Chinese language is symbolic – it uses pictures (now highly stylized and simplified) to represent concepts. Chinese culture, even today, is infused with symbolism.  What is a symbol?  There are many potential definitions, naturally.  For my purposes, I will simply say that a symbol is something perceptible that “points towards” a larger concept. There are many elegant and powerful systems of understanding symbols – one of my favorites comes from the work of Carl Jung.

To use a common example, the Apple logo () has come to represent a whole host of products, services, even people & communities.  You can, of course, look to religious symbols like the Christian cross, the Jewish Star of David, and so on.  These symbols hold great potency in many cases – in some real way they go beyond themselves.

Classical Chinese medicine takes the symbolic elements of the medicine very seriously. Over the thousands of years of the development of the medicine, a mind-boggling amount of symbolic information has been amassed and recorded.  So for those of us who are committed to a deep practice of this ancient medicine, nothing else could be more important in our study and practice.

Vast amounts of information usually ends up organized into more manageable chunks.  In Chinese medicine, various ways have been used to organize and help us find greater meaning in the symbols we encounter.  One of the ways we organize the symbolism concerning the organ systems of Chinese medicine is through the use of a 12 section “organ clock.”  Most people have heard about the organ clock – it’s one of the most popular Google searches that brings people to this website!  To get a sense for the basic layout of the organ clock – see my unbelievably amazing artistry below.

HT = Heart, SI = Small Intestine, BL = Bladder, KID=Kidney, PC=Pericardium, TW=Triple Warmer/Heater/Burner, GB= Gall Bladder, LIV=Liver, LU=Lung, LI=Large Intestine, ST= Stomach, SP=Spleen.

Note: Focus on the general picture as some of the elements will not be explained right now (such as the constellation names “Wie, Mao, Bi,” etc).

The organs are laid out in the order of the energy flow through the channel system, then information known to be related is inserted in each section.

There are a lot of pieces of symbolic information that come in twelves. This is, I assume, why a twelve piece pie is so often used in discussing organ systems. We can use all of these to help us understand the organ systems, and thus the human body. Some of these groups twelves are:

• The names of the organ systems, and thus the etymology of the Chinese characters associated with those organ systems. Also included here: information from a variety of medical systems concerning the physical organ associated with each organ system, information pertaining to the acupuncture channel associated with each organ system, etc…
• Earthly Branches and their associated zodiac animals
• YiJing (I Ching) tidal hexagrams
• Two hour periods of the day
• Month in the Chinese calendar, but also the related Western time of the year
• Agricultural nodes – two per month, 24 total

We can also overlay information onto the twelve-part organ clock that comes in other multiples including (but not limited to):

• The phase element (fire, earth, metal, water, wood) associated with each position (multiple of 5)
• The direction of the compass and trigrams of the bagua (multiple of eight)
• The six atmospheric influences or conformations (multiple of 6)
• The relative concentration of Yin/Yang (multiple of 2)
• The participation of each organ in one element of the Heaven, Earth, Human Being triad (multiple of 3)

Just imagine drawing several circles on tracing paper, one divided into twelve parts, one into eight, one into six and so on. Then imagine putting a representation of each piece of information in the correct section. When all of this information is put together, one begins to understand the complexity of the organ systems. For example, take the Heart. The Heart is explained as being the sovereign of the human body, keeping under control all of the other organ systems so they may work together in harmony. Using the organ clock we see that the Heart (only a partial list):

• Is called Xin (心) in Chinese. This is often described as being a picture of the human heart organ with three drops of blood above it. Not particularly interesting, perhaps – though why there are three drops of blood is worth investigating. They could represent the ancient triad of Heaven, Earth and Human Being. Some primitive forms of the character look like a uterus, prompting an association between the Heart and femaleness.
• Is associated with the Earthly Branch Wu (午), associated with the summer solstice and the animal of the Horse. The Horse is an interesting animal and deserves a post of its own, but everyone can agree that horses can work tirelessly (like the Heart) and that they tend to be very sensitive animals.
• Is related to the Chinese agricultural periods (solar terms) called Xiao Shu and Da Shu, which are Small and Big/old summer heat, respectively. Summer heat is a heat with a damp quality – something anyone who has travelled in the American south in the summer can attest to. So, then, the Heart is related to this quality of intense heat.
• Is associated with the element fire, in particular the Imperial fire that is pure, constant and the light of the whole body.

These are just a few of the elements we can use to expand our idea of what the organ system “Heart” represents. Now, because this is just a bit of an introduction and getting too long already, I won’t go into any greater detail. Let it suffice to say that when one investigates these elements to their fullest and combines it with more obviously medical information (like the kinds of herbs used to treat the organ, classical descriptions of physiology and pathology, etc) one has a true understanding of that system that is of great help in understanding difficult and complex diseases.

I hope to be able to continue to unpack the organ clock in future blog posts and possibly a course.  I’m particularly interested in demonstrating to others how this information can be used in Chinese herbal treatment.

Related posts:

1. Phenomenology and Chinese Medicine : Our body is the greatest medical technology
2. The six conformations: an exploratory post
3. The Yijing and Chinese medicine : Hexagram 11, Tai 泰

Chinese medicine and phenomenology thesis Part I

Chinese medicine and phenomenology thesis Part II

EDIT 8/5/09: I just realized that the portions linked above were mistakenly taken from an earlier draft of the thesis. I should be more careful! Please forgive me if there are any inconsistencies between the versions.

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According to Svenaeus, important information that penetrates the clinical encounter is, in a way of speaking, pre-scientific. It is prescientific insofar that is minimally mediated by theory and not readily systematized by the analytical processes recognizable as the basis of contemporary science. In the terminology of philosopher Edmund Husserl (and later, Martin Heidegger and Maurice Merleau-Ponty), this information is all part of the lifeworld. The lifeworld is the sum total of lived experience, not as a static object, but as it is lived. It is those things and experiences that, woven together, make up what we refer to as our life. Things only have meaning insofar that they are situated within the lifeworld. Abstracted outside of that, they cease to have what most of us think of as “meaning” or “importance.” This is obviously a very deep philosophical concept, and I cannot elucidate its full meaning here.

However, it seems, when applied to medicine, as a clinical encounter between two human beings, this theory can inform practitioners that we should seek to engage the wholeness of each person during each encounter. If we incorporate information taken from laboratory tests, or other processes that isolate particular characteristics of our patient, we should situate that information in a field of everything else we know and can perceive about the patient. This would include demographic information filled in on a form, the subjective reports of the patients, our understanding of the world and regional situation the patient is confronting (war, weather, and so on) as well as all the information available to the senses of the physician. Physical palpation (including of the pulse), the visual presentation on all levels, the sound of the patient’s voice, any odors that can be perceived may all provide us with information of use in diagnosis. Before the advent of modern medical technology, of course, this was the primary source of information that physicians worked with.

We can utilize this “lifeworld field” in the service of restoring the patient to a greater state of health. In this view, far from being extraneous information, the particular life characteristics of the patient are a key component in her disease process, physicians’ diagnosis of it the ongoing healing process.

Later, Svenaeus indicates that there are efforts in the mainstream medical community to take seriously the implications in the type of argument I am advancing. These enterprising physicians are attempting to construct a system of medicine that situates the lifeworld centrally in the clinical gaze. You can see evidence of this in the formation of medical centers that incorporate spa services, family and individual counseling and other such services. While the chapel has always been a feature of hospitals, increasing numbers of medical centers are also offering meditation, Taiji, yoga and other benefits that seek to address the spiritual side of its patient population.

The inclusion of these services within the medical center itself shows an understanding that the healing of the physical body is not separate from the health of the rest of the human experience. Some of these medical centers have also begun to offer complementary and alternative medicine alongside Western medicine. It is obviously important to point out that complementary and alternative systems of medicine (CAM) take the wholeness of the patient very seriously. In fact, the primary focus of most CAM therapies is to restore the person to harmony within that wholeness of their being.

“One central goal of CAM is to improve the “wellness” of the patient. Rather than just removing a disease-producing agent, “quality of life” is emphasized by treating functional or somatic problems with ancillary and important psychological, social, emotional, and spiritual aspects” (Complementary and Alternative Medicine: An Evidence-Based Approach, John W. Spencer, Joseph J. Jacobs) 17.

The continuing integration of CAM into hospitals and other large medical facilities indicates that many Western medicine practitioners are seeing the value of these services.All of these changes, and the important conversations they generate within the profession of Western medicine, are quite important. As CAM becomes increasingly integrated into mainstream medicine, it will begin to inform the practice of Western medicine even as it is informed by Western medicine. Perhaps, then, the holistic nature of the human being and the importance of considering the lifeworld of the patient when diagnosing and treating will become a more central principle in all of medicine.
There are a number of concerns that mainstream medical practitioners and Western scientists have about this integrative process – many of them discussed in my paper already. Much of the worry centers on two basic desires. First, people want to know that medicine, meant to heal, is not harmful for patients. Second, people are concerned that even if a therapy is not harmful, it may simply be an elaborate placebo-based swindle duping hapless patients. While there is much I have said and could say about this, I would like to suggest a few basic principles that can guide us when deciding what therapies and systems of medicine we would like to integrate into our unified health care system.

These principles encompass elements of all the criteria of demarcation I have already discussed, while creating a system of holistic care that takes seriously the lifeworld and personhood of the patient. If a system of medicine or particular therapy does not meet these criteria, I contend that it must work to rectify any deficiencies before being embraced by the mainstream.

Related posts:

1. Phenomenology and Chinese Medicine : Our body is the greatest medical technology
2. Phenomenology and Classical Chinese Medicine

If you missed the first installment, please go read about Phenomenology and Chinese Medicine (Part 1).

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The doctor possesses all the same complexities [as the patient]. When the two come together, they are also under the influence of the particular place and time where they meet. The multiple variables inhering on the situation boggle the mind. The weather, the paint, the particular complement of the room, what’s going on in the news and whether either is aware of it. This is all perceived, on some level, by everyone involved – though perhaps not consciously. I do not want to imply that each of these variables has some lasting, measurable effect on either one of the participants in the encounter. I simply want the reader to keep in mind that every single medical encounter is simply two human beings, with their messy lived experience, coming together for the purposes of rectifying or maintaining some particular state that each agrees is worth attaining – health or the cessation of disease – depending on one’s outlook.

I want to caution the reader against assuming that this “messiness” as I’ve called it is a detriment to medicine, as some might imply. It is attractive to some to believe that if we simply make diagnosis and treatment maximally objective, by using the mediator of advanced technology and standard diagnostic and treatment protocols based on sound science, we will come to a purer, more useful medicine. But if this results in the removal of the human being from the doctor, if this results in the replacement of the patient by a list of variables gleaned by diagnostic tests, it can do nothing but take us farther down the road of an impersonal medicine that makes mistakes because it does not know enough about the person of its patients. I do not want to imply that any particular medical system, in its totality, does this on purpose or by design. But it is a danger for any medical system, particularly one that seeks to become increasingly rooted in objectivity.

Several philosophers, particularly those who are categorized as “Continental” philosophers, such as Foucault, Heidegger and American Philosopher Richard Rorty can help us to understand why this subjective, messy and quintessentially human nature of medicine is so actually an important feature of its integrity and usefulness. To analyze all of these philosophers and develop a rigorous theory concerning this point is a dissertation-level project. Fortunately, philosopher Fredrik Svenaeus, in his book The Hermeneutics of Medicine and the Phenomenology of Health, does an admirable job of pulling together diverse thinkers in Continental philosophy and other traditions to develop a rigorous philosophy of medical practice. I will offer and annotate some of his argument here as I believe his work points a way forward in any discussion of whether and how

The central focus of Svenaeus’ argument is the examination of the clinical encounter – the functional unit of medicine. Svenaeus explains that technological medicine and an increasing reliance on laboratory research has created a separation between the patient and the doctor. This separation is produced when the patient is not seen as an integral human being with mind, body and cultural context but is instead seen as a kind of space in which particular biochemical reactions and microorganisms are present in specific concentrations and configurations. In essence, the patient has become an object to be carefully studied by the doctor. He explains,

“Negligence of the human side of medicine has been fostered and fed by a focus upon medical scientific research and its biological objects, as existing in a relation of opposition to, instead of connecting with, the encounter between doctor and patient with its specific ‘lived’ characteristics”(Svenaeus, 2001, p. 7).

Much of the patient’s lived experience is disregarded as irrelevant in the situation at hand, unless a study has vindicated that some feature of that experience affects something that can be measured in a laboratory. This, he believes, takes medicine away from its purpose and power as a clinical practice. In sum, the ongoing pursuit of solely objective information as provided by the “causal” studies I discussed above is creating an undesirable side-effect: the removal of the human from the practice of medicine.

There are obvious ethical implications here. When we approach human subjects as objects, our ability to relate to them and, ultimately, to treat them as persons suffers. In the most extreme cases, this leads to sociopathic behavior such as is found in scenes of torture and police brutality. Obviously, in the medical context, the situation is not so extreme. The vast majority of physicians, regardless of their ideological stance, seek to help their patients. But, this is not only a philosophical or ethical issue. I contend that medicine that takes the intersubjectivity and embeddedness of its patients seriously, even makes that the very center of clinical thinking, is actually more effective.

In his discussion, Svenaeus recommends a variety of introspective turns that medical professionals can take. In essence, they all point to the same holistic conclusion. While technological advances and laboratory testing can provide valuable information, physicians must see these variables as only a couple among many. The amazing advances brought about by technological science allow us to, in a way, extend our senses. However, this happy development should not cause us to abandon those bodily tools that physicians have been using since medicine began.

Related posts:

1. Phenomenology and Classical Chinese Medicine

Established readers : this is one of many reposted articles you will see in the coming months.  It is part of the redesign process.  I hope you agree that all of these articles are worth another look!

The topic of the Six Conformations is huge.  So huge, it’s a bit intimidating to write about.  If you’re here without much knowledge of the Six Conformations I hope that this, and related posts, will help broaden your understanding. If you’re here with lots of knowledge of the Six Conformations, I hope you will share your wisdom with us in the comments.

The Six Conformation system is another on par with the Five Elemental Phases. It is a way to sort the macrocosm and microcosm into manageable chunks that have meaningful relationships with one another.  Remember, in Chinese medicine we see the macrocosm and microcosm as completely linked. What happens in one impacts the other, and vice versa.  Holism!

In heaven (macrocosm), the six conformations are weather patterns – or atmospheric Qi. In the human being (microcosm), the six conformations exist as associated parts of the body, mind and spirit.   This is important – and complicated.  When people hear about the six conformations, they often think only about the channel system.  So, when I say Taiyin, folks automatically think, “Spleen and Lung channels.” This is erroneous thinking, even though many influential books translate Liu Jing as “Six Channels.”

Just as the Five Elemental Phases don’t refer only to organs or layers of the body, but include those; the Six Conformations don’t refer only to channels or even their paired organs, but include those.

Let’s get the nitty gritty details out of the way. What are the Six Conformations?

• Taiyang – 太陽 – Great Yang – associated with the Bladder and Small Intestine organ systems
• Yangming - 陽明 - Yang Brightness – associated with  Large Intestine and Stomach organ systems
• Shaoyang – 少陽 - Lesser Yang – associated with the Gallbladder and Triple Burner organ systems
• Taiyin – 太陰 - Great Yin – associated with the Lung and Spleen organ systems
• Shaoyin - 少陰 - Lesser Yin – associated with the Heart and Kidney organ systems
• Jueyin – 厥陰 - Reverting Yin – associated with the Pericardium and Liver organ systems

There’s a lot of layers of information associated with each of these categories.  I couldn’t hope to look at all of it in one blog post.  Let’s look at the most basic layers.

Climactic factors (for better or for worse)

The Six Conformations are related to Six climactic factors/Qi (Liu Qi).  These should be in balance in nature, but when they are out of balance we know them as the Six Evils.

• Taiyang – Cold :  associated with water, contracting quality
• Yangming – Dryness : associated with metal, dessicating quality
• Shaoyang – Fire : associated with fire, flaring/ministerial in quality
• Taiyin – Damp : associated with earth, sticky and heavy in quality
• Shaoyin – Heat : associated with fire,
• Jueyin – Wind : associated with wood, wandering in quality

As I said above, people often think Six Conformations = Six Channels.  Me, I have the opposite problem — I have it so embedded in my head that the Six Conformations = Six Channels = Six Qi (atmospheric and evil) that sometimes I become a bit confused by it.  My understanding so far is simple — when we talk about the Six Conformations out of context (as we are now) the concept includes shades of all these meanings (Qi/climactic factors, Jing/channels, layers of the body, etc) and much more.  When we are looking at a Conformation more specifically as in a disease, we can tease out what piece of information is most relevant for us at the time.  I hope this is clear.

The order of the conformations and the layers of the body

The specific order I keep using as I list the conformations is not without reason.  While there is some discussion about the placement of Yangming, most of my teachers seem to agree on this order.

Taiyang is the most outward of the conformations.  It governs the most superficial layers of the body and is associated with the Weiqi or defensive force of the human being.  Think of the premiere formulas associated with Taiyang – Gui Zhi Tang and Ma Huang Tang.  Both strongly resolve the surface.  Yangming is the next layer deep – both in some sense physically and also in terms of how external pathogens must progress in their quest to do harm.  It is in the Yangming stage that we get great fevers, this is a storehouse of immense Qi and Blood force in the average person.  Think how well this resonates with the Stomach and Large Intestine organ systems, both deep dealers in the most basic, primal functions of life.  The last Yang conformation, and thus the last protector against a disease becoming deeply internalized, is Shaoyang.  Shaoyang is said to “pivot” (a long discussion) between internal and external, and thus has a kind of oscillating quality.

Now we enter the interior of the body, going ever deeper.  Taiyin is the first of the Yin conformations and in some way exemplifies a kind of “doing without doing” — the most active of the passive organ systems.  Going a layer deeper we find Shaoyin, the north and south poles of the body – Heart and Kidney, the basic axis of the functioning of the human body.  When external pathogens reach this deeply, serious disease is the result.  Finally, Jueyin – the deepest, but also the possibility of rebirth into the Taiyang conformations in the classic cyclic manner of Chinese philosophical systems.  Jueyin is deeply involved with blood, as can be seen clearly in its encompassing of both Liver and Pericardium.

Pairing of the organ systems : insight into pathology

The more I write about this, the more I find to write.  For now, I’ll just mention one quick thing.  The conformations can be paired in the following way:

• Taiyang – Shaoyin : BL/SI with KD/HT
• Yangming – Taiyin : ST/LI with SP/LU
• Shaoyang – Jueyin : GB/TB with LR/PC

Anyone can see the wisdom of these pairings – reuniting the five elementally associated organ pairs.  We have been taught that these are pairings of mutual support.  Taiyang is supported by Shaoyin, and Shaoyin feeds Taiyang.  Thus, when you have a disease in one, the other is somehow involved.  There are particular ways that we have learned to understand this system of differentiation.  But a simple thing to consider is this — take one manifestation of Yangming disease, serious constipation.  What happens if one over purges in Yangming disease and why?  It’s easy enough to say that overpurging (using cold and bitter materials) will cause damage to the Spleen that can manifest itself in a variety of ways, including as diarrhea.  Why is that?

One way to explain it is to consider that Taiyin is the support of Yangming, so that when you overtax Yangming it will draw energy from Taiyin, ultimately depleting it.  Of course, there are people who would explain this in a much more nuanced way but when I’ve mentioned it to others they seem to understand.  Hopefully it will be helpful to you.