Key categories in Chinese medicine theory
Chinese Medicine Theory: A Brief Overview
Chinese medicine developed over 3,000 years ago as the tribes of China founded the Shang Dynasty (1766-1100 BCE), cultivating crops along the lower basin of the Yellow river precipitating the need for a medical system.
The “Legendary Rulers” who established their dynasty’s during this founding period are credited with the development of writing, poetry, war, astronomy, mathematics, engineering, science, philosophy and medicine. Perhaps the greatest legacy of the Zhou Dynasty (1100 - 221 BCE) was their medical system.
One of the first texts written, the Mangwangdui Scripts recovered from a Han Dynasty tomb (220 BCE) in Chengsha, Hunan Province provides evidence of a complex medical system. Later texts, ‘Huang Di Nei Jing’ (The Yellow Emperor’s Classic of Internal Medicine circa 220 BCE) sets forth a structured system of physiological concepts, post-mortem examinations, methods of diagnosis and principles of treatment. These same principles & treatments are practiced today as Chinese medicine.
The ancient character ‘Yi’ stands for medicine or cure. The top left half of the primitive form depicts a quiver full of arrows. Arrows reflect the idea of war and remind us of the developments that have been made in medicine during periods of war. Similarly, acupuncture the practice of piercing the body with sharp implements may also be represented by this idea. The upper right component indicates the right hand. Above the hand is a representation of a bird’s wing to denote the idea of a hand making a quick action. Such as pulling back a bowstring and releasing an arrow. This conveys the thought of shooting an arrow to release the harmful influence of disease.
The lower half of the character shows an amphora, a wide-lipped, three-legged vessel for the decoction and storage of herbal remedy, wine or sacrifical blood. Wine has also had a longstanding relationship with herbal medicine being used increase the effects. Similarly, the amphora was used in sacrifices of animals to store blood. The importance of these actions shows their observation that blood has an intimate relationship to life.
Figure : Yin-Yang relationship to the movement of the sun and seasons. Later arranged into a complicated system of correspondences.
The Ancients observed the interplay between geological patterns and their effects on humans. All forms of Oriental medicine rely on a ‘system of correspondence’: life arises from the endless interplay of polar forces of yin and yang, heaven and earth, active and passive, contracting and relaxing. Everything can be classified in terms of yin and yang; everything contains aspects of yin and yang in unique and constantly changing proportions. Yin includes yang, and yang includes yin. Yin attracts yang, and repel each other continuously. Their interplay creates all energy, matter and can be described as the dynamic interplay of life.
Chinese Medicine considers the natural forces which control the cycles of change in the greater world are duplicated in our bodies (man is a microcosm of his universe). The implication suggests there are a set of laws governing change and transformation. When applied to health, it concludes there is a hierarchy of therapeutics.
Yin & Yang
The Ancient pictographs depicted the nature of yin and yang to mean shady and sunny-side of a hill, respectively.
The yang character shows a picture of the sun above the horizon with its rays streaming down.
The yin character shows the pictograph for ’jin’ & ‘yun’. ‘Jin’ conveys the idea of actuality, presence or the actual moment; and ‘yun’ is for warm vapors rising into the sky to condense into clouds. The character ‘fu’ is added to both Yin and Yang to depict a side of a hill.
“The five elemental energies of Wood, Fire, Earth, Metal and Water encompass all phenomena of nature. It is a symbolism that applies equally to man.”
The Yellow Emperor’s Classic of Internal Medicine (2nd Century BC)
The theory of the Five Elements was first used to categorize seasonal & celestial movements to assist farmers to predict weather changes in order to plant crops; later the system was incorporated into the medical system and used to understand functioning of the organs, and their relationship to the senses and emotions; to describe patho-physiology as pattern of disease progression.
Wood Fire Earth Metal Water
Spring Summer Long Summer Autumn Winter
Seed Growth Development Maturation Death
Eyes Tongue Lips Nose Ears
Anger Joy Contemplation Grief Fear
‘Qi’, which translates as respiration, metabolism or ‘life force’ is fundamental to the concept of health and reflects the importance the Ancients placed on breathing and the assimilation and circulation of nutrients. If air is obstructed, or circulation impaired, as in a tornaquet applied to an arm , the area quickly becomes weak and begins to fail in functioning. The same is held true for circulation to the internal organs disruption to the circulation process can be the first signs of a disease pattern.
Originally the character for ‘Qi’ was a pictograph showing heat waves rising from the ground or a heated surface. Later the character also indicated exhaled breath which can be seen on a cold day. The character ‘Qi’ became the breath radical and has remained that way in modern Chinese.
The importance the Ancients placed on their observations of blood circulation and its intimate relationship to life and sustenance probably explains their detailed anatomical studies of the vascular system and development of the meridian ‘jing-luo’ network. From this, the Chinese improved their understanding of the role of blood in circulating nutrients, immune substances and metabolic function. These efforts led to great discoveries in understanding the mechanisms of the vascular system.
Just as in other primitive cultures, the early Chinese performed blood sacrifices or bloodletting of animals, and applied blood letting for treatment of humans. The most important evidence for this practice is provided by the character ‘xue’ that is used for the word blood. The original pictographic representation shows a small, wide-lipped, three legged vessel, containing a substance. In this case a horizontal line is used to denote blood in the container.
LONGITUDINAL MERIDIAN SYSTEM
Unique to Chinese Medicine is the importance of the longitudinal meridian system ‘jing-luo’ used to describe the distribution of blood & nutrients to the internal organs, soft tissue and sense organs. It describes somato-visceral reflexes governing internal organ metabolism & pathology; dermatome distribution of the peripheral nerves in the musculo-skeletal system; and the inter-relationships described between yin-yang partnered organs.
Each of the six viscera and six bowels has an associated meridian. Along these meridians are the acupuncture points. Acupuncture points are highly specialized areas in the skin, that when stimulated cause changes to the physiological function. i.e. changes heart rate, respiration, modifies immune response, etc..
CHINESE MEDICINE DIAGNOSIS
Qi, or ‘life force’ can be detected through Chinese Medicine diagnosis. Disease is caused by imbalance between qi, blood, yin substances and yang function, as well as organ pathologies, infections, and emotional factors. Each disease is classified as a pattern of disharmony. Treatment aims to restore harmonious balance by controlling and regulating the flow and balance of circulation.
To gauge a person’s general overall health, a Chinese Medicine practitioner conducts the Four Examinations: questioning, inspection, smell & listening, and palpation. Questioning requires a history of the patient’s general health and lifestyle. Patients are inspected for their physique, facial colouring, and hair, skin and nail consistency. The tongue is examined for shape, colour, moistness, and coating. The limbs & skin are inspected for temperature, colour, and areas of swelling. The strength and sound of the voice is noted. Bilateral palpation of the radial pulse reveals additional information. Pulse examination includes, rate, depth, width, length and regularity. Twenty-eight different pulse qualities are discussed in all. Lastly abdominal palpation and other relevant palpations are part of a routine examination.
Figure Observation of the tongue. Note the different shapes color and markings.
Figure: Palpation of the Radial Pulse: A Schematic of how a practitioner of Chinese medicine describes pulse qualities.
Through the Four Examinations, a practitioner gathers information necessary to diagnose one of several patterns of disharmony (disease). The treatment principle is then determined and one or more of the following therapies employed: Acupuncture, Chinese herbs, dietary modification, exercise and life-style counseling.
Chinese Medicine discipline includes: Internal Medicine (gynecology; urology; oncology; cardiology; gastrointestinal diseases; infectious diseases; neurology; psychiatry; ear, nose and throat diseases; and pediatrics) and External Medicine (orthopedics; dermatology; and trauma medicine).