is drawn entirely from specific conclusions already confirmed in the previous nineteen chapters of this book: the relationship between pulse diagnosis and blood pressure and heart rate, the correspondence between kidney-yang-deficiency syndrome and cortisol indicators, the relationship between the heartbeat and the electrocardiogram, and the relationship between circadian rhythm and the melatonin and cortisol curves — none of this is new evidence introduced by this chapter; it is a review, strung together, of what came before.

Third, the core message this thought experiment aims to convey is this: the ancients' observations and what modern instruments detect are two sets that partially overlap and partially stand independent — neither containing the other, nor entirely unrelated.

The gaps that must be left standing are equally clear. The fictional proportion “six or seven parts in ten” in this chapter has no quantitative basis whatsoever; it is merely a rhetorical device used to illustrate the structure of “partial overlap, partial non-overlap,” and readers should not take it as an actual statistical conclusion proposed by this book.

The thought experiment is complete. Next, this imagined checkup must be turned into a genuinely executable experimental method.

The next question: how can the ancients' theories be made to undergo a genuine, falsifiable test?

 

 

Chapter Twenty-One: Putting the Ancients' Theories to a Real Test

—Formally writing, as six steps, the method used repeatedly across the previous twenty chapters

The previous chapter left us with this question: how can the ancients' theories be made to undergo a genuine, falsifiable test?

This chapter tells no more stories. Instead, it writes out in full a method that has appeared again and again across the previous twenty chapters, without ever being formally named.

 

1. Six Steps

Looking back at earlier chapters — Shen Zi-yin's method for studying kidney-yang-deficiency syndrome (Chapter Eleven), how to compare ashi points against trigger points (Chapter Eight), how to design a blinded experiment for propagated sensation along the channels (Chapter Nine) — behind these practices lies, in fact, one and the same logic, which can be broken into six steps:

Step One: The classical text states the original claim. Without modernizing rewrites, first extract the ancients' own statement as it stands, and make clear exactly what it is saying.

Step Two: Convert the claim into a testable prediction. Strip away vague philosophical phrasing, and write it as a statement of the form: “if such-and-such is done, a specific, measurable outcome should be observed.”

Step Three: Fix the indicators in advance. Before turning on any instrument, write down what tool will be used to measure, which value will be measured, and how large a difference counts as “supporting” the prediction versus “not supporting” it — this step must be completed before seeing any data. As Chapter Eight emphasized in discussing pain-pressure measurement, it is precisely this step that most existing research fails to carry out properly.

Step Four: Measure independently with modern instruments. The measurement should be carried out by someone who does not know the content of the prediction, or at least does not know the group assignment — blinding wherever possible.

Step Five: Report all results, positive and negative alike. Whether the outcome supports or fails to support the prediction, it must be honestly written down — the propagated-sensation data in Chapter Nine, and the case of Kim Bong-han also in Chapter Nine, are both concrete demonstrations of this principle.

Step Six: Do not move the target after the experiment is over. If the result does not support the original prediction, one must not, after the fact, reinterpret it as “actually still consistent with what the ancients meant” — Chapter Sixteen's criticism of the after-the-fact attribution found in the “Treatise on the Five Phases” in the Book of Han addressed exactly this missing step.

 

2. Designing One Example Each for the Four Theories

The meridians: Prediction — skin resistance along a meridian path should be stably lower than that of non-meridian skin a short distance away. Method — recruit a group of subjects, keep the person measuring unaware of which points are meridian points, repeat the measurement multiple times, and see whether the difference is stably present and can be independently reproduced (Chapter Nine already discussed how existing research of this kind generally lacks this layer of blinding).

Qi and blood: Prediction — patients diagnosed with “kidney-yang deficiency” should show stably low urinary 17-hydroxycorticosteroids. Method — group patients blindly according to traditional criteria first, then send samples for uniform testing, comparing the difference between groups (Shen Zi-yin's research in Chapter Eleven is already a genuine, real-world example of this design).

Yin and yang: Prediction — a pair of physiological indicators categorized as a “yin-yang” relationship should display a dynamic relationship of waxing as the other wanes, mutually constraining one another, rather than changing independently of each other. Method — measure both indicators simultaneously, and observe whether, as one rises, the other correspondingly changes in the opposite direction (insulin and glucagon, in Chapter Thirteen, are the most solidly evidenced example of this kind of relationship).

Correspondence between heaven and man: Prediction — a given physiological indicator should show a regular pattern of change with the seasons or with day and night, and the direction of that change should match the description in classical texts. Method — collect data over the long term and across multiple locations, testing whether the pattern of change is stable and reproducible (the circadian-rhythm and seasonal-gene research cited in Chapters Seventeen and Eighteen are exactly this kind of test).

 

3. What This Method Can Deliver

These six steps cannot, in themselves, guarantee that every ancient claim will ultimately be proven correct. Their value lies in turning “supported” and “not supported” alike into results that can be written down and tested, rather than into an explanation that can be stretched to fit any situation. This is precisely what this book has been doing since Chapter One: not deleting a traditional understanding simply because it currently lacks a modern explanation, not declaring a modern finding to have proven it simply because the two look similar — but honestly designing a test capable of failing.

 

4. What This Chapter Can Actually Confirm

First, the testing logic used repeatedly across the previous twenty chapters of this book, though never formally named, can be summarized in six steps: state the original claim, convert it into a testable prediction, fix the indicators in advance, measure independently, report all results, and do not move the target after the fact.

Second, this six-step method can be applied, respectively, to the four theoretical systems of the meridians, qi and blood, yin and yang, and correspondence between heaven and man; each can be designed into a specific, operable experimental example. Of the four examples given in this chapter, some have already appeared in earlier chapters in the form of real research (such as Shen Zi-yin's study, and insulin and glucagon), while others have not yet been carried out by anyone to this level of rigor (such as blinded, repeated measurement of meridian skin resistance).

Third, this method does not, in itself, predetermine the truth or falsity of any ancient claim — it provides a procedure that allows truth and falsity to be tested.

The gaps that must be left standing are equally clear. Most of the four experimental examples given in this chapter remain at the design stage; this book has not personally carried out these experiments to obtain new, first-hand data — that lies beyond what a single book can accomplish. This chapter's task has been only to state the method clearly.

With the method now stated clearly, the next task is an uncomfortable but necessary one: to pour out everything confirmed, unconfirmed, and still unresolved across the previous twenty chapters, and sort it all into categories.

The next question: exactly which parts of Chinese medicine has modern science proven, and which questions remain unresolved?

 

 

Chapter Twenty-Two: Modern Science Has Not Proven Chinese Medicine — Nor Has It Closed the Question

—Sorting the conclusions of the previous twenty-one chapters into four categories

The previous chapter left us with this question: exactly which parts of Chinese medicine has modern science proven, and which questions remain unresolved?

This chapter introduces no new material. It does only one thing: sort everything that has come before into four categories.

 

1. Observations Already Backed by Strong Modern Evidence

This category consists of specific claims supported by cross-institutional, reproducible evidence:

Chunyu Yi's “diagnostic records” method of clinical documentation — diagnose first, then verify against outcome (Chapter Three); Hua Tuo's judgment that “the body wants exercise, but should not be pushed to its limit” (Chapter Five); kidney-yang-deficiency syndrome corresponding to multi-system dysfunction along the hypothalamic-pituitary-adrenal-cortical axis and others, reproduced across seven provinces in China and in Japan (Chapter Eleven); the mechanism by which insulin and glucagon wax and wane against each other to maintain stable blood sugar, matching the relational structure of yin-yang “opposition with mutual rootedness” (Chapter Thirteen); the existence of an internal circadian rhythm independent of external time cues, with a clear central anatomical structure (the suprachiasmatic nucleus) and molecular mechanism (Chapters Twelve and Seventeen); the seasons genuinely and systematically affecting human gene expression and the incidence of numerous diseases (Chapter Eighteen).

 

2. Phenomena With Interesting Correspondences, But Not Yet Provable as Equivalent

This category consists of cases where the direction aligns, but the mechanism has not been confirmed as fully corresponding:

The Suwen's four-part division of day-night yin and yang aligns, in direction, with the gradual curves of cortisol and body temperature, but it cannot be confirmed that the ancients perceived any specific hormonal mechanism (Chapter Twelve); the overlap between ancestral qi and respiration/heartbeat is direct, but touches only the most literal part of the concept of “ancestral qi” (Chapter Eleven); the partial overlap among ashi points, trigger points, and fixed points varies greatly depending on how loose or strict the comparison standard is (Chapter Eight); connective-tissue winding can explain part of the mechanical sensation of “qi arriving,” but this remains a mechanistic hypothesis, not a settled conclusion (Chapter Nine); the seasonal-routine advice in the “Four Seasons” chapter aligns, in broad direction, with seasonal-gene research, but the specific detail of “a given season injuring a given organ” lacks dedicated research to verify it item by item (Chapter Eighteen).

 

3. Theories With Insufficient Evidence

This category consists not of claims proven wrong, but of claims for which no sufficiently rigorous research yet exists to test them directly:

The specific correspondence between nutritive qi and the distribution of nourishment and formation of blood currently has less systematic research behind it than ancestral or primordial qi (Chapter Eleven); the specific prediction of a circadian rhythm for defensive qi has, to date, no dedicated experiment directly comparing it against modern cortisol or immune-cell rhythms (Chapter Eleven); the detailed timetable of “Meridian Flow at the Hours,” matching specific hours to specific meridians, has not been checked item by item against modern-measured organ rhythm curves (Chapter Seventeen); the relationship between propagated sensation along the channels and a practiced, cultivated state was observed only within a group of qigong practitioners in 1991, and the three-group blinded comparison this book has designed has not yet been carried out by anyone (Chapter Nine).

 

4. Claims Currently Lacking Reliable Support, or Possibly Mistaken

This category consists of claims that have been tested with evidence pointing against them, or that suffer from a fundamental methodological flaw:

Kim Bong-han's 1962 claim to have found the anatomical substrate of the meridians failed to stably reproduce its most critical part in subsequent independent replication (Chapter Nine); equating “qi,” as a whole, with “energy” originated in a historical translation expedient, not a verified correspondence (Chapter Ten); understanding wuxing as five chemical elements likewise originated in a translation analogy, inconsistent with the original meaning of movement and change emphasized in the Hongfan (Chapter Fourteen); the after-the-fact attribution found in the “Treatise on the Five Phases” in the Book of Han fails to meet the falsifiable standard of science, lacking any capacity for exclusive prediction (Chapter Sixteen); any claim of “correspondence between heaven and man” that blends astrology, fate, and omens of disaster together with an already-verified mechanism such as light and the biological clock lacks a testable experimental design (Chapter Nineteen).

 

5. What This Chapter Can Actually Confirm

First, the specific claims discussed across the previous twenty-one chapters of this book can be sorted into the four categories above: strongly supported, interesting correspondence not yet provable as equivalent, insufficient evidence, and lacking reliable support. This classification is itself an organization of the book's content, not new evidence.

Second, the existence of these four categories shows that the question “is Chinese medicine scientific” cannot be answered in a single sentence — different specific claims within the same classic, even within the same theoretical framework, may fall into four entirely different categories.

Third, this book does not shy away from the negative results in the fourth category, nor does it let the solid evidence in the first category vouch for the claims in the third and fourth categories that remain untested or unsupported.

The gaps that must be left standing are equally clear. This four-category division is based on the specific claims discussed across the previous twenty-one chapters of this book, not an exhaustive inventory of the entire theoretical system of Chinese medicine — there remains a great deal of specific theory and clinical experience this book has not touched on, which would need to be tested, item by item, using the same method; this chapter does not substitute for that work.

Once the four categories are laid out, a question emerges: if the same classic contains parts that have been verified, parts that have been disproven, and large stretches that remain unresolved, how should we regard the classic as a whole?

The next question: should the map of modern medicine and the map left behind by Chinese medicine really be pieced together into one?

 

 

Chapter Twenty-Three: Two Maps, One Body

—A mountain does not move just because someone drew its contour lines wrong

The previous chapter left us with this question: should the map of modern medicine and the map left behind by Chinese medicine really be pieced together into one?

 

1. Two Maps, Charting Different Things

The map drawn by modern medicine grows ever more fine-grained: cells, molecules, genes, receptors, neural networks — each layer can be magnified further still, revealing ever smaller structures. The map left behind by Chinese medicine emphasizes a different category of thing altogether: relationships, time, overall state, tendencies of change, and the interaction between a person and their environment.

These two maps were not drawn using the same method of surveying — their scales differ, and so do the things they mark. One map marks a mountain's elevation and the composition of its rock; the other marks which season the mountain tends to fog over, and which direction is prone to landslides. The two maps may well be charting the very same mountain, but one cannot simply lift a notation from one map and paste it onto the other, expecting it to correspond precisely.

 

2. Why This Book Does Not Adopt Several Common Claims

“The meridians are simply fascia,” “qi is simply ATP,” “yin and yang are simply the sympathetic and parasympathetic nervous systems,” “the Five Phases are simply five modern systems” — such claims are common, and appear to be “scientizing” Chinese medicine, but this book has repeatedly shown, through the specific discussions in Chapters Eight, Ten, Eleven, and Thirteen: every time such a simple equals-sign is drawn, something the original text meant to express is lost.

That connective-tissue winding can explain part of the mechanical sensation of “qi arriving” does not mean the meridians simply are connective tissue (Chapter Nine); that ancestral qi is directly related to respiration and heartbeat does not mean “qi” as a whole is some specific modern physiological indicator (Chapter Eleven); that the relationship between insulin and glucagon structurally resembles yin and yang does not mean yin and yang simply is the ancient version of homeostasis theory (Chapter Thirteen); that the mutual generation and overcoming of the Five Phases describes relationships among tendencies of change does not mean the human body genuinely contains five mechanisms corresponding to five modern systems (Chapters Fourteen and Fifteen). These simple equations, while appearing on the surface to give Chinese medicine a “scientific basis,” are in fact forcibly stuffing a relational map into the coordinate system of a structural map — and both end up distorted.

 

3. The Question Genuinely Worth Asking

A question more worth asking than “are the meridians fascia” is this: do these two maps, in certain places, each independently describe the same feature of the same mountain?

The research on kidney-yang-deficiency syndrome in Chapter Eleven is exactly such a successful comparison: Chinese medicine's diagnostic criteria singled out a group of patients, and modern endocrinology, working independently on this same group of patients, detected a stable, reproducible pattern of dysfunction. This is not a translation of “kidney-yang deficiency” into “hypothalamic-pituitary-adrenal axis dysfunction” — it is two maps, each using its own method, drawing contour lines on the same group of people that turn out to match. Chapter Thirteen's insulin and glucagon present a similar case: it is not that “yin and yang simply are these two hormones,” but that the relational structure between these two hormones happens to fall precisely within the kind of phenomenon that the relational language of yin and yang was originally meant to describe.

The way these two maps meet is not by painting over one to look like the other, but by each preserving its own way of drawing, and looking to see at which specific points they point to one and the same, genuinely existing thing.

 

4. What This Chapter Can Actually Confirm

First, modern medicine and the system left behind by Chinese medicine adopt different modes of observation and different objects of description — the former refined down to molecular structure, the latter emphasizing relationships, time, and overall state — the two are not the product of the same method of surveying.

Second, simple equations such as “the meridians are simply fascia” or “qi is simply ATP” have, as this book has shown one by one in its specific chapters, each lost part of the original concept's meaning, and cannot stand.

Third, the research on kidney-yang-deficiency syndrome in Chapter Eleven, and the example of insulin and glucagon in Chapter Thirteen, demonstrate the correct way for the two maps to “meet”: not by translating and replacing one with the other, but by each, independently, drawing matching results on the very same specific object.

The gaps that must be left standing are equally clear. This book has found only a small number of specific cases where the two maps can be confirmed to align; this cannot be generalized into a claim that “the two maps align everywhere” — nor, having found cases of alignment, can one turn around and say the two maps are, in essence, one and the same. They remain two independent systems of description, which happen, at certain specific points, each to touch upon the same real phenomenon.

The mountain is still the same mountain — it has not moved just because someone drew its contour lines wrong.

Two maps, each keeping to its own way of drawing, come closer to the truth than painting over one with the other.

The questions that needed asking have been asked. Finally, we must return to the question posed at the very beginning of this book: what did the ancients actually see?

 

 

Final Chapter: Do We See More Clearly Today?

Ancient physicians had no microscope.

They could not see bacteria, could not see viruses, could not see cells, and certainly could not see what had changed at a single base along a stretch of DNA.

Today, everything is different.

We can cut a tumor out, send it to a laboratory, and read out its genetic sequence base by base; we can identify exactly how a cancer cell differs from a normal one; we can even manufacture a drug tailored to a single person, based on that person's own tumor.

If ancient physicians could rely only on their own senses and long experience to observe the human body, then now that we have microscopes, scanners, and genetic sequencing, have we finally turned on every light there is?

A cancer treatment repeatedly making headlines in 2026 gives us exactly the occasion to examine this question.

It is not the protagonist of this chapter.

The protagonist remains: the act of “seeing” itself.

 

1. A Needle Made for Just One Person

The story begins with a dangerous skin cancer — melanoma.

The patient first undergoes surgery. The doctor removes whatever tumor can be found. After surgery, imaging can no longer detect the tumor at all.

But the problem is not entirely over. Even after complete surgical removal, high-risk melanoma can still recur.

So scientists proposed a very modern solution: since everyone's cancer is not quite the same, why not create a treatment belonging to each individual person?

This treatment was successively known as mRNA-4157 and V940, and later given the name intismeran autogene. It was developed jointly by Moderna and Merck, and is used in combination with pembrolizumab — already widely used in cancer immunotherapy, and known by the brand name KEYTRUDA.

Doctors send the excised tumor for genetic sequencing. The tumor cells may carry many mutations. An algorithm then selects, from among these mutations, up to 34 neoantigens unique to that patient — special targets the immune system may be able to recognize.

One can imagine this as creating a “wanted poster” for the immune system. In the past, the body only knew that dangerous cells had once appeared somewhere; now, the laboratory selects a set of special markers from this particular person's tumor, and hands this information to the immune system, in the hope that it will more easily recognize cells carrying these markers in the future.

Scientists write the information for these neoantigens into an artificially manufactured messenger RNA, package it in lipid particles, and inject it into the body.

It does not go directly to kill cancer cells.

What it actually aims to do is: train and activate a T-cell response targeted at these patient-specific neoantigens, so the immune system can more easily recognize cancer cells.

This idea is very elegant. And it is no longer confined to the laboratory.

 

2. What Does 49 Percent Mean?

In June 2026, five-year follow-up results presented at the American Society of Clinical Oncology annual meeting showed: among patients with completely resected, but high-recurrence-risk, stage III or IV melanoma, intismeran autogene combined with pembrolizumab continued to show a declining trend in the risk of recurrence or death, compared with pembrolizumab alone.

The number most easily seized upon by the media is “roughly 49%.”

Seeing this figure, it is easy to form the impression that cancer has been half solved.

But in medical statistics, “a roughly 49% reduction in risk” does not mean “49% of patients were cured.” What is being compared here is the relative risk of recurrence or death between two groups over the follow-up period.

There is another crucial detail: when receiving this adjuvant treatment, the patient's detectable tumor has already been completely removed by surgery beforehand.

In other words, this is not — there was a tumor in the body, and after one injection, the tumor disappeared.

It is — the tumor has already been removed, and now a new treatment is being used in hopes that it will be less likely to come back.

These are two entirely different things.

There is also a more basic question: in the end, do these people live longer?

At the five-year follow-up point, overall survival data remain immature. The research has seen a favorable direction, but it cannot yet be written up as proof of extended overall survival.

On August 19, 2026, the larger-scale Phase III trial INTerpath-001 announced top-line results: the combination regimen met its study endpoints on the two primary measures of recurrence-free survival and distant-metastasis-free survival. The companies had not yet released the complete data at that time, and the results still need to be presented in full at academic conferences and in peer-reviewed publications.

So the most accurate statement is not: “a cancer vaccine has cured skin cancer.”

It is: for patients with completely resected, high-recurrence-risk melanoma, this individualized neoantigen treatment, combined with pembrolizumab, has already shown evidence of reducing recurrence risk; how many more people this will ultimately allow to live longer still requires continued observation.

This sentence is not as thrilling as a news headline.

But it comes closer to what we actually know.

 

3. Modern Medicine Can Already See Extremely Small Things

Even so, we should still acknowledge: this is an astonishing technology.

Consider how far humanity has come.

Ancient physicians, observing a patient, could see their complexion, tongue, pulse, whether they felt cold or hot, pain, appetite, sleep, and urination and defecation.

Today's physicians can keep going further inward.

The organ.

The tissue.

The cell.

The protein.

The gene.

All the way down to a single mutation on a stretch of DNA.

In the past, a doctor faced a tumor.

Today, a laboratory may be facing: this particular set of genetic changes in this particular tumor in this particular person.

What precision medicine promises is exactly this: breaking the problem down to this level, and then searching for a solution suited only to this person, this tumor. An individualized treatment like intismeran autogene must even be redesigned according to the unique mutation profile of each patient's tumor.

Our eyes keep going deeper and deeper.

But here a very interesting question arises:

Does seeing smaller necessarily mean seeing more completely?

Being able to read out the genetic changes within a tumor is an enormous advance. But there remains a long road between “seeing an abnormality” and “knowing how to change it,” and further still to “actually letting a person live longer.”

Retrospective studies of newly approved cancer treatments by the U.S. Food and Drug Administration also remind us not to automatically equate “the ability to strike with precision” with “the ability to substantially extend life.” One study analyzing novel cancer treatments approved by the FDA between 2000 and 2016 found that, among randomized trials where an overall-survival benefit could be calculated, the median absolute overall-survival extension was 2.40 months. Another study, covering FDA cancer-drug approvals from 2003 to 2021, found a median overall-survival extension, among trials with available data, of 2.80 months.

This certainly does not mean these drugs are “useless.”

For a specific patient, those extra months may be extremely precious; the difference between individual drugs also varies enormously — a small number of breakthrough treatments deliver benefits far exceeding this figure.

What it genuinely reminds us of is only this:

Being able to see with ever finer resolution does not automatically translate into the ability to change the outcome of a whole, complete life.

Precision at the microscopic level does not automatically become completeness at the level of the whole.

 

4. The Microscope Grows Ever More Powerful, Yet the Person Remains a Whole

A cancer cell never lives in isolation.

It lives within tissue. The tissue lives within an organ. The organ belongs to a complete person.

And this person has an age, an immune state, a metabolism, a sleep pattern, a way of life, and a bodily condition shaped over decades.

One of modern medicine's greatest strengths is its ability to keep breaking a problem down into smaller pieces.

If the tumor is too large, study the cancer cell.

If the cancer cell is too complex, study the protein.

If the protein is still too complex, study the gene.

Eventually a mutation is found, and then a way is sought to target that specific point.

Sometimes this approach is extremely effective.

But cancer is not a static lock. Tumors change. Even the cancer cells within the very same tumor may not be entirely identical. The immune system changes. The microenvironment surrounding the tumor changes as well.

So we can, with great precision, identify a set of mutations, even select up to 34 neoantigen targets for a single person, and still be unable to predict, from these targets alone, how that person will ultimately fare.

This is not modern medicine failing.

Quite the opposite. This is the deeper problem modern medicine encounters, precisely because it has gone far enough:

Seeing the local picture ever more clearly does not automatically mean seeing the whole picture clearly as well.

Immunotherapy illustrates this same point. Releasing the anti-tumor immune response may help the immune system attack cancer cells, but it may also bring immune-related adverse reactions. What the treatment faces was never an isolated molecular pathway, but a human body that responds as a whole.

 

5. What the Ancient Chinese Looked At Was a Different Scale

Ancient Chinese physicians had no way of seeing cancer cells.

They did not even have today's entire system of pathological classification for “cancer.” Ancient medical texts contain various names — accumulation, aggregation, concretion, conglomeration, rock, wasting glory, stone abscess — but these names cannot simply be equated with any particular modern cancer.

What they saw was a different set of things altogether.

Does this person fear cold, or fear heat?

Are the hands and feet warm, or cool?

Is this lump hard, or soft?

Does it hurt, or not?

Can the person eat?

Can the person sleep?

Is the body growing stronger, or continuing to weaken?

How is the movement of fluids in the body?

What is the state of the qi and blood?

In the end, they placed these observations within frameworks of cold and heat, deficiency and excess, qi and blood, phlegm-damp, and stagnation, to make sense of them.

Modern people, encountering these concepts for the first time, often find them far too crude.

Compared with genetic sequencing, they certainly are crude.

But looked at from another angle, the scale at which the ancient Chinese observed was, in fact, extremely large.

Modern medicine can ask:

What mutation has occurred in this cancer cell?

Ancient Chinese physicians were more accustomed to asking:

Why has this person come to be the way they are now?

One keeps pressing ever deeper into the microscopic.

The other keeps placing the local part back within the whole person.

This is not to say one is superior to the other, nor that they can substitute for one another.

They simply place, once again, the question this book has been chasing since Chapter One, before us:

What, exactly, do the two maps each see in the human body?

 

6. What Is Most Worth Preserving in Traditional Case Records Is Not Just “the Lump Disappeared”

If an oncologist today wants to judge whether a treatment has worked, what do they look at?

What does the pathology show?

How much has the tumor shrunk?

Has it metastasized?

Has it recurred?

How many patients are still alive after several years?

Is there a difference compared with those who did not receive this treatment?

These questions matter enormously. Without them, it becomes very easy to attribute natural fluctuation, other treatments received at the same time, or even purely incidental change, to a particular therapy.

Ancient physicians had none of these tools.

What traditional case records more often document is a different set of changes: can this person eat again? Has the pain eased? Has the jaundice receded? Are the hands and feet warm? Can they sleep? Could they not walk before, and can they walk now?

These indicators cannot substitute for pathology, imaging, staging, and survival statistics.

That a person feels somewhat better does not mean the cancer has disappeared; that a lump feels softer cannot, by touch alone, prove the tumor has shrunk; that a patient lived a long time cannot, from a single case, prove which treatment caused it.

But this does not mean these observations are therefore worthless.

Because what a patient ultimately cares about was never only the shadow on a scan.

They will also ask:

Can I eat?

Can I sleep?

Can I still walk?

Can I hurt a little less?

Can I live a little longer, and still live, during that time, like a person?

The greatest strength of traditional case records is that they so often stay closely tied to “what happened to this person afterward.”

Its greatest limitation lies in exactly the same place:

It can tell us how one person fared afterward, but it can hardly, on its own, tell us how a hundred similar people would typically fare.

So traditional case records are worth preserving, and must also be held to a stricter standard of documentation going forward.

If these cases are to be studied again today, they should, at minimum, simultaneously preserve imaging, pathology, staging, any other concurrent treatments, symptoms, functional status, quality of life, and long-term follow-up, both before and after treatment.

Only then can “seeing a complete person” avoid becoming an excuse for refusing to measure anything at all.

 

7. Two Kinds of “Seeing,” Each With Its Own Blind Spot

Now, placing that individualized needle described earlier alongside the map of the human body left behind by ancient Chinese physicians, the difference becomes very clear.

A modern laboratory can take apart a single person's tumor, tracing it all the way down to a mutation on a gene, and from there select a set of targets to design an individualized treatment for that one person.

This is an observational capability ancient Chinese physicians could never have imagined.

The other tradition, left behind by ancient Chinese medicine, keeps reminding physicians instead to place the local part back within the whole person, to place today's symptoms back alongside yesterday and tomorrow, to place illness back within diet, sleep, cold and heat, exertion and rest, and the body's long-term pattern of change.

These things, of course, cannot substitute for pathology, imaging, and survival statistics.

The reverse holds equally true.

Because being able to see the gene does not mean the gene has explained the whole of the illness.

The easiest mistake to make here is rushing to decide who is right and who is wrong.

Without modern medicine, we would not know what genetic changes had occurred within cancer cells, nor could we manufacture an individualized treatment designed according to a patient's own tumor-mutation profile. These are real advances.

But if, because we can now see the gene, we conclude that the gene has already explained the whole of the illness, that too goes too far.

Traditional medicine's emphasis on a person's overall state is a valuable observational tradition. But simply knowing that a person is “cold,” “deficient,” or “stagnant” cannot, on its own, tell us what modern pathological type this particular lump actually is, whether it has metastasized, or how fast it is progressing.

So perhaps the question was never:

Were the ancients right, or are people today right?

What is genuinely worth asking is:

What did each of them see, and what did each of them fail to see?

 

8. We Can Finally Return to This Book's Original Question

Having come this far, we can ask again:

What did the ancient Chinese actually see?

They did not see cells.

They did not see genes.

Nor did they see the numbers that appear today on the screens of modern instruments.

But they observed, over long periods, a different set of things:

How a complete person moves from health into illness;

How cold and heat change;

How diet, sleep, emotion, exertion and rest, and the seasons change together with the body;

How a local problem appears alongside the state of the whole body at the same time;

Whether, after treatment, a person is moving toward recovery, or continuing to decline.

These observations were later organized into different frameworks: yin and yang, the Five Phases, the meridians, qi and blood, cold and heat, deficiency and excess.

Today, we certainly should not assume these concepts are all correct simply because they are ancient.

But neither should we assume the ancients saw nothing at all, simply because modern instruments cannot, for now, see certain traditional concepts.

Two thousand years later, humanity possesses the most powerful observational tools in its history.

We can see cells.

See viruses.

See molecules.

See genes.

We can even see the unique set of mutations within one person's tumor, and, based on them, select up to 34 neoantigens to design an individualized treatment.

The data from 2026 is already dramatic enough: the risk of recurrence can drop markedly, and yet humanity must still wait for time to answer the most basic question of all — will this person, in the end, live longer?

Our “eyes” have never been this powerful before.

Yet perhaps the very thing medicine most needs to guard against occurs precisely at a moment like this:

We very easily mistake “what I am able to see” for “everything that exists.”

The ancient Chinese may have made this mistake.

Modern people can make it just as easily.

So what this book ultimately leaves behind should not be an answer about who wins and who loses between Chinese medicine and modern medicine.

It should be a question instead:

As our instruments grow ever more powerful, are we truly seeing more and more — or are we simply seeing one particular part more and more clearly?

Genuine “seeing” must include not only successes but also the capacity to see failures; not only the tumor but also the person carrying that tumor; not only the curve of recurrence but also the eating, the walking, the sleeping, and the price paid in pursuit of a lower chance of recurrence.

Perhaps genuine progress is not only about building ever more powerful microscopes.

It also includes knowing — when it is time to set the microscope down for a moment, and look again at the whole, complete person.

The maps may differ. The human body is only one.

 

References for the Final Chapter

1. Merck & Moderna. 2026 ASCO Annual Meeting: 5-year data for intismeran autogene (mRNA-4157/V940) plus pembrolizumab in high-risk resected stage III/IV melanoma.

2. Merck & Moderna. 19 August 2026: Phase III INTerpath-001 top-line results in completely resected stage IIB-IV melanoma.

3. Naci H, et al. Clinical Trial Evidence Supporting US Food and Drug Administration Approval of Novel Cancer Therapies Between 2000 and 2016. JAMA Network Open. 2020. Median absolute overall-survival benefit: 2.40 months among trials with calculable OS benefit.

4. Michaeli DT, Michaeli T. Overall Survival, Progression-Free Survival, and Tumor Response Benefit Supporting Initial US Food and Drug Administration Approval and Indication Extension of New Cancer Drugs, 2003-2021. Journal of Clinical Oncology. 2022;40:4095-4106. Median OS increase: 2.80 months.

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