Framing the Arts (術) of Acupuncture and Chinese Medicine

Twenty-five centuries ago, the authors of the Great Commentary of Yìjīng (Xìcí (繫辭)) identified one key idea at the root of the natural philosophy investigations during the classical period of ancient China. They framed two ways to relate with and understand the world, which exhibit a clear yin-yang polarity:

  • The qì (器)-frame focuses on how one can use the world to fulfill needs and desires; I call this “the utility-frame,” and it exhibits the individual’s attempts to project his or her will onto the world of phenomena. It aims to control outcomes. The person is yang, relative to a yin world of stuff, which has found its highest expression in modern science and technology.
  • The dào (道)-frame focuses on disentangling from survival-based internal chatter, which seeks to control outcomes, and instead exercises the willingness to trust. This does not make one entirely passive, though practitioners focus their attention on subtle dynamics (of the Dào (道)) and influences that affect phenomena.

Within the field of medicine, there is a somewhat subtle though very real difference between these two frames. The utility (qì (器)) -frame of Chinese medicine has developed a clinical doctrine, which control or manage pathological expression. Students learn general functions and specific indications for each point or single herb or formula, which is A LOT of information. Alas, memorizing a lot of disparate information is not the same as memorizing the words of an inspired text. The former is stultifying, while the latter provides a wealth of fodder that is frequently brought to mind to facilitate insights in the moment. Memorizing inspired words is meant to transmit a measure of inspiration on occasion, as one flows through life.

While the conceptual framework of modern Chinese medicine is a tapestry drawn from several historical traditions, including Shang Han Lun, it is primarily a modern version of one idea among many suggested in Nèijīng (內經), which was subsequently developed into much more systematic form during the northern Sung Dynasty (960-1127). This is the familiar focus on differentiating ‘syndromes’ of the zàngfǔ (臟腑), and use the single property of expressing an internal-external relationship for the jīngmài (經脈). These are the zàngfǔ (臟腑) syndromes we still use today; they are ‘imbalances’ of a humor — qì (氣), xuè (血), jīnyè (津液)jīng (精)yīn (陰), yáng (陽), etc. Furthermore, these humors are generated and managed by the zàngfǔ (臟腑), which are widely understood as the ‘organs’ of Chinese medicine, and the humors are usually understood as various forms of ‘stuff.’ In a grammatical and semantic sense, we consider the names of both the zàngfǔ (臟腑) and their various humors to be nouns.

When the humors of various zàngfǔ (臟腑) are out of balance, they are identified as either ‘deficient’ (xū (虛)) or ‘excess’ (shí (實)). Alas, this translation for xū (虛) and shí (實) contributes to a general confusion within modern Chinese medicine concerning diagnosis, which shifts the practitioner’s focus away from identifying blocks in the dynamics of vital process onto classifying the manifestations of distress in symptom-sign complexes. Contemporary failure to translate xū (虛) and shí (實) accurately appears to be almost entirely between classical Chinese and modern Chinese, rather than between modern Chinese and English or another western language. Modern Chinese medical doctrine has been studiously rendered as ‘scientific’ as possible, so it naturally exhibits the biases of modern scientific worldview. It focuses the practitioner’s attention on measures of quantity of stuff — excess and deficient, and inexorably draws it away from quality and flow.

One the other hand, the dào (道)-frame perceives, and seeks to understand, a dynamic and responsive world. Rather than studying the interactions of physical things/stuff with measurable qualities as in modern science, the dào (道)-frame names directional movements directly, and studies how they influence each other. It doesn’t use a lot of fancy mathematics to model movement; instead it relies on the individual’s willingness to release their survival-based ‘utility’ or qì (器)-frame, and learn to use symbolic images creatively to gradually see dynamics directly. Alas, this is one of those things that can’t be explained; one needs to begin doing it. Each individual develops a dào (道)-frame, through accumulating and integrating experiences, which are not explained by the utility-frame. There are many such phenomena, regardless of how well some ‘scientific’ people believe modern science explains nature. Again, science isn’t ‘wrong,’ though it is limited, because it projects a particular framework for perceiving and understanding phenomena.

A practitioner working in the dào (道)-frame seeks to identify the nature and locations of blocks to vital flow, and especially to identify avenues for their resolution. This is not a process one seeks to control or even manage, but to facilitate the embodied spirit’s intrinsic potential to heal. Yet, this is not a random process. We seek clear perception and discrimination, and depending upon specifics, we ‘request’ (with needles, herbs, or other modalities) the patient’s embodied spirit to release, expel, transform, dis-inhibit, or otherwise resolve influences that block or impede flow.

Request? Is that not a rather strange verb to characterize a treatment? Certainly, it is from our familiar utility-frame, where we are encouraged to educate ourselves as consumers of health care services. We expect control, or if that isn’t possible we seek and expect effective management, of the body’s uncomfortable expressions. Most contemporary ideas of health care exhibit a simple and reactive relationships with symptoms — they are all ‘bad,’ as expressions of disease, and thus should be controlled or at least minimized. Why do we believe that ‘shooting the messenger’ will eliminate the problem? Do we fail to realize that each individual is an embodied spirit, which is MUCH more than a complicated bio-chemical machine?

Regardless of how effective a medicine may be, nor how accurately it may be applied, it does not cause healing. This remains true, whether one works with conventional western medicine, Chinese medicine, or any other medical or healing tradition. Healing is a natural expression of any individual’s life. As practitioners, the best we can do is support the embodied spirit to focus its intrinsic abilities, and get out of its own way in realizing its potential. Sometimes that includes the embodied spirit having to express (xiě (寫)) some blockage outward. This process may take many forms, depending on the nature of the blocking influence and the avenue by which it is expelled. Many of these expressions seem like pathological symptoms, though they may be understood as part of a healing process. Who is correct?

Well, like many other issues of Chinese medicine, it depends on how one frames the art. Within their own frames, I suggest both of them are correct. What? Well, this is a nice example of how people may talk right past each other, if they have sufficiently different perceptions. Does one regard acupuncture a ‘scientific’ system of transactional medicine, or does one regard it as an art to probe transformational healing? Early last year, I put together a concise one-page table to contrast these two approaches, according to a dozen parameters. There are many more, which can be discussed much more fully, but this table of an “Acupuncture Spectrum” is a nice start. The last of these parameters demonstrates this issue was clearly understood by the authors of Nèijīng more than two thousand years ago. In the opening lines of the first chapter of Língshū, the scientific approach is characterized as coarse (cū (麤)) and the other is considered superior (shàng (上)).

Why don’t contemporary practitioners know about this? Well, it’s a long story, which includes a fair amount of history and philosophy, and fermented by discussion of language, culture, and thought. I wrote several blog postings, during my previous attempt to reach out with some of these idea through this medium, and barely scraped the surface.