This simple question is at the heart of health care, yet modern scientific medicine fails to explore it beyond the mechanics of how to control symptoms. The effectiveness of both Western medicine and traditional Chinese medicine (TCM) are often measured by their ability to control symptomatic expression.
Patients want to avoid suffering and prolong life. Directly satisfying these values is central to the work of medical scientists and most practitioners of both systems.
The desire to diminish human suffering inspires practitioners to study the nature of life, emphasizing the origins of disease. Beyond the symptoms experienced by patients, we identify and use clinical signs. These are observed and/or measured by practitioners to further differentiate disease presentation and proactively identify impending disease.
Careful discrimination of signs is vitally important for both classical Chinese medicine and modern medicine. Followers of the Nanjing tradition consider palpation of pulse and hara central to their diagnostic process. While the highest healers in the Neijing tradition directly perceive a patient's spirit, followers of that seminal classic have devoted dozens of generations to deepening their understanding and refining their ability to perceive and interpret diagnostic signs, such as the radial pulse. Most historical schools of Chinese medicine developed more subtle approaches to pulse-reading than the modern doctrine, which recognizes only global pulse qualities at the radial artery, rather than differentiating individual positions (cun, guan and chi).
Western medicine uses a variety of amazing technologies to enhance our ability to identify and measure many signs of dysfunction that lie beyond most people's perception. Many modern practitioners of Chinese medicine have learned to interpret the information they provide, relative to Chinese medical theory, and to use them in both diagnosis and prognosis. Understanding the physical expression of distress often leads inquisitive practitioners toward treatments that diminish the suffering of patients.
Modern medicine initiates treatments based on various clinical signs, long before symptoms arise, from hypertension, high cholesterol and triglycerides (generally as asymptomatic signs of vascular disease), to PSA tests for prostate cancer, or mammograms or colonoscopies to detect cancer. The last of these tests even allow physicians to identify and remove precancerous lesions. In Western medicine's approach to preventative medicine, signs are often more important to practitioners than symptoms, especially when they can be "objectively" measured.
As in Western medicine, TCM practitioners consider both symptoms and signs to be direct expressions of pathology. Therapy frequently focuses on diminishing their intensity. Modern TCM teaches us to classify a patient's symptoms and signs into "imbalances" of the zangfu (vital and hollow organs), and design treatment strategies to control those imbalances. Success is generally measured in reliable and consistent control (or at least diminishing the intensity) of symptoms.
People have learned to expect that technology can control and manipulate our environments. We build all manner of machines, which provide wondrous powers to those who control them. Modern technologies immensely extend our ability to measure, understand and impact the physical nature of the world. In many contexts, modern society can move the physical world to suit their desires.
Both Western medicine and modern TCM accept the individual's projection that symptoms and the diseases that generate them are afflictions. They are foreign, so they must be controlled. Patients almost uniformly project aversion onto their symptoms, many of which are alarming. Practitioners seek to relieve their patients' suffering, and often adopt the same point of view of the symptoms as their patients. My compassion is directed toward the embodied spirit. I look at the symptoms from their point of view.
So, what are symptoms? They are a cry for help from an embattled spirit to the conscious mind. The embodied spirit communicates through gesture, just as a young child does by acting out. Most symptoms are unpleasant and warn of imminent danger, which attracts our attention and often generates the urge to seek help. Their function is to focus the being's attention on choices that facilitate life, rather than continuing to follow habituations that challenge it. We need only to learn to interpret these gestures from the embodied spirit to understand how to best support it.
Symptoms are my friend. They demonstrate the being's struggle to maintain life. The embodied spirit activates one's intrinsic responsiveness (wei qi) to confront pathogenic factors that stagnate vital flow. We can use them to discover ways to support the individual in releasing or expelling pathogenic stagnations, around which excesses and deficiencies accumulate. Some symptoms demonstrate that cathartic process, while others monitor the progress of a patient's qi mechanisms, as the individual opens the space to release habituations and the accumulations they generate.
Whatever diagnostic signs one chooses to utilize and however one categorizes them as symptoms, these are the messengers of distress, rather than its source. The patient's long-term prospects for healing are furthered by learning from symptoms, rather than vilifying them and "shooting the messenger." Therapeutic focus on control of symptomatic expression distracts from the process of disentangling the individual's complex knots of blocks, adjustments and compensations.
According to Nanjing (The Classic of Difficulties), chronic pathologies emerge from imbalances of the five phases. Modern TCM incorporated that idea, specifically attributing them to imbalances of various humors managed by the zang (vital organs). While that theory provides one set of conceptual tools for understanding the expression of chronic diseases, it fails to incorporate the rich framework developed in Neijing (The Inner Classic). One of the central functions of the "secondary" vessels is to contain the individual's unresolved and suspended struggle with pathogenic factors. We cannot treat by primary channels alone!
While direct attempts to mitigate or control symptomatic expression may be familiar to practitioners and patients, this approach forsakes the important messages from the embodied spirit encoded within symptoms and signs. Modern TCM incorporates a bias toward controlling the expression of imbalances, rather than stimulating their cathartic release. Releasing unresolved struggles with pathogenic factors allows the individual space to recondition automatic reactions to the vital interactions of life.
Modern Chinese medical doctrine differentiates diseases by their current manifestations, rather than as the result of accumulating unfulfilled process. We tonify or nourish deficiencies and, in extreme cases, astringe leaks. We clear excesses and pathogenic heat. This direct focus on controlling and minimizing symptomatic expression distracts the being away from learning to disentangle the knots and adaptations, the qi stagnations and compensations that create disease.
When practitioners penetrate past classifying symptoms and signs into diagnostic categories, and learn to "sort out" pathogenic factors from intrinsic responses, we can fundamentally support the healing process. Individually focused-treatment strategies that disentangle them can stimulate patients to release/expel the sources of their diseases. Many people with chronic or degenerative diseases benefit more from stimulating and facilitating the release of pathogenic factors, rather than controlling and suppressing their expression.
Human life is extremely adaptive. It finds ways to tolerate distress, often for a long time, with little or no symptomatic expression. The accumulation of unresolved pathogenic factors in a "dormant" state is a suspended and impending crisis. Suspending pathogenic factors allows people to live their "normal" lives, while planting the seeds of future pathology. When that pathology eventually emerges, one cannot treat the individual by controlling its expression. One must address the habitual reactions to experience that allowed them to accumulate.
Author's note: See "The Channels and Vessels of Acupuncture," published on www.daoistmedicine.com, for more information of the interrelated functions of the five sets of channels and collaterals discussed in Neijing.
Click here for previous articles by Steven Alpern, LAc.
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