TCM Terminology

Traditional Chinese Medicine (TCM) utilizes a unique language and terminology that is difficult for other cultures, and physicians rooted in modern science, to understand. Understanding a little of the roots of this medical language helps the patient become more in touch with the TCM physician and their framework for holistic diagnosis. In essence, this unique terminology was created so that complicated issues in disease and physiology could be communicated with few words, or characters, in the Chinese language, and so that fundamental concepts of natural science in a Daoist model would never be overlooked in holistic medicine. These strange Chinese medical terms are not meant to supplant modern medical terms, but to add perspective to them.

Today, as Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) are finally being integrated into standard medical care due to high patient demand and abundant accumulation of high quality scientific evidence of effectiveness, there is an effort underway to supplant this medical specialty with a superficial version of the holistic science that has continuously modernized and researched for nearly 6000 years. This effort to introduce a more superficial and less effective version of CIM/TCM involves discarding the unique history of holistic Daoist medical philosophy and applied practice, and is centered on ridiculing the thousands of years of Daoist concepts and terminology. While these concepts and terms may be difficult to grasp for many patients in modern times, they are important, and reflect a medical philosophy that is restorative, holistic and based on an individualized diagnostic system that contrasts to a one-size-fits-all allopathic model of medicine. Such a perspective in medicine has been touted and promoted worldwide throughout human history, and challenged by a medical industry that sees greater profits in a medical approach that alters physiology rather than restores it (allopathic rather than holistic). While this is a complex topic, it is vitally important to human healthcare, and patient understanding and support will be needed to preserve it. Integration of this type of medical approach with standard allopathic care will provide better outcomes. Traditional medicine has long been derided as "folklore" and belief in magic, but this is easily seen to just be a ploy to discourage public acceptance. Some of the greatest physicians in European history, as well as Chinese history, have strongly supported this holistic and integrative approach, and the importance of restoring natural homeostasis as the first line in solving health problems. The terminology in Traditional Chinese Medicine may be strange and complex, but it serves a vital purpose in individualized diagnosis and treatment, and integrates well with modern medical terminology and disease description. 

This complex topic of the use of traditional medical terminology in the integrative specialty of Traditional Chinese Medicine (CIM/TCM) can be summarized as the preservation of a system of diagnostic terminology that is both individualized in typing subsets of patients and holistic in perspective, but that is fully integrated with the standard allopathic system that instead seeks to diagnose by trying to define a health problem purely according to the definition of the disease state that fits all types of patients. There is no harm in integrating this individualized and holistic approach with the more efficient one-size-fits-all allopathic approach, and could lead to more specific treatment protocols and better outcomes for many patients. This is not a binary question, or issue, though, and all physicians need to respect the healthy integration of both approaches. This same issue has been argued in Western society since the age of Hippocrates and Democritus, reaching a height during the time of Paracelsus and the introduction of modern laboratory diagnostic science, and continues to be an issue concerning integrative holistic medicine (e.g. Eclectic Medicine) in the last century. It is an important issue, and with new approaches in standard medicine, such as the Big Data approach to diagnosis, and use of genotyping to individualize cancer chemotherapy, there is a movement away from the strict binary outlook. Patients need to understand as well that this is not a binary, or black and white, right or wrong, topic, and the TCM diagnosis can be fully integrated with the standard diagnosis to achieve a better and broader understanding and to better guide the overall integrative healthcare approach and protocol.

The words Qi, Yin and Yang bring to mind ideas of an esoteric and almost spiritual connotation to most Americans, yet these words were created in the Chinese language to express complex, yet concrete, ideas and concepts, within the context of TCM. This confusing situation has led many health professionals over the years to assume that TCM was nothing more than an esoteric quasi-medicine that only dealt with a balancing of some unseen cosmic energy call Qi. This is far from the intent of the early physicians in China, or the modern Chinese M.D.s that practice this complementary medicine today. TCM physicians in the United States, or Licensed Acupuncturists, do not use these Daoist medical terms because they have an 'alternative' medicine and do not understand modern medical terminology, but because they studied a complex medical specialty that is holistic and adheres to a Daoist context. These strange TCM terms are not esoteric and spiritual concepts. These words were created to objectively express fundamental ideas of complex physiology in the body. By using diagnostic terms that bring us back to fundamental concepts, or universal paradigms, the language helps the physician to see the body as an interconnected system, or holistic mechanism, that always adheres to natural laws and patterns, and continually strives to maintain a natural homeostatic balance of healthy substance and function, or the qi of yin and yang. Qi, Yin and Yang are not specific things that can be measured, but broad descriptive terms that can be applied to almost any measurable concrete entity in medicine.

The challenge for the modern medical doctor and the patient, when integrating with TCM, is to gain a basic understanding of these conceptual terms. Simplistic definitions for these three words are frequently repeated, such as Qi meaning energy, Yang meaning male, and Yin meaning female, but there is no single simplistic meaning to these words, rather an array of potential meanings that must be applied in context. In the Chinese language, familiarity with the array of potential meanings of both spoken words and written characters helps one to apply the word in the context to which it is used. This is an essential component of the Chinese language. In modern languages, especially Romanized languages, this complexity was reduced to make the written language more accessible. In common usage, our modern English often has basically one concrete meaning for one word, but in the specialty of TCM, terms may have many meanings depending on the context, and these meanings may even have changed over the centuries as well. Experts in Chinese language, or sinologists, continue to argue over the meanings of the Chinese characters and caution the readers to not jump to conclusions. The desire to standardize terms in historical interpretation has also led to gross misunderstandings of these TCM terms, and hence big mistakes in historical interpretations.

In China and many other Asian cultures these terms of Traditional Chinese Medicine (TCM) have a more concrete meaning to a majority of the population. Indeed, the flag of South Korea uses the ancient symbol for the fluid motion of Yin and Yang (taijitu, literally 'supreme ultimate diagram'), and the words Qi, Yin and Yang are often seen in common use, in a variety of contexts. To better understand these terms outside of Asian culture, one must understand the context of the language itself. The Chinese language is perhaps the oldest original language left on our planet, and is composed of pictorial characters rather than letters. This use of written characters allows the Chinese culture to express concrete ideas that are very complicated and dependent on the context of the surrounding characters. Unlike the Europeans, the Chinese opted to keep this original pictorial character written form to preserve language concepts. European, Middle East, and African cultures originally used pictorial characters, but switched to the Phoenician alphabet system to facilitate the ease of written language in commerce. In Asian civilizations, the original written language form was retained to preserve the advantages of the use of symbolic characters, as well as to preserve and standardize a central culture that retained its intelligent origins.To better understand this rich history and philosophy, a number of articles on this website provides historical facts that help elucidate this historical context.

Ancient Chinese written language both retained its form, yet differs from the modern Asian written languages. The more complex written characters are now simplified. Originally, sentences in Chinese script had no punctuation marks, and the reader could infer a separate meaning of a character when it was combined with the preceding character or the following character. Complex ideas could then be notated with minimal use of characters. Of course, this language was created in a time when only scholars knew the written language and before the printing press made a written text accessible to a large number of people. Originally, these symbols would be read by a person that was also familiar with the writer and knew the conceptual context of what was written. Since these written characters had no standardized meaning, knowledge of the intent of the author was important to understand the meaning conveyed by the written characters and text. In other words, the pictorial symbols for concepts such as Qi, Yin and Yang had specific meanings that were linked to the author, and changed in context and meaning when combined with other pictorial characters. In time, these three words eventually assumed cultural significance and were more easily understood in various contexts. Modern use of these terms is still dependent on the context of their use, and the specific meanings can vary widely depending on the context of the subject being discussed. This is some of the historical framework for the reasoning behind the use of key words, such as Qi, Yin, Yang, Shen and Jing in TCM diagnosis and terminology. Unfortunately, even TCM physicians often fail to take into account this historical context to their terms, and instead apply simplified universal definitions to the words. This is the easier path, but will not lead to a greater understanding of the Daoist medical concepts that are at the heart of Traditional Chinese Medicine.

There is a similar history with written words, or symbols, in European history. The Roman language, which became the root language of most of the modern European languages, which were Romanized, was a language designed to simplify the growing complexity of meaning and context, so that there could be an intellectual bridge between the scholars and the common people, who were becoming literate, or able to read. The Romans also simplified the written numerical system to aid in the construction of an empire, and ease the tallying of money and goods between a variety of cultures. Greek culture adopted an alphabetic system of writing, but many early Greek philosophers warned of the inherent problems with accurately passing on ideas with these words, which were phonetic and based on spoken words and concepts. Aristotle warned of the potential to misinterpret the written word, and instructed his students to pass on knowledge via the spoken language. He wrote that spoken words are the symbols of mental experience, and written words are the symbols only of the spoken words, not the experiences and true concepts. He thus refused to have his teaching expressed in written language, warning that the written words in Greek and Aramic would not capture the context and meaning, passing on simplified ideas rather than the true mental realizations. Of course, some of his students did record his teachings.

The Greeks, a culture famous for its central island location and its seafaring commerce between disparate cultures, were the first culture that switched to an alphabet, instead of pictorial characters, and borrowed this concept and alphabet from the Phoenicians. Historians believe that the main reason the Phoenicians developed an alphabetic written language was to facilitate the ease of trade and bookkeeping. In Greek language, vowels were added to a Phoenician alphabet in about 1000 BC, yet punctuation marks, clarifying the meaning of sentences and phrases of words, was not added until about 200 BC, by Aristophanes. Only in about 900 AD were spaces added between written words so that the meaning was not tied to the sound of the spoken words. After 900 AD in Europe, finally, the written language was seen as a true expression of ideas when read by anyone. Today, we have a difficult time understanding why Aristotle refused to capture his mental concepts out of their contextual frame as written texts, and why he warned his students that these written ideas and concepts would be misinterpreted. This same warning applies to the mental understanding of the Chinese terms in the Huang-Lao, or Daoist, medical theories, only more so, as even the most reknowned sinologists, or experts in Chinese written language, continue to argue about the true meaning of the ancient pictorial symbols in various contexts and historical time frames.

With the repeated purposeful destruction of texts in Chinese history, to consolidate and hoard information, as well as the natural deterioration and destruction of texts, many of the classic texts in Chinese medicine are only available today as passed down versions that were printed in the Ming Dynasty. Many experts that study the versions of TCM texts have stated that no two persons will translate a single paragraph in the same way because of the variety of character types and cultural differences in China, and the way they differ from modern Chinese characters, and of course the problems with translation into another language adds to this difficulty. The unique terms still used in TCM have their roots in very ancient culture, and their meanings have evolved and expanded over the centuries, as well as within a variety of contexts. The adherence to the Daoist terminology in TCM is largely due to the basic conceptual ideas in this holistic complementary medical specialty, those of homeostatic balance as the most fundamental aspect of health and healing. Unlike modern scientific theory, though, the Daoist physicians continue to regard homeostasis as not only a biochemical balance, but a mind-body balance, and a balance between the vitality, the fundamental energetic state, and the spiritual state. These less material aspects of life (sheng), the Shen, Qi and Hun/Po (the human and instinctive nature), are stored withing the 5 visceral systems as much as the blood, lymph and chemical nutrients, and stimulation with the needles, herbal and nutrient medicines, and energetic focus must have their fundamental purpose as the restoration of a more complex balance, or homeostasis. In the 20th century, civilization shifted its focus away from ideas that incorporated the physical and spiritual natures, separating all into neat binary categories, and calling prior ideas that united the physical and metaphysical as unscientific. In this century we are starting to see that our study of this new purely physical physics is instead showing us objectively that the metaphysical is not actually a separate world. We are getting closer to objectively calculating and measuring such metaphysical concepts as emotion, vitality, energetic states beyond the bioelectric, and spooky aspects of life such as quantum entanglement. As we head in this direction, the ancient concepts of the Daoists, as well as the spiritual beliefs of our great European scientists, will make more sense, and may play a large role in our expanded field of knowledge.

Examples of the use of TCM terminology in diagnosis

Typical root diagnoses in TCM read like this with American translation: Liver Qi Stagnation, Kidney Qi deficiency, Spleen Qi deficiency, Yin deficiency, Imbalance of the Ying and Wei Qi, Damp Heat invading the channels etc. This terminology expresses ideas that are so broad and dependent upon the condition of the individual patient that even advanced students of the medicine may remain somewhat unclear on the exact meaning when applied to a specific case. Patients would like a simple explanation of why they are diagnosed with Liver Qi stagnation or Kidney Qi deficiency and are often nonplussed with the explanation. Often, explanations in English language texts are far from satisfactory in explaining these typing diagnoses because they start with the assumption that each term means one specific thing. The truth is that each term may express far different meanings depending on the context of the use. The terms are also symbolic of broad physiological problems, not simplistic in meaning. For example, in TCM terminology, the word Damp does not mean what we commonly perceive the word damp to mean, but, depending on the context, may represent a biochemical imbalance that has the qualities of dampness in nature, such as a sluggish flow, or a heaviness, which must be applied to the context of use.

Qi is a word that was created to express a fundamental physical attribute that had no solid form that we could see or grasp, often described generally as a concept of vital life energy. This is somewhat like the word electron, or the word energy, in our modern language. An electron is a quantifiable particle of energy, yet has no real form, and is in continuous motion from one atom to another. Your electrons move from your body's atom to another person's atoms continuously, yet there is a balanced exchange of electrons that maintains the physical form that your atoms create. In modern terms we express energy with terms like calorie, which actually is not a tangible substance, but a measure of heat energy, yet everyone uses the term and calories are listed on food packaging. The term Qi was expressed as an essential substance of the human body, along with the blood and bodily fluids (humours in Greek medicine), and expressed the Yang essential substance as compared to the Yin essential substances of the blood and bodily fluids. While today, modern science may ridicule the history of Greek humours in theory, we still use the term humoral immunity to define the immune responses that are not strictly cell mediated, but involve antibodies and immune mediators in the bodily fluids, or humours. The meanings in this context for the blood and bodily fluids, though, refer to the basic chemistry of these substances, not the mere blood and saliva etc. as we think of them more simplistically. The term Qi was taken from the more abstract philosophical sciences, where it expressed the essential substance of all matter and energy, with a continuous transformation between essential matter and energy as the basis for our substantial world, and especially life itself. Modern physics and Quantum Theory express basically the same concept, and even the biological sciences are finally adopting Quantum Mechanics to replace the static and linear concepts we are accustomed to. Such concepts as Quantum Chromodynamics, Quantum Entanglement and Alchemical Energy are now being measured and utilized in modern medicine.

Qi is often described as energy, which is just part of its meaning. Energy is a word that may mean many different things in science, depending on context, yet always adheres to fundamental laws of nature. So too, Qi is a word that signifies the energetic function of the body and all life in the universe. Its character is composed of the symbols for aether, or gas, above an alchemical furnace, and hence denotes the basic energy of the animal derived from transforming foodstuffs into oxygen, carbon dioxide and other gaseous and charged molecules. In essence, this is how our body works. Food, water, air, sunlight radiation etc. are taken into our body and utilized in such a complex way that we may never fully understand the complete physiology. Life itself is still a mystery to our scientists, and has not been able to be recreated in the laboratory. Often, modern scientists cite the "Scientific Method" of being able to recreate something in the laboratory to prove that it works, yet they are unable to prove life itself by this "Scientific Method". Early Daoist physicians wrote that the human Qi is derived from three basic types of Qi, inherited (Yuan Qi), the qi of the air or pneuma (Zhen Qi), and the qi derived from the basic chemicals and energetic atoms in food and water (Gu Qi). Many famous Daoist physicians stated that the Human Qi is supported on 3 legs, Yuan Qi, Zhen Qi and Zheng Qi, the functional vitality of the organism. Qi is a word that expresses the results of this energetic physiology and keeps us in touch with the fact that we need to restore this basic energetic physiological function whenever we see disease and dysfunction causing problems. It keeps the practice of TCM centered on a medical goal of not only solving the specific health problem, but always maintaining a focus on restoring optimum health, or homeostasis, and preventing future health problems. TCM is thus not just a preventative medicine, but a medicine that always incorporates preventative medicine into the healing protocol. This holistic approach is what makes TCM science so practical and important.

Qi is therefore a conceptual word that refers to fundamental energetic function in the body, but is not a static concept. The use of the word is fluid and can be applied to any context in physiology or anatomical location. Not only does it describe in context the healthy function or vitality of the body, but is used also to describe disease (Xie Qi). Thus one can never take the word qi for granted and assume a standard meaning. One good example of the use of this fluid and universal concept of Qi lies in the phrase Liver Qi. In TCM, the word for liver, gan, can be used in context to mean either the organ itself or the physiological system that is rooted in the organ. Since the liver organ is responsible for a great amount of the key metabolic transformations in the body, the liver system refers to the metabolism of lipids (cholesterol), proteins (amino acids and enzymes) and sugars (carbohydrates and glucose). The liver organ is the main catabolic detoxifier in the body, breaking up circulating chemicals into basic components and then reassembling these components into useful chemicals in the body. When chemicals that are foreign to the body metabolism arrive in the blood, the liver may not be able to efficiently recognize these chemicals (pollutants, toxins and drugs) and will try to excrete them via bile or attached to another carrier chemical (such as a low density lipoprotein, or 'cholesterol'). When the process is too unusual for the body the unfamiliar chemical may be stored with the lipoprotein in our fat cells. Accumulation of toxins in the body occurs in this way, and the onset of "fatty liver disease" reflect this toxicity. This is an example of Liver Qi. Cholesterol imbalances, gallstone formation, cirrhosis, dysfunction of inflammatory mediators due to imbalance of essential fatty acids (omega 3 and 6), triglyceride imbalances, liver enzyme imbalances, etc. are all examples of Liver Qi pathology. Problems with healthy systemic function in regards to toxicity, diabetes, Metabolic Syndrome, lipid imbalance, biochemical dysfunction, etc. all may be termed Liver Qi Stagnation in TCM. Of course, the physician that practices TCM must also specify the disease using modern medical terminology, and this modern system is taught extensively in the specialized medical schools as well. Since Medical Doctors receive no training in TCM, they usually are practically illiterate when it comes to this specialized TCM terminology.

We can see that when one patient is diagnosed with Liver Qi stagnation and another patient is also diagnosed with Liver Qi stagnation that this may mean very different things in the context of the patient and the condition of the patient. When your friend says that his acupuncturist diagnosed him with liver Qi stagnation and explains why, this explanation may or may not have anything to do with your condition, except that you both have a problem with the liver or liver system function, or Qi. Qi is a word or term that completely depends on the intelligent context of its use. This intelligent context is best understood and explored by the diagnosing physician, and hence, if this physician simply writes Liver Qi stagnation as the diagnosis, this lacks enough specific meaning to inform the patient or another physician of what is exactly wrong with the patient. For this reason, a combination of modern terminology combined with the TCM terminology is essential. The physician may state that the patient has essential hypertension related to Liver Qi stagnation. In this way, we know that the specific problem being treated is essential hypertension, and the underlying problem is Liver Qi stagnation. The physician works to correct both the symptom of high blood pressure and the root dysfunction of inadequate liver system function, or metabolic concerns such as high cholesterol.

Yin and Yang are also words that have no specific meaning outside of a context. The simplified characters for these concepts depict the sunny side of a hill and the shady side, implying that the yin, or shady side, will become the sunny side as the earth moves around the sun, transforming yin to yang and yang to yin. In the body physiology this could be seen in hormonal function, with yin being the substance of the hormones and yang being the function of the hormones. The substance, or chemical, transforms into an activity in the body, and that activity then transforms the chemical substance into a different molecule. Hormones are in constant states of change and transformation, conjugating with carrier proteins and uncoupling when specific receptor proteins accumulate around this conjugated hormone. The hormone itself does not cause the specific chemical action at the target cell, but instead acts as a trigger in a situation dependant upon the chemicals and charged molecules around it. A problem with the yin of the hormonal system would imply a problem with deficiency of excess of hormonal substance, and a yang hormonal problem would imply a deficiency or excess of hormonal activity or function. In treating a Yin deficiency pathology, we might stimulate increase in production of progesterone or testosterone, and in treating a Yang excess pathology, we might try to achieve better function of the hypothalamus, or thyroid hormone receptors.

These terms denote a sort of quantum physics approach to the problems of pathophysiology and holistic medical approach. Not only the specific dysfunctions are examined, but the underlying diversion from homeostasis, or normal systematic function in a healthy individual, is considered. The goal is always to both relieve the symptoms and to restore homeostasis. In TCM we call this attention to both the root and the branch, and this is a fundamental precept of the science. It has always been written in classic texts of TCM that the superior physician will diagnose and treat according to the principles of Yin and Yang, and that the best practice of medicine will incorporate preventative medicine, diagnosing imbalance of Yin and Yang, and correcting this imbalance, before the health problem arises. The treatments in TCM are not limited to balancing of Yin and Yang, or homeostasis, but also are directed at relief or correction of specific localized problems.

The basics of TCM terminology are rooted in the concepts of Yin and Yang, and these terms do have concrete meanings in terms of signs and symptoms. General signs of Yin deficiency include dryness of the skin, mouth or membranes, poor control of body temperature with sudden heat flush to the head or upper body and unusual sweating, or deficiency in blood quantity or quality. Yin is always seen in relation to Yang. Body fluids, such as blood, joint lubricants, lymph and sweat, are more Yin than Yang, and solids parts of the body, such as bones, tendons, etc. are more Yang. Deficient production of blood cells, proteins or fluids are thus seen as a Yin deficiency. The fatique that results from blood deficiency may be seen as a Yang deficiency. YinQi refers to the functional Yin components and generally refers to the Kidney and Adrenal systems, while YangQi refers to the functional Yang aspects of our physiology. Yin deficiency will usually result in poor control of Yang, and overexuberance of Yang, such as heat flush to the upper body, high blood pressure or anxiety. Consequently, Yang deficiency, often seen in debility or aging, will often result in a poor production and regulation of Yin, such as blood and key metabolites. In this way the TCM physician is always keeping the big picture in mind when looking at your health problems and not overlooking critical components of the condition. We may see this as a practical rather than esoteric reason for TCM terminology.

In TCM, the three fundamental concepts of health, called the legs of a tripod, referring to the alchemical brazier metaphorically, are Qi, Shen and Jing. The terms Shen and Jing are often described simplistically, and thus are often used out of context, and conferring mistaken ideas to written Chinese text. The term Shen 神, is particularly taken out of context often to denote mistaken inferences, even by experts and historians. An authoritative historical dictionary started in 1979 to provide language translations correctly to Chinese words or symbols, the Hanyu Dazidian, lists eleven complex meanings for this Chinese character and the spoken word in the rising second tone. These meanings include spirit, mind, consciousness, concentrated attention, expression, state of mind, intelligence, demeanor, to rule or govern, precious, mysterious, and circumspect. The meanings listed also include magical, legendary gods or spirits, supernatural, miraculous, entrancement ecstasy, and the creator of all things, or the supreme being, God. The term Shen thus often means whatever the reader, writer or translator wants it to out of this broad context, which could be much different from what its intended meaning in context was in ancient TCM texts. Even in 200 BC, the term in different medical texts could mean very different things. The context of use is always very important in understanding these ancient Chinese terms. Now, many TCM physicians would describe Shen simply as the consciousness or spirit of the person, or the vitality. Many Western historians, though, describe it as magic, religious spirit, or shamanism (ghost). Hence, the term in context might be describing the mental state of an individual, or more broadly describing a human consciousness, yet could be taken out of context to refer to the TCM purported use of magic or shamanism, or out of context to refer to the patient's heart or spirit. The individual must be able to put this concept back into a reasonable context. The character Shen is often seen in writing with the character Tian, which is generalized as 'Heaven', yet any reader of Chinese historical texts will see that the word Tian is used in many, many contexts, referring to something that is superior, non-corporeal, congenital, high up, related to the mind, etc. Oversimplification and narrowly defining these terms out of context is widely seen in the West. The misuse of the contextual meaning of these words has been utilized to denigrate the history and science of TCM and Daoism, as part of a large Eurocentric historical bias.

The term Jing 精 is another elusive concept. Loosely translated as essence, in medical texts this term might be referring to sperm, ova, adrenal hormones, genetic substance, or DNA, sexual hormones, hormones in general, phytohormones, neurohormonal substances, energy or vitality, epigenetic substance, or healthy longevity. In one context, this Chinese character might mean one or the other of these contexts, and when one refers to Jing as one of the three pillars of your health, or to nourishing the jing, or the depletion of your jing, this could mean a number of differing things depending upon the context of which it is spoken or written. In the English language, it thus might be better to use the intended meaning expressed in actual English language. Nevertheless, the term is often used and implied to mean one's vitality or spiritual energy, conveying a more esoteric meaning. In general, the patient population should be aware of the importance of the context of these words, and beware of hearing or reading things out of context that may express mistaken concepts. It is thus important that your TCM physician went to medical college and actually studied these terms correctly. Since Traditional Chinese Medicine is more than just simply sticking acupuncture needles superficially into your skin, but actually a complex medical specialty based in a difficult conceptual framework, with a diagnostic science that is both different from standard medicine, and incorporates standard science, choosing a TCM physician with greater understanding of the Daoist medical terminology and meaning could have a great deal to do with the success of your diagnosis, design of the treatment protocol, and outcome.

The Five Element System is another concept widely seen in TCM terminology, and this too is difficult to translate into modern terms. Basically, the system refers to an ancient Daoist system of classification that sees all things in the Universe adhering to fundamental patterns, both microscopically and macroscopically. In European history and medicine we see a similar concept which was fundamental to medical theory for thousands of years as well, the Four Elements and Aether, the Fifth Element, or Quintessence. This was translated into the system of thought in many ways, but the most famous was the system of 'humors', or fundamental metabolic agents, or characteristics, of bodily substance. In the modern age this system was strongly derided as unscientific, yet our modern science still uses the term 'humoral' to describe many fundamental aspects of physiology and function, such as the humoral immune system, which refers to the immune responses with regard to antibodies in blood, lymph and tissue fluids. This Five Element System is widely ridiculed but the pattern can be widely seen in our modern scientific classification, as the 5 nucleotides that make up all genes, the 5-carbon ribose sugar that makes these 5 DNA components work, the 5 types of life forms on the planet, the 5 dimensions, the 5 types of Matter, the 5 types of energy, the 5 fundamental Forces, the 5 types of metal and the 5 types of non-metal elements in the Periodic Table. The examples of a pattern of five are numerous in Nature, but the concept of a pattern in Daoist cosmology is derided as pure superstition. To read more about this subject you can go to the article on this website elucidating the history of what we now call alchemy, a fascinating subject that was integral to ancient medical practice both in China and Europe, and obviously integral to 'chemistry', with the term alchemical preceding and defining the term chemical. The use of the Five Element System in TCM is just another way to type or classify medical concepts and relations between everything, but always in context. Defining this Five Element System and Yin Yang classification as something specific is obviously a mistake, yet this occurs, even in the TCM medical specialty, with a supposed 'Five Element' school of acupuncture and TCM that many adhere to, but has no real place historically. The most famous of these schools of 'Five Element Acupuncture' is a purely modern concept of the Englishman JR Worsley, who studied widely in Asia, impressed with classical Japanese schools of thought in Traditional Medicine, and established his own Worsley Institute in Florida. The restoration of balance between the Five Visceral Systems and Elements to achieve a healthy homeostasis has been recognized as a sound concept, and some of the Five Element Schools have been recognized as medical universities in the United States, such as the Maryland University of Integrative Health, formerly the Tai Sophia Institute.

Integrating TCM Terminology into Modern Medicine

In the modern medical world, the problem of communcation arises in the TCM system. So much attention is paid to TCM classification and terminology in TCM study, that there is often less attention paid to the modern medical terms. Adding to this problem is the concept of 'Alternative Medicine' which has created an idea of choice between TCM and modern medicine. This has further complicated a problem that is intrinsicallly complex. TCM medical schools teach modern medicine and terminology and stress the importance of understanding this system of disease and injury classification and diagnosis. Yet, the problem of thorough integration is still complicated by the language. Fortunately, over time there has been much progress in achieving improved education of the TCM physician, who is called a Licensed Acupuncturist in official designation, and the TCM medical schools are insuring the the graduates can integrate and communicate with modern medical doctors on a much higher level today than in the past.

For the patient and modern physicians to fully understand and communicate with the TCM physician, the TCM physician must speak intelligently using modern and commonly understood terms. For the TCM physician to understand the patient descriptions of their health problems and the diagnoses and findings of modern physicians, that TCM physician must rely on the commonly understood terminology. This is something that has been achieved in TCM care and continues to improve as the science becomes more integrated and complementary to modern medicine. Everyone, patient, medical doctor and Licensed Acupuncturist can now work together in an effective complementary manner to improve the overall health care and reduce health care costs to the nation with preventative medicine and low cost Complementary Medicine. Everyone must work together to achieve this goal, though, gaining understanding and integrating care.

The acceptance of TCM terminology is gaining acceptance in standard medical practice as well. The international classification of diseases (ICD) by the World Health Organization (WHO) is used by all physicians for diagnostic coding in the United States. This classification is periodically updated, and currently we are using ICD-9 as well as ICD-10. By 2015, the WHO is hoping to release ICD-11, and recognizes that many physicians in the world do classify disease with the diagnostic classification of Traditional Chinese Medicine (TCM). These disease classifications will be added to the standard international classifications, although how they will integrate with standard disease classification is still uncertain.

Modern research has recognized the value of the ancient TCM system of classification as well. For example, research published in the Journal of Clinical Rheumatology, October 2009 (15) Issue 7, explains how new systems approaches are being investigated to clarify disease, and in chronic diseases, a system based on TCM diagnosis has shown much progress. Patients with Rheumatoid Arthritis (RA) were divided into two groups, based on the TCM differentiation of Heat and Cold types. In TCM, the term Heat is a broad classification denoting the more energetic and active mechanism, whereas the term Cold may be applied to reduced or slowed metabolism and circulation. In this study, the RA patients differentiated as RA Heat types showed that the cells affected by the Rheumatoid Arthritis differed from those differentiated as RA Cold types. The RA Heat cells regulated programmed cell death, or apoptosis, differently from the normal controls or the RA Cold type. In the RA Heat group, cell apoptosis was stimulated, mainly via the enzyme caspase 8, while in the RA Cold group, the affected cells seemed to have apoptosis suppressed through the Nrf2 genetic expression (nuclear factor erythroid derived-like 2), which plays a role in the regulation of oxidative stress. The RA Heat type patients may thus have the cells of the affected joint synovial tissues turning over too fast, causing joint degeneration and pain, while the RA Cold type patients may have the affected joint synovial cells not dying quickly enough, causing cellular dysfunction or hypertrophy. To see a summary of this resarch article, click here: Of course, a more nuanced approach to treatment would be administered to the RA Heat and RA Cold type patients. This is currently how TCM physicians work, ideally.

TCM terminology applied to a specific health problem

An example of the integration of TCM terminology into modern medicine would be the diagnosis of high blood pressure due to adrenal stress. In this common form of essential hypertension, modern medicine may use an ACE inhibitor combined with a diuretic. ACE inhibitors are angiotensin converting enzyme inhibitors. This implies that there is a poor regulation in the body of the angiotensin, a protein hormone that is produced in the blood when stimulated by a hormone, renin, produced by the kidney in response to blood pressure. Renin also affects other adrenal hormones (such as diuretic hormone) as well as the nervous system and its control of vascular constriction and relaxation. Angiotensin is converted to an active form by an enzyme in the lung, the angiotensin converting enzyme, and hence the drug strategy to lower blood pressure. The diuretic hormone acts to excrete more fluid from the blood volume, thus also lowering blood pressure. This is an example of Kidney Yin affecting Yang. The chronic deficiency of Kidney Yin, or blood volume, stimulates increased renin, which stimulates angiotensin and increased unwanted blood pressure. When the yin deficiency does not support healthy yang function, the blood pressure is not maintained in homeostasis. The herbal formulas to decrease this adrenal hypertension may also utilize diuretic herbal chemicals, as well as herbal chemicals that aid the liver enzyme regulation, and support blood chemistry. The actual chemical goals are not that different, only TCM utilizes an array of treatment protocols to accomplish a broader effect by trying to correct the body's homeostasis, but allopathic medicine provides specific synthetic chemicals to do very specific actions to alter the homeostasis.

So, in essence, a diagnosis of adrenal hypertension could be described as an underlying Kidney yin deficiency not properly controlling Liver yang. In TCM, the signs and symptoms, as well as the individual constitution, lifestyle and age, and overall medical history, would contribute to a more complex potential choice for the patient with primary adrenal hypertension. For the individual diagnosis, the could also be diagnosed with hypofunction, or Cold, and Kidney Yang deficiency, especially if they were aged. A combination of both Kidney Yang and Kidney Yin deficiency might simply be called Kidney Qi deficiency, with Yang not supporting Yin, or Yin and Yang not supporting each other. A more refined treatment strategy would thus be implemented. While allopathic modern medicine works to find the most standardized treatment protocols, that work on the highest percentage of patients, the TCM physicians seek to better individualize treatment protocol based on more essential typing and concept. Each system has its benefits. Allopathic medicine treats more patients quicker and easier by standardization. Complementary Medicine provides more individualized and complex treatment protocols to better normalize the underlying homeostatic health. The two systems are easily integrated, complementing each other to provide a safer and more complete therapeutic protocol for the patient. The patient may benefit by gradually correcting underlying dysfunction and perhaps not having a long-term drug dependency. TCM is also preventive of future related health problems related to poor homeostatic health. The terminology in TCM is essential for this type of complex individualized diagnostic assessment and treatment design.

While this explanation is complicated, the real complication is even more elaborate, because the body acts as an array of physiological systems, or holistically, and there are a number of systems affecting the renin-angiotensin system. These are objective potential underlying problems that should not be overlooked in a holistic diagnosis. For instance, the precursor to angiotensin is a chemical that is produced mainly in the liver, angiotensinogen. Angiotensinogen levels may rise due to a number of factors, including stimulation by corticosteroids, estrogens and thyroid hormones, or treatment with synthetic corticosteroids, estrogens and thyroid hormone. Increased angiotensinogen may result in higher levels of angiotensin and hypertension. Here we see that healthy function of the liver and kidney/adrenal systems, and attention to the side effects of medications, may be an effective part of the holistic therapy. This is all expressed in the fundamental language of TCM, but must be correctly interpreted by the individual physician in an intelligent manner. The patient can understand from this analysis how the diagnostic assessment of Kidney Yin deficiency and exuberant Liver Yang, or even Kidney/adrenal Qi deficiency is applicable to the objective physiological facts.

Renin is also stimulated by an adrenal hormone aldosterone, which mainly regulates the sodium and water content in the body. More aldosterone is released in response to water retention and sodium levels in the blood, or outside of the cells. We see that a number of problems with body systems may be part of the problem here. Water retention may occur in hormonal imbalances, especially in women premenstrually or in pregnancy, causing a potential rise in aldosterone and subsequent rise in renin, angiotensin and blood pressure. Antidiuretic hormone, secreted in the brain by the pituitary, may be deficient, thus stimulating more aldosterone release. Pituitary hypothalamic dysfunction may occur due to a number of problems, including a subclinical hypothyroidism or even chronic pain or emotional pathologies with depression and anxiety. Our diets may include a low quality table salt, which increases circulating sodium levels, whereas quality sea salt, with a variety of chemicals more natural too the body, would result in a healthy utilization and excretion of sodium and less aldosterone. The TCM physician sees this whole problem as a complex condition of imbalance of the Yin and Yang, and seeks a variety of ways to correct it. Acupuncture stimulation may affect the hypothalamic and pituitary function, and dietary changes may add potential for success. This is why Traditional Chinese Medicine has always supported a broad array of treatments for each case, acting synergistically. There is no traditional specialties within TCM, where on specialist does a particular type of acupuncture and another administers the herbal medicine, while a third counsels on dietary changes. Each TCM physician is supposed to utilize all of these treatment protocols and study all types of diseases.

We see then, that the TCM physician may be taking into consideration a large number of factors when making the diagnosis and forming a treatment protocol. The language, or terminology, in TCM helps the physician with this complex process. The real choice seen by patients in these situations is often whether to take the simple pill to manage the problem, or to also seek the complementary care to correct the array of potential dysfunctions and and underlying contributors to disease in the body. Complementary Medicine with its holistic and conceptual approach can improve the overall outcome of your therapy with an integrated medical approach. In a way, both the modern medical doctor and the TCM physician are using terminology for the same ultimate purpose, to simplify the treatment strategy. The modern doctor simplifies the situation in his terminology by saying that you have hypertension and we'll try taking a combination of ACE inhibitor and diuretic. The TCM physician tries to simplify the situation by expressing the problem in terms of Yin and Yang and organ systems of the kidney and liver. In this sense we see a similar pattern of trying to expressively simplify a complex physiological dysfunction in the body. The patient, of course, has a difficult time understanding the underlying concepts and terms of both the M.D. and the Complementary physician. The terminologies are not meant to oppose each other, though, but rather to help to quickly elucidate, diagnose and treat, and the patient must place some trust in both the M.D. and the TCM physician.

Hopefully, the patient may gain some understanding of both the modern terminology and diagnosis and the TCM terms. My belief is that with difficult problems, patient education and a pro-active approach is very important. Hopefully, the patient's primary medical doctor will also gain some understanding of TCM terminology and approach and see this as a way to improve outcomes and help their practice.

Additional Information Regarding Traditional Chinese Medicine and Its Terminology

  1. Discussion of some of the more esoteric words and concepts in the Chinese language creates a complex answer. The meaning of Shen in Daoist and TCM practice is discussed here, showing that the character has a wide array of meanings historically that need to be interpreted only in context, not with a simplified one-size-fits-all definition. Western historians and scholars have widely agreed that the Chinese term Ying Shen cannot be directly translated into modern terms in Latin languages, although the German term Geist and the English word Spirit is often cited. Here we see that historically the term Shen has had a wide variety of meanings over the millenia and between various famed scholars in Chinese history:
  2. We see few realistic definitions of these ancient Chinese Daoist terms essential to TCM diagnosis and practice in the West, mainly just weird superficial attempts to ridicule the terms. The Internet Encyclopedia of Philosophy IEP presents a more recent academic attempt, and here is their explanation of Yin and Yang. Here, we finally see a broader and more complex definition of these terms as one entity that is universal in existence, describes all ineractions, and is constant process that provides universal balance and harmony, (applause), rather than the usual superficial definition in Western academia that the words just mean male and female. We also see the acknowledgement that by 100 BCE there was an actual school of philosophy called the Yinyang School, which coexisted with Daoism, Confucianism, Mohism, and the dubious Legalism and Fatalism schools. Hopefully, this website will continue to improve, and finally grasp ancient quantum and holistic concepts of Natural Science:
  3. The word Tian, or heaven, is seen quite a bit in TCM terminology, and in most government and historical texts in China, and is still integral to the names of many objects, buildings, institutions, businesses, and descriptions, having a broad contextual definition, both spiritual and secular. Here is a brief history of the term that shows how we cannot just equate a word like Tian with a European notion of a heaven, or assume that the meaning in context has anything to do with a God, soul, spirit, or even the celestial, or outer space. In fact, almost all rulers, regional and local, were referred to with the term Tian in Chinese history, and the modern era even used Tian to refer to the primary, or quintessential, substance, analogous perhaps to the concept of black matter in physics, or aether. Today, the term in medical terminology could just mean neurological, in the upper body, finer substance, or superior:
  4. The broad context of the question of specialized Daoist terminology in the medical specialty of Traditional Chinese Medicine (TCM) is addressed by experts from Stanford University, in Palo Alto, California, U.S.A. and the Plato Institute. Here we see that the debate in the last century concerning preservation of this language in standard medicine has been vigorous and is complex, even in China: