What is Traditional Chinese Medicine?
Traditional Chinese Medicine, or TCM, is a standardized and systematized collection of traditional models of health and pathophysiology. as well as a variety of therapeutic modalities, or clinical techniques, for the cultivation of vitality. As an holistic practice, a full picture of a patients past and present circumstances, both objective and subjective, is compiled from both traditional and modern perspectives and a process of differential diagnosis unique to Chinese medicine establishes a highly personalized treatment strategy that balances the patient's constitution with the patient's gols. Clinical goals may include the enhancement of baseline physical and cognitive performance, the stabilization of emotional behavior, the improved resilience and adaptability to stress injury, the assessment and management of pain and other symptoms and the prevention, diagnosis and treatment of disease. TCM draws from a rich variety of classical literature dating back as early as 220BCE. Although many classical schools of thought and practice have been preserved as lineage-based specializations of Chinese medicine, the term TCM refers to a somewhat more generalized and pragmatic application of classical ideas as coalesced into a common standard during the 1960's that attempts to reconcile traditional Eastern and modern Western thinking.
I. Theory
The thought forms behind Chinese medicine are both philosophical and scientific. They are both timeless and adaptive to and inclusive of new information. They are intentionally conceived as living paradigms that are at once sublimely simple and infinitely complex. Similar to modern physics or chemistry, they are models for fundamental processes and forces that combine to yield the sum total of reality. One of their unique distinctions as contrasted with modern sciences, however, is their incorporation of both rational organization and paradox into a relatively well-defined and coherent whole. It is far beyond the scope of this introduction to explore these paradigms thoroughly in their own right, but I will strive to define the key principles of classical Chinese phenomenology, or the study of fundamental processes, and provide some examples of how they apply to medicine.
A. Qi
Qi is the medium for all change and stability.
Qi refers broadly to energy. Just as in modern physics, there term 'energy' is extremely general and subject to many levels of distinction, and just as in other non-scientific contexts, the term is subject to interpretation. In its most general application, everything is an expression of Qi and everything propagates some form of Qi. There is no beginning or end to the cyclical expression and transmutation of Qi. In a more mechanical application, Qi can be likened to the vibratory nature of all matter or the oscillatory behavior of all waveform energy. As an all-encompassing and all-substantiating medium, Qi must also comprise the mechanics of sub-atomic particles, dark matter and any other abstruse realm of reality, regardless of how well such realms are currently understood.
In its physiological applications, Qi specifically means vitality or the vital processes that are the evidence bases for vitality. For example, body heat, tissue flexibility and rebound capacity, neurvous and endocrine regulation, tissue repair and growth, etc. are all expressions of Qi. It is the sum total of all vital processes that distinguish living, healthy tissue from dysfunctional or dead tissue, or inanimate substance. This is not to say that dead or inanimate matter does not posses Qi or obey similar patterns and laws that vital systems do, but that those patterns in vital systems are ordered, coordinated, balanced and regenerative. In the grand sense, all matter obeys the same laws as do living systems and all matter has Qi, but only cultivated, well-ordered and internally-balanced systems can sustain themselves in a greater context of threat or chaos. The following classifications of Qi assist the identification of basic vital patterns and how they can be perpetuated to maintain health.
Let it also be understood that the word Qi can be appended to any noun or adjective in order to communicate the behavior pattern ascribed to either a material state or an energetic process. For example, one can say "Water Qi" to describe the flowing and adaptable nature of water, as well as "constrained Qi" to describe the lack of water Qi's infuence on a process that results in a stagnant or immobilized nature. Any of the following concepts of yin, yang or the names of the five elements, below, can all be descriptors of Qi and the compound terms that result describe fundamental energetic and material patterns in the greater natural world and in any living system.
B. Yin & Yang
Vitality, stability and resilience to stress are the direct result of the balance between Yin and Yang. The act of balancing Yin and Yang is the process of healing.
Yin and Yang can be understood as two fundamental aspects of any system that are perpetually and simultaneously opposite, interdependent, mutually consumptive, inter-transformative and infinitely divisible--see below for a breakdown of these dynamics. This dualistic concept is perhaps the most characteristic of all concepts in the classical Chinese paradigm, and is also one of its most widely recognized despite often being only partially understood, The simplest way to illustrate Yin-Yang theory is through metaphor and example. This paradigm is both philosophical and practical in its inception and it is sometimes best to approach it from a mechanical perspective in addition to an abstract one. In order to be both thorough and succinct, here are the five fundamental mechanics of the Yin-Yang engine with some practical examples of how each can be applied in medicine.
1. Opposition
Each component describes a state or process that is opposite relative to another when compared in a similar context. For example, heat is Yang relative to cold, which is Yin. Interior and deep or lower spaces are Yin relative to exterior and superficial or higher space, which are Yang. Functionality and motility are Yang relative to substantiality and stability, which are Yin. Femininity is Yin relative to masculinity, which is Yang. Wave-form energy is Yang relative to particle-based matter, which is Yin.
In physiology, the energetic qualities of tissue such as its warmth, movement and communication with other tissues fall within its Yang functionality, while its physical integrity, nutrient stores, humoral abundance and resilience over time to stress are its Yin qualities. This principle allows us to better distinguish between problems with Yin versus Yang mechanics and establish a differential diagnosis.
2. Interdependence
Nothing is either yin or yang unto itself or in isolation. Both Yin or Yang qualities exist only when contrasted with alternate qualities along some common continuum. The same is philosophically true of any relative descriptor such as high, low, hot, cold, hard, soft, etc. Each attains meaning only when the object it describes is placed in some contextual opposition with another. For example, a tabletop is not inherently high or Yang when taken by itself, but is high or aYang relative to the ground below it which is not inherently Yin but is Yin or low relative to the tabletop. This begins to illustrate how Yin-Yang differentiation is cyclical, always relative and never absolute. To derive one is to presuppose the other.
In physiology, the simple balance between movement and rest and between consumption and excretion exemplify this principle directly. The principle of interdependence also guides our treatment plan so that we improve athletic performance, for example, not only by improving strength, flexibility and endurance, but also sleep quality, mood stability and nutrient absorption so that enhanced performance can be sustained autonomously by improved tissue integrity and well-modulated hormonal cycles.
iii. Mutual Complementation & Restraint
In an already balanced system, the qualities of one component complement and potentiate those of its counterpart, helping to maintainm balance. At the same time, as a system begins to become imbalanced, the qualities of one component may check or restrain those of its counterpart, helping to restore balance.
For example, healthy cartilage, connective tissue and joint tissues are all Yin structures that complement athletic behavior of muscles and blood vessels in their performance of heat-building, Yang energetics which, in turn, augment the overturn of blood and synovial fluid which perfuse Yin structures and ensure their proper maintenance and repair--i,e. mutual complementation for sustained balance. Conversely, in the event of excessive activity without sufficient rest, the inflammation process results in swelling and stiffness of joint structures or an increase in Yin fluids and metabolites that limit further taxation of injured tissues until they can repair and once again support normal Yang behaviors--i.e. mutual restraint in order to restore balance.
This principle is also evident in hormonal feedback loops. To maintain a balanced system negative feedback loops such as the maintenance of body temperature or blood presure activate opposite processes that, when in motion, down-regulate one another until balance is restored. When it is necessary to drive the system decisively through a challenging process that happens infrequently and must reach a singular outcome to regain balance, positive feedback loops such as labor contractions or the ripenning of fruit allow a structured departure from and returnj to normal behavior by prioritizing one set of processes over their opposing counterparts until positive change is effected.
iv. Intertransformation & Mutual Inclusion
Within each component is the seed of its counterpart and either component may evolve into its opposite in extreme circumstances. It is in the coldest, darkest period of the night that the temperature begins to rise again before dawn, seeding the Yang phase of the coming day and it is at the zenith of the day the sun begins to drop and the temperature to fall, seeding the Yin phase of the coming night. The same is true for inhalation and exhalation, waking and sleeping or any other phasic, cyclical alternation between polar states that occurs over time in a common space. Similarly, a star may exhibit the most Yang behavior of all celestial bodies, effulgence of heat and light, until its mass over time exceeds its ability to discharge additional energy and causes it to collapse into a black hole, which exhibits the most Yin behavior of celestial bodies--contraction, intense gravitation and darkness.
In physiology, we see similar patterns. For example, the brain is most active during deep REM sleep when all other body tissues can truly experience stillness and relaxation--motion within stillness. Conversely, when the body is allowed to maintain gentle, sustained movement, the nervous and endocrine systems are capable of the most stable and well-modulated behavior--a stillness within motion.
v. Infinite Divisibility
Any system or fraction of a system can be subdivided infinitely into ever-finer distinctions of Yin and Yang counterparts. The roof of a house is Yang relative to a tabletop within the house, but if tabletop is Yang relative to the ground beneath. This, of course, goes in both directions as a campfire is Yang relative to a candle's flame, but Yin relative to the sun.
In anatomy, our exterior skin is our most yang tissue system because it is most superficial to other tissues. It is also yang relative to our GI tract, for example, which is deep to the exterior skin. When examining a cross-section of the abdomen, however, the lumen of the GI tract can be said to be Yang relative to the organs that communicate with it because it links directly with the external world and is also composed of epithelial tissue just as our external skin is. What was originally a single body with a Yang exterior becomes a multitude of Yin spaces with Yang spaces on multiple sides when divided.
3. Five Element/Phase (Wu Xing) Theory
There are common patterns in all phenomena that fall into five categories--Earth, Metal, Water, Wood and Fire. In Chinese, these words are nouns as in English and as is true for Western conceptions of the four elements, but collectively, they are understood as Wu Xing, or "Five Phases," or "Five Movements,' implying that they are also fundamental patterns in natural processes. Given the dynamic behavior of Yin and Yang, it should be understood that even a seemingly inert state of being is rich with internal dynamics, stabilizing forces and sustained pattern expression. The Five Phases are no different and describe both states of material reality as well as patterns of process dynamics.
i. Five Phase Mechanics
Just as is true for Yin and Yang, there are specific mechanics associated with the Five Phases, which are as follows:
a. Yin-Yang duality
Each phase can be relatively Yin or Yang compared with alternate expressios of the same phase. For example, a marsh with would be Yin earth relative to a mountain, which would be Yang earth.
b. physiological cycles
There are
engendering cycle
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restraining cycle
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c. pathological cycles
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restraining cycle
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restraining cycle
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ii. Five Phase associations
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a. Earth
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b. Metal
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c. Water
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d. Wood
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e. Fire
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4. Twelve-channel pathway system of Qi flow through the body
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5. Fractile models of anatomy
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B. Practice
There are five basic modalities, or therapeutic interventions associated with Chinese medicine, regardless of which school of thought is concerned. Listed in order of least to most intensive, these are: traditional Chinese nutrition and dietetics; Qi Gong and movement therapy; Tui Na (traditional Chinese massage); acupuncture and moxibustion; and herbal medicine. Traditionally, these modalities were used in conjunction for best results and were often applied in this order so as to minimize side effects and cost of treatment and maximize the blending of interventions into patients' daily lives. Below is a breakdown of these five modalities, all of which are available upon request. Although not traditionally treated as a distinct modality, holistic patient counseling and clinical attention to psychological and psychospiritual concerns is incorporated into the other five owing to the fact that the classical model of mind and body was as a continuum where each was mutually reflected in the other. Nonetheless, holistic counseling is also offered as a discrete service upon request.
1. Traditional Chinese nutrition & dietetics
Culinary medicine is perhaps the most direct and accessible point from which to engage personal transformation simply because we must all eat well-balanced meals regularly in order to experience basic vitality. Minor adjustments made to diet will naturally influence all aspects of our physical, cognitive and emotional process.
There are two basic applications of Chinese culinary medicine in terms of intensiveness and focus. The first is the basic structuring and timing of daily menus according to individual patients' unique constitutional needs and health goals. This primarily deals with common foods, spices and preparation techniques, and while many ingredients and techniques draw from the Eastern hemisphere, basic principles of meal composition and timing can be applied to all cuisines. The second application is the strategic inclusion of more potent herbal, mineral or animal medicines that address specific symptoms or health goals when basic constitutional support via daily nutritional standards may be inadequate.
Both of these applications utilize a traditional means of classifying all foods, medicines and even toxins according to a flavor profile model derived from the Five Elements (Wu Xing) paradigm, discussed further in the herbal medicine section below. This allows smooth transition between mundane culinary practices and the use of traditional herbal formulas.
2. Qi Gong & movement therapy
The term 'Qi Gong' can roughly be translated to mean 'energy work.' In the context of movement therapy, Qi Gong refers to the practice of
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3. Tui Na, or traditional Chinese massage, & manual stimulation
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4. Acupuncture & moxibustion
Details coming soon!
5. Traditional Chinese herbal medicine
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