Understanding Principles as a Physician: General Framework of Heaven-Human Qi Transformation

Have you ever had this experience in daily life? You did not drink alcohol, binge-eat, stay up late, or get soaked in the rain yesterday, yet you wake up the next morning and find yourself ill. We have lived in our bodies for decades and still cannot always identify the pattern. That is actually quite normal.

The reason is that human beings and all living things exist within an extraordinarily multidimensional field of influences—an “energy field,” for lack of a better term. If we distinguish the layers more carefully, Heaven and Earth affect our state through many dimensions, like gears rotating at different speeds and acting on us through different cycles.

• Qi of Heaven: in the Five-Phase system—annual movement, host movement, guest movement; in the Three Yin–Three Yang system—Heavenly Administration (si tian), Terrestrial Effect (zai quan), host qi, and guest qi.
• Constitution of the person: the Three Yin–Three Yang person-types described in the Ling Shu: Tong Tian; the Twenty-Five Types in the Ling Shu: Yin Yang Er Shi Wu Ren; and qualities such as firmness or fragility and complexion discussed in the Ling Shu: Shou Yao Gang Rou and Ben Zang.
• Qi of Earth: the ancient Nine Provinces / Nine Fields.
• Weather and climate: the manifest result produced when the qi of Heaven and Earth interact, including the six climatic qi—Wind, Cold, Summerheat, Dampness, Dryness, and Fire—that can also be observed through modern meteorology.
• Acquired influences: diet, dwelling, and emotions.

For this reason, trying to trace every illness only to acquired causes after the fact is often futile. Moreover, the seven or eight “gears” above occupy different phase intervals at different times, their symbolic states change, and their strength rises and falls—much like what the ancients called “the six channels surging like waves.”

The human body is therefore both a sensor that receives the qi of Heaven and Earth and a carrier that also generates its own internal emotional constraints. Once these confounding factors are coupled together, the resulting state is highly time-varying.

How, then, should a competent physician deal with such complexity?

A. Observe the patient multimodally, as emphasized in the preface to the Shang Han Lun.

B. Understand what signs arise when the invisible dynamics of qi deviate from normal while operating through physiological structures at different levels of the body. To match reality, Chinese medicine often has a many-to-many relationship between symptoms and pathomechanisms. For example, dry throat can arise through at least eight distinct pathomechanistic pathways.

C. Use the relationships among nutritive qi, defensive qi, the channels, the zang-fu, and their externally corresponding subsystems—transmission, interior–exterior pairing, deficiency–excess, and so on—to compress many observations into fewer common causes.

D. Master spatiotemporal models at different scales so that what is observed in the patient can be matched against known regularities. The resolution times of the six channels and the number of days since onset in the Guilin ancient text are both examples of establishing spatiotemporal relations.

E. Work like a detective: eliminate competing possibilities until only the most coherent explanation remains.

The above describes the diagnostic stage.