Application of “Five Elements Theory” for Treating Diseases

The ancients thought that there were five indispensable qualities for living. These are Wood, Fire, Earth, Metal and Water, and they are otherwise known as the five phases. They each possess different characteristics, and all phenomena and substances within the universe belong to one of these five phases. The idea which has developed into the five-phase theory is that all phenomena and substances in the universe are the products of the movement and mutation of these five phases. The five-phase theory, as described in the Neijing, is a philosophical theory of medical practice in ancient China. This theory has served as the guiding ideology and methodology of physiology, pathology, clinical diagnosis and treatment. The characteristics of each phase in this theory have been derived from the observations of countless generations over the millennia, and they are reflected in clinical experiences. As will be mentioned, among these phases both engendering and restraining patterns exist. In the case of the excess of one phase, engendering becomes overwhelming, and restraint becomes rebellion. However, in five-phase theory, not every situation is well-defined because there are some contradictions and cross-overs in the signs of various physiological features. In both Yin Yang theory and five-phase theory, not all notions are necessarily clear. Nonetheless, despite such a lack of clarity, intractable diseases are sometimes cured or else ameliorated by applications of five-phase theory. More details about five-phase theory will be described below.


Introduction
The ancients thought that there were five indispensable qualities for living. These are Wood, Fire, Earth, Metal and Water, and they are otherwise known as the five phases. They each possess different characteristics, and all phenomena and substances within the universe belong to one of these five phases. The idea which has developed into the five-phase theory is that all phenomena and substances in the universe are the products of the movement and mutation of these five phases. The five-phase theory, as described in the Neijing, is a philosophical theory of medical practice in ancient China. This theory has served as the guiding ideology and methodology of physiology, pathology, clinical diagnosis and treatment. The characteristics of each phase in this theory have been derived from the observations of countless generations over the millennia, and they are reflected in clinical experiences. As will be mentioned, among these phases both engendering and restraining patterns exist. In the case of the excess of one phase, engendering becomes overwhelming, and restraint becomes rebellion. However, in five-phase theory, not every situation is well-defined because there are some contradictions and cross-overs in the signs of various physiological features. In both Yin Yang theory and five-phase theory, not all notions are necessarily clear. Nonetheless, despite such a lack of clarity, intractable diseases are sometimes cured or else ameliorated by applications of five-phase theory. More details about five-phase theory will be described below.

Characteristics and categorization
Wood signifies both bending and straightening, and has the characteristics of growth, upbearing and effusion. It refers to the state of the growing tree. All things which are characteristic of growth, development and elongation belong to Wood. Fire flares upwards, and has the characteristic of blazing heat. Things which have the characteristics of heat and rising belong to Fire. Earth is the source of everything, and it represents the characteristics of sowing, reaping and engendering transformation. Things which form and grow, or are sown, raised, and reaped belong to Earth. Metal is the working of change, and it has the characteristics of purification, elimination and malleability. Things which are constantly changing or are involved in purification and elimination belong to Metal.
Water is the moistening and descending element. It has the characteristics of moistening, downward movement and coldness. Things which are cold, cool, humid and move downwards belong to Water.

The relation between the five phases and the five viscera
The five viscera (Liver, Heart, Spleen, Lung, and Kidney: the first capital letter means Viscus in TCM) are related to the five phases according to their own properties. The physiological characteristic of Liver is to govern free-coursing, to thrive by orderly reaching, to rise and to move. As it is likened to spring -when plants grow -and since of the five elements spring relates to Wood, Liver is attributed to Wood. As Liver controls the sinew, and the eyes express the function of Liver, these also belong to Wood. The function of Heart is to control blood vessels and to warm the whole body by propelling qi and blood. It is likened to the summer heat. As the summer is attributed to Fire, Heart belongs to Fire. As pulse is caused by blood flow and Heart meridian leads to the tongue, they also belong to Fire. Spleen controls the transportation and transformation of the essence of food, and it is the origin of the engendering transformation of qi and blood. It is likened to the late summer and humid weather -when all things grow -and to Earth which brings up all things. As late summer corresponds to Spleen, Spleen belongs to Earth. Since the condition of Spleen is expressed in muscle and lips, they belong to Earth as well. Lung pertains to purification and down-sending. It is likened to the cool, crisp air of autumn -a quiet time when everything contracts. As autumn corresponds to Metal, Lung belongs to Metal. Equally, as the condition of Lung is expressed in body hair and the surface of the skin, as well as the nose, these also belong to Metal. The function of Kidney is to store essence and fluid. It is likened to the winter, when all things are stored and the bitter cold exists. As winter corresponds to Water, Kidney belongs to Water. Kidney opens into bone, ears and two yins. Accordingly, they belong to Water. Other correspondences between the natural world and the human body are shown in Table 1.

Overwhelm and rebellion amongst the five phases
When the normal restraining element gets excessive power, so-called overwhelm occurs. Overwhelm is an abnormal, excessive restraint. This happens in two cases. First, it may occur when one phase becomes excessively powerful and so overwhelms the corresponding viscera. Second, it may also arise when the restrained viscera becomes too weak and hence is overwhelmed by its restraining viscera Ref 3 . Conversely, when the restraining viscera becomes too weak, or the restrained viscera becomes excessively powerful, the opposite of restraining occurs. This is called rebellion. For example, Metal naturally restrains Wood. However, when Wood gets too much power, Metal can't, not only restrain Wood, but it is also injured by Wood's excessive rebellion against Metal. Similarly, and in applying this concept to the viscera, Lung normally restrains Liver. Nonetheless, when Liver becomes excessively powerful, Lung is not only unable to restrain Liver, but it is injured by Liver's reaction to Lung. Again, this is called Rebellion. In Zhong-yi-bing-yin-bing-ji-xue, Ref 4 engendering and restraining concern the mutual relations among human viscera. Overwhelm and rebellion relate to a pathological idea concerning the mutual influences and actions among viscera. For example, when Fire (Heart) gets excessive power, Water (Kidney) cannot ordinarily restrain Fire and so Fire overwhelms Metal to the point of damage; at this stage, inferior Water is boiled down by Fire qi (rebellion). In this way -in illness -overwhelm and rebellion always appear at the same time."

The physiological function and condition of the five viscera
Liver lies on the right side, beneath the diaphragm, whilst Gallbladder sticks to the undersurface of the right hepatic lobe. Liver is connected to Gallbladder with channels. Liver is an "exterior" organ and Gallbladder is an "interior" organ. Liver controls free-coursing, blood storage and the sinews. Free-coursing relates to the regulation of qi movement, psychological and emotional activity, and bile secretion etc. Blood storage means that it controls the blood in circulation as well. Controlling the sinews implies that Liver works to maintain the normal movement of the muscles and joints of the whole body. Liver channel starts from the great toe, climbing the leg and passing through the genitals and the lower abdomen, and then goes up through the costal region to the eyes and the vertex of the head. When pathological changes appear along Liver channel, they are described as Liver diseases. Dysfunction of the free-coursing causes change to Liver qi depression *1 , stagnated Liver qi transforming into fire, damage to Liver yin, yin deficiency, ascendant hyperactivity of Liver yang *2 , and further progresses to" Liver wind *3 . On the contrary, dysfunction of storing blood *4 is caused by blood deficiency as has been mentioned, "Liver yang and Liver qi exist always in excess and Liver yin and Liver blood exist always in insufficiency." Ref 5,Ref 6 The treatment for dysfunction of free-coursing is to smooth Liver and regulate the qi, and to apply drugs to pacify Liver and purge Fire. The treatment for dysfunction of blood storage is to tonify Blood and emolliate Liver, enrich Liver and tonify Kidney and so on. Ref 7 (Symptoms of *1 include depression, chest and side pain, and digestive symptoms; of *2, nervousness, surliness, headache, vertigo, tinnitus, insomnia, and lumbago; of *3, severe dizziness, headache, stiffness in the neck, tingling in the limbs, trembling lips and fingers, convulsive spasms and inhibited www.intechopen.com speech; and of *4, dizziness, insomnia, excessive dreams, flowery vision, inhibited sinew-vascular movement, lustreless nails, and reduced menstrual flow).
Heart is in the chest and is covered by the pericardium. Heart controls the blood vessels and the spirit. Heart opens at the tongue. Heart meridian is entangled with the meridian of Small Intestine, which is the corresponding interior viscus. Pathologies based on Heart qi deficiency *1 , Heart yang deficiency *2 , Heart blood deficiency *3 and Heart yin deficiency *4 involve diseases of the blood vessels, including arrhythmia, some psychological diseases and ulceration and/or pain of the tip of the tongue. Ref 8 Treatment is based on the pathology of the Heart Ref 9 .
(Each of *1,*2,*3, and *4 show symptoms of a dull pale complexion, palpitations, dyspnea and arrhythmia. Symptoms of *1 also include hyperhidrosis and a weak, fine and slow pulse; of *2, a dark grey, cyan or purple complexion, inversion frigidity of the limbs, and cold sweats; of *3, dizziness, insomnia, excessive dreams, a fine pulse, and palpitation; and of *4, vexing heat in the chest, the palms and the soles, and night sweats including the symptoms of *3).
The digestive system is composed mainly of Spleen, Stomach, Large Intestine and Small Intestine, of which Spleen and Stomach are the most important. The meridian of Spleen is external and that of Stomach is internal, and they communicate closely with each other. Spleen controls the transportation and transformation of water and food, whilst Stomach controls the acceptance of food. Spleen controls upbearing and Stomach controls downbearing. Both Spleen and Stomach are the origin of food digestion and transport, and they enable the transformation of the fine essences and the engendering and transformation of qi and Blood (in this manner it is called the postnatal root). The meridians of Small Intestine and Large Intestine are entangled with Heart and Lung. The function of the separation of clear and turbid substances of Small Intestine and the function of carrying and transforming the food waste of Large Intestine are each a part of digestive power and they have a strong connection with the function of both Spleen and Stomach respectively. Disorders of Spleen include Spleen qi deficiency, Spleen yang deficiency *1 , centre qi deficiency *2 , blood management failure *3 , Stomach yang deficiency, Stomach yin deficiency *4 , the counter-flow ascent of Stomach qi, persistent diarrhoea, and incontinence and constipation. Clinically, we recognize these as abnormal functions of digestion, absorption, and the carrying and distribution of essence and excretion. Ref 10,Ref 11 (Symptoms of *1 and *2 include white complexion and spiritual fatigue; of *1, abdominal pain relieved by warmth and pressure; of *3, bleeding such as hemafecia and metrorrhagia; and of *4, dry mouth, mirror tongue and constipation).
Lung is situated in the chest, connected with the throat, and opens at the nose. As it is the highest location among the viscera, it is called the canopy. The channel of the Lung connects to that of Large intestine; the former is interior and the latter is exterior. Its main function is to dominate the qi and control respiration. Lung qi faces the hundred blood vessels and channels, regulates the water passage, disperses essence externally to the skin and downy hair, and controls the surface defence qi of the whole body. In other words, Lung works as a respiratory system, but it also controls fluid regulation, the movement of qi and blood, and the defence system of whole body. Abnormalities of Lung include the non-diffusion of Lung qi, impaired depurative downbearing of Lung qi, Lung qi vacuity, and Lung yin vacuity *1 . Clinically, they appear mostly as dysfunction of the respiratory system, a part of the pathology of fluid metabolism and blood circulation (edema, urination abnormality), external contraction with superficial pathogens and some skin diseases like atopic dermatitis. They are treated based on the lung pathology. Ref 12,Ref 13 www.intechopen.com (*1 shows a dry cough with little phlegm) The Kidney is located in the lower back on either side of the spinal column and opens into the ear and the two yins (the perineal ante-tract and post-tract). Its condition is reflected in the hair of the head. The meridian of Kidney (interior organ) connects to Bladder (exterior organ). The main function of Kidney is to store essential qi which is the basis of growth, development, reproduction and the maintenance of the physiological activity of all the viscera. The function of Kidney of controlling the water and bone through the production of marrow is based on both Kidney essence and qi. Kidney yin and yang give yin and yang to all the viscera, which is called innate qi. Ref 14 As the vacuity of the yin and yang of the other viscera influences Kidney, long-term disease is said to influence Kidney. Kidney yang has a strong correlation with Spleen yang, as implied by the occurrence of Spleen-Kidney yang deficiency; similarly, Kidney yin has a strong correlation with Liver yin, as implied by the occurrence of "Liver-Kidney yin deficiency." It has been said that Kidney and Liver have the same source. Accordingly, when we coordinate Kidney yin and Kidney yang, we must take care to pay attention to the fact that Kidney yin and yang closely cooperate. The physiological function of Kidney includes the urogenital system, the reproductive system, internal secretion and partial cerebral function. Although the function of Bladder is to store and excrete urine properly, urinary retention, incontinence and enuresis are considered to be diseases of Kidney because of the strong correlation of Kidney yang and qi transformation. Dysfunctions of Kidney include Kidney yin deficiency *1 , Liver-Kidney yin deficiency *2 , Heart-Kidney yin deficiency *3 , Lung-Kidney yin deficiency *4 , Kidney yang deficiency *5 , Spleen-Kidney yang deficiency *6 , the failure of Kidney to receive qi *7 , Heart-Kidney yang deficiency *8 , yang deficiency with water flood *9 , insufficiency of Kidney essence *10 and insecurity of Kidney qi *11 . We must treat these diseases based on their pathology. Ref 15,Ref 16 (Symptoms of *1,*2,*3 and *4 include feverishness, dizziness, tinnitus, dry pharynx and/or mouth, and lumbago; those of *3 are palpitation, insomnia, and excessive dreaming; of *4, dry cough and night sweats; of *5, *6, *8 and *9, dizziness, tinnitus, sensitivity to the cold, cold limbs and pale complexion with weak knees and lumbar region; of *10,deficient reproductive function, hair and tooth loss; of *11, enursis, polyurea and low back pain)

Transmutation among the five phases and viscera
The mutual influences among diseases of the viscera are called transmutation. This is based on the engendering relation, the "mother and child relation," and restraint-based overwhelm and rebellion Ref 2 .

Transmutation based on engendering
One case is where the mother's disease is transmitted to the child. Another case is where the child's disease is transmitted to the mother. The former case is shown through the symptoms of lumbar vertebrae pain or languishing, tinnitus and nocturnal emission in Kidney yin deficiency. It starts to be accompanied by forgetfulness, insomnia, irritation and being easily angered in Liver yin deficiency or ascendant hyperactivity of the Liver yang. But as nurture exists in the first case, the situation easily improves. An example of the latter case (child to mother) is shown through Heart-Liver Fire effulgence. That is, Fire symptoms of Liver such as being easily angered, irritation, dizziness and headache, and following Heart fire symptoms such as insomnia, palpitation and inflammation of the mouth and tongue. The mother qi is stronger than that of the child, and so the mother's disease is apt to become aggravated.

Transmutation based on overwhelm and rebellion
Liver qi depression, with symptoms such as fidgetiness, being easily angered, and pain of the lateral costal region, begins to invade the stomach with symptoms of nausea, vomiting and abdominal fullness. In this case Wood overwhelms Earth. Before long, cough or hemoptysis appears, or Wood invades Metal, whilst in the viscera, Liver rebellions against Lung. As Liver should be restrained by Lung, symptoms are mild. If the viscera are weak, transmutation easily occurs; if not, it rarely occurs. However, in the case of acute disease this mechanism doesn't work.

Regulation of win qi and revenge qi among the five phases
In Su-wen, zhi-zhen-yao-da-lun-pian when one phase causes overwhelm to the corresponding phase, it is said to have "win qi". Once this happens, revenge energy to restrain it appears, (which is called revenge qi/Win Revenge). The more win qi there is, the more revenge qi there will be, and vice versa. After all, in the regulation process of win revenge qi, there exists the law of action and reaction, which means the volume of win qi equals that of the revenge qi. This is described in the Fig. 1   Explained in terms of Fire in Fig.1, too much Fire qi overwhelms Metal qi → too much decline of Metal qi → Metal qi cannot regulate Wood qi → Wood qi gets excessive win qi → excessive decline of Earth qi → Water qi gets excessive win qi, which restrains Fire → the first excessive Fire qi is normalised. In case of a shortage of Fire qi → Metal gets excessive win qi → Wood qi declines → Earth qi gets excessive win qi → Water qi declines → Fire qi recovers to be normalised. It may be said this mechanism has a kind of feedback system.

www.intechopen.com
When one phase (A) gets excessive qi and the phase which should restrain phase (A) cannot restrain it, the cooperation between these two phases is destroyed and the excessive qi of the phase (A) accumulates more qi while the declined phase is restrained by phase (A) and so declines further. This situation produces an abnormal condition of disorder. Following Su-wen, in Liu-wei-da-lun-pian: "Once a harmful situation is produced, engendering transformation becomes terribly out of order. In Si-sheng-xin-yuan (wu-xingsheng-ke-pian), engendering and restraining develop through qi transformation. The quality has no relation with these." 9. Treatments of diseases based on five-phase theory Ref 2

Restrain the transmission of pathological changes of viscera
Diseases develop through dysfunction of viscera, yin-yang and qi-blood. Dysfunctions of the viscera produce abnormalities of engendering and restraining. When we treat patients, we must pay attention not only to diseases themselves, but also to the transmission of pathological changes of viscera. We must regulate qi excesses and shortages of viscera based on the law of engendering, restraining, overwhelm and rebellion, by controlling the transmission of pathological changes of viscera and thereby maintaining normal function. For example, when Liver has a disease we must strengthen the function of Spleen and Stomach to protect them from transmission from Liver. Since, by the strengthening of the function of Spleen and Stomach, it is harder for the transmission of pathological change from Liver to Spleen to occur, the disease will be easier to cure. In Nan-jing.qi-shi-qin-an, it is advanced that once Liver gets a disease, it will transmit it to Spleen. Accordingly, we must give qi to Spleen. The possibility of the transmission of pathological change depends upon the function of viscera. If the viscera qi is in vacuity, the transmission of pathological change will occur; if the viscera qi is in sufficiency, no transmission will occur.

Treatment rules and treatment methods 9.2.1 Treatment based on the law of engendering
This includes two cases. First there is that of the disease of the mother invading the child. Second, there is that of the disease of the child invading the mother. In Nan-jing (liu-shi-liu nan), it is written that if the child qi is in vacuity, the mother qi must be supplemented (mother qi supplementation), and if the mother qi is sufficient, the child qi must be reduced (child qi reduction). Mother qi supplementation: In cases where the child qi is insufficient, the mother qi must be supplemented. A dysfunction between mother and child comes from deficiency.

Example
A shortage of Kidney yin cannot enrich Liver/Wood followed by Liver yin shortage; the ascendant hyperactivity of Liver yang and the so-called Liver qi ascending counterflow will result. Methods to enrich Water to moisten Wood: this is a therapeutic method to treat Liver yin deficiency by nourishing Kidney yin.
Methods of engendering Metal-Kidney (enrich Lung and Kidney) i. Lung deficiency causes circulation-dysfunction of fluids and humours such that Kidney is not enriched.
ii. Owing to the shortage of Kidney yin, Kidney essence qi can't rise, and this is followed by a failure of purification and the downsending of lung. This situation is characterized, for example, by dry cough, qi counterflow, hemoptysis, bone-steaming tidal fever, night sweat, and nocturnal emission etc. Tonify Spleen to engender Lung qi Tonify Spleen qi to tonify Lung qi. Usually, a continuing cough with plenty of clears puta, a small quantity of viscous sputa, appetite loss, pale tongue and weak pulse will appear. Purge Child qi: When mother qi is in excess, the child qi should be purged. The dysfunction between mother and child comes from the existence of excess qi. In the case of a disease of Liver derived from excess qi, such as Liver fire or Liver fire flaming upward, Liver/Wood is the mother and Heart/Fire is the child. The treatment is to purge the Heart Fire and it helps to purge the Liver Fire. When a child's disease is caused by a deficiency, we must not only tonify child qi but also tonify mother qi so as to get engenderment from the mother.

Treatment based on the law of restraining
This refers to the treatment by which the weak phase is recovered either by restraining the strong side or else supporting the weak side. In other words, before the strong side can cause overwhelm, treatment to strengthen the energy of the weak side is started. I Restraining the strong side is mainly applied to the morbidity in overwhelm and rebellion A. When Liver overwhelms Spleen, treatment to pacify Liver is applied. In this case, Liver easily causes rebellion to Lung, which means that at one phase, such as overwhelm by Liver, rebellion to Lung easily happens at the same time. When we treat Liver, it means that Spleen and Lung are treated as well. In this case Yi-gan-san-jia-chen-pi-ban-xia (in Japanese :Yokukansankachinpihange) is often applied. B. Depressed Spleen and Stomach qi → Rebellion from Spleen to Liver occur → Liver cannot do free-coursing and ordered reach, for which treatment to move Spleen-Stomach qi is applied.

II Supporting the weak side because of the shortage of restraining energy
Method to soothe Liver and fortify Spleen In Liver deficiency, when Spleen-Stomach transmission and transformation doesn't work, Liver is supplemented and pacified and the Spleen is fortified. In Liver depression and Spleen deficiency, this method is used. Symptoms include an oppressive feeling in the chest, hypochondria and a distended feeling including pain, appetite loss, abdominal distension, loose passage, belching and gas. (Depressed Liver qi can't give proper restraining to Spleen).
Method to cultivate Earth and suppress Water In Spleen, with an abnormal function like weak restraining to Kidney, warming Spleen yang moves the qi and fortifies it to improve the controlling water of Kidney (Spleen restrains for Kidney so as not to get water flood; in other words, fortify Spleen yang in order to warm Kidney). Clinically, this is applied to Spleen deficiency, Spleen-Kidney yang deficiency and water flooding the body tissues with edema, distension and fullness. To this symptom Renshen-tan (in Japanese: ninjinto) and fu-zi (in Japanese: bushi) are applied.
Method to support Metal to restrain Wood (weak restrain to Liver by Lung). In other words, a method to purge Liver and clear Lung, or else regulate Lung to purify. and downsending to restrain Liver. Hypochondriac pain, a bitter taste in the mouth, nervousness, agony and a string-like, rapid pulse and a cough with hemoptysis are often observed.
Method to purge Fire and fortify Water This means purging Heart Fire and fortifying Kidney water; in other words, to purge south and fortify north, or to nourish yin to move Fire down. With the combination of a shortage of Kidney yin and hyperactive Heart yang, so-called non-interaction between the Heart and Kidney occurs. Lumbago, nervousness, insomnia, nocturnal emission, palpitation, exhausting fever and night sweats are often observed. We must note the fact that Kidney belongs to Water and Fire (Kidney controls yin and belongs to Water, and the life gate that belongs to Kidney controls yang and belongs to Fire). Kidney yin deficiency causes hyperactive fire, blind movement and functional acceleration, such as nocturnal emission, tinnitus, throat pain and dryness. These phenomena are the result of Kidney yin deficiency or yang hyperactivity of Kidney itself, but they have no relation to the fact that Water cannot restrain Fire. However, when Kidney is weak to restrain Heart, tonify Kidney with yin and purge heart Fire which will support Kidney to restrain Heart. We can use the law of the relations of engendering and restraining among viscera as a mental therapy. Sorrow is the emotion of Lung and belongs to Metal. Anger is the emotion of Liver and belongs to Wood. As Metal conquers Wood, sorrow conquers anger. Fright is the emotion of Kidney and belongs to Water. Joy is the emotion of Fire. As Water conquers Fire, fright conquers joy. Anger is the emotion of Liver and belongs to Wood. Thought is the emotion of Spleen and belongs to Earth. As Earth can conquer Water, thought defeats fright. The modern cognition about the study with five-phase theory In TCM theory, the core of health exists in the dynamic balance between the body and its circumstances; the destruction of this balance is the real cause of disease. Accordingly, the main theme of the research and study of TCM is the pursuit of methods and remedies to restore degraded physical conditions to a balanced state. The basic rule of treatment within TCM lies in the regulating of yin and yang, the reforming of tendencies and defects and the recovery of general physical balances. In recent years, many monographs in cybernetics theory have been published which elucidate TCM theory. For instance, inhibition and the generation of the law of engendering and restraining within the five-phase theory reflect the self-control principle in the human body. With this law, the concept of feedback is included. The five-phase theory, which reflects the transformation law in the cause-and-effect rule, contains the programmatic control concept from cybernetics theory. Further, the method of classification in five-phase theory through the comparison of shapes is similar to the same class-system concept in cybernetics theory. The five systems in five-phase theory have many routes and form a closed system, with feedback regulations at numerous levels, and thereby maintains the stability of a selfcontrolled system. Further, the regulation of inhibition and the generation and regulation of win qi and revenge qi in five-phase theory exemplify the function of the five-phase system in performing automatic regulations. Applying the five-phase theory to disease in modern medicines Examples of mother-child transmission in five-phase theory  Between Kidney and Liver  Prolonged dysfunction of Liver is often followed by Kidney dysfunction (Liver Kidney depletion)  Several monographs have reported that human bone marrow cells, which belong to Kidney, are related to the improvement or progress of liver cell fibrosis. This pattern has been recognised in mice as well. Ref  Between Kidney and Lung Goodpasture syndrome shows hemoptysis followed by acute glomerulonephritis, which means that the mother's disease (Lung) is transmitted to the child (Kidney) based on mother-child transmission.  Between Liver and Heart In cardiac liver cirrhosis, liver cirrhosis is often derived from right heart failure. This is another case of transmission from the child to the mother. Examples of overwhelm and rebellion  Between Liver and Spleen Nervous gastritis and functional gastrointestinal disorder are caused by stress (Liver qi abnormalities).  Between Kidney and Heart In chronic heart disease, an important deteriorating cause is complication arising from Kidney disease; most likely, this will be accumulated Kidney evil resulting from Kidney disease, which will overwhelm Heart. In chronic Kidney disease, an important cause of death is the complication of Heart disease. This may be said to be a kind of rebellion from Heart to Kidney.  Between Liver and Lung Hepatopulmonary syndrome: in chronic liver disease, like liver cirrhosis, telangiectasis or telangiectasia is often observed in the lung, followed by dyspnea. This may be rebellion from Liver to Lung. Finally, various modern diseases, including incurable disease, have been recognised by five-phase theory and they have sometimes been successfully treated. Therefore, if fivephase theory is properly applied, chronic intractable diseases are sometimes successfully treated. In particular, in routine life, we have many stresses that we can't avoid and which inflict pain on us. When we consider that those stresses make liver qi abnormalities, we can obtain clues to their improvement, as shown below. In this chapter, I have applied the lecture Lu-Gan-Fu gave to his son Lu-xi*a, namely that "The evil qi accumulation in one viscus can overwhelm to the restraining viscus. If yang deficiency aggravated in a viscus, the evil qi equals cold pathogen, if heat accumulated enormously, the evil qi equals heat pathogen. On applying five-phase theory to treatment, the most important point is to identify the viscera causing the various symptoms. Next is the decision of the order of appearance of the symptoms. Usually by this means we can speculate upon which viscus is at the root of the patient's disease. Next by comparing the various symptoms, we can speculate upon the existence of engendering, restraining, overwhelming, and rebellion among the viscera. Ref 19 The "Organ pattern identification Table" is very useful and convenient Ref 16 in this regard. Below, eleven cases are discussed in detail and in terms of the correlations of medical diagnoses with TCM theory using five-phase theory. The formulas prescribed are shown in

Susceptibility to common cold caused by Kidney deficiency
Case 1 A 60-year-old Japanese female Chief complaint: Recent susceptibility to catching common colds Present illness: She found herself prone to catching colds. She had been sensitive to the cold and suffers from frequent urination (Kidney yang deficiency). She has had a weak constitution (Spleen qi deficiency) since childhood. Two years ago, a feeling of throat stuffiness continued. A close examination revealed as the cause a benign thyroid tumour, which was left untreated. Upon her visit to my clinic, she reported that every time she felt tired, she caught a cold (Lung qi deficiency), which was unusual for her. Intake of ge-gentang (in Japanese Kakkonto) released the exterior muscle layer and exorcised the common cold within a few days, but she soon caught a cold again. She had looked after her mother at her home and paid much attention to both her husband and mother, which induced a great deal of stress (Liver qi depression) until two years ago when her mother died. In spite of the fact that she was freed from her mother's care, since that time she has become even more susceptible to colds and so visited my clinic. Past history: She has suffered from dysmenorrhoea, for which total extirpation of the uterus was carried out (Liver qi depression with blood stasis). As she does not have enough stamina, she couldn't work hard (qi deficiency) and has been sensitive to the cold. Present status: Height, 158cm; weight: 48kg; pulse, 74/min, fine, slippery, string-like, tongue body, pale with reddish limbic, tongue fur, whitish with thin centre (yin deficiency); sublingual vessel enlarged (blood stasis) Identification: Kidney Yang deficiency, Lung qi deficiency Treatment: Ba-wei-di-huang-wan (tonifies the yang and yin of Kidney, nourishes the blood) Clinical course: With no change to her lifestyle and working conditions, she did not catch a cold for the 5 months or more since she started taking 30 pills of Ba-wei-di-huang-wan (common dosage: 60 pills/day). Discussion: Susceptibility to colds indicates qi deficiency of Lung. The fact, especially, that her colds appeared when she had some trouble which caused her stress implies a rebellion of Liver against the Lung. But she felt her stress decreased after her mother's death two years ago. Accordingly, stress does not influence her frequent catching of colds, but the fact that intake of ba-wei-di-huang-wan decreased her frequency of catching colds implies that the qi deficiency of Lung was reversed by giving yang to Kidney, which was transmitted through their engendering relation.

Ulcerative colitis case
Case 2 A 29-year-old Japanese female who works for civil aviation. Chief complaint: Diarrhoea, abdominal pain, bloody stool, lumbago, stress-induced insomnia History of present illness: Her bloody stool had continued in spite of the administration of routine remedies including sufficient rest since 24 th of Jan, X year. By continuing an adrenocortical hormone for one month, the bloody stool stopped. She visited my clinic in June, X year as she hoped to stop the recurrence of her bloody stools. Nine years earlier, she had been diagnosed with ulcerative colitis, which was brought on by a lot of stress. Since then she had been taking 5-amino salicylate. At the beginning she suffered from only bloody stools, but more recently she has suffered from lumbago as well. From seven years earlier to the present, the ulcerative colitis had recurred about once a year. This recurrence was usually evoked by stress or working all night (Wood overwhelms Earth). Overwork often led to abdominal pain followed by bloody stools. She reported that she was routinely feeling abdominal fullness and gassy stomach. Overeating or coldness caused diarrhoea (Spleen yang deficiency , -. She dislikes meats. Her digestive system easily gets cold (Spleen yang Deficiency. -) when stressful things happen and Spleen qi deficiency occurred with the failure of controlling Blood (Liver overwhelms Spleen -). During childhood, she suffered from chilblains, disliked the air conditioner during the summer, wore too many clothes in the winter, and had cold limbs (Kidney yang deficiency ). More recently, she became fatigued easily and perspired greatly during the summer (qi defficiency). She has an irregular period (Blood deficiency of Liver and Liver qi stagnation -, -) and menstrual pain (Liver qi stagnation and blood stasis -). Past history: She suffered from alopecia areata several times between the ages of ten and twenty-five years old Present state: Height, 160cm; weight, 55kg; Pulse, 56/min, fine, sunken, slippery; teeth-marked tongue (retention of water. -) with a thin white fur; Blood Pressure (BP), 98/62 (mmHg). Identification: Spleen failing to control the blood. Spleen and Kidney Yang deficiency with water flood. Bowels with damp and heat. Treatment: Tonify Spleen qi to control the blood, spread Liver qi and relieve constraint. When stressors lead to insomnia, nourish the blood and yin and warm the Kidney to promote urination and stop diarrhoea. Ref 16 Prescriptions: Jia-wei-gui-pi-tang (in Japanese: Kamikihito) benefits the Spleen qi to control the blood. This equals gui-pi-tang supplemented with chai-fu (Bupleuri Radix) which spreads Liver qi to relieve constraint and clear heat; and zhi-zi (Gardeniae Fructus) which drains heat and eliminates irritability, clears heat, and eliminates dampness (decoction). Ref 14 Zhen-wu-tang warms Kidney to promote urination and stop diarrhoea. This prescription was made by TSUMURA & CO (http://www.tsumura.co.jp /english/index.htm) (Tokyo Japan). Ref 20 Clinical course: After starting herbal therapy, little by little her diarrhoea improved. Her bloody stools decreased in number as well. When she visited my clinic in May, two months after her first visit, she informed me that she had no diarrhoea and no bloody stool, but she would like to continue 5-mino salicylate to make sure. She continued one month's medicine and then stopped. One year and three months later, she visited my clinic to obtain the same herbal remedies for prevention. She told me she had had no symptoms, including diarrhoea and bloody stools, so far (Fig. 2). Discussion: As the first bloody stool appeared following a stressful episode, the stressful event induced Liver qi depression which in turn overwhelmed Spleen leading to a failure to control Blood. In Jia-wei-gui-pi-tan, ren-shen, bai-chu, zhi-gan-zao, huan-qi worked to tonify the Spleen qi, to stop diarrhoea and bloody stool. Fu-ling, long-yan-rou and suan-zaowww.intechopen.com ren tonified and nourished Heart blood so as to tranquilise. The chai-fu worked to disperse stagnated Liver qi so that Liver would not overwhelm Spleen. The recent complication of lumbago may be a result of overwhelm from Spleen with excess coldness pathogen to Kidney. As mentioned already, a method to cultivate Earth and suppress Water, like Zhenwu-tang, was prescribed. The zhi-zi (Gardeniae Fructus) likely supported the subsidence of the colitis. Zhen-wu-tang warmed the yang of Kidney and Spleen, thereby tonifying Spleen and Kidney, which stopped the progression of her lumbago and bloody stools.

Great improvement after insertion of intra-cardiac pacemaker
Case 3 A 73-year-old Japanese housewife Chief complaint (First visit): Dull feeling in Stomach, frequent cystitis, Kidney ptosis with vesical inertia, oversensitivity to the cold History of present illness: She often had a dull feeling in her stomach. She could not take meats or fatty food. Coldness easily evoked abdominal pain or diarrhoea, and she felt that she easily got colds (Spleen Yang deficiency , Lung qi deficiency -). She often saw purple spots without any reason. She has serious kidney ptosis and vesical inertia (sunken middle qi -), frequent suffering from cystitis (Kidney yang deficiency -), and continuing throat discomfort throughout winter (Lung qi deficiency -). She visited my clinic in February of X year to decrease the frequency of cystitis. Present status: Height 140cm, Weight 41kg, Blood pressure 126/72mmHg, pulse, 70/min, weak Past history: She reported to have had a weak constitution since childhood and often felt lassitude (qi deficiency). She had been oversensitive to the cold and has suffered from cystitis. Her digestive system was weak. Her throat discomfort had continued throughout the winter and she felt as if she had been catching a cold all winter. Her menopausal symptoms continued for more than ten years with lassitude and perspiration, for which she had to take a tranquiliser. Identification before insertion of intra-cardiac pacemaker: Spleen and Kidney Yang deficiency, Heart qi deficiency, Lung yang and qi deficiency. Liver overwhelms Spleen Fig. 3. Relations among viscera with five phase theory of case 3 (Just before insertion of intra-cardiac pacemaker) Treatments: Warm the Kidney and Spleen yang, tonify Spleen, clear heat and moistness of bladder Prescriptions: bu-zhong-yi-qi-tang (in Japanese: Hochuekito) tonifies the qi of the middle burner and raises sunken yang, with fu-zi (Aconiti Radix) reviving and assisting the yang, warming the fire and dispersing cold, ba-wei-di-huang-wan (in Japanese: Hachimijiogan) warms and revives the yang and enriches the yin of Kidney. WTTCGE (Wisteria floribunda 2g, Trapa natans 2g, Terminalia chebulae 2g, Coix lachryma-jobi 4g, Ganoderma lucidum 4g, Elfuinga applanata 2g in dry weight/day: effective for herpes genitalis, labialis and chronic herpes viruses infectious diseases to increase the NK cell activity and prevent inflammation). Ref21, Ref22 Clinical Course: I prescribed bu-zhong-yi-qi-tang supplemented with fu-zi for yang deficiency of Kidney, ba-wei-di-huang-wan and hot water extracts of WTTCGE for continuing throat discomfort through the winter. The latter was combined with modified zhu-ling-tang (in Japanese: Chyoreito) in order to promote urination, clear heat, and nourish the yin for frequent cystitis. The cystitis improved but not perfectly. Her digestive system symptoms and purpura remained. Twelve years after her first visit, arrhythmia started -sometimes 30~40/min -and caused instantaneous unconsciousness. Fourteen years after first visit, the insertion of an intra-cardiac pacemaker was carried out without changing the intake of herbal therapies. After this, her appetite loss and other associated symptoms of digestive system -including purpura -disappeared almost completely and the disease rate of cystitis dramatically decreased and has remained decreased up until the present. Discussion: On her first visit, she did not have arrhythmia while her yang deficiency of Kidney and Spleen were long-term conditions. Twelve years later she had arrhythmia. This may mean that during the long duration of Spleen yang deficiency, based on the engendering relation between Heart and Spleen, the Spleen may have stolen her Heart qi in the long run. Finally, her arrhythmia continued. Fourteen years later after her first visit, an intra-cardiac pacemaker was inserted and the Heart qi was tonified and followed by the enrichment of Spleen qi. Accordingly, her purpura and digestive symptoms disappeared and her appetite was restored. As Kidney and Heart belong to the same lesser yin, with increasing Heart qi, Kidney qi was increased and Kidney yang was also increased allowing for Bladder to be warmed and being followed by the disappearance of Bladder inflammation. Her nervousness decreased, probably as a result of tonifying Heart.

Male climate period (Severe Autonomic nerve dysfunction syndrome)
Case 4. A 46-year-old Japanese male medicine wholesaler Chief complaint: Tachycardia, palpitation, hypertension, a hot face and staggering History of present illness: He began to suffer from a hot face, staggering, insomnia and hypertension (Liver and Kidney yin deficiency -, , -) in April. He had been doing aerobic exercise for a long time without any trouble. However, on September 25 of the same year, tachycardia and palpitation continued for more than one hour after aerobics (non-interaction between Heart and Kidney ( -). Furthermore, he suffered from tachycardia and palpitation not only after aerobics but also while resting, which led to his giving up aerobics. As he would sit, he felt palpitation and had a pale face and, upon standing up, he felt as though he was losing consciousness. An intake of psychotropic medications for one week had no beneficial effect. His blood pressure had been high and unstable. On straining during working, his face would get hot and the temples would throb uncomfortably (Ascendant hyperactivity of Liver yang --). His stiffness of shoulder, neck and back (Liver qi depression and blood stasis, interruption of meridian and collaterals -) and heaviness of the occipital region (retention of dampness -) continued. At his first visit on October 12, he felt something was heaving up from the epigastrium and his BP was 170/100mmHg (Kidney yin deficiency followed by ascendant hyperactivity of deficient fire: -). On that day he started taking chai-hu-jia-long-gu-mu-li-tang (in Japanese: Saikokaryukotsuboreito -this unblocks the three yang stages, and sedates and calms the spirit: TSUMURA & CO ) Ref20 which aggravated his hotness of face and palpitations and so was stopped. Generally, his general fatigue was severe, his urination volume was large, and he experienced discomfort on rainy days (retention of dampness: -). He often had muddy stools (Spleen qi deficiency: -) and was irritated, got angry easily, experienced hotness of the face and had night sweats ascendant hyperactivity of Liver yang ( --). When he was tired, his soles were hot with sweat (Kidney yin deficiency -). He felt asthenopia, dim eyesight and dry eye (Liver blood deficiency -). (Fig 4).
www.intechopen.com On October 25, he began an intake of gui-zhi-fu-ling-wan (in Japanese: Keishibukuryoganthis invigorates the blood and transforms blood stasis: TSUMURA & CO ) Ref 20 but only about 20% of his symptoms decreased. He visited a Kampo clinic and was administered ziyin-jiang-huo-tang (in Japanese: Jiinkokato Ref 20,Ref 24 -this tonifies yin:zhi-gan-zao, dang-gu, shao-yao, sheng-di-huang, tian-men-dong, mai-men-dong, bai-shu, chen-pi, huang-bo, zhimu, sheng-jiang, da-zao). Ref. 22 On November 17, tachycardia, palpitation and discomfort started to decrease and his irritation and instances of getting angry decreased by around 50%. No further improvement occurred. On November 24, he visited my clinic and diagnosed as follows. Identification: Liver qi depression with blood stasis, ascendant hyperactivity of Liver yang ( --), Kidney and Liver yin deficiency( -, -), Kidney deficiency with water flood( -). Treatments: Tonify Kidney yin and essence and Liver yin Prescription: Turtle powder (whole body was treated with heat and dried: 2g/day) was added. Clinical Course: One week later he had recovered completely. By mid-January of the following year, he could perform aerobics without any trouble, and the intake of all remedies except for turtle powder was stopped. He has been taking turtle powder since then, for several years, because if he stops he starts to feel strange and uncomfortable.

Discussion
During the male climacteric period, the male hormone decreases which means Kidney essence and yin decreases in TCM theory. It is reasonable that the prescription of zi-yinjiang-huo-tang Ref 23 caused symptoms to improve by 50%. The reason chai-hu-jia-long-gumu-li-tang worsened the situation is because his symptoms originated from the deficiency of Kidney essence and yin rather than by the inhibited three yang stages. This remedy tended to consume yin, which aggravated this situation. Shortage of Kidney yin caused Heart Fire effulgence ( -. . -), which means non-interaction between the Heart and Kidney. My TCM teacher, Lu Xi told me that his father, Lu Gan-fu, taught him that overwhelmingness occurs from viscus with excess evil qi to the corresponding viscus. If this theory is applied to Kidney, it may be said that hyperactive Kidney yang based on Kidney yin deficiency overwhelms Heart. Accordingly, hyperactive Kidney yang and Heart fire can exist together. Liver yin deficiency by engendering from Kidney ( -), and ascendant hyperactivity of Liver yang ( --) followed by overwhelm from Liver to Spleen ( -. -), which were almost all resolved by prescribing the turtle powder. There are many herbs for tonifying Kidney yin or essence, but when they are not effective; it is necessary to try animal-derived material in order to enrich Kidney yin or essence. Animalderived materials are sometimes very effective for these cases.

Aged female depression after husband's death
Case 5: A 76-year-old Japanese female Chief complaint: Depression with severe self-reproach, no vitality. History of present illness: Since two years ago, when her husband died, she had been suffering from impatience, depression with a guilty conscience (Liver qi depression), and insomnia. She could not get to sleep easily and she routinely took tranquilizers. Upon awakening, she felt heavy depression. As her false teeth did not fit, she ate by grinding her food. She had cold forefeet and had difficulty in hearing. Though table tennis had been her hobby, she had stopped due to lack of vitality. Up until her husband's death, she had climbed one mountain (600m height) once a week. Past history: She had been hospitalized after the great Hanshin earthquake. Menopause occurred at fifty-two years Family history: Her brothers all died from TB. Present status: Height, 156cm; weight, 48kg; BP, 138/78mmHg; pulse, 66/min. fine, slippery, sunken, with a weak chi/cubit pulse; tongue body, red; tongue fur, thin (Liver qi depression, Spleen qi deficiency ( , -) Identification: Qi deficiency, Liver qi depression, Deficiency of Kidney yin and yang Treatment: Soothe Liver to release depression, tonify Spleen and Kidney Prescription: bu-zhong-yi-qi-tang and soft-shelled turtle (tonifies yin and Kidney). Beginning on day thirty-eight nu-shen-san Ref 24 (in Japanese: Nyoshinsan -dan-gui, chuanxiong, gui-zhi, bai-chu, mu-xiang, huang-qin, huang-lian, ren-shen, gan-cao, xiang-fu-zi, dahuang, zong-lu-zi, ding-xiang soothes and tonifies Liver, clears heat, and warms the lower body) *1. Ref 25 was added to her previous prescriptions. Clinical course: Ten days after starting Kampo medicine (bu-zhong-yi-qi-tang, soft-shelled turtle) her mental irritation -including her depression with guilty conscience -decreased.
However, she still suffered occasionally from extreme depression. She continued with the same medicines. On day thirty-eight, a new prescription, nu-shen-san, was added. Three days after the addition of nu-shen-san, her feelings became more pleasant and her depression improved remarkably. She could go to the theatre and go shopping with a neighbouring housewife. She could not believe how depressed she had been. She continued for another thirty days with the same medicines and quit them all seventy-six days after starting Kampo medicine. She reported that she had completely recovered from her depression and could lead a satisfactory and normal life. Her insomnia disappeared as well. Discussion: This patient's Kidney yang and yin were rather deficient because her forefoot was cold even in the summer; she felt hot in sole and she had difficulty in hearing. She liked drinking cold cow's milk and had a dry mouth. The body of her tongue was red and her tongue fur was thin (Kidney yin deficiency -). The soft-shelled-turtle tonifies yin and Kidney. By taking this, Kidney would be enriched. The enriched Kidney may have engendered the Liver, which likely played a role in improving the depression to some extent. Bu-zhong-yi-qi-tang -which tonifies Spleen qi and supports the upbearing of qialso contributed to improving the depression. It is certain that these two medicines were partly effective in decreasing her depression, but her depression did not disappear completely and the addition of nu-shen-san improved the feeling of loss dramatically. Nushen-san soothed Liver and tonified it with other prescriptions, which engendered Heart, and was followed by the improvement of her insomnia and disappearance of her depression.
( * 1: This prescription was created by Sohaku Asada during the period between the Meiji and Edo eras, and has been used for any flush and dizziness surrounding childbirth as well as coldness of the lower parts of the body, by soothing Liver, discharging heat, tonifying Liver and warming the lower parts).

Interstitial Pneumonia
Case 6 : A 62-year-old Japanese female Chief complaint: Cough, dyspnea and palpitation aggravated on motion, cold legs, frequent urination History of present illness: Her dry cough continued until white sputa was discharged (Lung qi and yin deficiency ) followed by palpitation. Her cough was aggravated on rainy days (Lung fails in purification and downbearing -). Palpitation and dyspnea were severe (Lung influenced to Heart, Heart qi deficiency , -. Recently, even in the summer, her ankles would get cold (the Mother's abnormality is transmitted to the child by way of engendering -). The frequency of urination was more than ten times/day (Kidney yang deficiency: ). In winter, her soles felt hot (yin deficiency -). Recently, fatigue has increased (qi deficiency). Since menopause, she has experienced hot flashes and sensitivity to heat (yin deficiency with fire effulgence -, -, -). She prefers a cold drink ( -, -). In spite of suffering from cataracts and glaucoma evoked by adrenal cortex hormones, she continues to take 4mg of adrenal cortex hormone (predonine). She had high intraocular pressure (Liver yin deficiency , -). She has a small gallstone (1 cm). (Liver qi stagnation ). Past history: When she was fifty-eight years old, she had such severe dyspnea and palpitation that she was hospitalised for two-and-a-half months. She was diagnosed with interstitial pneumonia and, for three years, adrenal cortex hormones were prescribed. Five years later, dyspnea and palpitation were aggravated again. She visited another doctor and re-started adrenal cortex hormones therapy, which proved ineffective. Various other kinds of treatments have not worked. Family history: Her grandfather suffered from asthma Present status: Height, 158cm, weight, 57kg. Pulse, sunken, fine, forceless, 60/min (Heart qi deficiency ); tongue body, pale dark, swollen sublingual collateral vessels (Liver qi stagnation→blood stasis ); BP, 120/78mmHg Identification: Lung qi and yin deficiency, Heart qi deficiency, Phlegm obstructing the Lung, Kidney yin and yang Deficiency Treatments: Tonify Lung qi and yin, Tonify Heart qi Prescriptions: zhi-gan-cao-tang(in Japanese: Syakanzoto -this augments the qi, nourishes the blood, enriches the yin and restores the pulse) qin-fei-tang Ref 25 (in Japanese: Seihaitothis clears lung inflammation in order to remove sputa and stop coughs; Wan-bin-gui-chun, written by Gong Ting xian) *1Ref 24 supplemented with bai-he (Lilli Bulbus -this moistens Lung, clears heat to stop coughs, and enriches Lung yin), zhi-mu ( Anemarrhenae Rhizomathis clears heat and drains Fire and enriches the yin ) and pi-pa-ye (Eriobotryae Folium -this transforms phlegm, clears Lung heat and downbears Lung qi). Clinical course: She first visited my office on August 23, X year. Around seven days after starting herbal therapies, her conditions started to improve, and so she continued with taking them. On November 4 she visited our clinic and reported that she could do some housework, but that if she overworked, asthma occurred. As she felt a dry throat, owing to the side effects of conventional medicines, and I added zi-yin-jiang-huo-tang (in Japanese: Jiinkokato -this tonifies yin) *2 and ma-xing-gan-shi-tang (in Japanese: Makyokansekitothis facilitates the flow of Lung qi and clears heat) *3 for her asthma fits. Ma-xing-gan-shitang was quick to be effective. On her visit of November 30, she reported she could lead a normal life as a housewife and that her persistent cough and dry throat had disappeared. Fig. 6. Relations among viscera with five phase theory of case 6 (Interstitial Pneumonia before treatment) Discussion: As the patient had not been so oversensitive to the cold in her previous healthy days, the existence of recent cold legs and frequent urination could be the result of the transmission of accumulated Lung abnormalities to Kidney, from Lung, through the engendering route. Her symptom's aggravation on rainy days implies that Lung yang (qi) deficiency leading to retention of moistness. However, Lung yin deficiency also existed, which was the cause of her severe dry cough. Qin-fei-tang and pi-pa-ye cleared the heat and phlegm of the Lung and tonified the yin of Lung along with bai-he and zhi-mu. Enriching the Lung yin strengthened the Lung qi. Zhi-gan-cao-tang tonified the Heart qi, together with Lung qi enrichment, and worked synergistically based upon the close relation between the two viscera. It was likely that this was the reason why she improved so quickly. Her intraocular high blood pressure may have been due to the Liver yin deficiency transforming into Fire transmitted from the Kidney yin deficiency.

Pulmonary emphysema
Case 7 A 73-year-old Japanese male. Chief complaint: Frequent cough with transparent sticky sputa, dyspnea on motion, difficulty in walking with powerless legs, and sensitivity to the cold. History of present illness: He had serious dyspnea on motion (Lung qi deficiency ). Taking just one step in walking made him feel like choking (Heart qi deficiency , -). He complained of powerless legs (Kidney qi deficiency ). During the summer he didn't like air conditioning; instead, he dressed in heavy clothing and used a big futon ( -). He had feet that were cold to numbness (Kidney yang deficiency -). He also had a groin hernia. He had been light eater and sometimes he experiences stomach aches (Spleen qi deficiency -, ).
The previous year, he had been diagnosed with serious pulmonary emphysema at a major hospital, but continued to smoke two pieces of cigarettes a day. He generally discharges a lot of transparent sticky sputa (phlegm obstructing the lung ( , -). Sometimes he discharges yellow sputa (localised inflammation in Lung). He told me that he usually discharges sputa around ten times/day (Lung qi deficiency , -). As he easily catches colds during the winter, he rarely goes out. Present Status: Height, 156 cm; weight, 41 kg; BP, 146/70mmHg, Pulse, 72/min, string-like, slippery, weak (Heart qi deficiency ), purple-red tongue, white thick fur with spot defoliation (cold damp entering interior, stomach qi and deficiency ). Past history: Between the ages of nineteen and twenty-four years, he was hospitalised with TB. About four years ago, a fever of more than 39°C continued for around fourteen days, causing him to be hospitalised. Since this time, he has noticed dypnea on motion. His frequent cough and oversensitivity to the cold have been a long-term problem. zhi-gan-cao-tang (TSUMURA & CO.: this augments the qi, nourishes the blood, enriches the yin and restores the pulse). *1 Ref 24 qin-fei-tang *2 with supplemental bai-he (Lilli Bulbus: this moistens Lung, clears heat to stop coughs and enriches Lung yin) *1: Powder type -a product of Tsumura Co. *2:same as case 6) www.intechopen.com Clinical course: When the patient visited my clinic on April 11 for the first time, he reported that he had taken preserved zhi-gan-cao-tang for three weeks but that his cough and sputum had not changed, even though he felt slightly better. I added the qin-fei-tang. On his second visit on April 30, he reported that he could walk and move without much trouble. On June 26, he reported that routine movement and walking were much improved, and that the volume of sputa had decreased. He continued taking the same remedies, and around one year later, he could lead a more relaxed life without much trouble. He continues to smoke two cigarettes a day and he plays "go" from time to time. His sensitivity to the cold has improved and he can walk without trouble. He has not caught a cold so far. He has taken only qin-fei-tang for one year, and has done fine on this reduced regimen. Discussion: The patient suffered from TB during youth and he has continued smoking while playing "go" since then. That may be one of the reasons he suffered from pulmonary emphysema. The heavy abnormalities of Lung (Lung evil qi) were transmitted to Kidney, which depleted the qi further, leading to Kidney yang deficiency. Even in summer he was heavily clothed and used a thick coverlet. His Heart qi deficiency may have derived from Heart-Lung qi deficiency syndrome, or Lung qi abnormalities might have influenced the heart through the rebellion route. Spleen qi deficiency, such as being a light eater, experiencing occasional stomach aches or groin hernia, might have derived from the stealing of Spleen qi by the lung. Once Lung qi was restored, his coldness, stomach aches, groin hernia, and frequency of cough with sputa were remarkably decreased. It is clear that in his case Lung was the main organ that caused and aggravated his various symptoms.

Recurrence of metastatic kidney cancer in bladder
Case 8. A 52-year-old Japanese businessman Chief complaint: Intractable metastatic kidney cancer, nose dryness History of present illness: At age 51, the patient had noticed hematuria. Twelve months later, in April, X year, he was diagnosed with cancer of Kidney. A left nephroureterectomy was carried out in a national hospital in May. Partial cancer cell infiltration was recognised, which was resected without gross cancer tissues. Nose dryness has continued (yin deficiency of Lung -). Past history: He had been a heavy smoker. Since X-6 year, he suffered from hoarseness and pharyngitis (Lung yin deficiency -) and choking pressure in the chest (Heart blood obstruction with blood stasis -). In X-4 year palpitations accompanied these symptoms (Heart qi deficiency ) and his voice would become more hoarse, with a dry mouth and dry lips (Lung yin deficiency -). He usually took the drug for angina pectoris. In spring of the X-3 year, when he looked backwards, dizziness occurred (obstruction with blood stasis, upper orifices interruption , -), which was much improved with exercise. In June, he again felt tightness of the chest and numbness from right shoulder to the arm (Heart blood stasis -) and sometimes got edema of leg (Kidney qi deficiency, blood stasis ). He occasionally suffered reflex vomiting from too much smoke. In X-2 year, hematuria was detected. In February of X-1 year, a benign left tonsil tumour was extracted (Blood stasis of Lung meridian -). He stopped smoking after the extraction of this tumour. Family history: There have been no particular problems in his family regarding cancer or malignant tumours. Present status: Height, 171cm; weight, 60kg; BP, 146/80mmHg. Right pulse, string-like and slippery; left pulse, string-like; the body colour of the tongue is pale and dark, tooth-marked, and with a slimy yellowish fur (Dampness-heat of Spleen). There were no other particular problems. Identification: Blood stasis in Kidney, Qi deficiency of Lung and Heart with fluid retention. Treatments: Activate blood to remove stasis, clean heat, remove moistness and soothe liver, regulate qi. Spread Liver qi and reduce fever group: chai-hu (Bupleuri Radix 1); Tonify the qi, nourish the blood and calm the spirit, augment Heart qi group: ling-zhi (Ganoderma 2); Warms and unblocks the channels and collaterals and assists the yang group: gui-zhi (Cinnamomi Ramulus 2) and moderate, harmonise and tonify Spleen group: gan-cao (Glycyrrhizae Radix 1.5). The numeral at the end of parenthesis mean the daily used weight. All materials were decocted in hot water with the instrument on the market with the regular method. Clinical course: From September 28, X year, the patient started the prescription mentioned above and stopped smoking after the operation. During a periodic follow-up at the end of October, no tumour was detected. On November 25, three small tumours (diameter, 1 mm) and 1 larger tumour (diameter, 5 mm) were found. Until the middle of March of the next year, as intravesical instillation of an anticancer drug was carried out every two weeks(eight times in total) with prescription . During the periodic follow-up of April 6,X+1 year, only the 5-mm tumor was discovered to have survived and this was excised. To this situation, Prescription was added to Prescription I. Prescription II was composed of bai-hua-she-she-cao (Hydyotis diffusae Herba which clears heat and resolves dampness and fire toxicity 4.5), wang-bu-liu-xing(Viccariae Semen which promotes the movement of blood 4.5) and shui-zhi(Hirudo which breaks up and drives out blood stasis and reduces fixed masses 4.5) and continued without any conventional therapies. As a recurrence was not recognised at the periodic check, the moiety of the decoction was halved from October X+1. In April X+2 year, he returned to work and continued to take the same volume of the decoction. From X+11 to X+13year, he reduced his dose at 1/6 of the initial volume, and since X+14 he stopped. Now, more than three years have passed since then and without any recurrence. Discussion: A therapy of Prescription I with an anticancer infusion every two weeks for four months did not work to eradicate remaining one biggest cancer. Since then, Prescription I combined with Prescription has been continued for fourteen years. After stopping this, more than three years has passed without a recurrence, so far, which will mean Prescription I and worked to inhibit the recurrence. The fact that, by stopping smoking in X year before the first visit, the symptoms of Heart and Lung quickly disappeared would imply that these symptoms are all derived from smoking. In X-6 year, Lung related symptoms (hoarseness and pharyngitis) appeared with Heart related symptoms (a feeling of tightness in chest) appearing in X-4 year; these symptoms have continued and aggravated with palpitations. In X-2 year, hematuria appeared for the first time during a yearly medical check. In X-1 year, benign tonsil tumour was resected. This could mean Lung abnormality rebels Heart when his palpitations started( -). Next abnormalities transmitted to Kidney through the engendering route from Lung to Kidney. By stopping smoking before the first visit, the symptoms of the Heart and Lung had nearly all disappeared, but the abnormal situation of Kidney could not change. Drugs for activating the blood and moving qi, cleaning the heat and removing dampness, and tonifying the qi, worked synergistically to restore satisfactory function of Kidney such that the cancers would not recur.

A case of depression
Case 9 A 38-year-old Japanese housewife and office worker (48 kg, 155cm) First visit: On 16 th of February in X year Chief complaints: Depression, spiritlessness, a dull feeling in the stomach, menstrual pain Clinical history: She began working at age twenty-one, and married at age twenty-five. At thirty-five years, she changed her job because it involved too much stress. She has been suffering from depression, spiritlessness (Liver qi depression and stagnation ), stiffness of the shoulder and a blocked feeling of the blood vessels in the temple and at the base of the neck (Blood stasis -). Stress creates a dull feeling in the stomach (Wood overwhelms Earth -). Manual therapy improved her condition (freeing the collateral vessels), premenstrual nausea ( -), and the blood-shot condition and mucus of her right eye (Liver qi stagnation-transforming into heat -). Other symptoms included a dry feeling of the skin and lip ( -), coldness of the forefoot, constipation which improved by warming(Kidney yang deficiency -). She suffered from profuse dreaming (disquieted heart mind -), hot palms (yin deficiency -fever of three yin meridians of the hand), hay fever with rhinorrhea in fatigue (Spleen-Kidney yang deficiency → water dampness failing in transportation → cold fluid retention in Lung -). She smokes ten cigarettes a day (arteriosclerotic progression, impaired viscera). Past history: During primary school days, she often suffered from convulsions on falling asleep (her yin and yang couldn't copulate successfully). In the past, she has been pale, with a tooth-marked tongue (Spleen yang deficiency with dampness retention . -), and her sublingual collateral vessels showed blood stasis (Liver qi depression and blood stasis -). States Present: Height is 162cm; weight is 59kg; pulse is string like, slippery, fine, 72/min; tongue has a pale body and is teeth-marked (retention of water -、 -) with a thin white fur. Sublingual blackish vessel is enlarged (blood stasis). Identification: Liver qi depression and static blood, Liver overwhelms Spleen, Liver causes rebellion in Lung, Spleen-Kidney yang deficiency Treatment: Soothe Liver. Harmonise Liver and spleen. Warm and free collateral vessels. Prescriptions and herbs: Si-ni-san Ref 26 (in Japanese: Shigyakusan*1 -soothes liver, regulates qi, harmonises liver and spleen) Ref 26 together with xion-gui-tiao-xue-yin Ref27 (in Japanese: Kyukichoketsuin*2 -this regulates qi, activates blood, tonifies blood/regulates menstruation; this originates from Wan-bin-gui-chun), ban-xia (Rhizoma Pinelliae Ternatae -this dries dampness and transforms phlegm), mahuang (Ephedrae Herba -this induces sweating and releases the exterior) and gui zhi (Cinammomi Ramulus -this releases the exterior and warms yang to unblock the meridian) ( *1: Si-ni-san: chai-fu, shao-yao, zhi-shi, gan-cao * 2 : Xion gui tiao xue yin :dan-gui, chun-xiong, sheng-di-huang, bai-chu, fu-ling, chen-pi, *3 : wu-yao, xiang-fu-zi, mu-dan-pi, yi-mu-cao, da-zao, sheng-jiang, gan-cao) Clinical course: A numerical Rating Scale (NRS) employing the patient's self-report of symptoms in numerals (with the worst condition experienced so far scored as 10 and with no symptoms scored as 0) was used to monitor the course (Fig 9), and the patient's disease situation was described with five-phase theory (Fig 10). Discussion As shown in Figs. 9 and 10, herbal therapy decreased the NRS. Since I do not prescribe special medicines for Kidney, the improvement of foot coldness was not so successful. However, other symptoms improved relatively well. Si-ni-san mainly worked to reduce Liver qi stagnation and, with xion-gui-tiao-xue-yin in collaboration, this removed the blood stasis and regulated qi. Furthermore, the rebellion in the lung from Liver must have decreased since, in spite of the absence of treatment for rhinorrhea in fatigue, it disappeared completely (data not shown). The dull feeling in the stomach evoked by stress decreased comparatively well, which means that overwhelm in the stomach disappeared. The simultaneous treatment of every imbalanced viscus often leads to quick recovery because every normalised viscus works simultaneously and synergistically.. The qi movement of each phase will be normalised by this treatment. www.intechopen.com

Asthma with dyspnea and general fatigue
Case 10 A 50-year-old Japanese female who works for a Japanese pub Chief complaint: The patient finds it impossible to lie down, due to dyspnea and palpitation (Lung and Heart qi deficiency , ). She experiences suffocating dyspnea and general fatigue. Perfumes, cigars, cosmetics and other stimuli cause dyspnea. She has asthma and is sensitive to chemical substances (Lang qi deficiency ). History of present illness: For almost a year, beginning in the summer when her stress tremendously increased, she had been suffering from palpitation and suffocating dyspnea (Probably, Liver rebellions Lung, Heart and Lung qi deficiency -. , ), and she could not lie down or maintain a sitting posture with general fatigue (Lung qi deficiency ). Furthermore, she had cold limbs, sensitivity to coldness, frequent urination during the night, and edema (Kidney Yang deficiency -, -) and condition worsens on rainy days. She doesn't want to drink water even though she feels thirsty (Kidney yang deficiency with water flood -. -). She often had concentrated urine, her soles are hot during the night (Kidney yin deficiency -). She experienced fullness in the abdomen after meals, has many stressors in her life, breast pain, and fullness of the chest around the time of menstruation (Liver depression and qi stagnation -). Additionally, she has had severe shoulder stiffness, enlargement of the sublingual vessel (blood stasis -), asthenopia, dim eyesight, numbness of limbs (Blood deficiency of liver -), headache, a short temper, facial hotness, and she prefers cold water (ascendant hyperactivity of liver yang -). She cannot sleep easily, having insomnia, profuse dreaming, and a feeling of uneasiness (Heart blood and yin deficiency . -). She is sensitive to various chemical substances, such as smoke, dust, insecticide, cosmetics, exhaust gas, and the smell of dishes (Lung qi deficiency ). The adrenal cortex hormone that she takes causes eye pain, headache, skin irritation and choking (Lung qi deficiency ). At another clinic, yi-gan-san Ref 28 (this pacifies liver to extinguish wind) *1 added with banxia (Rhizoma Pinelliae Ternatae -this dries dampness, transforms phlegm), chen-pi (Citri reticulatae Pericarpium -this regulates qi, dries dampness, transforms phlegm), si ni san Ref 26 , qin-fei-tang Ref 25 with xing-gan-shi-tang, chai-hu-gui-zhi-tang (in Japanese: Saikokeishitothis releases and harmonises lesser yang-stage disorders and releases the muscle layer and exterior), ban-xia-hou-po-tang (in Japanese: Hangekobokuto -this promotes qi movement, dissipates clumps, directs rebellious qi downward, and transforms phlegm) were prescribed with conventional drugs such as montelukast sodium, salmeterol xinafoate and procaterol, but these were not effective. (*1 chai-fu, can-zao,dan-gui,bai-chu.fu-ling,diao-teng-gou) Past history: She had suffered from alopecia areata, which is possibly stress-induced. Present status: Height 162cm; weight 51.5kg; the tip of the tongue is red (Heart meridian has heat) and there is a fissure in the middle of the body of the tongue (Spleen yin deficiency); the tongue's fur is thin, pale and white; the sublingual vessel is blackish and enlarged (blood stasis). Pulse: float and weak (Heart blood and yin deficiency) Identification: Liver qi stagnation with blood stasis ( -), Blood deficiency of Liver and Heart ( -, -), Liver yin deficiency with ascendant hyperactivity of Liver yang ( -. Liver overwhelms Spleen ( -, Liver rebellions Lung ( -). She had to use bronchodilators, such as salmeterol xinafoate and procaterol hydrochloride. She worked for long hours in the air conditioning and her limbs must have been cooled, causing the Kidney www.intechopen.com yang to decrease, which might be inversely transmitted to Lung and which may be one of the reasons for the aggravation of her asthma. Treatments: Tonify Lung qi, soothe Liver, regulate qi, tonify Heart qi and blood,tonify qi, yin and yang of Kidney.
Clinical course Prescriptions were administered in late April. Ten days later, on May 11, she visited the clinic and reported that, although she was not completely cured, her condition was much improved and that she could resume working. The abnormal sensation of the Lung disappeared. Dyspnea during the day improved, but at night it was still not good. On May 31, she reported that daytime dyspnea had disappeared and that at night her asthma fits decreased and she did not need to use the bronchodilator. She could work without trouble. On June 17, she reported that she had stopped using two of her three bronchodilators and could pursue a routine life as in previous days when she was healthy. Only when she was tired would she use her bronchodilator in order to prevent fits. Discussion: Her asthma fits began during the summer one year ago, before she visited my clinic. As she experienced much stress through her work, Liver qi stagnation may have played a role in this aggravation. However, many Liver-soothing formulas did not work. I supposed that her asthma was aggravated not only by rebellion from Liver but also from the www.intechopen.com Lung qi deficiency brought about from Kidney yang deficiency that was transmitted inversely to Lung. This may be because, during the summer, she worked for long hours in the air conditioning and her limbs must have been cooled, causing Kidney yang to decrease, which was inversely transmitted to Lung. Moreover, she has been -by her nature -sensitive to coldness. Her deficiency of Heart qi may be a result of the mutual relation between the Lung and Heart. Some rebellion from the Kidney of yang deficiency may participate in the Heart qi deficiency. These included zi-yin-zhi-bao-tang for soothing the Liver and regulating qi, tonifying the Spleen and yin to clear the Lung Ref 30 , zhi-gan-cao-tang (Tsumura Co.) for augmenting the qi, nourishing blood, enriching the yin of Heart and restoring the pulse, and Ba-wei-di-huang-wan for warming and tonifying the yang of the Kidney. This means we treat all viscera at the same time. This is the reason she could recover so promptly from her disease and could work again. As a general rule, treating the dysfunction of all viscera to restore their qi at the same time will lead to a quick recovery, based on the smooth circulation of respective qi among viscera with synergy. If one of them were not to have been treated, the recovery would have been slower. (The treatment of this patient was carried out by Dr Shimizu Ishigaki, Director of Yasookodomo Clinic, Shizuoka Prefecture and the author).

Difficulty in walking with staggering for more than 1 year
Case 11: A 67-year-old Japanese housewife 160 cm, 68 kg Chief complaint: Dizziness, staggering, difficulty in walking (Heart blood and qi deficiency, -→ interruption of upper orifices), dyspnea, susceptibility to catching colds (Lung qi deficiency -, edema of face and limb (retention of water produced by yang deficiency ( --, -), coldness from occipital region to the back (Coldness of Du Meridian: governor vessel), facial flush (stagnated Liver qi transforming into fire → Liver yin deficiency --, -), cold forefoot (Kidney yang deficiency ), hand stiffness, numbness and pain on rising (Liver qi deficiency, blood stasis ). Clinical history: First visit: February 22 2006. Since more than two years ago, she has often pitched forward and has had a sensation of walking on air in spite of her paying close attention to her gait. Many thorough examinations by brain surgeons, and at several major hospitals, have produced no explanation for these symptoms. She had been suffering from insomnia, profuse dreams and amnesia (Liver, Heart blood deficiency. -, -), a feeling of stool stasis, abdominal fullness (Liver overwhelms Spleen, Spleen qi deficiency, gastric hyperacidity -, ), edema of face and limbs for several years (Spleen yang deficiency, retention of water and moisture --), low blood pressure on rising, aggravated by warmth, shoulder stiffness (stagnated Liver qi and blood stasis , -), dry eyes, blood-shot eyes, heat in her palm (Liver depression transforming into fire → Liver yin deficiency --), a heavy feeling in her legs (moisture retention by Kidney yang deficiency --), back pain on catching a cold (Lung qi deficiency , -), and chronic pancreatitis based upon her being a kitchen drinker for the past seventeen years (Spleen dampness-heat ). She had her menopause at age fifty-six. Past history: She suffered from rotary dizziness with vomiting between the ages of around forty and fifty ( , -). She takes camost mesilate from time to time because of chronic pancreatitis. Family history: Her older brother died from pancreatic cancer and her younger sister died from lung cancer. She has three children.
www.intechopen.com Present illness: 72/min, fine, slippery, sunken pulse (Heart qi deficiency ; a pale red tongue with white fur; over-swelling of dark sublingual collateral vessels (blood stasis). Standing blood pressure 110/80, sitting pressure 140/80. Identification: Liver depression with blood stasis, fluid retention with yang deficiency of Spleen and Kidney; Deficiency of Heart qi and blood; Interruption to upper orifices Treatment: Soothe Liver and regulate qi, activate blood, free the collateral vessels, remove moisture and tonify Spleen. Prescriptions: Bu-yang-huan-wu-tang (BYHWT: tonifies the qi, invigorates the blood, and unblocks the channels) Ref 30 *a combined with she-chong-yin (in Japanese: Sesyoin -this activates blood to solve stasis) Ref 31 *b included BYHWT, yan-hu-suo (this invigorates the blood and promotes the movement of qi) , niu-xi (this invigorates the blood and dispel blood stasis), mu-tan-pi (this clears heat and invigorates and dispels the blood ), gui-zhi (this releases the exterior, assists the yang, warms and unblocks the channels and collaterals). Further, gan-cao, wu-yao (this regulates qi, warms the Kidney) , xiang-fu-zi (this spreads and regulates Liver qi, regulates menstruation and alleviates pain), chai-fu(Bupleuri Radix which spreads Liver qi and reduce fever), jie-geng (Platycodi Radix -this opens up and disseminates the Lung qi, pushes out puss and opens up and raises Lung qi) and wu-lingsan (in Japanese: Goreisan -this promotes urination, drains dampness, warms the yang and resolves qi).were added.

Discussion
This patient has had too much stress for a long time, as she became a kitchen drinker with pancreatitis seventeen years ago. Stress made Liver qi depression and blood stagnationespecially in upper orifice -will be the main reason for her dizziness, staggering, and difficulty in walking and probably for her low standing blood pressure ( -). The excessive over-swelling of her sublingual vessel implies the occurrence of severe blood stagnation. As Liver overwhelmed Spleen, she displayed many symptoms through her digestive system relating to water retention, including pancreatitis. Furthermore, her stress was so enormous that she had dyspnoea, with coldness causing her back pain (Liver rebellions Lung). As she has Kidney yang deficiency, seen through cold feet with a stagger, as well as the retention of moisture ( , -), this might be caused by overwhelm from Spleen cold evil to Kidney and aging. Enormous Liver abnormalities, transmitted to Heart to cause palpitation, arrhythmia, dizziness with a stagger and blood deficiency ( , -). Water or moisture retention may influence her dizziness and staggering to some extent. I classified herb mixtures (BYHWT+she-chong-yin+others): Gr 1,to activate Blood in order to solve Blood stasis (chuan-xion,chi-shao, tao-ren, hong-hua yan-hu-suo, niu-xi, mu-tan-pi), Gr 2 so as to tonify Blood(dan-gui,chuan-xion); Gr 3 to tonify qi(huang-qi); Gr 4 to regulate Liver qi(chai-fu); Gr 5 to regulate qi(yan-fu-suo, xiang-fu-zi, wu-yao), and Gr 6 including others (gyu-zhi,gan-cao,jie-geng,di-long,wu-ling-san). Gr-1, Gr-2, Gr-3 and Gr-4 will work to soothe Liver, regulate qi, activate stagnated blood and tonify blood of Liver and Heart. As a result, the transmission of abnormal qi to Heart www.intechopen.com from Liver, rebellion to Lung from Liver and overwhelm to Spleen from Liver will all decrease. Gr 1, Gr 2, Gr 3, gui-zhi and gan-cao will also operate to tonify Kidney qi and for Spleen and Lung as well. Wu-ling-san would support disappearance of water retention. As such, each of the five viscus qi is tonified which leads to smooth recovery of her symptoms. Notably, after around two years of taking herbs, she became symptomless and was able to stop two years later without recurrence more than three years. I suppose main reason of her recovery will be the disappearance of stagnated blood in brain and other parts of the body.  www.intechopen.com