This article is also available in it's published form CJOM, Vol 11, No. 2 Spring 2000 (pdf)
In Search of A Philosophical Medicine
All medicine is philosophical in nature. Even modern medicine is based on our modern-day understanding of life as a biochemical, possibly mechanical, process. Chinese medicine also is based upon certain philosophical understanding cloaked in cultural terms appropriate to its time and geography. If we get caught in the language used we might loose sight of the essence of the medicine: its view of the human process. When we look deeper, past the cultural differences, we can find the core statements and realise their relevance to our lives also.
The I Ching (Classic on Change) represents the bases of Chinese understanding of life. Change is what life is about – everything changes, nothing remains static. The character I (change 易) represents the sun and movement, like the movement of a flag in the wind. It is one stroke different from the character yang. Life is about change: if we did not change all the time, no biological, or any other, process would ever take
place, we would never transform from sperm and ovum to embryo, to baby to child, to adult, etc. Inherent in this concept is the notion that life is about being yang, interacting, moving, changing.
The process of life is the process of change, of movement. Thus we must respect change, even when if sometimes we perceive the change to be adverse to how we currently perceive our happiness and health. To study life, and medicine, is to study change, its course, and the response to change. Because change is inevitable and natural, we must conclude that pathology must be the result of our response to change.
The character feng (wind 風) also connotes the sun, motion and extension, that is it represents the currents produced by the sun (atmosphere). One stroke off is pan feng (half wind) which is said torepresent a worm, something that is being pushed, and a hook that entices. This is to say that Wind is what entices us, pushes us, into change. We can view change and wind as synonymous. This is why we say that wind is the spearhead of all disease (in disease we have changed from “health” to “disease”).
Since change is inevitable and natural, we must look at our response to change as the cause of disease. Hence the major schools based on response: Cold (Shan Han), Heat (Wen Bing), and Dampness.
The character Han (cold 寒) represents a person who is separated from his/her field (work) and is crying. This is an inability to produce, an inability to move forward. Cold is the response that locks us in, refusing to change, perhaps even a denial of change. Cold physically represents contraction and lack of movement. Philosophically it represents the exact same qualities: a refusal to engage with the world. When looked upon as a response to an external pathogen we might call this the tai yang response – we fend off against change, becoming stiff and rigid (getting body aches and stiffness).
Heat is expansive, full of motion. When we are overeager to change, when we move too quickly towards the world, that is when we have Heat. Again, this can be a physical response or an attitude towards life, or both. We can call this the yang ming response, internalising the change/movement, creating heat (movement) inside our body.
Dampness is the viscous quality that makes it hard to move in either direction. It comes from hesitation, being uncertain as to whether to move with the change, towards it, or against it. We might alternate between being “cold” and being “hot” towards the situation (change) at hand. This is the shao yang response: “maybe this, maybe that.”
We can further say that Dryness is the result of Heat drying up our resources and exhausting our resources. Summer Heat can be said to be a combination of Heat and Dampness, one in response to the other, that is the Dampness is trying to slow down the Heat or the Heat is trying to get rid of the Dampness.
When viewed in this manner we understand that wind is not really the cause of disease, but merely the enticing factor. Our reaction to wind, that is, some rigidity within us, is what causes the disease. I refuse to change (Cold) because of some pre-existing attitude within me. Or I try to move too fast because of some resentment toward my current
state and this is enticing me towards movement away from the present. Or I might be holding on to both desire for and reluctance to change (Dampness). Any of these responses represent some inability to be in the present as it is, some rigidity, an attachment to the past, or an over-zealous determination to be in the future. The climatic factors are no longer external issues, but reflect our own responses to the world, responses that we can take responsibility for.
Movement and interaction are inherent in the human condition. This statement is reinforced by the order of the regular meridians. The human condition requires survival, that is, air and food, represented by the Lungs and Spleen (as well as Large Intestine and Stomach). But our physical survival is not enough, we then need to move towards life and interact with it in order to gain what we perceive as sovereignty over the world. This is the Heart and Kidney (as well as Small Intestine and Bladder) representing movement (circulation) and what enables one to move (the skeleton/bones). This is the self as it moves out to “conquer”/understand the world around it. But one always limits which experiences, or which understanding, one wishes to engage in. One becomes more aware of what one wants to engage in and what one wishes to ignore: I may choose to become a mathematician or a doctor, or an actor, or whatever, and concentrate my interactions with the world to those suitable for my choices. This is the Pericardium, the Heart protector, and the Liver (as well as San Jiao and Gall Bladder): the organs responsible for protecting (limiting) us and detoxifying (or creating smooth flow in Chinese terms – smooth flow means harmony with the world). Thus we see that our movement may have some inherent rationale and inner structure.
Having understood that humanity dictates that we seek to interact, “conquer”, and understand (limit) the world around us, and having looked at change as representing the “world” side of the interaction, we now need to look at the terrain of the human being in order to understand the “human” side of the process.
We say that the human is the level representing the interaction of Heaven and Earth. Thus we look at three levels of qi (influences): wei, ying, and yuan (or jing). The yuan qi is that which represents our original pattern, our connection to our ancestors (from where we came), and our destiny. Wei qi represents our spontaneous reaction to the worl which might be defensive but could just as easily be offensive. Ying qi is that
which nourishes the self, which can be food, thoughts, or emotions. We look at these as three levels of depth as well as qualities.
Wei qi, being spontaneous, is, theoretically, accepting of change, since it is spontaneous, it has no rigidity, not preconceived patterns: on this level we may accept change or reject it all together without being bothered. When change occurs on the yuan level, this means structural changes of the organs (or bones) and/or our destiny. Changes on the yuan level is the unfolding of our potential destiny in the reality of our life. It is the ying qi that represents the most resistance to change. Ying qi represents our blood, our thoughts, our patterns we have built in order to nourish ourselves. These are often influenced by our learned experiences, our social consciousness. Wei qi represents a desire to be one with the world as it flows currently. Yuan qi represents my desire/ability to be one with the world through my ancestral connection, through the common genetic code, it is my connection to the source of the vast ocean of life. Ying qi is the qi that has the tendency to separate me from the world. In my desire to discover and understand the world, and hence nourish myself, I might become too consumed with myself as a separate entity from everything else that exists, having become overeager to nourish myself. Ying qi is the foundation of the ego, thus it represents my rigidity, learned behavioral patterns, protecting the perceived self, separating the self from the world. This is where pathology easily develops, through the separation of self and “other.”
If I develop the virtue (de 德) to be in line with the way (dao 道) of all things/nature, then I am able to spontaneously be in contact with the world and with my pattern/destiny without too much interference from the intellect, learned patterns, conceptualizations, etc. We want to be able to nourish ourselves, but not too much, not to the point where feel separated from the flow of the world around us, needing to protect ourselves against the its currents. This is perhaps why we concentrate so much on the treatment of the regular meridians and why we have developed that system to such a greater level: this is the meridian system that deals with blood and wei, that is the system that represents how we nourish ourselves as we interact with and move through the world.
What we have stated up to this point is that the process/purpose of human life is to interact, learn, and understand the world, that change is inevitable and that our resistance to change is what creates disease (blockage in TCM terms), and that the experiences of our interactions with the world go through three levels within the human domain: wei, ying, and yuan. Now we can look more closely at the process of disease. Before we do that we must remind ourselves that in distinguishing stages of pathology we do not mean to isolate one level or phenomenon as independent of others, nor can we say that disease progresses from stage one to stage two in an absolute manner. Any stage or level will inherently contain and reflect the other stages and levels.
As we look at the process of disease we might look at how an unresolved issue disrupts the flow of life. We might say that at first it is on the wei qi level. At first we might not even understand that we are encountering an issue in our lives. We might accept it or we might fight it without much awareness of our response (just like pulling our hands
out of the path of fire before having figured out the fire was hot). Later our response might be one of Cold (slowing the change), Hot (moving towards it faster than invited), or Damp (moving both toward and halting at the same time).
If we have not accepted the encountered change we shall start developing greater awareness of its existence. Slowly, we might become more and more irritated by it. Now that it is in our consciousness, it is in the ying level. The response of cold, heat, or dampness become pronounced. We start to “invest blood” in the struggle, the way we digest the world (Spleen) is being affected, our emotional disposition might be affected. Now, it is no longer quite so easy to ignore/expel the “pathogen” (pathogen here means any issue, emotional or physical, that feels foreign to our lives). In this stage there will typically be pain, mental or physical, and the beginning of disruption of function. As the irritation increases, we may opt to “harmonise” the problem, that is, we learn to live with it. The problem is not gone, but it is manageable, it no longer has a pronounced effect on our lives, perhaps it is dormant, perhaps we simply learn to live with the problem, perhaps we suppress its symptoms.
At some stage, we are unable to maintain this “harmony,” or we have become so accustomed and we suppress the problem so strongly that it starts becoming part of who we are. This is the yuan level. Physically this may show as damage to actual structure or organs, while mentally it may show as repression and a change in outlook that is no longer conscious but has become part of who we are (as in “my pain and I are one” or “I am my problem”), or a feeling of total separation from the problem (as if it is a demon that has taken hold of our destiny). Now our destiny is being rewritten.
Another way to describe this process of penetration is through the concepts of latent heat and latent cold. Once the pathogen has entered the ying level, our reaction is no longer spontaneous. Now the enticement for change (wind, or wei qi) is in the blood, and might disrupt what we perceive as our normal functioning. The body mobilises the blood in order to suppress the pathogen. This can be done through defensive emotions, changes in behaviour, or relatively small changes in function and structure, e.g. the
building of extra capillaries, or hardening and closure of blood vessels, reduced function so the body is no longer at an optimal level, etc. This is called “latent heat” because we have taken that which is yang (change, movement which are “hot” by their nature) and suppressed it, perhaps encapsulated it with blood. This is the stage that we might observe the Luo vessels on the surface, as those represent the mobilisation of the blood. We may see phlegm nodules, etc.
At some point we will not have enough blood to handle the issue and suppress it. At this stage we start to mobilise the jing in order to keep the suppression. At this stage we might call this “latent cold” as it is the energy of the kidneys (cold), our core, that is
being utilised. Here greater substantiation takes place, the encapsulated pathogen begins to become more consolidated, fibroids and tumors are being formed, the loss of function is quite great, and grosser structural changes occur. Eventually, the jing is unable to contain the pathogen, and metastasis begins: the pathogen (heat, movement) is no longer held and starts to spread.
This, of course, is a natural process: we all have issues that we have not dealt with satisfactorily (physical or mental) and which we have suppressed to varying degrees. Thus we all have cancer: encapsulations, mutated DNA (changes in the jing), the potential for uncontrolled growth, and spreading of heat (movement). It might be said that it is all a question of degree and how “reasonable” our response is compared to
We can see this process in accordance with the three schools of thought: Cold, Hot, or Damp/Phlegm. This is the process of degeneration, of death and rotting. We can view it as a process of becoming colder and colder, that is less able to function, being less yang. We can view it as a process of Heat, the, possibly uncontrolled, movement towards death, and we can view this is a process of phlegm accumulation, as the body
builds up greater and greater accumulations that disrupts clarity and function. Rather than assume a particular dogma, it might be most useful to assume all three are correct, can coexist, and depending on the person, one will be more dominant.
We can also correlate this process of moving from wei to ying to yuan/jing to anatomical blockages. Anatomically we might say that the neck, diaphragm and pelvis represent major thoroughfares in the body, and hence obstacles. At the wei level, one might exhibit wind (cold, or heat) symptoms with blockages in the upper body, the head and neck area. As the pathogen moves deeper, to the ying level, one might get diaphragmatic constriction, while later, as blockages become more substantial, one will
develop pelvic obstructions. It is important to note that these three levels cannot be relied upon for palpatory diagnosis since most people will have at least some issues on all three levels, and thus may exhibit hardness/blockages on all levels. However, it does give one the option of freeing these blockages anatomically as an approach to bringing resolution.
This description of the process of disease as the process of creating accumulations emphasises the importance of the fu organs. The fu organs are often given relatively little emphasis in modern acupuncture. However, if we see disease as the over-accumulation of un-dealt-with experiences (toxins) then keeping the fu (bowels) open so that they can fill and empty as prescribed is of utmost importance. (We see this
attitude exercised in Western practitioners who believe in the critical role of leaky gut syndrome in chronic degenerative and autoimmune disorders.)
The meridian system is the conduit system of qi. Qi means influences, that is not just righteous qi, but also pathological qi. We can see how the meridian system is involved: Wei qi flows in the sinew meridians, and it is the qi of the lungs. Thus we say that the
tendino-muscular meridians (jing jin) are the main meridian system involved on the wei level, and that the liver (sinews are in the domain of liver) and lung are especially related to wei qi response. The luo meridians (luo mai) carry blood, thus they are the meridians responsible for the process at the ying level. (One can argue that the primary meridian system belongs here also.) The spleen (producing blood ying), heart, and pericardium relate to this level. Finally the 8-extra meridians (qi jing ba mai) are the conduits of yuan qi, and the kidneys and San Jiao are implicated here.
Since the regular meridians are conduits of both wei and blood (ying), we can see them as the system that mediates between the wei and the ying levels. It is also possible to see the primary meridians as representing the ying level, and the luo system as representing the bridge between the ying and yuan levels (this is because the luo are said to fill when the regular meridians can no longer hold the pathogen). It is a matter of personal judgement, and depending on the individual presentation.
The divergent meridians (jing bie) represent an attempt to divert the pathogen away from the organs, resulting in the pathogen being pushed into the joints (where these meridians originate). These meridians are somewhat equivalent to the lymph system both in location and function (diverting pathogens). It is the movement of a pathogen from the wei level directly into the yuan level (bones) and it is done so one might not have to consciously deal with the problem (the ying level). Thus we say that the divergent meridians communicate wei and yuan qi, with the exclusion of ying qi.
This view of the channel systems in correspondence with the type of qi, depth of penetration, and stage of disorder/disease can help us when we select treatment points. We might first determine what stage predominates in the particular person. This dictates the channel system we might want to work on as the channel system that corresponds to that level. We also need to assess as to whether we want to encourage the body’s current tendency, or to introduce a new direction. In other words, do we feel the client is ready to handle the issue, or is it perhaps best to help suppress it at this oint until the client is indeed more able to handle it (this might be especially considered in very weak patients). And what will be needed if the client does indeed confront the issue. The level and strategy/direction chosen can help us in selecting points that resonate with the channel system involved as well as points which might hint to the client’s body-energetic the direction chosen.
For example, if we determine that the divergent meridian system is involved, in, say, the bladder/kidney confluence, and we wish to encourage the pathogen outwards, we might choose to use B 40 and B 10 (the confluent points of this divergent system) with B 67 which is a Jing-Well point activating the sinews, hence indicating the direction towards the wei level, or SI 12 which is the meeting of the three yang zones and which
by name (bing feng – catch the wind) implies expelling the wind/change/pathogen factor. (Such combinations are naturally a matter of personal choice for each ractitioner.)
It is important to remember that the various meridian systems share points. Thus one might say that B 40 is the Earth point of the bladder regular meridian, but it is the lower confluent point of the U.B. Kidney Divergent system. One needs to be quite clear in ones intention as to what one is aiming at when choosing a point, so that you truly
do tap into the level you desire to influence. (This also means that rather than picking points by prescription, one might accomplish more by picking points according to their relationship with the problem level and nature.) Nothing can exceed mental intention, however, not all of us have such great mental clarity that we can trust to be transmitted through our needles. Here technique can help.
When intending at the luo meridians for example, one can use bleeding (with a 7-star needle for example) as a technique that supports one’s intention (one need not always get actual blood, but the activation of the blood may well be enough, and one can stop when the area becomes red). The sinew meridians are distinguished by the jing (well) points, which can be anywhere in the vicinity of the nail, not just the corner, obviously needled superficially, the meeting points of the sinews (SI 18, GB13, Ren3, and GB 22), as well as “local” knotted trigger points in the muscles which would be needled superficially like a trigger point. Cupping is another technique that resonates with the sinew meridians. The divergents are needled in the form that creates a circle, going through the lower and upper confluent points first (creating the circle – e.g. left B 40, then left B 10, right B 10, then right B 40), with each needle pointing to the next point to be needled, and needling at the superficial, then deep, then superficial levels at each point.
A common mistake is to make the mechanical correlation between the yuan level and the 8-Extra channels as the treatment protocol of choice. Naturally every issue has some 8-Extra component within it, because there is always some “ultimate self” involved in all action, on all levels. However, not all issues at the yuan level (and certainly not on the other levels), call for treatments of the 8-Extras. Many issues that have become “latent cold” and are threatening to our existence, be they tumors, fibroids, structural and functional deterioration, etc., are not necessarily a matter of the 8-Extra channels. If they are not a “pre-given”, nor have been created at a very early age, then they are not likely to in the 8-Extra domain. Many diseases are in the yuan level and have been created through our behavioural choices over the years, and this would connote the regular meridians (behaviour). In cases of autoimmune disorders, it is wei qi attacking the yuan level, connoting the divergent meridians. Instead of opting for 8-Extra treatments one might consider mu points, the yuan (source) points, as well as the (back) shu points in such cases.
The purpose of human life is to convert the yuan/jing into shen through the alchemical process of the qi. (This statement is substantiated through the progression of point names on the ren, that is the humanity, channel.) Thus we use our jing, and through our interactions with the world convert it to experiences that are stored in the brain/marrow. When the jing is exhausted, life ends, and the hun rejoins the ancestral realm with our life experiences. Hence our ability to influence the yuan/jing through the shen. We have all seen people who overcome cancer and other “terminal” diseases through the power of the mind, demonstrating this principle. Therefore in selecting to work in the domain of yuan qi, we must not ignore the power of the mind/spirit: our target to a large extent is the person’s animation (shen), to allow the shen an exploration that may have been obscured previously.
The treatment methods (of herbal medicine) can also be understood in accordance with this process. When encountering a challenge, or a call for change (wind), the body-energetics, having failed to accept it as useful, will attempt to expel it altogether. This
is basically the equivalent of the vomiting method – total rejection upon first encounter. Next we can activate the wei qi. This means that the pathogen has penetrated to some extent, but it can still be expelled, except that it will require effort. These are the sweating and purging methods. Once we have past this stage and the pathogen persists, we might be able to use the “opposition method”, assuming the person is able to confront the issue (physical or mental strength wise). These are the warming, cooling, draining and reducing methods (which represent the opposites to the three responses). Note that the body-energetics also uses this method, for example by creating dampness in response to heat, or heat in response to dampness.
There are times when we are unwilling to confront the issue, and this is when we use the harmonising method. This is by far the most popular choice of most ill individuals (as well as for many practitioners) as it allows one to live ones life relatively undisturbed while still not fully dealing with the issue. The harmonisation technique, a method that came to popularity much later than the others, is often deceiving in its results as it appears that the person is doing well, except that at any moment the issue might come back to afflict them. Thus in spite of its popularity (e.g. bupleurum formulas) it has some major drawbacks.
Finally, when the person is truly too weak both to confront the issue as well as having lost the ability to harmonise, the tonification method is chosen. When the person has gained greater strength they will hopefully be able to go back and confront, expel, or harmonise the problem, until a better resolution is found. (Again, there is a great tendency to use tonification, and one might want to consider the implications. In other words, whenever we tonify we might want to ask whether we are not making the person merely more comfortable in avoiding change, or whether tonification is truly the only choice. We need not be dogmatic about the issue, but it is well worth raising the question.)
In looking at the human process this way we start to develop a reverence to the processes exercised by the body-energetics. We may be very fond of the opposition approach, that is, “warm the cold,” “cool what is warm,” etc., but perhaps such approaches at times do not pay enough homage to the inherent wisdom of our life patterns. Perhaps we might see that what is warm simply needs resolution, or that what is cold needs to be “confronted.” By viewing the process philosophically we simply gain more options, not the least of which is the option of bringing the client’s awareness to where the problem is and what options are available.
It is not clear that the meridian system was formulated purely for the purposes of needling. In fact many of the contributors to the understanding of this system were not necessarily medical practitioners, but rather shamans, philosophers, qi gong practitioners, and other inquirers. Thus not the least of the advantages of viewing the meridian system and the process of life in this manner is our ability to further understand our own processes, and bring greater awareness to our lives, perhaps the highest achievement of the pursuit of medicine.
This article was written in response to colleagues requests for simplified (or perhaps systematised) presentation of the basic concepts underlying Jeffrey Yuen’s work. Naturally I cannot attempt to represent anything but my own understanding, and hence all errors, misconceptions, and mis-statements are mine.