What is Traditional Chinese Medicine (TCM)?
Preliminary note: If you are really looking for a definition of TCM and want to learn more about Chinese medicine in general, please check out this page of articles written especially for folks who are new to the world of Chinese medicine and want to learn more.
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I was just reading over some old journal entries from when Deepest Health began last year. One of the blogging techniques that I was taught by Yaro Starak during the Blog Mastermind training program was creating definition posts. I did use that format to define various things, including Qigong, acupuncture and herbal medicine. However, because I started to get interested in a lot of more complicated things and attracted some fairly sophisticated readers, I moved away from those basic types of posts.
I found a note that I should write a post about TCM - which really got me thinking. There’s a fundamental problem with my blogging purpose. I am interested in getting good information out there about Chinese medicine, it’s practice, power and philosophical foundation. I’ve been putting that information out as I learn it, revising points as I’m able and hoping that my good intentions and transparency will make sure that the good information overcomes the bad.
But, I’m trying to do too many things at once. How so? Well, consider terminology. When most people think about Chinese medicine, they think about acupuncture. This is so much the case that most people simply call all of Chinese medicine “acupuncture,” even some practitioners. One of my mentors even names his business using the word acupuncture and says nothing about herbs. Why does he do this? Because when most people think about contacting a Chinese medicine physician, the word that comes into their mind is “acupuncture.” It just makes good business and marketing sense.
Which, apparently, I don’t have. :) By talking constantly about Classical Chinese Medicine on this blog, I end up missing out on picking up on a lot of folks who are searching for information about this medicine. What do they search for if they are little more savvy? Maybe “Chinese herbs” or even “traditional Chinese medicine,” and if they’re REALLY on it, “TCM.” Those words appear very few times in any of my content. :D So, while I’m sitting here pumping out quality content, fighting the good fight, I’m missing probably half of my intended audience. In some way, I’m hoping to change the language around Chinese medicine. I honestly don’t care if the word “classical” makes it in there - simply calling it Chinese medicine would be fine.
So, if in the coming months and years, you see me using TCM or Traditional Chinese Medicine or Acupuncture a little bit more in the way that I write - do forgive me. I’m simply using the common vernacular to try and get the information out to the people who are looking for it.
All that aside, I’m interested to know how terminology plays into your life around Chinese Medicine. If you have a business or work at a school, how is Chinese medicine discussed in your marketing materials? Do you think there is some value in trying to change the language through marketing, or is that just dooming one to failure? Do you find that your patients/students are confused about the language used to describe what we do? Please leave your thoughts in the comments and, as always, thanks for reading.
Eric
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Tags: Blogging, Business, ccm, classical-chinese-medicine, language, tcm, traditional-chinese-medicineRelated posts
Learning from Chinese medicine masters : Liu Lihong visits Portland, OR
Since arriving in Portland to study acupuncture and Chinese herbalism, I have been unbelievably lucky with regards to the teachers to which I have been exposed. In fact, not a day goes by that I don’t find myself pretty much floored when I consider my good luck. You know that old adage that “When the student is ready, the teacher will come?” Well, I must be ready - because I’ve got some pretty incredible teachers. I’ve talked about only a few of them on the blog, but hope to feature more about them - even in their own words - in the coming year.
We have been blessed to have the presence of a true modern day master, Dr. Liu Lihong, at NCNM for the past couple of weeks. He gave a public lecture along with his colleague, Dr. Tang Nong, about the state of Classical Chinese Medicine in China and has since lectured on a number of other topics in an impromptu fashion. He also gave a more structured lecture to a small group of people with connections to Heiner Fruehauf and NCNM on the topic of the “Fire Spirit” school of herbalism of which he is a part. Every single opportunity I have had to listen to Dr. Liu has been a treasure. As someone new to the field, I appreciated his simple, yet deep, explanations on topics that mean a lot to me such as: What is a lineage and what is its meaning? What does it mean to be a physician in this day and age? What is the meaning of calling one way of practicing Chinese Medicine “Classical?” He also discussed more in depth topics such as the appropriate use of Fu Zi, the essential salient features of treating in a “Fire spirit” school way and a way to understand the theories of the five elements and six conformations.
To tell you the truth, it’s been so much information, I’ve almost willfully avoided going back over it because I’ve got so much on my plate already! But, I would like to share with you some of what I’ve learned and what it has sparked in me in terms of new ways of looking at Chinese medicine. It will likely take a few articles. I’ll try not to make you wait. :)
I’ll actually have to start with first things first - the series of talks was kicked off by Dr. Tang Nong, who is the chair of the Institute at Guangxi College of Traditional Chinese Medicine, where Dr. Liu is a senior professor, medical director and co-chair. The Institute they co-chair is the only of its kind - solely devoted to research into the clinical applications of Classical Chinese Medicine. Here patients are treated with Chinese medicine only. In other hospitals, even those that seem to be “Chinese medicine” oriented, patients are often treated more with Western medicine with Chinese medicine only as adjunct or supportive therapy. How then, are we supposed to know what Chinese medicine can do in a clinical context? This is the very question that Dr. Tang Nong addressed throughout his lecture.
Dr. Tang was a very charismatic speaker, full of energy and clearly very passionate about the medicine. I understand he is a skilled clinician in his own right and, further, understands the basic philosophical principles underlying the medicine in a nuanced way. I really enjoyed hearing him speak.
I was particularly interested in his discussion of the essential failing of TCM as it is often practiced. Dr. Tang told us that the trend in Chinese medicine research and development is towards increasing:
1) Modernization
2) Standardization, and
3) Internationalization
These three words aren’t inherently bad. Certainly moving forward and keeping our minds open to greater efficiency and clarity are all good things. It’s the way that these principles are understood and executed that creates problems - at least that what Dr. Tang seemed to be communicating to us. He spoke most against the effort towards standardization. In standardization of Chinese medicine, efforts are made to create “standard” diagnoses based on “typical” symptom pictures. These diagnoses are attached to “standard” formulas and point prescriptions. I expect that even the modifications are standardized (if x, then y). Thus, anyone with skill enough to understand the basics can simply match up a + b + c and come up with a treatment plan that can easily be supported by everyone else trained in the system.
What is the point of standardization? Dr. Tang didn’t address this much during the lecture, but I found myself thinking about it quite a bit. Often, things that don’t turn out well started out as good ideas. The road to Hell, as they say, is paved with good intentions. I think the reasons behind wanting to standardize are many, but I feel that it all comes down to expediency and fear for safety. When the numbers of patients you are seeing increase dramatically, you need a quicker way to cycle through them. Further, you can see even more patients if you can quickly and easily teach others how to treat safely. This is expediency. With a standard system you can see more people in a shorter amount of time. Admirable.
Additionally, there is a fear for safety of patients. This is still related to an increase in numbers of patients coming through the system. If you want to train ever larger numbers of physicians, to see ever larger numbers of patients, ultimately a quick way to do this is to reduce standards for entry into the profession. While some people would say that standards are still quite high for entry into the highest levels of Chinese medicine education in China, others would strenuously disagree. Certainly everyone can agree that it takes less to become accepted as a physician in China today compared to a couple of hundred years ago. Regardless, when you reduce the standards for entering into a potentially dangerous profession, you have to build safety valves into the essence of the system to avoid costly errors. In all, if we reduce professional standards and standardize sufficiently to ensure patient safety, we can see huge numbers of patients in a relatively short period of time. Why NOT standardize, one might ask…
Because Chinese medicine doesn’t work very well when it’s standardized. In fact, the system relies pretty heavily on individualization. While we can agree on certain basic sets of symptoms as emblematic of particular disease states or formula patterns, ultimately each person’s manifestation is likely to be slightly different and thus take a slightly different formula. Ultimately the creation of a formula or point prescription needs to be highly individual, based on the interaction between doctor and patient, the particular manifestation of the patient on that day, the particular weather patterns current and expected, the tendencies in any given year, the dietary habits of the patient and so on. While a “standard” prescription may lessen symptoms, it’s unlikely to have the kind of dramatically positive impact that a more individualized treatment would have. I’ve seen this in clinic many times, and I’ve experienced it myself.
But more importantly, these eminent physicians have seen this in thousands upon thousands of clinical cases and are adamant that standardization (as it is currently practiced) is a degradation of our medicine.
Dr. Tang talked about many other things, but it will have to wait for another post. For now, I’d be interested to hear folks’ thoughts about what I’ve said here. Why do you think people are so eager to standardize Chinese medicine? How do you see the benefits and costs? What are the alternatives? What are their benefits and costs?
Eric
Tags: classical-chinese-medicine, events, liu lihong, Portland, standardization, traditional-chinese-medicineRelated posts
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
Tags: Classical Texts (general), classical-chinese-medicine, Learning, materialism, Michael Givens, scholar, study, traditional-chinese-medicineRelated posts
Integrative medicine: What is the purpose of two kinds of medicine interpenetrating?
At NCNM, we learn Western medicine as part of our Classical Chinese Medicine education. Part of that is simply because a working knowledge of biomedicine is necessary for licensure. Part of it is because it’s good to be able to talk to Western physicians and Western educated patients about things that they can easily understand. Part of it, for some people, is more than that. Our Western classes are, for the most part, taught by Naturopaths. These are folks who are already in deep dialogue with contemporary Western medicine since they represent both its past and its future. So it is natural for them to try to help us see how Chinese medicine and Western medicine theory can come into conversation.
This has been the effort of integrators in Chinese medicine for a long time. A slapdash and ill-informed effort to accelerate the conversation resulted in TCM, narrowly defined. The idea is interesting, truly. In theory, we are all talking about the same thing just emphasizing different portions and using different language. In the West, I think we are particularly interested in explaining Chinese medicine concepts through our own language because we seem to have such a hard time understanding other people’s languages. Materialism and dualism are powerful mind altering substances, to be sure - they make the mind cloudy.
But what, really, is the potential benefit of describing Chinese medicine concepts in Western medicine terms - and vice versa? What could be gained by melding these two medicines together? I already know the dangers. The most persistent danger and the one that has been most roundly realized is the possibility that Western medicine will come to dominate the relationship. In this way, Chinese medical professionals will be mandated to learn well everything in Western medicine - Chinese medical research will be required to meet Western standards. The parts of Chinese medical theory and practice that don’t fit easily into a Western context will be discarded. The reverse will not be true. Or, at least, it hasn’t been.
So what is to be gained by this relationship and how can we avoid, or counteract, the negative forces inherent in it? I’d love to hear your thoughts. I am well aware that there are examples of good interactions between the two medicines and I’d like to hear your stories concerning them.
Eric
Tags: chinese-medicine, integrative-medicine, Theory, traditional-chinese-medicine, western-scienceRelated 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-medicine
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