“Don’t tell patients their heart pulse is weak,” my supervisor said, “they panic and go see their cardiologist and then when the cardiologist tells them their heart is fine they never come back.” This illustrates what is probably the greatest source of confusion and miscommunication between Chinese medicine practitioners and others, both patients and healthcare providers, who are looking at the body from the viewpoint of Western medicine. Chinese medicine diagnoses refer to many organs familiar to Western medicine: the large and small intestines, stomach, spleen, liver, heart, lungs, kidney, urinary bladder, gallbladder and pericardium all have diagnoses associated with them. Often, however, Chinese medicine will ascribe extra functions to an organ that differ from Western medicine’s understanding of the organ’s physiology.
In Chinese medicine, for example, the heart governs the circulation of blood and regulates the vessels—this matches Western medicine fairly well, and it is the failure of this function that corresponds to many western cardiac pathologies. Additionally, however, it is also said to have the job of “storing” the mind during sleep. If the heart is performing this function well then the body is able to sleep peacefully. If not, the mind “wanders” and causes the incessant thoughts that “just won’t turn off” all too familiar to anyone who has suffered from insomnia. The “weak heart pulse” my supervisor was talking about would be symptomatic of this type of insomnia.
The key to understanding the origins of these “extra” functions lies in the way Chinese medicine developed. Much of the development of Western medicine was driven by the dissection of cadavers and the vivisection of live specimens (usually animals, but in some recorded cases condemned criminals). These experiments gave Western medicine a clear picture of each organ’s functions and with technological advances such as the microscope this picture became increasingly more detailed and precise.
Chinese doctors, on the other hand, did relatively little dissection. The practice was not precisely taboo, but simply rather declasse. Observation, deduction and theoretical analysis were regarded much more highly than mucking about with actual physical bodies. The most renown doctors were those who could arrive at a correct diagnosis simply by looking at the patient or palpating the pulse. Having to ask questions or do a more detailed physical exam was the mark of a second-rate physician.
Due to this cultural atmosphere, the major forces driving the development of Chinese medicine were clinical observations and the refinement of medical theory. China has perhaps the longest unbroken tradition of literate, professional medical practitioners. The foundational textbook of Chinese medicine was written around 2 AD. The Huang Di Nei Jing, or Yellow Emperor’s Inner Classic, contains basic medical theory, herbal formulas and descriptions of various disorders along with information on diagnosis and treatment methods. Over the centuries, the Chinese medical corpus was expanded by doctors who collected and recorded their clinical observations and then developed and refined theories to explain the disease manifestations and progressions they had seen. In general, their approach was inductive rather than deductive and holistic rather than reductionist.
Due to this heavy reliance on theory and observation, an “organ” in Chinese medicine is best thought of not as a discrete physical entity, but rather as a “set of systems that fail together.” Chinese organ descriptions are based on clinical reality rather than physiological reality. My favorite example to illustrate this difference is looking at the Chinese medicine kidney. Among the many functions ascribed to this organ is an interesting role in respiration. According to Chinese medicine, one of the kidney’s jobs is to help the lungs “grasp the Qi,” that is, they assist the lungs in extracting energy from the air by allowing the body to take full, deep breaths.
Physiologically, the kidneys have nothing at all to do with respiration. Clinically, however, one of the complications of renal failure is pleural effusion. Impairment of the body’s fluid metabolism causes excess fluid to accumulate in the pleural layers—fluid-filled spaces that surround the lungs. This extra fluid can impair breathing by limiting the expansion of the lungs, making it difficult to take a full, deep breath. Chinese doctors observed this development in patients with kidney failure and, quite correctly, added it to the kidney’s “set of things that fail together.”
In upcoming blog posts I’ll look at each of the organs in detail, talk about their “extra” functions and the clinical manifestations that occur when they are out of balance.