Traditional Chinese Medicine (TCM) – Key Concepts
Traditional Chinese Medicine (TCM) is an ancient healing system that incudes acupuncture, herbal medicine, dietary therapy, massage (tuina), relaxation and special exercises, such as t’ai chi and qigong. Practitioners view the individual as an integrated whole, whose health or ill-health is determined by the flow of Qi (energy), and consider symptoms to be signs of a pattern of disharmony and not the result of a particular named disease.
The Huang Di Nei Jing (The Yellow Emperor’s Classic of Internal Medicine) is the first record of the teachings that form the foundation of Traditional Chinese Medicine. Written between around 200 bc and 100 ad, the teachings appear to be transcripts of discussions between the Yellow Emperor and his disciple, Ji Buo. The book emphasises three of the ideals of Taoist philosophy – balance, harmony and moderation in all things.
TCM practitioners see the main external causes of disease (“pathogenic factors”) as the following environ¬mental factors: Wind, Cold, Summer Heat, Damp, Dryness and Fire. The main internal causes of disease are the “Seven Emotional Factors”: Joy, Anger, Sadness, Worry, Grief, Fear and Fright. Each of these, if excessive, can cause disease, and tends to affect a particular organ. Other causes of disease include a weak constitution, incorrect diet, lack of physical exercise, over-exertion, excessive sexual activity, pollution and trauma (accidents).
Traditional Chinese diagnosis
Chinese diagnosis takes note of a broad range of symptoms and signs, many of which would not be considered especially significant in Western conventional medicine.
The pattern of the symptoms and signs of an ailment are the outer manifestations of “dis-ease” and are considered to reflect the condition of Qi and the Internal Organs.
Analysis of the symptoms and signs leads to identification of a “pattern of disharmony”, which is quite different from a conventional Western diagnosis. Examining the tongue and making a detailed pulse diagnosis are important procedures. Observation of the colour and shape of the tongue body, as well as the tongue’s coating, can reveal the state of the Internal Organs and the presence or absence of various pathogenic factors.
Pulse diagnosis is a complex technique and involves a high degree of subjectivity. The radial pulse is felt with the index, middle and ring fingers at three different regions in the wrist, and the pulse characteristics are noted at three different levels (superficial, middle and deep). The various pulses are said to reflect the state of the Qi, blood, yin and yang, and Internal Organs, as well as the presence of pathogenic factors.
Consulting a practitioner
At first, the TCM practitioner will look at the condition of your tongue and hair, the tone of your skin and the way you move. He or she will notice the sound of your breathing and voice and will note any distinctive odours. You will expected to give details of your family history, habits, bodily functions and symptoms of ill-health.
Finally, the practitioner will feel your radial pulse, checking for strength, rhythm and quality, and explore your body for hard or tender areas. Treatment can involve herbal medicines, acupuncture, dietary regimes and movement therapies, such as t’ai chi.
The Chinese herbal practitioner can choose from around 6,000 herbs, a few mineral and animal sources and hundreds of different formulas. Herbal remedies are used to restore the yin-yang balance within the body and to work in specific organs and channels to correct the relationship between the five elements. The herbs are classified under the five elements according to the remedial action of their taste – sweet, sour, bitter, pungent and salty – and their opposing yin-yang qualities of hot and cold. For example, skullcap is a bitter, cold herb that can be used to lower a fever.
Herbs are usually prescribed as a formula of 10-15 dried herbs on the basis of their reputation and record for treating a particular pattern of disharmony. For example, a practitioner might decide to treat a case of infected allergic eczema, which he would diagnose as “damp-heat eczema with fire poison” with Gentian Drain the Gallbladder Decoction (Long Dan Xie Gan Tang).
The practitioner often adapts a basic formula to match the patient’s individual pattern of disharmony. Remedies are usually taken as teas that are prepared in daily doses. They may also be taken as pills, powders, ointments, creams and lotions.
This ancient movement therapy is practised daily by millions of Chinese people. It is sometimes referred to as meditation in motion. T’ai chi is a non-combative martial art that combines breathing techniques with sequences of slow, graceful movements that improve the flow of Qi, calm the mind and promote self-healing. T’ai chi is a safe and enjoyable form of exercise and can be learned and practised by people of any age. Research shows that it relaxes the muscles and calms the nervous system, so improving the function of the body. It also benefits posture, balance and flexibility, thereby helping people who have arthritis and other musculoskeletal disorders.
Many people with arthritis who have practised t’ai chi praise its benefits, saying that it helps to relieve their pain and stiffness, brings relaxation and a lift to their spirits and increases their flexibility and muscle strength. Studies have shown that t’ai chi can not only improve balance but can also prevent falls. In 1996, a trial in Atlanta in the US found that t’ai chi improved the health of elderly people and another American study in 1989 found that it improved breathing without straining the heart.
THE FIVE ELEMENTS
Practitioners of Traditional Chinese Medicine have a profound understanding of the relationship between yin and yang and a practical grasp of the qualities that feature in five element theory. The five elements of TCM are fire, earth, metal, water and wood. These categories represent the qualities of everything in the universe, including the body’s Internal Organs, which are more than simply organs as understood by the Western mind. The interplay between these elements gives rise to the unfolding and unceasing changes that are involved in maintaining well-being and restoring balance in our lives. Each element relates to a yin organ and a yang
organ, and is associated with a specific taste, emotion and season (see below). In five element theory, one element supports or inhibits the function of another: fire melts metal, water douses fire, wood breaks through earth, metal lets water condense, water nourishes wood, earth dries up water, metal cuts through wood. In the body, the organs share the same relationships: the Heart (fire) controls the Lungs (metal); the Kidneys (water) control the Heart. The TCM practitioner will use the qualities of the five elements to understand the pattern of disharmony in the body and to restore the balance of the fundamental forces.
Key Concepts of TCM
Holism means that a person’s mind, body and emotions are seen as a single interacting whole. Ideally, they are in a state of harmony, both internally and in relation to the external environment. Problems in one part of the whole person affect the health of other parts. Holism is one of the key concepts of TCM, which also include yin and yang, the five elements (see box, left), Qi, the Internal Organs, the meridians and the acupoints.
Yin and yang
These are the two complementary and fundamental processes of nature of ancient Chinese philosophy. They are qualities that are both opposite and yet at the same time interdependent. Many of the familiar pairs of opposites are described as either yin (contraction, cold, water, female, moon, black) or yang (expansion, hot, fire, male, sun, white). From the unceasing interplay of yin and yang, everything grows, develops and changes.
Yin and yang are in a state of continual change and influence everything in the universe, from the very large to the very small. This includes a person’s health, which is affected by qualities in the external environment and the harmony of internal energy. Disease-causing (pathogenic) factors can disturb the balance between yin and yang. For example, a disturbed balance might lead to yin conditions that involve hardenings, such as osteoarthritis, or to yang conditions that involve inflammations. A TCM practitioner will diagnose the imbalance by assessing the flow of Qi with various techniques, such as feeling the pulses in the wrist, and will then direct treatment towards restoring the balance.
Qi is the “vital energy” or “life force” that exists in every living thing. It is a concept that is very difficult to explain in Western terms. One way of looking at Qi is to say there are three kinds. The first is the Qi that is given to a child by its parents at conception – this Qi is stored in the kidneys and contributes to the child’s constitution. The
second is the Qi which we receive from the digestion of food. The third is the Qi which we absorb from the air we breathe.
Qi moves between yin and yang: it can move inwards to the centre (yin) or outwards to the surface (yang). It governs the functions of the Internal Organs, and circulates via the meridians to every part of the body. Pain, for instance, results from disturbances in this circulation.
Two main categories of Qi can bring disharmony – deficiency and stagnation. When Qi becomes deficient it might affect the whole person or a single Internal Organ, such as the Kidneys. When it stagnates, Qi ceases to flow smoothly through the meridians, leading to aches and pains or a dysfunction of an Organ.
The Internal Organs are not the same as the Western equivalent although, confusingly, they have the same names, such as liver, kidneys, heart and spleen. To help avoid this confusion, the Chinese are written as starting with a capital letter – hence, Liver, Kidneys, Heart and Spleen and Internal Organs.
TCM sees each organ as a complex system which includes not only its anatomical entity and physiological functions, but also recognises its corresponding emotional and mental function.
The meridians are pathways, or channels, in which Qi energy circulates throughout the body. Each meridian is associated with an Internal Organ.
Acupuncture points, also known as acupoints, are specific sites through which the Qi reaches the body’s surface. An acupuncturist can manipulate the circulating Qi via these points to restore health in the relevant organs or meridians.
FINDING A PRACTITIONER
It is essential to find a suitably qualified Chinese herbalist. The Register of Chinese Herbal Medicine and the Australian Acupuncture and Chinese Medicine Association (AACMA) hold lists of practitioners. Expect the first session to last about an hour and subsequent ones about 30 minutes. You may be given a mixture of herbs to prepare as a tea each day, but herbs may also be prescribed as pills, powders and ointments.
Do not treat yourself with Chinese herbs unless they are prescribed by your herbalist. Make sure you give the practitioner full details of any conventional drugs and nutritional supplements you are taking.
If you would like to learn t’ai chi, the T’ai Chi Association can help you locate a qualified teacher.