Introducing Microcosmic Visceral Orbis of Classical Chinese Medicine Treating Fatigue Symptom as an Example

At the time of Neijing (B.C. 500), it had already mentioned about fatigue symptoms which was different from physical fatigue (). This physical fatigue used to pertain to workload while fatigue illness usually related to exterior and interior dampness. Dr. M. Porkert also said that both exterior and interior dampness might damage the function of splenic earth [1]. The splenic earth which handle and balance metabolic water in our body is called the dampness-earth () [2]. In my daily clinical practices, fatigue symptoms which is a common illness, can easily be cured from the perspective of TCM. I have already had my articles which emphasized that TCM has a strong foundation of theoretical approach [2,3] which has had great difference with orthodox western medicine [4]. 

Fatigue syndrome used to be considered as a minor or a neglectable illness in western medicine until 1994 the attention of Chronic Fatigue Syndrome (CFS) had been emphasized [5,6]. The ‘post-infectious’ fatigue syndromes resemble ME (Myalgic Encephalomyelitis)/CFS commonly occurred during the time of Covid-19 which a term of Long-Covid was given and economic costs had been huge [7], characterized by fatigue, post-exertional malaise, chronic muscle and cognitive impairment (brain fog). 

Fatigue illness will be further discussed with the idea of human-universe unification which was introduced by Dr. Porkert with the term visceral orbisiconography (tsang-hisang ) in TCM. Actually, the theoretical concept of macro- and micro-cosmic dimension in TCM, which was hidden in Neijing, it used to be an important diagnostic principle applying to postulate the causation of illnesses.

From the perspective of macrocosmic, there is six-qi from our atmosphere while dampness is one of them. This six-qi exists eternally and changes regularly within the 60-year circadian cycle. For instance, we have the Chinese lunar calendar which tells us about the time and space status in this year 2024 such as yin-yang, six-qi, five-element, ten-celestial, twelve-terrestrial systemized information and these terms had been explained thoroughly in my previous article [2]. 

Usually, dampness will be come up with hotness as in the summer time based on the five-element feedback mechanism (Figure 1). In Asia, typhoon and rainfall mainly occurs in summer season because of heat. As in figure 1, since the child of metal is water when fire assaults metal then water will be retributed for its mother ‘metal’ and then fire is suppressed. This feedback phenomenon occurs in nature naturally and was applied to treating diseases based on the foundation of five evolution phases. In 2024 related to lunar Chinese calendar is (chia-chen), during this summer dampness and coolness is dominant due to the fact that combination of macrocosmic yin-yang characteristics (chia , Dampness) and (chen , Coolness). The climate is compatible with heavy rainfall in my country during this summer time. 

Exterior dampness is one of the six-qi in nature which is transformed to interior dampness in our body. Exterior dampness enters into our body through the splenic earth channel which can handle water metabolic dampness effectively. Naturally, hotness during summer time, our body will intake much more water. Likewise, this is an act of fire suppressed by water in the five-element model. Fire and water are opponent to each other. Usually, people are fond of drinking ice-cold water in summer season. Too much water taken in summer time, fire-water conflict which our splenic earth will be hurt and dampness arose. From exterior dampness to interior which is a complicated process involving six-qi, four seasons, environmental change, food intake, body health, dampness status, functional condition of the splenic earth and defensive power of qi. Practically, pulse diagnosis of TCM is essential to tell defensive and offensive qi status in our body. Theoretically, macro- and micro-cosmic dimension in TCM with circadian rhythm, six-qi with exterior and interior transformation, and visceral orbis will be taken into account [3].

 Figure 1: Feedback mechanism of the Five Element Model.

Dr. Porkert mentioned that “Whereas in anatomy Western medicine, causal and analytic primarily describes the aggregate carriers (or substrata) of effects, inductive synthetic Chinese medicine is primarily interested in the fabric of functional manifestations are described systematically by the discipline called orbisiconography (orbis) [1]”. The concepts of orbis will be the theme clarified in this article. 

Preliminarily, orbis pertains closely related to microcosmic dimension. While human-universe which is unified as a whole and integrate into a set of measurable units is in terms of yin-yang. That is the reason why Chinese medicine is primarily interested in functional manifestations because of the need of correspondence between macro- and micro-cosmic dimensions. How does it bring forth with yin-yang Transform the visceral organs to yin-yang systematically which is the answer. Afterwards, TCM textbook transcriptions should abandon the anatomical visceral organ and preserve the functional visceral orbis which is an important part of human-universal unification by means of yin-yang. That is why the core concept of TCM is yin-yang because no matter the etiology, diagnostic principles, herbal medicine, acupuncture and all these are transformed into micro- and macrocosmic dimensions of yin-yang. 

Our ancestor knew that the anatomical liver is located on the right upper quadrant of the abdomen. Nevertheless, they insist to say that the attribute of liver is wood so that it should be on the left. Why left It is based on the idea of Hetu which indict that wood (liver) is on the left side [3]. That is the biggest differences between the idea of anatomical and orbis liver. The point is that these left, wood and liver are grouped into the same category which represent yang-in-yin(). Consequently, yin and yang truly are the main stream of theoretical approach to TCM while clinical experience is an accident [4]. The knowledge of visceral orbis transformation is originated from phenomenal representation in nature which were documented in Neijing and practiced clinically by our TCM ancestor.

CFS seems to be a newly emerged medical term with ambiguous definition in 1994 by Keiji Fukuda [5]. Definition should be: requires at least 6 months of persistent fatigue which cannot be alleviated by rest, is not the result of ongoing exertion, and is associated with substantial reductions in occupational, social, and personal activities [6]. Accordingly, patient with CFS should have: Severe chronic fatigue for six months with other known medical conditions excluded by clinical diagnosis. Four or more of the following symptoms: (a) substantial impairment in short-term or concentration (b) sore throat (c) tender lymph nodes (d) muscle pain (e) multi-joint pain without swelling or redness (f) headaches of new type, pattern, or severity (g) unrefreshing sleep (h) post-exertional malaise lasting more than 24 hours. Actually, CFS is not a newly discovered illness and references in medical literature can be traced back to 1860s’ with similar condition named neurasthenia [8]. 

It is so easy to confuse with psychological or physical fatigue so that further criteria should be summed up with the diagnosis of CFS. Since 2010 in Canada, “ME/CFS” Myalgic Encephalomyelitis (ME) had a name be changed officially to replace CFS. Well, CFS is some kind of “all in your head” illness and most clinician neglected even today. Researchers wants to discover the mechanism of ME/CFS is an ongoing research topic and it seems to be difficult to achieve the goal because diagnostic criteria of CFS mainly depends on fatigue symptoms affiliated with or without major diseases [9]. The globally reported ME/CFS prevalence ranges between 0.2% and 2.8% while ranged between 0.1% and 2.2% in Europe [10]. Studies on ME/CFS from CDC, Canada, Australia which the prevalence rate were different, due to the variety of criteria [11]. 

In TCM, fatigue symptom is such a common clinical illness and has had a long history over 2000 years as well as its documentation in Neijing. Not like X-ray, Laboratory data clinically to evaluate physiological or anatomical status, it is much more difficult to differentiate certain kind of diseases from symptoms alone. Logically, criteria of CFS may not be same from research center to center. It is inevitable that there are so many reasons of unknown from the perspective of scientific modern medical world. Sometimes, it is just a simple clinical problem such as CFS can easily be solved with thousand years’ treatment experiences. 

Clinically, fatigue symptom is really not an “all in your head” problem and sometimes even gives great trouble in one’s occupation [12]. As mentioned, there are pitfall in making a precise diagnosis about fatigue. Most of the patients just want to know whether their symptoms could be relieved and mostly do not worry about how medical explanation will be. Especially, in the variety of diagnostic criteria of CFS. Likewise, fatigue symptom, patient may not have any pathological findings clinically but they are really tiresome vulnerably while this group of patients could easily be relieved by TCM treatment no matter acute, chronic or Long Covid.

Orbisiconography was the term firstly unleashed by Dr. M. Porkert. He defined Orbis as “The ambiguity of the technical term ‘orb’ (Orbis) reflects almost exactly that of Chinese term tsang ?, which refers on the one hand to a bodily substratum with ill-defined material and spatial contours, and on the other hand to a physiological function associated with the substratum and qualitatively defined in the time with precision and subtlety.” Actually, tsang this word refers to ‘the ambiguity’ which most of the time is misled to viscera organ alone. Nevertheless, tsang has had the property of viscera functions involving yin-yang while in Chinese medicine its anatomical substratum property is just a minor issue which can be neglected. Consequently, the concept of viscera tsang is really important in TCM and its misunderstanding is commonly led astray by modern anatomy and physiology. Of course, ancient Chinese physician knew the gross anatomy of internal organ very well. The details of gross anatomy of gastrointestinal tract wherever the seven-sphincters (e.g. ileocecal value) was stated in the canon of Nanjing(??) could further explain TCM knows human gross anatomy concisely but they replace it with visceral functionality. 

Therefore, wood-liver, fire-heart, earth-spleen, metal-lung, and water-kidney these are the five-element plays in important role of qi cycling in our body from left(liver) to right(lung). Body is the substance whilst qi is potential functionality of visceral organs. Functional activity is qi which can be correspondence to each other through visceral organs. Boby is yin whilst qi is yang and these yin-yang constitute the cosmological view of TCM.

How does dampness give trouble to our body related to yin-yang? The category of six-qi matches into five elements respectively: wind(wood), coolness(water), dampness(earth), dryness(metal), hotness and summer-heat(fire). Therefore, dampness belongs to earth whichever the splenic-earth is the substance yin. Natural dampness is macrocosmic origin which is yin added to our body. External dampness refers to atmospheric humidity which affects our body with water disequilibrium in case of our internal viscera such as the splenic-earth could not handle this dampness situation satisfactory. No matter how external or internal causes of dampness does, the final consequences will be water disturbance in our body. If visceral orbis are treated and bring back to normal condition, then dampness will be alleviated and health recovered. 

Water or dampness redundancy initials the effect of elimination naturally by urination, perspiration, diarrhea, and etc. While from TCM, our visceral organ(orbis) can handle dampness effectively especially the splenic-earth. Reviewing the five-evolution, one of the duties of splenic-earth is given by bringing the renal-water disequilibrium back to normal [3]. 

Troubles given by dampness are a lot such as: fatigue, gastrointestinal disturbance, heavy-headedness, thirsty, poor appetite, frequency urination, myalgia, palpitation, blurred vision, etc. These troubles will be given by dampness internally. Dampness is water-yin redundancy and thereafter the qi-yang will be hurt. While yang or qi, which is energy, motion, movement in our body, whenever fatigue will be the trouble given by qi deficiency causing body weakness. Sometimes, people may find an unreasonable explanation that water redundancy and thirsty coexisted. It is due to uneven water distribution in our body. Like ascites, nephrotic syndrome, pulmonary effusion all these diseases are too much water accumulation in our body called the third space and patients will be suffered from heavy-thirsty and sometimes pertaining to a phobia of water intake. 

Uneven water distribution is a good example of treating diseases from view of TCM. Our body used to handle the category of five-element or substances: wind-motion, fire-energetic, earth-dampness, metal-dryness, and water-cooling. Our whole body is in a status of equilibrium and hemostasis. Whenever, metabolism in our body is functioning well so that we have body temperature, respiration, digestion, elimination, etc. in normal condition otherwise people will be sicked. The focus of TCM on body discomfort has had big discrepancy from orthodox western medicine. Functional chronic fatigue syndrome, which is one of the most common discomforts complained in the TCM out-patient clinic, can be treated effectively by elimination of dampness redundancy. 

Most of fatigue caused by dampness will be arose in the evening time which come up with heavy-headedness, drowsiness, myalgia, headache, etc. Doing laboratory blood tests clinically, all data results will be within normal limit that means no abnormal findings physiologically. Therefore, medical doctor may just pertain such discomfort to functional disorder and sometimes refers it to a psychologic behavior such as anxiety. Actually, it is quite easy and effective to treat CFS by eliminating dampness by TCM medication.

TCM is theoretical driven based on yin-yang which applies to diagnosis and treatment. Combination of theory and clinical experiences, which is our traditions in classical Chinese Medicine, there is a philosophical view in TCM which may not be so accurate as laboratory science but it is good enough to treat diseases. Theory of orbis is some sort of qualitative science and is different from the knowledge of quantitative aspect. In this article, an example of CFS was given to explain about the jargon about this orbis. It is worth to delve into theoretical approach in TCM practices in order to creating diagnostic accuracy as well as treatment effectiveness. 

The advantage of TCM remedy is safe and less side-effect. There is a so powerful water excretion medication such as Lasix. This generic name (Lasix) can be interpreted as ‘Last for six hours’. It is really true that the first six-hour urinations are a lot but there are a lot of side-effects and the common one will be electrolytes imbalance and with medication resistance later on. The strategy of treating dampness from viewpoint of TCM is different. TCM doctor used to nourish the splenic earth and let the water or dampness be eliminated by visceral orbis and let orbis do their own job to dispelling excessive water automatically (earth suppress water). 

Moreover, such dampness is one of the major reasons for fatigue illness which used to be missed by modern medicine. Perhaps, patients may not know CFS can be treated effectively by just eliminate excessive dampness in our body. Herbal remedy is really safe because of its natural characteristics and sometimes our daily herbal food (e.g. ginseng) can alleviate the dampness fatigue syndrome successfully.

Mild dampness is occurred, sometimes daily food and physical exercise may eliminate this minor fatigue syndrome. While heavy dampness should be diagnosed by TCM doctor and be given suitable prescription to expulse water imbalance (Tables 1 & 2).

 Table 1: Daily-use herbal food as medication for dampness elimination.

Table 2: Paradigm of Herbal Medicine treating splenic dampness. 

Group I: bitterness and coldness herb to suppress heat and dampness related to splenic-earth suffering

Group II: water imbalance and dampness elimination focus on its diuretic effect

Group III: dampness elimination by benefit the spleen helping water transfer to the lung

Group IV: aromatic agent arouses splenic-earth functional qi 

In table 2, there gives an idea of treatment, which is further subdivided into four different groups. These four groups represent four treatment strategies which are commonly used in TCM prescription and sometimes people refer it to recipe or formula. In the mid-1990s, Dr. David Ho was one of the pioneers who elicited antiretroviral combination therapy (triple cocktails therapy) to fight against the highly resistant HIV infection and referred to a turning point of HIV treatment clinically and academically [16]. Such kind of combination therapy is our daily practice in TCM too. We have our own treatment strategy in TCM via a thorough explanation by visceral orbis.

For example, summer hot-dampness is the major seasonal climate in Asia. Hot and dampness usually comes along together and causes acute fatigue syndrome. While serious heat stroke is a critical condition in summer time, sometimes body temperature can uprise to 45^oC which is an emergency ICU situation. Therefore, hotness in summer really can cause sicknesses from minor fatigue syndrome to severe critical heat stroke. It is really true that fatigue syndrome, which appears with an abrupt onset, can be lasted for several months even years. Apparently, fatigue syndrome may have the acute onset and chronic prolongation with different causes [12]. Most of our TCM ancestor emphasis on the causes of the disease and treatment will be different which described as in table 2. 

Further explanation of these four-group treatment strategy from table 2 and each are two items inside as an example. Reiterate that visceral orbis is not visceral organs, you may refer spleen as yin-in-yin attribute to splenic earth and heart as yang-in-yang attribute to fire which is based on yin-yang. Group I strategy: bitter herbal medicine itself can eliminate dampness (?) and actually its major effect is heat elimination. They can eliminate heat and dampness from the splenic earth (?) whichever its orbis function with water route had been stuck over there is recovered. Hereby, water can be transported smoothly throughout the body since dampness is removed from the spleen and fatigue syndrome will be alleviated. Group II strategy: water and dampness can be expelled from the body through diuresis. There is a water axis spleen-lung-kidney which control the route of water balance in the body. Water intake to the spleen, uprise to the lung, pass through the body and finally eliminate out of the body through kidney that is the water axis in TCM. Apparently, kidney pertain to be a water gate sometimes affiliated with large intestine which is the most powerful controller of water residual. Group III strategy: this herbal group belongs to the category of the five-element earth which can remove the splenic earth dampness redundancy easily. Apparently, this group can activate the function of splenic earth specifically and adjust the water axis deliberately. Group IV strategy: like group III and this group also belongs to splenic earth but its healing function is different. This herbal group consists of aromatic substance and give fragrance to arouse the splenic earth. Explicitly, splenic earth fond of aromatic material. 

Prescription of Chinese medicine sometimes refers to the TCM term of recipe or formula because of the purpose of delicate therapy adjustment. This selection and decision of treatment strategy should be based on TCM principal and herbal master’s clinical experiences. Actually, those four groups of herbal medicine have had their own therapeutic effects which can combined together or stand alone. For instance, single herbal drug such as Coptis Root?? is famous for eliminating heat from the body as well as treating dampness which is frequently used to treat stomatitis (mouth ulcer), urinary tract infection(bacteria) and dyspepsia(dampness) although with different etiology. Treatment strategy is a prescription’s direction while single herb or recipe is the component of herbal formula. Treatment is always supported by accurate diagnosis which is epistemological view of TCM given by Neijing’s theoretical principles and medical doctor’s own experiences.

Nomenclature of the twelve cardinal meridians used to be obtained from the viscera such as: lung, large intestine, stomach, spleen channel, etc., and it is obvious that TCM mentioned about visceral organ is not equivalent to the anatomical internal organs. Referring to my previous paper [2,3], I have already explained the Qi running through the route with yin-yang directions. Instantaneously, Wei (?) and Ying (?)used to be an important mechanism to deal with classical practice of acupuncture Hereby, this article will further give an example on the flow of Qi upward and downward through the meridians [3]. 

Those figures described above which showed the twelve meridians can further be subdivided into three categories (column I to III) [3]. Notice that Qi flows up and down of the body with regularity through these channels. For example, stomach channel(yang) starts from head to foot and connectively spleen channel(yin) from foot to internal abdomen. Therefore, visceral yin and yang must be in pairs, Lung-Large intestine, Stomach-Spleen, Heart-Small intestinal, Bladder-Kidney, Pericardium-Triple Energizer, and Gallbladder-Liver sometimes we refer it to the relationship of inner and outer (?) as well as qi flowing up and down likewise. 

Orbis are different from visceral organs and why is it crucial to orbis? Qi is yang it is uprise from the East goes down in the West vividly which is like the sun rise and set down. One of the important acupuncture theories is that when Qi is stuck in the channels and it will cause pain and illness. Thereafter, if the obstacles are removed then illness will be healed. 

Fatigue syndrome used to be given by dampness in the body and benefit the splenic earth is good enough to alleviate fatigue. Variety of fatigue symptoms are multiple: headache, lightheadedness, fatigue, dyspepsia, thirsty, and many others. Benefit the spleen channel yin and stomach channel yang simultaneously which always give better effect to relief fatigue symptoms from one single channel alone. Stomach yang and Spleen yin is a pair with the inner and outer, upward and downward, dry and wet, yang and yin relationships. Visceral orbis of stomach is yang-in-yang (?) and spleen is yin-in-yin (?). Equilibrium of yin-yang is the major therapeutic strategy in acupuncture. When Yang qi goes up that means Yin qi goes down spontaneously. Spleen Channel Sanyinjia(Sp. 6) and Stomach Zusanli(St. 36) and Hegu(L.I.4) are frequently used to eliminate dampness by regulating Splenic-yin and Stomach-yang pairs as well as eliminating exterior heat by Hegu (Table 3 i). Blood(yin) is in static state and its flow is moved by qi(yang). It is the reason why we should treat yin and yang simultaneously based on the theory of visceral orbis. Whenever knowing the concept of visceral orbis, we grasp the meanings of yin-yang representations of visceral organs. 

There is concepts of WuMenShiBan (?) from my previous paper [2] and it is necessarily to study tables 3 & 4 accompanied by those concepts. It is a good time to further explain how to use those concepts in acupuncture and give fatigue symptoms as an example. In table 3 ii to vi, is in the sequences of the five-evolution phases. Fatigue symptoms based on eliminating dampness can be divided into acute or chronic. Acute onset (Table 3) mainly due to dampness in summer season while chronic onset will be pertained to sickness of visceral orbis. 

Starting from table 3 ii, wood interact with earth and both L.I.1 and Liv.1 whenever both are Jingxue (?). From table 3 iii, fire is the “mother” precursor of earth, when splenic earth is in state of deficiency, benefit the fire with St.36 and K.10 both are the Hexue (?). From iv, splenic earth itself, when splenic earth is in state of sickness, G.B.41 and Sp.3 are used both are Shuxue (?). From v, metal is the “child” of earth, when splenic earth is in state of redundancy, benefit lung while L.I.1 and Liv.1 both are Xingxu (?). From vi, water is counteract with earth, when splenic earth offense renal water, benefit kidney with S.I.5 and Lu.8 both are the Jingxue (?).

Table 3: Paradigm of Acupoint for Fatigue Syndrome based on Visceral Orbis which is related to WuMenShiBan in table 4. 

CFS: Chronic Fatigue Symptoms; S/S sign and symptoms

 Table 4: Review the Theory of WuMenShiBan (?) and Acupoints.

In my daily TCM practices, acupuncture can relieve so many patients with fatigue symptoms and WuMenShiBan used to be one of the effective methods. It is really true that there are so many long Covid patients with CFS and can be alleviated by TCM mostly. A study in 2022 estimated the ME/CFS of 5 to 9 million in the United States starting from the outbreak of COVID-19 [7]. It is not an uncommon chief complain with fatigue symptoms both acupuncture and herbal medicine are helpful to treat CFS among long Covid. Mechanisms of acupuncture which was studied for treating CFS long Covid, was based on the assumption of neurological studies [13]. Sijunzi decoction (?) is a commonly use remedy in TCM prescription to nourish splenic earth for over a thousand year and it is effective to treat CFS clinically in recent cohort study [14].

The foundation of western medicine is based on measurement: such as anatomy, history, physiology, pathology, pharmacology, genome, microbiology, X-Ray, EKG, and laboratory data, all of them are based on scientific quantification. Science of measurement in the medical world is a fantastic in the laboratory but how about in the real medical world of human beings. It is not perfect to treat diseases by the orthodox western medicine because of its complexity and measurement difficulty as fatigue symptom. It is true that TCM is not in the arena of modern science but patient just concern whether they can be cured. 

There are so many ways to treat diseases especially those OPD patient who are not in emergency or critical condition. I believe that there are so many different kinds of alternative therapy from nation to nation in the world. Classical TCM is stand firm on the side of philosophical thinking. Theoretical approach by means of yin-yang is essential in classical Chinese medicine [2,3]. Macrocosmic, microcosmic and orbisiconography of classical TCM had already been introduced which was derived from the teaching of yin yang in Neijing. Human-universe unification is really a philosophical concern originated from nature. 

Perhaps, people may think that Chinese medicine is not scientific and does not like western medicine which is based on measurement. It is really true that human body physiological and pathological conditions which could not be applied concisely from experimental mice of the laboratory. Moreover, there are multiple causations to certain kind of disease and one patient may have several chronic and acute illness together. How can western medicine be deal with multiple diseases on one single patient? Are they really scientific? I think clinician may agree that there are so many unsolved problems in clinical medicine. I do treat so many illnesses that western medicine cannot be cured. The imperfectness of western medicine gives the chance of alternative medicine to compensate for the pitfall. 

Hegel said that “Logic did not fare quite so badly as metaphysics. That one learns from logic how to think (the usefulness of logic and hence its purpose, were held to consist in this — just as if one could only learn how to digest and move about by studying anatomy and physiology) ……” [15]. It is true that we are born to eat and digest whenever such inborn activity is not necessarily acquired from studying anatomy and physiology. This simple concept is also applied to all kind of human activities and behavior naturally. This is also the reason why Chinese medicine which has been claimed the medical knowledge from nature, never be obsoleted as well as ancient Greek philosophy. It is important to know that there is a closely connected yin-yang system in TCM theory, diagnosis and treatment which allow people to accumulate clinical experience as well as invented medical theory for over two thousand years. It is interesting that a term of ‘energy envelop’ talking about ME/CFS [12] was appeared to be so close to the TCM concept of qi energy generated by the splenic earth. It implies that qi equivalent to energy which is required to function the body parts fluently. 

Dr. Porkert dedicated his whole life to delve into theoretical approach to TCM [1] and wanted to promote the real classical Chinese medicinal spirit. In this article, it is a companion of my previous research topics [2,3]. Theory of yin-yang joins TCM as a whole. Micro-macrocosmic, human-unification, six-qi and visceral organs can be integrated as a huge system through yin-yang. Paradigm of fatigue symptom was used as an example to introduce the idea of treating diseases through visceral orbis. It can help to illustrate those complicated and boresome theory. In figure 1, which is a feedback mechanism from nature, is derived from the daily use five-element model and illustrated equilibrium function of visceral orbis in classical TCM. The above practical herbal and acupuncture description used to be my clinical experience to treat fatigue symptoms. 

I presented splenic-earth [3] in order to illustrate the idea of yin-yang in the aspect of central earth from Hetu, macrocosmic was illustrated the idea of universe-human as a whole [2], and this article explained the microcosmic dimension through the visceral orbis. All my articles are come up with clinical applications as acupuncture and herbal medicine. The framework in these articles was inspirated from the Dr. Porkert’s fantastic TCM textbook. People may find that TCM theory is so complicate and difficult to learn while acupoint applies to clinical treatment is so simple and practical comparatively. Everyone agrees that western medicine is so knowledgeable, educated and extremely complicated. Conclusively, none of knowledge in higher education from today is easy to acquire that is also applicable to TCM.

1. Porkert M (1982) The Theoretical Foundations of Chinese Medicine: Systems of Correspondence. The MIT Press, USA.
2. Chen Y-G (2023) Theoretical Approach to Classical Chinese Medicine – Macrocosmic Dimension. J Altern Complement Integr Med 9: 432.
3. Chen Y-G (2023) Disclosing Central-Earth Splenic Theory Based Upon two TCM Five-Element Models. J Altern Complement Integr Med 9: 365.
4. Schnorrenberger C (2011) Epistemological Evaluation of Chinese Medicine and Acupuncture - Part II, JOCM 22: 129-141.
5. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, et al. (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International chronic fatigue syndrome study group. Ann Intern Med 121: 953-959.
6. Nater UM, Heim CM, Raison C (2012) Chapter 34 - Chronic fatigue syndrome, Handbook of Clinical Neurology 106: 573.
7. Mirin AA, Dimmock ME, J LA (2022) Updated ME/CFS prevalence estimates reflecting post-COVID increases and associated economic costs and funding implications. Fatigue: Biomedicine, Health & Behavior 10: 1-11.
8. Luthra A, Wessely S (2004) Unloading the trunk: neurasthenia, CFS and race. Social Science & Medicine 58: 2363-2369.
9. Nowicki J, Murray MT, Dreher M (2020) Chapter 160 Chronic Fatigue Syndrome, Textbook of Natural Medicine, 2020: 1226-1235.
10. Estévez-López F, Mudie K, Wang-Steverding X, Bakken IJ, Ivanovs A, et al. (2020) Systematic Review of the Epidemiological Burden of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Across Europe: Current Evidence and EUROMENE Research Recommendations for Epidemiology. J Clin Med 9: 1557.
11. Tschopp R, König RS, Rejmer P, Paris DH (2023) Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A preliminary survey among patients in Switzerland. Heliyon 9: 15595.
12. Procknow T, Leung AWS (2015) Reviewing the Impact of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome on Daily Functioning Using a Holistic Model: It’s Implication on Intervention. J Altern Complement Integr Med 1: 002.
13. Li B-B, Feng C-W, Qu Y-Y, Sun Z-R, et al. (2023) Research progress on central mechanism of acupuncture treatment for chronic fatigue syndrome: ?. World Journal of Acupuncture - Moxibustion 33: 198-203.
14. Dai L, Liu Z, Zhou W, Zhang L, Miao M, et al. (2024) Sijunzi decoction, a classical Chinese herbal formula, improves fatigue symptoms with changes in gut microbiota in chronic fatigue syndrome: A randomized, double-blind, placebo-controlled, multi-center clinical trial. Phytomedicine 129: 155636.
15. Hegel’s Science of Logic (2024) Preface to the First Edition. Hegel’s Science of Logic, USA.
16. Gulick RM, Mellors JW, Havlir D, et al. (1997). Treatment with Indinavir, Zidovudine, and Lamivudine in Adults with Human Immunodeficiency Virus Infection and Prior Antiretroviral Therapy. N Engl J Med 337 : 734–739.