TCM: The Elusive Triple Warmer

Credit: Shutterstock

Credit: Shutterstock

The San Jiao, or Triple Warmer, herein as TW, is a hard organ to pin down in Chinese medicine. I find it similar to the Eight Extraordinary channels in that there is a lot of theory to explain the actions but not a lot of concrete useable information for the clinic. It is my goal to explain the three different concepts of the TW, explain how each can be used in a practical setting, and expose the patterns of acupoints used.

1/6 Yang Organs

The TW is considered one of the six Yang organs. In Five Element theory it is thrown in with the rest of the Fire element organs. As an organ it has four main functions that I will list below. These four actions can be stimulated with acupuncture points.

  1. Controls Water Passages

    • REN5 - Front-Mu of TW, UB39 - Lower He-Sea of TW

    • Both of these acupoints are effective at Draining Dampness. We can also add REN9, SP9, and ST40 to augment the treatment.

  2. Influences Defensive Qi

    • TW5 - Connecting

    • This acupoint opens the pores to let pernicious influences out, especially in the case of alternating chills and fever. It is also a favourite of mine to add in the case of Wind-Heat. GB20, LI4 and LU7 can augment the treatment. It should also be said that TW5 is named ‘Outer Gate’ and Defensive Qi can be viewed as being able to maintain boundaries.

  3. Influences the Nutritive Qi

    • TW4 - Source, REN12 - Front-Mu of ST & Influential of Fu

    • TW4 can be used to regulate the Stomach and is indicated for Wasting and Thirsting Disorder. REN12 improves digestion, satiety, and because it is Influential of Yang organs augments treatment.

  4. Influences Bladder Qi

    • REN 5

    • Only two Cun above REN3, Front-Mu of UB, REN5 influences bladder function. Of course, adding REN3 will augment the treatment.

Influences Original Qi

Yuan Qi, Original Qi or Pre-Natal Qi is a term described as "the metaphorical designation of the inborn constitution, the vital potential that is gradually used up in the course of life. It may be conserved but never replenished." (Pokert, The Theoretical Foundations of Chinese Medicine MIT Press (1974). The Triple Warmer is viewed as a conduit for this Original Qi. Acupoints can be used to make sure patients have lots of vitality and are living life to their full potential.

  • TW4, REN5, UB22 - Back-Shu of TW

  • Seeing as the topic is on Original Qi, Source acupoints are where Primordial Qi exists and spreads through the rest of the body. TW4, being a Source point, is a great choice to influence a patient’s health and vitality. REN5 is very close to REN4, which Tonifies Qi, Blood, Yin and Yang. REN5 is also close to the ‘Sea of Qi’ REN6. UB22 is directly above UB23, the Back-Shu of KD. UB22 can, perhaps, be thought of as the adrenals sitting atop the kidneys, and is a great acupoint with similar function as TW4.

Three Body Divisions

The final theory that belongs to the Triple Warmer is that there are three divisions of the body - each having a function. The Upper Warmer mists the organs below to keep them moist. The Middle Warmer warms and cooks the food. The Lower Warmer is the drainage ditch that rids the body of excess fluids. It is also a convenient way to communicate what is happening in a patient’s body section. This is due to the organs in a division having similar functions. It is quick and easy to make the comment that someone has Damp-Heat in the Lower Warmer rather than listing the affected organs.

  1. The Upper Warmer is like Mist

    • REN17 - Front-Mu of PC, Influential of Qi, DU20, TW3

    • REN17 influences Zong Qi, or Chest Qi, DU20 used together with TW3 lifts the Shen

  2. The Middle Warmer is like a Bubbling Cauldron

    • REN12, TW4, ST42 - Source, TW6, GB34 - Influential of Tendon

    • REN12 regulates digestion, whether that be in cases of excess or deficiency. TW4 and ST42 are a great combination for Spleen and Stomach Deficiency. TW6 has the action of affecting the Upper Warmer (febrile concerns with no sweating, eye swelling and ear pain), Middle Warmer (hypochondriac pain especially when combined with GB34), and Lower Warmer (helps move Qi in the Lower Warmer for menstrual concerns, as well as constipation especially when combined with KD6).

  3. The Lower Warmer is like a Drainage Ditch

    • REN5, TW4, UB64 - Source

    • REN5, along with aforementioned acupoints such as REN9, SP9 and ST40 is very good for helping excess fluid to pass out the body. TW4 and UB64 are a great combination to help drain excess from the Lower Warmer.

It should also be said that TW10, being the He-Sea acupoint on a Yang channel, does not have as strong a function as other acupoints. It can, however, clear the channel and is very effective for local pain.

Putting it All Together

The Chinese medicine practitioners of old were pack-rats. Instead of throwing out one theory in favour of another they saw the value in all of them. That is why in TCM-style acupuncture we have Yin-Yang, Weather Pattern Diagnosis, Five Element, Six Stages, Four Levels and Triple Warmer theories all intertwined - while relying heavily on Zang-Fu diagnosis.

If a patient has Phlegm-Heat in their Lungs I will use LI11, SP9, and ST40. Yes, I will add LU5 (Sea, Son), and I could also add LU7 and KD6 (Confluent Pair for the anterior midline), but Heat and Damp/Phlegm is all the same. If a patient has a benign prostatic hyperplasia, LI11, SP9 and ST40 will be my base again.

Triple Warmer theory and acupoints are treated the same as any other - they are used to augment my treatment. If a patient has Yin Edema, SP9 and ST40 will again be my base, but I can look to the help of TW to gain better results. REN5, REN9, and UB39 are great additions.

TW4 and REN12 can always be sought to help with digestion and vitality. UB22 can be added to a Kidney Tonification treatment. TW5 is a powerful acupoint to help with alternating chills and fever.

The Triple Warmer is an elusive organ, but we can still access some of its more concrete powers for better results in the clinic.

Kenton Sefcik