Oriental Medicine is a term with many variations of a general meaning. Among the majority of American practitioners it refers to a system of medicine which originated approximately 4000 years ago in in far east Asia. This area includes what are now China, Korea, Japan, Tibet, and Vietnam.

In the 20th century Oriental Medicine serves almost two billion people in far east Asia, the former Soviet Union and Europe. In the U.S. thirty-eight states have scope of practice for National Commission for the Certification of Acupuncture and Oriental Medicine (NCCAOM) or equivalent level practitioners. There are approximately 10,000 national board certified acupuncturists in the country.

Research on Oriental Medicine has been continual in China since the early 1950’s. After the civil war was settled in 1948, the Communist Government of China realized it could not afford to train, let alone equip, a sufficient number of allopathic doctors to meet the needs of the country’s population. The government evaluation of the traditional medicine showed that it had enough effectiveness to warrant not only active use and perpetuation but development. Today Traditional Chinese Medicine (TCM) is

practiced in allopathic hospitals, in traditional hospitals, in conjunction with allopathic medicine, and hybrids of both forms of medicine have been developed.

Although Oriental Medicine has a set of foundation principles it is not uniform. There have been and are many schools of thought. Oriental Medicine is a complete health care system capable of delivering both primary and specialized care. It’s based on principles which began evolving approximately between 2000BC and 4000BC and which continue to evolve. The roots of Oriental Medicine are considered by most to be Buddhism, Taoism, and Confucianism. Buddhism is a religion, Confucianism is social and

political philosophy, and Taoism is both a religion and a philosophy. These are gross simplifications. Literally thousands of volumes have been written on these subjects. But we are concerned here with giving you enough information for a useful understanding of Chinese Medicinals.

Taoism is the most influential root of Oriental Medicine. The Taoists main focus was on the observable and natural laws of the universe and the implications for human beings’ relationship to the universe. 2500 years (5000BC - 500BC) allowed much time for observation, study and speculation by many people. This activity yielded myriad principles. Below are five of the fundamental principles and applications of them to health and healing.

• • There are natural laws that govern the universe.

    • • You are part of the universe and therefore exist according to and subject to those laws.

  • The natural order of the universe is harmonious and organised.

    • • If you live according to it’s laws you will be harmonious.

  • The universe is dynamic change; Change is a constant.

    • • Lack of change is contrary to the universe and therefore causes illness.

  • All life is interconnected.

    • • Always use a systems approach.

  • Humans are a part of the universe, not outside of it. We are intimately connected to the environment and thus the universe.

    • • Your health is affected by your environment.

These principles are the axioms about existence that form the foundation for Yin & Yang, The Five Phases/Elements, and Chi (pronounced chee). And those concepts are the primary engines of Oriental Medicine.

An Introduction to Acupuncture and how it Works

There are two very different ways of looking at acupuncture: from the traditional Chinese perspective and from the modern international perspective. Each of these will be briefly described.

Traditional View

The understanding of how acupuncture works has evolved with its practice, but the descriptions set down a thousand years ago have largely been retained. The dominant function of acupuncture is to regulate the circulation of Chi (vital energy) and blood. Approximately 2,000 years ago, the pre-eminent acupuncture text, Huangdi Neijing (Yellow Emperor's Classic on Internal Medicine) was written. In it, acupuncture was described as a means of letting out excess Chi or blood by making holes in the body along certain pathways, called jingluo (meridians). For some of these meridians, it was advised to acupuncture in such a way as to let out the blood but not the Chi; for others, to let out the Chi, but not the blood. Many diseases were thought to enter the body through the skin, and then penetrate inward through muscle, internal organs, and, if not cured in timely fashion, to the marrow of the bone. By inserting a needle to the appropriate depth--to correspond with the degree of disease penetration--the disease could be let out.

Prior to the time when there were microscopes by which people could envision individual cells and before autopsies revealed the intricate structures within the body, doctors and scholars projected the internal workings of the body from what they could actually experience, which was the world outside the body. On this basis, the workings of the body were described in terms similar to those used to describe the visible world. One of the critical aspects of nature for humans living a thousand years ago, when Chinese civilization was well developed, was the system of water courses, which included tiny streams, huge rivers, man-made canals, and the ocean. It was envisioned that the body had a similar system of moving, life-giving fluid. This fluid was the Chi, and the pathways through which it flowed were the meridians.

Instead of discussing acupuncture in terms of letting something out of the body, physicians working a thousand years later described it in terms of regulating something within the body. The flow of Chi through the meridians, just like the flow of water through a stream, could be blocked off by an obstruction---a dam across the waterway. In the streams, this might be a fallen tree or a mud slide; in humans, it might be caused by something striking the body, the influence of bad weather, or ingestion of improper foods. When a stream is blocked, it floods above the blockage, and below the blockage it dries up. If one goes to the point of blockage and clears it away, then the stream can resume its natural course. In a like manner, if the Chi in the meridian becomes blocked, the condition of the body becomes disordered like the dryness and flooding; if one could remove the blockage from the flow of Chi within a meridian, the natural flow could be restored.

In a blocked stream, just cutting a small hole or crevice in the blockage will often clear the entire stream path, because the force of the water that penetrates the hole will widen it continuously until the normal course is restored. In the human body, inserting a small needle into the blocked meridian will have a similar effect. Just as a stream may have certain points more easily accessed (or more easily blocked), the meridians have certain points which, if treated by needling, will have a significant impact on the flow pattern. Many acupuncture points are named for geological structures: mountains, streams, ponds, and oceans.

Although this description of the basic acupuncture concept is somewhat simplified, it conveys the approach that is taught today to students of traditional acupuncture: locate the areas of disturbance, isolate the main blockage points, and clear the blockage. Of course, many layers of sophistication have been added to this model, so that the needling---which might be carried out in several different ways---can be seen to have subtle and differing effects depending upon the site(s) needled, the depth and direction of needling, and even the chemical composition of the needle (such as gold, silver, or steel). For example, some needling techniques are used for the primary purpose of increasing the flow of Chi in a meridian without necessarily removing any blockage; other techniques reduce the flow of Chi in the meridians. These tonifying and draining methods, as well as transference methods that help move Chi from one meridian to another, are part of the more general aim of balancing the flow of Chi in the body.

Ultimately, all the descriptions of acupuncture that are based on the traditional model involve rectifying a disturbance in the flow of Chi. If the Chi circulation is corrected, the body can eliminate most symptoms and eventually--with proper diet, exercise, and other habits--overcome virtually all disease.

Modern Views

When the human body was finally described in terms of cells, biochemicals, and specific structures (most of this accomplished less than 150 years ago), the Chinese method of acupuncture and its underlying concepts were evaluated in these new terms. As a first effort, researchers sought out physical pathways that might correspond to the meridians, and even a fluid substance that might correspond to Chi. Neither of these were found. Nonetheless, the action of performing acupuncture was shown to have effects on the body that required some detailed explanation.

From the modern perspective, diseases and injuries are resolved by a complex set of responses; the responses are coordinated by several signaling systems. The signaling systems mainly involve peptides and other small biochemicals that are released at one site, travel to other sites, interact with cells, and stimulate various biologically programmed responses. Rather than blockages of circulation described in the old Chinese dogma, diseases are understood to be caused by microorganisms, metabolic failures, changes in DNA structure or signaling, or breakdown of the immune system. Some of these disorders are resolved by the cellular functions that are designed for healing, while others become chronic diseases because the pathological factors involved have either defeated the body's normalizing mechanisms or because something else has weakened the body's responses to the point that they are ineffective. For example, poor nutrition, unhealthy habits, and high stress can weaken the responses to disease.

Modern studies have revealed that acupuncture stimulates one or more of the signaling systems, which can, under certain circumstances, increase the rate of healing response. This may be sufficient to cure a disease, or it might only reduce its impact (alleviate some symptoms). These findings can explain most of the clinical effects of acupuncture therapy.

According to current understanding, the primary signaling system affected by acupuncture is the nervous system, which not only transmits signals along the nerves that comprise it, but also emits a variety of biochemicals that influence other cells of the body. The nervous system, with over 30 peptides involved in transmitting signals, is connected to the hormonal system via the adrenal gland, and it makes connections to every cell and system of the body.

In a review article, Acupuncture and the Nervous System (American Journal of Chinese Medicine 1992; 20(3-4): 331-337), Cai Wuying at the Department of Neurology, Loyola University of Chicago, describes some of the studies that implicate nervous system involvement. According to a report of the Shanghai Medical University, cranial nerves, spinal nerves, and their terminals were dispersed in the area surrounding the acupuncture points for about 5 millimeters. They also found that the nervous distribution of the Bladder Meridian points (which run along the spine) was in the same area of the spine as that of the corresponding viscera. In Japanese research, it was reported that when acupuncture points were needled, certain neurotransmitters appeared at the site. In laboratory-animal acupuncture studies, it was reported that two such transmitters, substance P and calcitonin gene-related peptide, were released from primary sensory neurons. Acupuncture analgesia appears to be mediated by release of enkephalin and beta-endorphins, with regulation of prostaglandin synthesis: all these have an effect on pain perception. One of the dominant areas of research into acupuncture mechanisms has been its effect on endorphins. Endorphins are one of several neuropeptides; these have been shown to alleviate pain, and have been described as the body's own "opiates." One reason for the focus on these biochemicals is that they were identified in 1977, just as acupuncture was becoming popular in the West, and they are involved in two areas that have been the focus of acupuncture therapy in the West: treatment of chronic pain and treatment of drug addiction.

According to traditional Chinese doctors, one of the key elements of a successful acupuncture treatment is having the person who is being treated experience what is called the "needling sensation." This sensation may vary with the treatment, but it has been described as a numbness, tingling, warmth, or other experience that is not simple pain (pain is not an expected or desired response to acupuncture treatment, though it is recognized that needling certain points may involve a painful response). Sometimes the needling sensation is experienced as propagating from the point of needling to another part of the body. The acupuncturist, while handling the needle should experience a response called "getting Chi." In this case, the needle seems to get pulled by the body, and this may be understood in modern terms as the result of muscle responses secondary to the local nervous system interaction.

According to this interpretation, acupuncture is seen as a stimulus directed to certain responsive parts of the nervous system that set off a biochemical cascade which enhances healing. Some acupuncture points are very frequently used and their applications are quite varied: needling at these points may stimulate a "global" healing response that can affect many diseases. Other points have only limited applications; needling at those points may affect only one of the signaling systems. It is common for acupuncturists to combine the broad-spectrum points and the specific points for each treatment. Some acupuncturists come to rely on a few of these broad-spectrum points as treatments for virtually all common ailments.

This modern explanation of how acupuncture works does not explain why the acupuncture points are arrayed along the traditional meridian lines. At this time, no one has identified--from the modern viewpoint--a clear series of neural connections that would correspond to the meridians. However, acupuncturists have identified other sets of points, such as those in the outer ear, which seem to be mapped to the whole body.

The description, in the case of the ear, is of a layout of the body in the form of a "homunculus" (a miniature humanoid form). Such patterns might be understood more easily than the meridian lines, because the brain, which is adjacent to the ear, also has a homunculus pattern that has been identified by modern research.

Similarly, acupuncturists have identified zones of treatment (for example, on the scalp or on the hand) that correspond to large areas of the body, and this may also be more easily explained because there are connections from the spinal column to various parts of the body which might have secondary branches elsewhere. In fact, acupuncture by zones, homunculus, "ashi" points (places on the body that are tender and indicate a blockage of Chi circulation), and "trigger" points (spots that are associated with muscle groups) is becoming a dominant theme, as the emphasis on treating meridians fades. The new focus is on finding effective points for various disorders and for getting biochemical responses (rather than regulating Chi, though there is no doubt some overlap between the two concepts).

During this modern period (since the 1970's) an increasing number of ways to stimulate the healing response at various body points have been advocated, confirming that needling is not a unique method (the idea that the needle would produce a hole through which pathogenic forces could escape has long been fading). In the past, the main procedures for affecting acupuncture points were needling and application of heat (moxibustion).

Now, there is increasing reliance on electrical stimulation (with or without needling), and laser stimulation. Since the basic idea of acupuncture therapy is gaining popularity throughout the world while the practice of needling is restricted to certain health professions and is not always convenient, other methods are also becoming widely used. Lay persons and practitioners with limited training are applying finger pressure (acupressure), tiny metal balls held to the to the skin by tape, magnets (with or without tiny needles attached), piezoelectric stimulus (a brief electric discharge), and low energy electrical pulsing (such as the TENS unit provides with electrical stimulus applied to the skin surface by taped electrodes). Some of these methods may have limited effectiveness, but it appears that if an appropriate body site is stimulated properly, then the healing response is generated.

For many nervous system functions, timing is very important, and this is the case for acupuncture. The duration of therapy usually needs to be kept within certain limits (too short and no effect, too long and the person may feel exhausted), and the stimulation of the point is often carried out with a repetitive activity (maintained for a minute or two by manual stimulation--- usually slight thrusting, slight withdrawing, or twirling--- or throughout treatment with electrostimulation). It has been shown in laboratory experiments that certain frequencies of stimulus work better than others, as might be expected for nervous system responses, but not expected for simple chemical release from other cells.

Traditional and Modern Views Coexisting

The traditional and modern understandings of acupuncture arise from significantly different world views and from application of different levels of technology. It is difficult to directly correlate the two, though one can say that many of the traditional observations and ideas have partial explanations by modern mechanisms. Still, the modern practitioner can become aware of and trained in the application of both approaches to acupuncture. A person to be treated can be analyzed from both perspectives and the treatment strategy can be devised according to the conclusions derived from each perspective. Certain aspects of the case may be more amenable to traditional analysis and corresponding treatment, while other aspects are better suited to modern analysis and treatment approach.

An individual who is suffering from a chronic pain syndrome might be analyzed in terms of which meridians are blocked: through treatment of appropriate points on the meridian, the pain might be alleviated. The same individual might be analyzed according to which muscle groups are involved in the painful area and might be treated by acupuncture at points that specifically affect those muscles. An individual suffering from an autoimmune disorder might be analyzed according to which of the traditional organ systems are involved, with treatment of the associated meridians. The same individual might be analyzed in terms of the immune system disturbance and treated by stimulating points that have been identified as immune regulators.

Since the traditional acupuncture approach has been shown to be effective in clinical trials conducted in China (and elsewhere in the Orient), one can rely on the traditional methods. However, many practitioners in the West, with little or no prior exposure to Oriental philosophy but with experience and training in Western modes of analysis, may feel uncomfortable turning partly or completely to the traditional Chinese view, and will, instead, focus on the modern understanding of this healing technique.

Traditional Chinese medicine is not a static system, but an evolving one. Thus, in the Orient and in the West there are many doctors and researchers who are working on an integration of the earlier traditional approach and the modern understanding.

Herbal Training Formulas in the Taoist Tradition

From the beginning of time in Chinese history there have been mystic shamans who, living as hermits in remote mountains, danced the Dance of Yu and sought the ways of Immortality. In their search for the Elixir of Immortality the shamans experimented with herbs and other medicinal substances that eventually became the basis for Chinese Herbal Medicine. These shamans, who later collectively were known as the first Taoists, looked for a combination of herbs that would enhance their longevity and lead them to the court of the Mother Empress of the West, Hsi-wang Mu.

Sometime during the Tang Dynasty (618 - 960 C.E.) the distinction between Inner Alchemy (Nei Dan) and External Alchemy (Wai Dan) become more pronounced as royal and wealthy patrons secured the services of Alchemists. Wealthy patrons too lazy to practice meditation thought they could pay for immortality but in the process ingested pills composed of cinnabar, lead, mercury and other poisonous substances. Many died in the process, not realizing that the true Pill of Immortality is inside the body of the Taoist Yoga practitioner. The true Alchemists looked inside for all the elements of immortality.

Inner Alchemists used the Dan tian as the crucible in which the "herbs" were gathered and purified. The Kan and Li , or Kidney Water and Heart Fire were mixed to produce the Immortal Fetus inside the Yogin's body. However, although Inner Alchemists looked down on external pills or elixirs, there still remained a tradition of using Chinese medicinal herbs as adjuncts to meditative or Qigong cultivation practices. In particular, tonic herbs and formulas to aid cultivation have always been popular and widely utilized.

Most of the training formulas use herbs that are commonly known in Chinese medicine as tonic herbs. Perhaps the best example is Ginseng (Ren shen, Panax Ginseng C.A. Mey). It is a sweet and slightly bitter herb. Also, it is warm and nontoxic, entering the Lung and Spleen Channels. First mentioned in the Shen Non Ben Cao Jing , it is perhaps the best known herb the world around. In Taoist formulas Ginseng is used to tonify the Yuan Chi and Dan tian and it is believed to be closest in overall energy to man's. Thus, it can be particularly useful for people training in Qigong who need extra and balanced energy.

In combination, Ginseng is used with other tonic herbs such as Lu Rong, or deer antler. These two provide strong tonification of vital energy. Along with Shu di, or Rehmannia, Ginseng is used to tonify the lungs and the kidneys. In other combinations Ginseng can be used to remedy problems encountered in training, such as excessive sweating during practice due to vital energy deficiency. In this case Ginseng is combined with Astragalus (Huang Chi), Paeonia (Bai shao), and Schizandre (Wu wei zi).

Another tonic herb commonly used in training formulas is Gou Chi zi, or Chinese Wolfberry (Lycium barbarum L.). Wolfberry is a sweet and neutral herb that enters the Liver, Lung and Kidney Channels. Also first mentioned in the Shen Non Ben Cao Jing, Wolfberry is used particularly to nourish and tonify the Liver and Kidneys. Furthermore it is utilized in tonifying sexual energy, thus being particularly useful for practitioners of Sexual Alchemy. Yet another reason Wolfberry is employed by Qigong practitioners is that it can strengthen internal damage from stagnant or blocked energy.

A third herb that was prized in tonic formulas was tiger bone (Panthera tigris L.). Although still available from unscrupulous herb dealers, the use of tiger bone is now rare as tigers are a protected and endangered species. Tiger bone is commonly replaced with white stallion or ox bone. It is an acrid, sweet and warm herb that enters the Liver and Kidney Channels. Tiger bone was traditionally used to disperse wind and damp, although it was also used by Shaolin boxers in formulas to strengthen the body. Tiger bone along with Ginseng in alcohol was a secret Taoist martial arts liqueur devised by the physician Shie Jien Pao to strengthen the Wei Chi, internal organs, muscular endurance and bone strength.

Other herbs were added to complete formulas to enhance tonification. For example, Taoists favored using sea horse to help tonify vitality and sexual energy, and to also promote brain activity and spiritual development. Sea horse, or Hai ma (Hippocampus kelloggi Jordan et Snyder) is known as "Fallen baby of dragon" in folklore. It is a sweet, salty and warm herb that enters the Kidney and Liver Channels and is a Yang tonifier. Sea horse can be added to formulas containing Ginseng, Morinda or Psoralea to enhance overall tonification effect.

While it is enlightening to examine commonly used tonic herbs individually, it is even more interesting to examine entire formulas. Just as the use of individual herbs vary, the use of formulas can range from the very martial to entirely spiritual.

One example of a simple Taoist martial formula is the aforementioned Tiger Bone and Ginseng Liqueur developed by Shie Jien Pao. As tiger bone can expel wind and damp, it strengthens a martial artist's sinews and bones. Also, tiger bone can aid in Yang energy restoration. Ginseng is an overall tonifier, and when old Ginseng is used this formula becomes hotter and more energizing. Thus Tiger Bone and Ginseng Liqueur can strengthen the overall body, especially the internal organs, muscles and tendons, and improve the Wei Chi for protection.

Other formulas are less oriented directly with improving fighting techniques and are more appropriate for spiritual cultivation. One such example is "Yuan Chi Elixir." The entire formula is composed of nine herbs, the first and one used in the largest quantity is Shu di (Rehmannia glutinosa Libosch.). Alone, it is a blood tonifier. Also it can nourish the Yin and Jing. The second herb in the formula is Ginseng, which as previously mentioned, can enhance overall vitality and, together with Shu di, can strengthen the Lung and Kidney.

Shan yao (Discorea opposita Thunb.), the third herb, tonifies the Chi, especially of the Spleen, Stomach, Lung and Kidney. Still other herbs in "Yuan Chi Elixir" are blood tonifiers. These include Dang gui (Angelica sinensis Diels) and Gou Chi zi, which also tonifies the Yin and the Kidney. Two other herbs in the formula, Lu rong (Cervus Nippon Temmiinck) and Du zhong (Eucommia ulmoides Oliv.) are Yang tonifiers. Lu Rong is also a powerful tonic for the Kidney, Uterus and Dan tian. Suan zao ren (Ziziphus spinosa Hu.) in the formula nourishes the heart and calms the spirit, and the last herb, Gan cao (Glycyrrhiza uralensis Fischer), harmonizes the effects of the other ingredients.

The entire "Yuan Chi Elixir" strongly invigorates the Dan tian, Jing and Shen. It also moves and augments the Blood and Chi, especially of the Lower Warmer. Another important aspect of the formula is that it mixes the Fire and Water energies. Therefore it can be used by most Qigong practitioners or Taoist meditators to enhance practice. Students of Kan and Li meditations would also particularly benefit from "Yuan Chi Elixir."

One other formula is the "Two Immortals Wine." According to Taoist lore, the tortoise and the deer, the "Two Immortals," are symbols of longevity and vitality. This formula is used to strongly invigorate the Jing, Chi, Blood and Marrow. It is a very hot and Yang tonifying formula as it is composed of Lu rong, and Ginseng. The other two components of the formula are Gou Chi zi and Gui ban (Chinemys reevesii Gray, turtle shell). All together the herbs are soaked in rice wine or vodka for a minimum of four months, further enhancing the heating and moving qualities of the herbs. This formula should not be taken by Yang deficient practitioners unless it is modified.

The demands of serious Qigong or meditation practices are high. Often times practitioners, for one reason or another, come to training lacking a surplus in energy or needing extra help. For example, many people are drawn to Taoist meditation or Qigong late in life, after years of depleting Chi and Jing. In these cases herbal training formulas can be an necessary adjunct by endowing the student with ample energy to begin serious practice. Also, as already mentioned, herbal training formulas can remedy problems encountered in the normal course of training.

Thus in conclusion, although centuries ago in the Tang Dynasty there arose a schism between the Internal and External seekers of Immortality, the Inner Alchemists never fully left behind their external roots. Inner Alchemists who use herbs as an adjunct to training may thus be closest in actual training methodologies to the Alchemists of antiquity who saw no difference between meditation and drinking herbal decoctions. Just as Yin and Yang can never be separated, and the Sun and Moon are eternally entwined in a celestial dance, the external and internal methodologies should always walk a path hand in hand.

An Introduction to Chinese Herbs

The herbal tradition of China is valued scientifically, as well as being a fascinating and popular tradition. Scientists working in China and Japan during the past four decades have demonstrated that the herb materials contain active components that can explain their claimed actions. Modern drugs have been developed from the herbs, such as treatments for asthma and hay fever from Chinese ephedra, hepatitis remedies from schizandra fruits and licorice roots, and a number of anticancer agents from trees and shrubs. Several popular formulations produced in China, called "patent medicines," are relied upon daily by millions of Chinese (in China and abroad), such as the Bupleurum Sedative Pills and Women's Precious Pills that invigorate the energy, nourish the blood, calm tension, and regulate menstruation, and Yin Chiao Pian or Gan Mao Ling, which are reliable treatments for the early stages of common cold, sore throat, and influenza.

More than three hundred herbs that are commonly used today have a history of use that goes back at least 2,000 years. Over that time, a vast amount of experience has been gained that has gone towards perfecting their clinical use. According to Chinese clinical studies, these herbs, and others that have been added to the list of useful items over the centuries, can greatly increase the effectiveness of modern drug treatments, reduce their side-effects, and sometimes replace them completely.

In China, the two most common methods of applying herb therapies are to make a decoction (a strong tea that must be simmered for about an hour or more) and to make large honey-bound pills. Both of these forms meet with considerable resistance in Western countries. The teas are deemed too time-consuming, smelly, and awful-tasting to justify their use, and the honey pills (boluses) are sticky, difficult to chew, and bad tasting. Thus, modern forms that are more acceptable have been developed for most applications.

The two popular forms to replace the standard Chinese preparations are extract granules (or powders) and smooth, easy-to-swallow tablets or capsules. The extracts are made by producing a large batch of tea and then removing the water and producing a powder or tiny pellets; the resulting material is swallowed down with some water; the granulated form preferred in Japan is barely tasted. Tablets and capsules contain either powdered herbs or dried extracts or a combination of the two. Despite the convenience, one must take a substantial quantity of these prepared forms (compared to the amount of drugs one takes). For example, doses of the granules range from 1-2 teaspoons each time, two to three times per day, and the tablets or capsules range from about 3-8 units each time, two to three times per day.

The herb materials used in all these preparations are gathered from wild supplies or cultivated, usually in China (some come from India, the Mid-East, or elsewhere). There are an estimated 6,000 species in use, including nearly 1,000 materials derived from animal sources and over 100 minerals, all of them categorized under the general heading "herbs." Herbs are processed in various ways, such as cleaning, soaking, slicing, and drying, according to the methods that have been reported to be most useful. These materials are then combined in a formulation; the ingredients and amounts of each item depend on the nature of the condition to be treated.

In some cases, a practitioner of Chinese medicine will design a specific formulation for an individual patient, which might be changed frequently over a course of treatment. In other cases, one or more formulas already prepared for ingestion as pills are selected for use. The outcome is monitored, and the determination of whether to continue the current combination, change it, or discontinue use is made on the basis of actual versus desired outcomes and the obvious or subtle effects of using the herbs.

As a general rule, acute ailments (those that arise suddenly and are to be treated right away) are treated for a period of 1-30 days. If an outbreak of influenza or eruption of herpes virus is caught early enough, a one or two day treatment will prevent further development of the disease. In the case of acute active hepatitis causing jaundice, a treatment of 15-30 days may be necessary. For chronic diseases (those that have persisted for several months or years), the treatment time is often dependent on the dosage used and the ability of the individual to undertake all necessary steps to overcome the disease (perhaps changing diet or exercise). When a high-dosage therapy is applied, most chronic ailments can come under control (and some are cured) by a treatment of about three months duration. If the daily dosage is lowered (because of inability to take the higher doses), the treatment time increases---perhaps to 6-12 months. Examples of chronic ailments are autoimmune disorders and degenerative diseases associated with aging. In some cases, herbs are taken daily, for an indefinite period, just as some drugs are taken daily. This is typically the situation when there are genetic disorders or permanent damage that cannot be entirely reversed, problems of aging, and ailments that have been left for too long without effective treatment.

The main reason that more Westerners are turning to Chinese herbs rather than local herbs is because of the vast scope of experience in using the Chinese materials. In every province of China, there are large schools of traditional Chinese medicine, research institutes, and teaching hospitals, where thousands of practitioners each year gain training in the use of herbs. The written heritage of Chinese medicine is quite rich. Ancient books are retained, with increasing numbers of commentaries. New books are written by practitioners who have had several decades of personal experience or by compilers who scan the vast diverse modern literature and arrange the results of clinical trials into neat categories.

American practitioners are usually trained at any one of about 40 colleges in the U.S., with a three or four year series of courses that include basic Oriental medical theory, acupuncture, and herb prescribing. Certification is offered at the national level and licensing or registration is offered now by most states. Many doctors from China have come to the U.S. and currently offer professional services throughout the country, but most often in the larger cities. Continuing education is provided through numerous symposia offered by the colleges and professional organizations devoted to Oriental medicine. Often, these meetings focus on the treatment of specific diseases or training in the use of a specialized acupuncture technique or valuable herb formula.

Chinese herbs are provided in the U.S. as food supplements, not as drugs. Thus, they are not strictly regulated by the FDA except for monitoring the cleanliness of manufacturing facilities (for those materials made in the U.S.; for the imported items, FDA monitors only the listing of ingredients to help ensure no toxic herbs are being used). Random testing of crude herb materials and herb products made in the U.S. indicate that they are free of harmful bacteria and chemical contaminants. Imported products must be used with some caution, as some of them are problematic, yet get past the investigators. There are a few arthritis remedies that are labeled with only herb ingredients, but also contain several Western drugs. Some patents from China contain only Western drugs (and say so on the box, in Chinese), but purchasers may be unaware of this because they are told only that this is an effective remedy that came from China. Thus, imported Chinese herb products should be taken solely on the basis of a prescription from a trained health professional.

Adverse responses to Chinese herbs are monitored at the Institute for Traditional Medicine through its contacts with numerous practitioners around the country and subscriptions to technical journals published in China and Japan. Negative interactions with Western drugs have not been noted for any of the common herb materials when used in the normal dosage range. A few people experience allergic reaction to individual herbs, a problem that often cannot be predicted in advance since these are idiosyncratic responses. A more common reaction is a gastro-intestinal response, which might include constipation or diarrhea, nausea or bloating. Such reactions may occur if the individual has poor digestive functions, or if the herbal formula is not quite right for the needs of the individual. Taking the herbs at a different time in relation to meals may be helpful in resolving some of the gastro-intestinal reactions. In a few cases, use of Chinese herb formulas may cause dizziness, headache, agitation, sleepiness, hungry feeling, lowered appetite, sensation of heat or cold, or other sensory reactions. If such responses persist after about three days of using the herbs, it may be necessary to change formulas.

Successful treatments based on the application of Chinese herbs are also monitored at the Institute. However, most American practitioners find themselves too busy (because of the small number of practitioners in this country) to prepare detailed reports of their successful cases; thus, it is necessary to rely primarily on the large-scale clinical trials conducted in China for the purpose of learning about the success rates. Such clinical reports, published in the Chinese language, are abstracted and published in English by the Chinese University of Hong Kong. These reports, and other translated materials, are compiled by the Institute and sent to practitioners in a variety of formats, including a technical series called Clinical Tips. Trials supported by the Institute for Traditional Medicine in the U.S. that have generated successful outcomes include treatment of HIV/AIDS, multiple sclerosis, and endometriosis.

Following are some examples of common ingredients of Chinese formulas that have become widely used because of their reliable action, the quick results usually experienced, and the diversity of therapeutic activities that can be obtained from each. These reviews serve as examples of what Chinese doctors must know. It will be noted that the dosage range is often very large, reflecting various uses and different methods of application.

Fifteen Commonly Used Chinese Herbs

Astragalus (huangqi)

The long tap roots of astragalus are today the most commonly used herb material in China. Astragalus normalizes immune responses (used for immune deficiency, allergies, and autoimmunity), benefits digestive functions, and treats disorders of the skin from, burns to carbuncles. Astragalus is used as a promoter for the functions of several other herbs, such as salvia and tang-kuei (mentioned below). It is used in the treatment of AIDS and hepatitis, for chronic colitis, senility, and cardiovascular diseases. Cancer patients who take this herb can often avoid the white blood cell deficiencies (leukopenia) that occur with chemotherapy. The root is rich in polysaccharides and flavonoids that produce the beneficial effects. Astragalus may be used by itself, usually as a liquid extract, or in combination with other herbs, in the form of teas, pills, or tablets. Dosage is from 1 to 60 grams per day, depending on the application and form. Caution: some individuals may experience flatulence and abdominal bloating from use of astragalus.

Atractylodes (baizhu)

The rhizomes of atractylodes are considered very important to the treatment of digestive disorders and problems of moisture accumulation. The herb helps move moisture (and nutrients) from the digestive tract to the blood, reducing problems of diarrhea, gas, and bloating, and helps move moisture from the body tissues to the bladder for elimination, alleviating edema. The herb is frequently included in tonic prescriptions, and the herb is rarely used by itself. Dosage is from 200 milligrams in capsules and tablets to 15 grams per day in the form of decoction. Caution: persons suffering from a hot and dry condition may experience worsening of those symptoms if large amounts of atractylodes are used.

Bupleurum (chaihu)

The thin roots of bupleurum are one of the most frequently used herbs in the Japanese practice of Oriental medicine. Doctors in Japan have found it useful in the treatment of liver diseases, skin ailments, arthritis, menopausal syndrome, withdrawal from corticosteroid use, nephritis, stress-induced ulcers, and mental disorders. The roots are rich in saponins that reduce inflammation and regulate hormone levels. The herb is not used by itself, but rather in formulas with about four to twelve ingredients, made as teas, pills, or tablets. Dosage ranges from a few hundred milligrams of powder to about 15 grams in tea per day. Caution: some individuals may experience dizziness or headaches from use of bupleurum.

Cinnamon (guizhi and rougi)

The twigs (guizhi) and bark (rougi) of this large tropical tree are said to warm the body, invigorate the circulation, and harmonize the energy of the upper and lower body. Modern studies demonstrate that cinnamon reduces allergy reactions. Traditionally, cinnamon twig is used when the peripheral circulation is poor and cinnamon bark is used when the entire body is cold. If the upper body is warm and the lower body is cold, then cinnamon will correct the imbalance. Cinnamon is usually cooked together with other herbs to make a warming tea, or powdered with other herbs to make a pill or tablet that regulates circulation of blood. Dosage is 0.3 to 3 grams of bark and up to 9 grams of twig per day. Caution: large amounts of cinnamon are irritating to the liver and should not be used by those with inflammatory liver disorders.

Coptis (huanglian)

This rhizome (underground stem) is one of the most bitter herbs used in Chinese medicine. It is rich in alkaloids that inhibit infections and calm nervous agitation; it is usually combined with other bitter-tasting herbs, such as phellodendron, scute, and gardenia, to promote these actions. Examples of its many uses include treatment of skin diseases, intestinal infections, hypertension, and insomnia. Coptis is a close relative of an extremely bitter and very useful American herb, goldenseal. Because of its taste, coptis is most often used in the form of pills or tablets. Typical dosage is from a few hundred milligrams of powder to 3 grams in decoction per day. Caution: regular use of coptis in large dosage may cause diarrhea.

Ginger (jiang)

The fibrous rhizome of this herb is highly spicy and said to benefit digestion, neutralize poisons in food, ventilate the lungs, and warm the circulation to the limbs. Ginger is today commonly used as a spice in cooking; as a medicine it has been shown helpful in counteracting nausea from various causes including morning sickness, motion sickness, and food contamination. Many herbalists use ginger in the treatment of cough (it acts as an expectorant) and common cold. Ginger is used in making teas and the powder is encapsulated for easy consumption. Typical dosage is from a few milligrams used as an assistant in herb formulas to about 3 grams per day in making decoctions. Instant tea granules (sugar or honey base) are available. Caution: persons who suffer from dryness--dry cough, thirst, dry constipation, etc.--may find that ginger worsens the condition.

Ginseng (renshen)

The root has long been cherished as a disease-preventive and a life preserver. It calms the spirit, nourishes the viscera, and helps one gain wisdom. Modern applications include normalizing blood pressure, regulating blood sugar, resisting fatigue, increasing oxygen utilization, and enhancing immune functions. Traditionally, the root is cooked in a double boiler to make a tea, used either alone or with several other herbs. Today, teas can be made quickly from carefully prepared extracts in liquid or dry form; ginseng powder is made into tablets or encapsulated, and ginseng formulas are available in numerous forms for easy consumption. Typical dosage is 0.5-3.0 grams. Higher doses may be used over the short term for specific therapeutic actions: in China 30 grams is recommended to treat shock (sudden hypotension). Caution: excessive consumption of ginseng can lead to nervousness and may produce hormonal imbalance in women.

Hoelen (fuling)

This herb is a large fungus that grows on pine roots. It is used to alleviate irritation of the gastro-intestinal system and, like atractylodes, it helps transport moisture out of the digestive system into the blood stream and from the various body tissues to the bladder. When bits of the pine root are included in the herb material it is called fushen; the combination of the fungus and pine produces a mild sedative action. This herb, because it is quite mild, is mostly used in making decoctions or dried decoctions, with a dosage equivalent of about 10-15 grams per day. The herb is non-toxic and rarely causes any adverse effects.

Licorice (gancao)

The roots have an extremely sweet taste (but are also bitter) and are said to neutralize toxins, relieve inflammation, and enhance digestion. In Europe, a drug has been made from licorice extract that heals gastric ulcers. Licorice is used by Chinese doctors in the treatment of hepatitis, sore throat, muscle spasms, and, when baked with honey, for treatment hyperthyroidism and heart valve diseases. Traditionally, licorice is thought to enhance the effectiveness of herb formulas and is used to moderate the flavor of herb teas; as a result, it is found in about one-third of all Chinese herb prescriptions. Licorice powder is encapsulated for easy consumption or mixed with other herbs and tableted. Dosage is from very small amounts (a few hundred milligrams) to 15 grams per day in decoction used to treat viral hepatitis. Caution: excessive consumption of licorice over an extended period to time can cause sodium/potassium imbalance with symptoms of tachycardia and/or edema.

Ma-huang (ma huang)

The stem-like leaves when taken in a dose of several grams stimulate perspiration, open the breathing passages, and invigorate the central nervous system energy. It has been shown that most of these effects are due to two alkaloid components, ephedrine and pseudoephedrine, both of them having been made into modern drugs (for asthma and sinus congestion, respectively). In addition, the stimulating action of ma-huang has led to its use as a metabolic enhancer (burns calories more quickly) for those who are trying to lose weight. Ma-huang also has anti-inflammatory actions useful in treating some cases of arthralgia and myalgia. Ma-huang can be made into a tea, or used in extract form; powdered ma-huang is rarely used. Dosage range is 1 to 9 grams/day, usually in two or three divided doses. Caution: the stimulant effect of ma-huang can cause insomnia and agitation; persons with very high blood pressure may find this symptom worsened by use of ma-huang.

Peony (bai shao and chih shao)

The root of this common flower is used to regulate the blood. It relaxes the blood vessels, reduces platelet sticking, nourishes the blood, and helps get the circulation to the skin and extremities. The root of both wild and cultivated peonies are used. The wild peony yields "red peony" a fibrous root that is especially used for stimulating blood circulation. The cultivated peony yields "white peony" a dense root that nourishes the blood. Peony is often combined with tang-kuei, licorice, or other herbs mentioned here to enhance or control their effects. The dosage range is from 0.5 to 15 grams per day. Peony rarely causes any adverse reactions.

Rehmannia (dihuang)

The root of this herb is a dark, moist herb that is extensively used to nourish the blood and the hormonal system. It is frequently used in the treatment of problems of aging, because of its ability to restore the levels of several declining hormones. There are two forms of the herb that are currently used: one, designated shengdihuang or raw rehmannia, is given to reduce inflammation and is included in many formulas for autoimmune disorders; the other is designated shoudihuang or cooked rehmannia, and is used as a nourishing tonic. Often, the two forms are combined together in equal proportions to address inflammatory problems that are related to the lack of adequate levels of regulating hormones. The herb is mainly used in making decoctions or dried decoctions, with a dosage of 10-30 grams per day. Caution: persons with weak digestion and tendency to experience loose stool or diarrhea may find that this herb, especially cooked rehmannia, worsens those symptoms.

Rhubarb (dahuang)

This large root was one of the first herbs that the Western world imported from China. It serves as a very reliable laxative, and also has other benefits: enhances appetite when taken before meals in small amounts, promotes blood circulation and relieves pain in cases of injury or inflammation, and inhibits intestinal infections. Rhubarb also reduces autoimmune reactions. The impact of rhubarb is influenced by how it is prepared; if it is cooked for a long period of time, the laxative actions are reduced but other actions are retained. Typical dosage is 0.5 to 3 grams per day. Caution: rhubarb, alone or in formulas, should not be used by those with irritable bowel conditions, as it may cause cramping and diarrhea.

Salvia (danshen)

The deep red roots of this Chinese sage plant has become an important herb during the past two decades even though it was used for centuries before that. It is applied in almost all cases where the body tissues have been damaged by disease or injury--thus given for post-stroke syndrome, traumatic injury, chronic inflammation and/or infection, and degenerative diseases. It is best known for its ability to promote circulation in the capillary beds, the so-called microcirculation system. In addition, salvia lowers blood pressure, helps reduce cholesterol, and enhances function of the liver. It may be consumed alone or with other herbs, in wines, teas, pills, or tablets; dosage is 1 to 20 grams per day. Salvia rarely causes any adverse reactions.

Tang-kuei (dang gui)

The root has been long respected as a blood-nourishing agent. It has its highest rate of use among women because tang-kuei will help to regulate uterine blood flow and contraction, but when employed in complex formulas it can be used by both men and women to nourish the blood, moisten the intestines, improve the circulation, calm tension, and relieve pain. The recommended dosage for tang-kuei is 0.5 to 9 grams per day. Tang-kuei may be made as a tea or cooked with chicken to make soup (the taste is quite strong), but it is often used today as a powder, encapsulated or made into tablets, alone or with other herbs. Caution: some individuals find that tang-kuei causes nausea or loose stool.

Examples of Herb Combining to make and Effective treatment

An ancient formula prescribed for the initial stage of an infectious disease is Cinnamon Combination. It includes cinnamon, peony, licorice, and ginger. It is said that the cinnamon (twig) and peony coordinate the circulation at the surface of the body (where disease is believed to enter) and relaxes tense muscles. Ginger and licorice improve the digestive functions and improve the body's healing energy. An ancient formula used to treat chronic illness is Ginseng and Tang-kuei Ten Combination. It includes astragalus, ginseng, atractylodes, hoelen, licorice, cinnamon, tang-kuei, peony, and rehmannia. Astragalus, ginseng, atractylodes, hoelen, and licorice promote digestive functions, increase the energy, nourish the internal organs, and enhance weakened immune responses. Cinnamon (bark) warms up the weakened metabolism. Tang-kuei, peony, and rehmannia nourish the blood. Another ancient formula, used for a variety of diseases and function disorders, is Minor Bupleurum Combination. It includes bupleurum, ginseng, ginger, hoelen, and licorice. Bupleurum harmonizes the circulation between the internal organs and the body surface, it alleviates stress in the chest and abdomen, and it reduces inflammation. As indicated above, ginseng, ginger, hoelen, and licorice benefit the digestive processes and increase energy.

All of these formulas are widely used today, often by making some slight modifications to address the particular needs of the individual or the characteristics of the disease. For example, Cinnamon Combination (with appropriate modifications) has been used in Chinese clinical trials for treatment of frostbite, pernicious vomiting of pregnancy, and appendicitis. Ginseng and Tang-kuei Ten Combination has been applied to treatment of side-effects of cancer therapy and for prevention of cancer recurrence after successful treatment. Minor Bupleurum Combination is one of the formulas frequently given in cases of chronic hepatitis B infection, and it is also used for inflammation of the stomach and pancreas.

How do Chinese Herbs work?

Western science has, in the case of some of the Chinese herbs, been able to track down the active ingredient that affects the health of the patient. Ephedrine, the active ingredient in the Chinese herb Ma Huang is an excellent example. However, most Chinese herbs are unexplored territory from the perspective of Western science.

The National Institutes of Health (NIH), the Office of Alternative Medicine (OAM), and the Food and Drug Administration (FDA) are currently wrestling with the best way to regulate Chinese herbal remedies.

There is, however, a great wealth of knowledge about herbs from the Chinese perspective. The Chinese describe what they understand about herbs as "energetics."

An example of Energetics

Let's say that you're suffering from arthritis that is aggravated by humidity or rain. From the Chinese perspective, that would be an invasion of cold and damp into the acupuncture meridians, or freeways of energy within the body. Sometimes this cold and damp will lodge in the joints and this is what we, in the Western world, call Arthritis.

There are, however, certain plants that are very comfortable living in cold and damp environments. They have a natural defense against excessive cold and damp weather. There is one in particular that is called Hai Tong Pi. This translates to Sea Vine Bark. There is, in this bark, the necessary energetics required to keep this plant, which lives near the sea, free from constant invasion of cold and damp air. Ingesting the bark in the form of tea will provide those who suffer from arthritis the same relief from the pain associated with an internal invasion of cold and damp as is enjoyed by Hai Tong Pi.

No doubt there is some active ingredient involved in Hai Tong Pi, perhaps erythraline, or a combination of its known ingredients, but generally, the research on the specifics has not yet happened. Until then, it is a healthy mental exercise to look at pathology from the Chinese perspective. Walking away from any problem and coming back fresh to see it differently is the source of multitudes of creative and beneficial solutions to the problems of individuals and society. The Chinese perspective on health provides us with that new way of seeing problems of health, and creative new ways of healing. Practitioners must remember that it is more important to heal the patient than be able to explain how it was done.

Yin and Yang : A Basic Introduction

Chinese Medical theory, though scientific in its own right, is built on a foundation of ancient philosophical thought. Many of these ideas are based on observations of natural phenomena and are the reason why Traditional Chinese Medicine (TCM ) has remained a truly holistic approach to health and well being.

The Theory of Yin and Yang is one such philosophy. It is said to date back nearly 6,000 years to the third or fourth millennium B.C. and is attributed to an enlightened philosopher named Fu Shi (also credited with creating the I-Ching or Book of Changes). The basic premise of yin and yang is the notion that the only constant factor in natural phenomena is universal change. In other words, nothing remains the same; no disease, no condition, no emotion, no treatment or diagnosis, absolutely everything is in a constant state of flux and, therefore, subject to the laws of change.

Yin and Yang are metaphorical images used to express these constantly transforming interactions. They have no fixed, precise definition. Rather, they describe two broad categories of complementary concepts which include the relationships of positive and negative, dynamic and inert, creative and destructive, gross and subtle, and kinetic and potential. This is quite similar to the notion of dialectics as expressed in Western philosophy. Within dialectics the whole is the sum of its parts and in turn part of the sum of a greater whole. As these various components interact, things become their opposites; i.e., variables become constants, causes become effects, and the process of creation leads to destruction. Furthermore, this idea is demonstrated in modern physics where sub-atomic interactions are the result of ever shifting polarities and constantly vacillating magnetic attractions and repulsions.

The entire universe may be viewed as the interplay and alternation of yin and yang. Originally the Chinese characters for yin represented the moon and yang represented the sun. Gradually these terms were broadened to include yin as night and yang as day, yin as winter and yang as summer, and yin as female and yang as male. In fact, there is nothing which cannot be viewed from the standpoint of yin and yang.

Yin is that which maintains and endures, it is nourishing and supports growth and development as well as being something contracting and moving inward. It also includes the following:

Earth, Autumn, Cold, Coldness, Moisture

Yang is that which is creative and generating, it develops and expands; it is dynamic and full of movement. It also includes the following:

Heaven, Spring, Summer, Heat, Warmth, Dryness

It is important to remember that yin and yang are not static concepts and that they are constantly influencing and determining one another. There is always some measure of yin within yang and vice versa. To use the analogy of a hillside; during the day the sunlit side of the hill is yang within yang, while the shaded side is yin within yang. Conversely, at night the moonlit side of the hill is yang within yin while the dark side of the hill is yin within yin. In this fluid model it must be understood that neither yin nor yang can ever exist without the other. In fact, extreme yin will engender yang, an example of this can been seen in the popular expression "the darkest hour is right before the dawn". Naturally, the opposite is also true.

These types of relationships become significant when they impact the body's anatomy and physiology and it is precisely these designations that are used in the diagnosis of imbalances in TCM. For a TCM practitioner, the name of the disease is of secondary importance. The primary key to the proper diagnosis of syndromes is the identification of the condition in terms of yin or yang. In order to understand what this means let us examine these concepts in the context of human life.

Beginning at conception the sperm, which is yang, unites with the yin ovum and a new life is formed. As that life develops and progresses the energetic stages of youth are yang; whereas the later years are yin as life slows and becomes more deliberate. Each stage is also relative to the others and contains a measure of both yin and yang, just as the aforementioned hillside is an expression of yin within yang, etc. For example, the quick growth of early childhood is yang within yang and the transition from middle age to old age is yin within yang.

We can also see this philosophy expressed in everyday life. In respiration, the expansion of inhalation is yang while the emptiness which results from exhalation is yin. In digestion, the yin substance of food is transformed by the metabolic activity of yang. It is then converted into Chi (yang) and Blood (yin). Chi and Blood interact with one another using this paradigm. Chi moves Blood, yet Blood is thought to be the "mother" or source of Chi. Within the body yin is expressed as the material basis, the tissue and substance without which the transformation of yang would not be possible.

The physical body itself expresses this model. The lower part of the body which connects to the earth is yin while the upper body and extremities are yang and free to move. The front, which can easily be protected, is yin while the exposed back is yang. The internal organs, which are enclosed and protected, are yin relative to the surface of skin and muscle which are yang. In addition, the internal organs can be further differentiated into fu (yang), which are the "hollow" organs that are involved with digestion and elimination, and zang (yin) which are involved in assimilation and storage. Each zang has a corresponding fu organ which it is paired with and while these connections are not recognized in Western medical terms, they are often utilized in the treatment of disease in TCM.

Finally, disease and disease progression can be viewed using this paradigm. If the body's yang is weak it will be unable to ward off the invasion of a pathogen. If the yin is weak there will not be enough nourishment and support for the yang and the result will be the same. Expressed in other terms, without the substance, the active immune system is weakened and without activity the substance becomes vulnerable. Therefore, if yin is deficient over time then yang also becomes deficient and vice versa. Not only do yin and yang balance each other, they mutually generate one another. It is precisely this balance that the TCM practitioner uses various treatment strategies to restore. The idea is to reestablish the body's innate ability to maintain health and defend itself from disease.

The nature and progression of disease can also be understood using this pattern. When a disease develops rapidly, it is in the acute or yang stage. As it progresses and becomes more chronic, thus it enters the yin stage. Usually, acute diseases affect the surface or superficial aspects of the body while chronic diseases have already overwhelmed the body's defenses and gone deeper into the interior. In addition, regardless of location or duration, disease can be classified by its affects. Extreme, severe symptoms are considered excess and are consequently yang. In contrast, mild or diffuse symptoms accompanied by weakness are considered deficient and are therefore yin. With regard to diagnosis, that which is internal, cold, deficient or chronic is considered yin. That which is external, hot, excess or acute is considered yin. When conflicting signs are present it usually points to a more complex condition and the TCM practitioner must evaluate all the symptoms together to determine the appropriate treatment strategy.

In summary, it should be evident that the designations of yin and yang are universal and extend into every aspect of life. Because of its ubiquity, this theory is a very useful tool for understanding natural phenomena and therefore can be an indispensable diagnostic aid. While this is an ancient paradigm it is not primitive and though simple it can be developed into surprising complexity. The only limitation of the application of this universal truth is one's own perception and imagination.

The Theory of the Five Phases (Wu Xing)

Chinese medical theories have, in many ways, developed from a layering of disparate ideas. Many of these theories were born in ancient philosophical thought and still remain influential in modern Traditional Chinese Medicine (TCM). The Theory of the Five Phases, much like the Theory of Yin and Yang which preceded it, is an attempt to organize and classify natural phenomena using archetypal imagery. Where Yin-Yang Theory divides phenomena into two opposing forces, the Theory of the Five Phases creates a more complex picture of five interrelated forces that interact simultaneously along generating and restraining lines.

The Theory of the Five Phases is generally attributed to Tsou Yen (350 B.C.E. - 270 B.C.E.) and his followers. Gradually, it became the predominant ideology in political as well as scientific circles and was incorporated into Confucian dogma. Because of this position of prominence within the culture, the apparent inconsistencies within the theory were largely ignored and it became inextricably bound to the Chinese perception of every day life. It is interesting to note that one of the unique aspects of Chinese culture is its ability to assimilate apparently conflicting ideologies. Instead of rejecting the Theory of Yin and Yang for the Theory of the Five Phases, both were maintained and used wherever it was advantageous. Furthermore, Yin and Yang were incorporated into the Five Phase Theory and used to express it in more subtle and sophisticated terms.

The Theory of the Five Phases has often been misrepresented in Western circles and given the misnomer the Theory of Five Elements. The Chinese characters for this theory are wu (meaning five) and xing (which literally means “to go” and is the radical used in other characters to delineate motion). Wu Xing, therefore, suggests movement and motion, not static matter. However, true to Chinese thought, each process has a yin or static component and a yang or active component. The five archetypal images used to describe these processes are Wood, Fire, Earth, Metal and Water.

Wood is associated with active functions of growing and reaching skyward, just as a seed reaches for the sun and in a static sense connotes trees and vegetation. Fire designates maximum activity, is yang in nature and will soon begin to decline or rest. Metal suggests a declining state and one that is subject to change and in a static sense is associated with tools, implements and weapons. Water is associated with a downward flow, is yin in nature and the source of life and vitality. Earth is associated with balance and is a kind of neutralizing force for the other four phases.

As the theory developed, the five phases evolved into five generic categories which were used to classify virtually all phenomena from seasonal growth to colors, sounds, tastes, odors and directions, from emotions to dynasties, planets and everything else in the universe. These categories also extended into the realm of medicine and entire schools developed using them to explain everything from physiology to disease progression and treatment strategies. To this day there are practitioners who practice the Five Phase Theory exclusively and the vast majority of the remaining practitioners use it in some way in clinical practice. Let us now briefly examine the types of interactions involved in the Five Phase theory and their application in TCM.

There are primarily three different types of interaction:

The first is referred to as the sheng or generating cycle. The basic premise is that one phase engenders or gives birth to another and creates a mother-child like interaction. Water is the mother of wood and wood is the mother of fire, fire is the mother of earth, earth is the mother of metal, and metal is the mother of water. This interaction and those that follow are viewed as a continuum, a never-ending cycle of regeneration. The mother-child relationship can be viewed in nature as water producing plants and trees (wood), wood becomes the source of fire, fire produces ash which becomes soil (earth), soil brings forth metal (in the form of minerals and ore) and finally, when heated, metals produce steam which condenses and becomes water again.

The second type of interaction is known as the ke or controlling cycle. The basic premise here is that, if left unregulated, each phase will grow and flourish out of control and therefore must be kept in check. Thus, the controlling cycle is a kind of intrinsic regulation within the system. In this case, water controls fire, fire controls or melts metal, metal controls or overcomes wood (as an axe would cut a tree), wood controls earth and earth controls water (as a dike might stop the flow of water).

The third type of interaction is known as the cheng or insulting cycle. The ancient character cheng was a pictogram of a war chariot and this cycle suggests a kind of rebellion. In this case, the recipient of the controlling cycle rebels against its oppressor and insults that which has been controlling it. Inherent in this type of interplay is the time required for this energy to build up; therefore, this is most often seen in more chronic or serious conditions. Clinically, the Five Phase Theory is applied in many different ways. One of the most common applications is to use it to explain relationships between internal organs.

In TCM internal organs are viewed not just simply as physical organs, but rather as complex entities which have spheres of energetic influence as well as physiological functions. The Five Phase Theory is employed as a means of organizing the various aspects and consequences of this view. There is a yin and yang organ for each phase and each organ has its own meridian, through which qi flows and which can be used in treatment (using acupuncture). There are various other correspondences that also can be used clinically. The following table illustrates these.

Correspondences of the Five Phases

There is certainly much debate within the TCM community as to which correspondences are relevant practically and which are not. For example, the relationship between the Heart and Small Intestine is viewed by some to have limited importance. Whereas, the relationship between the Stomach and Spleen is almost universally viewed as valuable. Some of the other correspondences can be construed as a bit of a reach for some, while others find them helpful in determining the onset and etiology of various conditions.

In order to understand how the theory is applied, let us examine a disharmony with regard to the sheng cycle. As we have seen, mother engenders child. Following this logic, the Kidney (water) engenders the Liver (wood). Consequently, if the Kidney should become deficient then the Liver would also eventually become deficient because it is not receiving the proper “nourishment”. Conversely, if the Liver is deficient it may cause Kidney deficiency by draining its mother. This means that if an organ is deficient, treatment can be affected by strengthening the mother. Furthermore, when there is excess in an organ, the excess can be drained via the child. This mode of treatment is used quite regularly and effectively in acupuncture.

When we examine disharmony using the ke cycle we can see that the normal balance of harmonious control has somehow been disrupted. This may manifest as one organ exerting too much control over another. For instance, a frequent example of this can be seen in the Liver (wood) over-controlling the Spleen (earth). This ultimately leads to Spleen deficiency which can result in numerous digestive complaints. This is a relatively common occurrence and there are acupuncture and herbal treatments designed for just such a syndrome. Moreover, there are many such syndromes found in TCM and the Five Phase Theory is an excellent road map, if you will, for navigating their treatment.

In conclusion, it is important to understand that the Five Phase Theory is an explanatory theory and not an exclusive doctrine. It is not the “be all and end all”; rather, it is one of the many tools that a practitioner of TCM has at his or her disposal. In studying Chinese medicine, one of the difficulties for a Western mind is to learn how to incorporate the uniquely Chinese tendency to view phenomena from more than one perspective. It requires a great deal of open-mindedness. However, it is just this adaptability and open-mindedness that has helped to foster a medicine which is, in itself, adaptable and truly holistic and which has not been threatened nor diminished by modern technological advances. The theories of Yin and Yang and the Five Phases allow a TCM practitioner to treat disease as a fluid and unique occurrence in each individual rather than a static and immutable condition which is the same for everyone.