Systemic thinking and Chinese medicine – a relational exercise
Rebecca
Ewert, Georg Ivanovas
Abstract: Western
medical thinking is characterized by a morphological
thinking embedded in a clear-cut concept of cause and
effect. However, this approach neglects relational and
systemic aspects. It was systemic psychotherapy that first
introduced such aspects into medical discourse. On the
other side, Chinese medicine was always obliged to a more
systemic thinking. This paper highlights some of the
similarities between systemic psychotherapy and Chinese
medicine.
This paper has the purpose to demonstrate some systemic
concepts of Chinese medicine which are similarly found in
general systems theory and in systemic psychotherapy.
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. Bertalanffy, in his
General systems theory, tried several times to explain the
differences between systems theory and the vitalistic
approach, but never convincingly. Terms like sexual energy
or the aim to survive are vitalistic concepts as well. Or,
they are, at least explanatory principles according to
Bateson (Bateson 38-58). Such vitalistic concepts are
necessary as there is yet no scientific theory of the
living.
In using the word CHI we would like to explain what call
the relational aspects of Chinese medicine.
The pictogram for CHI
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 but 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
be an animal or a device for gymnastics. So the meaning of
a word or an expression changes according to the context.
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 by Watzlawick et. al. on communication is
concerned with the two possibilities: 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.
Blood sugar testing is often done with test sticks.
Depending on the blood sugar level, the colour of the stick
changes. With a reference table, the blood sugar can be
estimated approximately (analogical method). The stick can
as well be inserted into a machine. The machine then gives
an exact value, let’s say 132. For the same procedure
there exists an analogical and a digital possibility.
However, the digital result of the machine is not more
exact than the eye (Kleesiek 2003), but normally it is
considered as more precise than the eyes approximate
(120-140).
That is, digital results seem to be more scientific than
analogical. However, the relational aspect is lost.
Similarly we have two possibilities to a watch, an
analogical and a digital form. The digital has more to do
with exactness; therefore it is used in films for time
bombs. Analogical watches are more used for appointments.
Another example would be the outcome of a race. The digital
result on the scoreboard is a clear and precise list. A
photograph of the finish line does often not provide such a
decisive impression. But it shows the relation between the
athletes.
These two examples might give a first feeling for the
differences between an analogical and a digital medical
thinking.
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 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 as 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.
These examples demonstrate that in Chinese medicine every
phenomenon is seen in an energetic way that is embedded in
a relational structure. It might be accidental that it uses
the terminology of a family. However, this and other rules
(husband-wife-rule) resemble strikingly the circular
causalities of family therapy including certain therapeutic
strategies. Also the conclusions on how to change a
pathological pattern are not so different.
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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 Oct, 2005.
This paper can also be found on Georg Ivanovas' web
site: http://www.ivanovas.com/english/relational.html