Essential Principles

An Extended Introduction to the Ideas of Chinese Medicine




Yin / Yang

Chinese science differs fundamentally from the western in that it is concerned with the relative and functional properties of things, instead of the absolute and structural.

If everything exists in relation to other things the abstract form of these relationships is described as being Yin 陰 to Yang 陽. What begins must end, day turns to night and back to day again. These are not absolutes but depend on the context: while each day begins and ends so does each year, the tree is high compared to the grass beneath it but low compared to the bird flying above it, the night is dark in comparison to the day but the moon and stars make it bright compared to the depths of a cave. In a similar manner everything has both form and function and it is the combination of the two that gives everything its properties.

Qi

The opposition between Yin and Yang make them dependent on one another. Nothing can begin without ending, there is no high without something being lower, no light without a darkness it illuminates, no object without form and function and its function depends upon its form. The interaction of these in relation to each other is what brings about changes and known as Qi 氣. Since change is a fundamental force that allows existence so is Qi a fundamental force of the universe. By understanding the way this happens we can become empowered to direct these changes and guide the Qi. This has been a major concern of Chinese philosophy since one of its very earliest writings, the I Ching 易經, or Book of Changes.
There is a tendency in the west to translate these concepts neatly into familiar terms such as Qi as "energy" but it is my opinion that there is little to gain from explaining a 2000 year old system of therapy from China in terms of Vitalism, a disproven 19th century European medical idea. We will either understand it to be nonsense, or fail to understand it at all.

We see this definition of Qi as "interaction" in the ancient classics by the fact that Qi is almost never mentioned alone but always in relation to something, e.g. our Stomach Qi failing to digest food, our "ancestral Qi" (inherited factors) affecting some aspect of our lives, our defensive Qi fighting off illness, or the physician's Qi affecting the patient.

One important translation is that of "breath". Some translations to define Qi as "vital breath" to describe its use in practices of meditating on directed imagery and breathing to influence body states. Just as the wind brings changes in weather, so the way we breathe affects our body and mind, literally being the animating factor of life. Acupuncture probably developed from these practices as ways to demonstrate the feelings used to control the body in order to teach people to do it themselves, or to give a helping hand when practise alone was not quite enough.



Patterns

Another 3 opposing pairs are used to apply Yin/Yang to medicine:

Internal / External

Disease can arise from things outside of us (infections, exposure to elements), or from internal disturbance such as emotional states. It can also be a combination or an interaction between the two, as is seen in diet, lifestyle factors or a disturbing experience. These disruptions produce an illness when they reach the threshold our constitution can sustain. External diseases need to be expelled by the immune system while internal ones may require mental examination. Lifestyle factors are treated with behavioural changes.
里 表

Li / Biao

Excess / Deficiency

Imbalance can result if there too much or too little of something, for example tension or weakness in the muscles, or obsession with or ignoring an area of life. Excesses tends to build up and stagnate and must be moved on while deficiencies need to be nourished, strengthened or fortified with diet, herbs, gentle warmth and exercise.
实 虚

Shi / Xu

Cold / Hot

Another basic category is whether the symptoms are hot or cold suggesting the modes of treatment. Hot conditions suggest cooling techniques while cold is treated with warmth.
寒 热

Han / Re


Together with the essential Yin/Yang dichotomy these make up the 8 Principles (Bagang 八纲) of differentiating patterns. Using this an external excess heat pattern (a sore throat from a cold, sunburn, allergy) can be separated from an internal deficiency heat pattern (hot flushes and night sweats during menopause or when recovering from illness) and an internal excess heat (heartburn, emotional flushing, internal inflammation). It also suggests a focus for treatment such as helping to eject a cold from our bodies, remove an irritant, calm an excess, nourish a deficiency and warm something cold.

The next step is to consider which area of life and part of our body is affected.



Meridians

No discussion of Chinese medicine is complete without introducing the meridians. Here is my take on them.
經络

Jing-luo


Meridians are archetypes of the ways that we can interact with the world. Their trajectories represent how they manifest in the body and their organ associations (Zangfu 臟腑) are based on the way that principle manifests on our internal anatomy.

Their core principles include:
  • the ability to extend, turn, stop, hold position and draw in
  • the ability to connect, discriminate and choose to reject or absorb from the world
  • these are the same idea expressed on different levels (i.e. to pull something in is the same as to absorb it, to push it away is the same as to reject)
Since each principle manifests in different ways at different levels each one has several branches to show this:
  • superficial sinews (Jingjin 經筋) that cover the muscles required to do a movement
  • emotional branches (Luo 络) that reflect changes in blood flow and sensation (flushing, butterflies, palpitations, arousal, etc.)
  • deeper "divergent" meridians (Jingbie 經别) for chronic conditions
  • the primary meridians which bind these three above and their related Zangfu 臟腑 organ system together.
  • the Zangfu 臟腑 organs themselves most directly accessed by herbal medicine but also their front Mu and back Shu points.
  • the "extraordinary vessels" (Qi jing ba mai 奇經八脈) for spiritual practices and deep transformations
If an area is under or over represented in our life, or threatened by external pressures, it will suffer an imbalance in relation to the others. If left unaddressed then it may progress into a chronic state. The aim of needling a point on a meridian is to draw attention to the area and help us find a way to resolve it. The deeper a problem progresses the harder it is to resolve.

The more superficial meridians are addressed with superficial methods such as massage, moxa, quick needling and externally applied herbs while the deeper ones are addressed with acupuncture needles that are retained for longer. The bodily functions of the Zangfu 臟腑 organ systems are mostly addressed with internally consumed herbs. Since they all interact it is possible to affect any system using any technique and the ideal is to look after them all. The aim of any clinical intervention is to select which levels and systems are most affected and help them restore balance until they learn to regulate themselves.


Foot Taiyang Bladder Sinew

Example: The Foot Taiyang (Greater Yang) meridian runs across the back and legs and is about our ability to extend and move in a straight line: to stand up and move forward, towards or away from something. In martial arts it is this meridian and its arm pair that drive the power behind a punch or a kick.

A bad back or hamstring injury is an issue with this meridian on a Sinew level. It may be due to too much manual work (an excess condition), or sitting for too long until it becomes weak (a deficiency). An excess must have the tightness released while a deficiency needs training up. A combined pattern such as a strain from weakness, will need some of each. The main aim is to prevent progression into chronic lower back pain.

The emotional state associated with this meridian would be our fight-or-flight responses, the psychological equivalent of running away or towards something. This branch of the meridian ascends from the calf to the diaphragm and heart, manifesting in calf tension as our body is preparing to run, palpitations, abdominal discomfort and a knot in the diaphragm: common signs of stress-anxiety. Again the main aim is to prevent progression into chronic stress, or becoming a personality trait.



The organ associated with this meridian is the Bladder, or more accurately the external aspect of the Kidneys, one of the primary routes for ejecting unwanted materials from our body and so including many functions of the immune system. Many of the physical and emotional aspects above relate to the other external aspect of the Kidneys and our ability to fight off external threats, the adrenals and the musculoskeletal systems most involved in running or fighting.

If dealing with an actual bladder control problem then herbal diuretics or astringents are the most direct route, ideally accompanied with acupuncture on the front or back points which are the most direct route to stimulate the organ. Possible structural problems requiring referral, anxiety and social/environmental factors may also need to be considered.

If dealing with a problem in our body's ability to defend itself against infection or environmental attacks then it will likely manifest in cold-like symptoms with chills or temperature, muscle aches in our neck and shoulders, blocked nose and changes in sweating. In early stages acupuncture or massage might give this "defensive aspect" a hand but after a few days herbal remedies to boost our immunity from the inside and help with symptoms are required.

I have chosen this example because it demonstrates the problem of referring to a meridian by its organ name as many places do.

Foot Taiyang Bladder Luo
Back Shu point of the Bladder Front Mu point of the Bladder

Since each meridian is associated with a trajectory along the body for massage, points for needling, a movement that utilises the muscles along its pathway, an emotional state, an organ system, a meditation practice and an area of lifestyle that can be changed, it becomes possible to treat it in any number of ways. As these often overlap, so the meridians zigzag around the body, crossing over and connecting with each other at different places.

If you would like to read more about this interpretation of meridian theory, you can read my blog post on the subject here...



Interaction of Meridians

No aspect of life exists in isolation and Chinese medicine thrives on interactions between things so the next step is to consider where the problem may have come from or is heading to. Much of this derives from the classics of political and military strategy like the Sunzi Bingfa, 孫子兵法, The Art of War, which considers a humane approach to struggle, avoiding costly confrontations and overcoming a problem by surveying the field, strengthening our advantages, identifying the areas that the problem thrives upon and undermining or turning them to our advantage.

Various models are proposed to explain these relationships with the main ones being Five Phases theory (Wuxing 五行) for interior conditions and the Six Divisions (Liujing 六经) for exterior issues. Other conceptual ideas can also lead us to a clearer description of the problem.


Example: In our case above, our back problem could transfer itself to the hips and the meridian that runs along the side of the body, or spread to the upper back and its paired arm meridian, both following a Six Division relationship pattern.

In the emotional example, the meridian running to the Heart indicates it could transfer here becoming stress related heart disease or mental illness (the Heart is the seat of the emotions). This follows a Five Phase pattern of "water suppressing fire".

In a chronic pattern there may be many branches and relationships. It is the skill of a Chinese medicine practitioner to learn these relationships and try to tease out which are the symptoms (Biao, 標) and which are at the root (Ben, 本). We can then build a strategy to overcome or manage it.



Aims of Treatment

Once a pattern is identified its treatment can be deduced from these principles by attempting to reverse them.

Massage, heat, quickly needling painful knots and exercise will naturally affect the muscles most directly, while meditative styles of treatment that retain needles for longer and relaxation or visualisation exercises will probably help an emotional issue best. Herbal medicines can be prescribed to help our body function better. Treatment is re-evaluated and modified as it progresses to become more targeted and better suited to how the patient responds.

In chronic conditions we may need a combination of these approaches over time. For anything to have a lasting result we must look for lifestyle factors that generate the issue, bring them into awareness and try to change behaviour to create a better harmony.