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Five elements in Traditional Chinese Medicine

An Introduction to Traditional Chinese Medicine

Encompassing thousands of years of history, Traditional Chinese Medicine (TCM) is a summary of the accomplishments comprises an important cultural component within China’s cultural mosaic.

TCM has flourished under the influence and guidance of its ancient materialism and dialectics to evolve into the major medical theoretical system it is today. Succeeding numerous clinical tests, it had remarkable contributions to healthcare and the prosperity of the Chinese nation.

Bursting with youthful vigor, TCM has drawn increasing attention and interest from medical circles worldwide. The fundamental reason is that TCM has a track record with successfully solved practical problems and wrought with valuable clinical experience bearing marked curative effects. Grounded solidly in scientific ideology, and in accord with the objective laws of physics, TCM is a subject of interdisciplinary study encompassing a wide range of scientific theory.

TCM is a subject that deals with the physiology and pathology, as well as diagnosis, prevention and treatment of disease. TCM considers the body of man and the natural world as an inseparable whole. Using the method of synthetic analysis TCM on the macroscopic point of view studies dynamic intrinsic relationships of the body and the relationship between interior and exterior environments and then makes clear of basic physiology to serve medical practice.

After long term medical practice and revision, as well as thousands of years of clinical tests and improvements, TCM has evolved into a unique medical system with very special ways of diagnosis, theory, and medication.

TCM is based on laws, concepts, and theories, covering a widespread theoretical system encompassing the Yin and Yang theory, the theory of the five elements, Zang-Fu organs, the meridian theory, pathogenesis of disease, pathology, diagnostics, syndrome differentiation, prevention of disease, and therapeutic principles. It is these basic theories, which provide the theoretical basis upon which to build a deep understanding of medicine and which provided the tools necessary to probe into the theoretical systems of TCM.

The development of the theory of TCM dates back to the Spring and Autumn Period and Warring States in Chinese history. This period was a time of separation between the kingdoms resulting in the remarkable development of politics, economy, science and culture. Great academic thoughts emerged, due to relax of totalitarian and the drastic social change, and academic ideology materialist dialectical ideology of Yin and Yang, as well as the five elements theories which became public. During this time favorable conditions were met for the formation of the theories of TCM and they are as follows.

This provides the practical foundation for the development of the theories of TCM. Its origins lie in the very beginning of human activities, and since the 21st century B. C. there had been a deepening of the understanding of disease.

Slowly the study of the art of Chinese medicine has progressed. The first use of technical words was added during the Shang Dynasty, resulting from and interpretation made using inscriptions found on tortoise shell. Some examples of technical words are abdominal mass scabies, tympanitis, dental caries, etc.; some terminology derived form symptoms such as tinnitus, diarrhea, insomnia; however most of the diseases were named after affected parts such as head, eye, ear, nose, and skin diseases. According to Mr. Hu Houxuan, “man in Shang Dynasty named 16 kinds of diseases, for example the diseases of head, eye, nose, ear, mouth, tooth, throat, abdomen, foot, toe, as well as urinary, obstetric, gynecologic, pediatric, and infectious diseases, covering almost all aspects of internal and surgical medicine to day, including diseases of brain, ophthalmology, ear, nose and throat diseases, dentistry, urology, obstetrics and gynecology, pediatrics, infectious diseases etc.

During the Western Zhou Dynasty, Spring and Autumn Period and Warring States, man had more understanding of the nature of disease. The Mountain and Sea Classic recorded 38 types of diseases out of which 23 were given technical terms such as jaundice, blockage, diseases due to pathogenic wind, abdominal masses, scabies, rabies, epidemic diseases etc.; 12 were named after symptoms and signs such as abdominal pain, sore throat, vomiting, deafness and the like. Discovered in the excavation of No.3 Han Tomb at Mawangdui, Changsha, Prescriptions for 52 kinds of Diseases listed a total of 103 disease names, signs, and symptoms. According to incomplete figures, in The Book of Changes, The Book of History, The Book of Odes and others of the 13 classics, recorded over 180 kinds of diseases and symptoms. The above mentioned show the depth at which man’s understanding of disease has grown as well as the medical practical experience, thus providing a foundation for the formalization of medical law, and the formation of its theoretical system.

The development of natural sciences is always interrelated. They promote and benefit each other and the development of TCM is inseparable from the achievements of the ancient science and technology of China. For example, the development of astronomy, the calendar, meteorology, agriculture, mathematics, and other disciplines laid a solid multidisciplinary foundation for the formation of the theories of TCM, for instance, Yi He, a famous ancient doctor presented “the theory of Six Kinds of Climatic Factors,” which demonstrated that ancient people understood the inevitable effect of abnormal changes of climate on the health.

The formation of the theoretical system of TCM possesses profound philosophical origin. When systematizing long-term medical experience, ancient doctors purposely applied ancient materialistic dialectical viewpoints, such as the theory of vital essence and Qi, Yin and Yang theory, the Five Elements Theory, and so forth. This application transformed scattered and fragmented medical experience into a systematic and complete system. This change was gradually done through inducing, summarizing, analyzing and synthesizing the experience, which resulted in heightening the empirical knowledge to theories.

The formation of the theoretical system of TCM is symbolized by the first publica-tion of the Yellow Emperor’s Internal Classic. The classic summed up the medical achievements and clinical experiences of Chinese medicine during the Spring and Autumn Period and Warring States Period. This text established the theoretical basis and principle of TCM and derived many ideas from the achievements of astronomy, biology, the creation of the calendar, geography, anthropology, psychology and ancient philosophy. This theoretical system is still guiding the clinical practice of TCM today.

Through the theories of vital essence and Qi, Yin and Yang, and the Five Elements as the theoretical methods and holistic concept, the Yellow Emperor’s Internal Classic explains the laws of life, and the unity of the body with the natural world. It provides a systematical discussion of anatomical formation, viscera, meridians, physiology, and pathology; providing as well the diagnosis, prevention, and treatment of disease. Deliber¬ately combining natural science with philosophy, the classic combines the two to provide and in-depth interdisciplinary approach towards medicine. The classic was considerably advanced for its time and contributed greatly to the world of medicine. Still in academic importance today are skeletal descriptions, as well as those of the blood vessels, morphology of internal organs, circulation, and blood physiology. Contributions providing an understanding of the multiple functions of Zang-Fu organs in physiology are great, as are information regarding the integral relationship within physiology and pathology.

Another classic still plays an important role in present day clinical practice is the Classic on Medical Problems, which appeared before the Han Dynasty. It expounded on and supplemented the difficult questions posed by the Yellow Emperor’s Internal Classic and was a contribution to the basic theory of TCM. Throughout the Han Dynasty, TCM made even further progress. Using as a foundation the Yellow Emperor’s Internal Classic and the Classic on Medical Problems, an outstanding physician, Zhang Zhongjing, wrote the first clinical medicine treatise during the Eastern Han Dynasty (150 219 A.D.) Treatise on Cold Attack and Miscellaneous Diseases, and he further expounded upon the medical achievements of his forefathers while integrating his own clinical experience. Within the treatise, a system of treatment based on syndrome differentiation and the principles of medical theory, therapeutic methods, prescriptions and medication in clinical practice was established.

Arising from his methods of analyzing and differentiating exogenous diseases and internal miscellaneous diseases in accordance with the six pairs of meridians and eight principles was a solid foundation for the development and future abundance of clinical Chinese medicine. The Treatise on Cold attack and Miscellaneous Diseases was subsequently rearranged by Wang Shuhe and divided into two books: The Treatise on Cold Attack, and Synopsis of Prescriptions of the Golden Chamber. The former included 397 diagnostic and therapeutic methods, and 113 prescriptions; the latter listed 25 volumes and 265 prescriptions.

The Synopsis of Prescriptions of the Golden Chamber put forward: “There are only three causes for all diseases: the first, exogenous cause, is that the evils invaded from the meridians transmit into the viscera; the second is that the evils invaded from the four limbs and nine orifices transmit into the blood vessel and result in stasis and stagnancy; the third consists of such pathogenic factors as sexual indulgence, bites by insects and beasts, and trauma," This text further advanced the etiological theory in the Yellow Emperor’s Internal Classic by analyzing the symptoms and signs according to the patho-logical mechanism, theory of Zang Fu organs. Another text A B Classic of Acupuncture and Moxibustion written by Huang Fumi, a famous physician in Jin Dynasty, also offered a deeper understanding of the meridian theory. The Pulse Classic, is a jext by Wang Shuhe and summarizes the 24 kinds of pulse conditions and their related principal diseases, which made a contribution to the development of Chinese traditional Sphygmology.

The General Treatise on the Causes and Symptoms. of Diseases, compiled by Chao Yuanfang during the Sui Dynasty, is the first treatise of TCM on pathology. It detailed the causes and symptoms of numerous diseases and is an important source for reference. The Key to Therapeutics of Children's Diseases, compiled by Qian Yi, was another pioneer in the development of the treatment of diseases of the Zang Fu viscera, being based on symptom and syndrome differentiation. A more concrete summary of the causes of diseases was displayed in Chen Yan's Prescriptions Assigned to Three Categories of Pathogenic Factors of Diseases. It focused on internal factors of disease: The impairment caused by the seven emotions, as well as external factors: the impairment induced by the six climatic evils in excess, or of untimely occupancy. It also focused on the non endo exogenous: impairment due to improper diet, epidemics, bites by insects and beasts, poisoning, trauma, etc. This type of classification corresponds more with clinical reality and beame a new development of TCM etiology.

Each generation of doctors continue to study the past medical experiences found within books such as the above. And each generation builds upon past information' creating richer and more developed theoretical ideas while gradually forming various types of schools of TCM. For example, influenced by the theory of the five elements and six kinds of climatic factors, the eminent physician Liu Heiian, during the Jin and Yuan Dynasties, emphasized the theory that the diseases caused by the six kinds of climatic factors could become the heat fire evil in the body. He also believed that the heat and fire of the six kinds of climatic factors were the most important pathogenic factors thus explaining the pathological mechanism of the heat fire evil.

Zhang Congzheng advocated that the diseases were caused by exogenous evils which should be expelled using the methods of diaphoresis, emesis, and purgation. Li Dongyuan held that diseases were mainly brought about through the internal injury of the spleen and stomach, thus explaining the theory of the ascending and descending of the spleen and stomach and creating the theory of relieving high fever with drugs consisting of sweet fla¬vor and warm nature. Zhu Zhenheng advocated the theory that Yang is ever in excess while Yin is ever deficient. This further developed the theory of ministerial fire and enriched the theoretical system of TCM. In addition, there were Zhang Yuansu's theory of pathological mechanism of viscera, and Zhang Jing yue's explanation of Yin Yang, the kidney and vital gate etc. All of the above theories enriched and developed the theoretical system of TCM.

The theory of febrile diseases deals with the pathology, diagnosis and therapy of febrile diseases. In the period of the Ming and Qing Dynasties, the school of febrile diseases was developed. This symbolized the understanding and study of febrile diseases reached a new level. Wu Youke, a physician in the Ming Dynasty wrote the Treatise on Pestilence and offered the theory of pestilence evil, which was the first systematic exploration of the etiology and therapeutics of febrile diseases. This laid the foundation for the development of the theory of febrile diseases. During the Qing Dynasty, many books re¬garding febrile diseases were compiled, some of which are the Treatise on Tropic Febrile Diseases written by Ye Tianshi; The Treatise on Differentiation and Treatment of Febrile Diseases written by Wu Jutong; The Treatise on Damp Heat Diseases authored by Xue Shengbai, and A Compendium on Febrile Diseases completed by Wang MengYing.

Within the books listed above, the authors systematically summarized the pathogenic law of exogenous febrile diseases during the Ming and Qing Dynasties, making a breakthrough in traditional understanding that "all febrile diseases belong to cold attack", thereby creating the principles of differential diagnosis and treatment of febrile diseases on the basis of the theories of Wei, Qi, Ying and Xue as well as triple jiao. This completed the theoretical system in such aspects as pathogenesis, pathology, pulse diagnosis and treatment etc. Great contribution to the enrichment and development of the theoretical system of TCM was made. It is necessary to point out that the theories of both the cold attack and febrile dis¬eases are two major schools which supplement each other and play an important guiding role in the clinical practice and studies of TCM.

Great progress has been made in the development of TCM within the last 60 years. There has been an enhancement in the systematization, and research of the basic theories of TCM. The application of modern science and technology towards the understanding of the essence of Chinese medical theories have displayed remarkable achievements in such areas as the nature of Yin deficiency and Yang deficiency, the essence of cold and heat, the essence of kidney and spleen, meridians, etc. . Great interest has been aroused in medical circles world-wide. The continuing development of the basic theories of TCM will facilitate the development of entire TCM and continue to modernize its theoretical system.