Cultural Reference for Increased Understanding of the San Jiao

Glenn Grossman, L.Ac.
Integrated Health, 4111 Okemos Rd, Ste. 102, Okemos, MI 48864, USA
e-mail :

It has been translated into English as San Jiao, Triple Warmer, Triple Burner and Three Burning Spaces. Appropriate, perhaps, to have so many names for this mysterious triple system.


Where is the San Jiao?

There is no anatomical counterpart for this fu organ. Of the twelve Zang-fu the other ten are associated directly with anatomical organs, i.e., heart, lungs, liver, spleen, kidneys, gall bladder, urinary bladder, large and small intestines. The eleventh, the pericardium, is a type of space like its externally related partner the San Jiao. The pericardium, however, is recognized in western anatomical and diagnostic studies(1,2,3) whereas the San Jiao is not.

Where do we identify the San Jiao? The question of its location in Traditional Chinese medicine (TCM) as well as its identifiable western counterpart is problematic. TCM literature makes reference to the San Jiao by its function rather than its location. The San Jiao is located 'separately from the zang-fu organs and inside the body'(4) reports one book. 'The "Classic of Difficulties" in chapter 38 says there are 6 Yang organs including the Triple Burner which "has a name but no form".'(5) 'In the Nei Ching the function of the three burning spaces is compared to that of a sewage system of the body, while their location is not described. Some sources maintain that the burning spaces exist not in form but only in name, while others attributed to them a definite location and the consistency of fatty membranes. The most explicit theory about the three burning spaces considers them as a link between the universe and man, and sees them subdivided into upper, middle and lower parts controlling corresponding regions of the body.'(6)

Also difficult to understand is the relationship between the San Jiao and, its Zang partner, the Pericardium. One of the standard texts for use in TCM schools worldwide, Chinese Acupuncture and Moxibustion (CAM), contains no mention of the Pericardium/San Jiao in its section on The Relationship Between the Zang and Fu Organs.(7) To complicate matters further 'some Chinese teachers and doctors go so far as saying that the Pericardium and Triple Burner organs are not interiorly exteriorly related as the other organs are.'(8) Others state that the San Jiao and Pericardium's interior exterior relationship is important only for acupuncture.(9)


Theory of Cultural Context

In my TCM studies I did not originally find it very satisfying to think of the San Jiao as a name without substance. It seemed to be like some long lost uncle at a family reunion who no one will claim. I worked up a theory that saw the San Jiao as a way to account for the body's interstitial fluids. This idea was based in part upon the San Jiao's traditional function of regulating water metabolism in each Jiao as well as creating Jin Ye (fluids and liquids). CAM states 'The upper, middle and lower jiao combine with their related zang-fu organs, and each functions differently in order to carry out the digestion, absorption, distribution and excretion of water and food.'(10) The vital substance of Jin Ye (fluids and liquids) are also traditionally accounted for as a product of the transformation of the Qi of the San Jiao.(11)

The other part rested on the type of diseases attributed to dysfunction of the San Jiao. They are characterized by blockage of the flow of fluids leading to an accumulation of Heat and Dampness. Table 1(12) Biomedically-defined diseases affecting the San Jiao include the infections diseases Chyluria (chy*lu*ria), Schistosomiasis (schis*to*so*mi*a*sis) and Pulmonary Tuberculosis (tu*ber*cu*lo*sis) Table 2(13,14).



San Jiao Syndrome formula description of disease
Upper Jiao Agastache Powder To Rectify The Qi
(Huo Xiang Zheng Qi San)(15)
Western Medicine: influenza, intestinal flu, nonspecific acute colitis, and acute gastroenteritis.
Chinese Medicine:
no thirst, fever, fullness in gastricum, no appetite
tongue coating is White & greasy
P - Floating, soft, slow
Middle Jiao Three-Nut Decoction
(San Ren Tang)(16)
Western Medicine: enteric fever, pyelonephritis, undulant fever, and postoperative fever of various etiologies.
Chinese Medicine: low grade fever, thirst with no desire to drink, apathy
T - Red with yellow greasy coating.
Lower Jiao


Poria Peel Decoction
(Fu Ling Pi Tang)(17)
Western Medicine: cystitis, or nephritis.
Chinese Medicine: Olygouria, Thirst with no desire to drink, Constipation



Western Medicine disease name TCM treatment Description of disease
Chyluria Kidney Yang Deficiency and Middle Jiao Qi Deficiency Western Medicine: the presence of chyle in the urine as a result of organic disease (as of the kidney) or of mechanical lymphatic esp. parasitic obstruction.

Chinese Medicine: According to tradition, this illness is caused by Dampness and Heat collecting and 'steaming' the Triple Burner, thereby disrupting its distribution of water. The Yin is said to be Deficient in the Kidneys, which prevents that Organ from processing fatty liquids. Alternatively, because of insufficient Kidney Yang, the Middle Qi sinks and there is a general sagging, both literally and functionally, of the Organs in the abdomen.(18)

Schistosomiasis Qi and Blood blockage Western Medicine: infestation with or disease caused by schistosomes; specif : a severe endemic disease of humans in much of Asia, Africa, and So. America that is caused by any of three trematode worms of the genus Schistosoma (S. haematobium, S. mansoni, and S. japonicum) which multiply in snail intermediate hosts and are disseminated into freshwaters as cercariae that bore into the body, migrate through the tissues to the visceral venous plexuses (as of the bladder or intestine) where they attain maturity, and cause much of their injury through hemorrhage and damage to tissues resulting from the passage of the usu. Spined eggs to the intestine and bladder --called also snail fever.

Chinese Medicine: recognizes that this disease is caused by a worm whose poison forms an obstruction which impedes the circulation of Qi and Blood through the vessels, and causes the passage of water and food to stagnate.(19)

Pulmonary Tuberculosis Treatment is based upon strengthening the Lung Qi and invigorating the Spleen and Stomach Yang (Middle Burner). Western Medicine: a usu. chronic highly variable disease that is caused by the tubercle bacillus and rarely in the U.S. by a related mycobacterium (Mycobacterium bovis), is usu. Communicated by inhalation of the airborne causative agent, affects esp. the lungs but may spread to other areas (as the kidney or spinal column) from local lesions or by way of the lymph or blood vessels, and is characterized by fever, cough, difficulty in breathing, inflammatory infiltrations, formation of tubercles, caseation, pleural effusion, and fibrosis --called also TB

Chinese Medicine: In traditional medicine, pulmonary tuberculosis is referred to by a variety of names, most of which are types of 'Deficient Consumption'. . . The disease focuses primarily in the Lungs but also involves the Spleen and Kidneys.

Traditionally the disease is divided into two categories: Deficient Yin and Deficient Yang.(20)

I abandoned that approach as it seemed to only accounted for water metabolism and excluded other San Jiao functions such 'circulating the three (types of) qi and distributes them to the five zang and six fu organs.'(21) Also the regulation of interstitial fluid did not seem a compelling enough reason to have developed the theory of an invisible triple system.

The whole matter was on the metaphorical shelf until I read of a legendary figure from China's pre-historic period. Do to my reading in Chinese history and historical figures I found what I consider an appropriate cultural analogy for further understanding of the San Jiao. I now prefer to approach the idea of the San Jiao as an administrator of the other Zang-fu organs production processes. This approach is more in line with the idea of seeing the San Jiao as a name without substance.

Approaching the San Jiao through an analogy provided by cultural context can give greater understanding of this organs importance. The analogy can provide an immediate context for some traditional source reference statements about the San Jiao. It can, also, establish a basis for wider application of the diagnostic procedures in Zang-fu differentiation.

There are something's about each culture which do not translate in an entirely meaningful way to another. Chopsticks, for instance, in most western homes are a meal time curiosity. They pose no threat to the silverware industry. We 'understand' chopsticks but don't see any reason for them. The argument runs something like this: you can do everything with a spoon what do you need chopsticks for? But in China, in the Chinese home, chopsticks provide a shared skill for all the family members. Chinese feel strongly that daily use of chopsticks provides a massage for your hand and stimulates the brain. Use of chopsticks allows you to eat with one hand so that you may hold your rice bowl with the other. You may use your chopsticks to politely take food from the serving dish. Chopsticks are reusable, inexpensive and a family may eat with a minimum of utensils. There is an economy and art to using chopsticks which Chinese enjoy that isn't immediately apparent to westerners.


Discussion of San Jiao

Similarly aspects of TCM suffer in translation. The San Jiao has been poorly understood and a topic of disagreement for centuries in China. No wonder that it is hard to understand in English. Furthermore, it can have different degrees of importance depending on the way it is studied. It can be studied as a fu organ, a meridian system or as a major TCM pattern of differentiation.

In the study of single herbs the San Jiao organ and meridian system is basically ignored. In all of Chinese Herbal Medicine Materia Medica(22) there are only three herbs that enter its meridian Radix Glycyrrhizae Uralensis (gan cao), Rhizoma Cyperi Rotundi (xiang fu) and Bulbus Fritillariae Thunbergii (zhe bei mu), with Radix Glycyrrhizae Uralensis (gan cao) entering by default since it enters all the meridians.(23) Only when viewed as a differentiation pattern can we talk about San Jiao and herbs in the same sentence.

Chinese herbs and the San Jiao meet most comfortably in TCM theory under the theory of San Jiao pattern of differentiation. While few single herbs go the San Jiao per se any of the herbs that deal with water metabolism can be considered to have an effect on it.(24) San Jiao differentiation patterns are treated primarily with herbal formulas.

Probably the most extensive English translation of formulas used for San Jiao differentiation is found in Formulas and Strategies.(25) This book lists 'thirty-five formulas from Wu Ju-Tong's (1758-1836) book A Systematic Differentiation of Febrile Diseases (Wen Bing Tiao Bian). Three Burners differentiation identifies the level (of disease), in vertical terms on the body, to which the Heat has penetrated.(26) San Jiao patterns derive from the Wei or Defensive-Qi level of the Febrile Diseases (Wen Bing Tiao Bian) theory. As Maciocia points out in his book The Practice of Chinese Medicine Four Levels pattern identification for Defensive-Qi Level is differntiated by the pattern Wind-Heat, Summer-Heat, Damp-Heat and Dry-Heat.(27)

The greatest volume of writing about the San Jiao translated into English is in books on acupuncture and meridian theory.

'It is divided into three parts: the upper, middle and lower jiao.
(The San Jiao's) function is described in the 18th chapter of Miraculous Pivot:
'The upper jiao is like a fog.'
'The middle jiao looks like a froth of bubbles.'
'The lower jiao looks like a drainage ditch.'

Clinically, the terms upper, middle and lower jiao are often applied to generalize the function of the internal organs of the chest and abdominal cavity. Above the diaphragm is the upper jiao which include the heart and lung; between the diaphragm and the umbilicus is the middle jiao which include the spleen and stomach; and below the umbilicus is the lower jiao which includes the kidney, intestines and bladder.'(28)

Acupuncture theory is where we also find references to the San Jiao as 'the office of the sluices; it manifests as the waterways,'(29) or 'the official in charge of irrigation and it controls the water passages.'(30)

In reading the legend of Yu the reference that struck me as meaningful, in terms of understanding the San Jiao, was the cultural context it provided for the phrase 'official in charge of irrigation.' What was so important about 'the irrigation official who builds waterways'(31) that a fu organ would be liken to him? This legend gives a cultural context for understanding the high regard that Chinese culture has placed on the legendary irrigation official named Yu.


The Legend of Yu

Yu is the embodiment of the 'good official' in Chinese mythology. If he really did exist it was long ago, about 2350-2200 B.C.E.(32) He is placed far back enough in history to almost be a contemporary of the Yellow Emperor, Huang Di (Ti).

Huang Di, 'one of the most famous of China's legendary rulers' is said to have reigned from 2696-2598 B.C. . . However, this relegation of the Yellow Emperor to prehistoric times is made in spite of the fact that Ssu-ma Ch'ien, the great historian of the second century B.C., began his Historical Records with an account of Huang Di, whom he defined as the founder of Chinese civilization and the first human ruler of the empire.(33)

My purpose in giving the dates above is to offer an idea of how important and long lived the story of Yu is in Chinese mythology.

'The story of Yu is closely tied to the Chinese idea that the best government was a government of the best men.'(34) The legend says that Huang Di appointed Yao to come to his throne after his brother, who was 'not good,' may have been disposed. Yao appointed Shun who passed the 'supreme test of family virtue' by marrying two of Yao's daughters and still maintaining perfect harmony in his family. Shun appointed Gun to control the flood waters of the Yangzi (River). Gun didn't do a very good job and died in prison due to Shun's displeasure. Shun then appointed Gun's son, Yu, to his father's position.(35)

'Aggrieved by his father's failure and punishment, Yu assembled the necessary labor forces and for thirteen years hurried from place to place supervising the work, living very frugally, even passing the door of his own house without stopping. Instead of trying to dam and dike the waters away from fields and houses, he had his workers dig channels that would allow the waters to run off to the ocean more quickly. Many of China's major rivers, including the Yellow River, were rechanneled by his efforts. When the work was done, the plains were repopulated, agriculture flourished, and Yu set out on a great tour of the empire, writing down for each area the nature of its soil, the rate of its land revenues, and the special local products that it ought to contribute to the imperial court . .

Yu was eventually named emperor and the line of his descendants became China's first dynasty, the Xia.'(36)


Context for Appreciating the Irrigation Official

There are several important aspects of this legend that can be used to enhance our understanding of the importance of the San Jiao. First, the taming of the waterways of China was an important achievement for uniting the country, stabilizing food production and providing transportation and distribution. Present day China has 138,600 km of inland waterways about 109,800 km of which are navigable.(37) Even though the empire then was smaller than today's China these figures gives some idea of the enormity of the task of building waterways.

The comparison of the San Jiao's function to this important job of building waterways, which was done by an exemplary official, gives a sense of the high status afforded this fu organ. Other references in the literature to the San Jiao as 'the ambassador of yuanqi'(38), evoke a comparison of Yu's later assignment to tour the country and catalogue the land use of regions throughout China.

In touring the empire Yu again performed a task of Herculean proportions for his country. Additionally he set a moral precedent by his selfless devotion to the task at hand. A modern day tour of ports in China would include stops from the northern port of Harbin along the coast past Shanghai and Hangzhou to Guangzhou in the southern most region.(39)

China has showered great respect on Yu for his contributions. 'In Beijing, facing Mao's mausoleum, there is a large and excellent Museum of Chinese History. In each hall of the museum stands a large statue of a hero of that age. In the first hall, devoted to China's prehistory, the statue is of Yu.'(40)


Officials of the Empire and Zang-fu

There is precedent in TCM for using the legend of Yu as a cultural connection to help understand the San Jiao. TCM commonly uses terminology 'comparing the positions of viscera and the bowels to that of various officials in an empire.'(41) Among the twelve officials listed as associated with the internal organs in the Huang Ti Nei Ching Su Wen we see the irrigation official has high enough status to be included.

"The heart is like the minister of the monarch who excels through insight and understanding; the lungs are the symbol of the interpretation and conduct of the official jurisdiction and regulation; the liver has the functions of a military leader who excels in his strategic planning; the gall bladder occupies the position of an important and upright official who excels through his decision and judgment; the middle of the thorax is like the official of the center who guides the subjects in their joys and pleasures; the stomach acts as the official of the public granaries and grants the five tastes; the lower intestines are like the officials who propagate the right way of living and they generate evolution and change; the small intestines are like the officials who are entrusted with riches and they create changes of the physical substance; the kidneys are like the officials who do energetic work and they excel through their ability; the three burning spaces are the officials who plan the construction of ditches and sluices and they create waterways; the groins and the bladder are like the magistrates of a region, they store the overflow and the fluid secretions which serve to regulate vaporization. These twelve officials should not fail to assist one another."(42)

Herbal theory also uses imperial officials to describes the hierarchy of ingredients in a herbal formulas. Herbs in a formula are referred to as 'Chief (also known as monarch, ruler, king, emperor, principal) , Deputy (also known as minister, adjutant, associate), Assistant (also known as adjutant) and Envoy (also known as messenger, guide, conductant).'(43)



The legend of Yu can help us point to traditional San Jiao functions and say that they can be understood. On the basis of this cultural orientation we can see why the early TCM works placed importance on the office of water regulation.

Relating the story of Yu to the San Jiao is a way for non-Chinese TCM practitioners to develop an appetite for the flavor of Chinese culture. It is not supposed here that knowing this story will resolve the mysterious nature of the San Jiao. Chinese TCM practitioners, as does the general Chinese public, all know the legend of Yu. They have had this information for a long time and it has not solved the controversy surrounding the functions and location of the San Jiao.

Instead, like the difference between knowing how to use chopsticks and actually using them, we become better practitioners if we deepen our understanding of Chinese culture. We need to do more than memorize TCM texts. Through familiarizing ourselves with the cultural contexts of TCM principles we learn to 'think' about clinical situations in TCM terms. That, it is my hope, will allow the greatest understanding of and best results from the uses of traditional Chinese medicine.


About the Author

Glenn Grossman, L.Ac.
Licensed Acupuncturist in California
National Board Certification in Chinese Herbology & Acupuncture (NCCAOM)
Master of Science in Oriental Medicine
Bachelor of Science
Post-Graduate Training in China:
AnHui TCM College and China Beijing Institute of Acupuncture
Instructor of traditional Chinese medicine (TCM) and Taijiquan
Author of articles on Chinese medicine subjects in professional and popular publications.

Currently in practice at:
Integrated Health, 4111 Okemos Rd, Ste. 102, Okemos, MI 48864, USA
Phone: (517) 381-8173
web page:


  1. Barbara Bates, M.D., A Guide to Physical Examination and History Taking, Lippincott Company, ISBN 0-397-54781-1 pg. 72-3 and 320.
  2. Frank H. Netter, M.D., Atlas of Human Anatomy, CIBA-Geigy Corporation, ISBN 0-914168-19-3, Plate 200.
  3. Merriam Webster, Medical Dictionary, ISBN 0-877791-25-2.
  4. Cheng Xinnog Chief editor,Chinese Acupuncture and Moxibustion, Foreign Languages Press, ISBN 0-8351-2109-7, p. 36. (referenced in following entries as CAM, author.)
  5. Giovanni Maciocia, The Foundations of Chinese Medicine, Churchill Livingstone, ISBN 0-443-03980-1, pg. 120. (referenced in following entries as FCM, author.)
  6. Veith, The Yellow Emperor's Classic of Internal Medicine, First University of California Press Edition,, 1966, ISBN 0-520-02158-4, pg. 28.
  7. CAM, pg. 43-5.
  8. FCM, pg. 120.
  9. Wiseman, Ellis, Zmiewski, Fundamentals of Chinese Medicine, Paradigm Publications, ISBN 0-912111-07-0, pg. 91.
  10. CAM, pg. 37.
  11. FCM, pg. 55.
  12. Grossman, advance uncorrected proofs, SHANG HAN, WEN BING & SAN JIAO. A TRANSCRIPTION FROM LECTURE NOTES, Copyright 1994 , collection of the author, pg. 152
  13. Merriam Webster, Medical Dictionary, ISBN 0-877791-25-2.
  14. O'Connor and Bensky, Acupuncture A Comprehensive Text, Eastland Press, ISBN 0-939616-00-9, pgs. 585 - 7.
  15. Chinese Herbal Medicine Materia Medica, pg. 183.
  16. Chinese Herbal Medicine Materia Medica, pg. 186.
  17. Shang Han, Wen Bing & San Jiao. A Transcription From Lecture Notes, pg. 152 use the following herbs in these amounts:
  18. fu ling 9 - 15 g
    yi yi ren 9 - 20 g
    zhu ling 9 - 12 g
    da fu pi 9 - 12 g
    bai tong cao 6 - 9 g
    dan zhu ye 6 - 9 g