Our purpose is to demonstrate that Chinese and Western medicine follow a different strategy of how to observe and to describe the conditions of health and disease. These strategies might be called analogical and digital.

Chinese medicine is based on the concept of a ‘life force’ called CHI. CHI is the basic energy inherent in all things. Without CHI stars would not shine. It creates weather and it circulates in the body (Hammer: 79). But as such it cannot be measured (Worsley: 79). Only its effects can be observed.

This is a so-called vitalistic idea. Vitalism is obsolete for normal scientific thinking, as there is no evidence for such a force or energy. On the other side, current science does not provide a theory of the living, either. Moreover, there is no difference between vitalistic concepts and modern concepts of organisation as, for example, general systems theory (Bertalanffy) as long as the vital force is seen as a description, as a metaphor. The problem arises only when a ‘causal thinking’ is introduced. If one assumes that an energy like CHI ‘causes’ all phenomena a whole train of question arises, like: What causes the cause? How might it be quantified?

All this makes not too much sense in the context of Chinese nedicine. Actually the concepts of cause and effect – so predominent in Western thinking – are somehow irrelevant for Chinese medicine. It is more charactized by a relational thinking. This is already found in the structure of the language. The pictogram for the word CHI is:

It is composed of

steam or vapour, and

(uncooked) rice.

Therefore CHI (life energy) reads: steam over rice. This is, of course, only an analogy. But such pictures are the basis for Chinese thinking. As in the West such analogies are mainly found in poems, Chinese language and thinking seems poetic to us. But for the Chinese it is not poetic. It is their normal way of thinking.

The inherent relational aspects shall be demonstrated with the help of a reflection by Heinz von Foerster. Von Foerster maintained that computing in the semantic area is different than computing in the mathematical field (Foerster/Bröcker: 329-331). A word, an idea or a concept is always embedded in a net of other elements. Von Foerster compares it with an octopus having a lot of tentacles which represent relational possibilities. A word like ‘horse’ can represent an animal or a device for gymnastics. So the meaning of a word or an expression changes according to the context. Gregory Bateson called this the relation between frame and content (Bateson: 177-193). In poetry, normally words are used in such a way that different relational aspects remain possible, whereas a Western scientific text leaves no room for interpretation. The latter leads to exactness, the former opens possibilities for connections.

The 4th axiom on communication by Watzlawick et. al. is concerned exactly with these two possibilities. It says: Human beings communicate both digitally and analogically. Digital language has a highly complex and powerful logical syntax but lacks adequate semantics in the field of relationship, while analogic language possesses the semantics but has no adequate syntax for the unambiguous definition of the nature of relationship (Watzlawick et al: 66-67). This concerns not only communication but has to be seen more generally, as the following examples demonstrate.

There are analogical and digital watches. A digital watch has more to do with exactness. In films it is used when a bomb will explode, but is normally deactivated shortly before the detonation. Analogical watches are used when lovers ought to meet – but mostly miss each other. The two watches provide a totally different feeling of how time goes by. Isn’t it so, Sam?

The next example is the outcome of a race: There are digital results on the scoreboard. They are clear and precise. An (analogical) photograph of the finish does often not give such a decisive impression. It shows the relation between the athletes

Another example is blood sugar testing. It is often done with test sticks. Depending on the blood sugar level, the colour of the stick changes. With a reference table of colours, the blood sugar can be estimated approximately (analogical method). It might range between 120-140. The stick can be inserted into a machine, as well. The machine provides an exact value, let’s say 132. That is, for the same procedure of blood sugar testing there are an analogical and a digital mode. Although the digital measurement of the machine is not more exact than the eye (Kleesiek 2003), it is considered to be precise than the eyes approximate. Just because there is a digital number. The price for the quantification of medicine is high: the relational aspect is lost.

In the West an organ like the liver has a defined anatomy and physiology which can be disturbed leading to a certain kind of pathology like hepatitis, cirrhosis, fibrosis or other. Everything is clearly digitalized and neatly categorized. The Chinese approach is different. The Chinese liver (GAN) might have local swellings, tensions or pains. But a disturbance of the liver might lead to problems in the digestion (constipation, diarrhoea), often accompanied by certain desires or aversions for food (fat or sour food). Although such symptoms are also somehow connected in Western medicine, they would not be seen as a liver symptom. But for Chinese medicine the liver (GAN) is responsible for many other issues. It makes the body smell sour, it involves all symptoms of the circulation, e.g. pulsating in the head with headache. Furthermore, GAN influences muscles and tendons, alters their expression including tension, cramps of the legs and tendonitis. Every organ has also a related organ, and in the case of the liver it is the eye. So all kind of ocular symptoms are a liver sign. That is, a bad diet overloading the liver might lead to eye problems. GAN is also connected to certain emotions, especially to anger and flexibility in thinking and in behaviour.

We see here a major difference between the two approaches: Western medicine is mainly structural, Chinese medicine is mainly functional. Therefore, for the Chinese the disease of an organ (ZANG-XIANG) is not only an alteration of the organ itself. It includes every sign the alteration provokes. ZANG-XIANG has been translated as ‘reflectoral and algetical signs of an inner organ’ (König/Wancura, 1983: 13). By that it comprises not only objective signs and subjective feelings (König/Wancura, 1979: 121), but all vegetative impacts, neuromuscular relations, the representation on body surface and corresponding emotions as well (König/Wancura, 1979: 216).

These are (in Western terms) not only somatic, psychological and psychosomatic aspects. The Chinese diagnosis includes the semiotic aspect as well. Semiotics is concerned with symbols and their influence. People with ‘a broken heart’ who suffer from emotional stress might develop a distinct form of heart symptoms (Ebert 2005). Although this might be explained by stress hormones it involves also a semiotic aspect: we all know what a broken heart is and that the heart is the centre of love and compassion. So this very knowledge alters the expression of stress or even is able to create stress.

Whereas for Chinese medicine all this is an expression of the same organ, in Western medicine these are different subjects treated by different specialisations. The physician is mainly concerned with the anatomical and physiological aspect. Reichian psychotherapy and bioenergetics are concerned with the functional aspect, although they seem to match best the Chinese concept of organs. But they still miss the semiotic aspect which is mainly covered by psychoanalysis or Jungian psychotherapy. What we see here is actually the split between body and mind, between objective and subjective that is inexistent in Chinese medicine.

In systemic psychotherapy some concepts such as Minuchin’s ‘conjoined physiology’ (Minuchin/Fishman: 12-13), or the concept of family somatics (Kröger/Altmeyer 2000) go in this direction, but they are not comprehensive. On the other side, systemic psychotherapy goes beyond the limitations of a theoretical ‘individual’ and includes the nearer environment. This is also the case with Chinese medicine, but in a different way. The handling of the symptoms is quite similar to systemic psychotherapy, especially to the strategic approach. Chinese medicine is very much based on the observed and uttered symptoms. The felt reality is of main importance (König/Wancura, 1979: 188). Furthermore some causal factors are taken into account such as the outer factors heat, cold, fire, wind, dryness, dampness and the inner factors joy, fear, anxiety, worry, anger, grief. However, these factors are interrelated and basically – just as in systemic psychotherapy – digital distinction of cause and effect is inexistent in Chinese medicine.

For example, cold and fear are correlated with each other, such that a fearful person will be more susceptible to a disease from cold than a less timid one, and excessive exposure to cold can trigger fearfulness. That is, the causal connection becomes relative, as each factor is not only cause, but effect as well. That is, the cause and the reactional type are equated (König/Wancura, 1979: 185): only a cold type suffers from cold, only an angry type develops anger. A disease can only arise after the inner balance was lost in the first place, and thus only an ill person becomes ill. Basically, the loss of harmony is already the disease.

The signs and symptoms are but hints for the real nature of the disease (Hammer: 44) which help to decide on the correct therapy (König/Wancura, 1979: 122). In order to do this all symptoms (observed and felt) are investigated with the logical operators Yin and Yang. The two represent the ‘sunny’ side or the ‘shady’ side of a situation. Nothing is yin or yang; the terms characterize a relation. This relation is described for example according to the 5 elements.

The elements fire, earth, metal, water, wood represent the cyclic rhythm of nature in which all living is embedded. Therefore their circular organisation is a blueprint to understand all processes connected to CHI. Thus, the processes in humans can be described in the same manner. We have here an ‘energetic’ structure, or better: a relational pattern.

According to the theory of the 5 elements energy circles from one element to the next in a clockwise direction. Through this “nourishing” (sheng) cycle, every element is linked to the two adjoining ones. Chinese medicine describes the relation between these elements through an analogy of the family. The element or meridian that nourishes the next is called the ‘Mother’ and the element or meridian that receives this energy is called the ‘Son’ or ‘Child’. If the mother is disturbed (and thus can’t properly nourish its child), then the child becomes sick. This might cause the ‘grandmother’ to become sick in turn, like a worrying grandparent who feels they cannot do anything to make the grandchild get better. This is the frame in which every therapy is designed. The ‘Mother-and-Child-Rule’, for example, says that if the mother is in excess (has too much energy) the child has to be sedated and if the child is in deficiency (too little energy) the mother has to be tonified. If in such a case the child is treated the mother becomes even worse (Worsley: 48)

Another strong dynamic between the elements is the “controlling” (ko) cycle, through which every element is related to the two opposite elements in the circle: too much water will extinguish a fire, while no “watery” restriction at all will cause it to flare up and then consume itself. A grandparent who spoils their grandchild rotten will cause trouble to their own child because the grandchild will act up to her mother afterwards. A grandparent that is too strict with their grandchild will make it very needy towards its mother, at least for a while. Through these two cycles, every element is linked directly to every other element and thus can balance or imbalance the whole system.

Western medicine is based on a digital understanding of the world. This shall be demonstrated with the following citations:

Measure what is measurable. Make measurable what is not measurable.
attributed to Galileo Galilei (1564-1642)

Everything that exists, exists in a quantity and can therefore be measured.
attributed to Lord Kelvin (1824-1907)

Know which abnormality you are going to follow during treatment. Pick something you can measure.
C. Meador (1999)

As a consequence the understanding of relations is lost. This leads to an ‘autistic-undisciplined thinking’ (Bleuler). Modern definitions of autism (“impaired language, social and communicative deficits, repetitive and stereotyped behaviors” – Powell 2004) refer exactly to this lack of relational thinking. Interestingly, Westerners trying to adopt Chinese medicine have often the tendency to digitalise it. For example, every point of influence (the acupuncture points) have a name connected to their function. The point Shugu (Restraining Bone) influnces bones and joints. In the West it is just number 65 on the urinary bladder meridian. These numbers are unknown in China.

It is not necessary to demonstrate this tendency to ‘digitalise’ relational aspects with other examples. The important point is to be aware of the basic difference in the two ways of thinking.

REFERENCES:
Bleuler E (1962): Das autistisch-undisziplinierte Denken in der Medizin und seine Überwindung, Springer, Berlin
Ebert J (2005): A broken heart harms your health, news@nature.com, available (5.4.05):
http://www.nature.com/cgi-taf/DynaPage.taf?file=/news/2005/050207/full/050207-11.html
Foerster, Heinz von and Bröcker, Monika (2002): Teil der Welt. Carl-Auer-Systeme, Heidelberg
Hammer, Leon (1990): Dragon rises, red birds fly Station Hill, Barrytown; citation of pages according to the German translation Psychologie & chinesische Medizin, Joy, Sulzberg, 2000
Kleesiek K (2003): Unzureichende Qualität patientennaher Glucosebestimmungen: Ringversuche offenbaren erhebliche Unterschiede zwischen den benutzten Geräten. Dtsch Arztebl 100: A 2454–2455
König G, Wancura I (1979): Praxis und Theorie der neuen Chinesischen Akupunktur – Band 1, Maudrich, Wien
König G, Wancura I (1983): Praxis und Theorie der neuen Chinesischen Akupunktur – Band II, Maurich, Wien
Meador C (1999) A Little Book of Doctors’ Rules IARC Press, Lyon
Powell K (2004): Opening a Window to the Autistic Brain, PloS Biology 2; 8, available
http://www.plosbiology.org/plosonline/?request=get-document&doi=10.1371/journal.pbio.0020267
Watzlawick, Paul; Beavin, Janet Helmick; Jackson, Don D. (1967): Pragmatics of Human Communication. Norton, New York
Worsley JR (1982): Talking about acupuncture in New York, College of traditional Acupuncture, Leamington Spa. Side citation from the German translation Was ist Akupunktur, Neue Erde, Saarbrücken, 2000

CITATION:
Ewert R, Ivanovas G (2005): Systemic thinking and Chinese medicine – a relational exercise, 3rd Greek Conference of Systemic Therapy, gemeinsam mit: Rebecca Ewert, 3. Πανελλήνιο Συνέδριο στη Συστεμική Θεραπία Heraklio 21.-23.10.2005