The holism refers to the unity and the integration of the body, and the relationship of the natural world to the human being. The body and the external environment together create an organic whole ,the body itself epitomizing the larger universe. The universe is the macrocosm, while the human being is a smaller microcosm within the larger macrocosm. The holism therefore includes two aspects. Firstly, the body itself is an organic whole. This viewpoint is applied within both the study of the physiology and the pathology of the body, and in the diagnosis and treatment of disease. Secondly, both the body and the natural world(external environment)are enriched by the naturally existing holistic relationship of the unity of opposites.
1) The Body, an Organic Whole
TCM holds that the body possesses various viscera, tissues and organs with separate functions. These interact together to make up an entire system whose activities determine the body's ability to maintain itself through the coordination and balance of its physiology. Each component is intimately connected and inter-influenced thereby producing, complicated pathological reactions. This integrated interrelationship is formed by the five zang-viscera as the center, and is brought into existence through the connecting action of the meridian system. These systems are concretely bound in physiological, pathological, diagnostic, therapeutic and other aspects.
a. Physiological Aspect
According to TCM, the five zang-viscera and the six fu-viscera are related with
tissues such as skin, muscle, vessel, tendon, bone etc. ,and such organs as the mouth,
nose, tongue ,eye, ear, external genitalia, and anus, among others. Together these tissues and organs form a unified whole ,coordinating their functional activities together. Among the tissues themselves exists an inseparable relationship of mutual cooperation ,interaction, and mutual adjustment. Through the following diagram the liver be taken as an example:
¢Ù Lung ¢Ù inter-restrain
¡ý ¢Ú inter-generation
¢Ú Liver---Gallbladder----Tendon----------Eye-------------------Nail
¡ý ¨O ¨O ¨O ¨O
This digram shows that the liver is internally-externally related with the gallbladder (one of the six fu-viscera) ,dominates the tendon(one of the five tissues) ,opens into the eye (one of the five sense organs) ,and manifests on the nail (one of the five outward manifestations). Since the liver pertains to wood, the heart to fire ,and the lung to metal according to five elements, liver-wood can promote heart-fire physiologiclly, and lung-metal can confine the liver-wood. It is the same case for other viscera. For example ,the spleen is internally-externally related with the stomach, dominates muscle and limbs, opens into the mouth ,and manifests on the lips.
The whole dietary process of reception, digestion, absorption, transmission, and excretion also is accomplished by the coordination and cooperation of the stomach, gallbaldder, small intestine, spleen, liver, and large intestine. The functional activity of each of the viscera is not isolated, but rather is a component part of the body's integral functional activities. In other words, the physiological activity of each of the viscera has a interpromoting and interacting relationship, a unity of opposites with the other viscera. This forms a system of five interdepending, interacting physiological functional activities. This system has the five zang-viscera as its center, internally links the zang-fu-viscera, and externally connects the limbs and joints to cooperate with the six fu-viscera, limbs, and the five sense organs. However, it should be pointed out that the concept of the five physiological functional activity system is different from the circulative, respiratory, digestive, reproductive, and urogenital systems of Western medicine.
Under the guidance of the holistic concept ,the physiology of TCM places emphasis on the maintenance fo normal life activities of the body. On one hand, this depends on the full play of functional actions of various visceral tissues ion the full play of function- al actions of various visceral tissues; on the other hand, however, it relies on the supplementary cooperative actions among various viscera. The normal play of functions of each of the viscera ,in turn, results from the cooperation of integral life activities ,which is the unity of the body locality and the organic whole. It should be pointed out that the holistic concept in the physiology of TCM is mainly used to explain the relative dynamic balance of yin and yang. This is accomplished through the theories of unity of opposites of yin and yang, the calm of yin and steadiness of yang, and other theories and it reveals the holistic relationship of cooperation and coordination. The interaction and regulation between the zang-viscera and the fu-viscera are, in turn, explained through the theory of interrelationship between generation and restraint. The understanding of zang-fu-viscera dynamic balance, interaction and regulation is not only of great significance in the physiology of TCM, but also of importance in enlightening the course of development of modern physiology.
b. Pathological Aspect
TCM not only explores the life activities of the body from the view of the holistic soncept, but it emphasizes the organic whole while analyzing the cause of disease. Specifically, TCM examices the holistic pathological reactions caused by the diseased local part. Because the locality and the whole of the body are unified ,the pathological change in a particular locality of the body always conveys holistic information on the prosperity and decline of yin and yang, qi and blood ,and the viscera of the entire body. TCM unifies the local and holistic pathological changes ,thus placing emphasis upon the relationship between the affected local part and its related viscera ,as well as other viscera.
Generally speaking, TCM applies yin and yang theory to analyze and summarize the holistic reaction status manifested by the imbalance of bodily functions. It uses the inter-relationship of generation and restraint in the theory of five elements to reveal particular types of disease transmission between zang-viscera and fu-viscera. For instance, pathological changes in visceral functions can be reflected on the body surface through meridians and collaterals, and vice versa. Meridians and collaterals also serve as channels for interaction and disease transmission between zang-viscera, between zang-viscera and fu-viscera ,and between fu-viscera.
For example, the cold due to the exogenous attack and the skin invaded by the evils can bring about the tension of skin and muscle, disharmony of nutrient-qi and defense-qi, resulting in such symptoms as aversion to cold ,fever ,floating pulse ,etc. Because failure of lung-qi in dispersing and depurative descending is internally-externally related with the skin and hair ,the exogenous attack of the lung results in the dysfunction of the lung-qi, This ,in trun, produces cough. Cough may be caused by the pathological change of the lung, or by the effect of the pathological change of the other viscera on the lung. For instance, the abnormal rising of the liver-fire can flame up to burn the lung, thus bringing about cough, even hemoptysis.
The early stage of liver diseases (including icterus hepatitis and non-icterus hepatitis) is caused by the damp-heat in the stomach and spleen, or by the stagnation of the liver-qi. This results in symptoms such as vomiting, nausea, abdominal distention, loose stool ,etc. ,which are refletion of disharmony between the stomach and spleen functions induced by the liver disease. As stated by Zhang
Zhongjing, "To treat the liver disease one should first invigorate the spleen, because the liver disease can be transmitted to the spleen, "in the Synopsis of the Golden Chamber.
Further illustrations of the reflection of pathological changes in zang-fu viscera through the meridian system can also be seen. For example, the exuberance of the liver-fire brings about red face and eye ;the flaming-up of the heart-fire may result in ulceration and pain in the tongue, or in a red tip of the tongue; the accumulation and excess of the lung-fire causes dryness and a burning sensation in the nose; the lung invaded by the windheat induces a running and stuffy nose; and the deficiency of the kidney gives rise to soreness in the loin and tinnitus like the singing of cicada.
c. Diagnostic and Therapeutic Aspects
According to the book Mencius, "Internal change must exhibit external manifestations. "Chapter 47 in Spirit Pivot states, "To see external manifestations will be to know the corresponding zang-fu-viscera ,thus identifying the disease. "On this theoretical basis, TCM diadgnoses disease. It attempts to deduce and understand the pathological change of the viscera from exterior to interior by observing the abnormal manifestations of the five sense organs, vitality, appearance, pulse, and so on, and thus lays a foundation for the establishment of proper therapy.
The tongue is extremely important in this process. It links the five zang-viscera directly or indirectly through meridians and collaterals. Tongue Diagnosis for Clinical Practice states, "The meridians and collaterals communicate with the tongue, and therefore the ailment of the viscera and meridians communicates with the tongue. "There is a paragraph in the Tongue Coationg General Records saying, "The tongue is the messenger of five zang-viscera and six fu-viscera. For example, the heart opens into the tongue, and the stomach and gorge connect up with it. The Spleen Meridian holds the base of the tongue, the Heart Meridian fastens itself on its root, the Spleen Meridian links up with its side, and the collateral branches of the kidney and the liver also link up with it. The heart is the house of mental activities and the governor of the five zang-viscera; the spleen dominates the transportation and transformation of nutrients, on which the other four zang-viscera depend to be nurtured, and therefore the ailment of the viscera must reflect itself on the tongue.
Thus, it is a central tenet of TCM that observation of the tongue can diagnose the pathological change of zang-fu-viscera. The internal and external observations, and the combination of the four diagnostic methods of TCM (inspection, auscultation and olfaction, interrogation, and pulse feeling and palpation)are the concrete reflections of the central nature of holism.
As regards treatment, for example, of the common cold and cough, this condition is caused by the cold-attack of the lung, and the abnormal rising of lung-qi caused by the failure of the lung in dispersion and descent. Clinically, the method of promoting the dispersing function of the lung is the use of such herbal medicines as Tongxuanlifei Pills or Zhisouqinguo Pills.
The loss of hair and hearing is mainly caused by the deficiency of kidney-essence, and can be treated by the method of nourishing the kidney to replenish its vital essence with such herbal drugs as Liuweidihuan Pills. The kidney stores the essence and dominates growth and development. The hair is the surplus of the blood, and the essence and the blood can produce each other. Thus, kidney has its outward manifestation on hair. It also opens into the ear, meaning that a deficiency of the kidney induces deafness. TCM therapeutics stresses that the treatment of an ailment should consider the organic whole and pay attention to the imbalance of yin and yang and qi and blood. Treatment should coordinate these elements, strengthen the body's resistance to eliminate pathogenic factors, remove the effect of pathological change and cut off the chain pathological reaction caused by the transmission of diseasc between the viscera. This treatment process is another concrete example of the use of the holistic method.
2) Unification of the Human and Natural World
Not only is the body itself and organic whole, but the body and natural world demonstrate the integral relationship of unity of opposites. The natural environment and its conditions are the material basis for humans' survival. The movement and change of the natural world has a direct and indirect influence on the body, and the body keeps in touch with the natural environment through various sense organs. As it is influenced by natural change ,the body exhibits various physiological and pathological changes correspondingly. It is said in Chapter 71 in Spirit Pivot, "Man corresponds with the natural world. " The work goes on to say, in Chapter 79 ,"Man harmonizes with the heaven and the earth, and corresponds with the sun and the moon. " This is to say that the life activities of the body are closely related to changes in the natural world.
Incorporating this belief in the correspondence between man and nature, TCM believes that the heaven has six climatic agents, Including three yin-qi and three yang-qi, and the motion of the five elements ,i. e. wood, fire, earth, metal and water. The body also has six meridians-qi, Including three yin and three yang, and the movement of five zang-viscera. Furthermore, the change and movement of yin and yang, and the five elements of the natural world correspond with that of the five zang-viscera and the six meridians-qi of the body.
The unified and integral relationship between the body and the natural world is mainly manifested in the following aspects:
a. The physiological Aspect
Man is brone by receiving qi from the universe. Man retains the adaptation and unity between himself and the natural world with certain physiological limits by the self-regulation and self-control functions of the body. This adaption is not a passive one , but a dynamic one. Life activity is the inevitable product of natural development, and the movememt of unity of opposites between yin-qi and yang-qi of the univeese provides the opimum environment for producing life.
Thus, Chapter 25 in Plain Questions says, "Man lives by the qi of the heaven and earth, and grows according to the natural law of the four seasons. " Chapter 9 of this work says, "The heaven offers five kinds of smells for man ,the earth presents five kinds of flavors... and therefore the combination of various qi gives birth. The body fluid and the saliva are mutual generating, then the spirit spontaneously takes place. " The five kinds of smells refer to foul, scorched, fragrant, stinking, and decayed; while the five kinds of flavors refer to sour, bitter, sweet, pungent, and salty.In a broad sense, the correspondence between five smells and five flavors refers to the combination and metablism of air and essential substances from food-stuff, which are the necessary conditions to produce the vitality of life activities. Based on the holism, the law of four seasons includes the following two meanings:
First, the climates of the four seasons correspond with functions of the five zang-viscera. That is to say, the climates of the four seasons can nourish, promote, and adjust thefunctions of the viscera. For example,liver-qi corresponds with spring,heart-qi with summer,lung-qi with autumn,the kidney with winter,the spleen-qi with later summer,etc.
Second, the physiological activities of the body must adjust themselves correspondingly under the influence of the climates. To begin with,the climates of seasons exert influnce on the body ,and therefore it is said in Chapter 44 of Spirit Pivot , "Germination in spring, growth in summer, harvest in autumn, and storage in winter are the normalchanges of the four seasons,and man also corresponds with these changes. " There also is a paragraph in Chapter 25 of Plain Questions saying,"If man can adjust to the climatic changes of the four seasons,the heaven and earth will become his parents. "Adjust" in this sence means adaptation and regulation.
In the normal climatic change of the four seasons, spring pertains to wood, and the climate is warm,summer pertains to fire,and the climate is hot;later summer corresponds to earth,and the climate is damp;the autumn pertains to metal, and the climate is dry ;and the winter corresponds to water, and the climate is cold. Under the influence of these climatic changes, the body also has corresponding changes and adaptive adjustment. Chapter 36 in Spirit Pivot points out: "If man wears heavy clothes in summer, the sweat pores open, and man perspires. On cold days, the sweat pores close and there is no way for sweat to go, and then the water empties downward into the bladder to urinate. "These things happen because the body is attempting to regulate the balance of yin and yang in reaction to changes in the environment.
The pulse also undergoes certain adaptive changes in response to the climatic changes of the four seasons. Chapter 17 in Plain Questions points out: "The pulse condition in spring is floating as if fish swam in the water. Pulse can be fully felt on the skin in summer as if everything was growing luxuriantly. Pulse can be felt just below the skin in autumn as if insects began to hibernate,and in the winter,it is deepened to the bone as if insects hibernated closely and deeply. " Li Shizhen in Four-Character Compendium said:"The pulse condition tends to be taut and surging in spring and summer ,deep and thin in autumn and winter. The normal pulse condition should generally be gentle in all seasons.
The change of pulse condition reflects the adaptive adjustment of the qi and blood of thebody under the influence of the climatic changes of the four seasons. Thus,Chapter 26 in Plain Questions states: "On warm or clear days, blood flows smoothly and defense-qi floats to the exterior, thus blood and qi moves easily. On cold and cloudy days, blood circulates stagnantly and defense-qi goes down to the interior. "
In addition, TCM believes that qi and blood also adapt themselves according to the change of day and night, or morning and evening. For example,there is a paragraph in Chapter 3 of Plain Questions that says:" Yang-qi part of the body during the daytime. Yang-qi begins to be active at day break,reaches its
peak at noon,and starts to be insufficient at sunset,thus causing sweat pores to close. " Besides being main way for the body to perspire, sweat pores also radiate heat and regulate the balance of yin and yang. Hence, TCM holds that one falls asleep when yang-qi goes into the interior, which reflects the adaptive changes of physiological activities of the body in response to varying times of the day.
The influence of day and night and morning and evening on the body mainly lies in the periodic rhythmic changes fo the five elements' motion and the six climatic factors of the heaven and earth. These have yearly, monthly, and daily rhythms. Chapter 18 in Spirit Pivot states: "Without cessation in the body, nutrient-qi circulates in the blood vessels and defense-qi circulates outside the blood vessels. Nutrient-qi and defense-qi meet again after 50 times of separate circulations. Yin links up with yang without beginning and ending,like a ring. Defense-qi circulates 25 times along yin meridians at day, 25 times along yang meridians at night. Beginning from yang meridians and ending at yin meridians, this kind of endless circulation corresponds with the relattive movement of the sun and moon. "As shown above,yang-qi of the body activates the viscera,tissues, and organs to carry out all kinds of functional activities.
b. The Pathological Aspect
If the body's function is abnormal, or its regulatory ability is impaired through, for instance ,a drastic climatical change the physiological adaptive function of the body will be hampered resulting in ailment. Pertaining to the holistic concept, the interaction of the body and the natural world will be reflected in the pathological changes through the following ways :
Firstly,the etiology and pathogenesis of TCM regard abnormal climatic changes as a main pathogenic factor. An example of this is the six exogenous evils(wind,cold,summerheat, dampness ,dryness ,and fire). Regarding the occupance fo disease, Chapter 66 in the Spirit Pivot states: "If the genuine-qi is strong in the face of such evil-qi as wind,rain,cold and heat,the evil-qi can not invade the body. "Chapter 33 in the Plain Questions further states: "The genuine-qi must be weak if invasion of the evil-qi takes place. "The process of occurrence and transformation of diseases as follows:
Secondly, frequently encountered diseases vary within different seasons. Generallyspeaking, epidemic febrile diseases(including respiratory infectious disease)often occur inthe spring; summer-heat diseases occur in the summer months; dysentery (including digestive infectious disease)and diarrhea occur in the summer and autumn;while exogenous cold-attack diseases occur in the winter.
Thirdly,due to the change between yin and yang during the day and night,the stateof illness varies around the clock. Usually the patient's condition is more improved during the day,while worse at night. Chapter 44 in the Spirit Pivot states:"Yang-qi of the body is active and the evil-qi inactive in the morning so that the patient feels more refreshed;yang-qi grows and overtakes the evil-qi during the day so that the patient's condition is stable;yang-qi begins to decline and the evil-qi starts to be active in the evening so that the patient's condition decline; yang-qi rests in the viscera at midnigth and the evil qi is still in action so that the patient's condition grows worse. " The above quote is a good explanation of the degree of seriousness fo the illness,and its round-the -clock rotation due to the changdes in the yang-qi. Therefore, the above quote places emphasis on the fact
that a patient's state is periodically good and bad depending on the time of day or night.
c. Diagnostic and Therapeutic Aspects
One emphasis of TCM is that to diagnose disease, one must consider both internal
and external pathogenic factors, and observe all potential causes of disease, not simply the manifested symptoms. In order to make a correct diagnosis,there needs to be a consideration of the climatic changes of the four seasons, the geographical locality, the habits and customs, disposition, constitution, age, sex, occupational features, etc. The four diagnostic methods (inspection,auscultation and olfaction,interrogation,and pulse feeling and palation)must be applied to understand the patient's condition in its entirety. A doctor must carefully summarize and analyze the cause of disease ,the infected part, the property of the disease, as well as the status of the interaction of the pathogenic factors of the body.
It is therefore said in Chapter 77 in Plain Questions: "When a wise doctor make a diagnosis and treatment he must know yin and yang of the universe, climatic and seasonal changes, five zang-viscera and six fu-viscera,sexes,exterior and interior,use of acupuncture needles, stone needle and herbs, changes of human affairs, routine of diagnosis and treatment, different constitution of the rich and the poor, patient's age, disposition, affected part, cause of disease, direction of the eight winds, and different pulse-taking methods in different pulse-taking positions. Only on this basis is the diagnosis of disease an all sided and precise one. " This type of diagnosis clearly reflects the integral relationship of the unity of opposites between man and the natural world.
Regarding the prevention and treatment of disease,TCM stresses the unity of man and his external surroundings as well as the integral relationship of the body itself. The selection of herbs for treatment should be in accordance with the objective law of the unity of internal and external surroundings of the body, with the patient's ability to adapt to the climatic and seasonal changes,and the change of yin and yang between day and night. The ancients put forth the principle of preserving health and preventing disease.. "Preserving and nourishing yang-qi in spring and summer, and the yin-essence in autumn and winter. "
When considering the selection of herbs in treatment, it is useful to keep in mind Chapter 17 in Plain Questions, which states, "If one first forecasts the evils due to climatic and seasonal changes,the berbs will not be misused to damage the balance fo the body. " Chapter 5 also points out that"Disease will come if one attempts to resist the changes due to climate,season,yin and yang,etc. ,while building up one's health. " The Law of Medical Circles also speaks on this topic, "The doctor who does not account for climatic and seasonal changes,or the excess or deficiency of yin and yang,is at fault when pathological factors invade the body, when symptoms become more acute, and deficiencies increase. "Thus,the desired curative effect can only be obtained by conforming to the holistic concept of the correspondence between man and the universe ,seasonal and climatic changes,and proper therapeutic methods. TCM therapeutics dictates that treatment of disease
should vary in accordance with different environments, seasons, and patients in order to achieve the goal of eliminating the evils and curing the disease.
To sum up ,man and the natural world are an organic whole. It is highly commendable that our forefathers established a similar concept of chrono-biology,and discovered that the physiological activities or pathological changes of the body manifested periodical rhythms in order to allow man to adapt to natural changes in the long-term evolutionary course. The changes of qi, blood, yin and yang correspond with the objectively existing wane and wax,and with the prosperity and decline of yin nad yang in the natural world.
It is reasonable that the body is a small universe because it makes up its own system and unity of opposites. TCM believes that the body divides into layers,such as the exterior and interior,upper and lower,ascending and descending,qi and blood,nutrient-qi and defense-qi,body fluid,vitality,yin meridians and yang meridians. The two sides of unity of opposites consist of the organic whole, but the organic whole is not equal to the simple addition of parts. This is one important concept of system theory in modern methodology.For example, the internal organs and tissues of the body surface are interrelated and interact with one another in order to give full play to the physiological functions that each possess. Once the local tissues and organs are isolated from the organic whole, they will not have the original functions and features.
Guided by holism, TCM sets up its own unique physiological system with the five
zang-viscera as the center,and with the heart as the center of the five zang-viscera. This kind of systematic structure theory is greatly related to clinical practice. This theory also points out that any locality reflects,to some extent,the information of locality and integrity. On this basis,TCM formulates its diagnosis and treatment,and creates many unique methods for doing so. Five facial colors diagnosis, tongue diagnosis, pulse diagnosis, ear diagnosis,etc. ,are all designed to deduce the integral reaction status based upon the external changes of locality, in an attempt to know the pathological changes of the internal organs. The treatment of these internal organs and the organic whole can improve the symptoms of the locality.
