Traditional Chinese Medicine (TCM): Principles and Seasonal Energy

Nearly one in two adults in Europe has already resorted to complementary medicine, and Traditional Chinese Medicine is among the most consulted. Since 2019, the World Health Organization has even dedicated an entire chapter to it in its International Classification of Diseases, a decision that sparked intense scientific debate. (1)

This article pursues a dual objective: to honestly explain the concepts of Traditional Chinese Medicine (Qi, Yin and Yang, meridians, the five elements, seasonal energy) and then to confront these concepts with evidence-based medical data. Not to discredit those who find meaning in it, but to enable you to make informed health choices.

The Principles of Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is a healthcare system built over more than two millennia, which includes acupuncture, pharmacopoeia (herbal medicine), Tui Na massage, dietetics, and physical practices like Qi Gong. It is based on a reading of the body radically different from Western anatomy.

Qi, Yin, and Yang

Qi (pronounced "chee") is described as a vital breath, an energy that circulates through and animates the body. Within this conceptual framework, health corresponds to a fluid and abundant flow of Qi; illness arises from a blockage, deficiency, or excess.

Yin and Yang describe two complementary and opposing qualities: Yin relates to cold, rest, interiority, and matter; Yang to heat, movement, exteriority, and function. Neither is "good" or "bad"—it is their dynamic balance that matters. An "excess of Yang" would manifest as restlessness and heat, while a "Yin deficiency" would present as dryness and exhaustion.

An important point must be emphasized for proper understanding: these notions are not biological hypotheses in the modern sense. They are descriptive categories, born from an ancient Chinese naturalistic philosophy, used to organize clinical observations into coherent patterns.

Meridians and the Five Elements Theory

Meridians are described as the pathways through which Qi circulates. TCM classically identifies twelve main meridians, each linked to an organ (Liver, Heart, Spleen, Lung, Kidney, etc.) and studded with acupuncture points. Note: these "organs" do not correspond exactly to anatomical organs. The "Liver" in TCM refers to a set of functions (free flow of energy, emotional regulation, flexibility of tendons) much broader than the physical hepatic organ.

The Five Elements (or Five Movements) theory completes this system: Wood, Fire, Earth, Metal, and Water. Each element is associated with a season, an organ, an emotion, a flavor, and a color. They generate each other in a cycle (Wood feeds Fire, Fire produces Earth, etc.) and control one another. This grid of correspondences structures the entire seasonal vision of TCM.

Seasonal Energy According to Chinese Medicine

In Chinese thought, the human being is not separate from the environment: they go through the same cycles as nature. Each season is therefore associated with an element, an organ, and a specific lifestyle hygiene. This is one of the most popular and intuitive aspects of TCM. If you are interested in this topic beyond the Chinese perspective, our guide to well-being throughout the seasons approaches these same rhythms from a physiological standpoint.

Spring in TCM: The Season of Wood and the Liver

Spring is associated with the Wood element, the Liver organ, the color green, the sour flavor, and the emotion of anger. Within this framework, it is the season of renewal and rising energy: sap rises, and Yang grows after the winter withdrawal.

Practitioners traditionally recommend promoting the "free flow" of Liver Qi in spring: moving more, stretching, getting light exposure, lightening the diet (sprouts, leafy green vegetables, a touch of acidity), and limiting alcohol and fats. Clinical manifestations classically attributed to an "excessive Liver" in spring include irritability, muscle tension, headaches, and dry eyes.

Summer in Chinese Energetics: The Season of Fire and the Heart

Summer corresponds to the Fire element, the Heart organ, the bitter flavor, the color red, and the emotion of joy. It is the peak of Yang: maximum heat, expansion, social life, and exteriority.

Associated seasonal advice aims to prevent Fire from becoming excessive: staying hydrated, prioritizing fresh and light foods (fruits, raw vegetables, so-called "cooling" foods), avoiding heat exposure during peak hours, and cultivating inner calm despite external busy-ness. An overflowing "Heart Fire" would manifest as insomnia, palpitations, mental restlessness, and mouth ulcers.

Winter in Traditional Chinese Medicine: The Season of Water and the Kidney

Winter is linked to the Water element, the Kidney organ, the salty flavor, the color black, and the emotion of fear. It is the season of maximum Yin: withdrawal, conservation, and replenishing reserves.

The Kidney holds a central place in TCM: it is described as the reservoir of "Essence" (Jing), the vital capital inherited at birth and consumed throughout life. Winter is thus considered the period when one must conserve this reserve: sleeping more, going to bed early, protecting oneself from the cold (particularly the lower back and feet), eating warm, slow-cooked meals, and reducing exertion. Reported signs of a "Kidney deficiency" include deep fatigue, lower back pain, chilliness, and urinary disorders.

Recurrent Urinary Tract Infections: The TCM Interpretation

It is precisely through this Kidney–Water–winter connection that TCM approaches recurrent cystitis, a very common clinical presentation. Recall the scale of the issue: 40% to 50% of women will experience a urinary tract infection in their lifetime, 20% to 30% of them will have a recurrence, and about a quarter will develop highly recurrent episodes. (4)

In TCM terminology, urinary tract infections belong to the category of "Lin" syndromes: painful or difficult urination syndromes. Practitioners classically distinguish several patterns: a "damp-heat Lin" of the bladder for acute episodes (burning sensation, dark urine, urgency), and, for chronic, recurrent forms, a "Kidney Qi deficiency" or "Kidney Yin deficiency" that leaves the system vulnerable. Recurrence is therefore not viewed as a bacterial reinfection but as an underlying systemic weakness requiring reinforcement.

The proposed therapeutic approaches derive from this: herbal formulas aimed at "clearing heat" or "tonifying the Kidney", acupuncture on Kidney and Bladder meridian points, dietary advice (avoiding cold foods, sugar, and alcohol), lower back protection, and stress management. Some of this advice aligns with common-sense medical recommendations: staying well-hydrated, not holding back urine, and regulating bowel transit. (5)

What Science Says: Meridians, Seasons, and the Placebo Effect

Here is the core of the issue. What does scientific data validate in all this, and what does it not? The answer is more nuanced than a simple "everything is false" or "everything is true."

Do Meridians and Qi Exist Anatomically?

On this point, the answer is clear and must be stated directly: no. No anatomical structure corresponding to meridians has been identified, whether by dissection, imaging, or histology. Meridians and acupuncture points are not anatomically visible, and their existence as distinct entities remains debated even within acupuncture literature itself. (7)

Various hypotheses have been explored—the fascial network, perivascular spaces, skin electrical properties—without any achieving consensus. Similarly, no measurement method has ever objectified Qi. There is no device that measures vital energy, because there is no corresponding physical quantity.

A decisive scientific test consists of comparing a needle placed on the "correct" point with a needle placed nearby (sham acupuncture). If meridians corresponded to physical reality, localization should change everything. However, systematic reviews show contradictory results depending on the pathology, and very often, stimulating non-points produces effects comparable to those of "true" points. (8) In other words: the map of meridians is probably not what drives the clinical effect.

Does Seasonal Energy Have a Biological Reality?

Here, nuance is essential, and this is the most interesting point. The concept of "seasonal energy" in the sense of Qi has no scientific basis. However, the underlying intuition does, and it is solid.

A landmark study conducted on cohorts in Europe, Oceania, and Gambia showed that more than 4,000 protein-coding genes exhibit seasonal expression in white blood cells and adipose tissue, with inverted profiles between the Northern and Southern Hemispheres. The immune system adopts a distinctly pro-inflammatory profile during European winter, with markers such as CRP and soluble IL-6 receptor increasing. (2)

Chronobiology therefore confirms that the human body functions differently depending on the season, mediated by photoperiodism, melatonin, vitamin D, and thermoregulation. The fact that TCM observed this reality two thousand years ago and coded it in a language of elements and correspondences is significant. Where agreement ends is on the mechanism: it is not Wood rising in spring, but the photoperiod lengthening and altering hormone secretion.

Practical consequence: much of the seasonal advice from TCM (sleeping more in winter, getting light exposure in spring, staying hydrated in summer, eating seasonally) is good advice. Not because Kidney Qi is being strengthened, but because these are valid lifestyle rules that modern medicine also recommends. The advice is sound; the explanation is inaccurate. Both can coexist.

Acupuncture: Simple Placebo or Real Effect?

This is the most thoroughly studied and discussed aspect of TCM. The benchmark meta-analysis, conducted on individual patient data from nearly 18,000 patients across 29 high-quality randomized trials, showed that acupuncture is superior to no acupuncture and, slightly, to sham acupuncture for chronic back and neck pain, osteoarthritis, chronic headaches, and shoulder pain. (3)

Two honest interpretations coexist. The difference with sham is statistically significant, suggesting it is not a pure placebo. However, it is small—on the order of 0.15 to 0.23 standard deviation—and much smaller than the difference with no treatment at all. This means that most of the perceived benefit comes from non-specific effects: the practitioner's attention, consultation time, the therapeutic ritual, and positive expectation. These clinical effects are real and not shameful; they are part of any medical care, including conventional medicine. However, they do not validate the meridian theory.

Finally, the most documented physiological pathway has nothing to do with Qi: needle stimulation activates known neurophysiological mechanisms, including descending inhibitory pathways, endogenous opioid release, and segmental pain modulation.

Recurrent Cystitis: Why TCM Does Not Replace Medical Treatment

This is the most important point of this article, and the only one where there is no room for nuance.

A review evaluated Chinese herbal medicine for recurrent UTIs in women: seven randomized trials, 542 participants. The results suggest a possible benefit, either alone or combined with antibiotics, both during the acute phase and in reducing recurrences at six months. However, the authors are explicit about the limitations: all trials were judged to have a high risk of bias, sample sizes were small, and the majority of participants were postmenopausal, meaning the findings cannot be generalized to younger women. Their conclusion is unambiguous: it is not possible to formulate robust clinical recommendations, and more rigorous research is required. (4)

Key takeaway: "encouraging preliminary data" does not mean "it works." It means we do not know yet.

Faced with this, the French medical position is established. Cystitis is a bacterial infection, most commonly caused by Escherichia coli. It requires short-course, targeted antibiotic therapy. The Haute Autorité de Santé (French National Authority for Health), in partnership with the French Infectious Pathology Society, publishes guidelines specifying recommended molecules and treatment durations. For preventing recurrences, validated clinical measures exist: adequate hydration, not holding back urine, regulating bowel transit, discontinuing spermicides, cranberry intake at 36 mg/day of proanthocyanidins for E. coli cystitis, local estrogen therapy in postmenopausal women following gynecological advice, and antibiotic prophylaxis reserved for cases with at least one episode per month after other measures have failed. (5)

The risk of delaying medical treatment is concrete: neglected cystitis can progress to pyelonephritis, a kidney infection that is a medical emergency. Any fever, back pain, chills, or blood in the urine requires immediate medical consultation. No energetic approach dispenses with this reflex.

Safety: What You Need to Know About Chinese Herbal Medicine

"Natural" does not mean "safe," and French medical history offers a painful example of this. In the early 1990s, first in Belgium and then in France, several women developed end-stage renal disease after consuming weight-loss preparations containing Chinese herbs. The investigation established that one plant, Aristolochia fangchi, had been accidentally substituted for another due to very similar Chinese names. The aristolochic acid it contains is nephrotoxic and carcinogenic: in a Belgian cohort of 39 exposed patients who developed end-stage renal disease, 46% subsequently developed urothelial carcinoma. (6)

This case does not condemn Chinese pharmacopoeia as a whole, but it recalls safety principles that apply to all phytotherapy: traceability of herbs, risk of substitution or contamination (heavy metals, drug adulteration), interactions with current medical treatments, and above all, informing your physician. Systematically report any supplements and preparations you take, even "natural" ones, especially if you have renal or hepatic impairment, are pregnant, or are taking anticoagulant therapy.

How to Position Yourself as a Patient?

A reasonable approach is neither outright rejection nor unreserved compliance. It hinges on a few reference points.

• What is seriously documented: A modest but real clinical effect of acupuncture on certain chronic pain conditions, mainly through neurophysiological mechanisms and non-specific effects.

• What is validated common sense: Seasonal lifestyle advice, whose explanation is inaccurate but whose practical recommendation is often correct.

• What lacks clinical evidence: Meridians and Qi as physical realities, and herbal medicine for treating recurrent infections.

• What is dangerous: Substituting an energetic approach for the medical treatment of a bacterial infection, and consuming untraceable herbs without informing your physician.

In other words, TCM can find a place as a complementary approach for comfort, stress management, or chronic pain support alongside medical follow-up, never in place of it. If you are unsure which practitioner to consult and in what order, our guide on when to consult an alternative medicine practitioner details the criteria to check, and our overview of complementary and manual therapies compares the main approaches and their level of evidence.

For chronic pain specifically, the approach with the highest level of clinical evidence remains tailored and progressive therapeutic exercise, supervised by a professional. This is where structured support truly makes a difference: physical therapists and other clinicians equipped with Andrew® prescribe personalized exercise programs that their patients follow via video between sessions, with remote progress monitoring. Practitioners interested in this approach can connect with the Andrew® team to see concretely how it is implemented.

Maintaining Open-Mindedness and Rigor

Traditional Chinese Medicine is a coherent, ancient, and respectable system of thought that grasped, long before modern science, a reality that chronobiology confirms today: we do not function the same way in January as we do in July. Its seasonal lifestyle advice is often wise, and its therapeutic ritual brings many a perceived benefit that is not an illusion.

However, a philosophical framework is not proof of efficacy. Qi and meridians have no demonstrated physical existence, and when facing cystitis, only appropriate antibiotic therapy treats the infection. Complementary, yes. Alternative, no—and above all, never as a replacement for a treatment on which your health depends. To discover how evidence-based care takes shape on a daily basis, you can explore the Andrew® platform or request a free demo.