Traditional Chinese Medicine
Updated: Apr 6, 2020
I did a quick search on Google of “What is TCM?”, and I encounter this article from National Center for Complementary and Integrative Health of US Department of Health and Human Services, in which written
Traditional Chinese medicine (TCM) has evolved over thousands of years. TCM practitioners use various mind and body practices (such as acupuncture and tai chi) as well as herbal products to address health problems.
In one of my classes last week in which we had very fruitful discussions about TCM, one friend of mine on being asked about public views towards TCM in his country told us
“In our country, people will only resort to Chinese medicine whence biomedicine has already refused to take effect”.
A Chinese friend of mine then asked with alacrity
“What do foreigners think about TCM, especially when it comes to the very common use of of herbal drinks with weird tastes and sometimes with no timely effects for treatment of diseases?”.
The article, the comment, and the question are all apposite examples as to how the notion of TCM has been much bounded only by our familiarity with its “practices” - acupuncture, tai chi, cupping, herbal drinks, etc., all coalesced into a notion of “backwardness”, “primitive”, “alternative” and sometimes even “superstitious” or “witchcraft”. This is a direct corollary of Orientalism - “the term has been used disparagingly to refer to the allegedly simplistic, stereotyped, and demeaning conceptions of Arab and Asian cultures generally held by Western scholars”. This article, therefore, is an attempt to disabuse my readers of the ubiquitous and chronic misconception of TCM. I will offer a more well-rounded picture of TCM, starting with a brief but hopefully enlightening introduction of its history and philosophy, then move on to locate TCM in juxtaposition with Western biomedicine. The article will close up with some of my thoughts on the future of TCM in contemporary society through the case of COVID-19.
History, Philosophy and Basic Concepts of Chinese medicine
The history of Chinese medicine could be traced back as early as the Han Dynasty 2200 years ago. The earliest Chinese medicine canon surviving is 黄帝内经 Huangdi Neijing (Inner Canon of the Yellow Emperor), composed of two main books, the Basic Questions (Huangdi Neijing Suwen 素問) and the Divine Pivot (Huangdi Neijing Ling Shu 靈樞), which fundamentally contain many medical syntheses that sustain as the basis of Chinese medicine even until now. The book was written with Daoism as the backbone, and in fact, Chinese medicine should not and even could not be understood separately from the realm of Chinese philosophy, namely Daoism and early Confucianism. As believed by Daoist, the cosmos began from a status of “nothing”, of “emptiness”, sometimes called the “greatness” or the “Dao 道” from which evolved the positive "yang" the the negative "yin". The “yin 阴” and the “yang 阳” interacts and are born from each other, so-called “太极 taiji”, from taiji “ten thousands things on Earth” are born.
The Dao that can be trodden is not the enduring and unchanging Dao. The name that can be named is not the enduring and unchanging name. (Conceived of as) having no name, it is the Originator of heaven and earth; (conceived of as) having a name, it is the Mother of all things.
(the above excerpt is taken from 道德经 Dao De Jing chapter 1)
Lying at the core of Chinese medicine is the Daoist concept of “balance” or “harmony” between the “yang”, which stands for activeness, masculinity, the Heaven and the “yin”, which stands for passiveness, femininity, the Earth. According to Daoism, humans, as part of the cosmos - the ten thousand things, are susceptible to the course of the Dao with ceaseless movements and interactions between the yin and yang. The human body in Chinese medicine as a result is viewed as a miniature, or a microcosm of the cosmos embracing in itself the yin-yang balance. The cardinal philosophy to lead a good life is to conform to the Dao, hence, to maintain the yin-yang harmony through the regulation of the “气 qi” - a flow of force that basically means “spirit of breath of life in living creatures” (De Bary and Bloom 1999). Liu (2009) presented to us a relatively concise summation of the definition of this “qi” and its linkages with the yin-yang nexus as follows:
“The concept of Qi postulates that Qi is the basic substance that constitutes the universe. All objects in this universe are born of the transformation of Qi. Qi is neither abstract nor beyond sensation. It can be perceived through its various forms of existence. The ancients asserted that Qi have two states of existence: that of dispersion and that of condensation. These two states of existence of Qi determine its two modes of human perception: that of having form and that of being formless.” (Liu 2009, p.9)
“The Internal Classic distinguishes two types of Qi, namely Yang-Qi and Yin-Qi. Yang-Qi is characterized by being light, clear, active, ascending and warming. Yin-Qi is characterized by being heavy, murky, quiescent, descending and cooling. Hence, the immense Heaven is formed through the movement and flight of Yang-Qi, whereas the vast Earth is formed through the congealing of Yin-Qi. Because of the interaction between Yang-Qi and Yin-Qi throughout the universe, all the living things and non-living matters, including human beings, animals and plants, appeared in the natural world. The large variety of living things in the natural world results from the mercurial nature of Qi, and from differences in the quantity and in the combinative modes of the two types of Qi.” (Liu 2009, p.10)
Every ailment or sickness take its root from the imbalance of yin-yang, also known as the obstruction of “qi”. Hence, the pivot of TCM is to ensure that the yin-qi and yang-qi balance is there to be and obstruction would be eradicated. Not only restricted to "qi", the representation of "yin" and "yang" expanded into the characterization of various parts and activities of the body as well, demonstrated by the table below.
Figure 1: Yin - Yang in the Human Body (Tsuei 1990)
Figure 2: Application of Yin - Yang Theory in Physiology and Pathology (Liu 2009)
Emerging from the essences of yin and yang came the concept of the cycle of “五行 Five Phases”: Metal, Wood, Water, Fire, and Earth. The cycle of Five Phases is a self-generative one, which means each of the element would bear another one, and similarly each would be exhausted by another one. For instance, Metal creates Water, yet, is exhausted by Fire (fire can melt metal into liquid). The concept of Five Phases is engraved in every corners of a Chinese life: seasons of the year, time of a day, directions, objects, animals, food, and even the viscera in your body (Figure 3).
Figure 3: Partial classification by the five elements (Liu 2009)
Figure 4: Yin - Yang and the Five Phases (Source can be found here)
Note: the Pinyin pronunciation for 阴 should be "yin", not "ying". I decided to use this diagram since there was no other one which I found that could as succinct for explanation.
In Figure 2, 3 and 4, a focal point that must be emphasized is the resonance of the yin-yang nexus in the division of the body viscera into five Yin organs 脏 Zang and six Yang organs 腑 Fu, supplemented by the classification of all zang and fu organs into the Five Phases. The pivotal function of the six Fu organs and give Zang organs is to regulate the "qi" movement within the body and henceforth, maintaining the yin-yang balance. Zang organs oversees the production and storage of "qi" and blood, Jin Ye (body fluids), Jing (essence), and Shen (spirit) while Fu organs shoulder the responsibility of nutrients transmission, digestion and waste excretion (Acupuncture and Massage College 2017).
Figure 5: Zang - Fu organs in TCM (source can be found here)
Note: In reality, TCM categorized the Yang organs into six Fu organs, with an inclusion of 三焦 sanjiao as "3 placeholders/cavities or jiao for the organs within the body’s trunk". More detailed explanation of sanjiao and zang/fu organs can be found here.
What I have attempted to briefly introduce above are just very basic concepts of TCM. It must be underscored that Chinese medicine itself has gone through tremendous changes throughout the trajectory of history. Chinese medicine as it is today is unquestionably different from how ancient Han Chinese doctors practiced it 2000 years ago. However, the philosophy behind TCM stands the test of time. Ironically, it is also the philosophy standing behind the complex system of TCM that has been misunderstood, or frankly saying, ignored by many Westerners when they came to China and claimed to have brought the light of "modernity" to this country.
Chinese medicine - Western medicine and the problem of "standing point"
I want you to take a look at this picture for a moment before we move on.
A simple question: What do you see? Some might say a duck, some say a rabbit. The problem is that no one is right, and also that no one is wrong. This sketch was used by an American psychologist named Joseph Jastrow in 1899 to prove that what we perceive as “truth” is actually based on “where we stand”. This photo has been used by Kuriyama (1999) in his book The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine as a quintessential demonstration of how one should decipher the difference between the way Greek medicine and Chinese medicine come to understand the “body”. It is just another depiction of how the two following schemas of the body should be interpreted.
Figure 6: Hua Shou, Shisijing fahui, 1341 and Veslius, Fabrica, 1543
What could be observed from the following diagrams? According to Kuriyama (1999), the Chinese version of sketching a body seems to lack the level of detailedness (the muscles which are absent in the Chinese picture) that the Greek had achieved and even broach elements that could never be found through dissections. However, he explicated such an ostensibly meager description as merely a matter of “where they stand and look”, not in a physical but rather an epistemological term. To be more specific, in chapter 4 of his book, Kuriyama wrote:
“…visual knowledge in Chinese medicine was mostly a matter of diagnostic sight. It engaged a gaze trained on living persons rather than on lifeless corpses. This accordingly is the main focus of what follows - how Chinese doctors scrutinized the living” (Kuriyama 1999, p.155)
Another notable scholarly work that contain an eclectic variety of profound comparisons and insights into this divergence between the Chinese construction of the image of body is Multiplicity, Point of View, and Responsibility in Traditional Chinese Healing from Judith Farquhar. In this section, I will summarize several ideas taken form Kuriyama (1999) and Farquhar (1994) that I fervently believe to be worth sharing.
To begin with, the most imperative philosophical belief that makes Chinese medicine seem absurd from biomedicine's perspective is the idea of “microcosm”, the view towards the body as a mini-cosmos that closely corresponds to the nature. The body in Chinese medicine is not an independent entity from its surroundings but rather a miniature of the cosmos, whose inner parts correspond with each other as well as with the surroundings, both in terms of space and time.
Getting back to the idea of categorizing organs according to the Five Phases theory, what did ancient Chinese doctors hope to achieve by doing so, or more importantly, what led them to do so? As for Chinese medicine, the body is a "living" entity that entails constant interactions within itself (among the organs), all of which are dovetailed perfectly with the concept of yin-yang balance, of "qi" movement, and of the interplay among Five Phases. The following excerpt from Liu (2009) helps to clarify this point.
"...the kidney stores the essence of life, and the liver stores blood. The kidney-essence can generate liver-blood; this is the process of “Water generating Wood.” The liver stores blood and regulates its volume, and it assists the heart in the governance of the pulses and the vessels and their normal activities; this is “Wood generating Fire.” The heart governs the vessels and mental activities, and the spleen governs transportation and transformation and commands blood. Only when the heart performs its functions can blood nourish the spleen, and enable it to perform its function normally. This is the process of “Fire generating Earth.” The spleen governs transportation and transformation of water and grain, and the lung governs dispersion and depuration. The spleen can transport the essence of food to reinforce lung-Qi, thus maintaining the lung’s function of guiding Qi and ensuring that the lung can carry out dispersion and depuration normally. This is the process of “Earth generating Metal.” The lung governs the movement of Qi and has the function of depuration, and the kidney stores essence and receives Qi. Lung-Qi assists the kidney in consolidating kidney-essence and receiving Qi. This is the process of “Metal generating Water.” (Liu 2009, p.28)
Furthermore, the logic of Five Phases interactions is not restricted to only within the body and among the organs but also spans into how the body reacts to outside forces and and the other way around. The root of ailments could also be observed from the imbalance in the environment that the patient lives in, and the symptoms could be curbed by rebalancing the food he/she absorbs by applying the theory of Five Phases for example.
Liver functioning is disrupted when one becomes very angry, although feeling sorrow can lessen the anger. In terms of climate, damp wind can harm the tendons and cause liver trouble, but dryness can create balance. A diet with too much sour food can harm the tendons and the liver, while acrid and hot food can overcome this condition. Heart disease is related to emotional imbalance manifested as excessive joy or exhilaration, which can be lessened by fear; extreme heat, which can be overcome by coolness; or too much bitter food, which can be overcome by saltiness. Traditional Chinese doctors consider the pancreas as belonging to the spleen, functioning to regulate the blood and help digestion. The major emotional cause of spleen disease is seen as disruption of the digestive system caused by obsessive thinking, which can be stopped by the emotion of anger. High humidity and dampness harms the spleen and the flesh, which also relates to the spleen, but ventilation decreases the dampness in the air. Sweet foods harm the flesh and spleen, but sour foods or herbs can overcome the effects of excess sweet. Extreme grief harms the lungs, but happiness can counteract the grief. Hot weather and acrid foods can harm skin and hair, which are associated with the lungs, but cold and bitter can prevail over heat. Fear is harmful to the kidneys, but contemplation can calm the fear. Intense cold is sufficient to harm the blood and kidneys, but dry heat can overcome the cold. Salt can do harm to the blood and the kidneys, but sweet can overcome the salt. (Tsuei 1990, p.82)
Kuriyama (1999), by comparing ancient Greek medicine and ancient Chinese medicine brought into discussion several other discrepancies. Anatomy, for instance, served very different purposes in Greek and Chinese medicine: both to conduct measurements, however, the measurement in the latter case was aimed to consolidate the belief in cosmic correspondence on human body (already explained above). Moreover, when it comes to somatic structure, even though there exist similarities in the depiction of blood vessels and "脈 mo" as connectors of distant organs, unlike in Greek medicine in which the body was depicted as a structure with the central organs (the brain and the heart as rulers) overseeing the function of the body and the other peripheral viscera, Chinese medicine emphasized the an absence of such hegemony within the body.
“To be sure, when the Neijing drew parallels between the body and the body politic, it did speak of the heart as the ruling lord (junzhu zhi Buan), and it even endowed the heart with intelligence (shen-ming). But the heart hardly monopolized a person's mental resources. Decisiveness, for example, belonged to the gall bladder, the capacity for calculated planning resided in the liver, craftiness belonged to the kidneys, and the sense of taste to the spleen” (Kuriyama 1999, p.161)
“Yes, the heart governs the mo; but in the same way that the lungs govern the skin, the spleen governs the flesh, the liver governs the sinews, the kidneys govern the bones” (Kuriyama 1999, p.162)
An interesting anecdote that I got from my Professor and believe to be relevant to what has been discussed is a common saying that “When you visit a TCM clinic, tell the doctor you have a headache and he might treat your feet”. Bizarre as it may sound, I believe the saying makes much more sense after we have delved into how the structure of the body have been understood differently from the stance of Chinese medicine and Western medicine.
“For the treatment of illnesses, one must understand the principles of the Yin Yang changes. Long long ago, Chinese acupuncturists studied the I Ching and discovered principles which have been integrated into acupuncture. For example, when a patient cannot move his arm, medicine based on Western science may treat only the shoulder joint, while Chinese medicine looks at the whole body. Based on the theory of Yin Yang balance, an acupuncture treatment might stimulate a point on the leg in order to affect the arm. For a headache, the needle might be put in the foot. If the patient's mind is relaxed, the treatment can help a great deal, and shortly after insertion of needles, pain disappears or movement is restored to the limb. Yin Yang theory also indicates acupuncture treatment for such conditions as mild strokes, where a person's center is lost and the whole body is affected, and in recent years acupuncture has been used for anesthesia, internal medicine and immunity.” (Tsuei 1990, p.62)
However, Kuriyama (1999) was convinced that “governance” differs in Chinese and Greek medicine not only in terms of “sources of governing” but also in the conception per se. The interconnectedness among the body parts, beside being a matter of space, is simultaneously contingent upon time, something that is impossible to witness by dissection.
“A weakening of the spleen may result in emaciation, and injury to the lungs may coarsen the skin, but there is an elusive indirectness to these effects that makes them quite unlike the paralysis caused by severing a nerve. Before the cause becomes fully manifest in the effect, days, months, even years may pass. We are dealing with connections spanning not just distant parts, but distant times. We are dealing with ties invisible to dissection.” (Kuriyama 1999, p.162)
Rather than resorting to Kuriyama’s explanation which tend to be much illustrative, I would like to refer to a more practical case mentioned in Faquhar (1994)’s work to better clarify this point: A publication of Dr. Zhuong Jianhua’s in 1977, titled simply “Stomachache”. From the text comes the following excerpt:
“Stomachache is also called stomach cavity pain. Quite a few classic works of Chinese medicine also called it “heart pain”, linking it to the illness syndromes that frequently have stomach cavity pain as a main feature. The most common causes are the emotions of longing, worry, rage, and irritation, loss of regulation in the liver visceral system, horizontal backwash attacking the stomach, or lack of vigor of the spleen and stomach system, with concomitant loss of orderly descension functions/ It can also be brought about by fire stagnation or Blood stagnation of long duration transforming into heat and giving signs of collateral channel damage. To treat it was necessary to enliven Blood and transform statis to stop the aching, regulating Blood to add qi. Although Blood was being treated, the movement encouraged was that of qi, which was assisted with yuanming powder to flow downward. Hence this therapy incorporates a courageous insight” (Yu and Gao 1983, p.200)
It would be impossible to understand how fascinating and thought-provoking this small portion of text is without knowing the context against which Dr. Zhong’s diagnosis was made. The patient had already been diagnosed by a Western medicine doctor as having a duodenal ulcer. What does this mean? It means that without denying the existence of an ulcer, Dr. Zhong actually sought for a more long-lasting, implicit root of the ulcer. It was the imbalance of “qi” movement. It can also be interpreted that ailments from the perspective of Chinese medicine take time to evolve, therefore, prevention of a disease by having a balanced lifestyle is more meaningful than treating the disease.
Another very interesting feature of Chinese medicine analyzed in Kuriyama (1999) is the "gaze" on the body used by doctors to diagnose diseases. Unlike in Greek medicine where the action of observation is utilized for instant identification of abnormalities (the ulcer as a seeable wound leading to stomachache in the above-mentioned case), gazing in Chinese medicine is to also look for ailments that has yet to come into existence. By gazing at the color of the skin, which varies among 五色 Wu Se Five Colors correspondent to the Five Phases, doctor could figure out the injuries to the inner organs.
"Too much redness in the face indicates too much heat or emotion. Too little red indicates cold, blood deficiency and joylessness. Too little lustre would indicate lack of spirit or vibrancy. Too much yellow indicates that the digestive organs are not transforming the food properly and food stagnation is taking place creating dampness. Too little yellow would mean that the person isn’t taking in enough nourishment. A white color would indicate Qi deficiency, low immunity, or that someone has been grieving a lot. A blue facial color would indicate cold, exhaustion or fear. A black facial color would indicate serious illness or kidney disease. A green color would indicate Qi stagnation from frustration or anger where qi is being constricted in the vessels. Within these colors there are all kinds of variations due to coexisting factors. For instance an orange color might indicate both stagnation in the digestive system and too much heat." (Hammond, n.d)
To sum up, from all the explanations provided, it can be seen that the Orientalist judgement of Chinese medicine as being "backward" actually stems from the inchoate knowledge of Chinese world view, which differs greatly from its Western counterpart. It should be noted that such incongruity apropos of "standing points" should not gainsay any of the two world views, nor should any of the two be judged as inconsequential or intransigent. Chinese medicine and the philosophy at its center do have a lot to contribute.
Chinese medicine and the COVID-19 pandemic: the rise of an "alternative"
The COVID-19 pandemic shook the world. It has debunked humans' incapability to tackle a public health crisis of such a large scale. Medical systems around the world are gradually paralyzed and hundreds of thousands fatalities have been recorded. Yet, a silver lining is that humans have gradually learnt an invaluable lesson from this pandemic: the lesson of "an alternative". When biomedicine is still struggling to find a good remedy for the disease, TCM has been widely applied in treatment and is proving to be effective even for patients in critical conditions. My professor has very gracefully contacted a medical expert who has been fighting at the frontiers in Hubei Province in the past few months for some statistics and this is what we have got: In a clinical experiment, out of 146 patients among which 120 are in very serious condition and 26 in extremely serious condition (with assistance of ICU), 115 have been discharged from hospital (78.77% recovery). Among these 115 patients, 67 of them used only Chinese medicine, 38 used a combination of biomedicine and Chinese medicine and the rest only used biomedicine. This article from CGTN also reported positive treatment results from the usage of TCM in combating the virus.
Ms. Yang, 56, thought she was dying three weeks ago, before she was assigned to this hospital. "I was in serious condition when I first came here. I could barely walk," said Yang. "Her face was blue, staggering against the wall, as if she was dying," her roommate said, recalling the first day they met. Yang had experienced nausea and vomiting after taking an injection using Western medicine. After counseling with her doctor-in-charge, they decided to switch to full TCM treatment. Only a week after receiving treatment, Yang felt her condition was getting better day by day."I was brought back to life and health. I really appreciate the doctors and other workers at the hospital. TCM has been a great help for me," said Yang.
Although it cannot be ruled out that the practice of TCM today is in fact heavily influenced by biomedicine, its inherent potentials and values should be further embraced. This blog from me is not to ask for "justice" nor to claim the "truth" for TCM, simply because I fervently believe that there is no "absolute truth". Rather, I would love to offer you some fresh perspectives from academia not only towards TCM but also Chinese values which you might not be able to see often on mainstream media nowadays. To close up, here comes three simple suggestions from me for all of you on how to lead a life of balance and wellness during this pandemic time.
1. Drink a lot of hot water. Hot water in TCM is a yin beverage that could help to lower the internal temperature of the body, hence, helps you to prevent excessive yang restore the balance.
2. 早睡早起 Sleep early and rise early. Following a good sleeping schedule would help to maintain the yin and yang flow within your body. Go to bed between 9pm and 11pm as this period of time is perfect for the gallbladder and the liver, which controls emotions and judgements, to have a rest.
3. Exercise, but pay attention to frequency and intensity. Activities such as running, boxing, etc are those of yang-style, while yoga, taichi or just stretching are of yin-style. Keeping a fine balance between these two types of activities would enhance the flow of qi in your body and improve your health in general.
Ames, Roger T., and Philosophy Documentation Center. “The Meaning of Body in Classical Chinese Thought:” International Philosophical Quarterly 24, no. 1 (1984): 39–54. https://doi.org/10.5840/ipq19842413.
De Bary, Wm Theodore, Irene Bloom, Wing-tsit Chan, Joseph Adler, and Richard John Lufrano. Sources of Chinese Tradition. 2nd ed. Introduction to Asian Civilization. New York: Columbia University Press, 1999.
Judith, Faquhar. “Multiplicity Point of View and Responsibility in Traditional Chinese Healing.” In Body, Subject & Power in China, edited by Angela Zito and Tani E. Barlow. Chicago: University of Chicago Press, 1994.
Kuriyama, Shigehisa. The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. New York: Zone Books, 1999.
Liu, Zhanwen, ed. Essentials of Chinese Medicine. New York ; London: Springer, 2009.
Tsuei, Wei. Roots of Chinese Culture and Medicine. ACCHS Series, no. 1. Oakland, Calif: Chinese Culture Books Co, 1989.
Note: Links to E-sources are attached directly in the text.