This article is based on notes from a course in East Asian Medicine I took between April and October 2019, expanded from the standpoint of September 2026. It was originally five separate pieces, one for each session, but the five elements (also called the five phases) lose their shape when read apart, so I have brought them together. A note at the end sets out what became visible only later.
About the Course
On April 7, 2019, I began attending a course in East Asian Medicine at Kei.K Aroma Studio in Kanagawa, Japan. Six days in all, two sessions a day, from ten in the morning until three in the afternoon. The teacher was Masamichi Abe, an acupuncturist based in Sapporo who runs a clinic called Kazenone.
This article covers four of those six days.
| Session | Date | Subject |
|---|---|---|
| 1 | April 7, 2019 | Yin-yang and the five elements |
| 2 | May 12, 2019 | Wood and fire |
| 3 | June 2, 2019 | Earth and metal |
| 4 | July 7, 2019 | Water (first half of the day) |
I have written elsewhere about why I took the course. In IMAC — a course taught by Hiroki Sato in Osaka — the state of the meridians is assessed by measuring range of motion. I wanted to understand the thing being measured. What are meridians? What do the five organs refer to? I wanted that from the side of East Asian Medicine itself.
The handout on the first day was twelve pages. Open any book on the subject and you will find yin-yang and the five elements described at length. What you will not find is which parts matter. Abe’s twelve pages were only those parts.
Making Qi into Something You Can Picture
The first thing taught was what this medicine is dealing with.
East Asian Medicine deals with qi — energy — which cannot be seen. But qi on its own is hard to get hold of. So the tradition built something imaginable in its place: yin-yang and the five elements.
The order matters. Yin-yang and the five elements did not come first. They were made afterward, as instruments for handling something invisible.
Yin and Yang Are a Tool for Comparison
Yin and yang are a comparison, made after you have decided what the basis of comparison is. So what counts as yin and what counts as yang shifts depending on what you are comparing.
Abe put it this way: you get to decide the basis yourself. That is what makes East Asian Medicine interesting, and what makes it useful.
There is a second idea in yin-yang as well — that a stronger quality affects a weaker one. On a cold day, you are affected by the cold. Unless you keep this separate from the question of what the basis is, the yin-yang used in macrobiotics, for instance, will not make sense.
There was also this: people live by taking in the qi of heaven and the qi of earth. Heaven’s qi is breath; earth’s qi is food. Where people go wrong is food, which is why understanding food matters.
The Five Elements Sort Things into Five Groups
The five elements are wood, fire, earth, metal, and water. You work with them by likening them to human temperaments and to the body’s physiological functions.
Each phase has an organ and a bowel assigned to it.
The image is that the organs are solid and full, while the bowels are hollow — passageways, pipes.
What I found interesting is this: focus on how to put the five organs in order, and the five bowels fall into order by themselves. To clear a passage, work on the thing that is solid.
Then there are the generating and restraining relationships. Because the phases affect one another, a disturbance anywhere moves the body back toward balance of its own accord.
That idea startled me.
Western medicine separates emotion, temperament, and physiological function, and handles each on its own. East Asian Medicine sorts them into the same group and treats them as one thing. Order that group and the balance comes back. Which is to say you do not need fine-grained anatomy or nutrition to work in that direction.
Working in the direction of balance — on that point, Rolfing, Source Point Therapy, and IMAC are all facing the same way.
Fire — Heart and Small Intestine
From here, the phases one at a time.
Fire’s organ is the heart; its bowel is the small intestine.
In East Asian Medicine, the heart governs everything about a person’s mind and body. It sits at the top and issues instructions to the other organs and bowels. Trouble is handled by the various departments — liver, spleen, lung, kidney. So if there is a problem with the heart, you can read it as a serious situation indeed.
This is why the phases must be understood as connections rather than as separate items — a point Abe stressed particularly when working through fire.
At the same time, he said, emotion is governed not by the heart but by the kidney. When kidney function drops, emotional regulation fails.
That sounds confusing at first, but it holds up from the Western side. When the brain registers stress, it acts on the adrenal glands — East Asian Medicine includes the adrenals within the kidney — and adrenaline and cortisol are released to meet the stress. If the adrenals cannot work well, stress cannot be met, and emotional regulation fails.
All of which was known long before Western medicine arrived at it.
The pairing of heart and small intestine was also explained through an image. Both are organs that never stop moving: the heart beats, the small intestine has its peristalsis. Abe returned again and again to how much images matter.
Wood — Liver and Gallbladder
Wood’s organ is the liver; its bowel is the gallbladder.
The liver is said to govern the free flow. To make things pass and circulate; to send things out, to excrete. That is how its function is understood.
The liver is also said to govern the muscles, and in East Asian Medicine it is tied to communication between brain and muscle, to the nerves, and to the autonomic nervous system in particular. Burden the liver and the body stiffens.
The liver has a great deal to do with menstruation. When qi circulates poorly, the period comes late; when blood circulates poorly, pain arises beforehand and impurity accumulates.
The liver is involved in digestion and absorption, stores blood, and regulates it. Its role in cleaning the blood is particularly emphasized, and the hours when liver and gallbladder work hardest — eleven at night to three in the morning — are said to be when the blood is cleaned most efficiently.
Which is why, to put wood in order, you go to bed early. And waking well becomes the thing to watch.
From the Western side: food digested and absorbed in the small intestine travels through the portal vein to the liver. There it is processed into a usable form, passes through the heart, and is carried by the blood to the organs. Surplus nutrients are stored, harmful substances are broken down, and bile acids are produced to help absorb fats.
So what is absorbed in the small intestine goes first to the liver, not to the heart, and reaches the heart only after the blood has been cleaned. Producing blood and cleaning it — the East Asian account holds up from the Western side too.
The liver is said to be involved in anger.
In The Spark in the Machine, Daniel Keown suggests histamine may be what is at work here. Histamine acts locally, but sometimes overflows, producing allergies, asthma, anaphylaxis, and itching. That leads to irritation and frustration, and from there to anger. If this shifts according to the liver’s capacity to clear such substances from the blood, then the liver is indeed involved in anger. That is Keown’s suggestion.
Earth — Spleen and Stomach
Earth’s organ is the spleen; its bowel is the stomach.
This is where the difference from Western medicine is largest.
In Western medicine, the spleen is a hematopoietic and lymphatic organ in the left flank, roughly ten by six by three centimeters. In infancy it produces blood cells; it processes old ones, stores blood, produces lymphocytes, and takes part in immunity.
The spleen of East Asian Medicine is nothing like this.
Its roles: to govern the entire digestive tract from mouth to anus and produce qi, blood, and fluids from food. To digest, absorb, and transport throughout the body. To produce refined essence in the stomach and small intestine and circulate it to nourish the whole. To send the water in food and drink to the lung and kidney, regulating the body’s water.
In Western terms: food enters the mouth and passes to esophagus, stomach, duodenum, and small intestine, broken down with the help of gastric acid and pancreatic hormones, absorbed in the small intestine, gathered in the liver through the portal vein, processed, and distributed. What is not absorbed has its water taken up in the large intestine and leaves as stool.
The organ that oversees this whole sequence — the command post — is what East Asian Medicine calls the spleen.
The stomach, its pair, receives food, performs a preliminary digestion, and sends it to the small intestine. Here the two systems agree.
The division between spleen and stomach runs in opposite directions. The spleen raises the energy made from food upward — to the head, heart, and lung. The stomach sends what has been eaten downward, to the small and large intestines.
When the spleen weakens: drowsiness after meals, lack of strength, dizziness, prolapse. When the stomach weakens: loss of appetite, bloating, belching, vomiting, bad breath, constipation.
The spleen also stores nourishment in the flesh. The liver is said to govern the muscles as well, but that concerns movement itself — range, ease, flexibility. The roles are divided.
The relationship to the mind was interesting too. When the spleen works properly, you can think deeply and feel things. But excessive fixation and worry lower digestive function instead.
Which is why, in East Asian Medicine, when you find yourself boxed in on every side, the advice is to put the digestive system in order.
Why? Because appetite is understood to arise from the desire to produce qi and blood. And what is interesting is that appetite is not divided into several drives as Western psychology would divide it. It is taken as one thing, and all desire, including desire for possessions, is included in it.
Since the spleen governs the whole digestive tract, its condition can be read from the mouth and lips — sores at the corners, ulcers. Sweets in excess, an unbalanced diet, artificial flavorings, and additives all burden the spleen, so the work is done through food.
There was also a point about yawning. Moving the mouth matters — for circulating qi, for releasing the viscera, and for switching between an active mode and a resting one.
Metal — Lung and Large Intestine
Metal’s organ is the lung; its bowel is the large intestine.
In Western medicine, the lung exchanges oxygen for carbon dioxide.
The lung of East Asian Medicine covers far more. It governs the entire respiratory system — nose, throat, trachea, lungs, skin. It takes in the clear qi of heaven through breath and releases the turbid qi of the body. It circulates the qi produced by breath and food. And it governs the work of attending to others: in East Asian thought, to be attentive to someone is to give your own qi to them.
Governing the skin, governing mood — this is an organ with a wide reach, and it handles the psychological as well. Call it delicate work.
When something unnecessary is to be dispersed outward, the lung controls it. What cannot be seen goes through the lung; what can be seen goes through the large intestine.
When lung function drops, dispersal becomes difficult. Since this includes the dispersal of stress, a weakened lung means stress that cannot be released.
The lung also has a downward-bearing role. Oxygen taken in on the inhale is sent downward and stored in the kidney. The pores close, holding heat inside; water goes to kidney and bladder. Because the lung sends things down, a weakened lung leaves you without ground under your feet.
The lung is also a barrier against what comes from outside. It sorts: accept what is natural, refuse what is not. When the lung weakens, it shows on the skin. Abe added that skin symptoms often come not from the lung alone but from weakened large intestine or liver function affecting the lung.
Since the lung is the entrance to the respiratory system, it also affects smell, and a good scent supports breathing, aids dispersal, and eases tension. Spices, herbs, and coffee came up.
Psychologically, when the lung weakens, melancholy and sorrow appear, and outlook darkens. Melancholy and sorrow consume qi, which weakens the lung further.
The large intestine, its pair, is home to a great many resident bacteria.
In Missing Microbes, Martin Blaser puts the total at a hundred trillion, with somewhere between a thousand and five thousand species. That is more than the thirty-seven trillion cells of the human body. In Western medicine, the diversity of these organisms is understood as central to health, functioning as a barrier in the gut.
The skin has its own version: resident bacteria feed on water from the sweat glands and fatty acids from sebum, forming a barrier there.
The East Asian view — that lung (skin) and large intestine (gut) work as a pair, forming a barrier — sits alongside this.
Water — Kidney and Bladder
Water’s organ is the kidney; its bowel is the bladder. In East Asian Medicine the kidney includes the adrenal glands.
The kidney’s main work in Western medicine is producing urine. Most of what enters through the mouth is absorbed in the digestive tract, and what is not leaves as stool. Stool merely passes through. Urine, by contrast, always passes through the blood and is made entirely from it.
A hundred and eighty liters of primary urine are filtered through the glomeruli each day, and ninety-nine percent of it is reabsorbed in the tubules. By adjusting how much is returned, the composition and volume of the blood are regulated.
What is interesting is that this tubular work is affected by substances from other organs. ANP from the heart acts on the tubules to adjust sodium excretion. When blood calcium falls, PTH from the parathyroid releases calcium from bone and suppresses phosphate reabsorption in the kidney.
The kidney, in other words, regulates the blood through an exchange with organs throughout the body. The Western image of the kidney is that it manages the blood as a whole.
The kidney of East Asian Medicine also controls the yin-yang balance by regulating the body’s water. The two agree.
They agree on aging as well. Mice lacking the gene for Klotho, secreted from the glomeruli, show a premature aging syndrome; the kidney is said to be involved in aging. East Asian Medicine holds the same.
The adrenals handle the stress response to fear and anxiety. The amygdala fires, the signal passes through the hypothalamus to the adrenals, and cortisol, adrenaline, and noradrenaline are produced. Adrenaline drives the fight-or-flight response and acts quickly; cortisol has a daily rhythm and works more gently over a longer span.
In East Asian Medicine, too, the kidney is tied to anxiety and worry. Here again the two agree.
So how does East Asian Medicine see kidney and bladder? The roles Abe gave were these.
To store essence. The energy for living is stored in the kidney — in the lower dantian.
To govern the fluids. Body fluids are managed, the body’s water regulated to control the yin-yang balance, and the volume of urine adjusted. The bladder stores and discharges what is not needed.
To make the body strong. The kidney fortifies the body against physical and mental stress. Physically, it governs the hard things — bone, marrow, brain, teeth — and what they contain. When the kidney weakens, bone and marrow weaken, teeth are lost, posture declines. Mentally, it is tied to fear and anxiety.
The kidney opens into the ears and into the two lower orifices. And its flowering is in the hair, where the state of the kidney essence shows.
The kidney stores energy and burns it within. Its season is winter.
What I found interesting is that the kidney is the organ that stores essence.
Two kinds are stored there. Prenatal essence, inherited from one’s parents, is the energy for growth, development, and reproduction. Postnatal essence, produced after birth by spleen and stomach, is the energy for activity.
In childhood the kidney is not yet complete, so children are naturally weak in kidney. And it declines with age.
East Asian Medicine holds that men are creatures of qi and women creatures of blood, and reckons a difference between them. Women are counted in sevens, men in eights. Women peak around thirty-five, men around forty-eight.
Spend too much qi and you draw on prenatal essence rather than postnatal. That leads to burnout, and shortens life. So the thing to do, Abe said, is to replenish the postnatal essence made by spleen and stomach while gradually repaying the debt to the prenatal.
Kidney qi comes in two kinds. Kidney yang moves and warms the organs and tissues — it produces the heat for activity. Kidney yin nourishes them; it restores the body.
Keown’s The Spark in the Machine offers the thought that cortisol from the adrenal cortex may function as kidney yin, and adrenaline from the medulla as kidney yang.
What is interesting is the difference in what each is looking at. Western medicine grasps the kidney through invisible hormones and exchanges between organs. East Asian Medicine looks at the visible exterior. Bone (posture), teeth, brain, ears, hair, the lower orifices. When the kidney weakens, these are affected.
East Asian Medicine holds that hair is made from surplus blood. So women, being creatures of blood, keep their hair the longest.
Posture was covered too. The kidney is tied to standing; a moderate amount of standing is good for it. Likewise the liver to walking, the heart to looking, the spleen to sitting, the lung to lying down.
Seeing It as Connection
Having gone through the phases one at a time, what Abe kept returning to was that taking them apart will not get you there.
You learn them organ by organ — wood, fire, earth, metal, water — but health is maintained by their exchange with one another. Only by understanding the connections does the whole become visible.
Western medicine has arrived at the same place.
A documentary series broadcast by NHK in 2018 was built on the premise that the body contains an enormous information network. It named the substances carrying information from organ to organ and cell to cell “messenger substances,” and gave examples.
Hormones are the old example. Growth hormone from the pituitary, sex hormones from the gonads — substances released by particular sites. But it is now known that heart, kidney, stomach, gut, and also muscle, fat cells, and immune cells release messenger substances, and that organs regulate the body’s balance through exchange with one another.
Fat tissue releases leptin, which acts on the brain to suppress appetite; the stomach releases ghrelin, which promotes it. The kidney releases renin, but blood pressure rises only when angiotensinogen from the liver and ACE from the lung are also present. Gut bacteria release substances that regulate immunity in the gut.
That the idea of life being sustained by cells exchanging messages should emerge from the Western side struck me as facing the same way as an East Asian Medicine that grasps organs and bowels through generation and restraint.
Note, September 2026
I want to set down where the view I learned here — that balance restores itself — eventually led.
In 2019 I got no further than saying it was close to Rolfing and IMAC. Close, and that was all.
In 2025 I took the Advanced Rolfing Training. At its center was a stance the practitioner takes: trust that the body can regulate itself. It is not the practitioner who restores order; the body does. The practitioner’s work is to make the conditions for that.
I had been taught the same thing six years earlier, as generation and restraint among the five elements. A disturbance anywhere, and the body moves back toward balance through its relationships. What startled me then was that you could work in that direction without fine-grained knowledge. Reading it back now, the substance of that surprise lay a little further on. It is not you who restores order.
There is a second thing. Abe’s repeated insistence that you will not understand it unless you see the connections also changed meaning later.
Jeffrey Maitland distinguishes three paradigms of practice: healing, corrective, and holistic. The corrective paradigm assumes a correct state exists in advance. You find what is wrong and fix it.
Which of these do generation and restraint belong to? Nothing is singled out and fixed; order returns through relationship. That is closer to the holistic.
In 2019 I did not have this distinction. I could write that there were two scales, Western and East Asian, but not how they differ as a stance toward practice. I did not have the name for it.
Related Articles on This Course
East Asian Medicine — A Summary of Six Days Across Six Months of Study
- Qi, Blood, and Fluids — Dividing the Invisible into Three
- What the Meridians Are — Channels for Qi and Blood, and the Center Line
- Pattern Differentiation as a Procedure — Why You Don’t Start with the Organs