Model and Medicopsychology of Traditional Chinese Medicine

Qiu-li Yang,Chong-cheng Xue

Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China

Abstract

Key words:TCM; medical model; medicopsychology; temporo-spatio-psycho-socio-biological medical model

Introduction

The medical model is the discussion of the medical ideology,belonging to the category of philosophy,it derives from medical practice and is the overall understanding of medicine,that is,the concept of medicine.The behavioral facts of medical education,administration,research,clinical and preventive medicine are carried out under a certain medical model,so the medical model also guides medical practice.No matter the nature of a medical worker’s work is clinical,preventive,scientific research,teaching or administrative management,no matter he is aware of or willing to and agreed,his daily work is carried out under a certain medical model.At the end of the 1970s,with the development of medicine,the modern medical model is changed to a “social-psychological-biological medical model”,which conforms to the concept that human being is the wholenesses.This change is dominant in medical psychology.The western medical model is a retrospective knowledge and named along with the medical development.In field of traditional Chinese medicine（TCM）,there is not such a term of medical model but in the Yellow Emperor’s Medical Canon,medical doctrine is recorded,guiding the medical development direction and practice.Its significance is similar to that of medical model.Medical doctrine contains factors of biology,psychology and biology,as well as chronology and space such as astronomy,geography,orientation and timeliness.These five factors form the universe and people as a whole,soma and mind as a whole,society and man as a whole.In 2000,the authors have proposed the social-psychologicalbiological medical model as the holistic medical model of TCM field[1].It guides practice and development of TCM for more than two thousand years,which is accordingly prospective.Its application value and practical significant remain advanced at present.

Medical Model of TCM

In the TCM theory for thousands of years,although there is no term of medical model,a term of medical doctrine is recorded,which has similar meaning.This term was first seen in “Inner Canon of Yellow Emperor·Plain Questions·Zhuzhijiao Chapter”.“Medical doctrine”requires doctors to “know astronomy,geography,and personnel relationship,and focus on the correlation between yin and yang,exterior and interior,upper and lower,and male and female”.It states the five faults of medical staff in the “Discussion on Five Faults” and punishment on four mistakes of medical staff in the“Discussion on Four Mistakes”,the faults listed are:not knowing the principle of yin and yang in the diagnosis of a disease; no inquiry about the patient’s social situation,the changes in their property and position; not distinguishing people’s courage and cowardice; no inquiry about the patient’s life,death,fear,joy,anger,violent joy and suffering,initial happiness and subsequent pain; no inquiry about the objective of the patient; no inquiry about diet and housing; no inquiry about the presence or absence of disorganized living style; not comparing the patient’s normal and abnormal conditions; no inquiry about the patient’s gender.Diseases caused by the above factors may be not influenced by the viscera or the body,but rely on the mental health although it is not pathogenic.Accordingly,“the essence is gone daily,the pathogenic qi emerges,the qi and blood are separated,and the five internal organs are insufficiently functional”.Without the aforementioned inquiry,a diagnosis is not definite and clear.For those diseases,the diagnosis is not only restricted to the body factor.If the doctor is not conscientious and does not think about the potential factors,the symptoms and disorders are severe,the disease cannot be completely cured,and the medical diagnosis and treatment will not work.Medication alone will not achieve good outcome.The reason for these problems is that “unreasonable diagnosis and unclear understanding of the patient’s condition”.

In the practice of clinical diagnosis and treatment,TCM emphasizes that “the doctor should know the yin and yang,four periods,internal organs,male and female,exterior and interior,acupuncture and moxibustion,as well as stone needle,the role of poison,interpersonal relation for analysis; inquire the property and social position of the patient to distinguish their manifestations,inquire the age of the patient to prescribe the medication at different dosages; analyze the root cause and formulate appropriate treatment.Only in this way,the diagnosis is definite and clear.

The above records fully show that,the “socialpsychological-biological medical model” of modern medicine has been included when the “Yellow Emperor’s Medical Canon” was written.Since the publication time of the book,it has guided medical practice for more than 2,000 years.Notably,it demonstrates the comprehensive and advanced medical model of TCM,which is the essence of Chinese culture.

In addition to the social,psychological,and biological factors,the “medical doctrine” in the “Yellow Emperor’s Medical Canon” includes vast natural factors such as the astronomy,geography,orientation and timeliness.In the “Tian Yuan Ji Chapter”,“Five Movements Chapter”,“Five Chang Zheng Chapter”,“Qi Jiao Bian Chapter”,“Liuyuan Zhengji Chapter”,“Liu Wei Zhi Chapter” and“Yifa Fang Chapter” and other chapters,the various natural environments such as timing,seasons,wind and rain,dark and light,morning and evening,day and night,years,stars,position and region,as well as the influence of their current,past and future changes on the human body and their relationship with diseases are described.The interactions of rays,electricity,and magnetic fields currently investigated are also included.Therefore,the medical model,medical doctrine of TCM,is not only a “social-psychological-biological medical model”,but includes many factors of time and space.Therefore,a statement that TCM is a “holistic concept” cannot express its specific connotation,and confuses with the “simple holistic medical model” that has existed in the western medicine field.For the sake of clarity and specificity,according to the interpretation of the universe and nature in “Huainanzi” and “Zhuangzi”,the meaning of “eon”refers to the time and the meaning of “eonothem” refers to the space.Therefore,the medical model of TCM is actually “temporo-spatio-psycho-socio-biological medical model”,which is more comprehensive than the “socialpsychological-biological medical model” of modern medicine.

The five factors of the medical model of TCM embodies the overall concepts of “correspondence between nature and humanity”,“integration of mind and body”,and“somatic and spiritual harmony” in TCM,and reflects that human beings are social beings and are influenced by the social and natural environments,they constitute the medical model of TCM,which also reflect the holism concept of TCM and is also the direction of the world’s medical development.

In the first chapter of the “Yellow Emperor’s Medical Canon”,it states that “the heart is safe and fearless,the body is tireless,the food is delicious,the work is acceptable,the mind is happy,the craving cannot puzzle the eyes,the evil spirits cannot confuse the mind,no jealousy and no fear,thus the body and mind are harmonious”.Its meaning is consistent with the definition given by the World Health Organization in 1946 for health.

In a Chinese ancient book “Shan Hai Jing”,witch doctors are also recorded,which may have become a model at that time.However,the “medical affairs” （medical administration） of Chinese inherent medicine has begun in the Shennong era.Since the Zhou Dynasty （770-221 BC）,it has been under the jurisdiction of the government and is applicable in the local area.Therefore,Monasticism Theocracy medical model appeared in foreign countries is not present in China.The “Yellow Emperor’s Medical Canon” clearly points out that,“the one who sticks to the ghosts and gods is not sufficient to speak ethically,”indicating that TCM is opposed to believing in ghosts and gods.Therefore,the TCM theory recorded in “Yellow Emperor’s Medical Canon” is the “temporo-spatiopsycho-socio-biological medical model”,and has guided the practice and development of TCM for more than two thousand years,without change,and its practical value and practical significance have remained advanced.Therefore,the medical model of TCM is prospective.

TCM pays attention to the influence of time,space,social and psychological factors on human health.As stated in“Yellow Emperor’s Medical Canon”,“the ancients who used acupuncture well regard the five states of the person as the rule”.“Five states” discusses five types of temperament.From these two sentences,it can be seen that even if the ancients used acupuncture and moxibustion treatment,the treatment should be based on the type of temperament of the patient.As for the treatment,it is necessary to pay attention to the age and the qi,the wind and rain,the time,and geographical position,which are all considered from time and space.It is now concluded that these factors are very important in the treatment of some diseases,especially psychosomatic diseases.If these factors are ignored,drugs alone will not be effective.The health care also pays attention to the influence of social,environmental,seasonal and individual psychological and physical factors on human health,and the adjustment and adaptation of various influencing factors in daily life[2].

Modern Medical Model

In foreign countries,the western medical model is a retrospective understanding,which has been revised and changed many times due to different times and different medical practices.From the 15thcentury to the early 20thcentury,as the progress of social civilization and the development of science and technology,new medical issues continuous emerge.Since the 1940s,due to the development and progress of science and technology and its application in medicine,western medicine has entered the molecular,quantum,and cellular level.Comparative physiology,comparative pathology,pathological anatomy and genomics research have been deepened,medical engineering has also been developed,the basic theory research and applications of mechanics,materials science,information,control in medicine have been performed,replantation of severed limbs,organ transplantation,artificial organs and other achievements have been achieved,so the development of western medicine is great.Not only in the treatment,but also in the prevention,especially the control of infectious diseases,the results have also been remarkable.These discoveries and inventions and their applications are based on the biological properties of the human body,so they are called“biomedical models”.

This model continued until the 1970s.Due to social progress,changes,and the development of medicine and science,infectious diseases,malnutrition and other diseases in the past years have gradually receded into secondary importance,while diseases caused by mental stress,increased stress,overeating,accidents,suicide,alcohol abuse,drug abuse,environmental pollution are increasing.Psychological factors and social factors are increasingly closely related to the occurrence of diseases.The emergence of new infectious diseases and the increase of pathogen resistance induce the great change of disease spectrum.Some medical conditions,such as human anatomy,human experimentation,abortion,organ transplantation,and IVF,involve ethical issues.As the branches of medicine have become more detailed,the relationship between doctors and patients,doctors and doctors,and patients and patients has also changed.These circumstances have made the purely natural science of medicine incomplete.In 1946,the World Health Organization defined the health as:“Health is a state in which all aspects of physical,mental,and social life are satisfactory,rather than no disease and weakness.”It shows that humans are not only biological entity,but also social being.Human beings not only have bodies,but also minds.It is obviously insufficient to consider it from the biological view alone.Thirty-one years later,Engel,American psychiatry professor,has proposed the“social-psychological-biological medical model” to replace the “biomedical model”.Since then,the term “medical model” emerges.Through an overview,there have been the identifications of “witch doctor model”,“simple holistic medical model”,“monasticism theocracy medical model”,and “biomedical model”.Subsequently,the “socialpsychological-biological medical model” was introduced to China and accepted by the western medical community in China.The related work has been carried out rapidly and obtains many achievements.

Since the change of the medical model,western medicine work has been carried out swiftly and innovatively,so that patients are regarded as spiritual and socially attributed people,and their contributions to medical psychology are particularly prominent.More attentions are paid to the impact of social and psychological factors on health and disease.The focus changes from the disease to the people with disease and to the overall changes of people’s mind and body.This is very consistent with the medical model and clinical practice of TCM.

TCM Psychology

TCM psychology is a discipline covering TCM,psychology,society,humanities,and philosophy.Although TCM does not have the subject term “medical psychology”,it has extremely rich related connotations.67% of the chapters in the classic Chinese medical book“Yellow Emperor’s Medical Canon” involve the psychology and psychiatry.“Yellow Emperor’s Medical Canon” covers all the categories discussed in modern psychology.For some people’s psychological activities,such as “meaning”,“thinking”,“concern”,“wisdom”,“emotion”,and “will”,there are also corresponding definitions[3].TCM emphasizes “the unity of mind and body”,which runs through all aspects of disease prevention and treatment,rehabilitation and health preservation.The treatment of the disease depends not only on the external cause,but also on the person’s specific physique and mentality.The records of the relationship between people’s personality,behavior,posture,expression and physical structure and treatment are very detailed.

The relationship between emotions and human physiology and pathology has been discussed,and a system of TCM psychology has been formed.In the practice of diagnosis and treatment of “psychogenic” diseases for more than two thousand years,ancient physicians in successive dynasties have gradually accumulated richer clinical experience and strengthened the theoretical foundation.With the continuous development and improvement of medicine,humanities and social sciences in the past dynasties,the research on human psychology,physiology,and pathology has gradually deepened,and the concepts of “somatic and spiritual harmony” and “the unity of mind and body”have been formed[4].It is the most accurate,complete,and incisive summary of the relationship between the spirit and the body by TCM,and also the guiding ideology for disease prevention and health care.Notably,psychological factors have long been an indispensable part of TCM and a key component of forming the overall model of “temporospatio-psycho-socio-biological medical model” of TCM.

TCM attaches great importance to the relationship between human psychological factors and diseases,and has made many important contributions in this field.It is earlier than the western medicine and better than the western medicine.For example,in terms of discourse on temperament,according to the theory of Yin and Yang and the theory of five elements,there are two classifications of “five-form person” and “five-shape person”,which is more than three hundred years earlier than ancient Greece classification.The classification of the “five forms” was similar to that of the nerve classification in the outstanding Pavlovian theory,but it is more than two thousand years earlier than the latter.The “five-shape person” is similar to the famous German Krestchmer theory of the “relationship between human body structure and character”,but it is also more than two thousand years earlier than the latter.Because they have practical value so far,the author has formulated the “Five-Form Personality Test Form（formulated in 1987,revised in 2008）” according to the requirements of modern international psychometrics and upon standardized work as per the classification of the “five-form person”.The national,regional,and dimensional norms have been established and become the first indigenous personality measurement tool in China.Based on TCM theory and clinical practice experience,in the program sponsored by the National Ministry of Science and Technology in 2004,the five-form personality test is revised while the “Five-Five Physique Test Form（formulated in 2008）” is established,which has become the first TCM psychosomatic measurement tool in China,providing standardized measurements for clinical practice and health care.This has been discussed in another article.There are many types of psychological therapy in TCM,such as “appropriate speech enlightenment”,“subordination to desire”,“desensitization”,“disgust”and many other methods,which are created from BC to the Qing Dynasty,and basically similar to modern psychological treatment techniques.Both the “Explanation of Treatise on Febrile Diseases” and “Pulse Jing” written by Wang Shuhe,the diagnosis and treatment of “malingering”are recorded.No matter it is proposed by Zhang Zhongjing or Wang Shuhe,its early establishment is an important contribution of our ancestors in psychology.As for the therapies such as “shifting essence and transforming qi”and “emotionally dominant”,they are more characteristic and have now become native TCM psychotherapy techniques.

The medical model and psychology of TCM are advanced.Although its formation is closely related to clinical practice,it is obviously influenced by the philosophical theories of hundreds of ancient scholars in China.The theory of “Yellow Emperor’s Medical Canon” also supports this point,which shows the wisdom of our ancestors.

Each of the five factors of time,space,society,psychology,and biology has the overall and specific difference.Generally speaking,they are applicable for almost any field,but they must be specific to the actual situation,for example the latitude and longitude of the person’s location,time and geography,mountains and lakes,and climate have their similarities and differences; different countries have different cultural and social backgrounds and customs; different situations,education,race,age,gender are associated with different individual psychological factors and physical conditions; for the pathogens concerned,their biological properties and the relationship with the environment and climate are also different.Although these are different,they are all included in the overall medical model of TCM.When dealing with specific problems,any medical behavior such as medical research,clinical diagnosis and treatment,prevention,teaching or administrative management should not focus on the part or the individual separately,or ignore the whole body and its environment （society and nature） as a whole; On the other hand,we should combine the whole condition with the specific situation,especially for clinical treatment of patients.

The contribution of modern medicine in the period of the biomedical model cannot be buried.The medical model guides the development of medicine.The western medical model is revised with the advancement of medicine.The current medical research has involved the “space”,“diving”,“time change”,“biological clock” and “environmental pollution”,because its medical model is retrospective,it will be changed to “temporo-spatio-psycho-sociobiological medical model” in the future and is expectable.In the future,the development in this field will inevitably continue.The system of both TCM and western medicine serves for people with disease and pay attention to the psychosomatic health.They have the gradually same goal of benefiting mankind and should be inherit each factor and maximize their role.