Often shortened to just 吐納, Tu Na, this term originates from the Zhuangzi (3rd or 4th century BCE), ch. 15, which describes longevity practices as:
"To huff and puff, exhale and inhale, blow out the old and draw in the new, do the 'bear-hang' and the 'bird-stretch,' interested only in long life – such are the tastes of the practitioners of Daoyin, the nurturers of the body …
吹呴呼吸，吐故納新，熊經鳥申，為壽而已矣，此道引之士，養形之人…"
Expelling the Old and Absorbing the New as a basis for the 10 Questions
It has generally been assumed that Tu Gu Na Xin is a further reference to breathing practices associated with exercises, and remains a core practice health cultivation. However, the individual characters actually have meanings as varied as:
吐: "to spit or vomit"
故: "old, deceased, accident, misfortune"
納: "to accept, receive or enjoy"
新: "new, fresh"
which actually have little to do with breathing, making it entirely possible to interpret on a broader level and applicable to all types of Qi, especially those of the Five Phases and Zangfu. It can easily become a basis for the Ten Questions of Chinese medical diagnosis, by asking if each Phase's Fu can effectively expel the old, pathogenic or impure, and if each Phase's Zang is receiving and assimilating the new, fresh and pure.
By delving a little deeper, and asking what is being expelled and absorbed in relation to each Zangfu pair, a complete questionnaire of 24 areas can be systematically developed by which to examine a patient's physiology, lifestyle and environment, resulting in a Five Phase or Zangfu diagnosis, and lifestyle improvements:
- Can the Fu expel appropriately?
- Is the Fu expelling putrid matter?
- Can the Zang receive appropriately?
- Is the Zang receiving wholesome Qi?
Viewed in the context of the Five Phases and Zangfu, the following areas can be assessed:
- Metal:
Governed by the Lungs and relates to the air we breathe:
- Can they expel airborne pathogens effectively by coughing, sneezing or sweating?
- What are they coughing up, sneezing or sweating out (i.e. Wind-Cold, Heat, or Phlegm, Yang Qi leakage?
- Are they able to extract Qi from the air effectively, without puffing, wheezing or shortness of breath?
- Is the air they are breathing clean?
- Earth:
Governed by the Spleen, and refers to food and drink:
- Are the bowels moving correctly to transport waste to the colon (i.e. vomiting, transit time, undigested food)?
- What is the nature of anything they display an intolerance to?
- Are they able to extract nutrition from their food?
- Is their diet healthy?
- Water:
Governed by the Kidneys, refers to the ability to effectively store what has been absorbed, and excrete waste. Both quantity and quality of water is essential to storage. Too little will result in dry constipation, scanty urination and even the formation of stones, while poor quality water will result in diseases like sudden turmoil with an inability retain anything.
- Are they excreting appropriately through the lower orifices?
- What is the nature of their excretions (constipation or diarrhoea from the bowel; difficulty, turbidity, blood or essence in the urine, discharges from the genitals)?
- Are they able to store what has been absorbed?
- Are they consuming enough water to facilitate excretion, and is it clean enough to enable storage?
- Wood:
Governed by the Liver, referring to physical activity and rest due to it generating the Sinews:
- Are they able to move without pain, or does Xie Qi need to be expelled from obstructing the Sinews?
- What is the nature of any Bi Syndrome?
- Are they able to stop moving and find repose?
- Is the amount and type of physical activities they are doing appropriate for their constitution?
- Sovereign Fire:
Governed by the Heart, referring to the balance between sleep and wakefulness, due to it housing the Shen. In this instance, expulsion refers to the ability to turn off consciousness and sleep, while acceptance refers to the ability to enjoy wakefulness:
- Are they able to sleep?
- Is the quality of their sleep refreshing, and timed in relation to natural cycles?
- Are they able to wake?
- Is their waking consciousness bright, alert and their senses perceptive?
- Ministerial Fire:
Governed by the Pericardium, refers to mental and emotional activity, due to its role as the Heart protector:
- Can they handle negative emotions and experiences in a healthy manner?
- What negative experiences do they have to deal with on a daily basis?
- Are they able to accept positive life experiences?
- s their social and emotional environment conducive to a healthy mental state?
Comparison to the Six Essential Lifestyle Factors of Unani Tibb
Together these make up a list almost identical to Avicenna's Six Essential Lifestyle Factors (Asbab-e-Sittah-e-Zaruriah, الأسباب الستة الضرورية) in the Canon of Medicine which attributed good health to a balance between:
- Clean Air (Hawa-e-Muheet, هواء المحيط):
Environmental air quality.
- Food and Drink (Makul-wa-Mashrub, مأكول ومشروب):
The quality and quantity of nutrition and hydration.
- Physical Activity and Repose (Harkat-wa-Sukun-e-Badani, حركة وسكون بدني):
Exercise and rest.
- Mental and Emotional Activity and repose (Araz-e-Nafsani, أعراض نفسانية):
Psychological state, emotions, and rest.
- Sleep and Wakefulness (Naum-wa-Yaqza, نوم ويقظة):
Proper sleeping habits.
- Excretion and Retention (Istifragh-wa-Ihtibas, استفراغ واحتباس):
The elimination of metabolic waste and retention of essential fluids.
It can be easily seen that the general approach of evaluating one's air, food, water, physical and mental activity, sleep and excretion habits are a core principle to evaluating health that works in the Chinese and Unani systems alike.
References
Choopani, R., & Emtiazy, M. (2015). The concept of lifestyle factors, based on the teaching of avicenna (ibn sina). International journal of preventive medicine, 6, 30. https://doi.org/10.4103/2008-7802.154772
Ibn Sina (1025). The Canon of Medicine.
Graham, A. C. (1986). Chuang-tzu: The Inner Chapters. Allen and Unwin: London. p265.
