Conscious Choice: Principles of Traditional Chinese Medicine

December 2000

Principles of Traditional Chinese Medicine

by Lorene Wu, M.D.

Traditional Chinese medicine is a complete system of medicine encompassing the entire range of human experience. Thousands of scientific studies that support traditional Chinese medical treatments are published yearly in journals around the world. However, even patients who benefit from treatments such as acupuncture or Chinese herbal therapy may not understand all the components of the traditional Chinese medical system. That may be, in part, because traditional Chinese medicine (TCM) is a combination of poetry and science. It is based on a dynamic understanding of energy and flow that has more to do with Western physics than Western medicine.

Energy and Flow

According to traditional Chinese medical theory, the fundamental substances of the body are qi (pronounced "chee"), blood, jing, shen, and body fluids. The proper formation, maintenance, and circulation of these substances are essential to health.

Qi, or chi, can be loosely interpreted as energy, similar to prana in the Ayurvedic system. We are born with a certain quality of qi that we get from our parents (congenital or yuan qi). We build qi from the food we eat (grain or gu qi) and the air we breathe (natural or kong qi). We then form qi that functions in each organ (organ or zang-fu-zhi qi) and in each meridian, or channel, along which qi flows in the body (meridian or jing-luo-zhi qi). Certain types of qi protect the body from external disease (defensive or wei qi), nourish the body (nutritive or ying qi) and nourish the lung and heart (aggregative or zong qi).

Thus, traditional Chinese medical doctors stress the importance of living in a way that nourishes qi and does not deplete it. Many people in the United States are qi deficient, either from not making enough or from using it up too quickly. Qi depletion is usually involved in all chronic conditions due to the exhaustion of the body’s reserves over time. Qi deficiency is one important factor in the development of depression because a person does not have enough energy to fully participate or find joy in life. Qi nourishing herbs are often given as treatment of certain kinds of depression.

Blood, in TCM, is not only the plasma-based fluid Western medicine recognizes, but a fluid that nourishes the body and spirit. The lack of blood or poorly circulating blood can lead to symptoms such as palpitations, pain, and insomnia. Scarring in the body from surgery or trauma is viewed as blood stagnation. Chronic pain conditions also often involve blood stagnation. Herbs that can dissolve blood stagnation are often given to lighten scars and decrease pain.

Jing, or vitality, is the basis of reproduction and development. It is inherited from our parents, nourished by food and proper living, and depleted with age. Women are thought to follow seven-year cycles of development and men, eight-year cycles. At age forty-nine, after seven seven-year cycles, women are thought to have depleted their jing. This age corresponds to the average menopausal age of fifty in Western cultures. In the United States, menopausal symptoms are appearing earlier, and infertility rates are increasing among men and women. A depletion of jing, often through chronic exhaustion, excessive ejaculation and/or sexual activity, and improper diet, is a significant cause of this trend.

Shen is spirit. Traditional Chinese medical doctors often look into the eyes of a patient in order to see the brightness in their eyes. Luminous eyes indicate an abundance of shen — a wealth of physical, mental, emotional, and spiritual health. Treatments are not often given specifically to increase shen. Instead, shen is a measurement of the overall internal environment.

Fluids include all other fluids beside blood such as tears, nasal discharge, saliva, digestive juices, urine, and sweat. Since their functions are similar, body fluids in general are called jinye. Whether thin (jin) or thick (ye), they each lubricate different areas of the body. A lack of body fluids can result in dry skin rashes. It can also exacerbate arthritic pain due to the lack of joint fluids. Fluid balancing herbs are used frequently.

Responsibilities of the Patient

Traditional Chinese medicine maintains health by balancing both internal and external environments so that qi and other fundamental substances can flow freely and nourish each of the body’s systems. Its broad scope offers prescriptions in a wide range of areas. The many different disciplines within traditional Chinese medicine include herbal therapy, acupuncture, tuina (a form of massage), dietary therapy, and feng shui (arranging the external environment to affect health) as well as the martial arts of tai chi and qi gong.

In ancient times, people were skilled in many of these areas. They were able to achieve health by changing their lifestyle or environment. For example, if they were experiencing fatigue in the winter, they might eat less cold food, take warming herbs, receive invigorating acupuncture, practice more martial arts and qi gong, and rearrange their furniture to increase energy flow in their home. This level of participation assumes a knowledgeable and disciplined approach to health. If symptoms persisted, they would consult a traditional Chinese medical doctor, who would suggest more specific prescriptions.

In traditional Chinese medicine, people are encouraged to take responsibility for their own diet and lifestyle changes, because they are the first line of defense against disease. Health, TCM practitioners know, depends not on a daily pill, but on the way a person lives from day to day. Traditional Chinese medical doctors are aware that no amount of acupuncture or herbs will overcome a poor diet or lifestyle.

Patients in the traditional Chinese medical system, therefore, are educated on the most therapeutic foods for their condition. For example, a person with an internal climate of dampness would be advised to eat more drying foods such as aduki beans and celery, and less mucus forming foods such as dairy and greasy food. They may also be given suggestions for stress reduction, ranging from exercise, meditation, and relaxation to the evaluation and possible elimination of unhealthy relationships.

However, despite these efforts, patients sometimes continue to suffer from their symptoms. Reasons for this condition are varied. A person’s inherited constitution may make her or him prone to certain conditions. Or, a patient’s poor diet, lifestyle, and accompanying emotional and physical stress may have been chronic and severe. In addition, the person may have been invaded by a particularly aggressive pathogen. In cases where dietary and lifestyle changes are insufficient, Chinese herbal therapy and acupuncture may be necessary.

Responsibilities of the Doctor

How then are the specific prescriptions for the dietary, herbal, and acupuncture therapies derived? A traditional Chinese medical doctor uses the diagnostic techniques of inspection (looking), auscultation (listening), olfaction (smelling), inquiry (asking), and palpation (touching). Inspection involves observing the patient’s physical shape, mind, complexion, tongue, and secretions and excretions. Auscultation involves listening to the voice, respiration, and cough. Olfaction involves smelling the breath and body. Inquiring involves asking questions about specific symptoms as well as about the general condition. The smallest detail can be very important to a traditional Chinese medical doctor. For example, the doctor may ask many questions about the nuances of one’s bowel movements, urination, appetite and cravings, energy, sleep, temperature, and mood. After inquiry, comes palpation, which involves touching the pulse and various body parts. The most common examinations are pulse diagnosis and examination of the tongue.

Once all this information is collected, the traditional Chinese medical doctor forms a syndrome diagnosis describing the fundamental substances of the body and how they function in the body according to the theory of yin-yang, five element theory, zang-fu organs, and information regarding channels and collaterals. In addition to offering diagnostic information, these elements of TCM also describe the etiology of disease, including six exogenous factors, seven emotional factors, and other pathogenic factors.

Eight principle patterns help the traditional Chinese medical doctor further differentiate syndrome patterns. (Additional theories, which particularly describe febrile diseases, also inform TCM.) The formation of an accurate syndrome diagnosis leads to the selection of appropriate foods, herbs, and acupuncture techniques to remedy the illness.

Yin and Yang. TCM is governed by the Chinese philosophical concept of yin and yang — two opposing factors, one continually becoming the other, each depending on the other for definition. Thus nighttime grows out of daytime and overtakes it. Then it approaches daytime, which lessens its power, until daytime overtakes night. Yin and yang distinctions can be applied to an infinite number of phenomena, and in TCM, they apply to the body. Imbalances between yin and yang in the body contribute to a significant number of diseases. For example, a deficiency of yin, the cooling, calming element, often leads to excessive heat with dry eyes, tinnitus, and night sweats. A deficiency of yang, the warming active element, can lead to diarrhea and back pain.

Five Element Theory. The five elements that TCM practitioners consider — earth, metal, water, wood, and fire — correspond to particular organs in the body. Each element has its own strengths and weaknesses, its own particular function, and its own particular relationship with other elements. A TCM practitioner is concerned that each element operates in harmony with the others. (See the in-depth look at Five Element Theory in this issue.)

Zang-Fu Organ Theory. Traditional Chinese medicine recognizes five zang, or yin, organs and six fu, or yang, organs. Zang organs are "solid" ones, such as the heart (including the pericardium), lung, spleen, liver, and kidney. They manufacture and store fundamental substances. Fu organs, which include the gall bladder, stomach, large intestine, small intestine, and urinary bladder, transform and transport these substances. Extraordinary fu organs include the brain, marrow, bone, blood vessels, gall bladder, and uterus. TCM treatments involve a thorough understanding of the clinical manifestations of zang-fu organ imbalance and knowledge of appropriate acupuncture points and herbal therapy to rebalance the organs.

Channels and Collaterals. Energy in the body is viewed as traveling along channels, or meridians, and collaterals. Twelve main channels correspond to the zang-fu organs. Other channels each cover specific areas in the body. They include the eight extra channels, the fifteen collaterals, the twelve divergent channels, and the musculo-tendinous and cutaneous regions of the twelve regular channels. Often, they are extensions of the twelve main channels, but they perform different functions, such as communication between channels. In addition are hundreds, if not thousands, of acupuncture points, including 361 main acupuncture points, where needles can be placed to either increase healthful energy or decrease excessive amounts of pathogenic energy in the meridian.

Etiology of Disease

According to TCM, six external factors and seven external factors can cause specific symptoms. External factors include wind, cold, heat, dampness, dryness, and fire. (Epidemic diseases of severe heat and dampness such as smallpox and cholera, comprised of communicable external factors, are known as pestilential factors.) The symptoms caused by external factors can aid in their detection. For example, mouth ulcers, eye inflammation, fever, and excessive sweating may be caused by fire or extreme heat invasion. A person’s basic constitutional weaknesses may be aggravated by these external factors. For example, a person may be constitutionally prone to heat. He or she may also crave spicy, greasy food, caffeine, alcohol, smoking, all of which increase internal heat. This person will not be able to tolerate hot weather as well as a person who is internally cold. Thus, even a person’s preference for hot or cold weather can be important diagnostically.

The seven emotional factors are joy, anger, melancholy, worry, grief, fear, and fright, each of which corresponds to a particular zang-fu. Every human being experiences these emotions, but excessive amounts of any emotion (yes, even joy) can damage the body, mind, and spirit. Conversely, physical illnesses can impair a person’s emotional health. Thus, treatment for mood disorders involves treating the corresponding organ.

This view reduces the stigma often attached to imbalanced emotional states. For example, unresolved grief beyond two years of the causative event in Western medicine is regarded as a pathological mental/emotional state. Traditional Chinese medicine regards it as an imbalance in the lung, lung being the organ associated with grief. The grief cannot lessen until the lungs are cleared and strengthened. Treatment for grief can involve acupuncture of lung points and Chinese herbal therapy directed toward the lung.

Other pathogenic causes for disease include improper diet, trauma, parasites, excessive phlegm, and blood stagnation. According to traditional Chinese medical theory and practice, the accumulation of phlegm and blood stagnation is a major contribution to the development of mass formation and cancer. These accumulated masses can range from benign cysts and fibroids to malignant tumors; the etiology is the same. The implication for treatment is that phlegm and blood stagnation need to be cleared rapidly in order to prevent future tumor growth. (This concept does not imply that benign masses will transform into malignant ones but rather that an internal environment that nurtures benign masses, if left unchanged, will eventually develop enough toxicity and heat to allow the growth of malignant masses.)

Eight Principle Patterns

In general, TCM categorizes disease into four pairs of syndromes. These classifications include exterior and interior, cold and heat, deficiency and excess, and yin and yang. The eight principle patterns help practitioners pinpoint the interrelationship between fundamental substances, elements, organs, channels, and collaterals in the body.

Two people with the same Western diagnosis can receive very different acupuncture and Chinese herbal therapy depending on their syndrome diagnosis. For example, someone with essential hypertension who is robust, with a red face, red eyes, constipation, irritability, thick yellow coat on a red tongue and a wiry full pulse will be treated with acupuncture and herbs that calm down liver fire. Someone with the same diagnosis of essential hypertension who presents with a pale frail appearance, loose stools, low energy, a pale flabby tongue, and a weak pulse will be treated with acupuncture and herbs that invigorate kidney yang.

TCM is a complex and yet extremely useful clinical tool. It allows for variable, individualized treatments for known conditions, and illuminates difficult-to- categorize disease states, as well. A patient presenting with strange symptoms, unclassifiable by Western medicine, often can be understood, and successfully treated, by traditional Chinese medical principles. Treatment proceeds logically from the syndrome diagnosis.

Integration

This brief and very simplistic overview of the basic principles of traditional Chinese medicine cannot begin to convey all the power and beauty behind the science of TCM. It merely summarizes some of the ways in which this sound scientific discipline elevates the art of medicine to new heights. In China, of course, entire medical schools, hospitals, and clinics are devoted to this form of medicine. Others, unfettered by Western dogmatism regarding medicine, are combining traditional Chinese and conventional Western modalities. Happily, this trend also is developing in the United States. Continuing integration of Eastern and Western medicine promises to build our potential for health and harmony, so that achieving balance can be increasingly life affirming and joyful.

Dr. Wu is a board-certified family practitioner and licensed acupuncturist who specializes in Traditional Chinese Medicine. She is the founder and director of the Whole Life Center, 40 East 31st Street, LaGrange Park, IL 60526, 708-352-7212.

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