Traditionally, the conceptualization of health and well-being in China is rooted within the broad context of classical Chinese cosmology (Lu, Cooper, Kao, & Zhou, 2003). The human organism is viewed as a miniature version of the universe, which means that nature is regarded as a macrocosm and man as a microcosm (Petri Jr, Delgado, & McConnell, 2015). Just as the natural world adjusts itself to climatic and seasonal
20
changes, people are supposed to adjust to the outer forces of nature as well as to inner forces such as emotional and glandular changes.
Two philosophical systems - the duality of Yin-Yang and the Five-Elements provide the foundations of Chinese medical theory and bases for clinical diagnosis and treatment plan in the health service (Chu, 2014; Fang, 2012; Gurung, 2013).
Yin and Yang
Chinese conceptualization of health and well-being can be traced back to the theory of
Yin-Yang (the 4th century B.C.) (Harris, 2016), which depicts how things function in
the universe. According to Yin-Yang theory, everything in the universe is seen as parts of a whole, which goes along with the continuous natural changes. The correlation of Yin and Yang exists among everything, and nothing is isolated from the rest. Yin and Yang are two complementary forces that together describe the nature of real-world elements, and they express the interdependence of opposites in the individual, nature, and the cosmos. The Yin - Yang Theory suggests the following philosophical underpinnings:
1. Yin and Yang coexist in everything, and everything embraces Yin and Yang. 2. Yin and Yang give rise to, complement, and reinforce each other.
3. Yin and Yang exist within each other and interplay with each other to form a dynamic and paradoxical unity (Wang & Zou, 2011).
The Yin-Yang theory is viewed as fundamental to the practice of TCM in terms of
understanding, diagnosing and treating health issues (Zhang & Wang, 2014). TCM treatment seeks to restore the balance of Yin and Yang both physically and mentally. This balance of Yin and Yang is symbolized as a “Yin – Yang fish” (see figure 2.1).
21
The curvy line (“S” shape) in the symbol signifies that there are no absolute separations between opposites (Fang, 2012, p.7). The dark circle in the light part looks like the eye of the fish, suggesting that Yang entity contains Yin element; and in a similar vein, Yin entity contains Yang element as well, indicating the coexistence and unity of the opposites to form the whole.
Figure 2.1. Bi-polar construct of Yin and Yang
Notes 2: Light colour = positive side; dark colour = negative side.
The Shi Jing (诗经) (The Classic of Poetry, 601 BC), contains possibly the origins of
the Yin-Yang link. The written character for Yin is a pictograph which means the
‘shady side of the hill’, and the character for Yang is the ‘sunny side of the hill’ (Yuan, 2015). From then on, Yin and Yang have been endowed with innumerable qualities with many of the additional connotations either related to or derived from the original concepts (Ling, 2015).
Ancient Chinese people would take Yin and Yang as one entity, which exists in everything such as foods, drugs, body organs, disease etc. and stages of the life cycle etc. The theory of Yin and Yang describes the human body as an organic and dynamic whole, unified but with opposing aspects. Yin usually connotes “water” property: i.e.
22
coldness, darkness, femininity and weakness; while Yang stands for “fire” characteristics: i.e. hotness, brightness and masculinity.
The notion of Yin and Yang lays an important foundation for the theoretical development of TCM as evidenced in the following five aspects:
1) All things have two aspects: a Yin aspect and a Yang aspect. Illness is associated with slowness, coolness, weakness or under-activity which are characterised as Yin; whilst sickness related to manifest strength, over-activity or heat is related to
Yang.
2) Any Yin or Yang illness can be further explored. For example, heat or hyperactivity is associated with a Yang illness; whereas weakness or loss of weight may be related to Yin illness.
3) Yin and Yang are regarded as interrelated or interdependent.
4) Yin and Yang are believed to have a mutual control relationship. For instance, if Yin is excessive, and then Yang will be weak (Maciocia, 2015).
5) Yin and Yang are thought to have the potential to transform from each other (Mair & Tzu, 2012).
For TCM, the affinity of Yin and Yang is vital to human health and well-being. To be concrete, harmony between Yin and Yang indicates good health, whereas disharmony or preponderance of one element over the other may result in disease or death. It is postulated that the balance or imbalance of Yin and Yang reflects one’s physical and emotional status of the body. Balance and harmony give structure and meaning to the understanding of the complementary and yet antagonistic forces (Xutian, Cao, Wozniak, Junion, & Boisvert, 2012).
In health service and medical treatment, a practitioner needs to judge whether an illness is located in the interior or exterior of the body, i.e. in the Yin or Yang (regions
23
of the organism), and whether an affliction is caused by cold or heat, either inside one’s body or the external environment. Good health condition is considered as a harmony or balance between Yin and Yang. When the harmony is broken, illness will occur (Kaptchuk, 2014). Hence, Yin and Yang dominates Chinese health beliefs, illness causation and health management choices, with an emphasis placed on the internal and external balance between the body and the mind. In brief, Yin-Yang philosophy serves as the theoretical foundation for Chinese medical diagnosis and treatment (Fang, 2012).
Five-Elements Theory
Coexistent with the Yin-Yang-Theory, the Five-Elements Theory (also called Five Phases Theory) is highly valued in ancient Chinese health and well-being civilization. The five phases (i.e. wood, fire, earth, metal and water) are often used to describe clinical processes and relationships, helping to conceptualise proper medical treatments. According to Kaptchuk (2014), Five-Elements Theory was first systematized by Zou Yen (approximately 350 B.C. to 270 B.C.) and his followers. Chinese physicians in the ancient time noticed that the inter-relationship among the internal organs corresponded closely to that of the five elemental processes in nature.
Originally, the five phases were used to show the general processes that take place during the annual cycle. The sequence - the mutual production order of Wood, Fire,
Earth, Metal and Water – describes normal generative functions. In the sequence, the
producer is called the Mother and the produced is termed as the Child (Kaptchuk, 2014). The Five Elements are believed to distribute over the seasons, i.e. wood
24
belongs to the season of Spring, fire to Summer, earth to late Summer, metal to Autumn and water to Winter.
As such, health and well-being were perceived as a harmonious balance that existed through the interaction of the five fundamental elements, interacting in harmony with related forces and elements in nature. Illness was attributed to the natural conditions such as ‘wet’, ‘dry’, ‘hot’, ‘cold’, ‘wind’ and ‘flame’; or to the related emotions: ‘grief’, ‘fear’, ‘anger’, ‘hatred’ and ‘desire’ (King, 2005). Good health is maintained through the balance between the five elements and the control of human emotions.
Within the framework of the Five-Elements Theory, natural phenomena and abstract concepts can be put into five lines of correspondence (Patwardhan, Warude, Pushpangadan, & Bhatt, 2005). For example, the five flavours of foods are considered vital to human health and well-being (Mennella, 2014). Foods with a salty flavour are thought to moisten the body, strengthen the bones and viscera, calm the nerves, loosen the bowels and reduce swellings. An excess is however believed to harden the pulse. Salty foods manifest their effects on kidney and urinary bladder. Foods with a sweet flavour could slow down the acute symptoms of disease and promote energy circulation whilst an excess is thought to cause aches and pains. Sweet flavours manifest their actions in the spleen and stomach. Sour flavours are to have an astringent action as well as activating blood circulation. An excess is believed to toughen the flesh. Sour flavours manifest their actions in the liver and gallbladder. Pungent flavours are considered to induce perspiration and promote blood or energy circulation. An excess could knot the muscles. Pungent flavours manifest their actions in the lung and large intestine. Foods with a bitter flavour are thought to have an
25
antipyretic effect, eliminate dampness and stimulate the appetite. An excess is thought to wither the skin. Bitter flavours manifest their action in the heart and small intestine.
The Five-Elements Theory was an exploratory theory, not taken as a binding doctrine. The relationships of mutual destruction and of mutual generation are symbolically expressed as follows: Water overcomes fire; fire melts metal; metal (in the form of a knife for example) - overcomes wood; wood (as in a spade) - overcomes soil; soil (as in a dike) subdues water. Water/watering produces plants and trees, that is wood; wood brings forth fire; fire produces ashes, that is soil; soil brings forth metal; when heated, metals produce steam, that is water (Yuan, 2015).
The use of the five elemental processes in diagnosis was perceived as a concise and symbolic way of explaining complicated symptoms and changes (Williams, 2016). For example, giddiness, watery eyes, irritability, anger and incessant flow of tears are taken as “wood symptoms” related to diseases of the liver meridian. Reddish face, fiery feeling and excessive perspiration are “fire symptoms” related to the heart meridian. Yet, while diagnosing patients, Chinese physicians do not rely on those classifications alone, nor are these classifications rigid or compartmental. Viewed in this way, the Five-Elements Theory only served as a helpful guideline in the medical treatment of ancient Chinese people.
Noteworthy is that the Yin-Yang Theory and the Five–Elements Theory co-existed independently during the third and fourth centuries (Kaptchuk, 2014). It was not until the Han dynasty, the two systems began to merge in Chinese medicine (Kaptchuk, 2014). From then on, different attempts were made to fit the Five Phases neatly into
26
the Yin - Yang framework (Veith, 2015). Active in character, wood and fire were
viewed as the Yang Phase; whereas metal and water associated with quiescent functions were taken as the Yin Phase. Earth was believed to be the balance point for Yin and Yang. Given that one organ is diseased (Yin deficiency) or is not functioning properly (Yang deficiency), it can be restored to normal by nourishing its related organ. In other words, when one organ suffers from diseases, it would directly or indirectly affect other organs. When a person is healthy, all the organs function properly in harmonious coordination (Kiew Kit, 2002).
In spite of the possible marriage between the Five-Phases Theory and the Yin – Yang Theory, the two systems of correspondence frequently interpreted health and disease in a different manner. From the perspective of Five Phases, the Liver opens into the eyes; the Kidney opens into the ears; the Heart opens into the tongue. Disorder in a particular orifice would be necessarily linked to its corresponding organ (Kaptchuk, 2014). From the standpoint of Yin - Yang, the following assertions of the Huang Di
Nei Jing (Inner Classic of the Yellow Emperor) were emphasized: The pure Qi
(energy) of all organs is reflected in the eyes; all of the meridians meet in the ears; the tongue is connected to most of the meridians. Yin-Yang Theory would not necessarily see a link between one part and another part. Instead, all disharmonies of the eyes, ears, or tongue would be interpreted in terms of patterns. For instance, an eye disorder could be part of a Liver disharmony, perhaps a Kidney, or Spleen disharmony, depending on the configurations of other signs.
The differences between those medical interpretations stem from the fact that the Five-Phases-Theory tends to emphasize the one-to-one correspondence, whereas the
27
Yin - Yang-Theory tends to address the need to understand the overall configurations
upon which the part depends (Kaptchuk, 2014; William, 2016). Irrespective of these differences, the Five-Phases-Theory and the Yin-Yang Theory work together, and play an important role in the interpretations of health and diseases in Chinese culture, ancient and contemporary.
Qi
It is worth noting that ancient Chinese people conceptualized an invisible energy force as Qi (vital energy - the source of life), which is believed to circulate through the body to give life (Palos, 1972). Qi pervades all forms of matter to create change or movement. A proper balance of Qi throughout the body is assumed to increase the body’s resistance to disease and illness results when circulation of Qi is blocked or when organs suffer from excess or insufficient Qi (Kohn, 2013). The essential Qi comes from birth and other forms of Qi come from food and nutrients. An excess of Yin forces is thought to produce cold air (han Qi 寒气) whilst excess Yang forces produce hot air (re Qi热气).
Both Qi and blood are considered to circulate through the body and interchange with each other. Health is attained through the production and accumulation of sufficient Qi in the body. The maintenance of health depends on the vital Qi energy’s circulation through the regular patterns in human body. In this Qi circulation process, energies are distributed, and stored in organs. The rhyme of the seasons, equilibrium in dealing with time though routine and the proper timing of meals, and climatic conditions are crucial to the health, the balanced state of the vital energy - Qi.
28
The balance and harmony in the body are the most fundamental health constructs in TCM. “Health is maintained not only within the body, but also in social relations, in relations with the landscape and nature, and in relations with the supernatural” (Fang & Schinke, 2007, p.403). Health results from sufficient and adequately distributed energy whereas illness is the symptomatic manifestation of energy disequilibrium or insufficiency.
Both internal and external factors could cause energy imbalance in human body. The former embraces one’s hereditary proneness to having a Yang or Yin which can be affected by personality, age, poor diet, infections, accidents, fatigues, or excessive emotions such as joy, anger, fear or sadness. The latter is related to natural or meteorological conditions such as temperature, humidity and volume of rainfall, atmospheric pressure, wind speed and direction, together with the movement of celestial bodies. Environmental factors include irritants, germs, viruses and bacteria etc., and of these external factors, windy, cold, wet, hot or dry weather conditions seem to be the most salient dimensions used to explain the cause of illness.
As can be seen from the above that the conceptualization of health and well-being in Chinese culture involves a range of theories and central concepts, including Yin and Yang Theory, Five Elements Theory, the Qi concept and harmonious balance, which prove to be central to the conceptualization and the development of health and well- being in Chinese culture.
29