The Role of Time in Acupuncture Theory
by Roisin Golding

First published by the Chinese Medicine Times 2009

“The physician should await the right moments regarding the movements of the Sun, the Moon, the stars and the energy of the four seasons and the eight seasonal dates, and as soon as the right moment arrives relative to the stable state of energy, acupuncture treatment should begin.” Suwen ch. 26:4

Time has held a very special place in the mind of early Chinese philosophers and scientists. Joseph Needham explained that, “The earliest, and in the long run the most influential kinds of scientific explanation, those so basic that they truly pervaded the ancient Chinese world view, were in terms of time.”

Classical Stems and Branches theory provides the tools for understanding time and its eternal flow of yin to yang, and the changes in the five elements. It explains how time is an essential factor in human life and health

The central role of time in acupuncture theory unifies many otherwise competing concepts. Importantly, to know where we are in time, in this moment, allows us to treat in harmony with the Dao.Why is time so special? In order to understand this, let’s first define time.

Time is the measurement of movement or change. For most human intents and purposes, time is the measurement of the apparent movement of the Heavenly bodies around the Earth. The chief movements that are taken into account are the apparent daily movement of the Sun, the apparent yearly movement of the Sun, the movement of the Moon, and the apparent movement of the stars. Calendars and clocks are a reckoning of these movements. In other words, time is based on the interaction between Heaven and Earth. After Heaven rose to become yang and yin sank to become Earth , their subsequent interactions produced the dramatic eternal movement of yang to yin to yang, and night follows day follows night.

When the Su Wen directs physicians to know something about astronomy, it is because through astronomy that we understand time. When we know the height of the Sun at midday we know whether it is reaching the summer or winter solstice. Qi Po even describes how to use a gnomon for this purpose! For the Han Chinese, to understand the Plough and the direction it is pointing to at dusk was to pinpoint the season as well as one of the twenty-four solar periods of the Farmer’s Calendar . To recognise whether the Moon is in its waxing or waning phase also has important implications for tonification or sedation of qi and blood.

“Excess and deficiency are in accord with the sequential order of Heaven, and sedation and tonification are to be applied in accord with the phases of the Moon .”

Since humanity is born of the interaction between Heaven and Earth , time runs through humanity, it is hardwired into our systems. Time is intrinsic to acupuncture theory. The Chinese, as is often the case, had a precocious and intuitive understanding of very modern biological concepts. In Chronobiology: Biological Timekeeping, the authors proclaim that “Structural organization and time organization are two pivotal parallel features of living organisms.”

Structural organization and time organisation are primary functions of the six divisions. The six divisions are part of stem and branch theory. They represent an interaction between heaven and earth and are mapped onto the body in line with their reciprocal heaven and earth relationship, i.e. guest heaven and guest earth divisions are diagonally opposite each other on the same limb. Their associated elements and their quantities of blood and qi are in line with their host energy sequence, i.e. according to fixed arrival times in the calendar.

The six divisions, while aligned with the yearly branches, interact with the ruling elements of the year, known as the great movements of the stems. These are the guest divisions and they follow a different sequence to the host divisions. It is the (reverse) sequence of the guest divisions that are linked with the progression of fevers as described in the Nei Jing and expanded in the Shang Han Lun.

In all, the combination of stems, branches, and six divisions, as well as the ruling element of the year, combines to produce a set of energies for the time of treatment as well as the time of the birth of the patient. It allows one to assess the subtle energies prevalent at the time of treatment and at the time of the patient’s birth. These can give insights into how a particular patient responds to certain elements and climates, about their strengths and weaknesses, and how their particular energies interact. Are they prone to an over excitation of the fire element? Are their issues with stagnation and damp from an overabundance of earth or a weak earth? Are their energies being over controlled by another element?

But stems and branches is about much more than assessing a patient’s energies from a constitutional point of view – after all not every person suffers from a constitutional failure or weakness. Stems and branches, by analysing time at the core of acupuncture theory, provides a robust, water-tight and fully integrated system that unites the concepts of yin and yang, the five elements, and heaven earth man, and even explains many seemingly contradictory statements found in the Neijing. Time and again, understanding the Chinese concepts surrounding time allows one to predict many of the concepts found in the Neijing. For instance, that the three arm yang, three leg yang, three arm yin, three leg yin, all start from the same starting position (arm, leg etc.) is connected with the calendar, the branches, and the fact that the six divisions have to divide into a 365 ¼ day year! (This combination of branches also existed before the Neijing, and combined for instance according to origin of seasons as described in Huainanzi.

Time is linked in much more ordinary ways with acupuncture theory. The following are just some of the most basic concepts which are inextricably linked with time and must also be taken into account when treating according to classical stems and branches theory.

• Yin and yang is related to day and night and the movements of the Sun and Moon.

• The five elements are related to the four seasons (interacting with Earth)

• The twelve meridians are linked with the twelve two hour periods and twelve months

• 361 points are related to the cycles of the Sun, Moon, Jupiter, and Saturn.

• The muscle meridians are linked to the seasons

• And of course the ten stems and twelve branches combine to form a sexagesimal counting system for the hours, days, months and years.

Very briefly, the ten stems interact with yin and yang aspects of the five elements (known as great movements). The twelve branches interact with the elements of the seasons. The yang stems and yang branches combine, while the yin stems and yin branches combine, to total sixty combinations of stems and branches. This sexagesimal system lays bare the sheng and ke cycle of the five elements as they interact with yin and yang. They illustrate the inner workings of the organs and allows us, as practitioners, to sum up very quickly the core imbalances at work in our patients. (The host divisions stay the same each year, much like the seasonal energies of the five elements, while the guest divisions move through a sequence to combine with the same branch during specific years.)

Ying qi moves in the meridians according to the clock, which is the branch sequence.

“Nutritive qi is to secrete fluids and send them to the meridians to be transformed into blood for nourishing the four extremities; it also sends the fluids to the five viscers and the six bowels and it circulates according to the clock.” Ling Shu.

Just in case you think that all this concern with timing is out of date, chronotherapy is fast becoming the ‘new kid on the block’ to watch out for in Western medicine. “Internal biological clocks play a role as temporal regulatory pacemakers in practically every function of every living species.” This is so interesting. Just when Western medics are looking at the nervous system as an explanation for the effects of acupuncture, “circadian clocks have become a favoured neurobiology model for decoding the regulatory processes of neurons.”

In the West the scientific community has finally woken up to the fact that our bodies are in tune with time – for example that there are daily and seasonal variations in hormone levels affecting the most basic functions in our body. Chronotherapy has become the new Holy Grail for drug companies. Even the U.S. Drug and Food Administration have taken on board the necessity to take time into account for healing, whether using medicines or surgical interventions.

While the interest in chronobiology is steadily increasing, there is much more still to be known about circadian, circannual, and circalunar rhythms in humans. It seems possible, and maybe even likely, that through knowledge of these rhythms we will come to a modern understanding of how acupuncture really works. The circadian flow of yin and yang in relation to temperature regulation is becoming better understood, along with insights into sleep wake patterns. There is much more to come.

For acupuncturists, to focus on the essentials of energy regulation while acting in harmony with time is not simply to expedite treatment, but to bring the patient back into harmony with the essentials of life, to allow their energies to follow “the patterns of yin and yang, which is the regular pattern of heaven and earth.” There seems no reason on earth to ignore the principle of time when we treat.