Int J Med Sci 2011; 8:s26-s42. doi:10.7150/ijms.8.s26


Health Maintenance in Ancient China

Livia Kohn Corresponding address

Professor Emerita, Boston University, P.O. BOX 609, Dunedin, FL 34697, USA

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See for full terms and conditions.
Kohn L. Health Maintenance in Ancient China. Int J Med Sci 2011; 8:s26-s42. doi:10.7150/ijms.8.s26. Available from

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The ancient Chinese concept of health reaches far beyond the mere absence of symptoms to include the presence of a strong vital energy known as qi. A smooth, harmonious, and active flow of qi creates harmony in the body and a balanced state of being in the person. This personal health is further matched by health in nature, defined as regular weather patterns and the absence of disasters. It is also present as health in society in the peaceful coexistence among families, clans, villages, and states. This harmony on all levels, the cosmic presence of a steady and pleasant flow of qi, is what the Chinese call the state of Great Peace, a semi-utopican but pervasive vision venerated by all philosophical schools.

Defining the body in energetic terms and requiring the perfect functioning of bodies on all levels of existence, the Chinese health program is not limited to one set of methods or practices, nor does it stop at healing patients. Rather, it leads people to reach extended years, improve their quality of life, and realize themselves fully in the World.

Keywords: Vital energy, Han dynasty, acupuncture, longevity, exercises, meditation, energy medicine, energy psychology


The essential concept of Chinese traditional medicine is vital energy: qi. Qi is the concrete aspect of the Dao, the material energy of the universe, the basic stuff of nature. In ancient sources it is associated with mist, fog, and moving clouds. The character for qi as it appears in the oracle bones of the Shang dynasty (1766-1122 BC), consists of two parts: an image of someone eating and grain in a pot. Even today, it shows the word for “rice” under a wind-blown “sail”: 氣. Combined, these various parts signal qi as the quality which nourishes, warms, transforms, and rises. Qi, therefore, is contained in the foods we eat and the air we breathe; it is the life force in the human body and as such the basis of all physical vitality.

By extension, qi also denotes anything perceptible but intangible: atmosphere, smoke, aroma, vapor, a sense of intuition, foreboding, or even ghosts. There is only one qi, just as there is only one Dao. But it, too, appears on different levels of subtlety and in different modes. At the center, there is primordial qi, prenatal qi, or true, perfect qi; at the periphery, there is postnatal qi or earthly qi­—in constant motion and classified in categories such as temperature, density, speed of flow, and impact on human life.

2. AIM

The aim of this paper is to present the core medical practices, as documented in manuscripts and early textbooks that go back to the Han dynasty (206 BC - 220 AD), including first of all acupuncture and moxibustion as well as various herbal remedies. In addition, a number of so-called longevity techniques will be presented, these being both preventative and health-enhancing. Finally, such topics as the fundamental attitudes of moderation and ethical awareness, methods of dietary adjustment and sexual control, as well as physical and breathing exercises and visualizations of energetic patterns will be addressed.


3.1 Smooth flow

Qi is the basic material of all that exists. It animates life and furnishes functional power of events. Qi is the root of the human body; its quality and movement determine human health. Qi can be discussed in terms of quantity, since having more means stronger metabolic function. This, however, does not mean that health is a by-product of storing large quantities of qi. Rather, there is a normal or healthy amount of qi in every person, and health manifests itself in its balance and harmony, its moderation and smoothness of flow. This flow is envisioned in the texts as a complex system of waterways with the “Ocean of Qi” in the abdomen; rivers of qi flowing through the upper torso, arms, and legs; springs of qi reaching to the wrists and ankles; and wells of qi found in the fingers and toes (1)1. Even a small spot in this complex system can thus influence the whole, so that overall balance and smoothness are the general goal.

Human life is the accumulation of qi; death is its dispersal. After receiving a core potential of primordial qi at birth, people throughout life need to sustain it. They do so by drawing postnatal qi into the body from air and food, as well as from other people through sexual, emotional, and social interaction. But they also lose qi through breathing bad air, overburdening their bodies with food and drink, and getting involved in negative emotions and excessive sexual or social interactions.

It is thus best to breathe deeply and to eat moderately in accordance with the seasons, to move smoothly, exercise without exertion, and match activities to the body's needs. This is how one keeps balance and creates health. As the Spring and Autumn Annals of Master Lü (Lüshi chunqiu), a text from about 260 BC, has it:

One wants the skin to be tight, the blood vessels to allow unimpeded motion; the sinews to be firm and the bones hard; the heart, mind, and will to be concordant; and the vital energies to flow. When this is happening, agents of disorder [sickness] have nowhere to abide and pathology has nowhere to be produced. The abiding of agents of sickness is the origin of pathology, which is blocking the flow of qi. (2)2

Health is not just the absence of symptoms and ailments. It is the presence of a strong vital energy—especially in the five main energy centers of the body, the five inner organs (heart, lungs, liver, kidneys, and spleen) and the six viscera (small and large intestine, stomach, bladder, and gall bladder; (3))— and of a smooth, harmonious, and active flow of qi through all the various energy lines or “meridians” that connect these ceterns with the periphery of the body, notably the hands and feet. This is known as the state of zhengqi or “proper qi,” also translated as “upright qi.” The ideal is to have qi flow freely, thereby creating harmony in the body and a balanced state of being in the person. This personal health is further matched by health in nature, defined as regular weather patterns and the absence of disasters. It is also present as health in society in the peaceful coexistence among families, clans, villages, and states. This harmony on all levels, the cosmic presence of a steady and pleasant flow of qi, is what the Chinese call the state of Great Peace (taiping), a state venerated by Confucians and Daoists alike (4).

3.2 Pathologies

The opposite of health is xieqi or “wayward qi,” also called “deviant qi,” “pathogenic qi,” “heteropathic qi,” or “evil qi.” All these expressions are used in Western textbooks to translate the same Chinese term. The variety reflects the different views of the translators and shifts the meaning of the term and thereby the understanding of what goes on in the body. Typically, medical or Latin-based words like “heteropathic” tend to be more technical and overshadow the moral implications of the original term, while words like “evil” or “deviant” have moral and social rather than medical implications.

Xieqi or “wayward qi” is qi that has lost the harmonious pattern of flow and no longer supports the dynamic forces of change. Whereas zhengqi moves in a steady, harmonious rhythm and effects daily renewal, helping health and long life, xieqi, disorderly and dysfunctional, creates change that violates the normal order. When it becomes dominant, the qi-flow can turn upon itself and deplete the body's resources. The patient no longer operates as part of a universal system and is not in tune with the basic life force around him or her. Xieqi appears when qi begins to move either too fast or too slow, is excessive or depleted, or creates rushes or obstructions. It disturbs the regular flow and causes ailments (5).

Qi can become excessive through outside influences such as too much heat or cold or through inside patterns such as too much emotion or stimulation. Excessive qi can be moving too fast or be very sluggish, as in the case of excessive dampness. Whatever the case, from a universal perspective there is no extra or new qi created, but localized disharmonies have arisen because existing qi has become excessive and thus harmful. Still, even describing it in this way we are thinking in terms of qi as an energetic substance, which it really is not. A better way to speak of it would be to say that the process itself of turning hot or angry is qi, that the way things move and change is what constitutes our being qi.

Similarly, qi can be in depletion. This may mean that there is a tense flow of qi due to nervousness or anxiety, or that the volume and density of qi have decreased, which is the case in serious prolonged illness. However, more commonly it means that the qi activity level is lower, that its flow is not quite up to standard, that there is a lower than normal concentration of qi in one or the other body part. In the same vein, perfection of qi means the optimal functioning of energy in the body, while control of qi means the power to guide the energetic process to one or the other part (6).

 FIG 1 

The proper (left-hand) and wayward (right-hand) flow of qi.

Int J Med Sci Image (Click on the image to enlarge.)

To conceptualize qi in the body, imagine a fluid-filled sack under water. The sack has a semi-permeable membrane: it can absorb the external fluid and excrete fluid out. The water surrounding the sack has waves that also influence its inner fluids. Viewed from a bird's-eye perspective as an integrated system, every wave and eddy in both sack and water are “upright” or “correct,” because that is just how things are. However, within the smaller system of the sack there is a microcosm of flow, which can be out of balance (see FIG.1). This imbalance can come from exposure to certain aspects of the greater flow, which causes the internal flow to become overly committed to one specific pattern. Or it could be that the fluid in the sack has too much or too little internal substance, and is thus unable to keep up with external patterns. Whichever it is, the uncooperative flow within the smaller sack is xieqi or “wayward qi.” From a universal perspective, any flow is just flow. From the perspective of the individual body, some flow may be wayward because correctness (health) is the desired state (1)3.

For the Chinese system, this means that medical treatments serve to correct qi-flow from a deviant or wayward pattern back to a harmonious or correct flow, matching the rhythm of the Dao, creating health and well-being in the person, and aiding him or her in familial and professional interactions. By extension, in the preventative branch of medicine, known as yangsheng or “nourishing life,” treatments combined with various practices also serve the enhancement and strengthening of the proper flow of qi, allowing people to fully go along with all the movements of the manifest Dao in order to enjoy health, retain vigor, and live long and successful lives.

3.3 Physics

To understand qi properly, we need to realize that it functions in subtle forms and activities and that, therefore, it should not be described in terms of substance or as a limited “energy.” Rather, the way qi works should be expressed in terms of relationships and correspondences, in terms of what it does and how it impacts cosmos and self. Qi is process. The way to describe health and sickness accordingly is by speaking not about an existing quality but about the way things function.

In this respect Chinese medical worldview is not unlike that of modern physics (7). Here chaos theory describes the way things work in terms of a well-functioning natural control system marked by a fair degree of unpredictability; a constant chance for new possibilities and new discoveries; an unceasing process of movement, change, and transformation. This transformation, moreover, is described in terms of quantum fields, which unlike gravity or magnetism, carry neither matter nor energy.

Quantum physics states that the subatomic world is in no way like the World we inhabit. Energy is not continuous, but instead comes in small units: quanta, the energy that electrons absorb or emit when changing energy levels; and gluons, the forces that hold atoms together. The most basic subatomic particles behave like both particles and waves, and many of these particles form pairs like yin and yang, where one cannot exist without the other. The movement, moreover, of these particles is inherently random. It is impossible to know both the exact momentum and location of a particle at the same time—in fact, there is an inverse relation in that the more information one has about the former, the less is known about the latter, and vice versa (see

Quantum physics has shown that matter is made up of vibrating energy and fields, which change their state very rapidly—trillions of times in one second. Atoms are largely empty and consist of a tiny nucleus that is ten thousand times smaller than the rest of the particle—99,999 parts being emptiness. Body and mind consist of the same vibrating atoms that are constantly oscillating, arising and dissolving: all empty, no solidity, no firmness. As a result, reality has to be understood less as the combination of solid entities than as an interlocking web of fields that each pulsate at their own rate. These interlocking fields of vibration—described in China as patterns of qi-flow—can come into harmony with each other and mutually support and increase their amplitude. But they can also interfere with each other and create disturbance. Since all fields are ultimately interlocked, even a small disturbance in any one of them carries into all the others. This holds true not only for the body, but also integrates the mind into a vibrational body-mind totality. Just as bodily transformations are of unlimited possibilities, so the mind is ultimately non-local; it can be anywhere and exchange information with anything else instantaneously.

3.4 Sounds and vibrations

The body-mind continuum is also at the root of the understanding of qi in Chinese cosmology, which explains it in terms of vibration and sound. It states that all existing things consist of qi-flow and have form or shape, which inevitably vibrates at a certain frequency, creating a certain wave pattern and a specific sound. As a result, the entire universe is humming along in the joining of many different qi-sounds. The Book of Master Zhuang (Zhuangzi; ca. 250 BC) accordingly talks about the “piping of humanity,” the sounds people make when they speak and interact; the “piping of earth,” the sounds of nature in all the different places on the planet; and the “piping of heaven” the creation of the universe in its diversity through the Dao. The description of the “piping of earth” is most vivid and also applies to the other forms. The text says:

They roar like waves, whistle like arrows, screech, gasp, cry, wail, moan, howl. Those in the lead cry out yeee; those behind cry out yuuu. In a gentle breeze, they answer faintly; but in a full gale, the chorus is gigantic. And when the fierce wind has passed on, then all the hollows are empty again. Have you never seen the tossing and trembling that goes on? (8, 9)4

The formation of pathology follows the same paradigm of the cosmic creation of sounds and vibrations through the movement of qi. “Wind is the cause of the hundred diseases,” the ancient medical classics say. “It enters the body and exhausts human qi,” mingling with “the eight winds in heaven and the five winds in the arteries of the body.”

A similar view of the universe as a conglomeration of vibrating, closely interconnected entities is also found in modern physics. As Itzhak Bentov describes it, all is constantly surrounded by sound. Sound can appear as random acoustic disturbances, such as voices, body, hand, or air movements, or again in rhythmic patterns as a note, a single acoustic frequency (10). An experiment known both to the ancient Chinese and modern physicists is the harmony created among two string instruments. If you pluck the string of one lute, the matching string on a lute sitting next to it will begin to vibrate. Similarly, if you apply the violin bow to sheet metal with sand, you get a distinctive pattern of standing waves or nodal points that form both active and quiescent areas. These show the pattern of qi in the universe, the alteration between ups and downs, activity and rest.

Smooth qi-flow is thus essentially entrainment or vibrational harmony among different objects or parts of the same entity. Various modes are possible. Superimpose two sounds of identical wave pattern: hill matches hill, valley matches valley, and the amplitude of the original wave pattern is doubled. This is called constructive interference or the “productive” pattern of qi-interaction. Superimpose two sounds of opposite wave pattern: the exact opposite happens, they cancel each other out and the wave vanishes into a straight line. This is disruptive interference, the creation of disharmony and a “destructive” form of qi- interaction.

In the case of varying wavelengths, moreover, some phases match each other while others do not. This results in a curve that goes up and down, is far apart at one point, then meets again and parts again. A rhythmic pattern of interaction emerges, typical for the natural and human world. This, in turn, matches not only the classical view of the movements of Dao and qi in the Chinese universe, but also modern physics. As described by David Bohm in Quantum Theory (1951), living organisms are intrinsically dynamic (11). Their visible forms are nothing but apparently stable manifestations of underlying processes that change continuously in rhythmic patterns—fluctuations, oscillations, vibrations, waves.

The ideal of harmonious qi-flow and entrained vibrations, then, is a completely resonant system. The waves of one entity impinge on another so that it moves in the same frequency. This, in essence, is the definition of health in Chinese culture. The qi-vibrations of each body part resonate smoothly with all others. We as people resonate harmoniously with the people and things around us; society and nature resonate perfectly with each other. The ideal of Great Peace, the total harmony of Dao, is reached when all beings and things hum on the same wavelength and frequency, in a state of optimum transfer and total resonance.

3.5 The body

In terms of medicine, this means that the body is a conglomeration of various vibratory fields described in terms of energy centers and channels. Never can there be just one single cause for a given symptom, but the interconnection of the whole needs to be examined. Nor can the body be viewed in isolation, but should be seen in relation to the many fields outside: planets, earth, society, family, and so on. Disease and disorder may be related to the out-of-tune behavior of one or the other section in the flow of vibration, but they affect the whole and can be approached from many different angles. Corrections come accordingly in various forms and should have an effect on the entirety of the system, applying a strong harmonizing rhythm to any given part of the vibration pattern. Eventually the flow moves back into its harmonious rhythm and health is recovered.

To sum up, the body, society, nature, and the planetary fields can be imagined as a huge bowl of fairly rigid jelly with raisins in it (10). Vibrate one part of it, and the rest also vibrates. One section cannot move without the other, and even the slightest touch to one single raisin will immediately transmit movements to all the others and the body of the jelly—a concept the Chinese describe as “impulse and response” (ganying). The same also holds true for human bodies. We all have electrical charges in and around us, which are measurable and can be felt. The Chinese see these charges as the body's qi-field which not only interacts with the organs and parts on its inside but also with the electric field of things around it and the planet at large—a field that is weaker but still present. Through systematic qi-enhancement practices, people can achieve a fully tuned system that not only is very healthy, but may attain long life and even immortality.


In 1973, a group of manuscripts written on silk, bamboo, and strips of wood, was excavated from tomb no. 3 at Mawangdui near Changsha (Hunan) (see FIG. 2). In the Han dynasty, this region was part of the ancient southern kingdom of Chu, where feudal lords still ruled over their own small enclaves in semi-independence. The tombs at Mawangdui accordingly belonged to the members of a local feudal family, the Marquis of Dai, his wife, and his son.

4.1 The tombs

All three tombs consisted of a vertical pit about 17 meters (50 ft.) deep, with a wooden burial chamber at the bottom. The burial chamber had a central area to hold three internested coffins plus four surrounding storage areas for burial goods (12). Undisturbed, the three tombs contained a veritable treasure trove, which included not only food stuffs, garments, and miniature servants and companions, but also the famous Mawangdui banner from tomb no. 1. A T-shaped, rectangular piece of colorfully illustrated silk, it covered the inner coffin and showed the tomb's inhabitant how to move toward the celestial realm, presided over by the sun and the moon together with various deities (13).

This tomb held the body of the local ruler's wife, the Marchioness of Dai, a lady of about fifty years of age. Although her tomb was excavated first, she was in fact the last of the three to die—in 168 BC. Tomb no. 2 was the last resting place of the Marquis himself, a man by the name of Li Cang, who served as chancellor of the Chu kingdom in Changsha. He was installed as Marquis in 193 and died in 186, his tomb therefore being the oldest. Tomb no. 3 housed the son, a younger man of about thirty, who like his mother, was buried in 168. It is not clear which of the Marquis's children he was. Some think he was the oldest, Li Xi, who succeeded him as lord; others suspect he was a younger son who pursued a military career, as possibly indicated by the various weapons and other military insignia found in the tomb (12).

His tomb contained the manuscripts in a rectangular lacquer box with a roof-shaped lid, 60 cm long, 30 cm wide, and 20 cm high (2 ft. by 1 ft. by 8 in.), found in a storage area east of the coffin. Most manuscripts appeared on silk sheets but some were also written on slips of bamboo or flat sticks of wood. In general, bamboo and wood were less expensive and easier to work with, since scribes could erase any errors with a sharp carving knife. Silk was more precious and demanded higher skill, as technicians had to blot out any mistakes they made. On the other hand, silk was much easier to handle, fold, and store. Also, it preserved the contents better, because wood or bamboo slips would over time come out of their fastenings and be mixed up (12).

 FIG 2 

Map of China. Changsha, north of NANYUE, is the area where the manuscripts were discovered.

Int J Med Sci Image (Click on the image to enlarge.)

4.2 The texts

The total number of manuscripts found at Mawangdui is thirty, covering forty-five separate texts (12). This means that some pieces of silk or bundles of bamboo slips contained more than one text, which in some cases gives an indication of how certain techniques or ideas were possibly related. Many of the texts are nonmedical and discuss various aspects of traditional Chinese thought. The best known among them are two versions of Laozi's Daode jing, which closely resemble the standard, transmitted version we are familiar with and thus establish the presence of this classic in the early second century BC (translation 14).

The texts are written in both Han clerical and traditional seal script, the latter—according to traditional historiography—being the dominant form of Chinese writing before the script reform under the First Emperor of Qin in 214. Using the scripts as a basis, Donald Harper dates some of the manuscripts to the third century BC and others a bit later (15,12)5. Recent research, as for example the study on the development of Chinese writing by Imre Galambos (16), suggests, however, that all kinds of different scripts were still being used well into the Han dynasty, so that we cannot be certain of the texts' date on this basis.

Fifteen texts are specifically medical manuscripts on qi­-channels and ways of preserving health. For the most part, they deal with technical questions, such as the diagnosis of disorders and the use of moxibustion or cautery—the burning of dried mugwort or artemisia vulgaris—on points of the major channels (17). Five texts among them, one included in two editions, clearly represent an early stage of the channel and diagnostic system as it became dominant later. Three contain herbal and magical recipes; one specializes in childbirth (12,18).

They speak about ways to harmonize yin and yang, find alignment with the Dao, nourish life through herbs, breathing exercises, sexual techniques, as well as methods of absorbing qi, abstaining from grains, and undertaking therapeutic exercises (12). The texts describe various healing modalities, including moxibustion, spells, rituals, healing exercises, sexual practices, drugs, massages, cupping, bathing, and fumigation, but no acupuncture. Needles are mentioned only as a means to open abscesses in the body and to apply pressure to hemorrhoids. The main method used to stimulate qi in the body is moxibustion (18). More specifically, the texts know of eleven meridians, associated with the five yin and six yang organs. However, they do not call them meridians (jingluo), but arteries or vessels (mai), thus expressing a concept of qi linked intimately with the blood and its circulation. They form an important basis for the full expression of Chinese medical treatments in the classical textbooks, which arose a century or two after the manuscripts.

4.3 Classical textbooks

The main group of classical textbooks, which form the foundation of traditional Chinese medical knowledge is the corpus surrounding the Yellow Emperor's Inner Classic (Huangdi neijing), a collection of texts from several medical schools of the Han dynasty. Here for the first time a twelfth meridian was added for symmetry and the blood vessels were separated from the meridian system, thus establishing two different networks of circulation in the body. The concept of qi became more abstract and was classified as a major yang vitality, while the blood was seen in more cosmic and energetic terms as a key yin vitality, although it never lost its concrete meaning (see

The most important collection on Chinese medicine, the group consists of dialogues between the Yellow Emperor (Huangdi) and various medical masters who teach him how to understand and heal the human body. It describes how the Dao underlies all as universal harmony, how yin and yang establish the world, and how the body is organized and works. Relying on qi energetics, it outlines the major methods of diagnosis and key types of diseases, recommending not only immediate cures but also long-term adjustments in lifestyle through calming the spirit, regulating the diet, and taking proper exercise. It deals extensively with the practice of acupuncture.

The Yellow Emperor's Inner Classic consists of four separate texts, which in contents go back to the Han dynasty but were edited later. The most important is the Yellow Emperor's Simple Questions (Huangdi neijing suwen; translation in 19, 20, 21), where the Yellow Emperor is in dialogue with the mythical physician Qi Bo. Its surviving edition was compiled by Wang Bing and dates from 762. A second version is the Yellow Emperor's Divine Pivot (Huangdi neijing lingshu; translation in 22,23), edited by Yang Shanshan around the year 600. It contains similar materials as the Simple Questions but presents different partners of the Yellow Emperor and is an indication of different schools within acupuncture.

A third text of the same group is the Yellow Emperor's Classic of Great Simplicity (Huangdi neijing taisu), also edited around the year 600 but not translated to date. The fourth and last work is the Yellow Emperor's Classic of 81 Difficult Issues (Huangdi bashiyi nanjing; translation in 24), which was transmitted as a key manual to Korea and Japan and has remained popular among acupuncturists there. It is divided into eighty-one parts that each begins with a question or “difficult issue,” which is then addressed in detail. This text, too, is in dialogue format and presents essentially the same material as the Simple Questions, but it is more integrated, better organized, and reveals a more complex system of different schools, pathologies, and diagnoses joined together. All three texts received numerous commentaries and were reorganized variously by medical masters.

A comprehensive summary of much of the same material was created in 282 AD by Huangfu Mi and is known as the Systematic Classic of Acupuncture and Moxibustion (Zhenjiu jiayi jing). “The oldest extant technical book devoted to acupuncture and moxibustion” (20), this already lists 649 of the 670 acupuncture points commonly used today. It is the first extant text to emphasize acupuncture as a means of disease prevention, providing detailed descriptions of the meridians, point names and locations, as well as needling techniques. From the same period stems also the Pulse Classic (Maijing) by Wang Shuhe (210-286 AD), which describes twenty-four pulses with analytical diagnoses. The book served to establish the study of pulses as an independent branch of Chinese medicine.


The dominant mode of treatment that distinguishes Chinese medicine from those of other cultures is acupuncture. Its origins are unclear. One argument says that it was discovered when soldiers were wounded by arrows in battle and upon recovery found that their various other diseases had disappeared together with the injury. Another argument, presented by Paul Unschuld in Medicine in China, speaks of demon medicine based on a form primitive thinking that saw the cause of sickness outside the body and located it predominantly in the supernatural realm (25). Thus the earliest Chinese character for “sickness” (ji) shows the combined picture of a bed and an arrow, signifying that the person was hit by a supernatural arrow and is now lying prone on his bed (see FIG. 3). The character for “physician” (yi) consists of an arrow in a box together with a lance and a pitcher of wine, revealing the military-style repertory of early physicians. Also, many medical texts speak of disease “invading” while physicians “attack” and “vanquish” it.

 FIG 3 

The Chinese characters for “sickness” and “physician”.

Int J Med Sci Image (Click on the image to enlarge.)

Another speculation on the origins of acupuncture maintains that it developed from the treatment of boils and abscesses with pointed stones in conjunction with the practice of bloodletting to release wayward qi. This practice, joined by an elementary connection of extremities to inner organs, is also known from ancient Greece and may indicate a possible contact among the ancient cultures (26). It is also documented that cramps, numbness, and paralysis were treated with needles in south China from an early period. As part of this theory, scholars suggest that the burning of moxa preceded acupuncture and that the needles were later added to support and help it. This is supported by evidence from the Mawangdui manuscripts.

A specific aid to memorization of acupuncture channels and points has been the use of human figurines, first discovered in a wooden statue with meridian lines and point markings that was unearthed in Sichuan in southwest China and dates from the second century BC, leading to speculations that the technique may have originated there. Similarly, a bronze figurine from the eleventh century shows remnants of mercury and wax at indentations marking points. Written documents explain that these indentations were filled with mercury and covered with wax for examination purposes. When a candidate at a prefectural or imperial medical school correctly stabbed the point, the mercury would flow out, and he would pass the exam. Similar statues are still common today, mostly made from plastic and painted with lines in different colors.

5.1 Needles

Acupuncturists in traditional China used needles made from various materials. The earliest needles from stone, thorns, bamboo, or bone, were later replaced by metal—iron, copper, bronze, gold, and silver. Steel was not discovered until the middle of the fifth century AD and only sufficiently developed for acupuncture practice around the year 800. Still “acupuncture could never have reached the height of its effectiveness, administering its stimuli while causing the minimum of injury to the tissues, without wire-thin, and therefore metallic, needles” (20). The stainless steel, disposable needle is still standard today.

 FIG 4 

Types and shapes of acupuncture needles. Source Zhenjin dacheng

Int J Med Sci Image (Click on the image to enlarge.)

The needles, moreover, came in various forms, many of which are still in use today (see FIG. 4). Most common are thin needles of medium length used for general acupuncture. Sharp arrowheads are used for superficial or shallow needling, applied to particularly sore areas, as well as in children and the elderly. Needles with a soft, rounded top are used for local massage. Those with a blunt head help to exert pressure in specific areas. Three-edged needles are used to puncture veins; sword-like needles help to drain abscesses; sharp and round ones are for rapid pricking; and very long needles, up to five or six inches, are used for joints and solid tissue areas. Contemporary Chinese needles tend to be longer and thicker than those used in Korea and Japan, where they are as thin as a hair and come in a plastic tube for safe- keeping and easy insertion.

5.2 Needle techniques

Before inserting a needle, the practitioner finds the correct point by exerting pressure in the area where it should be located. The point is found when the spot is sensitive and slightly sore to the touch, or the skin forms a slight hollow or a distinct mound. Then he or she inserts the needle, holding it between the thumb and index finger of one hand while tightening the skin with the other. The most common angle of insertion is 90 degrees, but on the chest, head, and arms it is often also 45 degrees, usually in the direction of qi-flow, or even only 15-25 degrees in more sensitive areas, such as the top of head or near the eyes.

To enhance the qi-giving power, the needle can be raised and lowered or twirled and rotated a few times after insertion, using movements that often have exotic names, like “circling dragon,” “fire on the mountain,” or “three emanations of heaven.” Balanced raising and lowering ensures that the meridian is both tonified and drained equally. A deeper, slower lowering causes tonification, while a more shallow, faster lowering creates drainage. Similarly, small twirling and rotation ensures tonification, while larger, more extensive rotation causes the qi to drain. Also, the needle can be placed in the direction of the meridian to enhance tonification or against it to provide draining. Should a stronger effect be desired, the skin may also be pressed outward from the needle and along the meridian to encourage qi-flow.

To protect himself or herself, the practitioner should synchronize breathing with that of the patient and ideally insert needles on a mutual exhalation. This prevents large amounts of wayward qi flowing directly into the practitioner. There should be neither blood nor pain when a needle is inserted, although certain spots can be sensitive. However, there should be a definite feeling of “getting qi.” This can be felt both at the insertion point and in the area of symptoms. For the patient, getting qi means a sense of warmth and vitality when a point is tonified, and a sense of coolness, release, or opening when qi is drained. The practitioner, too, can feel the arrival of qi, sensing a fullness and stronger pulse in cases of successful tonification, and receiving a feeling of tension and contraction under the needle and a lesser pulse in cases of drainage. The rule of thumb is that the faster deqi is achieved, the better the prognosis.

Once the qi has arrived, the needles may be taken out again immediately or left in place for ten or more minutes to keep up stimulation. In some complex cases, and as guided by some practitioners, needles are left in even longer, for half an hour or more. The time of continued stimulation allows the patient's system to adjust to the new balance created in the body, activating his or her own innate healing powers and homeostatic functions. The same process is repeated twice, once for the front and once for the back of the body.

Other acupuncture techniques include cutaneous needling, where a delicate hammer-head instrument called a plum blossom needle is tapped lightly over the skin in the direction of meridian flow (in cases of severe deficiency); bloodletting, where a sharp, triangular needle is inserted in a specific point to release some blood (in cases of excess heat or high fever); piercing, where the skin is pierced open and underlying fibers are severed with a large needle or knife (in cases of skin eruptions); and cupping, where a vacuum is created in a round glass vial by passing an open flame inside it, then the vial is quickly placed on the skin where it pulls the flesh and muscles upward, thus stimulating an entire area.

5.3 Moxibustion

Supplementing the needles is the practice of moxibustion, the burning of mugwort or artemisia on the body. Collected best in the fifth month, the herb is thoroughly dried in the sun, then ground into a powdery substance. It is applied in four ways: moxa cones, moxa cigars, moxa boxes, and moxa on needles. The most common are moxa cones. Small amounts of the powdered herb are shaped into small cones, which are then dried again in the sun so that the oils evaporate and the herb burns slowly. The cone is placed either directly on the skin or on top of a small buffer, such as a layer of salt or a slice of fresh ginger or garlic. With a lighted incense stick, the cone is set afire and burns slowly down. If placed directly on the skin, it can either be extinguished as soon as the heat reaches the body or be allowed to burn down to leave a scar. The latter is used mainly for chronic conditions in patients with a strong constitution. Usually moxa is applied several times to the same point (3).

Moxa cigars are long, rolled up cylinders that contain larger portions of the herb. They are lighted at the front and held about one inch above the chosen point to create a sense of heat and qi-flow. They may be removed at times by raising the cigar, then lowered again, over a period of several minutes. The moxa box is a small wooden box with a web-like bottom on which powdered moxa is placed. When the herb is burned, the box warms up. Held over the treatment area, it allows a diffuse and less intense heat to influence the flow of qi in a larger segment of the body. Moxa on needles, used mainly in Korean and Japanese acupuncture, involves the placing of a small cone of moxa at the end of a needle. As it is set alight, the needle heats up and has increased impact on the qi.

Moxa is dominantly used to tonify and stimulate qi-flow as well as to expel cold and dampness. It smells rather like marijuana and creates a fairly intensive smoke, which also tends to linger in clothes. For this reason, although it is a highly efficient way of treatment, it is received with some reserve by Westerners who prefer smokeless forms of moxa or TDP lamps. In East Asia, on the other hand, moxa is used commonly, not only by practitioners but also by the patients themselves. Readily available do-it-yourself kits provide small home-use cones, where the herb is placed in a tiny cylinder placed on a round base, which in turn has a sticky bottom for adherence to the skin. These cones never burn directly down to the skin and give some relief to colds and muscle aches. The modern explanation for the efficacy of moxibustion is that it is a heat-transfer medium, but the traditional view sees it as vibratory stimulation, like rubbing or stroking.

5.4 Points

While nearly all acupuncture points are available for needling, quite a few are not indicated for moxibustion. The textbooks will in each case specify whether or not a point is recommended for moxa treatment or should be avoided (see To treat a given disorder, the acupuncturist after establishing a diagnosis, has to decide which points to treat and in which manner. To select a point, various guidelines are offered.

First there are local points, near the area of pain or symptoms. A good example is “Large Intestine”-20 at the side of the nostrils for nasal congestion. Next, there are remote or distal points, located on the meridian associated with the disorder but at a distance, most commonly below the elbow or knee. Examples here are “Stomach”-36 on the lower leg and or “Liver” -3 on top of the foot. Third, there are symptomatic points, chosen not because they are close to the pain or on the same meridian but because they work for the same kinds of symptoms. For example, “Large Intestine”-4 between thumb and index finger or “Liver”-11 in the crease of the elbow may be chosen for their fever-reducing qualities even if the disease has nothing to do with the large intestine (5).

Another type is what might be called theme points, i.e., points that contain a similar name and work for similar disorders. A good example is a group of points that have to do with “wind,” a major cause of disease, almost all are found at the back of the head and around the neck and shoulders. Needling them in all cases controls wind after it has entered the body, having a releasing and warming effect. They are used to treat colds, paralysis, itches, joint pains, headaches, and vertigo (27). Another example is a set of three points that deal with “water.” They are used to reduce swellings, help in cases of epilepsy, and enhance digestion, especially urination. Located in the face, abdomen, and lower torso respectively, they are also closely associated with the triple heater and open their respective body sections to the release of water (28).

Acupuncture is effective and useful for a plethora of conditions and is increasingly accepted also in Western medical circles. However, the other, possibly even more far-reaching contribution of Chinese medicine to modern bio-science is the systematic restructuring of life-style and the integrated practice of the so-called longevity techniques.


The foundation of all longevity techniques (yangsheng) is a regular life-style in moderation, which means adapting to the seasons and the natural environment and living without excess in any form or shape. This is also coupled with certain basic ethical rules, such as being compassionate to others and avoiding potential harmful behaviors. Beyond these fundamental tenets, the actual practices involve guidelines for diet, sexual activity, physical exercises, and qi guiding through visualization. Let us now look briefly at each of these.

6.1 Moderation

Moderation involves avoiding all overindulgence in food and drink as well as other sensual and sexual pleasures, observing instead guidelines for healthy living. The principle of moderation goes back far in the literature and is the key topic of most longevity texts, from the early medical manuscripts through numerous medieval works to the modern age (29, 30, 31). A major way in which the texts express it is in the format of twelve things to do only in “little” increments:

Think little, reflect little, laugh little, speak little, enjoy little, anger little, delight little, mourn little, like little, dislike little, engage little, deal little.

If you think much, the spirit will disperse.

If you reflect much, the heart will be labored.

If you laugh much, the organs and viscera will soar up.

If you speak much, the Ocean of Qi will be empty and vacant.

If you enjoy much, the gall bladder and bladder will take in outside wind.

If you get angry much, the fascia will push the blood around.

If you delight much, the spirit and heart will be deviant and unsettled.

If you mourn much, the hair and whiskers will dry and wither.

If you like much, the will and qi will be one-sided and overloaded.

If you dislike much, the essence and power will race off and soar away.

If you engage yourself much, the muscles and meridians will be tense and nervous.

If you deal much, wisdom and worry will all be confused.

All these attack people's lives worse than axes and spears; they diminish people's destiny worse that wolves and wolverines. (30,32)6

In other words, harmony with Dao manifests itself in mental stability and physical wellness, and any form of agitation or sickness indicates a decline in one's alignment with the forces of nature. The various mental activities and strong emotions will harm key psychological forces and thus bring about a diminishing of qi, which takes one further away from the Dao and reduces life.

Citing the ancient immortal Pengzu, the fourth-century Long Life Compendium (Yangsheng yaoji ) further points out that heavy clothing and thick comforters, spicy foods and heavy meats, sexual attraction and beautiful women, melodious voices and enticing sounds, wild hunting and exciting outings, as well as all strife for success and ambition will inevitably lead to a weakening of the body and thus a reduction in life expectancy (30). Along the same lines, the Discourse on Nourishing Life (Yangsheng lun) has a set of six exhortations to release mental strain and sensory involvement:

  1. Let go of fame and profit.
  2. Limit sights and sounds.
  3. Moderate material goods and wealth.
  4. Lessen smells and tastes.
  5. Eliminate lies and falsehood.
  6. Avoid jealousy and envy.

In other words, to practice moderation for long life, one must understand self and body as manifestations of Dao and qi, and maintain an attitude of fundamental goodness and moderation in all things—both physical and psychological. As the Zhuangzi says: “Focus on the essence of life and do not trouble yourself with what life cannot do” (8)7.

6.2 Ethics

Since Dao and qi arrange the World to perfection, there should really be no need for ethical behavior. However, while Dao and qi are in essence morally neutral, the universe functions in such a way that human goodness contributes to its positive unfolding—as in zhengqi—while evil or moral laxity may create obstructions—as in xieqi. For this reason, ethics play an important role in long life practice.

The seventh-century work On Nourishing Inner Nature and Extending Life (Yangxing yanming lu) says:

The reason why diseases arise is because of the five exertions. Once these are present, they will affect the two organs of the heart and kidneys, which will in turn be subject to wayward qi. Then organs and viscera will equally become diseased. The five exertions are [creating exertion through] 1) the will, 2) thinking, 3) the mind, 4) worry, and 5) fatigue. They create six forms of extreme pressure [stress] in the body, in 1) qi, 2) blood, 3) tendons, 4) bones, 5) essence, and 6) marrow. These six in turn cause the seven injuries, which transform into the seven pains. The seven pains create disease. (32)8

Remedies not only involve general forms of sensory moderation, but also the practice of the five Confucian virtues which each have a positive impact on an inner organ: benevolence counteracts aggression and the urge to kill, associated with the liver; wisdom helps with greed, the inner urge to steal and take what is not freely given associated with the kidneys; righteousness or social responsibility ward off the tendency toward sexual misconduct associated with the lungs; propriety and awareness of social niceties helps to release the desire for intoxication and other forms of uncontrolled behavior associated with the heart; and, finally, honesty or trustworthiness prevents lying and cheating in every form associated with the spleen. Ideally all virtues should be practiced equally to prevent the negative impact of ethical violations on health and long life, but it is perfectly acceptable to work mainly on one—the preferred center being honesty—and thereby set a positive cycle of overall goodness and stress release into motion.

Texts also outline ethical principles in terms of formal precepts, which typically include first of all the classic five precepts against killing, stealing, lying, sexual misconduct, and intoxication, central in Vedic, Buddhist, and Jain ethics as well as in Daoism and in moral systems all over the world—often called the great universal rules (33). They further include guidelines for social behavior, requiring filial piety toward the parents and loyalty toward the ruler as well as generosity and kindness toward those worse off than oneself and circumspection in using language: no lying, gossiping, slander, backbiting, bragging, cursing, or using bad words (34). All these contribute not only to social harmony but also to an easier personal life, which in turn prevents the various stresses on body and mind and therefore helps to avoid disease. Living a good life thus means living a long and healthy life.

6.3 Diet

The basic dietary teaching in China is to use clean and fresh foods, pure in color and clear in texture. Avoid anything old, moth-eaten, rotten, poor in quality, as well as anything processed, canned, or preserved. The more natural the food, the better. In this point, Chinese food cures are in perfect agreement with Western health food supporters.

Then, however, the differences begin. Food in China is not classified on the basis of the food pyramid and its chemical constituents, such as carbohydrates, proteins, and fats, nor do they use calories or free radicals or other modern evaluation methods. Rather, the Chinese system arranges foods according to properties, flavors, and energetic movements. The most basic division is into yin and yang. Yin foods tend to grow in the earth and in dark, shady locations; they are sweet in flavor, fatty in consistence, and rich in potassium. Yang foods grow in air and sunshine; they are salty in flavor, lean in consistence, and rich in sodium. Yin foods include raw food, leafy vegetables, fish, and mellow tasting substances; they have a cooling, moisturizing, and decongesting effect, and promote fluid production while mitigating heat accumulation. Yang foods include anything fried, boiled, fatty, or spicy, as well as meats; they are warming, drying, and stimulating in nature, and as they absorb the cooking heat, they generate heat in the body and stimulate circulation.

Within this general system, food has three major properties:

  1. stimulating: yang—warming—expanding—rising—qi-enhancing
  2. calming: yin—cooling—contracting—sink­ing—qi-reducing
  3. neutral: neither yin nor yang—stabilizing—conserving—qi-maintaining (1)9

Chinese food is cooked and generally eaten warm, ready to be transformed energetically and absorbed into the body. Portions in all cases should be small and one should never eat to fullness but leave a quarter of the stomach empty. Thus in the morning, for example, when yang is low and yin is dense after a night's sleep, one should take warm, dynamic foods that do not burden the central organs of spleen and stomach. The ideal form of preparation is accordingly a cooked cereal, closely followed by whole-grain bread, while anything cold (juices, cereals) or heavy (bacon and eggs) tends to be counterproductive.

At noon, the body needs to replenish its qi and continue to be warmed and energized. Lunch should, therefore, be warm and plentiful, consisting of steamed food and stir-fries, with soups as a supplement. Dishes should be mainly made from vegetables with minor amounts of lean meat, seafood, or eggs. Cold food (salads, yogurt) or heavy dishes (fatty meats, cakes), increase dampness and phlegm and will create tiredness rather than aid the positive flow of qi.

In the evening, yang should begin to calm down and yin be allowed to rise. To this end, the best food is gentle and quieting, and one should avoid all kinds of intense yang as found in hot spices and fatty, heavy dishes. Stews are ideal, but easy stir-fries and soups may also serve. It is important not to eat too late to allow the body time for digestion before going to sleep. Also, many medical texts recommend taking a short walk after the evening meal to stabilize the energetic pathways (35,36)10. Again, matching the seasons and adapting the life-style to one's personal needs are central features in managing health.

6.4 Sexual practices

Sexual energy is one of the major forms of qi in the human body. Known as essence (jing), it resembles breath and food in its exchange with the outside world and role in maintaining health. Essence is the key to vitality and health; it easily diminishes through sexual engagements. As a result, Chinese medicine focuses on how to conserve the stock people have originally and how to replenish what is lost. The first—conservation—tends to focus on times and frequencies of intercourse as well as on massage techniques that keep the qi flowing. It does not advise celibacy, since the flow of sexual energy is important for health, and complete abstinence creates qi-blockages that do more harm than good in the long run. The second—replenishing—concentrates on the “return” or “reversion” of essence into qi with the help of both partner and meditative practices.

In general, sexual exchange with a loving partner should be undertaken regularly. However, there are certain times when it is not recommended to have sex: after a heavy meal, when intoxicated, after strenuous activity or an acupuncture treatment, when acutely ill, during emotional upheaval, when suffering pressure in the bladder or bowels, during menstruation, and at times of severe, inclement weather. All of these are situations that upset the internal qi-balance of the person. They need to be resolved before successful sexual activity can be experienced.

To enhance sexual enjoyment, partners should take certain herbs and teas, such as ginseng, cinnamon, cardamom, nutmeg, ginger, and other warming, yang-inducing substances. Before engaging in sexual activity, they should create a pleasant atmosphere in a clean environment and prepare by taking a bath. It is good to allow plenty of time for foreplay, making sure both partners are ready and aroused, focusing on the exchange of qi in mouth, breasts, and genitals—stimulating the jade spring (saliva), the white snow (nipple qi), and the moon flower (vaginal excretion). Both male and female sexual secretions contain hormones, enzymes, proteins, and vitamins, and both benefit from their exchange.

In addition, a key practice is the reversion of sexual energy upward and inward instead of letting it flow down and out. Men in particular are to create a state of arousal in a sexual encounter, wait for the urge to ejaculate, then—holding their breath, clenching their teeth, and contracting the perineum muscles (may even use manual pressure)—they prevent ejaculation and instead guide the aroused and clearly tangible essence back into the body, moving it up along the spine and circulating it through the torso. This method is “reverting essence to nourish the brain.”

This practice is recommended especially in older males and for people wanting to enhance and increase their longevity. It also stands at the center of sexual longevity techniques known as “bedchamber arts,” documented already in the Mawangdui manuscripts.11 The bedchamber arts taught men to have interrupted intercourse, ideally with as many women as possible, preferably young and healthy ones. They should bring their partners to orgasm so the women would emit their sexual essence but never have an ejaculation themselves. The doctrine behind the practices assumes that while women's qi is lost through transformation into menstrual blood they possess an inexhaustible supply of yin fluids and will not suffer from having frequent orgasms.

Women, then, have their own set of practices to contain and revert essence or rather “blood” (xue), the equivalent of jing in the female body (43, 44). They involve daily breast massages (moving the hands in various ways and directions), a change in diet to lighter foods, supplementing the diet with various herbs (usually those today used for menopause symptoms), and a series of meditations in which the red menstrual blood is visualized rising upward and transforming into clear-colored qi. The practice helps to enhance vital energy and improve health; if done in conjunction with partner massages and gentle sexual activity, it can have a profoundly healing effect for conditions that in bio-medicine may require surgery or massive doses of drugs (40).

6.5 Exercises

Chinese healing exercises are called daoyin, literally “guiding” the qi and “stretching” the body; today they are known as qigong or “energy work.” Like other body practices such as the much better known yoga, daoyin uses physical stretches and movements in all the different positions of the body, proposes systematic sequences of postures, and gives them names that may be descriptive or after various animals. It also works with conscious control and manipulation of the breath and with the intentional guiding of qi through the body.

Historically daoyin is first documented in Han-dynasty manuscripts, notably the Exercise Chart (Daoyin tu ) and the Stretch Book (Yinshu) (see FIG. 5). The former consists of forty-four color illustrations of human figures performing therapeutic exercises that are explained in brief captions. The figures are of different sex and age, variously clothed or bare-chested, and shown in different postures (mostly standing) from a variety of angles. In many cases, they have one arm reaching up while the other stretches down, one arm moving forward while the other extends back, possibly indicating rhythmical movement.

 FIG 5 

Illustrations of Han-dynasty exercises. Source: Daoyin tu.

Int J Med Sci Image (Click on the image to enlarge.)

The captions are often illegible, but among them are the well-known “bear amble” and “bird stretch” (still used in qigong), showing a figure walking in a stately fashion with arms swinging and one bending forward with hands on the floor and head raised, respectively.

The Stretch Book is a prose text with no illustrations. It supplements the images by providing concrete practice instructions, describing and naming specific moves. For example:

“Bend and Gaze” is: interlace the fingers at the back and bend forward, then turn the head to look at your heels (#12).

“Dragon Flourish” is: step one leg forward with bent knee while stretching the other leg back, then interlace the fingers, place them on the knee, and look up (#19).

“Pointing Backward” is: interlace the fingers, raise them overhead and bend back as far as possible (#29). (32, 45)

After presenting forty exercises of this type, the text focuses on the medical use of the practices. It often repeats instructions outlined earlier and in some cases prescribes a combination of them. For example, a variation of lunges such as “Dragon Flourish” is the following, which can be described as a walking lunge:

To relieve tense muscles: Stand with legs hip-width apart and hold both thighs. Then bend the left leg while stretching the right thigh back, reaching the knee to the floor. Once done, [change legs and] bend the right leg while stretching the left leg back and reaching that knee to the floor. Repeat three times (#46).

Another variant of the lunges is recommended to relieve qi-disruptions in the muscles and intestines. Lunging with the left foot forward and the right leg back, one goes into a twist by bending the right arm at the elbow and looking back over the left shoulder. After three repetitions on both sides, one is to maintain the lunge position while raising one arm at a time and then both arms up as far as one can (each three times), bending the back and opening the torso (#68). The idea seems to be that by stretching arms and legs one can open blockages in the extremities while the twisting of the abdominal area aids the intestines.

Exercises like these in the medical section of the text also include breathing techniques, notably special exhalations that serve to balance the temperature, to strengthen the body, and to harmonize qi-flow, as well as exercises in other than standing positions, such as seated, kneeling, or lying down. For example, to alleviate lower back pain, one should lie on one's back and rock the painful area back and forth 300 times—if possible with knees bent into the chest. After this, one should lift the legs up straight to ninety degrees, point the toes, and—with hands holding on to the mat—vigorously lift and lower the buttocks three times (#55).

Following its outline of concrete exercises, the text places the practice into a larger social and cultural context, noting that the most important factors in causing disease are climatic excesses and lack of moderation:

People get sick because of heat, dampness, wind, cold, rain, or dew as well as because of [a dysfunction] in opening and closing the pores, a disharmony in eating and drinking, and the inability to adapt their rising and resting to the changes in cold and heat. (46)12

Later documents expand on these early prescriptions, creating daoyin exercises, sequences, and entire systems (like the Five Animals) that loosen muscles, lengthen tendons, release tensions, and lubricate joints. Done gently but regularly, they greatly help in the maintenance and enhancement of health.

6.6 Visualization

Supplementing these exercises, practitioners also mentally harmonize vital energy and guide it systematically into the various parts and throughout the body. The most fundamental technique involves a visualization of the five inner organs with their appropriate colors, seeing them glossy and radiant and connecting to the cosmic energies of the five directions: liver—green—east; heart—red—south; lungs—white—west; kidneys—black—north; and spleen—yellow—center.

Another method involves seeing the inner organs as objects and activating them energetically with the help of psychological agents. For example, the fifth-century Exercise Scripture (Daoyin jing) presents the “Eight Spirit Exercises” of the immortal scribes to Wangzi Qiao. According to this, practitioners begin by lying on their back, their neck supported by a pillow, their feet five inches apart, and their hands at ease three inches from the body. Relaxing the mind, they inhale through the nose and exhale through the mouth, allowing the breath to become so subtle that it is all but inaudible but remaining aware of movements in the belly as the qi is swallowed together with saliva. Next, they engage in a systematic vision of the body:

See the throat as a succession of white silver rings, stacked twelve levels deep. Going downward, you reach the lungs, which are white and glossy. They have two leaves reaching tall in front, and two leaves hanging low in back. The heart is connected to them underneath. Large at the top and pointed below, it is shining red like an unopened lotus bud hanging down from the lungs.

The liver is connected to it underneath. Its color is a clear green like a male mallard's head. It has six leaves that envelop the stomach—two in front that reach up tall and four in the back that hang down low. The gall bladder connects to it underneath, like a green silk bag. The spleen is in the very center of the belly, enwrapped from all sides. It is bright yellow like gold, lustrous and radiant.

Behind all this, see the kidneys lying back to back like two sleeping rats, curled up with elbow to navel and as if they wanted to stretch out. Their color is a thick, glossy black. Fat streaks run through them, so that the white and black glow jointly. (32)13

Following this, practitioners are to become aware of the different psychological agents that reside in the various organs: the spirit, subtlest form of qi and master of the psyche (heart); the spirit souls that move us toward intellectual, artistic, and spiritual pursuits (liver); the material souls, responsible for our survival that manage the instincts to eat, sleep, and reproduce (lungs); the intention, the function that provides general direction to our endeavours (spleen); and the will, which channels this direction into concrete patterns (kidneys) (6,47,3)14. They should also note whether there are any areas in the body that are empty or full, that is, suffer from insufficient or excessive qi. Should there be places that are empty, it is best to keep the eyes closed during practice; for full areas, it is best to keep them open. In addition, if there are major blockages or painful areas, they can consciously infuse qi into them, breathing deeply and calmly or holding the breath for a period. They thereby gradually dissolve the obstruction and relieve the pain.

7. Conclusion

To sum up, the ancient Chinese embraced a concept of health that included physical well-being, psychological balance, and social harmony as well as an extended longevity—in the firm belief that human beings should be able to fulfill their natural life-span of 120 years—and a considerable amount of both awareness of and control over their health conditions. The most important contribution they can make to modern bio-science is to open the understanding of the body as an energetic system and of the importance of conscious life-style choices, mental (and ethical) attitudes, simple but regular movement, and inner visions of body and self. In many ways, these aspects—together with traditional Chinese methodology—are already being included in the new branches of science called energy medicine and energy psychology.

Energy medicine is at the forefront of developing a new energetic understanding of the body and advanced medical terminology. Its most important new concepts are measurable biomagnetic fields and bioelectricity. Biomagnetic fields are human energy centers that vibrate at different frequencies, storing and giving off energies not unlike the inner organs in the Chinese system. Their energetic output or vibrations can be measured, and it has been shown that the heart and the brain continuously pulse at extremely low frequencies (ELF). It has also become clear through controlled measurements that biomagnetic fields are unbounded so that, for example, the field of the heart vibrates beyond the body and extends infinitely into space, verifying the Chinese conviction that people and the universe interact continuously on an energetic level.15

Similarly, bioelectricity manifests in energy currents that criss-cross the human body and are similar to the meridians of acupuncture. Separate from and, in evolutionary terms, more ancient than the nervous system, these currents work through the so-called cytoskeleton, a complex net of connective tissue that is a continuous and dynamic molecular webwork. Also known as the “living matrix,” this webwork contains so-called integrins or trans-membrane linking molecules, which have no boundaries but are intricately interconnected. When touching the skin or inserting an acupuncture needle, the integrins make contact with all parts of the body through the matrix webwork. Based on this evidence, wholeness is becoming an accepted concept, which sees “the body as an integrated, coordinated, successful system” and accepts that “no parts or properties are uncorrelated but all are demonstrably linked” (52)16.

The body as a living matrix is simultaneously a mechanical, vibrational, energetic, electronic, photonic, and informational network. It consists of a complex, linked pattern of pathways and molecules that forms a tensegrity system. A term taken originally from architecture where it is used in the structural description of domes, tents, sailing vessels, and cranes, tensegrity indicates a continuous tensional network (tendons) connected by a set of discontinuous elements (struts), which can also be fruitfully applied to the description of the wholeness of the body.

Energy psychology similarly sees the body as consisting of “various interrelated energy systems (such as the aura, chakras, and meridians), which each serve specific functions” (53). According to this understanding, the visible and measurable material body is supported by an underlying network or skeleton of living energy that forms the foundation of all bodily systems.17 With the help of various simple daily exercises, not unlike daoyin and visualizations of qi, people can enhance their “energy aptitude,” the ability to work effectively with internal energies. It has four components: a fundamental careful awareness of energetic patterns, the ability to influence these patterns in a beneficial way, the faculty to perceive energies in other people and outside objects, and to join or transform these outside energies in a beneficial way (53)18.

Daily exercises include many moves familiar from qigong and already used in daoyin; they involve pressing key acupuncture points while breathing deeply and visualizing energies flowing through the body. Like daoyin exercises, they make use of various bodily postures and involve self-massages of key areas, such as the face, the scalp, and the abdomen. In some cases, meridian lines are opened through placing the hands at either end and allowing the energies to flow, in others simple bends stretches in conjunction with conscious breathing and mental release serve the purpose. While these are all similar to practices already advocated in daoyin, the closest exercise is something known as the Auric Weave, a passing of the hands over the energy lines of the body, which is known as Dry Wash in daoyin and practiced as Marrow Washing in qigong (53)19.

Like energy medicine, energy psychology thus makes ample use of traditional Chinese concepts and practices, requiring more active involvement and responsibility of the individual but also leading to greater well-being and quality of life.

Conflict of Interest

The author has declared that no conflict of interest exists.


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Author contact

Corresponding address Corresponding author: Tel: 727-501-6915; E-mail: Liviakohncom



See page 33


see chapter 4, page 121


See page 13


See chapter 2, page 35 of Watson B. 1968


See chapter 2, page 15 of Harper D. 1982


See page 170-171 in Stein S 1999 & page 71 in Kohn L. 2008


See chapter 19, page 197 in Watson B. 1968


See chapter 2


See page 138


See page 613-617 in Engelhardt U. & Hempen C-H. 1997 & page 31-32 in Kohn L. 2010


Western presentations of Chinese sexual practices include Chang (37); Ishihara and Levy (38) for translations of manuals; Chia and Winn (39); Wik and Wik (40) for technical instructions; van Gulik (41); Wile (42) for cultural and historical context as well as translations.


See page 216


See page 124


See page 184-185 in Porket M. 1974; page 52 in Ishida H. 1989, & pages 59-62 in Kaptchuk TJ. 1983


The most important works in this context are Becker and Sheldon (48); Gerber (49); Seem (4, 50); Targ and Katra (51). A good summary of recent findings appears in Oschman (52).


See page 49, citing E. F. Adolph


Other, earlier works on energy psychology include Pert (54); Gach and Henning (55); Gallo (56).


See pages 204-205


See pages 233-235

Published 2011-2-15