Classical Chinese Medicine and Contemporary Science: The ......The practice of physician acupuncture faces unique challenges in its development and inclusion as a recognized medical

PERSPECTIVES

Classical Chinese Medicine and Contemporary Science:The Vascular Model of Disease Pathogenesis.

A Common-Path Theory of Human Illness

Edward Neal, MD, MSOM

ABSTRACT

The practice of physician acupuncture faces unique challenges in its development and inclusion as a recognizedmedical specialty. Information contained in early Chinese medical texts offers solutions to some of the dividesthat separate Chinese Medicine from contemporary biomedicine. Recent advances in classical text research—made possible by the establishment of Chinese language databases—provide new hypotheses of diseasepathogenesis and new strategies for treating various acute and chronic illnesses.

The Vascular Model of Disease Pathogenesis summarizes some theories of early Chinese medicine intolanguage recognizable by modern science. This theory bridges some of the current disparities between ancientand modern practices and offers a new model of human health, illness, and clinical therapeutics.

Key Words: Classical Medicine, Neijing, Acupuncture, Traditional Science, Vascular Model of Disease Pathogenesis(VMDP)

INTRODUCTION

Chinese Medicine (CM) is one of the world’s oldestand most-practiced forms of health care. Around the

world, many patients are helped by these therapies on adaily basis. Yet, recent reevaluations of early Chinesemedical texts suggest that current practices may yield onlypartial efficacy from these therapies. The reasons for thisare complex and include issues of history, culture, politics,language, and basic medical theory. Navigating these is-sues successfully is a critical challenge facing the de-velopment of physician acupuncture and the broader fieldof CM.

CURRENT CHALLENGES

Some challenges facing the practice of physician acu-puncture are outlined in the sections below.

Basic Principles

Many principles in CM were described in early Chinesemedical texts written between the fourth century bce andsecond century ce.* While these texts are recognized as thetheoretical foundation of Chinese medicine, their fullmeaning has remained elusive over the centuries.1

Over the past 25 years, a majority of surviving earlyChinese texts have been archived on computer databases.{

Xinglin Institute for East Asian Medical Research, Portland, OR.

*Examples of important early medical texts include theHuangdi Neijing: Suwen and Lingshu (Yellow Emperor’s InnerClassic: Plain Questions and Divine Pivot), Shennong BencaoJing (Shennong’s Herbal Classic), Shanghan Lun (Treatise onCold Damage) and Zhouyi (Zhou Dynasty Classic of Change—more commonly known as the Yi Jing or I Ching).

{The CHANT database at the D.C. Lau Research Centre forChinese Ancient Texts at the Chinese University of Hong Kongwas the primary source for the Chinese text used in this article.This project started in 1988.

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This allows for new types of Sinological text research thathave shed light on the meanings of early Chinese medicaltheories—theories that often differ from current under-standing and that are, at times, curiously biomedical inconcept. Early medical texts provide innovative ideas ofhuman health and disease and offer new promise to Chineseand Western medicine as well as to Western scientific re-search and methodologies.

When considering the role that basic medical principlesplay in clinical medicine, it is useful to consider the conceptof primary and subsidiary definitions of meaning. Primarydefinitions describe the elementary meanings of a givenprinciple; subsidiary definitions describe secondary mani-festations of the primary principle. For example, to under-stand that the terms Yin ( ) and Yang ( ) describe aprimordial tendency of the universe to expand and contractreflects a primary understanding of these terms. To knowhow these principles qualify different states of cold and heatrepresents a subsidiary understanding of these terms. Here,different conditions of heat and cold arise from the primaryforces of expansion and contraction and, thus, representsecondary manifestations of the primary principle. Knowingprimary definitions allows one to comprehend subsidiarymanifestations but the reverse is not always true (Table 1).{

The distinction between primary and subsidiary defini-tions becomes important when examining the role thephysician plays in clinical medicine. Regardless of any

specific professional licensure, a physician can be under-stood to be an individual who, who by virtue of training andability, manages medical complexity successfully from athorough knowledge of basic medical principles. In con-trast, regardless of licensure, ancillary health care workersare introduced to basic medical theories but typicallypractice from sets of established rules and protocol guide-lines based on subsidiary manifestations of principle. Usingthis metric, most CM in the West today is practiced at anancillary health care level. Put another way, while there aremany CM practitioners in the West, there are few whopractice as CM physicians.x Early medical texts help resolvethis issue by providing sine qua non definitions of ele-mentary Chinese medical principles such as Qi ( ), Yin( ), Yang ( ), Jing ( ), Shen ( ), and Wuxing ( ).

Historical and Cultural Understanding

In the West, many practitioners lack basic knowledge ofChinese language and history. They are thus dependent onsecondary sources of information that vary in accuracy andquality. Lack of historical and cultural understanding alsolimits the capacity to test new ideas and practices and leavesthe profession, as a whole, vulnerable to speculation andhearsay. Hypotheses and statements may too often be val-ued on the basis of narrative persuasion, general esthetics, ornonspecific resonance with archetypal symbolism ratherthan on the precision or accuracy of ideas. In contrast,established Western medical specialties, such as general

Table 1. Primary and Subsidiary Definitions of Principle

Basic principle Primary principle Secondary manifestations

Yin Yang Impulse of the universe to expand and contract Cold & heat, night & day, heaven andearth etc.

Qi Fabric of space–time Energy, steam, clouds, etc.

WuxingFive Circulations

Motion of the stars & planets around the pole star Five elements, Four seasons, Wood,Fire, Earth, Metal, Water. etc.

Sanyin sanyangShaoyang, Yangming, Taiyang,

Jueyin, Shaoyin, Taiyin

Patterns of motion within the biosphere Yangming channel, Yangmingsyndrome, etc.

Shen A dimension of space–time around which lifeorganizes itself that does not follow normalfluctuations of nature

Spirit, intelligence, vitality, God

BiObstruction Syndromes

Regional anatomical freezing of the space–timebreath

Painful obstruction syndromes, arthritis

Primary definitions of medical principle provide the elementary meaning of the principle; subsidiary definitions describe secondary manifestations of

the basic principle. Here, primary definitions from the Huangdi Neijing: Suwen and Lingshu (refs. 1 and 2) are shown alongside corresponding subsidiary

definitions found in contemporary Traditional Chinese Medicine.

{Early Chinese texts describe complex patterns of change andmotion that are reflected in the primary meanings of the terms Yin( ) and Yang ( ). In contrast, qualities of heat and cold representdescriptions of discrete physical states. Typically, descriptions ofcomplexity, change and motion characterize early Chinese med-ical thinking; descriptions of static states and unchanging materialreality epitomize Western medical thought.

xA Western medicine-trained physician performing CM tech-niques is not commensurate with an individual practicing as a CMphysician. It is the view of the author that physician acupuncturistsshould strive for high-level competency in both Western medicineand CM—being fluent in both systems and not simply practicingas allopathic physicians who utilize CM techniques.

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surgery, share a common culture, language, and history thatallow Western medicine’s members to test new ideas better.

Clinical and Theoretical Fragments

Like boulders coming to rest at the bottom of a glacialmoraine, CM in the West currently consists of a diversity ofpractices drawn from many sources. This heterogeneity is

sometimes described as the ‘‘rich tapestry’’ of CM. WhileCM does draw from many sources, in the West, diverseapproaches are often linked in ways that lack theoreticalcohesion. This presents basic challenges to the profession.For example, how is relevant research pursued when indi-vidual practitioners each practice something unique?Lacking organizing themes, it is difficult to understand thesediverse practices in a unified framework. Early medical

FIG. 1. Traditional versus modern science. Traditional and modern sciences differ in basic ways. In a window from ChartresCathedral, scenes of religious life are seen intermingled among geometric patterns that frame the scene. Modern observers will tend tofocus on the scenes of religious life. In contrast, traditional science investigates the organizing patterns that lay behind the world we see.In traditional systems, different manifestations of nature have scientific meaning to the degree that they clarify deeper questions of theunseen, organizing patterns of nature. (Source: https://upload.wikimedia.org/wikipedia/commons/e/ef/Chartres_-_Vitrail_de_la_Vie_de_Joseph.JPG ; figure is in the public domain).

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texts help address this problem by providing the funda-mental theories and principles that are able to unify diversedoctrines and practices.

Traditional Versus Contemporary Science

Modern biomedicine is a relatively young science. Fur-thermore, it is only one of a number of ways that can be used totest the world. Like any descriptive system, modern sciencehas both strengths and weaknesses. In particular, it often hasdifficulty analyzing issues of change and complexity found innatural systems. Traditional Chinese medical science offers analternative paradigm to modern scientific inquiry that can beused coequally to test and gain useful insight into the world.

To be recognized as a true science any intellectual activitymust meet several basic criteria: (1) Scientific conclusionsmust be based on (or be consistent with) observed naturalphenomena. (2) Scientific conclusions must be meaningfulwithin a broader theoretical framework. (3) Scientific con-clusions must have consistent, predictive capacities.

According to these criteria, both contemporary medicalresearch and traditional Chinese medical research qualify astrue sciences, although the principles and methods they use toreach their conclusions are different. Importantly, traditionalChinese scientific research represents a unique instance of ascientific culture with its own established rules and principles.Until these differences of scientific culture are understood,modern scientific inquiry is likely to stay limited in its con-clusions about, and insights into, these traditional practices.

Traditional Chinese medical research differs from con-temporary science in several basic ways. Some of these in-clude: (1) Traditional Chinese science sees the distant past asthe source of theoretical authority and inspiration; contem-porary science often values what is new and currently dis-covered. (2) Traditional Chinese science prioritizes the studyof the unseen cyclical patterns of nature that are thought toexist behind the visible world we observe; contemporaryscience emphasizes the manifest world as it is perceived di-rectly. (3) Traditional Chinese science prioritizes the study ofchange and complexity in natural systems; contemporaryscience commonly limits research variables by intentionallyexcluding issues of change and complexity in order to un-derstand the world in discrete segments (Figs. 1 and 2).

Classical Medicine

Early Chinese medical texts contain an extensive amountof theoretical and clinical information. Much of this mate-rial awaits further research and lies outside the scope ofthis article. But a summary of the ideas related to medicalacupuncture—as described in early medical texts such as theHuangdi Neijing: Suwen and Lingshu—can be described asin the sections that follow.2,3

The universe is a breath that moves through dif-ferent states of order and complexity. Early Chinesemedical theory is built around the central hypothesis that, at

the most basic level, the universe behaves as breath thatmoves back and forth between different states of chaos andorder. In early medical texts, the primordial forces of cy-clical motion are called Yin ( ) and Yang ( ).{,k Anymedical practice that cannot trace its ideas back to thisoriginal principle does not exist within the traditional rubricof classical Chinese medicine.**,{{

All aspects of existence arise from the universal Yin( ) and Yang ( ) breath. All phenomena in the uni-verse—including the human body—derive from differentexpressions of the universal Yin ( ) and Yang ( ) con-traction and expansion impulses. In medicine, this meansthat all aspects of the physical body, and the experience ofhealth and illness, can be traced back to different phasemotions of this breath.{{

Where the body moves freely with the universal Yin( ) and Yang ( ) breath there is health; where it does

{Early Chinese medical texts describe the relationship thatexists between patterns of cyclical change and human health andillness. In early texts, the primary forces of cyclical change arecalled Yin ( ) and Yang ( ). In the Huangdi Neijing: Suwen andLingshu,2,3 both the motive impulse of these motions and thecomplex motion patterns they generate on earth are called dao( ). The intrinsic ruling factor that keeps these motions movingwith overall coherence and organization is called ji ( ) mecha-nism. In this article, the author summarizes these different qual-ities by using the term breath.kCf. the following description given by the nineteenth-cen-

tury missionary Ernst J. Eitel: ‘‘Nature, as I have had occasionto remark before, is looked upon by the Chinese observer as aliving breathing organism, and we cannot be surprised, there-fore, to find the Chinese gravely discussing the inhaling andexhaling breath of nature. In fact, with the distinction of thesetwo breaths, the expanding breath, as they call it, and revertingbreath, they explain almost every phenomenon in nature. Be-tween heaven and earth there is nothing so important, so al-mighty and omnipresent as this breath of nature.’’ From FengShui, or, the Rudiments of Natural Science in China by Ernest J.Eitel [1873], published in Hong Kong by Trubner & Co.

**A practitioner inserting a needle into a trigger point mayachieve therapeutic results, but, unless this is done according tothe theoretical principles of Chinese medicine, it is not considereda CM therapy.

{{Some ideas, such as the varied theories of herbal medicinefrom later dynasties, may seem far removed from early medicaltheory. The ideas upon which these succeeding theories are based,however, may be traced back to earlier texts such as the HuangdiNeijing: Suwen and Lingshu.2,3 This is a primary reason why thesetexts are considered to be foundational.

{{In early Chinese medical theory, different aspects of thephysical body arise from different qualities of phase motion. Forexample, the liver, gallbladder, connective tissue and nails werethought to arise from the expanding phase of the universal Yin ( )and Yang ( ) breath; the lungs, respiratory tract, large intestineand skin arise from the contracting phase of this breath. On Earth,the different phase directions of the Yin ( ) and Yang ( ) breathare typically notated as Wood ( ), Fire ( ), Earth ( ), Metal ( ),and Water ( ) and/or East ( ), South ( ), Center ( ), West ( ),and North ( ), respectively.

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not there is impairment and illness. When the body’scirculations move freely in response to innate physiologicprocesses and the larger external patterns of Nature, theindividual is considered healthy and should commonly liveto be *100 years old. During their lifetimes, they shouldnot become ill or require medical attention. However, whenthis circulation is impaired, the individual frequently be-comes sick and life expectancy is cut roughly in half.xx,{{

The primary pathology of human illness is the Bi( ) syndrome. In early Chinese medical texts, the pri-mary pathology of human illness was described as the Bi( ) syndrome.kk Bi ( ) syndromes are localized areas oftissue obstruction in the body’s three-dimensional anatomywhere the universal Yin ( ) and Yang ( ) breath ceases tomove freely. These obstructions were seen to arise from a

FIG. 3. Original descriptions of acupuncture circulation. Theoriginal descriptions of acupuncture theory describe the ana-tomical pathways and clinical qualities of the body’s three-dimensional mai ( ) (blood vessel) circulation. Later, asacupuncture point theory rose in influence, many of these path-ways were shifted to the external surface pathways of the bodyand, in the process, were displaced from their original locationnear blood vessels. Modern descriptions of vascular circulation,such as those seen in this contemporary angiogram, share signif-icant commonalities with early acupuncture theory. (Source:Vince Michaels/Getty Images).

FIG. 2. Patterns of Nature’s complexity and change. Cloudsmoving across the surface of the earth behave according to well-recognized laws of scientific meteorology. Yet, on a second-to-second basis, it is impossible to predict their motion because ofthe overall complexity of their circumstances. Similar patternsare seen in natural systems such as the physiologic processes ofthe human body. In these instances, explanations provided by themodern scientific method often prove to be inadequate. (Source:http://upload.wikimedia.org/wikipedia/commons/d/db/Nasa_blue_marble.jpg ; figure is in the public domain).

xxThese descriptions are given in the first chapter of theHuangdi Neijing (Yellow Emperor’s Inner Classic)‘‘Treatise on the Heavenly Truths of Ancient Times.’’1

{{Cf. Lingshu chapter 92,3:

. ‘‘The term ‘pingren’ ( )balanced person, (means) no illness. No illness (means) that themaikou ( ) radial and renying ( ) carotid pulsations changewith the four seasons, that the (motions) of ascent and descent movein accordance with the (motions) of departing and arriving, that themai ( ) blood rivers of the six channels move without restriction,that the (forces) of cold and warmth moving within the roots andbranches (of the body) are protected and governed, that the(circulation) within the form, flesh, blood and qi do not contendtogether. This is called (the state of being) a ‘pingren’ (balanced person).’’

kkIn modern Traditional Chinese Medicine, the term Bi ( )syndrome describes a category of ‘‘painful obstruction syn-dromes’’—a clinical classification of painful arthritis syndromes.This represents a narrower definition than was originally envi-sioned in early medical texts and illustrates the difference betweenprimary and subsidiary definitions of basic principles.



variety of causes and can appear anywhere in the humanbody.*** Bi ( ) syndromes create impaired patterns of flow( ) and counterflow ( ) circulation and create functionalblood reservoirs that impair the body’s homeostatic regulationand hold the circulation in fixed patterns of illness.{{{

In early Chinese medical theory, Bi ( ) syndromes wereseen to be the physiologic basis for the majority of chronichuman diseases. Early medical texts, such as the Neijing,1

focus extensively on the diagnosis and clinical resolution ofBi ( ) syndromes. Classical acupuncture itself was an ex-

FIG. 4. The Vascular Model of Disease Pathogenesis (VMDP).The VMDP summarizes basic ideas from early Chinese medicaltheory and translates then into a language recognizable to modernclinicians and scientific researchers. In this model, human diseaseproceeds in a series of discrete steps: Inciting pathologic eventsdisturb areas of preexisting weakness, resulting in acute impair-ments of regional blood circulation (1,2). Acute circulation dis-turbances then either spontaneously resolve (3) or generatechronic tissue plane-based obstructions (4). Chronic obstructionsgenerate fixed vascular configurations that generate the conditionsnecessary for chronic illness to develop and flourish (5,6). Fixedvascular impairments generate diverse clinical syndromes de-pending on the constitution of the individual patient, the locationand nature of the original obstruction and the environmental mi-lieu in which they occur (7).

FIG. 5. Role of the human vascular system. A majority of thebody’s homeostatic regulatory systems rely on the vascular systemto carry out their functions. When this circulation is poorly reg-ulated, the body’s healing capacity becomes impaired and acute orchronic illness is a common result.

FIG. 6. Human microcirculation. The human vascular systemcomprises a complex collection of circulation patterns that con-stantly shift in relation to activity, physiology, and external en-vironmental changes. In early Chinese medical texts Bi ( )syndromes cause chronic obstructions of both local and nonlocalvascular circulations that may allow illnesses to arise and persist.Here, thermographic images show complex, surface vascularchanges in a patient with breast cancer. Early Chinese medicaltheory predicts that alterations in micro- and macrovascular cir-culation antecede both acute and chronic illness such as cancer.Such a causal link remains to be proven by modern researchmethodologies. (Source: http://upload.wikimedia.org/wikipedia/commons/7/73/BreastCancerRightSamplel.jpg; figure is in thepublic domain).

***In early medical texts, Bi ( ) syndromes arise from severalfactors. These include: (1) issues of climate/environment; (2) is-sues of lifestyle and diet; (3) issues of prenatal and postnatalconstitution; and (4) issues of emotional distress. Each pathologicfactor operates by destabilizing the body’s vascular equilibriumand predisposes the individual to illness. In modern practice, en-vironmental pollutants, medications, surgery, and injuries are alsoseen in the development of Bi ( ) syndromes.

{{{Bi ( ) syndromes form functional blood reservoirs that trapcirculating pathogens within the body’s three-dimensional anat-omy. When Bi ( ) syndromes are released through correct di-agnosis and treatment, significant amounts of pathogenic factorscan be released into the circulation. This is a potential danger forboth patient and practitioner and must be approached with care.

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ternal surgery that was used to resolve Bi ( ) syndromeswhere they existed in the various tissue planes of the body.When Bi ( ) syndromes are treated correctly and vascularcirculation restored, in many cases, the body’s homeostaticmechanisms are reestablished, areas of impairment nor-malize, and human illness spontaneously resolves in ahighly orchestrated and elegant way.

Modern acupuncture channels arose from earlycomplex descriptions of the human vascular sys-tem. Early Chinese medical texts provide complexdescriptions of the human vascular system.{{{ These de-pictions encompass the entire micro- and macrovascularcirculation of the human body and provide portrayals that, insome ways, eclipse even modern understanding of bloodcirculation in both scope and insight.xxx For various histor-ical reasons, the initial associations with blood circulationfaded relatively early and point action theory rose inprominence and displaced some of these early ideas. At-tention then shifted to surface channel anatomy and thelocation and action of specific acupuncture points. Pathwayswere often moved away from their original locations near

blood vessels (Fig. 3). The loss of association betweenacupuncture theory and the body’s vascular anatomy re-mains a significant obstacle to the integration of traditionalChinese medical practices and contemporary biomedicine.

THE VASCULAR MODEL OF DISEASEPATHOGENESIS

Early Chinese medical texts define principles that can beused to construct a model of disease recognizable to thevernacular of contemporary biomedicine and modern sci-entific research. The Vascular Model of Disease Pathogen-esis (VMDP) is a summary of some ideas of early Chinesemedical theories designed to allow better recognitionand understanding by modern researchers and clinicians(Fig. 4).{{{ A primary goal of this model is to provide aconceptual and translational bridge for modern research-ers and clinicians to access some ideas of early Chinesemedicine for evaluation, testing and clinical implementa-tion.

Concepts of VMDP

VMDP is stated according to the following sectionsbelow.

FIG. 7. Tissue plane obstruction and chronic illness. Bi ( ) obstructions are physiologically inert impairments that create complexshifts in the body’s vascular ecology and set the stage for chronic illness to arise and persist. Here, identical Bi ( ) obstructionsoccurring in two different patients (A1, A2) generate two distinct clinical syndromes because of differences in each individual’sconstitution and unique response. Two unique clinical syndromes arise from the same cause but are treated by the same therapeuticmethod.

{{{Early descriptions of human circulation offer not only de-tailed descriptions of the physical anatomy, they also articulatehow these structures function dynamically in living systems, howthese structures function in health and illness, and how thesestructures are perceived as individual felt experiences. Thus, thesedescriptions augment Western anatomical descriptions that arelargely based on observations of nonliving systems.xxxEarly descriptions of mai ( ) blood vessel circulation cate-

gorize and detail signs and symptoms of impaired regional bloodflow circulations. These observations currently have no correla-tion in Western medicine.

{{{The VMDP is a model developed by the author from earlyChinese medical theories to facilitate the discourse betweencontemporary biomedicine and traditional Chinese medical sci-ence and to increase access to these advanced ideas for contem-porary practitioners and researchers.



All human illnesses involve a primary impairmentof blood circulation. Regardless of the inciting event, allpathologic processes in the body must disrupt either micro-and/or macrovascular blood circulation to become a rec-ognized human illness or clinical syndrome. Without adisruption of vascular circulation, pathogenic factors simplyrepresent disease potential but cannot express as actualhuman illnesses and impairments. Some of the reasons forthis are intuitive: a majority of the body’s homeostaticmechanisms act via the blood circulation (Fig. 5). Whenmicro- and/or macrovascular circulation patterns are im-paired, regulatory processes cease to function adequately.The body’s healing mechanisms begin to fail and the indi-vidual becomes susceptible to illness.kkk

Impairments of blood circulation represent a ‘‘com-mon-pathway’’ in disease pathogenesis. Disruptions ofvascular circulation represent a functional ‘‘gate’’ throughwhich all pathologic processes pass before they become arecognized illness. Because vascular impairments are thefundamental prerequisite for disease expression, they are acommon step in disease pathogenesis that may be targeted forclinical intervention. This suggests that previously diverseand unrelated categories of human illness can potentially betreated by a single and unified therapeutic protocol.****

Chronic vascular impairments generate a diversityof local and nonlocal clinical syndromes. Because thevascular system consists of a complex set of linked regionalcirculation ecologies, localized tissue plane impairments ina specific location generate both local and nonlocal clinicaleffects. How a given impairment expresses clinically de-pends on the location and nature of the original obstruction,as well as the constitution of the individual patient and the

environmental milieu in which that patient resides. Becausetissue-plane obstructions exist outside the body’s normalphysiologic processes, primary obstructions themselves aremost often clinically silent and typically express throughsecondary, nonlocal signs and symptoms (Fig. 6).{{{{

Chronic illness results from fixed obstruction pat-terns within the human vascular circulation. Thehuman vascular system comprises an elaborate set of inter-related micro- and macrovascular ecologies that constantlyshift in relation to complex changes of physiology, activity,and the external environment (Fig. 7). Chronic illnesses arisewhen obstructions in the body’s anatomical tissue planesconstrain vascular circulation, resulting in a fixed ‘‘configu-ration of illness.’’ This sets the stage for impairments in ho-meostatic regulation and allows for the formation of chronicillness. In modern practice, tissue-plane impairments remainlargely unrecognized; most health care systems in today’sworld do not recognize these primary impairments but in-stead attend to the various secondary sequelae generated bythese underlying obstructions.

Treatment of vascular obstructions reestablishes thebody’s healing capacity. When the vascular circulationis normalized through proper diagnosis and treatment, in amajority of cases, homeostatic regulation returns and the bodyspontaneously and elegantly heals itself through a highly in-telligent process that has few significant, adverse effects.

DISCUSSION

Early Chinese medical texts provide a complex descrip-tion of the body’s vascular circulation and facilitates anunderstanding of the role that vascular impairments mayplay in the expression and treatment of human illness. Inthese descriptions, various inciting events generate fixedobstructions in the body’s tissue planes that, in turn, giverise to both transient and stationary alterations in the body’svascular ecology. This results in diverse patterns of illnessand clinical syndromes.

These theories suggest that human illness may result, notfrom the overt expressions of illness that are commonlyobserved but, rather, arise from the many and diverse waysin which the body’s vascular circulation and homeostaticregulations fail. The majority of these impairments occur inways that are currently unrecognized by many current healthcare systems. An integral part of these ideas is the idea that

kkkOn first examination, the idea that vascular impairmentsrepresent a common pathway for the development of all humanillness may seem improbable. Yet, on closer examination, thishypothesis does not seem entirely far-fetched. Infectious diseases,such as tuberculosis, are not considered vascular diseases per se.They do, however, affect regional microcirculations in the formsof inflammation and alterations in local blood flow. Metabolicdiseases, such as diabetes, cause clinical syndromes primarilythrough their effect on micro- and macrovascular blood flow.Psychiatric illnesses show significant differences in regional braincirculation on dynamic scans. Inflammation—a hallmark of manyhuman diseases—affects the microcirculation in well-documentedways. Even general conditions, such as stress, alter in bloodpressure, heart rate, regional muscle blood flow, and hormonalregulation. In fact, on closer examination, it is difficult to identifyany human disease that does not impair micro- or macrovascularcirculation as an integral part of the disease process. This suggeststhat there may be validity to these early ideas and that they areworthy of further investigation.

****Early texts such as the Neijing1 present a unified thera-peutic approach to diverse human illnesses. Specifically, this wasthe targeted regulation of the body’s micro- and macrovascularcirculations.

{{{{By definition, Bi ( ) syndromes represent localized areasof the anatomy where normal homeostatic mechanisms do notoperate; these areas do not communicate with the body’s physi-ology and thus are, themselves, most often clinically silent. Dur-ing treatment with acupuncture needles, Bi ( ) syndromes mayappear to the clinician as areas of devitalized, leathery, or woodentissue.

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vascular impairments represent a common pathway in theevolution of illness that can be strategically targeted forresolution through correct diagnosis and treatment in a diverseset of illnesses and clinical syndromes. If modern researchvalidates this hypothesis, it have the potential to significantlyalter clinical practice and disease outcomes.{{{{,xxxx

According to these ideas, the single greatest health challengefacing the world today may not be any commonly recognizedhealth care problem. Rather, it may be the inability of currenthealth care therapies to understand, diagnose correctly, andtreat complex vascular impairments and areas of homeostaticdysregulation that occur in a diverse set of medical illnessesand clinical syndromes. Early Chinese medical texts, suchas the Huangdi Neijing, give specific instructions to resolvetissue-plane–based obstructions and normalize vascular circu-lation. Because early Chinese medical therapies are low-cost,have few side-effects, require little physical infrastructure,and can be used in a variety of global health care settingsthen, if proven true, the impact of these ideas on humansuffering and health care dollars could be significant.

CONCLUSIONS

Early descriptions of CM offer a different view of thebody from those currently given by either Western medicine

or contemporary CM (Traditional Chinese Medicine). TheVMDP summarizes and articulates some ideas of earlyChinese medical texts and provides a new model of humanhealth and illness. If validated by contemporary research,the VMDP has the potential to alter the practice of medicinesignificantly and become an important discovery of moderntimes.

ACKNOWLEDGMENTS

The author would like to thank Joslyn Dugas, LAc,Stephen Boyanton, LAc, and Chris Estes, MD, for com-ments and editorial review.

This work was supported by a generous grant from theSamuel Lawrence Foundation.

DISCLOSURE STATEMENT

No competing financial interests exist.

REFERENCES

1. Neal E. Introduction to Neijing classical acupuncture, part I:History and basic principles. J ChinMed. 2012;100:5–14.

2. Neal E. Introduction to Neijing classical acupuncture, part II:Clinical theory. J Chin Med. 2013;102:20–33.

3. Neal E. Introduction to Neijing classical acupuncture, part III:History and basic principles. J Chin Med. 2014;104:5–22.

Address correspondence to:Edward Neal, MD, MSOM

The Xinglin Institute for East Asian Medical Research4201 NE Couch Street

Portland Oregon 97213

E-mail: [email protected]

{{{{According to this model, a definitive measure of illnessprogression and resolution may be assessments of micro- andmacrovascular blood circulation. Thus, in a case of acute hepatitis,while decreases seen on liver-function tests and fever may heraldsignificant clinical improvement, the VMDP predicts that resto-ration of hepatic micro- and macrovascular circulation may be amore accurate predictor of disease resolution. Similarly, if liver-function tests and clinical signs return to normal but hepaticmicro- and macrovascular circulation remains impaired, thismodel suggests that some of the effects of illness are still present,even though standard clinical signs and symptoms have resolved.xxxxIf this model proves valid, future preventive health evalu-

ations could conceivably include assessments of micro- andmacrovascular circulation—thus, identifying areas of homeostaticdysregulation years before signs and symptoms of illness orclinical syndromes arise.



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Classical Chinese Medicine and Contemporary Science: The ......The practice of physician acupuncture faces unique challenges in its development and inclusion as a recognized medical