Western Herbal Medicine- Module 1
Traditional Chinese Medicine
Introduction
Traditional Chinese medicine (TCM), which encompasses many different practices, is rooted in the ancient philosophy of Taoism and dates back more than 5,000 years. Today, TCM is practiced side by side with Western medicine in many of China’s hospitals and clinics.
Underlying the practice of TCM is a unique view of the world and the human body that is different from Western medicine concepts. Traditional Chinese Medicine (TCM) has a view that not only is the human body an organic whole, but it is also an entity being able to unify with mother nature. In other words, changes in the natural environment may directly or indirectly affect the body. For example, changes of the four seasons, and the alternations of day and night may change the functional condition of the human body, while various geographical environments can influence differences in body constitution, and so on so forth. These factors must also be considered when diagnosis and treatment are given because the body can react differently during different seasons. The principles of treatment are therefore expected to accord with the different seasons and environments.
The theoretical framework of TCM has a number of key components:
- Yin-yang theory—the concept of two opposing, yet complementary, forces that shape the world and all life—is central to TCM.
- In the TCM view, a vital energy or life force calledqicirculates in the body through a system of pathways calledmeridians. Health is an ongoing process of maintaining balance and harmony in the circulation of qi.
- The TCM approach uses eight principlesto analyze symptoms and categorize conditions: cold/heat, interior/exterior, excess/deficiency, and yin/yang (the chief principles). TCM also uses the theory of five elements—fire, earth, metal, water, and wood—to explain how the body works; these elements correspond to particular organs and tissues in the body.
These concepts are documented in theHuang Di Nei Jing (Inner Canon of the Yellow Emperor), the classic Chinese medicine text.
Application of treatment according to the differentiation of syndromes is another characteristic of traditional Chinese medicine. "Differentiation of syndromes" means to analyse the disease condition in order to know its essentials, to identify the causative facts, the location and nature, and to obtain conclusions about the confrontation between pathogenic and anti- pathogenic factors. In traditional Chinese medicine, differentiation must be performed to outline the specific principles and methods of treatment based on the underlying patterns –not the named condition. Treatment in traditional Chinese medicine stresses the differences of syndromes, but not the differences of diseases. Therefore different treatments for the same named disease exist.
Origins of Traditional Chinese Medicine
The origin of TCM theory is lost in prehistory, before writing was invented. Written language started in China during the Shang Dynasty in 1766 BC. The writings on medicine at that time project back in history over two thousand years. Ancient works are alluded to in the prehistoric period, but are now lost as "legendary".
Origin of Channels and Points
One current theory of how acupuncture points were discovered can be traced back to Stone Age. It is thought that stone knives and sharp tools were used to relieve pains and disease. Often these were used just for lancing boils and primitive surgery, however it is thought that patients may have noted sensations or changes on other parts of the body subsequent to treatment with these "needles". Later these needles were replaced by bone or bamboo.
Other interesting theories include:
•Warriors in battle were hit by arrows and noticed conduction of pain to other areas of the body and spontaneous remission of pain elsewhere.
•Spots on body became tender/discoloured when disease was present.
•Constipation was frequent, owing to primitive Stone Age diet. People found certain points tender when constipated and that manipulating them with pressure or pricking them brought relief.
•Relief of pain was found when heat was applied (after fire was discovered). This treatment became more specific at certain areas as results were noticed.
•Monks would notice energy moving in specific areas when they would perform meditation techniques. Over centuries these energy movements were painstakingly noted, and the channel system was gradually elaborated.
•Whatever the exact origin, acupuncture is not exclusive to China. However, only in the East was it so highly developed. This occurred because of observation by ancient Chinese over hundreds and even thousands of years. It was noted that:
•An individual point could affect many different symptoms. Symptoms could be treated that were near to and distal from the actual point itself, including internal organ pathology. It was natural therefore to assume that points with common symptomatology could somehow be related. In other words the therapeutic potential extended over a considerable distance within the body. This was confirmed by the transmission of needle sensation along specific pathways.
•A therapeutic property could be achieved by a number of different points. From this evidence they inferred the existence of channels and the flow of Qi along them. As location and therapeutic characteristics of points was gradually discovered, they were named.
TCM is heavily rooted in traditional Eastern philosophy. The philosophy was not a single one and did not originate in only one era of Chinese history, but was built on, added to, and modified throughout history. This is very typical of the Chinese, who are a very pragmatic people. They have no problem accepting a wide variety of philosophies into their culture and not seeing any conflict between them.
An example would be The Three Teachings: Taoism, Confucianism and Buddhism
co-existed harmoniously in China: we can see them together in paintings, with Lao Tzu, Confucius and Buddha all depicted together.
Shang Dynasty (1766-1122 BC)
Beginnings of the Bronze Age was when proper civilisation first appeared. The Chinese had developed writing and had religion: their deity was called Shang Ti, who lived in heaven in imperial court populated with dead ancestors.
Ancestor worship was very important (and actually is still) in China. Rituals with ancestral bronzes were performed. Shang already had high-tech bronze casting: bronzes cast with incredible atavistic animal forms. Animals were accorded great respect for their power; this shows in art.
The Shang believed illness resulted from:
•Upsetting an ancestor and being cursed
•Demon "evil" enters body; Curing involved placating ancestors by suitable rituals or asking their help to expel the demon.
Shamans were mediators who talked to the ancestors, who in turn talked to Shang Ti. Questions were asked by writing them on "oracle bones", usually scapula bones or tortoise shells, which were then heated and the cracks were "divined", in other words, read by a shaman to find an answer. Questions ranged from "Will it rain?" to "Will the king die?"
Shamanism
As late as 6th century BC physicians were still linked with shamanism. Demonology and shamanism persisted through the next Dynasty (Chou: 1122-403).
Even today the "Six Evils" or six kinds of "perverse energy" persists in TCM theory, except now they are environmental energies, i.e., wind, cold, dampness, heat, summer heat and dryness.
In some areas of the East, shamanistic medicine survived almost intact, e.g. parts of Vietnam and esp. Tibet.
Chou Dynasty (1122-403 BC)
This was s high point of Chinese civilization, however during the Eastern Chou period
(722-481), centralized control declined, local aristocracy began fighting, among themselves, and social order degenerated into the Warring States Period, a time of great instability.
Despite this unrest, the unstable times produced great thinkerse.gConfucius was born in 551 BC. Different philosophies dating back into antiquity were investigated for possible solutions to the present problems. This was the time of the "Hundred Schools", referring to the many philosophical schools of thought that prevailed. Much was actually recorded during this period of time, incorporating different philosophical ideas.
The major medical classic, the Huang Ti NeiChing (Yellow Emperor's Classic of Internal Medicine) was written down at this time from earlier knowledge. This is the most important of the medical classics. (Shortly thereafter, China was unified again under the harsh and repressive Chin Dynasty).
Confucius and TGaosiem were two major philosophical influences that influenced thinking (and medicine) during this crucial period.
Confucius (K'ung Fu-tzu) (551-479)
Born at end of Eastern Chou period and beginning of Warring States period. We know about him from the "Analects", a series of passages written by his disciples. Confucius wanted to be an advisor to a monarch. He travelled around in search of a monarch, but no one wanted his ideas; he was too moral. Everyone wanted pragmatic techniques for use in winning the wars. He therefore became a teacher. Not until 200 years after his death were his ideas taken seriously. Eventually his ideas became the imperial creed. Confucian classics: these include the Li Ching (book or rites) and the I Ching (a more ancient text which he developed and for which he wrote commentaries).
Taoism
Taoism is not a religion, more a philosophy based on the concept of Tao. Sometimes said to mean "the way", or something like unknowable, unimaginable, source of all phenomena. Before Tao there was chaos, then suddenly Tao manifested as the universe (comparable to the modern "big bang" theory). Tao expresses through the duality of Yin-Yang. Tao is like the eternal primeval law of nature.
The best known ancient Taoist philosopher was Lao Tzu (Lao Tzu = "Old Master"). He wrote the Tao Te Ching: a mystical Taoist work, full of poetic allusions, riddles, etc. to expand consciousness, promote love of nature and simplicity, and rejection of worldly ambition. The Tao Te Ching is a composite text, probably dating from 3rd century BC (the same time that the major medical classic, the NeiChing, was officially written down) but Lao Tzu has had his traditional dates fixed to make him slightly senior to Confucius (i.e., 6th century BC). It is impossible to know the exact birth date.
The way the ancient Taoists' would teach would be via observation of the nature, in the hopes of obtaining a direct grasp of the truth. Taoists advocated simplicity, living according to the Tao, according to the laws of nature.
Taoism had a strong influence on medicine: the idea of humans being part of nature and needing to remain in harmony with nature was fundamental. "As above, so below." As an example of this, guidelines were established in the NeiChing as to how one should conduct oneself in various seasons. In the winter time, one should go to bed early and get up late, and not waste one's energy, for winter is the time of conservation and storage (a time where Yin is strongest). In the summertime one should rise early and go to bed late and "act as if one loved everything outdoors", for Summer is the time of maximum Yang, and people's naturally have more energy to expend.
Huang Ti Nei Ching Su Wen Ling Shu
During the time of the "Hundred Schools", (3rd century BC), the famous classic of TCM, the Huang Ti NeiChing (Yellow Emperor's Classic of Internal Medicine) was written down in its present form.
It had existed far earlier in one form or another, parts probably being handed down by word of mouth, and is thus a compilation of much earlier material, with added commentaries (commentary writing is very popular with the Chinese). The "NeiChing" as it is called, is a mixture of ideas and philosophies, some more ancient (i.e. Taoist philosophy) and some from the time it was written (3rd century BC), such as the Yin-Yang, Five elements and theories of the Zang Fu (Organs). It is also likely that more was added to this classic by later dynasts.
The book describes the conversations between the Yellow Emperor (Huang Ti) and his physician (Chi Po), hence it is a historical (actually legendary) account.
Huang Ti is said to have lived 2697-2595 BC, i.e. before writing existed. He was portrayed as a true Renaissance man. He designed a cart based on the big dipper, designed a series of musical notes and instruments to play them on, but his great love was medicine, which is shown in the conversations he has with his physician.
The book describes how to live in harmony with nature, and the results of not doing so (imbalance and disharmony). Therapies are based on restoration of harmony and balance to the body.
Surgery is mentioned, but only as a last resort e.g. to remove tumors.
Acupuncture is mainly mentioned in the Ling Shu. Commentaries were added, both in the 3rd century BC and in later dynasties.
One commentary published in the same period was the NAN JING (Difficult Classic) appeared. This filled out the Nei Jing and answered some difficult questions. Points for acupuncture and moxibustion are discussed, as well as physiological and pathological conditions of the eight Extra Vessels. Many commentaries were added in the Tang dynasty. These are important, and render the work easier to read, the essential part was left intact.
Chinese Medicine Formulation
Chinese herbal medicine follows an organizing principle that orders the ingredients into a hierarchy of 4 categories – Chief, Deputy, Assistant and Envoy.
The Chief herb(s) has the greatest effect upon the principal pattern of disharmony and is absolutely indispensable to the formula. The Deputy herb(s) aids the chief ingredient in treating the principal pattern or disease, and is the main ingredient directed against any co-existing pattern (when there is more than one pattern of disharmony).
The Assistant herb(s) has up to 3 functions in the formula: 1. Reinforce the effect of the chief or deputy herbs (helpful assistant); 2. Moderate or eliminate any toxicity or harsh properties of the chief or deputy herbs (corrective assistant); and 3. In very serious and complex cases, the assistant has an effect opposite to the chief (opposing assistant).
The last category of herbs in a formula is Envoy. These herbs have 2 major functions – to focus the actions of the whole formula on a certain meridian or physical area of the body; and to harmonize all the actions of the herbal ingredients together.
Yin and Yang
Yin and Yang (pronounced yong, as in 'gong') is one of the most fundamental concepts in Traditional Chinese Medicine (TCM), as it is the foundation ofdiagnosis and treatment. The earliest reference to Yin and Yang is in the I Ching (Book of Changes) in approximately in 700 BC. In this work, all phenomena are said to be reduced to Yin-Yang.
Yin / YangFemale, passive, negative principle in nature
the moon
shaded orientation
north or shady side of a hill
south of a river. / Yang
positive, active, male principle in nature
south or sunny side of a hill
north of a river.
Four Main Aspects of Yin and Yang
1. Yin-Yang are opposites
They are either on the opposite ends of a cycle, like the seasons of the year, or, opposites on a continuum of energy or matter. This opposition is relative, and can only be spoken of in relationships. For example: Water is Yin relative to steam but Yang relative to ice. Yin and Yang are never static but in a constantly changing balance.
2. Interdependent: Cannot exist without each other
The Tai Ji (Supreme Ultimate) diagram shows the relationship of Yin & Yang and illustrates interdependence on Yin & Yang. Nothing is totally Yin or totally Yang. Just as a state of total Yin is reached, Yang begins to grow. Yin contains seed of Yang and vice versa. They constantly transform into each other. For Example: no energy without matter, no day without night. The classics state: "Yin creates Yang and Yang activates Yin".
3. Mutual consumption of Yin and Yang
Relative levels of Yin Yang are continuously changing. Normally this is a harmonious change, but when Yin or Yang are out of balance they affect each other, and too much of one can eventually weaken (consume) the other.
Four possible states of imbalance:
•Preponderance (Excess) of Yin
•Preponderance (Excess) of Yang
•Weakness (Deficiency) of Yin
•Weakness (Deficiency) of Yang
4. Inter-transformation of Yin and Yang.
One can change into the other, but it is not a random event, happening only when the time is right. For example: Spring only comes when winter is finished.
YIN / YANGDarkness / Light
Moon / Sun
Feminine / Masculine
Shade / Brightness
Rest / Activty
Sunset / Sunrise
Earth / Heaven
Flat / Round
Matter / Energy
More material / Non-material
Substance / Function
Lower / Upper
The Yin Yang theory holds that all phenomena consist of two opposite aspects, yin and yang, which are variously defined as: