The Biggest Obstacle to the Integration of Acupuncture: The Meaning of Qi from the Ancients to Einstein

Abstract

Qi continues to be questionably translated in the West as the biblical idea of lifeforce. The true meaning of qi may be closer to the Western scientific definition of energy as the material basis of everything in the Universe. To illustrate this, parallels are drawn between the writings of ancient Chinese thinkers and Western definitions of energy, including the laws of thermodynamics underlying Western scientific thought and yin–yang theory underlying Chinese scientific thought. The focus is on the similarities in theories of material reality while acknowledging how differences in cultural mindset create distinct styles of description of the same ideas. The purpose in establishing a more accurate translation of qi, by removing Western projections, is to improve patient–practitioner communication and to remove obstacles to the acceptance of acupuncture and Traditional Chinese Medicine as a mainstream medical intervention in the West.

INTRODUCTION

Accurately translating the Chinese term qi is imperative for the integration of Chinese Medicine with Western medical practice. Qi is a foundational concept in the theory of acupuncture and, therefore, it cannot be disregarded or extracted from the practice. Conversely, this 1 word takes the divide between Western and Chinese Medicine and turns it into an unpassable chasm. The reason is that the existence of an energy exclusive to living beings—lifeforce—is considered disproven and a thoroughly unscientific notion.

The significance of qi is an inescapable hurdle that must be tackled if acupuncture is ever to gain status as a standard medical intervention in the West, as it is enjoyed all over Asia. A 1997 consensus statement on acupuncture by the United States National Institutes of Health noted that concepts such as qi “are difficult to reconcile with contemporary biomedical information.”¹ Clarification of this term will be instrumental in the acceptance of acupuncture into medicine.

Acupuncture research articles generally include an introductory paragraph describing acupuncture as a technique that regulates the flow of a lifeforce energy called qi through channels in the body. Is this an accurate translation of the meaning of qi or is it the projection of a familiar Western idea onto an unfamiliar Chinese concept? Although “lifeforce” or “vital energy” is a common Western interpretation of the Chinese word qi, as used in Traditional Chinese Medicine (TCM), Chinese scholars² and sinologists^3,4 generally translate qi as cosmic energy or material force.

An analysis of not only the written character for qi but also the linguistic and cultural mindset that created the character is needed to understand the true meaning of the word. Just as revealing is an in-depth analysis and inquiry into the Western mindset that has hitherto translated the word qi as lifeforce to see how the confusion occurred, why it persists, and why this must be corrected before acupuncture can be broadly integrated into Western health care settings.

LANGUAGE CONSTRUCTION IN CHINA VERSUS WEST

Broadly, Western language speaking people think in terms of nouns, that is objects and categories of objects, whereas Chinese-speaking people think in terms of verbs, that is actions and relationships between objects/people.⁵ In one illuminating study on language acquisition, a group of 4-year-old American and Chinese children were shown 3 pictures—a cow, a chicken, and some grass. They were asked to group 2 of the pictures and say why they chose that pairing.

The American children chose to group the chicken and the cow together as part of the abstract category of “animals,” whereas the Chinese children preferred to pair the cow with the grass based on the real-world relationship of one eating the other.⁶ Knowledge of this linguistic enculturation can be used to inform the translation of foundational concepts such as qi.

Before directly examining the Chinese character for qi, which is a composite character, a review of this type of character in general is useful and further unveils the differences between Western and Chinese language formation. For example, if a Western language speaking person was presented with the words or pictures of a woman and a child and they were asked to create a new word using these, that person would likely use those 2 people/objects to create a category of objects. In this case, a group containing both “woman” and “child” might create a category called “family.”

By contrast, in Chinese, when the character for “woman,” 女 is positioned beside “child,” 子 a new word is created that describes the relationship between the people/objects. That word is “good,” 好. The intention of this composite character is to imply the inherent goodness in the relationship between a mother and child. This style of language construction discloses another major difference between Western and Chinese languages. Western languages tend to be explicit, whereas in Chinese, meaning is implied.⁵

The written word for qi (氣) is composed of the character for rice (米) combined with the pictogram for vapor (汽) positioned above the rice. In modern simplified Chinese, the character can include only the vapor part. The Encyclopedia Britannica translates this word thus, “qì means air, breath, or vapour—originally the vapour arising from cooking cereals. It also came to mean a cosmic energy.”⁷ This translation aptly demonstrates the snare of the Western “object-category” lens when attempting to interpret Chinese characters.

Just as the combination of “woman” and “child” points to the goodness between them, the pictograms for “rice” and “vapor” are being used to imply a concept that may have little to do with those actual objects (cooking cereals) so that the meaning can vary depending on the context. The translator then provides a second quite abstract definition—cosmic energy—which seems to be something entirely different to “steam coming from rice” (and is also at odds with the everyday use of qi in modern Chinese as demonstrated in Table 1). Instead, the implied real-world relationship between the uncooked rice and the steam is more likely pointing to the process occurring between them. For example, it could imply a process of transformation involving thermal energy.

Table 1.

Common Chinese Words Containing QI with a Literal Translation of the Individual Characters, the Correctly Interpreted Meaning of the Composite Character, and Suggested Conversational Uses of the Words in English in Terms of the Colloquial Understanding of “Energy”

Chinese compound word (氣/气 +…)	Literal translation	Meaning	Colloquial use
年轻气盛	Youth abundant in qi	Youthful/thriving	Full of energy
丧气	Lose qi	Depressed	Low energy
人气	Human qi	Popularity	Popularity
和气	Harmonious qi	Polite, kind mannered	Balanced energy
好脾气	Good spleen qi	Good temper/humor	Good temper
坏脾气	Bad spleen qi	Bad temper/humor	Full of spleen
运气	Move qi	Luck	Luck
好运气	Good move qi	Good luck	A stroke of good luck
坏运气	Bad move qi	Bad luck	A run of bad luck
生氣	Life/grow qi	Angry/get mad	Explosive energy
氣氛	Qi atmosphere	Atmosphere/ambience/mood	Energy in the room

In simplified Chinese, either the full or abbreviated version of the character is used depending on the context.

The Merriam Webster dictionary defines qi as “vital energy that is held to animate the body internally and is of central importance in some Eastern systems of medical treatment (such as acupuncture) and of exercise or self-defense (such as tai chi).”⁸ It is clear that the Western author of this lexicon believes that qi is an energy that exists exclusively inside living beings and with a function to animate organisms. The writer is also under the impression that the term is used by Chinese speakers only in relation to traditional medicine and body movement.

The usage of qi by the modern Chinese demonstrates that in a contextual language, the meaning of words change depending on the situation and their root meaning is inferred through the many contexts where they can be applied rather than a single universal definition (Table 1). Many modern contexts wherein qi can be applied are discussed further below. Before that, an analysis of the Western story of “lifeforce” is followed by the ancient, philosophical, and scientific origins of qi.

LIFEFORCE

The idea that living beings are animated by a special force of nature that is different to other known forces is one of the key issues that sets Western science and spirituality in opposition to each other. What makes the concept of lifeforce repugnant to the scientific and medical community lies deep in the history of European thought, far beyond the current trend of evidence-based medicine. The inclusion of this concept within the acupuncture research literature is one of the main sticking points that makes it easy for a single politician or minor group of scientists to cry “pseudoscience!,” resulting in the banning of acupuncture from societal use and the expulsion of acupuncturists from medical universities, as has occurred in some Western countries.^9,10

It is worth diverging into the story of how the concept of lifeforce energy emerged and how it came to be rejected in the West to understand the current predicament of qi (and by association, acupuncture) in Western health care.

In the writings of the Greek philosopher Plato, an idea sprang into Western thought that living beings have the special property of self-motion and this differentiates them from nonliving objects that can only be moved but cannot move of their own accord. He called this special property the soul (psūkhḗ) and used a certain logic to surmise that it exists before a person is born and it survives after death.¹¹ In the following centuries, the lifeforce concept was modified by the Judeo–Christian movement that spread across Europe. Under this belief system, the force that brings matter to life requires a life-giving creator god.¹²

It was not until the 18th century in Europe that animal locomotion came to be considered as a natural force rather than a supernatural force. In 1791, Luigi Galvani came up with the concept of animal electricity through his experiments with dismembered frogs' legs. He found he could make the legs twitch and kick by attaching the sciatic nerves to various electric apparatus. His contemporary, Alessandro Volta, went 1 step further by asserting that the energy flowing in the nerves was no different to the electrical force flowing between metal contacts. In proving his point, he inadvertently invented the first battery and Galvani's concept of animal electricity lost respect in the scientific community.¹³

A distaste for electrophysiological practices still survives today within medicine as a result of this outcome even though it is now known that they were both partially right and partially wrong. Different forms of electrical conduction are possible depending on the medium, but Volta won the debate after his development of the battery that proved, crucially to the lifeforce argument, that electricity could be stored without a living body. After this a dichotomy was set up (in true Western style) between spiritualists who believe in an animating force and scientists who believe there is no natural force that sets apart living beings from machines.

Current science has moved on to describe life as forces that give rise to flows of energy.^14–16 The mathematical Western-style definition of life-generating forces is now being developed as the thermodynamics of life. This area of physics, called far-from-equilibrium thermodynamics, analyzes how steady states of energy flow are spontaneously set up and maintained in nature. That approach moves closer to the Chinese way of perceiving reality where everything is formed by its environment and focus is on the dynamic interplay between an object's form and function with the external forces acting on it.⁶

Under this paradigm, life is generated by energy flows, occurring within and outside of the organism, acting as driving forces that form the physical shape, function, and appearance of the living being.¹⁵ Examples of driving forces that form shape and function are ubiquitous in nature. The pattern seen on sand when the tide goes out is formed by the motion of the waves on it. The movement of the water is the driving force that shapes the sand, and the movement of the moon around the earth is the gravitational driving energy that moves the water.

The force of the heartbeat is the driving force that makes the vasculature the shape of a fractal tree because this is the shape that takes the force of the beat and converts it into flow most efficiently and most safely for the whole structure.¹⁷ This holistic way of looking at the energy of living things, where all the forces and movements of energy both inside and outside the organism are considered, is distinctly Chinese and is the focus of the Neijing Su Wen (simple questions).¹⁸

Although conventional medicine still approaches health and disease from the Volta perspective, where organ systems are isolated, mechanical battery apparatus, there is a movement beginning to emerge where medics could instead treat patients in terms of optimizing their energy flow systems.¹⁹ Emulating the Chinese approach to living organisms as energy-flow systems, far-from-equilibrium thermodynamics can shed new light on how to advance medicine using what is known about the laws of physics in living bodies.

From the standpoint of optimizing energy throughput (entropy production) as measured by cellular metabolism, oxygen consumption, cardiac output, perfusion, and heat production, there are already ways that medical practice optimizes energy flow to achieve health. Namely by ensuring adequate oxygen delivery, maintaining function of the organs of elimination, and striving for early ambulation after surgery or critical illness.¹⁹ This idea is familiar to holistic medical practices such as acupuncture wherein health is a downstream effect of optimizing energy flow throughout the system.

WHAT IS QI?

Life-Generating Forces in the Neijing

The role of qi in the formation of life is mentioned in Chapter 8 of the Huang Di Nei Jing Ling Shu (The Yellow Emperors Internal Classic).

Heaven manifests itself within me as virtue (dé). The earth manifests within me as qì. When the virtue flows and the qì have joined, life begins.²⁰

And similarly, from Zhuang zi, the 4th century BCE philosopher of the Warring States era,

What the things are endowed with, before they have assumed a physical appearance, to generate their life, that is called virtue (dé). When yin and yang unite their qi and my body is given its material physicalness, that is the way (dào) of the earth.²⁰

Virtue or kindness was seen as something that is present first and then the physical energies of the earth form themselves around this dé to create life. These passages have a spiritual element but they have no creator god to “make” life. It seems the dé aspect is included as a cosmic generating force and life forms around it.

A current Western translator and interpreter of the Neijing texts describes shén as a form-generating force that exists as

a transcendent dimension of space-time in which the normal measurable rules of yīn-yáng motion do not apply…Shén and shén illumination are seen to be transcendent forces around which the natural world is organised and maintains its coherence.²¹

Shén and dé are metaphysical concepts used to explain the emergence of natural and living forms in the ancient Huang Di Neijing texts. The key piece of information to consider for this argument is that qi appears not to be the God-given or transcendental lifeforce familiar to Western minds. According to the passages above, qi are the forces of nature that forms consist of, such as matter. They are the physical energies of the world that join together to form material objects. If an analogue to the God-given lifeforce energy or transcendental self-moving soul is to be found in the Chinese literature, dé and shén would be more promising contenders than qi.

Exploring the foundations of the Chinese philosophy further, one discovers that qi is in everything and is what everything is made of, not just living things. As the 3rd century BCE scholar Xun Kuang put it,

Water and fire have qì but not life; plants and trees have life but not awareness; birds and animals have awareness but no sense of morality and justice.³ [emphasis added].

He describes qi as the force that makes up the elements, the basic building blocks of the material world. In the hierarchy of beings, qi is not something exclusive to living beings. A larger definition is needed to express its full meaning.

Qi and Matter–Energy Equivalence

“Qì in dispersion is substance, and so it is in condensation,” according to philosopher Zhang Zai (1020–1077 CE).²² Here qi is tangible, both the dense substances that have been crushed down into metals and also the lightest components of the air. Western scientists call everything along this continuum of dispersal and condensation matter but also “energy.” The relationship between energy and matter as the same basic substance is encapsulated in the famous mathematical equation of Einstein, E = mc² (where E is energy, m is mass, and c is the speed of light), and expressed linguistically as matter–energy equivalence.²³

In the West, it is not commonly known to the layperson that everything is made of something called energy. Unlike in China, the concept of matter–energy as the unifying stuff of the world is confined to the corridors of scientific institutions and even then, only in departments of physics or chemistry. Within the biological sciences and biomedicine, measurement mainly focuses on concentration changes, whereas quantities of energy or fields of force within the body are seldom considered relevant.

Yin Mass and Yang Movement

The Chinese scientists subdivided qi into 2 types, yin qi that has the properties of substance and stillness, and yang qi that denotes the properties of movement and heat. These qi are continually transforming into each other, their forces are mutually opposed, and they are inseparable, one cannot exist in isolation from the other.⁴ In the Chinese style of simplicity, all of these qualities can be read at once in the Taiji (“supreme ultimate”) or yin–yang symbol. Similarly, Western scientists also assigned all energy into 2 types. One is called potential energy, that which has the potential to move (mass) and kinetic energy, the energy associated with movement. Put concisely in the Western mathematical style; E_total = E_potential + E_kinetic.

Einstein's equation mentioned above represents just half of the full matter–energy equivalence expression. The memorable E = mc² part represents the energy of substance when it is at complete rest, unmoving. The other half of the equation is E_r = pc (where E_r is the energy of a relativistic particle such as a photon, p is momentum, and c is the speed of light) and represents the energy of pure motion or momentum without mass.

Since every atom is vibrating and every bit of matter on this planet is hurtling through space at great speeds, there is in reality no substance at absolute rest, and so the complete (less popularly known) Einsteinian equation is really the mutually opposed and inseparable energies of substance and motion combined; E² = (pc)² + (mc²)².²³ Symbols East and West are different, one promotes simplicity, the other exactitude, but the fundamental meanings are the same.

Qi and the First Law of Thermodynamics

The idea of energy as a totality of the universe was really brought to the fore, in the West, by the development of thermodynamics in the 19th century, by physicists such as Carnot and Kelvin while working out the mechanics of engines.²⁴ Their work demonstrated that all energy must be accounted for when one wants to move an object from one place to another with the greatest efficiency. The mathematics of thermodynamics showed with precision how energy cannot be created or destroyed, only transformed from one state to another. In other words, energy is conserved. In the words of modern physicist Richard Feynmann,

There is a certain quantity, which we call energy, that does not change in the manifold changes which nature undergoes.²⁵

This first law of thermodynamics was expressed similarly by Wang Fu Zhi in the 17th century,

Despite the condensation and dispersion of qì, its original substance can neither be added or lessened.⁴

Qi and the Second Law of Thermodynamics

The second major law that forms the foundation of thermodynamics, and physics in general, is the concept of entropy. This follows from the observation that everything moves from a more ordered to a disordered state. Everything falls apart. Living organisms can grow into ordered structures during their lifetime but only by increasing the disorder around them so that the overall order of the world decreases, and eventually, even the order of a living thing is temporary and falls away as it ages and transforms into nonliving matter.

Entropy is rather a large concept that Chinese academics were already grappling with at least a thousand years ago. Zhang Zai describes how

The Great Void consists of qì. Qì condenses to become the myriad things. Things necessarily disintegrate and return to the Great Void.⁴

This is a good description of the process of matter coalescing from the dust of Space into the world of objects seen around us. The inevitability of their disintegration and return to the emptiness of Space is not something that Europeans traditionally espoused, quite the opposite. Western societies, through their religious leanings, promoted a world without end. It was only with the rise of scientific culture in recent centuries that Western people began to imagine the unstoppable process of disintegration, laid out by Zhang Zai and his predecessors, that is leading to the eventual heat death of the Universe.

Types of Qi and Energy

Whereas mass and momentum are strictly defined, quantifiable aspects of matter and natural forces such as electromagnetic energy, “yin and yang are designations and have no physical appearance.”²⁰ However, in practice there are subdivisions of quantifiable energy in the Western sense and qualitative qi in the Chinese sense that can be surmised to be approximately equivalent. What is known as chemical energy from food, the ancient Chinese called grain energy (guqì); the enzymatic energy of digestive organs, they called spleen (or pancreas²¹) qi; and adrenal hormonal energy might be understood as kidney yang qi.

The energy that arrives upon stimulation of a nerve by an acupuncture needle was termed déqì by acupuncturists and means simply “get/obtain qì” or “arrival of qì.” It could now be more specifically named an action potential or electrical energy, born from the movement of ions across a nerve cell membrane.

MODERN USAGE OF QI

It must be stressed that the term qi is not only something for ancient scholars and scientists to grasp. It is something understood by the contemporary Chinese layperson as the unifying material of reality.⁵ An American lecturer, teaching a class of Chinese university students about Western culture, described to them the idea of reality as something objective and unchanging.⁵ He described a solid bedrock that exists underneath the social conditioning that warps the mental perceptions and creates seemingly different versions of reality for each individual.

It is this warping of human perception that the scientific method attempts to subvert, using statistics and repeated measurements, until something constant is found. Those consistent objective facts are considered to be the real world that exists beyond the fallibility of human perception.

A Chinese student from the class put up his hand and said “this is not what Chinese call reality.” Looking to his classmates for affirmation and seeming to receive it, he went on,

For Chinese, reality is qì. Qì is everywhere—in air, in rocks, in people, in things—everywhere. Qì never stays in one place. Qì moves all the time everywhere and through everything. Not possible to stand on qì.⁵

Not only is this a very different definition of reality compared with that coming from the Western mindset, qi is also a much broader concept than most Western attempts at translation would lead one to believe, such as lifeforce, vapor, breath, electromagnetism, and so on.

Qi is also an everyday word that can be used in a variety of contexts in much a similar way as Western language speakers use the word “energy” colloquially. Table 1 provides a list of these qi containing words with their literal translations as separate characters beside their actual meanings as composite characters. Of particular note is the word that is produced when life/grow is placed beside qi. Instead of life–breath or life–force, the word shēng qì (生氣) means to get angry!

These examples demonstrate the difficulty in finding linguistic equivalents, even when direct translations are recognized as inaccurate, since the cultural understanding of reality is expressed in such a different way.⁶ In summary, none of these words are expressions of a supernatural force that turns inanimate matter into living beings. Moreover, an average Chinese would think of qi as having to do with forces in general rather than lifeforce.

It may seem unwieldy to hold the larger definition of qi within the confines of the practice of acupuncture and to make use of it in the context of human health and illness. This difficulty is addressed in the words of the court physician Qì Bo to the Yellow Emperor in the foundational text on acupuncture;

Now, an individual person may well experience a disorder of qì; the phenomena under the heavens, they include disorders of humans. All of this forms one unit.²⁰

That level of holism can appear distant from modern biomedicine and perhaps too esoteric to be scientific but the insight of Einstein can bring clarity to the problem of separateness for the Western scientific mind;

A human being is a part of the whole, called by us “Universe,” a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest—a kind of optical delusion of his consciousness.²⁶

Although packaged in different language constructs and reflecting different mindsets, these 2 passages convey the same message, that everything in the Universe forms a connected whole including human bodies, minds, and their diseases.

Researchers in the field of acupuncture recognize the need to reconcile modern physiology with the foundational concept of qi. Renowned neuroscientist and pioneer of neuroimaging technologies Zang-Hee Cho has suggested that “efforts to harmonize the qì of the patient may well be metaphorical explanations for fundamental physical processes that we are only now beginning to observe in medical research laboratories.”²⁷ The observed interconnectivity between stimulation of somatic acupoints with the corresponding ebb and flow of neural and hematologic activity in brain imaging studies may be interpreted as the movement of qi in the channels and the resultant blood flow responses.

For (medical or TCM) acupuncturists communicating with their Western patients, who think in terms of separate objects that interact in discrete ways, phrases such as “qì of the channels” could be substituted with “activity of the nerves.” Establishing balance between yin and yang energies in the body generally could be read as the autonomic outflow between the sympathetic and parasympathetic arms of the nervous system. Continuous qi of the organ systems could be exchanged for the particles associated with those organ systems, for example, pancreas (spleen) qi referring to pancreatic enzymes.

The yin qi that gives the structural and cooling element to the stomach could be specified as the muscle and mucilaginous walls, whereas its heating, digestive yang force is represented by the production of HCl. Once the concept of lifeforce is replaced simply by force, there are no types of qi that cannot be interpreted as known natural forces in the scientific sense, including atomic, photonic, electronic, thermal, gravitational, and on and on.

CONCLUSIONS

Concepts such as qi, rooted in ancient Chinese thought, need not be a stumbling block to the acceptance of Chinese medicine into mainstream medical practice in the West. Instead, qi can be understood as entirely congruous with scientific theory but the onus is on the Western practitioners and promoters of Chinese medicine to update the understanding of qi so that it is in line with authentic Chinese thought and free from Western projections such as lifeforce energy.

The Chinese have not invested belief in a separate lifeforce energy, mostly likely because Chinese do not tend to form abstract categories containing objects with specific properties, such as living versus nonliving with lifeforce versus natural force. For the Chinese, everything is a continuously evolving substance and that substance is qi. Qi is more than life, qi is the energy and forces of all, the fabric of existence itself.

AUTHOR DISCLOSURE STATEMENT

No competing financial interests exist.

FUNDING INFORMATION

No funding was received for this article.