Traditional Chinese Medicine
Traditional Chinese MedicineAt the center, man A design of life The classics of the medical tradition The fundamental notions Conception and structuring of man
- In the center, man
- A design of life
- The classics of the medical tradition
- The basics
- Conception and structuring of man
- Man: microcosm and micro-society
- The energetic structure of man
- Organs and viscera (zang / fu)
- Shen theory and the psychosomatic issue
Conception and structuring of man
Man, as seen in Chinese thought, has two characteristics which differentiate him from the man of western medical and scientific thought. In the first place it is considered as an open system, closely linked to the life of the universe and dependent on the environment in which it lives. Its energy structure, which we will briefly illustrate here, takes up the fundamental characteristics of cosmic energy, which structures it as a microcosm in perfect resonance with the environment that surrounds it.
Secondly, man is considered to be one: there is, as we shall see, the psyche / soma separation typical of western culture. Body and spirit can be conceived separately only on the understanding that division is theoretical. The energetic body of Chinese medicine therefore approaches more than the mechanistic body of Newtonian physics, the basis of western medical-scientific thought, the cybernetic body, which constitutes the most advanced interpretation model of modern neurophysiology.
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Man: microcosm and micro-society
The study of Chinese medical thought cannot fail to mention its main elaboration tool, the analogy, considered as a mode of relationship between entities or things different from each other for quality and quantity: it represents the privileged method adopted by Chinese thought to structure that world of correspondences which is the basis of ancient knowledge.
The Chinese have always given much importance, rather than to the measurement of effects and the search for causal links, to the observation and cataloging of correspondences, up to hypothesize a phenomenally comprehensive knowledge of reality.
The analogy allows the essay of Chinese antiquity to transpose knowledge of the relationships between the various objects and events of the macrocosm to that small, defined and delimited area of it, which is man. It is no coincidence that the statement, however inaccurate, that the Chinese doctors did not need to perform anatomical dissections could be spread, being sufficient for them to study the energy correlations between the various organs, within the laws correspondence between the organs themselves and the celestial structures. In humans, with the proper proportions, phenomena would occur "as in the universe", and the relationships that govern the generation and mutual control of the internal breaths would be structured on laws of similarity similar to those that govern the great movements of the breaths at the level cosmic.
Thanks to analogical thinking, the notion of correspondence also developed, which expresses nothing but a particular case of similarity; The correspondence theory finds its model in the Five Movements theory illustrated above.
Starting from the third century BC, the era in which cosmological systems were developed, the natural order became a functioning model applicable to every field of knowledge: natural, medical, social, political. In medicine, the model of physiology refers not only to cosmology, but also to politics, because with the unification of the Empire in 221 BC a cosmology of the state developed, understood as a world, which was also applied to the human body. Thus the human body is considered as a country, made of mountains, rivers and seas, palaces and doors, and where, for example, the vases correspond to the streets, the organs to the barns and barns. This country is administered by gentlemen and officials: "The heart has the function of a Lord, the lung is the Minister and Chancellor, the liver is the commander of the army" (Suwen, chap. 8).
Below we will try to briefly exemplify these concepts, starting from the first and fundamental analogy. The Lingshu states that man responds to Heaven and Earth and that this is explicit also in its structure. “Heaven is round, Earth is square; the round head and square feet are in accord with Heaven and Earth "(Huang Di Neijing Lingshu, ch. 10).
According to ancient cosmology, the breath (qi), which logically constitutes the One, emanation of the Tao, differs and expresses itself as Two (the yin and the yang). The light, ethereal yang breaths rise and form Heaven; the heavy, coarse yin puffs pile up and give life to the Earth. The supreme unity, primordial breath, passes from the unmanifest to the manifest through the yin / yang dynamism. Between Heaven and Earth a median space opens where man lives, the result of the unity of their breaths: it is the Three. Thus there is the triad Heaven / Earth / Man, or median yang / yin / void, where the latter is the space in which the yin and the yang are present and intersect, allowing life and its continuous transformations.
Man, proceeding from the union of the energies of Heaven and Earth, defines himself as one of the manifestations of the breath of the universe. Microcosm in the image of the macrocosm, as a third element, it participates in the work of Heaven and Earth and is constituted and reconstituted by their influences at all times.
Three lives and exists insofar as it proceeds and depends on Two.
The anthropological vision of Chinese thought is not only coherent, but fascinating, because it affirms trust in the universal order of Life, based on the constant interrelationships and transformations of the parts that constitute it: man cannot be separated from the universe in which he lives, from Heaven / Earth that constitutes it. "The Heaven-Earth interval / is like a bellows / empties itself without getting tired / wants to blow again in action" (Lao Tseu, Tao Te King, The Book of the Way and Virtue).
The Heaven / Earth interval, the so-called median void in which living beings live, is therefore compared to a bellows: the breaths come and go, the living beings come out and return to life, remaining alive all the time in to which the breaths of Heaven / Earth that constitute them remain firmly intertwined. The living reality is one: for ancient Chinese philosophy everything lives in the One and everything returns to the One.
To live is to go out and take a form; to die is to leave this form and return to the undifferentiated. We are one with the universe and the environment around us, against which there is an unceasing exchange of energy, of breaths. We follow the laws and the cyclical nature of the rhythms of the universe. This is what Chinese medicine teaches, which requires this awareness from the doctor when he is in front of his patient: to evaluate his health, he must be able to judge the flow of his energy according to the time of day, the season of ' year, the period of his life and the place where he is, because it varies according to cosmic variations.
But what exactly are Heaven and Earth in the structuring of man?
For ancient Chinese thought, "man is formed by the combined virtue of Heaven and Earth, by the meeting of yin and yang" (Liji, Book of Rites). From Heaven he receives not only the cosmic energies (qi), but above all the Shen, the Spirits (very important notion of Chinese thought and medicine), which constitute his mental, psychic and spiritual aspect. From Earth man receives the nourishing energies, the essences (jing) which constitute the materiality of his body.
We cannot talk about health and disease or prevention without having these concepts clear. In fact, man responds to Heaven and Earth, in the sense that there are laws that define the ways of existence and functioning of the universe, which also determine the functionality of the organism, because man is an integral part of the universe and participates in its movements and energy changes.
According to Chinese philosophy, Heaven not only regulates the laws of the universe, establishing seasonal and circadian cycles, but it is what gives each one its own nature; moreover, it is what gives each being its own destiny. Heaven in ancient cultures is, in fact, ambivalent: it has a physical aspect and a spiritual and moral aspect.
Every man, with existence, receives the constituent parts of his being from Heaven and the law that must govern his actions. He carries the natural law in his heart and, consequently, loves the virtue of which he knows the beauty.
For Chinese thought, the Earth is a dispenser of forms, and gives man the shape of his body. In fact, the earthly part of man is made up of jing, whose meaning is "essence", the most material aspect of the human organism.
The hereditary jing, given to the new being by the parents at the moment of conception, is the primary matter from which the fetus is formed; after birth, stored in the kidneys, it determines the growth and development of the individual. Jing is limited and can be partially reintegrated with food. Its quality depends on a person's health, vitality and lifespan. The biological phases of human life that follow natural laws are closely related to the state of jing, its floridity or its decay. Growth problems, such as abnormalities or delays, as well as premature aging phenomena are all related to jing disorders. The jing is also the physical support of the manifestation of the Shen, the Spirits, who incarnate in man when the father and mother jing unite. The Shen, which derive from Heaven, and the jing, which derives from Earth, form the joining of the vital Spirit (jingshen), the principle of individuality that makes man unique and unrepeatable, a mysterious expression of the life that animates him.
The fact that the Chinese considered man to be a model of Heaven / Earth is shown by the ancient pictogram that distinguishes him: the round head is a symbol of Heaven, the feet designate a square, a symbol of the Earth. This character evokes in a suggestive way the pictogram of the tree, which represents a trunk from which branches go upwards and roots downwards.
With the roots immersed in the Earth, in the deepest yin, and with the branches reaching out towards Heaven, towards the yang, the tree recalls the reality of man: like the tree, man lives a rhythmic cycle of birth, growth and death; it has within itself the constant flow of its nourishment and the biological memory of its life. Rooted to Earth, man must make a ascent to Heaven, to mature the spiritual germ and become fruit. The tree is thus the symbol of this spiritual ascension through which man completes his maturity. His Earth is a matrix in which he must give birth to himself; for this reason, in many cultures, the tree / man was represented with the roots at the top to indicate that there, in Heaven, is the beginning of life and there man must return (think of the Tree of Life of Jewish tradition or the Tree of Happiness of the Muslim tradition).
The modern character that designates man, ren, represents him erect, structured and integrated in Heaven / Earth, of which he is the most eminent representative.
As stated in Suwen, "of all the existences that take place between Heaven that covers them and the Earth that brings them, the most precious is that of man". This man is not a theoretical being, but a concrete individual, inserted, starting from the initial moment of his conception, in a space and time that are his personal history.
Ancient Chinese embryology, which is presented for the first time in Huainanzi (philosophical text of the second century BC), says that in the instant in which the jing of the father and mother unite, the Shen intervene to make the individual unique. Not only all his biological reality, but also his nature (xing) and his personal destiny (ming), which he has, are inscribed in this living being, which Heaven and Earth have realized thanks to the profusion of their most subtle essences. the task of researching and completing.
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The energetic structure of man
Man owes his life to a condensation of qi: while this remains condensed he lives, while as soon as he disperses he dies, and man's qi returns to the indefinite potential state (Zhuangzi, ch. 22).
To study the various types of qi, it is possible to isolate and subdivide them, but it must be borne in mind that they constitute ontologically a unit.
Man, like the macrocosm, lives within a dialectic between the most manifest yin (form, body, most material substances such as blood, liquids, essence) and the least manifest yang (the energy that activates all the processes that take place in the organism, the spirit, the psyche). In fact, the main concepts expressed in the term qi are two: energy as a fundamental substance that constitutes the organism and energy as a vital activity that allows all the processes of growth, development, transformation that make human life possible within nature.
Chinese medicine believes that the murmurs that make up and regulate the animation of living things flow along vessels, called meridians, and that the state of qi can be appreciated on the wrist. One of the most important characteristics of qi is linked to the notion of circulation, very important for understanding one of the most relevant functions of qi, that of correlating the whole organism to determine a continuous flow of information from one end of the body structure to the other. . Qi is constantly present everywhere, but is subjected to flow and outflow phases; therefore it is often predominant in certain areas of the body at certain times of the day.
The qi, which is actually unique, in medicine is made the subject of a very detailed classification, which identifies its distinctive features in the origin (anterior and posterior sky), in its localization (in an organ, in a body area) and in the functions performed (defense, nourishment): this refers to the specific physiological activity of each of the organs and viscera qi (for example, the heart qi has the characteristics and qualities of this organ, and performs functions other than spleen qi.
The qi, the puffs, are divided into puffs of the anterior Heaven, or innate puffs, and the puffs of the later Heaven, or acquired puffs.
The first term designates the energies of the father and the mother, which are contained in the gametes at the moment of conception, as well as the energies of the cosmos present at that precise moment. Conception is the moment that marks the transition between the innate and the acquired. The hisses of the posterior Sky, on the other hand, correspond to the energies that are acquired through food and breathing.
The innate energies of the anterior Heaven are the yuan energy, the jing energy and the zhong energy. The first, defined as original, is the most important energy of the organism, because it constitutes the spark of all the vital processes and the energetic patrimony received at the moment of conception; with its slow decrease it will determine the life span of the individual. As we have already seen, the jing energy (or essence) instead constitutes the energy that is transmitted by parents to conception and has the main function of determining the development and growth of the individual both in the phases of intrauterine life and in successive stages of life, until death; together with the acquired jing of the later Heaven, which man derives from food and breathing, it forms the jing circulating in our body. The concept of jing highlights how the front and rear Heaven can never be separated, precisely because man is the continuous cross and combination of the breaths of Heaven and Earth, of congenital and acquired, and only with death can he separate. The third innate energy, zhong or ancestral energy, has the task of transmitting the genetic patterns typical of the species, such as the rhythms, some vital parameters and all the characteristics of species that make man a mammal different, for example, from the dolphin or mouse. Yuan qi, jing qi and zhong qi come into play in the fertilization of the egg, constitute the energy potential of each individual, preside over the development, growth and maturation phases and will tend to decrease according to the natural processes of senescence.
The main energies of the posterior Heaven, which preside over the daily functions of life, are the ying energy and the wei energy. The first, nourishment at the purest stage, is deep and provides the basic energy: it is, in fact, the product of the distillation of everything that our organism takes from the outside (food and air) for its sustenance, after being passed the sieve of the viscera; it also has an important function for the formation of fluids and blood. The circulation of ying energy permanently crosses all the main and secondary meridians, therefore all organs and viscera.
Wei energy is a defensive energy that Neijing defines as "fierce, rapid, of great mobility". Unlike the other energies, it does not flow into the meridians, but between skin and muscles, and is used to combat the external "perverse" energies xie qi, that is, carriers of energy imbalances and therefore of diseases.
Original energy (yuan), essential (jing), ancestral (zhong) on the one hand, and ying and wei on the other are authentic, legitimate energies, zheng, as opposed to perverse energies, xie qi, of both internal and external origin, that attack the individual and trigger the state of alert and defense.
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Organs and viscera (zang / fu)
The organs of Chinese medicine may recall similar structures of western medicine, but in reality they are very different entities: they are in fact considered from a functional rather than anatomical point of view, as the tendency of Chinese thought is to seek functional dynamic activities when describes structures; they also have an original psychic connotation, since they each house a specific Shen. The latter, the Spirits, in addition to providing widespread animation to all living matter, represent the theoretical prerequisite for the psychosomatic conception of the organism, and are therefore nuclei of psychic structuring but also foundations of the structuring and development of organs, zang, and viscera, was.
Zang means keeping in a safe and hidden place, hoarding: the organs in fact receive the refined and purest breaths and accumulate them. They are full organs and are five: lung, heart, spleen, liver, kidneys. They are yin, because they are located more internally than the fu (yang, because they are more external).
I fu, which we call the viscera to differentiate them from the organs, are responsible for the transformation and transport of the breaths: their ideogram represents a transit warehouse for precious goods. They are hollow organs, where jing energy derived from food is processed and refined, and there are six: stomach, small intestine, large intestine, bladder, triple heater, biliary vesicle.
Considering the ontological structuring of the zang / fu, their function and above all the deep relationships that connect them with each other and with the whole organism, it must be underlined that the translation of the various names with the relative names of western medicine is inadequate. The error of this translation consists in tracing back to known anatomical entities (liver, kidney, spleen etc.) of structures which, if on the one hand in their most material aspect comprise the anatomical datum, on the other hand exceed it. In fact, each organ implies a functional and connecting aspect that goes beyond the organ in its material constitution. “The concept of zang is actually, for Chinese medicine, a broader concept that comes close to our concept of system. The organ system, in fact, includes in addition to the western organ, classically understood, other structures such as a meridian, a sense organ, a fabric, an orifice, all connected and connected to each other by some well-defined and precise energy characteristics ".
The organ is the center of this system to which everything refers and therefore, when we speak of zang in Chinese medicine, we always refer to the organ-function, meaning by this term an organic structure, its psychic instance, its specific dynamic activities within the organism and all intra- and intersystemic connections that it maintains.
The network of main and secondary meridians departs from the organs and viscera, which runs through the whole organism, both on the surface and in depth, transporting the vital energy qi. In good health energy runs harmoniously through the meridians; when, due to an intervention of external or internal agents, an imbalance is created between the energy of man and that of the environment or between the energy of one organ with respect to the others, the organism weakens, the person gradually loses its defense capabilities and gradually the more or less serious symptoms of the disease appear.
It is not possible to analytically illustrate the functions of the five organs and six viscera; we will limit ourselves here to reporting a similarity that often occurs in classical medical texts. In fact, as we have seen, the zangs and the fu are related to the human body, as well as from physiological considerations, also from analogical correlations: thus the human body, considered as the Great country of the Center, is administered and governed by structures similar to those which govern the empire.
The heart performs the functions of sovereign and at the same time of minister. Being the seat of the Shen, it is the place where discernment, intelligence is formed. As sovereign he is responsible for the organization and organization of all the Shen of the organism; as minister, thanks to his ambassadors and messengers, he transmits his orders, so that all that must be accomplished is accomplished. The heart assisted by the other organs is the sovereign who resides in his palace located in the heart of the empire.
The peace, prosperity and security of the sovereign and his kingdom depend on the vigilance of the guards. The organs have the function of watching over the doors which are the orifices of the sense organs. They must oppose the intrusion of the pernicious energies that bring disease and prevent the Shen who animate the body from abandoning it.
The spleen, as a controller of digestive transits, serves as the minister of transport and transformation. Its task begins as soon as the food has been ingested until the assimilation of nutrients.
The liver is the general of the armies, because it commands the defensive energy and because, like the general in chief, it has the main task of planning the battle.
The lung has the ministerial task of transmitting the orders of the heart to the periphery: it acts as an official of the heart, which nourishes the body, nourishing the blood; moreover it rhythmically propagates the energetic blows, informed of the orders of the sovereign.
The kidneys are the custodians of the jing, the essential energies that derive, as we have seen, both from the energies that the parents transmit at the moment of conception and from the energy that is obtained from the transformation of food. In the kidneys there is therefore the foundation of the force of life; they are also the seat of will and practical knowledge (knowing how to live).
The fu receive, contain, transform and absorb the fundamental substances and provide for the elimination of waste.
The system just illustrated would seem the same as that of western medicine, while there are many differences. An example for all: the bladder, minister of water, whose function is to collect the liquids that must be eliminated, has at the same time, according to Chinese medicine, an extremely important function of regulating all the liquids in the body. The length of its meridian and the multiplicity of its points indicate its importance for the treatment of the imbalances of the movement and circulation of liquids.
The murmurs that penetrate man through the sense organs, solid and liquid foods, atmospheric air, loaded with different qualities depending on the time, day, season and geographical location, are accumulated and processed by the six it was. The subtle energy, the result of the purification and elaboration of the fu, passes into the zang, where it is further refined in contact with particular catalysts, the ancestral blows, which will give the breaths hoarded by each organ its own functional specificity. From here the pure breaths visit the organism, maintaining the vital energy.
Following the proper modalities and needs of each region of the body, the rhythms of the seasons, the day and the night, the currents of the yin / yang energy, they regulate the exchanges up to the deepest parts, giving all the regions of the body the appropriate yin / yang balance in which health consists.
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Shen theory and the psychosomatic issue
Man is not only the embodiment and concretization in a given time and in a certain space of cosmic energy (qi), but he is also animated by the same vitality (Shen) that pervades the universe. The Spirits are, from time to time, the psychic and spiritual instance that animates man, the conscience that man has of himself, his vital spirit, in other words the vitality of man, so much so that Shen imbalances often give rise to symptoms that affect qi and its distribution.
The man inserted in the Heaven / Earth system is, as has been said, a unique entity, not divisible in psyche and soma, body and spirit, and this not only on the philosophical level, but on the real level. To explain this concept, Chinese medicine speaks precisely of Shen, who since conception preside over the growth and development of the various organs thus becoming true structures of the psyche-soma.
The theory that describes the formation and importance of the Shen is one of the oldest and most important in the doctrinal corpus of Chinese medicine, and will only be mentioned here. With great originality and completely different from Western knowledge, this theory connects the Spirit, and more generally the psychic activity of man, not to the brain but to the heart, as an organ that coordinates the activity of all organs and viscera. From this necessarily develops a conception of psychosomatic or somatopsychic man, because it highlights his specificity, that of being one and global. Indeed, man cannot be reduced to the mere juxtaposition of his bodily structures, albeit with superior control operated by the brain.
For Chinese medicine, this completely different being made up of psyche and soma is born at an embryonic level. At the moment of conception, in fact, the Spirits, Shen, who incarnate and fixate themselves at the junction of the parents' jing (energetic materiality), endow the new being with both spirit and body (jingshen), making it unique and unrepeatable. During the embryonic phase of growth, the Shen (yang) join more yin structures to form somatopsychic entities, which are the organs and viscera, of which they contribute to promoting the development according to the specificity of each organ and according to the various growth phases of the 'individual. Five are the organs and five are the Shen. In the first place the heart, sovereign and head of the organism as seat of higher entities which are the celestial Spirits (the Shen proper), then the liver seat of the Hun, the lung seat of the Po, the spleen seat of the purpose (yi ) and the kidneys seat of the will (zhi). These mental faculties that direct the individual's behavior, and on which the proper functioning of the organs and viscera depend, have also been called vegetative souls, as they allow and maintain physical life.
For its being the seat of the Shen, the heart is also the seat of mental activity because it constitutes man's ability to think, reflect, analyze, plan, implement, and is also the seat of emotional and affective life and the processes by which man becomes aware of it.
The role of the heart also concerns the physical field, the vital processes of the whole organism: in fact, as the seat of the Shen, it allows the intertwining of innate and hereditary energies with those acquired at all times and therefore promotes the psychophysical development of the person. The Shen are the impulse itself to life, what recreates the desire to live in man. From the heart therefore depend the balance of the person, one in his body-mind-soul, and his ability to relate to others.
The data of this physical-spiritual unity is fundamental to understand that an attack carried on a zang-organ will always involve an attack carried on its intimate, its Shen.
In fact, the outcome of any ailment often implies, in addition to tangible physical damage, also mental or psychic anomalies.
Conversely, many functional or even organic diseases can be the result of disorders in the distribution of vital energy due to psychic factors (such as saying that "bad thoughts" hurt as much as germs, viruses or "perverse energies") .
Reading the ancient medical texts, but not only these, one is struck by the fact that every place of the body is at the same time the seat of body and soul, and there is no moment of health or illness in which the two aspects are not connected. : for this reason in therapy it is taught that one can start from the cure of one to reach the other, but that to heal a sick both aspects must be considered. Thanks to this global vision of man, traditional Chinese medicine has managed to keep its postulates alive and always valid over time until it becomes very topical today.
Conventional medicine, the one with which hundreds of millions of people are treated every day, is instead based on the distinction between the psychic event and the physical event, a division between psyche and soma attributable to Plato's thought and even earlier to orphism.
This division was proposed again by Descartes, at the dawn of the modern era, with the division of man into res cogitans and res extensa, to end with the mechanistic-positivist model that he chooses to deal with, in a sort of fracture of reality, only the measurable empirical reality. The object of study is a man conceived and rebuilt like a machine. So this machine is made of levers (muscles), hydraulic pumps (heart), electrical systems (nerves), to which have been added, more recently, computers capable of connecting and integrating all the information coming from the various sectors of the body, processing them and transforming them into internal or external messages. Here, however, the model stops and reveals all its limits, since in this "cybernetic fiction" there is no place for consciousness, intellect or other more or less superior functions of man.
To explain emotionality, instinct and affectivity, a second model of man is born, which finds in the animal the paradigm of the lower functions. Again, however, the model does not explain man. In hindsight, in fact, it is not a question of higher or lower functions because even the instincts (not by chance defined as low) can be so simply brought back to animal functioning schemes: the human instinct, when it corresponds to a real and healthy drive that pursues its purpose, has so much cultural that it can be constituted as a sort of world view, capable of upsetting a life as of creating masterpieces and constituting the maximum expression of a human talent, which leaves for example the reader of a poetry or the spectator of a tragedy in the embarrassing and insoluble question if art derives from higher faculties or from lower desires. In the models proposed by conventional medicine, the indisputable datum of a continuous cleavage that cuts man like a slit remains.
Psycho-neuro-immuno-endocrinology is today the attempt to trace that unity of biological epiphenomena which closely connect to variations in psychism, emotionality, desire, becoming a sort of large chessboard whose changing positions constitute a indirect sign of the player's will, intelligence and perspicacity.
The attempt to understand Shen theory can be a very useful reflection point for western medicine. With the breakup of this couple our medicine, in fact, has produced a series of irreparable damages, including, not least, the ever greater estrangement that people feel for a hyper-technological and hyperspecialistic medicine, founded on a mechanistic vision of man, in which life in its complexity finally becomes incomprehensible.
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