Chinese medicine divides diseases into two broad categories:
1. Diseases of "external contraction" (Wei Guan), which are relatively simple conditions that are acute in nature.
2. Diseases of "internal damage" (Nei Shang), which are usually chronic and complex involving simultaneous contradictory symptoms, such as a combination of hot and cold, dry and wet, acute and chronic.
Diseases contracted by external influences
These conditions are caused by external factors known as the Six Pernicious Influences corresponding to weather and seasons, as follows:
1. Wind involves exposure to drafts that cause chills, fever, headache, spasms and diseases caused by airborne pathogens. Symptoms tend to alternate, move and spread. Wind is considered a Yang condition.
2. Cold is a Yin condition and includes conditions characterized or caused by coldness including low metabolism.
3. Heat is a Yang condition and includes diseases caused by hot climates, exposure to heat, or that are aggravated by heat.
4. Dryness is associated with Autumn, low humidity, and can be subdivided into diseases that are dry and cold as opposed to diseases that are dry and hot. Obvious symptoms of dry skin, thirst, dry cough, etc, would be included. Dryness can also be caused by Blood Deficiency and deficiency of body fluids.
5. Dampness is a Yin phenomenon and includes conditions of Damp Cold which is associated with winter, or Damp Heat, which is associated hot, humid conditions. In the body, Dampness is wet, edemic, heavy and slow. People feel sluggish, heavy, dull, and congested. Damp Cold causes body stiffness, such as rheumatic and arthritic conditions aggravated by cold, damp exposure. Damp Heat includes all sorts of purulent inflammatory conditions, discharges, oozing sores, and infections.
6. Summer Heat diseases occur in summer and have symptoms of heat stroke, high fever, dizziness and nausea.
Internal Damage diseases are caused by the Seven Emotions, as follows:
1. Joy (as in excess partying)
4. Pensiveness (over-thinking)
7. Fright or shock
These may also include diseases caused by diet or lifestyle.
What was true for the ancient Chinese was probably also true for our ancestors all over the world: people who lived agrarian lifestyles intimately involved with geographic climatic and seasonal conditions developed ailments quite different from those who lived in urban environments.
A largely agrarian lifestyle informed one of the great classics of Chinese medical literature, the Shang Han-Lun (Diseases Caused by Cold) written by Zhang Zhong Jing toward the end of the Han Dynasty around 220 BCE.
Moving into the Tang dynasty (618-907 ACE) there occurred the growth of cities which gave rise to more complex diseases with mixed and often contradictory patterns. During this period, Confucian doctors had to develop a system to diagnose and treat diseases caused by stress, overcrowding, diet and lifestyle. These Internal Damage diseases inspired a new class of medical literature ushered in by the four great masters of the Jin-Yuan dynasties (1115-1368). The greatest of these four was Li Dong Yuan, regarded as the founder of the Spleen Stomach School as described in his masterpiece, the Pi Wei Lun, which regards the Spleen and Stomach as the center from which disease originates.
Natural medicine of all cultures has often claimed the gut as being the root of disease. Western herbalists have a long tradition of prescribing digestive herbal bitters before meals to enhance better digestion and assimilation by stimulating the production of hydrochloric acid in the stomach. If digestive ‘fire’ is chronically weak, this sets up a process of malabsorption of protein and minerals that could go on for years, setting the stage for disease. Stress, grief, worry and other emotional problems strongly influence our digestive secretions, diminishing or shutting them off and causing a plethora of diseases beginning with bloat, heartburn, GERD, small intestinal bacterial overgrowth (SIBO) disease, so-called "leaky-gut" which lead to food allergies (including gluten and dairy intolerance), inflammatory immune reactions, asthma, emotional diseases, chronic fatigue, and other conditions too numerous to mention.
While Western herbalists dealt with these through the broad use of digestive herbal bitters, Li Dong Yuan’s Pi Wei Lun addressed these conditions more specifically, often with large complex herbal formulas. At the heart of Li Dong Yuan’s treatment approach was Liver-Spleen disharmony. Typically, his formulas addressed fundamental issues of digestion (in Chinese medicine this is the function of Spleen and Stomach organ system). Also addressed were the Liver, which is involved with regulating the flow of Qi or vital energy; symptoms of inflammation and Dampness (Damp-heat); and mixed patterns that would in modern times come to be recognized as hormonal imbalances.
Chinese organ systems don’t always coincide with modern concepts of physiology. For example, in Chinese medical philosophy, the Stomach receives food and begins the process of breaking it down, while the Spleen is mostly involved with what happens to food after the digestive mechanisms of the Stomach and Small intestine are complete, followed by how nutrients are absorbed and utilized by the cells in the process of energy conversion. Therefore the Chinese concept of the Spleen really refers to the process of mitochondria replication in the cells of the body. The degree to which that is effectively accomplished is based on how available the broken down nutrient molecules are in the blood.
Food is never perfectly broken down and is therefore never perfectly, completely assimilated. This means that digestion and assimilation is always a matter of degree no matter how strong one’s digestive system is. The body actually uses the more imperfect byproducts of digestion to create fluid and mucus. This, in turn, is used to lubricate the mucous membranes of the lungs, reproductive organs and the joints. So weak digestion tends at first to result in an excess of mucus. This is what happens when we consume too much sugar or flour products – excess mucus and a tendency to allergies as the body responds to various ‘triggers’ to eliminate the excess.
This is only one of many of the consequences of too much mucus, or as TCM would describe it, Dampness and Phlegm. Ayurveda describes this kind of toxic residue as "ama" and uses herbs and an elaborate process of purging to eliminate it from the body.
Obviously this description could go on and entire books can be written describing the effects of weak digestion, the diseases that can result, and methods of treatment. That is precisely what Li Dong Yuan did and why he is regarded even to this day as one of the greatest herbalists of all time.
In the next installment of this blog, I will describe Li’s primary formula Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang, which in Planetary formulas is called Ginseng Elixir) and how it can be modified to treat some of the most difficult chronic diseases.