Sunday, June 19, 2011

The Progression of Disease According to Oriental Medicine: Part 1

Warning:  This series of blogs presents an alternative Chinese-scientific perspective on the development of disease.  I won't and can't provide 'research' to back everything largely because modern scientists have not shown much interest in understanding the directly observable marks of deteriorating health, due to their entrancement by laboratory tests which may distract them from direct observation of the people they attempt to help.

In the Yellow Emperor’s Classic of Internal Medicine (Huang Di Nei Jing), Qi Bo, the emperor’s personal physician, says (paraphrased): 

“Those who wait to treat disease until it has already arisen are like those who wait until they are thirsty to dig a well, or wait until they are in battle to forge weapons.  Are not these actions too late?”

Due to this preventive perspective, for several thousand years of development Chinese physicians focused on identifying early signs of imbalance so that they could take actions to avert health disasters by adjusting their own, and their patient’s diets and lifestyles.   Perhaps as a consequence, famous traditional Chinese physicians had extraordinary healthy lifespans for their times.    For example:

Dr. Sun Su Mao (Ssu-Mo) (581-682) – lived 101 years, an impressive feat for the 6th century.  He once said “Anyone over 40 years old should try to avoid laxatives, which will weaken his body, and begin to take tonics.  Anyone over 50 years old should take tonics all year round; such are the secrets of nourishing life to enjoy longevity.”

Dr. Meng Shen (621-713) – lived 92 years.  He once said “A person who really knows how to nourish the body should always keep good foods and herbs handy.”

Dr. Luo Ming Shan (1869-1982) lived 113 years.

In Chinese Foods for Longevity, Henry Lu points out that according to Outstanding Chinese Physicians in the Past and their Medical Theories published by Peking College of Chinese Medicine in 1964, the 37 most outstanding Chinese physicians between 581 CE and 1964 CE had an average lifespan of 80.56 years.

Many of these guys lived well before the 18th century, yet, on average they lived 10 years longer than the average modern citizen of modern industrialized nations.

Over the millennia of its development,  due to their considering dietetics one of the essential branches of medicine, Chinese physicians realized that many supposedly ‘minor’ symptoms arise from dietary imbalances, and that if left unchecked the process producing these 'minor' symptoms would eventually produce a major disease.  Gradually this came to formulation as an understanding of how the bodymind (Chinese medicine considers mind and body as one unit) progresses from minor to major diseases based on an imbalance between dietary intake and elimination or expenditure.

The Chinese perspective rests on the realization that to maintain homeodynamics (health) the bodymind must have just the right amount of nutrition, neither too much nor too little.  Like Plato, ancient Chinese physicians noticed a clear division of disease incidence between wealthy aristocrats and ordinary peasants.  

So long as they had adequate quantity and variety of simple plant foods and a little animal products, the peasants remained lean, healthy and fit and had long lives.  If they suffered food shortages, often due to excessive taxation (taxes were paid in bushels of grain) by overlords, they developed deficiency diseases marked by infectious disease susceptibility, weakness, wasting,  mental and physical listlessness, and pallor. 

In contrast, among wealthy and overfed overlords who used some of the grains procured by taxation to produce grain-fed animal products for their own feasting, physicians saw diseases of excess marked by abnormal accumulations:  obesity, diabetes mellitus (identified by Chinese physicians by 700 AD,  900 years before Europeans), tumors, restlessness, tension, and sluggishness.

This led the Chinese philosopher-physicians to both political and medical conclusions.  On the political side, they vigorously opposed taxation, as recorded in the Tao Te Ching and many works of Confucius, Mencius, and other so-called Confucians:

"Human hunger is the result of overtaxation; For this reason, there is hunger."  Tao Te Ching Chapter 75

They also developed a unique view of the role of the physician, and identified three ranks of physicians:

Lower doctors:  Those who treat and heal sicknesses symptomatically but do not treat the whole personality of the patient or guide to a healthy lifestyle.
Middle doctors:  Those who treat and heal by guiding the patient to change his or her personal habits and attitudes, including diet, exercise, meditation, and ethics.
Highest doctors:  Those who treat and heal the sicknesses of society, nation, and world through philosophy and education to align self with others, and humanity with nature. 

The "Confucian" Classic of Great Learning encapsulates some of the central tenets of "higher medicine" as conceived by Chinese philosopher-physicians.

On the medical side, by treating both the wealthy and the poor, Chinese physicians developed a clear understanding of how disease develops. 

On the one hand, deficiency of intake relative to requirements (elimination and expenditure) will create deficiency diseases, and on the other hand, excessive intake relative to requirements will create diseases of excess, accumulation, congestion, blockage, and stagnation. Chinese philosopher-physicians saw this process occurred whether talking about diet (excess or deficiency of food) or other matters (excess or deficiency of clothing, shelter, possessions, etc.).  

To the Chinese, health, whether personal, mental, social, or political, could arise only through achieving the Golden Mean, a concept held in common with Aristotle.

These days, in modernized industrial nations, a majority of the people live like the royalty of the past, with plenty of rich food to eat.  Consequently, people in modern industrialized nations suffer primarily from nutritional excess diseases such as obesity (accumulations of body fat), diabetes (excess fat and sugar in the blood), cardiovascular diseases (accumulations, congestion, and blockage of blood vessels causing stagnation of blood circulation), neurological diseases involving accumulation of plaque (Alzheimer’s, multiple sclerosis), and numerous others. Among affluent populations, deficiencies occur almost always in a context of excesses.

Oriental medical theory maintains that in most cases these late stages of psychophysical degeneration are preceded by a long gradual process of apparently minor alterations in health that herald the oncoming or eventual disaster and offered opportunities for self-correction.   Chinese physicians taught their patients to stay aware of this process and to self-correct using food therapy.  

However, one must understand that these food therapy methods work well only in the context of the basic healthy diet developed and integrated into Asian cuisine:  starch-based, low in fat and animal products, rich in colorful vegetables.  You can't overturn the ill effects of a very imbalanced diet by adding a few servings of a medicinal food.  

Basically, if you understand how disease progresses from minor to major, you can interrupt the process before it becomes so deeply rooted that you will have trouble correcting it with natural approaches.  Updated application of this perspective using traditional Chinese medical theories (yin-yang, Eight Principles, and Five Transformations) can easily incorporate and make sense of otherwise inexplicable medical findings, such as why many people with skin disorders have a history of respiratory allergies or asthma as well.    

In outline form, the progression looks like this:

1. Health:  Balanced intake and normal discharge
2. Abnormal discharge and general fatigue
3. Impairment of blood circulation and aches and pains
4. Impaired blood quality with chronic discharge
5. Accumulation of excess material in circulation
6. Storage of excess material in various compartments
7. Nervous disorders
8. Diseases of mind and spirit, summed as self-delusion

1. Healthy condition: Balanced Intake and Discharge
We take in nutrients from foods and beverages as well as influences from climate (hot, cold, damp, dry) and social environment (emotions, sounds, colors, etc.).  All of these inputs have some effect on our physiology.  To maintain health we have to retain what we need and discharge any excess.

We all transform or discharge inputs through respiration, perspiration, urination, defecation, and physical and metal activities. Women have additional avenues of discharge through menstruation, parturition, and lactation.
Every physical or mental activity we express reflects the quality of what we have ingested.

Accordingly, in addition to climate, time and place, diet exerts an influence on culture through its psychophysical effects on the creators/participants.  Thus, different climates and diets produced different historical qualities of art, music, architecture, literature, games, sports, etc..  For example, the traditional Chinese diet produced people who resonated with the traditional Chinese music, the Indian diet produced people who resonated with traditional Indian-style music, and the diet of certain youth in the U.S. produced people who resonated with heavy metal rock.  

What comes out reflects what went in.

 2. Excessive intake and abnormal discharge.

If from a healthy state you ingest or inhale or otherwise absorb an input that supplies something that exceeds the bodymind’s needs and the capacity of normal routes of discharge, the bodymind will manifest alterations of function, most moving the excess input out of the body, such as:
  • coughing and sneezing
  • more frequent defecation
  • more frequent urination
  • increased and spontaneous sweating and sudden rashes
  • fidgeting, tapping, muscle spasms and tension, acute hyperactivity
  • rapid blinking
  • irritability, anger
  • anxiety, excitability

The more extreme the imbalance of intake, more extreme the output, such as:  shivering, trembling, nausea, vomiting, crying, shouting, screaming.

The input here could include healthy food (subtle reactions), spoiled food or an allergen (strong reactions), or traumatic experience like witnessing some aweful crime, losing a loved one, or enduring a natural disaster, among many other possibilities. 

Chinese physicians did not recognize a dichotomy of body and mind, nor did traditional Western physicians or culture. Chinese physicians watched the development of internal organ disorders and saw mental and emotional effects of those disorders, and also the reverse, that sudden emotions resulted in altered operations of internal organs.  They correlated fear with the kidneys, anger with the liver, joy with the heart, rumination with the digestive system, and grief with the lungs, by noticing how emotions affected or were affected by the organs.  

So for example, in fear people may lose control of urination, in anger they may get indigestion marked by reflux, bloating and pain, rumination can destroy the appetite, overjoy (excitement) can affect heart rate and strength, and grief affects respiration (sobbing).

 In English, we still have words reflecting this ancient understanding.  For example, an disrespectful person "has the gall,"  referring originally to an imbalance of the gall bladder,  a depressed person has 'melancholy,' an imbalance of the bile (chol-), and an aggressive or angry person is 'bilious' or 'choleric,' again, an imbalance of the bile, or liver/gallbladder system [1].  And how about being "pissed off" and "so scared I shit my pants"?  Chinese medicine has a way of physiologically understanding the actual experiences that gave rise to these locutions as well.

I know, where are the 'studies' to support this?  I don't know of any, yet.  Chinese physicians discovered that eating animal liver would treat night blindness hundreds of years before laboratory science discovered retinol (vitamin A) and showed that night blindness results from retinol deficiency.  If they had waited for double-blind, placebo-controlled studies and modern biochemistry to confirm that eating animal liver treats night blindness, thousands of people would have gone blind from deficiency over the years.  

Modern laboratory and clinical science creating 'top-down' knowledge only studies a quite small part of reality and moves very slowly compared to empirical discovery growing from 'bottom-up.'

Check your own experience. For my part, I see these relationships in my clinic on a daily basis.

Anyway, these signs, among others, indicate that the specific organ(s) have taken the brunt of the dietary excess:
• A tendency to obsessive thinking, rumination, whining, complaining can indicate an overload of the digestive system.
• A tendency to anger, impatience, or shouting can arise from an overload of the liver and indecision can arise from an imbalance of the gall bladder.
• A tendency to anxiety and fear can arise from an imbalance affecting the kidneys, urinary bladder, or endocrine system.
• A tendency to fall into crying or grief can indicate an imbalance affecting the lung or large intestine.
• A tendency to nervousness, hyperexcitability, or inappropriate laughter can indicate an imbalance affecting the heart.

At this stage of imbalance we may also feel general fatigue resulting from the burden placed on body organs by the overload of input. 

At this stage of disease, recovery requires removal of the dietary and other causes, and improvement of diet and exercise.  Since the imbalance does not have deep roots, it may take only several hours to several days to recover.

I'll go through the  rest of the stages in future posts.


Brave Friend said...

Lovely post, again. Thanks so much for all these new viewpoints.

Anonymous said...

Hey Don,
great to see you covering TCM and Oriental medicine in general, as I am very interested in those.
Also,I have two questions concerning the subject. Maybe you can help me out there:

1.) Is there any book that you would recommend that deals with Chinese herbal medicine or herbal medicine in general? Something that would serve as a good starting point and offers a basic overview of different herbs and their application.

2.) I once read in an article of a person who is also quite familiar with Chinese medicine, that saturated fats are to be avoided, as they damage the liver. Now my question is, do you know, whether Chinese medicine has anything negative to say about saturated or animal fats or did the author pick that up somwhere else? So far, I've come to the conclusion that saturated fats are not only harmless but actually preferable to MUFAs and especially PUFAs, so I wonder what stance the traditional Chinese medicine does have towards saturated fat, if any.

AL-209 said...

Great article Don, i await your blog posts eagerly these days.

Phil GB said...

As Tim Minchin states in his great poem, Storm, "Do you know what they call alternative medicine that they have proven to work? Medicine."

Link to poem:

portland_allan said...

A tendency to obsessive thinking, rumination, whining, complaining can indicate an overload of the digestive system.

Wow, sounds like an otherwise precocious 7 year old I know. Care to elaborate what is typical digestive overload?

As far as I know he doesn't get much in the way of sweets or sugar.

Flowerdew Onehundred said...

"modern scientists have not shown much interest in understanding the directly observable marks of deteriorating health, due to their entrancement by laboratory tests which may distract them from direct observation of the people they attempt to help"

Wow, is that ever the truth. This is why I mostly find physicians useless outside of accident or specifically identified illness.

Anything vague or chronic and their office is just a money pit.

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