About Chinese Medicine Part 2: So how does it all work?

Today I will set about the complicated task of trying to explain the logic behind Chinese Medicine, or How It All Works. I use the word complicated, not because the logic itself is complicated, in fact it is all based on very simple and practical principles. However, to explain it to someone with no formal knowledge of TCM can be tricky. I remember the first time I was battling with TCM theories. It was during my TCM course with the Beijing University. We were all medical doctors and we all struggled. It was very hard for us to comprehend what the lecturers were saying. It was completely different from everything that we knew (and remember most doctors think they know most things there are to know about human health). The main problem was that we heard about Qi and Yin and Yang, heat, cold, dampness and what happens when these are out of balance. It sounds initially like a dry list of statements that didn’t make much sense,it was like reading out of telephone directory. How do you know? Where is the proof? What makes you think that all of this is actually true? We all felt a bit uncomfortable, with some of us probably questioning the wisdom of paying out good money for attending the course.

This heart-sinking feeling started to gradually change when we began to see patients. All of these seemingly dry and abstract theories (for modern doctors) started to come to life. We could actually see then that the Yin deficient patients were getting hot and dry mouthed at night for example, and that the patients with excess dampness felt heavy, bloated and sluggish. The Qi deficient ones were tired and their speech sounded like they were straining to get the words out of their mouths. The blood deficient ones were pale and a bit dizzy; the liver stagnation patients were emotional and impatient and so on. It all started to make sense. We started to realise that all of these TCM theories are based on careful and patient observations, and are based in reality. The warming up of our attitude towards the TCM theories further strengthened when we noticed the night heat and dryness had improved when the patient was treated for the Yin deficiency; the mood swings and irritability had disappeared when the liver stagnation had been attended to, and so on. Brilliant, I thought; as I keep on telling my patients-the proof is in the pudding. I have never looked back since.

In the beginning, however, it was all a bit difficult to understand so I will do as I always do and try and simplify TCM for you. So, where shall we start? I think that the two most important principles in maintaining health according to Chinese medicine are flow and balance. Flow refers to the flow of Qi (body energy), blood and body fluids. Balance refers to the balance between Yin and Yang, heat and cold, dryness and dampness and excess and deficiency. As long as free flow and balance are maintained in our bodies then all is good; we feel well and are not suffering from any ailments or symptoms. However, if the flow is blocked or disturbed, or if the balance fails to be maintained, then problems will start. These problems can be on the physical, emotional or mental levels. I will explain in more detail, starting from the flow. The most important flow is the flow of the Qi. Blockage of this flow will result in pain that is usually dull or throbbing in nature. A common example of pain from the stagnation of Qi is the abdominal pain suffered by some of the IBS (irritable bowel syndrome) sufferers. On some occasions the flow of Qi is not blocked but just disturbed. A very common example of that is when the liver Qi flow is disturbed usually following stress or worry. The resulting symptoms will be mainly emotional such as mood swings and irritability. The Qi is needed for all the body functions and therefore a disturbance in its flow can be followed by symptoms in different systems of the body. It will usually start to cause a problem in the weakest area in each individual. Problems with the flow of blood will also primarily manifest as pain. Pain from blood stasis will typically be sharp and stabbing in nature. Blood is most important in women and most gynaecological problems are related with blood circulation problems. Examples are endometriosis, PCOD (polycystic ovary disease), infertility and painful periods.

The flow of blood is also essential in the healing process of wounds and traumatic injuries. It is quite astonishing to see how quickly traumatic injuries are healed when treated with Acupuncture and herbs to improve blood flow.Another example is non-healing ulcers. These are typically occurring in diabetics and old people and are the result of poor blood circulation that prevents healing.These patients will have to go to the GP clinic two or three times a week to change the dressing on the wound/ulcer but there is not a prospect of it healing. However, if it is treated with Chinese herbs that improve blood flow then the wound/ulcer will heal within a few weeks!

The flow of body fluids is also very important-we are 70% water. Still, normally, we don’t feel that damp. However, if the normal flow of fluids around the body is disturbed then problems will start to manifest. These types of problems can manifest in different systems of the body. A few common examples are: digestion problems such as bloating and diarrhoea, oedema, skin conditions like eczema and psoriasis, joint problems like arthritis, thrush and others. So, maintaining the free flow of Qi, blood and body fluids is very important. As long as they flow then all is in working order.

Now, what about balance? We mentioned Yin and Yang, heat and cold, dryness and dampness and excess and deficiency.First Yin and Yang, this blog is too short, of course, to explain the Yin and Yang concept properly. It’s a bit tricky to understand and I have met a few practitioners who still struggle with it but I’ll try to explain. Yin and Yang are the two opposite aspects of any energy. They contrast but co-exist and are co-dependant. Everything in nature has a Yin and Yang aspect to it. The famous Yin and Yang symbol (see picture) symbolises this co-existence. It shows two separate powers creating the whole. The little dot represents the small amount of Yin within the Yang and vice versa. They are co-dependant and nourish each other. Yang is hot and fiery and rising upward and Yin is cool and watery and going downwards and so on. So what does it all mean to human health? In the human body the Yin and Yang have to be operating in perfect balance. Any change from this balance will start to manifest as physical symptoms e.g. if the Yin energy is weak then the person may feel hot, particularly at nights-night sweats are possible, dry mouth, or general dryness and sleeping difficulties. It’s like our coolant and moisturising fluids are missing. The Yin deficiency symptoms tend to be more prominent at night as night is normally the time when the Yin is predominant whilst the Yang is predominant during the daytime. The most common example of Yin deficiency is the menopausal age. At this age the woman experiencing a sudden drop in the Yin energy results in symptoms of night sweats, dryness and so on. These women, by the way, will respond wonderfully well to a course of treatment to strengthen their Yin energy. When the Yang energy is low, the patient will feel cold and tired. Low libido, sexual function and difficulties, and water retention are common as well. The deficiency of Yin or Yang can be general in the body but can also be limited to a specific organ e.g. asthma arising from lung Yin deficiency will typically manifest as wheezing with a dry cough and a dry throat whilst asthma arising from a lung Yang deficiency will more often manifest with wheezing with a cough with a large amount of phlegm obstructing the airways. The picture can be a bit more complicated when there is a mix of Yin and Yang deficiency but an experienced TCM practitioner should be able to make the right diagnosis and apply the right treatment!

The second type of balance that needs to be maintained in order to promote health is dampness and dryness. Our body needs to be in a perfect level of humidity throughout all the different tissues and organs. We are made of 70% water and yet we normally don’t feel watery. That is due to this perfect working balance of the fluids within us. What happens if this balance is disturbed? We start to struggle. This can happen in certain areas of the body (e.g. digestive system) or within certain systems (e.g. joints) or it can be general in our body. An added complication to these conditions is that when fluids start to accumulate in the body they often turn from clear healthy fluids to more thick heavy and sticky fluids, termed by TCM as damp. Damp is a major pathogen in TCM. It commonly arises as a side product of ineffective digestion and is found to gradually accumulate and spread in the body. It’s common in modern day due to rich and often unhealthy diet and eating habits, often combined with being under pressure and with a weakened digestive system. When it accumulates it can cause problems in different systems of the body e.g. abdominal pain, bloating and diarrhoea, arthritis and asthma. Heaviness and stiffness are common.
The opposite of dampness is dryness. In these situations the organs and tissues are suffering from a lack of moisture. This situation can arise from the presence of heat which dries the tissues, from problems in the body water distribution system or pathway or from lack of Yin ( remember, the energy that keeps us cool and moist). A common manifesto can be constipation with dry stools, dry skin conditions like eczema, and lung conditions like asthma.

The third balance is the one between heat and cold. The temperature has to be right all over the body to sustain good function. As is the case with other elements, heat and cold can affect one area of the body or be generalised all over the body. Some of us are naturally colder and will be more susceptible to cold related problems, and vice versa with the naturally hotter people. In some cases we can have a mixed picture where in certain parts of the body there is too much heat and in others too much cold. This can make treatment a bit tricky and an accurate diagnosis is essential here. The most common symptom from excess cold is pain. It is commonly in joints (the ones that get worse on a cold day), in the digestive system or in the gynaecological system. Heat problems are very common these days. Generally speaking, a rich diet and stress are to blame for that as both tend to generate excess heat in the body. Excess heat is a common cause of most skin conditions, inflamed joint conditions like gout, most types of migraines and many others.

The balance between excess and deficiency is very important but is also a bit hard to explain. Generally speaking the practitioner has to decide, in any one case, are the symptoms a result of the patient lacking in something or having too much of something. In other words, what is causing the imbalance-too much (excess) or too little (deficiency)? For example, the patient is feeling too hot-is that a result of too much heat in the body or is it a result of a deficiency in the Yin energy which is the energy that keeps the body cool? The patient feels a lack of energy – is it a deficiency in his Qi energy or is it a result of dampness clogging his body and making him feel heavy and sluggish? Correct diagnosis is absolutely essential and getting it right is more than halfway towards successful treatment.

Alongside free flow and balance, there is one more critical aspect of Chinese Medicine, which I have not yet discussed with you: the function of the body organs.

One of the most amazing insights of TCM into the human body is the understanding of the subtle function of the organs. Try and tell a doctor that the heart is responsible for our sleep and our mental ability and he will think that you are tripping on something! The heart is just a muscly pump which pumps the blood around the body, he will say. A similar bemused reaction will follow the claim that the liver is in charge of our emotional functions and is of crucial importance in conditions like depression and anxiety. Modern medical science knows only about the physical and chemical functions of our organs but unfortunately has no idea about their subtle functions! Understanding the function of the different organs, particularly of the heart, kidneys, lungs, liver and spleen ( in TCM the concept of spleen includes the pancreas, the duodenum and the small intestine) is essential for successful diagnosis and treatment.

In reality, of course, humans are not simple and often symptoms will arise of a combination of two or more of these imbalances. For example, stress can disturb the flow of the liver Qi which will often affect the spleen; a weak spleen will cause inefficient digestion which will result in an accumulation of dampness. The dampness can clog the flow of Qi and so on. In my clinics I often see cases which are very complicated, many systems are involved and imbalances are intertwined.
The longer you leave the problem without treating it the more complex things tend to get. The reason for this is simple: when one area or system starts to malfunction it inevitably puts pressure on other areas or systems of the body; after all, they are all connected and intertwined in the great living work which is our human body. It is very important therefore for the TCM practitioner to have a deep understanding of the subtle workings of the body and of the different pathologies that may affect it. An accurate diagnosis is key to a successful treatment.

I hope this post makes TCM a bit more understandable. It is about a fully established and very effective form of medicine and it’s important to me that people understand more about it.

In my next post (or maybe few posts since it’s a big subject) I am going to compare Western and Eastern medicine in their philosophy, understanding and methods. That is, I am going to try and look at how they compare in treating different conditions.

Good health to all of you,

Dr Ilan Shahor