Dr. Hongwei Liu, PhD   New York, USA

Abstract: Based on 30 years of systematic research, this article builds on the foundation of leading contemporary TCM kidney disease expert Professor Shi Zhensheng’s theory of treating the kidneys, and gives full play to the diagnostic and therapeutic characteristics of TCM’s holistic concepts and evidence-based treatment to propose that the theoretical construction of the male reproductive axis in TCM consists of “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber”. This serves as a theoretical basis for the treatment of male diseases in TCM, with “the kidneys as the foundation; the kidneys, heart, liver, and spleen as the core; the thoroughfare, controlling, governing, and girdling vessels as links; and the essence chamber as the target point”. This basis provides improved guidance for the clinical use of acupuncture and medicinals; makes the most of the therapeutic advantages of TCM and acupuncture, which enable regulation via multiple pathways, levels, links and targets; and constantly improves the theoretical understanding of the human reproductive system in TCM.

Keywords: male, kidney, tian-gui, thoroughfare vessel, controlling vessel, governing vessel, girdling vessel, essence chamber, reproductive axis

TCM has a long history of recognizing human reproduction; in TCM, it is thought that “the kidneys govern reproduction”, and a theoretical system of reproduction gradually formed with the “kidneys” as the core. Dr. Shi Zhensheng, a leading expert on contemporary TCM and kidney disease, was engaged in clinical and scientific research on TCM and kidney disease as early as the 1950s, and in the 1980s, he put forward concepts related to “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber” in Chinese medicine and men’s health. After more than 30 years of clinical research, the author has put forward the theory that the male reproductive axis in TCM consists of “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber”, with a view to improving the understanding of the theoretical system of human reproduction in TCM. The following is a brief introduction to the theory of the reproductive axis of the “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber”. If there are any inaccuracies, corrections are welcome.

I. The relationship between the kidneys and reproduction

1. The kidneys store essence and govern reproduction, growth, and development

TCM considers the essence to be the basic substance that makes up the human body. For instance, chapter 10 of  Ling Shu [The Magic Pivot], entitled “Channel Vessels”, states: “At the beginning of human life, the essence of life is formed first; then the brain and the marrow form”. Chapter 8 of the same text, entitled “The Spirit”, states: “That which enables life to come [into being] is called the essence”. Chapter 30, entitled “Understanding Qi”, states: “When 2 spirits [i.e., yin and yang] approach each other, they combine to create a form; the substance that exists prior to the body is called the essence.” Because the reproductive essence is characterized by reproduction, it is also known as the earlier heaven essence. Although the earlier heaven essence is endowed with the reproductive essence of the parents, it is not the same as the reproductive essence of the parents; rather, it is the subtle substance inherent in the body that determines the individual’s heredity, growth, and developmental characteristics and abilities. The earlier heaven essence is engendered by the kidneys alone, determining the basic characteristics of human growth and development. The later heaven essence can be generated by the 5 viscera and mainly plays a nutritional role. Just as Zhang Jingyue said: “The beginning of a person’s life is rooted in the source of essence and blood; once a person is born, they are nourished by water and grain […] The governance of essence and blood is in the life gate, and the governance of water and grain is in the spleen and stomach, which depend on the control of earlier heaven, and the sea of essence and blood depends on the resources of earlier heaven.” Li Dongyuan also said: “The true qi, also known as original qi, is the essence qi of the body that is produced before the body and then must be nourished by stomach qi.”

Chapter 9 of Su Wen [Plain Questions], entitled “Treatise on the 6 Periods and Visceral Manifestations”,  states: “The kidneys govern hiding, and are the root of sealing and storing; they are the location of the essence.” Therefore, in TCM it is believed that the kidneys store the essence. The development and maturation of the human reproductive organs and reproductive capacity are dependent on the essence qi in the kidneys. After a person is born, the earlier heaven essence is nourished and continuously enriched by the later heaven essence, producing the tian-gui. Tian-gui has the function of promoting the development and maturation of the human reproductive organs and maintaining reproductive function. After middle age, the essence qi in the kidneys gradually declines, and the tian-gui also decreases or may even be exhausted. The reproductive organs of the human body will shrink and reproductive function will decline until it is lost. The essence qi of the kidneys serves to promote and maintain the reproductive function, growth, and development of the human body, so it is said that “the kidneys are responsible for reproduction, growth, and development”.

2. Fill tian-gui and promote the production of reproductive essence

Tian-gui is a unique term in TCM. It is cultivated in the embryonic stage of the human body and gradually matures as the kidney qi develops. Only when tian-gui is nourished by the kidney qi to a certain extent can the human body engender reproductive essence and only then will the physiological activities of human reproductive function have a sufficient material basis. Tian-gui promotes the formation, development, and maturation of reproductive essence through the thoroughfare, controlling, governing, and girdling vessels. The reproductive essence, which is stored in the kidneys, is the material basis for the reproduction of life and the beginning of embryonic formation. Chapter 1 of Su Wen, entitled “Treatise on Heavenly Truth from High Antiquity” says: “When a woman is 7 years old, her kidney qi is exuberant, she grows new teeth, and her hair grows longer. When she is 14 years old, her tian-gui arrives, her controlling vessel is open, her great thoroughfare vessel is exuberant, and menstruation occurs at the appropriate time, so she can bear a child. At the age of 21, her kidney qi reaches the normal status [of an adult], so her permanent teeth grow and her hair reaches its fullest length. At the age of 28, her sinews and bones are firm, her hair is at its fullest length, and her body is exuberant and strong. At the age of 35, her yang brightness vessel weakens, her face starts to become parched, and her hair begins to fall out.  At the age of 42, her 3 yang vessels [i.e., greater yang, yang brightness, and lesser yang] all begin to decline from the top, her face is completely parched, and her hair begins to turn white. By the age of 49, her controlling vessel is vacuous, her great thoroughfare vessel is declining, her tian-gui is exhausted, and her tunnel is blocked, so her form decays and she can no longer bear children.”

“For a man, at 8 years old, his kidney qi is replete, his hair grows, and he grows new teeth.  At the age of 16, his kidney qi is exuberant and tian-gui arrives. The essence and qi overflow, and yin and yang are harmonious, so he is able to father a child. At the age of 24, his kidney qi reaches the normal status [of an adult], his sinews and bones are strong, so his permanent teeth grow and reach their fullest state. At the age of 32, his sinews and bones are very strong and his muscles are full. By the age of 40, his kidney qi declines, his hair falls out, and his teeth begin to wither. At the age of 48, his yang qi is exhausted at the top, his face is parched, and the hair on his temples is white. By the age of 56, his liver qi declines, his sinews cannot move, his tian-gui is exhausted, his essence is scarce, his kidneys decline, and his body is at its limit. At the age of 64, his teeth and hair are gone.”

“The kidneys control water; they receive the essence of the 5 viscera and 6 bowels and store it. Therefore, when the 5 viscera are exuberant, then [the kidney essence] can drain out. Now, the 5 viscera are all declining, the sinews and bones are slack, and the tian-gui is exhausted. Therefore, the hair on the temples is white, the body is heavy, walking is difficult, and it is impossible to bear children.”

3. The kidneys govern the bones, generate marrow, and connect to the brain

In TCM, it is believed that the kidneys govern the bones, produce marrow, and are connected to the brain.  As chapter 10 of Ling Shu says: “At the beginning of human life, the essence of life is formed first; then the brain and marrow are formed. The bones serve as the structure, the vessels act as connections, the sinews provide hardness, the muscles serve as walls, the skin is firm, and the body hair grows.” The kidneys store essence, the essence generates marrow, the marrow fills the bones, and the brain is the sea of marrow. When the brain marrow is full, the spirit will be clear and energetic, and the mind will be flexible, assisting the heart spirit in controlling the body. If the kidney essence is adequate and the brain marrow is sufficient, the brain spirit will be clear and will regulate the normal storage and release of the essence chamber, so the essence orifice and urine orifice will be opened and closed appropriately. If this is not the case, the brain spirit’s regulatory function will be disturbed, the kidneys’ storage and release will be abnormal, the essence chamber will malfunction, and disorderly opening and closing of the essence orifice and urine orifice will lead to abnormal semen ejaculation and urination.

4. The kidneys govern the transformation of qi and regulate the excretion of urine and semen

The qi transformation of the kidneys is the central link in regulating the balance of water and fluid metabolism in the human body.  Chapter 34 of Su Wen, entitled “Treatise on Disharmony”, points out: “The kidneys are the water viscera and govern body fluids.” Only when the kidney qi is abundant, the qi transformation is normal, and there is appropriate opening and closing can the distribution and excretion of water proceed normally. If the qi transformation function of the kidneys is abnormal and there is inappropriate opening and closing, illness will occur. Too much opening and too little closing may lead to increased nocturia, profuse urination, or incontinence; too much closing and too little opening may lead to a weak urine stream, incomplete urination, or urinary block.

Male genitals include an essence orifice and a urine orifice. The 2 orifices are combined into a single outer opening, and are nourished by the kidney yin fluids in the thoroughfare, controlling, governing, and girdling vessels. Through the synergistic action of the kidneys, the essence orifice governs the opening and closing of the essence chamber and controls the excretion of semen. Chapter 8 of Su Wen, entitled “Treatise on the Arcane Book of the Orchid Chamber in the Spirit Tower”, says: “The kidneys hold the office of labor and strength, from which ingenuity emanates”. Yijing Jingyi [Essential Meaning of Medical Classics], written by Tang Rongchuan, states: “There is an essence orifice in the anterior yin [i.e., the genitals], which is paired with the urine orifice, but they are different. The urine orifice connects internally to the bladder, and the essence orifice connects internally to the essence chamber.” This text also says: “The essence chamber is an intersection point of qi and blood, the place where essence is transformed into the fetus; it is the most important.” “The place where men store essence is controlled by the kidneys in particular.” That is to say, the kidneys govern the 2 anterior yin orifices and can make the penis erect, open the essence gate, and excrete the reproductive essence from the essence orifice, thereby reproducing new life. The synergistic action of the kidneys and bladder regulates the excretion of urine, which comes out through the urine orifice. If the kidneys store and release appropriately, the essence orifice and urine orifice will open and close in an orderly manner; if the kidneys store and release in a disorderly way, the storing and releasing of the essence chamber will be dysfunctional, and the opening and closing of the essence orifice and urine orifice will be disordered, leading to abnormal ejaculation and urination.

5. The kidneys hold the office of labor and strength, from which ingenuity emanates

The statement that “the kidneys hold the office of labor and strength, from which ingenuity emanates” comes from chapter 8 of Su Wen. Zhongyi Dacidian [The Great Dictionary of Chinese Medicine], compiled by Li Jingwei, states: “The office of labor and strength refers to the kidneys. Zhang Zhicong’s commentary says: The kidneys store the mind. If the mind is established, it will be strong in its labors. If it can labor internally, it will be ingenuous externally. Ma Shi’s commentary says: Only the kidneys are capable of labor and strength; men and women form the essence, engendering people and things, and ingenuity emanates from this. Therefore, if the kidney qi is exuberant, the essence spirit will be fortified and effulgent, the sinews and bones will be strong, and the movements will be agile; at the same time, the reproductive capacity will be normal, and the fetus will be produced.” Tang Rongchuan’s Yijing Jingyi adds: “The marrow is produced by kidney essence; if essence is sufficient, the marrow will act [to serve its function]. The marrow is in the bones; if the marrow can act, the bones will be strong, so they can labor and enable outstanding ability. Essence generates spirit; if the essence is sufficient to make the spirit strong, there will naturally be a lot of ingenuity. If there is insufficient marrow, one will not have much strength. If there is insufficient essence, one will not have much wisdom.” Hu Tianxiong’s Suwen Bushi [Supplemental Thoughts on Plain Questions] states: “Labor and strength means to be strong in one’s actions, and ingenuity means to be refined and versatile. According to the theories that the kidneys govern the bones, the kidneys produce the bone marrow, and the brain is the sea of marrow, it is known that when kidney qi is effulgent, the bone marrow will be full, the bones will be strong, the sea of marrow will be full, and brain power will be strong, so [the kidneys] have strong, refined, and versatile effects.” Just as chapter 33 of Ling Shu [The Magic Pivot], entitled “Treatise on Seas”, says: “If there is excess in the sea of marrow, one will be energetic and strong, and naturally exceed one’s limits; if the sea of marrow is insufficient, the brain will spin, the ears will ring, the shins will be sore, there will be veiling dizziness, the eyes will not be able to see, and one will be lazy and want to rest.” In summary, the reason for labor and strength is that the kidneys control the bones, produce marrow, and control the strength of the body, so they hold the office of labor and strength. What is referred to as “ingenuity” is the fact that that the kidneys store the essence of the body. These essences exist between the intangible and the tangible. They can reach throughout the whole body and transform into things that the body needs. Those who have ingenuity are quick to change; there is nothing at which they cannot succeed and there is no path that is blocked for them. Therefore, ingenuity in reproduction, thought, and behavior emanates from the kidneys.

綜上所述，中醫認為腎藏精、主生殖和發育，腎臟是人類生殖系統和性系統的核心。To sum up the above, in TCM, it is believed that the kidneys store essence and govern reproduction and development. The kidneys are the core of the human reproductive and sexual systems.

對“天癸”的認識
II. Understanding tian-gui

1.  About tian-gui: Tian-gui is an important concept in TCM. It is related to TCM physiology and pathology, and plays a decisive role in human sexual activities and reproduction. We believe that tian-gui is an essential substance that promotes sexual development and maintains sexual functions (including reproductive functions). Its functions include promoting the development and maturity of male and female sexual characteristics and reproductive organs, maintaining sexual functions, stimulating sexual desire and sexual impulses, and participating in the transformation of reproductive essence to produce offspring. This functional scope is completely consistent with the function of kidney qi in “governing reproduction”. In terms of tian-gui’s material, essential, vital, and stimulating properties, it also fully possesses the key elements of “qi” in TCM. Therefore, there is reason to infer that tian-gui is the essential system of kidney qi that dominates sex and reproduction. It belongs to the category of kidney qi, but it is not equivalent to all kidney qi; rather, it is an important branch of kidney qi that dominates human reproduction. The statement that the kidneys govern reproduction is realized through tian-gui.

2. About the material basis and functional form of tian-gui:

(1) The material basis of tian-gui: Kidney essence is the material foundation of tian-gui, and this kidney essence should be the earlier heaven essence in the kidneys, that is, the reproductive essence. Since the reproductive essence contains the life information of each parent, when tian-gui promotes the physical development of the human body, this information also affects the offspring in all aspects. This is heredity. It can be said that tian-gui is an important material for human inheritance.

(2) The function of tian-gui: This refers to the physiological fire that stimulates human beings to have sexual desire and engage in sexual activities. It is also called “the fire of lust” and “ministerial fire” (which is part of kidney qi). After the production of tian-gui, the human body not only can reproduce, but also has the desire to “attract the opposite sex” and engage in sexual activities with them. Both of these have complementary roles in completing the continuation of future generations. The higher the level of tian-gui, the stronger the ministerial fire. After humans enter the change of life, the level of tian-gui decreases, and the ministerial fire also decreases along with it.

(3) Tian-gui has time limits and rhythms: Huangdi Neijing [The Yellow Emperor’s Inner Canon] states that tian-gui has obvious time limits. It is produced at the age of 14 (2 x 7) or 16 (2 x 8), and is exhausted at the age of 49 (7 x 7) or 56 (7 x 8). It only exists in the childbearing stage of life. After this, the level of tian-gui decreases sharply. Women undergo menopause, no longer produce eggs, and lose their fertility. Although men can still produce a certain amount of sperm, the quality of the sperm is greatly reduced. At the same time, the secondary sexual characteristics of men and women, controlled by tian-gui, begin to atrophy, and sexual desire and sexual function are greatly reduced. In addition to time constraints, tian-gui also has various forms of rhythm, including an annual rhythm, seasonal rhythm, monthly rhythm, and daily rhythm. The monthly rhythm of tian-gui is particularly obvious for women and forms the physiological basis of the menstrual cycle. In men, the annual and daily rhythms of tian-gui are relatively obvious; this can be confirmed by their level of testosterone secretion. Peripheral testosterone levels in adult men are highest in autumn and lowest in spring. During the day, they are highest in the early morning and lowest at night.

(4) Tian-gui is closely related to the channels and network vessels, especially the thoroughfare, controlling, governing, and girdling vessels.  After the formation of tian-gui, the thoroughfare, controlling, governing, and girdling vessels gradually become full; specific changes begin to appear in the internal and external genitalia, women’s breasts, and men’s Adam’s apple and voice, and fertility becomes possible. The statement that “the thoroughfare vessel is the sea of ​​blood and the controlling vessel controls the womb and fetus” is realized under the influence of tian-gui. From a practical point of view, the thoroughfare, controlling, governing, and girdling vessels are the main pathways by which tian-gui is transmitted in the body. In addition to relying on tian-gui to perform their functions, these 4 vessels also use their connections with other channels and network vessels to deliver tian-gui to the 5 viscera, 6 bowels, 4 limbs, and the skeleton, thereby expanding the effects of tian-gui to the entire body. It can be imagined that once the thoroughfare, controlling, governing, and girdling vessels are damaged, the effects of tian-gui will inevitably be impacted along with it.

To sum up, kidney qi and tian-gui are independent and separate from each other, but also mutually restricting and unified, thus forming a contradictory unity of diversity and stages of kidney qi, which promotes the normal progress of various life activities of the human body and reproduction of offspring.

III. Understanding the essence chamber

“Essence chamber” is a unique term in TCM andrology. It is also referred to as the “essence house”, the “palace of essence”, and “the male womb”, and it is classified among the male extraordinary organs. It is the place where the reproductive essence is stored. It has the functions of producing, storing, secreting, and seeding sperm, thus playing a role in reproduction and producing offspring. It is dominated by the kidneys and is a male reproductive organ that participates in maintaining male sexual function. It is closely related to the 5 viscera and 6 bowels, qi, blood, body fluids, and the thoroughfare, controlling, governing, and girdling vessels. It is an important component of the kidneys’ control of reproduction and corresponds to the “female womb” in gynecology.

(I) Physiological functions of the essence chamber

1. The essence chamber governs the production and storage of essence:

First, the essence chamber is the place where reproductive essence is produced and stored. In TCM, it is believed that the production of reproductive essence is related to age and tian-gui. For example, chapter 1 of Su Wen says, for a man, “at the age of 16, his kidney qi is exuberant and tian-gui arrives. The essence and qi overflow, and yin and yang are harmonious, so he is able to father a child.” Second, the essence chamber is where the essence is stored. Chapter 9 of Su Wen  states: “The kidneys govern hiding, and are the root of sealing and storing; they are the location of the essence.” According to Nanjing [The Classic of Difficult Issues], reproductive essence is stored in the life gate: “The life gate is where the essence spirit resides. In men, it is used to store essence; in women, it is used to fasten the womb, and its qi is connected with the kidneys.” Qing dynasty medical expert Tang Rongchuan said in Xuezheng Lun [On Blood Patterns]: “A man’s womb, also known as the essence chamber, is where essence is stored.” This explains that a man’s womb (essence chamber) is where essence is stored, and “the essence stored in the essence chamber comes from the abundance of kidney yang qi. When the kidney qi is sufficient, the essence and qi are abundant, and the fire of the life gate is abundant, the essence chamber will be full, and when it is full, it will overflow. It is connected to the essence orifice.” The essence orifice, also known as the essence gate, refers to the opening of the ejaculatory duct. Semen is mainly composed of sperm produced by the testicles and secretions from glands including the seminal vesicles, prostate gland, and bulbourethral glands. Although sperm is produced in the testicles, it must pass through the epididymis and vas deferens to mature. The essence chamber does not refer to a specific physical organ, but rather is a functional summary of the storage of male reproductive essence (including sperm and semen). Tang Rongchuan said in Yijing Jingyi: “There is an essence orifice in the anterior yin [i.e., the genitals], which is paired with the urine orifice, but they are different. The urine orifice connects internally to the bladder, and the essence orifice connects internally to the essence chamber.” He also said: “The essence chamber is an intersection point of qi and blood, the place where essence is transformed into the fetus; it is the most important.” “The place where men store essence is controlled by the kidneys in particular.”  Zhang Xichun’s Yixue Zhongzhong Canxi Lu [Records of Chinese Medicine with Reference to Western Medicine] considers the essence chamber to be the “place where essence is produced” and “where essence is transformed.” The essence chamber produces essence, promotes the maturation of reproductive essence, and has essence storage and reproductive functions.

2. The essence chamber is responsible for secreting essence and seeding sperm:

Semen consists of sperm and seminal plasma. The essence chamber is an important site of storage and secretion in the male reproductive system. The normal function of the essence chamber depends on whether the kidneys’ yang qi is sufficient. When the kidney qi is exuberant, it will be full of essence. The excretion of essence requires the nourishment of body fluids and kidney yin has the function of nourishing yin fluids. The secretion of semen and the activity of sperm complement each other. If the yin and yang in the kidneys are harmonious, the sperm will be abundant and the secretion of semen will be sufficient; thus, the sperm will be secreted and seeded to successfully carry out the function of procreation and reproduction. If the lower burner or essence chamber is disturbed by external evils or toxins, damaged by the affect-mind, or invaded by dampness and heat, the palace of essence will be damaged, and even if the yin and yang of the kidneys are harmonious, the secretion of semen will be obstructed. If the yin and yang of the kidneys are depleted, essence production will be insufficient. If there is little fluid, there will be difficulty moving the essence, thus impairing the reproductive function.

The essence chamber’s function to produce and store essence is like that of the viscera, while its function to secrete essence is like that of the bowels. It can store as well as secrete, and the substances secreted are not waste products from the body. Therefore, it should be classified among the “extraordinary organs” in men. Since the essence chamber is where the essence is stored, it should be filled up regularly with essence so that male sexual and reproductive functions can proceed normally. Only when the essence is full can there be strong sexual desire, and only when the essence is sufficient can offspring be produced. However, if there is excessive sexual activity involving the repeated release of semen without storage, then the essence in the essence chamber will have difficulty assisting the sexual desire, so it will ultimately become a fire without a source, which will make it difficult for there to be strong desire. If one indulges in sexual desire, has frequent sexual intercourse, and releases semen without storage, one is likely to dissipate the essence and damage the fluids, resulting in an empty essence chamber, depleted fluids, kidney vacuity, and exhaustion of essence, and it will be hard to produce offspring. Therefore, the essence in the essence chamber should not be released recklessly. This is why Huangting Neijing Jing [The Classic of Inner Light of the Yellow Court] says: “Guard the essence chamber carefully and do not discharge it recklessly. Keep it closed and treasure it so that you can live longer.” The essence chamber is responsible for the discharge of sperm, so its nature should be unblocked and not stagnant. The essence in the essence chamber should not be too full and stagnant; the key is that it should be circulated, so there is no need to deliberately abstain from sex. Since reproductive essence is continuously produced, it can be appropriately discharged from the body through sexual activity or seminal emission to maintain normal male physiological functions.

Jingyue Quanshu [Jingyue’s Complete Compendium] states: “There are those who are in their prime with exuberant qi, but have abstained from sexual activity for a long time and still emit [semen]. In such cases, the emission is due to fullness.” This refers to the physiological emission of semen. As another example, in Yixue Yuanliu Lun [Treatise on the Origin and Development of Medicine], it is said that “thus, the essence as a material substance will be created if there is the desire to move, and it will not be created if it is no movement. If it can be in its natural state without movement, this is beneficial; if it is forced, this is harmful, and if it is overused, it will be exhausted. Letting it be natural without forcing it is the way to preserve the essence.” When the essence chamber is full, it is discharged through sexual activity, seminal emission, or masturbation; as the essence decreases, desire also decreases. The essence in the essence chamber continues to be generated and accumulates until it reaches a full state again.

In summary, the physiological functions of the essence chamber are essence production, essence storage, essence secretion, and seeding of sperm. The functions of the “essence chamber” are closely related to the exuberance and debilitation of the kidney essence and qi, so it is dominated by the kidneys and is an important part of the kidneys’ reproductive function. It involves multiple tissues and organs of the entire male reproductive system, such as the testicles, epididymis, prostate, seminal vesicles, and vas deferens in modern anatomy. However, we should emphasize that the essence chamber, like the 5 viscera and 6 bowels, cannot be matched one-to-one with the physical organs from an anatomical point of view alone. What TCM emphasizes is its functional role.

(I) The relationship between the essence chamber, the viscera and bowels, and the channels and network vessels

1. The relationship between the essence chamber and the Zang-fu

1. The relationship between the essence chamber and the viscera and bowels

Essence is the foundation of male health, and essence and blood have the same origin. Essence and blood are mutually transformed and generated, and both essence and blood come from the viscera and bowels. Among the viscera and bowels, the kidneys store essence, which transforms into blood; the heart governs blood, the liver stores blood, and the spleen controls blood. The spleen and stomach are both the source of engendering transformation of qi and blood. They are responsible for the engendering, transformation, control, and regulation of blood. Thus, when the viscera and bowels are harmonious, the blood flows smoothly through the vessels, and the sea of blood is full, the essence will fill up and overflow naturally. Therefore, among the 5 viscera, there is a particularly close relationship between the essence chamber and the kidneys, liver, heart, and spleen.

（1）The essence chamber and the kidneys:

The kidneys are the foundation of earlier heaven, storing essence and producing marrow. The exuberance and debilitation of kidney essence and qi govern the growth and development of the human body and its reproductive capacity. The relationship between the kidneys and the essence chamber is first reflected in the exhaustion of tian-gui and in terms of reproduction. Huangdi Neijing Suwen Zhuzheng Fawei [Commentary and Elaboration on the Yellow Emperor’s Inner Canon Plain Questions] states: “Tian-gui is yin essence; the essence of both men and women controls the kidney water, so it can all be called tian-gui.” Tian-gui is an important substance necessary for promoting the development of reproductive organs and the maturation of reproductive functions. It is the product of the kidney essence being filled to a certain degree. Therefore, when a man reaches puberty, his kidney essence is full; through the action of tian-gui, his essence palace matures, his essence overflows, and he becomes fertile, so the conditions are ripe for bearing offspring. Conversely, when he enters old age, due to the decline of kidney essence, tian-gui gradually becomes exhausted; his fertility declines along with it and may even be lost.

Secondly, the essence chamber belongs to the kidneys, which store essence and control reproduction. Through the action of the kidney essence and qi, the essence chamber transforms, stores, and releases the reproductive essence. If the kidney yang is depleted, the life gate fire is debilitated, or the kidney essence is depleted such that the ability to transform essence is weakened, then there will be symptoms of seminal cold and thin or scant semen. If the kidney yin is insufficient, with fire effulgence due to kidney yin vacuity and burning vacuity fire, or the kidney yang is insufficient, with vacuity cold in the essence palace, then it can lead to symptoms such as semen failing to be transformed into fluid.

Thirdly, the relationship between the kidneys and the essence chamber is also reflected in the fact that the storage and discharge of the essence chamber is subordinate to the storage and discharge of the kidneys. Given that “the kidneys store essence and control reproduction” and “the kidneys control water”, the essence chamber, through the action of the kidney essence and qi, regulates the opening and closing of the essence orifice and the urinary orifice by means of the essence chamber. If the kidneys store and discharge appropriately, the essence orifice and urinary orifice will open and close in an orderly manner; if the kidneys store and discharge irregularly, the essence chamber’s storage and discharge will malfunction, and the essence orifice and urinary orifice will open and close chaotically, resulting in abnormal ejaculation and urination.

（2）The essence chamber and the liver:

The liver governs free coursing and stores blood; it serves as the hub of qi and blood regulation for the whole body. The main physiological function of the essence chamber is to store and release semen. Essence and blood are the material basis of semen; essence is stored in the kidneys and blood is stored in the liver. Essence can produce blood and blood can transform into essence. Essence and blood have the same origin, since the liver and kidneys are of the same source, and they support each other. The liver is the sea of ​​blood and is responsible for storing blood. When the liver blood is sufficient and the blood storage function is normal, the liver blood will pour into the sea of ​​blood, so the thoroughfare vessel will be exuberant and the sea of ​​blood will be full. Therefore, the essence chamber will also be full of semen at the same time, and if the controlling vessel is unblocked and the great thoroughfare vessel is exuberant, a man’s essence will fill to the point of overflowing. The liver governs free coursing and it regulates the free flow of the qi dynamic. When the liver qi flows smoothly and can course freely, the qi dynamic will be regulated, the qi and blood will be peaceful, and the heart will be at ease. Only then can the essence chamber play its normal role of producing, storing, secreting, and seeding essence. Therefore, the kidneys’ reproductive function must rely on the cooperation and coordination of the liver.

At the same time, the liver governs the ancestral sinew and the liver channel vessel runs through the anterior genitals. Internally, it carries the ministerial fire, which has the functions of arousing the genitals, opening and closing the essence orifice, and governing the overflow of semen. If the liver qi is well regulated, it helps to maintain normal male sexual function. Therefore, the relationship between the liver and the essence chamber is mainly reflected in the normal male reproductive and sexual function. If the liver does not store blood, does not govern the sinews, or fails to course freely, it can lead to many male diseases such as impotence, difficulty in ejaculation, seminal emission, efflux discharge, and even symptoms such as scant semen, weak sperm, seminal cold, sperm deformity, and infertility. In addition, the liver’s free coursing function can also affect emotions. If there is emotional damage such that the liver does not store blood or fails to course freely, this can lead to scant blood in the thoroughfare and controlling vessels or inhibited flow of qi and blood, and can also cause abnormal essence chamber function and infertility. Therefore, many male diseases in clinical practice are mostly treated from the perspective of the liver.

（3）The essence chamber and the spleen (and stomach):

The spleen and stomach are the “root of later heaven” and “the source of qi and blood formation”. They control the center burner qi and govern the blood. The stomach is responsible for absorption; it is the bowel that serves as the sea of ​​water and grain, and has copious qi and blood. Blood is the essence qi of water and grain, which is harmonized in the 5 viscera and spread in the 6 bowels. The kidneys are the root of earlier heaven, control the essence chamber, and dominate the growth, development, reproduction, and aging of the human body. The spleen and kidneys support each other and complement each other so that the human body can function normally. The earlier heaven essence is stored in the kidneys; it is transformed into reproductive essence through the nourishment of the later heaven essence of water and grain and the catalysis of tian-gui. When the spleen and stomach are functioning normally and the qi and blood have a source from which to be formed, the kidney essence can be moved and transformed. Conversely, when the kidney essence is full, qi and blood can be generated, so both systems complement each other. As Zhang Jingyue said: “The beginning of a person’s life is rooted in the source of essence and blood; once a person is born, they are nourished by water and grain […] Without essence and blood, there is no way to establish the foundation of the body; without water and grain, there is no way to achieve the full vigor of the body. The control of essence and blood is in the life gate, and the control of water and grain is in the spleen and stomach. Therefore, the life gate obtains the earlier heaven qi, and the spleen and stomach obtain the later heaven qi. This is why the sea of ​​water and grain depends on the control of earlier heaven, and the sea of ​​essence and blood necessarily depends on the resources of later heaven.” Therefore, the relationship between the essence chamber and the spleen and stomach mainly affects the essence chamber’s transformation of reproductive essence. If the spleen qi is fortified such that its source of transformation is sufficient and its control is strong, then the essence chamber will fill up and overflow normally, and the reproductive essence will be vigorous. If the spleen’s movement and transformation function becomes abnormal such that the qi and blood lack a source, it can often lead to a lack of kidney essence and insufficient reproductive essence. On the one hand, this can lead to low sperm count and infertility; at the same time, it can also cause dampness and phlegm due to spleen vacuity, which can obstruct the qi dynamic, leading to symptoms such as perineum and smaller-abdominal distension and pain, essence turbidity, and sterility. In addition, according to Li Dongyuan’s yin fire theory, spleen and stomach qi deficiency with downward flow of grain qi and hyperactivity of yin fire can also cause some forms of sexual dysfunction.

Furthermore, in TCM it is believed that the spleen and stomach are responsible for moistening the ancestral sinew. For example, chapter 44 of Su Wen, entitled “Treatise on Wilting”, says: “The yang brightness [channel] is the sea of the 5 viscera and 6 bowels; it controls the moistening of the ancestral sinew. The ancestral sinew controls the leashing of the sinews and bones, and disinhibits the joints”. Chapter 75 of Ling Shu, entitled “Needling Divisions, True and Evil [Qi]”,  states: “The male genitalia is the mechanism of the body, the leader of yin essence, and the pathway of body fluids”. Chapter 45 of Su Wen, entitled “Treatise on Reversal”, points out: “The anterior yin is the place where the ancestral sinew gathers, and it is where the [channels of] greater yin [i.e., the spleen] and yang brightness [i.e., the stomach] unite.” Chapter 44 of Su Wen·says: “The thoroughfare vessel is the sea of channels and network vessels. It controls the permeation and irrigation of the ravines and valleys [i.e., the contours of the body]. It unites with the yang brightness [channel] at the ancestral sinew. Yin [channels] and yang [channels] combine at the ancestral sinew and meet at the Qi Thoroughfare [ST-30], and the yang brightness [channel] is their leader.” This shows that the yang brightness channel and thoroughfare vessel merge at the ancestral sinew. The thoroughfare vessel originates from the uterus (essence chamber), belongs to the kidneys, and is an important pathway for the movement of tian-gui. Therefore, the water and grain essence produced by the spleen and stomach can be transported through the channels and network vessels to the genitals to meet their growth and development needs and maintain sexual function.

（4）The essence chamber and the heart (and brain)

The essence chamber is an extraordinary organ. The heart governs the spirit and holds the office of monarch (the brain is the house of the original spirit). The heart (brain) is the master of the viscera, bowels, channels, and network vessels. The heart (brain) can affect male sexual function and the physiological “storage and overflow” functions of reproductive essence by regulating the storage and discharge of the essence chamber. For instance, chapter 33 of Su Wen, entitled “Treatise Discussing Heat Disease”, says: “The uterine [or essence chamber] vessel belongs to the heart and is connected to the essence chamber.” At the same time, in TCM it is believed that the heart and kidneys are the hubs of human physiological activities. The kidneys are the basis of reproduction, the source of tian-gui, and the home of yin and yang; the reproductive essence also comes from the kidneys. When the heart and kidneys interact, and water and fire are in harmony, together they maintain the balance of yin and yang. Essence and blood are mutually generated. The heart governs blood and stores spirit. Heart blood can transform into essence to replenish the kidneys, and kidney essence can also transform into blood to nourish the heart and calm the spirit. If the heart blood and kidney essence are deficient such that the brain spirit is not nourished, or the brain spirit is dim, then there will be low sexual desire; or if there is a loss of regulation resulting in disorder of the storage and discharge of the essence chamber, such that the essence orifice opens or closes excessively, then there will be premature ejaculation, seminal emission, or other symptoms.

If the heart blood is insufficient or the heart vessels are blocked, and the heart spirit is not nourished, this can lead to insufficient heart yin and heart yang, resulting in symptoms such as low libido and failure of the ancestral sinew to rise. Insufficient heart blood supply can also lead to the brain spirit being deprived of nourishment and irregularity of the essence chamber, resulting in issues like seminal emission, premature ejaculation, and essence turbidity, accompanied by symptoms such as insomnia, forgetfulness, palpitations, and oppression in the chest, or headache, anxiety, impatience, and irascibility. If the kidney water is insufficient and the heart fire is hyperactive, it can lead to vacuity and delirium of the brain spirit, resulting in vexation, agitation, irascibility, insomnia, and hyperactive sexual desire. If the heart fire is insufficient such that the kidney water is too cold, the essence chamber will lose its warmth, resulting in issues such as scant semen, seminal efflux, thin semen, and frequent nocturia. If the heart and kidney yang are vacuous, the body and the limbs will be cold, the libido will be low, there will be wilting and a lack of firmness, and there will be frequent long voidings of clear urine. If the heart and kidney yin are vacuous with vacuity fire harassing the inner body, the mouth and throat will be dry, and the semen will be scant and thin or even bloody. If both the heart and kidneys are deficient, the ministerial fire will move recklessly, disturbing the essence chamber and causing issues like seminal emission, premature ejaculation, and seminal turbidity.

2. The essence chamber, channels, and network vessels:

The essence chamber is an important organ of the male reproductive system. It is closely related to the viscera and bowels in terms of channels, network vessels, and functional connections. The thoroughfare, controlling, governing, and girdling vessels are classified as “extraordinary vessels”, and the essence chamber is classified as an “extraordinary organ”. The thoroughfare, controlling, and governing vessels start from the uterus and intersect with the girdling vessel. The thoroughfare, controlling, governing, and girdling vessels are connected to the 12 channel vessels. Therefore, the physiological function of the essence chamber is closely related to the functions of the thoroughfare, controlling, governing, and girdling vessels. As Tang Rongchuan of the Qing Dynasty said in Zhongxi Huitong Yijing Jingyi [Essential Meaning of Chinese and Western Integrated Medical Classics]: “According to these 4 vessels, the governing vessel is on the back and governs all yang, and it belongs to earlier heaven. The controlling vessel is on the abdomen and governs all yin, and it belongs to later heaven. The thoroughfare vessel disinhibits the yang brightness [channel] and passes through the uterus; it is the one that connects later heaven to the earlier heaven of the kidneys. The girdling vessel originates from the kidneys and circulates around the location of the spleen; it is the one that connects earlier heaven to the later heaven of the spleen. These 4 vessels’ functions are mutually dependent and it is necessary to study them in detail.”

（1）The thoroughfare vessel and the essence chamber

A.  The channel and network vessel connections between the thoroughfare vessel and the essence chamber

Chapter 65 of Ling Shu, entitled “The 5 Sounds and 5 Flavors”, clearly states that the thoroughfare vessel “starts from the uterus [i.e., essence chamber]”, which shows that there is a channel connection between thoroughfare vessel and essence chamber. The thoroughfare vessel has ascending and descending branches, as well as internal and external branches, and its external branch emerges at the Qi Thoroughfare [ST-30].

The thoroughfare vessel is an extraordinary vessel and its function is based on the viscera and bowels. Chapter 38 of Ling Shu, entitled “Treating the Fat and Thin According to Circumstance”, records the following: “The thoroughfare vessel is the sea of ​​the 5 viscera and 6 bowels […] Its upper part comes out of the forehead and penetrates all the yang [channels] […] Its lower part pours into the great network vessel of the lesser yin [channel] and comes out of the Qi Thoroughfare [ST-30] […] Its lower part is connected to the lesser yin channel and penetrates the 3 yin [channels] […] It penetrates all the network vessels and warms the flesh.” This shows that the ascending branch of the thoroughfare vessel is connected with all the yang meridians, enabling the blood of the thoroughfare vessel to be warmed. Another branch is connected with the foot yang brightness stomach channel, enabling the thoroughfare vessel to be nourished by stomach qi. Its descending branch runs parallel to the kidney channel, enabling the true yin in the kidneys to be nourished within it. In addition, due to the fact that it “penetrates the 3 yin [channels]”, it naturally connects with the liver and spleen channels, so it uses the blood of the liver and spleen.

In addition, the thoroughfare vessel is closely related to the foot yang brightness stomach channel. The stomach is an organ with abundant qi and blood. Chapter 10 of Ling Shu says that the stomach channel “goes from the supraclavicular fossa to the inner edge of the breast, goes down along the navel, and enters the Qi Thoroughfare [ST-30]”. Chapter 60 of Su Wen, entitled “Treatise on Bone Hollows”, says that “the thoroughfare vessel starts (or comes out) from the Qi Thoroughfare [ST-30]”. Nanjing Yishi [Explanation of the Classic of Difficult Issues] also says that “the thoroughfare vessel starts (or comes out) from the Qi Thoroughfare, connects with the foot yang brightness channel, moves up along both sides of the navel, and disperses in the chest”. All of these passages clearly point out that the thoroughfare vessel and the yang brightness channel meet at the Qi Thoroughfare [ST-30] and are closely connected, hence the saying that “the thoroughfare vessel is subordinate to the yang brightness”.

B. The functional connection between the thoroughfare vessel and essence chamber

The thoroughfare vessel “penetrates all yang [channels]” and “penetrates the 3 yin [channels]”, and is connected to the 12 channels. It is the place where the qi and blood of the 12 channels converge, and it is the key point for the circulation of qi and blood throughout the body. Therefore, it is called “the sea of ​​the 12 channels” and “the sea of ​​blood”. The thoroughfare vessel starts from the essence chamber. Men are based on essence and qi, and the channel that nourishes essence is called the thoroughfare. Because the thoroughfare is the sea of ​​blood, yin-blood accumulates in and overflows from it. When yin-blood is abundant, essence fills and overflows naturally. Therefore, the thoroughfare vessel should be the root of the essence chamber.

Tang Rongchuan’s Zhongxi Huitong Yijing Jingyi says: “The uterus [or essence chamber] is also known as the sea of ​​blood. The juice from food and drink in the stomach is taken to the heart to be transformed into blood, and goes down into the uterus [or essence chamber]. It is guided downward by the thoroughfare vessel. Hence, Neijing says: ‘When a woman is 14 years old, her tian-gui arrives, her controlling vessel is open, her great thoroughfare vessel is exuberant, and menstruation occurs at the appropriate time.’ In short, the uterus is the place where the kidney qi of earlier heaven and stomach blood of later heaven meet. The thoroughfare vessel originates in the uterus [or essence chamber], guides the kidney qi of earlier heaven upward to meet the stomach, and guides the yin-blood of later heaven downward so that it enters the uterus [or essence chamber] to meet the kidneys. It guides the qi upward, guides the blood downward, connects to the kidneys, and benefits the yang brightness [channel]. Thus, the function of the thoroughfare vessel can be known.” The testicles and penis are the thoroughfare channel organs. As Neijing states: “[Male] castration removes the ancestral sinew and injures the thoroughfare vessel […] in those who are naturally castrated […] the thoroughfare vessel is not strong.” Male castration injures the thoroughfare vessel, and the congenital defect of underdeveloped testicles and penis is caused by a weak thoroughfare vessel. Therefore, the testicles and penis are in the thoroughfare vessel. For this reason, only when the thoroughfare vessel is full of essence and blood can the essence chamber carry out its normal physiological functions of producing, storing, secreting, and seeding essence.

（2）The controlling vessel and essence chamber

A. The connection between the controlling vessel and the essence chamber

The controlling vessel also “starts from the uterus [or essence chamber]”, which confirms the channel connection between the controlling vessel and the essence chamber. Regarding the path of the controlling vessel, it emerges from the perineum and runs forward along the midline of the abdomen to the throat, travels up around the lips, and branches to the bottom of the eye sockets.

Similarly, the function of the controlling vessel is also based on the viscera and bowels. Chapter 10 of Ling Shu says: “The foot yang brightness vessel […] runs along both sides of the mouth, circles the lips, and goes down to meet the Sauce Receptacle [CV-24].” This shows that the controlling vessel and the stomach meridian meet at the Sauce Receptacle [CV-24], and the controlling vessel is nourished by the stomach qi. The liver foot reverting yin vessel “runs along the groin, enters the hair, passes the genitals, and reaches the lower abdomen”, and meets the controlling vessel at the Curved Bone [CV-2]. The spleen foot greater yin vessel “goes up the inner front edge of the knee and thigh, enters the abdomen”, and meets the controlling vessel at “Central Pole [CV-3]”. The kidney foot lesser yin vessel “goes up the inner back edge of the knee and thigh, penetrates the spine, belongs to the kidneys, and connects to the bladder”; it meets the controlling vessel at “Pass Head [CV-4]”. Therefore, the controlling vessel meets the liver, spleen, and kidney channels at “Curved Bone [CV-2]”, “Central Pole [CV-3]”, and “Pass Head [CV-4]”, respectively, taking the essence and blood of these 3 channels for nourishment.

B. Functional connections between the controlling vessel and the essence chamber

The controlling vessel governs the yin of the whole body. All yin essence, including essence, blood, and body fluids, is under the control of the controlling vessel, so it is called the “sea of ​​yin vessels”. Tang Rongchuan’s Zhongxi Huitong Yijing Jingyi says: “The controlling vessel is in the abdomen and governs all yin, so it is called ‘controlling’. Yin and yang intersect, so the controlling and governing vessels must intersect. Below, they intersect between the anterior and posterior yin [orifices]. Above, they intersect at the upper and lower lips. In terms of earlier and later heaven, the governing vessel is in the spine, belongs to the kidneys, and belongs to earlier heaven. The controlling vessel is in the abdomen, belongs to the stomach, and belongs to later heaven. Earlier heaven governs qi and intersects below with the uterus, while later heaven governs blood and intersects below with the uterus, all of which are in these 2 vessels. In terms of water and fire, the governing vessel belongs to qi and water; the controlling vessel belongs to blood and fire. Therefore, the controlling vessel should also belong to the heart. When the heart and kidneys interact, water and fire are in harmony. All because of this, the controlling vessel is the sea of ​​yin vessels.” This text also states: “Looking closely at the beginning and end of the intersection of the controlling and governing vessels, we know that the governing vessel governs yang and qi, and the controlling vessel governs yin and blood, and they intersect with each other and are the general managers of the body.”

In short, the controlling vessel is the sea of ​​yin vessels and accumulates yin-blood. Only when the qi of the controlling vessel is unblocked can the essence chamber carry out the physiological functions of producing, storing, secreting, and seeding essence. If the yin-blood of the controlling vessel is insufficient, over time it will lead to depletion of essence in the essence chamber and kidney vacuity, thus causing symptoms like scant semen, weak sperm, and infertility.

（3）The governing vessel and the essence chamber

A. The connection between the governing vessel and the essence chamber

Wang Bing of the Tang dynasty commented on Huangdi Neijing as follows: “The governing vessel is also an extraordinary vessel. However, the controlling, thoroughfare, and governing vessels are 3 branches [emanating from] a single source […] and just like the controlling and thoroughfare vessels, [the governing vessel] originates in the uterus [i.e., the essence chamber].” This theory was recognized by later medical practitioners. For example, Li Shizhen said in the Qijing Bamai Kao [Exposition on the 8 Extraordinary Vessels]: “The governing vessel is the sea of ​​yang vessels, and its vessel originates in the uterus under the kidneys.” Therefore, the governing vessel also originates in the uterus (or essence chamber). Regarding the path of the governing vessel, it emerges below at the perineum, ascends along the spine, connects with the brain at the Wind House [GV-16] point on the neck, and then goes up, forward, and down along the midline of the head from the neck to the Gum Intersection [GV-28] point on the upper lip.

The function of the governing vessel is also based on the viscera and bowels. Chapter 10 of Ling Shu·says that the governing vessel and the liver vessel “meet at the vertex”; the governing vessel uses the liver qi, the liver stores blood and carries the ministerial fire, and the body of the liver is yin in nature while its function is yang in nature. Chapter 60 of Su Wen records that the governing vessel “joins the lesser yin [channe;] and goes up to the inner and posterior edge of the thigh, penetrates the spine, belongs to the kidneys, and connects with the kidneys; it is warmed and nourished by the life fire in the kidneys. Its vessel goes up through the heart and enters the throat; it connects with the heart and is assisted by the sovereign fire. Moreover, the governing vessel starts from the inner canthus of the eye, connects with the foot greater yang, runs along the back of the body, and controls the yang of the whole body. It is also assisted by the ministerial fire, life fire, and sovereign fire, so it is called the ‘sea of ​​yang vessels’”.

B. Functional connections between the governing vessel and the essence chamber

The governing vessel is the “sea of ​​yang vessels”. The governing vessel and the controlling vessel both originate in the uterus (essence chamber). One runs on the back of the body, while the other runs on the front of the body, and they meet at the Gum Intersection [GV-28]. Their qi circulates back and forth, connecting yin and yang and regulating qi and blood to maintain the normal physiological activities of the essence chamber.

As Tang Rongchuan said in Zhongxi Huitong Yijing Jingyi: “The governing vessel starts from the kidneys and goes down to the uterus chamber [i.e., the essence chamber]. The gui-water produced by the heavenly one in the kidneys enters the uterus [i.e., the essence chamber]. This is all guided by the governing vessel. When the kidney qi reaches the uterus, the controlling vessel responds to it, and then the blood of the heart and stomach goes down to the uterus [i.e., the essence chamber]. This is where the controlling and governing vessels intersect, and the heart and kidneys help each other. It is the site of what the Daoists call fire and water, sexual intercourse. The governing vessel connects the genitals, runs between the 2 yin orifices, meets the controlling vessel at the bottom, passes through the spine up to the vertex, intersects at the Human Center [i.e., the philtrum or GV-26], and meets the controlling vessel at the top.”

The governing vessel starts below the navel and runs through the genitals. It is closely related to the function of the essence chamber, and is connected to the heart and brain. Therefore, its main function is to transmit instructions from the heart spirit to the ancestral sinew. It plays an important role in the erection and ejaculation of the male penis and other sexual activities. The governing vessel governs the yang of the whole body and is the sea of ​​yang vessels. A man’s masculine energy and the firmness of the penile erection are closely related to the governing vessel. If the governing vessel is damaged, it can cause impotence, difficulty in ejaculation, seminal cold, infertility, and other symptoms.

（4）The girdling vessel and the essence chamber

A. The connection between the girdling vessel and the essence chamber

Nan Jing says: “The girdling vessel starts from the flanks and goes around the body in a circle”, which means that the girdling vessel runs horizontally around the waist and binds all the channels. Chapter 44 of Su Wen says: “The thoroughfare vessel […] all belongs to the girdling vessel and is connected to the governing vessel”. Wang Bing’s commentary on Huangdi Neijing says: “The controlling vessel goes up from the uterus [or essence chamber], passing through the girdling vessel and going up through the navel”. The horizontal girdling vessel intersects with the vertical thoroughfare, controlling, and governing vessels, and indirectly connects to the uterus (essence chamber) through the thoroughfare, controlling, and governing vessels.

The function of the girdling vessel is also based on the viscera and bowels. Zhenjiu Jiayi Jing [The Systematized Canon of Acupuncture and Moxibustion] says: “The Linking Path [GB-28] […] is the meeting point of the foot lesser yang and the girdling vessel”.  Chapter 44 of Su Wen says: “The foot yang brightness is the leader, and all belong to the girdling vessel”; earlier in the text, it says that the foot greater yang is connected to the governing vessel, and the governing vessel and the girdling vessel are connected, so the foot greater yang is also connected to the girdling vessel through the governing vessel. Chapter 11 of Ling Shu, entitled “Channel Divergences”, says: “The right [location] of the foot lesser yin […] is at the 14th vertebra (Kidney Transport [BL-23]), and it comes out from the girdling vessel”. Because the girdling vessel is connected to the controlling and governing vessels, it must also be connected to the liver and spleen. From this, we can know that the girdling vessel is connected to the 3 yin and 3 yang meridians of the foot, so the girdling vessel can also take the qi and blood of the liver, spleen, kidneys, and other channels for its use.

B. The functional connection between the girdling vessel and the essence chamber

Tang Rongchuan’s book Zhongxi Huitong Yijing Jingyi states: “The girdling vessel binds all the vessels together, so that there is no frenetic movement. It is so named because it is like a belt tied around a person. If we trace the origin of the girdling vessel, we will find that it passes through the kidney system, so the girdling vessel should belong to the kidneys.” Another example is found in Tang Rongchuan’s book Xuezheng Lun: “The girdling vessel is tied to the uterus [i.e., essence chamber] below, binds the human body in the middle, and is located in the center of the body.” Therefore, we can know that the girdling vessel uses the qi and blood of the 3 yin channels and 3 yang channels of the foot, thereby restraining the qi and blood of the thoroughfare, controlling, and governing vessels to maintain the normal physiological activities of the essence chamber.

In summary, the thoroughfare, controlling, and governing vessels start from the uterus and intersect with the girdling vessel above. The thoroughfare, controlling, governing, and girdling vessels are connected to the 12 channels as well as the viscera and bowels, thus organically linking the essence chamber with the entirety of the viscera, bowels, channels, and vessels. Because the thoroughfare, controlling, governing, and girdling vessels are connected to the 12 channels and store the qi and blood of those channels, the function of these 4 vessels to control the essence chamber is based on the viscera and bowels. That is, the qi and blood of the 12 channels are infused into the uterus through the thoroughfare, controlling, and governing vessels, and serve as the source of essence and blood. The essence chamber is directly or indirectly connected to the 12 channels and receives the qi and blood of the viscera and bowels, thereby completing its main functions of producing, storing, secreting, and seeding essence, and playing its role in reproduction and producing offspring.

In short, the theory of the essence chamber is a unique theory of TCM andrology. Combining ancient literature and the clinical experience of practitioners throughout the ages, we believe that the kidneys are the ruler of the essence chamber, the heart (brain) is the master of essence and blood, the spleen is the source of essence and blood, the liver is the manager of essence and blood; the thoroughfare, controlling, governing, and girdling vessels are the pathways of essence and blood, and the essence chamber is the home of essence and blood. If the heart (brain) spirit is clear, the kidney essence is sufficient, the spleen qi moves and transforms, the liver qi is capable of orderly reaching, the thoroughfare, controlling, governing, and girdling vessels are unobstructed, and the essence chamber’s storage and discharge occur in an orderly manner, then the essence chamber can carry out its normal functions of producing, storing, secreting, and seeding essence. Therefore, the clinical treatment of essence chamber pathology should be based on treating the kidneys, with the kidneys, heart, liver, and spleen as the core, the thoroughfare, controlling, governing, and girdling vessels as links, and the essence chamber as the target point.

IV. The significance of studying the reproductive axis of “Kidneys—Tian-gui—Thoroughfare, Controlling, Governing, and Girdling Vessels—Essence Chamber”

1. Theoretical significance:

The theory of the TCM male reproductive axis has great significance in TCM studies. Professor Shi Zhensheng, a leading expert on kidney disease in contemporary TCM, was involved in clinical and scientific research on TCM for kidney disease as early as the 1950s, and proposed the relevant concepts of “the kidneys, tian-gui; thoroughfare, controlling, and governing vessels; and the essence chamber” in TCM andrology in the 1980s. After more than 30 years of clinical observation and verification, we have proposed the theoretical system of the male reproductive axis that consists of “kidneys—tian-gui—thoroughfare, controlling, governing, and girdling vessels—essence chamber”. We have also emphasized the TCM male reproductive axis theory of “taking the kidneys as the root; the kidneys, heart, liver, and spleen as the core; the thoroughfare, controlling, governing, and girdling vessels as the links; and the essence chamber as the target point”. This theory gives full play to the TCM diagnosis and treatment characteristics of the holistic perspective and pattern identification as the basis for determining treatment. In particular, we have highlighted guidance for combining acupuncture and Chinese herbal medicine, thus reflecting the therapeutic advantages of this combination that can be adjusted via multiple targets, multiple levels, and multiple links, and constantly improving the understanding of the theoretical system of human reproduction in TCM.

The theory of the male reproductive axis in TCM not only enriches TCM reproductive theory, but also elucidates its corresponding relationship with the female reproductive axis in TCM. At the same time, we should also clearly emphasize that TCM believes that the kidneys, tian-gui, the thoroughfare, controlling, girdling, and governing vessels, and the essence chamber are closely related to reproduction. The reproductive axis of “kidneys—tian-gui—thoroughfare, controlling, governing, and girdling vessels—essence chamber” is the core of the regulation of male reproductive and sexual function, which coincides with the reproductive axis of “hypothalamus—pituitary gland—testes” proposed by modern medicine. However, these cannot be simply viewed as equivalent and their relationship cannot be exaggerated. Therefore, when applying these concepts in clinical and scientific research, we should give full play to the advantages of TCM’s holistic view and pattern identification as the basis for determining treatment.

2. Significance in andrological therapy:

The significance of these concepts is mainly reflected in their applications in the field of andrology, especially in the treatment of reproductive and sexual diseases. Common male diseases like impotence (erectile dysfunction), premature ejaculation, seminal emission, seminal efflux, low libido, sexual dysfunction, male infertility, male menopausal syndrome, and acute and chronic prostatitis are closely related to physiological and pathological changes in systems such as the kidneys, tian-gui; the thoroughfare, controlling, governing, and girdling vessels; and the essence chamber. Treatment can start from the theory of the kidneys, tian-gui; the thoroughfare, controlling, governing, and girdling vessels; and the essence chamber. That which is excessive should be repressed, that which is insufficient should be supplemented, and that which is unbalanced should be adjusted. For example, fluctuations in the tian-gui level can also affect many diseases outside of sexual medicine, especially some diseases affecting the middle-aged and elderly, such as hypertension, coronary heart disease, diabetes, and osteoporosis. In addition to other causes, the role of tian-gui level imbalances should not be underestimated. In the treatment of such diseases, if some medicinals that replenish kidney essence (increase the material basis of tian-gui) and supplement the ministerial fire are used in addition to conventional methods, unexpected results will often be achieved.

As another example, sexual dysfunction can be caused by physical or psychological factors. Many sexual dysfunction problems are caused by a combination of physical and psychological factors. Physical problems can lead to psychological disorders (such as anxiety, fear, and tension) and psychological problems can in turn aggravate physical diseases. Sometimes men will experience a feeling of vexation (performance anxiety) due to their personal stress or because they cannot meet their spouse’s higher sexual demands. This anxiety can cause distress to the patient and further affect his ability to enjoy sexual intercourse. Therefore, using this axis theory, at the same time as one regulates the kidneys, one can also regulate the liver, the heart, and the spirit in combination, which often achieves good therapeutic effects.

Acute and chronic prostatitis: This is a common inflammatory condition of the male reproductive system, mostly seen in young and middle-aged people. It is often causally related to urinary tract inflammation. Common clinical manifestations are urinary discomfort, pain, sexual dysfunction, and neurasthenia. We treat it according to the theory of the essence chamber of TCM and often achieve good results.

3. In terms of eugenics:

To conceive a healthy fetus, it is necessary to cultivate healthy reproductive essence. The reproductive essence of men and women is produced through the stimulation of tian-gui. The rise and fall of the level of tian-gui directly affects the quality of reproductive essence. Based on the time limit of tian-gui, the best time to obtain healthy sperm and eggs is between the ages of 20 and 30. Reproductive essence contains all the information of life and this information may play a role in the offspring’s life through tian-gui (such as talent, personality, physique, appearance, and life span). Therefore, in terms of eugenics, one must also consider the health and longevity of the offspring throughout their whole life. This requires young men and women to work hard to create life information that is beneficial to inherit and change information that is not beneficial to before conception. This is a complex systematic project and the highest goal of eugenics.

4. Significance in TCM:

The “kidneys—tian-gui—thoroughfare, controlling, governing, and girdling vessels—essence chamber reproductive axis” has important guiding significance for TCM health cultivation and can also help to build a system for protecting men’s health. In TCM, it is believed that the kidneys store essence and are responsible for reproduction and development, and tian-gui has an important influence on our growth, physical strength, tooth development, and appearance. Many common acute and chronic diseases are closely related to this axis, especially some complex chronic diseases. For example, many elderly people present with prostatic hyperplasia. In addition, for many men, after the change of life, their body further declines due to the decrease in tian-gui levels, and issues such as sexual dysfunction, osteoporosis, vascular sclerosis, and muscle weakness occur one after the other. Therefore, studying the tian-gui theory and prolonging the time of sexual activity by nourishing tian-gui can not only relieve symptoms associated with the change of life and reduce the occurrence of geriatric diseases, but also improve the quality of human life and even play an important role in prolonging life. The thoroughfare, controlling, governing, and girdling vessels are pathways for the circulation of qi and blood in the human body, and they have an especially close relationship to the essence chamber. Therefore, the use of acupuncture, acupressure, and other self-care practices can help the circulation of qi and blood and promote the health of the male reproductive system.