It would be tempting and easy from the outside to assume that Chinese medicine is a bunch of hogwash.
It would also be easy to assume that Chinese medicine is practiced by hippies wearing bird’s nests, putting crystals under their car seats, and calling in incantations to long-departed ancestors.
Fortunately, none of these things are the “real” Chinese medicine.
Unfortunately, Traditional Chinese Medicine has been suffering from a case of mistaken identity.
It’s my hope here that by the end of this article you’ll realize three things:
- Chinese medicine is based on science, and is clinically effective (e.g. it works)
- Chinese medicine has a different language (not the Chinese language) surrounding health, and illness
- Chinese medicine is misunderstood because, well, it’s misunderstood
Let’s jump in. This article is in-depth, so it might make sense to book mark it for later.
What the Heck is “Chinese Medicine?”
Chinese medicine differs from what you may know in a few key ways.
The primary way the Chinese looked at the world is a function of the underlying philosophy, medicine, and culture of the time. What’s called “western” medicine is also a product of the scientific revolution of the west.
It differs in a few key ways:
How it views illness, and health
How it treats illness and health
How it defines pathology and the progression of disease
1. Traditional Chinese Medicine Views Human Life, Medicine and Longevity Differently
Since conventional medicine is based on the underlying philosophy or scientific insight of the culture, Chinese medicine is no different.
Having been born out of Taoist, Confucian and some Buddhist (and other) concepts, there are a few big ideas that repeatedly crop up.
A. Humans Are a Microcosm of the Earth, and the Dao
There’s a saying in the Dao De Jing (道德經) which highlights this relationship:
人法地，地法天，天法道，道法自然 – Humans follows the way of earth, the earth follows the way of heaven, heaven follows the Dao, the Dao follows [its own] nature.
Whether or not we like hearing it, we humans are animals that still have to live by the laws of nature – sunrise, sunset, work and rest, sleep and activity, withdraw in winter, expand and become more active in spring.
The reason for understanding in a connected way that we are part of the greater whole is because going against universal laws produces illness. Understanding the way of nature, heaven, and the Dao mean we can prevent illness and live a long, healthy life.
B. We should align ourselves with the forces of the universe for longevity and wellness.
In the early chapters of the Huang Di Nei jing (黃帝內經), a key medical text, there’s a lot of discussion about the fundamental laws of the universe, and nature, and how going against them producing illness:
“The three months of spring are the time of renewal: the old and stale dissipates, heaven and earth come to life, and everything blossoms. Rest at night and get up early, stride freely through the courtyard, let your hair down and indulge in the leisurely feeling of a morning stroll; this is how you should raise your spirits in spring… Going against these characteristics of the seasonal flow will have harmful effects on the liver…At this time, it would be against the dynamics of nature to sit around dwelling on things and grow stagnant and depressed.” Translation by Dr. Heiner Fruehauf
Chinese medicine developed through observations of nature, the natural order, and through an understanding of the laws of the universe.
In other words, in conventional medicine, you rarely hear about the principles of medicine – how one ought to live in order to be healthy and life a quality life.
2. It’s All About That Qi
One of the most frustrating concepts to understand in the west is the concept of Qi (氣).
It’s most commonly translated as energy, in a physics sense, or bioenergy, however (like most concepts in Chinese medicine) it can’t accurately be translated. It’s the same dilemma as trying to translate concepts from other languages that have broader meanings, and don’t literally translate.
Sometimes, to help understand Qi, it helps to look at other (modern) Chinese words which also use the character.
Examples of Usage of “Qi” in Modern Chinese
- 生氣 – birth (生）+ qi (氣） ＝ to get angry
- 天氣 – sky/heaven (天）+ qi (氣) = the weather
- 呼氣 – to breathe out, exhale (呼）+ qi (氣) = to breathe out
Qi is a concept used to understand the fundamental nature of the universe – from air, to material things, to describe the varying levels of materiality. This is partly why trying to say “what is Qi?” is such a futile question.
Qi usually isn’t just one thing, and it’s not something you can just put in a jar – it’s usually described to illustrate a concept. (E.g. if you feel bloated and have a distended stomach, it’s qi stagnation (氣滯). Well, what’s that stuff made of? Is it gas? Food? All of the above? Something else?
Many concepts in Chinese medicine are broader than most scientists are comfortable with – Qi being a great example.
Classically, Chinese medicine understood illness and wellness through the movements of Qi. Looking at a clinically depressed person, you can see them slumped down, collapsed in on themselves – and one could describe the person by what’s going on with their Qi. In Chinese, this is called the Qi dynamic or Qi mechanism (氣機).
We’re going to talk about the changes of Qi later, but for example, how do you describe the changes in winter vs. spring? Obviously, the two are different right? They’re different in how they make you feel. They’re different in how animals and plants respond to the seasons – compare the dead of winter with the peak of spring – just the noise levels in the woods are a night and day difference.
Well, how do you describe that in plain English? In Chinese medicine, you can describe the change in the Qi of the season – winter is contracting, withdrawing, storing, while spring is expanding, growing, pushing outward. Can you see how hard of a concept that would be to translate? However, can you also see how useful it is to describe what’s going on?
- Ideal health is the free flow of Qi
- If a person feels a constant stuffy feeling in the chest, Qi is not flowing properly
- If a person feels bloated in their stomach or intestines, Qi is not flowing properly
- If a person feels a sharp pain in their ribs, Qi or Blood is not flowing properly
How does wellness come into the picture here?
Qi naturally flows in one direction when everything is okay within the individual. For example, the stomach naturally flows down – when it flows up, this is considered pathological, and might manifest as burping, vomiting, indigestion and so on.
So we can understand the natural flow of stuff in the stomach (Qi): it naturally flows down. When it flows up, the Qi is going in the wrong direction for some reason.
*Note: modern Chinese isn’t entirely the same as classical Chinese, however it helps here to understand the concept of Qi as stuff, and difficult to translate.
3. Health and Illness are Understood Through Relationships, Not Reductionism
A core difference in how Chinese medicine treats illness, and observes health, is that health is understood as the harmonious balance of relationships, rather than isolated parts.
For example, it’s typical in the west to look for the origin of a health problem where we feel the health problem. If I have a stomach ache, we assume something’s wrong with the stomach. If I have a foot ache, we look at the foot for the underlying issue. If I have a heart problem, we look at the heart.
In Chinese medicine, a skilled physician may not even look at the stomach for a stomach ache – but might look at the relationship between the stomach and liver. A common pattern is called “liver invading Spleen/Stomach,” (肝氣犯胃) and since the two share a relationship, treating the liver in Chinese medicine often effects an improvement in the digestive system.
An example of the controlling (剋) cycle in the five phases theory (五行).
A. Chinese Medicine Models Relationships Observed in Nature
Chinese medical concepts were originated from observing concepts and relationships in nature. For example, concepts of balance can easily be observed in nature:
- When predators like wolves die off, deer populations can become excessive, where they typically starve to death from the lack of food, or they die of disease. If we viewed this like medicine, there would be two ways to change the population here – change something about the wolves, or something about the deer. In Chinese medicine, organ systems are linked together – so based on the status of the “mother” or “child” organ, you can predict what’s going on in the other.
- Seasons all affect each other – if one season shows changes, there are often changes in the other seasons (e.g. a long summer may result in a change in winter, or the cultural belief about the groundhog seeing his own shadow)
- Dampness or dryness produce a certain set of environmental conditions in nature, resulting in new flora and fauna (like moss or cacti).
B. Health and Illness Are Understood Through The Relationship of Natural Elements – Like Dampness or Dryness
Moss image: Bob Blaylock
Excessive dampness in natural environments leads to the death of certain species, and the growth of certain others (like mold).
In addition, in the human body, a damp or moist environment not only worsens certain conditions (like digestive ones or asthma – related to water passage ways), it can predict them.
For example, the naturalist can predict that in the damp, pacific northwestern United States, there will be more algae, mold, and damp-adapted flora and fauna. As a result, he or she can also predict the exact kinds of animals and plants that may exist there.
The physician (knowing what creates “dampness” in the body) can predict what he or she will see in the patient’s body based on that relationship. In addition, the physician will know ahead of time how a diet or environment will affect the patient’s body based on this relationship.
C. The Physician Looks at Relationships Between The Organs
Building off of the above two concepts – relationships, and modeling the patterns found in nature – the physician looks at the relationships occuring in the body, and where there may be imbalance.
For example, look at the following patterns, which may seem illogical from a conventional medical approach, but are well documented within Chinese medicine:
Example: Liver overacting on spleen.
Symptoms: Diarrhea or constipation, abdominal distention and pain, fatigue.
If a person presented with these symptoms, a logical approach would be to see what’s going on with the person’s digestion, right?
In Chinese medicine, the treatment approach here could involve strengthening the spleen (called tonifying or supplementing (補), it would also involve a heavy emphasis on sedating what’s going on with the liver.
Compared to Conventional Medicinal Approaches
All of these concepts are wildly different from conventional medicine, where if your toe hurts, you see the “toe doctor,” if your stomach hurts, you see the “tummy doctor,” and if you have a headache, you see the “head doctor.”
In Chinese medicine, it’s well understand how the stomach might be the origin of your headache, or how the liver might be the origin of your stomach ache. To paraphrase Ida Rolf, founder of Rolfing:
“Where you feel the pain is not the origin of the pain.”
4. The Concept of Shen (神) “Spirit”
If you look at a person, without knowing anything about them, and you just get a lifeless feeling, an intuition that they are ill, how do you describe that?
In Chinese medicine, this would partly be called a person’s Shen (神) or “spirit.” Like almost all the translations and terms in Chinese medicine, spirit isn’t an exact translation, but for the time being it’s as close as we can get.
Understanding the state of a patient’s Shen is critical in knowing what’s going on with a patient, and at varying levels of illness, a person’s Shen status varies wildly – an alert, clear, responsive person with more brightness in their eyes usually has a recent-onset illness or one that is not serious. A patient who is very slow to respond, with a cloudy-ness about them, whose eyes seem dull may have a chronic illness or may be closer to death.
A. Chinese medicine is more than just the physical, and the Neijing (a key medical text) is filled with references about observing a person’s Shen, and how observing a diagnosis at the highest level involves seeing that which has not manifested as a physical illness yet.
B. One thing distinguishing humans from animals is the amount of Shen we have, shen being “spirit.” One low level way of assessing the state of a persons’s Shen is looking at their eyes – compare the bright, vital look in a child’s eyes versus someone with the far off look as they near the end of their life.
“The physical body–yes, you need to work with it when your eyes cannot perceive, by asking where the discomfort is and by palpating the channels…Shen, on the other hand, yes shen— in order to diagnose on this level you need not be focused on what the patient tells you. Your eyes see the invisible, your heart is open, and your intuitive sensing is front and center. All of a sudden, then, the subtle truth will reveal itself to you, without being able to put your experience into words, seeing while everybody else does not; as if the night turns bright for you alone while everybody else remains in the dark, like the invisible hand of the wind moving the clouds. That is why it is called shen, mysterious.”
Understanding the realm of the “spirit” is the highest level of medicine, the mark of the 上工, or high/upper level physician.
Even in conventional medicine, there’s a rough concept of the “gestalt.” Skilled physicians in any speciality can often make a guess when the patient enters the room (based on what they’ve seen) about what’s going wrong. Often, this intuitive ability comes after years of experience in any field.
Chinese Medicine Fundamental Medical Concepts
Many of the foundational concepts in traditional Chinese medicine don’t seem scientific, and yet, if you think of them in terms of physics, they’re the foundational laws of the universe. It’s tempting to assume Chinese medicine is some woo-woo energy medicine, but it’s built on the same bedrock that all science is: pattern recognition, physics, and symptoms.
Usually, when people assume that Chinese medicine is “far out,” they don’t really understand it (including many practitioners of Chinese medicine itself!).
The first, most important concept in Chinese medicine is the concept of Yin and Yang. Let’s talk about where it originates, and the importance in clinical medicine.
A. Yin and Yang in Medicine
Almost everyone in the world knows what a Yin Yang is, but very few people understanding that Yin Yang is an incredibly sophisticated yet simple physics concept. Obviously, certain associations are given to Yin and Yang like time of the day (day vs. night), masculine vs. feminine, strong versus weak, but there are many deeper applications.
For example, in a medical context, assessing where a patient is on a spectrum is considered a key concept.
Based on assessing the patient in an intake, we can assume whether an illness is resulting from excess or deficiency. E.g. a patient presents with a fever, rapid and forceful pulse, and vomiting due to something they caught (likely excess), versus a patient having dull headaches and indigestion (likely deficiency).
- Everything in Chinese medicine is broken down into Yin and Yang pairs, so that the physician can assess where the patient is on a spectrum. That’s why fundamental questions like assessing the pulse, sleep, bowel habits, temperature preferences, water regulation status are so vital. The practitioner can assess where the patient is on a spectrum – and seek to bring the person back to the middle. A patient with a weak pulse vs. one with a forceful pulse will be treated very differently.
- Force of the pulse. When diagnosing a patient from their pulse, one of the core Yin and Yang pairs is assessing the depth of the pulse and the strength of the pulse. If a pulse is superficial (near the surface) it can mean several things, like an acute infection or illness, or what’s called Yin Deficiency (陰虛). A deeper pulse can mean the person is too deficient or depleted to generate the sufficient force in the blood vessels. The strength of the pulse can indicate deficient qi or excessive qi, which either fail to push the blood strongly or push the blood too forcefully.
- Temperature preference. Preferences for hot or cold are also considered key indicators on the Yin Yang spectrum – a patient showing a strong preference for cold, who is overweight, who easily sweats, who has red, rosy cheeks, acne, and complains of being hot constantly is clearly on the very hot side of the spectrum. Giving this patient a diet that generates more heat wouldn’t be smart, because they’re already showing heat-related pathology.
- Sleep. Fundamentally, having insomnia or disturbed sleep is an imbalance of yin and yang, which can be as simple as overwork and under rest. One physician, Dr. Li Xin mentions that assessing sleep is the quickest way to assess the current balance of Yin and Yang in the patient’s body.
Yin and yang are genius concepts put into a coherent system for seeing where a patient is on a spectrum. Beyond that, there are limitless applications.
B. Five Phases Theory （五行）
Five Phase Theory is a medical concept also known as 五種流行之氣 – which roughly translates as the five kinds of changes in qi.
五行者，天地間五種流行之氣 － As for the five phases, they are the changes in the five kinds of Qi between the sky and the earth.
Fundamentally, like all concepts in Chinese medicine, the five phase (五行）theory originates from observations in nature, and the changes in the “energy” (Qi) of the seasons:
- Spring – related to the phase of “wood” like the growth of plants in spring – massive upward and outward action. Associated with the liver and gallbladder organs (肝，膽).
- Summer – related to the phase of “fire” like the heat of summer, which is warming, heating and moves upward. Associated with the heart and pericardium (心，心包).
- Long summer (the Earth phase) – Typically associated with either the long summer part of the year, or as an “integration” phase
. The earth phase is associated with the organs that primarily digest – stomach and spleen (胃，脾).
- Fall – related to “metal” phase, where the natural world is falling down and beginning to retract inwards for the winter. The metal phase is associated with the lung and large intestine pair (肺，大腸).
- Winter – related to the “water” phase of winter, where things are consolidating, the animals are quiet, nature “sleeps” longer, and the natural world conserves its energy. Related to the kidney and bladder organ pair (腎，膀胱).
Okay… this is some fine and dandy alchemical talk, but aren’t we talking about medicine?
That’s where (one of) the powers of the five phases comes in.
Five Phases as a Concept for Illustrating Change
One of the common reasons why Chinese medicine is so misunderstood is because concepts like Qi and the Five Phases are just that – concepts. When a scientist says, “there’s no evidence of this Qi stuff, what a bunch of pseudoscience!” they typically don’t understand that Qi is both nothing, and everything – it’s a concept.
The five phases is similar, it’s just a concept to understand what’s really going on in nature, and in the human body, when health and illness are involved. For example, understanding the relationships in the five phases predict what organs are often affected in illness.
The Five Phases 五行 in Action – In Treating and Diagnosis Illness
For example, take a look at the pattern of “wood overacting on earth.” A very common pattern seen in overworked professionals is liver/gallbladder and stomach/spleen pathology. In the five phases, this is described as wood controlling earth ( 木剋土 ).
We already talked about this in #3 above, but it’s a fairly common pattern. The patient shows up to the clinic or doctor’s office with the following symptoms:
A 38 year old woman has recently been having insomnia, in particular, trouble getting to sleep. But once she falls asleep she tends to have weird, active, or violent dreams and sometimes wakes up from them. She’s slightly overweight but is athletic. Occasionally when she gets stressed out she has a lump in her throat that she can’t seem to get rid of, with headaches that form a tight band around her head. When the stress crops up regularly, she tends to sigh and has a “stuffy” feeling in her chest she can’t describe, and some rib pain occasionally. In addition, she complains of abdominal bloating and sometimes acid reflux.
The symptoms here related to the liver would mostly be the dreams, chest pathology (sighing, stuffiness), the lump in the throat, headaches near the temples, and rib pain.
The symptoms here related to stomach and spleen are the digestive ones.
The five phases are a concept that help illustrate potential pathology and pathophysiology. Based on thousands of years of experience, physicians pieced together some of the most common patterns observed in illness. If there is liver pathology, it’s important to look at the mother and the child.
The mother and the child are the phase before or after the one we’re specifically focusing on. Remember, it’s the pattern-based philosophy that has allowed practitioners to piece things together – rather than looking at isolated parts. This is part of the genius of Chinese medicine.
C.Organ Manifestation Theory（臟象學說）
Organ manifestation theory is used to illustrate something that modern medicine knows well – that there are indicators on the outside of the body that illustrate how the inside of the body is doing.
Chinese medicine, however, took this one step further, with the pulse diagnosis, physical palpation, tongue diagnosis, and more.
In conventional medicine, it’s well known that liver failure is associated with yellowing of the eyes and skin (jaundice).
. This would be an outside indication of what’s going on internally in the body. What’s more, organs that are physically or physiologically impaired, like having a swollen liver, are tender when they are palpated or sometimes visibly distended. For example, in Hepatitis (an inflamed liver) the liver can be incredibly tender to the touch.
Another seemingly unrelated outside indicator would be pain referred from an organ in an unrelated area.
Sufferers of gallstones and gallbladder pain, for example, often report pain in the shoulder region. Well, how’s that possible? There is no digestive tract in your shoulder blade, is there? In Chinese medicine, look at the gallbladder channel:
This is a really crude drawing which doesn’t highlight all the aspects of the twists and turns in the gallbladder channel, but take a look at how it comes up into the shoulder.
Organ Manifestation Theory in the Pulse
One of the most “mysterious” looking aspects of Organ Manifestation theory is what happens in pulse diagnosis according to Chinese medicine.
Pulse diagnosis is largely considered one of the most difficult to master skills in Chinese medicine, and each pulse represents a different organ in the body. The left hand typically is said to represent the blood pulse, while the right hand is said to represent the “Qi” pulse.
Each position of the pulse reflects what’s potentially going on with an organ, but like any differential diagnosis, it’s just a piece of the picture. Some of the most important aspects of the pulse diagnosis are a few pairs, viewed as important “Yin Yang pairs:”
Organ Manifestation Theory in Other Organs
Another example of organ manifestation theory would be looking at relationships that are more superficial.
For example, the skin is associated with the lung in Chinese medicine (they’re considered one of the organ pairs), and as a result, looking at a patient’s skin can potentially indicate the status of their lungs.
How Traditional Chinese Medicine Really Works
My hope here is that in showing you a little bit about how Chinese medicine works, you can understand just how scientific it really is. You can see many parallels with conventional medicine, as well as differences in how physicians diagnose and treat illness.
Actually understanding the medicine can help you see exactly how it’s incredibly scientific and precise – with commentary after commentary written for millenia on each of these theories.
Ultimately though, the big difference in how physicians see their patients, and treat them.
How a Chinese Medicine Doctor or Acupuncturist Will Treat You
When you go to the conventional doctor, you typically might expect a few things: a handshake (or no physical contact at all), an intake, and then a brief conversation before being sent on your way.
When you go to a Chinese medicine doctor, a few things are different, and you may or may not notice:
- An intake process. Similar to conventional medicine, questioning the patient as to what’s wrong is pretty common across all medical disciplines. In Chinese medicine, this is also the case, although you’ll typically be asked other questions that seem unrelated, like your preference for hot or cold, your energy levels, bowel movements, sleep, emotions, and more. This is often to get a feel for your current “baseline.” Hot? Cold? Exhausted? Tons of energy? Can’t sleep? Sleep is okay?
- Physical touch, lots of it. Practitioners vary quite a lot in their approach, but the first thing you might notice is that there’s a world of difference in the amount of physical contact. The practitioner or physician will feel your pulse, they may palpate certain regions of your body, like the abdomen, and in general you are touched a lot more.
- Palpation. Physically touching regions of the body associated with organs and channels is considered one of the four major methods of diagnosis in Chinese medicine, and depending on practitioners, you may be palpated a lot.
- Your pulse will be taken. The pulse is used for many things, but the fundamental reason is to determine where you are on that Yin and Yang spectrum we talked about earlier. The most base observation is the force of your pulse, the depth, and the rate.
- Your tongue may be looked at. Tongue diagnosis is an important concept, but often indicates what’s going on with the stomach.
- Herbs may be prescribed. As one of my mentors says, herbs (internal medicine) are the true power of Chinese medicine, with the potential to resolve long-term, chronic illnesses. Your practitioner may give you herbal formulas to help with your recovery.
In my experience, what most commonly happens is a lengthy intake form, with a pulse diagnosis, and then an acupuncture treatment.
Afterwards, if the practitioner is trained in herbs, you may be given an herbal formula to take daily.
Wrapping up Traditional Chinese Medicine’s Concepts
Well, that’s a “brief” introduction to an incredible form of medicine, which is in my opinion, one of the greatest contributions humans have ever made to this planet. Sometimes, assuming that crystal-wearing hippies moving energy is Chinese medicine is purely a matter of ignorance.
When I learned just how codified diagnosis, observation, and treatment were in Chinese medicine, I had a new respect for the level of sophistication and detail, and the scientific principles it’s based on.
And to look at some of facts, for most of its history, Chinese medicine was over a thousand years more advanced than “conventional” medicine, including its understanding of pharmacology, diabetes, goiter, etc. Physicians like Sun Simiao 孫思邈 were treating and codifying illnesses 500-1,000 years before anything was done or written about in the west.
What have been some of your assumptions about Chinese medicine? Comment below.