Traditional Chinese Medicine (TCM) - Energetic Perspectives on Practice

Energetic Perspectives on Practice


In this essay; the author would like to discuss Traditional Chinese Medicine (TCM) and the philosophies, beliefs, religions and values of the Chinese culture that have influenced the health care system in China. The author would also like to include a comparison between the Chinese and Western approaches to diagnosis and treatments of illness and disease and how the integration of the five element theory (5E) could contribute to the holistic care of an individual combined with aromatherapy. Also included will be the regulation, training and research requirements of both China and the U.K.

Tradional Chinese Medicine

Traditional Chinese Medicine is more than 3000 years old and is very important to the Chinese culture (Robinson 2006 pp132-140). Chinese medicine has a strong emphasis on prevention of health and illness and is successful at treating certain health conditions that biomedicine may not be, such as inflammation and autoimmune disorders. TCM and other complementary health care is concerned with the person as a whole and will prescribe treatments based on the evaluation of a consultation with the client to discover the cause of the problem. Chinese physicians will provide safe and effective treatments like herbal remedies and nutritional therapies (diet) (Kaptchuk 2000 p2). Prescribed Chinese medicine can be administered in many forms which include infusions, liquids, ointments and pills (Buksh 2006 p25). Chinese medicine can be hard to understand unless there is some knowledge of the Chinese values and beliefs or the language and philosophies. Most of TCM is based on anecdotal evidence and life experience, there is not much evidence based research that can be measured, although this is changing as interest in TCM is expanding within Western countries. Acupuncture and herbal medicine can be measured and proven (Kaptchuk 2000 p2).

Chinese research papers are not usually published in other languages making this very difficult to translate and understand in the Western medical field (McNamara & Xuan Ke 1995 p5). The values, beliefs, philosophies and religions of China have had a strong influence on the attitudes and ways of thinking to their approach to health and health care (Chen 2001 pp270-273). TCM has a holistic approach to health and wellbeing by looking at the lifestyle of individuals, and asking about exercise, diet, employment details, family history etc (Buksh 2006). The main philosophies and religions in China include Confucianism, Taoism and Buddhism, the values and beliefs include education, diet, herbal medicine and acupuncture (Chen 2001 pp270-273). The Nei-jing (Yellow emperor text), written approximately 300 years BC is one of the most sourced historical texts available that supports the theories of Chinese medicine (Robinson 2006 pp132-140).

Practitioners of TCM will use many diagnostic methods to assess and treat patients. These include taking the pulse, tongue diagnosis, yin and yang theory and the five element correspondences (Robinson 2006 pp132-140). The treatment techniques applied comprise of acupuncture, herbal medicine and exercise (qi gong & Tai-chi), and in more recent years consists of aromatherapy and reflexology (Robinson 2006 pp132-140).


Confucius (551-472 BC) was the founder of the Confucianism theory and principles which originated approximately 600 years before Christianity (Zang & Veenhaven 2008 pp425-443). Confucianism believes in social interactions and harmony with other humans, and involvement with communities. A follower of Confucianism should show compassion towards others, lead an active life continue learning to expand their knowledge, take responsibility for self, family and friends. The philosophy also teaches the following of the rules of the law put in place by the government (Zhang & Veenhoven 2001 pp425-443). It is considered that if a person has a positive outlook and enthusiasm towards these values and followers of this philosophy live up to them they will have a good life (Zhang & Veenhoven 2001 pp425-443).

In Confucianism philosophy it is also thought that life is worthwhile and care should be taken to preserve life which will lead to a long and healthy one. Confucianism theory thinks that death should be ignored, but when it is about to happen it should be accepted and not dwelled on (Zhang & Veenhoven 2001 pp425-443). The Chinese elders accept that in achieving these values and principles it will lead to self-worth and contentment, providing wellbeing and health (Chen 2001 pp270-273).

Taoism (Daoism)

Taoism is another main philosophy in China and was founded much later than Confucianism, it originated in the sixth century BC ( Zhang & Veenhoven 2001 pp425-443). It is believed by Taoists that the human body is regarded as a small universe which is supplied through an energy force. This energy force is known as qi. Qi is the life force energy believed to balance and harmonize the essential life activities which include the physiological, physical and psychological aspects of individuals (Kao et al 2006 pp92-101). The theory sees the universe as a relationship between individuals, heaven and earth and if there is harmony in the universe then there is equilibrium between the microcosm of an individual and the macrocosm of the universe creating health and wellbeing (Kao et al 2006 pp92-101). This Taoist theory has some similarities to Roger’s principle of integrality (Kao et al 2006 pp92-101). Dr Martha Roger’s derived a conceptual system for nursing science in the 1970’s this system is now known as Roger’s science of unitary human beings. It is Roger’s believe that humans are energy fields occupied in a mutual process within the environment field. (Woods-Smith & Broida 2007 pp217-225). Roger’s theory is that everything in the universe is pandimensional, and that energy fields are identified by continuous changes from low to high frequency wave patterns (Woods-Smith & Broida 2007 pp217-225).

Taoists have two levels of life, which are the natural or inner life and the social or public life. They consider that while it is good to interact socially and live peacefully with other humans, they must retain their independence, as the most important feature for Taoists is individual freedom (Zhang & Veenhoven 2001 pp425-443). Knowledge, rules of law and social interaction are not considered important issues for health and happiness in Taoism and are considered to reduce happiness. They believe the simple life is best and encourages individualism, and that everyone should have their own identity, independence, dignity and freedom (Zhang & Veenhoven 2001 pp425-443). Death is considered natural and an extension of life in China. Terminally ill patient usually prefer to die at home where they feel safe and belong (Chen 2001 pp270-273).

Yin and Yang

Yin and yang is a theory that was expanded further by Taoism (Chen 2001 pp270-273). There is a possibility it originated during the Han dynasty, as in the Shiji (Records of the Historian), they list a representative of the yin yang school as Zou Yan. Although none of Zou Yan’s work has survived the Shiji suggests that Yan had a profound knowledge of the yin and yang theory and that he wrote a thousand words on the subject (Wang ND).
The yin and yang symbol comprises of a circle and within this circle there are two tadpole interlinked shapes. One is black with a small white circle, this is the yin aspect displaying a link with the yang aspect and the other tadpole shape is white with a small black circle this is the yang aspect displaying a link with the yin aspect (McNamara & Xuan Ke 1995 p239). Yang is known to show the light, rising, exterior, excess and heat aspects and yin is known to show the dark, descending, interior, deficient and cold aspect (McNamara & Xuan Ke 1995 p239). The words yin and yang mean the two banks of the river (McNamara & Xuan Ke 1995 p239).

This theory is used as a way to explain the nature of phenomena. It is believed that everything throughout the universe, such as seasons, calendrical science, agriculture and medicine are guided by the theory and that all phenomena contain both of the yin and yang aspects (Wiseman 1994 p1).
The concept of yin and yang describes how the theory groups everything in the universe into pairs of opposites for example male and female and hot and cold (Wiseman 1994 p1). Each opposite is known as either a yin aspect or a yang aspect. There is always a bit of yin in yang and yang in yin which suggests they are not only opposites but share a part of each other (interdependent). If there is a decrease in yin energy then the yang energy would increase, keeping the circle whole (Kao et al 2006 pp92-101).

Good health and equilibrium is viewed as yin and yang working in harmony together, although this does not mean it has to be equal on both sides. An individual could have a 70% yin and a 30% yang aspect or vice versa but still be healthy (Chen 2001 pp270-273). If an individual’s personal yin and yang harmony is out of balance it is viewed as disequilibrium in Chinese medicine which results in ill health (Chen 2001 pp270-273). Herbs and foods are considered to have yin and yang aspects and Chinese physicians will prescribe herbal or diet therapies to bring back harmony and equilibrium to the imbalance of yin and yang within the body (Chen 2001 pp270-273).


Buddhism is another tradition of China. It was founded by Buddha Gautana (560-480 BC), and originated in Northern India (Zhang & Veenhoven 2008 pp425-443). Gautana an Indian prince left his family and home to gain spiritual enlightenment (Zhang & Veenhoven 2008 pp425-443). Around the time of the birth of Christ, Buddhism was introduced to China, but took many centuries to evolve into many sects in the Sui and Tang dynasties (Zhang & Veenhoven 2008 pp425-443). Buddhism theory teaches that everything is impermanent and co-dependent and everything in the world comes and goes (Zhang & Veenhoven 2008 pp425-443). The belief that all phenomena in the universe are a manifestation of a person’s mind, and how an individual talks, acts and thinks will have an effect on future events, so this will determine the persons existence (Zhang & Veenhoven 2008 pp425-443).

The three concepts in Buddhism is Karma which is the chain of causes and effects, this is based on how a person will be reincarnated depending on how good or bad they were in a past life. Samsara is the belief that people are reborn and experience many lifetimes and the third is Nirvana and this is the belief that once you die you do not have to be re-born again, but can choose to leave the suffering behind breaking the circle of birth and death (Zhang & Veenhoven 2008 pp425-443).
Buddhism does not value knowledge, responsibility or any social interaction and asks that a follower of Buddhism give everything up, even their own happiness. They do ask for tolerance and kindness towards others and too share the pain and sorrows of the world wide. Meditation and reflection is important in this tradition and is seen as a way for self improvement (Zhang & Veenhoven 2008 pp425-443). The Buddhist belief is that if you are kind and considerate to others and are aware of your own behaviour and morals, you will have no guilt and will have peace of mind which will promote health and well being (Chen 2001 pp270-273). Mortality is seen as caring about death and life after death and that an individual should not look for a long life (Zhang & Veenhoven 2008 pp425-443).


In Chinese medicine and philosophy the existence of qi is thought to be a basic substance which explains movements and manifestations within the universe. Qi is seen to be the fundamental formation of the human body and that man would not exist without it. The theory is that when qi gathers a body is formed and when qi disperses the body will die (Wiseman 1994 p17). Qi is active within the whole body, and there are various substances, types and functions of qi which are all vital to the health and wellbeing of an individual (Wiseman 1994 p18). There are three vital substances believed to be manifestations of qi, these are blood, essence (jing), and body fluids (Wiseman 1994 p17). Maciocia (2005) suggests a fourth being the mind (Shen). All these functions interrelate and form relationships with each other suggesting that there is qi within qi and that if there is harmony amongst the organs, blood and fluid there will be good health, but any disharmony will cause disease and illness (Wiseman 1994 pp17-28). The basic functions of qi are to transform, transport, hold, raise, protect and warm (Maciocia 2005 p55). Original qi is what vitalizes and warms the body, blood and fluid are what nourishes the body and the essence aids the development and reproduction of the body (Wiseman 1994 p17).

The Five Elements

There are two major texts that formed the foundations of the five elements theory (5E) that applies the concepts to Chinese medicine (Hicks et al 2004 p1). The Nei jing was the first text written approximately -200 and comprised of Su Wen (simple questioning) and Ling Shu (spiritual pivot). The Nan jing was the second text written approximately +200 this text further developed the ideas of the 5E’s (Hicks et al 2004 p1). The Nei jing and Nan jing were developed around the time of the Han dynasty era when there was a more complex medicine system that came about from ideas about health and disease and how to treat these conditions (Hicks et al 2004 p1).

The 5E theory attempts to explain the phenomena of the five quintessential processes. The emblems of wood, fire, earth, metal and water represent this process (Kaptchuk 2000 p437). There is some uncertainty as to when the 5E’s theory originated. Maciocia (2005) suggests that the 5E’s and the yin-yang theory originated at the same time and that both theories date back to the Zhou dynasty, but Kaptchuk (2000) suggests that the yin-yang theory came first and dates back further to earlier ancient Chinese times, and that there was no documentation to the five elements until the fourth century B.C.E.

The five element theory is not only used for medical purposes, but to also explain the relationships between the emblems of wood, fire, earth, metal and water and how they relate to other perceptions such as colour, seasons, odours and sounds. Everything in the universe can be linked to the five element theory (Kaptchuk 2002 p439). The 5E theory represent the external circle of growth, vigour and decline (McNamara& Xuan Ke 1995 p16). The popularity of this theory has lead to most phenomena’s being classified in to fives (Maciocia 2005 p20). The 5E’s are associated with the earthly phenomena and the number five is used more and more as a process to search and analyse thought mode (Maciocia 2005 p21). The five quintessential processes has many facets and the theory is that each element is interdependent on another element, so as in the theory of yin-yang and qi there is a part of one element in another and an understanding of this idea is vital when applying the 5E theory to diagnosis and treatment (Worsley 1998 pp65-76).

There are five different states of phenomena within the five elements theory and these include the different qualities of natural phenomena, the elements as movement, the cycles of the seasons, the interrelationship of the elements and the correspondences of the elements (Maciocia 2005 p21). The basic qualities of the elements are that wood can be twisted or straightened, fire will flare upwards, earth allows growing and nurturing, metal can be moulded and then toughened and water will dampen things (Maciocia 2005 p22). The elements as a movement are wood expands, fire moves upwards, earth is the centre point and creates stability, metal will shrink and contract and water will move downwards (Maciocia 2005 p22). The cycle of the seasons are wood relates to spring, fire relates to summer, earth relates to the centre but not to any season, metal relates to autumn and water relates to winter (Maciocia 2005 p23). The interrelationship of the elements consists of different sequences which include the cosmological sequence, generating sequence, controlling sequence, overacting sequence and the insulting sequence (Maciocia 2005 pp23-24).

The table of relationships explains the interaction of the correspondence to each other and how the elements can aid or antagonise the other (McNamara & Xuan Ke 1995 p29).

The table of relationships are as follows:

Heart-tongue-Small intestine-Fire-Red-Hot-Bitter-Laugh
Lungs-Nose-Large intestine-Metal-White-Dry-Pungent-Weeping
Spleen-Mouth-Stomach-Earth-Yellow-Damp-Sweet-Sing (McNamara & Xuan Ke 1995 p31).

An awareness of how the relationship of the sense organs sound, colour, seasons and taste elements can be interlinked with the organs of the body will show the relevance of how they contribute to health and well being (McNamara & Xuan Ke 1995 p31). The sounds and colour of the patient will be observed by the practitioner of Chinese medicine and if someone is groaning, this will indicate a disharmony with the kidney. Tongue diagnosis can also identify organs out of harmony by the colour, shape or size and the eyes can indicate a dysfunction of the gallbladder (McNamara & Xuan Ke 1995 p30). The five element perspective to health is the belief that the person is a whole and identifies that there is a connection between the body, mind and spirit (Foster 2006 pp163-169). The aim of the holistic approach is to restore and balance the harmony within the individual to return them to health. This approach achieves this by providing the person with a treatment that helps the body stimulate its own ability to heal itself, seeks the root of the problem, treatments are more gentle and pleasurable, provides time for client to discuss problems and be listened to, encourages client to participate in their own care and provides therapeutic touch in some treatments (Foster 2006 pp163-169).

Western Perspectives

Health and medicine started to take shape in the West approximately around the seventh and sixth centuries B.C. It is believed that a legendary Greek physician named Asclepius turned into a God and that Asclepius was responsible for the beginning of the medical profession (Salvo 2007 p5). Hippocrates (460-375 B.C), a Greek physician is known as the “Father of Western medicine,” and his philosophy is that a healer should cause no additional harm to the patient (Salvo 2007 p6). Ancient Western medicine evolved through the years with the incorporation of Greek and Roman medicine. Many Greek and Roman physicians studied the work of Hippocrates each adding their own theories and philosophies (Salvo 2007 p6). Galen (AD 130-200), a Roman physician combined the knowledge of anatomy and medicine. This system was used for many years during the middle ages and beyond (Salvo 2007 p6). The main views to the treatments were very simplistic and usually involved bathing, diet, massage and some drugs (Salvo 2007 p6). Western medicine expanded again during the renaissance when a Flemish physician, Andreas Vesalius (1514-1564) established the foundations of the modern human anatomy. His work is considered to be the most important studies of medicine (Salvo 2007 p7). During the Seventeenth Century, there was some scientific advances arising and it was thought there was a need to record clinical descriptions of disease and to develop treatments for specific diseases (Salvo 2007 p7). At this stage the philosophy was that health should be attained and preserved (Salvo 2007 p8).

The need for evidence based research grew from the seventeenth and eighteenth centuries in to what is now modern day health care. This is based on the methodical principle of science where Western medicine looks for scientific evidence to explain the effects of drugs to measure the direct consequences of the identifiable cause (Schnaubelt 1998 p2-3). Modern day medicine is very expensive and because of the size of the health care system is struggling to keep up with the changes and demands of patients (Schnaubelt 1998 pp2-3). The Western perspective to health separates the body and mind. This reductionist view isolates people in its failings to respond to human suffering (Foster 2006 pp163-169). Conventional practitioners will look at the symptoms rather than the cause of disease or illness and the treatment will include the use of refined or synthesized drugs to suppress the symptoms (Mojay 2002 p131-141). These synthetic substances can lead to other health problems within the body by overloading the body with toxic chemicals that have negative effects on the organs, metabolism and excretion process (Schanubelt 1998 p5).

Combining the Five Element Theory with Aromatherapy

The clinical value of combining aromatherapy and the Chinese five element theory would be beneficial to the client/patient relationship, as the diagnosis and treatment would be based on a thorough evaluation of the client/patients personal needs taking in to account their constitution and terrain (immune system). The 5E theory provides an understanding of the correspondence to the organs and their functions and the system patterns causing disharmony (Mojay 2004 pp81-88). Incorporating the 5E’s theory to aromatherapy would increase the synergistic values and properties contained in the essential oils and would enable the aromatherapist to give other forms of treatment if a massage was unsuitable or there were time constraints for the client/patient. These treatments could be administered in the form of gels, creams and lotions applied to specific meridians and acupoints, this will also allow the client to take some control of their own wellbeing (Mojay 1998/1999 pp105-114). The treatment would be effective for headaches, musculoskeletal disorders such as arthritic pain or sports injuries (Mojay 1998/1999 pp105-114).


As patient interest and demand for complementary and alternative (CAM) health care increases, there is a growing need to integrate services such as aromatherapy, reflexology, traditional and modern Chinese medicine into Western medicine (Stumpf et al 2007 pp1-5). There have been some “definitional” changes to the use of the words CAM and it is more frequently being replaced by integrated medicine, due to the introduction of evidence based research (Stumpf et al 2007 pp1-5). Complementary and alternative medicine has been widely accepted as standard in Chinese hospitals and is a well established system of holistic medical care and part of daily life (Robinson 2006 pp132-140). There are two thousand four hundred and forty nine TCM hospitals in China and 95% of general hospitals have TCM departments within them. Patients attending these hospitals do not need to make appointments and can choose which doctor they would like to see by looking at their profiles and pictures that are displayed in the reception areas (Robinson 2006 pp132-140).

The average wage that is paid to practitioners in the hospitals is £180 - £250 per month and the average cost of treatment is between £1 and £3.50. Although the cost to individuals appears to be affordable, it is not the case for many of the Chinese populations from the rural areas (Robinson 2006 pp132-140). As suggested by McNamara and Xuan Ke (1995) integrating TCM in to biomedicine in the U.K. would incorporate the strengths of both methods, providing a more effective, cost effective form of medicine that would be beneficial to the health care system and the patients. TCM is practiced alongside Western treatments in China and Hong Kong as part of the standard care provided this can make it complex and show a weakness in how to measure the effectiveness as to what aided the patient’s recovery (Robinson 2006 pp132-140).

There are thirty TCM Universities/colleges in mainland China and they all have museums which exhibit written text on the history of TCM. The gardens have plants where the students can study, recognise and distinguish the specimens. The Shanghai University also have their own medical engineering department and skills laboratories (Robinson 2006 pp132-140). Students have to pass an entrance exam to study Traditional Chinese Medicine and are then required to study a five year syllabus, which consist of 30% Western medicine and 70% TCM. After completion of the five year studies, students must then apply for a license to practice (Robinson 2006 pp132-140). The State Administration of Traditional Chinese Medicine (SATCM) is the regulating body of TCM and is responsible for setting the guidelines, policies and laws of TCM. The SATCM also sets the educational and technical standards for health care (Robinson 2006 pp132-140). At the moment there is no statutory regulation or set education standards for TCM practitioners in the U.K. If integration into the health system is to be taken seriously then research, education and regulation will need to be addressed (Stumpf et al 2007 pp1-5).


There are many comparisons between the Western and Chinese medicine approaches and attitudes towards health and health care. The Chinese have welcomed the integration of the two medical systems and combine the two to provide holistic care. The holistic approach takes in to account the mind, body and spirit of the individual and healing the whole person and root of the cause. Western medicine does not accept most of the theories and traditions of Chinese medicine as they want more scientific evidence to prove the efficiency of the diagnosis and treatment policies. Although orthodox medicine wants scientific evidence today, it started with the same philosophy as TCM as it was based on life experience and observation. The integration of Traditional and modern Chinese medicine into the Western orthodox system would help to move the health care system in the U.K forward and also provide holistic care, this would be beneficial to all patients, as there are many different cultures with their own believes and values living in the U.K. The philosophy of keeping individuals healthy to prevent disease and illness would be more cost effective to the National Health System and could help with the time restraints that General Practitioners and hospital staff have to adhere too. Although there would need to be changes within the education programmes and regulation would have to be put in place to safe guard patients, it would still be beneficial to all.

I have a great interest in the energetic approach to health and I believe this is the best approach for my practice of Aromatherapy. Aromatherapy has the same perspective to treating individuals as a whole in a synergistic way, taking in to account not only the cause of the condition but the client’s thoughts and feelings towards illness and disease. In my practice I prefer to use the “Vertical Synergy” functional group approach, it is an approach based on a concept devised by French medical aromatherapists Franchomme and Penoel to blend oils for more than one purpose. The study of the yin-yang and five element theories and their connections with the universe has given me a greater understanding and knowledge of how this approach will help me give a better treatment for my client.

I also have an interest in Gabriel Mojay’s approach. Mojay an aromatherapist who’s approach to blending essential oils is based on the Five Elements theory of Traditional Chinese Medicine. Not having enough knowledge of this theory, I could not include the approach to my blending of oils for my client. With a bit more study of this theory I will be able to apply Mojays energetic approach to my practice. I think that if TCM was integrated with the French approach of intensive aromatics this would create a universal holistic approach to health care.


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