I recently re-read The Web That Has No Weaver: Understanding Chinese Medicine by Ted J. Kaptchuk, O.M.D. More accurately, I read it thoroughly for the first time, from cover to cover, all notes and appendices included. This is a classic, foundational textbook for students of Traditional Chinese Medicine.
It had been recommended reading when I was in herb school. I bought a used copy of the 1983 original edition (there is also an updated 2000 edition). I read the first chapter. I skimmed the charts and diagrams. And then it sat on my bookshelf.
Recently, a friend asked me about the book, and my interest was renewed. I’m so glad we had that conversation, which inspired me to take the book off the shelf and really read it this time! It’s a fantastic review of some fundamental concepts.
The book is organized into ten chapters and nine appendices. There is a copious section of notes at the end of each chapter. I quickly developed a two-bookmark system: one to mark my place in the chapter, and one to mark my place in that chapter’s notes. It may sound like a lot, but I would encourage other readers not to skip the notes: there’s a lot of good additional information there!
Additionally, I sometimes left off the chapter reading to explore one or the other of the appendices. For example, a footnote in Chapter 1 references Appendix H, The Five Phases. I put Chapter 1 on hold, while I read about The Five Phases. I ended up reading some of the appendices as they were referred to in the chapters; others waited until I got to the end of the book.
Chapter 1 is titled “Medicine East and West: Two Ways of Seeing, Two Ways of Thinking (and the landscape patterns of nature and the body)”.
It provides a general introduction to the philosophical approach to health and medicine in China, as told from a Westerner’s point of view. It introduces the concept of Yin and Yang theory. It offers fine art painting as an analogy for how the Chinese practitioner views the body within its environment, and how this informs diagnosis and treatment approaches.
From there, the book goes chapter to chapter, explaining different fundamental aspects of Chinese medicine, each one building upon the last.
Chapter 2 covers The Fundamental Substances: Qi, Blood, Jing, Shen and Fluids. The Substance of Qi is further broken down into Origins, Functions, Types and Disharmonies. “The idea of Qi is fundamental to Chinese medical thinking, yet no one English word or phrase can adequately capture its meaning.” (p. 35) The author offers a comparison and contrast of this concept to Western medical thinking, and how the Chinese approach differs from the Western tools of chemistry, biochemistry, anatomy and physiology.
Once we are familiar with these Substances, we are introduced to the Chinese concept of Organs.
Again, there is a fundamentally different view of organs between the East and the West. “For example, the Organ known as the Liver is for the Chinese very different from the Western liver. The Chinese Liver is defined first by the functions associated with it, the Western liver by its physical structure.” The Chinese Organs are organized in Yin & Yang pairs, and this section gives an overview of the function of each one.
From the Organs, we move to the Meridians: the Warp and Woof. For me, this section was particularly helpful, since I am not an acupuncturist, and my herbal training has not delved very deeply into learning the Meridians. This section offers diagrams of the Fourteen Major Meridians:
1-2. Lung, Large Intestine
3-4. Spleen, Stomach
5-6. Heart, Small Intestine
7-8. Kidney, Bladder
9-10. Liver, Gall Bladder
11-12. Pericardium, Triple Burner
13. Governing Vessel
14. Conception Vessel
This section also offers some insight into the practice of acupuncture and herbology, how these two modalities may be used individually or together. From my perspective, practicing herbal medicine but not acupuncture, I especially appreciated this acknowledgement of the emphasis on herbs.
“An understanding of the interconnections between Substances, Organs and Meridians informs the practices of acupuncture and herbology. These are the two main forms of treatment used in Chinese medicine, and Meridian theory allows the physician to apply them to particular patients.” (p. 79)
Furthermore, “the science of herbs is central to Chinese medicine. During the last two millennia, many more books have been devoted to herbology than to acupuncture. And while Chinese physicians tend to practice both medical techniques, physicians who practice only with herbs are more numerous than those who practice only with acupuncture.
The body of knowledge of Chinese herbology has been preserved in a great succession of pharmacopoeias and clinical manuals, a tradition that began during the early Han dynasty (the third century B.C.E.).” (p.81-82)
That’s 5,000 years of continuous practice and refinement of herbal medicine: truly amazing!
The first four chapters provide the reader with a basis for understanding the viewpoint of the human body and its functions. Chapter 5 shifts into the human body and its environment: “Origins of Disharmony: Stormy Weather (or when a cause is not a cause)”. The environment includes Six Pernicious Influences:
and Seven Emotions:
(These 7 emotions are sometimes condensed into 5: sadness & grief are combined, as are fear & fright. In my experience, this fits rather neatly into Five Element Theory - which is given an appendix of its own in this book.)
The Pernicious Influences and the Emotions may be factors of imbalance in the bodily landscape, and often appear in combinations. For example, if someone catches a cold, it may be a result of a Wind-Cold-Damp invasion. This is not that hard for the Western mind to imagine, if a person has been out walking on a rainy, cold, windy day.
Furthermore, in my experience, if that person is also experiencing sadness or grief, an emotion that is associated with the Lungs, that emotion may leave the person more vulnerable to Pernicious Influences affecting the Lungs - in this example, the combination of Wind-Cold-Damp. The Lungs open to the nose, and rule the exterior of the body. “The Lungs regulate the secretion of sweat, the moistening of the skin, and resistance to External Pernicious Influences.” (p. 56-57) Conversely, if this person experiences Wind-Cold-Damp invasion, they may be more susceptible to sadness. The physical is affected by the emotional, and vice-versa.
Ok, we’re half-way through the chapters! We’ve been introduced to the body terrain and the environmental terrain. Now we learn how a Chinese practitioner approaches diagnosis.
Chapter 6 covers The Four Examinations: Signs and Symptoms. The Four Examinations are:
Listening & Smelling
Looking involves observation of the appearance overall, but for many practitioners, really focuses on the tongue. This section provides a brief introduction to tongue diagnosis, which is considered one of the two pillars of the Four Examinations. The other pillar is Feeling the Pulse.
In this diagnostic technique, pulses are felt at the radial artery near the wrist. The practitioner places three fingers at the client’s wrist, feeling for three different positions, and each at three different depths. We are given illustrations of the 28 basic pulses defined in Chinese medicine. As the author states, pulse diagnosis is a very sophisticated art. These illustrations provide a useful tool for the Western practitioner to begin to comprehend the various qualities one might feel beneath one’s fingertips.
The next category we consider is that of Eight Principle Patterns: the Faces of Yin and Yang.
This can be simply summarized as:
Hot / Cold
Wet / Dry
Interior / Exterior
Deficiency / Excess
Once we understand these basic relationship pairs, we can begin to further refine various combination patterns, and apply them to the Organs and Meridians.
Now we have the basic pieces to consider in Chinese medical analysis. The next step is learning to discern Patterns.
In this diagram, we see
the Organ (Liver);
a Pernicious Influence (Heat);
qualities of Yin & Yang;
references to the Emotions;
symptoms appearing along the Meridians (eye symptoms, various kinds of headache);
and qualities of Pulses.
We are beginning to see how the individual symptoms add up to a whole picture of the person within the environment.
In Chapter 9, “Chinese Medicine as Art”, the author reviews this process of discovering patterns, in terms of a clinical case history. He also draws comparisons to classical Greek medicine, which remains the foundation of modern Western medicine. He states: “Any example of pre-modern scientific, pre-quantitative, pre-technological medical thinking reveals a commitment to the idea of balance. There are striking similarities to be found in the Greek medicine of antiquity, in the practice of the Arab physicians who followed them, and in the Hindu Ayurvedic systems… Health and illness were usually defined in terms of balance.” (p. 247-248)
Finally, Chapter 10 brings us back around to “The Web That Has No Weaver - and Mount Sinai”. The author returns to a general comparison and contrast of Eastern thinking and Western thinking, both on the grand scale of the universe, and in the specific approach to practicing medicine. How can Eastern and Western cultures understand each other? How can we recognize our similarities, and our differences? Can we allow two very different systems to coexist side by side, without a need to prove one right and the other wrong?
These remain relevant questions today. I think, I hope that the answer is YES.
However, we’re not quite done! This book includes nine appendices, and they are also worth reading thoroughly! So here’s a quick summary.
Appendix A: The Stages of Disease: A Series of Clinical Scenes
Defines the Six Stages, as developed in the classic Discussion of Cold-Induced Diseases, the Shang-han Lun, written by Zhang Zhong-jing around 220 C.E.
(Think about that: what was Western medicine doing in 220 C.E.? That’s about 600 years after Hippocrates; 200 years after Dioscorides; 100 years after Galen; about 200 years before the fall of the Roman Empire. But I digress.)
1. Tai Yang/ Greater Yang
2. Yang Ming/ Yang Brightness
3. Shao Yang/ Lesser Yang
4. Tai Yin/ Greater Yin
5. Shao Yin/ Lesser Yin
6. Jue Yin/ Absolute Yin
The Four Stages, developed during the 14th c., became known as the Warm Disease School. This was considered a supplement to the Six Stages, with accepted roots in classical Chinese medical literature.
Wei (the Chinese word for Protective Qi)
Ying (nutritive aspect of Qi)
Appendix B offers examples of Yang Organs in Disharmony, with charts of symptoms and the corresponding tongue & pulse presentations.
Appendix C offers a series of 22 tables, outlining potential Patterns based on a Primary Complaint or symptom, such as fever or headache.
Appendix D: Pulses Revisited takes us further in-depth on this pillar of diagnosis. While Chapter 6 outlines the 28 basic pulses, Appendix D shows various pulse combinations that may be found in clinical observation. Examples include Rapid + Thin; Rapid + Slippery; Rapid + Wiry; and the associated symptoms and/or patterns.
Appendix E considers Western diagnoses and offers potentially comparable Chinese pattern diagnoses. Twenty Western diseases are included, such as Hyperthyroidism, Liver Cancer, Arthritis, Diabetes and Pneumonia.
Appendix F: a page defining the Curious Organs: the Brain, Marrow, Bones, Uterus, Blood Vessels and Gall Bladder. (Personally, I wonder if the Uterus should be given greater consideration than it is in this, or any, patriarchal medical system.)
Appendix G offers further detail on Looking, and facial diagnostic techniques.
Appendix H offers a thorough introduction to Five Phase Theory (also known as Five Element theory). A great refresher!
Appendix I is a Historical Bibliography. I found even this listing of texts to be informative. It helped me gain greater clarity on some of the classic Chinese titles, authors, and dynastic eras that are often referenced in the study of Chinese medicine.
And that’s it!
In conclusion, I read this book in about two weeks. I would enthusiastically recommend it to any student of Chinese herbal medicine; and generally to any practitioner of Chinese medicine, including herbs, acupuncture, and qigong or the other internal martial & healing arts. Even for the seasoned practitioner, it’s good to review the fundamentals.
“Repetitsia est Mater Estudiorum” - Repetition is the Mother of Study/Learning
As I read this book, I also found myself thinking of the Western medical doctors in my family. I would recommend this book as a theoretical introduction to practitioners of Western medicine, who are curious about different approaches to health care. I think we all benefit from widening our perspectives.