The Conceptual Basis of Traditional Chinese Medicine

1. The Conceptual Basis of Traditional Chinese Medicine
One of the major assumptions inherent in traditional Chinese medicine is that disease is due to an internal imbalance of Yin and Yang; therefore disease can be treated by correcting the Yin Yang imbalance, thereby returning the body to a healthy state. Western medicine tends to approach disease by assuming that it is due to an external force, such as a virus or bacteria, or a slow degeneration of the functional ability of the body. Both Chinese and Western concepts are valid alternatives. Although this chapter is devoted to the philosophy of traditional Chinese medicine it is useful to start by examining briefly some of the assumptions and philosophies of Western medicine. This will provide a useful comparative basis which will elucidate the understanding of both systems. Western medicine is based on the Cartesian philosophy that the body represents one functioning system and the mind another It accepts that each system may affect the other, but essentially it sees disease as either physical or mental. The Chinese assume that the body is whole, and each part of it is intimately connected. Each organ has a mental as well as a physical function, as will be discussed later.

Until fairly recently most Western doctors and pharmaceutical companies have worked on the basis that there is 'a pill for every ill'. The philosophical approach behind this idea is that an external force, or chemical, can cure disease, but although some pills are of great value, both the general public and the medical profession have become considerably more skeptical about the widespread use of such chemicals. Traditional Chinese medicine states that the body has the potential to cure its own diseases if pushed (or needled) in the correct way.

Some authors, such as Ivan Illich, have been hypercritical of Western medicine and thus some people have looked upon acupuncture as not just an alternative but a superior system of medicine. Acupuncture is just another medical system, with ideas that may be of benefit to the individual patient and Western medicine as a whole, but it cannot be promulgated as either superior or a cure all. The major disadvantage of Western medicine is that it has the potential to cause a great deal of harm. Acupuncture, on the other hand, is most unlikely to cause any serious damage as it is a particularly safe form of therapy; this is undoubtedly one of its main advantages.

Even though the traditional Chinese explanations for acupuncture are somewhat enigmatic to the Western doctor, acupuncture does seem to have a clearly validated scientific basis. In spite of their radically different philosophical assumptions it is wiser to look at these two medical systems as mutually beneficial, rather than mutually exclusive. Each system has ideas and therapeutic methods that can be explained both scientifically and philosophically, each can benefit the individual, and together they can broaden the philosophical and ideological basis of medicine.

The Balance of Nature
The Chinese believe that health is achieved, and disease prevented, by maintaining the body in a 'balanced state'. This concept was applied to both individuals and society at large. In individual terms the ancient Chinese physicians preached moderation in all things, such as alcoholic intake and gastronomic excess. They also stated that daily activities should include mental as well as physical tasks. The wealthier Chinese visited their doctor when they were well, paying a retainer to the doctor to keep them healthy. If they became ill the doctor lost his fee.

Such a highly sophisticated and personal system of health care is impracticable within the current limitations of Western society, but the concept behind such ideas represents a radically different approach to health and disease. The Chinese culture was also one of the first to grasp the potential within the broader field of preventative medicine. Many of these ideas were effected in the public health measures, which first began to be introduced during the Warring States period.

The body is a delicate balance of Yin and Yang. Yin represents water, quiet, substance and night, whilst Yang represents fire, noise, function and day. The two are polar opposites and because of this one must be present to allow the other to exist; for instance, how can you experience joy if you do not understand misery? The state of the body is determined by the balance of Yin and Yang within it. Each of the organs of the body has an element of Yin and Yang, although one organ may be more Yang in its nature, whilst the other is more Yin. One organ may be more important in its substantive form (Yin) whilst another is more important because of its functional abilities (Yang). When the healthy body is examined as a complete functioning system the Yin and Yang properties within it are in a fluctuating balance.

The balance of Yin and Yang is not always exact. Sometimes a person's mood may be more fiery, or Yang, whilst at other times he may be quieter and therefore more Yin. Normally the balance changes from hour to hour and day to day, but if the balance is permanently disordered, for instance if Yin consistently outweighs Yang, then the body is unhealthy and disease results.

The Therapeutic Application of Yin and Yang
When there is imbalance external agents can invade the body and cause disease, these external agents being called pathogens. The essential principle of Chinese traditional medicine is to decide on the exact nature of the imbalance between Yin and Yang, and the pathogen causing the trouble, and then to correct these pathological processes. As the natural forces of the body return to a normal balance the disease is then cured.

The art of traditional Chinese medicine is to particularize the imbalance accurately so that it can be corrected quite specifically The patient is then treated by using specific acupuncture points on the body, or the ear, in order to re-balance the body. This broad system of traditional medicine applies to all aspects of

therapy used by the ancient Chinese, particularly acupuncture and herbal medicine.

The diagnostic and therapeutic principles of Yin and Yang and the pathogens are based on a system of anatomy and physiology peculiar to traditional medicine. The anatomy of traditional medicine is represented by the acupuncture points and the channels that connect them. The physiology is represented by the organ functions that are outlined in the Nei Ching Su Wen,1 and will be discussed later in this chapter.

The Anatomy of Traditional Chinese Medicine
The channels are a system of conduits that carry and distribute Qi, or vital energy, throughout the body. Each of the organs of the body is represented by a channel, and diseases of a particular organ can be treated by using acupuncture points on the channel representing that organ.

Disease is present when the flow of vital energy through the channels is disrupted. This may occur when the integrity of the channels themselves is damaged by a sprain or strain. The Chinese describe this as a disease of 'Bi', or pain, caused by a localized disruption to the flow of Qi. The flow of Qi through the channels may also reflect the result of internal disease; for instance, if there is a disease of the liver then the flow of Qi through the liver channel will be abnormal.

The concept of channels exists exclusively in traditional Chinese medicine. Many of the facts handed down to us by the ancient Chinese do seem to have scientifically explicable reasons, but their ideas about the channels have eluded any explanation, so far. A variety of research workers have tried to correlate the channels with nerve pathways or muscle groups in the body, but all these explanations are inadequate. In spite of their elusiveness the channels represent a practical working system for acupuncture and are therefore still useful.

Acupuncture points are quite specific areas on the channels. They represent points of maximum influence on the flow of vital energy, or Qi, through the channels. This can be demonstrated clinically by thinking about the disease process that occurs when someone tears a muscle. The traditional Chinese explanation for

this disorder is that the channel running through the damaged muscle has been physically disrupted, resulting in local pain, a disease of Bi. In order to treat the pain, the integrity of the channel and the flow of vital energy through the channel, must be restored. This can be achieved by the selective use of acupuncture points on the damaged channel, which restores the flow of Qi and relieves the pain.

If the internal balance of Yin and Yang is seriously disrupted (so that disease results), then there will be an abnormal flow of Qi, or vital energy, through the channel representing the diseased organ. The diseased organ must be diagnosed and then acupuncture points can be selected from the relevant channel. The use of these specific acupuncture points corrects the flow of Qi in the channel and this, in turn, has an effect on the diseased internal organ. The overall result of this therapy is to correct the imbalance within the body, and thus heal the disease; an internal disease can therefore be treated by external means.

The Chinese Biological Clock
Vital energy flows through the channels in a well defined circadian rhythm. As the diagram overleaf shows, vital energy, or Qi, flows through the stomach channel in the early part of the day. A recent French survey showed that an accident driving to work is much more likely if breakfast has been missed. The ancient Chinese would explain this by saying that the energy required by the stomach, during the morning, has not been absorbed and therefore the body is not in a healthy state because it has 'missed breakfast'. Perhaps the idea of a large English breakfasts is more healthy than previously supposed.

The lung channel is dominant between 3.00 a.m. and 5.00 a.m. If there is a disease of the lung it should manifest itself at these times, as indeed it does; the worst time for a sufferer from bronchial asthma is usually in the early hours of the morning.

The circulation of Qi represents the traditional Chinese view of the biological clock within all of us, and, in the light of current medical knowledge, it is interesting to note how accurate are some of their observations.

The Physiology of Traditional Chinese Medicine
The physiology of traditional Chinese medicine has many similarities to that of Western medicine. Most of the specific organ functions defined in the Nei Ching Su Wen are astonishingly accurate in the light of modern scientific discoveries.

The heart is said to dominate the circulation of the blood. The Nei Ching Su Wen says, 'The heart fills the pulse with blood . . . and the force of the pulse flows into the arteries and the force of the arteries ascends into the lungs'. This seems to be a clear description of the circulation of the blood through the body, via the lungs. The idea that blood circulated in this way was peculiar to Chinese medicine until it was 'rediscovered' by William Harvey in the early seventeenth century. The publication of Harvey's work Du Mote Cordis has subsequently been hailed as one of the great landmarks of Western medicine, although at the time Harvey was thought to be mad, 'inflaming the medical profession by the suggestion of such a preposterous idea'.

The Nei Ching Su Wen also makes some surprising observations about the kidneys. It states that the kidneys dominate bone, that they play an integral part in the process of growth and reproduction (in fact the Chinese character for kidney and testicle is sometimes indistinguishable) and that the kidneys control body fluid in concert with the lungs.

During the last forty years it has become obvious that vitamin D is a very important factor in bone growth, and if it is not present then rickets results. The exact mechanism of this disease process was unclear as it was not really understood how vitamin D actually worked, but recently it has been shown that the kidney provides the missing link in the control of bone growth and development, by changing the chemistry of vitamin D. The idea that the 'kidney dominates bone' is therefore an accurate, detailed, complex and surprising observation to have been made some 2,500 years ago.

Embryology is the study of the growth and development of the foetus in the mother's womb. With the advent of good microscopic technique, in the early part of this century, embryology developed apace. It has been shown, quite conclusively, that both the ovaries and the testicles develop from the same original cells as the kidney. This process begins when the foetus is about five weeks old, (when a baby is born it is said to be in its fortieth week of development). The kidneys therefore, do seem to play an important part in the process of growth and reproduction.

The detailed and specific control of body fluid is a very complex chemical system, and one that we are only just beginning to understand properly, but it is quite obvious that the kidney and the lung do work together to control the fluid in our bodies. Most of this information has become available since the Second World War, with the development of complex and expensive machines to look at small changes in the chemicals and fluid within the body.

Communication Problems
The Nei Ching Su Wen contains a vast array of medical knowledge, much of which has been hidden from the West by the Chinese language, and it was not until this text was translated that the information became freely available. Many of the observations and rules within the Nei Ching Su Wen are based on the intricate and detailed observations made by the Chinese physicians. It does not seem to be part of the cultural make-up of Western societies to use this time-consuming method of gaining knowledge. Often we tend to be too impatient to 'waste time' observing petty detail, seeming to pursue instead the idea of scientific 'break-throughs', although, in the end, both approaches yield the same answer. One of the major precepts of Taoism is that if the individual waits and watches the 'Way' will become clear. In the West we are motivated to search actively for the answer and therefore the 'Way' sometimes takes far longer to become clear. This is well illustrated by medical concepts contained in the Nei Ching Su Wen, and their subsequent rediscovery.

The Five Zang Organs
Although many organs have the same functions as in Western medicine there are also radical differences between the Western and Chinese systems. In traditional Chinese medicine the major functions of the body are built around the five main organs which are the heart, the lungs, the kidneys, the liver and the spleen. In Western medicine these organs are important, but not to the same extent as in traditional Chinese medicine. The Chinese call them the five Zang or five solid organs, and the system of the five Zang organs controls the main Yin Yang balance of the body.

Each of the Zang, or solid, organs is linked to a hollow or Fu organ. For instance, the kidney is linked both structurally and functionally to the urinary bladder. In Eastern and Western medicine both organs control the production and passage of urine. The channels representing the kidney and urinary bladder are also 'paired' as Qi is said to flow from one channel to the other. The liver and gall bladder are linked in a similar manner; they both control the formation and secretion of bile and they are also 'paired' charnels.

For these specific 'paired' organs the linked functions are exactly the same as in Western medicine. The 'pairing' of the channels is particularly important when deciding on which acupuncture points should be used. Diseases of any organ can be treated by using the 'paired' channels; for example, diseases of the liver can be treated by using acupuncture points on the gall bladder channel. Traditional Chinese medicine considers migraine headaches to be a disease of the liver and they can be effectively treated (with acupuncture) by using points on the gall bladder channel.

The Emotions and Mental Disease
Traditional Chinese medicine considers that the emotions are governed by individual organs. They do not consider the brain, or subconscious, as discrete entities, therefore the body and the mind are a real part of the same functional system. Each organ is given a particular emotion; for instance, the liver is said to be the organ affected by anger. The concept that emotional functions are completely tied in with physical ones is deeply rooted in Chinese culture. In China there is less 'mental disease' as we know it in the West, because the neurotic is considered to have a disease of the liver or spleen, rather than anxiety or depression. Perhaps this explains the fallacious claim that 'no mental disease exists in China'. In my experience, having worked in a Chinese hospital, the Chinese are just as prone to neurosis as we are in the West.

There are great advantages in seeing mental functions in this way because, instead of being labeled a depressive, the patient feels that the liver is playing up and therefore perceives the disease in a different context. In the West a depressive may still be stigmatized and considered weak because he, or she, is unable to cope. In China this is not so because the cultural history and social context of mental disease is different, the depressed patient being made to feel that the disease is real and organic, rather than imagined. In spite of the constructive efforts of those who work in the field of mental health in Western nations, the body and the mind are generally still considered to be separate, and those who are unable to keep the mind under control are thought, by some, to have failed.

In acupuncture, the Chinese have a method of effectively treating a proportion of mental disease, which therefore has not been considered incurable, and there has been no necessity to shut all sufferers away in institutions. In the West most of those who are working within the area of mental disease are dealing with diseases that are poorly understood. As a general rule the level of understanding in any area of human knowledge can be judged by the number of theories that are used to explain a single phenomenon. If there is one theory that seems to explain all the facts, for a given observation, then it is probably correct. If many ideas are used to explain the same set of facts then it is likely that most of them are, at best half truths. At present the field of mental health embraces a large number of theories which are used to give opposing explanations for the same basic facts.

Without a defined idea of the origin of disease, treatment is difficult, therefore a wide variety of poorly understood treatment methods are used in mental disease, such as electroconvulsive therapy. Perhaps the lack of social stigma attached to mental disease in China is because there has been some form of consistent explanation, and treatment, for this type of problem for the last 2,000 years. The area of mental disease is particularly interesting as I am sure that there is as much mental disease in China, if not more, than in the United Kingdom, but it would seem that the cultural and medical heritage of the Chinese people has allowed them to deal with it in a different manner from that in the West, and possibly more effectively.

Vital Energy (Qi) and Blood
The force behind the biological functions occurring in any living tissue is Qi. Qi represents the vital energy of the body but it also has a material form. It is both substance and function; the substantive or material form of Qi is oxygen (clean Qi) or food, the non-substantive form of Qi is the real but evasive concept of 'vital force'. The idea of a 'vital force' is common to many early, medical systems, but it has been highly developed within the concept of traditional Chinese medicine.

If a substance has no Qi then it is dead. The Qi of the liver is the functional ability of the liver, and the Qi of the body is the total vital force of a human being. Qi is disseminated through out the body by the channels. It is also divided into various sub groups such as original Qi, or the Qi with which you are born and nourishing Qi, or the Qi that you gain from the food you eat. Defensive Qi is the Qi that protects the body from invasion by disease, circulating just below the skin and fending off invasion by viruses and bacteria (pathogens).

Qi is a very wide concept, difficult to understand in detail, but it is an essential part of the traditional Chinese picture of the body. Blood also exists in the system of traditional Chines medicine, and blood production is said to be dependent on the liver, the kidney and the bone marrow. The modern medical theories on blood production also tie up these three organs as being the functional system for blood production.

Pathogens
Disease results when the Qi of the body is weakened and unable to resist the onslaught of pathogens (disease-causing factors). In Chinese medicine the agents that cause disease are given the name of meteorological conditions; an infection (often associated with a fever) is called a disease of heat, and a chronically painful joint is usually a disease of cold. These pathogens allow diseases to be grouped according to their broad symptoms. The pathogen wind is an interesting idea. Wind means a changeable symptom, so the type of muscular ache often occurring with 'flu, would be classed as invasion by wind. The idea that disease is due to physical conditions is an intuitive explanation for many common aches and pains. People often complain that 'the caught a chill when they got wet', or that their 'neck is stiff after

having slept in a draught'. The Chinese pathogens represent formalization of this approach.

A particular pathogen usually presents itself with a defined symptom complex. By using the information gained from the history of the disease, and the physical examination of the patient, it is often possible to make a clear diagnosis of the pathogen causing the disease. If the patient has a fever then heat is one of the pathogens involved in the disease process. Once the diagnosis has been made, then specific acupuncture points can be used to disperse the pathogen; when heat is the invading pathogen, then specific points are used to reduce the fever. Acupuncture points are therefore used to correct the Yin Yang balance of the body and to disperse pathogens.

If the pathogen cold is responsible for a particular disease process, then heat must be used to treat it. Moxa is the Chinese version of the heat lamp and, as shall be discussed in a late chapter, the Chinese burn the dried leaves of Artemisia vulgaris over the areas that require heat. Heat, or more specifically smoldering moxa, provides local heat for a variety of chronic muscular aches. It is interesting to note that the types of disease due to cold are commonly the muscular and rheumatic ache which are temporarily alleviated by heat lamps.

More than one pathogen can invade at the same time; if a patient is suffering from 'flu, then there will be a fever and all muscular aches that wander all over the body. This is defined as invasion by the pathogens wind and heat and, as one doctor said when I described this to him, 'the patient will be suffering from a great deal of hot air.'

Other factors may also cause disease, such as worry, or eating contaminated food. The Nei Ching Su Wen states that excessive grief, anxiety and overthinking will cause cancer. This idea has been supported by some recent comments in the medical press which suggest that if a woman has a breast removed for cancer she will survive longer if she is of a 'happy' disposition.

Pulse Diagnosis
For the acupuncturist, one of the most difficult aspects of traditional Chinese medicine is the diagnosis of the specific organ affected by any particular disease. In ancient China this was achieved by using a refined form of pulse diagnosis.

The palpation of the pulse enables the acupuncturist to assess which organ is diseased, whether the organ is over- or underactive, and the pathogen causing the damage. This is achieved by feeling the pulse at three positions at each wrist, and by feeling the pulse at the superficial and deep positions at each end of three positions on the wrist. There are six pulses at each wrist, three superficial and three deep. There are twelve main organs in the Chinese medical system2 and each of these is represented by one of the pulses at one of the wrist positions. It is unclear how this system of pulse diagnosis came into existence but it was a refined and very important system by the time the Nei Ching Su Wen was written. This method of diagnosis allows the whole body to be assessed, and it also defines the relative balance between each of the organs. In addition, pulse diagnosis is said to give a clear idea of the type of disease process, whether it is acute or chronic, and to give a prognosis for that disease in that individual patient. This allowed the Chinese physician to give an indication of how the disease would affect the individual.

The observation that each of these pulses represents a different organ is a difficult fact to accept and understand. It is astonishing to think that different organs are represented by the pulse in the left and right hands, and that these pulses are separated only by a centimeter or so. There are also severe different types of pulse that can be felt in any given position, for instance the pulse in the spleen position can be described as a 'Fu' pulse in one disease, or a 'Ch'en' pulse in another disease. These pulses were given rather poetic descriptions. A 'Fu' pulse is described as a superficial pulse, it is light and flowing like a piece of wood floating on water, whilst a 'Ch'en' purse is a deep pulse, like a stone thrown into water.

Surprisingly enough, these pulses can be recorded accurately with the aid of modern technology. They can be printed out from a six channel oscilloscope with three pulse sensors at each wrist. In terms of modern electronics this is not a particularly complex device and allows clear graphic verification of the idea of the ancient Chinese. The poetic description of the pulse characteristics also seems to be verified by the recording; a superficial pulse

is indeed superficial in that there is an upward deflection of the pulse wave on the recording, and very little downward motion of the pulse in that position.

In Western medicine examination of the pulse only gives information about the rate, rhythm and volume of the pulse wave, and this information is correlated with the state of the heart and blood vessels. From the pulse recordings it is obvious that the pulse shows a great deal of variation over a small area at the wrist. It is also obvious that the shape of the pulse wave changes radically when a little pressure is placed on the artery. A superficial pulse is felt superficially and a deep pulse is felt when a little pressure is put on the artery by a finger or, in the case of the pulse-recording machine, an inflatable cuff. Although not easily explicable these facts are certainly of interest.

The Ancient Diagnostic System
Pulse diagnosis is not used in isolation, but as part of a system that involves taking the history of the disease and examining the patient. The facial complexion, smell and posture of the patient are also used diagnostically. Assessing the history of the complaint is the basis of all good medical practice, whether Western or Eastern, and can be summed up by an old Chines quotation called the ten askings: 'One, ask chill and fever; two perspiration; three, ask head and trunk; four, stool and urine; five, food intake and six, chest. Deafness and thirst are seven and eight; nine, past history and ten, causes. Besides this, you should ask about the drugs taken and for women you should ask the menstrual and obstetric history. Finally, for infants ask about normal childhood diseases'. This ancient Chinese system of history-taking is almost exactly the same as that employed in the West today. Pulse diagnosis was therefore included as an important part of a sophisticated system for diagnosing disease.

Modern Chinese Diagnosis
Modern Chinese acupuncture differs from the old tradition system. The old traditional system of diagnosis by the 'twelve pulses' takes many years to learn to a standard of competence which allows the acupuncturist to make a clear diagnosis Although there are some people in both China and the West

who are able to diagnose by the twelve pulses, they are few in number, and a modified system of pulse diagnosis has therefore been developed by the Chinese. This allows a simple but relatively accurate system of traditional diagnosis to be taught and practiced, quite quickly and proficiently, the mainstays of this 'shorter method' being the use of a pulse generalization and the tongue.

The pulse is not felt in any particular position, but for its general character, hence the term 'pulse generalization'. The pulse can be felt at either wrist and classed as generally excessive or deficient. The tongue is also used to give quite specific information about the disease process and, in combination with the history, this system gives much the same answer as the 'twelve pulses'. Proficiency at this method will usually give the same traditional diagnosis as the pulse-recording machine, so the simplification of this system has not caused a significant loss of diagnostic accuracy.

The Selection of Acupuncture Points
The diagnosis of a particular problem does not tell the acupuncturist where to place the acupuncture needle. A set of therapeutic rules must be applied to solve that problem. To a large degree all medical systems are based on clinical experience and acupuncture is no exception to this; the rules that govern point selection are therefore based on a combination of philosophic concepts and empirical clinical experience.

There are special points that can be used to disperse the invasion of specific pathogens, such as cold or heat, and judging by some recent Chinese research work it would seem that the points used to disperse heat do lower fever. These pathogen-dispersing points are based largely on practical experience, and they form part of the basic grammar of acupuncture.

The other rules of point selection are many and varied; for example, points can be selected on the basis of the law of the five elements. This law assumes that each of the organs represents one of the five elements in traditional Chinese thought (earth, fire, water, metal and wood). They have a creating and destroying cycle.

On each of the channels there are points representing one of these elements and by applying a complex set of rules the diseased organ

can be sedated, (if it is overactive) or tonified, (if it is underactive). There are also points on the back and front of the body that represent specific organs, and these too can be used to treat the represented organs when they are diseased. There is a plethora of such rules, each of which is applied in specific conditions and at specific times. The problem for the acupuncturist is to define the few points that will be best in any particular condition. The skill of point selection is based largely on clinical experience; the rules of point selection give guidelines, although they are not the complete answer.

The Use of Specific Points
Why does acupuncture need such specific diagnostic and treatment methods7 Why not use all the acupuncture points at the same time? It would seem logical that if one acupuncture point helps, then two will help even more, and if all the points are used then the patient is bound to get better!

The Western doctor sometimes assumes that 'more is better'. If a drug does not give therapeutic benefit, or side effects at a given dose, then he may double the dose and the patient will probably improve. Traditional Chinese medicine implies that a small stimulus is probably more effective than a large one. Biological systems do seem to respond to small stimuli; for instance, a small change in the ecology of a 'food chain' can be amplified to cause major damage to another animal species in that environment. The emphasis in acupuncture therapy is to select a minimal number of acupuncture points in order to give the body a small but specific stimulus, as this seems to result in a better therapeutic response.

Clinical Skill
It is quite simple to practice acupuncture because it is quite simple to needle patients, but it is difficult to learn and practice the traditional Chinese acupuncture properly. It also takes some time to gain the clinical skill required to insert and manipulate the acupuncture needle. The Chinese teach that each needle inserted should be manipulated so that the patient receives a numbing or burning sensation in the acupuncture point. Many Western schools of acupuncture do not believe this and state that this sensation, which the Chinese call needling sensation, is not required. The available evidence suggests that if a needling sensation is obtained then the acupuncture is more effective, although many patients obtain adequate symptom relief without experiencing needling sensation.

Acupuncture is not a static subject. The Chinese have achieved a great deal by adapting and redefining the ideas of traditional Chinese medicine so that they are more understandable and acceptable to Western doctors. Technologically based acupuncture techniques have also been developed by Western doctors and these will be discussed in the next chapter.

1 The Nei Ching Su Wen is the first known acupuncture text (see The Physiology of Traditional Chinese Medicine, a section of this chapter).

2 The main organs are the heart, kidney, liver, spleen, lung, pericardium, triple warmer, large intestine, small intestine, stomach, gall bladder and urinary bladder.