One challenge modern people face in studying classical Chinese medicine is recognizing, appreciating, and eventually participating in the peculiar nature of classical Chinese scholarship. While modern scholarship has contributed substantially to our understanding of Nèijīng (內經) by establishing the ‘provenance’ of the received texts, its value wanes substantially beyond that. Literary reading of classic texts like Nèijīng (內經) can only recognize a portion of their teachings, because they were designed as contemplation companions rather than textbooks.
The Nèijīng (內經) consists of two texts: Sùwèn (素問) and Língshū (靈樞), which were recorded approximately a thousand years before the advent of mechanical printing in ancient China. When those texts were conceived and initially codified, a student could not simply go to a store and buy them, as one can today. They were only available to individuals who found a teacher that would convey their teachings and allow the seeker to copy the written texts by hand. They are not textbooks; rather, they are poetry intended to stimulate contemplation and creative problem solving. Specifically, nearly all chapters of Nèijīng (內經) are snippets of dialogue, which together present a conceptual tapestry of an approach to classical Chinese medicine.
The Written Texts of Classical Chinese Medicine are NOT their Entire Teachings!
As a student or practitioner contemplates his or her experience, he or she can find more meaning in the classical texts of Sùwèn (素問) and Língshū (靈樞). Of course, this is true for many profound texts, either ancient or modern. However, in addition to finding multiple ‘levels’ of meaning in this relatively common way, the texts of Nèijīng (內經) have another process of encoding ‘secret teachings’ into their text through ambiguities and alternate reading of various passages. The language of these texts is subtle and beautiful, and most importantly poetic. The text invites contemplative reverie in one’s experience, both as an embodied spirit and as a practitioner who considers the trial and tribulations of many embodied spirits. The words can be translated, and one can tell a few stories to share A BIT of one’s experience, but the breadth of one’s experience cannot be shared in words. Each individual student of Nèijīng (內經) must grasp for oneself the ability to identify and work through its conundrums. Learning classical Chinese medicine is so much more than simply learning to differentiate the expression of distress into diagnostic categories.
Perhaps the greatest confusions concerning the meaning and import of classical Chinese medical texts arise from modern scholarship, which organizes and categorizes the information conveyed in the language of the texts. This ‘HAVING’ (in Chinese, yǒu (有)) of information gives the impression that one knows Chinese medicine, but it is divorced from practical knowledge of the material, so it fails to truly understand the texts. The texts of Nèijīng (內經) invite practitioners to cultivate a dynamic and responsive ‘NOT HAVING’ (wú (無)) approach to practicing Chinese medicine. What the heck is that?
‘HAVING’ (有, Yǒu) and ‘NOT HAVING’ (無, Wú) in Chinese Medicine
Clinical doctrines of Chinese medicine contain bits of discrete information. We learn associations for a fairly large number of symptoms and diagnostic signs. Then, we learn that when a patient presents with a few of the key symptoms and signs of various “imbalances,” that person HAS that syndrome. Most often patients are identified with a few syndromes, and then a treatment strategy is determined. It is relatively easy to project the clinical associations of a clinical doctrine of Chinese medicine onto a patient, and that is only the first step of diagnosis. It is a yǒu (有) approach to medicine, and thus represents only the grossest of beginnings.
Classical Chinese thought, especially inspired by Daoist perspectives, was focused on wú (無). Relative to medicine, that means keeping all the theory and information one knows IN THE BACK GROUND, while one is simply present with the patient — following the flow of life. The ‘goal’ of this process is NOT to attribute the patient to a group of symptom-sign complexes, but to identify his or her blocks in life. While that may just seem like ‘just language,’ these are profoundly different activities. Yǒu (有) knowledge projects it onto phenomena which are then differentiated according to the categories of one’s knowledge. On the other hand, wú (無) knowledge allows the symbolic imagery of Chinese medicine to be elicited by what one sees and feels in examining a patient, so one can make key differentiations to discern the flux of the individual patient’s life.
Clinical doctrines that differentiate the symptoms and signs of disease into diagnostic categories exhibit a yǒu (有) approach to Chinese medicine, which can only be partially correct. Well, that’s quite a claim! There are at least two good reasons for that claim:
- By nature, pathologies progress. While that MAY be simply a matter of accumulating more of some pathogenic factor that directly stagnates the intrinsic flow of qì (氣), most often the embodied spirit reacts to change pathogenic factors in some way. The expression of most pathologies evolve, so how they present is often not their original nature.
- Symptoms and signs ARE NOT the direct expression of pathology; rather, they reflect the embodied spirit’s reaction to pathogenic factors the individual has failed to resolve. Manifest ‘imbalances’ arise from both the ‘underlying’ pathogenic factors, and how wèiqì (衛氣) has activating to defend the individual. Thus, treatments that manage manifest imbalances suppress the individual’s wèiqì (衛氣), while they try to resolve pathogenic factors.
When practitioners yǒu (有) a clinical doctrine to project onto their patients, they gain a sense of security and empowerment. Yet, they limit their inquiries into their patients’ suffering to how that doctrine understands various diseases. Differential diagnosis from the perspective of yǒu (有) with a clinical doctrine generally assigns patients to various diagnostic categories, rather than identifying specific individual blocks leading to their manifest imbalances.
On the other hand, as they continue to study Chinese medicine, practitioners who are willing to wú (無) their knowledge can begin to use their experience creatively to discern each individual patient’s blocks. What the heck does that mean?
A Prolegomena to ‘Not Knowing’ Chinese Medicine
All perceptions are accompanied by questions, and every conclusion inspires several more questions than it answers. One’s ‘knowledge’ does not grow from a secure basis; rather, it is an ongoing inquiry:
- From where do these symptoms and signs (as the expression of distress) arise?
- What is the dynamic process of the pathology, rather than simply ‘what is the nature of its expression’?
- How can I ‘sort out’ the pathogenic factors from the embodied spirit’s reactions to them?
- How can I stimulate and facilitate the embodied spirit’s intrinsic response to pathogenic stagnation, rather than suppressing or ‘harmonizing’ its expression?
Seek the ‘subtle,’ (hidden) dynamic within any expression, rather than simply describing its manifest nature. This is the way of wú (無)-type Chinese Medicine, which probes into the magical possibilities for profound healing of the embodied spirit (jīngshén (精神)).