Fundamentals of TCM

Board exams are 200 questions. It’s sitting and taking a test. It’s a multiple choice. Point location is often done on a computer. Sunday seminar is the needle technique. It’s a demonstration & lecture.

The MCOM has a comprehensive test that preps you for the exam.

Western and Chinese Medicine

Don’t mix east with west. It is crucial that you avoid mixing Chinese medicine theory with that of Western medicine.

Wherever there is pain there is stagnation of Qi. Injuries will tend to block qi. Because qi is warming, upstream of a bruise is generally warm, downstream from the injury it’s cool. Qi moves blood. If the qi is blocked, the blood will pool: i.e. a bruise will result.

The acupuncture points are kind of the on and off ramps of the qi highways (the channels – meridians). Each channel is associated with an organ. Each channel has a set of points. Each point has a Chinese name and an English number. There are right and left (except the “ren” - conception and the spine (“du” – governing). There are 35 main points, but there are extra points and new ones being discovered all the time.

There are ahshi points (Japanese for ouch!). These can be needled as well. They are not acupuncture points however.

Qi stays in the channels for a 2-hour period. It flows through different areas of the body at different times. We adjust the energy in the channels using needles. We can tap into and adjust the flow by using needles.

We can take heat out or we can “tonify” or build qi. The tonifying has recently been proven to be able to increase a patient’s hematocrit.

We can “cool” the body.

There’s a Jama article for dealing with nausea. (Pericardium 6) It’s been proven to be effective and calming.

TCM has a 3000 year old tradition based on observation. The story goes:

There was a warrior who always had stomach pains. He goes to war and gets stabbed in the leg. (Just below the knee – Stomach 36). His pains went away. (Acupuncture points aren’t always local.)

We’re not doing anything to the body; we’re helping the body heal itself. It’s trying to balance the body. We adjust the balance of the body to help the body heal itself.

The theory behind TCM is not based in a study of the anatomy. The Chinese regard the body is a gift and do not want to perform any kind of autopsy.

“Although the organs of Chinese medicine are virtually identical anatomically with the organs of Western physiology, they are ascribed very different functions. Western organ physiology links function entirely to the study of form; all functions must have some precisely identifiable physical matrix. Often this takes the study of physiology and two anatomy and biochemistry, sciences which are completely alien to Chinese medicine. Although the organs of Chinese medicine have a definite form, the understanding of the function does not truly stem from their morphology. Instead, Chinese organ physiology is rooted in folk beliefs Taoists metaphysics, and analogies with nature and human society.”

Chinese regard the body as a gift and don’t want to perform any kind of autopsy. It’s more functionally and simplistically correct. It works within it’s own set of logic.

The five organs of the body should work in harmony. We diagnose by looking at how the organs aren’t functioning together correctly. Something may not be working harmoniously, that’s when you have problems. The channels connect the top to the bottom, the inside with the outside, and the organs with one another.

The liver is in charge of the qi movement in the whole body. This is nothing like how western medicine sees the liver (detoxification/digestion).

Between the skin and the muscles is the Wei Qi or defense Qi. It acts to protect our body from the outside pathogens. It works like the western immune system. So this is sort of like western medicine, but the mechanism is completely different. In TCM, “wind” can break through the barriers of the body (the wei qi). The wind can combine with cold or heat and break in. So, a cold can be a “wind heat” common cold. The wind gets in and sticks the lung qi. A cold is treated by exteriorizing the pathogen and building the wei qi.

Even in China they don’t rely solely on TCM. They tend to combine both east and west traditions in combination. It’s not either one or the other. It’s just another specialty. You do what’s best for the patient.

Basic Theories and History

History

Taoism

Around 400bc to 300ad

Taoism was created by a bunch of guys really into nature.

They see our place as within nature and resonating with nature. A lot of the body processes are compared to being within nature.

Their way of looking at the body was by analogy with nature.

They got into elixirs and exercises for acquiring immortality.

They infused medical prevention as a part of the Chinese body of medicine.

Huang Ti – waiting to treat a disease after it’s started is similar to waiting to dig a well once you are thirsty, or making weapons only after the war has started.

They invented medicine for good health – Qi Gong.

Lot’s of other things: meditation and alchemy. The alchemy is a poetic way of describing what’s going on. Taoists added this to the body of knowledge.

Taoists – we should be like nature and sleep at night. Winter is the time of hibernation. Human energy goes deeper inside the body during the winter.

Confucianism

Confucius was born in 551BC

Came from a humble background and was self-taught. Knew what it was like for the common people.

Confucianism is a philosophy for how to make a better society. It is based on moral principles and rituals to maintain society. (Almost anal retentive at heart when it comes to rituals.)

They lived in the cities.

They added an intellectual logic to Chinese medicine. Their influence on Chinese medicine was after the Taoist tradition.

He took a lot of natural phenomenon and added man-made models.

Taoists call the meridians rivers; Confucianism called them canals.

Shamanism

The earliest practitioners saw disease in caused by evil spirits (xie) that entered the body. They used to have “bian” stones about the size of a finger and nicked the body to let out a few drops of blood. These were the primitive acupuncture needles. Needles didn’t come about until the bronze age.

Astrology

Used by the Taoists and the Confucianism.

We don’t necessarily get into the astrological stuff. This is like the 13 signs based on the year you were born.

Four classics

Nei Jing

Classic of internal medicine. Oldest known document of internal medicine for Chinese medicine. Attributed to the emperor Huang Ti. (one of three noted emperors) He was about 2600BC The full title is “Huang Ti Nei Jing Su Wen Ling Shu”. Parts are “Yellow Emperor – Huang Ti” ad Su Wen – simple questions. This is a conversation between Huang Ti and his major physician, Qi Po. Qi Po is telling Huang Ti the guidelines to being healthy.

Cover’s organs, elements, describes circulation of blood (45 centuries before the west!)

Empirical observations that formed the foundations of traditional Chinese medicine.

Also sometimes called “Su Wen” or “Yellow Emperor’s”

Nan Jing

The complicated classic. The classic of difficulties. This explains the more difficult passages of the Nei Jing. It’s kind of tricky to read.

Attributed to Bian Que in the fifth century BC.

Ben Cao

Cao – means herb.

This is written by Shen Nung – another one of the legendary emperors

2698BC - 2598BC

He was an herbalist. “he was able to eat the herbs and tell what they did”. It’s the material medica.

Herbs are safe to use on a daily basis, herbs that are safe for a limited time, herbs that are toxic – can be life saving if used for a limited time.

Shang Han Lun

Treatise on cold diseases.

2000 years old

Zhang Zhong Jing wrote this. He’s written a couple of books. This is the most important. This is an herbal book.

Explains how diseases can go deeper inside the body. How diseases can progress. There are six levels/six stages of disease in the body, from the outer yang channels to the inner yin channels.

The wind gates on the back of the upper and lower neck are how the wind can attack and break through the wind gates.

Fu Tzi - the third of the legendary emperors. Didn’t have as much to do as Huang Ti and Shen Nung as with medicine. He had more to do with agriculture and culture.

Modalities

Acupuncture and Moxabustion

Acupuncture

Where you start.

Deals with stagnant qi

Da Qi – obtaining qi – it’s like going fishing for the person’s qi.

Depths are measured in “cun” which is a particular measurement that is proportional to a body. It’s generally the length of the width of the thumb.

There are different gauges of needles. 28 being the largest. 36 is a finer gauge it’s what Barbara uses. You can get from a “face needle” that is ¼” long up to 8 inches.

Moxabustion or Moxa

The herb - Artemesia vulgaris

About a 9 inch roll of the herb.

It burns really hot. It’s like a smoky heating pad.

It moves the blood.

This is for cold problems.

You can use “warming needle” by adding moxa directly to the needle.

Or direct moxa – (you can’t do this in Wisconsin or any other states) and put it directly on the skin. It leaves a little scar or blister on the skin. You roll up a little ball of moxa and burn it directly on the skin.

Herbalism

Chinese herbs

They may seem disgusting, but you know you’ve got the right thing if it tastes good despite it all. :-)

Dosing is based on age and size.

Herbs have heating, cooling, and neutral properties. So you might treat someone who’s always cold with warming herbs in a tea.

Prepared pills are more popular than the herbs.

Message Therapy

More important than acupuncture. Uses the acupuncture channels. Pressure points are the same points or similar points anyway.

Tui Na

Anma

Shiatsu

Diet Therapy

Foods have properties is much like herbs.

Cinnamon, wheat, brown sugar, sugars for warming

Cooling foods would include watermelon, cucumber, and raspberries for the summer time.

There’s a Taoist diet where you separate starches from proteins. Vegetables can go with starches however. Fruits should generally be eaten by themselves. Don’t combine acidic and non-acid fruits. No orange/apple, but apple/pear is ok. Milk should be taken by itself. (Rice is considered a grass. It’s not really as bad a starch.)

Congee – white rice turned into porridge. – Jook is congee with herbs.

Exercise

Swimming (like liquid tai chi), walking, Tai Chi

Meditation

Qi Gong – physical movement combined with meditation.

Meditation is the result of Buddhist influence.

Not too popular in the US.

Geomancy

Feng Shui – acupuncture for the environment.

Began as a method to determine the proper burial sites.

Astrology

Ming Shu, Destiny calculation.

Points have different effects according to when they are needled.

There are also other accessory modalities

All of these are moving qi where it’s stuck.

Tapping needle - Plumb blossom or seven need hammer

Magnet therapy

Herbal patches

Lancets (bleeding)

Cupping – for pulling cold out, or sliding cupping (Cupping over a needle can be done as well.)

Guasha – scraping along the wind gates for a cold.

Auricular or Ear acupuncture.

Cold Lasers

Electro Stimulation

Korean Hand Acupuncture

French/English Acupuncture

Yin and Yang theory

Nei Jing: “Yin s quiet, Yang is active. Yang gives life, Yan makes it grow. Yan is transformed into Qi, Yang is transformed into life.” The Yin character is clouds and a mountain. Yang is a picture of the sunny side of a mountain.

The Tai Qi symbol (the standard yin & yang symbol) yin is dark, yang is white. They define each other as opposites, but the spot inside the other is how they flow into each other.

Fire is yang water is yin – they balance each other.

Yin is more female while Yang is more male.

What we’re looking for is the Goldilocks principle. Not too much, not too little, but just the right balance needs to be achieved.

You have to have a balance between the yin and the yang. It’s like a checking account, you have to have enough yin For your yang. It the imbalance that’s the cause of the disease in Chinese medicine.

The five principles

The Categorization Principle

Yin and Yang are complementary opposites and the fundamental categories of all phenomena.

A real low temperature is more yin.

Someone who wants to sleep all the time – yin

A temperature – yang

Someone who’s excited and restless – yang

The Subdivision Principle

Yin and Yang are divisible into further subcategories of yin and yang.

Every yin aspect has both yin and yang aspects. You can break it down this way forever.

The Mutual Creation Principle

Yin and Yang are rooted in each other.

They cannot exist separately.

The concept of light can only be known by contrast with darkness.

The Seesaw Principle

Yin and yang counterbalance each other.

When yang increases, yin decreases. When yang decreases, yin decreases.

The soup pot example: The fire is yang and the soup is yin. If there is too much heat, the yin is burned off. If there isn’t enough yang, the soup has too much yin. vHeat = ^Water and ^heat means vWater

This is true of people as well. ^water means edema. A high fever can mean dehydration.

Yang deficiency is a lack of heat.

The fire at the gate of life Ming (Fire) Men(gate) Ho(life) (the body pilot light). At the base of the spine. You could treat this with a moxa stick.

A yang deficiency would mean that someone feels cold.

If vWater, you’ve got a yin deficiency.

Similarly, you can have an excess of yin. A car on a really cold day.

Or you can have excess yang. Like on a really hot day.

If there is a yin deficiency, the body will tend to run a little hot.

The sea-saw principle. There’s constant motion, constant balance and rhythm.

Yin breathing in, yang breathing out.

This should be a nice gentle and smooth ebb and flow.

The Inter-Transformation Principle

Yin and Yang transform into each other

Without this law, yin or yang would grow unchecked yin or yang would go uncheck until it consumed the universe.

Yang germinates when the yin reaches its peak – winter solstice is the time when nights are at their longest, but it’s also the time when days start getting longer again.

Major Zang Fu organs

Zang organs

These are the solid organs. They are known as the treasure organ because they all store or contain “treasures” They are yin in nature because they are all considered to be internal organs.

The organs are:

Heart

Joy (appropriate, too much, too little, vs. just right)

Emperor

Stores shen.

Governs the blood.

Pericardium

The emperor’s guardian – also associated with Joy. It’s like the pimp.

Much like the heart. Some people pair the pericardium with the triple burner and the heart with the small intestine.

Spleen

Worry – preoccupation or ruminating, ideas, thinking

Agricultural Minister

Lung

Grief or sadness, anxiety

Store Mucus

Architect

Kidney

Fear/will power/inner strength/fight flight (adrenal)

Treasurer

Liver

Anger

Anger stagnates qi.

General

Notes:

You want to go through the emotions in a harmonious way. You don’t want to dwell or deny your emotions. This can also be a diagnostic tool. Emotions can help to diagnose or give trends where harmony doesn’t exist.

All have to work harmoniously to have good heath.

Fu

The Fu-bowels are the “tube” organs. They are consider more yang then the zang-viscus organs because they are more external and they actively fill up and empty.

Small Intestine

Paired with the heart.

Triple Warmer

3 places “San Jiao” – upper space (heart and lungs), middle space (stomach & spleen, liver bladder), Lower space (kidney, bladder, large intestine, small intestine)

Paired with the pericardium

Stomach

Paired with the spleen. They form the basis of digestion and the acquiring of “grain qi”.

Large Intestines

Paired with the lungs

Urinary bladder

Paired with the kidney.

Gall bladder

Paired with the liver.

Five Elements

Five elements come from Taoism

Fire – heart /Pericardium (small intestines/triple burner)

south

Earth – digestive organs spleen (stomach)

center

Metal – lung (large intestines)

West?

Water – kidney (urinary bladder)

North/cold

Wood – liver (gall bladder)

east

Five Phases

Phenomenon	Wood	Fire	Earth	Metal	Water
Zang Organ	Liver	Heart	Spleen	Lung	Kidney
Fu Bowel	Gall Bladder	Small Intestine	Stomach	Large Intestine	Urinary Bladder
Direction	East	North	Center	West	South
Season	Spring	Summer	Late Summer	Fall	Winter
Transformation	Birth	Growth	Maturity	Old Age	Death
Tissue	Sinews(help the muscles to move)	Blood (vessels)	Flesh Complexion	Skin (skin rashes treated with topical steroids can turn into asthma)	Teeth & Bones (false teeth and osteoporosis)
Exterior	Nails (extensions of the sinews)	Complexion	Lips	Body Hair	Head Hair
Sensory Organ	Eyes	Tongue – the tongue is the sprout of the heart.	Mouth	Nose	Ears
Sensory Commanded	Vision	Speech (aphasia – inability to speak)	Taste	Smell	Hearing
Fluid	Tears	Sweat – the fire element.	Tongue Saliva	Mucus	Gum Saliva
Portal	Eye Socket	Auditory Canal	Mouth	Nostrils	Anus & urethra (yin gates)
Odor	Goatish	Scorching / Burning	Fragrant	Rank – dirty oily smell. Raw flesh or fat that clings to the nose.	Rotten – rancid or musty. Knd of like decayed meat.
Pathogen	Wind	Heat	Damp	Dry	Cold
Emotion	Anger	Joy	Preoccupation Rumination	Anxiety	Fear

Star Cycles

Ke or Ko

Control is a father/sun Grandmother/Grandchild relationship.

Also called the restraining cycle.

Wood Controls Earth

Earth Controls Water

Water Controls Fire

Fire Controls Metal

Metal Controls Wood

Insulting sequence is just the opposite.

Sheng – pronounced “shung”

Engendering or mother/child

Fire generates/creates earth

Earth generates metal

Metal engendering Water

Water creates wood

Wood engenders fire

Use this for prognosis. Use to determine source of problem. For example, alcohol is a hot food. Alcohol generates heat in the liver. The heart is liver’s child. Since the liver isn’t doing it’s job. The liver won’t give the heart what it needs. It’s a lousy mom for the heart. On the other hand, the liver is taking a lot of energy away from the kidney. Kidney’s function in aging means that the person will age quickly. The liver will not control the stomach properly either. The person won’t have much of an appetite. The liver “invades” the digestive system causing problems.

Substances

Qi

Qi is the most yang of all substances.

Qi is actually a process. It is the potential for energy. It’s not until you “plug in” that you can actually use it. It has the potential to be used.

Organ qi does a specific job for that organ.

Heart Qi

Spleen Qi

Lung Qi

Kidney Qi

Liver Qi

Organ Qi has a direction.

Stomach Qi goes down.

Lung Qi goes down.

Liver Qi spreads out. Just as a tree grow, the liver qi moves.

Kidney Qi goes up

Spleen Qi goes up.

Wei Qi is a warming qi that acts as the little warrior going around protecting the body. It warms the layer of skin between the muscle and the skin. It opens and closes the pores according to Chinese medicine. If the pores aren’t closed properly, the pathogens can get in.

Generic Qi has five jobs in the body

Defense (wei)

Warms

Activation

Transforms

Containment

There are several forms qi. These forms include:

True qi

True qi is commonly referred to as simply qi. True qi is formed when essential, grain and great qi are combined in the lungs. It is responsible for all qi functions that subsequently occur in the body. In other words, the great, grain, and essential qi’s are crude precursors to a more functional form of energy which is used to carry on bodily activities.

Great Qi

The lungs draw this in from the air we breathe. Thus it comes from the heavens and the name great.

Grain Qi

This is derived from ingested food and drink that is extracted by the stomach and spleen.

Essential Qi

This is stored in the kidneys.

Meridian qi

The Meridian Qi flows through the meridians and is responsible for circulation of energy throughout the body.

Organ qi

Organ qi belongs to the organs.

Defense qi or Wei Qi

See above. This is relatively Yang it flows outside the meridians, and defends the body. It is fiery, independent, and combative in nature. It depends on kidney Yang.

Construction qi

This is relatively Yin. It flows inside meridians and nourishes the body. It is harmonizing and supportive in nature. It depends upon the spleen.

Right qi

This is essentially the same as true qi. This term is only used when the body's capacity to resist evil is being referred to. It is much broader than defensive qi; it summarizes all of the factors responsible for protecting the body from evil.

Evil qi

Although this original referred only to pathogens from the outside, in later years the body was imagined being capable of generating its own evil.

Ancestral qi

This is also known as gathering qi or the zong qi. This is simply the qi that gathers or accumulates in the chest. It is sometimes referred to as the see of qi. It is responsible for the beating of the heart and the movement of respiration.

Original qi and Source qi

Xue - Blood

Blood is the most yin of all substances.

It’s fluid. It nourishes the body. It has three main functions:

Skin – blood maintains a ruddiness, brightness and tone. A deficiency of blood will produce pale skin.

Muscles/Body mass – blood maintains our “flesh”. People with blood deficiency look wrinkle and emaciated looking.

Menstrual Flow – the menses is a form of blood. Deficiency can cause scanty flow or late flows.

Yunnan Pai Yao or Yunnan Bai Yao is a powder to help stop the flow of blood. – They are/were studying this in UW-Madison. Can be used externally as well as internally.

Jin Ye - Fluids

The function of fluids is to moisturize the skin, flesh, organs, bones and mucous membranes. Examples of fluids include sweat to, saliva, and gastric secretions. Fluids fall into one of two categories:

Liquid – yang. Found primarily on the surface of the body. Examples include sweat and saliva.

Humor – more yin. Found primarily in the bowels, viscera, brain and bones.

Jing - Essence

Essence is considered yin cause it’s nourishing, but not as yin as blood because you can’t see it.

In Essential qi that is stored in the kidneys.

There are two sources of essence. Both are found in the kidneys and are pooled together. They are:

Congenital – gift from our parents’ essence of former heaven. This is a fixed amount. If your parents were healthy when you were conceived you get a good amount of this. When this is gone we die.

Acquired - essence of later heaven. This is what we build each day by taking in food and drink. This is formed by the spleen out of nutrients extracted from food through the stomach.

The total pool of essence is responsible for the following functions:

Growth and development in early life

The onset of puberty in the ability to reproduce

The general strength of the Constitution and the vigor of youth

Spirit (Shen)

Involved with our intelligence, our memory, and our reality.

It’s stored in the heart.

When the shen is stored properly the spirit rests comfortable and the mind is peaceful.

This is the spark of consciousness.

Pathologies such as heat or phlegm can disturb the heart causing the spirit to become restless and agitated.

Deficiency in shen will cause the patient to be dull and withdrawn and the eyes appear vacant and there may be a loss of consciousness.

Shen is considered yang – it changes quickly and cannot be seen.

Stored in the heart.

Shen is partially inherited and partially acquired.

It needs adequate amounts of blood for the shen to remain peaceful and calm. Without enough blood insomnia can occur.

The shen can be affected with phlegm. Phlegm confounding the portals of the heart.

Hot phlegm makes people manic.