A medical worker at a neighborhood clinic applies acupuncture to the leg of a local resident. PHOTO BY JOAN LEBOLD COHEN.
Traditional Chinese medicine focuses on the body as a whole, and involves six main principles: the theory of yin–yang, the five elements, viscera, qi (life force), blood and body fluids, and the theory of the channels and collaterals. The principles of traditional Chinese medicine, though often intertwined with Western medicine, are still taught and practiced throughout China today.
The practice of medicine has a long unbroken history in China. Texts on traditional Chinese medicine (TCM) more than two thousand years old are still consulted by practitioners today. The most important ancient medical treatise is Huangdi Nei Jing (Yellow Emperor’s Canon of Medicine), also called the Canon of Acupuncture. It represents a monumental break from previous magical or supernatural healing systems in the East, much the same way the works of Hippocrates do in the West. This classic is the foundation for traditional Chinese medicine and continues to help the world’s largest health care system, which serves nearly 25 percent of the world’s population.
Basic Principles of TCM
The basic principles of TCM are the theory of yin–yang, the five elements, viscera, qi (life force), blood and body fluids, and the theory of the channels and collaterals.
A basic characteristic of TCM is its focus on the entire body. A symptom presented in one part of the body is viewed in relationship to the whole body. While the Western physician begins treatment by identifying a symptom and then searching for a cause, the TCM physician examines the overall physiological and psychological condition of the patient and searches for a pattern of disharmony to provide the basis for treatment. In other words, the Western practitioner asks, “What X is causing Y?” while the Chinese practitioner asks, “What is the relationship between X and Y?”
Yin–Yang
The concept of yin–yang rose from Confucian and Daoist philosophies. Yin–yang describes how opposing forces—such as motion/stillness, hot/cold, dark/light, male/female—are intertwined, interdependent, opposite yet equal. Yin–yang represents all the opposite principles in the universe. Each of these opposites produces the other. One cannot exist without the other. The doctrine of yin–yang influences every aspect of TCM’s theoretical system. It helps to explain the anatomy, physiology, and pathology of the human body. Yin–yang theory directs clinical diagnosis and treatment.
The common treatment with medicinal herbs is based on yin–yang theory. The properties, tastes, and functions of medicinal herbs are carefully considered before being mixed. This is one reason why yin–yang theory is still taught in the colleges of traditional medicine. Without an understanding of yin–yang theory, practitioners cannot learn how to use Chinese medicinal herbs for proper treatment.
The Five Elements
More than 2,000 years ago the Chinese Naturalist School identified wood, fire, earth, metal, and water as five dynamic processes—not five types of inactive matter—that were basic to understanding the natural world. Later they developed principles of mutual creation, mutual closeness, and mutual destruction to explain relationships in the natural world. In addition to representing the natural world, the theory of the five elements provides guidance for physiology, pathology, diagnosis, and treatment in TCM. All the tissues and organs of the human body, as well as the emotions, can be classified according to the theory of the five elements. For example, the liver and gallbladder are associated with wood; the heart and small intestines, with fire; the spleen and stomach, with earth; the lungs and large intestines, with metal; and the kidneys and bladder, with water. When applied to medicine, the theory of five elements stresses the interrelationships among the internal organs, not their individual functioning.
The Viscera and Bowels
In TCM the internal organs of the human body are divided into three groups: the viscera, the extraordinary organs, and the bowels. The five viscera are the heart, liver, spleen, lungs, and kidneys. These yin organs preserve the body’s vital substances. The extraordinary organs are the brain, bones and bone marrow, blood vessels, uterus, and gallbladder, which is both an extraordinary organ and a bowel. The extraordinary organs are also called bowels, but their functions are different from those of the six bowels. The six bowels, which are yang organs, are the gallbladder, stomach, large intestine, small intestine, bladder, and the triple warmer (sanjiao). They work together to move and process food and water.
Triple warmer (also called triple heater or triple burner) appears only in TCM. It is a term for the concept of an organ that transfers energy. It also is involved with metabolism. The triple warmer is conceptualized as a large bowel containing all the internal organs. It is used to anatomically locate the body parts. The triple warmer has three parts. The upper warmer is the section of the body cavity above the diaphragm that contains the heart and lungs. The middle warmer is the section between the diaphragm and the navel that houses the spleen and stomach. The lower warmer is the section below the navel that houses the liver, kidneys, bladder, intestines, and uterus. The triple warmer controls the flow of qi through the body.
Qi, Blood, and Body Fluids
TCM holds that qi, blood, and body fluids are the basic components of the body and help to maintain the body’s normal functions. Qi is especially important because it supplies the vital energy needed by all the organs and tissues of the body. Qi refers both to the vital substance, or life force, of the body and to the physiological functions of the viscera, bowels, and channels and collaterals. In accordance with yin–yang theory, qi is yang and blood is yin; blood is the physical representation of qi.
Channels and Collaterals
Qi flows through the channels (jing), the main pathways running lengthwise through the body. Collaterals (luo) are branches of a channel in the system. The channels and collaterals circulate throughout the entire body, link with each other, and connect all the sections of the body to create an organic whole.
Development of TCM
The legendary ruler Shen Nung, who lived some 5,000 years ago, is considered the father of agriculture and herbal therapy. Huangdi, the mythical Yellow Emperor, born in 2704 BCE, according to legend, is considered the creator of ritual and of medicine and the compiler of the Nei Jing (Canon of Medicine). During the Warring States period (475–221 BCE), doctors (yi) formed the first medical organization independent of priests and magicians (wu). This organization’s first known representative was said to have been Bian Que (430–350 BCE, but thought by some to be legendary), who used the pulse rate as a basis for diagnosis and prognosis. He has been credited with writing the Nanjing (The Classic of Difficulties).
Zhang Zhongjing (b. 158 BCE, in Nanyang, Henan Province), the Chinese Hippocrates, systematized the study of symptoms and the treatment of disease using drugs. Zhang’s masterwork is titled Shanghan Lun (Treat
ise on Fevers), the oldest clinical textbook in the world. While the Canon of Medicine listed only twelve prescriptions and five forms of drugs (pills, powders, pellets, tinctures, and teas), Zhang’s work listed 370 prescriptions and a greater number of drug forms, including emulsions. His prescriptions for treating dysentery, encephalitis B, pneumonia, and hepatitis are still appropriate today.
Hua Tuo (d. 208 CE) was the preeminent surgeon of the Three Kingdoms period (220–265 CE). He contributed to the use of anesthetics, surgery involving opening the stomach area, and the practice of hydrotherapy. The Daoist alchemist and pathologist Ge Hong (284–364 CE) wrote a comprehensive medical handbook that covered such diverse ailments as infectious and parasitic diseases and neurological disorders. The first known monograph on surgery was a collection of procedures by Gong Qingxuan (d. 208 CE). Early surgery focused on the treatment of boils and ulcers, ailments of the upper classes.
The first state-sponsored medical schools in China opened in around 443. In 581, during the Sui dynasty (581–618 CE), the government opened the Imperial Medical Academy. Officials of the Tang dynasty (618–907 CE) expanded the academy in 624.
More medical classics appeared during the late Sui and early Tang eras. In 610 Chao Yuanfang and others compiled the medical classic Zhou Bing Yuan Ho Lun (General Treatise on the Causes and Symptom of Diseases), the earliest surviving work in China on the origins of diseases. Its fifty volumes are divided into seventy-six classifications listing some seventeen hundred disorders. Included in the book are details on pathology, descriptions of symptoms of many known diseases, and essays on internal medicine, surgery, gynecology, and pediatrics.
Sun Simiao (581–682), one of the giants of traditional Chinese medicine, wrote two books that updated earlier medical knowledge: Ji Bei Qian Jing Tao Fang (Prescriptions Worth a Thousand Gold Pieces for Emergencies) and Qian Jing Yao Fang (A Supplement to the Essential Prescriptions Worth a Thousand Gold Pieces). Sun believed in diet over drugs. His books deal with diet therapy, preventative care, health preservation, acupuncture, and moxibustion (the burning of herbal leaves near the skin).
During the Song dynasty (960–1279), the Imperial Medical Bureau was established and the education of doctors in the principles of TCM became more important. Students were offered such courses as Plain Questions Classic on Medical Problems and Treatise on Febrile Diseases. In 1026 Instructor Wang Weiyi designed two life-sized bronze figures to use in his teaching of acupuncture and moxibustion. When used for testing, the figures were filled with water and coated with beeswax. When a student punctured the correct acupuncture point, water would issue from it.
Four famous medical schools opened during the Jurchen Jin dynasty (1125–1234) and the Yuan dynasty (1279–1368). Each school specialized in the diagnosis and treatment of certain diseases. They were the School of Cold and Cool, represented by Liu Wansu (1120–1200); the School of Attacking or Purging, headed by Zhang Congzheng (1156–1228); the School of Injuries of the Spleen and Stomach, headed by Li Dongyuan (1180–1251); and the school of Nourishing the Earth, founded by Zhu Zhenheng (1281–1358).
The Bencao gangmu (Compendium of Materia Medica) of Li Shizhen (1518–1593) appeared during the Ming dynasty (1368–1644). It is perhaps the last great medical work written in China not influenced by Western scientific thought. Compendium of Materia Medica listed 1,892 medicines and more than 10,000 prescriptions. In addition to medical information, the work contained chapters on natural history, including a classification of mineral, vegetable, and animal products; chemical and industrial technology; geography; history; diet and nutrition; and other information. Li spent twenty-seven years compiling his encyclopedia. It is considered a major contribution to the development of pharmacology both in China and throughout the world and has been translated into all the languages of East Asia and the principal languages of the West.
Chinese doctors continued to correct ancient texts and develop new theories and procedures up through the Qing dynasty (1644–1912). Wang Qinren (1768–1831) wrote Corrections on the Errors of Medical Works. Wang corrected the errors in autopsy procedures in ancient medical books, reemphasized the value of autopsy, and developed the theory that pooling or stagnation of blood would result in pain and disease.
To put these developments into a Western historical context, William Harvey published his seminal work on the circulation of blood in 1682. His work built upon the work of other earlier European scientists who had read the Arab studies of al-Nafis (1228). Metabolism, hormone disorders and therapy, and circadian rhythms were discussed in second-century BCE Chinese texts, 2,200 years before their acceptance in the West. Chinese doctors were ahead of their European counterparts by nearly a thousand years in attempting to identify and control diabetes (although they never connected the disease with the pancreas). Studies of the body’s immune system developed in China in the tenth century CE, which led to a vaccine to prevent smallpox, among other advances. European doctors did not develop a smallpox vaccine until the eighteenth century.
Around 1911 or 1912, in the early years of Republican China, the emphasis officially switched to Western medicine. President Sun Yat-sen (1866–1925) was a Western-trained physician who steered his country toward Western medicine. Nevertheless, most Chinese people continued to go to TCM practitioners.
The status of TCM was officially reinstated following the establishment of the People’s Republic of China in 1949. By the 1950s experienced TCM practitioners were again producing texts with government support. By the time of the Cultural Revolution (1966–1976), the official emphasis in general health care had shifted back to TCM from Western medicine. By then the body of written knowledge was sufficient to train the so-called barefoot doctors and provide them with a manual describing traditional treatments.
Contemporary Development of TCM
Since the early years of the twentieth century, with the popularization of Western medicine in China, Western medicine and traditional Chinese medicine have developed side by side. Chinese medical professionals have realized that TCM and Western medicine each has its own advantages. In the Chinese way of adapting ideas from outside to serve Chinese needs, efforts have been made to combine the knowledge and practices of the two schools. Much of this effort has come since the end of the Cultural Revolution, when many Western-trained medical specialists returned from labor in the countryside and were assigned to TCM institutions. They have been conducting basic and clinical research, using modern rigorous methods, to determine the effectiveness of TCM treatments.
Traditional Chinese medicine is now widely practiced in China. New technologies, such as laser technology, are used to augment 2,000-year-old methods. The State Council has created the State Administration of Traditional Chinese Medicine of People’s Republic of China, which is responsible for the regulation of the TCM industry. There is now an estimated 340,000 TCM practitioners; 1,500 TCM hospitals with some 100,000 beds; and 26 colleges and 30 academies of TCM in China.
Further Reading
Geng Junying & Su Zhilong. (1990). Practical traditional Chinese medicine & pharmacology: Acupuncture and moxibustion. Beijing: New World Press.
Geng Junying & Su Zhilong. (1990). Practical traditional Chinese medicine & pharmacology: Basic theories and principles. Beijing: New World Press.
Geng Junying & Su Zhilong. (1990). Practical traditional Chinese medicine & pharmacology: Medicinal herbs. Beijing: New World Press.
Huang Jianping. (1990). Methodology of traditional Chinese medicine. Beijing: New World Press.
Institute of Traditional Chinese Medicine of Hunan Province. (1985). A barefoot doctor’s manual. New York: Grammercy Publishing Company. (Originally translated and published in English in 1975 by the National Institutes of Health, U.S. Public Health Service, U.S. Department of Health, Education, and Welfare as DHEW Publication No. [NIH] 75–695
Porkert, M., & Ullmann, C. (1982). Chinese medicine. New York: Henry Holt & Company.
Shang Xianmin, et al. (1990). Practical traditional Chinese medicine & pharmacology: Clinical experiences. Beijing: New World Press.
State Administration for Traditional Chinese Medicine. (1992). Traditional Chinese medicine and pharmacology: A textbook for foreign students at colleges of traditional Chinese medicine. Beijing: New World Press.
Zhang Enqin. (1990). Basic theory of traditional Chinese medicine. Shanghai: Publishing House of the Shanghai College of Traditional Chinese Medicine.
Zhang Junwen, et al. (1993). Integrating Chinese and western medicine: A handbook for practitioners. Beijing: Foreign Languages Press.
Prescribe the right medicine for a symptom.
对症下药
Duì zhèng xià yào
Source: Chen, Bao-xing, & LeCompte, Garé. (2009). Medicine, Traditional. In Linsun Cheng, et al. (Eds.), Berkshire Encyclopedia of China, pp. 1435–1440. Great Barrington, MA: Berkshire Publishing.
Herbs used in traditional Chinese medicine are harvested from Mount Emei. PHOTO BY JOAN LEBOLD COHEN.
A vendor selling some scaly and armored critters whose byproducts are used for medicinal cures. The sixteenth-century text Compendium of Materia Medica included a number of non-plant classifications—from bugs and birds to beasts—that were components of early traditional pharmaceuticals. PHOTO BY JOAN LEBOLD COHEN.
Medicine, Traditional (Zhōngyī 中医)|Zhōngyī 中医 (Medicine, Traditional)
