Voices of Qi: An Introductory Guide to Traditional Chinese Medicine. By Alex Holland. North Atlantic Books and Northwest Institute of Acupuncture & Oriental Medicine, 1999. 96 pages. $13.95.
Review by Lawrence A. Whitney, 2011 | Review by Thurman Willison, 2009
Review by Lawrence A. Whitney, 2011
This volume sets out to provide an introduction to the history, theory, and practice of Traditional Chinese Medicine (TCM) accessible to virtually any audience, but particularly for patients considering TCM for treatment and medical professionals considering TCM as a complimentary modality of treatment. A slim volume, its brevity is best interpreted as the result of concisely penetrating presentation on the part of the author as opposed to shallowness or a failure to achieve a comprehensive treatment. The author, Alex Holland, is a longstanding North American student and practitioner of TCM, and so his perspective is particularly helpful in bridging the gap between TCM and a culture in which contemporary biomedicine is dominant. Five appendices at the end of the volume go a long way in establishing the antiquity and authenticity of TCM, and provide interested parties with avenues of access.
In the introduction, Holland explains that the concept of Qi (¬¬chee) is at the very heart of TCM. Qi is also a central concept in Chinese philosophy, and is best understood as “the energetic template on which all of existence is fashioned” (1). Qi is not a substance, but all substances are Qi; substances are merely Qi in one particular modality. It is because Qi is so universal–pervading all of existence–that the healing undertaken through TCM is not merely concerned with the physical body but with all of the energies that make up life. Thus, TCM should be considered a holistic approach to healing, in the sense of working across distinctions of body, mind, spirit and nature.
The first chapter explores the conceptual foundations of TCM arising from the worldview that pervades the Chinese cultural framework. Holland notes at the outset of the chapter that health in TCM is best understood as an achievement of balance and harmony among the many aspects of Qi: balance and harmony within the patient as well as balance and harmony between the patient and the environment. The importance of balance is epitomized in the twin notions of Yin and Yang. Yang is dynamic, active and male, while Yin is foundational, quiescent and female. However, neither of these twinned forces of Qi can exist without the other, and in fact each contains at least a small portion of the other. Furthermore, any component classified as Yin or Yang can then be subdivided into further Yin and Yang components. Speaking metaphysically, existence is Qi made up the interplay of Yin and Yang forces from the highest ontological principal all the way down to molecules and atoms.
The remainder of the first chapter explores how the need to achieve harmonious Qi by balancing Yin and Yang leads to two diagnostic models for developing a treatment plan. The models are independent, but may be employed complementarily in any actual diagnosis. The first diagnostic model is called the Eight Principles. It is made up of four pairs of polarities that are used to classify symptoms into the essential features of a particular malady. The interior/exterior polarity analyzes the location of the problem as being inside the body (i.e. in organs or bones) or at the outside edges of the body (i.e. skin or muscles). The cold/hot polarity refers to the nature of the imbalance, where cold is either a lack of sufficient Qi (temperature) or an attack upon particular tissues, and hot is an overabundance of Qi. The deficiency/excess polarity accounts for both the inherent energy of the body as well as pathological factors that may have been introduced. The final polarity, Yin/Yang, is both the other three taken together as well as any factors not taken into account in the previous polarities.
The second diagnostic model is called the Five Elements Theory. It is a correspondence theory between natural elements and the energies of the body. The five elements are wood, fire, earth, metal and water. Wood corresponds to growth, fire to the peak of activity, metal to decrease and decline, water to the trough of decline, and earth to centering and neutrality. These correspondences are then each further correlated with Yin organs, Yang organs, seasons, colors, odors, directions, climate, emotions, tastes, sounds, musical notes, tissues, meats, cereals, fluids and sense organs. These correlations are then used to derive both diagnoses and treatment recommendations. Furthermore, a TCM practitioner must account for the mutual production cycle of the elements, in the order of wood, fire, earth, metal, water, and the mutual control cycle of the elements, in the order of wood, earth, water, fire, metal.
The second chapter turns to a discussion of the theoretical framework of TCM, which is to say the theories of anatomy and pathology, and the diagnostic methods TCM practitioners employ. As regards anatomy, TCM divides the body up into vital substances, organ systems, and points and meridians. The vital substances include Qi, blood, Shen and body fluids. There are many types of Qi that interact in various ways to perform six functions: catalyzing, transporting, stabilizing, raising, protecting and warming. Blood is intimately related to Qi, and is in itself a form of Qi, an a particularly material form. Shen is the spirit, mind or consciousness of a person. Body fluids are either clear and watery or turbid and heavy, the former nourishing the exterior and the latter the interior of the body.
Organ systems are related to each other less physiologically than energetically in TCM. In addition, they are associated with emotions and states of consciousness. For example, the lungs are related energetically to the large intestine, are associated with the metal element, house the corporeal soul and are associated with the emotion of grief. The spleen, is related energetically to the stomach, is associated with the earth element, governs intellect and is associated with the emotions of pensiveness and worry. Holland also covers the associations for the kidneys, heart, liver and pericardium. It is interesting to note that the organ paired with the pericardium, the “triple burner” is not recognized in contemporary biomedicine but is one of the primary meridians in TCM.
The meridian and point system in TCM describes flows and concentrations of energy in the body that do not necessarily correspond to distinguishable parts of human physiology. Imbalances in meridians can be reflected in organ imbalances and vice versa but they are not reducible to each other. Points refer to places in the body where the Qi flowing through the meridians emerges. Furthermore, the energy flows in the various meridians are stronger and weaker at various times of day in two-hour episodes. Meridians and points, and their underlying theories, are particularly important in the TCM treatment of acupuncture.
Pathology in TCM can be described in terms of the six evils: wind, cold, dampness, dryness, heat and summer heat. The climactic factors create the conditions for various forms of pathogenic Qi to enter the body and create disharmony and imbalance, thus causing an unhealthy state.
The second chapter concludes by explaining the four traditional examinations undertaken by TCM practitioners to diagnose various maladies: looking, listening/smelling, asking and touching. Much of this diagnostic practice is also observed in contemporary biomedicine, but two diagnostic methods stand out: looking at the tongue and taking the pulse. In TCM, looking at the tongue can help diagnose the state of Qi and blood in various parts of the body, as various parts of the tongue correspond to various organs. The pulse is taken twelve times in TCM, in each wrist at three locations at superficial and deep levels, with each of the twelve readings being associated again with a particular organ.
In the third and fourth chapters, Holland reviews the modes of treatment and offers the reader a preview of what to expect when visiting a TCM practitioner. Modes of treatment include acupuncture and acupressure, moxibustion (heat treatment), cupping (skin suction), plum blossom needling, electroacupuncture, Chinese herbal medicine, and medical Qi Gong. The fifth chapter is Holland’s personal vision for a future of world medicine. Holland believes that a holistic world medicine will emerge “of necessity and by demand.” His optimism is hopeful and refreshing. Of particular importance to note is that while he points to the fact that TCM is generally less costly than contemporary biomedicine, the current poor economic climate may hinder the further experimentation that will be necessary to bring about his desired result.
Voices of Qi succeeds admirably in providing a lay introduction to TCM that will be helpful to patients considering this modality for treatment of a condition. Unfortunately, the volume fails to achieve its goal of providing an adequate introduction for medical practitioners considering integrating TCM into their practice. Particularly, the book fails to make an evidentiary case integrating TCM with western biomedicine, which would be necessary for the consideration of western medical practitioners given the evidence-based approach in that modality. While the volume is excellent at explaining the philosophical foundations of TCM, it suffers from a lack of critical evaluation of the theoretical framework and modalities for treatment. Finally, the volume suffers from a lack of explanation of how the cosmology underlying TCM can be plausible in a late modern context. Nevertheless, the book is significant for its conciseness and clarity of presentation and can serve as a helpful introduction to novices in TCM theory and practice.
Review by Thurman Willison, 2009
Alex Holland’s Voices of Qi is a compact, accessible, and thorough introduction to the art of Traditional Chinese Medicine (TCM) that benefits the reader on both theoretical and practical levels. The reader is challenged to look deep into the foundations and theoretical framework behind TCM and is also practically guided on how to discern between different healing modalities and how to ultimately decide upon a practitioner. Holland stresses all throughout the work the “powerful roles that balance and harmony play in…health” (9) as well as the interrelatedness of spirituality, energy, and physical nature, which is holistically understood under the concept of Qi.
According to Holland, Qi is a dynamic force, always moving and ubiquitous. It relates not only to the health of our physical bodies but also to the “activity of our mind, emotions, and Spirit (21)”. Qi is an “enigma” to many because it is “both a noun and a verb.” For example, Qi is “the force propelling the blood through the arteries and veins, yet it is the very quality of that blood itself (22)”. As one can see, Qi is cloaked in metaphorical language and one must be an artful interpreter of this language if one is to be a skilled practitioner of TCM. The thing to remember is that Qi is always seeking balance and healthy integration between all the varied aspects of one’s physical, mental, spiritual, and emotional life. Sickness is always a result of imbalance and disintegration. Thus, the diagnostic models and healing modalities developed within TCM have been carefully created to address directly these imbalances.
Holland surveys two traditional diagnostic models used in TCM. The first of these models is the “Eight Principles” model in which there are four pairs of polarities (Interior/Exterior, Cold/Hot, Deficiency/Excess, and Yin/Yang) that each relate to a different potential imbalance in the overarching Yin and Yang cycle of Qi. This model, according to Holland, is used to “unravel complex disease patterns and reduce them to their essential qualities” (14). The second model is the “Five Elements” model in which Qi is represented by five elements that correspond to five phases of Qi. These elements do not represent temporal, sequential phases of Qi, but they rather represent functions of Qi that are in constant reciprocal interaction with each other. The elements are Wood (growth and increase), Fire (peak followed by decline), Metal (decrease), Water (maximum state of decline and preparation for growth), and Earth (neutral element serving as a buffer between other elements). It is important to note that all of these elements relate to each other in a cycle of mutual production and all are mutually controlling of each other.
Holland also surveys the various healing modalities of TCM, which are all designed to bring vital physiological substances (Qi, Blood, Shen, and Body Fluids) and organ systems (lungs, spleen, kidneys, heart, liver, and pericardium) back into harmony with Qi. These healing modalities work most effectively when the TCM practitioner competently diagnoses the internal (injury, poor diet, emotional instability, etc.) or external (wind, cold, dampness, dryness, heat, or summer heat) causes of disharmony through the skillful application of the Four Methods: looking, listening/smelling, asking, and touching. The healing modalities surveyed are acupuncture, acupressure, moxibustion, cupping, plum blossom needling, electroacupuncture, Chinese herbal medicine, and medical Qi Gong.
Holland also gives helpful advice on how to seek out a skilled TCM practitioner. The first priority in developing a successful relationship with a TCM practitioner is to establish a relationship of good communication “based upon respect, trust, confidentiality, and openness (66)”. The next step is to do a diagnostic interview. A good practitioner will make artful use of diagnostic models (Eight Principles and Five Elements) and will know how to probe information related to all of the components of Qi using the four examinations. Holland tells the story of how one Chinese physician forced student applicants to spend several weeks examining a fish before he would grant them an audience. This story might seem ludicrous, but it accentuates just how important the process of examination is for the TCM practitioner and just how acute his sensitivity to Qi must be in order to make a successful diagnosis.
After diagnosis, a skillful practitioner will then know how to choose the proper method of healing for the patient. Acupuncture will be the most common treatment, but there are many occasions when other therapeutic methods are called for such as moxibustion or herbal treatment. Perhaps even counseling will be implemented if a strong enough emotional or spiritual factor is known to be contributing to the illness. Whatever the case, the important thing to remember is that the practitioner must know how to make these subtle decisions and therefore the patient needs to put in the time to find the right practitioner. This involves getting good referrals (possibly from a nearby school of Oriental Medicine) and carefully checking any practitioner’s certification, license, or registration. And at the end of the day, patients should be comforted to know that TCM is relatively painless and cheap and possibly insurable and therefore worth a little extra time and effort.
Holland closes by highlighting some ways in which the principles of TCM have begun to integrate with the broader field of Western medicine and health. Holland points out as key examples 1) new western therapeutic methods of mental visualization, 2) increased emphasis on the power of forgiveness, 3) worldwide recognition of the health benefits of meditation, 4) acknowledgment of environmental and electromagnetic pollution in health policy discussions, and 5) increased attention to the importance of living and working environments in relation to personal health. Holland’s vision for the future of world medicine is ultimately optimistic. He foresees that World Medicine will one day “be rooted in the traditions of multidimensionality of human beings honoring intuition as a major healing tool” and “will incorporate the understanding that the emotions, mind, and spirit are vital components in both our well-being and disease (74)”.
The real strength of Holland’s work in Voices of Qi is the fact that he manages to accentuate TCM’s unique features of spiritual and physical interrelatedness and metaphorical diagnosis while also succeeding to make TCM look appealing to the strictly scientific western mind. Holland manages, as best as one can, to break TCM up into accessible, easily distinguishable components that western thinkers can access. Holland reminds his readers constantly of the importance of metaphor and spiritual intuition in the practice of TCM, but he never loses his readers by overemphasizing these concepts. In short, Voices of Qi is a fantastic volume for any lay reader who has no background in the complexity of TCM interpretation. One walks away not only with a helpful beginner’s knowledge of theoretical TCM, but one also knows after reading this book how to practically avail oneself of TCM’s benefits. Holland’s work is not only a successful introduction to TCM. It is also an appealing invitation, one that helps to minimize TCM’s foreignness to newcomers and heighten the sense in which TCM is already integrated in the mindset of worldwide medicine.
The only thing that felt truly lacking from Holland’s introduction to TCM is a more substantial introduction for readers to the historical context of TCM. Despite the fact that Holland gives a quick historical survey in the first appendix, a brief chapter on the history and development of TCM within the book itself would have been greatly appreciated. Perhaps there is no way to make such a history brief. But it is difficult to give TCM a thorough assessment without more background. In any case, Holland’s work still stands as a successful introduction and one to be heartily recommended to any curious reader.