External Disease and formula composition

By Derek Yang

According to traditional Chinese philosophy, human body is created in the same way as the universe,
sharing the same underlying physical material, and the same set of underlying forces that supports all
functions and movements.

In this paper, we leverage the ancient classic “Fu Xing Jue” to help us under the underlying theory of
pathogenesis and treatment of external diseases, or knowns ad heavenly induced diseases.

How our universe is formed, and what moves it?

According to Taoism, the universe is formed through the following stages:

1. At the beginning, there is nothingness

2. From nothingness, one singular being emerges. This is called the Primordial point
3. The Primordial point evolved into two bearings: Heaven and Earth, resulted in TaiJi
4. With Heaven and Earth defined, a plane in between emerges, where the four coordinates are
set: North, East, West and South
5. Within the dimension defined, Earthly materials are composed from the five fundamental
elements: Water, Fire, Earth, Wood and Metal
6. Within the dimension defined, 4 sets of opposing heavenly forces are established, which are
represented by the Chinese Trigram
a. Heaven and Earth: representing ascending and descending actions
b. Fire and Water: representing heating and cooling actions
c. Mountain and Wind: representing stopping and moving actions
d. Thunder and Sea: representing expanding and collecting actions
7. It is through interaction of Earthly materials and Heavenly forces, that all fates and phenomime
are created.

Human body and the universe

Human body mirrors the universe in both material aspect, as well as the functional aspect:
Earthly Material: The five yin organs of the body represent the five elements that underly the
material world:
1. Liver – Wood
2. Heart – Fire
3. Spleen – Earth
4. Lung – Metal
5. Kidney – Water

Heavenly Force:

3 of thhe 4 sets of actions are performed by each of the yin organs

1. Ascending and Descending: function of SP (or Earth element)

 2. Expanding / Collecting: Function of Liver / Lung
3. Heating / Cooling: Function of Heart / Kidney

The final set of function: stopping and moving, are not considered in the book, as the human body is
always moving and circulating, and stopping means death.

As individual organs are closely related to each set of heavenly functions, practitioners may enhance /
moderate each heavenly functions by tonifying / reducing each function’s corresponding organ.

Fu Xing Jue, a new classic for treating external diseases

Throughout history, Traditional Chinese Medicine practitioners have been leveraging the classic “Shan
Han Lun”, and its paradigm of 6 layers of depth in human body, for the treatment of external diseases.
In the early 1900s, a new classic, call “Fu Xing Jue”, or Extraneous Secrets, provided a new paradigm in
looking at how to approach the understanding and treatment of external disease.

Fu Xing Jue was first discovered in a cave near Duan Huang, along with lots of other religious artifacts, by
a French archeologist. It is essentially a religious scripture, teaching individuals how to reach the state
of enlightenment. The content of the book include how individual organ functions in the body, how the
body organs correspond to different constellations, and how to treat any imbalance within the body’s
micro universe using herbs with specific flavors.

During the culture revolution, the original copy of Fu Xing Jue on a silky scroll was taken apart to make
shoes. The descendent of its original owner and his disciples attempted to resurrect the classic by
resighting it from memory. As a result, there are multiple versions of Fu Xing Jue today, and minor
inconsistencies existed among these versions, especially around herbal categorizations.

However, the key contents around organs, their functions, and their associated flavors for treatment are
consistent across different versions of Fu Xing Jue, and is quite reliable as a reference of the original text.

Organ / Flavor description according to Fu Xing Jue

In accordance with Fu Xing Jue, each organ has a corresponding material base and a unique function in
our body. Individual organ is responsible to convert its associated material base, sometimes called the
yin aspect of the organ, to the organ’s unique heavenly function, also known as the Yang aspect of the
organ. When the organ is healthy there is a constant conversion between and Yin and Yang aspect of
the organ. When the Yin and Yang aspect of organ is in balance, that also means the body condition
surrounding individual organ is favorable for the organ to convert its material base to its function, and
the organ is said to be in a harmonized state.

Internal disease happens when individual organ’s conversion of Yin and Yang is out of balance. This
could manifest in either:

1. Functional deficiency: Insufficient conversion of and organ’s material base into its function,
resulting in a relative deficiency of the organ’s function against its material base.
2. Functional excess: Over active conversion of an organ’s material base into its function, resulting
in a relative deficiency of the organ’s material base against its unique function.
In functional deficiency, the insufficient conversion may be due to the weakness in the organ’s ability to
convert Yin into Yang, or it could to due to an unfavorable condition surrounding the organ to prevent it
executing the conversion action.

By combining individual organ’s description, as well as the action of individual flavors, one can
summarize the teaching as the following:

1. Liver:
a. Corresponding Heavenly Function is Expanding
i. Use Acrid to Tonify it
ii. Use Sour to Reduce it
b. Fear Tension, use Sweet to loosen it
2. Heart:
a. Corresponding Heavenly Function is Heating
i. Use Salty to Tonify it
ii. Use Bitter to Reduce it
b. Fear slackness, use Sour to tighten it
3. Spleen:
a. Corresponding Heavenly Function is Ascending /Descending (SP is ascending, ST is
descending)
i. Use Sweet to Tonify it
ii. Use Acrid to Reduce it
b. Fear dampness, use Bitter to dry it
4. Lung:
a. Corresponding Heavenly Function is collection and constriction
i. Use Sour to Tonify it
ii. Use Salty to Reduce / prevent over astringent, which may lead to over binding
and un-yielding.
b. Fear qi stagnation, use Acrid to ensure free flow of qi
5. Kidney:
a. Corresponding Heavenly Function is cooling and consolidating
i. Use Bitter to Tonify it
ii. Use Sweet to Reduce / loosen it
b. Fear dryness, use Salty to moisten the essence

Pathogenesis of Heavenly Induced Disease

Our universe moves in predictable cycles, following the movement of the sun and the moon. As
time moves, the 8 heavenly forces strengthen and weaken, creating different seasons and
weathers. As long as our body’s central qi is strong, the forces in our body would be able to
react and adapt to the changing forces in our environment, which helps us to reach harmony
with external world. However, as our body’s primordial qi weakens, or if the external
environment moves unpredictably, the external forces may interfere undesirably with our
body’s internal forces, which result in diseases.
Treatment of external diseases according to Fu Xing Jue
According to Fu Xing Jue, three sets of imbalances of internal body forces ultimately are
influenced by external environment:
1. Ascending and Descending
2. Expanding and collecting / constricting
3. Heating and Cooling
And the treatment of such imbalances will be through tonifying/reducing the underlying organ /
element to restore harmony:

1. Restore the Earth

2. Balancing the Wood and Metal
3. Crossing the Water and Fire

Restore Earth:

1. When Ascending Function is impaired, clear Yang cannot rise. This would yield the following signs
and symptoms:
a. Yang cannot contain Wei at body surface: Body surface heat and sweat
b. Wei exhaustion: Wind aversion
c. Yang deficiency: Fatigue
d. Yang exhaustion: Abd urgency and low appetite

Treatment formula for these conditions is: Yang Emerging Decoction

RenShen, ShenJian, GanCao, DaZao and ShaoYao is called the Primordial decoction, which generally
tonify Earth with 3 sweet flavor and 1 acrid flavor, and with overall neutral temperature.

To enhance ascending of clear Yang, the Yang Emerging Decoction adds GuiZhi, YiTan and HuangQi,
with further tonify the Earth function with warm temperature

2. When Descending Function is impaired, turbid yin cannot be descended. This would yield the
following signs and symptoms:
a. Turbid stagnated in the body: Trunk heat Abd fullness / pain
 b. Qi stagnated: Fullness in chest/coastal region, vomit / diarrhea
c. Qi rebel: Headache / eye pain, dizziness / vertigo
d. Unsmooth qi movement: alternative chill and fever

Treatment formula for these conditions is: Yin Emerging Decoction

RenShen, ShenJian, GanCao, DaZao and ShaoYao is called the Primordial decoction, which generally
tonify Earth with 3 sweet flavor and 1 acrid flavor, and with overall neutral temperature.

To enhance descending of turbid yin, the Yin Emerging Decoction adds HuangQin, BanXia and
ChaiHu. With 2 Bitter herbs and 1 salty herb, this addition tonifies water (which is said to belong to
the same family with Earth) with cold temperature

Balance Wood and Metal

1. When Expanding function is impaired, the following would result:

a. Yang and Wei constricted below body surface: No sweating and internal heat. Cold aversion
b. Chest qi constricted: Coughing and wheezing
c. Vessel constricted: Body pain and tight pulse

Treatment formula for these conditions is: Azure Dragon Decoction

 This formula includes 4 acrid herbs, 2 sour herbs, and 1 sweet herb. Overall this tonifies Wood’s
expanding function with warm temperature

2. When Constricting function is impaired, the following would result:

a. Yang and qi flowing out of surface: Fever and Sweating
b. Fluid loss: Thirst and irritated
c. Vessel expanded: large pulse

Treatment formula for these conditions is: White Tiger Decoction

This formula includes 3 sour herbs, 1 salty herb, and 1 acrid herb. Overall this tonifies Metal
constricting function with cold temperature.

Cross Water and Fire

1. When there are Insufficient water to support fire, the following would result
a. Deficiency heat: fidgeting, unable to sit still. Agitation and irritability. Toss and turn at
night
b. Excess heat in blood: Dysentery
c. Qi exhaustion: Thin and exhausted
 Treatment formula for these conditions is Vermillion Bird Decoction

This formula includes 2 bitter herbs and 1 sweet herb, helps tonify water with cool
temperature. It also has two salty and moist herbs (JiZiHuang and EJiao) to help nourish the
fire.

2. When there are insufficient fire to support water, the following would result
a. Yang deficiency: Cold limbs, fatigue and tiredness, and diarrhea
b. KD Qi deficiency: Frequent urination
c. Cold stagnation: Cold and pain in abdomen

Treatment formula for these conditions is Black Tortoise Decoction

This formula includes 3 sweet flavor, 1 bitter herb to reduce water with hot flavor. The
formula also has 2 Acrid herbs, which combined with the sweet herb and bitter herb, would
tonify earth.

Future research opportunities

There are many additional topics in Fu Xing Jue that offers interesting and exciting research
opportunities, including:

 Comparison of FuXinJue’s external disease pathogenesis paradigm with that of ShanHanLun

 Acupuncture modality
Even today, with all the TCM theories we have in our pockets, we still cannot claim a full understanding
of how our body contracts external diseases, and why external diseases sometimes would result to
internal diseases signs and symptoms. There will always be opportunities to further refine our
understanding and sharpen our skills through research and mapping classic knowledge with clinical
practices.