What is Traditional Chinese Medicine?

I have erred on the side of thoroughness, here, while still trying to be as succinct as the subject permits. To help keep nested concepts clearly organized, I've used a multi-level enumeration system where main topics are indicated by uppercase Roman numerals and successive sub-topic layers use uppercase alphabetic letters from A-Z, Arabic numerals, lowercase Roman numerals and lowercase letters a-z, respectively. This system shall be used throughout this site when presenting multi-level content sructures.

More broad-stroke descriptions immediately follow larger topic headings while more granular ones follow smaller sub-topics. In this way I hope to satisfy all levels of curiosity about the subject of TCM, which is beautiful enough to warrant a comprehensive introduction for those who are interested, but coherent enough to be presented simply for those who prefer brevity.

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.


NOTE: TCM-specific terms are defined in the references sub-section

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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 as well as all stability.d

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.
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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.

3. 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.

4. 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.

5. 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.
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C. Five 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.

Just as Yin-Yang theory strives to encompass all perceivable reality, Five Phase theory does so for all manifest reality. It is worth noting that the periodic table of elements is roughly divided into five groups of elements based on their behavior patterns and interactions with other elements.k

1. Five Phase Mechanics

Just as is true for Yin and Yang, there are specific mechanics associated with the Five Phases, which are as follows:

i. Yin-Yang duality

Each phase can be relatively Yin or Yang compared with alternate expressions of the same phase. For example, a marsh would be Yin earth relative to a mountain, which would be Yang earth while an oak tree would be Yang wood relative to the Yin wood of a willow tree.

ii. physiological cycles

There are two cyclical circuits or chain reactions between the Five Phases that define balanced interactions between them and constitute the basis for vitality. These are the engendering cycle and the restraining cycle. In the Five Phase associations section, below, the organs and tissues of the body are all assigned to different elemental classes and thus the Five Phase theory applies patterns observed in the natural world to normal, healthy physiology via the following relationships.

a. engendering or generating cycle

Each element or phase is generated by one other element and, in turn, generates third. The generative flow is as follows: Metal generates Water; Water generates Wood; Wood generates Fire; Fire generates Earth; Earth generates Metal. In this manner, there are said to be parent-child relationships between certain pairs of elements.

b. restraining cycle

Each element is checked into functional and structured behavior by one other while serving this same purpose for a third so that no element becomes excessive in its expression to the exclusion of other elements or in such a fashion that it fails to uphold the balanced expression of all. The restraining cycle procedes as follows: Metal restrains Wood; Wood restrains Earth; Earth reetrains Water; Water restrains Fire; Fire restrains Metal.

iii. pathological cycles

There are two cycles that only arise when one of the two physiological cycles has failed to maintain balance between the elements. These are the overacting cycle and the insulting cycle, according to contemporary translation of the Chinese terms.

a. overacting cycle

This cycle essentially an excessive application of the restraining cycle so that one element checks another beyond the latter's ability to withstand and reduces its functionality as a result. Theis may be because the former has grown too strong, or because the latter has grown too weak. See the Eight Pillars of Diagnosis and the concepts of excess versus deficiency below.

b. insulting cycle

This cycle is a refusal, so to speak, of one element to be functionally checked by its normal restraining element, resulting in potential dysfunction of either or both elements.  This may arise either due to the restrainee being too strong, or the restrainer being too weak.

2. Five Phase associations

Just as Yin-Yang theory is a universal dynamic that applies to all phenomena, Five Phase classification can be applied to any context of manifest reality. To remain within the scope of this discussion, however, below are some examples of Five Phase associations that are most relevant to human physiology and consciousness.

There are overlapping concepts between the Five Phases and the 12 Organ Systems descried further down on this page. One of the trait classes presented in both subjects is that of the Five Minds, which are five categories of consciousness, cognition and emotional perception that are ascribed to both the Five Phases and the Five Zang or vital organs. In the medical classics of China, it is often said that the root of all vitality as well as all pathology lies in consciousness, cognition and emotional perception. Emotional intelligence is divided into five realms, each of which shares associations with the energetics of the Five Phases, as well as with the physical body so that dysfunctions in the mind-body continuum can be more easily diagnosed and treated using Five Phase dynamics and physical stimulation of the body. For these reasons, the Five Minds are included here as well as further down in the 12 channel pathway and Organ System content.

NOTE: Please see the references sub-section for terms definitions.
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i. Earth

ii. Metal

iii. Water

iv. Wood

v. Fire

D. Twelve-channel pathway system of Qi flow throughout the body, Acupoints & the Twelve Organ Systemsd

Each physical organ has an associated energetic channel pathway with its attendant acupoints and branches. These chanels are conduits for the flow of Qi and blood throgh the body. There are multiple layers of channel pathways from the superficial paths of the skin and adipose tissue to the deep pathways of the musculoskeletal structures and the organs, themselves. There are also many complex branchings, divergences and convergences of these pathways, just as our nerves and blood vessels exhibit. These pathway nuances and details are beyond the scope of this introduction but may be thoroughly explored in some of the texts listed in the 'references' sub-section. Together, a physical organ together with its energetic channel pathways constitute an Organ System.

1. Channel Pathways

There are 12 primary channels associated with the 12 organ systems of traditional Chinese physiology as well as eight extraordinary channels associated with systemic functionality and embryological development. These channels have many layers, traversing the skin and sub-dermal adipose tissue, musculature and fascia as well as the internal organs. There are numerous branches along each channel, many of which communicate with one another, forming a complex network that integrates all body regions into a functional whole.

These channels are conduits for the flow of Qi and blood. Rather than material structures, they are tracts of tissue that share similar anatomical and energetic patterns. The 12 primary channels are further sub-divided into into six pairs of analogous channels with similar anatomical distribution relative to the four limbs. Each pair has one hand and one foot channel. There are three Yin and three Yang channels for both hand and foot channels. The names and course trajectories are listed below.

For a thorough discussion on channel pathways, please consult Peter Deadman's text, listed in the references sub-section. Ted Kaptchuk, a general surgeon, also composed an intriguing discussion on the anatomical nature of the channel pathways from a biomedical perspective.

2. Acupoints

There are about 400 commonly-used acupoints. These are regions along the channel pathways as well as between pathways where the energetics of Qi and blood flow can be influenced in specific ways. Some studies have indicated a heightened level of electrical conductivity at these points in contrast to surrounding tissue, but this is only one aspect of their behavior. They are also sometimes likened to eddies or vortices in flowing water or estuaries where energy is concentrated or transformed in some way. Also known as pressure points, acupoints can be stimulated i a variety of ways such as needle insertion in the case of acupuncture, or manual stimulation in the case of the Japanese practice, Shiatsu. Points are selected based on their signature characteristics and are combined in treatment plans according to a customized formula or recipe for patients' goals.

For a complete exploration of these points, please consult Peter Deadman's text, listed in the references sub-section.

3. The Twelve Channels & Twelve Organ Systems

I will limit this introduction to the 12 primary channels and their related organ systems. For a more thorough exploration of the extraordinary channels, please consult Peter Deadman's text listed in the references sub-section.

Each channel is matched with a physical vital organ with which it shares a name. Each vital organ is perceived as resonant condensations or crystallization of the Qi that circulates through its associated channel pathway. Together, a channel pathway and its associated vital organ are known as Organ Systems.

Each Organ System is also associated with a specific time interval of two hours' duration during which the body's resources are focussed on the functions of that particular Organ System, as well as its upkeep or repair. Qi and blood circulate through the channel system, being relayed from one to the next in a continuous circuit in the order described below so that every 24 hours, each Organ System plays a leading role, as it were, in the physiologival behavior of that time of day.

There are six Yin channels and six Yang channels. Hand Yin channels arise in or near their associated vital organs and travel distally to the fingertips. Hand Yang channels receive their Qi and blood from hand Yin channels and travel to the head and face. Foot Yang channels receive their Qi and blood from hand Yang channels in the face and travel down to terminate in the toes. Foot Yin channels arise in the toes and travel proximally to return Qi and blood to thevital organs.

The six Yin systems are associated with the six so-called Zang or 'solid organs,' those with comparatively higher density of stroma or solid matrices of metabolically active tissue. The six Yang systems are associated with the so-called Fu or 'hollow organs,' those with more pronounced lumens and predominence of parenchyma or membranous tissue responsible for physical conveyance of substance throughout the body. Each of the Five Minds responsible for both normal and abnormal cognitive processes and emotional perception are housed in the Five Zang or Yin Organs.

Each of the Five Phases is ascribed to a pair of Organ Systems that are arranged consecutively on the 24-hour circuit of Qi and blood so that each Phase has one Yin and one Yang Organ System, except Fire, which has two of each, one pair of which contains vital organs not formally recognized as such in conventional biomedicine or anatomy. There is much, much more to be said on the subject of these channels, organs and the means by which they are organized, classified and applied in TCM and I would urge anyone interested in learning more to consult both Wiseman and Deadman texts listed in the references sub-section. For now, here are a few of the most fundamental properties of each system.

i. Lung

ii. Large Intestine

iii. Stomach

iv. Pancreas-Spleen

v. Heart

vi. Small Intestine

vii. Urinary Bladder

viii. Kidney

ix. Pericardium

x. San Jiao / 'Triple Burner'

xi. Gallbladder

xii. Liver

E. Fractile models of anatomy

Just as our genetic code allows stem cells to develop into any tissue of the body, there are energetic correlations between all body regions and some regions possess a microcosmic reflection of the whole body within them.  For example, the hands, feet, face, tongue, scalp, ears and abdomen are all microcosmic distortions of the whole body so that any part of the whole can be treated using specific points within each of these regions.  This becomes useful when treatments are focussed both on imrpvoing local functionality as well as treating general patterns at the same time. These fractal regions are known as micro-systems and each has its specific advantages in terms of treatment goals. Reflexology is a common application of the micro-system of the feet, for example.


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II. 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.

A. Diagnosis, Plan & Prognosis

Perhaps the most outstanding aspect of Chinese Medicine as a clinical practice is its dedication to individualized diagnosis and treatment. All decision-making is centered around the patient's unique constitution, biometrics and life circumstances, as well as their level of commitment and freedom to make reasonable adjustments to personal routines.

1. Differential diagnosis

This term refers to the process by which symptoms, syndromes and patterns in biometrics are cross-referenced against traditional models of constitutional patterning and pathogenesis to arrive at a diagnosis that is at once responsive to all available information and simplified as much as possible to a root cause for a collection of branch symptoms. This diagnosis is contstructed according to four sets of binary differentials called the Eight Pillars of Diagnosis. Below are descriptions of these two sets of dichotemies, Root vs. Branch and Eight-Pillars.

i.  Root vs. Branch

All pathology arises from constitutional imbalances or root patterns. All symptoms noticeable abnormalities that branch out from a common root imbalance. Although therer may be more than one root pattern, most symptoms arise in clusters or cascades and emerge over time or in concert from common root patterns. In TCM, we strive to address both root and branch. Many conventional medical interventions focus primarily on alleviation of branch symptoms without correcting the underlying imbalances that caused the symptoms in the first place,. At best, this is a bandaid solution that obscures rather than corrects the problem. At worst, harsh pharmaceuticals are introduced that over-ride physiological parameters in order to eliminate the natural expression of one symptom but further corrupt the underlying constitutional imbalances, giving rise to new cascades of symptoms known as side-effects. While it is critical to alleviate discomfort, it is necessary to do so while also correcting root pathology. Treating brancy symptoms makes patients feel better immediately while treating root imbalances may be a slower process but will ensure sustainable relief and potentially life-altering restoration of more youthful vitality. Part of my responsibility as a TCM clinician is to clearly identify the root and branch components of patients' complaints or wellness goals and communicate them with equal clarity to patients, providing them with lifestyle guidance so that they may continue to remedy root patterns at home and work outside of clinic.

The distinction of Root vs. Branch is similar to the Western biomedical distinction between a disease or condition and a symptom or syndrome. Unfortunately, many diseases or conditions are defined merely by a list of symptoms rather than by a well-defined departure from vitality. Even more unfortunate is that the biomedical definition of vitality is overly convoluted and is often defined as a lack of symptoms. In TCM vitality is simply a well-balanced constitution in which Yin and Yang and the Five Phases and Twelve Organ Systems are harmonized. Departures from this harmony are root patterns defined by The Eight Pillars, below. Branch symptoms can be either noticed by te patient (subjective) or the clinician (objective) and are merely perceptible dysfunction or abnormalities in the body or conscious experience. Branch patterns should also be defined using the Eight Pillar syntax, but are distinguished from Root patterns in that they are caused by Root patterns and give rise directly to sjubjective or objective symptoms.

ii. Eight-Pillars of Differential Diagnosis

The Eight Pillars of Differential Diagnosis are four pairs of binary distinction that help define root and branch patterns in such a way that the appropriate treatment methods for each are pre-determined by the pattern definitions. A thorough diagnostic pattern should include each of these four distinctions. Similar symptom arrays with different underlying patterns are generally treated differently. Conversely, patients presenting different symptom arrays that share underlying Eight Pillar patterns are often treated the same. They are as follows:

a. internal vs. external

An internal or endogenous pattern is one that arises due to constitutional imbalances and individual behavior. An external or exogenous pattern is one that arises from contact with the external world. Most infectious diseases cause an external pattern upon exposure but may produce internal patterns if untreated. Most internal patterns develop more slowly over time but can weaken constitutional resistance to infection, making one susceptible to external patterns that might not otherwise have arisen. The treatment protocols for internal and external patterns are vastly different. it is possible to have a mixed patern of internal-external pathology as well but one is generally a Root Pattern while the other is a Branch Pattern.

b. excess vs. deficiency

This distinction should be fairly intuitable. If there is too much of something or an over-expression of one of the Five Phases or Twelve Organ Systems, an excess condition arises. If there is a scarcity of vital resources or an inadequate expression of one of the Five Phases or Twelve Organ Systems, a deficiency pattern arises. Treatment protocols for excess and deficiency patterns are also very different. It is also possible to have mixed excess-deficiency patterns but one is generally regarded as a Root Pattern while the other is a Branch Pattern.

c. heat vs. cold

This distinction is also somewhat intuitable. Inflammation is generally thermogenic and therefore produces a heat pattern. Cold patterns arise either from exposure to exogenous cold, or Cold Evils, to use TCM syntax, or by the onset of Internal Cold, which is marked by lack of circulation, stiffness, subjective cold and a number of other factors. Heat patterns are also marked by dryness and friction where as cold patterns often involve fluid retention. Just as with the above distinctions, mixed pattenrs exist and treatment methods differ considerably between different patterns.

d. yin vs. yang

The broadest of the Eight Pillar distinctions, Yin vs. Yang is more of a summation of the other three pillars than an isolated differential. If a condition is defined more by an excess or deficiency of functionm it is more easily defined in terms ofYang. If a condition is characterized primarily by an excess or deficiency of substance or tissue integrity, it is more easily defined in terms of Yin. Just as with the other pillars, there are mixed patterns and treatment methods for different patterns differ widely.

d. two examples

A patient who contracts the flu virus and suffers from fever & chills with body aches and a runny nose has developed a pattern of External Cold. This pattern is seen as an Excess Yin type and is treated with Yang-stimulating substances and points that drive out the Cold Pathogens by warming the body, improving surface circulation and forcing a vigorous sweat.

Conversely, a patient with tachycardia, insomnia, muscle atrophy and dry skin, nails and hair has developed an Internal Deficiency pattern, in this case, a deficiency of Heart Blood. Such a condition is characterized by a lack of Yin Blood which causes what we call deficient Heat symptomms such as tachycardia and dryness just as a poorly lubricated machine will experience friction and dry heat. The lack of calming, grounding Yin Blood prevents sleep and causes emaciation and atrophy of muscle tissue. We treat such a condition by using herbs and points that Tonify or nourish and augment the Heart Blood over time.

2. Patient-specific and feedback-based planning & evaluation

Every perso brings a unique set of experiences, family history and personal circumstances to bear on the patterning of her or his path through realms of vitality and challenge. The sum total of all of this information is one's constitution and it is at once a source of stability and a potential for change. With this in mind, each patient encounter involves some degree of intake wherein the patterns reflecting the present state of the constitution and the most relevant dynamics required to steer change in a particular direction are continually evaluated and re-evaluated. During the initial intake, a thorough medical history is conducted to deliver a functional idea of how the constitution has evolved to its present state, and this process is repeated in miniature each visit before or during preliminary treatment so that changes in the constitution can be recognized and adjustments can be made to treatment planning if appropriate. Patients are also encouraged to reach out between visits to share any relevant experiences that might help inform the next treatment. At all phases of a course of treatment, emphasis is placed on the concept of evolving vitality that is necessarily different for each unique individual.

Prognosis, or the clinical appraisal of probable outcomes is also an evolving perspective that can change from week to week depending on a variety of factors including ambient stress factors, regularity of treatments and patient commitment to lifestyle and/or behavioral and postural adjustments. Those patients who have not only committed to regular treatments and reasonable adjustments to personal or professional routines, movement and postural patterns and mindful acknowledgement of emotional patterns have enjoyed resounding successes, not only in overcoming symptoms but in improving overall vitality and outlook.

As the classics of Chinese medicine remind us, all pathology and all vitality begin with the subtle balancing of our emotional perception. The most fundamental prerequisite to good health and happiness is a sense of optimism despite challenge. If we can find this most subtle of impulses, all positive change is possible.

B. Treatment

There are five categories of intervention, known as modalities, in TCM. Holistic counseling is also an important part of TCM therapy, although not specified as a discrete mdality. Physical and psychological well-being are seen as inextricably-bound aspects of a common whole and counseling, generally in the form of lifestyle and mindfulness guidance, is integrated into any course of treatment. Below are descriptions of each modality as well as how TCM counseling is uniquely woven into each.

1. Culinary medicine & Eastern 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 highly intentional movement that is guided by and often synched with the breath and that reinforces fundamental patterns in vital energetics of the Organ Systems as well as with general immunity and resilience under stress.

In the broadest context of self care, Qi Gong can be any movement or postural adjustment that is done mindfully im order to improve physical or physiological performance. Similar to culinary medicine, it is often a big part of the homework patients are encouraged to participate in to potentiate other treatment modalitiies in the purusuit of their health goals.

Also as with other modalities, Qi Gong recommendations can be highly personalized according to constitution and individual circumstances. However, Qi Gong, like Yoga or Tai Ji (the latter being a specialized version of Qi Gong) there are often prescribed forms or sequences of movements that are commonly practiced based on tradition and the common need for movement that resolves common postrual challenges. In today's world, for example, far too many people are hunched forward when driving or using smart phones, tablets, computers, etc., and can generally benefit from Qi Gong maneuvers where the neck and back are gently extended and deep breathing is employed to expand the ribs and improve bloodflow to these upper spinal regions, as well as to the head and brain.

3. Tui Na, or traditional Chinese massage, &  manual stimulation

This is essentially the Chinese word for massage. In this country, I am obliged to use the term Tui Na or An Mo to define the specific service that I offer as I have not formally licensed as a 'massage therapist.' Many of the techniques are the same and my training involves the same or highter levels of familiarity with human anatomy and physiology. The word Tui means 'pushing' in the sense of a linear rubbing away from the practitioner in a pusing direction, The term Na means 'grasping' as ofthe practitioner kneeding and lifting tissues of the limbs. The terms An and Mo are similar, describing different hand techniques used in traditional Chhinese massage.

Tui Na is used not only as a treatment modality but also as a diagnostic process by which important information about patients' constitutions can be gleaned before applying more precise modalities like acupuncture or herbal medicine. Needless to say, manual therapy also helps relax the patient and his or her tissues and makes the needling process much less of an affront, further potentiating the treatment as a whole.

4. Acupuncture & moxibustion

The most well-known of the TCM interventions in this country, acupuncture is actually a compound word in Chinese wherein the use of needles is only half of the concept. Zhen Jiu is the full namefor this modality and refers to two similar practices. Zhen means needle and the use of needles to stimulate acupoints. Jiu refers to the practice of using direct heat, most often from the heat of burning embers of powdered mugwort on or near acupoints. This latter practice, known in English as Moxibustion, may have preceeded the use of needles in the form of heat delivered from hot stones or other blunt implements place at strategic points on the body.  Moxa, as it is known in short form, can also involve the burning of powdered mugwort over an intervening layer of salt, sliced ginger, aconite or other substance whose energetic quality alters the basic function of Moxa, which is to warm and circulate Yang Qi at specific points.

In acupuncture, needles varying legnths and thicknesses depending on the tissue structure of the target regions, are inserted to varrying depths and at varying angles into specific points, often in specific order and for specific durations. Needles are often manipulated in specific ways. All of these parameters influences the overall effect of the process and are informed by unique patient constitutional factors and the practitioner's differential diagnosis.

5. Traditional Chinese herbal medicine

The traditional Chinese herbal pharmacopia contains not only plant-based ingredients, but also a rich variety of mineral substances and animal ingredients. Herbs are broken down into five basic flavors in accordance with the Five Phase theory, escribed above. They are also categorized as being hot, warm, neutral, cool or cold in nature. Finally, they are each further classified according to which Organ Systems they 'guide' to. One of the most characteristic aspects of TCM's herbal medicine isits elegant use of herbs in formulas based on a rational balancing of these characteristics in order to best customize the formula to unique patient goals in a way that are potent but balanced enough to avoid side-effects.

Herbal medicine requires an additional level of expense and discipline on the patient's part, as well as of evaluation by the clinician. It is often, therefore, applied most often after other modalities have tried and deemed too slow or when other modalities are less accessible such as in remote treatments or telemedicine.

In some cases such as a Yin Deficiency (described below in Eight-Pil.ar diagnosis) herbal medicine is one of the only means by which to remedy certain chronic conditions characterized by auto-immune taxation of resources, chronic inflammation or malnourishment. While other modalities stimulate the movement of substances that already exist in the body, as well as potentiate the body's ability to cuild new resources, herbal medicine is the only means by which potent energetics can be paired with readily-available ingredients for tissue repair and regeneration.

III. History

Chinese medicine was first presented as a coherent system more than two thousand two hundred and forty years ago in the classic, 'The Yellow Emperor's Inner Cannon,' 221BCE. Although earlier texts exist dating back several hundred years earlier, the InnerCannon was the first to bring the energy channel system and the mechanics of its usage together in one coherent work. The second major work by Zhang Zhong Jing entitled Shang Han Lun (Treatise on Cold Damage) and written in the 2nd century CE accomplished the same systematization of Chinese herbal medicine and Differential Diagnosis. Since then, there has been a rich history of recorded case histories and refinement of practice that makes Chinese medicine one of the most evidence-based healthcare systems in terms of well-documented accouunts of its successes and short-comings.

While there has been some level of awareness among Westerners about Chinese medicine in recent history (Benjamen Franklin's great grandson, for example, was the first documented American acupuncturist), it was not until the 1970's under President Nixon that it became a subject of public awareness. Chinese medicine continues to evolve alongside biomedicine and is increasingly incorporated into conventional care protocols in hospitals worldwide.For more information about its history, please see the References sub-section.



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I have tried to provide an overview of TCM theory and practice structure here. If you are curious about how it works, I have addressed this in the FAQ section. Please feel free to reach out with further questions and I will do my best to satisfy your curiosity. Thank you for your interest!




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