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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 (不引比类¸ 是知不明 bù yǐn bǐ lèi, shì zhī bù míng).

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.

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.

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.

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.

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.

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 (水湿 shuǐ shī). Phlegm is of interest here because a distinction is made between tangible phlegm, which is coughed up from the lung, and intangible phlegm which can travel around the body, giving rise to numerous diseases without necessarily being associated with expectoration. Phlegm diseases of any kind tend to be intractable and often characterized by a glossy slimy tongue fur and a stringlike pulse.

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 (癫狂 diān kuáng, various kinds of mental illness). It is also a major cause of dizziness. Since these conditions do not necessarily involve expectoration of phlegm, their attribution to phlegm rests on similarities in the tongue fur and pulse and on the analogy between the physical properties of phlegm and clouding of the spirit.

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