Healing from the Heart: The Meaning of Wholism in Medicine




Though those of us in the healing arts outside the narrow confines of biomedicine may chafe at the term ‘alternative medicine,' a moniker which manages to marginalize even as it oversimplifies, it is worth considering what might unify the grab-bag of modalities that includes--to name just a few--chiropractic, reiki, homeopathy, rolfing, shamanic healing, ayurveda, western or Chinese herbs, and acupuncture.

It's a question that may be easier to answer through a process of elimination, for part of what these approaches to medicine share is a non-compliance with some of the fundamental assumptions of biomedicine. To start with, there's the modern scientific gospel of strict materialism--to which we reply that, even if consciousness were ultimately demonstrated to emerge strictly from material interactions, a material approach is still not the most productive or illuminating way to engage with living, breathing people.

A related, methodological assumption is reductionism, the idea that if you want to understand whole systems, you need to analyze their constituent parts, starting with the parts' parts. With regard to particle physics, this idea has famously been likened to trying to understand a swiss watch by smashing it into another swiss watch. But in medicine, where clinical practice tends to lag behind cutting edge science by a few decades, reductionism still reigns supreme. So does what I'll call compartmentalization, whereby specialists with increasingly narrow areas of focus pursue uncoordinated lines of enquiry. This can easily give rise to dissociation, where the patient effectively gets lost in the shuffle of labs and chart notes. The forest gets lost for the trees.

Then there's the obsession with sterility, or what we might call biophobia. Despite a mounting mass of evidence to the contrary, most of modern medical practice systemically wipes out the diversity of our internal environments, probably as fast or faster than the materialist, reductionist, capitalist mindset is wiping out diversity--of species, languages, cultures--externally.

That's as far as I want to take the critique of biomedicine, which for all its limitations does sometimes offer interventions that can seem nothing short of miraculous. Since it views the body in largely mechanistic terms, biomedicine is most effective when there is a structural issue (broken bone, severed tendon) or a specific pathological lesion that can be targeted and eliminated. It's not so good at fostering health, however, or even defining that concept as anything other than an absence of detectable disease. This is one area where alternative medicine parts ways.

It may make us suspect in the eyes of the scientific establishment, but in alternative medicine we're simply working with a different set of assumptions. In the traditions I'm most familiar with--Chinese medicine, Ayurveda, and Western herbalism--and I suspect in most of the modalities you'll come across in the back pages of progressive papers and on the bulletin boards at the local co-op, people are not primarily viewed reductionistically, mechanistically, or even materially. Mind and body--and indeed spirit--are inextricably intertwined, no one of them separable from the others.

Spiritual health and a fulfilling, meaningful life are at the top of the pyramid of concerns, and the roots of most disease lie in this largely intangible realm. The body is not to be ignored or denigrated, but physical ailments are often viewed as manifestations of a higher-order disturbance in what we might call the etheric realm. The principle here might be articulated as ‘the subtle precedes and underlies the gross,' or ‘form follows function.' In Chinese medicine, we say ‘yang leads, yin follows.' Thus, in Chinese medicine, it is understood that the best treatment is to head disease off at the pass, averting it before it has made so much as a whimper. The ancient Chinese medical text The Yellow Emperor's Inner Classic (Huang Di Nei Jing) asks "When the battle has already been joined, is it not a bit late to start forging weapons? Might as well start digging a well once thirst has already struck." In other words, full-fledged disease is indicative of imbalance that has been ignored or nurtured. Like an avalanche, illness depends on both unstable terrain and on a trigger. If we correct the terrain, the sometimes-uncontrollable triggers will have nothing to trigger.

This emphasis on terrain brings into play the "energetic" and constitutional approach shared by virtually all of the ancient medical traditions. Different traditions have slightly different systems, but in essence they all divide the world into quadrants, sometimes with a fifth ‘quadrant' holding down the center. Each compass direction represents a season, a weather pattern, and can be associated with particular colors, organs, animals, emotions. To take the example I know best, the classical Chinese system associates the northern direction with water, winter, cold, the kidneys, the bones, the color black, the salty flavor, the smell of rotting or fermentation, and the process of storage of resources.

What's the connection between these seemingly random concepts? In winter, as in the north, it's cold, and in the cold things freeze, consolidate, harden. In the body, the hardest, most consolidated tissue is bone, and it's the functional system of the kidneys that governs mineral balance. Moreover, the kidneys' adrenal glands govern storage of resources, the same resources that are so burnt-out in many of us, as a result of us trying to maintain what we might think of as a state of perpetual summer--always expansive, always energetic, staying up late, etc. Each of these aspects of the northern direction resonates with the others and with the direction as a whole, so that in assessing a patient the practitioner may be led through a cumulative association of signs and symptoms to a diagnosis pertaining to the water element, usually in relation to another of the five elements, all of which are in dynamic relationship with one another.

For instance, one of water's roles is to control fire; when there is insufficient water, fire is apt to burn too hot. Water is controlled, in turn, by earth, which dams water like the banks of a river. The system is rich and complex; it is also internally-consistent and, when applied sensitively and skillfully, highly clinically effective. It puts to use the five senses and that most finely-tuned instrument of all, human cognition.

What do the five elements or phases have to do with that other, more familiar Chinese concept, that of yin and yang? The ancient symbol-based divinatory handbook Yi Jing (Classic of Change) consists of sixty-four hexagrams, and only two of the sixty-four are made up of pure yin or yang lines. The other sixty-two are mixtures, interactions of yin and yang. Everywhere on this plane, yin and yang, dark and light, square and round, masculine and feminine interact, intersect, intercourse to comprise the cacophony of life. The same holds for the body and the seasons. The year tracks the course of yang, of the sun; yin is in a sense merely yang's shadow (the classical characters for yang and yin depict the sunny and shady sides of a mountain, respectively). The seasons, from spring through summer and fall to winter and back to spring, describe the successive, cyclical phases of emergence, flourishing, gathering, and storage of yang, of vital warmth. As holographic microcosms of the universe, we cannot maintain health apart from this natural cycle. In accordance with this seasons, we must alternate activity with rest, expansion with contraction, dark with light. It is not a question of balance as much as of dynamic equilibrium; like the march of the seasons, we are ever shifting. But our movements must be in accordance with prevailing macrocosmic forces in their nested, overlapping cycles.

It all sounds rather abstract and ambitious. We're not just talking about medicine, after all; this is a far-reaching and systematic understanding that overlaps with what we tend to try and separate out as philosophy, religion, astronomy, science, art, and relatively misunderstood disciplines such as alchemy and astrology. But this highly developed, nuanced worldview has both predictive power and a wealth of practical applicability. The most I can hope to do here is scratch the surface, but I can offer an example of how typical modern pathologies make sense in five phase, yin-yang terms.  

A great many modern people suffer from some combination of insomnia, anxiety (whether acute or chronic, low-grade), hypertension, hot flashes, and acid reflux. These ailments share a common thread: what we can describe as heating moving up to the head or out to the surface. In broad energetic terms, our vital warmth--our yang--is escaping upwards and outwards, as fire is wont to do. Meanwhile our water--yin--is left cold, unenlivened by yang, in a sense dead. This is reflected in dry, degenerative changes to tissues themselves, in loss of libido, in poor physical and mental reserves. This state of affairs reflects a deep disharmony between the heart (the representative organ of the fire phase element) and the kidney (the primary organ of water) and a "separation of yin and yang." Insomnia, hypertension and acid reflux are different manifestations of this disharmony, each with their own contributing factors and with etiologies that differ to some extent, but Chinese medicine recognizes the larger pattern within which they all fit. And through herbs, acupuncture, and allied techniques, it offers time-tested strategies for restoring harmony. In the symbolic language that Chinese medicine favors, this may sometimes mean bringing spring to a patient who is stuck in winter, or it may mean helping a summer-bound person contract into autumn. It may mean, as in the foregoing example, putting fire and water back in communication.

As healers in this paradigm, we can give appropriate stimulation to aid the body in re-establishing a harmonious relationship to the constant flux of life. But we cannot do the work for anyone. In the case of our prototypical modern day anxiety-insomnia-hot flashes patient, we may give a prescription that encourages storage of yang back inside of yin, in effect helping to "recharge the battery"; we may stimulate with needles or moxa points that elicit an analogous effect or that help calm the mind and that "tonify the kidney water"; but the change we are trying to encourage will not come to fruition if the patient is not actively engaged in the process. They have to be on board the train if they want to reach the station.

A few all-nighters can mitigate the benefits of weeks of replenishing herbs, and a lifestyle dependent on overstimulation (whether from caffeine or media saturation) will never be conducive to the sort of deep conservation and storage of energy that is needed to reverse the pathology. I should note, though, that this sort of water-fire disharmony is considered a very deep level of illness, and thus comparatively difficult to treat, whereas a number of common problems resolve much more quickly with appropriate acupuncture or herbal treatment. Still, for deep healing to take place, I believe a process of transformation is essential, and at some point the patient needs to engage fully with this process.

The work that the practitioner must encourage and that the patient must ultimately undertake can be understood as realignment; considering bodywork, herbs, dreamwork, acupuncture, qi gong, my impression is that all of the various modalities can serve to put us back into alignment with something--our higher selves, divine will, destiny, the universe, take your pick.

Chinese medicine expresses this state of alignment in terms of the traditional structure of the state. Each organ system has a role to play, but they must all be subservient to the noble lord, the heart. It is the the heart who receives the mandate of heaven and communicates it so that the government as a whole has a righteous purpose. From this perspective, as Classical Chinese Medicine scholar and clinician Heiner Fruehauf puts it, "all disease comes from the heart." If the lord is weak, if her power is usurped by an uppity contender from within her ranks, the state will be overthrown.

We've all seen what happens when someone lives from and for their stomach instead of their heart; Ayurveda corroborates this perspective with its insistence that all disease comes from raag, craving, which in turn leads us to commit prajnaparadha, literally "crimes against wisdom." Access to that innate wisdom is a birthright, it is just a matter of clearing the obstacles and aligning ourselves with our feet on the ground and a clean, empty (hence always ready to be filled) heart open to the heavens above. For this reason it is said in Chinese medicine that "the heart is the human heart." To whatever extent we fail to live through our hearts, we fail to embody our potential as humans. But the beginning of the journey towards health and integration is never more than a step away.

 

Image by gilichupak, courtesy of Creative Commons license.