Qi and Modern Medicine

Tsun-Nin Lee, MD

Qi or chi is a ubiquitous term in the literature of Traditional Chinese Medicine (often abbreviated as TCM), which encompasses three main areas: acupuncture, herbal medicine and Qi-Gong. Western-trained physicians, myself included, typically have considerable difficulty in embracing Qi as a scientific concept, because it appears to be transcendent, with no equivalent in modern biomedical science. Not surprisingly, this extraordinary concept has erected a barrier sometimes insurmountable to the understanding and consequently the acceptance of TCM, the time-tested and highly practical system of healing, by modern physicians.

Recognizing the difficulty for Westerners to understand TCM, I will here try to connect the transcendent view of Qi to scientific neurophysiology.

Exploring Qi Through Acupuncture

When a needle is inserted into an acupuncture point, it must achieve "deQi," which literally means "getting the Qi," by inducing a tingling, numbing or paresthesia on the part of the patient and a grabbing of the needle due to localized muscle contraction perceived by the treating doctor; this is somewhat akin to the twitch response elicited by the modern technique of trigger point injection. The deQi phenomenon can be abolished by cutting or blocking the afferent nerves innervating the acupuncture points, which are often located along major nerve trunks or their branches. This observation substantiates the close relationship between Qi and a viable nervous system. According to the acupuncture theories, the healing effects of acupuncture are based on their influence on the flow of Qi through the body's energy network-known as meridians-to attain internal homeostasis, thereby ridding the body of illnesses. Unfortunately, modern research has not yet been able to turn up any anatomical equivalents to the meridians, although human studies have shown that the sensations induced by acupuncture often follow the meridian pathways, which coincidentally are often the same as the patterns of referred pain.

Extrapolating the well-established conclusion on the central origin of phantom limb pain, the author postulated in 1976 the Thalamic Neuron Theory (TNT) to reconcile these apparent contradictory observations by equating the meridians to central neurological pathways embedded in the evolutionarily ancient part of the brain. The acupuncture-induced sensations traveling along the meridians experienced by a subject are actually nothing more than the neural transmissions along these central pathways, which in turn are equivalent to chains of neurons, while acupuncture points are merely clusters of neurons on these neuronal chains.

The efficacy of acupuncture in treating pain has been well recognized by the World Health Organization as well as the National Institute of Health. Neurophysiological research in recent years has focused on the mechanism known as central sensitization as the basis of chronic pain. In other words, the constant bombardment of painful stimuli originating from the periphery and impinging on the central nervous system can activate central neurons into hyperexcitable states, leading to the development of chronic pain. In the lingo of neuroscience, this process is known as "winding up" of neurons. Repetitive strain injuries including carpal tunnel syndrome are good examples of this process. The nerve cells in the central nervous system somehow become habituated into hyperactivity, which often can be reversed by repetitious acupuncture stimulations. The keyword here is repetition because it is through repetition that these hyperexcitable neurons can relearn their old normal behavior by memorization, much like the memorization of a poem or perfecting skill in golfing through constant practice. These are basically a series of training exercises to set up brain neural connections dedicated to specific tasks. It is for this reason that acupuncture treatments must be implemented repeatedly, in sufficiently frequent intervals in one or more series to produce sustained relief. When properly performed in this manner, significant relief of symptoms may be achieved for long periods of time-sometimes permanently. Since acupuncture can influence the behavior of neurons by modulating the excitability of neurons in a given neural circuit, it can therefore normalize the pattern of neural transmission-the flow of Qi.

The reason acupuncture may be effective against painful conditions now seems tangible. But what about its alleged effectiveness in treating hypertension, nausea, asthma and a whole host of other medical problems? Eighteen years after the initial publication of TNT, part two of TNT was advanced in 1994 to deal primarily with this question. It proposes that various medical conditions relate directly to deranged neural circuits in the central nervous system that control the various physiological processes of the body. Basic functions such as blood pressure, heart rate, respiration rate, sensitivity of the gut and bladder all rely on the central nervous system for control. Similar to controlling the room temperature with a thermostat, the brain controls the blood pressure with the blood pressure stat, the body weight with the weight-stat, the volume of urine in the bladder by the distention stat, and so on. Deviation from the normal positions of these controls lead to diverse symptoms.

For instance, patients suffering from irritable bowel syndrome are found to have heightened sensitivity of neural receptors in the large intestine, and overly active neural sensors in the bladder wall, can cause urinary frequency. These peripheral receptors project input onto the neural circuits in the brain, which in turn control the peripheral functions via a descending nervous system that includes the peripheral nerves. These central controls or switches for physiological functions may be jarred into abnormal positions by events such as trauma, infections, physical agents and emotional upheavals, either acutely or chronically. Once reset to abnormal positions, they tend to remain so as if they are stuck, resulting in chronically pathological functions.

The plasticity of the central nervous system generally enhances an organism's ability to survive in the course of evolution due to its capability to learn and adapt. Unfortunately, this survival advantage comes with an inherent disadvantage: the ability to learn to be sick, as in the case of repetitive strain disorders and stress-induced hypertension.

Based on this new paradigm, the efficacy of acupuncture in the treatment of nonpainful conditions is now quite amenable to scientific explanation. The pathological switches controlling the abnormal processes can now be turned up or down, not by craniotomy to reach into the brain to make adjustment for these switches, but by the remote controls available on the body surface known as the acupuncture points that provide convenient portals to communicate and influence the neural circuits in the brain to effectuate the healing process.

Modulation of Qi via Chinese Herbal Medicine

Most people-some TCM practitioners included-believe Chinese herbal medicine and acupuncture to be two separate and distinct disciplines, and their respective therapeutic effects based on different principles of action. In reality, however, the two disciplines are very similar, as they both act on the energy channels or meridians, which are neural circuitries within the central nervous system, to accomplish the objectives of healing.

Historical TCM literature classified herbal agents according to their therapeutic actions on the meridians, which supply and bear close relationships with various organs of the body. For instance, ginseng (both Chinese and Korean) acts predominantly on the heart and spleen meridians, whereas danggui strongly influences the liver meridian. The Physician's Desk Reference is full of examples of modern drugs with central actions as the basis of their efficacy. Since all Chinese herbal agents act on the meridians-which may be viewed as the controlling brain pathways-all such agents may be considered to be centrally active. This is not to say, however, that they do not possess pharmacological effects on the various tissues in the periphery, only that their central effects are more important.

Unlike acupuncture, which works on the central nervous systems through mechanical stimulation of peripheral nerves-a mechanism we may call physical neuromodulation-Chinese herbs act on the central nervous system by pharmacological actions, or perhaps more appropriately, chemoneuromodulations. Chinese herbal medicine differs from Western herbal medicine in that it seldom employs single agents, such as St. John's Wort, in the treatment of depression, ginko biloba for colds, etc. Chinese herbal treatment relies on teamwork-combining several agents to achieve a strategic goal.

For example, the four substances decoction, often used to treat a variety of women's diseases, consists of danggui, which tonifies the blood; chuanxiong, a strong Qi mobilizer; baishao, a yin tonifier for the liver, and shudihuang, which benefits the urogential system, all combined for their synergistic effects.

Chinese herbal formulae can impact neural transmission in yet another way. It has been well established that peripheral nerves serve not only to conduct electrical impulses, but also to transport either antegrade or retrograde multiple substances and organelles along the nerve fibers to achieve various trophic effects. The hypertrophy of muscles after repeated stimulations and contractions, as with weight training, is the result of trophic changes induced by the excretion of trophic factors from the nerves supplying the muscles. Other than the transmission of vital information by the fast conducting action potentials, peripheral nerves, as well as nerve tracts, can also transmit much slower but no less critical communication via biochemical signals by neuronal transport. TCM herbal agents-by altering the behavior of neurons-naturally affect their Qi as well.

At a minimum, Qi can be defined as cellar communications, of which neural transmission is but one type. Recent research has also discovered a great many similarities between the neuronal synapse and the neural-immune synapse, which exists between a neuron and an immune cell. Hence, there should be no surprise in the concept of emotional stress causing decreased resistance to infectious diseases, a phenomenon well observed in the practice of TCM thousands of years ago. Intercellular as well as intracellular communications, whether through secreting neural transmitters into the synapse, gene expressions by messenger RNA, or the transportation of cytokines, hormones or chemotaxic factors, all are just different expressions of Qi.

Qi Gong and Biorhythm

Qi gong literally means work on Qi. Qi gong is an exercise to replenish and balance the internal Qi to promote health and healing. It has been practiced by millions in the past several thousand years in China and may be considered as an integral part of TCM. The types of Qi gong are numbered in the hundreds. However, all forms of Qi gong share certain common features: controlled rhythmic deep respirations, mental concentration or imagery and, in the variety known as kinetic Qi gong, body movements. A prototype of kinetic or action Qi gong is tai chi, characterized by shadow boxing-like movements. Tai chi has been shown recently to significantly reduce the incidence of falls in nursing home patients who practice it. Before the advent of biofeedback, we had the preconceived notion that bodily functions such as heart rate, blood pressure and skin temperature cannot be voluntarily controlled, hence the term autonomic functions. We have since realized that the brain can indeed learn to control such physiological functions. Qi gong takes it one step further by enlisting the mind to amplify the Qi and direct its flow through the meridians to help open up blockages or to normalize central neuronal malfunctions that cause symptoms of disease. This process is assisted by coordinated deep breathing, imagery and sometimes muscular actions to push the Qi along. It is no accident that the word Qi in Chinese can mean both air and vital energy.

According to TCM, the internal flow of Qi follows specific meridian pathways, activating different organ systems sequentially at different times of the day. This understanding coincides with what is known in modern medicine as circadian rhythm, which controls such things as changing cortisol level throughout the day. The circulation of energy through the 12 meridians in a 24-hour period may also serve as the internal biological clock, important in phenomena such as jet lag and the navigational instinct of migratory birds.

TNT postulates that this biological clock may be embedded deep in the ancient part of the brain, such as the thalamus, or even the pineal gland, which is closely linked to the body's biorhythm. The flow of Qi in the meridian system (neural transmissions in central neural pathways) drives respiration, which in turn drives the circulation of Qi through the meridian system. This circulation of internal Qi is eminently trainable and may be reinforced to improve health as well as to withstand stress. It has been well documented scientifically that certain Tibetan monks who had accomplished a high level of Qi gong could stay in subzero temperature outdoors overnight with only a thin layer of clothing, with no apparent ill effects at all.

To sum up: Qi, which encompasses all cellular communications (the very foundation of Traditional Chinese Medicine), may be harnessed, expanded and directed to prevent as well as treat diseases. The central nervous system appears to be the site where Qi resides. Qi is in fact the chief ingredient cementing the mind-body connection. The lack of understanding of Qi is the proximal result of the lack of understanding of the brain, and for too long the central nervous system has been ignored as the master of all physiological systems. Hopefully, the infusion of Qi into the mainstream of modern medicine will expand our vision, stimulate novel ideas about old problems and help develop new treatment methods to alleviate the suffering of our patients.

Dr. Lee received his BA degree from Columbia College and his medical degree from New York University. He has been training physicians since 1979 to incorporate acupuncture into their patient care. Currently Dr. Lee is the Director of the Academy of Pain Research and maintains a private practice in San Francisco. He has authored many scientific articles and is the proponent of the Thalamic Neuron Theory.