Classical Chinese Medicine

The story of this medicine is long.  Over the years it has evolved from a purely divinatory, shamanic practice into a body of knowledge incorporating the cumulative science of several millennia and the rise and fall of 14 dynasties.  Chinese medicine is intimately connected with Daoism, which is the folk religion of the Chinese people.  The two systems are really two parts of one system, and we could just as easily (and perhaps even more accurately) call this classical Daoist medicine.  Regardless, this medicine as it exists today has endured because the people recognize its value and have preserved it for self cultivation and for treatment of disease.  This is a holistic medicine, meaning no part is considered outside the context of the whole (from the greek όλός - whole/all).  That means no symptom stands alone, nor can any symptom be evaluated outside the context of the rest of the body.  This is why Chinese medicine doesn't treat insomnia, but it treats organ patterns that can give rise to disorders like insomnia.    

The title "classical Chinese medicine" is used today in reference to those practicing the medical tradition following directly from the Chinese medicine classics:

黄帝内经 - Huang Di Inner Canon / Huang Di Nei Jing

黃帝難經 - Huang Di Classic of Difficulties / Huang Di Nan Jing

神农本草经 - Shen Nong Herbal Foundations Classic / Sheng Nong Ben Cao Jing

傷寒論 - Treatise on Cold Injury / Shang Han Lun

These are the fundamental texts, all compiled during the Han Dynasty (3rd century +), upon which Chinese medicine stands.  These texts are building upon even older and more fundamental classics like the Yi Jing, the Lao Zi, and the Zhuang Zi, which were compiled at least as early as the 3rd century BC, with roots tracing back several more millenia.  Together these books embody the philosophy and science which underlies classical Daoist medicine.

In the 1950's Mao Zedong had Chinese medicine re-organized into a standardized model which could be easily taught to large numbers of students and which modernized many concepts and strategies.  This shift, while it did bring the medicine to many more people, abandoned complexities in diagnosis and treatment for the simplicity of point prescriptions. It caused nearly all emphasis to be placed on the treatment of the primary channels, teaching very little of the other four channel systems.  Furthermore it eliminated any aspects which seemed religious, esoteric, or shamanic in nature in an effort to garner respect from the strictly materialist western scientific community.  This style of medicine was exported as TCM (Traditional Chinese Medicine) and has become the pervasive style of Chinese medicine throughout the west.  The title "classical Chinese medicine" distinguishes those practicing without regard to this change.

holistic vs allopathic healthcare

Holistic, from the greek όλος, meaning whole, is a term used to describe a system of medicine which approaches diagnosis and treatment with consideration to the body as a whole rather than as parts. Within the paradigm of a holistic model, no system can be evaluated outside the context of its environment.

Allopathic, from the greek αλλος, meaning different or other, is a system of medicine which treats disorders by prescribing a remedy with an action opposite that of the disordered state. This can be contrasted with homeopathy which treats disorders by prescribing remedies with an action that is the same as the disordered state. For example: In the case of fever, an allopath will prescribe a bitter-flavoured herb or an anti-inflammatory drug like a corticosteroid because these substances are cooling in nature and will reduce the fever. This is treating the presentation with its opposite. A homeopath will prescribe a very small dosage of a warming herb which would typically induce fever, like aconite, in order to cause the body to respond by reducing the temperature. This is treating the presentation with its like. Holistic evaluation takes into account the fever within the context of the entire system. A fever is mounted for a purpose.

Within the United States and most of the world today, Allopathic medicine is the standard; this is the medicine practiced my MD’s, and it is the school of medicine which has become the most popular.

Within Chinese medicine there are many cases when a seemingly direct allopathic approach is taken (id est, someone feels cold, so they are prescribed cinnamon bark and honey tea to warm the kidneys), and indeed this is often the case. Other times a more nuanced approach may be taken to resolve the disorder. The primary factor though, which sets Chinese medicine apart from conventional allopathic medicine today, is the holistic method of diagnosis. Within the Chinese medicine model each of the organs depend upon one another in order to function: The liver supports the heart, the heart supports the spleen and pancreas, the spleen and pancreas support the lungs, the lungs support the kidneys, and the kidneys support the liver. This is the most basic of frameworks that may be derived from the medicine. When there is a problem with the lungs, the physician will look first to the lungs, then to the spleen and pancreas, then also possibly to the kidneys to understand the dynamic between these organs and to see where the body is failing so as to have allowed a diseased state to take hold. The dynamic in the body is then treated and corrected to return proper functioning.

Within the conventional allopathic paradigm, though this strategy is employed wherever possible, the system isn’t designed to accommodate such diagnostics, and therefore is much more short-sighted. Allopathic pharmaceutical medicine is fast, it is powerful, it is effective and it can save your life, but it is not as elegant nor comprehensive as Chinese medicine in the diagnosis and treatment of chronic and complex disorders.

A notable shortcoming of standard allopathy is in the treatment of chronic systemic disorders. These types of diseases often involve a progression which stems from the subtle interactions between the organ systems, and effective treatment involves nuanced assessment of the state of each organ system. For example, autoimmune disorders are famously difficult to resolve for most physicians. They are officially considered to be incurable by allopathic standards, and the treatment tends to not lead toward resolution, but rather toward symptom management without necessarily protecting against symptom progression. Autoimmune disorders are characterized by an overactive immune response which may lead to inflammation and consequent complications — the allopathic solution is to suppress the hyperactive immune system so that it ceases to cause inflammation; this may be achieved with NSAIDs, corticosteroids, or immunosuppressant pharmaceuticals. The body depends, however, on a strong immune system for defense, maintanence, and repair, so such a course of treatment causes the body to decline over time. Furthermore, the immune response is mounted for a reason - the body is responding to a pathogenic factor which has been unresolved. Holistic evaluation and treatment involves stimulating the body to release latent pathogenic factors in order to remove the irritant to the immune system rather than suppressing the immune response directly. In this way the methods of treatment administered are vastly different. The narrative is similar for many other chronic progressive disorders including: Hypertension, High blood pressure, Atherosclerosis / Heart Disease, High Cholesterol, Congestive Heart Failure, Anxiety, Insomnia, Metabolic and Endocrine disorders, the list goes on and on. These disorders are managed effectively and treated in most allopathic contexts but not with an end toward resolution of the disorder. Chinese medicine uniquely offers treatment toward resolution of these disorders

The holistic approach to diagnosis and treatment allows for a more thorough understanding of the dynamic balance or lack thereof within each particular body and provides a basis for developing a treatment strategy which is tailored perfectly for every individual.

Qi

definition

Qi - 氣 is the capacity to interact.

Under most circumstances I avoid utilizing phoneticized Chinese characters in discussion, opting instead for a translation of the word into English.  In the case of this concept, however, there is not a good direct translation, so I use the pinyin "qi".  

The word for qi is a combination of the radical 气 (also pronounced "qi") and the character 米 (pronounced "mi").  The former means air, gas, breath, or spirit (as in "he is in high spirits").  The latter means rice.  Together they create the character 氣, which is the image of the steam associated with cooking rice or you could think of it as the steam rising from hot rice.  Because rice is the staple food in China, it represents nourishment, life, physical existence.  The concept then is something like the breath of life. This is the same as the Greek word πνεύμα or the Hebrew word רוּחַ, but there isn't a single English word that encompasses the full extent of the meaning.  Energy is the most common translation.  

Qi is the animating force.  It is life.  Therefore every living thing has qi, and death comes when qi is exhausted.  Each organ in the body has a particular function.  The extent to which that organ is able to perform its function is measured as qi.  In this way, lung qi describes the strength of the respiratory system, kidney qi describes the strength of the renal and adrenal systems, etc.  

within medicine

The functional capacity of the body is measured in qi.  Because this is a complicated system to describe, there are several divisions of qi, each referring to a particular aspect of physiology.  

Wei Qi - This translates to defensive qi. Wei qi is quick moving and hot natured.  It is described as being slippery and it circulates in the exterior of the body, just below the skin, moistening the skin, sinews, sensory orifices, and gastro-intestinal tract.  Wei qi is the interaction with the exterior.  This correlates to the immune system, it relates to allergies, to environmental sensitivities, to sensory perception and mood, to our capacity to meet and interact with the world around us.  This is the lightest, most superficial qi and it circulates 50 times per day.  

Ying Qi - This is nutritive qi.  Ying qi circulates once a day with the blood and is related to the nourishing of the vital organs and to the transportation of nutrients throughout the body.  The phenomenon of the conscious mind and the emotions are described by ying qi. 

Yuan Qi - This is source qi.  Yuan qi is the deepest, slowest moving, and most essential qi in the body.  It is the qi that relates to the hormonal system, it is the foundation for the metabolic system, it describes genetic expression and ancestral patterns and it circulates with the marrow on a three month cycle.  

Yin and Yang

In the beginning there was Chaos

From Chaos there emerged duality

The one became the two

This is the basic concept of the creation story in Daoist mysticism.  First the universe existed in a state of undifferentiated unity.  This is sometimes called supreme emptiness.  Then there emerged a motivating force with causality and potential -- this was called yang, the active, the provocative.  That which remained was called yin, the receptive, the still.  It is the interaction between these two primal states of being that gives rise to all things.  

Yin and yang are in a constant state of interaction, one never existing in isolation (perhaps coming nearest mutual severance as a singularity).  They are opposites, yet they are completely dependent upon one another.  This interaction is depicted in the taiji symbol, with yin being represented as shaded, and yang as bright.  Within a system, yin and yang must reach a dynamic balance in order to achieve homeostasis.  Through mutual consumption and mutual transformation of one another, this state of dynamic equilibrium is maintained.  This process is largely what is studied and described by modern physicists.  

Yin describes substance while yang describes function.  Within the context of the medicine this is applied in many different ways.  Blood is yin, qi is yang.  Qi moves the blood and the blood holds the qi.  Every organ has yin and yang.  If the organ has a compromise in function, it is yang deficient.  If there is a compromise to the substance of the organ, it is yin deficient.  So respiratory failure due to cystic fibrosis is a yang deficiency of the lungs because the function is compromised due to an accumulation of this yin substance (excess mucous).  Respiratory failure due to pulmonary emphysema, however, is lung yin deficiency, because the substance of the alveoli has been compromised by an excess of this yang environment (the caustic and hot nature of cigarette smoke usually).  So this might give you an idea of the thought process in Chinese medicine diagnosis from the yin and yang perspective. 

The Five Elements

Chinese medicine developed out of the folk medicine of ancient east Asia.  This means it is intimately connected with Daoism, which is the folk religion of the same people.  This is a school of naturalism -- one which derives philosophical truths from observation of natural systems.  One of these concepts which is fundamental to the theory of Daoist cosmology and medicine is that of the five elements.  

The five element model is a metaphor for understanding humanity.  Just as white light refracts through a prism to reveal the constituent color spectrum, such is the nature of all reality to unify and to divide arithmatically according to intrinsic habits.  This process is the differentiation of God.  This is the abstraction of the universe into constituent dimensions.  Humanity follows the way of fives.  

Wood is representative of beginnings.  It lies in the east where the sun rises and it represents birth, springtime, new growth, and expansion.  Through a medical lens, the wood element represents anabolic activity, reproduction, and the capacity to maintain consciousness and motor function in the body.  The wood organs are the liver and gallbladder and the wood energy manifests through the tissues responsible for motor function like sinews, muscles, nerves, and the hindbrain.  The wood element also corresponds with our ability to relate to time, this means our memories of the past and our plans or anticipation of the future.  Poetically enough, this relationship to that which is distant from us is associated with the eyes, and so the wood element also governs the eyes.  It manifests through the organs we use for reproduction (and so our expansion as a species).  That is, of course, the genitals.  Lastly we see the wood element manifest through keratin-rich tissues like fingernails, hair, the enamel of teeth, and in the horns and claws of animals.

Fire represents activity.  This is the the most yang of the elements and it is a metaphor for transformation, consumption, motivation, passion, and intercourse.  Within medicine, fire represents catabolic activity, it represents the capacity for warmth and for finding passion in life and in love.  It is responsible for mobilizing resources through the circulatory system, and for fueling metabolic function (a strong correlation may be drawn to the mitochondria within this system).  The organs associated with fire are heart and small intestine as well as two functional organs -- the pericardium and the triple burner.  The fire element manifests in the organs which facilitate exchange.  The heart and blood vessels exchange resources and hormonal signals throughout the body.  The small intestine exchanges resources from the external to the internal. The pericardium and the triple burner mediate the interaction between water (the kidneys) and fire (the heart).  

Earth represents stability.  The earth element is where there is support, integrity, nourishment and resources.  This is the gastro-intestinal tract, it is the adipose tissue, the spleen, the thyroid, and the pancreas.  Failure of the earth element causes sinking and prolapse conditions because integrity has been lost.  Weak earth is also most often root of metabolic disorders and obesity.  The conscious mind is also rooted in the earth element.  As a result, mental acumen, cognitive functions, and clarity of perception are governed by the health of this system.  The degree to which one is able to bond with other people, the ability to form intimate relationships and the relationship with family is woven into this system.  The spleen and stomach are the associated channels with the earth.  

Metal represents consolidation, organization, and structure.  This element also represents the relationship with the external environment.  This is the skin, the opening and closing of the pores, the immune system, the lungs, and the large intestine.  It corresponds with acceptance -- of things we have been given, and of things we have lost.  It is our relationship with the present moment, breath by breath, and it is the process of senescence -- the refinement and decline of a life cycle.  On a social level, the metal element is how we establish boundaries.  It is structure through logic, math, architecture, and bureaucracy.  

Water represents chaos, darkness, and mystery.  This is the element associated with the kidneys and the urinary bladder, the marrow, the bones, the teeth, and the ears.  The water element governs the unconscious, the ancestral, and the instinctual.  This is the DNA, it is the well from which we derive innovation on a biological level as well as on a social or intellectual level.  The water element is death, following the decline of metal and prior to the rising energy of wood, water is rest, stillness, inactivity.  

The Channels

There are five channel systems that collectively interact to give rise to the complexity of the human being.  These are the sinew, primary, luo, divergent, and extraordinary channels.  

The Sinew Channels

These are the most superficial channels in the body.  They conduct qi across the fascia and the sinews of the body, beneath the skin and above the muscles.  The capacity to interact with the external world is directly dependent on the functionality of these channels.  This includes movement, waking, maintenance of homeostasis, appetite and digestion, speaking, the immune system, wound healing, etc.  The type of qi involved in this system of channels is called defensive qi (卫气) and it is fast moving and unconscious.  While the conscious emotions are related to the primary channels, the sinew channels give rise to the mood.  There are twelve sinew channels -- one corresponding to each of the primary channels.    

The sinew channels are utilized most often for the treatment of acute injury like sprains, strains, broken bones, or trauma from laceration/surgery, but they may also be utilized in any disorder where the ability to interact with the external world is compromised.  

Treatment of these channels involves shallow needling to just below the skin.  Most of the needles are not retained during the treatment, and the use of gua sha or cupping may also be utilized.  Because defensive qi is quick moving it cycles once every day.  For this reason, sinew treatments may be performed daily.

The primary channels

These are the channels that most people mean when they discuss the acupuncture channels (hence the name).  There are twelve primary channels.  Five correspond to the solid organs, five to the hollow organs, and the other two correspond to functional systems rather than individual organs. 

Lung

Large Intestine

Stomach 

Spleen (pancreas)

Heart

Small Intestine

Urinary Bladder

Kidney

Pericardium

Triple Burner

Gallbladder

Liver

Whereas the sinew channels conduct only Wei qi, the primary channels conduct Wei and ying qi, the latter being more substantial and also intimately connected with the blood.  The primary channels represent the circulation of qi and blood in and out of each organ and are therefore most directly related to organ function.  They are the channels which maintain our functionality day by day and they have the strongest effect on the way we feel and think.   

The luo channels 

These are collaterals of the primary channels, minute offshoots which serve to connect the channels with one another and with the rest of the body.  The name of the channels is 絡 (phonetic - luò) and describes a net or a network.  Every day stress upon the primary channels is mitigated through this collateral system.  Over time, consistent stress may lead to the development of stagnation in the luo vessels which practically manifests as the stagnation of blood in the capillaries, causing them to become visible at the surface of the skin.  According to the progression of this stagnation, the luo pathology can also lead to the development of spider veins, varicosities,nodules, swellings, bruises, lipomas or cysts along the affected channel.  

The luo channels are highly interactive with the emotions and with consciousness in general because consciousness is carried in the blood.  Emotional extremes can be a symptom of fullness in these channels.  Similarly, treatments where these channels are bled can be emotional because circulation is brought back into the area where the blood was stagnant. Every encounter in life is facilitated through one of the 12 channel systems.  The buffering mechanism of the luo channels operates as a protective mechanism to prevent damage and to retain functionality of the organ itself.  The most common cause of stagnation in the luo channels is psycho-emotional resistance -- an unwillingness to accept the current state of affairs, to let go of a past experience, or to be subject to a future one.  Because consciousness is stored in the blood, mental resistance often manifests over time as stagnation of blood.  This unwillingness to accept change informs further interesting discussions concerning 'unfinished business' and the freedom of the spirits to depart a body.  For this reason the luo channels play an important part in considerations of death and transitioning.   The luo channels are indicated as a treatment strategy when spider veins are visible at the surface of the skin or when palpable nodules (such as lipomas or cysts) are present along the channel.  

These treatments are sometimes performed for cosmetic reasons, to eliminate the visibility of spider veins, but are always approached within the context of the medicine as a progression of pathology, and the treatment, thus, as a therapy toward resolution of that pathology.  

The Divergent Channels

These are a system of latency, like the luo channels, which divert pathogenic factors away from the vital organs.  This system of channels works with the mediumship of the essence (精) and facilitates the buffering of unconscious stress.  The principle behind these channels is that the body is self preserving, and when given the opportunity to forego an acute state of stress or disease directly affecting the viscera for a more chronic and slowly progressing disease, it will do so.  Such a mechanism avoids potentially life threatening disease in favor of chronic degenerative disease.  Because the primary channels are the network directly connecting the organs systems with one another, when sufficient stress is applied to one of these channels such that the body perceives a danger for the respective organ system, that stress is diverted to the deepest aspect of the exterior anatomy -- the joints.  This diversion is the namesake of the channel system and it describes the process by which rheumatism and a host of other chronic degenerative diseases arise. 

Just as the luo channels use blood as the medium for buffering stress, the divergent channels use the marrow.  The diverted pathogen is held latent in the joint by the Wei qi but is still recognized as alien.  This containment is a struggle which generates heat.  Stagnation in the large joints results and, if left unresolved, eventually leads to arthritis and damage to the joint itself.  Pathogens may be held in this state for years, only to re-emerge in old age (with the waning of physical resources) as inflammatory conditions.  This channel system is the preferred method of treatment for most disease classified in allopathic medicine as auto-immune disorders.  The rheumatic auto-immune state isn't one of the body attacking itself, but of the body attacking a latent pathogen.  

Because the marrow circulates once every three months, treatment of these channels is recommended for the duration of three months, three days on, three days off, in order to reach full resolution.  Sometimes the treatment is successful before three months and may be stopped at that point.  This schedule is difficult for many to follow.  If the patient can't follow the schedule with acupuncture treatments, essential oils are a useful alternative which may be applied at home in lieu of needles.  

The Extraordinary Channels

These are the channels which resonate at the deepest level of humanty.  They are entirely subconscious and, whereas the primary channels relate to daily activity, these channels relate to activity over the course of a lifetime.  

Chong Mai - The Penetrating Channel

Du Mai - The Governing Channel

Ren Mai - The Conception Channel

Wei Mai - The Linking Channels (there are two of these)

Qiao Mai - The Bearing Channels (there are also two of these)

Dai Mai - The Belt Channel

Treatment on these channels has the potential to effect very deep and lasting change on a person, even relating changes in genetic expression.  For this reason, these are the preferred avenues of treatment for diseases which are congenital and which have been inherited.  Furthermore, these are the most important channels for treating patterns which developed in utero or in early childhood. Chong Mai represents our relationship with ancestors and with descendants.  It is the energetic analog of DNA, that biological matrix which connects us with our predecessors and through which we influence our progeny.  The Daoists believe we have direct influence over seven generations in both directions.  Treatment on the Chong mai is exceptionally centering.  It refocuses attention upon the biological blueprint (again, DNA), effectively realigning one with their original state at birth.  This beckons themes of destiny, true self, and higher purpose (cue the Enya soundtrack).  Chong mai has several branches, but the original pathway is from the center of the perineum through the core of the body (just anterior to the spine) to the crown of the head.  

Ren mai is the sea of yin.  It is our relationship with the feminine.  This channel forms first (following the Chong mai) in utero and it travels along the ventral midline of the body.  First stimulated through breastfeeding, the Ren is how we bond with our mother.  This channel then informs our ability to make relationships and to bond with others over the course our lives.  Our nourishment, at the most primary level, is reflective of the state of the Ren mai.  Deficiency in the Ren mai, most often from a lack of intimate connection with mom as a child (not breastfeeding or weaning too soon/not being held), causes one to feel inadequate or incomplete and can easily grow into a lifelong pattern of codependency.  Furthermore, our understanding of how to bond with others and what intimacy should feel like is a product of the state of Ren mai.  For instance, if a mother is anxious or fearful, her breastfeeding baby, who is just developing an understanding of intimacy, will come to associate these emotions with nourishment.  Later in life, this early childhood impression continues to inform our understanding of intimacy, of what feels nourishing and safe, so a relationship with someone who evokes feelings of anxiety or of fear may feel very comfortable.  In this way, people fall into patterns of unhealthy relationships.  

On a physical level, the Ren mai is associated with breasts, ovaries and testicles, uterus, thyroid, prostate, and valve and sphincter muscles such as those around the eyes, mouth, digestive tract, urethra, and anus.  Stagnation of yin (such as masses or tumors) in these organs which are vital to nourishment and reproduction could be caused by Ren mai dysfunction.  Likewise with disorders of the sphincter muscles in patterns such as mitral valve prolapse, stenosis, chronic constipation, asthma, and dysfunction of the orbuculari oris or oculi.  

Standing as the counterpart to Ren is the Du mai, the sea of yang.  This channel travels the dorsal midline and together with the Ren creates a complete sagittal circuit.  The Du mai is our relationship with the masculine, with father.  This channel is about differentiation and individualization.  The Du represents independence -- the ability to move from the helpless state of infancy to a standing position where we have the option to walk away.  Overactivity in the Du mai presents with a compulsion toward rebellion.  There is an aversion to conforming and so an inability to accept external authority.  This often manifests physically as inflammation and neural disorders such as epilepsy, Parkinson's disease, stroke, fever, and paralysis.  Together, these two channels mutually balance and control one another.  When in a state of harmony, a person is able to bond with others and form healthy relationships while also maintaining independence and personal identity.  If out of balance, lifelong difficulty with these things may present.  

The Ren gives birth to the Yin Wei mai, the first of the linking vessels and the channel which serves as our connection with the past.   Du gives birth to the yang Wei mai, the connection with the future.  Yin Qiao mai is about relationship with self and yang Qiao mai is relationship with other.  The Dai mai serves to maintain the integrity of all of the other channels by buffering pathology.  These are the channels of evolution.  They are the most difficult to change and must be treated for a minimum of three months in order to see permanent effects.  These channels are often treated with essential oils and with qigong exercises or meditation as well as acupuncture.  

Diagnosis

In Chinese medicine an evaluation of systems involves taking the pulse, looking at the tongue, asking questions, palpating the channels, and observing physical signs in odor, vocal timbre, and skin complexion.  Chinese medical diagnosis is particularly valuable because this system has the ability to identify disease patterns before they manifest into serious physical problems.  Early diagnosis of disease means simple treatment and quick recovery.  Late diagnosis requires more invasive treatments and difficult recovery.  This is why annual or seasonal check ups are recommended in order to detect any developing imbalances in the body before they cause physical damage.  

Pulse

The pulse is the most complex and dynamic of the diagnostic methods.  It is felt at the radial artery on both sides at three standard depths and it is evaluated for rate, volume, strength, width, length, and shape.  Together, these variables inform the palpable terrain of the pulse.  There are 28 pulse qualities described in the classics.  The slippery pulse, the choppy pulse, the wiry pulse, etc., they all refer to a particular state of the corresponding organ system (i.e. metabolic activity, fluid dynamics, availability of resources, irregularities in form or function).  In some modern systems, such as the methods developed by renowned pulse master Dr. John Shen (and compiled by his student Leon Hammer) there are up to 80 different pulses described.  The complexity of this system demands years of practice and keen study to understand and master, but once grasped, pulse diagnosis becomes the most valuable and reliable tool for clinical evaluation.  

Tongue

Looking at the tongue is another means by which the physician is able to evaluate the state of the organ systems.  The tongue body, coat, moisture, and color are all taken into account to create a complete picture.  This visual inspection (no tongue depressors needed) is an inspection of the mucous membranes, the state of the tissues, and the state of the blood and fluids throughout the body.  Dryness in the tongue indicates dryness in the corresponding organ.  Cracking indicates a further progression of dryness into yin deficiency.  A thick coat suggests phlegm stagnation.  Redness indicates heat, which corresponds to an acidic pH and may lead to inflammation.  Purple in the tongue indicates blood stagnation and pallor indicates blood deficiency.  Taking the full presentation of the tongue into account is an important part of developing an accurate diagnosis.  

INtake

Regardless of the chief complaint when visiting a Chinese medical office, diagnosis involves collecting information about all of the systems in the body.  Nothing exists in isolation.  This means that the initial visit will involve filling out an extensive review of systems, covering the full health history, even as distant as conditions during gestation and birth.  Symptoms which may seem entirely unrelated may be very significant within the context of Chinese medical diagnosis.  Every subsequent visit will involve an abbreviated intake covering the points of interest from the initial intake.  It is important that as much information as possible be gathered in order to provide a detailed and complete picture of the state of health.  

Treatment

the eight methods 

Sweating is utilized when there is a pathogen in the exterior of the body.  This is seen in external invasion of a pathogen, giving rise to symptoms like stiffness in the neck, sore throat, nasal congestion, poor temperature regulation, malaise, and headache.  It is also seen when something internal is being released, with symptoms like skin eruptions/papules/pustules, fever, restlessness, insomnia.  The last case of external pathogens involves a compromise of the lung or spleen function, in which case the lymphatic and metabolic systems become sluggish, leading to swelling, edema, and rash.  This technique works primarily with the lung organ and with the taiyang channels (Urinary bladder and small intestine), and utilizes acrid herbs to dilate the pores and move fluids.

Vomiting is useful for treating conditions where the pathogen is lodged in the upper abdomen.  Indications for this treatment method include fullness in the abdomen, incessant belching, distention in the epigastrium, food retention, acid reflux, and chronic nausea.  This method is also used in the case of acute poisoning.  It is the least often used of the eight strategies, but can be used in extreme cases.  The treatment involves taking emetic herbs which irritate the stomach to induce vomiting.  

Purging is the strategy of clearing out the intestines.  This method is useful when there is constipation (chronic or acute), intestinal accumulations such as nodules, cysts, or polyps, intestinal distention or cramping, edema/ascites, and it is especially important in some breathing and psychological disorders.  In the case of acute bowel obstruction or ascites, harsh purgatives are used which will soften the stool and induce diarrhea.  In less acute conditions, this method involved gently softening the stools and simply increase frequency of bowel movement.  The herbs used in this strategy are often salty and bitter.  

Harmonizing (also called regulating) is the method used for pathogens which have compromised the functioning of an organ system and have lodged beneath the exterior and above the interior.  These disorders are often chronic in nature and intermittent in effect.  The most common indications are depression/anxiety, intermittent constipation/diarrhea, chronic dizziness/vertigo, migraine headaches, PMS, and malarial diseases, which includes malaria, influenza, dengue fever, and other disorders which present similarly with:  Intermittent fever and chills, often as a tidal fever (coming on in the afternoon), headache, dizziness/disorientation, nausea and vomiting, sweating, and fatigue.  This method focuses on treating the shaoyang channels (gallbladder and triple burner) and leans heavily on chai hu or qing hao based formulas.  

Warming is the method used for treating cold disorders.  Symptoms of cold disorders (aside from physically feeling cold) include slowing of metabolism, cramping, pain, and loss of function.  Some common indications include adrenal fatigue, cold intolerance, erectile dysfunction, menorrhagia, infertility, edema, weight gain, slow mental faculties, etc.  This method focuses on treating the kidneys and (secondarily) the spleen with yang tonic formulas which are traditionally rooted in the use of gan jiang and fu zi.  

Cooling is the method used for treating heat disorders.  Heat causes hyperactivity, inflammation, consumption of fluids, tissue damage, and bleeding.  Heat disorders are often associated with bacterial infection.  Example indications include fever, ulcers, anxiety, palpitations, receding/bleeding gums, UTI, cirrhosis, smoker's cough, mania, cancer, etc.  This method mostly employs bitter herbs and often involves work on the yangming channels (stomach and large intestine).  

Tonifying (also called nourishing) is the method of strengthening a system by providing resources according to what is deficient - qi, blood, yin, yang, essence, or fluids.  The indications for this method are so far reaching that they shouldn't be summarized in a short list.  This is a very important method and is utilized in nearly every herbal formula in some way.  

Reducing is the method of treating diseases of repletion anywhere in the body.  This method generally uses moving, draining, clearing style techniques to eliminate the five accumulations: phlegm, qi, blood, food, and cold.  When there is an accumulation of any one of these it gives rise to distention, pain, congestion, stagnation, and can lead to serious conditions if not resolved.