The Six Conformations of Chinese medicine – a primer

The Six Conformations (6C) system of pathophysiological understanding in Chinese medicine is the primary one relied upon by Zhang zhongjing, author of the Shanghan za bing lun, and originator of the received version of Chinese herbalism. It is also commonly misunderstood.

The primary mistake people make is in associating the 6C solely with their channel manifestations.

The majority of TCM students first learn (and last learn) of the 6C when they learn the full names of the acupuncture channels. For example, the Bladder channel’s fuller name is the Bladder channel of foot Taiyang (paired with the Small Intestine channel of hand Taiyang). Certainly the paths, relationships and qi dynamics of these channels have something to do with the mature concept of the 6 Conformations.

The Six conformations include the channels but also go beyond them.

Like the 5 phases, the 12 organ systems and the various tissue models used in Chinese medicine, the 6 Conformations is a way of dividing up all the structures and functions of the human body into a form that works as a guide for diagnosis and treatment. With the 5 phases, most students and practitioners readily adapt the symbolism to a variety of structures and functions, including those inside and outside of the body. We simply need to extend this flexibility to our understanding of the 6 conformations.

Each conformation is a pair of two organ systems – three yang pairs and three yin pairs.

These are in turn described with a term (listed below) that describes the orientation and functionality of that pair. There are many layers of theory that assist the practitioner in applying the basic symbolism to their patients’ treatment. Each layer is fascinating and useful! But, first, I just want to lay out the basics as best I can.

The conformations’ names and their associated organ systems

  • Taiyang – 太陽 – Great Yang – Bladder and Small Intestine organ systems
  • Yangming -陽明- Yang Brightness – Large Intestine and Stomach organ systems
  • Shaoyang – 少陽 – Lesser Yang – Gallbladder and Triple Burner organ systems
  • Taiyin – 太陰 – Great Yin – Lung and Spleen organ systems
  • Shaoyin – 少陰 – Lesser Yin – Heart and Kidney organ systems
  • Jueyin – 厥陰 – Reverting Yin – Pericardium and Liver organ systems

The Six Conformations are related to Six climactic factors/Qi (Liu qi).

These should be in balance in nature, but when they are out of balance we know them as the Six Evils.

  • Taiyang – Cold :  associated with water, contracting quality
  • Yangming – Dryness : associated with metal, desiccating quality
  • Shaoyang – Fire : associated with a guttering flame, like a torch
  • Taiyin – Damp : associated with earth, sticky and heavy in quality
  • Shaoyin – Heat : associated with a steady fire, like a hearth
  • Jueyin – Wind : associated with wood, wandering in quality

The climactic factors lend their qi to the conformations. So, the pathophysiology of Taiyang is influenced in some way by cold. The particular ways in which that manifests is laid out, though not clearly, in the Shanghan lun. For now, it is fine just to know that when we’re working with one of the conformations both organ systems associated have a relationship to the climactic factor it is associated with.

The order of the conformations and the layers of the body

The specific order I keep using as I list the conformations is not without reason.  While there is some discussion about the placement of Yangming, most of my teachers seem to agree on the order they are listed above. Straightforward cold damage pathology is said to transmit through these layers one at a time, passing from Taiyang to Yangming and so on. The details of this, again, are embedded within the concentrated teaching text the Shanghan lun.

Taiyang is the most outward of the conformations.

It governs the most superficial layers of the body and is associated with the Weiqi or defensive force of the human being.  Think of the primary formulas associated with Taiyang – Guizhi Tang and Mahuang tang.  Both strongly resolve the surface.  Yangming is the next layer deep – both in some sense physically and also in terms of how external pathogens must progress in their quest to do harm.  It is in the Yangming stage that we get great fevers, this is a storehouse of immense Qi and Blood force in the average person.  Think how well this resonates with the Stomach and Large Intestine organ systems, both deep dealers in the most basic, primal functions of life.  The last Yang conformation, and thus the last protector against a disease becoming deeply internalized, is Shaoyang.  Shaoyang is said to “pivot” (a long discussion) between internal and external, and thus has a kind of oscillating quality.

Now we enter the interior of the body, going ever deeper.

Taiyin is the first of the Yin conformations and in some way exemplifies a kind of “doing without doing” — the most active of the passive organ systems.  Going a layer deeper we find Shaoyin, the north and south poles of the body – Heart and Kidney, the basic axis of the functioning of the human body.  When external pathogens reach this deeply, serious disease is the result.  Finally, Jueyin – the deepest, but also the possibility of rebirth into the Taiyang conformations in the classic cyclic manner of Chinese philosophical systems.  Jueyin is deeply involved with blood, as can be seen clearly in its encompassing of both Liver and Pericardium.

The 6 Conformations provide us with a fascinating and clinically useful way to look at the human body and its pathologies.

These basics provide a scaffolding for future posts on this important subject. If you have any questions about this essential information, or would like to offer a correction or comment – please feel free to leave it in the comments section below.

[This post has been updated during the 2020 site updates. My goal during post updates was to keep the character of the original post, but update for corrections and clarity, as well as to remove broken links.]

15 Comments Add yours

  1. Abdallah B. Stickley says:

    Thanks Eric. Another great post. This also provides the key to understanding Dr. Shen’s Systems as discussed in Ch. 14 of Dragon Rises, Red Bird Flies. The failure to understand the true nature of six conformation has yielded some hilariously erroneous misunderstandings of Dr. Shen’s work. It usually involves the magical belief that TCM is the standard, professional benchmark for practicing Chinese medicine. The more we examine Chinese medicine models as descriptions of the microcosm and the macrososm, and of our palce therein, the close we get to exploring the reality in which we are immersed.

  2. Abdallah B. Stickley says:

    Oh and please,please write a post about the word: “pivot.”

  3. Party pills says:

    Thanks for the nice post. All types of alternative medicine are so effective. I don’t know why people prefer to be blind and prefer to use synthetic drugs for nearly every condition.

  4. Anonymous says:

    Hello Eric,

    I’m a graduate of Jung Tao School of Classical Chinese Medicine.

    I learned the Liu Qi (what you refer to as the “Six Conformations”) as follows:

    Taiyang: Small Intestine (fire, heat, thermogenesis, etc.) and Bladder (water, cold, hydrogenesis, etc.)

    Shaoyang: Yang hinge (pivot); Sanjiao (fire, heat, metabolism, etc.) and Gall Bladder (wood, wind, fuel, etc.)

    Yangming: Large Intestine (metal, dryness, etc.) and Stomach (earth, humidity, etc.)

    Taiyin-Yangming Yolk (pivot)

    Taiyin: Lung (metal, dryness, etc.) and Spleen (earth, humidity, etc.)

    Jueyin: Yin hinge (pivot); Xinbaoluo (fire, heat, metabolism, etc.) and Liver (wood, wind, fuel, etc.)

    Shaoyin: Heart (fire, heat, thermogenesis, etc.) and Kidney (water, cold, hydrogenesis, etc.)

    Sorry, but, I don’t have time to go into the intricate relationships.

    In regards to “climatic factors,” Taiyang, for example, is associated with both heat and cold. Do you think that it is only associated with cold? If so, then that is erroneous thinking. Why? Because Taiyang is both Small Intestine/heat and Bladder/cold. In other words, both Small Intestine/heat and Bladder/cold represent the poles of Taiyang. Taiyang’s endogenous cold and heat are auto-regulatory functions of the antithetical relationships of the five movements. I hope that this is clear.

    To think that “external pathogens must progress” from Taiyang to Yangming, etc., is also erroneous thinking. It’s not that simple. For example, cold could “enter” the Zu Taiyang Jing and then progress to the Zu Shaoyang Jing and then “jump” via this jing’s Luo point directly to the Zu Jueyin Jing. This is why knowing where the jings meet, and having an understanding of the “pivots” is so important for both diagnosis and treatment.

    In regards to the “order of the conformations,” it depends on whether you’re diagnosing and treating from a classical Chinese herbal or acupuncture perspective. Have you been taught about this at your school?

  5. Eric says:

    Hey anonymous,

    I think we are on similar pages. Please do understand that this post was only a simple introduction and that there is much more to come. Please don’t assume that what I wrote is all that I have to offer. 🙂 To address your points:

    1. I do not think Taiyang is associated only with cold, but I think for a different reason than you do. The pairings show us the deeper way to understand the conformations. Taiyang is paired with Shaoyin. Shaoyin is said to be the Zhong Qi of Taiyang – simply, it helps to keep a balance within the body. I am going to post in more detail about how, then, the disease manifests (as hot, as cold, etc…) but I wanted to simply explore the basics for now.

    2. Anyone who reads the Shang Han Lun can see that progression directly through the conformations one by one is not the only way for disease to progress. I certainly did not intend to imply that.
    BTW: I often try to use simple English translations on my blog, introducing Chinese terms gradually, as I find average readers receive this a little better. Thus, I didn’t use Liu Qi.

    3. Regarding the order of conformations. We have talked extensively about this at school, especially about all the arguments about why there are two systems of understanding and how they developed.

    Thanks for your comment,

    Eric

  6. Anonymous says:

    Yes, Taiyang is the functional aspect of Shaoyin. Just as Shaoyang is the functional aspect of Jueyin, and Yangming is the functional aspect of Taiyin. Yin creates Yang, and Yang stimulates Yin.

    I’m glad to see that your school is helping you to learn how to think about Chinese medicine.

    I have been told by a recent graduate of your school’s CCM program that your school’s focus is significantly more on herbs than on acupuncture. Is that true?

  7. Eric says:

    Anonymous,

    I’m similarly glad. I am not sure that I would say that the focus is SIGNIFICANTLY more focused on herbs. We have several doctors who are scholars and specialize in acupuncture – Drs. Neal and Qin among them. I would say that many of the powerhouses of our department have traditionally been more herbally focused than acupuncture focused, but that this balance is shifting.

    In terms of student interest, however, I’d say we’re evenly balanced. That might be why the balance is shifting.

    Eric

  8. Richard Goodman says:

    I like this post. You make an important point about the Liu Qi; I think the same point can be made (and you allude to it) about Yin-Yang, the five phases, the six levels, the 10 stems and 12 branches, and on and on. These are all meant to be representations. The map is not the territory…no matter how long we stand and look at a map, we aren’t in the place. I think it is difficult for most of us to step out of the materialistic thinking we were raised with to see that there is more to all of this than the surface. We want the channels to all be in an exact spot, but they aren’t. Chinese medicine offers a unique world view, and if we can step into that, suddenly the medicine starts to make sense…according to that view, not the one we were raised with and are surrounded by.

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  10. Colleen says:

    Very helpful to read your explanation of the 6 conformations… I love the mini “aha!” moments that come to me as I explore a variety of practitioner/student’s discussions on it. Thank you for sharing (back in 2008!) 🙂

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