Understanding Chinese Medicine
We’re excited to finally share a bit of the Chinese herbal medicine perspective from acupuncturist Dylan Stein. Dylan specializes in dermatology, men’s health, and pain management. In addition to acupuncture, he also passionately practices Chinese herbal medicine and will be joining us over the next few months to introduce us to this ancient healing practice!
Chinese Medicine ~ Between Heaven and Earth
The roots of Chinese medicine lay in a time before X-rays and blood tests, a time when people lived by the light of the sun and spent time observing the world around them. This gave birth to the notion that the best lifestyle is lived in harmony with nature and the ebb and flow of the seasons.
Our place in the universe was seen as quite unique. We walk on two feet connecting us to the Earth and our head points to the sky connecting us to Heaven. Humans are suspended between Heaven and Earth.
Our most ancient and important extant medical text is The Yellow Emperor’s Inner Classic (Huangdi Neijing). The first mention of the Neijing is in 111CE, but it is believed to have been written some time in the last four centuries before the Common Era.
The text is written in the form of questions and answers, and begins with a discussion of why people “in the old days” lived for more than 100 years when the people of the day were only living about half of that. The answer given is the long-lived ancestors were in sync with the rhythms of nature, and thus able to live until they were very old.
The rhythms of nature not only applies to sleeping late and retiring early in Winter and rising early and staying up late in summer, but also to the natural world mirrored within us. Because we are suspended between Heaven and Earth, the human body is seen as a microcosm of the universe.
Just as there are Wind, Dampness, Heat, Cold, Summer-heat (think about August in the South) and Dryness (the Six Qi) in the natural world, these climactic factors are present inside the body. These are all naturally occurring phenomenon, so their presence in the body is totally normal. Disease arises when one of the factors becomes imbalanced, either too weak or too strong. We use acupuncture and Chinese herbal medicine to restore the relative balance of these elements, thereby restoring a person’s internal climate and harmony with the universe.
Understanding Chinese Medicine Disease Diagnosis
Chinese medicine has a number of diagnostic paradigms. As the centuries passed, so changed the way ancient doctors understood and desired to classify disease.
The most essential, in my opinion, and most basic classification system is based on the concept of Yin and Yang. The classic example of how to understand Yin and Yang pictures a mountain. The sun shines on one side while the other is shaded. The sunny side is Yang and the shaded side is Yin. The shaded side can become the sunny one and vice versa. Yin and Yang are constantly in flux, constantly transforming one into the other. Yin is stillness and Yang activity, but how do we know stillness without knowing activity? Cannot stillness become activity in the next moment? This is the nature of Yin and Yang. We see this in the Yin-Yang symbol, also known as the Taiji. Within the white portion there is a seed of black, within black a seed of white; the promise of dawn even in the night sky, the lengthening day at the apex of Winter.
Every disease can be classified in terms of its nature as either Yin or Yang. This is the basis of what becomes Eight Principle Diagnosis, our most basic (and sometimes most powerful) diagnostic paradigm. The Eight Principles are a 4-step contrast of diseases symptoms: Interior vs. Exterior, Hot vs. Cold, Excess vs. Deficiency, Yin vs. Yang.
The Interior versus Exterior step of this equation tells us the location of the disease. Is it an internal organ pathology? Was disease created by a thought pattern or lifestyle? Exterior diseases are those caused by external pathogenic factors (the meteorological phenomenon I mentioned above) causing disease in the most superficial layers of the body. Exterior diseases can move inwards to become Interior ones, too, but this implies some kind of pre-existing deficiency that let the disease move inward.
Hot versus Cold classifies the nature of the temperature of the disease. Are there Heat signs like fever, thirst, sweating? Are there Cold signs like chills, desire to curl into a ball, diarrhea?
When we ask if the disease is Excess or Deficient, we are really asking is there a pathogen (Excess) or is the body weak or missing some vital substance (Deficient)? Sometimes the answer is simply one or the other; sometimes it is both.
The last step in the equation is the Yin and Yang differentiation. Together these allow a synthesis, which guides our treatment principles.
In addition to Eight Principle Diagnosis, the important major diagnostic paradigms in brief are:
~ 6 Stage Diagnosis, which tracks the course of an Exterior disease caused by Cold as it travels inward to the core of the body
~ 4 Level Diagnosis, which tracks the course of an Exterior disease caused by Heat as it travels inward towards the Heart
~ Organ-Bowel Diagnosis, which assigns symptoms and diseases to each of the organs of the body
~ Sanjiao Pattern Diagnosis, which classifies Damp-Heat diseases in terms of their location in the upper, middle or lower part of the body
~ Qi, Blood and Fluid Diagnosis, which is related to Organ-Bowel Diagnosis, but looks at irregularities in these vital substances of the body
In just this small bit alone, I’ve managed to tell you about six different ways to look at disease. There are others, too. Sometimes this makes our job easier, and sometimes harder. This is why I like to always come back to Eight Principle Diagnosis when I’m formulating my treatment plan. It keeps things as straightforward as possible, in my opinion.
Treating disease in Chinese medicine is like peeling an onion. Each layer reveals something a bit different. Sometimes it’s difficult to see one layer at a time. The more clear we can be on a diagnosis, the more effective we will be as practitioners. So, pick whichever paradigm resonates with you and stick to it. Get to know it inside and out. Use it until it is well worn. You will have an easier time formulating treatment plans, and if you are a clinician, your patients will thank you.
In my next post, I will start to talk about the herbs themselves, specifically the herbs Chinese and Western herbal medicine traditions share.
We Are A Zero
Excellent post to describe in English the Chinese process of diagnosis. I would love to see in future posts about your opinion on “hot” and “cold”. My Chinese mother’s opinion is to never drink ice water as that “disturbs the organs” – which I have no idea what that means.