Integrative TCM: The Neurological Basis of Hara Diagnosis

In Traditional Chinese Medicine (TCM), hara diagnosis, or abdominal palpation, is used to assess the health of the internal organs (zang-fu). The hara, located in the abdominal region, is considered the body’s physical and energetic center. By palpating this area, practitioners can identify patterns of firmness, sensitivity, or tension, which indicate imbalances in the organs and meridians.

Each region of the hara is said to correspond to a specific organs and meridian. Through touch, practitioners assess texture, warmth, and tension, which reveal the dynamic state of the body’s internal environment. For instance:

• The upper hara (jiao) reflects the heart and lung.

• The middle hara (jiao) aligns with the stomach, spleen, and liver.

• The lower hara (jiao) represents the kidneys, intestines, and bladder.

These patterns give practitioners insight into organ health, emotional states, and, through a neuro-informed approach, stress responses. The hara manifests patterns of high or low tone, often felt as areas of increased or decreased firmness or responsiveness.

Correlating Hara Regions with Autonomic Plexuses

As we integrate our understanding of TCM with neuroanatomy, we recognize that each organ corresponds to a neural plexus. A plexus is a network of nerves that regulates the function of specific organs and their associated structures. These plexuses align with the front mu and back shu points used in classical TCM palpation. High or low tone in the fascia reflects the autonomic state of the organ and its surrounding tissue. Imbalances in tone signal dysfunction in the organ or meridians, influenced by the local nerve centers. This approach links autonomic regulation, fascia tone, and organ health, providing a clearer view of how the body maintains balance.

High and Low Sinew Tone in the Hara: Patterns of Induration and Fascia Accumulation

High Tone Patterns (Indurations): High sinew tone manifests as regions of hardness or density within the abdomen, signaling congestion or microcirculatory stasis in the fascia overlying specific organs. These indurations, termed oketsu in Japanese palpation theory, correspond to stagnation in Traditional Chinese Medicine (TCM). Kiiko Matsumoto’s work complements this by identifying oketsu as a microcirculatory issue, pointing to fascial restrictions or adhesions. Barral’s work in visceral manipulation emphasizes that resolving adhesions is key, as they impede normal organ function and affect the surrounding fascial network. High-tone patterns often reflect sympathetic dominance in the autonomic nervous system. This sympathetic overactivation causes dysfunction in organ function and the meridians they govern.

Low Tone Patterns: Low sinew tone appears as softness or flaccidity in specific areas, signaling deficiency states in TCM or hypoactivity in the associated nerve plexuses. These patterns indicate a low sympathetic charge, or a diminished autonomic nervous system response. In this state, the body struggles to mobilize energy and adapt to environmental stimuli. Low tone in the fascial network reflects an imbalance in the neurovisceral relationship, where reduced neural input weakens fascial support and reduces the structural integrity of the organs. TCM practitioners have classically treated these deficiency patterns with tonetsukyu (rice grain moxa). Treating these areas requires addressing the body’s tone as a whole to restore balance to the autonomic nervous system. Localized treatments for low tone will help the specific organs but do not resolve the systemic pattern of autonomic dysfunction.

The Hara Reflects the ENS

While hara diagnosis offers valuable insight into organ-specific imbalances, it can be somewhat reductionistic. As part of a broader whole, the five yin viscera form a gestalt that mirrors the health of Enteric Nervous System (ENS), the largest part of the autonomic nervous system (ANS). The ENS, located in the middle jiao, with its network of ganglionic plexuses, governs digestion and the production of post-natal Qi in TCM. It serves as a central hub for autonomic regulation, balancing sympathetic and parasympathetic activation to support harmony across the physical and emotional landscape.

Chronic sympathetic dominance is a systemic imbalance that affects the entire body, not just isolated organs. As the main heart pattern in the 20th century, sympathetic dominance impacts all five yin viscera and the sinew channels. Treating individual organs does not resolve the systemic nature of high arousal. The middle jiao, where digestion and emotional regulation occur, becomes inhibited under retained fight-flight-freeze (FFF) patterns, disrupting balance across multiple systems. Only by addressing the body as a whole and harmonizing the autonomic nervous system (ANS) can we restore equilibrium and resolve persistent stress responses. 

 Here’s how the five viscera connect with their neurological counterparts:

1. Lung (LU) – Pulmonary Plexus
   The lung’s hara area in TCM is typically located in the upper abdomen. Neurologically, the pulmonary plexus regulates lung function and provides an equivalent basis for assessing tone through palpation. High tone here indicates excess or spasticity, and low tone reflects deficiency. 

Front Mu Point: LU1 and LU2 in combo with Ren 17 (Zhongfu) – correlates with the pulmonary plexus, assisting in the regulation of respiratory Qi.

2. Liver (LIV) – Hepatic Plexus
   The liver’s hara area corresponds with the hepatic plexus, which governs liver functions, including metabolism and detoxification. Tone variations here provide insight into the state of the liver in TCM terms, with firmness suggesting excess and softness indicating deficiency.

Front Mu Point: LV14 in combo with GB 25 (Qimen) – reflect the hepatic plexus, reflecting liver health and regulating blood and emotional flow.

3. Spleen (SP) – Celiac Plexus
   The middle hara, representing the spleen and stomach, aligns with the celiac plexus, which innervates these key digestive organs. Tone within this plexus mirrors the firmness or softness felt in the spleen hara area, offering a neurological foundation for the spleen’s transformative and transportive roles in TCM. 

Front Mu Point: LV13 (Zhangmen) – corresponds to the spleen’s function and is located near the solar plexus, impacting digestive energy and organ tone.

4. Kidney (KID) – Renal Plexus
   The lower hara region in TCM, associated with kidney function, reflects vitality and essence storage. Its corresponding renal plexus provides a neurological correlate for tone patterns—higher tone aligns with excess, and lower tone with deficiency—reflecting the organ’s stability and resilience.

Front Mu Point: GB25 (Jingmen) – positioned to reflect kidney health, balancing fluid regulation and grounding Qi.

5. Heart (HT) – Cardiac Plexus
   The heart’s hara area corresponds with the cardiac plexus, which manages cardiovascular regulation. Variations in tone in the heart region of the hara provide insight into the heart’s strength or vulnerability in TCM, with high tone often indicating excess and low tone a sign of deficiency.

Front Mu Point: CV14 , CV 15 (Juque) – mirrors the cardiac plexus in its role in regulating the heart’s emotional and physiological states.

Spasticity or high tone over the organ plexus reflect HIGH AROUSAL (sympathetic charge) and altered organ function, the basis of zang-fu. As these adhesions release through appropriate manipulation techniques, the visceral structures regain their mobility, improving the overall functional alignment and reducing the associated high tone patterns in the fascia.

Plexus	Governs	TCM Correspondence
Cervical Plexus	Controls the neck, diaphragm, and upper shoulder	Ren, Du, and Upper Jiao
Brachial Plexus	Governs the upper limbs	Yang Wei, Yin Wei P, SJ, Heart
Cardiac Plexus	Controls the heart	Heart meridian
Pulmonary Plexus	Manages the lungs	Lung meridian
Esophageal Plexus	Manages the esophagus	Cervical Spine Qiaos
Gastric Plexus (Ventral Vagal Trunk)	Governs the stomach	Chong Mai (stomach), Middle Jiao
Celiac Plexus (Solar Plexus)	Governs the spleen and stomach	Spleen/Pancreas/Stomach meridians; middle jiao
Hepatic Plexus	Controls the liver	Liver meridian
Superior Mesenteric Plexus	Regulates the small intestine	Small Intestine meridian
Inferior Mesenteric Plexus	Manages the large intestine	Large Intestine meridian
Renal Plexus	Governs the kidneys and adrenal glands	Kidney meridian
Pelvic Plexus	Manages pelvic organs and urinary function	Kidney, Bladder, and Lower Jiao
Visual Plexus	Governs visual information	Eyes, Gallbladder (GB) channel
Sacral Plexus	Governs the reproductive organs, lower limbs	Ren, Du, and Kidney meridians
Auditory Plexus	Governs auditory input	Ear, Gallbladder (GB) channel
Visual Plexus	Governs visual information	Eyes, Gallbladder (GB) channel

Chronic sympathetic dominance is a systemic imbalance that affects the entire body, not just isolated organs. As the main heart pattern in the 20th century, sympathetic dominance impacts all five yin viscera and the sinew channels. Treating individual organs does not resolve the systemic nature of high arousal. The middle jiao, where digestion and emotional regulation occur, becomes inhibited under retained fight-flight-freeze (FFF) patterns, disrupting balance across multiple systems. Only by addressing the body as a whole and harmonizing the autonomic nervous system (ANS) can we restore equilibrium and resolve persistent stress responses. The brain cannot form new neural pathways or harness neuroplasticity until we resolve the underlying ANS imbalance.

Bibliography

1. Barral, Jean-Pierre. Visceral Manipulation. Eastland Press, 2006.
2. Deadman, Peter, et al. A Manual of Acupuncture. 2nd ed., Journal of Chinese Medicine Publications, 2001.
3. Matsumoto, Kiiko. The Channel Pathways in Traditional Japanese Acupuncture. Kapp, 1998.
4. Schultz, R. Louis, and Rosemary Feitis. The Endless Web: Fascial Anatomy and Physical Reality. Elsevier, 2012.