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Traditional Chinese Medicine

The universe is expanding. All existing things in nature are constantly moving: movement generates transformation. Microcosmos and macrocosmos are in constant transformation and development under these characteristics.
Since ancient times in China, men have been considered part of this universal system and 
product as well of “cosmic forces “. The development of health and illness in men are a result of the state of balance or unbalance of those same “forces”.
To be able to understand this “system of thought”, basis of TCM, it is fundamental to know certain concepts, which strictly speaking, integrate a philosophic system on which all the social and cultural life of China lies.
Although known and divulged in the occidental world, some of these ancient concepts, such as energy or yin-yang, and also a method like acupuncture, the empiric branch of TCM, are
encircled by certain mystery where frequently, theory and practice, are confused with myth and legend.
One of the most ancient books in China is the Huan g Di Neijing, referred to as “The First Cannon of the Yellow Emperor”, which concentrates the great medical advances of the ancient times and settles the basis of the theory system of TCM. In this classic book, relatively complete and systematic, we find “Life of men is the result of energy. If energy is concentrated, life emerges: if energy is dispersed, death arrives. (2)
Here, certainly, the idea of energy refers more to the empiric observation of the XIX century, which concluded that although energy can be transformed, it cannot be created or be destroyed, than to the idea of energy as a capacity of a physical system to perform a work.
In the first place, the energy, Qi in TCM, is the structural material basis of the universe, its essence, therefore this concept is used to explain each one of the elements of universe and the events which take place in it.
In this way the generation of all things and their changes, as well as the structure and transformation of the process of health-illness, are only manifestations of the activity of the energy or Qi. More so, all things in universe are the result of the movements and changes of Qi.

The corporal Qi

The corporal energy receives different names and these depend on the different activities on areas such as production, distribution, function, etc.
The energy previous to birth, is known as “ancestral energy” (original or “YUAN QI). It arises from the essential union- JING – of the ovule and the spermatozoid and it stores up in the kidneys.
The energy obtained after birth is known as “acquired energy”, it comes from food and air and it stores up in the pectoral area and in the stomach. The defensive energy (WEI QI ) protects the body from the invasion of pathogenic exogenic factors and it stores up on the surface of the skin. The energy (QI), the blood (XUE) and the corporal liquids integrate the system.
Another manifestation of the energy is the own Qi of the ZANG-FU organs ( Zang: solid-organs, Fu: hollow-viscera ), which are related to the characteristics of each organ and each viscera.

The Yin and the Yang

From the cosmogony Chinese view and on the basis of the concept of energy, two “forces” settle,ruled by the principle of opposition and contemporarity: the Yin and the Yang. The Chinese philosophy has developed and has generalized the use of these terms for the whole nature, showing that the principle of – opposite- complementary, is everywhere and that it is, in a way, the origin of all manifestation. Furthermore, the principle itself contains, in variable proportion, the Yin the the Yang, one of which predominates on the other though only temporarily.
All the variable relations between the Yin and the Yang to explain in a specific manner, the physiology and pathology of the human body in order to guide the diagnosis and the treatment in clinic work. (3)
The terms Yin -Yang were mentioned for the first time in the Book of Mutations (4) and they literally mean, the water spring (of the mountain) facing the shade (yin) and the spring facing the sun (yang). Besides, the darkness is inherent to the shade, Yin implies all what is passive, static and feminine, while Yang represents all what is active, dynamic and
The discussion about if Yin and Yang are two different energies or two different states of the same energy, must make way, from the scientific point of view, to admit that it is predominant in nature and in the health and illness of the body. The opposition Yin-Yang is ruled by the dialectic principle of contemporarity and it is not on a a dualistic conception. The theoric frame of the TCM remits to the unity of duality: light-shade, cold-heat, contraction-expansion. There is no shade without light; there is no light which does not project shade. There is more or less light and more or less shade. Several points of view,.
applicable to the process observed between the predominance of light or of darkness, between the balance and unbalance, between the state of health and the estate of illness as well as their consequences in each human being, constitute the empiric corpus of TCM.

The acupuncture

The term Acupuncture (from the Latin acus needle and puncture prick ), divulged in Occident by missioners, Jesuit priests, who visited China in the XVII century, described the method, but they mentioned only one part of it. According to its original name, it should be called Acupuncture and Moxibustion. Known since very early times and apparently simple to be practiced, this therapeutic method consists in the introduction of metallic needles or in the stimulation by heat of certain points on the skin (intro). Its simplicity however, comes from a great logic structure, from a theoretical-practical construction which parts are connected among them as a high precision mechanism.
The points that are stimulated are Chinese points, in precise places along all the skin and linked among them by lines : the Meridians (CHINGS).

The lines are, in the Chinese “map”, conducting vessels of energy; the points are the equivalent to Qi “knots” in different parts of the conducts. Such map diagrams the twelve symmetric meridians, six Yang and six Yin along which the energy elaborated by the five organs and the five viscera flow. Two more meridians have been added to reach the perfect symmetry of number twelve. The viscera are the twelve symmetric meridians, six Yang and six Yin along which the energy elaborated by the five organs and the five viscera flow. Two more meridians have been added to reach the perfect symmetry of number twelve. The viscera are Yang and the organs are Yin.
The viscera, the first ones to transform the food, are the stomach, the short and long intestines, the gall bladder and the bladder. The sixth function added to that of the five viscera is the Triple Warmer or SANJIAO SHAOYAN, which expresses a triple function, cardio-respiratory, digestive and genito-urinary. In the same way to the five Yin organs, heart, spleen, lung, kidney and liver, a sixth Yin function has been added, circulation-sexuality, or Pericardium Meridian, the Hand JUEYIN. It is a totalizing function which can only be understood in relation to the Triple Warmer, the external Yang pole and to Circulation-Sexuality Meridian, the internal Yin pole.
When the body is healthy, these two forces, which contain their opposite as well: Yang contains Yin and Yin contains Yang –remain in balance. Health, for TCM, is a sign of energetic balance, because Yin and Yang represent the related and contrary aspects of all things ; they are not absolute, they are relative. This phenomenon of opposition and interconnection of all things is endless in nature. Graphically it is represented by the Tai-chi or Supreme Culmination, where the dialectic Yin-Yang is shown in two symmetric forms of different color (white and black) limited by a wave line inside a circle, which includes in each one of them, a small circle of the opposite color.


For the TCM, there are two causes of illness: a major internal cause and a secondary external cause. The first one is called the antipathologic factor (ZHENGQI) and is referred to the capacity of the human body to resist the action of different pathogenic agents and to maintain a relative balance in the interior of the body and in the exterior world. The second one, called pathogenic factor (XIEQI) remits to those external agents inclined to break any of the relative balances in the body. To say it in a simple way, health depends on the capacity of reaction of the body to face external agents. Then, illness invades the body when the antipathogenic factor ZHENGQI, is weak to fight, thus leaving free way to the pathogenic action XIEQI, producing unbalance in the interior of the body (between Yin and Yang). This is the reason by which the internal cause is considered in TCM a basic factor when illness emerges, while the external cause has a conditional place The external cause has action through the internal cause (5); if it enters it has its action in the body because the antipathogenic factor cannot react against it. This is taken into account in TCM when treating illness and puts special attention in the regulation and protection of the ZHENGQI or, which is the same, in regulating and strengthening all the defense mechanisms of the human body. 
Due to the own characteristics of its etiology, the TCM relates illness to climate changes. These changes further to the adaptability of the individual, are considered pathogenic factors with different symptoms and set up clinical manifestations which reflect the abnormality or incompatibility between ZHENGQI and XIEQI factors. Therefore pathogenic factors also include the pathology.
Notwithstanding, and due to the fact that the pathology is fundamental to guide the treatment, the pathogenic factors must be investigated in relation to their nature and their real significance, considering and studying the relations between them and the organic dysfunctions.
To the identification of the pathogenic factors, we must add the careful observation of the preponderance or the decay of the pathogenic or antipathogenic factors in their action and reaction fight. For example, through the normal or abnormal functioning of the Zang Fu organs, not only the cause of illness can be known but also the changes that they produce in the body, allowing to consider the specific symptoms which will determine the principle 
of the treatment.
Summarizing, the pathogenic factors are classified in three groups: 1) six exogenic factors; 2) seven emotional factors and 3) assisting factors.
The six exogenous factors are: wind, cold, summer heat, humidity, dryness and heat (moderate heat). The six emotional factors are related to mental activities linked to the emotions: joy, anger or rage, anxiety, meditation, sadness, fear and terror. 
Finally, the assisting factors are, improper feeding, excessive work or rest, traumatisms, blood stasis and phlegm – humor (TANYIN). (6)

Functional antithesis in Physiopahology

If a simple approach to common sense permits to verify the concept of Yin-Yang in nature, from the view of physiopathology it is possible to observe that it refers to vital functions.;
Lungs: inspiration-exhalation, Heart: systole-diastole, Short and Long Intestine: repletion-evacuation, that is to say dilatation and contraction; Yin-Yang This law rules the functional mechanisms and also responds to chemical mediators which precede to the mechanical effect:, on one side, adrenaline and noradrenalin and on the other side acetilcolina (ACh) which show opposite properties in cardiac rhythm.. Following the same logic, up to the present, it does not exist in the enzymatic system an enzyme without a counterpart, its inhibitory enzyme. All the cellular chemistry operates in this way. The autonomic nervous system also does, showing a clear example of functional antithesis between the sympathetic and parasympathetic, where the first one dominates during the day and the second one during the night.
The compared action of the sympathetic and the parasympathetic systems, product of the study
of the functional antithesis in organs where the action of the neurovegetative is well known, shows a new element of opposition.
The sympathetic system (Yang) activates the Yin organs (heart, lung, circulation ) and inhibits the activity of the Yang organs (stomach, long and short intestine, bladder ). The parasympathetic (Yin) has a contrary action: it inhibits the Yin organs and activates the Yang organs. In the functioning of both system as well as in other examples of antithesis in vital functions, we find the concepts of Yin-Yang which also applies to the classification of organs. 

The embriologic theory and the function of the nerveous system

Dr Roger de la Fuye (1890-1961) founder of the Societé Francaise d”Acupunture, proposed his embryology theory on the basis that the ectoderm of the embryo simultaneously originates the skin and the nervous system; and Svann Horstadius professor of the Upsala University, in his book “The Neural Crest” refers that the formation of the spinal cord, of the skin and of the nervous system and the skin have given theorical sustain in Occident to the thousands of years of theory and practice of TCM. 
It must be pointed out that although since ancient times there is abundant bibliography on this subject, the delay in translations and its poor diffusion are the main causes of the lack of theorical knowledge on this medical system. As an example the theory of Horstadius mentions: “ If in fact, in the first stage of formation of the human egg, that point of the ectoderm (that in nine month will become skin and nervous system) is in close relation with that point of the ectoderm (which in nine months will reach the state of that organ, for example the stomach), it can be thought that in the course of the evolution of the egg, and further the human embryo up to the final state of the child and further to the development of man, until his death, the same close relations persist between that same organ (stomach) and the skin, through the nervous system, with the difference that the initial ectodermic point must have been developed in a cutaneous line, which can precisely explain the stomach CHING (meridian). The same is applicable to all the other points. “
One stimulus results in the body in reactions of high complexity. That is why in the physiologic scheme of the medullar reflex arch, where only two neurons participate ( sensitive and motor) are of limited interest for the TCM. Simplifying, the reflex arch leaves out the richness of the existing connections in the horizontal and vertical planes in the sensitive and motor stages and in the neurovegetative connections. Richness that is possible to observe if the theory of Ramón y Cajal is applied, by which the neuronal synapse plays a main role when permitting the formation and destruction of connections and within an infinite variety of possibilities.
The theoric possibilities of the nervous system were also explored by W. Scidt, anthropologist of the Hamburg University, on the basis of histologic works, performed by several investigators. According to Dr Stohr, “ all the nervous system represents a neuroplasmatic “syncytium” that is to say, a close network of nervous with “interposed” cells and, on the other hand it has been demonstrated moreover that the neurofibrils constitute the conducting element within the neuroplasma and that those, far from being fixed formations, are essentially variable: they change and are formed under the influence of the difference of potential of the invervated tissues, contributing, at the same time, with the function of conducting and balancing the differences of potential. The “Synneurona “ theory built on this basis, states that all the nervous system of the animal organism has a closed structure of neurofibril rings linked to one another by a phenomenon similar to electric induction, structure which is constantly changing. 
It is important to point out that this theory derives from the fact that the denominations sympathetic and parasympathetic – just as an specific example – are not applicable to nerves or ganglions but to links that are changing – being this the outstanding point. Each tissue is sympathetic or parasympathetic linked to the Synneurona of the medullar organ. That what changes according to the functions, remits to the predominance of one or any other link. So, to lead the links towards the acupunctural operation and having in mind Dr Bachmann”s words (7) “All repairing and healing process in the body is produced by a transposition of Synneuric perturbations (….) “.

Mechanisms of acupunctural action

It is fundamental to consider the predominant influence of the nervous system in the pathologic processes to understand why Acupuncture has been effective in the healing of illness along thousands of years. On the empiric base of the stimulus produced by the acupuncture needle or the application of localized heat or moxa on specific points of the body and the organic reactions that such stimulus generate, the Acupuncture and Moxibustion are settled, methods of “interior treatment of illness from the exterior” (8), which are continually perfectioning at the rhythm of new technologies which develop higher electric potential devices.
Going back to the embryologic theory and in accordance with Dr Horstadius”s theory “puncturing one of the points on these lines (meridians) there will be a repercussion specifically on the organ and consequently, on the function of the organ, originally linked by this line. “
Energy circulates on the body through twelve meridians corresponding to the five Yin organs and the five Yang organs and the other two functions, Triple Warmer and Circulation-Sexuality. The correspondence among meridians and internal organs is given by secondary vessels linked among them in charge of their connections. The secondary
vessels are the key to understand the relation between the peripheral circulation of energy and the functioning of the organs, and to give account of the mechanism of action of Acupuncture. Through the puncturing on specific points, energy is influenced, all the modifications of the flow of energy are transmitted to the organs they are connected with (viscera- cutaneous reflex ).
Besides the proceeding of differentiation of pathological conditions that must be carried on in accordance with the theory of TCM, the Acupuncture treatment is based on the following principles: dispersion for “excess” symptoms and tonification for the “deficiency” symptoms. In order that the application of the principles be appropriated, it comes necessary to know perfectly the course of the meridians, the distribution of the Chinese points and the indications for each part of this system.
In what is referred to the action of Acupuncture itself, and from the point of view of neurophysiology and of the existing relations between nervous system and blood circulation, the most outstanding functions must be pointed out:
  1. It has a reflexologic activity on the internal organs.
  2. It produces a “ reinforcing of the nervous central system and has action on functional disturbances.
  3. It has a normalizing influence on the reticular formation of the brain and on the tone and reactivity of all the vegetative nervous system, which keeps a direct relation with the normalization of all the functions in the organism.
  4. It has an action on the functioning of the hypothalamus, hypophysis, and suprarenal glands, thus rising the organism defense.
This is a brief description of the basic principles of Acupuncture, therapeutic proceeding with high effectiveness in the healing of illness, subject to a correct diagnosis.
The TCM, since ancient times uses a diagnosis methodology based on theorical fundaments interrelated (pillar of the method) among which we find the Yin-Yang theory, the five element theory, the differentiation of syndromes, the interrogation (if the patient feels cold or warm, if he has fever or chills; on his appetite and taste; on urine and stool; on pain etc.), the ocular inspection (the expression, the color, the glosodiagnosis, etc ) the auscultation and the palpation (pulse and abdominal palpation and others ) (9).
Once the doctor formed in TCM, determines which is the meridian or the organ affected, he must establish the main and secondary symptoms, the mechanisms of development of the illness and the state (chronic or acute) of the patient, to be able to decide on the technical elements to be used for the treatment (Acupuncture, moxibustion, etc). He arrives at a decision after considering several theorical-methodology aspects which are based on the principles of opposition and complementarity, in the internal connections which rule the organic functioning and on its union with the outside, in an integrated cosmogony vision where each thing has its own place and at the same time is part of a whole.
Between day and night, Yin and Yang, the human being and the universe, there are interrelations, meetings which permit a complementary vision in the focus of health.

Translated from Spanish by María Isabel Bennasar.

Dra. Cecilia Y. Cáceres