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The Case for a Re-imagination of the Triple Warmer Meridian and a Reorganization of the Fire Element

Updated: Mar 23, 2023

When advised to “mind the gap” while waiting for an arriving train at the train station, it is common to take a step back and observe the space in between the platform and the train. After hearing this guidance many times, it is common to take a reflexive step back on approach, and appreciate this space in between where you are and where you are going. From this platform, waiting to be transported to the next destination, you have only the information that you have been given regarding your current experience, often taking for granted that this information is truth. This trust is granted because there is no knowledge of any landscape other than what is within the realm of your current awareness. The observer, simply can only live the experience that has been constructed for them to appreciate. While at this platform between the present and the future, there exists and opportunity to step back, mind the gap, and think about how to approach your destination.

The information that the West has been given regarding the organ pairs of the Fire Element and assigned yin and yang polarities has never resonated with me through my years of study of the human body. I have reasoned certain truths that have proven to be fact through research of anatomy and physiology, and observations within my clinical practice of visceral and neural manual therapy. Physically, the pericardium is the tissue system that protects the heart and provides a support for this precious organ, through suspension of the heart within the thoracic cavity. These are yang qualities, and the heart is, naturally, the pericardium's yin pair. Moreover, the small intestine, as a very yin organ, receives the nutrients that we take in through the process of digestion, and is protected and supported by the tissues of the greater omentum, the yang lower burner of the Triple Warmer. (Keane)

Victor Frankl, in his 1946 book 'Man’s Search for Meaning' said that,“between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

The greater omentum is a protective layer of lymph and brown adipose tissue (BAT) that overlays the small intestine. This organ can create adhesion to wall off infection, and clear the area of bacteria and fungal imbalance through immune function. (Platell, et al.) The Greek physician, Galen (128-199 AD), reasoned that the role of the greater omentum was to warm the intestines, as he observed that a gladiator who had an omental resection after a stab injury, was unable to feel warm thereafter, always experiencing a sense of cold. (Goldsmith)

In my clinical practice in myofascial, visceral, and neural manual therapy, I often work with people that have survived childhood trauma, or had significant physical or emotional injury as an adult. Either of which may lead a person to a chronic stress response, or elevated pain levels through much of life. I have noticed a few things about how the body's Autonomic Nervous System (ANS) manages the flow of energy, emotion, and tension through a healing process. I write about this, as well as two specific treatment theories that I have developed, in the book, 'The Tao of the Polyvagal Theory: A Five Element Perspective for a Future of Healing the Spirit and Balancing the Autonomic Nervous System.'(Keane) In addition to this book, I offer an online class with a complete five session case study illustrating the treatment theories presented in the book, along with details that are meant to enhance and evolve Five Element clinical practice. These treatment theories are called The Tan Cycle, and The Yu Angles. More detailed information on these theories and their practical applications in a clinical setting is available through my website,

A keystone aspect of these treatment theories is the relation of the pathway of the Vagus nerve, and several important anatomical areas of the Polyvagal complex of cranial nerves, to the primary and divergent channels of the Gallbladder, Triple Warmer, and Bladder meridians. Another paramount component to these observations of the body is the notion that the Fire Element provides intrinsic support to the Wood Element, which is evident through direct correlation within the anatomy and physiology of the body. Gentle, supportive, manual therapy techniques such as myofascial, visceral, and neural mobilizations, relative to each of the five elements, may create transformation within the ANS. This is especially the case when used in conjunction with the Tan Cycle and Yu Angle treatment theories. Detailed information regarding these clinical therapies is given in a series of classes called Elemental Manual Meridian Theory and Techniques (EMMT), through

I have found though my clinical practice, and demonstrate through the content of the EMMT curriculum, that the Triple Warmer is analogous to areas of Brown Adipose Tissue (BAT), also called “brown fat.” This thermogenic substance is found throughout the body. The three primary areas of BAT within adult humans are the locations of the main tissue complex of the Triple Warmer: the greater omentum, as the lower burner; the lesser omentum, being the middle burner; and the thoracic inlet, or supraclavicular area, which serves as the upper burner.

The adult body has various amounts of BAT, dependent on factors of both “nature and nurture,” or genetics and the environment, as it is experienced. For instance, the “Ice Man,” Wim Hof, who is well known for his ability to sustain himself for prolonged periods of time in frigid water, and winter hikes in his bathing suit, has been clinically studied and found to have much more BAT than the “average” human. His website claims that he has approximately 15% more BAT than the average adult.

Other areas of BAT in the human body include: the upper thoracic area, between the shoulders, where the Triple Warmer prime meridian happens to be located; as well as the area surrounding the kidneys. The area in between the shoulders has much more BAT in infancy due to the inability of infants to contract their muscles, or shiver, to keep warm. During times of cold, BAT is activated to create warmth in the body through thermogenesis. And still there are many other minor areas throughout the body where BAT is concentrated.

Perivascular visceral BAT has been found surrounding the aorta, common carotid artery, brachiocephalic artery, epicardial coronary artery and veins, internal mammary artery, intercostal arteries and veins, and within the pericardial mediastinal fat. (Sacks, et. al) These locations give some credence to why classical Asian medical theory may have classified the Triple Warmer as the yang pair to the pericardium.

Other locations of visceral BAT in the body include the periviscus areas of the heart, trachea, and major bronchi of the lung hilum, the esophagus, and transverse mesocolon. BAT also surrounds the pancreas, kidney, adrenal, liver, and hilum of the spleen. (Id.)

Subcutaneous diffuse BAT has been found between the anterior neck muscles, such as the sternocleidomastoid, within the supraclavicular fossa; as well as the subclavian area, the axilla, anterior abdominal wall, and inguinal fossa. (Id.)

As you can see by the diverse placement of BAT throughout the body, much of which corresponds with the primary and tertiary path of the Vagus nerve, as well as the primary meridian and divergent channels of the Triple Warmer; the metabolic and neuroendocrine effects that BAT and the Triple Warmer have on the ANS are quite relevant to homeostasis and autonomic regulation.

The vagus nerve is a crucial, bi-directional neural pathway between the body and brain that relays an array of sensory information from visceral tissues to the brain, also called afferent pathways, as well as from the brain to the viscera, or efferent pathways. These information pathways are integral for the regulation of metabolism, respiration, cardiovascular functions, digestion, and inflammation. The autonomic vagal pathway regulates the mechanical function of the parasympathetic nervous system through efferent motor pathways. This electrical relay system from the brain to the viscera is also responsible for direction of the chemical neuroendocrine and exocrine processes of the stomach, duodenum, ileum, heart, aorta, liver, lung, trachea, and pancreas. (Chang)

Basic autonomic functions of the respiratory, cardiovascular, digestive and immune systems are mediated by the relays of the vagus nerve complex. The location of visceral afferent nerve fibers correspond to the location of BAT deposits throughout the body, which just so happen to correspond to the location of the Triple Warmer channels. Could it be that the thermogenic and chemical processes created through activation of BAT are an example of the supportive functions of the Triple Warmer, toward balancing autonomic regulation through the body? And that the activation of BAT aids in the conduction and transmission of information along the parasympathetic vagal neural pathways?

“The vagus nerve is highly heterogeneous, containing a diversity of sensory afferent fibers and motor efferent fibers that have distinct morphological, pharmacological, electrical, and genetic properties. While vagal afferents might directly sense visceral tissue temperature changes and mediate diverse visceral thermal reflexes, metabolic and immune signals carried by the vagus nerve may also play a role in thermoregulation.” (Id.)

Thermogenesis in BAT is activated by sympathetic innervation, through peripheral heat sensing neurons within the skin, as well as visceral afferent pathways that register energy metabolism within the organs, taking that information to the brain. The afferent information that is brought to the vagal ganglion in the medulla, is then sent on toward the hypothalamus. The vagal ganglion in the medulla function essentially as an electrical relay. Neurons in the arcuate nucleus of the hypothalamus activate sympathetic preganglionic neurons in the spinal cord, which then stimulate an increase in thermogenesis in BAT, at specific locations throughout the body, through postganglionic sympathetic innervation. (Hyun, Sohn)

Thermogenesis in BAT is one of the main ways the body can balance energy metabolism. BAT is the only organ in mammals that is able to generate heat by intracellular mechanism, a chemical cascade that signals specialized proton channels within the cellular structure, resulting in the production of energy. Studies have also shown that parasympathetic neurons can also inhibit thermogenesis in BAT. (Chang)

Vagal afferent nerve fibers are likely different from each other, and specialized to assess specific visceral changes, orchestrating a range of thermoregulatory reflexes, and leading to a spectrum of down regulation or up regulation of thermogenesis. Moreover, varying parasympathetic efferent motor neurons bring information from the brain to the body, depending on the specific stimuli and environmental inputs received through afferent pathways. This process results in regulation of energy balance and glucose homeostasis. (Hyun, Sohn)

The involvement of specific, specialized neural pathways alludes to the sophistication of the ANS, and the body's impressive ability to dial in how a stimulus is activated, and what response is produced as a subsequent reaction. This specialization has been hypothesized to happen through electrical frequency modulation, as well as the quality of the specific neural stimulation. This level of detail and spectrum of possibility is why even modern researchers, with the most specialized techniques, have such a hard time studying the ANS, and definitively coming to conclusions about the function of the vagus nerve with respect to thermoregulatory processes. This echos how the mysteries of the Triple Warmer have also been difficult to give a name, throughout centuries of medical philosophy.

Interestingly, there was a research experiment that proved an increase in BAT weight, as well as the expression level of thermogenic receptors within BAT, after electrical stimulation of the auricular branch of the vagus nerve. (Hyun, Sohn) The auricular branch of the vagus nerve, and superior and inferior vagal ganglia that the nerve originates from, happen to be the exact location of the Triple Warmer meridian, near the jugular foramen; with the auricular branch of the vagus nerve continuing up, following the Triple Warmer meridian behind the ear.

If we had been given the truth about the organ affiliations of the Fire Element, and the information that the Triple Warmer was a metaphor for thermogenic areas of the body, when the Mao administration packaged up classical Asian medical theory for the West in the 1940s and 50s, would we have even been able to recognize it as truth? Well now, with modern knowledge of anatomy and physiology, we have gradually, without even noticing it, lived our way into the answers that were never given.

From the pictographs of ancient Taoist wisdom, to the present moment; through centuries of translation by a ruling class focused on controlling a population, and known for its secrecy toward the World, we now are presented with an opportunity for clarity through modern study and awareness.

Ranier Maria Rilke had some Taoist advice for minding the gap in his 1929 publication, 'Letters To A Young Poet': “Be patient toward all that is unsolved in your heart and try to appreciate the questions themselves, like locked rooms and like books that are now written in a very foreign language. Do not now seek the answers, which cannot be given to you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”


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