by Shawn Kirby L.Ac.
In Part I, I discussed some of the unexamined assumptions of Western common sense and how these shape our world. In today’s post I will be shifting from West to East in an effort to establish a new way of looking at things, specifically with the eyes of a Chinese herbalist. Making this cognitive shift is the most important and potentially the most difficult skill you must develop in order to learn, understand, and practice Chinese herbal medicine.
In Western thought, we focus on dividing the world into discreet, quantifiable units and then learning how one “thing” affects another. This basic metaphysical principle informs our most fundamental, bedrock assumptions about the world, in part because it informs Western language in a very specific way. The English language is a current that is fed by many tributaries, but which finds its origins – as does Latin, Greek, and Sanskrit – in what we now refer to as Proto-Indo-European, or “PIE”. PIE is estimated to have been spoken as early as the 4th millennium BCE. In all languages derived from PIE, the universe is divided into nouns and verbs, objects and actions. This, of course, later informed Newtonian physics and further divided reality into matter and energy.
Here again, however, we are confronted with an aspect of “reality” that we have taken for granted which is nothing more than another cultural artifact. Other cultures different from our own have devised languages that consist entirely of processes, without the need for objects at all. Take the language of the Native American Nootka tribe, which uses only verbs and no nouns. In Nootka, you would never say that you have a “hand.” There might be “pointing,” or “waving,” but there is no “hand.” (Imagine, just for a moment, how this kind of language would inform things like property rights, a judicial system, an economy, or banking. Would your world look the same if we banished all use of nouns tomorrow?)
Once again quoting Alan Watts, our Western version of “reality” is based on the, “… grammatical illusion that all verbs have to have subjects, and that a verb, or action, or event must be set in motion by a noun, that is to say, a non-event or thing.”[i] Alan goes on to say, “…what is the difference between a thing and an event? I cannot for the life of me tell. We could devise a language … where there are no nouns and only verbs. The Chinese language is very close to that, and the superimposition of noun and verb on the Chinese language seems to be a Western invention.”[ii]
In direct contrast, classical Chinese thought and language focuses on seeing the world as an undivided, contiguous whole similar to the Western concept of a system. In Chinese medicine we never divide reality into discreet units and then look for cause and effect. Instead, we look for a pattern within the whole and address that pattern. What do I mean by a “pattern within the whole system?”
An example of what I mean by a pattern would be an eddy or current within a river. Perhaps there is a large rock that forms a backflow, or a turn along the bank that changes the river’s course, or a shift in the gradient causing the river to flow more swiftly. It is not the rocks or the earth that are important – it is the changing current, the eddies, the rapids, the flowing process that the Chinese herbalist pays attention to exclusively. Where Western sensibilities might want to see the body as a “machine” made of parts (nouns), the Eastern tendency would be to regard the body as a flowing process (verb), like a river. Viewing the world in this manner is almost completely antithetical to Western thought in almost every way.
When a Western physician talks about a disease, they are talking about a specific condition that has a specific and direct cause. For instance, if a patient goes to a doctor complaining of heartburn, the doctor will then begin to look for the direct cause of the problem. To begin with, the doctor hypothesizes that the subjective complaint of “heartburn” may indicate a peptic ulcer caused by an infection of H. pylori. This peptic ulcer is understood to be, “a chronic condition of the stomach and duodenum resulting in circumscribed ulcerations of the mucous membranes penetrating through to the muscularis mucosa and occurring in areas exposed to stomach acid.”[iii] The physician then tests his or her hypothesis by running a test for H. pylori. If the test comes back positive, the physician prescribes an antibiotic. Such is the wonderfully efficient, focused, and effective nature of Western logic and Western medicine. Chinese medicine, however, works with a very different form of logic.
Let’s take our patient with the peptic ulcer. They have been to their Western doctor, received their diagnosis and they have come to see us as an adjunct to standard therapy. The temptation at this point would be to try to figure out “a good herbal formula for ulcers” and prescribe this to the patient as an “alternative.” To do so would be – as the kids are saying these days – an “Epic Fail.”
We do not treat Western diseases with Chinese herbal medicine. It’s not what Chinese herbal medicine is designed to do. Trying to treat Western diseases with Chinese medicine is like trying to windsurf on a chicken – it just doesn’t work. (It’s also outside of our scope of practice.) In Chinese medicine, a cure is not effected by solving a problem. Rather, a cure is effected by restoring harmony to the entire system.
Bian zheng lun zhi 辨证论治 means “differential diagnosis.” This concept can best be understood by the use of the following iconic phrase –
异病同治, 同病异治, Yi bing tong zhi, tong bing yi zhi
“Different diseases, same treatment; same disease, different treatments”
Let’s say that your patient has come in with a diagnosis of a peptic ulcer. They have marked irritability, they complain of a “stitch in their side,” mild indigestion, poor appetite, fatigue, and a bitter taste in the mouth when they wake up. They have a slightly pale and dusky tongue with teeth marks and very wiry and slightly rapid pulse. You diagnose this patient as having a liver spleen disharmony with depressive heat, and prescribe Jia Wei Xiao Yao San.
However, let’s say another patient comes in, also with a diagnosis from their physician of peptic ulcer. This time the patient complains of a dry mouth and throat, a dry, unproductive cough, and thirst. In addition, they always seem to be hungry. Their tongue is dry and red, and their pulse is fine and rapid. This is a completely different pattern than the first patient. Even though they have the same disease – a peptic ulcer – the overall presentation is completely different. Because of this, were you to give the second patient Jia Wei Xiao Yao San, they would become worse due to iatrogenesis from improper diagnosis. This patient has a pattern of stomach yin deficiency, and should receive Mai Men Dong Tang.
It might be tempting after an initial success to prescribe Jia Wei Xiao Yao San for every peptic ulcer you see. As you can see, however, this would have disastrous results. There is not a Chinese herbal formula that is “good for ulcers.” Chinese herbal formulas only work for treating Chinese medical patterns. The failure to practice Chinese herbal medicine this way will lead to failure every single time.
The Chinese herbalist is concerned with how the body is currently working – the “flowing or “streaming” of bodily processes – at that moment in time, and looks at all of the various signs and symptoms that the body is producing, not just the chief complaint. By focusing on the body in this way, the Chinese herbalist addresses the entire person, restoring balance to the entire system. Once this is achieved, health is a natural end result.
Assumed in this paradigm is the idea that if you address the whole, the inherent organic intelligence at work within the living processes and systems will kick in and take over, automatically restoring harmony. One of the classical Chinese concepts that reflect this notion is the Daoist concept of 自然 ziran, literally “self so.”
“The fundamental sense of [ziran 自然] is that the Tao operates of itself. All that is natural operates of itself, and there is nothing standing over it and making it go on. In the same way one’s own body operates of itself. You don’t have to decide when and how you’re going to beat your heart; it just happens. You don’t decide exactly how you are going to breath; your lungs fill and empty themselves without effort. You don’t determine the structure of your own nervous system or of your bones; they grow all by themselves.”[iv]
By learning to see the world in this way, not only are we afforded the ability to practice Chinese herbal medicine successfully, we may even begin to have other insights into the nature of reality itself. You are far more like a river than a “solid object” if such a thing can even be said to exist. Every cell in your body, all the way down into your bones, is completely replaced in the course of seven years. You are not the molecules of water in this stream; you are the ripples on the surface of the water. You are, in fact, the dance of life itself. It is within this flowing that the Chinese herbalist practices their art – changing the flow with an herbal prescription in much the same way that a stream might be changed by moving a few stones just beneath the rippling surface of the water. This is the art of Chinese herbal medicine – not to treat diseases, but to tend to the flowing of the patient’s stream