How these medicines evolved in different directions and how they can come together
When Wang Qingren, a doctor of Chinese medicine, attended public executions in 1797, tagging along to the gravesites, then returning in the shadow of night to perform autopsies, his clandestine activities served an honorable purpose. In the early seventeenth century an Italian explorer and missionary had brought into China the book Method of the West, which had provided the first glimpse into Western medicine. After that, Western medical literature was further introduced into China via Christian missionaries. Performing autopsies helped Dr. Wang verify some of the knowledge of anatomy that he had learned from his reading.2 Unlike his Western counterparts of that era who freely attended gross-anatomy classes, Dr. Wang was forced to work under a cloak of secrecy because of the Chinese cultural veneration for the body as a whole.
The restrictions Dr. Wang worked under began centuries earlier. The history of Chinese medicine reaches back to the dim and ancient past where the distinction between myth and historical facts is blurred, food and medicine were interchangeable and shamans, high priests, witches and doctors all provided medical care. Thousands of years before written language, the knowledge of Chinese medicine was passed through oral retelling of tales and legends.
The concept of wholeness in Chinese medicine took form through legendary discussions and dialogue between Emperor Huang Ti (the Yellow Emperor) and his physician Qi Bo (circa 2697 to 2205 B.C.). Nearly two thousand
2. In Chinese, the surname is actually the first name. Jane Doe would be Doe Jane in Chinese.
years later (circa 200 B.C.) Nei Jing, or The Yellow Emperor's Classic of Internal Medicine, was written down in eighteen volumes.3 It is said to contain the bulk of those discussions, including information on medicinal herbs, anatomy, medical theory, acupuncture, spirituality, life force, Yin and Yang. (Many of the major Chinese terms are capitalized throughout this book to define them as specific Chinese medical terms and in some cases to differentiate them from similar Western terms.) Nei Jing thoroughly explored the synergistic relationship between man and nature and health and illness to further define the concept of wholeness.
Taoism is a philosophical system derived chiefly from the Tao-te-ching, a book traditionally ascribed to Chinese philosopher Lao-tze but believed to have been written in the sixth century B.C. Taoism, a central influence of Chinese medicine, stated that “the heaven and the human are one” and described an ideal human condition of freedom from desire and of effortless simplicity, achieved by following the Tao (path)—the spontaneous, creative, effortless path taken by natural events in the universe. The notions of Qi (the life force) and Yin and Yang—which are the foundation of Chinese medicine—are inherited from Taoism.
In addition to these influences, within a hundred years of Confucius's death in 479 B.C., a system of ethics for the management of a well-ordered society began to develop from his teachings. So powerful was Confucius's influence that by the Han Dynasty (140 to 85 B.C.), Emperor Han Wu Di issued two decrees, “Banishment of all other schools”and “Favor only that of Confucianism,” making Confucianism the sole official national philosophy and effectively forbidding all other social codes of behavior. One of Confucianism's main tenets was that the whole body was sacred and should remain complete throughout life and death.
Because of the veneration for the body as a whole, Confucianism opposed the practices of anatomical study and surgery, which would maim the body or corpse. These restrictions—which continued over many centuries—forced researchers such as Wang Qingren underground. While Western medicine continued delving into and learning from the human body's organs, tissues and bones in order to diagnose and treat illness, Chinese medicine evolved in the opposite direction, developing methods of diagnosis via external means such as observing, touching and listening to the patient.
3. Nei Jing is attributed to the Yellow Emperor but it is believed to be a collection by numerous doctors and scholars.
In primitive times, throughout the world, disease was considered to be the result of a malevolent spell cast by an angered enemy, of displeasing a god or of inviting an evil spirit into one's body. Medicine consisted of magic and religious rites with witch doctors and sorcerers. For Western medicine, the transition from superstition to science was a gradual process, extending over centuries. When Greek physician Hippocrates, the so-called father of modern medicine, was born (circa 460 B.C.), medical thought had only partially discarded magic and religion as a basis for healing. As did the Chinese medical bible Nei Jing, Hippocrates rejected supernatural belief systems. He spoke disparagingly of the “charlatans and quacks” who perpetuated such beliefs and urged the exploration of disease as a natural phenomenon that could be observed and investigated. Like doctors of Chinese medicine, Hippocrates focused on the effects of food, occupation and environment in the development of disease. Understanding that mind and body were connected, he said, “Our natures are the physicians of our diseases.” But by the seventeenth century, French mathematician and philosopher René Descartes introduced the premise that the body and the mind were entirely separate, which was quickly and heartily embraced by Western science as absolute truth. To explain why this premise was so readily accepted could take volumes of conjecture and discussion. Perhaps explaining the working of the human body, although incredibly daunting, at least seemed possible. To accept the mind as part of the system would have made the task virtually impossible. Another reason may have been that the mind seemed connected to the soul and, to the highly religious society of the day, separating the two was both logical and reverential.
Ancient Chinese, desiring to present themselves to their ancestors as whole, feared decapitation as capital punishment. This core reverence for the wholeness of the human being encouraged the development of a mind/body-oriented medicine. At the same time, due to the belief in the separation of mind and body, Western medicine proceeded to develop a “headless” medicine.
Western medicine generally revolved around folk medicine until scientific breakthroughs in human anatomy and physiology, knowledge of infectious agents, drugs and therapeutic procedures began to occur in the nineteenth and twentieth centuries. The discovery of microorganisms such as bacteria and fungi led first to the germ theory of disease in the mid to late 1900s, which precipitated major scientific advancements. Continued advances have removed Western medicine far from its humble origins.
Unlike Western medicine's dramatic and exponentially exploding development, Chinese medicine has not needed to change very much from its original philosophy of wholeness and balance. One change that has begun to occur over the past two hundred years is Chinese medical doctors' interest in capitalizing on Western scientific knowledge and technologies. This change occurred very slowly and initially with great resistance.
When in 1830 Chinese doctor Wang Qingren used his newfound knowledge of human anatomy to write a book attempting to correct some erroneous assumptions of anatomy made by ancient Chinese scholars, critics accused him of magnifying confusion. Because the Western concept of physical organs does not have much significance in Chinese medicine, they said that it did not matter where the organs were located. At the same time, as Western medicine progressed, physicians and scientists viewed Chinese medicine as charlatanism and the notion of any kind of credibility was considered preposterous. This disdain from both sides kept the line drawn in the sand.
Integration, however, took on a life of its own and proceeded tenaciously, however haltingly. The first Western medical clinic was established in China in 1827, the first Western medical hospital in 1834. By the beginning of the twentieth century Western medical hospitals were starting to spring up in the larger cities. From the mid-nineteenth century to the early 1950s a rudimentary form of integrative medicine began to develop in China. Both Chinese and Western medicine were used, but in a side-by-side fashion instead of a truly combined, integrated use.
Unfortunately, one of the consequences of this approach is that those who were trained in Western medicine began to advocate the abandonment of Chinese medical theories entirely. They wanted to use Chinese herbs as Western doctors used drugs. In other words, they looked for effective herbs, isolated the active ingredients and extracted those from the natural substance to use only the isolated ingredient as Western medicine does. For example, in the 1920s the active ingredient, ephedrine, in the Chinese herb Ma Huang—which has been used in China for nearly four thousand years—was isolated and used to treat asthma and similar conditions. But this was not integration.
In his early seventies, Ke-ji Chen, M.D., is an internationally recognized authority on the integration of traditional Chinese medicine and Western medi-cine.4 “Until the early seventeenth century China had been decidedly more advanced technologically compared to the Western world,” Dr. Chen said. In
4. Ke-ji Chen, M.D., is president of the Chinese Association of Integrated Traditional and Western Medicine, professor and chief researcher of the China Academy of Chinese Medicine, editor-in-chief of the Chinese Journal of Integrated Traditional and Western Medicine and academician of the Chinese Academy of Sciences.
fact, by 1523 B.C. a writing system with two thousand characters was in use in China (in the West an alphabet emerged in Greece circa 800 B.C.). The Chinese discovered the orienting effect of lodestones, from which they pioneered the navigational compass around 101 B.C. In 105 B.C. a Chinese eunuch refined the process of papermaking. Gunpowder was believed to have originated in China in the ninth century. These are only some of the accomplishments by ancient Chinese.“But the momentum was lost around the early seventeenth century for cultural and historical reasons,” Dr. Chen said. “When Europe emerged from the long dormancy of the Dark Ages, it was thrust forward through the Renaissance, which stimulated scientific knowledge and discoveries. In the meantime the deterioration—socially, culturally and scientifically—in China continued and culminated in a series of defeats by foreign powers that resulted in the collapse of the Ching Dynasty [1644 to 1908]. China's entrance to the modern era came with tremendous pain. China had had a brilliant past and civilization but had been left far behind.”
By the turn of the twentieth century, the young and elite intellectuals of China took it upon themselves to redeem the country. “They were so pained and blinded by the humiliation and hurt pride that the country had suffered in the past several hundred years that they could not see anything valuable in Chinese tradition,” Dr. Chen said. “In search of an answer they pondered what it was about the West that gave it power and vitality. A prevalent sentiment among the Chinese intellectuals was that it would best serve China to do away with tradition and adopt the ways of the West. It was against this background that the abandonment of Chinese medicine was proposed. The trend was so extreme that in the 1920s the nationalist government had banned Chinese medicine entirely. Within three months, the decision caused a tremendous outrage from the Chinese people of all classes, and the ban was lifted.”
In 1949, Mao Tse-tung established the People's Republic of China. Seventeen years later, the turbulent political atmosphere erupted in the Cultural Revolution and the Red Terror swept over China. Those in power turned a blind eye as marauding bands of crazed teenagers pillaged the country, arresting and imprisoning high-ranking government officials and persecuting so-called intellectuals and antirevolutionaries. While most of China's culture was dismantled, by 1954 Chairman Mao Tse-tung officially recognized Chinese medicine as “the legacy of the motherland.” From that point on, Chinese medicine was fully reinstated and endorsed by the government.
However, as a result of this influence, Chinese medicine evolved into two different schools. Traditional Chinese medicine continues to integrate mind, body and spirit in a true spiritual sense, relying on an ancient form of meditation called Qigong to build self-awareness, unity of mind and body and ultimately enlightenment. The school influenced by the Communist regime in China uses Chinese medical modalities such as herbal medicine and acupuncture in more of a nuts-and-bolts fashion. Eschewing a belief in spiritual unity, this more clinical practice of Chinese medicine views the mind/body connection in a more scientific and psychological manner.
Figure 1
Leonardo da Vinci (1452–1519)
Anatomical study of the principal organs and arterial system of a female torso
(Used by permission of The Royal Collection © 2002, Her Majesty Queen Elizabeth II)
Western medicine sees the human body as a collection of physical components such as bones, fluids, organs, tissues, cells, DNA and molecules. Chinese medicine does not delve into tangible components but rather views the body's R patterns of Energy as part of a greater whole that is constantly in motion and constantly seeking balance. While the material dimension of a living being is made of the same elements that make up all tangible substances, what gives a living being life is the Energy within. Energy is formless, though we all know it exists. In Chinese medicine, the pattern of Energy within the body (and its environment) is referred to as Qi (pronounced chee). Broadly speaking, Qi is the integration of Yin and Yang. In other words, instead of being made up of materials, the human body is made up of Yin and Yang Energy—two opposing yet mutually dependent forces. Yin Energy is water, cool, calm, passive, and Yang Energy is fire, warm, active, aggressive.
Figure 2
Within the traditional Yin/Yang symbol, black and white holes signify that Yin is part of Yang and Yang is part of Yin.
Chinese medicine evolved from the belief that true health results from balancing the entire system. In Western thought the word system is thought of in compartmentalized terms, such as the system of the human body, the endocrine system, the nervous system and so on. Other examples are the solar system, Freud's system of psychological functioning (superego, ego and id), the U.S. system of government and a computer system. Chinese medicine considers human beings (who are composed of an interconnected mind and body) and their environment to be part of the same system, or part of a whole. Yin and Yang, and their constant fluctuations, dictate the balance of this whole. These constant fluctuations of Energy occur within a never-ending circle of nature, so that all occurrences have a consequence, sometimes positive and sometimes negative.
Meridians are invisible channels in your body in which Qi (the integration of Yin and Yang Energies) flows. Meridians do not correspond to any known physiological structure in Western medicine. They are not like the Western concept of the circulation system, the nervous system or lymphatic system.
Meridians are a complex web of channels that branch out to smaller and smaller Meridian channels that become as minuscule as capillaries. Qi continually flows through these channels to create the wholeness of your body. Because Qi permeates the universe, Meridians connect your internal body with the outside universe as well.
Figure 3
Ancient illustration of the
Meridian system
In diagnosing and treating illness, Western medicine uses sophisticated scientific technologies to attempt to pinpoint the exact cause—whether it be bacterial, viral, cancerous cells or another tangible cause. Chinese medicine does not need to isolate tangible causes of disease in order to treat illness.
From a Chinese medicine point of view, your Qi flows through the Meridian system of your body. Yin and Yang Energy form an infinite number of patterns within your body. For example, the Heart, Liver, Spleen, Kidneys and Lungs have individual Yin and Yang Energy. (The following chapters describe the Five Energetic Systems based on these organs.) Moreover, each human has his or her unique Energy balance. This pattern of Energy is constantly in motion and strives to be in balance. The balance is achieved as the Energy movement delivers nutrients and oxygen to nourish the body, and also removes toxins and metabolic waste. Toxins result from various sources: environmental (such as pesticides and carbon dioxide), biological (such as bacteria and viruses), biochemical (such as mercury, lead or other heavy metals and alcohol) and physical (such as radiation and cigarette smoke). Metabolic waste is the end product of metabolism—in other words, imagine each cell to be like a living being that must eliminate waste.
If the equilibrium of Qi is upset for any reason, there will be a slowing down of the Energy flow and the toxins and metabolic waste will not be sufficiently removed. When Qi becomes weakened, blocked or stagnated, this Energetic imbalance will result in illness and disease. To arrive at a diagnosis, the Chinese doctor compiles a complete picture of you as a whole being (more will be said about the methods of diagnosis in chapter 3). Chinese medicine then uses herbal medicine, acupuncture and other ancient healing methods to get Qi moving and correct the imbalance that caused the problem. Chinese medicine places all of its emphasis on the fact that you and all of your systems—body and mind—are a whole, interconnected and interdependent.
By the twentieth century in the West, biomedical theory had been designated the one true path to health. But several decades ago, consumer confidence in Western medicine began to wane. The cultural revolution in this country in the sixties and seventies helped shift the attitudes of the public from utter reliance on and belief in the medical system to one of questioning, personal exploration and self-confidence. In the eighties and nineties, as health care payment systems and time constraints dictated by insurance companies increasingly limited the effectiveness of physicians and weakened traditional patient-doctor bonds, the movement was pushed along.
In 1993, Harvard Medical School physician and researcher David Eisenberg, M.D., and his colleagues published the results of a survey that showed that in 1992 one in three respondents had used at least one alternative or nontraditional therapy. A second survey published in 1998 indicated that between 1990 and 1997 total visits to alternative providers increased 47 percent, from an estimated 427 million in 1990 to 629 million in 1997. More people paid visits to alternative-care providers than to all allopathic (Western-style) primary-care providers. Annual expenditures for alternative-medicine services increased 45 percent, to $12 billion.
Responding to this trend, in 1995 Beth Israel Deaconess Medical Center created the Center for Alternative Medicine Research and Education, which is associated with Harvard Medical School. Dr. Eisenberg was appointed director, and Ted J. Kaptchuk, O.M.D., author of the classic comprehensive guide to Chinese medicine, The Web That Has No Weaver, was named associate director. The center studies the scientific and medical dimensions of complementary and alternative treatments as well as the legal, ethical and economic implications of these therapies. The research of Drs. Eisenberg and Kaptchuk and others at the center encourages interaction between Western doctors and their patients. This research also recognizes the tremendous influence of public demand for alternative medicines, and that as a result there are increasingly more courses in alternative medicine offered in Western medical schools.
In addition, research on complementary/alternative treatments within universities and medical schools is becoming more commonplace. Since natural substances, such as herbs, currently cannot be patented, many pharmaceutical companies have little interest in promoting the research of traditional Chinese medicine. Oncology nurse and researcher Diane Fletcher, M.A., R.N., O.C.N., from the University of Pittsburgh Cancer Institute, said, “Research on Chinese herbs has been going on for thousands of years in China. Even though there has been a significant amount of research published there, it usually is not up to Western scientific standards for design, implementation and reporting of results. So in one sense, research on Chinese herbs in the U.S. is light-years behind, but in another sense we need to do our own research according to our own standards. But it can take years to get results, and then studies must be replicated to further prove or disprove those results.”
The government responded to this need in 1998 and formed a division of the National Institutes of Health called the National Center for Complemen tary and Alternative Medicine (NCCAM). The government has subsequently given the NCCAM millions of dollars of funding for research studies. Across the United States, many academic institutions are starting to organize and conduct research on Chinese herbs. At the same time, many Western physicians and other health care practitioners are incorporating Chinese medicine into their practices. No doubt the eighteenth-century Chinese doctor Wang Qing ren would have found great satisfaction in seeing the line in the sand becoming blurred and integration naturally occurring.
