International Journal of Clinical Case Reports, 2025, Vol.15, No.1, 1-11 http://medscipublisher.com/index.php/ijccr 4 Figure 1 The five elements theory and the zang-xiang theory in traditional Chinese medicine (Adopted from Zhang and Fang, 2023) Image caption: The five elements include wood, fire, soil, metal, and water. The mutual generation orders of the five elements are wood, fire, soil, metal, and water, while the mutual restraint orders of the five elements are wood, soil, water, fire, and metal. The five elements theory refers to that all things in the world are generated by the movement and changes of the five basic elements. The zang-xiang theory investigates the physiological functions, pathological changes, and interrelationships of various organs in the human body by the observation of physiological and pathological phenomena. The zang-xiang theory is based on the zang organs and the fu organs, which include the five zang organs (including the liver, heart, spleen, lung, and the kidney), the six fu organs (including the gallbladder, small intestine, stomach, large intestine, urinary bladder, and the sanjiao), and the extraordinary fu organs (a collective term for the brain, marrow, bone, vessels, gallbladder, and the nü-zi-bao [usually indicating the uterus], these organs are not shown in this figure). The liver, heart, spleen, lung, and the kidney belong to wood, fire, soil, metal, and water, respectively. The mutual generation or restraint orders of the five elements are the same in their corresponding five zang organs. The five zang organs belong to the interior, while their corresponding six fu organs (the gallbladder, small intestine, stomach, large intestine, and the urinary bladder) belong to the exterior. The opening of the five zang organs is as follows: the liver opens into the eyes; the heart opens into the tongue; the spleen opens into the mouth; the lung opens into the nose; and the kidney opens into the ears. The eyes, tongue, mouth, nose, and the ears are collectively termed as the five sense organs (Adopted from Zhang and Fang, 2023) 4.2 The relationship between seasons and the five elements, and its influence on dietary adjustments The Five Elements Theory also emphasizes the importance of seasonal changes in dietary adjustments. Each season is associated with a specific element: Spring corresponds to Wood, Summer to Fire, Late Summer to Earth, Autumn to Metal, and Winter to Water. As the seasons shift, the body’s needs change, and dietary recommendations are adapted accordingly. For instance, during Spring (Wood), the focus is on nourishing the Liver with fresh, green, and lightly sour foods that promote the free flow of qi, such as leafy greens and sprouted grains (Shen, 2014). In contrast, during Winter (Water), foods that nourish the Kidneys, such as salty and warming foods like seaweed and bone broth, are recommended to conserve energy and strengthen the body’s core vitality. This seasonal dietary adaptation aligns the body’s internal environment with external conditions, ensuring that energy is distributed efficiently and health is maintained throughout the year (Cao, 2008). 4.3 The five elements properties of food ingredients and the selection of functional foods In TCM, each food is categorized according to its elemental properties (Wood, Fire, Earth, Metal, Water) and is used to correct imbalances in the body’s internal environment. For example, foods with Wood properties, like sour fruits, are used to nourish the Liver, while Fire-associated foods, such as bitter greens, are beneficial for cooling excess Heart Fire. This classification helps in selecting functional foods that can target specific organs and health conditions. For instance, bitter foods like kale and dandelion greens are often recommended to support heart health and reduce excessive heat (Zhang et al., 2022).
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