Four movements

Upward, downward, inward, and outward movement; the basic movements of qì. These are two pairs of opposites that are analyzable in terms of yīn and yáng. Upward and outward movements are yáng, while downward and inward movements are yīn. Chinese medicine observes that what is high bears downward; what is low bears upward and what is full spills outward; what is empty draws inward. Upward, downward, inward, and outward movements are merely abstractions influenced by the yīn-yáng paradigm. Qì actually moves in all directions, a fact that is nowhere more apparent than in the channel and network vessel system. However, they are the most significant movements and can be observed in all physiological processes, as can be seen in the following examples from the five viscera:

Lung: The lung has two opposing and complementary movements: diffusion and depurative downbearing. By the upward and outward movement of diffusion, turbid qì is forced out of the body. By the inward and downward movement of depurative downbearing, clear qì is drawn into the lung.

Spleen and stomach: The stomach governs intake of food. Ingested food passes into the stomach, where it is ripened and rotted (i.e., undergoes initial digestion). It is then passed down to the intestines. The downward movement of food is understood in terms of the downbearing of stomach qì. The spleen extracts and refines the essence of food and water, which it then transports upward to the lung and heart, during which process it is formed into qì, blood, and bodily fluids. These processes are understood in terms of the upbearing movement of spleen qì.

Liver: The liver’s free coursing action ensures the free movement of qì around the body. Belonging to wood among the five phases, the natural movement of liver qì is upward and outward. This is often described as upbearing and effusion. When liver qì’s free coursing becomes excessive (as in ascendant hyperactivity of liver yáng), upper body signs such as a red face and eyes and a subjective feeling of heavy head and light feet appear.

Kidney: The kidney receives fluids brought down to it by the lung. It warms them so that the clear part of them steams upward and returns into circulation and draining the turbid part off in the form of urine, which is passed to the bladder for discharge from the body. At the same time, the kidney as helps to absorb qì into the body, which assists the depurative downbearing action of the lung. Some cases of panting are explained in terms of a vacuous kidney failing to absorb qì. Thus the kidney has a dual action: upward and outward (steaming of the fluids) and inward and downward (absorption of qì).