Medical Acupuncture
A Journal For Physicians By Physicians

Spring / Summer 2000- Volume 12 / Number 2
"Aurum Nostrum Non Est Aurum Vulgi"

ARTICLES

Classical Chinese Medicine:
The Science Of Biological Forces
Edward S. Garbacz, MD
Sean C. Marshall, Dac

ABSTRACT
    Chinese medicine, including acupuncture, is a science in its own right. Its foundations were based on careful observations and application based thereon of natural phenomena by Daoist masters who were addressing the same set of universal physical and biological laws that apply today. The symbols that were developed and used to document this science are qualitative in nature and include Yin Yang, wuxing, and bagua. These qualitative symbols were used to document the level of understanding of those universal physical laws and as such, lead to consistent observations and clinical correlations.

KEY WORDS
    Classical Chinese Medicine, Acupuncture, Daoism, Qualitative Science, Yin Yang, Electromagnetism

INTRODUCTION
    To truly understand Chinese medicine, we need to perceive it at the same level that the originators of the system, Daoist masters 3000 years ago, understood it. A fuller grasp of the original guiding ideas and principles is essential for more complete appreciation of acupuncture's full potential; included is the proper integration of clinical experiences and research data with this mode of thinking and practice, without necessarily modifying by Western scientific interpretation. At the same time, it is essential that scientific, observational, and analytical methods are used (especially in physics) to further elucidate the underlying energetic mechanism of the ancient art of acupuncture if it is to be better understood and applied in modern terms.
    Chinese medicine may seem mysterious to many in Western scientific and medical fields, but it is a science. The scientists and practitioners of the Han period of China (late 2nd BCE, the period that produced and recorded the principles of Daoism and Chinese thought and philosophy), grappled with understanding, recording, and applying the same laws of physics and biology that we deal with today.
    The science that resulted did so without the equivalent of modern technology or the desire to quantify. Furthermore, because of its qualitative nature and inclusive, inductive approach, traditional Chinese science has, in many ways, been more successful than its Western counterpart in illuminating the workings of nature. This has produced a potent method of understanding, preventing, diagnosing, and treating infirmity at a level of sophistication and accuracy that is unique, are concordant with the most advanced physical scientific theories, and has stood the test of time.
    The authors discuss the Daoist philosophical roots of Chinese medicine with special references to its qualitative, symbolic nature of observation and analysis, and its meaning and contemporary relevance. Contrasts and correlations are made with Western science, including physics, biology, and medicine.
The Role of Daoist Philosophy in Chinese Science and Medicine
    Daoist philosophy espouses the belief that Dao is the ultimate source and sustenance of all things, living and non-living; it is at once invisible, boundless, and inexhaustible. All things come from the Dao and ultimately return to it.1 Despite the obvious spiritual allusion, Dao is not a spirit or a deity. At the heart of Daoism is its recognition of the unification of all nature, both in macrocosmic and microcosmic realms. Indeed, all phenomena, living or non-living, find origin, natural history, and evolution in the same unified processes based on the same universal actions or laws.
    Modern physics teaches that all matter in the universe, whether on the cosmic or subatomic level, is constructed from the same elemental particles.2,3 Furthermore, these elements are organized and behave in identical fashion regardless of the constituents of scale. The elementary particles within atoms move at the same speed of light according to Einstein's law of relativity.4 Superstring theory, as an attempt to realize a unified field theory of the 4 known physical forces, on examining and analyzing the theoretical ultrastructure of space compared with that of known subatomic particle behavior, finds it similar if not identical to subatomic random and chaotic quantum action.2,5
    The Daoists termed both the origin itself and the interrelated, interdependent, unfolding processes of life and their ramifications, Dao or The Dao. Translations of this word and concept include "way," "the way," "the path,"1 or "cosmos."6 As in all of the Chinese language and its symbols, or ideograms, the meaning is simple yet profound.

Figure 1.

    The word Dao as concept speaks at once to a very primal force within, and origin of, phenomena, things or beings, and the continuing progression and evolution of these in a predictable and orderly way over time. Dao is the motivating force behind all things. It holds also to the simultaneous and coexisting concepts of a totality and a singularity.1 This is fully consistent with current physical principles regarding the origin of the universe and the commonality of subatomic, elementary particles, and force makeup of constituent atoms, whether quantum or cosmic.2,3
    The Dao represents the way in which events happen and the pathway or process of such events through time and space. As such, Daoism speaks to an inclusive, interrelated, inductive universe, environment, and process. Daoism prescribes that human existence and its quality (i.e., health or lack thereof) are fully dependent on humans ability to live in consonance with the environment and, indeed, with the universe.

Figure 2.

    The early classic Daoist treatise, Dao de Jing (Tao teh Ching), "The Book of the Way," was thought to have been written around the 5th century BCE by Lao Zi (Lao-tzu), an older contemporary of Confucius.1 His name is often translated as "Old Master." Some consider him to be a mythic character, others an obscure record-keeper in a minor kingdom at the time.
    The Dao de Jing records in poetic fashion in 81 "verses" the principles of the Dao, the way to live and "be," and how and why. At the core of its observations of common natural phenomena and human endeavors is the concept of "wu wei," often translated "doing nothing" or "non-action."1 Yet the passivity and non-participation implied are not its point; it is the quality of that action or participation that matters most. Its teachings believe that people find themselves most engaged and synchronized with the world, and therefore most happy, healthy, and productive at all levels, when they trust the processes of the universe, trust the intelligence of the universe from which we originate and take sustenance. Humans "master" nature this way, not in the sense of conquering it but by being in accord with it.

"Express yourself completely, then keep quiet.
Be like the forces of nature:
When the wind blows, there is only wind;
When it rains, there is only rain;
When the clouds pass, the sun shines through.
If you open yourself to the Tao,
You are at one with the Tao and you can embody it completely.
If you open yourself to insight,
You are at one with insight and you can use it completely.
If you open yourself to loss,
You are at one with loss and you can accept it completely.
Open yourself to the Tao, then trust your natural responses;
And everything will fall into place."1

    Many consequences may be derived from these concepts. An example includes the oneness or commonality of things and beings, both in their literal origin and in their progression. This includes the notion of a single-ordered universe6 and the power of the internal, self-generated process of life itself without evoking the often-appealing external cause or influence. These concepts do not sacrifice the idea of the singularity of things and events, but instead underscore it as unique yet continuous with all other phenomena within a central unifying field of influence.
    Nowhere are these principles better illustrated than in the fields of astronomic and particle physics, and the ongoing attempts to find a unified field theory to explain the interrelated elementary particles that form the matter of the universe, and their simultaneously-generated energetic field effects both in the grand cosmic and ultrastructural scales. One such line of reasoning has coalesced as the superstring theory of the fundamental nature of all matter and energy.5 This theory postulates that all matter and energy may be resolvable to simple, pure energetic vibratory loops or strings. Further proof of this revolutionary theory is awaited.
    Also derived from Dao is the critical concept of the importance of the situation or context for a set of things or events. The universe's elements do not exist in isolation nor do they express themselves as such. The question presents: is this true for even the most fundamental of biological or chemical processes? This is true for human processes and health. All phenomena have a time and place to occur, interact, and evolve.
    Thus, Daoist philosophy outlines the origin and ways of existence: 1 common origin, 1 common process, with all its ramifications and expressions being interrelated and interdependent. It is consistent with current models of the origin and unification of the physical universe, and it is from this context that Chinese medicine and acupuncture developed.
Daoist Philosophy and Modern Physics
    At a biological and ecological level, the Dao describes an immutable relationship of humans to the environment. Indeed, we well recognize that we depend on our environment for life itself. Perhaps the best example of this absolute dependence on earth is when we depart it; in space travel, all vital resources must be taken along for survival.7 At the same time, human existence and activity can greatly impact the earth and its quality, both positively and negatively. Local earth forces can also impact humanity in the form of weather and climate. Chinese medicine honors these influences in the forms of specific external etiologies of human disease (i.e., pathogenic or "perverse" energy invasions).8
    What can become equally apparent is the impact the universe and its forces have on the development of life on earth and its attendant form and function. Theories purport that humans evolved as a species on earth under the same universal laws and primary forces (and were constructed from the same physical elemental particles that formed from those laws and forces) as all other constituents in the universe: atoms, molecules, stars, planets, quasars, nebulae, microbes, minerals, plants, animals, etc. These are the same forces (gravity, electromagnetism, weak and strong nuclear forces) that evolved from the creation of the universe itself.3,5
    The past century of physics, specifically quantum theory, the Einsteinian theories of special and general relativity high-energy particle physics, and the superstring theory, have provided a much finer understanding of the nature of matter and energy and therefore, of the commonality (in terms of origin) of constituents and processes of the universe.9 Although discovered by and used in physics, the same universal law applies to all phenomena including biological systems. Matter and energy are one and the same phenomenon, occurring, as it were, along a continuum of expression in the natural world, both macrocosmic and microcosmic. The energetic nature of acupuncture is a prime example of this matter-energy continuum in scientific and clinical action.
    Indeed, the notion that literal matter exists at all is rapidly becoming unpopular in modern quantum and Einsteinian physics.5,9 This is not unusual in the context of Chinese medicine. Since its most ancient Daoist roots, the Chinese considered matter as nothing more than another variety of energy (at a more consolidated or Yin state); they coined the concept of "Qi."
    Qi may be understood as a matterless forcefield on which matter is constructed, organized, expressed, directed, and affected. Qi creates and "moves" or directs matter; acupuncture stimulates or otherwise manipulates that Qi or matterless forcefield. The familiar electrochemical, opioid analgesic, and other physiologic changes proposed as the mechanism of acupuncture are perhaps actually the result of the existence, action, and manifestations of Qi.10
    Not surprising is the fact that ancient Daoism and modern physics share much in their observations and interpretations of the origin and process of the universe. The simple, emblematic, non-scalar symbols of qualitative Chinese science actually are compatible with, and could serve to verify, some of the most scientifically sophisticated physical observations and calculations.
    To paraphrase Albert Einstein,4,5 there is only 1 set of physical laws in the universe, and all things and phenomena in it are subjected to those laws, and are bound to and by and behave according to them. As noted earlier, those same physical laws (and their consequences) are unchanged from the laws that the ancient Chinese lived by and with, and by which they interpreted their world millennia ago. Those same physical laws such as momentum, gravity, inertia, electromagnetic fields, weak and strong nuclear forces, properties of fluids, solids, and gases, and laws of thermodynamics and of astronomy and cosmology are all, relatively speaking, unchanged.
    The difference between what the Chinese understood then in the universe, and what we observe and understand today, is the context in which the universe is observed. The content, the universe itself, and its constituents are not different; only its observers and their methods of cognizance and interpretation.11,12
    Western science functions in a context of reductionism, linearity, and causality; individual events are isolated from their whole and subjected to the "scientific method" to see how they may interrelate. Concurrent events and processes are eliminated. A hypothesis is posed and experiments are designed to prove or disprove it. From this, a theory regarding the law or principle is formulated. Established theory verified thus predicts the law or principle: Hypothesis (guess), Experiment (experience), Theory, Confirmed Truth.
    Chinese science, a qualitative science, derives from a context of inclusion, concurrence, and induction. Events are seen as initially interconnected, co-influenced, and studied in that context; the interrelationships of simultaneously-occurring, coerced events in their unique context. Daoism predicts the natural laws (i.e., observable phenomena) first by observation, and next seeks to examine the law or theory via appropriate further observation and experimentation. From this comes confirmation of that natural law or theory, e.g., the law or theory and its ramifications are further exposed: Law (observable phenomena), Experiment (experience), Theory, Confirmed Truth.
    That there are differences contextually in observations does not mean the phenomena (the content) themselves are different. Actually, because these 2 divergent systems make conclusions about the same phenomena, there is much potential in building a unified understanding of biology and physics from both of them and thereby, completing the science of health care.
    Thus, small wonder that Western science struggles with and frequently dismisses Chinese scientific and clinical concepts. Because of the non-technical origins and qualitative standards of Chinese medicine, it is assumed that somehow, it must be elevated to the level of Western scientific stringency and understood in the framework of Western language and method. The reality is that conceivably, Chinese scientific and medical observation and methodology are whole, complete, and stand on their own.

Figure 3.	Figure 4.

Chinese Science as Qualitative Science: Symbols and Units
    The methods by which Chinese scientists formulated, analyzed, and recorded their observations were qualitative in nature; the units of measure they used to document observations of physical or clinical phenomena were qualitative, emblematic, and symbolic in form. It is apparent from studying their content and application that the Chinese felt no compunction to quantify phenomena. Yet the symbols and "units" they used were akin to the unit systems of Grecian/European scientific origin (e.g., gram, centimeter, second). Furthermore, these qualitative units turn out to be as accurate, reproducible, and scientifically and clinically useful as that of the more familiar numerical unit systems.
    These methods of analysis and recording are rooted in the time-honored Daoist observations of natural phenomena, including those of earth-bound and cosmological nature. At one important level, they are emblematic and were intentionally and appropriately constructed by the Daoists as ambiguous; these symbols allow broader inclusion and understanding of many different but inductively related phenomena.
    Freeing a phenomenon's description from numerical or mathematical context is perhaps more uncomfortable to the Western scientist so invested in those methods of analysis. It may actually allow more opportunity to analyze and understand it in different ways. Application of this departure from quantitative context is being seen in physics in the form of a return to more qualitative symbols to allow a different understanding and reformulation of some of the most profound areas of quantum and cosmological physics. In this regard, physicist Stephen Weinberg said, "How can we get the ideas we need to describe a realm where all intuitions derived from life in space-time become inapplicable?"13 He, in part, refers to the limitations of physics and its mathematical concepts in extending the ultimate understanding and grasp of the universe.
Yin Yang (Matter/Energy)
    Yin Yang, wuxing, and bagua represent conventions of qualitative measures or units that may be applied to any phenomena to allow cogent, meaningful analysis and understanding of that phenomena.
    At the heart of Daoist observations of the universe, and in the whole of Chinese culture and medicine, is the pervasive and profound concept of Yin Yang. The ramifications of analyzing and understanding Yin Yang are infinite yet quite specific in application.
    Yin Yang symbolizes the qualitative representation of polarity, or the relationship of opposite but related constituents. It speaks to the immutable duality, mutuality, and balance between events, actions, and individuals; indeed, within or between any and all phenomena. Yin Yang also represents the coupled or coupling nature of events and processes. Simultaneously, Yin Yang implies uniqueness, opposition, and both mutual inclusion and exclusion. Implied also is the reversing/restoring nature of phenomena.
    All phenomena, matter, and beings (and their processes) may be analyzed by, or divided into, Yin and Yang components. In this way, Yin Yang is infinitely divisible yet inexorably interrelated and interdependent in nature.
    Yin and Yang as separate entities are only known or described in relationship to one another; there is no quintessential or free-standing Yin or Yang. In referring to "Yin," one has already implied or evoked "Yang." The classic Chinese text, Huangdi Neijimg (The Yellow Emperor's Classic), says, "Yin creates Yang" and "Yang activates Yin,"14 further illustrating Yin Yang's interdependent, interrelated nature. From Chinese antiquity, the origin of Yin Yang is attributed to the simple Daoist observation of the movement of the sun from rising to setting over a hill, and the subsequent shadow cast.15 It is represented pictorially by the venerable and universally recognizable taiji symbol (Figure 1).
    Yin refers to the shady (black) side and Yang to the sunny (white) side of the hill. Herein elegantly and memorably depicts the interrelated, interpenetrating nature of Yin Yang. Of great significance is the image generated by NASA's COBE (Cosmic Background Radiation Explorer) satellite recordings of a 6° arc of observation of the universe (Figure 2).
    Manfred Porkert16,17 has further described and qualified the polar/dichotomous nature of Yin Yang. Yin: structure/structive, contractive, intrasusceptive (absorbing into), centripetal, responsive, conservative, completing, confirming, consolidating, condensing, concentrating; Yang: function, action/active, expansive, extraversion (bringing to the surface), centrifugal, aggressive, demanding, incipient, setting loose, inducing change/transformation, developing, negative.
    Because of its fundamental, elementary, and universal nature, Yin Yang represents a universal descriptor that can be applied to any phenomenon or its processes or components. Figure 1 lists some of the correspondences of polar opposites of Yin Yang. Its indispensable clinical value is well established for the practitioner of Traditional Chinese Medicine and is essential to both proper diagnosis and treatment, including the use of acupuncture. Many practitioners find a renewed, more thorough understanding and organization of apparently disparate, often-dismissed patient complaints that otherwise may not be understood or acted on therapeutically if they were confined to a Western, pathologically-based paradigm. Furthermore, using needles to balance Yin Yang is critical to a successful treatment outcome, and is reflected at every level of treatment with acupuncture.
Wuxing: The 5 Movements of "Phases" (Motion/Time)
    In translation, wu refers to the number 5; xing refers to "walk" or "path." Thus, one useful interpretation of wuxing is the "5 movements."16 Another analogous concept is the 5 evolutive phases or the 5 transformative phases.17
    The prototypic natural event representing the wuxing is the progression of the seasons during an earth solar year. There are 4 seasons, each with their own palpable, influential, and observable physical and energetic qualities. Figures 3 and 4 show 2 versions of the wuxing, and depict the concept of movement over time.
    Well-known are the renewal and "birth" represented as Spring (Wood phase); the development and "growth" of Summer (Fire phase); the harvest and "decline" of Fall (Metal phase); and the consolidation and apparent "death" of Winter (Water phase). These qualities are expressed in unique, ubiquitous, and infinite ways in all seasons and within human bodies and their cells. The seasons are the expression of the matter and energy of earth over time, and their attendant and varied physical conditions that themselves are the consequences and expressions of cosmic and local physical forces.
    According to the wuxing, all phenomena and their processes in the universe, on this planet, and in human bodies are concordant with and classifiable. All practitioners of Chinese medicine are most familiar with these concordances. Table 1 presents the depth of these profound yet simple qualities and associations.
    The "elegance" of wuxing is its organizing, all-inclusive nature. It allows the understanding and productive, accurate analysis of any and all symptoms and signs presented by the patient. These include many, especially functional, pre-pathological symptoms that Western medicine can perhaps neither find a place for nor properly understand in relation to its disease-oriented symptom classification and clinical methods.

	Figure 5.
	Figure 6.

    Wuxing encompasses 5 aspects or phases; the 5th, the Earth phase, represents the transition and transformation between the other 4, and is consistent with the known qualities of that phase. From the standpoint of modern physics, the 4 known elementary forces (gravity, electromagnetism, weak nuclear force, and strong nuclear force) may be applied to and are concordant with 4 of the phases as shown in Figure 5. In this model, the Earth phase may again represent the transition and/or transformative aspect that relates to or unites these forces, or may represent the 5th force, antigravity, proposed most recently by physicists.
Bagua: The 8 Marvels (Direction, Vector/Momentum, Space)
    The bagua, as with wuxing, is a ramification, permutation, and expression of Yin Yang based on 8 aspects. The bagua was partly formulated based on Daoist observations and recordings of the 8 cardinal directions. The oldest known Daoist text, the I Jing (I Ching), records the bagua and its relationships to the natural world and human relations as a derivative of its 64 hexagramic symbols that are derived from Yin Yang.18 They represent the directional or vectorial component and expression of Yin Yang and wuxing.
    According to the Chinese classics, the bagua exists in 2 forms in the organism (Figure 6). The prenatal form and proximal source of bagua is the "dantian," or the energetic lodge of the kidneys. Its energetic form is Yuan Qi that is stored in the energetic lodge and remains there, as yet uncirculated, in the organism. The postnatal form is prenatal Qi that is deployed and circulates and functions in the organism within its own circulation channels known as the 8 Curious Vessels.
    From the standpoint of physical science, bagua corresponds to the concepts of directionality of matter and energy and, therefore, of momentum and vector. Bagua is the qualitative representation of space: "where" mass and energy "are," how they move in 4-dimensional space, and the force with which they do so.
    Clinically, the concept of bagua is applied to the vectorial nature of disease (e.g., pathogenic energy "invasions" and their therapeutic "extractions," or the spreading of various infections such as in a cellulitis). Additionally, bagua is reflected in the 8 diagnostic methods (Yin Yang, hot/cold, inner/outer, excess/deficiency), and the 8 therapeutic modalities (e.g., sudorification, vomitorization, calorification, etc).
    Taken as an integrated whole, then Yin Yang, wuxing, and bagua represent the physical science concept of space-time. Therefore, matter and energy exist, manifest, and interconvert; there is a place and time for them to occur and move; they possess momentum and vector. This is most consistent with our current understanding of the origins, manifestations, and evolution of elementary particles and forces as outlined in the last century of cosmological and
quantum physics.2-5,9

DISCUSSION
    Collectively, Yin Yang, wuxing, and bagua, the standard, qualitative descriptors of Chinese medicine, are the observable, expressed units of Qi, the matterless forcefield that underlies the energetic nature and mechanism of action of acupuncture. As derivations and expressions of Qi, Yin Yang, wuxing, and bagua integrate to form an inclusive, thorough, accurate, and effective methodology of clinical measure and therapeutic action. They derive from careful and reproducible observations over millennia of natural phenomena. Observations and ramifications bear close homology to recent discoveries and theories in cosmological and quantum physics. Close, planned examination of Chinese medicine in light of modern physics will conceivably support these conclusions and open valuable doors to further, necessary research which may establish the elementary mechanism and extend and enhance the more complete understanding of acupuncture. In this way, the full potential of acupuncture as a science and healing modality can be understood in Western medicine.

CONCLUSION
    A national priority is the completion of the U.S. health care model and its systems of practice. The past 20 years have seen efforts at making it more efficient and economical. However, less effort has been expended in envisioning an urgent need to reformulate it vis-à-vis its paradigm and modes of practice. Perhaps Western medicine's disease-oriented approach is inadequate because it is incomplete.
    The developing movement in the United States of "alternative," "complementary," or "integrative" medicine is an example of such a vision of change, and a response of our health care system to a population requiring and demanding more of it (especially in terms of addressing unique questions and health problems that have changed and evolved over time).
    Chinese medicine, particularly acupuncture, has attracted much interest in recent years. The more widespread use of acupuncture in the United States (including its increasing incorporation into regional health care plans), the 1996 Food and Drug Administration (FDA) upgrading of acupuncture needles as more than experimental medical devices, the 1997 National Institutes of Health Consensus Conference on acupuncture in Washington, DC, and evidence of a call for more research into acupuncture19 are a few examples.
    More creative, exacting, accurate, and verifiable approaches to acupuncture are clearly needed based on careful, integrative translation of the Chinese classics, and theoretical, basic science, and clinical research based on these. The work of Nguyen Van Nghi and Tran Viet Dzung20,21 are examples. Current methods and models of education of acupuncture in the United States and around the world should be assessed. Acupuncture has proven itself over millennia to be a complete, coherent, and encompassing method of health care that is simple yet powerful, affordable, accessible, safe, and effective. The authors believe that its breadth of practice, especially in the broader context of the whole of Chinese medicine (including herbalism, qigong, and taijiquan), is capable of filling the gap in the ailing U.S. health care system. Acupuncture's full potential for use is being recognized and addressed. Our belief is that the blocks to acceptance of acupuncture and Chinese medicine in the United States are largely cultural, underscored by widely differing modes of cognizance.
    Because Chinese medicine and Western medicine make their observations of the same universe and the same physical laws that define it (yet from obviously different modes of cognizance, methods of recording, and analysis), it will not be surprising to discover more unification between them. Such unification of ideas holds much promise, including the application of physics to the biosciences, the subsequent more complete application of the biosciences to our health care model, and perhaps, the desirable adjustments to the U.S. health care system.

REFERENCES

AUTHORS' INFORMATION
Dr Edward S. Garbacz is a Board-certified Internist in private practice in Atlanta, Georgia. Dr Garbacz is Chief Academic Officer/faculty member at Jung Tao School of Classical Chinese Medicine in Sugar Grove, North Carolina (www. Jungtao.com).

Edward S. Garbacz, MD
3082 E Shadowlawn Ave NE
Atlanta, GA 30305-2404
Phone: 404-848-0033 (office); 770-966-9873 (home)
Fax: 404-848-0438
E-mail: egarbacz@jungtao.edu

Dr Sean Marshall is Founder/President/ Headmaster of Jung Tao School of Classical Chinese Medicine in Sugar Grove, North Carolina; and is a Diplomate in Acupuncture, National Commission for the Certification of Acupuncture and Oriental Medicine, and Overseas Member, British Acupuncture Association.
Sean Marshall, DAc (UK), DiplAc (NCCAOM)
207 Dale Adams Rd, Suite 200
Sugar Grove, NC 28679
Phone: 828-297-4171
Fax: 828-297-4171
E-mail: smarshall@jungtao.edu

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