Medical science as practiced in the west is a world apart from that which is practiced in China. How can the two sciences differ so much if they have the same goal? This article will look at the different theories and philosophies that build the basis for these medical systems.

 

There are several different theories that build the basis for Traditional Chinese Medicine (TCM). This combination of basic philosophical theories are used to explain the interaction of all things in nature and was greatly shaped by the believe systems that shaped Chinese society at the time. The amalgamation developed the underlying theoretical system to one of the oldest medical systems known to man. Allowing for expansion and interpretation, it gives the practitioner the freedom to think and develop organically. 

 

One of the core Chinese philosophical concepts it that of the Tao. Translated literally as ‘the way’, it refers to the way of the universe and the order of nature. ‘In its original cosmic sense, the Tao is the ultimate, indefinable reality’ (Capra 1980, p111).

 

The principle nature of the tao is the cyclic nature of its ceaseless motion and change.  This was seen in nature by the ancient Chinese as the continual cycle of day and night and the unceasing rotation of the seasons.

 

To give structure to this theory the concept of Yin and Yang were introduced to represent to two polar opposites. Originally they indicated darkness and light, female and male, yielding and solidity. The earth was seen as Yin and heaven Yang, man was seen as a combination of these to extreme manifestations. It exemplifies the Chinese viewpoint that all things in the universe are integrated and inseparable.

 

The Tai Chi T’u (diagram of the supreme ultimate) gives a visual demonstration of the theory of Yin and Yang. The diagram itself is a circle; this represents the cyclic nature of the tao. Within the circle/tao are Yin and Yang, represented by the shaded section, Yin and the light section, Yang.

 

The two sections are not static but instead represent the continual flux and movement between the two opposites, as Yin reaches it’s extreme (largest area) so Yang is born. Yang grows continually stronger and Yin weakens (its area decreases). Then when Yang reaches its extreme Yin starts of again, thus repeating the cycle. This demonstrates the theory that once Yin or Yang reaches their extreme they will transform in to the other. This can be seen also in this example: ‘if a man continues to walk east will he not end up in the west?’

 

Also within the Yin portion is a seed of Yang, and within the Yang portion is a seed of Yin. This is to demonstrate that there can never be pure Yin or pure Yang but that everything within the circle/ tao/ universe is a combination of both aspects Yin and Yang.

 

The Ba Gua or eight trigrams also depicted Yin and Yang visually; here Yin was shown as a broken line (- -) and Yang as an unbroken line (--). Yin and Yang were combined in to three tiers and formed eight combinations, these are the Eight Trigrams. 

 

Legend tell that these were given to the Chinese by one of the August Ones, a god named Fu Xi. The trigrams were used for divination by inscribing them onto bones or shells and tossing them into a fire. The ones that cracked would then reveal a message. This system was revised by a ruler named Zhou Wen Wang who arranged the trigrams into two tiers to form 64 hexagrams, he also wrote explanations of all of them. His son, Zhou Gong continued his work and wrote explanations of the individual lines of each hexagram and commented on the significance of the integration of the two trigrams. This was the birth of the I Ching.

 

 

I Ching literally translated means the ‘Book of changes’; its name refers to the continual changes and movement of the universe that are the very essence of Tao. ‘The I Ching was written to help people perceive the rules of the environment, heaven and destiny, so that they might try their best to create and enjoy a better life.’

 

The I Ching had a huge impact on Chinese thinking from that point onwards. In the opinion of R. Wilhelm, an authority on the I Ching and Chinese history, “Nearly all that is great and most significant in the three thousand years of Chinese cultural history has either taken its inspiration from this book (the I Ching), or has exerted an influence on the interpretation of its text.”

 

This does not exclude the classics of TCM either, due to its use of Yin and Yang theory it was extremely influential in the progress of medical philosophy. The great doctor Sun Si-Miao (581-682 A.D.) said, “if you do not know the I Ching, you cannot understand medicine at all.”

 

The Huang Di Nei Jing (The Yellow Emperors Classic on Internal Medicine) discloses theories that refer heavily to the theories of Yin and Yang used in the I Ching. Tsui cleverly describes their relationship thus “If the Nei Jing is a door to the treasure-house of Chinese medical classics, then the I Ching is the Key.”

 

Wu Xing, the Five Elements or the Five Phases, is another ancient view of the world that has made a considerable impression on Chinese medical philosophy. The ancient Chinese saw that in nature everything could not only be divided into the categories of Yin and Yang but also into the Five Phases.

 

The Five Phases can also be seen as the five ultimate constituents of matter that constructs the world, namely Wood, Earth, Fire, Water and Metal. In following with the way of nature these elements are not static but interact upon one another in various ways, also each phase has certain properties or attributes that classify it. The different interactions were named Sheng, Ke, Chen & Wu, which directly translated mean Generation, Restriction, Take Advantage and Rebellion.

 

This theory was incorporated into TCM providing classification of organs and pathogenic factors alike. It is still used as a tool in TCM diagnosis today. It is very popular in certain western schools who have attempted to interpret Chinese medicine. However, the framework this theory provides is slightly more rigid than the Yin and Yang theory and therefore plays less of a role overall in Traditional Chinese Medicine.

 

Confucianism and Taoism are the Chinese philosophies that have dominated in China since their conception. The theories of Yin & Yang, I Ching and the Five Phases were well developed and accepted by the time these philosophies came about and were simply incorporated them into their ideologies.

 

Congfuzi (551-479 B.C.) lived in a society in turmoil his philosophies tried to find a way out of the darkness of war and return the Chinese people to the golden age of the August Ones. He emphasized learning, knowledge, benevolence, courtesy and morality; he wanted to teach people to be virtuous. His philosophies shaped society from the individual through the use of his minor taos (ways). ‘His works were the model for all people, and political factions made use of his teachings to strengthen their own rule.’ They also set the ruling classes as examples of morality; Aristotle described it as the “philosophy of princes”.  

 

The Si Shu Wu Jing (the Four Books and Five Classics) are the classics of traditional Chinese literature and Confucius contributed heavily to them. One book stands out in regard to TCM and that is Zhong Yong (The Doctrine of Mean). One of the ‘Four Books’, it echoes the ideologies of the I Ching emphasizing the importance of balance, staying to the middle and not diverging to the extremes.

 

It is hard to date its conception but the core Taoist text, the Tao Te Ching, was said to be written by one of the great Taoists, Laozi. The book is written in verse, which leaves the meaning often obscured, but the work is very open and accessible. In it he gives his knowledge to help with political matters, every day life and in understanding nature and the way of the universe. 

 

Taoists strive to simply follow the ‘way’ of nature, to understand natures many manifestations (i.e. Yin Yang, Ba Gua, Wu Xing) and achieve perfect harmony with the universe. The heroes of Taoism are normally depicted as the common people, often able to out wit the educated classes through the simplicity of Tao. Of these two philosophies Taoism had a much greater bearing on TCM. Confucianism saw that as being moral and being human were inseparable concepts, therefore a moral person would have strong qi and good health.

 

 

Modern Western medical philosophy only began to emerge around the fifteenth century, although philosophies about science, nature and medicine did exist prior to this. However, they were far removed from the form in which they exist today. Several drastic philosophical breakthroughs were made by a few men that allowed modern Western medicine to progress to its present state. Before these breakthroughs medical philosophy was based on ideas, classical Greek theories and held back by the restraints of religion.

 

Francis Bacon (1561-1626) was an Englishman distinguished in law, politics, literature, philosophy and science. He saw the shortcomings of the two separate views of science; rationalism and empirism.

 

He thought the rationalists although having impressive structure to their ideas lacked sufficient contact with external reality, leading them to inaccurate assumptions and conclusions. He saw Empiricism as collecting data but not having sufficient knowledge to know what to do with it. He compared the two philosophies to a spider and an ant respectively, he thought that the ideal philosophy should be like a bee, able to collect the data and have the knowledge to know what to do with it.

 

His ideology stated that people should follow controlled and systematic procedure; they must observe the facts, record the observations, and amass a body of reliable and accurate data. This would reveal regularities and the patterns of the laws of nature. ‘This formulation of scientific method was to have a simply immense influence from the 17^th century to the twentieth. As generation after generation of scientists were guided by it.’

 

One of the first discoveries to come out of Bacon’s empiricism was the discovery of circulation by William Harvey in 1628. Harvey was a man torn by his love of the classical philosophies of Aristotle and disgust of ‘New Science’ and their view of nature as ‘machine like’. His discoveries on circulation contradicted the well-accepted views of Aristotle and Galen, yet his education in their ways stopped all of his conclusions being completely correct. Descartes rejected what he saw as, Harvey’s vitalistic explanations, he believed ‘that the heart acted mechanically, rather like a combustion engine.’ By the 1660’s the new mechanical philosophies were quickly replacing the older philosophies and despite his dislike of them Harvey’s discoveries really paved the way for New Science.

 

Descartes (1596-1650) theories gave birth rationalism; he saw that knowledge of the world should be based on reason not on unreliable sensory input. He saw that science needed to ‘start from simple undoubtable facts and then derive logical consequences from these facts in chains of deductive reasoning’. This became the very foundations of western science. Descartes was very sure that sensory input was inherently unreliable and more a source of error than a source of knowledge. However, modern scientific philosophy has since been modified to acknowledge observation in its search for indisputable facts.

 

With ‘new science’ came a more accurate understanding of the body and its workings but at the same time it started to move away from the more holistic view of the classical philosophies. The world was explained by ‘dealing with the relationship between cause and effect and everything would become clear when divided it into small parts or elements by dissection and analysis.’

 

Science continued to develop out of the anatomical tradition of dissection and the study of individual parts but the picture of the whole was lost. The Chinese have proverbs describing this type of approach to life; ‘looking at a leopard through a bamboo tube’ and the ‘three blind sages trying to describe what an elephant looks like while only feeling one part of its anatomy’.

 

With the advances in the field of medicine over the last century western philosophies have been forced to change and start to incorporate a more holistic view of the body. With the advent of neurophysiology, endocrinology, immunology and molecular biology views that can observe the relationship between the whole and its parts have been incorporated into modern western medical philosophy; e.g. systematics, cybernetics and informatics, to name a few.

 

 

Eastern and western viewpoints clearly show that although doctors strive cure the patient, they take very different routes. Western ideologies direct the doctors to isolate the disease, identify it, then follow set procedures to eliminate it. This method has very often been likened to the car mechanic when servicing a car, the faulty part is found and either fixed or replaced. Even with the incorporation of new methodologies, the older ideas of viewing things in an isolated way is still the norm.

 

‘Traditional Chinese Medicine embodies rich dialectical thought, such as that of the holistic connections and the unity of Yin and Yang.’ It is this set of philosophies, which from the outside seem overly simplistic, that has allowed TCM to survive more than two thousand years, even with the emergence of western medicine.

 

TCM philosophies strive to see a problem from every conceivable angle, to understand not only what its direct implications are but also what other systems could also be disturbed by its manifestation. The western view is one that is static or dead, it is to root out the problem and deal with it, as their understanding is not one of systems and interrelations.

 

This view is changing and in my opinion will continue to change, it seems that the natural ‘way’ that medicine must follow is one that not only sees problems within man but sees how man interrelates to all things in nature. This is simply said but history teaches us that old habits die hard and man often holds on to what has been accepted for a long time. Yet all the major discoveries of recent years have been made due to a change in philosophical outlooks.

 

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