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systems of CHINESE TRADITIONAL : AN INTRODUCTORY OVERVIEW Harriet Beinfield, LAc, and Efrem Korngold, LAc, OMD

Harriet Beinfield and Efrem Korngold are authors of petence, enhance re c u p e rative power and immunity, decre a s e Between Heaven and Earth: A Guide to Chinese Medicine.They dru g - r eliance, and contribute to a sense of grea ter , expand- practice at their , Chinese Medicine Works, in San ing its users’ capacity for pleasure, work, and creat i v i t y . Francisco, Calif. HISTORY AND DEVELOPMENT Chinese medicine is a comprehensive form of healthcare t h at has been in continuous use for more than 23 centuries. ho comes for , and why? A Codified during the Han Dynasty in the second century BC, the menopausal woman with heaving mood Huang Di Nei Jing Su Wen articulates the fundamental philosoph- swings and drenching hot flashes seeking an ical, diagnostic, and therapeutic concepts that form the basis of a l t e r n ative to hormone replacement thera- clinical practice today. Over the last millennia, this system has py, an asthmatic child reacting poorly to pre- been carried throughout , Eu rope, India, , and the scriptionW medication, a man with a history of unexplained bone Americas. Records from the mid-19th century indicate that tra- f ra c t u res, a woman undergoing chemotherapy with pro f o u n d ditional Chinese doctors in Oregon and Idaho successfully treat- f atigue, a computer pro g rammer disabled by hand and wrist ed re s p i rat o ry, digestive, and re p roductive as well as pain, and a man tormented by anxiety attacks are all likely can- a rthritis and symptoms of card i ovascular . Because the didates. Chinese achieved such success with their“barefoot doctor” pro- Whatever the complaint, the preponderance of those enter- g ram in the 1960s, the Health Or g a n i z ation (WHO) has ing the acupuncture and in the hav e supported the dissemination of Chinese traditional medicine in a l ready been seen by . They venture beyond conven- developing countries. tional medicine because nothing else has worked, because they In the United States the popularity of acupuncture mush- hope for an alternative to pharmaceutical or surgical interv e n- roomed after diplomatic re l ations with China were normalized tions, or to complement their present therapeutic re g i m e n . in 1971. Americans were introduced to it when New York Times Ac c o rding to Harva rd re s e a rcher David Eisenberg, M D, 96% of journalist James Reston was tre ated for postsurgical pain while the 22 million Americans who sought an alternative thera p y on assignment in China, and he reported, “I’ve seen the past and p rovider in 1990 were also under the care of a conventional it works!” Chinese medicine, how e v e r, is not limited to pain (note 1). management. For more than a decade, WHO has listed problems Sometimes acupuncture and are used in tandem with such as bronchitis, flu, arthritis, stroke, infert i l i t y, dizziness, p rescription drugs; sometimes they can replace them. This insomnia, and depression as amenable to acupuncture . determination is made with careful consideration and ideally is Acupuncture is also used in alcohol and drug detoxification pro- monitored by a cooperative . grams, where it has reduced recidivism.1 Over the course of 21 years of practice, the authors hav e More than two dozen US schools have 3- or 4-year academic obs e r ved that usually, but not always, Chinese medicine (note 2) and clinical pro g rams which, upon completion, qualify gra d u- helps. It appears to relieve symptoms, increase physiological com- ates for licensing exams in acupuncture in 25 states. There are now about 10,000 acupuncturists nationally. Nu m e rous schools of thought and diverse methods are found within the vast historical of Chinese medicine. It has never been, nor is it today, a monolithic institution; millions

Correspondence: Chinese Medicine Works, 1201 Noe Street, San Francisco, CA 94114. of doctors over several millennia have practiced its techniques, Reprint requests: InnoVision Communications, 101 Columbia, Aliso Viejo, CA 92656. Phone (800) developing and disputing its theories. Like those of Western med- 899-1712. Fax (714) 362-2020. icine, its methods and interpret a tions are in constant evol u t i o n .

44 ALTERNATIVE , MARCH 1995, Vol. 1, No. 1 Chinese Traditional Medicine: An Introductory Overview Although this pluralistic body of knowledge contains many the language of Chinese medicine is based on metaphors fro m explanatory models within it, they exist within the framework of n at u re. Each person has a unique terrain to be mapped, a a common logic. resilient yet sensitive ecology to be maintained (Fi g u re 2). As a g a rdener adjusts irrigation and applies compost, so the tra d i- COMPARING EASTERN AND WESTERN tional Chinese doctor uses acupuncture, herbs, food, massage MEDICAL CONCEPTS (), and exercise (Tai Chi and Gong) to recover and pre- Chinese medicine holds assumptions that diverge funda- serve health. mentally from those of modern Western medicine. Health results from the proper balance of contending I n c o r p o ration of what is useful from this age-old system there- f o rces. In simple terms, diagnosis identifies imbalance, while f o re re q u i res acquistion of a conceptual vo c a b u l a ry foreign to treatment seeks to restore harmony. Whereas in Western medi- our own. The ideas that form the ground of a culture are so cine, diagnosis is an attempt to name disease, in Chinese medi- taken for granted that, like air, water, or gravity, other legitimate cine the goal is to recognize patterns of disharmony. Health is systems of meaning are difficult to imagine. Ap p re c i ation of considered to be the ability of the organism to respond appropri- Chinese medicine involves a willingness to entertain the possibil- ately to a wide variety of challenges while maintaining equilibri- ity of merit in a point of view that differs from our own. um, integrity, and coherence. Every medicine is a language that presupposes the nature of Ontology and are closely linked: how people get the universe and, like religion, assumes tremendous power in a sick is inextricably tied to who they are. Chinese medical think- culture. It determines how we are born and how we die, defines ing is holographic: each aspect of bodily life reflects the whole of health and sickness, and sets standards for how we care for our- which it is a part, all parts are in constant interaction with each selves day to day. Most important, medicine explains us to our- o t h e r, and universal patterns are re p l i c ated at every level of selves, establishing the categories within which we manipulat e human existence. The categories of classification in Chinese and construct our reality, how and what we name things. Every medicine are interdependent, exist along a continuum, and are medicine reflects cultural values that are held sacred. neither fixed nor absolute. The body is viewed more as a func- The Cartesian model, from which modern medicine tional entity than a structural one (Table 1). emerges, pictured the world as a machine. Reality is located in the tangible stru c t u re of matter: that which can be measure d , Body Constituents: Shen, Qi, Moisture, Blood, Essence quantified, and analyzed. Descartes unequivocally separat e d Just as nature is the manifest union of Heaven and Earth, a mind from body, because consciousness could not be under- person embodies the fusion of Shen (psyche) and Essence (soma) stood solely by physical eva l u ation. The body, perc e i v e d (note 3). As a landscape includes air, river, and soil, a human mechanically, was reduced into smaller and smaller constituent being is composed of Qi (pronounced c h e e), Moisture (body parts (Figure 1). fluids), and Blood (tissue) (Figure 3). These basic constituents exist along a continuum that MAJOR CONCEPTS ranges from intangible to tangible: Shen, or Mind, re p re s e n t s OF TRADITIONAL CHINESE MEDICINE the nonmaterial expression of the individual; Qi, the animating Chinese medicine rests upon another set of assumptions.2 force that manifests as activity (moving, thinking, feeling, work- Within the Eastern worldview, the human being is a microcosm, a ing) and warmth; Moisture, the liquid medium that protects and universe in miniatu r e, the offspring of Hea ven and Earth, a fusion lubricates tissue, is tangibly more dense than Qi but less so than of cosmic and terrestrial forces. People are recognized as beings Blood; Blood, the material out of which bones, nerves, skin, with a self-awa r e mind cast in physical form. The unseen and the muscles, and organs are cre ated, is yet more substantial; and seen, psyche and soma, are mutually valid and cogenerati v e . Essence (J i n g), the most dense substance, is the fundamental W h e reas Western medicine relies on Cart e s i a n - New t o n i a n seed of reproduction and regeneration from which the physical science, Chinese medicine is embedded within a philosophy of body arises. nature. A postulate of Chinese medicine is that by observing pat- The phrase Shen-Jing refers to the Yan g - Yin totality of a per- terns in the nat u ral world, the dynamics of human nat u re are son; Shen is the organizing force of the self reflected in the men- k n own. As above, so below. The world is a single, unbro k e n tal, emotional, and expressive life, and Jing or Essence refers to w h o l e n e s s — Ta o — t h at exists within. Chinese medical logic physical struc t u r e and sensate life. Qi can refer to vital functions relies upon correspondence thinking: things that correspond to (like movement and warmth) as well as the aggreg a te sum of life the same thing correspond to each other. Life arises from the pr ocess and the organism’s motive force. A Taoist text reads, “Tao magnetic interplay of the polar forces Yang and Yin, Heaven and or i g i n a ted from Emptiness and Emptiness produced the universe. E a rth, heat and cold, sun and shadow, dryness and wetness, The universe produced Qi… That which was clear and light drift- summer and winter. Just as these divisions are relational, so all ed up to become heaven [Shen, psyche], and that which was living processes are seen as a mosaic of connected relationships he a vy and turbid solidified to form earth [Essence, soma].” and conditions. Qi is considered to be both ethereal and substantive. In short, the is viewed as an ecosystem, and H a rva rd Sinologist Nathan Sivin says this is a difficult idea for

Chinese Traditional Medicine: An Introductory Overview ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No. 1 45 W E S T E A S T Body As Machine Body As Garden

Outlook of Outlook of medicine = medicine = War-on-disease Cultivate with doctor as health with general, disease Health = doctor and Health = as enemy, absence of patient in integrity, patient as disease and partnership to adaptability, occupied functioning improve eco- continuity territory–goal within logical condi- is to eradicate normative tions–goal is symptoms and parameters to enhance maximize self-regulatory performance capacity

FIGURE 1 Body as machine. The body is like a machine that can be FIGURE 2 Body as garden. The human landscape embodies the pri- dismantled and reduced into smaller and smaller constituent parts mal forces in nature–Wood, Fire, Earth, Metal, Water–that organize with the heart as pump, the lungs as bellows, the joints as gears and the body’s inner air, rivers, and mountains. Five functional systems levers, the nervous system as electrical circuitry, the brain as comput- called Organ Networks–the Liver, Heart, Spleen, Lung, and er, the eye as camera, the stomach as chemical beaker, the intestines Kidney–govern particular tissues, mental faculties, and physiological as plumbing, and the liver and kidneys as filters. (Figures 1 and 2 activities, generating and regulating the body’s constituents–Shen, Qi, used with permission.2) Moisture, Blood, and Essence.

46 ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No. 1 Chinese Traditional Medicine: An Introductory Overview TABLE 1 Assumptions E A S T W E S T

Assumptions of holographic model Assumptions of biomechanical model Humans are a microcosm of nature Humans are an autonomous system within nature Reality is one unified matrix within which all things are connected Reality can be reduced into smaller and smaller discrete and cogenerating constituents and substantiated concretely Seen/unseen, Earth/Heaven, Yin-Yang, soma/psyche are contend- The composition of matter, fixed and unchanging, can be ing dualities in a continuous process of transformation that can be measured, quantified, and replicated described and understood Functional interactions – Process – Pattern Mechanical structures – Substance – Evidence Each person has a unique terrain to be mapped–a resilient, sensitive Uniformity of body parts allows for standardized procedures ecology to be maintained Thinking: holistic, both/and, syncretic Thinking: reductive, either/or, synthetic Knowledge is subjective and relative Knowledge is objective and absolute Cyclical progression of events: mutual arising and recurring Linear progression of events: cause and effect “The mechanical view of the world simply did not develop in “All science is certain, evident knowledge. We reject all knowledge Chinese thought, and the organiscist view in which every phenome- which is merely probable and judge that only those things should non was connected with every other...was universal among Chinese be believed which are perfectly known and about which there can thinkers...The harmonious co-operation of all beings arose, not be no doubts.” –Descartes from the orders of a superior authority external to themselves, but “I do not recognize any difference between the machines made by from the fact that they were all parts in a hierarchy of wholes form- craftsmen and the various bodies that nature alone composes.” ing a cosmic and organic pattern and what they obeyed were the –Descartes internal dictates of their own natures.” –Joseph Needham “There is nothing in the concept of body that belongs to mind; and “Illnesses may be identical but the persons suffering from them are nothing in that of mind that belongs to the body.” –Descartes different. The emotions and excesses affecting people are not the same. If one treats all patients who appear to suffer from one identi- cal illness with one and the same therapy, one may hit the nature of the illness, but one’s approach may still be exactly contraindicated by the influences of Qi that determine the condition of the individ- ual patient’s body.” –Hsu Ta-ch’un in 1757

moderns, with their clear distinction between substance and Blood. Depletion to weakness, fatigue, frequent illness, poor function—but Qi is synchronously “what makes things happen a s s i m i l ation, and inadequate blood flow. Congestion results in in stuff,” “stuff that makes things happen,” and the “stuff in stiffness, pain, abdominal distension, irritability, and swelling. which things happen.”3 This lack of distinction can be likened to Blood governs tissue, Moisture engenders fluid, and Qi ini- the modern physicist’s inability to distinguish particles fro m tiates the activity of the body in the process of forming itself. The w aves. There are different forms of Qi: condensed, Qi assumes body is completely dependent on their interaction. Wi t h o u t physical form, but it manifests also as mind and the ineffable proper Moisture, the Qi becomes hot and agitated and the Blood quality we call spirit. Types of Qi include inherited, nutritive, dries up and congeals. Without Blood, Moisture is dispersed and respiratory, and defensive. Its functions are to transform, trans- Qi is scattered. Without Qi, Moisture and Blood stagnate, coagu- port, contain, lift, protect, and warm. of Qi manifest late, and cease circulating. All functions and processes are cogen- as deficiency, collapse, stagnation, and rebellion. erating and mutually regulating. Put simply, health exists if adequate Qi, Moisture, and Blo o d But Qi may also imply the totality of Blood, Moisture, and a re distributed equitably and smoothly. Symptoms as varied as Qi—the sum of the life of the organism. Just as ice, wat e r, and joint pain, edema, dizziness, dyspepsia, and cough occur when steam are three manifestations of the same molecular entity, so this circ u l ation is disrupted. Illness is understood as a conse- Blood, Moisture, and Qi are three manifestations of the same quence of either depletion or congestion of Qi, Moisture, and “life force,” the coalescing of Yin-Yang in human shape.

Chinese Traditional Medicine: An Introductory Overview ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No. 1 47 Organ Networks: Liver, Heart, Spleen, Lung, Kidney Thus, the Kidney Net w o r k includes, yet extends beyond, fluid Nat u re can be further differe n t i ated, beyond the duality of metabolism, which we in the West associate with the kidneys. The Yi n - Yang, into five primal powers (wu-xing)— W ood, Fir e, Earth , Kidney stores the Essence that is responsible for re p ro d u c t i o n , Metal, and Wate r . Corres p o n d i n g l y , the body is divided res p e c t i v e - g rowth, and re g e n e ration. It controls the teeth, bones, marrow, ly into five functional systems known as Organ Net w o r ks: Liver, br ain, inner ear, pupil of the eye, and lumbar region, and is associ- He a rt, Spleen, Lung, Kid- ated with the state of alarm, n e y. Th es e Ne t w o rk s the will, and the capacity for re g ul ate the basic con- sharp thinking and perc e p- stituents—Shen, Qi, Mois- Shen: (Heaven) tion. Problems such as ret a r d- t u re, Blood, and Essence the integrative quality known as mind, ed growth, ringing in the ears, spirit, intelligence and the capacity for self- —organizing them into the i n f e rt i l i t y, low back pain, awareness: psyche complex life of the body. p a ranoia, fuzzy thinking, Each Organ Ne t w o rk weak vision, apathy, and des- Qi: (air) refers to a complete set of the animating force that is expressed pair are viewed as symptoms functions, physiological through all living processes–movement, of impaired Kidney Ne t w o rk and psychological, rat h e r warmth, thought, sensation, and emotion fu n c t i o n . than to a specific and dis- The He a rt not only pro- c rete physical stru c t u re Moisture: (inner sea) pels blood through the ves- fixed in an anatomical loca- the liquid medium that lubricates mem- sels, but harbors the Shen tion. These systems are branes, sheaths, joints, body cavities, and is and governs the mind. identified by the name of the source of all body secretions Symptoms as varied as panic, the Yin Organ, but include restless sleep, angina, and a paired Yang Organ as well Blood: (terrain) p a l p i t ations occur when the as corresponding mental the material out of which tissue (bones, Heart is agitated. The Spleen faculties, emotional stat e s , nerves, skin, muscles, and organs) forms as is in charge of the assimila- tissues, sense organs, and well as the vehicle of the mind tion of food and fluids, as channels within their well as ideas. When this s p h e r e of influence. Essence: (core) Organ is disturbed, indiges- Whereas in Western physi- the fundamental material matrix that tion, bloating, fatigue, scat- o l o g y, thoughts and feel- engenders and sustains reproduction, t e red thinking, and poor ings are localized in the growth, maturation, and regeneration: c o n c e n t ration ensue. The b rain, in the Chinese view soma Liver is responsible for the they exist in the realm of s t o rage of Blood, flow of Qi, the Organ Ne t w o rks, and FIGURE 3 Five body constituents: a continuum from lesser to and evenness of tempera- greater density and substantiality their expression is attribut- ment. When the Liver is able to the character of the thwarted, tension in the neck Organs and their re c i p rocal interactions. Thus, emotions affect and shoulders, high blood pre s s u re, headaches, cra m p i n g , the state of each Organ Ne t w o rk, and by tre ating the Or g a n s , moodiness, or impulsive behavior follow. The Lung sets the body emotional and mental processes can be modulated and rhythm, defends its boundaries, and affords inspiration. A trou- enhanced. bled Lung might trigger tightness in the chest, skin rashes, vul- To summarize these re l ations: the Liver Ne t w o rk gov e r n s nerability to colds or influenza, rigid thinking, and melancholy. Blood; tendons and nerves; the volume, pres s u r e, and evenness of ci rc u l a ting Qi and Blood; and temperament and judgment. It is Pathological Conditions: Cold, Heat, Damp, Dry, Wind damaged by excessive anger and frus t r ation. The Hea r t gove r n s In nat u re, extreme wind, dampness, dryness, heat, and the Shen; arteries; the propulsion and perfusion of Blood; joy, cold wreak havoc in the world. These same forces derange bal- clear perception, and intuition. It is damaged by ove r s t i m u l at i o n . ance within the human body, weakening or ob s t ructing the The Spleen governs Moisture, muscles and flesh, assimilation of m ovement of Qi in the Organs. As wind shakes trees, scat t e r i n g nutrients, and the capacity for thinking and remembering. It is l e aves, internal Wind manifests as vert i g o, unsteady mov e m e n t , damaged by worry and inertia. The Lung governs the Qi, skin and and trembling. As sat u rated earth generates swamps, so body hair, the rhythm and tempo of res p i r ation and circu l at i o n , Dampness becomes edema and phlegm. As aridity withers veg- and subconscious drives and appetites. It is damaged by exce s s i v e e t ation, so Dryness causes chapping or cracking of mucous grief and longing. The Kidney governs the Jing necessary for m e m b ranes. Just as ice inhibits the rush of winter water in a development; bones, marrow and brain; and instincts. It is dam- s t ream, so internal Cold re t a rds circ u l ation and depre s s e s aged by ov e rw o rk and pessimism (Fig u r es 4 and 5). metabolism. And just as fire scorches the earth, so internal He at

48 ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No. 1 Chinese Traditional Medicine: An Introductory Overview m ay inflame tissue or generate fever. kidney stones, mental illness, epilepsy, or nodular deformities These internal and external pathogenic agents also con- and cysts. Dampness and Phlegm are similar, but Dampness tribute to the congestion or depletion of body constituents. tends to affect the lower body, whereas Phlegm invades the upper Chinese medicine identifies five pernicious body climates as Cold, bo d y . Signs of Damp-Hea t are signaled by red, painful swelling, Hea t, Wind, Dampness, and Dryness. When fire the skin, thick discharge, blisters as in herpes, and inflammations such as it causes redness, swelling, p ro s t atitis, jaundice, dysen- and pain. Ac c o rding to cor- te r y, and bron c h i t i s . respondence logic, when D ryness damages fluids these symptoms arise spon- Fire: Heart and is manifested by symp- t a n e o u s l y, they are due to propels the Blood and envelops the Shen, estab- toms of dehydration such as the pathogenic influence of lishing communication with all parts of the psy- brittle hair and nails, wrin- internal fire, or He at. The che and soma kled, cracked skin or mu- s o u rce of this fire cannot cous membranes, irritat e d necessarily be seen, but its Metal: Lung e yes, dry stool or constipa- governs respiration, the rhythmicity of bodily effects can be ob s e rv e d . tion, lack of perspirat i o n , processes, circulates Moisture and Qi, and Because He at produces in- maintains defensive boundaries , and scant urine. fl a m m ation and agitat i o n , D ryness can generate irrita- such symptoms are re f e r re d tion, inflammation, and Earth: Spleen to as signs of Hea t. He at due to lack of lubrica- digests and assimilates nutrition, distributes S i m i l a r l y, a person fluids, maintains stability, density, and viscosity tion and secretions; He at exposed to icy weather shiv- of tissue and fluid may to Dryness. ers and becomes lethargic, Supplementing Moisture dull, and unre s p o n s i v e . Wood: Liver will relieve Dryness, just as When these symptoms arise regulates the volume of circulating Blood, e l i m i n ating Moisture will re g a rdless of the external smoothes the circulation of Qi, nutrifies the c o u n t e ract Dampness. The t e m p e rat u re, the person is Blood, and tempers emotions principle of complementari- manifesting the condition of ty applies: for Cold, warm; Cold. Coldness is associated Water: Kidney for Heat, cool; for congested with low e red metabolic stores the Essence, regulates growth, develop- Qi, Moisture, or Blood, en- a c t i v i t y, depressed mental ment, fertility, sexual capacity, and the elimina- c o u rage movement; for function, re t a rded circ u l a- tion of surplus fluid depletion, nourish; for inter- tion, weakness, and malaise. nal Wind, subdue; for exter- J e rky movement, dizzi- FIGURE 4 Five Organ Networks nal Wind, relieve surf a c e ness, incoordination, or dis- congestion; and for Phlegm, c o m f o rt that migrates fro m dissolve. one region to another, appearing and disappearing suddenly, DIAGNOSIS suggests the presence of Wind. External Wind manifests as sore- Diagnosis seeks to determine the prevailing balance within ness, tightness, itching, and sensitivity of the skin and muscles. the ecosystem of an individual by assessing the quantity and The common cold is an example when symptoms include dizzi- quality of Qi as it affects the channels and Organs. The physician ness, migrat o ry pain in the joints, muscles, and head. Internal uses himself as an evaluative instrument, using sense modalities Wind is characterized by labile emotions, vert i g o, spasm, and to glean the essential clinical information necessary to formulate emotional instability. Chills, body ache, and clear, runny secre- a diagnosis and treatment (Table 2). tions are indicative of Wind-Cold; fever, thirst, stuffy nose, sore involves palpation along the radial artery at t h ro at, and ye l l ow secretions indicate Wi n d- He at. Win d- D a m p six positions and two depths. The positions reveal the state of p roduces neurologic disorders such as clumsiness, numbness, the Qi and Blood within each Organ Network. Variable rates and p a ralysis, disequilibrium, headache, vert i g o, joint pain, and qualities of the pulse provide information such as depletion or muddled thinking. congestion of the Organ Ne t w o rks and the presence of pat h o- Dampness appears as swelling and a sense of fullness, heav- genic factors such as Wind or Heat. For example, a rapid pulse iness, or indolence. It can appear on the surface of the body as i n d i c ates hyperactivity and He at (Ya n g), whereas a slow pulse, oily skin, sticky perspiration, and subcutaneous edema, or hypoactivity and Cold (Yin). instead as joint swelling, cloudy urine, and malodorous vaginal Inspection of the tongue—ob s e rving its size, shape, and discharges. t e x t u re as well as the quality of its fur—reveals the severity, Congealed Moisture becomes Phlegm, recognized by heavi - nature, and location of illness. A pale tongue with white fur indi- ness of the head and limbs, dull pains, abundant sputum, gall or cates the presence of Cold, whereas a red tongue with yellow fur

Chinese Traditional Medicine: An Introductory Overview ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No. 1 49 indicates Heat. A flabby or thin tongue indicates deficiency of Qi ing of the Organ Networks associated with the channels and, by and Blood, whereas a tense or swollen tongue suggests conges- so doing, enhances the self-re g u l at o ry, self-protective, and self- tion of these constituents. A quivering or rigid tongue indicates aware capacities of the organism. the presence of Wind. The para d i g m atic models within the acupuncture field are Feeling the temperature, tone, and moisture of the skin and diverse. The languages of the explanat o ry models differ: the muscles, testing the flexi- neurohumoral from the auto- bility of the joints, and nomic nervous system to the p robing the sensitivity of Fire: Heart e l e c t romagnetic or the holo- South • Summer the acupuncture points g ra p h i c .4 A neuro p h y s i o l o g i c and channels provides fur- effect of acupuncture 5 h a s ther information about the been demonstrated to be the s t ate of the Organ Ne t- release of neuro t ra n s m i t t e r s w o rks and the presence of such as endorphins. Al- pathological conditions. Shen though thousands of clinical Diagnostic e g o r i e s human trials have been con- can be corre l ated with Wood: Liver Metal: Lung ducted in China, re l at i v e l y c o n fi g u rations of symp- East • Spring Earth: Spleen West • Autumn few in this country have been toms. For example, blurry Center • Transition published. vision, restless sleep, mus- cle cramps, irritability, pal- Remedies and p i t ations, and emotional Supplements sensitivity are all indica- Western pharmaceutical tions of deficient Bl o o d . d rugs capitalize on a single Because the Liver store s biologically active ingre d i e n t the Blood, many of these Moisture that produces a specific phys- iologic effect. This accounts symptoms appear again Blood under the cat e g o ry of dis- Qi for their potency but also for turbed Liver function. their secondary, or side, effects. Although drugs often TREATMENT Essence c o n t rol symptoms, they do Acupuncture not alter the pat h o l o g i c Organ Networks com- process ( eliminate m u n i c ate with each other Water: Kidney bacteria but do not increase a via an invisible web of North • Winter p e r s o n ’s resistance to infec- channels that transport Qi. tion; diuretics rid the body of FIGURE 5 Five primordial powers, cycles, Organ Networks, Ac u p u n c t u re points are and body constituents excess fluid without strength- l o c ated in small depre s- ening kidney function; as- sions in the skin called shu pirin controls arthritic pain ( h o l l ow). Access to the internal circ u l ation of Qi and Blood is without altering the degenerative course of the disease). achieved by inserting sterile, solid, slender stainless steel needles Sometimes further aggravations or adverse effects ensue (ye a s t at these sites for the purpose of adjusting the flow of Qi within may follow a course of antibiotics; kidney damage may the channels associated with the Organ Ne t w o rks. This tech- follow long-term diuretic use; erosion of the stomach lining from nique influences not only functional or biodynamic pro c e s s e s long-term aspirin use may trigger internal bleeding). but stru c t u ral elements along and in proximity to the channels With herbs, active ingredients are enfolded within the themselves. whole plant, and this tends to buffer their . Also, Acupuncture and are known to be helpful herbs are often blended together to counteract undesired effects in problems as varied as developmental ret a rd a tion in childre n and enhance intended results. Chinese herbs address the under- resulting from birth injury, meningitis, pain, infert i l i t y, colitis, lying condition as defined by traditional diagnosis and, when stroke, flu, despair, irritability, and the side effects of chemother- used properly, rarely cause disagreeable consequences. apy and radiation. Certain herbs are nutritive—more like foods than drugs— Pain is considered to be due to congested Qi, Moisture, and as such can supplement the diet as well as prevent or reme- and Blood, and weakness, from their inadequate supply. Ac u- dy ailments. Sometimes long-term herb use is advisable, whereas puncture increases the circulation of these constituents, relieving extended use of pharmaceuticals might not be healthy. Other s t a g n ation and ob s t ruction. It stimulates the optimal function- herbs function in ways we do not associate with food, such as

50 ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No. 1 Chinese Traditional Medicine: An Introductory Overview TABLE 2 Patient assessment

Et i o l o g y: Pat h o g e n i c In fl u e n c e s Pathological Patterns External Internal Miscellany Organ Networks Wind Frustration and rage Diet Liver Depletion • Congestion • Conflict with Spleen and Lung Heat Pleasure and frenzy Living habits Heart Depletion • Congestion • Conflict with Lung and Kidney Dryness Sadness and grief Work, exercise, recreation Spleen Depletion • Congestion • Conflict with Kidney and Liver Humidity Worry and anxiety Environment (social) Lung Depletion • Congestion • Conflict with Liver and Heart Cold Fear and fright Hereditary and congenital Kidney Depletion • Congestion • Conflict with Heart and Spleen conditions Body constituents Shen Disturbance, detachment Qi Moisture Deficiency, stagnation Blood } DIAGNOSIS Essence Erosion Observing: eyes, tongue, nails, hair, gait, stature, affect, posture Yin/Yang Yang: exhaustion of vital heat Listening and smelling: sound, strength, and rhythm of voice, Yin: exhaustion of vital fluids breath, odor of breath; skin; excretions, secretions Adverse conditions Interrogating: current complaints, family and childhood health his- External Wind tory, inventory of body functions (ie, sleep, appetite, elimination, Internal Wind menses), quality of mental faculties, sensory modalities, emotional Heat states and responses Cold Palpating: pulse, channels, muscles, joints, back, chest and abdomen Damp-Heat Phlegm

ridding the body of something unwanted, like He at (anti- shoulder muscles, stiffness of the lower back, and tightness and i n fl a m m at o ry) or Dampness (diuretic). Herbs tend to hav e soreness of the Achilles tendons. g re ater concentrations of nonnutritive compounds than do EF’s history of sexual frustration and hyperactivity, together foods (ie, glycosides, resins, , polysaccharides, and ter- with his tense neck, painful Achilles tendons, poor circulation in penes), which contribute to their effectiveness as medicine, that the extremities, tight Liver pulse, and redness on the sides of the is, a substance capable of promoting a desirable biologic process tongue indicated Heat and congestion of the Qi and Blood of the or altering a pathologic one. Chinese herbs are usually combined Liver Ne t w o rk. His bladder discomfort, stiff back, deep, thin, into formulas and made into tea, packaged pills, or bottled liq- and tight Kidney pulse indicated weakness of the Kidney uid extracts (note 4). Ne t w o rk. The flatulence and indented and flabby tongue, with ye l l ow, sticky fur, reflected a weakness of Qi and congestion of CLINICAL PRACTICE: CASE ILLUSTRATIONS Heat and Dampness in the Spleen Network. EF: Prostatitis The diagnosis was chronic congestion of Liver Qi, leading EF, a 47-year-old man, had chronic prostatitis since his early to weakening of the Spleen and Kidney and the accumulation of 20s. He re p o rted that pain and discomfort in his pro s t ate were D a m p - He at in the genitourinary system. Tre atment ob j e c t i v e s p re c i p i t ated by feelings of anger and incomplete ejaculat i o n . were to disperse the congested Qi of the Liver, purge Damp-Heat Originally his complaints were associated with frequent sexual f rom the pelvic region, and strengthen the Spleen and Kidney. arousal without ejaculation, accompanied by feelings of frustra- Weekly acupuncture treatment and twice daily ingestion of 4 mL tion and rage. As a child EF had had frequent ear infections and of compound herbal extract resulted in complete remission of was considered to be hyperactive. He complained that his blad- symptoms after 2 months. der was uncomfortable when full, his hands and feet chilled easi- ly, his neck and shoulder muscles were chronically tense, and he JL: Menopausal Mood Swings was often flatulent. His pulse was generally tight, especially in JL was a 56-ye a r-old woman who reacted poorly to hor- the position of the Liver, his Spleen pulse was thin and slippery, mone replacement thera p y — n a m e l y, she gained weight, had and his Kidney pulse was deep, thin, and tight. EF’s tongue was edema, cystitis, severe menstrual cramping, bleeding gums, red at the tip and sides with teeth marks along the edges, and breast pain, and abnormal body swelling. Yet JL was desperate to flabby in tone, with sticky ye l l owish fur at the center and ro o t . stabilize her vo l atile mood swings and end her fitful spells of Ex a m i n ation of the body revealed tenderness of the neck and weeping, which hormone replacement therapy had helped.

Chinese Traditional Medicine: An Introductory Overview ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No. 1 51 Without hormones, her moods were again intolerable, dre n c h- c h e m o t h e ra p y. After a month of weekly acupuncture visits and ing hot flashes woke her several times a night, she had a flare-up daily doses of 9 mL of compound herbal extracts, her creat i n i n e of chronic arthritic pain, and her memory worsened dramatical- level dropped to 2.3 mg/dL, the lowest it had been in 3 years, she ly. JL had a history of bronchitis, asthma, tendinitis in the right was no longer short of brea th and was able to tolerate continued s h o u l d e r, pain in the elbow, index finger, and foot, leg cra m p s , ch e m o t h e ra p y . For RG and BR, Chinese medicine produced tangi- and hip replacement at age 39 due to arthritic degeneration. ble, dram a tic, and measurable benefits without necessarily rev e r s - J L’s pulse was generally tense, pounding, and weak under ing the disease process. For others, anxiety attacks, chronic fati g u e , p re s s u re. Her Spleen pulse was slippery, her Lung pulse was high blood pres s u r e, and arthritic pains subside altogether. small and thin, her Kidney pulse was deep and feeble, her Liver pulse was large and ro p e y, and her He a rt pulse was tense, APPLICATION BY WESTERN PRACTITIONERS inflated, and uneven. Her tongue was swollen, flabby, and pale, L a r ry Baskind and Stephen Cowan, pediatricians in the with a red tip and greasy yellow fur. Her flesh was puffy, flaccid, Hudson Valley of New Yo rk, have incorporated Chinese herbal and tender, and her hands and feet were warm. medicine into the management of a variety of common pediatric In Chinese medicine menopause is considered to be a result illnesses including otitis media, asthma, colic, sinusitis, tonsillar of the decline of Kidney Essence. Because the Kidney Essence is hypertrophy, and seasonal rhinitis. They have also used herbs as the source of Blood and Qi for the other Organs, its insufficiency a component in the tre atment of neurodevelopmental condi- will result in dysfunction of those Organs, especially the Liver tions such as attention deficit disord e r. They summarized their and He a rt. The history of JL’s early development of art h r i t i s , approach by saying, “If it helps our patients, we’ll use it. Herbal along with the deep and feeble Kidney pulse, confirmed the remedies are gentle, and kids are re m a rkably responsive to c h ronic deficiency of the Kidney Ne t w o rk. The puffiness of the them. We have not seen any of the adverse effects associat e d limbs, swollen tongue, greasy fur, and slippery Spleen pulse sug- with prescription and ov e r- t h e -counter medications. For us, gested that weakening of the Spleen had led to generalized stag- t h e re’s really no such thing as ; there’s just n ation of Moisture. The vo l atile moods, leg cramps, tendinitis, effective, compassionate patient care.” and large, ropey Liver pulse indicated that the Liver Ne t w o rk How the human body is perceived and explained varies East had been severely congested, leading to the accumulation of and West, as do the methods used to treat illness. What remains internal Heat and depletion of Blood. The inflated, tense, uneven the same are patients and their quest. Incre a s i n g l y, We s t e r n e r s quality of the He a rt pulse, weepiness, re d-tipped tongue, and are exploring and manipulating a vastly different ground of sym- poor memory reflected instability of the He a rt due to exc e s s i v e bol and metaphor so that they can use Chinese medicine as He at, deficient Blood, and stagnation of Qi. Fi n a l l y, the small, either a primary therapy or as part of their conventional thin Lung pulse was congruent with JL’s history of asthma and Western practice. bronchitis. The greasy, yellow tongue fur indicated Damp-Heat. The hot flashes, sweating, and mood swings were intense and Notes unpredictable because of the obstruction of the circulation of Qi 1. Lecture, Philosophy and Medicine Series, California Pacific Medical and Blood and because of the fundamental Kidney weakness and Center, San Francisco, Calif, September 29, 1994. severe body congestion. 2. Known as the methodology of traditional medicine, originating in ancient China, this term refers to a system of thinking and practice rather than to The objectives of treatment were to strengthen the Kidney c u r rent medical convention in China. Many other countries in Asia have now Ne t w o rk, combined with aggressive purging of Damp-He at , contributed to the development of the body of knowledge and the techniques decongesting of Blood and Qi, pacification of the He a rt, and that are here referred to as Chinese medicine. 3. Specially defined Chinese medical terms are capitalized throughout the strengthening of the Liver and Spleen. Weekly acupuncture ses- text to differe n t i ate them from their common meaning, such as heart as an sions and 10 mL per day of compound herbal extract in four an a tomically located organ in the chest versus Heart as an Organ Netwo r k , or wind divided doses produced relief of mood disturbances within 2 th a t wafts through trees versus Wind as an adverse pathological phenomenon. 4. Information about an integrated herbal system formulated by the weeks. Within 3 months, JL’s hot flashes, night sweats, and mus- authors and accompanied by the text “Chinese Modular Solutions Handbook for cle and joint pain ceased. In addition, the frequency and severity Health Professionals” is available by calling (800) 543-5233. of her bronchial illnesses diminished markedly. Chinese medicine is neither panacea nor . For exam- ple, RG has been living with hepatitis C for 12 years. Having had a course of acupuncture and Chinese herbal therapy for the prev i o u s Ref e re n c e s ye a r, his liver enzymes were substantially lower than they had 1. Bullock ML, Culliton PD, Olander RT. Acu p u n c t u r e trea tment of alcoholic rec i d i v i s m : a pilot study. Alcohol Clin Exp Res. 198 7 ; 11 : 2 9 2 -2 9 5 . been in a decade. BR had been diagnosed with ovarian cancer 6 2. Beinfield H, Korngold E. Be t ween Hea v en and Earth: A Guide to Chinese Medicine. New years previously and tre ated with , ra d i ation, and Yor k, NY: Ballantine; 1991 . 3. Sivin N. Traditional Medicine in Contemporar y China. Ann Arbor, Mich: University of ch e m o t h e ra p y . She sought acupuncture and herbs when her mild Michigan; 198 7 : 4 7- 5 3 . congestive heart failure, secondary to cardi o m yo p a thy induced by 4. Kenner D. Taxonomy of acupuncture. Proceedings of the First Symposium of the Society for Ac u p u n c t u re Re s e a rch. January 23-24, 1993; Rockville, Md: Society for Ad r i a m ycin, and kidney problems as evidenced by a cre at i n i n e Acu p u n c t u r e Res e a r ch; 199 4 . level of 4.9 mg/dL disqualified her for another round of 5. Pom e r anz B, Stux. Scientific Bases of Acu p u n c t u r e. Berlin, Germany: Springer-Verlag; 198 9 .

52 ALTERNATIVE THERAPIES, MARCH 1995, Vol. 1, No.1 Chinese Traditional Medicine: An Introductory Overview