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Chapter 4
Ludwig Wittgentstein
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flowing out of the blood vessels. The liver stores blood and regu-
lates the volume of blood, smoothing the role of qi to promote
blood circulation. Blood circulation can be disturbed by changes
in the body’s internal environment expressed as, heat, phlegm,
dampness, blood stasis.
Blood and qi are closely related like two sides of the same coin:
‘Blood is the mother of qi and qi is the marshal of blood (㹰Ѫ≄
ѻ⇽, ≄Ѫ㹰ѻᐵ).’ Blood carries qi and is also essential to the pro-
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74
Wu (2002:161–162) describes “the five endogenous pathogenic factors” (neisheng wuxie
⭏ӄ䛚); Chai (2007) refers to all internal factors collectively as endogenous pathogens
(neishang bingyin Ք⯵ഐ).
Yin is soft, dark and cool, whilst yang is hard, bright and warm.
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Wind
Wind that is part of the external climatic environment is exogenous
wind, considered a pernicious source of illness that penetrates the
skin and brings about such conditions such as headache, joint
stiffness and arthritic pain. In combination with cold, heat or
dampness, it can lead to sore throats, coughs and colds and fevers.
A characteristic of ailments caused by exogenous wind is movement;
hence arthritic pain that moves from one part of the body to another
is thought to involve the wind pathogen.
Endogenous wind is usually produced by pathological processes
in the liver. It is also referred to as ‘liver-wind’ and its movement as
‘internal disturbance of liver-wind’ (ganfeng neidong 㛍仾ࣘ).
Phlegm
Phlegm is more than sputum, the sticky viscous substance that
lines one’s throat and bronchioles and causes irritation and cough-
ing. In TCM it also takes the form of nasty clear fluids that inhabit
the vital organs, causing ailments ranging from indigestion, lassi-
tude, insomnia and irascibility to headaches, epilepsy and strokes,
earning it the nasty aphorisms ‘A hundred ailments are induced by
phlegm’ (bai- bing duoyou tan zuosui Ⲯ⯵ཊ⭡Ⱐ⾏) and
‘Strange diseases are caused mainly by phlegm’ (guaibing duo tan
ᙚ⯵ཊⰠ).
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Heat and cold will be further discussed under syndromes in Chapter 6.
Blood stasis
Blood stasis (yuxue ⰰ㹰) is a pathological substance, a by-product of
disturbances in blood circulation, leading to clots, subcutaneous pur-
pura or lumps. When stasis is not manifested in clots or lumps but is
more widespread, it is thought to cause general pain, irregular pulse
and manic anxiety. It originates from exogenous climatic factors like
cold that causes blood to stagnate or coagulate, or from emotional
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76
Reid (2001).
77
See Kaptchuk (2000:43) and the references to Sivin (1976) and Bennet (1978).
78
Based on the Huangdi Neijing, two college texts on TCM theory, Wang (2001) and the
entry “Qi” in the Encyclopedia of Chinese Medicine Zhongguo Dabaikequanshu.
generated from air and food after birth throughout life. Part of it
can be converted to replenish the body’s stock of yuan-qi which is
depleted by work, stress and illness.
By function: The main forms are pectoral-qi, nutrient-qi and
defensive-qi. Pectoral-qi or zong-qi (ᇇ≄) is situated in the thoracic
area, warming the blood vessels and nourishing the lung; an abun-
dance of it gives a person a sonorous voice. Nutrient-qi or ying-qi
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Physiological functions of qi
The principal functions of qi are:
The propelling function that drives blood, enables fluid passage
within the body, and is the moving force behind digestion.
The warming function, with qi as a source of heat for the body,
carrying nourishment for body tissues.
The protective function, with qi circulating at the surface of the
body and protecting it against external pathogens such as wind
and cold.
The nutrient function, with nutrient qi (ying-qi) derived from
digestive processes being converted into material constituents
of the organs and meridians, as well as providing energy to
them.79
79
Wu (2000:43).
body and between the inner and outer layers of the body.80
4.4 Interpreting Qi
In addition to the principal meanings of qi enumerated above, the
literature of Chinese medicine contains numerous others. According
to one estimate, in the Huangdi Neijing alone has 1,700 different
uses of the word qi.81
Questions naturally arise:
80
Wang (2001:71–72).
81
Wang (2001:44).
82
See, for example, Wu (2002:173) and Wu (2000:133).
83
Wu (2002:174).
Phlegm-resolving herbs
Why did the ancients group all four of the apparently disparate con-
ditions listed above under phlegm? Would it not have been simpler
to give a different name to each pathogen that caused a different set
84
Wu (2000).
convulsions and dizziness, but the formulation would use one or more
phlegm-resolving herbs. In other words, the different pathological
conditions might have been grouped together because they appeared
to have something in common — they enjoyed relief from particu-
lar herbs or formulations containing these herbs. An example might
help to elucidate this point.
The herbs banxia ॺ༿ (rhizoma pinellieae) and jupi ₈Ⳟ (peri-
carpiun citri tangerinae), the dried and aged peels of Chinese tange-
rines, have from ancient times been found to be effective in treating
cough with white sputum. Banxia is a phlegm-resolving herb; jupi
regulates (smoothens the flow of) qi to eliminate dampness;85 it also
helps to prevent the formation of more phlegm transformed from
dampness. They are the main ingredients of the popular formula-
tion for cough with sputum called Erchen Tang Ҽ䱸⊔. This formu-
lation also includes fuling 㥟㤃 (poria), a diuretic that complements
the dampness-eliminating function of jupi, and gancao ⭈㥹 (liquo-
rice), for harmonising the effect of the other three herbs.
By adding two herbs to the four already in Erchen Tang, a dif-
ferent disorder could be treated, the so-called ‘disharmony between
gall bladder and stomach’, a condition manifested in nervousness,
dizziness, heart palpitations, vexation, insomnia or restless sleep
with troubling dreams and, in extreme instances, epileptic fits.
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The term ‘regulate’ (li ⨶) has a specific meaning in TCM theory. It refers to promoting
flow. Hence regulating qi is promoting its flow in the body.
Ingredients Functionality
Erchen Tang Wendan Tang
Banxia Banxia Resolves phlegm
Jupi Jupi Regulates qi and removes dampness
Fuling Fuling Removes dampness
Gancao Ganco Harmonises the other herbs
Zhuru Clears internal heat
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Interpreting phlegm
The explanatory role of phlegm covers a multitude of sins, being a
proxy for all physiological factors that bring about clinical condi-
tions regarded by TCM as phlegm-related. Phlegm (except as spu-
tum) is not directly observable because, from a biomedical
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The role of the monarch role in TCM formulations is explained in Chapter 7.
(a) Extreme heat that scorches the yin of the liver and can lead to
convulsions;
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(b) The yang of the liver is transformed into wind, disturbing the
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In the case of (a), when the yin of the liver is damaged by heat, bal-
ance is upset, yang gains ascendancy, becomes hyperactive and brings
about convulsions. In the case of (b) and (c), yin and yang behave like
substances in the liver. When the yang of the liver is in excess, it can be
converted into wind; when there is deficiency in yin, yang becomes
relatively stronger and ascends, stirring up wind in the process.
Chinese medical theory has not always drawn a firm distinc-
tion between exogenous and endogenous wind. Before the Jin-
Yuan dynasties, exogenous wind was regarded as a cause of zhong
feng ѝ仾 or cerebral strokes. Later texts attributed the condition to
internal processes that are now described as by TCM theory as
endogenous wind.87 There does not appear to be any direct relation
between exogenous and endogenous wind.88
87
Wang (2001:455).
88
If a body deficient in qi suffers an attack of exogenous wind when there is a sudden
change in weather, it can trigger reactions that eventually lead to the formation of endog-
But it has also been used to treat ailments like infantile convulsions
attributed to endogenous wind. Since exogenous wind is readily
observable, fangfeng is likely to have been discovered first for treating
symptoms thought to be caused by exogenous wind. Later when it
was also found to relieve symptoms like a form of arthritis in which
pains are not fixed in one part of the body but move from one place
to another, mimicking the movements of wind, the arthritis would
have been attributed to endogenous wind.
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Tang (2003:277).
Qi Phlegm Wind
Form Formless Sometimes liquid/solid as Formless
in sputum, but possibly
formless in the stomach
and organs
Substance When stored in Sputum is a substance, but Never a substance
organs other forms of phlegm
are ambiguous
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It would appear that the concepts of qi, phlegm and wind were
invented and modified over time with Chinese medical theory to
take on the roles needed to explain the healthy functioning of the
body, the illnesses caused by deviations from the body’s healthy
balanced state, and restoration of health by particular kinds of
herbal agents.
Qi evolved to be a catch-all concept for all normal functioning
of the body that involves change and movement. To account for the
body’s ability to produce qi continuously, the idea of storage in
substance form in the organs was also necessary; hence qi is also
portrayed in some contexts as a substance.
The concept of phlegm was associated with symptoms that were
persistent (sticky like sputum) and the tendency to cause obstruc-
tions (of qi, blood and body fluids); certain herbs seemed to be able
to alleviate these symptoms and were classified as phlegm-resolving
herbs. As many illnesses are persistent and were understood to be
the result of obstructions (for example obstruction of qi flow in the
spleen and stomach, causing dyspepsia), phlegm came to be associ-
ated with many illnesses, ergo the conclusion that phlegm causes a
hundred ailments.
90
Kaptchuk (2000:76).
gogical point of view this may be a good way for a new reader to
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Kaptchuk (2000:97–98).