Abstract: One of the most powerful aspects of Chinese medicine is its emphasis on time as a core factor in health and disease. Classical texts such as the Shang Han Lun, Su Wen, and Nan Jing present sophisticated protocols for the diagnosis and treatment of specific illnesses during specific time periods for maximum efficacy. Biorhythms and circadian rhythms as factors in the course of illness have been a major part of Chinese medicine for millenia, reflected in the 24-hour Chinese clock of the channels, viscera and bowels, or cyclic charts of 60-day and seasonal cycles of yin and yang influences on health.
Unknowingly, modern medicine has begun to explore one of the fundamental principles of Chinese medicine: the recognition that human beings have an intimate connection to nature, and are being influenced continuously by environmental and chronological factors. Historically, Chinese medical literature has always understood medical phenomena through the lenses of time, patterns and cycles, and has attempted to diagnose and cure disease accordingly.
Chronobiology can be defined as the science of transformations in organic life forms according to circadian rhythms. In contemporary biomedicine, chronobiology is being applied to the regulation of drug and surgical therapies according to time of day, weather conditions, and lunar phase. Journals and research institutes have been formed to investigate these phenomena.1 The principles of chronobiology have become increasingly important in modern practice, because of the effects of technological civilization on circadian rhythms. Jet travel, computers, radiation, artificial living and working environments, medications, movies, television, electric music, and many other technological innovations have transformed our environment and largely insulated us from direct contact with nature. This has led to disruption of sleep, eating, and other body/mind cycles which can cause degeneration of health. Extensive studies are available on such topics as jet lag, night shifts, sleep deprivation and their effects on overall health. Other applications of chronobiology are chronoepidemiology, or cycles of epidemics, and chronopharmacology, which can help determine how to medicate patients in harmony with circadian rhythms.
In Chinese medicine, chronobiology first was revealed in the theory of wu yun liu qi/five movements and six qi, a concept translated by Nigel Wiseman as “cosmobiology” and by Manfred Porkert as “phase energetics.” According to this theory, the body and mind change day by day, in correspondence with a complex polyrhythmic dance of twenty-four hour, lunar, solar and seasonal rhythms that subtly influence the movement of blood, lymph, fluids, qi and jing/essence through their channels and vessels, as they gather and subsequently move through different visceral systems. Therefore, when treating patients, we can use chronobiology to deepen our understanding of the mind/body terrain, by providing a context (in cosmic and natural cycles) that is beyond the specific etiology. Chronobiology theory can be applied to the treatment of metabolic, immune, gynecologic and infectious disorders. By understanding the cyclical movement, gathering and resolution of qi, blood and fluids, we can regulate vital substances produced by the body and avoid their exhaustion and depletion. Chronobiology has also been used traditionally in Chinese medicine for calculating effective treatment for shi bing/seasonal disorders, including warm febrile epidemics.
The first treatise dealing with chronobiology is the Huang di nei jing su wen/Yellow Emperor’s Classic of Internal Medicine (Simple Questions). The most reliable and comprehensive translation is by Paul Unschuld, whose introductory volume is available (Huang Di Nei Jing Su Wen). Su wen treatises 66 through 74 are extensively devoted to this topic. While much or all of this material is attributed to a later editor of the text (Wang Bing), it has remained the original source text on the subject. In Treatise 69, “The Comprehensive Discourse on Changes (Resulting from) Qi Interaction,” Qi Bo, physician to Huang Di, said, “Knowing the normal and abnormal movements of heaven and earth, one can readily know and anticipate the same movements within mankind.” This chapter goes on to discuss calculations of stems and branches and their influence on resistance to disease in a given year, along with remedial herbal and dietary therapies. For example, a wood repletion year will cause windy conditions, liver pathology, diarrhea and indigestion, fatigue and loss of appetite will prevail. If it is a wood vacuity year, vital qi will be weak, plants will be poorly developed, people will suffer from cold, rib and abdominal pains, flatulence and watery diarrhea. In Su wen treatise 74, “The Comprehensive Discourse on the Essentials of the Most Reliable”), Huang Di states, “People and nature are inseparable. In nature, the cyclic movement of the heavenly bodies produces atmospheric influences that exert control over the rhythms of the seasons and is responsible for change to the myriad living and non-living things. These cycles are repeated endlessly with patterns of predictability, and yet simultaneously with a tendency towards chaos. It is this chaos in the macrocosm that upsets the balance of the delicate ecology within people that produces disease” (translation by Mao Shing-Ni, Yellow Emperor’s Classic of Internal Medicine).
There is tremendous and understandable controversy over the accuracy of Chinese astronomy and its accuracy in predicting weather and climate changes, and these theories are by no means universally accepted in the modern Chinese medical world. As Chinese medicine has spread through the world, these principles need to be reexamined in light of different latitudes, climates, and seasonal changes. However, the underlying principles of understanding the relationship between season, climate and health are very powerful ones, and deserve to be reexamined in the context of what we know about subtle yearly changes in lunar and solar eclipses, orbits, global warming, and other factors. It is notoriously difficult to predict long cycles of weather change, and it would be interesting to see if there are any records to test the accuracy of these predictions.
There are other expressions of chronobiology in Chinese medicine that are easier to understand and apply, such as the twenty-four hour clock, which records the movement of qi through the twelve channels and associated zang/fu viscera and bowels over a twenty-four hour period. Acupuncturists particularly have developed calendars to choose points which are most active at these times, or which channels or visceral systems are optimal to treat. For example, the lung channel is most abundant in qi at 3-5 AM, and most depleted at 3-5 PM. So, according to this theory, lung diseases will tend to worsen in the late afternoon. Dr. Yoshio Manaka’s text, Chasing the Dragon’s Tail, has comprehensive charts and treatment strategies based on this clock.
In acupuncture practice, one can apply chronobiology by choosing specific points for the disorder or pattern with appropriate open points to secure a deeper and stronger effect. Such strategies may include selecting the five shu/transporting points or master and coupled points of the extraordinary vessels. This method is called zi wu liu zhu /stem-branch point selection. It is based on the circulation of qi in the channels as it waxes and wanes in resonance with time of day or night, season, and astronomical/astrological changes based on the five stems and six branches recorded in the Nei Jing Su Wen. The eight extraordinary vessels are very effective in treating endocrine disorders. The master and coupled points of the chong mai/generating vessel and ren mai/conception vessel have a deep-acting influence on hormonal cycles in the body. And the 66 shu xue/corresponding points and are best activated at their open times, as they become active in sequence according to the 24-hour Chinese clock. By needling the shu xue/corresponding points of the visceral system that is most susceptible, that organ system will be harmonized and thus avert any potential disorder. There are several texts and calendars available that easily calculate the best points for treatment according to hour, day, season and year, including the nai zhi fa/daily branch method, nai jia fa/ten-day stem method, and 60-day ling gui ba fa/divine tortoise eight methods.
Herbal medicine can also be applied according to the principles of chronobiology. The concept of seasonal variation of herbal prescriptions was first mentioned in the Nei Jing Su Wen, and more fully developed in the Pi Wei Lun Treatise on the Spleen and Stomach, written by Li Dong-yuan in the 13th century. For example, Dr. Li recommends adding different herbs to prescriptions in different seasons, such as wu wei zi/fr. schizandra in summer, or proscribes herbs such as ma huang/rm. Ephedra in autumn or winter. In general he admonishes us to be sensitive to seasonal qi in choosing herbal prescriptions. Other authors recommend herbal prescriptions to be taken at certain times of day, such as taking Liu wei di huang wan/Six Flavor Rehmannia Pill at bedtime to nourish the kidneys. The Shang Han Lun/Treatise on Cold Damage has extensive discussions on periodicity of infectious disorders, waxing and waning at different times of day, with appropriate treatment according to time and changes in the disorder. For example, tai yang patterns are said to subside between 9 P.M. and 3 A.M., and increase in severity between 9 A.M. and 3 P.M. This would be, theoretically, the most advantageous time to treat this pattern.
This short overview of chronobiology shows its central importance in Chinese medical literature from its earliest developmental phase. Potentially, by calculating the best times for treatment and their appropriate prescriptions, as well as using these principles to predict epidemics, we can greatly improve and individualize our treatment of patients, applying the best of Chinese medicine with its great subtlety, complexity and depth.
1 Such as the Chronobiology International Journal, published by Pergamon Journals Ltd., Oxford, England and the Department of Chronobiology at the University of Texas Health Science Center at Houston, TX.
This article appears with the permission of the author, Z’ev Rosenberg, and the Pacific College of Oriental Medicine.