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“The core of this book deals with the epistemological issues concerning the scientific
status of medical conjectures in Traditional Chinese Medicine, very intelligently
written and bringing to bear a great deal of common sense and good philosophy.
There is much that is highly original in it.”
“Despite its efficacy in treating ailments (for some of which Western medicine offers
no cure), traditional Chinese medicine (TCM) continues to be regarded with skepti-
cism in the West. To a large extent, this is due to the fact that TCM practitioners are
unable to explain TCM theories using Western scientific categories. A TCM doctor
trained in the philosophy of science at Cambridge and the London School of
Economics, Hong Hai delivers a fresh and at times iconoclastic interpretation of
Chinese medicine. This is without doubt the most important contribution to the field
in the modern era. At last, Chinese medicine makes sense. Surprisingly accessible, this
work is a must read for doctors East and West.”
“A very engaging read. This book takes an unbiased look at both biomedical science and
TCM. It leads the reader on an enjoyable journey through the philosophical principles
that underpin their respective concepts on disease causation and approaches to illnesses.
An essential read for anyone with an interest in understanding the role of TCM in a
biomedical world or how it can work alongside conventional western medicine.
I strongly recommend it.”
“Lucid, brilliant explanation of the terminology and principles of TCM and its
approach to the management of syndromes. This is a book that anyone with even
the slightest interest in complementary medicine should read.”
“The book builds up a case for the clinical testing of Traditional Chinese Medicine
(TCM) to bring it up to par with modern medicine. The author explains that what
TCM seeks to contribute to medical science is … to provide an additional means of
preventing and alleviating serious illnesses like cancer, arthritis, cardiovascular disease
and many of the diseases that come with aging. Terminologies and concepts that get
lost in translation … find a common ground with scientific clarity, doing away with
the ambiguous nature of TCM.”
“There is an urgent need to adequately explain the complicated TCM theories and
methodology of the ancient classics not only in modern language, but also with a
scientific understanding. This issue has been addressed duly and attractively in The
Principles of Chinese Medicine. This book discusses many unscientific criticisms of
TCM in detail. Interestingly, the book explains TCM theory by reinterpreting key
concepts like qi and “phlegm” and by elucidating the nature of TCM models. It sug-
gests that scientists should be less concerned with the ontological status of TCM mod-
els than with the ability of these concepts and models to guide practitioners who offer
TCM therapies.
The book significantly contributes to the full understanding of the theory in order to
endorse its usage beyond the East. This is not only an fascinating book for all interested
parties, but it has special implications for medical professionals, both in TCM and con-
ventional Western medicine.”
vi
vii
Foreword
Donald Gillies
ix
Link :: T.me/AcuListings
Preface
xi
xii Preface
Preface xiii
Acknowledgments
The book is the outgrowth of research work over many years at the
Beijing University of Chinese Medicine (BUCM), the Department
of the History and Philosophy of Science (HPS) at Cambridge
University, and the Department of Philosophy, Logic and Scientific
Method at the London School of Economics (LSE).
My first exposures to Chinese medical literature in English were
to Ted Kaptchuk’s The Web that has no Weaver and Manfred Porkert’s
Foundations of Chinese Medicine. Both books greatly stimulated my
interest in the subject but left me only partially satisfied, eventually
leading me to research and offer the more scientifically pragmatic
views in this book.
Porkert’s book was a courageous attempt to replace Chinese
medical concepts with exact equivalents in biomedicine. It may not
have succeeded, but did provide the inspiration for others to try a
different approach to linking the two systems of medicine.
Kaptchuk’s book is a brilliant introduction to the theory of
Chinese medicine based on the traditional understanding of the
subject, and has been helpful to generations of readers attempting to
grasp the subtleties of ancient medical thought. In my early studies
the portrayal of Chinese theories as “a poetic exploration” resonated
with me as I sought transient refuge from the strictures of scientific
logic.1 But later, after many years of formal schooling in TCM and
confronted by the imperatives of the scientific method, I viewed
with some sympathy the criticism that biomedical scientists heap
1
Kaptchuk (2000: 98).
xv
xvi Acknowledgments
Acknowledgments xvii
Inhalt
xix
xx Contents
Contents xxi
Bibliography 245
Index 257
Chapter 1
2
For example, Needham’s massive Science and Civilisation in China (various volumes
and dates)
Until the second half of the 20th century, Chinese medicine was
the main system of health and healing in China, faithfully serving
emperors and concubines in palaces, soldiers in battlefield and
humble folks in farms and city streets. Well into the 21st century,
Traditional Chinese medicine (TCM) remains the most significant
alternative to modern Western (‘biomedicine’) in the industrialized
economies, accounting for an estimated 40% of patient visits in the
ethnic Chinese-dominated developed economy in Singapore and a
sizable proportion in Hong Kong, Taiwan, China, Japan and Korea.3
It commands smaller but significant followings in Australia, Europe,
Japan and North America. In the United States, Chinese acupunc-
ture is practised under licensing laws in most states, and in some are
recognized for medical insurance coverage.4 In many areas of medi-
cine that have enjoyed the best of modern biomedical technology,
TCM continues to find a unique role.
In the cardiology department of the Guang’anmen Hospital of
the China Academy of Chinese Medical Science in Beijing , one group
of patients with ischemic heart disease have previously received series
of stents in other hospitals, but see their arteries continue to clog
within months after each stent despite large doses of statins and anti-
coagulant drugs. They are administered herbal formulations contain-
ing such common ingredients as ginseng, chuanxiong and safflower
to reduce the incidence of restenosis.
In the 2002 global outbreak of the severe acute respiratory syn-
drome (SARS), the average mortality rate in China was 7% compared
to 12%–25% in the other countries. Only China combined TCM
herbs with Western therapies that used steroids and antipyretics.5
3
In Japan and Korea they have different names but are substantially derivatives of Chinese
medicine.
4
Back and shoulder pains are among the conditions recognized as treatable by acupuncture
by the World Health Organisation (2003).
5
Report of the International Expert Meeting to review and analyse clinical reports on com-
bination treatment for SARS (2004), referenced in http://apps.who.int/medicinedocs/fr/d/
Js6170e/4.html (retrieved Feb 19, 2015).
6
“A Top Hospital opens up to Chinese herbs as medicine”, Wall Street Journal, April 23, 2014.
7
Post hoc ergo propter hoc is Latin for “after this, therefore because of this”. It is a logical
fallacy that states “Since event Y followed event X, event Y must have been caused by event
X.” In medicine, the he post hoc ergo propter hoc fallacy is the assumption that the patient
gets better as a result of the treatment when in fact he recovers as a natural progression of
the disease (which normally happens with an ailment like the common cold).
Ancient Origins
Chinese and Greek medicines in distant antiquity had much in
common. They were originally dominated by the belief that ill-
nesses were caused by spirits and demons, hence healing required
the intervention of mediums or deities. In the practice of ‘temple
8
“The Yellow Emperor” is an inept translation of Huangdi, the name of Huang emperor
(‘di’). ‘Huang’ has two usages — it is the colour yellow and it is a common surname in
China. There was nothing yellow about the legendary emperor Huangdi, not any more than
former British Prime Minister Gordon Brown had to do with the colour brown. He would
(not) be amused at being called ‘The Brown PM’.
9
Although its origin is attributed to the Han dynasty, the Neijing was continually refined,
edited and expanded right up to China’s final imperial dynasty, the Qing (1644–1911).
Hence many editions of the Neijing exist. The Wang edition commonly used as a reference
manual was compiled in the Tang dynasty (618–907).
10
Unschuld (2003: 319)
11
Unschuld (1985:5, 54) uses the term “systematic correspondence” to describe the influ-
ence of natural laws on physiological phenomenon.
Schools of thought
The Neijing has remained the ultimate authority on Chinese medi-
cine ever since. Over time different schools of thought grew from
varied interpretations and extensions, yet in essence not departing
from its core models.12
Among the earliest of these schools was that based on The Treatise
on Febrile Diseases (Shanghan Lun Քሂ䇪) by Zhang Zhongjing
(150–219), which postulated that the harm caused by climatic influ-
ences such as cold, wind and dampness travelled along meridians
and brought about progressive changes of body state (pathogenesis).
During the Song dynasty ideas from neo-Confucianism, Taoism and
Buddhism stimulated the development of new medical doctrines,
followed by vigorous contention among ‘a hundred schools’.13
The rival schools introduced differing emphases in Chinese
medicine that were in tune with the times and places in which they
flourished.14 For example, the yin-nourishing school of Zhu Danxi
was influential in the Yuan dynasty among wealthy officials who
over-indulged in food and sex, thought to harm the yin of their
kidneys, hence the need to nourish yin.
Late Ming and early Qing saw further developments, notably in
studies of infectious diseases common in spring and summer in the
south by the ‘warm disorders school’, in contrast to the ‘cold-damage
12
Ren Yinqiu (1986:5–6), who started the study of “schools of thought in medicine”
(ѝ५ᇦᆖ䈤) in the 1950s, emphasises that contending schools did not depart from
the core models of the Neijing.
13
Among the influential schools were those associated with Liu Yuansu (1120–1200) who
founded the ‘school of cooling’ (hanliang pai ሂ߹⍮), stressing the elimination of excess
‘internal heat’; Li Gao (1180–1251), who regarded the digestive system as the fundamental
basis for good health, hence founding the ‘spleen–stomach school’ (piwei pai 㝮㛳⍮); and
Zhu Danxi (1281–1358) who founded the ‘yin-nourishing school’ (ziyin pai ⓻䱤⍮)
which claimed that man’s body by nature tends to be deficient in yin, hence nourishing yin
must be the basis of good health.
14
Ren Yinqiu (1986:5–6), who started the study of “schools of thought in medicine”
(ѝ५ᇦᆖ䈤) in the 1950s, emphasises that contending schools did not depart from
the core models of the Neijing.
15
Hanson (2001:262–292). The Wenbing xuepai (⯵ᆖ⍮) was led by Wu Youxing
(1582–1652).
16
The movement has also been termed ‘The Chinese Enlightenment’ by some Western
scholars in perhaps an inapt comparison with the Enlightenment in 17th-century Europe.
Schwartz (1986).
17
In 1949, there were 38,000 Western and 276,000 Chinese physicians; by 1975, there were
292,980 and 228,640 respectively (WHO 1985:17).
18
Yu (1933)
19
Okasha (2002), 14.
20
We shall see an example of this in the theory of the five elements covered in Chapter 6.
21
Wang (2003) and Lei (2002).
22
See Yu Yan (1933) and Yun Tieqiao (1922). The Chinese convention of stating the family
name (surname) first is followed, thus, ‘Yun’ is Yun Tieqiao’s surname.
23
Taylor (2005:13–17, 120).
24
Scheid (2002:74). A 1972 text The Revised Outline of Chinese Medicine ᯠ㕆ѝ५ᆖᾲ㾱
was translated into English by Sivin (1987).
Chapter 2
The eminent Canadian physician William Osler, who held the Regius
Chair of Medicine at Oxford University, had an old-fashioned sus-
picion toward etiology (the science of disease causation), as well as
synthetic medications: “It is more important to know what sort of a
patient has a disease than what sort of disease a patient has .... . The
first duties of the physician is to educate the masses not to take
medicine.”28
He would have found great favour with ancient Chinese physi-
cians, who lacked the technology of modern diagnosis but focused
on direct observation and detailed conversation with the patient to
assess his internal physiological condition, and treated with diet and
natural herbs.
Chinese medicine’s capability for diagnosis is limited by visual
examination, palpation, sounds and the patient’s own account of his
condition. The TCM physician pieces together a picture of the
patient’s health condition through these external manifestations of
the body. This compels a holistic view based on inferences regarding
imbalances in the body.
28
http://www.brainyquote.com/quote/author/w/william_osler.
15
29
‘Heat’ and ‘phlegm’, which have somewhat different usages in TCM theory from those in
Western medicine, will be explained further in Chapter 3.
30
The combined use of Chinese and Western medicines is permitted in China but prohib-
ited in most other jurisdictions, including Hong Kong, Singapore and Malaysia.
“The man who first saw the exterior of the box from above later sees its
interior from below.”31
31
Kuhn (1970:111).
32
See, for example, Porkett (1974) and Katpchuk (2000).
33
Singh and Ernst (2008:328): “TCM is difficult to evaluate. Some elements may be effec-
tive for some conditions, while other elements (e.g. cupping) are unlikely to offer any
benefit above placebo.”
34
The 20th century philosopher Ludwig Wittgenstein famously said that the aim of phi-
losophy is to show the fly the way out of the fly bottle. In taking a philosophical perspective
of Chinese medical theory, I am of the opinion that criticism by some scientists, that TCM
entities are unobservable and unmeasurable, stems from treating them as physical entities
rather than abstractions. That gets them into the fly bottle.
35
Lakatos (1970:91): “[P}hilosophy of science provides normative methodologies in terms
of which the historian reconstructs ‘internal history’ and thereby provides a rational expla-
nation of the growth of objective knowledge.”
36
Bloodletting (therapeutic phlebotomy) is used to treat hereditary hemochromatosis in
which there is slow excessive iron build-up in the body, causing damage to organs such as
the liver, heart and joints. Regularly reducing the volume of blood in the body is also cur-
rently the main treatment for polycythemia rubra vera in which the blood becomes much
too thick, increasing the risk of clots and strokes. Phlebotomy can also help people who are
producing too many red cells because their bodies are starved of oxygen owing to a heart
or lung problem. See Barton (2009) and Mestel (2001). A small amount of bloodletting
can (and is still used by some Chinese physicians) to temporarily relieve conditions like
hypertension.
37
For example, Liu (2003).
38
Kuhn (1970). Psillos (2007), 115 comments, “Kuhn supplemented this notion of
untranslatability with the notion of lexical structure: two theories are incommensurable
if their lexical structures (i.e. their taxonomies of natural kinds) cannot be mapped into
each other.”
39
For example, TCM concepts were called “gobbledygook” in “Dangerous Science taught at
Middlesex University”, see DCScience (2010); charges of “quackery” were made by Western
doctors objecting to alternative medicine being taught at Australian universities, eliciting
retorts of Western medical “dogmatism” (The Straits Times, 4th February 2012). Even less
elegant language is common when Western medical scientists debate Chinese medical
theorists at conferences.
40
Le Fanu (2011) points out that the cause of these and other diseases continues to baffle
biomedical science in spite of great advances in molecular and cellular biology in the last
fifty years.
Chapter 3
When many different diseases appear at the same time, it is plain that
the regimen [that is, diet and exercise] is responsible in individual cases.
Hippocratic Writings (circa 400 BC)
25
41
Syndromes will be covered in detail in Chapter 6.
42
For example, the treatment of malignant tumours in Western medicine may involve
chemotherapy that kills cancer cells using chemical substances that are also toxic to normal
cells and therefore can cause severe side effects. TCM treatment has little with which to
attack the tumour, except in the case of some herbs have anti-angiogenesis effects, reducing
or cutting off the blood supply to tumours and causing them to shrink Wang et al. (2004).
TCM has also been found useful in restoring to the body after the devastation of
chemotherapy or radiation therapy. It is also the possible that by helping the body reach a
balanced state, there is less chance of tumour cells growing again to bringabout a relapse.
When a large number of people all catch the same disease at the same time,
the cause must be ascribed to something common to all and which they all
use; in other words to what they all breathe…However, when many differ-
ent diseases appear at the same time, it is plain that the regimen [that is,
diet and exercise] is responsible in individual cases.44
43
Porter (1997:XI)
44
Lloyd (1983: 22–23).
45
Nutton (2004:188).
tied together the part of the body affected by disease and the etiologi-
cal theory to explain the cause of the disease.46 The Methodists
insisted that good medicine was simply effective therapeutic practice
and it was not necessary to search for the hidden causes of disease.47
They spoke of ‘affections’ (pathe) rather than disease (nosoi) and did
not concern themselves with etiology.48 They emphasised notions of
repletion and depletion, similar to excess (shi) and deficiency (xu)
syndromes in Chinese medicine, which we shall discuss in Chapter 6.
The great Roman physician Galen (AD 129–216), whose ideas
dominated Europe up to the end of the 16th century, rejected much
of Methodism but in fact his view of human health was not all that
different. Drawing inspiration from Aristotle and the Hippocratic
Writings, he viewed organised human bodies, like bodies in nature,
as comprising the four elements of fire, water, earth and air, with the
qualities of heat, moisture, dryness and cold respectively. Disease
stemmed from abundance, scarcity or change taking place in the
humours, consisting of blood, phlegm, and yellow and black bile.
Such notions of excess and deficiency were to persist in Western
medical thought right through to modern times, when their impor-
tance was eclipsed by discoveries in microbiology. It is as if the daz-
zling discoveries of microbiology diverted Western medical science
to cells and genes and held it captive on the nosological track, caus-
ing it to neglect viewing the body as a whole and in relation to
its environments. Chinese medicine on the other hand knew no
microbiology and had little choice but to look at the body’s external
manifestations as a whole.
46
Tecusan (2004:10).
47
Nutton (2004:190).
48
Tecusan (2004:4,10–11).
49
Bardsley (1845), for example, attributed diabetes to indulgence in excessive amounts of
cold fluid, poor living, sleeping at night in the open air in a state of intoxication, sudden
halting of perspiration, and mental anxiety.
50
See Kuhn (1977:63).
51
Kuhn (1977:60).
52
Porter (1999:306).
53
Hempel (1966:3–8); von Gyory (1905:94)
54
Evans (1993:30)
55
Carter (2003:1)
56
Porter (1997:454–457)
57
Evans (1993:1, 46, 107).
Only in medicine can the same effect flow from the most varied possible
sources… For almost every disease…one finds the same horde of harmful
influences — poor housing and clothing, liquor and sex, hunger and anxiety.
This is just as scientific as if a physicist were to teach that bodies fall because
boards or beams are removed…60
[At] the crux of the issue is the use and meaning of cause in medicine…
If epidemiology continues to disregard the misusage (sic) of terminology … it
threatens the very survival of logic and science in medicine.61
61
Stehbens (1992:116).
62
Carter (2003:201).
63
Rothman (2002).
Fig. 3.1 Causal Pies: Three different causal mechanisms, each a sufficient cause of disease
Source : Rothman and Greenland (2005).
66
Nagel (1961: 486).
67
See, for example, Rudner (1953) and Douglas (2009). The meaning of ‘value’ here is dif-
ferent from that in moral values, and some may prefer like Nagel to use the word ‘interest’ .
68
Oxford Concised Medical Dictionary (2007).
69
Lloyd (2003:1).
system was down because I had been working too hard, would you
not say that as a result of working too hard and the chill my immune
system weakened and succumbed to the virus: was this not the real
cause of my cold rather than the virus?”
The virologist was focused on the viral etiology of the com-
mon cold while I was focused on the environmental and internal
physiological factors. Both of us were guilty of what Lewis terms
“invidious discrimination”, each singling out a “decisive” cause of
the cold and leaving the others as “causal conditions”.70 The virol-
ogist saw the rhinovirus as the cause of the common cold and my
weakened immune system only as a contributing condition.
However, as a person interested in improving the health and fit-
ness of people, I was biased towards the holistic picture of internal
body balance and the chill that broke the back of my immune
system. I saw the presence of the rhinovirus in the human body as
the definition of the common cold, not its cause. As there was
nothing I could do to prevent people from being exposed to that
virus, my value of medical efficacy led me to look for causes that I
could manage or manipulate such as diet, exercise and the avoid-
ance of chills. The clinical trials that I would advocate for any
study of causation of colds would therefore involve these factors
in the causal pie.
Cancer
Some cancers are associated with specific pathogens, such as the
human papillomavirus (HPV) for cervical cancer, the helicobacter
pylorus for stomach cancer and the Hepatitis B virus for liver
cirrhosis, a fatal form of liver cancer. Other are associated with living
habits (smoking with lung and pancreatic cancers), and yet others
with environmental pollutants (insecticides with nasal-pharynx
cancer). There is also clear evidence that emotional and genetic
70
Lewis (1973:556–567).
71
Campbell and Campbell (2004:34–36).
72
Chapter 9 has a more detailed treatment of the causes of cancer from the TCM stand-
point. Yu and Hong (2012) document Chinese medical explanations of the causes of vari-
ous forms of cancer.
Chapter 4
45
flowing out of the blood vessels. The liver stores blood and regu-
lates the volume of blood, smoothing the role of qi to promote
blood circulation. Blood circulation can be disturbed by changes
in the body’s internal environment expressed as, heat, phlegm,
dampness, blood stasis.
Blood and qi are closely related like two sides of the same coin:
‘Blood is the mother of qi and qi is the marshal of blood (㹰Ѫ≄
ѻ⇽, ≄Ѫ㹰ѻᐵ).’ Blood carries qi and is also essential to the pro-
duction of qi by providing nutrients to the vital organs and the
meridians. Qi is the driving force that enables blood circulation.
Body fluids (jinye ⍕⏢) help maintain life activities in the body.
They are components of fluid in the blood vessels and also flow
outside the vessels in the vital organs. Body fluids can be excreted as
tears, nasal discharges and saliva. They moisten and nourish and
transport used (turbid) qi for excretion.
By assigning a variety of functions to qi, blood and body fluids,
TCM theory tries to capture all physiological processes in the body,
depicting them as the movement of these entities inside the body.
74
Wu (2002:161–162) describes “the five endogenous pathogenic factors” (neisheng wuxie
⭏ӄ䛚); Chai (2007) refers to all internal factors collectively as endogenous pathogens
(neishang bingyin Ք⯵ഐ).
Wind
Wind that is part of the external climatic environment is exogenous
wind, considered a pernicious source of illness that penetrates the
skin and brings about such conditions such as headache, joint
stiffness and arthritic pain. In combination with cold, heat or
dampness, it can lead to sore throats, coughs and colds and fevers.
A characteristic of ailments caused by exogenous wind is movement;
hence arthritic pain that moves from one part of the body to another
is thought to involve the wind pathogen.
Endogenous wind is usually produced by pathological processes
in the liver. It is also referred to as ‘liver-wind’ and its movement as
‘internal disturbance of liver-wind’ (ganfeng neidong 㛍仾ࣘ).
Phlegm
Phlegm is more than sputum, the sticky viscous substance that
lines one’s throat and bronchioles and causes irritation and cough-
ing. In TCM it also takes the form of nasty clear fluids that inhabit
the vital organs, causing ailments ranging from indigestion, lassi-
tude, insomnia and irascibility to headaches, epilepsy and strokes,
earning it the nasty aphorisms ‘A hundred ailments are induced by
phlegm’ (bai- bing duoyou tan zuosui Ⲯ⯵ཊ⭡Ⱐ⾏) and
‘Strange diseases are caused mainly by phlegm’ (guaibing duo tan
ᙚ⯵ཊⰠ).
75
Heat and cold will be further discussed under syndromes in Chapter 6.
Blood stasis
Blood stasis (yuxue ⰰ㹰) is a pathological substance, a by-product of
disturbances in blood circulation, leading to clots, subcutaneous pur-
pura or lumps. When stasis is not manifested in clots or lumps but is
more widespread, it is thought to cause general pain, irregular pulse
and manic anxiety. It originates from exogenous climatic factors like
cold that causes blood to stagnate or coagulate, or from emotional
factors. The condition or pathological process that leads to the forma-
tion of blood stasis is termed ‘blood stagnation’ (xueye 㹰ⰰ). It is
thought to be caused by exogenous factors such as prolonged expo-
sure to the cold and by certain emotions that upset internal balance.
The biomedical scientist who is presented with this strange
array of entities that TCM supposes constitute the basic ingredients
of the body cannot but wonder about their ontological status: what
exactly are they and in what sense do they exist? To make matters
worse, most TCM entities are complex and have multifarious
meanings depending on the context of their use.
We address this key question with an illustrative analysis and
interpretation of three entities: qi, phlegm and wind.
76
Reid (2001).
77
See Kaptchuk (2000:43) and the references to Sivin (1976) and Bennet (1978).
78
Based on the Huangdi Neijing, two college texts on TCM theory, Wang (2001) and the
entry “Qi” in the Encyclopedia of Chinese Medicine Zhongguo Dabaikequanshu.
generated from air and food after birth throughout life. Part of it
can be converted to replenish the body’s stock of yuan-qi which is
depleted by work, stress and illness.
By function: The main forms are pectoral-qi, nutrient-qi and
defensive-qi. Pectoral-qi or zong-qi (ᇇ≄) is situated in the thoracic
area, warming the blood vessels and nourishing the lung; an abun-
dance of it gives a person a sonorous voice. Nutrient-qi or ying-qi
(㩕≄) circulates in the body and nourishes the internal organs.
Defensive-qi or wei-qi (ছ≄) circulates in the outer layer of the
body and forms an armour that defends against external pathogens
like cold, wind, dampness and heat. It also helps regulate sweat to
maintain body temperature.
By location: Qi is present in and plays a role in every organ and the
meridians, hence the existence of such terms as heart-qi, spleen-qi,
stomach-qi and lung-qi as well as meridian qi.
Physiological functions of qi
The principal functions of qi are:
The propelling function that drives blood, enables fluid passage
within the body, and is the moving force behind digestion.
The warming function, with qi as a source of heat for the body,
carrying nourishment for body tissues.
The protective function, with qi circulating at the surface of the
body and protecting it against external pathogens such as wind
and cold.
The nutrient function, with nutrient qi (ying-qi) derived from
digestive processes being converted into material constituents
of the organs and meridians, as well as providing energy to
them.79
79
Wu (2000:43).
4.4 Interpreting Qi
In addition to the principal meanings of qi enumerated above, the
literature of Chinese medicine contains numerous others. According
to one estimate, in the Huangdi Neijing alone has 1,700 different
uses of the word qi.81
Questions naturally arise:
80
Wang (2001:71–72).
81
Wang (2001:44).
82
See, for example, Wu (2002:173) and Wu (2000:133).
83
Wu (2002:174).
Phlegm-resolving herbs
Why did the ancients group all four of the apparently disparate con-
ditions listed above under phlegm? Would it not have been simpler
to give a different name to each pathogen that caused a different set
84
Wu (2000).
85
The term ‘regulate’ (li ⨶) has a specific meaning in TCM theory. It refers to promoting
flow. Hence regulating qi is promoting its flow in the body.
Ingredients Functionality
Erchen Tang Wendan Tang
Banxia Banxia Resolves phlegm
Jupi Jupi Regulates qi and removes dampness
Fuling Fuling Removes dampness
Gancao Ganco Harmonises the other herbs
Zhuru Clears internal heat
Zhishi Regulates qi and removes dampness
Interpreting phlegm
The explanatory role of phlegm covers a multitude of sins, being a
proxy for all physiological factors that bring about clinical condi-
tions regarded by TCM as phlegm-related. Phlegm (except as spu-
tum) is not directly observable because, from a biomedical
86
The role of the monarch role in TCM formulations is explained in Chapter 7.
(a) Extreme heat that scorches the yin of the liver and can lead to
convulsions;
(b) The yang of the liver is transformed into wind, disturbing the
upper orifices and causing dizziness and convulsions;
(c) The presence of yin deficiency causes yang to ascend, stirring up
wind in the process and causing inadequate nourishment for the
tendons and ligaments, leading to convulsions;
(d) Blood deficiency results in lack of nourishment for the liver
and tendons, stirring up wind that is manifested as muscular
peristalsis and tremors.
In the case of (a), when the yin of the liver is damaged by heat, bal-
ance is upset, yang gains ascendancy, becomes hyperactive and brings
about convulsions. In the case of (b) and (c), yin and yang behave like
substances in the liver. When the yang of the liver is in excess, it can be
converted into wind; when there is deficiency in yin, yang becomes
relatively stronger and ascends, stirring up wind in the process.
Chinese medical theory has not always drawn a firm distinc-
tion between exogenous and endogenous wind. Before the Jin-
Yuan dynasties, exogenous wind was regarded as a cause of zhong
feng ѝ仾 or cerebral strokes. Later texts attributed the condition to
internal processes that are now described as by TCM theory as
endogenous wind.87 There does not appear to be any direct relation
between exogenous and endogenous wind.88
87
Wang (2001:455).
88
If a body deficient in qi suffers an attack of exogenous wind when there is a sudden
change in weather, it can trigger reactions that eventually lead to the formation of endog-
But it has also been used to treat ailments like infantile convulsions
attributed to endogenous wind. Since exogenous wind is readily
observable, fangfeng is likely to have been discovered first for treating
symptoms thought to be caused by exogenous wind. Later when it
was also found to relieve symptoms like a form of arthritis in which
pains are not fixed in one part of the body but move from one place
to another, mimicking the movements of wind, the arthritis would
have been attributed to endogenous wind.
Recent clinical research has indicated that fangfeng contains
anti-spasmodic ingredients that could play a calming role in condi-
tions like headache, intestinal irritability and convulsions, all of
which are often accompanied by spasms. Thus one could conjecture
that wind in TCM could be a proxy for a family of conditions in
which spasms are present.
Another common herb used to treat wind is tianma ཙ哫
(rhizoma gastrodiae) of the orchid family. Tianma however is used
for treating only endogenous wind, to “arrest convulsions, calm the
liver and suppress (an exuberant) yang”.89 Combined with other
herbs, it is used to treat conditions varying from convulsions and
dizziness to tension headaches and hypertension. For example, the
decoction Tianma Gouteng Yin ཙ哫䫙㰔侞, commonly used for
certain types of hypertensive condition, comprises 10 herbs, with
tianma and another herb gouteng (ramulus uncariae cum uncis) used
commonly to treat ‘endogenous wind’, playing the monarch roles in
the formulation.
89
Tang (2003:277).
Qi Phlegm Wind
Form Formless Sometimes liquid/solid as Formless
in sputum, but possibly
formless in the stomach
and organs
Substance When stored in Sputum is a substance, but Never a substance
organs other forms of phlegm
are ambiguous
Energy Exists at times Never in energy form Appears to have energy
as vital energy to move like qi
Flow Must flow to Obstructs qi when stagnant Flows to cause harm
function
It would appear that the concepts of qi, phlegm and wind were
invented and modified over time with Chinese medical theory to
take on the roles needed to explain the healthy functioning of the
body, the illnesses caused by deviations from the body’s healthy
balanced state, and restoration of health by particular kinds of
herbal agents.
Qi evolved to be a catch-all concept for all normal functioning
of the body that involves change and movement. To account for the
body’s ability to produce qi continuously, the idea of storage in
substance form in the organs was also necessary; hence qi is also
portrayed in some contexts as a substance.
The concept of phlegm was associated with symptoms that were
persistent (sticky like sputum) and the tendency to cause obstruc-
tions (of qi, blood and body fluids); certain herbs seemed to be able
to alleviate these symptoms and were classified as phlegm-resolving
herbs. As many illnesses are persistent and were understood to be
the result of obstructions (for example obstruction of qi flow in the
spleen and stomach, causing dyspepsia), phlegm came to be associ-
ated with many illnesses, ergo the conclusion that phlegm causes a
hundred ailments.
90
Kaptchuk (2000:76).
91
Kaptchuk (2000:97–98).
Chapter 5
In the Chinese medical picture of the human body, there are two
core systems — the vital organs and a complex network of meridians
(jingluo 㓿㔌).92 In this chapter we describe these systems according
to conventional TCM theory, then interpret them in the light of
modern knowledge of anatomy and physiology.
Organs in TCM are different from those with the same names in
modern anatomy. They should be viewed as clusters of functions and
not the somatic structures to which modern anatomy gives the same
name. This in part reflects the influence of ancient Chinese thought
which emphasizes functions and processes rather than the physical
nature of the entities with these functions and processes. Thus the
kidney in TCM theory is not one of two cashew nut-shaped physical
structures in the lower abdomen, but a collection of functions rang-
ing from growth and reproduction to the filtering of urine for excre-
tion. It is a source of perplexity for patients unfamiliar with TCM
terminology who, if told by his physician that there is a weakness in
his ‘kidney’, typically reacts by saying that he has not encountered
92
The term ‘meridian’ is used here rather than ‘channels and collaterals’ only because it is
shorter and more convenient. Some translators prefer ‘channels and collaterals’ to ‘merid-
ians’ object to the latter because the Chinese term ‘jingluo’ literally means channels and
collaterals. In the light of the diversity of ways of translating TCM terms (Annex 3), this
objection may not be of much practical relevance, and I have chosen the use of meridians
for its terminological convenience.
69
any urinary problem. The physician may in fact have only detected
weakness in kidney yang in the patient that causes him to have an
aching back, feel cold and suffer erectile dysfunction.
This apparent disregard in Chinese medicine for ontology is
encountered in many other contexts. For example, yin and yang are
treated sometimes as attributes and at other times as substances
(Chapter 6).
TCM organs are divided into two categories, the five solid zang 㜿
organs (e.g. the liver) that store qi and other entities, and the six fu 㞁
organs (e.g. the small intestine) that are hollow and process food
and body fluids as these pass through them.
We know of course that there are other organs like the brain,
pancreas and uterus. Chinese medicine recognises their existence
but have simply incorporated most of their functions into those of
the five solid and six hollow vital organs. For example, many of the
functions of the brain have been captured by the TCM ‘heart’.
The exact nature of organs has some ambiguity in TCM litera-
ture. At the time that the Neijing was written, little was understood
about human anatomy. Because of the prohibition of dissections of
the human body in China, physicians tended to focus their atten-
tion on the external manifestations of organs through their pre-
sumed physiological functions. The result was that functions were
ascribed to a number of key organs in such a way that they fitted
an overarching model of human physiology and pathology. For
example, the kidney in TCM theory is involved not only in excre-
tion but also in such diverse functions as growth, ageing, warming
the body, sex drive, reproduction, and the inheritance of innate
biological (genetic) characteristics from parents, thus earning it the
status of being the “pre-natal foundation of life”. Likewise, the
spleen is the key organ involved in transforming food into nutrients
and supplying them to the vital organs, hence it is conferred the
honour of being the “post-natal foundation of life”.
TCM textbooks sometimes appear to show inconsistency, refer-
ring to organs sometimes as somatic structures and at other times as
Zang Fu
Liver (gan 㛍) Gall bladder (dan 㛶)
Heart (xin ᗳ) Small intestine (xiaochang ሿ㛐)
Spleen (pi 㝮) Stomach (wei 㛳)
Lung (fei 㛪) Large intestine (dachang བྷ㛐)
Kidney (shen 㛮) Bladder (pangguang 㞰㜡)
93
Wu (2002:42, 44).
94
It is called the ‘triple energiser’ because it is divided into three parts, the upper, middle
and lower sanjiao, forming a continuous conduit for the flow of qi and energy.
95
Wu (2002:62–63).
96
‘Chyme’ is the “semi-fluid mass of partly digested food expelled from the stomach into
the duodenum” (Webster Collegiate Dictionary).
97
Wu (2002:75).
98
Oxford (2007:682).
99
Wu (2002:62).
100
Oxford (2007:673).
101
See, for example, Farquhar (1994), Kleinman (1995) and Julien (1995).
qi, jing, body warmth, marrow, brain matter and resistance to illness.
In effect, the kidney is the seat of youth and vitality. This explains
why so much of the Chinese approach to preserving vigour in mid-
dle and old age has to do with protecting and boosting the functions
of the kidney.
The main physiological functions of the kidney to be found in
TCM texts are as follows:
102
Wu (2002:65–70).
103
Kaptchuk (2000:57).
104
Wu (2002:70–71).
would be that for men urine is discharged through the same ori-
fices involved in sex and reproduction, and in adjacent orifices for
women.
It is also possible that the ancients chanced upon the sexual func-
tions of the adrenal glands covering the superior surface of the kid-
ney. To the unobservant eye of those in China involved in illegal
dissections, the gland could have been regarded as part of the kidney.
The cortex of the adrenal gland is derived embryologically from the
mesoderm (the middle germ layer of the early embryo) and is stimu-
lated by the pituitary gland (which regulates post-natal growth) to
produce various hormones, among which are those secreted by the
sex glands, mainly oestrogen and androgen. An association between
the kidney and sex and reproduction would therefore have seemed
plausible.
For completeness, we deal with the other three zang-organs
albeit cursorily as descriptions the spleen and kidney are already
sufficiently rich for illustrating a biomedical interpretation of TCM
organs.
105
Borrowed and adapted from the Stanford Encyclopedia of Philosophy.
106
Liu (2003:14–16).
107
Lo (2002:Introduction, xlix).
108
It is not entirely clear in what ways the blood that flows in the meridians is different from
blood that flows in blood vessels. Chinese thought seems not to have differentiated between
the two but regard them as playing complementary roles.
109
The nine orifices comprise the eyes, nose, ears, mouth, and the sex organ and the anus.
110
Filshie and Cummings (1999:31).
111
The term ‘myo’ is a descriptive for muscle; ‘fascia’ pertains to the fibrous membrane
separating muscles and also forming the layer between the skin and the muscles. See Taber’s
Cyclopedic Medical Dictionary (2001:775).
112
Filshie and Cummings (1999:38–42).
113
See for example Ernst and White (1999). These procedures have since been challenged
and there have been claims that other analgesia/anaesthesia may have been involved. What
is not in doubt is that they captured the attention of the medical world and aroused an
interest in acupuncture.
114
Various explanations of the mechanism of acupuncture are offered separately in papers
by Lundeberg, Birch and Hsieh in Hong (2013).
115
See Filshie and Cummings in Ernst and White (1999:36).
116
See, for example, Hong (2013), Kaptchuk (2000) and Evans (2003).
117
Lu and Needham (1980:186).
118
Leung et al. (2003:176–177).
and blood and its use to relieve pain. Pain in TCM theory has to do
with obstructed flow, as captured in the aphorism ‘where there is no
flow there is pain; when there is no pain, there is flow’ (butong ze
tong, butong ze tong н䙊ࡉⰋ, нⰋࡉ䙊). The TCM explanation is
that the acupuncture needle stimulates the flow of qi and blood.
Pain is therefore mitigated by promoting better flow with a needle
at the locus of pain or, more commonly, at a receiving point and
transmission point along one of the meridians.
The second aspect of meridians is their connection to the organs
and their therapeutic use for illnesses associated with the organs. For
example, TCM theory would prescribe acupuncture on points along
the spleen and stomach meridians to stimulate the production and
flow of spleen-qi and stomach-qi, which are needed to alleviate
problems of digestion, bloated stomach, or lack of appetite. This
function of the meridians is the more important one for TCM the-
ory as it is an integral part of the overall holistic framework of expla-
nation for illness, diagnosis and therapy.
In the light of the TCM concept of the organs as a set of func-
tions rather than somatic structures with fixed loci, the notion of
meridians physically tracing their paths to the site of organs becomes
suspect, and the conventional maps showing the intricate paths of
each meridian with an endpoint in a (Western anatomy) organ
could conceivably come to grief. An escape from this dilemma is to
interpret the meridian maps as being merely schematic once a
meridian enters the visceral region, where it somehow interacts with
the functions of the organ with which it is supposedly linked. This
is too vague to be satisfactory.
My conjecture is that the intricate network mapped out in
ancient Chinese texts and extensively used by modern TCM physi-
cians in clinical work does not exist as a set of physically isolatable
pathways. Attempts to map the network using electrochemical and
other techniques are likely to be doomed to failure, for the same
reason that it does not make sense to isolate qi, phlegm and wind for
chemical analysis. The meridian system is an explanatory model that
119
See “The Ontological Status of Meridians” in Hong (2013).
120
Filshie and Cummings (1999):32.
121
Tung Ching-Chang (2005). Advanced Tung Style Acupuncture: Dao Ma. Translated by
James Maher. Taos, New Mexico: The Redwing Book company.
Chapter 6
Methods of Diagnosis
and Therapy
There are extensive discussions of yin and yang in the I-Ching and it
undoubtedly was a major source of philosophical insight in Taoism,
which gave it full expression in poetry, metaphysics, statecraft and
medicine.
The ideas of yin and yang in Chinese philosophy and medicine
are usually presented as Yin-Yang Xueshuo (䱤䱣ᆖ䈤), the
doctrine (or theory) of yin and yang. The doctrine reflects a dia-
lectical logic that attempts to explain relationships and change.
Stripped to its bare essentials, yin and yang are not much more
than labels that capture the perception of duality in nature —
light versus darkness, hardness versus softness, male versus female.
Thus the yin-yang doctrine is a holistic view of the world, a way of
thinking that places all entities as part of a cosmic whole — enti-
ties that cannot have existence independent of their relationship
to other entities.
Chinese medicine took these concepts from cosmology and,
viewing the body as a microcosm of the universe in which ideally
things are in harmony and balance, it regarded human health as
being based on a balance between yin and yang in the body.
As such, the yin-yang doctrine is not so much a scientific theory
as it is a conceptual framework for the models in TCM theory. The
models in turn are used for explanation and prediction and, if they
claim to be scientific models, must be capable of yielding testable
hypotheses.
The basic idea of yin and yang is simple and might appear to be
an unlikely source of medical wisdom. Dualism of natural states
implies that an attribute like brightness has meaning only relative to
darkness, as does beauty relative to ugliness.122 Objects and states
can be similarly classified: day and night, summer and winter, hard
and soft. Attributes come in contrasting pairs: male and female,
122
Laotze, the founder of Taoism, explains it in terms of recognition of attributes: “It is
because everyone under Heaven recognises beauty as beauty that the idea of ugliness
exists.” (Daodejing, Chapter 2, line 1).
Yang Yin
Strong Mellow
Bright Dim
Rigid, unyielding Flexible, yielding
Hard Soft
Transparent Unfathomable
Hot, dry Cool, moist
Fast, hurried Slow, patient
Analytical Discursive
Insensitive Sensitive
123
Nisbett (2003).
124
Oxford Concise Medical Dictionary (2007).
125
http://www.drmarkholmes.com/pdf/Homeostasis.pdf, retrieved 12.23.2013.
126
http://drlwilson.com/Articles/CATABOLISM.HTM, retrieved 12.23.2013.
condition that arises from yang being weaker than yin in the kidney
functional system, possibly the result of poor nutrition, overwork or
sexual excess. It manifests itself in symptoms of lassitude, a pale
complexion, fear of wind and cold, a thin pulse, chronic back pain,
frequent urination and sexual dysfunction. The treatment is with
yang tonics for the kidney.
The yin-yang principle reflects the common observation of
dualism in nature, that attributes mostly come in pairs. The bal-
ance between yin and yang and their mutual dependence can be
seen as the need for some kind of homeostasis-like equilibrium in
physiological functions. As for the waxing and waning of yin and
yang, these were originally derived from the cyclical character of
natural phenomena — the diurnal cycle, the seasons and circadian
rhythms of the body. They became useful tools for analysis of the
workings of the body, and their meanings expanded as early medical
thinkers tried to explain physiological phenomena inside the body.
TCM models use these concepts to capture what were perceived to
be attributes of various entities in the body and the forces driving
their dynamic states.
It should be noted that treating yin and yang sometimes as
attributes and at other times as substances can cause confusion for
those working with these concepts for the first time. When we speak
of qi as yang and blood as yin in nature, we mean that they have yin
and yang attributes respectively. But when we refer to deficiencies in
yin or yang, we treat them like substances (see Chapter 6.5 below).127
127
An unusual morbid condition of a weakened body is the classical joint deficiency of yin
and yang ( 䱤䱣є㲊) syndrome, characterized by lassitude, vulnerability to infection, and
intolerance of either hot or cold temperature. The body may be deficient in both qi (which
has yang attributes) and in blood (which has yin attributes). Such a concept makes sense
when one regards yin and yang as substances, but runs afoul of logic when they are oppos-
ing attributes. (One cannot logically get darker and brighter at the same time.) One way to
interpret a double-deficiency syndrome is that substances like qi with yang attributes and
blood with yin attributes have both declined in level, resulting in extreme body weakness.
This is an example of how the blurring of distinctions between substances and attributes
can cause conceptual distress to the scientist who is unaccustomed to making mental
switches between the two. It would appear more sensible to incorporate the above morbid
condition under the wider category of ‘depletion of genuine qi’ (↓≄㺠ㄝ) depicting a
body in an extremely weakened state. I should caution, however, that such a suggestion
would not find much favour with scholars who regard ancient texts like the Neijing as the
ultimate authority on medical truths rather than brilliant but fallible conjectures about
how the body works.
128
Zhang (1996, 1999).
129
Frigg and Hartmann (2006).
130
Psillos (2007).
131
Hesse (1967:357).
eventually learnt to stand on its own two feet and the billiard ball
model was no longer needed.
In the social sciences, particularly in economic science, models
are used to represent idealised situations that approximate to real
economic conditions at particular places and times. For example,
Adam Smith’s model of economic efficiency in competitive markets
holds true provided that the conditions for perfect competition exist.
These include free markets, absence of state intervention, perfect
information, and the absence of transaction costs. In the demand-
supply model, consumers are pictured as seeking a fictitious entity
called “utility”, yielding an equation for an objective function to be
optimised under supply and budgetary constraints.
For the purpose of reconstructing TCM theory, which can be
viewed as having a number of models associated with it, it is
convenient to use that term in a similar manner to Ronald Giere.
A scientific theory comprises a cluster of models, together with a
number of hypotheses about real things claimed to be similar to one
or another of the models. “A theoretical hypothesis is […] a state-
ment asserting some sort of relationship between a model and a
designated real system […]. Hypotheses, then, claim a similarity
between models and real systems.”132
Whether TCM models qualify to be called scientific models
must then depend on whether hypotheses regarding illnesses can
be derived from these models and whether these are testable in
principle, preferably also in practice. To establish the scientific
nature of TCM models, one must therefore be able to present test-
able hypotheses based on these models. This must mean that the
methods of diagnosis and treatment can be put to clinical test. If
these hypotheses can be put to the test, the claim that TCM is sci-
entific can begin to be made. Testing may well lead to a rejection
of much of TCM theory. However if some parts of the theory were
confirmed through hypothesis testing, it would give TCM more
132
Giere (1988:80).
Wood (Liver)
134
See Ou ( 2005).
135
It is instead in accordance with the mingmen or ‘gate of life” theory which places the kidney
in the central role of warming the body’s organs. See Wu (1995) Zhongyi jichu xue, 31.
Climatic influences
Climatic influences are usually referred to as the six exogenous fac-
tors ()␛ޝ: Wind (仾), cold (ሂ), summer heat (᳁), dampness
(⒯), dryness (⠕) and fire (⚛).
136
Deng (1988).
When these climatic factors invade the body and are not
expelled, they can become internal pathogenic factors with charac-
teristics similar to their external counterparts. We have previously
dealt with their endogenous counterparts in Chapter 4.
Wind is blamed for the largest variety of illness. It is character-
ised by movement; hence a form of rheumatism with pain moving
to different parts of the body is thought to be due to wind within
the body.
Cold and heat in the weather have parallels internally in patho-
logical conditions of heat and cold. Summer heat is extreme heat
(fire) often accompanied by dampness as well.
Dampness is high humidity when it is external and is associated
with symptoms of stickiness (being difficult to eliminate) when it
penetrates the superficies, slowing a person down and causing stag-
nation in digestion when it is present in the spleen. Dryness, on the
other hand, is present typically in the autumn and winter months in
temperate countries and air-conditioned rooms in the tropics.
Emotions
The seven emotions (гᛵ) in TCM are pleasure, anger, anxiety, grief,
fear, shock and melancholy, of which the first five are more com-
monly encountered. Each of the seven is thought to be associated
with a specific zang-organ (see Table 6.2).
137
See Farquhar (1994), Scheid (2002:201) and Sivin (1987:109).
138
Oxford Concise Medical Dictionary (2007): A syndrome is “a combination of signs and/
or symptoms that forms a distinct clinical picture indicative of a particular disorder”, e.g.
chronic fatigue syndrome.
139
The translation of ‘disease’ here for bing (⯵) is not totally satisfactory as the Chinese
bing has a wider meaning that includes the universe of disease and illness in the Western
sense as described in Chapter 2).
140
Scheid (2002:207) notes that while the differentiation of syndromes was discussed in
various parts of the Neijing and The Treatise on Febrile Diseases, and were used at various
times in the history of Chinese medicine, there was also emphasis on diseases and symp-
toms in addition to syndromes. It was only in the Republican era that, under the influence
of classifications seen in biomedicine, TCM underwent the “wide-scale systematization of
the presentation of diseases, patterns and symptoms and signs” that was needed to make
differentiating syndromes a distinguishing feature of contemporary Chinese medicine.
141
Sivin (1987), Farquhar (1994) and Kaptchuk (2000).
142
Wang (2002:2).
143
Ren (1986).
144
Yellow Emperor’s Canon of Medicine (2005:Ch. 28) Suwen. ‘Essential breaths’ here refers
to essence (jing) and qi.
Pathogenesis
A patient is subjected to cold harsh weather and his body defences
break down. He catches a chill that develops into a fever. He has a
runny nose, a mild cough and a headache, and is averse to cold and
wind; his tongue is pale with little fur, and his pulse is ‘floating’.
In TCM thought, these are symptoms of ‘cold damage’ affecting
the outer layers of the body. The patient’s syndrome is ‘cold at the
exterior (surface) level’ (biaohan zheng 㺘ሂ䇱).
At this stage, if he has sufficient zheng-qi, the body can be
assisted to resolve the condition with a warm diaphoretic medica-
tion like the Ephedra decoction (Mahuang Tang). Essentially this
145
See, for example, Nutton (2004), “Humoral alternatives”, pp. 202–215.
146
TCM considers perspiration as resolving both cold and warm conditions at the exterior
level. If the condition is that of heat at the exterior level, a cool diaphoretic like dried chry-
santhemum flowers (juhua) would be used.
Inquiry
Inquiry can be a fairly long process, lasting for over half an hour for
a new patient. At the first visit to a physician, the patient should be
asked a long list of questions concerning his past medical history,
bowel movements, urination, appetite, sleep, adaptability to hot and
cold environments, aversion to wind, sexual activities, eyesight and
moods. The patient is also asked to describe how he feels, and the
main medical complaint that led him to consult the physician.
An experienced physician can ask penetrating questions that
allow him to accurately narrow down the range of conditions with
which the patient might be afflicted. In a sense, the inquiry part of
the four examinations is the most challenging but rewarding one as
a tremendous amount of information can be extracted from this
process. Physicians who rely heavily on laboratory diagnostic tests
and spend less time understanding how the patient feels, could be
missing crucial information that can help the doctor determine the
patient’s condition.
Therapeutic methods
After a diagnosis is made and the syndromes differentiated, therapy,
the second part of bianzhenglunzhi is applied. The principle involved
is simple: treat a condition with opposing and balancing force, for
example:
147
Qigong therapy, involving meditation and breathing exercises, is used in some circum-
stances, although some forms of qigong are shrouded in mystique and have possible
spiritual or psychiatric dimensions. Most TCM physicians do not practise it.
148
Lloyd and Sivin (2002:259).
149
This point was used by, a trained biochemist and a rabid critic of Chinese medicine, as
an argument for concluding that Chinese medical theory and practice are superstitions.
150
Farquhar (1994:1).
151
Huang (1995:18–21) discusses this analogy in some depth.
152
See Liu Lihong (2003:14–16).
153
Sauer et al. (2007:550–551).
154
Zhu (2005).
155
Peng (2011).
156
These findings of a research team led by Jia are reported in Peng (2011), based on Xie
et al. (2009). Characterization of Pu-erh Tea Using Chemical and Metabolic Profiling
Approaches Journal of Agricultural and Food Chemistry 57: 3046–3054.
157
Chapter 8.
158
See, for example, Okasha (2002:56–57).
159
Liu (2003:14–16).
Chapter 7
Treating Illness:
Herbs and Other Therapies
127
Classification of herbs
Herbs can be classified according to their natural characteristics, or
according to their therapeutic effects.
remove internal heat, but can have the side effects of harming the
stomach and spleen if inappropriately used.
The flavour of a herb is akin to its taste, except that in Chinese
medicine certain actions are associated with the flavour classifica-
tion, hence there is not always an exact correspondence between
flavour and taste. The five flavours are pungent (䗋), sweet (⭈),
sour (䞨), bitter (㤖) and salty (૨) and their common actions are
shown in Table 7.1.
Each herb is thought to have one or more preferential routes
along the meridians for their actions to affect specific organs.
Chrysanthemum and wolfberry seeds both prefer the liver meridian,
and are often used in therapies involving the liver; chrysanthemum
also has a preference for the lung meridian and is used in some
medications for coughs with heat in the lungs.
HIV changes every time it replicates, so high replication rate meant high
error rate and therefore HIV was able to mutate very quickly […] if you
treat this virus with one or two drugs at a time the virus is predictably
going to mutate and escape from the action of the drugs. But at the same
time we could also calculate what it would take to corner the virus so it’s
not able to escape. Those calculations suggested to us that three or more
drugs would do the trick. So we knew that by 1995 and launched a series
of experiments in patients using what is now called a cocktail therapy of
three drugs or more.161
160
Ho (2001).
161
David Ho interview (April 20, 2010). http://bigthink.com/videos/discovering-the-
hivaids-drug-cocktail-in-an-equation.
162
See “Oslerisms” http://lifeinthefastlane.com/resources/oslerisms/
Chapter 8
We now confront the central issue that biomedicine, with fairness and
complete justification, has traditionally posed to Chinese medicine:
Scientists can to some extent condone TCM concepts being fuzzy and
hard to understand and the models for diagnosis and therapy lacking
the rigour of modern physiology but, to be regarded as serious medi-
cine, TCM needs to show that its therapies really work.
For too long, most of the Chinese medical community has
regarded such a question as being superfluous. Look at the millions
who visit TCM clinics each year and keep coming back for more,
they say. Examine the the case records of Chinese physicians around
the world and the testimony of numerous patients who get well after
treatment. What more proof do you need? Would Chinese medicine
have survived and thrived for over two thousand years if it was not
working?
139
Many scientists believe that the scientific paradigm has absolute truth
value, but philosophers such as Thomas Kuhn reject this. If no paradigm
does have absolute value, there is no absolute basis with which to judge
another paradigm. Any paradigm will appear limited or incorrect from
the perspective of a different paradigm, so Chinese medicine will seem
incorrect from a biomedical point of view.164
165
Krauss (2012).
166
See, for example, Liu (2003).
167
Kleinman (1995).
(a) Evidence for the existence of TCM entities and the detection/
measurement of their properties;
(b) Evidence for the usefulness and efficacy of TCM diagnostic and
therapeutic methods.
168
See, for example, Lo (2004).
169
Serendipitous discovery occurs when one finds a cure for a disease while looking for a
cure for another. See, for example, Ban (2006:335–344).
170
See, for example, various papers in the volume by Ernst and White (1999).
171
See, for example, Wang (2002:234).
Methodological issues
1. Syndromes are in a dynamic state, hence for practical purposes
clinical trials should be limited to those syndromes that are rela-
tively stable and that do not change without intervention within
the duration of the trial. For example, most cases of deficiency
of kidney-yin tend to be chronic, accompanying ageing and pro-
longed stress; prolonged weakened kidney-yin also frequently
occurs for patients who have recovered from severe fevers and
infections, or have received strong Western treatments like chem-
otherapy and radiation therapy. TCM treatments that claim to be
able to resolve this condition may take many weeks or months,
hence these cases would be suitable for RCTs carried out over a
relatively long trial periods.
But there are also cases of kidney-yin being damaged with
inadequate sleep and stress. Most of these are claimed by TCM
to resolve within a week or two with suitable medication, hence
a RCT spread over about a week would be an appropriate test
for this TCM claim. An appropriate refinement of the clinical
trials would employ samples of people that belong to the first
172
For animal studies in which the application of the four examinations is not feasible,
Lu et al. (2009:501–505) propose the method of determining the presence of a syndrome
by observing the animal responses to a standard Chinese herb prescription for that
syndrome: those that respond are then deemed to have the syndrome, and biological
biomarkers of these are then studied compared to those that do not respond. Such a
methodology presumes that the efficacy of the prescription for that syndrome, something
that needs to be separately established.
8.3 Biomarkers
Although there is in practice a high degree of consistency in the
diagnosis of common syndromes by TCM physicians, this would not
be the case for multiple syndromes. If there were established biomark-
ers for determining the presence of any particular syndrome, this
would greatly simplify the problem, but to date, the use of biomarkers
for differentiating syndromes has not been satisfactorily achieved.
Some researchers have tried using statistical data mining methods to
develop these biomarkers.173 Such methods are not without problems.
The use of biomarkers makes the presumption that there is an
exact set of biological states, such as the presence of microbiologi-
cal pathogens or changes in the level of blood component or
endocrinal secretions, corresponding to a TCM syndrome. But is
every syndrome associated with a unique set of biomarkers? There
is no reason to believe that this would in fact be the case of all
syndromes, or even any syndrome.
There is a similar issue in Western medicine for more complex
conditions like rheumatoid arthritis, for which the RA (rheumatoid
arthritis) factor measured from blood samples is used as a probabil-
istic indicator of the presence of the disease, but the correlation is
notoriously imperfect. A person with a high RA factor may have no
symptoms (false positive), and an acute rheumatoid arthritis
sufferer exhibiting classical symptoms of inflamed joints and con-
nective tissue may have a normal RA factor (false negative).
Recent research findings indicate that the PSA index used for
detection of prostate cancer is similarly flawed.174 For most diseases
in biomedicine, however, the biomarkers are unambiguous. For
example the presence of lung lesions seen in chest X-rays and the
presence of the tubercle bacillus in the blood is a definitive indicator
of tuberculosis, or the presence of the rhinovirus in blood and nasal
discharges a definitive indicator of the common cold.
173
Guo et al. (2009:531–546).
174
Damber and Aus (2008).
By ruling out RCTs for all clinical trials of TCM therapies, ‘RCT
detractors’ run the risk of being dismissed by ‘TCM detractors’ who
would charge that since TCM cannot be subjected to RCTs it is
therefore not scientific. Either polar position leans toward the dog-
matic and is at variance with the more enlightened views and cogent
arguments offered by Urbach, Worrall, Rawlins and others that
RCTs are not the only useful means for validating the efficacy of
interventions; in fact oftentimes they are neither the best means nor
even a feasible way of testing.176
In his 2008 Harvein Oration to the British College of Physicians,
Sir Michael Rawlins puts it pointedly: “The notion that evidence can
be reliably placed in hierarchies is illusory” and such hierarchies
with RCTs at their summit and various forms of observational stud-
ies “nestling in the foothills” put RCTs on an “undeserved pedestal”.177
175
Shea, JL (2006:258).
176
Urbach (1985), Worrall (2002, 2007), Rawlins (2008).
177
Rawlins (2008:1–2).
He might also have added that RCTs, despite a mixed record in reli-
ability, are also notoriously costly to conduct, leaving only large
pharmaceutical companies with substantial resources to conduct
them for approval of new drugs in a mass market. These companies
would not find it economically viable to finance similar trials for
Chinese formulations that, because of the patient-centric individu-
alised nature of Chinese prescriptions, would not easily find a mass
market comparable in size to those for Western drugs.
“RCT detractors” among TCM researchers are correct to
de-emphasise RCTs but are being overly pessimistic to rule them out
in all situations. While RCTs need not be the only way to conduct
clinical trials and while there are considerable methodological dif-
ficulties dealing with syndromes for clinical trials as pointed out
above, they can in principle be conducted when available samples
are large enough. They do not violate any “fundamental essence” of
TCM if the trials were conducted on differentiated syndromes and
therapies applied according to TCM principles rather than on
“Western herbal medicine” and “Western acupuncture”.
TCM does emphasise individualised treatment by virtue of
focusing on multiple syndromes in a dynamic state, which makes
each patient potentially different from most others. This militates
against the use of RCTs. But it can be argued that patients are all
different anyway, whether looked at from the point of view of
TCM or Western medicine. It is for RCTs to be designed in such a
manner as to average out these differences such that the patient
samples in the treatment and control arms of the RCTs are statisti-
cally as close as possible. This may not always be possible, which is
why observational studies and case studies (discussed below) should
also be considered and used when appropriate.
In sum, clinical trials based on syndrome differentiation tend to
be more difficult compared to those for Western medicine, largely
because of the highly patient-centric approach of TCM therapy. In
practice, no two persons suffering from the same disease are likely
to be given the same prescription by a TCM physician, in part
178
Lu et al. (2009), Zhang Jie (2005).
179
One attempt was by Zheng (1985).
180
A summary of such papers is presented in Bian (2010). TCM concepts in the trials,
CGCM August 2010 presentation. The same pattern was seen in the 2011 meeting.
181
See, for example, Tang et al.(1999) and Kaptchuk (2000:Appendix E).
Case-based reasoning
The use of cases as an analytical and pedagogical tool was institu-
tionalised at Harvard Law School in the 19th century and over a
hundred years ago at Harvard Business School. Case-based reason-
ing versus rule-based reasoning has been a subject of discussion in
the recent philosophical literature.
Case-based reasoning does not attempt to solve a problem from
first principles or a set of accepted rules or laws, as a rule-based
system would. Instead, as Nickles argues, it employs “some sort of
182
Lai (2001, 2010).
183
Shang et al. (2007).
184
Worrall (2002).
185
Nickles (1998:70).
186
Hacking (1992:2) and Forrester (1996).
187
Nickles (2003:162).
188
See, for example, Cullen (2001:309–321).
189
See, for example, cardiovascular disease cases treated with Chinese medicine in Becker
et al. (2005).
190
Data mining is the process of applying computer science methods such as neural net-
works, cluster analysis and decision trees to data with the intention of uncovering hidden
pattern in large data sets.
data, one can test the hypothesis that the herb huangqin (radix
scutellariae) clears internal heat in the lungs. A random sample is
created from past cases in which huangqin was used as part of
various formulations for treating patients with internal heat in the
lungs. A suitable method of statistical analysis would then be used.
For example, multiple regression analysis could be used to deter-
mine the statistical significance of the huangqin factor in reducing
lung heat. The regression methodology implicitly builds in a con-
trast class into the study. If huangqin emerges as a statistically sig-
nificant variable, this would lend support to the proposition that
using huangqin is more likely to achieve a heat reduction outcome
than if it is not.
It is to be hoped that more research resources will be put into
such studies. As for ancient case records of famous physicians, it is
likely that these cases will be taken on faith by TCM physicians and
employed as tools for training new physicians rather than a valid
source of evidence for TCM theory.
Summing Up
TCM models of therapy based on syndrome differentiation consti-
tute the core theory of TCM; these models can and should be put to
the test through clinical trials if TCM is to be considered a scientific
system of healing. Clinical trials can be done in a variety of ways and
need not be limited to RCTs.
To be sure there are methodological difficulties in using double-
blind RCTs to test TCM interventions, but they do not amount to a
need to reject them. Rather they should be used selectively, as
should observational trials. Classical case studies of famous physi-
cians are useful as pedagogical tools for training TCM physicians,
but they do not provide a reliable database for observational trials.
Properly-kept detailed records of modern TCM clinics and hospi-
tals with large patient bases are more promising for this purpose.
Chapter 9
One of the most successful physicians I have ever known has assured me
that he used more bread pills, drops of coloured water, and powders of
hickoryashes, than of all other medicines put together.
Thomas Jefferson
191
Finniss et al. (2010).
192
Beecher (1955).
193
Kaptchuk (1998).
194
In Kienle and Kiene (1997).
195
Evans (2005).
196
Finniss et al. (2010).
197
Evans (2003:44–69).
198
See a survey by Shang et al. (2007: 1086) of some of the recent findings and Wu (2010).
199
Shang (2007:1086).
200
Kaptchuk (2000:33, footnote 27).
for fever and antibiotics for secondary bacterial infection but suffers
post-flu chronic dry cough and lassitude. He believes that the TCM
would fix his problem. The TCM physician treats his dry cough as a
deficiency syndrome in the lung-yin and lassitude as arising from
damaged qi. His confidence in TCM treatment raises his spirits: he
sleeps better and is more physically active, and his immune system
improves as a result. If he recovers quickly, he might be inclined to
regard this as a vindication of TCM for chronic conditions.
Another reason is that alternative therapists tend to spend more
time with their patients than do conventional doctors (40 minutes
versus 17 minutes); they also engage in more direct physical contact
than doctors who prescribe pills after a quick examination.201 The
higher perceived level of empathy for their patients is likely to evoke
a stronger placebo response.
Third, in Eastern cultures, TCM patients tend not only to be
strong believers in TCM therapy, but can also relate better to the
terms and language used by Chinese physicians without the prob-
lems of translation of these terms that a non-Chinese speaker would
experience. This is particularly so with respect to the differentiation
of TCM syndromes and their treatment. The average Chinese patient
in China or Singapore, for example, has little problem understand-
ing the physicians who tell him that he suffers from qi deficiency or
damp heat, but may have more difficulty understanding blood test
results that show a low platelet count or an elevated ESR. Explanations
offered by the TCM physician to the patient of the underlying prob-
lem of his illness and the method adopted to tackle it builds confi-
dence of the patient in the physician and may well evoke a stronger
placebo response.
Recent neurophysiological studies suggest that genetic varia-
tions in the neurotransmitter pathways that mediate placebo effects
can modify these effects. Considering the possibility of interaction
between placebo and drug molecular pathways, one can conclude
201
Evans (2003:157–158).
202
Linde et al. (2005), Melchart D, Streng A, Hoppe A, et al. (2005), Brinkhaus B, Witt CM,
Jena S, et al. (2006), Haake et al. (2007).
203
Linde et al. (2007).
204
Kaptchuk (2000: Appendix E, 357).
Chapter 10
175
205
In Chinese, the syndromes are ᗳ≄н䏣, and ⰰ㹰Ⱙ䱫, ᗳ䱤ҿ亪, Ⱐ⍺䰝䱫.
See, for example, a detailed description of TCM treatments for heart disease may be found
in Becker et al. (2005).
206
The “monarch” herb in the main one and the “minister” herbs play the chief supporting
function. See Chapter 6.
207
Noted advocate of natural healing, Andrew Weil (M.D.) recommends the regular
consumption of black fungus for coronary heart health. See Weil (1995:166).
Interpretation
Compared to Western treatments using the nitrates for vasodilation,
blood thinners (like aspirin) to reduce the risk of blood clots, and
surgical interventions like angioplasty and bypass surgery, TCM
treatments are slower and cannot deal effectively with acute angina
or emergency situations of coronary infarction. But they could be
useful either as complementary treatment or as an alternative to
surgical intervention.
TCM treatments, with proper medical advice recognising drug
contraindications and the condition of the patient, can and are
being administered alongside Western treatments. TCM approaches
208
See the work of Fu Yalong and his colleagues at Beijing’s Guanganmen Clinic: http://
www.bj.xinhuanet.com/hbpd/health/jdt/2014-09/03/c_1112313492.htm, retrieved 28th
Feb 2015
209
See, for example, Sinatra and Roberts (2007), Campbell and Campbell (2004), and
Esselstyn (2008). On yellow ginger or turmeric (curcumin) for heart health, see, for exam-
ple, Akazawa et al. (2012) and Sinatra (2012).
exponentially after the age of 65. Both Western medicine and TCM
treat patients to prevent strokes and, if a stroke has occurred, to
ameliorate its effects and improve quality of life. The approaches
taken by the two systems of medicine appear radically different, but
in fact have underlying commonalities.
Of the two major kinds of strokes, the ischaemic stroke and the
haemorrhagic stroke, the former is by far the more common, being
precipitated by sudden impeded blood flow in an artery of the brain.
This could be caused by clotting at the artery (thrombosis), or a
detached clot from another location — usually the heart or the
carotid artery — that lodges itself within the artery (embolism),
cutting off oxygen supply to part of the brain. A haemorrhagic
stroke results from rupture of an artery wall, leading to cerebral
haemorrhage, and it is commonly correlated with degenerative dis-
ease of the arteries and hypertension. The use of blood thinners like
warfarin can also raise the risk of a haemorrhagic stroke.
Western medicine attributes strokes to a combination of risk
factors, which may include hypertension, smoking, excessive choles-
terol (LDL) levels, and diabetes. Heart arrhythmia in the form of
atrial fibrillation can also produce clots that travel to the brain.
TCM views that the underlying conditions predisposing a per-
son to strokes involve the endogenous wind (feng) pathogen; hence
the Chinese term for stroke is zhong feng, or “attack by wind”.
Endogenous wind may arise from one or more of several factors,
which include (a) weakness of yin and blood giving rise to liver heat
and wind; (b) overwork and strain stirring up liver wind; (c) inap-
propriate diet that creates warm phlegm in the spleen, generating
endogenous wind; (d) emotional stress particularly anger triggering
fire and the production of harmful wind.210
A large number of TCM syndrome combinations are associated
with strokes, depending on the nature of the stroke and the stage of
progression, whether at the onset, in the immediate aftermath, or
210
These standard explanations may be found in textbooks like Zhou (2007:304–310).
during the longer term debilitated phase of the patient. At the onset
and immediate aftermath stage, hyperactivity of liver-yang, phlegm
with wind, and stirring of liver wind (ganfeng neidong 㛍仾ࣘ)
are the common syndromes; at the later recovery stages, phlegm and
blood stasis are often present, and the patient may suffer from severe
qi deficiency and weakness of the liver and kidney.
Tianma Gouteng Yin (ཙ哫䫙㰔侞) with suitable variations to
suit the patient is most often used in the early stages whilst tonics
with ingredients added for resolving blood stasis such as Buyang
Huanwu Tang (㺕䱣䘈ӄ⊔) are administered in the recovery stages.
Thus, treatment of these TCM syndromes associated with strokes
follows the principle of customising therapy to the syndrome and
the constitution of the patient.
Treatment usually combines herbal prescriptions, acupuncture
and tuina, and is continually varied as the internal state of the
patient changes and new syndromes are exhibited. TCM theory
explains that acupuncture helps the rehabilitation process by
enhancing flow of qi and blood in the body, leading to better recov-
ery of motor skills and overall physical functioning by inducing
beneficial changes in the blood flow to the brain. Common points
used in post-stroke acupuncture treatment include taichong ཚߢ
hegu ਸ䉧 renzhong Ӫѝˈbaihui ⲮՊˈsanyinjiao й䱤Ӕ
neiguan ˈޣyanglingquan 䱣䲥⋹ and quchi ᴢ⊐. These acu-
points can also be used in the treatment of hypertension.
Exercises like qigong and taijiquan, for patients with sufficient
mobility, are believed to enhance recovery from post-stroke disabili-
ties. Social interaction within qigong groups may also help to
improve patient morale and nurture the positive emotions that
facilitate recovery.
Interpretation
Western medical explanations for stroke revolve around vascular
impediments to blood flow and the contribution of diet, lifestyle
Interpretation
If clinical trials indicate a high rate of success of TCM treatments for
digestive disorders and IBS and related disorders, then biomedical
explanations for the mechanisms of these treatment would present
interesting research opportunities.
213
See Chapter 7 for a description of Xiangsha Liujunzi Tang and Annex 2 on Xiaoyaosan.
214
For example, Bensoussan et al. (1998).
10.4 Depression
Depression in Western medicine is a mood disorder “characterised
by the pervasive and persistent presence of core and somatic symptoms
215
Oxford Concise Medical Dictionary (2007:195).
Interpretation
A biomedical interpretation of the claimed therapeutic effects of
TCM treatments for depression may lie in the effects of these herbs
sustaining healthy levels of neurotransmitters in the parasympa-
thetic nervous system. For example the seed of Ziziphus Spinosa Hu
(suanzaoren 䞨ᷓӱ) has been found to be related to melatonin, a
derivative of serotonin which is a key neurotransmitter for calming
the body. Such explanations are likely to be incomplete, as the res-
toration of smooth qi flows in TCM implies a better functioning in
general of physiological processes in the body — improved motil-
ity in digestion, enhanced sleep quality and a higher level of energy;
these combine to produce a better feeling of well-being, encourag-
ing the patient’s own mind to overcome depressive moods.
Chinese exercises like qigong involving breathing, meditation and
relaxed movements are thought to promote the flow of qi and has
traditionally been one way of countering depression. A recent clini-
cal trial involving daily doses of the popular depressant Zoloft against
patients taking a walk three times a week showed that the latter gave
better therapeutic results (Ilardi 2013). This seems to suggest that the
Chinese concept of promoting qi flow, through either qigong or plain
walking exercises, can provide a viable alternative to medications, for
at least some forms of depression.
10.5 Cancer
The mechanism of growth and spread of cancer cells, after malig-
nant tumours have developed in the body, has been extensively
researched, but the underlying reason that cancerous tumours first
appear in a human body does not appear to be well understood by
biomedical science.216 Certain cancer risk factors have been reason-
ably well established, such as smoking, environmental pollution,
high-fat diets, carcinogens in foods and, in a few cases to specific
microbiological agents like the human papilloma virus in cervical
cancer and the helicobacter pyloris bacterium in stomach cancer.
At a more basic level, inflammation has been associated with the
onset of malignant tumours, as suggested by recent studies. For
example, the anti-inflammatory effects of blood serum high density
lipoprotein (HDL) was found to be related to lower incidence of
cancer.217
TCM does not deal with cancer as a disease or a syndrome, and
does not have a comprehensive theory explaining the origins of can-
cer and the principles of therapy for this family of diseases. Chinese
216
See, for example, Agus (2012), Le Fanu (2011).
217
“The clear association between inflammation and cancer is real and has many examples.
One of the most exciting recent studies was published in the June 22, 2010, issue of the
Journal of the American College of Cardiology. The analysis of two dozen randomized,
controlled trials that were studying therapies for cholesterol found that each 10 mg/ dl
higher increment of HDL cholesterol (the good cholesterol) was associated with a relative
36 percent lower risk of cancer. The researchers were quick to note that these association
studies cannot prove cause and effect, although it’s been suggested that HDL may have
anti-inflammatory and antioxidant properties that could potentially fight cancer.” Agus
(2012), Chapter 9: “Hot and Heavy”, section entitled “Inflammation’s Path of Destruction”.
218
Chao Yuanfang of the Sui dynasty writing in 610AD about shi yong (⸣⯸) in Treatise on
the Pathogenesis and Manifestations of All Disease.s Ge Zhi Yu Lun (an Inquiry into the
Properties of Things) (1347 AD). See Yu and Hong (2012), 94
219
Yu and Hong (2012), 95
220
Ilardi (2010, 2013).
10.6 Conclusion
In all the five cases above, TCM provides both complementary and
alternative treatments to common chronic illnesses, working largely
from the vantage point of restoring imbalances in the body system
and encouraging the body’s own healing powers to ameliorate the
symptoms or bring about recovery. It is patient- centric in the sense
of addressing directly the nature of the underlying syndromes
present and adapting to changing syndromes as the illnesses evolve
and progress in each patient.
Millions of patients around the world receive TCM treatments
to relieve their sufferings and many more practise its system of
Chapter 11
The man who first saw the exterior of the box from above later sees its
interior from below.
Thomas Kuhn: The Structure of Scientific Revolutions
Chinese medicine came under furious attack after the May 4th
movement of 1919 in China, first by Chinese youth educated in
Western science and technology, and later by scientists in the West
influenced by philosophical positivism. After the revolution of
1949 Chairman Mao ordered its modernisation. In the 21st cen-
tury, even as TCM clinics and colleges flourish in China, East Asia
and many Western countries, challenges to its scientific credentials
remain strident from a generation of biomedical scientists nur-
tured in the reductionism of molecular and cellular biology and
armed with the statistical arsenal of the new evidence-based
medicine.
TCM continues to play a significant role in health care because,
among its regular users, it enjoys a reputation for healing not
demonstrably lower than that of biomedicine. However, in the
absence of clear explanations of TCM concepts and convincing
evidence that the healing was not just placebo or fortuitous, the
scientific validity of TCM remains in doubt among most scientists
and biomedical physicians.
195
221
See Annex 3 for a detailed account of translation issues in TCM.
Clincal trials
Because of the complexity of the human body and the patient-
centric nature of TCM which biases toward individualised treat-
ment as against uniform mass treatment convenient for clinical
trials, there are challenging though not insurmountable methodo-
logical problems for these trials. There is a good case for making
more use of observational trials for testing TCM therapy models.
Insisting on employing only double-blind randomised controlled
trials (RCTs) is to ignore the limited feasibility of such trials in prac-
tice and to place RCTs on an unwarranted high pedestal.
Most of the clinical trials in Chinese medical research have been
directed at what should rightly be termed ‘Western medicines from
herbal sources’ and ‘Western acupuncture’ rather than TCM models
based on syndrome differentiation. This leaves much more clinical
work to be done to directly address TCM theory.
The current lack of rigorously collected evidence for the efficacy
of interventions based on TCM theory places it a notch below eco-
nomic science in the scientific hierarchy. Despite the presence of
contending theories, the frequent failed model, and doubts over
the feasibility of modelling complex economic and social activity
encountered in economic science, ‘the dismal science’ has earned a
measure of credibility through statistical testing of its models and
occasional successes of these models in prediction. It is a worthy
example for TCM to follow.
Some of the therapeutic models, including the five-element
model, may fail the test and eventually be abandoned. What should
emerge is a set of constructions and models that together constitute
a holistic non-reductionist understanding of body functions and
pathology to serve as tools for clinical practice.
The two great projects of the last two decades — The New Genetics and
The Social Theory — constitute the fall of modern medicine. Their sci-
entific bases — molecular biology and epidemiology respectively —
could not have been more diverse, yet they shared the same aspiration…
The lure of The New Genetics lies in its reductionism, the explanation of
the phenomena of disease at the most fundamental level of the gene and
its products. The main reason why these two projects have failed is that
the causes of common diseases are neither genetic nor social, but are
either age-determined or biological and (for the most part) unknown…
Medicine’s post-war success, built on the chance discovery of drugs
and technological innovation, concealed the fact that its impressive
achievements had been won without the necessity to understand the
nature or causation of disease. And now, fifty years on, medicine still
knows the cause of only a fraction of the diseases in the textbooks…
222
Le Fanu (2011), extracted from 405–495.
Chinese yangsheng
This lifestyle and dietary approach to understanding disease such as
Ilardi’s theory of the “diseases of civilization” has a striking similar-
ity to that found in the traditional Chinese philosophy of yangsheng
for health preservation as depicted in the classics.223 In the Chinese
paradigm, health and disease prevention are attained by observance
of regularity in living habits, moderation in diet, mastery over
223
Ilardi (2010, 2013).
224
Human microbiome project consortium (2012).
225
Atkins (2001), Noakes (2014), Campbell (2004), Esselstyn (2008).
226
New York Times (2015) http://well.blogs.nytimes.com/2015/02/19/nutrition-panel-calls-
for-less-sugar-and-eases-cholesterol-and-fat-restrictions/.
227
See, for example, Sinatra and Roberts (2007).
228
Buettner (2008).
11.3 Convergence
A conclusion one can draw from the work of medical scientists like
Agus, Ilardi and Le Fanu is that reductionist medicine is inadequate
for dealing with some of the most fundamental questions of health
such as the cause of disease and the right foods to eat. Holistic medi-
cine such as TCM, no matter how abstract its concepts and simplil-
stic its heuristic models, offer alternative views that may help
address these deficiencies.
The new science of systems biology holds promise for bringing
closer the thinking of reductionist and holistic medicine, and in the
long run may lead to the convergence of biomedicine and TCM.
The latter will surely appear to be the junior member of this con-
vergence, just as yin has always been less noticeable and more
yielding than yang. But this should not lead one to underestimate
its subtle but essential role, perhaps like that of the quiet mother
in the background who does not partake in the earthshaking work
of her husband and sons and only knows how to hold her family
together.
Convergence is a consummation devoutly to be wished.
Annex 1
3. Promote diuresis
Guizhi Ṳ᷍ (Cinnamon) Pungent and sweet; Heart, lung and 1. Induce sweating to relieve superficies
Warm bladder 2. Reinforce yang and warm the meridians
Fangfeng 䱢仾 (Divaricate Pungent and sweet; Bladder, liver and 1. Expel wind
Saposhnikovia Root) Slightly warm spleen 2. Resolve dampness to relieve pain
3. Relieve spasms
Shengjiang ⭏ဌ (Fresh Pungent; Warm Lung, spleen and 1. Expel wind-cold pathogens
Ginger) stomach 2. Warm the abdomen to relieve nausea and vomiting
“9x6”
3. Warm the lung to relieve cough
Xinyi 䗋ཧ (Magnolia Pungent; Warm Lung and stomach 1. Expel wind-cold pathogen
Biondii Flower) 2. Clear the nasal passageway
6/8/2015 4:00:13 PM
228
Annexes 1 and 2 were compiled with the assistance of Karen Wee, TCM physician at the Renhai clinic (www.renhai.com.sg).
b2120_Annex-1.indd 206
206
Diaphoretic Herbs with Pungent Cool Property 䗋߹䀓㺘㦟
“9x6”
Gegen 㪋ṩ Pungent and sweet; Spleen and stomach 1. Anti-pyretic
(Kudzuvine Root) Cool 2. Promote production of fluids to quench thirst
3. Uplift yang-qi to stop diarrhoea
4. Promote the outburst of measles
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“9x6”
Selfheal Fruit-Spike) Cold bladder 2. Disperse abnormal growth/masses to reduce swelling
Juemingzi ߣ᰾ᆀ Sweet, bitter and salty; Liver and large 1. Clear liver-heat to improve vision
(Cassia Seeds) Slightly cold intestine 2. Moisten the large intestine to promote bowel
movement
207
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208
Herbs for Clearing Heat-Dampness ✝⠕⒯㦟
“9x6”
Chuanxinlian クᗳ㧢 Bitter; Cold Lung, heart, large 1. Eliminate heat and toxins
(Common Andrographis intestine and bladder 2. Cool the blood
Herb) 3. Reduce swelling
4. Resolve dampness
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(Continued )
b2120_Annex-1.indd 209
(Continued )
“9x6”
(Oldenlandia) bitter; Cold intestine 2. Remove dampness by promoting diuresis
209
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b2120_Annex-1.indd 210
210
Heat-Clearing and Blood-Cooling Herbs ✝߹㹰㦟
“9x6”
3. Treat malaria
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“9x6”
211
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b2120_Annex-1.indd 212
212
“9x6”
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b2120_Annex-1.indd 213
“9x6”
4. Clear heat and promote pus discharge
Dongguaren ߜ⬌ӱ Sweet; Cool Spleen and small 1. Clear lung-heat and resolve phlegm
(Winter melon seeds) intestine 2. Remove dampness and promote pus discharge
213
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b2120_Annex-1.indd 214
214
Herbs for Regulating Qi ⨶≄㦟
“9x6”
Laifuzi 㧡㨄ᆀ (Radish Sweet and pungent; Spleen, stomach and 1. Promote digestion and relieve abdomen
seed) Neutral lung distension
2. Promote the descent of qi and resolve dampness
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Hemostatics →㹰㦟
“9x6”
Name of Herb Flavour and Nature Meridian Tropism Actions
Sanqi йг Sweet and slightly Liver and stomach 1. Remove blood stasis to stop bleeding
bitter; Warm 2. Promote blood circulation to relieve pain
215
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b2120_Annex-1.indd 216
216
Herbs for Promoting Blood Circulation and Removing Stasis ⍫㹰ॆⰰ㦟
“9x6”
3. Relieve cough and dyspnea
Honghua 㓒㣡 (Safflower) Pungent; Warm Heart and liver 1. Promote blood circulation and menstruation
2. Remove blood stasis to relieve pain
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Herbs for Resolving Phlegm and Relieving Cough and Dyspnea →ૣॆⰠᒣை 㦟
“9x6”
Zhebeimu ⎉䍍⇽ Bitter; Cold Lung and heart 1. Clear heat and resolve phlegm
(Thunberg Fritillary 2. Disperse abnormal masses or growths to promote
Bulb) healing of carbuncle
(Continued )
217
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b2120_Annex-1.indd 218
218
(Continued )
Herbs for Resolving Phlegm and Relieving Cough and Dyspnea →ૣॆⰠᒣை 㦟
“9x6”
(Gingko Seed) astringent; Neutral; 2. Stop abnormal vagina discharge (leucorrhoea) and
Toxic reduce urination
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“9x6”
(Lucid Ganoderma) kidney 2. Relieve cough and asthma
219
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b2120_Annex-1.indd 220
220
Qi Tonics 㺕≄㦟
“9x6”
3. Consolidate the exterior to strengthen the body’s defence
against external pathogens
4. Promote diuresis and the healing of wounds/ulcers
(Continued )
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b2120_Annex-1.indd 221
(Continued )
Qi Tonics 㺕≄㦟
“9x6”
(Chinese Dates) heart 2. Nourish blood to calm the mind
Baibiandou ⲭᡱ䉶 (White Sweet; Slightly Warm Spleen and stomach 1. Tonify the spleen
Hyacinth Bean) 2. Resolve dampness
221
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b2120_Annex-1.indd 222
222
Yang Tonics 㺕䱣㦟
“9x6”
intestine 2. Moisten the large intestine to promote bowel
movement
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b2120_Annex-1.indd 223
“9x6”
Warm 2. Promote blood circulation to relieve pain
3. Moisten the large intestine to promote
bowel movement
223
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b2120_Annex-1.indd 224
224
Yin Tonics 㺕䱤㦟
“9x6”
3. Nourish blood and tonify the heart
Heizhima 唁㣍哫 (Black Sweet; Neutral Liver, kidney and large 1. Tonify the kidney and liver
Sesame Seed) intestine 2. Moisten the large intestine
3. Tonify essence and blood
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b2120_Annex-1.indd 225
“9x6”
225
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b1816 MR SIA: FLY PAST b1816_FM
Annex 2
Diaphoretic Prescriptions
1 Yinqiaosan 䬦㘈ᮓ Expels wind-heat exogenous pathogens. Eliminates heat
and toxins. Often used in the early stage of an external
syndrome invaded by wind-heat pathogens.
2 Guizhitang Ṳ᷍⊔ Expels wind-cold exogenous pathogens. Regulates the
nutrient and defensive qi to strengthen the body. Can
be used for treating external syndromes caused by
wind-cold exogenous pathogens or for individuals who
feel weak and are recovering from chronic illnesses.
227
(Continued )
(Continued )
(Continued )
(Continued )
33 Chinese Angelica Invigorates qi to promote blood production. Used in
Decoction for blood deficiency syndrome, particularly blood
Tonifying the deficiency with fever and headache following childbirth
Blood or menstrual disorder with severe loss of blood;
ᖃᖂ㺕㹰⊔ (Danggui anemia.
Buxue Tang)
34 Decoction for Tonifies qi and blood. Strengthens the spleen and
Restoring the nourishes the heart. Treats deficiency syndrome in
Spleen ᖂ㝮⊔ heart and spleen.
(Guipitang)
35 Danggui Nourishes blood and promotes its flow. Expels wind to relieve
Yinzi ᖃᖂ侞ᆀ pain. Treats eczema or rubella caused by blood deficiency
syndrome (with the invasion of wind pathogen).
Annex 3
Perhaps the best solution [to the translation problem] will always
be to refrain from seeking exact equivalents, in the case of Asian
languages to coin new words from familiar roots.
Joseph Needham
Historical Controversies
The translation of Chinese medical terms has a long history. The
first original Chinese text to appear in a European language was a
translation of the MaiJue (‘Secrets of the Pulse’) published in French
233
229
See Wiseman (2000:180).
230
Needham and Lu (1975); Porkert (1974).
231
Porkert (1974:5–7).
232
Porkert and Needham use the old Giles–Wade spelling; as mentioned in the Preface, this
book uses the modern pinyin system throughout, even in quotations from authors using
the old system.
233
See Reid (2001).
234
Porkert (1974:166–173).
235
Wang (2001).
236
Wittgenstein (1953:IX).
237
Needham and Lu (1975:498).
238
Needham and Lu (1975:499).
239
Needham and Lu (1975:491, 500).
240
Porkert (1974:502).
241
Xie and White (2005).
242
At Chang Geng University, Taiyuan (Taiwan) in December 2008 where he was teaching
medical translation to students in TCM.
243
Wiseman and Feng (2002:17, 21).
244
Wiseman (2000:1).
245
It is similar to the transliteration, using “the closest corresponding letters of a different
alphabet or language” (Oxford Concise Medical Dictionary). For Chinese translations to
English, the result is generally the same as the loanword.
246
Han in Foreword to Xie’s On Standard TCM Nomenclature (2003).
247
Xie (2003:1).
248
Xie et al. (2005:Abstract).
249
Wiseman (2006:225).
250
Taber’s Cyclopaedic Medical Dictionary (2001) lists 17 medical uses of the term conjunc-
tivitis for inflammations of the conjunctiva.
251
Unschuld (1989:100–102).
For example, the term xue 㹰 (blood) in the classics has some
functions not found in Western medical understanding of the term,
xue should still be translated as “blood”. Unschuld seems to be sim-
ply saying that such translations are not always very good, some-
times even silly, but they are the best available.
On the other hand, modern textbooks in China were written to
systematise the theory and practice of Chinese medicine and to
ensure a level of uniformity in terminology for the teaching of TCM
in colleges. Key portions of ancient texts like Huangdi Neijing as well
as later works by famous physicians like Zhang Zhongjing and Li
Dongyuan were extracted and subjected to interpretations with
fewer ambiguities than in the original. Preservation of the thinking
of the ancients was already compromised by extraction and
explanation in modern language. Even the vocabulary and concepts
of Western medicine crept into the terminologies used in these
modern texts.
The extent to which Western medical terms could be used as
equivalents of Chinese medical terms ultimately has to be limited by
the differences in the theoretical foundations of the two systems of
medicine. For example, Chinese diagnosis revolves around ‘zheng’
䇱 (‘syndromes’) as distinct from Western medical ‘diseases’.
Syndromes in TCM theory are imbalances in the body caused by
deficiencies or excesses in yin or yang, or by stagnation of blood or
qi. A TCM condition like bi Ⱙ, caused by blocked or stagnating qi,
when translated as ‘arthralgia’ would fail to include the variety of
symptoms associated with the condition of bi. Arthralgia in Western
medicine is severe pain in a joint,252 and does not capture pain in the
muscles and tissues nearer the skin, which bi includes. Wiseman uses
the term ‘impediment’, but this is not satisfactory either as impedi-
ment refers to the blockage of qi, whereas bi is the resultant painful
condition felt by the patient.
252
Oxford Concise Medical Dictionary (2007).
253
See Buck (2000).
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Index
257
Index 259
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