This article was written by a Westerner. His understanding of Chinese medicine is very instructive. He has also raised some important point deserving further discussion. This editor is no medical expert, but personally has some different understanding of the idea of Yin vs. Yang in general. To him, Yin represents “relation” (passive, receptive, nourishing, protective, holistic), while Yang “substance” (active, assertive, offensive, aggressive, divisive).
An understanding of Chinese medicine is not only beneficial to people’s personal health but to mutual understanding between different cultures in general as well, because Chinese medicine is a living embodiment of traditional Chinese philosophy as represented by Daoism. There has been an old saying in China: While lower-level medicine treats physical illness, high-level medicine helps manage a state (下医治病，上医治国). Through an understanding of Chinese medicine, one can more easily understand the traditional Chinese way of managing a society as represented by Daoist-Legalists.
THE TEXT
Depending on how you look at it,
you may see two silhouettes or a vase.
Ever see that drawing of two silhouettes looking at each other? One moment you see two faces, the next moment, it’s a vase. Which is it? Obviously it is just a matter of your perception or the way your brain links together visual clues.
That’s the difference between Western medicine (WM), and Chinese or Oriental medicine (CM). Same symptoms, same signs, same patient, but very different ways of organizing the information.
An excellent example of how we can look at the same body with two perspectives is diabetes. Diabetes happens when sugar (glucose) is unable to pass through the wall of cells. When the glucose doesn’t get into the cell, the amount of glucose in the blood stream increases and this is what causes the problems associated with diabetes.
Two Perspectives – Two Solutions
However, CM doesn’t see diabetes as just one issue (or two, as is the case in WM). Rather, CM sees many possible conditions depending on the particular signs and symptoms of a given patient. One of these disease patterns is known as “xiao ke” or “wasting and thirsting”. Extreme thirst is a well-known symptom of diabetes, and Chinese medicine agrees. However, the mechanisms (and hence, treatments) are somewhat different.
We look at this as the cell (or the inside of the body, as CM describes it) as being dry or lacking water. Drinking more water only results in more urination (another sign of diabetes). The problem isn’t how much water you’re drinking, but how little is being absorbed.
Guess what helps water be absorbed by the cell? Glucose. When the body’s functions that enable the body to absorb (or “transform” as we say in CM) fluids are stimulated, the glucose also gets pulled in to the cell and out of the blood stream at the same time.
So, while Western medicine says that the cell can’t absorb glucose, leading to a dry cell，Chinese medicine says that the cell is unable to absorb fluids, and that is why it isn’t absorbing glucose at the same time. [1, 2]
This is a nice example because in a way it looks like Western and Chinese medicine are in agreement on this. However there are stages of diabetes that do not conform to this symmetry. This is actually one of the strengths of Chinese medicine, to uniquely treat the way that a particular patient experiences their particular disease.
Microscope and Macroscope
Another way of looking at the difference between WM and CM often comes down to the magnification that one chooses to use. Ever look at your house online? You can zoom in to see your house, or you can zoom out to see the shape of your city, or the region, or the state, etc. Each view presents different information, whether it is the construction materials of your roof, the urbanization of your neighborhood, the agriculture of your region, or the plate tectonics of your state. Different magnifications provide different benefits.
With Western medicine, we like to use technology to isolate the smallest possible particle that may be diseased all the way down to the electrical charge of a molecule. Chinese medicine doesn’t look to the smaller units, but rather the larger perceptions unique to our human senses. We look at the big picture, not the electrical charge of a particular molecule or a cell with a leaky wall, but through the eyes of the human organism.
Chinese medicine makes diagnosis without lab tests. We approach the body as a human and listen to what the body is saying in its totality using OUR totality. We feel it through the qualities of its pulse at the wrist. We can look inside the body through the appearance of the tongue. We smell and listen to diagnostically significant changes. And finally, we interact directly with the patient to locate issues within their awareness.
We also observe and sense a patient’s “spirit” which is a mixture of brain functions (cognition) and emotions. This is something that a machine would have trouble with. Cutting edge technologies may be able to monitor changes in the brain as thoughts and feelings take place, but it is difficult to know something really basic such as if the technology is measuring anger or joy. Something so obvious to human perceptions is so difficult to quantify with technology. Much of Chinese medicine is based on these really obvious perceptions that any human would immediately understand.
What’s All This I’ve Heard About Qi?
One concept that is unique to Chinese medicine that the scientific world is still struggling with is an internal substance that the Chinese call “qi” (pronounced “chee”, sometimes spelled “chi”). There are entire books devoted to the definition of qi. For example, I once went for a bike ride with a Chinese friend, she pointed to her tire and said that it needed some qi. We rode to the gas station and pumped it up with air. Chinese people actually use the word “qi” to describe the air in a tire. That’s how widely the term is used.
In general, qi can be thought of as another word for “function”. Lung qi is the lungs’ function of gas exchange (or in CM terms, absorbing the clear and exhaling the turbid). Acupuncture seeks to treat the body on the level of qi. There are pathways in the human body wherein this qi flows. They are called meridians, or channels. Needles inserted along these meridians influence the qi that flows to internal organs thus affecting their functions.
Needles can also work on specific areas of pain that may not be associated with internal problems, such as sports injuries for example. A needle inserted near the area of a pulled tendon or over strained muscle will increase the flow of qi and blood to that area which removes pain and quickens the healing process.
Yin and Yang and the Philosophical Basis of Chinese Medical Theory
Another aspect of the difference between Oriental and Western medicine can be described as Oriental treats the Yang and Western treats the Yin. Everything in the universe can be described in terms of Yin or Yang. This is one of the underlying philosophies of Oriental Medicine. Yin is the feminine qualities in the universe, Yang is the masculine qualities.
These aren’t really gender specific. If you have ever studied a foreign language where nouns have a gender, you’ll understand this. For instance, “the table” in Spanish (la mesa) is a feminine noun, but this gender has nothing to do with the style or use of the table. Same thing with yin and yang, the law isn’t really about dividing things into boys and girls, but rather recognizing that everything has two opposing aspects that do best when they’re in balance.
The following tables describe some yin/yang pairs.
Basics of yin/yang theory
Yin Yang
passive active
dark light
inside outside
As applied to Western medicine
Yin Yang
Anatomy Physiology
As applied to Oriental medicine
Yin Yang
Blood Qi energy
When applied to medicine in general, Western medicine acts upon the Yin of the body, the substance of the body, the actual cells and chemicals. Acupuncture works more on the function of those organs and cells. Herbs are kind of in between. We categorize them by their functions, but they are also substantial things we put into the body, and they can also directly affect the yin of the body like Western medicine.
Think of this yin/yang relationship as Western medicine acts on the cars, but Oriental medicine acts on the timing and regulation of traffic lights. When the traffic light system is working correctly, the cars flow through town correctly. This is the holism of qi. The larger vision of functional relationships.
This is one reason that many of those functional problems such as Irritable Bowel Syndrome (IBS), fibromyalgia and depression are difficult to diagnose according to Western medicine. First they have to rule out every other cellular or organic cause. Only then can WM take a step back and call it a “functional” disorder.
Still, as time goes by, and Western medicine begins to look more carefully at functional relationships, the line between CM and WM begins to blur. This is taking place from the Chinese medicine side too. Scientific research has determined that some Chinese herbs have known Western affects such as the herb Huang Lian (Rx. Coptis) being used as an antibiotic for h-Pylori infection ulcers. (Funny story, we were using this herb as a particular type of ulcer treatment that pre-dated WM’s discovery of the h-Pylori infection type! Only after this point did WM discover Huang Lian’s antibiotic functions.)
We’ve Got Spirit, How About You?
Where we get into this idea of the body-mind-spirit is through these very human perceptions serving as our diagnostic tools because all three are evident when using the human senses rather than a machine. Machines can monitor chemical changes and signs of life on a very minute scale, but only our human perceptions can monitor the larger totality and context of all that the human organism is. This is where we get into one’s “sprit” in terms of diagnostic information.
This approach to “spirit” is not unheard of in Western medicine, though they call it “affect“. When Chinese medicine first came to the states in the 1970′s (ignoring for the moment the Chinese immigrant communities of the 1800′s) Chinese medicine’s holism got wrapped up in the human potential and new-age movements, and Chinese medicine soon became something very much other than what is now practiced in Asia.
It is inevitable for this medicine to evolve and change as it enters a new culture. However, I favor the tried-and-true approaches and definitions as they currently exist in China. Still, many patients like Westernized spiritual approaches especially when they share a new-age worldview or are otherwise not feeling understood or listened to by conventional physicians or medical community.
The Value of Scientific Research Versus Time-Tested Approaches
Currently, in the West, there is a great deal of research being done on the effects of acupuncture, Chinese herbs and even disciplines such as Qi Gong. Some of the research tells us the things that the CM industry wants to hear, that it works for a given condition. Other times, the research does not support the time-tested approaches that have arrived here from the East.
However, it should be noted that research has also been taking place over the past 2,000 years in the form of time testing and the wisdom of the marketplace. There are many herbs and therapeutic approaches that have fallen out of favor over the past 2,000 years because they simply didn’t produce the intended results. In some ways, this long-term approach is actually more scientific than the unnatural short-term placebo-controlled research made famous by pharmaceutical companies.
This kind of long-term research is really closer to economics or Darwinian evolution than biomedicine. Essentially, over the past 2,000 years, the therapies that worked withstood the test of time. If they didn’t work, the doctors wouldn’t get any patients or students and an idea simply wouldn’t spread. One good example of this is the hangman’s noose. This rope, after an execution, was thought to actually have some medical benefits for the lungs. But over time, this simply didn’t prove to be true (fortunately!) And so we do not use hangman’s rope medicinally anymore.
We should also make sure that we understand the difference between WM and CM mechanisms of action. A mechanism of action would be like the diabetes example provided above. WM’s mechanism for the treatment of diabetes (Type 1) is to put more insulin into the blood stream, which then helps to pull the glucose through the cell walls. CM’s mechanism says that if we moisturize the lungs, then the thirst will abate as the lungs represent the means by which fluids are distributed in Chinese medicine. Many of the herbs in Chinese medicine said to “generate fluids” also lower serum glucose. My point being that we have very well thought out and time tested ways of looking at the activities of the body, even when they do not conform to the Western body of knowledge.
If we give an acupuncture treatment that is designed solely to stimulate the movement of the qi in the body, many aches and pains will be abated. When modern Western research attempts to determine what happened to take away the pain they’ll look toward the brain’s release of endorphins, the body’s natural pain killers. They’ll take pictures of more active areas of the brain during an acupuncture treatment, they’ll chemically block certain pain relieving tracts in the spinal cord or on a cell’s surface to see if that affects the acupuncture treatment. What is really strange is that wherever they look, they find something! There is seemingly no end to the scientific mechanisms of acupuncture.
I believe that this is consistent with the holistic idea that maintains the coherence of Chinese medicine. Acupuncture’s effects are not limited to any one given system, whether we’re talking about the nervous system, cardiovascular, hormonal, or any other. Acupuncture affects them all at the same time. Again, that’s because Chinese medicine doesn’t act exclusively on the tiniest of human structures, but the larger whole person. Of course it would affect multiple systems simultaneously.
Many Western researchers expect acupuncture’s effects to resemble a “man-to-man defense” in basketball where one player defends the basket against another single player. However, holistic medicine tends to be more like a “zone defense” whereby all five players scoot over a bit toward whoever has the ball in a given moment. So wherever the ball goes, so do all five players. Whenever you stick a needle in to the body, you can measure one man, but it is really all five that are responding.
Oriental medicine also has a great deal to offer the Western discipline of internal medicine, perhaps more than the “pain control” applications that are finally being accepted in the Western medical community. Twenty years ago, using acupuncture for pain control was considered quite silly. In another ten years, I hope that we’ll see a greater acceptance of Oriental medicine’s true genius, and this is in the area of internal medicine.
Within both CM and WM, there is an enormous amount of time tested information that has its own logic and usefulness. Both Western and Chinese systems have their place. Some believe that the greatest strength of Western Medicine is in it’s trauma care and therapies for acute problems, while Chinese medicine excels in the areas of chronic problems and preventive medicine. It is my notion, and that of Chinese research as well, that using both CM and WM provides for better clinical outcomes than using either of them separately.
References and Citations:
1. When fluid is successfully drawn into a given cell, biomedicine does not assume that it pulls glucose in at the same time. However it is clear that Chinese herbs said to “generate fluids” have been shown to lower the amount of glucose in the blood stream as described in citation #2 below.
2. Zhongguo Zhong Yao Za Zhi. 2003 Feb;28(2):108-13.
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