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Analogy vs. analysis
分析与类比 〔分析與類比〕 fēn xī yǔ lèi bǐ
The Chinese medical model is based on direct observations, logical inferences from them, and on similarities and connections between the human body and the outside world. It evinces two forms of reasoning: analytical and analogical. By analytical reasoning,
any given object or phenomenon is understood in terms of its constituents and things with which it comes into contact. By analogical reasoning
, things and phenomena are understood by comparing them with similar things or phenomena. While the latter is the prominent cogintive mode applied in the modern sciences and biomedicine, Chinese medical theories appear to be the product of both. See cognitive features.
Although the scholars who laid down the theoretical foundations of Chinese medicine in the Huáng Dì Nèi Jīng did not describe how they arrived at specific explanations of the health and sickness. How they arrived at them is a matter of speculation. What their direct observations were, how they made inferences, and to what degree analogy shaped their ideas is not always clear. Nevertheless, they stated quite clearly that analogy was essential to their understanding, since the Sù Wèn (Chapter 76) states, Without drawing comparison of kinds [i.e., analogy], this cannot be clearly understood
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Analogy usually rests on similarities between source and target qualities but may involve prospective mapping of source qualities onto the target. Since different sources of analogy can be applied to one and the same target, either from distinct domains (yīn-yáng, five-phase, and empire domains) or from subdomains of systems of correspondence (e.g., the material
and seasonal
domains), the way in which theories about targets arose can in some cases be highly complex. Hence, this section provides some examples to give an idea of the way in which analogical reasoning interacts with analytical inferences and how analogies interact among themselves. Although this endeavor is speculative, it provides an understanding of the kind of thought processes that unquestionably lay behind the development of Chinese medical theory and thus the subtleties of how these ideas are applied clinically.
The theories about the five viscera and disease evils provide especially clear examples of the interplay of analogy and analysis.
Analogy vs. Analysis in the Five Viscera
Analysis of naked-sense observations revealed basic functions and attributes of the organs, e.g., the stomach’s digestive function; the lung’s respiratory function; the liver’s blood-storing function (even though this is not consistent with biomedical theory); the kidney’s urinary function; the heart’s spirit-storing function; and the differentiated location of the five minds and seven affects. Witha couple of exceptions, notably the blood-storing and spirit-storing functions, these inferences are largely consistent with biomedical theory.
Such inferences from naked-sense observations provided the basis for incorporating the organs into the analogical framework of yīn-yáng, the five phases, the empire paradigm, and the qì paradigm, involving numerous metaphors (natural, mechanical, governmental, transportational, container metaphors). This prompted the attribution of functions to organs for which naked-sense observations provided no hints, e.g., the spleen’s digestion-absorption function; the liver’s free coursing function; the kidney’s essence-storing function; the lung’s waterway-regulating function; the attribution of the seven affects to the viscera.
In the process of applying analogies, the season-related characteristics of the five phases and the government positions of the empire paradigm (Sovereign, Minister-Mentor, General, etc.) played a dominant role.
Associations of the Five Viscera | |||||
---|---|---|---|---|---|
Viscus | Liver | Heart | Spleen | Lung | Kidney |
Phase | Wood 木: east, spring, birth | Fire 火: south, summer, growth | Earth 土: center, late summer, transformation | Metal 金: west, autumn, withdrawal | Water 水: north, winter storage |
Function | Stores blood; free coursing | Store the spirit; governs blood and vessels | Movement and transformation; controls the blood | Breathing; governs qì and the waterways | Governs water; stores essence |
Bowel | Gallbladder | Small Intestine | Stomach | Large Intestine | Bladder |
Orifice | Eyes | Tongue | Mouth | Nose | Ears |
Body Constituent | Sinew | Vessels | Flesh | Skin (and body hair) | Bone |
Bloom | Nails | Face | Lips (and four whites) | Body Hair | Hair of the head |
Humor | Tears | Sweat | Drool | Snivel (nasal mucus) | Spittle |
Spiritual entity | Ethereal soul | Spirit | Ideation | Corporeal soul | Mind |
Mind | Anger | Joy | Thought | Worry | Fear |
Voice | Shouting | Laughing | Singing | Wailing | Groaning |
Government office | (Military) general | Sovereign | Office of the Granaries | Minister-Mentor | Official for forceful action |
Aversion | Wind | Heat | Dampness | Cold | Dryness |
The attributes of the viscera can be summarized as follows:
Liver: The liver belongs to wood, stores blood, and governs free coursing. It governs the sinews, opens at the eyes, and has its bloom in the nails. Its humor is tears, and its mind is anger. It holds the Office of General. For more detail, see analogy vs. analysis: liver, wood, general.
- The ascription to the wood phase comes from the shape and color of the liver.
- Blood storage is inferred from the color of the liver and from massive hemorrhage following laceration.
- Free coursing and upbearing effusion derive from the association with the orderly reaching quality of wood.
- The sinews and eyes are directly associated with the
orderly reaching
quality of wood and are dependent on blood storage. - Anger is associated with disturbances of free coursing and upbearing effusion.
- The liver is averse to wind, as plants in nature are easily damaged by wind when they are not sufficiently supple.
- The army general represents command over the nation’s territory and territorial expansion. The army under his command is the sinew, claws (nails), eyes, and anger of the nation, while he himself is its intelligent strategist.
Heart: The heart belongs to fire and stores the spirit. It governs the blood and vessels, opens at the tongue, and has its bloom in the face. Its humor is sweat, and its mind is joy. It holds the Office of Sovereign. For more detail, see analogy vs. analysis: heart, fire, sovereign.
- The association with fire derives from the bodily heat that develops during strenuous exercise that makes us aware that the heart is throbbing.
- The association with the blood and vessels derives from the radial formation of large vessels from the heart. Given the location in the center of the chest, this reflects the radiating quality of fire.
- Storing of the spirit derives from the sensing of emotions in the heart. The concept of spirit derives from that of an unseen, all-powerful, all-knowing being in the other world with which fire provides a channel of communication (burning of incense, money).
- The tip of the tongue is associated with fire because it is flame-shaped.
- The face is the clearest reflection of the state of the spirit.
- Fire represents safety, the center of social life, conviviality. Hence, it is associated with joy. Fire also represents power and splendor. Hence the heart is said to hold the Office of Sovereign, who gains his mandate from heaven (the spirit world) and who ensures the safety and well-being of the nation.
Spleen: The spleen belongs to earth and governs movement and transformation. It governs the flesh, opens at the mouth, and has its bloom in the lips and four whites. Its humor is drool, and its mind is thought. It holds the Office of the Granaries. For more detail, see analogy vs. analysis: spleen, earth, office of the granaries.
- The location on the underside of the stomach prompted the idea that the spleen was the storing organ corresponding to the stomach and hence an organ of digestion responsible for movement and transformation, helping the stomach to digest, extracting the essence of grain and water to produce qì and blood, and warming and transforming water-damp.
- The association with earth rests on the spleen’s being the source of qì and blood production, as earth provides sustenance for humans and animals.
- The flesh is associated with the spleen because it is marker of strength of digestion and assimilation. The mouth, lips, and drool are associated with the spleen they all directly related to digestion.
- Ideation and thought derive from the productiveness of earth. Excessive thought damages the spleen is like the over-intensive use of soil. Singing is the creative use of the voice.
- The Office of the Granaries, securing food supplies for the nation, naturally corresponds to earth in nature.
Lung: The lung governs breathing and governs qi. It governs the skin and body hair, opens at the nose, and has its bloom in the body hair. Its fluid is snivel, and its mind is worry (and sorrow). Its government epithet is the Minister-Mentor. It has a special association with acridity. For more detail, see analogy vs. analysis: lung, metal, Minister-Mentor.
- Breathing is a directly observable function of the lung.
- The lung’s governance of qì is derived from this.
- The lung’s belonging to metal, the phase associated with the purification of nature in autumn, is explained by the lung’s need to inhale clear qì and expel turbid qì and by its need to keep the airways free of nasal mucus and phlegm.
- Acridity is the smell of metal and acrid medicinals clear the airways.
- Lung qì has an upward and outward movement called
diffusion
that is responsible for exhalation. A complementary downward and inward movement calleddepurative downbearing
is responsible for inhalation. Diffusion and depurative downbearing work together, not only to keep the airways free of nasal mucus and phlegm but also to control the wider movement of fluids in the body. The understanding of this function may have developed by an analogy to the rain cycle and may explain the connection with the skin and body hair (which are directly associated with metal among the five phases). Just as the rain cycle is governed by the qì of heaven, the lung, which is the governor of qi, controls the movement of water throughout the body. - The voice is associated with the lung not only because it is located on the airway but also because the lung resembles a metal bell in that it rings clearly only when empty, i.e., when the airways are free of obstructions.
- Worry and sorrow are associated with the lung because they are felt in the chest and easily affect lung function. They also reflect the lugubriousness of the autumn.
- The lung holds the Office of Minister-Mentor because it controls the qì of the entire body. Breathing has a powerful regulatory impact on the heart rate and emotions, just as the Minister-Mentor, by his wise counsel, tempers the excesses of the sovereign.
Kidney: The kidney belongs to water and governs water (producing urine). It governs the bone and engenders marrow, opens at the ears and the two yin, and has its bloom in the hair. Its humor is spittle, and its mind is fear. It holds the Office of Forceful Action. For more detail, see analogy vs. analysis: kidney, water, office of forceful action.
- Responsible for producing urine, the kidney governs water and hence belongs to the water phase.
- Storing essence derives from the association of winter with the water phase, a time when nature is silent and inactive, storing resources for warmer weather. Essence controls reproduction, development, and aging. The kidney also has a general storage function, preventing the loss of urine, stool, semen, menstrual blood, and fetuses.
- The connection with the bones (which store marrow), the brain (marrow stored in the skull),
mind
(mental faculties) including memory (memories are stored experiences) further reflect the storage function. - The ears being the outer orifice of the kidney is related to the loss of hearing in old age, which resembles the silence of winter.
- Fear is associated with the kidney because fear and fright impair the storage function, causing incontinence, and because death, the thing we fear most, is the end of the human cycle as winter is the end of the seasonal cycle in nature.
- The kidney holds the Office of Forceful Action, reflecting the observation that the ability to work physically or mentally relies on the health of essence.
Analogy Unviable?
The discrepancy between Chinese medical and biomedical attribution of functions to the organs is one major reason why many scientifically minded people are dismissive of Chinese medicine. The spleen’s movement and transformation function (digestion and absorption), liver’s free-coursing function, the heart storing the spirit, the kidney storing essence and being responsible for reproduction are viewed as mistakes
so serious that they undermine the validity of Chinese medicine as a whole. However, from a pragmatic perspective, these mistakes may be of less consequence than feared.
Chinese medicine relies on direct naked-sense observations and therefore focuses on gross functions (breathing, digestion, reproduction, etc.). Having no knowledge of the internal structure of organs or of the chemical and biological reactions that occur within the body, it ascribes functions to organs on the basis of observable data aided by analogies to the outside world. The use of analogy is obviously where the mistakes lie.
The main concern of Chinese medicine has always been to treat disease. In fact, we can assume that much of the physiology of Chinese medicine developed through clinical observation of dysfunction. The focus of clinical practice is on identifying impairments of the gross functions of the body and on restoring those functions by appropriate treatment. The only basis for gauging the success of a treatment is whether or not functions are restored. The treatment is not based on knowledge of the organ itself, its internal structures, its cells, or the chemical and biological reactions that take place in it. Therefore, the misattribution of a function to an organ is irrelevant. This is quite different from biomedicine whose purview goes down to the level of cells, molecules, and atoms, where a clear relationship between functions and substrates is crucial.
Once this issue is understood, other features of the Chinese medical model that are inconsistent with the biomedical model become easier to explain, namely qì and essence. These things are presumed to exist on the basis of identified functions. Neither of these two entities corresponds to any single substance detectable by modern science, and hence they are now largely conceived of as simply being functions. Yet, insofar as they can be treated successfully, they can be considered useful concepts.
Analogy vs. Analysis in Disease Evils
Disease evils are the pathogens of Chinese medicine. They include the external evils
wind, cold, summerheat, dampness, dryness, and fire, which are environmental qì that affect the body. They also include internal evils
that arise from imbalances within the body and that mimic the external evils, as well as phlegm and static blood.
Affliction by a disease evil is characterized by certain signs, most of which can be explained by natural causality, since they arise after the initial exposure. Exposure to cold, for example, is naturally followed by cold sensations, a curled-up body posture that preserves bodily warmth, a pale complexion resulting from constriction of blood vessels, and copious clear urine that results from the absence of normal fluid loss through sweating. Even though there may be fever, which is attributed to the body’s efforts to fight the evil, it is less prominent than the sensations of cold. Summerheat naturally gives rise to fever and sweating that causes a decrease in the volume of urine and a deepening of its color. Dryness naturally gives rise to a dry nose, dry mouth, and dry throat.
Despite the prevalence of natural causality, numerous conditions appear to have been associated with disease evils at least partly by a process of analogy, magical causality, and the qì paradigm. Wind, dampness, fire, and phlegm are major cases in point. Whether analogies guided observations or merely provided the language to explain pathological processes is, of course, a matter of speculation.
Wind: Wind in the environment is moving air, which, in our modern scientific view, is naturally stopped by the skin. It can only affect the inside of the body indirectly by its temperature- and moisture-reducing effects on the skin. Despite this, Chinese medical understands wind as a qì that, being able to penetrate matter, can enter the body and disrupt functions. However, the only way in which its presence is detected in the body is by the qualitative analogy of symptoms to the environmental influence. The points of analogy are established very clearly:
Wind easily damages yáng regions.
It affects the yáng (upper and outer) regions of the body, just as wind in the environment affects things in high exposed places more than things in lower protected places. Wind is a major cause of what we now call colds, flu, and upper respiratory tract infections in which there upper-body signs such as nasal congestion and sore throat, as well as exterior signs such as heat effusion and aversion to cold. A statement similar in meaning is wind is light and buoyant,
emphasizing that it tends to affect the exterior, giving rise to a floating pulse.
Wind by nature causes opening and discharge.
It opens the pores and causes sweating, just as wind in the environment can blow open doors and windows as well as damaging irrigation and drainage structures.
Wind is mobile and changeable.
It can come suddenly and disappear suddenly, giving rise to common colds that usually go as quickly as they come. It can affect different parts of the body successively, giving rise to wandering pain and itching in different places.
Wind by nature stirs.
It can cause spasms that cause the body to move in abnormal ways, just as wind in the environment causes trees and plants to bend, sway, and flap. Severe wind can also cause paralysis, just as environmental wind can break the branches of trees so that they no longer bend and sway.
Wind can also arise internally when a yīn-yáng imbalance results in a surfeit of yáng qi. Internal wind is characterized by various forms of spasm or immobility and reflects an analogy between the effect of wind on trees in the environment and the effect of internal wind
on sinews in the body. Wind stroke was originally attributed to external wind, but as empirical observation caused earlier theories to be questioned, it eventually became attributed to internal wind. Whether the cause is external or internal wind, the contribution of analogy to the formulation of wind a cause of the disease is the same.
Dampness: Dampness is a yīn evil that affects people living in wet or damp places or working in wet or damp environments. It can arise internally when the lung, spleen, and kidney fail to deal with ingested fluids adequately.
Dampness by nature is heavy and turbid.
It makes the limbs and head feel heavy. Being heavy, it tends to flow downward to the lower body, giving rise to vaginal discharge and diarrhea. Being turbid, it gives rise to murky, dirty-looking excretions, such as thick eye discharge, turbid vaginal discharge, turbid urine, and turbid nasal mucus. In such cases, it is often referred to as damp turbidity.
Dampness by nature is sticky and stagnant.
Once it lodges in the body, it sticks around for a long time and is hard to eliminate. When it affects the skin, it gives rise to persistent conditions such as eczema. When it clogs the stomach and spleen, it gives rise to fullness and distension with ungratifying defecation. When it gets into the joints, pain of fixed location arises. Affecting the large intestine, it causes sticky, mucous stool accompanied by tenesmus.
Fire: As a cause of disease, fire is heat in the environment or heat that develops from internal causes. The word fire
is here used metaphorically, since it refers to an evil prevailing in the environment rather than actual fire, and although it may give rise to a higher body temperature, there is never any combustion. Yet the causes and effects of fire in the body closely match the causes and effects of real fire in the environment.
Fire by nature flames upward.
It naturally affects the upper body. Fire is also the cause of highly inflamed sores. The notion of fire causing a sore on the surface of the body may have been influenced by the eruption of lava on the earth’s surface or by the discharge of hot water from hot springs and geysers.
Fire can be caused by qì stagnation (qì depression), static blood, dampness, and food accumulations. Common to all these factors is the idea of things failing to move or accumulating. In particular, qì stagnation and food accumulation are associated with flatulence (intestinal gas). The attribution of pathological fire in the body to such factors may have been influenced by marsh fires. Marshlands are places of stagnant water and rotting plant material that produces gases such as methane and hydrogen sulfide, which can undergo spontaneous combustion. The ability of static blood and dampness to transform into fire may be an extension of this.
Fire gives rise to wind and can be intensified by wind. Extreme heat engendering wind
is a pathomechanism whereby a condition of high fever from externally contracted heat can give rise to wind that manifests in severe spasm (as in child fright wind). The understanding of this process may have been influenced by the observation of wind created by forest fires, where the rising of hot air draws in air from the surrounding area. Wind and fire fanning each other
is a condition in which externally contracted wind and fire exacerbate each other. This idea may have been influenced by the observation of fire giving rise to wind and by the knowledge that a fire can be intensified by fanning or the use of bellows.
Phlegm: Phlegm is closely related to dampness. Both are considered forms of water-damp
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Intangible phlegm can gather in lumps in various parts of the body, giving rise to scrofula, goiter, breast lumps, and even certain suppurative lesions. It can cloud the orifices of the heart, giving rise to epilepsy, feeble-mindedness, and mania or withdrawal (