Traditional Chinese Medicine
by Victoria Dragon
Traditional Chinese Medicine, TCM, is concerned with restoring balance to the person and promoting the flow of energy - called Qi or Ch'i, pronounced chee - throughout the body.
The pathways of energy are called meridians. TCM primarily works with 12 basic meridians plus two special ones. There are more than 14 meridians, but the other meridians rarely are used by most TCM healers.
The 12 basic meridians are the Liver and Gall Bladder meridians, the Heart and Small Intestine meridians, the Spleen(-Pancreas) and Stomach pair, the Lung and Large Intestine, Kidney and Bladder meridians, and the Pericardium and Triple Heater (Warmer) meridians. The other 2 meridians belong to what the Chinese call "The Strange Flows" meridians. These are the Governing Vessel - which runs from the base of the spine up the midline of the back and over the head to a spot just above the upper lip - and the Conception Vessel - which runs from the perineum up the midline of the front of the body to the chin.
Problems can arise in the meridians when there is a lack of energy (Deficiency of Qi), when there is too much energy because of blockages or Stagnation of Qi, when the quality of the energy is off (too much or too little Yang energy, too much or too little Yin energy), when the flow of the energy is off (i.e., ascending when it should be descending or vice versa), and when there is Stasis of Blood.
TCM uses 4 main methods of treatment in order to restore balance to the person. These are diet, herbs, acupuncture/ acupressure, and massage. The first line of defense is diet. There often is a blurring of distinction between dietary herbs and medicinal herbs because the Chinese culinary arts have developed over the centuries to incorporate health-promoting practices. For example, in the winter - the time of the greatest Yin energy and the least Yang energy - Chinese cooks will prepare dishes with Yang and warming energy in order to provide these energies at this coldest, most Yin time of the year. However, Chinese cooks also will include some Yin and Cold (energy) foods at this time of year so as to be in harmony with the season. How much of the Yang/Warm foods and of the Yin/Cold foods eaten in a particular season will depend on the particular needs of the individual.
TCM is highly individualized in its treatments. There are no "one size fits all" (or even most people) therapies. TCM is concerned primarily with identifying and treating root causes rather than symptoms. TCM recognizes that several people could have identical liver symptoms, yet, the root cause (and hence, the appropriate treatment) could be different for each of them. The root of the problem for the first may indeed lie in the liver or the Liver meridian. In this case treatment directed at the liver and/or Liver meridian would be appropriate. But the root cause of the symptoms for the second may be in the kidneys or the Kidney meridian. The root cause for the third may lie in the Lung meridian, or the Heart, or even the Spleen meridian. The treatment which is appropriate for the person whose root lies in the liver or Liver meridian would either not help or could even harm one of the others whose root lies in another meridian.
TCM healers are very careful about identifying causes instead of symptoms. To this end several diagnostic techniques are used to double- and triple-check findings. Some of the primary diagnostic techniques are general observation, pulse diagnosis, tongue diagnosis, and a very lengthy questionnaire with questions arranged according to meridians.
From the time a client first walks into the office of a TCM practitioner, the healer is noting things about the individual. Is the person's voice too loud, movements fast, face flushed? (Possible Yang and/or Heat excess or Yin deficiency.) Is the person's voice weak, movements slow, complexion pale? (Possible Yin and/or Cold excess or Yang deficiency.) What does the person smell like? What is the posture? How much of the whites of the eye are showing above or below the iris? Etc.
The most controversial of the TCM diagnostic techniques is the pulse diagnosis. Most Western doctors are trained to recognize 3 things in the pulse. Western cardiologists are trained to spot a few more things in taking the pulse. TCM practitioners take the pulse at a minimum of 3 locations on each wrist at the same time, taking each of the 6 at a swallow depth and a deep depth. They are trained to differentiate between dozens of qualities of pulse - strong, weak, "slippery", hard to find, "full", "thin". "long", "choppy", etc. Pulse diagnosis is the hardest part of TCM to learn and takes the longest time and the most practice to become proficient at.
The TCM tongue diagnosis also is a bit more involved than the Western counterpart. One of the basic concerns of TCM is identifying if a disorder is a Heat disorder (the person in general or a specific meridian is too Hot) or if it is a Cold disorder (the person in general or a specific meridian is too Cold.) The normal color of the tongue is pale red. In general, a tongue which is too red will indicate a Heat condition. A pale tongue will indicate either a Yang Deficiency or a Blood Deficiency. If the pale tongue is too wet, and especially if it is swollen, this usually indicates a Yang Deficiency. If the pale tongue is too dry, this usually indicates a Blood Deficiency. If the sides of the pale, dry tongue are especially pale or have slightly orangey, this may indicate Deficiency of Liver-Blood. A purple tongue indicates stasis of Blood. Reddish-purple indicates Blood Stasis and Heat. A Bluish-purple tongue indicates Blood Stasis and Cold. The tongue coating also is checked. A thin, white coating is normal. The shape, texture, and length also are checked.
The TCM questionnaire is very thorough, and questions are grouped according to meridians. A meridian encompasses more than just the organ it is named for. For example, the Kidney meridian includes not only the Kidneys, but also the adrenal glands as well as the ears, the skeletal system, the bone marrow, and the hair. For this reason the group of questions under the Kidney meridian will include questions on the ears and hearing. "Do you currently suffer from or do you have a history of suffering from problems with the ears and hearing?" Note: TCM considers if a problem (a weakness) existed from birth, or if it is acquired.
TCM pays far more attention to environmental conditions than Western medicine does. Each of the 6 pairs of main meridians is particularly vulnerable to a specific weather condition, and specific weather conditions are more likely at certain times of the year. Spring (in the U.S. and China) is the season when Wind is the predominate atmospheric condition. The Liver and Gall Bladder meridians are most vulnerable to attack by Wind. Early summer is Heat, and the Heart, Small Intestine, Pericardium, and Triple Heater meridians are most vulnerable to attack by Heat. Late summer is Dampness, and the Spleen and Stomach meridians are most vulnerable. Fall is Dryness, and the Lung and Large Intestine meridians are most vulnerable. Winter is the season of Cold, and the Kidney and Bladder meridians are most vulnerable to attack by Cold. These are general comments because the Stomach also is vulnerable to attack by Dryness and the Spleen also is vulnerable to attack by Cold.
Each of the 6 pairs also is vulnerable to particular emotions. For example, the Liver and Gall Bladder meridians are particularly vulnerable to attack by anger. However, the TCM understanding of the Mind-Body (actually the Mind-Body-Emotion-Spirit) connection is far more sophisticated and practical than the Western counterpart. It is recognized that anger can damage the liver and Liver meridian, as can trauma to the liver, infection, toxins, etc. But TCM recognizes that once the damage occurs - regardless of the trigger - that the damage will create anger. It is a snowballing process. For this reason, physical intervention via herbs, acupuncture/ acupressure, massage, and/or diet is always called for, and mental/emotion symptoms are always considered as being symptoms of a physical imbalance. Dismissing a patient's problems as "just psychological" is not a part of the TCM system. Neither is merely treating emotional symptoms with psychoactive drugs. Nor just treating any physical symptoms with drugs or herbs. TCM is concerned with identifying and treating causes and restoring balance.
Herbs are classified according to their energy - Hot, Warm, Neutral, Cool, or Cold. According to flavor (sweet, bitter, pungent, sour, or salty). According to meridians which the herb has an affinity for. And according to class. (Transform Dampness, Herbs to Correct Deficiencies (Energy, Blood, Yang, and Yin tonics), Herbs to Regulate Qi, Regulate Blood, Clear Food Stagnation, etc.) The main action of the herb is given. For example, to warm the interior for ginger. The healer then consider other things to determine if ginger is the best herb for the individual or if one of the other herbs which warms the interior would be the best or using both.
Note: Warm herbs can be used with individuals suffering from Heat disorders, BUT the herb with Warm energy must be mixed with herbs with Cool/Cold energy so that the overall balance of the mixture is on the Cool side. Likewise, Cool herbs can be used with people with Cold disorders as long as the overall balance of the mixture is Warm. Very proficient TCM herbalists also know how to mix herbs so that an herb which ordinarily does not target a specific meridian will. (Licorice frequently is used for this as it enters all 12 main meridians. It also is used in mixtures to remove energy blocks. For example, taking ginseng - an energy tonic - can make a person sicker is there are energy blocks in the meridians. For this reason ginseng frequently is decocted with licorice in order to correct both problems at once - the blockage as well as the Qi Deficiency.)
TCM will speak of an environmental energy (Cold, Heat, Wind, Dampness, Dryness) attacking at the external or internal level. Translated, "attacking externally" usually means the meridian is being affected. "Internal" usually means that the organ has been affected. It also means that enough damage has been done that the body is now creating the Cold, Heat, Wind, Dampness, and/or Dryness. For example, once an attack of Cold goes on long enough and is severe enough, the kidneys are damaged. The kidneys and the Kidney meridian can no longer warm the body. It does not matter what the external temperature is, the person will feel cold and suffer from the symptoms of excess Cold. (Also note that the adrenal glands are part of the Kidney meridian, and at least one adrenal hormone, RHEA, is known in Western medicine to play a significant role in maintaining body temperature. The gap between Western medicine and TCM is not as wide as may first be thought.)
External disorders are easier and quicker to treat than internal ones.
Any environmental energy - even Cold - can turn into Toxic Fire if it goes on long enough without treatment. In the TCM system, the common cold is caused by Wind Cold. If the Wind Cold is not adequately treated, the common cold can turn into the Toxic Fire pneumonia. Adequate treatment is a relative term in TCM. It may mean merely going to bed earlier for one individual whereas for another it may mean staying in bed.
TCM healers also recognize that Heat and Cold can masquerade as each other. The terms are "False Cold, True Heat" or "False Heat, True Cold." The latter is the more common.
One of the most off-putting things about TCM to people unfamiliar with it is the terminology. TCM terminology is at the same time both more literal and poetic than Western medical terminology as syndromes frequently are named for the environmental energies which trigger them.
TCM syndromes rarely correspond to Western diseases and disorders. The common cold is one that does. So is arthritis. TCM recognizes that not only do Dampness and Cold play roles in arthritis, but Wind does too. Arthritis can be triggered by any of the three or a combination of any of the three. Wind arthritis is characterized by pains that migrate and usually are not as severe as the Dampness and Cold arthritis. The pain of Dampness and Cold arthritis tends to be very deep, very severe, and to stay in one place. Swelling will be seen in Damp arthritis. Arthritis is treated by the class of herbs that counteract rheumatism, herbs to induce perspiration, and herbs to promote blood circulation, In addition, depending on the cause(s), the arthritis also will be treated by herbs to warm the body or remove cold sensations, herbs to transform dampness (the aromatic herbs that act on the Spleen) or promote urination, and/or herbs to extinguish Wind. (Note: Herbs that transform dampness or promote urination have to be used very carefully or may even be contraindicated in thin, weak people suffering from Yin Deficiency. The same remarks apply to herbs to warm the body for people with Heat excess. This entire paragraph is highly simplified for beginners.)
Environmental energies can combine to cause problems. Wind is the most common environmental energy as it can occur all during the year and readily combines with other energies. In Western terminology Wind also includes changes in barometric pressure. Herbs that promote blood circulation also are employed in treating Wind disorders because good circulation is one of the strongest defenses against Wind.
For more introductory information on TCM see the book Chinese Herbal Cures by Henry C. Lu. Also see Chinese System of Food Cures by the same author.
For more advanced understanding see The Foundations of Chinese Medicine by Giovanni Maciocia (particularly good for diagnosis but geared to acupuncture) and A Manual of Chinese Herbal Medicine: Principles & Practice for Easy Reference by Warner J.W. Fan, MD.