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The Conceptual Basis of Traditional Chinese Medicine

© George T. Lewith MA, MRCGP, MRCP
 (Excerpted from Acupuncture-Its Place in Western Medical Science, Thorsons Publishing Group)

The Physiology of Traditional Chinese Medicine
The physiology of traditional Chinese medicine has many similarities to that of Western medicine. Most of the specific organ functions defined in the Nei Ching Su Wen are astonishingly accurate in the light of modern scientific discoveries.

The heart is said to dominate the circulation of the blood. The Nei Ching Su Wen says, 'The heart fills the pulse with blood . . . and the force of the pulse flows into the arteries and the force of the arteries ascends into the lungs'. This seems to be a clear description of the circulation of the blood through the body, via the lungs. The idea that blood circulated in this way was peculiar to Chinese medicine until it was 'rediscovered' by William Harvey in the early seventeenth century. The publication of Harvey's work Du Mote Cordis has subsequently been hailed as one of the great landmarks of Western medicine, although at the time Harvey was thought to be mad, 'inflaming the medical profession by the suggestion of such a preposterous idea'.

The Nei Ching Su Wen also makes some surprising observations about the kidneys. It states that the kidneys dominate bone, that they play an integral part in the process of growth and reproduction (in fact the Chinese character for kidney and testicle is sometimes indistinguishable) and that the kidneys control body fluid in concert with the lungs.

During the last forty years it has become obvious that vitamin D is a very important factor in bone growth, and if it is not present then rickets results. The exact mechanism of this disease process was unclear as it was not really understood how vitamin D actually worked, but recently it has been shown that the kidney provides the missing link in the control of bone growth and development, by changing the chemistry of vitamin D. The idea that the 'kidney dominates bone' is therefore an accurate, detailed, complex and surprising observation to have been made some 2,500 years ago.

Embryology is the study of the growth and development of the foetus in the mother's womb. With the advent of good microscopic technique, in the early part of this century, embryology developed apace. It has been shown, quite conclusively, that both the ovaries and the testicles develop from the same original cells as the kidney. This process begins when the foetus is about five weeks old, (when a baby is born it is said to be in its fortieth week of development). The kidneys therefore, do seem to play an important part in the process of growth and reproduction.

The detailed and specific control of body fluid is a very complex chemical system, and one that we are only just beginning to understand properly, but it is quite obvious that the kidney and the lung do work together to control the fluid in our bodies. Most of this information has become available since the Second World War, with the development of complex and expensive machines to look at small changes in the chemicals and fluid within the body.

Communication Problems
The Nei Ching Su Wen contains a vast array of medical knowledge, much of which has been hidden from the West by the Chinese language, and it was not until this text was translated that the information became freely available. Many of the observations and rules within the Nei Ching Su Wen are based on the intricate and detailed observations made by the Chinese physicians. It does not seem to be part of the cultural make-up of Western societies to use this time-consuming method of gaining knowledge. Often we tend to be too impatient to 'waste time' observing petty detail, seeming to pursue instead the idea of scientific 'break-throughs', although, in the end, both approaches yield the same answer. One of the major precepts of Taoism is that if the individual waits and watches the 'Way' will become clear. In the West we are motivated to search actively for the answer and therefore the 'Way' sometimes takes far longer to become clear. This is well illustrated by medical concepts contained in the Nei Ching Su Wen, and their subsequent rediscovery.

The Five Zang Organs
Although many organs have the same functions as in Western medicine there are also radical differences between the Western and Chinese systems. In traditional Chinese medicine the major functions of the body are built around the five main organs which are the heart, the lungs, the kidneys, the liver and the spleen. In Western medicine these organs are important, but not to the same extent as in traditional Chinese medicine. The Chinese call them the five Zang or five solid organs, and the system of the five Zang organs controls the main Yin Yang balance of the body.

Each of the Zang, or solid, organs is linked to a hollow or Fu organ. For instance, the kidney is linked both structurally and functionally to the urinary bladder. In Eastern and Western medicine both organs control the production and passage of urine. The channels representing the kidney and urinary bladder are also 'paired' as Qi is said to flow from one channel to the other. The liver and gall bladder are linked in a similar manner; they both control the formation and secretion of bile and they are also 'paired' charnels.

For these specific 'paired' organs the linked functions are exactly the same as in Western medicine. The 'pairing' of the channels is particularly important when deciding on which acupuncture points should be used. Diseases of any organ can be treated by using the 'paired' channels; for example, diseases of the liver can be treated by using acupuncture points on the gall bladder channel. Traditional Chinese medicine considers migraine headaches to be a disease of the liver and they can be effectively treated (with acupuncture) by using points on the gall bladder channel.

The Emotions and Mental Disease
Traditional Chinese medicine considers that the emotions are governed by individual organs. They do not consider the brain, or subconscious, as discrete entities, therefore the body and the mind are a real part of the same functional system. Each organ is given a particular emotion; for instance, the liver is said to be the organ affected by anger. The concept that emotional functions are completely tied in with physical ones is deeply rooted in Chinese culture. In China there is less 'mental disease' as we know it in the West, because the neurotic is considered to have a disease of the liver or spleen, rather than anxiety or depression. Perhaps this explains the fallacious claim that 'no mental disease exists in China'. In my experience, having worked in a Chinese hospital, the Chinese are just as prone to neurosis as we are in the West.

There are great advantages in seeing mental functions in this way because, instead of being labeled a depressive, the patient feels that the liver is playing up and therefore perceives the disease in a different context. In the West a depressive may still be stigmatized and considered weak because he, or she, is unable to cope. In China this is not so because the cultural history and social context of mental disease is different, the depressed patient being made to feel that the disease is real and organic, rather than imagined. In spite of the constructive efforts of those who work in the field of mental health in Western nations, the body and the mind are generally still considered to be separate, and those who are unable to keep the mind under control are thought, by some, to have failed.

In acupuncture, the Chinese have a method of effectively treating a proportion of mental disease, which therefore has not been considered incurable, and there has been no necessity to shut all sufferers away in institutions. In the West most of those who are working within the area of mental disease are dealing with diseases that are poorly understood. As a general rule the level of understanding in any area of human knowledge can be judged by the number of theories that are used to explain a single phenomenon. If there is one theory that seems to explain all the facts, for a given observation, then it is probably correct. If many ideas are used to explain the same set of facts then it is likely that most of them are, at best half truths. At present the field of mental health embraces a large number of theories which are used to give opposing explanations for the same basic facts.

Without a defined idea of the origin of disease, treatment is difficult, therefore a wide variety of poorly understood treatment methods are used in mental disease, such as electroconvulsive therapy. Perhaps the lack of social stigma attached to mental disease in China is because there has been some form of consistent explanation, and treatment, for this type of problem for the last 2,000 years. The area of mental disease is particularly interesting as I am sure that there is as much mental disease in China, if not more, than in the United Kingdom, but it would seem that the cultural and medical heritage of the Chinese people has allowed them to deal with it in a different manner from that in the West, and possibly more effectively.

Vital Energy (Qi) and Blood
The force behind the biological functions occurring in any living tissue is Qi. Qi represents the vital energy of the body but it also has a material form. It is both substance and function; the substantive or material form of Qi is oxygen (clean Qi) or food, the non-substantive form of Qi is the real but evasive concept of 'vital force'. The idea of a 'vital force' is common to many early, medical systems, but it has been highly developed within the concept of traditional Chinese medicine.

If a substance has no Qi then it is dead. The Qi of the liver is the functional ability of the liver, and the Qi of the body is the total vital force of a human being. Qi is disseminated through out the body by the channels. It is also divided into various sub groups such as original Qi, or the Qi with which you are born and nourishing Qi, or the Qi that you gain from the food you eat. Defensive Qi is the Qi that protects the body from invasion by disease, circulating just below the skin and fending off invasion by viruses and bacteria (pathogens).

Qi is a very wide concept, difficult to understand in detail, but it is an essential part of the traditional Chinese picture of the body. Blood also exists in the system of traditional Chines medicine, and blood production is said to be dependent on the liver, the kidney and the bone marrow. The modern medical theories on blood production also tie up these three organs as being the functional system for blood production.

Disease results when the Qi of the body is weakened and unable to resist the onslaught of pathogens (disease-causing factors). In Chinese medicine the agents that cause disease are given the name of meteorological conditions; an infection (often associated with a fever) is called a disease of heat, and a chronically painful joint is usually a disease of cold. These pathogens allow diseases to be grouped according to their broad symptoms. The pathogen wind is an interesting idea. Wind means a changeable symptom, so the type of muscular ache often occurring with 'flu, would be classed as invasion by wind. The idea that disease is due to physical conditions is an intuitive explanation for many common aches and pains. People often complain that 'the caught a chill when they got wet', or that their 'neck is stiff after

having slept in a draught'. The Chinese pathogens represent formalization of this approach.

A particular pathogen usually presents itself with a defined symptom complex. By using the information gained from the history of the disease, and the physical examination of the patient, it is often possible to make a clear diagnosis of the pathogen causing the disease. If the patient has a fever then heat is one of the pathogens involved in the disease process. Once the diagnosis has been made, then specific acupuncture points can be used to disperse the pathogen; when heat is the invading pathogen, then specific points are used to reduce the fever. Acupuncture points are therefore used to correct the Yin Yang balance of the body and to disperse pathogens.

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