The principles of health, illness and treatment - The key concepts from “The Yellow Emperor's Classic of Internal Medicine”

Abstract

The Yellow Emperor's Classic of Internal Medicine is an important book in the study of Traditional Chinese Medicine (TCM) with the text presenting an integration of the essential TCM practices and philosophy in the use and application of Chinese medicine for healthcare. Within the Chinese Health System, TCM provides a balancing and integrating approach to health and the prevention of disease. The book provides the story of human existence, of our relationship to the environment and how ‘balance’ provides us with health and wellbeing in our daily lives. The role of the TCM practitioner is to look for wellness as a way of preventing disease. This paper discusses the key terms of the ‘Dao’, ‘Qi’, ‘Yin’ and ‘Yang’, ‘Ben’ and ‘Biao’ and the essence and role of the elements of fire, water, wood, metal and earth in health and disease prevention. TCM is an integrative approach to health and has many lessons for global health systems.

1. Background

I am a Traditional Chinese Medicine (TCM) practitioner. I was trained as an apprentice of TCM from age of 13, in the middle of China called Hubei, where in Ming dynasty (about 1500AD) the most known Chinese doctor, Li Shi Zhen was from. Dr Li wrote his famous book, called Encyclopaedia of Chinese Medicine after his 20 years of collecting herbs and classifying them. Later Charles Darwin quoted and praised some his works.

The traditions of medicine men, like Dr Li, are kept up to today. I followed few local medicine men or masters for few years and learned how to collect wild herbs and use them to treat patients. Later I went to a university and studied medicine specialized in TCM. From 1986 I left my job as a teacher of TCM in Guangzhou University of Chinese Medicine, settled in London. Ever since then I have been practicing and teaching Chinese medicine in the UK and many European counties. I introduced an Acupuncture service to the Whittington Hospital, Royal Free Hospital and North Middlesex Hospital in pain management and maternity service. Some of the services have lasted for more than 20 years.

I believe and work on integration of health systems (整体疗法what is the word in Chinese for integration?) and in integrative approaches to health through bringing TCM into the National Health Service (NHS) in the UK. The Yellow Emperor's Classic of Internal Medicine continues to guide my practice and I believe has important message around ‘integration’ and ‘integrative approaches to health’ for global health forms and structures.

2. Introduction

One of the most important books of Chinese medicine is “The Yellow Emperor's Classic of Internal Medicine” or in Chinese "黃帝內經 “, pronounced as Huang Di Nei Jing [1]. It was written in the Han Dynasty, about 2000 years ago, and has been treated as the fundamental doctrinal source for Chinese medicine for more than two millennia. The key messages of the book are about human health, illness, and treatment, and today, these teachings continue to guide our Traditional Chinese Medicine (TCM) practices in all areas of diagnosis, treatment, and prevention of disease.

2.1. ‘The Yellow Emperor's Classic of Internal Medicine’ – lessons on health, disease and treatment (REF)

2.1.1. Health

What is health and what does the Yellow Book say about health? Nowadays in general medicine, with all the latest advances in new technology and equipment, good health, or having a healthy body, means good results of blood tests, scans, or other measurements. People often do these tests once a year to ‘get a clean bill of health’. Everything is measurable with numbers and is tangible to the patient. However, in this ancient book, good health and having a healthy body has quite different meanings. It is simply about being in a state of ‘balance’ or BEING a ‘balanced being’ [2]. But being balanced with what? The balance that is sought is the equilibrium among/between the Heaven (or sky), Earth and human, and these are medical as well as metaphysical and categorical concepts.

• •Our Body and Nature

As human beings, our bodies exist in the world among many others including the wind, water, sunshine, tree, grass, animals, and insects …., we cannot exist without the others. We, and others, form a bond of co-existence, relying on each other, influencing each other and even changing into each other. Outside of our human body we will directly face two parts of the world, the part above and the part below. The part above is called the “Heaven” and the part below our body is called the “Earth”. We are in the middle. Heaven means the sky, sun, air, wind, rain, snow, etc and the earth means the water, food, animals, bugs, insects, trees, grass, ocean, mountains etc. So, these three parts, Heaven, Earth, and human together form a unity and our ‘living world.’ [3]. This unity of 3 becomes a tangible world, and this is, generally speaking the basic philosophy of the Chinese people and of Chinese medicine (TCM), although there may be other views held by smaller ethnic or religious groups in the country.

As we are only one of the three parts, so we must be constantly keeping ourselves in balance or with the other two, Heaven and earth. In fact, the ancient Chinese says, ‘only if the heaven-human-earth balances are reached then the world can tangibly exist and can be a reality, or a ‘real world’ [4] and in this real world we are able to survive and to live our lives.

• •The Dao

So, the next question is how can we keep this heaven-human-earth balance? The secret is to follow the rule of nature, namely the ‘Dao’. The Dao is the basis of Chinese philosophy [5]. It is pronounced Dao or Tao in Cantonese and Taoism is derived from this. The fundamental rule of the Dao is to change ourselves as nature changes, or to constantly adjust ourselves with the heaven and earth. In medical health practice this means we need to merge our bodies into the natural environment. For example, if we are living in a cold place, we need to keep warm by dressing with more clothes or staying in a warm place, as well as eating warm food. If we are in a damp place or during the time of the rainy season, we need to keep dry by dressing against the rain with waterproof clothes, and by eating dry food such as hot spicy foods and drink hot drinks, such as hot tea, or spirits which can dry up the cold or/and dampness. In contrast, if in hot places or in the hot summer we need to keep our body cool by drinking more water and eating cooling foods to cool the body down.

The concept of cooling, warming and drying of food may be new to other medical systems and clearly needs a good explanation. I will briefly tell you that in Chinese medicine, the way we differentiate between warming or cooling and drying food, is to pay attention to the food, plants and animals' relationships with water, land, and the seasons and with their particular growth cycle. Multiple links with water are classified as a ‘cooling food’, and the opposite is a ‘warming food’. For example, rice grows in water and therefore is a cooling food, In contrast, barley grows on the land and is a ‘warming food’. If cooking food with water such as boiling, or steaming, these contribute to cooling the food whereas cooking with direct fire or firing food such as roasting, baking, frying and barbecuing make the food warm or hot. Of course, there are some exceptions. Therefore, the true health of the human is very much dependent on how we can keep our balance with nature and the outside world. This natural balance of heaven-human-earth is a very important pre-condition for good health. Balance and integration are fundamental to our health and to TCM teaching and practice and is a profound ‘Integrative Approach to Health’.

Reaching a balance with nature is only a starting point. We also need to keep the balance within ourselves. ‘Ourselves’ here can also be divided into three parts, YOU, I, and HIM (HER), a base of our human society. This balance is fundamental to the existence of human society [6]. Equality, peace, and humanity are based on this kind of balance and are crucial but not easy to reach. Our civilisation is dependent on these.

Furthermore, there is also an issue of the ‘balance of our body within itself [7]. Our body is made up of many parts, including tissues, and organs, which together form a unity or an organism, all of which need to be in balance with one another to maintain good health. The Yellow Book says because our body is from nature, and it is a part of nature it naturally has the code of nature. Our body contains all the secrets of nature, it is viewed as a small universe within itself. It mimics the human universe. This “human universe” can be further divided into many smaller sub-organ universes, which go on and on to include all the parts of the body through sub-body universes which work together to form a unity called a ‘human-being’. Each part of this unity relies on each other; helping each other in the good times, fighting with each other in the bad times, and finally changing into each other for balance and wholeness. These processes of ‘helping’ (xiang shen), ‘fighting’ (xiang ke) and ‘interchanging’ (xiang bian) with each other constantly and infinitely makes our human a living body with a life cycle. All the organs work together as a one and for the one (life), and in turn the one (life) also works for all. (Ref from the Yellow Book).

• •‘Our body is a small world in itself’.

The ruler of this small country is the ‘Heart’. In TCM, the Heart controls the ‘spirit’ or ‘Shen’ (a kind of force dominating life and soul) of the person; the Lungs are the premier of the body, controlling the ‘Qi’, or breathing or running of the living force; the Spleen is the Treasury for the nutrition and supply of nourishments; the liver is the Justice Ministry which protects the body and clears away ‘the bad stuff’ and keeps the state of the body in balance; the Kidneys are the Defence Ministry and protect the body, the land and water, from the invasions of germs from outside, also clearing toxins from the inside. The Kidneys also carry the body's deepest secrets, our inheritance like our DNA, and the secrets of our life and future life which we call ‘JING’ or ‘Essence’. The above five organs, Heart, Lung, Spleen, Liver and Kidneys are the most inner organs, they are the executive powers of the body, which mimic the five elements: fire, metal, earth, wood and water, the basic elements on the earth. Other organs such as the small intestine, large intestine, stomach, gall bladder, and urinary bladder are all subsidiary organs of the five elemental organs and assist in this complex unity and system. Other parts of our body such as the skin, muscles, bones, ligaments, hair, eyes, nose, mouth, and ears, are further sub–sub elements to these five organs. All these organs form a complete network, a unity, a human body. If any part of this unity is out of order, say, too weak or too strong, underpowered or overpowered, this will result in an imbalance which may lead to an unhealthy body or even illness. Therefore, to be healthy in Chinese medicine is about all these organs being balanced.

• •Qi, what is it?

How are these complete networks of the human body linked? In the Yellow Book it says there are two ways: the visible and invisible. The visible linkages such as the blood vessels can be seen and are easy to understand. But there are also some invisible linkages such as the Qi channels or sometimes called the ‘meridians.’ Acupuncture treatment is based on this meridian theory. In our body there are 14 big meridians, and they are interlinked. On each meridian there are many key points called acupuncture points, in total 365.

We all understand the blood flows around inside blood vessels. But what is inside the meridian? There is something invisible called Qi or Qi flows inside meridians. What is Qi? In the Chinese Dictionary Qi 气 means ‘air’. Air is invisible. The air on earth is everywhere, linking everything, changing everything, often without us seeing or knowing it. Hence the Qi in our body is just like the air on earth. In our body Qi can link one part to another part, interior and exterior, upper portions and lower portions or the reverse and because it is invisible it can link with the invisible SHEN 神 (spirits and vitality) of our body. This means it links mind and body and it can also link with outside spirits, so the ancient people believed. If you are alive it is because the Qi makes us alive. If you are dead, the Qi has ceased moving and has gone. The quality, quantity, speed, and direction of Qi movement, as well as the timing of the movements are also vital to the balance of the body, and hence very important for our health. So, in the clinic TCM practitioners use needles or other treatments such as moxibustion and cupping, to alter the flow of the Qi in the meridians, or even use their hands to massage the meridians to change the flows of the Qi to get therapeutic results.

If we accept the idea of this hypothesis of meridians, then inevitably we should explain more about Qi and ask how can Western Medicine miss this vital force in life? What is the tangible proof of Qi? It is very or perhaps most difficult to find. Until now there is no hard and convincing evidence to provide tangible proof of the concept of Qi. People should only explain Qi as a kind of energy, or force. It is invisible but can be felt like a mild heat. A good analogy would be a blind person not seeing the sun but being able to feel its warmth. Qi is difficult for us to understand but exists and can be felt. Of course, by saying this it is still not good enough. Not answering this foundational question will have devastating consequences for the existence of TCM. Without a Qi theory the whole acupuncture treatment will be unplausible, and the whole of Chinese medicine will be missing a big part of the jigsaw puzzle of health.

• •Yin and Yang

Blood is something we are all familiar with, the concept of ‘blood’ in the Yellow Book is very similar to what we see today. But there is a major difference, which is that the blood works together with Qi, and pairs with Qi. Both flow around the body. Blood flows in the blood vessels and Qi flows in the meridians. They are inter-dependent and inter-enhance each other in normal physiological circumstance and in heath, but in pathological circumstance or in illness, they inter-weaken and interfere with each other. Qi in our body brings the energy, force, warmth, movement, and activity which we call ‘YANG’, and the blood provides the supply of nourishment, moisture, cooling growth, and stability, which we called ‘YIN’. A healthy balance of Qi and blood is also a healthy balance of YIN and YANG. They are another philosophical doctrine of TCM.

In the Yellow Book, YIN and YANG are the two opposites sites of one thing. Everything has always two sides, such as front and back, negative, and positive, bright, and dark. The two sides of the one thing make the thing real. The two sides of YIN and YANG is a natural phenomenon, even considered as a natural and universal principle.

Healthy environments in nature are a healthy balance of Yin and Yang (Fig. 1). The healthy body in the human being is also a healthy balance of Yin and Yang within our body.

Fig. 1.

An Illustration of Yin and Yang, Opposite, Interchangeable and Interdependent.

HEALTH is not static, or a singular sign of somebody's physical status, but a comprehensive, complicated, and constantly changing status of balance between body and environment, as well as among all parts of the body, mind, and emotions. Sometimes people call it the balance of body, mind, and spirit. This concept of health is holistic within as well as without.

2.1.2. Illness

What is illness? The concept of illness has changed and evolved a lot over time. I remember 30 or 40 years ago, in a normal GP clinical practice if a man told you he had been in a low mood for a while, tired or fatigued, with a low sperm count, low sexual libido, and was overweight, the GP would probably have said to the patient, this is not a medical problem and simply told the patient to rest, ‘pull himself together’ and then get on with life. But today, these are considered as a medical problem or an illness. So, how did the ancient Chinese people define illness? It is simply the opposite of health. Good health is good balance, then bad health is due to the body being out of balance. But not all imbalance in our body will result in illness immediately, there is a gap, a ‘grey area develops’ and if our body is out of balance it will first go to this grey area and if we neglect this grey area in our body, it will further develop into a real illness. The Yellow Book uses the word “WEIBING” or “not yet Ill “to name this grey health condition. It says that the best doctor is not simply treating those patients who are dying or seriously ill but treating these ‘not yet ill’ conditions. In other words, prevention is more important than treatment. These ‘not yet ill’ conditions and real illness are not that clearly labelled in patients at a TCM clinic. It is very difficult to give a precise diagnosis, so in TCM there are terms like ‘weakness’ and ‘deficiency’ which are very often used to describe these kinds of ‘grey area’ conditions.

• •Imbalance

Since balance is the basis of health and imbalance is the cause of illness, illnesses of any kind are all due to an imbalanced state. These unbalanced states could be an imbalance with the outside i.e., with nature, such as staying in too hot a place that causes heat stroke, too cold a place that causes hypothermia, or living in too damp a place that can cause arthritis or joint pain. The imbalance could also be within the body itself, for example, a kidney disease. In TCM the Kidney is a water element, the weakness of Kidney often results in ‘fire rising’. The fire element of the body is linked to the Heart and heat; therefore, a Kidney weakness often causes heart problems such as high blood pressure, palpitations, and even heart failure. In addition, heat problems can cause rashes or spots on the skin, like eczema. Furthermore, as the heart dominates spirit and the mental state, the rising fire can cause symptoms such as insomnia, restless, hallucinations, and other mental conditions.

• •The 5 Elements

Talking about fire and water elements, these are part of the doctoring metaphor of the 5 elements. In other ancient philosophies, namely European, there are 4 elements, earth, fire, water, and air, whereas in Chinese philosophy there are 5 elements, fire, water, earth, wood, and metal.

This five elements theory considers the universe is composed of basic 5 elements or forces, called Wuxing (五行), usually Fire (火), Water (水), Wood (木), Metal (金), and Earth (土). These five elements in nature are balanced among themselves.

The main cycles are the generating cycle (Fig. 2) and its direct opposite, the insulting or overcoming cycle (Fig. 3).

Fig. 2.

The five elements generating cycle showing one element generating another.

Fig. 3.

The five element insulting cycle showing one element antagonising another.

These metaphors still have wide applications in many other areas of life and society in China even today. In medicine they are also widely used to guide us in analysing the pathological development of illness as well as the treatments.

2.1.3. Treatment

People normally understand that ‘treatment’ means to clear or remove the bad things from the body, to kill the germs, to reduce the overly grown part of the body 肿瘤(tumour) or to ease hyper-function of the body, and to increase the under-growth part of the body or hypo function of the body. The methods are certainly logical and scientific and include many kinds of treatment including surgical operations, antibiotics, antiallergy treatment, chemotherapy and so on. But in the Yellow Book, medical treatments are very different. They are very simple, and they are all about balance, to help the body to reset to balance and after reaching balance, the body can then heal itself, or can correct itself, or be in a better position to fight germs, or to ease the “too much” aspects and to replenish the “not enough” parts of the body. Then illness or disease will spontaneously disappear, and the body will be cured.

• •‘Ben本’ and ‘Biao标’

This sounds like a miracle and hard to believe but in fact, it is very reasonable. Firstly, let me give an example of cancer. We all know that nobody is born with a cancer, (although they may have some genetic disorders and defects that pre-dispose to cancer which may be a part of reasons for future cancer development). The causes of cancer happen sometime and somewhere during our life. There could be broken balances with the outside environment or imbalance within our body. The body gets out of tune with itself leading to immune system malfunction. The system is unable to protect our body providing an opportunity for cancer to occur. So, imbalance is the key. This key cause of illness is called “BEN” 本and the symptoms or signs of the illness, are called “BIAO” 标.

BEN in Chinese means the root of a tree, underground and not easy to see; BIAO means the branches and leaves of a tree, above the ground and easy to see. Therefore, the real treatment of Chinese medicine (TCM) is to treat the Ben of diseases, or the root of the disease. If the Ben is treated and the imbalance corrected, then the disease will be easier to cure. Otherwise, if you only cut the grass or trim the leaves of the tree as treatment, then later the grass and the leaves will grow back, it is just a matter of time. That is why we see so many patients have their cancers removed but later they grow back again.

People may say, ‘we all know that treating the root of problem is the most important thing to do, but what is the root of the problem?’ The answer is to check and find out what and where in our body the balance has gone or is ‘out of tune’. This is we need to concentrate on, the Ben. Within the Ben and Biao treatments, we also have a different priority, but in some cases the immediate priority could be Biao, for example, some patients suddenly have very low or high blood pressure, so for their treatment the priority is to treat the blood pressure or to get the blood pressure to the norm first even if the Ben is something else. After the blood pressure is stabilized then we'll go back to treat what is the cause of Ben. The methods and approaches within TCM are many but they always involve lifestyle changes, food and dieting, exercises, sometimes herbs, acupuncture, cupping and so on. They all focus on the issue of balance. Finally, treatment of the “not yet ill” conditions and therefore prevention, is the main message from the Yellow Book.

In my old hospital in China, an example of integration of medical systems could be seen in the treatment of gall stones. Initial diagnosis would be carried out using x-rays or other scans to confirm the presence of the stone. The patient would then be given acupuncture and herbal medicine which would aid the breakup of the stone, followed by exercises to dislodge it. IF this combination of treatments was unsuccessful, then surgery was used as a last resort to remove the stone.

3. Conclusion

From study of this ancient book, we can learn some of the wisdom of the ancients, especially their ways of dealing with the body and health. With the fast advances of science and technology we still need to keep a cool head and not get lost into small details, thus forgetting the bigger picture. The big picture of our world is that we are still very humble and know very little about our world and the body. To get good health for ourselves and our families we simply have to follow the nature or the Dao.

This philosophy is all about ‘integration’ of the body, heart and mind and the role of universal spirit. TCM has much to teach global health systems on ‘integration’ and its importance in the wellbeing of both individuals as well as the population.

Sources of funding

The author did not receive any funding for the production of this article.

Conflict of interest

There are no conflicts of interest.