Why does Classical Chinese Medicine seem so complicated? A continuing conversation…
Here is the second part of the article by my colleague Michael Givens. You can read the first part here. I hope we will see more of him here on Deepest Health. Please be sure to leave your thoughts in the comments, as he is a regular reader of the blog and will most certainly be interested in hearing what you have to say.
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In the broad view it is simply the nature of Yin and Yang, yet it is also because Chinese medicine has had such a long fermentation process; the classical texts as we’ve understood them, present the view that I’ve described above, one of functional dynamics, but as Chinese society grew and changed, and as the West’s materialism influenced them, the lens of the Chinese doctors went through a few very important changes. This is why it is so complicated. It is not “one medicine.” Like most things in China’s history, there has been a perpetual push to maintain an umbrella called “Chinese” for all things “Chinese” but this actually barely holds together. It is the same with the Chinese language: though there is a claim that the Chinese have had the same language for thousands of years, it is not completely true. What is true is that there is a continuous thread linking the oracle bones to modern Chinese, but that does not at all mean that it is the same language. The language meaning and usage within the context of culture and understanding could not possibly be the same.
With Chinese medicine, we could really isolate the different eras and dynasties and call these “Chinese medicine periods,” and there are some very real differences among them. Yet, the reason for our program is that there is a common root. There are the Shennong Ben Cao Jing, the Neijing, the Shang Han Lun, the Zang Zhong Jing, the Nan Jing, the Jia Yi Jing and the Maijing, for starters. Within these classical texts, while there are some significant differences and disagreements (even within the Neijing there are important discrepancies) it does seem that there is a common perception and worldview amongst them, a common understanding of the functional dynamism of human physiology and its correspondence to the movement of nature. However, after these texts and times, Chinese medicine becomes confusing and complicated.
This does not mean that anything written or practiced after Wangshu He in the second century CE is wrong by any means; it means that all of the formulas and treatments after this have to be carefully examined to gain any sort of understanding of the perceptions of those who created them. All Chinese scholars of all periods had a very deep and profound understanding of the classics, so in some ways we could say that what TCM (the Chinese medicine practiced and taught everywhere that has the approval of contemporary Chinese medical scholars of today) has to offer is the best of two thousand years of practice and scholarship. But, I believe we are in a better position today than that. We are in the position to broadly see how human consciousness has traversed from immaterialism to materialism, from conceptualization of process and movement, to a conceptualization of matter and physical (Western) physiology, and today, we can see how we are now reaching about as far as a materialist view can go. This allows us to move forward to a new, yet much less material understanding. Western science is also running up to this point and it appears that a subtle, yet great paradigm shift is underway. I believe classical Chinese medicine can be at the forefront of this shift.
Thus, I am advocating for the importance of not acquiring too many useful tools of TCM, but rather to push Chinese medicine further by doing what the scholars of all times have had to do. It should be each one of our responsibilities to read, study, examine, practice and experiment with what the classical texts have to offer, before we try to see what others have done with them. We should do this so that we can at the very least, understand why for instance, one scholar in Chinese history decided to modify Li Zhong Wan (a formula from the Shang Han Lun, Han Dynasty, 1st century, designed to “rectify” the spleen and “center” using the herbs: dried ginger, ginseng, atractylodes, and honey-fried licorice) and turn it into Bai Zhu Tang or the later more well known name, Si Jun Zi Tang (Four Gentlemen’s Decoction: Song Dynasty, 11th century, designed to strengthen the Spleen, using the herbs: ginseng, atractylodes, poria and honey-fried licorice), which is so widely used today.
Was it because he was more evolved in his understanding? Did he have a better grasp of the human body and human diseases, or did he simply have a different understanding of it; was he, perhaps more materialistic and narrow in his understanding? The only way for us to know, despite the fact that our teachers will advocate for one or the other, is to have a specific frame of reference. Otherwise, we just have to choose one or the other and see what happens. But, I believe that we will at some point, have to define for ourselves our own understanding of what medicine does and how the body works.
Of course, this is what we have been learning while at school, but it has not been consistent. The holistic view of classical Chinese medicine is not the holistic view of TCM, though TCM claims it is. The holistic view of one teacher, for that matter is not always the holistic view of another. Yet, based on what we have learned from the classical texts, classical holism is a dynamic interplay between function and matter, internal and external, time and space. It is based on the concept that matter follows energy, and energy follows consciousness; this is what we have been taught, yet is easy to neglect. It is also essential to recall that, like (classical) Naturopathic medicine, classical Chinese medicine works primarily through helping the body (functionally, not materially) to regain balance rather than doing something to the body (supplementing materially) to re-establish balance.
The holistic view of TCM is simply that internal and external are mutually related, and that the laws of yin and yang and the five elements apply to both humans and to nature, that’s it. There certainly is the concept of functionality in TCM, but it is clear that material concepts are much more predominant, and this is seen in the way disease is treated. For us to be able to effectively evaluate the various treatments and protocols from the thousand years of fermentation, we must be able to know when they are doing something to the body and when they are communicating a functional shift within the dynamic of the whole person. We can only know this by knowing the classical understanding of physiology. We really can only know classical physiology by understanding deeply the classical theoretical principles of nature and the cosmos.
I believe that we can only foster a growth and evolution of the future of Chinese medicine through deeply assimilating our perceptions and understandings to the perceptions and understandings of the ancient scholars. We must understand our medicine from a physiological, dynamic, functional perspective that takes in to consideration space (physical and relational), time (seasonal breath and astrological changes) and direction (momentum, flow, and interrelation) to begin to understand what was intended in the Chinese medical classics. With this kind of an understanding, we can then easily evaluate classical and traditional Chinese formulas and treatments; more importantly, we will be able to develop new, yet classical methods of treating diseases, for we will be protecting the functions and warmth of life, flowing with the processes of nature, and never working against either.
Michael Givens - National College of Natural Medicine - 3rd year in Classical Chinese Medicine program
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Tags: Classical Texts (general), classical-chinese-medicine, Learning, materialism, Michael Givens, scholar, study, traditional-chinese-medicineRelated posts
Isn’t Chinese medicine just a bunch of spiritual mumbo-jumbo pseudo-science?
There are quite a few folks who would like to discount Chinese medicine out of hand. These people are unlikely to be convinced of its benefits until Western materialistic methods so thoroughly confirm it that there is no shadow of a doubt. Really, this group of people want to see all concepts of Chinese medicine translated into Western terms - eventually rendering Chinese medicine as just a quaint alternative way to discuss In my opinion, this promised land of verification is unlikely to be achieved. Much of the benefit of Classical Chinese medicine simply cannot be verified by the current commonly accepted forms of study. This is not to say that some level of verification is impossible to achieve - I think some level can and will be achieved. It simply isn’t likely to come from the land of double-blind placebo controlled studies or the realm of extraction, purification and verification of individual chemicals within herbs. No such verification is necessary, as Chinese medicine grows from its own ground and has internally consistent methods of testing and verification that have yielded a medicine that is remarkably safe and effective.
There are other people who, instead of discounting the medicine out of hand, simply want to strip it of all of the elements that seem to conflict with the findings of materialism. This is what Mao and Co. did when they took the diverse and interrelated parts of ancient Chinese medicine, sanitized them and gave birth to Traditional Chinese Medicine (TCM). This is what many people continue to do. The argument is that discussions of Spirit, demons, elementals and possession are superstition, while Qi and Blood are medicine. To make Chinese medicine relevant, they say, we need to purge it of all of that silly nonsense and retain that which is more reasonable.
To be sure, there are things that should be included in the official canon of Chinese medicine and there are things that should not be included. But to purge things simply because they relate to non-material aspects of being or involve language that some people are uncomfortable with is irresponsible. We need to understand what these things mean, interpret them within their ancient context and understand their relevance. It may be that we find different language is more appropriate for our contemporary context to describe some of these concepts - or it may be simply that we need to discard our prejudice and embrace more complex medical terminology.
Let’s take one concrete example - the concept of Shen 神, often translated as Spirit. Shen is said to be the domain of the Heart, it is also said to be the light of consciousness, the animating principle. It is present in every part of the body, carried in the blood, but it is uniquely carried in the Heart. The primary pathology involving Shen, “Shen Disturbance” is often likened to various forms of mental illness. To illustrate, in the Neijing, Qi Bo says, “神 有 餘 則 笑 不休 ， 神 不 足 則 悲” which can be translated as “When Shen is in an excess state, one has hysteria or mania. When Shen is in a deficient state, one has depression or profound sadness.” Here we can see the emotional dimensions of the Shen. It would be tempting to leave it at that, but elsewhere in the Neijing and other texts we find many different functions and concepts attributed to the Shen. Some of these functions and concepts do relate more to “spiritual” matters as they are seen in many Western cultures. Shen includes all of these things.
I think it is this multifaceted nature of Chinese medical terminology that puts people off of it and compels them to demand that it be as monodimensional as other forms of medicine. Because many terms cannot be easily defined or put in a one-to-one relationship with easily recognized Western medical concepts, people simply dismiss it. However, it is this complexity that make the medicine so powerful. If we take the time to study these concepts, to understand them intellectually as well as experientially we can understand a complex disease like clinical depression much better. I have used this approach trying to understand my own medical problems and have found it to be very helpful in finding new treatment directions.
Eric
Tags: clinic, disease, herbs, language, materialism, nature, neijing, Science, study, tea, traditional-chinese-medicineRelated posts
7 keys to understanding the Classical Chinese Medicine concept of organs
I’d like to piggyback off of the organ clock post and introduce the Chinese medicine theory of organs in a little more
depth. It’s important to understand that there is not just one right way to view the body. There is no more validity in viewing it in the Western medicine manner than there is in viewing it in the Chinese medicine manner. Each system (and many others) have taken different features of the human being to be primary, each system has used their own conceptual understanding to render a viable picture of the body and its interactions. Perhaps most importantly, each system uses their vision of the human being to craft effective treatments. It seems that different systems will create different spheres of effectiveness - a topic for a future post. With no further ado, here are seven things you need to know to enhance your understanding of Chinese medicine organ systems.
- There are twelve organ systems in Chinese medicine: Heart, Small Intestine, Bladder, Kidney, Pericardium, Triple Burner, Gall Bladder, Liver, Lung, Large Intestine, Stomach and Spleen. The typical convention is to capitalize when we are talking about Chinese organ systems and not to capitalize when we are referring to the anatomical organ known to Western medicine. Another convention is to refer to the in the singular. So, for instance, the Lung organ system includes the Lungs, but we don’t say - for example - The emotion of the Lungs is grief.
- They’re not ORGANS. Probably the most important thing to understand is that the Classical Chinese view is not based on materialism. Although the ancient Chinese did investigate the inside of the body and were clearly aware of the physical structures that Western medicine now names “organs” this is not primary for the medicine’s understanding. The organ is included in a larger concept that is often called the “organ system,” which you have already seen me use many times. This organ system includes the physical organ, it’s associated channel(s), the tissues, surfaces, functions and other bodily features associated with that organ and other more rarefied aspects of the system.
- The organs work together as a dynamic whole. While each system has specific functions and can be talked about in isolation, the beauty of the Chinese medical view of the body only becomes truly apparent when you focus on the interconnections. No system is complete without seeing its relationship to the rest. This can make it a little confusing to study because our brains seem to find it simpler to focus on one mono-dimensional thing at a time. TCM has largely lost its understanding of the physiological interactions of the organs except where those interactions are extremely simplified.
- The organs are a reflection of the macrocosm. This principle relates back to Chinese philosophical understanding of the holographic nature of reality. For a complete review of the holographic worldview, see Michael Talbot’s The Holographic Universe. The basic gist of this philosophy is that the fundamental nature of reality is reflected in its smallest pieces just as much as in its largest. The small reflect the large, and the large reflect the small - they’re both reflecting something much deeper than themselves. In Chinese medicine we study this principle all the time. On one level, each organ is a reflection of all the others - the parts reflect the whole. On another level, the total complex of organs and each organ individually reflect some aspect of nature. For example, the Heart reflects the nature of our Sun and acts as such within the body. Understanding these layers of meaning help us to fully comprehend the human body, and studying the human body through this lens helps us to gain a greater understanding about the Universe. It’s funny like that.
- Following from that, then, the organ systems can be understood using natural and governmental symbolism. For me personally, learning about the Chinese concept of the body was much easier once I learned to think about it as an ecosystem or as a country. With the former, I could simply walk in nature in a mindful way and reflect on the various features I found there. IS the Heart like the Sun? What would that mean if it were? How does that bear out in diagnosis? In treatment? I think this practice does its work on more subtle levels as well - it must be why we are constantly urged to spend time in nature as CCM students. Using metaphors about the government helped me a great deal in understanding the functional relationships between organ systems. If the Heart is like the Emperor (or the King, possibly the President) then what relationships should I see between it and the Lung, which is said to be like the Prime Minister (or Presidential Cabinet?).
- The organs’ interrelationships are therapeutically useful. Far from being a simple intellectual exercise, understanding the organ systems as networks of interrelationship bears out in treatment. An example: imagine we are looking at some kind of problem that - through the intake process, including tongue and pulse taking - we come to understand as being centered in the Heart organ system. A TCM process of differentiation would then focus on the Heart, most likely, only adding other organ systems in limited circumstances (such as adding Lung if there are breathing difficulties). A more nuanced approach will consider the interrelationships using various systems, such as five-element or six conformation. Using a five element approach, we might wonder whether fire is failing to be generated by wood, or whether it is being over-controlled by water. We would search for symptoms that might suggest this, we would recheck the pulse to see whether we had missed something. There are specific systems to use when doing these investigations, but the key is simply to dive deeply into the physiology in order to comprehend pathology. It will yield excellent treatment.
- Even with this complex understanding - the organ systems are not PRIMARY. In a sense, the organ systems are simply a useful way of organizing the overwhelming amount of information we can get from studying the human body. It is a convenient way because it has clear physical correlates. But we must also consider the fluids of the body (Qi, Blood, Jing, Shen, JinYe) as well as any more subtle aspects of the human being. We must also keep in mind that the body is not just a jumble of parts, but a integral functioning whole - when we treat we are not “tonifying the Kidney” but instead having a specific kind of impact on an infinitely complicated system using a particular technique. Maybe that’s splitting hairs, but it seems an important distinction.
There’s a lot more to know - but that’s a good start. Please put any questions or thoughts in the comments!
Eric Grey
Tags: classical-chinese-medicine, exercise, five phases, flu, focus, health, Learning, liver, lung, materialism, nature, organ system, Organ systems, organizing, overwhelm, pericardium, philosophy, pulse, rest, spleen, students, study, studying, symbolism, tea, Theory, traditional-chinese-medicine, visionRelated posts
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