Differentiating Organ Wellness by Circadian Rhythm in TCM

The onset of wellness in the human body is often related to time and hour. Based on the principle of correspondence between the human body and the universe, this article makes a preliminary exploration into the differentiation of syndromes according to time and hour for wellness with a fixed onset time.

The twelve time periods were named by the ancients based on various characteristics observed on Earth during one full rotation of the Earth around the Sun and its own rotation. These periods are Midnight, Crowing of the Rooster, Dawn, Sunrise, Breakfast Time, Late Morning, Noon, Early Afternoon, Late Afternoon, Sunset, Dusk, and Human Rest. Due to the changing seasons of spring, summer, autumn, and winter, the length of day and night varies, and the times represented by the twelve periods are not fixed clock times. For example, dawn indicates the break of day; in summer, dawn occurs before 5 o’clock and is considered the period of Yin (3-5 AM), while in winter, it occurs after 5 o’clock and is considered the period of Mao (5-7 AM). Because of the correspondence between humans and the universe, the vital energy of the body’s organs undergoes changes in strength and decline with the passage of day and night. This is the theoretical basis for differentiating organ and visceral wellness based on time periods.

1. The wellness occurs at sunrise, indicating deficiency of the Spleen and stomach.

Sunrise is classified as wood in the Five Elements theory and corresponds to the Liver and gallbladder. At this time, the ascending and dispersing function of gallbladder qi is already vigorous, and Liver qi is also abundant. The Spleen and stomach belong to earth. When earth is weak, it is vulnerable to invasion by wood. Therefore, wellness that manifest at sunrise are due to Spleen-stomach deficiency. After sunrise, from the breakfast time to late morning, it is the period when the Spleen is strong throughout the four seasons. Spleen-stomach qi deficiency will naturally recover, and the wellness can supports on its own. Thus, wellness that occur at sunrise can be differentiated as Spleen-stomach deficiency, and the supports should focus on regulating the Spleen and stomach.

For example: Patient Xu XX, female, aged 30. For the past half month, she has experienced dizziness, limb fatigue, and mental and physical exhaustion around sunrise, and these signs of imbalance would only subside after having breakfast. One day, by chance, she had breakfast before sunrise. Since the Spleen and Stomach (BL20, BL21) had already received nourishment from the essence of water and grains, the aforementioned signs of imbalance did not occur at sunrise. Based on this, it was determined that she had Spleen-Stomach deficiency (pattern). Huangqi Jianzhong Tang (Astragali Decoction to Strengthen the Middle) was prescribed, and she recovered after three doses.

2.The wellness occurs at midday, indicating excessive Heart fire.

At midday, according to the five elements classification, it belongs to fire and is mainly related to the Heart and small intestine. The Heart is the organ of fire. At midday, the yang qi is abundant, and the Heart qi is vigorous during this time. If the Heart fire is excessive, it will over-restrain the organ it governs and counteract the organ that restrains it, leading to various pathological changes. After midday, the yang qi begins to decline, and the yin qi gradually increases. The excessive Heart fire subsides on its own, and various signs of imbalance resolve accordingly. Therefore, if a wellness occurs exclusively at midday, it indicates excessive Heart fire, and the supports should focus on purging the Heart.

For example： Mao XX, female, aged 45, suffered from toothache for two hours at noon (midday) for three consecutive days, which stopped on its own. This was due to excessive Heart fire. She took two doses of Xiexin Decoction from Jin Gui Yao Lue and the toothache stopped immediately. Another case involved a boy named Li X, aged 5, who had suffered from sores and rashes all over his body for three years without recovery, and frequently experienced epistaxis, mostly occurring at midday in summer. He had received blood transfusions four times due to excessive bleeding. At the time of consultation, he had experienced epistaxis at noon (midday) for four consecutive days. This was also due to excessive Heart fire, and he was supports with Xiexin Decoction from Jin Gui Yao Lue. After taking two doses, the epistaxis stopped, and after six doses, the sores and rashes disappeared. This is because Xiexin Decoction from Jin Gui Yao Lue is effective in purging Heart fire.

3. The wellness occurs at dusk, mostly due to Lung-Kidney Yin Deficiency.

The period of “Ribu” (before sunset) is classified under the Metal element in the Five Elements theory, primarily associated with the Lung and Large Intestine. During Ribu, Yang energy begins to retreat and Yin energy can be stored. However, when deficient fire rises upward, wellness occurring during Ribu often persist until midnight before subsiding. This is because after midnight, Yang energy starts to ascend while Yin diminishes, aligning with the natural ebb and flow of Yin and Yang. Therefore, wellness manifesting during Ribu are often supports by nourishing the Lung and Kidney, enriching Kidney water to replenish Lung Yin, and vice versa—a principle known as “nourishing Metal and Water mutually.” This approach harmonizes Water and Fire, balances Yin and Yang, and ensures that by the time Ribu arrives, the fiery energy is subdued, helps maintain the recurrence of the wellness.

For example： Patient Yao XX, female, aged 33, suffered from a persistent dry cough without phlegm from late afternoon to midnight for more than two months. Various Chinese and Western medications proved ineffective. I prescribed Siwu Decoction (Four-Substance Decoction) with Chebulae Fructus (he zi), Schisandrae Fructus (wu wei zi), and Achyranthis Bidentatae Radix (niu xi) to nourish blood, replenish yin, clear heat, and astringe the Lungs. After three doses, the cough ceased. Another case, Patient Li XX, female, aged 23, developed postpartum fever from late afternoon to midnight daily. Despite half a month of supports with Western anti-infective agents and bitter-cold heat-clearing Chinese herbs, her condition worsened. She was later supports with Baihe Gujin Decoction (Lily and Figwort Decoction) to moisten the Lungs and nourish the Kidneys. After two doses, the fever subsided.

4. If the wellness occurs at midnight, it must be due to excessive Kidney water.

At midnight, according to the five-element classification, it belongs to water and is associated with the Kidney. Midnight is the time when water is most abundant and also the moment when yang begins to generate. The Kidney is the organ of water. At midnight, when Kidney water is excessively abundant, it can over-restrain fire and overact on earth (the Spleen). This hinders the generation and ascent of yang qi. After midnight comes the period from cockcrow to dawn, which is the time when the Spleen is most vigorous throughout the four seasons. When the Spleen is vigorous, it can restrain the excessively abundant Kidney water, and various signs of imbalance can resolve on their own. Therefore, if a wellness manifests at midnight, it must be due to excessive Kidney water. supports should focus on warming the Kidney yang to restrain the Kidney water.

For example：Patient Wang X, male, aged 52, had suffered from lumbar pain accompanied by calf cramps every midnight for more than ten years, with the signs of imbalance being more severe in winter and less severe in summer, and worsening upon exposure to cold. He was supports with Shenqi Pill from the Jin Gui Yao Lue combined with Quanlu Pill to warm the Kidney yang, and recovered after three months of supports.