Foundations of the Traditional Chinese Medicine

The roots of the Traditional Chinese Medicine (TCM) are the concept of the Dao of the Daoist philosophers, the doctrine of yin and yang, the energy of life (Qi) and the system of the five phases of transformation. The classical textbook of TCM is the Huang Di Nei Jing, the textbook of the physical medicine of the yellow Emperor.

The Dao, the primary natural principle, gives rise to a polarised world. Its complementary state is expressed in the doctrine of yin and yang. This world is in constant change, which is expressed through the five phases of transformation. Qi, the energy of life is part of all matter and keeps yin and yang balanced. Thereby, it is also crucial for physical and mental health.

The Dao of the Old Masters

The Dao is regarded as the universal law and supreme natural doctrine. Lao-Tze, the Old Master, describes the Dao in his major book, in the Dao De Jing and it is likely translated as "Sense", "Way" or "The One". The creative foundation of the Dao is the basis of all dynamic changes and life processes. All these things are in the stress field of yin and yang. (Stux, 1992)

The Doctrine of Yin and Yang

According to Kaptchuk (1983) the doctrine of yin and yang describes the two complementary extremes, which together build up and control the universe with its five elements. There is no mythological or supernatural force behind this concept.

All things in the universe have a yin and a yang aspect. And each of this aspects has itself another dimension of yin and yang. Following example shall demonstrate this concept: Water can be hot (yang) or cold (yin); hot water can be subdivided again into very hot (yang) and lukewarm (yin).

There is no yang without a yin, as there is no hight without deep, or hot without cold. yin and yang control them reciprocally and transform form one to the other.

The character and the inseparability of yin and yang are illustrated in the so called Taiji monade (figure 1) or in the illustration of the dragon (yang) and the Ling-zhi mushroom (yin). The holistic perception of the Daoistic world is demonstrated by the cycle, the dynamical interaction between yin and yang by the curved division line and the small cycles in the big fields demonstrate the dynamic transformation from yin to yang (and vice versa)

The Chinese pictogram for yin originally means the shady side of a hill, whereas yang stands for the sunny side. Therefor, yin also stands for passiveness, receptiveness, quietness, negativity, coldness, hypofunctions, static, regression, dullness as well as the direction down and inside (see table 1).

Yang on the other hand stands for activeness, positiveness, heat, stimulation, hyperfunction, dynamic, progression, gain, agitation, vitality as well as the directions up and outside. In the physiology yin and yang dominate distinct sections in the human body. Yin controls the inner, lower and ventral parts of the body, and yang the outer, upper and dorsal parts (see table 1).

Table 1. The polar yin/yang correspondent system (Stux, 1992)

The System of the Five Movements/Elements

The interaction of the five movements or elements wood, fire, earth, metal and water and their balance in yin and yang explain all changes and activities of nature, and so the homeostasis of the human body.

According to the Wu-Hsing theory there are two cycles of balance, one of creation (positive influences) and one of destruction (negative influences). In the positive sheng cycle wood burns, generatimg fire, this arises ashes, which becomes earth. Earth makes metal, which shall lead to water. Water makes plants grow, which in the negative ke cycle process earth. Earth overcomes water, by soaking it and soiling its clearence. Water itself overcomes fire, fire metal and meatl wood. (Chan, 1995)

Table 2. The Five movements (Stux, 1992)

Table 3. Classification according to the 5 movements (Stux, 1992)

Ethiology in TCM - Qi

A Chinese doctor diagnoses a disease by inspection of the pulse and notice of imbalances in the life force Qi. The total Qi of the body is called veritable Qi (chin. zhen-Qi) and possesses three sources: pre-natal Qi (chin. yuan-Qi), food Qi (chin. gu-Qi), and the Qi of the air (chin. kong-Qi). Ancestral Qi is handed from the parents to the child, and is responsible for the overall constitution of the body. Ancestral Qi is stored in the kidney system. Food-Qi is deprived from the daily diet and the Qi of the air is intaken via the lung system.

Qi travels along the human body in channels, the so called meridians. These invisible meridians build up a network of channels, which are the foundation of acupuncture. According to the Nei Jing these channels transport blood and Qi, regulate yin and yang, keep tendons and bones flexible and support the joints. (Kaptchuck, 1983)

This system contains 12 major channels (chin. mai) of the 11 organs, the so called Jing channels and 8 Extraordinary pathways (chin. Qi Jing Ba Mai). Of these 8 Extraordinary patways Ren Mai and Du Mai, biuld the so called heavenly energy circle. Ren Mai follows the ventral body midth from the mouth cavitas to the perineum. Du Mai runs along the spin, upwards over the head and closing the cycle in the cave of the mouth. Tigether, these 12 major meridans and the 8 Extraordinary channels are known as the Jing-Luo system. (Stux, 1992)

Acording to TCM most diseases can be reduced to some disturbance in the homeostasis of Qi. That way a richness or weakness of Qi can lead to stagnation and blockage of energy flow. Organs of the participating organ systems can then become weak and ill.

Weakness of Qi (chin. xu) is a yin state, richness in Qi (chin. shen) is a yang state. Xu and shen have characteristic symptoms (see table 4).

Table 4. Xua and Shen state (Stux, 1992)

The Human Body in TCM

The eleven organs or rather organ systems are tradtionally devided in six yang-organs and five yin-organs. The anatomical building plan of the organs are not in the main focus of TCM, but rather the function networks. For example, icludes the organ lung the whole apperatus for breathing including the smell sensation.

Yang-organs are characterised as hollow organ (chin. fu). Yin-organs are reservoir organ and are characterised by the Chinese pictogram zhang. In accordance to the doctrine of yin and yang each fu organ is joined by one zhang-organ.

Lung system (chin. fei)

• respiratory and smelling function
• Absorption of air-qi and control the free flowing of the Qi
• rules skin, hair and expression of the voice
• manifests in the nose
• breathing therapy against depression and sadness
• maximal time of the day: 3-5 in the morning
• movement/element is metal
• linked fu-organ is the large intestine
  

Spleen-pancreas system (chin. pi)regulates the blood an the Qi

• nurishes muscles and connective tissue
• weakness leads to atony of the connective tissue and atrophic muscles
• dominates taste sense
• maximal time of the day is 9-12 midday
• movement/element is earth
• linked fu organ is the stomach

Liver system (chin. gan)

• regulates free flow of Qi and blood in the body
• dominates muscle movements and softness of tendons
• nurishes eyes
• liver disturbances lead to stagnation, pain and tension in muscles as well as head and thorax, and night blindness
• maximal time of the day is 9 to 12
• linked fu organ is gallbladder

Kidney system (chin. shen)

• purification of the body fluids and water excretion
• dominates sexuality and reproductive functions
• programs the balance of yin and yang
• dominates psychic activities and will
• controls bones, oints, ear and head hair
• Disturbances lead to activity deficiency, tiredness, fear, depression or psychic rigour, hardness of hearing, tinnitus, loss of hair, or loss of hair colour
• maximal time of the day is 5 to 7 pm
• element is water
• linked fu organ is bladder

Heart system (chin. xin)

• domicille of the consciousness
• responsible for psychic functions and mind activity
• desturbances lead to inner concern, restlessness, nervousness, tachycardia and cardiac arrythmia
• maximal time of the day is 11 am to 7 pm
• element is fire
• linked fu organ is the small intestine

Pathogenesis in TCM

TCM knows a large number of disease causing factors. These factors include climate, emotions, infections, false diet, exhaustion, traumata and insect bites.

Climatic Factors

Climatic factors are classified according to the system of the five movement (see table 3). Beside the disease causing effects these factors are important in describing medical issues. So does fiever count for a heat symptom, migrant pain is described as inner wind and cold limbs are a expression of a inner coldness.

Wind (chin. feng) is an active yang-factor and is assigned to spring. Feng brings disharmony in the body and damages the face, the neck, the skin and upper respiratory passages as well as the liver. Wind mostly is companied by other climate factors like coldness, and humidity.

Heat (chin. re) is a exterior disease cousing factor of variable intensity. In a medical issue Re describes complaints and pain. In the body re has a ascending tendency and can damage the heart. Re symptoms are fatigue, vertigo, dullness, heavy breathing till unconciousness (heat stroke), but also psychic symptoms are Re and heart classified.

Humidity (chin. shi), represents a pssive yin state, like dullness, heavyness, rigour, and is classified to late summer. Shi causes a stagnation of Qi and among other things can cause rheuma.

Coldness (chin. han) opposes heat (chin. re) and therefor belongs to the yin polarity. Outer coldness particularly together with wind can damage a weak body, by blocking the Qi flow in the meridians. An acute han disease expresses itself by pungent crampy pain, and slowing down of movements. Chronic han-yin disease are degeneration and diseases of the arthrosis Formenkreis. Coldness especially damages the kidneys, source of acitve yang Qi, the bones and joints. The typical therapy against han diseases is the moxibustion.

Emotional Factors

Psychic burdens can cause physiological illness or at least abet it. A more and more recognised fact also in Western medicine. Interdisciplinary research tries to combine psycho-, neuro-, endocrino- and immunological aspects which have an impact on the body in a situation like stress or fear.

In TCM it is known for long that a excess of emotional states as fear, wrath, sadness et cetera can cause illness. Emotions are also classified in the five movements and distincted organs (see table 5).

Table 5. Emotions in the system of the 5 movements (Stux, 1992)

Diet in TCM

An ancient Chinese saying of onknown origin goes as following:

TCM is a preventive rather than a symptom healing medicine. The most important tool for illness prevention is the dail diet. Via this diet we integrate food Qi (chin. gu-Qi) from our environement. Therefor, a too much or a too little of food uptake, or a imbalanced diet can cause illness. Foods can be classified yin and yang and the Five movements.

The according element of a nourishment is determinated by its taste and his yin/yang character by it so called inner heat. In each flavour category there are hot, warm, neutral, cool as well as cold foods. Hot eatables protect against a yang weakness, neutral foods give Qi and cold foods protect against a yin weakness/yang abundance (Temelie, 1992).

Diagnosis in TCM

There are eight categories (chin. ba gang) for diagnosing a disease. These ba gang categories consist of four polar pairs: yin and yang, inside (chin. li) and outside (chin. biao), weakness (chin. xu) and abundance (chin. shi), coldness (chin. han) and heat (chin. re).

A diagnosed illness will be categoriesed by a Chinese doctor with exact these categories. A syndrome, a pattern of disturbances, will therefor not only be classified according to its symptoms, but also to its causes and interpretations by the doctor.

Li-disturbances are disharmonies of the five zhang- and the six fu-organs. Characteristica of these chronic diseases are pain in the thorax or abdomen, fiever, disturbance in the gastrointestinal system as diarhoe, nausea and sickness.Li-disturbances are mainly caused by internal factors, like emotions (fear, terror, agitation) or by unbalanced or contaminated food.

External disturbances (chin. biao) are disharmonies in the meridian system (meridian and collateral) especially in the periphery and th surface of the body.

The meaning of xu and shi for the pathogenesis have already been mentioned. Table 6 summarises typical symptoms of these disturbances.

Table 6. Typical disturbances of Shi and Xu (Stux, 1992)

Han disturbances occur if external coldness effects the body. These coldness symptoms also can change into heat symptoms (chin. re) like fiever due to a yang activity of the body. Achronic yang activity of the body weakens the yin forces and body fluids. Table 7 lists typical re and han symptoms.

Table 7. Typical Re and Han Symptoms (Stux, 1992)

Treatment in TCM

For treating a disease in the TCM the physician tries to rebalance the energies within the body of the patient. Balancing can be achieved by external and internal approaches, like moxibustion, acupuncture, herbal drugs, diet, as well as Qigong and Taijiquan.

References

Chan, K. (1995): Progress in traditional Chinese medicine. Trends Pharmacol Sci. 16: 182-187.

Kaptchuck, T.J. Das große Buch der chinesischen Medizin. Die Medizin von Yin und Yang in Theorie und Praxis. Otto Wilhelm Barth Verlag 1988.

Stux, G. Grundlagen der Akupunktur. Dritte erweiterte Auflage. Springer Verlag 1992.

Temelie B. Ernährung nach den fünf Elementen. Joy Verlag GmbH. Sulzberg. 1992

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