Also traditional Chinese medicine; TCM. Any healing practice that has emerged and developed in China.

Below is an outline of Chinese medicine as taught in colleges in the Chinese-speaking world. For more information, see also Chinese medicine: history, features, influences, and perceptions.

Philosophical Bases (哲学基础 zhé xuē jī chǔ)

Qì, the Basic Substance of the Universe

Centuries before the common era, Chinese cosmologists became interested in the properties of mist, cloud, and vapor, which in the language of the time they called qì. They observed how vapor in the air could gather to form thick clouds that produced rain and how mist could easily be dispersed by the warmth of the sun. They observed how steam rising from a pot could have the power to lift a lid. These observations prompted the idea that one thing could take multiple forms. From this evolved the notion of qì as the basic substance of the physical world. According to the theory, qì existed in a rudimentary form that could concentrate into solids and liquids. It could also transform into an intangible, diffuse form capable of pervading and activating matter. Qì in its infinitely varying forms thus became both the material basis of the natural world, as well as the propelling force of all change within it. When medical scholars applied this concept, they posited that various forms of diffuse, active qì accounted for all movement and transformation of substances in the body.

Systems of Correspondence (Yīn-Yáng and the Five Phases)

Among the early cosmologists of China were proponents of the doctrines of yīn-yáng and the five phases, which we generically term systems of correspondence (对应系统 duì yìng xì tǒng).

Yīn-yáng: The terms yīn and yáng originally denoted topographic inclines facing toward the sun (yáng) and facing away from it (yīn). Early natural philosophers observing that sunlight was associated with warmth and activity and its absence with cold and stillness extended the concepts of yīn and yáng to classify a large gamut of natural phenomena. Spring, summer, and daytime were classified as yáng, while autumn, winter, and night were classified as yīn. Movement was classed as yáng, in opposition to stillness, which was classed as yīn.

The various forms of qì thought to be the basic matter of the universe were also classified. Solid and liquid forms of matter were classed as yīn. Diffuse, active forms were classified as yáng. Thus, flesh, sinew, bone, and fluids were called yīn qì, while diffuse, intangible, and active forms were called yáng qì. When we speak of qì as the motive force of the body, we are referring specifically to yáng qì.

Medical scholars found applications for the yīn-yáng doctrine in all aspects of medicine: physiology, pathology, diagnosis, and therapy, including acumoxatherapy (acupuncture and moxibustion), and medicinal therapy. Arguably the greatest significance of yīn-yáng theory lies in the complementary and opposing nature of yáng qì and yīn humor (fluids), which can be understood by analogy to fire and water. When these are in balance, health is maintained. When yáng qì is stronger than yīn humor, there are signs of heat, dryness, and excessive movement; when yīn humor is stronger than yáng qì, there are signs of cold, moistness, and insufficient movement. All illnesses manifest in some form of imbalance between yīn and yáng.

Five Phases: The five phases are wood, fire, earth, metal, and water. The term 五行 wǔ xíng literally means five movementsor five agents. They were originally called 五才 wǔ cái, denoting material entities. However, as they grew into a system of correspondence encompassing the seasons, cardinal points, colors, and flavors, they came to represent phases in a cycle of movement; hence the change in name.

• Wood is the substance wood, as well as living trees and plants in general. It represents bending and straightening, that is, suppleness and resilience. It thrives by orderly reaching, reflecting how plant life stretches upward and outward. Wood is associated with spring, when nature burgeons forth after the winter in the beginning of the yearly cycle of nature. It is associated with east, green-blue, and sourness. In the body, the liver is ascribed to wood.
• Fire by nature flames upward. It is associated with summer, when growth reaches its peak, as well as with south, red, and bitterness. In the body, the heart is ascribed to fire.
• Earth is the mother of all (living) things. It is associated with late summer, the latter part of the summer, when crops ripen, as well as with the central position, yellow, and sweetness. In the body, the spleen is ascribed to earth.
• Metal is the working of change. Metal is used to make tools that create and destroy things. It is associated with the autumn, the time when staple crops are harvested and animals are slaughtered to provide food for the winter, and when the first frosts purge the natural world and cause nature to withdraw into itself. Metal is also associated with the west, white, and acridity. In the body, the lung is ascribed to metal.
Water by nature moistens and descends. It is associated with winter, when nature stores its forces until the return of spring, as well as with north, black, and saltiness. In the body, the kidney is ascribed to water.

The five phases interact with each other in specific ways. One is the engendering cycle, whereby a given phase is said to engenderanother. This is modeled on the interactions between the phases understood materially. Wood burns to create fire, so wood is said to engender fire. Fire burns wood to ashes, so wood is said to engender earth. Metal comes out of the earth, so earth engenders metal. Water condenses on metal, so metal engenders water. Trees and other plants need water to survive and grow, so water is said to engender wood. This can be schematically represented as Wood → Fire → Earth → Metal → Water. The succession of the seasons notably follows the engendering cycles.

Another cycle is the restraining cycle, also called the overcoming cycle, whereby each phase keeps the next-but-one phase in the engendering cycle in check: Just as wood moves earth (as tree roots and spades break through soil), earth dams water, water douses fire, fire melts metal, and metal cuts wood, so wood restrains earth, fire restrains metal, earth restrains water, metal restrains wood, and water restrains fire. This can be schematically represented as Wood → Earth → Water → Fire → Metal.

There are two other cycles, both of which are variants the restraining cycle: The overwhelming cycleis an exaggeration of restraining, in which one phase becomes weaker and allows the phase that normally restrains it to invade and weaken it further. The rebellion cycle is the restraining cycle in reverse. This comes into play when a phase becomes relatively stronger than the phase that would normally restrain it.

Five-phase theory was applied by medical scholars in physiology, pathology, and treatment. Notably, it provided the impetus for the development of theories concerning the function of internal organs, as is explained under Bowels and Viscera below.

Physiology (生理学 shēng lǐ xué)

Bowels and Viscera

Under the influence of yīn-yáng theory, two classes of internal organ: bowels and viscera.

• The viscera (脏 zàng), five in number, are the liver, heart, lung, spleen, and kidney, which deal with internal products of the body (qì, blood, fluids),
• The bowels (腑 fǔ), six in number, are the stomach, small intestine, large intestine, gallbladder, bladder, and the triple burner, which handle substances that enter the body from outside or that are discharged out of the body.

Each viscus is paired with a bowel, with the pericardium being evoked to provide the triple burner with a partner.

• spleen and stomach
• heart and small intestine
• lung and large intestine
• liver and gallbladder
• kidney and bladder
• pericardium and triple burner

In addition to the bowels and viscera, there are the extraordinary organs(奇恒之腑 qí héng zhī fǔ): the brain, marrow, bones, vessels, gallbladder, and uterus.

Chinese medicine accords bowels and viscera specific functions, which bear many similarities to the functions recognized in modern biomedicine. However, some functions are different. Those that differ from the biomedical understanding were mostly identified by analogies originating in yīn-yáng and especially five-phase theory. For more, see Chinese medicine: history, features, influences, and perceptions.

The viscera are central to physiology because, in addition to performing key functions, they also control other body parts. They are said to govern a body constituent (sinews, vessels, skin, flesh, and bone) and open at an orifice (eyes, tongue, mouth, nose, ears). They are even associated with five emotional or mental states called the five minds. Many of the associations of body constituents and orifices to the viscera, like many of the functions of the viscera, were prompted by five-phase analogies.

Heart: The heart stores the spirit (consciousness, mental activity) and moves the blood. It governs the vessels and opens at the tongue. Its mind is joy. The heart is associated with fire among the five phases. Fire is associated with warmth and power. The light it provides is a symbol of perspicacity, intelligence, and wisdom, which are reflected in the notion of the spirit. The heart’s corresponding bowel is the small intestine.

Heart problems mostly manifest in spirit signs, which, depending on the cause, can take the form of heart vexation (restlessness) and insomnia, even manic agitation, or else clouded spirit (partial or complete loss of consciousness). Mental disorders invariably involve disturbances of the heart spirit. Conditions called myocardial infarction and other heart diseases in modern medicine are understood in Chinese medicine to involve both the heart’s blood-moving and its spirit-storing functions.

Lung: By its respiratory function, the lung absorbs air (traditionally called clear qì), which is required to produce the yáng qì of the body. For this reason, it is said to govern qì, which means that it has a dominant role over qì in the body. Qì is responsible, amongst other things, for the movement of all substances around the body and all their transformations. In this conception, the qì that powers the lung (lung qì) is also accorded an important role in the movement of fluids, sending them down to the kidney. This function is known as governing the waterways.

The lung also governs the skin and opens at the nose. Its mind is worry. The lung belongs to metal, whose epithet is the working of change. Metal is associated in the yearly cycle with autumn, the time when nature is purified by the first frosts. This is reflected in the fact that the lung draws in clear qì and expels turbid qì, ensuring that the body has plentiful supplies of yáng qì to work all the necessary changes in the body for human life. The lung’s corresponding bowel is the large intestine.

When the lung is not working properly, respiratory problems such as cough, abnormalities of breathing, and changes in the volume and quality of the voice may be observed. When the function of governing the waterways is affected, there may be accumulation of water in the form of edema, which in Chinese medicine is called water swelling.

Spleen, stomach, and intestines: The spleen and stomach stand in exterior-interior relationship with each other. The spleen is considered the main organ of digestion and absorption of nutrients contained in food: it governs movement and transformation of grain and water (i.e., food and drink). Food is digested in the stomach and small intestine. However, the spleen is said to move the fluids of the stomach, that is, it helps the stomach to digest the food. The spleen absorbs the essence of grain and water (nutrients contained in food) to provide the materials for the production of qì and blood. For this reason, the spleen is called the source of qì and blood formation. Accordingly, the spleen is also said to control the blood, which refers to its function of preventing spontaneous bleeding. The waste passes on to the large intestine, where it is formed into stool after more liquid is drawn off.

The spleen and stomach are ascribed to earth among the five phases because, just as earth produces crops for human food, so the spleen and stomach extract from food the nutrients for the human body. The spleen is also said to control the blood. The spleen opens at the mouth and governs the flesh. Its mind is thought.

When the spleen fails to function adequately, digestive problems such as poor appetite, abdominal fullness and sloppy stool arise. Qì and blood production may also be affected. Some forms of bleeding are attributed to the spleen failing to control the blood. When stomach function is disturbed, there may be poor appetite, a local sensation of fullness, nausea, vomiting, belching, and hiccup. The small intestine is prone to heat, which gives rise to painful voidings of reddish urine. The large intestine is susceptible to both diarrhea and constipation.

Liver and gallbladder: The liver has two main functions. One is storing the blood, which is apparent from the liver’s bloody texture and color. The other is free coursing, by which the liver maintains the spread of qì to all parts of the body. The liver governs the sinews (muscles and tendons) and opens at the eyes. Its mind is anger. The liver’s corresponding bowel is the gallbladder. In the five phases, the liver belongs to wood. The free coursing function is understood by analogy to trees spreading their branches.

The liver governs the sinews, which rely on plentiful supplies of blood stored by the liver. The sinews are understood by analogy to the bending and straightening qualities of wood.

Failure of the liver to store blood reduces the supply of blood for the sinews, eyes, and menstrual flow, giving rise to blurred vision or scant menstrual flow. Yīn-yáng imbalances can give rise to liver wind stirring internally, which manifests in spasm of the sinews. Impaired free coursing gives rise to qì stagnation, which manifests in distension and pain along the channel associated with the liver (throat, chest, rib-side, lower abdomen). Anger and frustration are associated with many liver problems.

The gallbladder stores and discharges bile, which is made from the surplus qì of the liver. It also governs decision. The functions of the gallbladder are closely related to the liver’s free coursing action.

Kidney and bladder: The kidney is associated with water in the five phases. It governs water, reflecting the fact that it produces urine from fluids. Urine is sent to the bladder for temporary storage before discharge.

The kidney also stores essence, the substance that is responsible for reproduction, physical and mental development, and aging. This function was derived by analogy to the kidney’s association between water in the five phases and winter, the season when nature stores its potential for growth and development until the coming spring. The health of the kidney is crucial to the body’s yīn-yáng balance, and hence it is called the root of yīn and yáng of the whole body. The kidney also has the function of helping the lung to absorb qì. It opens at the two yīn (anus and genitals) and governs the bones. Its mind is fear.

Impairment of the kidney’s function of governing water is impaired manifests in urinary problems such as copious urine, frequent urination, enuresis, urinary incontinence, or water swelling. Insufficiency of kidney essence manifests in poor development in childhood, in reproductive problems such as amenorrhea and infertility, or in premature aging. When the kidney qì’s absorption function fails (called kidney failing to absorb qì), there is panting (labored breathing).

Basic Substances

The basic substances of the body are qì, blood, essence, and fluids.

• Qì, here specifically referring to the diffuse active yáng qì, is the substance responsible for all activity in the body. It has the functions of movement (e.g., propelling blood and fluids), transformation (e.g., turning nutrients in food and air into things needed by the body), retention (holding organs in place and blood in the vessels), and defense (protecting the body against external pathogenic influences such as wind, cold, and heat). Each of the internal organs has its own qì, which drives its action. When qì is abundant, all the functions of the organs are normal and healthy.
• Blood provides nourishment for the body, notably helping the production and movement of qì. When blood is abundant, the complexion is healthy, the tongue is a fresh red color, and menstruation comes at regular intervals, with normal volume and color of its discharge.
• Fluids (differentiable as thin liquid and thicker humor) provide moistness. When fluids are abundant, the skin and tongue fur are moist, there is a normal amount of urine, and thirst is absent.
• Essence is a substance that accounts for reproduction, physical and mental development, and aging, as previously mentioned under Kidney above.

In pathology, inadequacy of qì in performing any of its numerous functions manifests in a condition, or pattern, called qì vacuity, which can result from numerous factors. It manifests in fatigue and lack of strength, but many signs are specific to the organ affected. For example, lung qì vacuity manifests in weak breathing and faint low voice, spleen qì vacuity in signs of inability to digest food properly, such as abdominal fullness and sloppy stool. Failure of the blood to provide nourishment to the body is called blood vacuity, which manifests in a pale complexion and tongue, and scant menstrual flow. Failure of essence to perform its functions of ensuring development and reproduction is called insufficiency of essence, which manifests in developmental, reproductive, and aging problems, as mentioned under Kidney above.

Qì, blood, and fluids can also stagnate, accumulate, and concentrate in what are known as repletion patterns. The numerous causes of these will be discussed later. When the flow of qì becomes sluggish and jerky, this is qì stagnation, which is characterized by localized distention and pain of unfixed location, and menstruation at irregular intervals. When blood fails to move properly, the condition is one of blood stasis, which is marked by hard abdominal masses, pain of fixed location, and purple speckles on the tongue. Bruises from external injury are one form of blood stasis. When water or dampness accumulate and concentrate, the result is phlegm-rheum. Phlegm is thick mucus, while rheum is a thinner form. Phlegm collects in the lungs, but in Chinese medical theory it can affect other parts of the body. For instance, phlegm clouding the heart spirit manifests in clouded spirit (impaired consciousness). Rheum is thin fluid that accumulates in the abdominothoracic cavity and that can often be detected by palpation. Finally, water can accumulate in the flesh to form water swelling, which corresponds to edema in biomedicine. Water swelling can be a repletion pattern when resulting from external wind blocking the lung’s action of keeping the waterways free but is otherwise usually attributable to kidney yáng vacuity. Unlike qì, blood, and fluids, essence never accumulates to form a repletion pattern.

Channels and Network Vessels

Often referred to as meridians and collaterals, the channels and network vessels are pathways of qì. There are twelve main channels, which are six channels duplicated on either side of the body. These link the bowels, viscera, and all parts of the body. The network vessels are branches of these channels that provide wider coverage. There are also eight extraordinary vessels, which among other things, serve as reservoirs of qì and blood for the main channels.

The channels and network vessels have no anatomical correspondences. They appear to have developed from the observation that stimulation of certain points on the body’s surface could elicit responses in other regions. These points would have been found to be arranged in linear fashion, with adjacent points often having similar distal effects. This suggested that the lines that could be traced between the points were the pathways of circulating qì, even though these pathways had no physical substrates. The various channels are described as having different proportions of qì and blood. However, it was the flow of qì rather than blood that early medical scholars focused on. Chinese physicians never charted the system of blood vessels.

Pathology (病理学 bìng lǐ xué)

Causes of Disease

Causes of disease include:

• Externally contracted causes of disease, including the six excesses and epidemic qì;
• Internal causes of disease, including harm caused by emotional and mental states, dietary irregularities, and excesses of activity and inactivity;
• Pathological products as causes of disease, phlegm-rheum, static blood, and calculi;
• Miscellaneous causes of disease, including external injuries, worms (parasites), misuse of medicinals (and side effects of modern drugs), and congenital factors.

The six excesses: The six qì—wind, cold, summerheat, dampness, dryness and fire (heat)—are normal weather or local environmental conditions. When these qì are excessively strong or untimely in their appearance, they can cause illness. Hence, they are referred to collectively as the six excesses. These are the main exogenous pathogens, which in traditional parlance are called external evils.

• Wind is mobile and changeable. When it enters the body, it causes conditions of swift onset, like colds and flu. It affects the body’s exterior, causing fever, aversion to cold, and disturbances of sweating. Affecting the lung and respiratory tract, it can cause cough, sore throat, and runny nose. Wind often combines with cold or fire (heat), giving rise to wind-cold or wind-fire (also called wind-heat), characterized by signs of cold or heat together with signs of wind.
• Cold entering the body causes cold signs (e.g., aversion to cold) and contraction and tension. This causes contraction of the interstices (in simple terms, sweat glands and pores) and blood vessels, so the patient does not sweat and has a tight pulse. Combinations with other evils include wind-cold and cold-damp.
• Summerheat is the torrid heat of summer. It manifests in high fever, vexation and agitation, a red face, and a large, surging pulse, and in some cases dizziness. Combined with dampness, it is called summerheat-damp.
• Dampness obstructs and damages yáng qì, causing oppression in the chest, poor digestion (called torpid intake), and fullness and distension in the stomach and abdomen. It can also manifest in heavy-headedness and a sensation of heavy cumbersome limbs. It is associated with copious discharge, as from sores or from the vagina. Combinations with other evils include cold-damp, damp-heat, and summerheat-damp.
• Dryness manifests in signs such as dry throat, dry mouth, and dry nose.
• Fire, often called heat, refers to any environmental heat other than summerheat. It causes a wide range of signs reflecting heat, increased movement, and redness: such as fever or heat sensations; a rapid pulse, red face and tongue (fire flames upward), and spirit signs such as agitation and mania. Fire stirs the blood and is a major cause of bleeding. Combinations with other evils include wind-fire and damp-heat.

The six excesses are classed according to yīn and yáng. Cold and dampness are yīn; wind, summerheat, fire, and dryness are yáng. Early in Chinese medicine, many febrile conditions were ascribed to cold (cold damage theory). Later, possibly because of changes in climate and expansion of populations into warmer southern climes, greater emphasis was placed on heat (warm disease theory).

External evils invading the body usually affect the exterior and sometimes the lung first, as in the case of colds and flu. If the body’s right qì (resistance) fails to overcome these evils, they can then penetrate the interior of the body, giving rise to more severe conditions. Evils can also enter the channels. Wind, cold, and dampness enter the channels and give rise to pain in the joints. This is called wind-cold-damp impediment (bì), which includes arthritis and other musculoskeletal ailments. Finally, all evils except summerheat can arise from within the body.

Seven affects: Emotional and mental states of abnormal intensity and duration also cause illness. In the context of pathology, Chinese medicine observes seven mental states, called the seven affects:joy, anger, worry, thought, sorrow, fear, and fright. These are the same as the five minds, with the addition of sorrow and fright.

Excessive anger and frustration tend to impair the liver’s free coursing action and depress liver qì. Excessive thought (preoccupation with problems and brooding) damages the spleen. Excessive worry and sorrow damage the lung. Excessive fear damages the liver and kidney, while fright affects the liver, kidney, heart, and gallbladder.

Dietary irregularities: Insufficient and excessive consumption of food causes emaciation or obesity. Different kinds of food can foster different conditions. Hot spicy food can cause heat and dryness. Rich sweet and fatty foods can cause damp-heat. Raw and cold foods can cause cold-damp. Alcohol causes damp-heat. Dairy products foster phlegm.

Imbalances of activity and rest: Excessive physical activity can cause damage to the sinews and damage qì. Insufficient physical activity can inhibit digestion and cause decreased qì and blood production. Excessive mental activity can damage spleen qì, causing poor appetite, abdominal fullness, and sloppy stool. It can also damage the heart, giving rise to heart palpitation, heart vexation, and insomnia.

Phlegm and static blood: These are secondary causes of disease. Phlegm arises out of a concentration of fluid as a result of qì stagnation or heat. Static blood is blood that fails to move. It is caused by external injuries, heat, cold, or qì stagnation and manifests in localized pain of fixed location and purple speckles on the tongue.

Pathomechanisms

A pathomechanism is the mechanism by which illness arises and develops. Pathomechanisms explain the way in which causes of disease affect the body. For example, external cold gives rise not only to cold sensations, but by causing contraction and tension, it can make a patient adopt a huddled posture, close the pores of the skin to prevent sweating, cause pain and stiffness, and make the pulse feel tight like a string pulled taut. Heat evil can cause not only heat sensations, but being urgent and rapid in nature, it causes a rapid pulse and, in some cases, rapid breathing.

The seven affects have a direct impact on organ functions. Excessive anger and frustration tend to impair the liver’s free coursing action and depress liver qì, giving rise to qì stagnation that manifests in fullness, distension, and pain. Excessive thought (brooding and preoccupation with problems) damages the spleen, affecting the production of qì and blood.

Excessive mental activity at night, a yīn time when one should be asleep, can cause debilitation of yīn fluids that causes yáng qì to become overactive, giving rise to excessive excitement of the heart spirit that manifests in heart vexation and insomnia.

The various causes of disease can interact in many different ways. When spleen qì becomes weak, water and dampness are not eliminated through the digestive tract, giving rise to abdominal fullness and sloppy stool. If cold is present in the body, it develops into cold-damp, marked by additional cold signs. Conversely, if heat is present, this can give rise to damp-heat, which can flow to the lower body, giving rise to foul-smelling stool or vaginal discharge. Both cold-damp and damp-heat may further affect the gallbladder and give rise to jaundice. Cold-damp jaundice is marked by a dull coloration of the skin and whites of the eyes, while damp-heat jaundice is marked by a bright orangey coloration.

Yīn-yáng exuberance and debilitation are pathomechanisms seen in any illness. When external fire (heat), a yáng evil, invades the body, the natural yīn-yáng balance of the body is tipped toward yáng. Yáng qì becomes exuberant, causing damage to yīn fluids that manifests in thirst, dry mouth and throat, and a reduced volume of urine.

Diagnosis (病理学 zhen3 duan4 xué)

Diagnosis

Diagnosis involves observing symptoms and deducing treatable pathological states. The process of identifying symptoms is called the four examinations. The process of analysis includes disease identification and pattern identification.

Four examinations: The four examinations are inspection, listening and smelling, inquiry, and palpation. Listening and smelling constitute one examination simply because the Chinese 闻 wen2 means both listening and smelling.

• Inspection is the visual examination of the body and excreta. It focuses on the size and shape of the body, posture and bearing, general vitality. Attention is paid to anomalies in any particular part of the body. Inspection notably includes the complexion and tongue examinations, which are of great importance in diagnosing almost any condition.
• Listening and smelling: Listening covers respiratory sounds and sounds of the voice, while smelling covers odors emitted by the body and excreta (sweat, urine, stool, menstrual discharge, vaginal discharge). Listening and smelling are lumped together simply because the Chinese term 闻 wen2 means both.
• Inquiry involves asking the patient about possible causes of disease (e.g., exposure to the elements, dietary irregularities, activities) and subjective sensations such as pain, numbness, itching, feelings of fullness, and heart palpitation. It also covers symptoms that belong to other examinations but that the practitioner cannot easily witness during consultation (such as urine, stool, and menstrual discharge).
• Palpation regularly includes feeling the pulse and in some cases the abdomen or other parts of the body. The pulse examination is a particularly important element of Chinese medical diagnosis.

Disease identification: Based on data gathered through the four examinations, specific diseases may be identified, e.g., mumps, measles, and dysentery, which affect any sufferer in similar ways, regardless of sex or age. In Chinese medicine, certain major symptoms such as cough, headache, and abdominal pain, are considered as diseases. Some diseases are broad categories. For example, impediment (bì) is a blanket term for conditions characterized by pain in the limbs and joints, including notably arthritis and sciatica. Wilting (weǐ) includes conditions characterized by atony and atrophy of the limbs. Mania and withdrawal (dian1 kuáng) is a composite disease category that includes a large variety of abnormal mental conditions.

Since antiquity, physicians have known that the identification of a disease is often not enough to be able to treat it effectively. This is because any given disease can arise, develop, and manifest in different ways depending on the state of the body. For example, multiple patients subject to the same adverse environmental conditions may react differently. Some may have strong right qì (strong resistance) and do not fall ill at all. Others may develop slightly different conditions depending on any pre-existing imbalances in the body. In other words, a disease may develop by different pathomechanisms. Therefore, it is most effectively treated when the underlying pathomechanism is understood.

Pattern identification: The notion of patterns, regarded as a unique feature of Chinese medicine, developed out of pathomechanisms. While pathomechanisms represent the development of an illness through time, a pattern encapsulates the state of the body at any given moment. Since any given disease can develop in different ways, it can manifest in different patterns and hence is treated in different ways.

While physicians have always been aware that understanding the pathomechanism of a disease is a requisite for being able to provide effective treatment, the notion of patterns developed slowly. Only in the twentieth century were pathomechanism-related states codified into a comprehensive gamut of patterns. Some modern reference works contain upwards of 300 patterns.

A pattern is defined and named in terms of locus, cause, and state:

• Locus is the part, substance, or yīn-yáng aspect of the body that is affected, the lung, qì, blood, or spirit.
• Cause is usually an external cause or pathological product (wind, dampness, phlegm).
• State is an abnormal condition of the locus, expressed as the relative strength or right and evil qì (vacuity or repletion).

Examples: qì vacuity; qì stagnation; blood vacuity; blood stasis; lung qì vacuity; depressed liver qì; liver wind stirring internally; phlegm clouding the heart spirit.

Treatment (治疗学 zhì liao2 xué)

Chinese medicine has numerous therapeutic modalities, the most common of which are medicinal therapy and acumoxatherapy.

Medicinal therapy: Medicinal substances are unprocessed or simply processed animal, vegetable, and mineral substances. The vast majority are of vegetable origin. Each medicinal is ascribed a flavor, a qì (or nature), a degree of toxicity, a channel entry, actions, and indications.

Flavors are five in number (sour, bitter, sweet, acrid, and salty), corresponding to the five phases. In addition, there is blandness, which is the relative absence of flavor.

The qì, or nature, of a medicinal is its capacity to produce warmth or cold in the body. There are four qì: cold, cool, warm, and hot. Some medicinals need to be used carefully because they are toxic.

Actions are the way a medicinal affects the body. They include:

• supplementing insufficiencies of qì, blood, or fluids,
• eliminating evils,
• restoring bodily functions.

Examples of actions: supplementing qì; nourishing the blood; moving qì; dispelling stasis; clearing heat and draining fire; transforming dampness; fortifying the spleen; promoting sweating.

Each medicinal is said to enter one or more channels and thereby act upon bowels, viscera, and associated body parts. For example, ma2 huáng (Ephedrae Herba, ephedra) is said to enter the lung channel because it promotes sweating, a function governed by lung qì.

Each medicinal is ascribed indications, i.e., conditions that it treats. For example, ren2 shen1 (Ginseng Radix, ginseng) treats qì vacuity; huáng qin2 (Scutellariae Radix, scutellaria) treats repletion heat conditions.

Flavors are to some extent related to actions. For example, acrid medicinals are dispersing in nature. They move qì, free the orifices, and resolve the exterior (allow external evils lodged in the exterior to escape from the body).

Medicinals are usually combined in a formula. A formula can be prepared in various forms, such as decoctions, pills, or powders.

Acumoxatherapy: The term 针灸 zhen1 jiu3 literally means needling and moxaing. It is normally referred to simply as acupuncture in English, but we use the term acumoxatherapy to reflect the Chinese concept more accurately.

Needling involves the insertion of fine needles into the body to influence the flow of qì through the channels. Moxibustion, i.e., the burning of moxa, or processed mugwort, close to or on the skin, provides warmth to stimulate the flow of qì.

Needling and moxibustion is performed at sites called points where they are known to have specific curative effects. Most points are located on channels, and the effects of stimulation at them are mostly related to the bowel or viscus to which each channel belongs.

Links

Newcomers to Chinese medicine can follow the following links to learn more about the subject in a systematic way.

• Philosophical bases
• Physiology
• Pathology
• Diagnosis
• Treatment