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Traditional Oriental Medicine And Traditional Chiropractic Theory.

A basic principle of the practice of chiropractic is that the human organism can heal itself (vis medicatrix naturae). In the past two decades, medical and psychological research has strongly suggested that the human organism does, indeed, possess remarkable capabilities, both to prevent illness and to restore health, when disease strikes. Chiropractic shares this view with many other health care disciplines besides medicine and psychology.

In fact, chiropractic as a profession shares similar interests with a number of health care professions. For example, chiropractic shares with naturopathy an interest in natural therapy, particularly nutrition. With Western medicine it shares a common interest and knowledge in anatomy, physiology, pathology, diagnosis and psychology. With physical therapy it shares an interest in exercise, physical modalities and rehabilitation. Additionally, chiropractic shares with Eastern medicine, or Traditional Oriental Medicine (TOM), a common interest in manipulation, nutrition, vitalism, and even meridian theory. According to Alex Hollard, licensed acupuncturist, author and former faculty member of the Northwest Institute of Acupuncture and Oriental Medicine in Seattle, the blend of acupuncture and chiropractic for neuromuscular conditions is an excellent therapeutic combination (1995). Applied Kinesiology (AK) is based, in part, upon meridian theory. In turn, TOM is based on an energy system theory that is viewed fro m both a universal as well as an innate perspective called "Qi" (pronounced "chee"). Qi is similar in many respects to D. D. Palmer's concept of Universal and Innate Intelligence. Finally, in addition to TOM, chiropractic shares an interest in vitalistic principles similar to other vitalistic healing arts such as homeopathy and ayurvedic medicine.

Both chiropractic and Traditional Oriental Medicine emphasize the importance of proper rest, good and proper nutrition, exercise, a calm and positive attitude, and normal physiologic activity. Both theories, as noted, are vitalistically based, more so with TOM which rests its entire theory on the presence of Qi. In contrast, though historically a vitalistic theory, chiropractic stresses a balanced autonomic nervous system (ANS) as central to its philosophy and practice. TOM practitioners adjust the spine to balance Qi. Chiropractors adjust the spine to correct nerve interference (by extension: to balance the ANS).

Keeping the "whole" person in view is the key to understanding TOM and chiropractic. The Western medical paradigm sees disease as having a body. The Eastern and Palmer paradigms see the body as having a disease. Similar to the early Greek physicians, the physicians of TOM and chiropractic recognize that each person has within himself a life energy, called "physis" (from which term "physician" is derived). As Leviton notes in his book, Physician, "The physis is the human organism's innate ability to keep itself in dynamic balance (or homeostasis), to heal when it is sick, to restore when it is depleted, and to thrive when it is given the proper nourishment. You might consider the human organism's inborn intelligence of health and vitality, its homeostatic regulator. Natural therapeutics support the physis, the human organism's physical ability to heal itself; these approaches do not seek to kill a disease (as does conventional medicine), but to strengthen the body's ability to transmute its ill-health-producin g effect and restore itself to health..."(2000).

In other words, one of the differences between the traditional chiropractic physician and the Western physician is not only the recognition of an innate intelligence but the lack of military rhetoric and combatant philosophical principles. To Western medicine pathogens or germs are enemy agents invading the body. Health is seen as a battle. Western medicine fights off disease. The chiropractic physician supports the "physis" or Innate Intelligence of the body. Internal harmony is its goal, not combat.

In the past, and to some extent today, chiropractic traditionalists have attacked the term "physician" when attached to the word "chiropractic". They have engaged in a war of semantics unhampered by facts. The practices of yesteryear are not necessarily the best for our own. Principles do not change, but practices must. It is important to know why you do something. What you do is not as important as why. The reactionary attempt to force the solution of today's advancing problems through the set patterns of the dead past violates every known and established essential of progressive learning. This does not mean rejecting past practices because they come from the past. Change for the sake of change is nothing less than foolishness. TOM is 4,000 to 5,000 years old. We neither want to stunt our own professional growth nor dry up the wellspring of inspiration. Nor should we assume that all true knowledge comes only from the West. The concept of Qi is an excellent example.

Many doctors of chiropractic and some Western scientists accept the concept of Qi as being a fundamental fact. One of these scientists is Robert O. Becker, MD. Dr. Becker is an orthopedic surgeon who is a pioneering researcher and leading expert in the field of biological electricity and regeneration. He has been twice nominated for the Nobel Prize. He is the author of two texts, The Body Electric and Cross Currents. Dr. Becker believes Qi to be a bioelectrical magnetic energy.

Dr. Becker notes: "... acupuncture has come to be viewed as a discipline of energy medicine, operating via electrical forces ...

"... The insertion of a metallic needle into any part of the body will produce a very small electrical current, because the needle insertion produces a local current of injury and the metal of the needle reacts with the ionic solution of the body ...

"... The theory that we derived from our experiments was simple, in accord with physical principles and supportive of classifying acupuncture as one of the reinforcement techniques of energy medicine ..."(1990)

Dr. Becker also notes that a new scientific concept is beginning to emerge that is bringing energetic systems back into biology. Dr. Becker's research has linked a bioelectrical system to the nervous system. This has major implications for chiropractic and TOM as much as it does for Western medicine.

Indeed, Western medicine in Europe has essentially discarded the meridian theory for the theory that there are neuro-electrical impulses that follow certain pathways through the ANS. Doctors following this thesis note that acupuncture points on the body's surface have lower electrical resistance than the surrounding tissue.

Following European thought, Dr. Nakatani, a Japanese medical physician researcher, developed Ryodoraku acupuncture therapy, which when translated into English has the astounding name of "Autonomic Nervous System Therapy"! Dr. Nakatani states that sympathetic nerves on the skin may be measured through various acupuncture point levels of resistance. Treatment is then directed towards certain acupuncture points based on the previous findings of resistance. Ryodoraku theory postulates that when an internal organ develops some type of dysfunction there is a corresponding change on the skin surface at the corresponding points. These changes are the result of sensory, motor or sympathetic or parasympathetic nerve reflexes.

Hirohisa Oda writes in Ryodoraku Textbook, Ryodoraku Autonomic Nervous System Therapy: "The Study of Ryodoraku Therapy, originated during research on the autonomic nervous system by a succession of professors in the department of physiology at Kyoto University, School of Medicine. In the 1950s Dr. Yoshira Nakatani experimented with acupuncture, a form of skin stimulus therapy, proposing that the effects of Acupuncture Stimulation were due to the effects of the autonomic nervous system ...

"Dr. Nakatani defined classical acupuncture techniques as a form of stimulus therapy and advocated that the sympathetic nervous system should be used as a parameter for standard diagnostic procedures.

"Galvanic Skin Reflex, which has been known for years, is based on the principle that changes in electrical resistance of a specific area of skin are influenced by the reflexes of the sympathetic nervous system. On the other hand, Ryodoraku therapy is based on the differences in resistance of specific areas of skin, simultaneously." (1989)

Ryodoraku becomes important from a chiropractic philosophical viewpoint when one grasps the concept that historically, according to Palmer theory, a vertebral subluxation causes neurological interference to the ANS. However, neither the science nor art of chiropractic has been able to predict with any degree of clinical, much less scientific certainty, the effects of correcting such interference.

This sad fact has led Palmer philosophy to paradoxically argue that correction of the interference is not the treatment of disease (or disturbance, such as the interference itself) but the correction of the cause of the disturbance (i.e., the subluxation). What this amounts to is clearly demonstrated in the following example. An individual presents at a chiropractic office complaining of constipation. The "traditional Palmer" chiropractor (by "Palmer" I mean philosophy not school) examines the patient for subluxations only, even though he or she cannot with any degree of certainty be assured that the subluxations when found are in fact the cause of the constipation. In short, the patient seeks care for constipation and the traditional chiropractic philosopher seeks a subluxation, with the belief that adjusting the subluxation is good for the patient, even if the problem for which the patient seeks relief from remains! The patient (or third party) pays for an apple and gets a watermelon at best or a grape at worst!

This philosophical logic is expressed in the statement that medicine treats the disease that has the body and chiropractic treats the body that has the disease. Of course, this is not entirely correct since viewed from traditional philosophy the only thing "treated" is the subluxation. It also leads to the irrational, and sometimes dangerous, position that doctors of chiropractic do not or should not diagnose. Some chiropractors hide behind this argument thinking that they will be protected from charges of malpractice. For many doctors the conclusion is sincere though irrational. Treatment is not the same thing as fighting an invading army, a view taken by Western medicine. Chiropractic like TOM treats disharmony by assisting in the restoration of harmony. Webster's New Concise Dictionary says "treatment" means "a manner of dealing with." Chiropractors deal with disease but not by fighting or suppressing it.

Unfortunately statistics reveal that the argument that chiropractors don't diagnose does not stand up in court and even the Palmer institutions teach diagnosis. So did D.D. Palmer. How ironic it is to note that D.D. Palmer, the father of our profession, insisted that those chiropractic physicians who did not diagnose were not, in his opinion, practicing chiropractic (more about that later).

Diagnosis is not a moot point, nor one of simple semantics. Most young doctors of chiropractic are not aware, much less remember, that it was a central issue with Congress when the profession was being considered for Medicare coverage. It came down to a simple fact: no diagnosis, no coverage. After all, a profession that does not diagnose is dangerous to the public health. A patient with back pain can have a subluxation or cancer or both. If chiropractors do not diagnose, then they should not be allowed to be portal of entry primary health care providers. The public needs gatekeepers who diagnose. Up to that point in time, the International Chiropractors Association (ICA) rejected "diagnosis." Once the ICA leaders came to recognize the consequences of such a position, they joined the ACA leadership with all CCE accredited colleges in acknowledging the fact that chiropractic doctors did in fact diagnose.

Out of that wise union of leadership a small seed of disunion and resistance was formed. It has grown into a small but very vocal group of chiropractors insisting that chiropractors don't diagnose. Fortunately the majority see the foolishness of such a position.

TOM practitioners also diagnose. Like most doctors of chiropractic they recognize the importance of when to refer to another health care provider. Diagnosis is not just about recognizing a particular disease. It is a rare DC that ever tells a patient he or she has cancer. Hopefully it is not so rare for a DC to recognize certain signs as suggesting a serious departure from normal and the possibility of cancer. Such referrals to other health care providers do not prevent the doctor of chiropractic from offering the patient chiropractic care. TOM practitioners often provide supportive care to patients undergoing cancer therapy. For example, acupuncture and herbs are often very effective in reducing the side effects of chemotherapy.

Subluxation-only chiropractic offers the patient undergoing chemotherapy a strong and healthy functioning nervous system which is important but finds itself often in the position of objecting to the introduction of such toxic chemicals (or in general, drugs, vaccines, etc.). Yet it cannot promise a full recovery to the cancer patient. It embraces the principle of "The Limitation of Matter." But of course this is a false principle since it assumes that matter is limited after the subluxation has been corrected. It assumes, I believe incorrectly, that neural function and vital life force are identical.

At best it can be said that traditional chiropractic, when it focuses on the subluxation and not the symptoms or signs, lacks specificity. Of course, when chiropractic focuses on musculoskeletal problems (e.g., sciatica, discopathy, sprain/strain), it does so with an understanding of the location of a problem and the tissues involved in producing the symptoms. When traditional chiropractic faces an organic/functional disorder it tends to stress the subluxation and to treat it rather than the disorder. By "treat" I mean Webster's definition, i.e., to deal with the disorder.

There are many modern day doctors of chiropractic who embrace traditional philosophy and at the same time take a Western diagnostic approach to locating the organs and tissues producing the symptoms before formulating their treatment plan. And as noted, such doctors are more consistent with the philosophical principles of D.D. Palmer than many modern day "subluxation-based" chiropractors. By combining such procedures with Traditional Oriental Medicine procedures and historical chiropractic spinal analysis, the chiropractic physician has the best of three worlds to offer his or her patient.

How does this all relate to acupuncture? Ryodoraku provides a diagnostic technique which serves several important objectives from the chiropractic point of view. Firstly, it allows a diagnostic approach that clearly relates to the traditional chiropractic clinical approach pertaining to the subluxation and the ANS. Secondly, it provides adjunctive support in the form of electrical stimulation that increases the degree of predictability related to the patient's complaints and a successful outcome. The patient pays for an apple and gets one.

Acupuncture meridian theory, as it relates to organ function, and Ryodoraku as it relates to the same, plus the ANS, provide strong indicators as to what subluxations are in actual fact doing to the ANS. In addition to this, Ryodoraku allows chiropractic practitioners to determine if the ANS, by measuring the electromagnetic changes taking place, is becoming more balanced and normal. In Ryodoraku the meridians and the ANS are similar in that as the ANS becomes balanced, so do the meridians, and vice versa.

Traditional Oriental Medicine provides energetic clues as to what is going on within the patient. The TOM practitioner considers all symptoms and signs as part of the body's language that enables the practitioner to evaluate the energetic state of the patient's vital forces. Chiropractic practitioners of TOM must discover methods of making TOM diagnostics and technique work for them, while at the same time remaining true to chiropractic science and art. This is splendidly done within Ryodoraku technique.

One of the leading chiropractic proponents of Ryodoraku is Dr. John Amaro. Dr. Amaro has spent a good portion of his professional career dedicated to teaching doctors of chiropractic about TOM, particularly Ryodoraku. Dr. Amaro graduated from Cleveland Chiropractic College in 1969. He obtained his certification in acupuncture in 1973 from Columbia Institute of Chiropractic and later from Chinese Medical Institute, Kauloon, China in 1976. In 1980 he received his Diplomate in acupuncture from Shanghai Research Institute of Acupuncture. He is the Founder and Executive Director of the International Academy of Medical Acupuncture, which he founded in 1978.

The Academy has graduated over 9,000 doctors who have attained "Fellowship" status through this program internationally. He has presented over 1,200 educational symposiums in 25 years of teaching internationally, including escorting more than 500 doctors on 13 visits to the People's Republic of China. Dr. Amaro was appointed by the Governor of Arizona to serve on the Arizona Board of Acupuncture Examiners and served as its first chairman.

Dr. Amaro has created the Electro Meridian Imaging (EMI) computer enhanced diagnostic method, which is used throughout the world by thousands. Through his efforts, thousands of doctors of chiropractic have been able to remain focused on a health career in chiropractic as a primary family healthcare practitioner, rather than becoming just musculoskeletal health care providers.

Instead of reducing the practice of chiropractic to sprain and strain, or evolving its traditional philosophy to a vague subluxation/adjustment wellness principle, Dr. Amaro recognized very early in the 1970s that Traditional Oriental Medicine offered an Eastern approach to understanding the body's energetic system that was in harmony with traditional chiropractic philosophical principles, particularly its emphasis on the Vital Life Force. (As an aside, many doctors have asked me why I use the term Traditional Oriental Medicine also known as TOM, instead of TCM, which stands for Traditional Chinese Medicine. The chief reason why I prefer TOM to TCM is that TCM is a particular technique or approach similar to Gonstead, Thompson, or Activator in chiropractic. TOM represents all types of techniques, including philosophy, and is similar to the term "chiropractic," a general term that can mean many different things).

The father of our profession, D. D. Palmer, accepted the principle of a Vital Life Force as did the ancient Orientals. Over thousands of years of observation, ancient Oriental practitioners came to understand how Qi worked and how to monitor it. The TOM version of a spinal subluxation causes disturbance to the Qi, which can result in disease. Some postulate that Qi may be a metaphor for the operation of the nervous system or it may be a bio-structural magnetic signal closely related to the nervous system. Disturbance to the nervous system can cause disturbance to the electrical magnetic signal as suggested by the pioneering research of such scientists as Dr. Becker.

Whether Qi is a neurological signal, some type of electrical magnetic force, or something else is not beside the point, since many doctors of chiropractic have put all their philosophical eggs in the neurological basket. It may well be the adjustment reduces "nerve interference," but it might do much more. Indeed, there is considerable scientific evidence to strongly suggest that Qi, or the Vital Life Force, is a form of electromagnetic energy. Thus a "subluxation" not only causes "nerve interference" but also disturbs the Vital Life Force or electromagnetic balance of the body. I am not talking about a vague philosophical concept but basic physiology supported by a growing body of research.

D. D. Palmer knew that the Vital Life Force he believed in was not the same thing as the neural impulse. Nerve interference might cause an imbalance in Vital Life Force, but it was not the same thing as Vital Life Force. He wrote in his classic text:

"A subluxation does not restrain or liberate vital energy. Vital energy is expressed in functional activity. A subluxation may impinge against nerves, the transmitting channel may increase or decrease the momentum of impulses, not energy. Vital energy is not transmitted through the nervous system..." (1910)

A question many "traditional" doctors of chiropractic might want to ask themselves is this: If the Vital Life Force is electromagnetic and not neurological, and if a subluxation causes an imbalance in this force, ought not it be included within chiropractic philosophy and practice? For the modernists who reject chiropractic philosophy per se, how will this emerging vitalistic paradigm be assimilated?

Yoshio Manaka, a medical physician researcher established a scientific model called the "X-signal system" which attempts to explain acupuncture. Dr. Manaka speaks of various approaches made to study acupuncture in his classic text, Chasing the Dragon's Tail. The first method is the classical traditional method. The second method rejects anything that is not scientifically measurable. This approach dismisses traditional methods of diagnosis. The third approach attempts to find correlations of acupuncture and East Asian medical models with Western medical systems. Dr. Manaka calls this the "integrationist" approach.

He writes, "...It attempts to avoid rejection of the models and concepts of either system, seeking instead to create a delicate symmetry between them...Often the analysis and technology adopted by these approaches discovers information and correlations not described in the traditional literature. This has led to the development of adapted versions or new synthesis. Good examples of this can be seen in the work of Dr. Voll in Germany, and from Japan, in the work of Dr. Nakatani. Both of these methods base their starting point on findings that the channels and their acupoints are measurable electrically. From this common base, each group has evolved unique equipment, technique and theories."

Dr. Manaka's model recognizes the following:

1) Qi is difficult to measure and define.

2) It flows through the body in organized patterns, through pathways, the so-called meridians.

3) The meridians are information channels that probably evolved early in evolution.

4) Yin-Yang and Five Elements symptoms are operationally defined by signals. These signals have low energy content, but high information content.

5) These signals can be changed or modified by applying appropriate low-energy signals to the acupoints of the meridians or channels. Thus very exact changes in the channels and flow of information can be measured or monitored.

6) Essentially, this information system upholds the known physiological systems as a more primitive regulatory system.

Dr. Manaka calls this the "X-signal system" because the exact nature of the signals is not known.

How ironic it would be if Western science ultimately determines that disturbance to the nervous system does in fact cause disturbance to a bioelectrical magnetic system that provides organizing information to human physiology. Ironic, if one remembers that the father of our profession, D.D. Palmer, before "re-discovering" chiropractic, was a magnetic healer.

In the meantime, thousands of doctors of chiropractic have studied TOM, and many have decided to include it within their general practices. Such doctors utilize TOM modalities as they would other adjunctive modalities. Perhaps the main difference between these and other broad-scope chiropractic practitioners who don't include TOM modalities in their practices is the recognition that the West is not the sole repository of healing knowledge, and that the East has a lot to offer healthcare providers, especially those providers who offer full family care. On the other hand, if there is an "X-signal system", then doctors of chiropractic need to know that fact as much as they need to know there is a circulatory system. Moreover, they need to know how this "X-signal" is affected by the adjustment, modality, prescribed herbal, etc.

Dr. Amaro's EMI or Ryodoraku is a form of electrodermal testing and treatment. Remember electrodermal testing measures the difference between certain acupoints and determines energetic imbalances within the energy channels or meridians based on Five Phases (or Elements) Theory and practice. Acupuncture points can be found by introducing a low voltage electrical potential onto the body surface and then measuring the electrical conductance of the skin. The acupuncture points have less electrical resistance or are more conductive than the surrounding skin. Diagnostic information (based on TOM and Five Elements theory) about various meridians and corresponding organ systems as well as musculoskeletal regions is obtained by the level of the readings. For example, an EMI analysis looks at the level of the meridian being tested (either excessive or deficient) and compares it with its corresponding meridian (Yin and Yang). Some meridians are yin and have corresponding meridians that are yang. For example, the Heart/yin meridian has a corresponding Small Intestine/yang meridian. Meridians are named after major organs they pass through. Thus three conditions can be determined: excess, deficiency and imbalance.

EMI has discovered another interesting fact, a fourth set of conditions. This finding is that a right side yin or yang meridian may also be imbalanced, deficient or excessive, when compared to the same meridian on the left side of the body (see Figure 1).

A small number of scientists have attempted to determine the character of the energy that is being measured. As I have previously noted, some believe it is what TOM calls it -- Qi. Others believe Qi is an electromagnetic force. Science, of course, doesn't even know what electricity or magnetism is. Robert Beck (not to be confused with Robert Becker, MD) notes: "Man is an extremely complex bio-cosmic resonator ... People ask me occasionally why this or that works and I tell them the truth, that although I'm a physicist, I don't know what electricity is. Neither does anybody else. But we certainly build a lot of marvelous things with it, from toasters to televisions sets to computers. And it will be quite a few years before even the effect of some of these simple stimulation type devices are well understood, much less fully understood." (2000)

The important point for clinicians is that a great deal of research has been done worldwide regarding electrical conductance changes at various acupuncture points and correlating such changes with various disease states. Most of the research published has been in Chinese, Russian, Japanese, French, and German, much of which has not been translated into English.

A German medical physician, Reinhold Voll, in the early 1950s first determined that acupuncture points had a different resistance than the surrounding tissue. Voll's research led to identifying different electrical changes in various acupuncture points with certain diseases. For example, he was able to identify abnormal readings at the lung acupuncture points of patients who had lung cancer. This research was later verified at UCLA and USC. (See a few examples of the large number of published papers on electrodermal research in the reference section).

The clinical implications for doctors of chiropractic should be obvious, especially for those physicians who are energetically rather than biomechanically focused. Dr. Amaro's computer program is especially beneficial since it offers guiding principles for the doctor to consider when attempting to determine what areas to adjust. And by the way, adjustments are given at the end of the EMI treatment. After three or four treatments, the patient is re-evaluated energetically. Charts are made at each evaluation so the practitioners and patients can see what progress is being made. As the "energy" (Qi) becomes more balanced within the system, the patient's symptoms improve. The correlation between the energetic charts and the symptoms are remarkable. While Dr. Amaro's computerized EMI program points to certain areas of the spine to be evaluated, such evaluation remains up to the doctor of chiropractic, as well as to what type of chiropractic adjustment to utilize.

The actual EMI treatment consists of an electrical stimulation at a certain acupuncture point based on Five Elements (Phases) Theory and practice. For tonification (balancing a meridian) a 15-second stimulation is given. To sedate an excessive meridian a 30-second stimulation is given. There are no needles used and the stimulus is comfortable.

A basic understanding of Yin-Yang and the Five Phases/Five Elements Theory is required to understand EMI. The ancient Taoists attempted to comprehend both universal and internal processes. They would compare such internal processes with external cosmic and natural processes. They traced nature's energy back to its primordial source, which they termed the Wu Chi. The Wu Chi is depicted as an empty circle. This is the Great Void, or Emptiness - the Tao. From this Void comes the One, the primordial cosmic energy. The Tai Chi symbol (see Figure 2) symbolizes this unity where yin and yang are perfectly balanced. Yin and yang are the terms that express two complementary opposites. Almost all things can be divided into yin and yang. Electrically yin is negative and yang is positive. While yin and yang are opposites they are not two separate things. Everything has a yin and yang attribute. For example, yin is down and yang is up. Yin is front and yang is back. Everything has a yin quality and a yang quality. Yin is s olid, still; yang is action, movement. The heart is yin while the heart activity is yang. Yin and yang are relative to each other.

In Traditional Oriental Medicine there are twelve important internal organs called the Zang-Fu. They are divided into the yin (Zang) and yang (Fu) organs: Heart, Pericardium, Spleen, Lung, Kidneys and Liver (Zang-yin) and Small Intestine, Sanjiao (Triple Heater), Stomach, Large Intestine, Urinary Bladder and Gall Bladder (Fu-Yang).

The Zang-Fu fill the three burning spaces or the Triple Heater which correspond to the pelvic, abdominal and thoracic cavities. When disturbed by diet or emotion they become diseased. This also corresponds to two of the chiropractic determining causes of disease (chemical/toxic and emotion/mental).

The Zang-Fu produce, transform, and store Qi and blood. Qi is yang and blood is yin. All internal physiological functions, either pathological or healthy, are viewed by TOM in terms of either the Qi or the blood. The relationship between the two is expressed in TOM as: Qi leading the blood and blood nourishing the Qi. Interestingly TOM theory also holds the view that the mind leads the Qi. This is confirmed in Western biofeedback practice where patients are taught to lead the blood from the brain into the hands (called thermal biofeedback) with their minds. This is also one of the principles utilized in Qi Gong, a system of exercise for health in Traditional Oriental Medicine.

Since the Zang-Fu includes entirely the physiology of the body, various Zang-Fu have specific functions: the Lung dominates Qi and controls respiration, regulates the water passages, and dominates the skin and hair; the Spleen controls the blood, dominates the muscles and four Limbs, transforms food into Qi and blood and governs transportation and transformation; the Heart houses the mind; the Kidney dominates reproduction and water metabolism, receives Qi, helps the Lung with respiration, protects the Heart; the Liver stores the blood, regulates menstrual flow, nourishes the eyes, affects bile secretion, controls tendons, and regulates Qi flow.

The Fu or yang organs have the following functions: the Large Intestine is paired with the Lung and receives waste from the Small Intestine, absorbs fluids and excretes feces. The Stomach is paired with the Spleen and receives and decomposes food. The Small Intestine is paired with the Heart and receives and temporarily stores partially digested food and separates the clear from the turbid. The Urinary Bladder is paired with the Kidney and temporarily stores the urine and controls the discharge. The San Jiao controls water metabolism and is paired with the Pericardium. The Gallbladder is paired with the Liver. It stores bile and excretes it to aid digestion.

As it can be seen much of the above corresponds to accepted Western physiology in addition to its own framework which refers more to various functions and qualities than to anatomical organs or structures

In addition to yin and yang, all things or objects are divided into five categories, phases, forces or elements, which are wood, fire, earth, metal and water. The ancient Taoists, by observing the workings of the universe, developed a theory to explain the balance of antagonistic forces, of which the universe is composed. The various attributes and relationships of these forces are explained in the Five Elements Theory. The Five Elements (or Forces, Phases) work together to sustain all existence. Accordingly, the life force in all of its manifestations comes and goes through the interaction of the Five Elements, fire, earth, metal, water and wood. Each of the meridians and organs correspond to one of the Five Elements. For example, the wood element is associated with the Liver (yin) and Gallbladder (yang); the fire element with the Heart (yin), Small Intestine (yang), Pericardium (yin), and Triple Burner (yang); the earth element with the Spleen (yin) and the Stomach (yang); the metal element with the Lung (y in) and Large Intestine (yang); and the water element with the Kidney (yin) and Bladder (yang).

There are other aspects and physiological activities within the body that are also associated with the Five Elements. For example, joy or over-excitement can injure the heart; anger can harm the liver; grief the lungs; worry the spleen; and fear the kidney. A patient who exhibits emotions such as fear or anger may have kidney or liver disturbance. Of course every emotion can affect any number of organs. According to Five Elements Theory, an extreme emotion can affect a meridian and cause an imbalance in its corresponding organ. These aspects form a significant psychological division in TOM and Five Element Theory.

As a psychologist and Colorado-licensed psychotherapist and doctor of chiropractic, I would be remiss if I did not also call the reader's attention to the vast array of scientific articles and papers published within the mental health community dealing with biological energy and psycho-physical interaction. For an extensive list of references, see the "References" section of my textbook, Behavioral Considerations in Patient Management (ACA Press, 1996).

One such reference is Dr. Wilhem Reich (1942) who is credited with having discovered the meaning of what he termed "human armoring" His concept was of fixed muscular patterns or "armor" as expressing a person's way of being in, and relating to, the world. Armoring is a blockage to the flow of normal biological energy, which Reich came to term Orgone Energy because of its intimate relationship to organic life and function. Energy trapped in muscular armor means less energy for cognition and somatic activity. Ultimately Reich came to view Orgone Energy as the Vital Life Force -- astoundingly similar to the Qi of TOM and Innate and Universal Intelligence of traditional chiropractic philosophy.

The more well known and certainly the most interesting aspect of Five Elements Theory is the two cycles, the Generating (or Mother-Son) Cycle and the Controlling (or Grandmother-Son) Cycle. In the generating cycle, wood promotes fire, fire promotes earth, earth promotes metal, metal promotes water, and water promotes wood. In the controlling cycle, wood has control over earth, earth over water, water over fire, fire over metal and metal over wood (see Figure 3).

The term Five Elements is more properly rendered from the ancient Chinese medical texts Five "Phases." The word "Phases" is a more literal meaning which symbolizes the energetic aspects of a greater Cosmic System in ancient Chinese philosophy. The Five Elements or Phases is an attempt to organize philosophical concepts into a whole. It basically represents the relationships that exist between cosmic energies to one another. For the clinician, it metaphorically explains physiological relationships and interactions between them, and cosmically, our relationships to the external environments, earth, heaven and the cosmos. The first force of nature is the Universal Force, also termed Heavenly Qi. This cosmic force manifests itself as the energy of the galaxies and stars. It nourishes everything in the universe including us.

Historical chiropractic philosophy (Palmer) has approached this concept in its description of Innate Intelligence and Universal Intelligence. According to Palmer philosophy, Universal Intelligence creates universal forces. The function of Innate Intelligence is to adapt such forces (or energies) for use in the body so that all of its parts will be coordinated for its mutual benefit. Five Elements Theory, like Palmer philosophy, attempts to describe energetic balances and correspondences within the body as well as outside of it, and how these interact to bring about health, or become disturbed by interference and cause disease. Five Elements Theory recognizes internal and external forces as causation factors. Palmer philosophy has external and internal factors as well. Palmer principles included such external forces as physical or chemical interference, and internal forces such as mental disturbance. So do TOM and Five Elements Theory. Palmer philosophy embraces the concept of internal forces and resistive for ces. So does TOM and by extension Five Elements Theory.

Five Elements Theory has the Generating Cycle and Controlling Cycle. Palmer philosophy has the "Safety Pin Cycle." Just as the Generating and Controlling Cycles are not anatomically or physically correct but are merely schematic in describing the passage of energy, so too the Safety Pin Cycle is not physiologically or anatomically correct but merely symbolizes the passage of neural impulses from tissue cell to brain cell and vice versa (see Figures 3 & 4).

In Traditional Oriental Medicine there are three basic disease stages. In the first stage only one organ, or meridian, manifests disease. All symptoms and signs present will correspond to a single Element (i.e., wood, fire, etc.). In the second stage there will be two organs or meridians and here the Generating Cycle becomes important since it will explain the various symptoms and signs and their relationship to one another. For example, the patient may present Fire symptoms and Wood symptoms. The third stage is also two organs or elements or meridians but will manifest symptoms and signs through the Controlling Cycle.

Another TOM theory sees disease progressing in six stages. From the beginning to the most serious, these stages are as follows:

1) Taiyang

2) Yangming

3) Shaoyang (the Three Yang Diseases)

4) Taiyin

5) Shaoyin

6) Jueyin (the Three Yin Diseases)

Ancient Oriental physicians approached the diagnosis of such diseases through four methods of physical examination: inspection, questioning, smelling, and listening. Several methods of diagnostic inspection have been developed, such as pulse diagnosis, tongue and facial diagnosis, and abdomen or hara palpation. By far pulse diagnosis is the most difficult, and as Dr. Amaro is fond of telling his students, it takes years if not decades to master.

Dr. Amaro's answer to pulse diagnosis is the Electro Meridian Imaging or the EMI. The EMI computer read out gives a colorful graphic presentation of each meridian, far superior to pulse diagnosis. There is no question about it, EMI allows the diagnostician to "see" energetically what is going on in the patient's body. While this energy is most likely related to neurological function, the EMI is "looking" at Vital Life Force, not the nervous system, at least not directly. EMI (Electro Meridian Imaging) is looking at electrical resistance and current flow, not nerve flow or interference. That the two are related, I have no doubt.

I have no doubt because I have done a small amount of research myself. Nothing spectacular or even published but clearly convincing to me. I am certified in biofeedback and neurofeedback (EEG) by the Biofeedback Certification Institute of America (BCIAC). I have on a number of occasions indirectly monitored a patient's ANS while doing EMI. Based on these clinical observations I am convinced that there is an indirect relationship between the nervous system and the Vital Life Force or Qi which is clearly of a electromagnetic character. I should point out that the biofeedback technique I utilized is also of an electrical nature. It is electrodermal response feedback. The electrical conductivity of the skin is known as the electrodermal response. The best known feature of this physiological response is the galvanic skin response (GSR). This general measure of autonomic arousal rests on the observation that an arousal increases sweat gland activity as well as skin moisture. Conductance of electricity increases cur rent flows with less resistance through the salty moisture on the skin surface, and conductivity decreases as moisture decreases.

Various biofeedback instruments have been developed which monitor different aspects of this physiological activity. Some instruments measure conductance rates and others measure resistance rates. But basically these instruments measure the degree of sweat gland activity. The major use of electrodermal feedback, in addition to treatment of elevated sweat gland activity (hyperhidrosis), is in the reduction of levels of sympathetic (ANS) tone and reactivity in treatment of phobias and anxiety states. Such monitoring usually accompanies ANS desensitization.

I bring all this to the reader's attention so that he or she can appreciate the fact that a number of different scientific disciplines have concentrated on similar areas of interest without "talking" to one another. The therapeutic difference between GSR biofeedback and EMI is that biofeedback attempts to teach the patient how to reduce ANS arousal through measurement of the GSR while the EMI introduces an electrical charge or needle into an acupuncture point based on the EMI findings.

Yuasa Yasuo in his text, The Body, Self-Cultivation and Ki (Qi) Energy, notes the following:

"At present it is possible to give only a hypothetical explanation of why and how an intense magnetic field is generated in the human body. Where there is a flow of electricity, a magnetic field is naturally created. Bioelectricity flows most actively in the nerves, but in addition there is, though very slightly, a bioelectricity generated in the activities of visceral organs and muscles, which also triggers the generation of a magnetic field. For example, when a person compresses the motor nerves and diaphragm through abdominal breathing, a relatively large amount of muscle electricity is generated. In view of these observations, we might say that the human body has a capability somewhat analogous to a generator. This principle itself has been well known, but that an intense magnetic field several times stronger than the magnetic field of the earth, could be generated in the human body, was beyond expectation...

"The preceding is concerned with electromagnetic waves and magnetic fields, but in addition to these, the generation of static electricity and infrasonic waves can be detected in and around the human body."

Traditional chiropractic theory, like chiropractic art and science, should be subject to revision as knowledge increases. Chiropractic philosophy (Palmer) is not religious dogma. It must conform to scientific facts. Indeed, one of the purposes of philosophy is to explain scientific facts and integrate such facts with its art. Unfortunately, attempts to present traditional philosophy in modern-dress ("subluxation based chiropractic") is often strong on dogma and semantic arguments rather than science. Such apologists would do well to study TOM's historical and modem day attitude. It not only explains its millennial survival but it's continuing success. Yet it essentially remains true to its philosophical principles.

Research presently shows not only a magnetic field associated with neural and organ or visceral function but also with bone (particularly spinal bone) and physical stresses like gravity. Misaligned spinal vertebrae (subluxations), like all physical objects, are subject to gravity. The interaction between bone and gravity results in a form of bone cell regulation (Bassett and Becker, 1962). Bones convert mechanical energy through a piezoelectric effect into electrical energy.

Piezoelectricity is a form of pressure electricity and is a property of bone (Liboff and Shamos, 1971). The magnetic field created by this can adversely affect the nervous system and its magnetic field. Interestingly, at least one modern-day doctor of chiropractic has recognized the importance of this fact (Pettibon, 1973) and made it an important aspect of his spinal "Bio-Mechanics" theory.

It may well be that the common denominator between TOM and chiropractic is bio-magnetic energy. Indeed it is very likely that it is the common denominator between all vitalistic health care disciplines. Given the increased scientific and public interest in bioenergetics, it is not unreasonable that it may emerge as a separate biological healthcare discipline, in contrast to chemical biology. Over the decades chiropractic theory and practice has moved from a vitalistic energy-based model to a biomechanical model. Hopefully it will not remain so.

Western medical science attempts to arrive at a disease entity. Traditional chiropractic theory originally did the same thing. D. D. Palmer argued that until the doctor of chiropractic knew what was wrong with the patient, and what nerves were most likely involved, he or she would not know what area of the spine was more likely than not causing the problem. As previously noted in this article, modem day traditionalists reject diagnosis altogether, putting the focus on the spine only and the various models of subluxation. Modem day chiropractic physicians who reject the traditional view often become "naturopathic chiropractors" (i.e., Western diagnosis plus a form of natural therapeutics). The chiropractic adjustment/subluxation often becomes reduced to a general form of manipulation.

To illustrate what I mean, consider what D. D. Palmer wrote in 1910:

"Diagnosis is the recognition or determination of the nature of disease and the pathognomonic signs of each. The act of recognizing a change in organs, functions or vital phenomena, in contradiction to that found in health, deciding there from as to its character, is diagnosis.

"Chiropractic diagnosis or analysis, is radically different from any other method; as much so, as adjusting causes is different from treating effects.

"The physician makes his diagnosis from the subjective symptoms experienced by the patient; the objective signs perceived by himself; the chemical analysis of excretions; the microscopic examinations of morbid tissues; ocular spectrum analysis; percussion; ausculation; pulsation; repercussion; palpation; and temperature. From these he determinates the nature and progress of the affection and prescribes for the morbid conditions found.

"The chiropractor depends largely upon the subjective and objective symptoms, as his material to locate the cause of the ailment. Knowing the impingement which is the primary cause of deranged function." (561-562).

Traditional Oriental Medicine arrives at an energetic diagnosis (especially Five Elements Theory). TOM diagnosis embraced Eight diagnostic Principles in conjunction with the Five Elements or phases. "Phases" is a more descriptive term of the dynamic process. The Eight Principles are guiding diagnostic criteria. TOM diagnosis is a diagnosis of a pattern of disharmony. The Five Phases keep the practitioner focused on the energetic movement of the disharmony. The Eight Principles allow the practitioner to apply a systematic evaluation of the data gathered. The doctor assesses a particular phase (e.g., wood) in accordance with the Eight Guiding Diagnostic Principles.

The Eight Principles are:

1) Yin

2) Yang

3) Hot

4) Cold

5) Empty

6) Full

7) Internal

8) External

The Five Phases (and their correspondences) allows the practitioner to see that a particular problem (excess, deficient or imbalanced) exists in a specific element or energetic phase (wood, fire, earth, metal, water) but it does not assist us in defining the nature of that element's disharmony.

Certainly Dr. Amaro's EMI program given numerous examples of the types of disharmonies that might be present in Western terms but it too does not give us a specific breakdown. This is where the Eight Guiding Principles can help us. It allows us to systematically categorize every symptom and sign in relation to the particular element.

TOM has developed a number of diagnostic systems that allow the practitioner to be more specific. My two favorites are tongue diagnosis and Hara diagnosis (Figure 5 & 6). Tongue diagnosis is just that, a diagnosis based upon signs displayed by the tongue. Hara diagnosis relates to abdominal diagnosis. Two other very important diagnostic systems are the Associate Points and the Alarm Points (see Figure 7).

Tongue diagnosis is a valuable method of differentiating clinical syndromes. In many patients the syndromes of Cold or Heat, of Excess or Deficiency, of Exterior or Interior can be reached solely upon tongue inspection.

A Heat syndrome has the attribute of a red tongue body with a coating that is creamy yellow, dry or charred. The body of the tongue is pale, red, or bluish-purple. A cold syndrome has the attribute of a pale tongue, with a moist, smooth white coating. Coatings are white, yellow, and black.

An Excess syndrome has the attribute of a firm, withered, and dark-colored tongue with dirty-looking, creamy coating which may be in small piles. A deficiency syndrome is usually plump, has a pale color, and very little or no coating.

If the problem is internal, the tongue coating will turn from white to yellow, thin to thick and wet to dry. External denotes a thin coating, white, not dry in most cases.

Finally, various geographic areas of the tongue relate to various organs. The tip of the tongue is the heart. The root is the kidney. The center of the tongue is the stomach and the spleen surrounds it. Between the spleen and the heart are the lung areas and the sides of the tongue representing the liver/gall bladder (see Figure 5). This gives a rough idea about different viscera. A red tip tongue with a EMI heart meridian "excess" can tell a practitioner a lot, whether or not there are any standard Western signs (i.e., chest pain, palpitations, etc). Moreover, further Western diagnostic procedures (EKG, blood tests, etc.) might be advised. Treatment protocol might include EMI/acupuncture, herbs, diet, adjustment, plus whatever the clinician thinks appropriate. A red tip tongue with an EMI deficiency, as compared to one of excess, may alter the treatment protocol.

A thick yellow coating in the middle of the tongue suggests Heat in the Stomach. No coating at the tongue root suggests Kidney Yin exhaustion. Dark red tongue sides suggest Heat in the Liver-Gallbladder. Combine such findings with the EMI and Western signs and symptoms to help shape a treatment plan.

Each of the main twelve meridians is named in accordance with that organ the meridian passes through. The Lung (LU) meridian passes through the Lung, the Heart (H) meridian through the heart, the Large Intestine (LI) through the large intestine and so on. If the EMI determines an energetic imbalance in the Liver (LV) meridian, the doctor of chiropractic can evaluate the liver reflexes, do Western liver blood tests, and of course do a spinal analysis of the nerve supply to the liver. Structurally a T8 transverse process that is nodulated and tender to palpation, combined with tenderness along the lower right rib tips (anterior), symptoms of headache and lassitude, a medial right scapula that is painful to palpation, signs of burning feet, wandering pain, irritability or anger, and right sides of tongue signs (TOM) strongly suggest liver functional problems or even organic disease.

Additional TOM diagnostics can include Alarm or "Mu" points (see Figure 7) and Associated points. All the associated points are located on the Bladder (BL) meridian (see Figure 8). The Alarm Points are on the front of the body except for the Spleen (SP) and Kidney (KI). If an Alarm Point or Associated Point is tender it indicates that the meridian is likely out of balance. Stimulation of the Alarm Point is also therapeutic and helps rebalance the meridian.

A Vignette

The following demonstrates the use of the EMI in case management.

On 5/5/99 a young teenager, Keyna Cook, presented herself for care while I was on the staff of Southeast Colorado Hospital in Springfield, Colorado. She presented with symptoms of multiple allergies (airborne, grass, wool, food, etc.). She also reported constant fatigue and chronic pain (headaches, as well as low-back and neck pain).

I ordered blood tests for food sensitivity, did the standard orthopedic, neurologic and chiropractic tests as well as an Electro Meridian Imaging analysis (see Figure 1A). Her EMI was not totally out of balance, clearly indicating five meridians in balance (Pericardium, Triple Heater, Spleen, Kidney and Bladder). Keyna received nutritional advice and was placed on a rotational diet, as she was sensitive to over 20 foods. She also received chiropractic adjustments, EMI stimulation: the Lung meridian was sedated, the Heart balanced, the Small Intestine (a significant factor in food sensitivity) was also balanced, as were the Large Intestine and Liver meridians. The Gall Bladder meridian was sedated and the Stomach meridian balanced.

All of her EMI evaluations are not presented in Figure 1 A. The last EMI was done on 3/7/00 and shows an almost completely balanced meridian reading. Her symptoms had also vastly improved. Keyna is now eating most of the foods she was initially sensitive to, rarely had symptoms related to airborne substances and when she did they were extremely mild and her energy level was normal.

Allergy treatment with the EMI was simple. The patient brought in the offending substance. I would test her strength using the o-ring finger meter. The reading would be noted. Another reading would be done while holding the substance in one hand. If she were sensitive her reading would drop. If she were no longer sensitive her reading would remain the same. If the reading dropped she would continue to hold the substance while she received EMI stimulation based on her graph. Keyna was then tested with the meter after the EMI treatment. She was then instructed to wash her hands and avoid the substance for 24 hours. It never took more than four such treatments per substance, and usually only two, to eliminate the sensitivity.

As an interesting aside, Keyna raised sheep, which she would show each year at the County Fair. Each year she would suffer the consequences of being near their wool for extended time periods with severe allergic reactions. She requested I treat her several weeks before the 2000 Fair. I treated her as described above for lamb's wool. It took two treatments. She had no allergic reactions to her sheep throughout the fair or thereafter. Needless to say, she was delighted. So was I. Importantly, this demonstrates the clinical effectiveness of the EMI procedure as a stand-alone modality. The Cook family has kindly given permission their stories to be told. Keyna's cousin, Brad, another allergy case, was far more dramatic and I would like to include his story at a later date.

Historic chiropractic care, whether broad or narrow scope, has always been holistic in theory because it has always been concerned with the total health, welfare and survival of the patient. From the chiropractic broad-scope perspective, this philosophical principle has evolved into a clinical approach that includes procedures, used in accordance with the chiropractic physician's clinical judgement, such as the spinal adjustment, manipulation, massage, physical modalities (heat, cold, ultrasound, electrical stimulation, diathermy), rehabilitation, exercise, nutrition, herbs, as well as lifestyle, stress and psychological counseling. Supportive appliances and emergency first aid have also been offered at times to chiropractic patients.

Certain chiropractic broad scope physicians have been centered vitalistically and have included homeopathy within their practice, as well as bio-magnetism, and Traditional Oriental Medicine. TOM is an excellent adjunctive partner to the Western chiropractic approach and offers a vast array of modalities within itself: manipulation, Tuina, Shiatsu, acupuncture, nutrition, moxibustion, bleeding, Qi Gong, herbal medicine, electrical stimulation, and magnetism. For the doctor of chiropractic already trained in the Western basic sciences, it does not require a three-year postgraduate program to become clinically proficient in TOM. Dr. Amaro's course in Five Elements and Electro-Meridian Imaging is an excellent choice for those physicians wishing to broaden their scope while remaining true to their vitalistic roots. Traditional Oriental Medicine and Chiropractic Theory are very compatible and extremely effective clinically.

More information on EMI training courses and workshops can be obtained by contacting the International Academy of Medical Acupuncture, P.O. Box 1003, Carefree, and Arizona 85377. Phone 800-327-1113, Fax 602-595-9881.

Note: Special Thanks to Brisvany Velasquez, PTA for her drawings included in this paper.

About the Author

Dr. Edward C. Sullivan is licensed to practice chiropractic and psychotherapy in Colorado. He is the present director of the Denver Rehabilitation Clinic at 50 South Federal Blvd, Denver, CO (303-922-2977). He holds a degree in chiropractic, as well as a Masters Degree in Psychological Counseling and a PhD in Health Psychology and Behavioral Medicine. He holds diplomates in psychotherapy (APA), professional disabilities, (ABPDC), and Acupuncture (FIAMA). He is the author of the textbook, Behavioral Considerations in Patient Management (ACA Press, 1996), and of over 50 published articles (including peer review journals).

He lectures and holds workshops for the Chiropractic Rehabilitation Association and the International Academy of Medical Acupuncture. He is available as a guest speaker and workshop leader.

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