By Barry Kapke
Originally published in Massage & Bodywork magazine, August/September 2003.
The point of healing is to re-establish, and to help maintain, harmony. Balance, after all, is the normative state. According to Traditional Asian Medicine (TAM), the natural condition is the intricate and graceful dance whereby Yin and Yang, Blood and Qi, and the organs and the channels complement, support and counterbalance one another. It is in the disruption of this systemic equilibrium, or of the harmonious relationship between the body and its environment, that disease emerges.
We are systems of energy, within a larger system of energy. In the TAM terminology, fundamental energy is called Qi (pronounced “chee”). Qi has five main functions within the body: It is the source of activity and movement; it maintains normal body temperature through its warming action; it is the source of harmonious transformation, converting food and air into other substances, such as Qi, Blood and Body Fluids; it governs retention of the body’s Substances and organs, helping hold everything in its respective place and preventing the loss of Bodily Fluids; and it protects the body. When Qi gathers, the physical body is formed; when Qi disperses, the body dies.
Qi in the body, in its general sense, is often referred to as Normal Qi, or simply as Qi. Three sources of energy contribute to the production of the body’s Qi: Original Qi, Grain Qi and Air Qi.
Original Qi (yuan-qi), sometimes called Source Qi or Pre-natal Qi, is inherited from our parents and contributes to our fundamental energetic constitution. It is the foundation for yin and yang energies of the body, and because it is finite, we are wise to try to conserve it and to draw from other sources of renewable energy for our day-to-day needs. As a dynamic and energetic form of Essence (Jing), it is stored between the Kidneys.
From our environment, we are able to draw upon two principle sources of supplemental or acquired energy (Post-natal Qi). Grain Qi (gu-qi) is derived from the food and drink we ingest and is associated with the Spleen/Pancreas, and Air Qi (kong-qi) is extracted from the air we breathe by the Lungs. Since these combine to form the Qi of the body, it should be obvious that the quality of the source is significant. The book Empty Harvest makes a convincing case that the depletion of our farming soils has led to a substantial decline in the nutritional value of our food supply. In the most literal sense, we are what we eat, what we drink and what we breathe. We should choose wisely.
These three forms of Qi contribute to the production of the Normal Qi (zheng-qi) that permeates the entire body. Food Qi and Air Qi intermingle in the chest to form Gathering Qi (zong-qi), which is further catalyzed by the action of the Original Qi to form Normal Qi. This pervasive Qi of the body assumes two forms: Nutritive Qi (ying-qi) and Defensive Qi (wei-qi).
Nutritive Qi is responsible for nourishing the internal organs and all the tissues of the body. Nutritive Qi is closely related to Blood (Xue, pronounced “shway”) and flows in the blood vessels and in the channels or meridians of the body. Organ Qi (zang-fu zhi-qi) and Channel Qi (jing-luo zhi-qi) are both manifestations of Nutritive Qi. When Nutritive Qi flows through the solid (zang) and hollow (fu) organs of the body, the energy functions according to the respective characteristics of those organs. Thus the activities of Spleen Qi are different from those of Lung Qi, despite both being manifestations of Nutritive Qi. It is this nourishing Qi flowing through the body that responds to the stimulation of the acupuncturist’s needle or the shiatsu therapist’s thumb pressure.
Defensive Qi (wei-qi) is the most yang manifestation of Qi in the body and is responsible for resisting and combating external pathogenic factors that seek to disturb the body’s peace and harmony. It stands guard, ready to defend. It is a more pervasive and diffuse energy than the Qi of the Channels, traveling in the body’s cavities and between the skin and muscles, and forming an energetic “suit of armor” around the surface of the body. It warms the organs and moistens and protects the muscles, skin and hair. Wei-qi controls the opening and closing of the pores and regulates body temperature by regulating perspiration. To maintain the body’s systemic integrity and harmony, it is important to foster a strong and robust immune response through the agency of our Defensive Qi. It is no surprise that we are seeing so many immunity-compromised diseases now as our water, food and air are increasingly becoming less vital sources of energy for the production of Defensive Qi.
Pathogenesis of Disease
In practice, TAM focuses less on viruses and bacteria as agents of disease and more on the various influences that promote patterns of disharmony in the Yin and Yang, the Essential Substances, the Organ systems, the Channels and the Five Phases.
The various physiologic activities of the body — the natural flux of Yin and Yang, the production of Xue and Qi, and so forth — have an inherent resistance to disease. The body in balance maintains its balance naturally with Yin and Yang, Xue and Qi, and the Organs and Channels, complementing, supporting and counterbalancing one another. When these intrinsic relationships are disrupted, the conditions for disharmony or disease are present though it is not a given that disease will ensue. Often, internal conditions — the functional condition of the organs, the strength of the body’s defensive energy and regenerative ability, the mental and emotional state — may be such that balance is easily restored; this is the body’s self-adjusting tendency. At other times, this capacity may be impaired or overwhelmed and disease arises.
According to the view of TAM, there are three principal roots of disharmony: Exogenous (external) pathogenic factors, endogenous (internal) pathogenic factors and pathogenic factors that are neither exogenous nor endogenous (independent). In Chinese, the literal translation of “pathogenic factor” is “evil qi.”
There are six climates — internal conditions which resemble external environmental conditions. These are Hot, Cold, Dryness, Dampness, Summer Heat and Wind. These six environmental conditions are referred to as the six environmental qi’s.
Although it certainly does affect our moods, weather doesn’t normally have an adverse effect on our health. Our bodies adapt to changing weather. In spring and summer, Yang Qi expands and both Qi and Blood move toward the body’s exterior, the pores open and the body is cooled by perspiration. In autumn and winter, Yang Qi recedes and the pores of the skin incline more toward closure, conserving heat and energy. When the body exists in harmonious relationship with its environment, the body responds appropriately to changing external conditions.
On the other hand, if the body’s defensive strength (wei-qi) is low, or if climactic conditions become excessively severe or abrupt, these environmental qi’s may become a pathogenic factor. When exogenous pathogens cause sickness, they are referred to as the Six Environmental Excesses, or, more simply, the Six Excesses.
Wind is said to prevail in spring, the season of the Liver and a time of rapid change, although pathogenic Wind, and the disharmonies it engenders, can arise in any season. Wind disharmonies appear suddenly and change quickly. The nature of Wind is changeability and motion.
Wind is a Yang energy and External Wind tends to attack yang parts of the body first — the skin, head, throat and lungs. Of all the Excesses, Wind is considered the most virulent. It can creep into the body just as easily as wind forces its way through the cracks and crevices of your home. The neck and shoulders are particularly vulnerable and are often the points where pathogenic Wind gains entry. The acupuncture/acupressure points TW-17 (“Wind Screen”), GB-20 (“Wind Pond”), UB-12 (“Wind Gate”) and GV-16 (“Wind Mansion”) are useful points on the neck for dispelling Wind. Of course, as mothers around the world have been warning for centuries, it is important to cover up your neck in windy and cold weather.
Symptoms of Wind invasion include sensitivity of the skin, muscle tics and twitches, itching, sudden headaches, nasal congestion, itchy or sore throat, and fear of drafts or aversion to wind. Symptoms may come and go, or change location. Rheumatism, called “wind arthritis,” is characteristically marked by migratory pains in the joints. When external wind invades the body more deeply, it can result in seizures, ringing in the ears or vertigo. Wind is said to be the Excess that transports other Excesses into the body. It is common for pathogenic Wind to be paired with Cold or Heat. According to the Neijing, “The hundred diseases develop from Wind.”
Cold is the climate of winter, the season of the Kidneys. Cold causes things to contract, to congeal and to slow down; it is a Yin energy. It is associated with the Water Phase.
When there is invasion by pathogenic Cold, the body, or a part of the body, feels cold and may have a pale frigid appearance. Common symptoms include chills, mild fever with little or no perspiration, aches, cramps, stiffness, throbbing headaches, toothaches, a marked aversion to cold and a desire for warmth. Due to Cold’s congealing and contracting nature, the flow of Yang Qi in the body is impaired, resulting in stagnation and pain. Pain, from the perspective of Asian Medicine, is the experiential consequence of obstruction in the flow of Qi or Blood. External Cold, often paired with Dampness, affects the Kidneys and may result in low back pain. Typically with pain resulting from Cold, warmth will offer relief. When Cold disharmonies are present, body excretions (mucus, phlegm, urine, etc.) tend to be white or clear and watery. Congealed Blood conditions, such as clots, lumps or tender masses, may result from Cold.
Cold, too, may enter the body through the Wind Points on the neck and shoulders. In cold weather, it is best to bundle up and stay warm. An internal climate of Cold can develop from inadequate nutrition (such as regular consumption of fast foods) and from the ingestion of cold foods such as salads and raw vegetables, tofu, yogurt and refrigerated foods. Ice cream and iced drinks are particularly damaging to the Yang Qi. Medications that combat inflammation or fever, such as antibiotics, aspirin and antacids, contribute to Internal Cold.
Heat, sometimes also called Fire, is associated with the heat of summer, the season of the Heart, but pathogenic Heat disharmonies may arise in any season. It is the tendency of Heat to rise and to move outward toward the surface. Its nature is to accelerate metabolic activity, dilate blood vessels and activate circulation. It is a Yang energy, flaring up, and is associated with the Fire element.
The sensation of heat is the most obvious symptom. The body, or a part of the body, will feel hot. Symptoms often appear in the head and face and may include a flushed complexion, fever and dry tongue. Fire in the Heart may demonstrate as ulcers in the mouth and tongue, Fire in the Stomach as swollen and painful gums and Fire in the Liver as pain in the head and swollen uncomfortable pink eyes. Heat injures the Bodily Fluids, causing a strong thirst, high fever, dark-colored urine and dry stools. Body excretions tend to be dark or yellow, sticky and/or foul smelling, and sometimes the act of expulsion may be accompanied by a burning sensation. Heat may disturb the Blood, causing it to move outside of its channels, resulting in hemorrhages, nosebleeds, bleeding gums, excessive bruising or blood in the urine or stool. The body’s attempts to dispel Heat through the skin may cause rashes, welts and other skin eruptions. Heat is disturbing to the Spirit (Shen), causing irritability, muddled thinking, delirium and troubled sleep. Typical to Heat-caused disharmonies, there will be an aversion to heat and a desire for coolness.
Heat disorders may follow as a consequence to climatic excesses of heat but also may arise from home or work environments with central heating or hot working conditions such as kitchens or boiler rooms. Heat disharmony may develop within the body as a result of heating foods such as spices, coffee and alcohol or from hot emotions like anger. Certain B vitamins, thyroid hormone, adrenaline and amphetamines also produce heat. It is also the case that disharmony caused by one of the other Excesses may transform into Heat in the body. It is important to keep the body hydrated by drinking plenty of water.
Dampness is associated with late summer, the season of the Spleen, and the time of highest humidity in China. Like a bog or swamp, its nature is to sink and to accumulate. It is a Yin energy. With characteristics of sluggishness and stagnation, Dampness impairs Yang Qi. Dampness is associated with the Earth Phase.
Pathogenic Dampness generally attacks the yin parts of the body and the Spleen Yang. When the Spleen’s transforming and transporting functions are weak, Interior Dampness may result and the entire body, or a part of the body, is affected by swelling or edema. The limbs may feel heavy and thick, resulting in a feeling of general malaise and fatigue. The head may feel like it is in a paper bag and thinking is muddled and foggy. When Dampness invades the channels and joints, especially when accompanied by Cold, movement may be difficult, and the joints may ache. If there is pain, it tends to be stationary. Diarrhea, scanty urine, edema (especially in the legs) and ascites are symptomatic of Dampness. Diseases caused by pathogenic Dampness tend to persist and relapses are frequent.
Dampness disharmony is likely to occur during damp weather or when a person comes into contact with moisture for extended periods of time, as with high humidity, sweaty clothes or wet or damp environments. Occupations such as gardening, working in a laundry and dishwashing may be fertile grounds for diseases of Dampness. Worrying, anxiety and thinking too much can exacerbate Dampness symptoms. Excessive sweets, dairy, starchy and glutinous foods, greasy or fried foods, watery fruits and vegetables, and alcohol may contribute to Damp conditions, as may steroids and birth control pills. Ginger, cayenne and spicy foods can help to dispel Dampness.
Dryness is the exogenous pathogen of autumn, the season of the Lungs. It is a Yang energy and is closely related to Heat. Dryness and Heat may be seen along a continuum, with Dryness creating evaporation and dehydration and Heat creating redness and warmth. Dryness is associated with the Metal Phase.
Dryness attacks the Bodily Fluids, causing dryness of mouth, nose, throat, lips and tongue. It tends to be accompanied by dry skin, chapped lips, lusterless hair, constipation and scanty urine. Dryness interferes with the circulating and descending function of the Lungs and may account for a dry, hacking cough or asthmatic breathing.
Arid desert-like climates, or excessive exposure to climate-controlled environments with central heating and air-conditioning, can incur Dryness disharmonies. Internally, it can arise as a result of Blood deficiency or Yin deficiency. Hot spicy foods (Thai, Szechuan, Mexican, and heavily salted or peppered foods), coffee and caffeinated drinks may contribute to Dryness, as can alcohol, nicotine, stimulants, diuretics, antihistamines and astringent medications. Try to avoid excessive heat and dry winds, and replenish fluid loss with additional water intake.
Summer Heat is the one Excess that is exclusively linked to direct climatic conditions. Pathogenic Summer Heat only appears under hot, humid, summer-like conditions. It is associated with summer, is related to the Fire Phase and is a Yang energy. It is always an exogenous factor.
Summer Heat produces an effusion of Yang Qi, which, in turn, generates high fever, profuse sweating, thirst and total lethargy. Its dissipating action leads to the consumption of Bodily Fluids and Qi, leading to exhaustion and dehydration. Dampness almost always accompanies this Excess.
Individuals are exposed to different Environmental Qi’s relative to the climate and environment in which they work and reside. The extent to which these endogenous climatic factors may be injurious and lead to disharmonies will depend upon the individual’s constitutional predispositions, the overall robustness of their Normal Qi (that is, the general well-functioning of the Organ and Channel Qi and the strength of the Defensive Qi) and their lifestyle (diet, activity, relationships, attitudes, etc.). It is not always possible to choose the climate in which we will live, but in whatever environment we find ourselves, generally, our bodies have an amazing capacity to adapt. Wind, cold, heat, dampness and dryness are very much a part of the environment in which we live. The care with which we promote harmony within our bodies will to a great degree determine how these factors will affect us.
(Author’s Note: The next issue of Massage & Bodywork will continue the examination of the roots of disharmony, looking at the emotional and lifestyle causes of disease.)