This is the first in a series on the big ideas in Chinese medicine. Through the ages, these ideas have been the lens through which practitioners view illness and wellness. In clinical practice, they are harnessed to effect the best possible outcome for each individual. In addition to their use in the clinic, I believe they are easily relatable to the human experience and that the ideas themselves may have therapeutic value.
Say it’s the end of the day and you are tired. Maybe you didn’t sleep enough last night or haven’t had the time to eat well in the past couple of days. You notice your throat is a little scratchy. It’s that time of year, and several others have been coming into work with sniffling noses. So, you go home, eat a nourishing dinner, get a full night’s sleep and wake up feeling fine. This is an example of the upright conquering the pernicious. Your upright qi is relatively intact - all it needed was a good meal and some rest to overcome the pernicious. Suppose, however, you wake up the next day feeling worse to the extent that you need to call out sick. Later, you find out that half your office is also laid up. In this case, the pernicious was much stronger, so much so that it would give even the most upright of upright qi a very hard time for a while.
Upright vs. pernicious is one of the ways of understanding the dynamics of illness and health that Chinese medicine practitioners use as we observe and treat our patients. It helps us tailor each treatment to meet the unique needs of each individual in each unique situation. There are four possibilities:
strong upright qi — weak upright qi
strong pernicious — weak pernicious
with an endless number of variations. Understanding this dynamic informs how much we attack the pernicious and how much we support the upright in each situation. Suppose at the first sign of a scratchy throat, you had called your practitioner. Your Chinese medicine practitioner would be familiar with the condition of your upright qi - how prone you are to catching colds and how they tend to present, whether you run cold or hot, whether you sleep well or poorly, whether you tend to be full of energy or fatigued. With that baseline information combined with your symptoms, tongue and pulse, the practitioner would devise a treatment appropriate to your constitution and the circumstances of the given moment.
Let’s take another example: say you and a robust companion fall asleep on an airplane. Both of you wake up with a classic crick in the neck, unable to turn your heads from side to side. The two of you find a local practitioner. Again, you are run-down and have been dealing with a stiff neck for the past couple of months - your upright qi is not at its fullest. Noting your recent history as well as defiencies showing up on your pulse and tongue, the practitioner does some acupuncture and bodywork, and also sends you away with a warming liniment and herbs to support your circulation. In contrast, your robust and perhaps youthful companion gets a strong acupuncture treatment, some massage and is good to go. Why no herbs, no liniment? They are not necessary. In this situation, his or her circulation is strong enough to clear out the knots - the pernicious is attacked, the thorns are removed, the upright qi strong enough to complete the healing.
If in reading this, you have become concerned about your upright qi, don’t worry! While it might seem that more upright qi is better, this is not always the case. Future posts will offer context, with the introduction of yin/yang theory and the idea of balance in Chinese medicine. And, if you are wondering if there are ways to improve your upright qi, yes there are! Stay tuned.