Chinese medicine
consists of a substantial and valuable body of herbal medicine along with a well-developed
system of acupuncture that can be respected.
After saying all that, the actual theory is very much a work in progress
that is ongoing for centuries and certainly remains unsatisfactory to western science
and bordering on hand waving to eastern ears.
Needless to say, it continues to evolve.
Its value rests in that
the practitioner focuses on the general wellbeing of the patient. This of course has the value that problems
that the body is able to resolve are then resolved and often quite quickly. Naturopathy follows the same agenda with
similar success. It is obvious that
chronic conditions are excellent prospects and that has proven true.
Western medical focus
is on aggressive intervention and that makes complete sense when simple health
enhancement fails. Thus we have an
evolving medical system in which the survivors of failed interventions tap
alternative therapies to halt disease progress at least and even sometimes
reverse it.
Zen and the Art of
Chinese Medicine
July
31, 2013
Steven
Alpern
The
scroll of Zen Buddhist monk Sengai (1750-1838) entitled Circle, Triangle, and
Square is a concise symbolic expression of classical (Neijing style) Chinese
medical thinking. While this brush painting may not be language in the
conventional sense, it articulates Sengai’s intention with clarity and power.
Practitioners raised and educated in the modern world can benefit from his
creative inspiration. We liberate ourselves most effectively from the confines
of modern thought, when we grow more conscious of the divergence between our
scientific conceptual models and classical oriental thinking.
Each
of the three simple geometric figures represents a basic orientation toward
being and knowing. Their relation to each other on the scroll presents Sengai’s
observation concerning the relationships among their respective modes of
thought. Throughout eastern Asia the square signifies Earth, the circle refers
to Heaven, and the triangle is the potential of Humankind to stand on the Earth
and reach toward Heaven – both physically and metaphorically.
The
physical thinking represented by the square is static and structured. The
square is the most diffuse among the three figures, thus the least invested as
real by Sengai. Physical thinking is governed by the naïve perception that
objects displace each other in space. That is, two objects do not occur in the
same place at the same time. This principle is then generalized to apply to all
qualities and characteristics. It becomes the “principle of the excluded
middle” in common logic (formally known as Aristotelian Logic), which creates a
world of objects with fixed attributes and qualities. This structured thinking
forms the basis of modern scientific thought, and its investigation of nature.
Scientific thinking provides a stable cognitive structure (determined by the
rules of material implication) that individuals can use to project point of
view, and control limited aspects of their environment.
The
circle represents the undifferentiated whole that abides either before
individuals establish separate points of view or after they transcend them.
While the undifferentiated embodied spirit is always present, it is commonly
covered over by the individual’s personality. Living in the circle resolves the
conflicts that are necessarily engendered by individuality. The circle does not
touch the square, and has no stable base from which to project individual point
of view. Unconscious projection of interpretations and judgments leads
individuals to have attachments that obscure the subtle nature of the world,
and their interactions with it. The circle represents instead the ideal of
knowing the world separate from point of view, as a dynamic flux of constantly
evolving and transforming inter-dependent influences. It allows every
perspective because any assertion (or even expression) is understood as merely
the projection of individual point of view. Within the “mind of Dao” (the
circle) there is no point of view. There is only being and presence.
The
triangle represents the embodied spirit’s potential to dynamically transcend
the limitations of the square, and progressively approximate the circle. Sengai
presents the triangle as barely touching the most diffuse side of the square –
the less obvious implications of physical thinking – indicating that it is not embedded
within the point of view expressed by the square. The horizontal side of the
triangle emerges from the square, and is parallel with its base. This side
represents the distilled veracity of the physical point of view supporting the
square. The other side touching the square departs in another direction; it
represents those aspects of experience not expressed in the square, thus
highlighting its limitations in comprehending the fluid dynamic nature of life.
The
third side of the triangle (not touching the square) represents the resolution
of these diverging points of view. Each is represented by an equally bold
stroke (strong investment), but when its extent is realized and the corner is
turned toward the other, Sengai withdrew the brush somewhat from the scroll,
leaving only a narrow meeting between the two bold ends. His brush painting
suggests that resolving diverging points of view is accomplished through
perspective – by distancing from both in order to allow the common thread
joining them to emerge. This narrow bridge symbolically represents the capacity
to resolve opposing points of view by recognizing the contextual validity of
each. Individuals can approach knowledge of just what’s so about the point
touching the square, and consequently the square itself, by releasing the
limitations of individual point of view.
Much
of the single stroke of the circle is the most bold and dark of all three
figures – to Sengai it is the most real. It begins at the base of the triangle,
then immediately includes this bridge within its arc. The circle eventually
returns to the base of the triangle, where the stroke becomes somewhat more
diffuse. While the loop closes into a circle, it does so without being strictly
defined for human perception. The circle interlinks with the triangle around
the narrow bridge, which becomes the individual’s point of access into its
holistic thinking. The “mind of Dao” cannot reside in any fixed conceptual
framework concerning nature. It can only be pursued through an ongoing process
of resolving divergent points of view – working the triangle to approach the
circle.
Modern
science has developed very complex and sophisticated theories of the physical
world. Scientists delineate and measure myriad physical parameters, especially
with the aid of various sense-enhancing technologies. While this socially
agreed upon investigation provides a measure of security, scientific
investigations typically fail to discern truths beyond the limits of their
physical models. Perhaps Einstein is so widely revered because he stepped
outside the conceptual model of his time, and explored genuinely new ways of
seeing and understanding phenomena. This is indeed rare in the scientific
world!
Scientists
generally eliminate experiential phenomena as subjective, and give precedence
to “objective” measurements. They remain focused on statements of physical
status, rather than discerning the fluid dynamics of evolving process, which is
based in individual responsiveness rather than uniform movements. The physical
bias of scientific thinking seeks direct, predictable, and reproducible
relationships between causes and effects. It reduces the complexity of systems
by focusing only on parameters that can be physically defined and measured.
This process results in mechanistic models of physical reality that prioritize
single (proximal) causes and the material implications they engender, rather
than exploring the variety of contributing causes that generate individual
variations.
The
“experimental method” for investigating the world falls short of being truly
empirical, because it projects the physical perspective of the square. Only the
circle, which accepts all possibilities, is truly empirical. Yet, the physical
theories of the square appeal to many because they provide conceptual models
that explain (and can predict) certain phenomena. While this may be an
expedient method for controlling a limited scope of the environment (in space
and/or time), investment in the mechanistic model blocks a deeper understanding
of the complex web of causation that characterizes individual situations.
Physical
theories typically evolve in response to conflicting data. Gradually,
scientists recognize the limitations and/or inaccuracies introduced by both
their explicit assumptions and unconscious projections. Integrating certain
considerations from the other side of the triangle can refine the conceptual
model projected by the individual’s point of view. But, a box remains a box.
The increased sensitivity of the model may help one control certain aspects of
the environment, but it does not capture the potential of individually
differentiating the blocks to vital process that create distress, and the
embodied spirit’s need to express symptoms.
The
application of scientific thinking to issues of health has pervasive
implications. It impacts both how doctors understand the nature of various
diseases, and the practical (clinical) approaches developed to address them.
Scientific medicine absorbed its purpose from the common emotional urge to see
disease and suffering as afflictions, rather than a natural result of life.
This bias has created a theory of external (physical) etiology, which relieves
individuals of responsibility for both the development and resolution of
disease. The clinical emphasis of modern medicine is controlling the expression
of disease, rather than resolving the roots of its dynamic process within each
individual’s life (which cannot be standardized into protocols). Focus narrows
to controlling symptoms (often through suppression), rather than discerning and
disentangling the factors creating and sustaining the individual’s blocks.
There
are many specific topics within the various scientific fields related to health
care that demonstrate the implications of physical bias, especially in clinical
implementation. Relative to:
*
Nutrition and Herbs: There is far more emphasis among most experts on the
amounts of specific nutrients and “active ingredients” (easily measurable and
external), rather than on the individual’s ability to utilize them (internal
and not easily quantified or measured). Within the scientific model, attempts
to understand and evaluate life as a vital process led to the refinement of
overly simplistic chemical models into more sensitive biochemical ones. This
led to the idea of “bio-available nutrients,” which represents a significant
improvement over the earlier standard. Yet, it remains a uniform (external)
measure rather than one that differentiates individual (internal) capacity to
utilize nutrients and “active ingredients.” The Chinese medical ideas of food,
qi and blood stagnation address some of an individual’s specific blocks in
resolving material that has been internalized. Individuals may struggle with
many different blocks and/or insufficiencies that undermine their ability to
process physical and experiential inputs into smoothly flowing qi and blood.
They may need a wide variety of therapies to stimulate them to release,
transform, dissolve, or vaporize their impacted attachments. The effects of
neither foods nor herbs can be analyzed down to nutrients or “active
ingredients.” Rather, the impact of their qi on an individual person’s qi is
generally discussed in experiential terms: flavor, nature (temperature), and
channels resonance. Such metrics help practitioners individualize treatments to
stimulate and facilitate a patient’s intrinsic responsiveness rather than
attempting to generically control disease expression.
*
Infectious Disease: There is nearly exclusive emphasis upon various
microbes as the (proximal, physical, and measurable) causative factors, and
nearly none on the individual’s internal ecology as a terrain for the
particular microbes. This idea includes but is not limited to the effectiveness
of immune response. Therapeutic focus is directed toward immobilizing the
reproduction of microbes (physically measurable), without considering the
vitality and effectiveness of the individual mechanisms that expel them and/or
impede their penetration (not measurable). Therapy is directed toward
measurably controlling the external environment, and considered complete when
the proliferation of microbes is rendered inert. Little attention is focused on
the impact therapy has had upon the terrain – the integrity of the individual’s
physiological homeostasis (which is difficult to measure), unless it has been
sufficiently deranged to support another infestation, such as candida in the
gut. The Wen Bing (Warm Diseases) School of Chinese medicine differentiates
three terrains, each with its distinctive nature, typical paths of development
within individuals, and characteristic paths of expulsion and resolution. It
provides guidance for therapeutic intervention in people struggling with
chronic or recurrent viral (wind-cold), bacterial (wind-heat), or fungal
(wind-damp) infections.
*
Osteo-arthritis: There is nearly exclusive emphasis upon inflammation as
the (proximal) cause of pain and the growth of osteophytes. There is little
discourse concerning either habituated muscle contractures, which provide a
stable platform for the growth of osteophytes, or as a contributing cause to
strain, which precipitates inflammation. Neither is there much discussion of
nutrition, and even emotional patterns, as contributing causes of a biochemical
terrain supporting the growth of osteophytes and/or a particularly strong (or
poorly controlled) inflammatory response. The medical approach to clinical
management of people with osteo-arthritis is directed toward controlling the
inflammation and pain, rather than stimulating the individual to change his or
her (internal and individual) factors supporting habituated contractures. While
many physicians suggest exercise for patients with osteoarthritis, there is
little emphasis upon the quality of movement. Specifically, there is little
focus on devising and teaching movements to release the individual’s habituated
contractures, which precipitate and sustain the development of osteophytes.
There are many such systems of therapeutic movement (Qigong, T’ai Chi, and
Daoyin) inspired by Chinese medical theories, which facilitate movement and can
eliminate or dramatically reduce pain and physical restrictions. There are
several other systems of exercise that are equally valuable in stimulating the
flow of qi, which derive from other medical traditions such as yoga from
Ayurveda.
While
the historical and philosophical roots of classical Chinese medicine lay deep
in the shadows of ancient China, the thinking process of the triangle – working
the triangle to approach the circle – remains vitally important. One can work
ideas rooted in modern science with that thinking process to discover pervasive
physical bias. Individuals can learn to observe and discriminate the
unconscious projection of point of view, and release their rigid models for
understanding the physical world, which each person must develop to survive. We
can learn to release how we analyze what we know, and accept fluid
interpretations of what we sense. This can help practitioners develop true
intuition, which is based in calm and quiet acceptance of circumstances,
events, and reactions.
The
language of modern science can make many subtle differentiations, if those
using it remain sensitive to its inherent physical bias. People with any
disease process can be examined with a focus on the internal factors that
generate and support dysfunction, rather than simply focusing on precise
physical descriptions. Patients who learn to disentangle from the conflicts
that generate their blocks can reduce their dependence on reactive attempts to
control symptomatic expression.
Some
modern practitioners of Chinese medicine seek the certainty of a fixed
conceptual model. Rather than including the wide variety of historical theories
and having to “work the triangle” to differentiate individual cases, modern
Chinese medical doctrine provides a single explanation for many symptoms and
signs. Practitioners are taught to classify the manifestations of dysfunction
into symptom-sign complexes, and develop therapeutic strategies aimed directly
at managing them. This clinical model is familiar to people trained in physical
(scientific) thinking.
Rather
than classifying the manifestations of imbalanced function, Neijing style
practitioners seek to identify clearly the individual’s specific blocks, and his
or her struggle to maintain life. The classic texts of Neijing (Suwen and
Lingshu) use the dynamic interactions among the five sets of channels and
vessels (sinews, luo, primaries, divergent/distinct, and extraordinary) to
facilitate the embodied spirit’s intrinsic process, rather than just
classifying their manifestations into syndromes of imbalance in the zangfu
(vital and hollow organs) and trying to manage them with the primary channels
alone.
For
instance, modern TCM subscribes to the ideas of Chao Yuanfang concerning the
source and generation of phlegm. Chao was an Imperial physician during the Sui
Dynasty (581-618), who focused on the proximal cause of phlegm as inadequate
transformation and transportation of food essence by the spleen/pancreas, which
collects in the lungs according to the “normal” physiology of generating
post-natal qi. While this is an important source of phlegm, many other ideas
about it have been used and validated during the long history of Chinese
medicine:
Liver
qi stagnation, which allows for the stagnation of fluids and compresses them
into phlegm; continued impulse (yang) generates heat (hot-phlegm), and can
degenerate into wind (wind-phlegm). The etiology of these was first clearly
delineated by Zhang Zihe (1150-1228).
De-vitalization
of kidney essence (Kidney yang deficiency), which directly degenerates into
phlegm. Blocking or withdrawal of impulse allows cold-phlegm to collect, and
the individual’s failure to control fluids (generally exacerbated by diet)
generates damp-phlegm. While these names would not be developed for several
hundred years until Tang era (618-907) doctors focused on fluids and phlegm as
primary pathogenic factors, Zhang Zhongjing certainly recognized the basic
dynamic of these etiologies in herbal formulas such as Xiao Qing Long Tang
(Minor Blue Dragon Decoction) in Shang Han Lun. Later authors, such as Zhang
Jingyue (1563-1640), developed further the idea that “life is yang,” and
focused on preserving it.
Exhaustion
of kidney essence (Kidney yin deficiency), which generates phlegm as a
distorted attempt to preserve essential yin – phlegm as a response. Zhu Danxi
(1281-1358) focused on essential yin as the foundation of life.
Lack
of willingness by the embodied spirit to see (Heart qi) its experience as it
is, which the cognitive basis of denial. Denial is somatized into phlegm by the
embodied spirit – to make it dormant. This allows the individual to internalize
“new” inputs to process and thereby continue generating post-natal qi.
The
clinical ideal of classical Chinese medicine considers each treatment a unique
creative response to an individual patient. The immediate focus stimulates his
or her intrinsic responsiveness (wei) and/or capacity to internalize experience
(ying). The purpose of acupuncture (and other Chinese medical therapies) is
facilitating the individual’s release of habituated holding patterns, which
accumulate to restrict movement and create various distortions of the
individual’s interaction with the environment. Eventually, these distorted
interactions derange physiological process and create disease. Resolving these
disturbances to vital process (qi) allows disease resolution, rather than
having to settle for its management.
Instead
of releasing their points of view and resolving recurrent conflicts and
struggles, many individuals develop various adaptive and compensatory
strategies to accommodate them. These can be probed with therapies, but
regardless of how insightful the conception and implementation of a therapeutic
strategy, the patient must be willing to release habituated patterns of
interpretation and reaction. Therapy does not directly create healing, but it
can stimulate profound transformations of vital process (qi), allowing
individuals to grow out of the disease(s) they host through distorted
physiological process.
A
practitioner who uses the wide variety of historical ideas of Chinese medicine
can enrich his or her contemporary practice with a rich framework for making
differentiations, and determining therapeutic strategies. There is no limit to
the variety of disease manifestations that have been discussed and treated
during the history of Chinese medicine. While the modern world presents new
stressors to challenge the embodied spirit, there are not new ways for it to be
overwhelmed and fail to sustain individual life.
Therapeutic
results beyond those predicted (or even accounted for) by the physical theories
of “scientific medicine” are available when both the practitioner and “patient”
are willing to go “outside the box” – the square – to engage the intrinsic
wisdom of the embodied spirit. Many treatments stimulate the individual’s
intrinsic responsiveness to expel stagnating factors, and thus liberate the
“patient’s” vitality to focus on supporting life process. Treatment strategies
are found by the practitioner listening to the embodied spirit’s expression of
distress, and facilitating its intrinsic movement to live.
Therapeutic
work inspired by the profound mysteries of life cannot be standardized into
protocols. It arises from identifying and stimulating release of an
individual’s blocks and impacted struggles. Healing ensues when “patients”
allow their whole beings to engage experience in an open and focused way to
support vital function. There is no limit to the awesome potential of the
embodied spirit!
About
the Author
Steven
Alpern, LAc practices acupuncture and Chinese medicine as applied clinical
philosophy. He has followed the inspired teachings of Jeffrey Yuen for more
than fifteen years. Steven seeks to identify and locate blocks to flourishing
health and stimulate their release, rather than classifying symptoms and signs
as the manifestations of distress. His efforts to discern the nature and
dynamics of an individual’s health struggles draw upon the classics of Chinese
medicine and several historical traditions and specialties.
He
focuses on discerning the various contributing causes of disease, rather than
simply classifying manifest symptoms and signs according to a single clinical
doctrine. Instead of trying to control the expression of pathologies, Steven
seeks treatment strategies that stimulate profound and transformational healing
by supporting the individual’s intrinsic process to expel stagnations. That
quest has led Steven to focus on the Neijing (Inner Classic [of Medicine])
theory of the five systems of channels and vessels.
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