Structural vs Functional

3 thoughts on “Structural vs Functional”

  1. Dear Elio,
    Thank you very much for your speedy and informative reply.
    I would like to explore this issue further, as to be honest, from what you wrote, I don’t understand what is the point of differentiating between a structural and functional disorder. You wrote:

    The reason why he defines autoimmune disorders as related to Qi dynamic (functional) resides in the fact that autoimmunity can be seen as a disruption of Wei Qi attacking the constitutional level (Yuan Qi/Jing). It can still be argued that the end result, being an inflammation, will also be a structural problem; however, what Wang Ju Yi is telling us is that
    1. in case of autoimmunity we should try to act on the functional cause of the problem"

    If this is the case, doesn’t any problem in the body stem from a disruption in the qi dynamic?

    So it seems to me that in all structural problems we should approach them from a treatment on the qi dynamic?
    Also,I don’t know what is the practical difference in treatment when one approaches something at the level of the qi dynamic, and approaching something from a structural level? Simply leading the treatment using the inner line of bladder points instead of the 5 transport points? (As Wang Ju Yi says in the page I was quoting from, p.203)
    Apart from that, with acupuncture, are we not always addressing things at a functional level, i.e. always working on the qi dynamic?

    Actually, on reading it again, I notice that he writes:

    "Then, as now, I used the 'inner line' of back shu points closer to the spine when there were physical or structural problems with the organs".

    So perhaps the only reason he raises this point is to say that it is important to make a distinction in acupuncture simply whether organic change is the organs, rather than elsewhere in the body, as this will affect your choice of points. Although on the other hand, this does not completely fit with the idea of the organs in Chinese medicine being extended spheres of influence rather than just the physical organ, i.e. if the bones are organically affected, is this a sign that the kidney “organ” is organically affected?

    1. Hi Eliaz thanks for your reply because it gives me the opportunity to clarify what I believe is a semantic ambiguity.

      You are right every problem always stems from a disruption of the dynamic of Qi. This is why I quoted SuWen 5 where there is a progression from functional to structural and more precisely from spirit to matter.
      In fact the whole passage is

      The east generates wind; wind generates wood; wood generates sour [flavor]; sour [flavor] generates the liver; the liver generates the sinews; the sinews generate the heart;
      In heaven it is darkness, in man it is the Way, on the earth it is transformation. Transformation generates the five flavors; the Way generates wisdom; darkness generates the spirit.
      The spirit, in heaven it is wind, on the earth it is wood, in man’s body it is sinews.

      In my understanding the same cascade of events takes place in pathological processes that in turns need to be therapeutically addressed according to the stage we encounter the disease. In the case described by Wang Ju Yi the treatment is eventually based on the use of points of the outer BL line (spiritual/mental) because the disruption happens at the higher level of the hierarchy described in SuWen 5. His premise serves the purpose of differentiating/clarifying the origin of the pathology.

      At this point I think it is important to address firstly a semantic problem and then differentiate between CM and WM description of the human body. When in CM we talk of Organ-Qi we are referring to the function (Qi) of that specific Zang/Fu (i.e. Liv-Qi directs and controls all movement in the body and its preferred direction is upwards). If there is a problem with the ability of the Liv to perform that function we can have stagnation of Qi and/or counter-flow (acceleration of Qi to the top of the body). Now, let’s look at a typical CM functional problem like Head Ache (H/A). In CM it is broadly described as a counter current of Qi (functional); however, in WM it is broadly described as an irritation of the meninges and blood vessels in the brain (structural). In CM we treat it mostly with Shu-transporting points addressing the flow of Qi to the head (the Liv-Qi and its relationships manifest their pathology in the head).

      Conversely in a case of Liver cirrhosis manifesting with ascites (described in CM as “drum distention” gu zhang) you might be confused about what to do if you look at the problem according to the CM or WM perspective. If you follow the CM approach ascites is caused by an inability of the Sp to distribute fluids in the Middle Jiao. The intervention in this case is complex and generally includes treating also the Lu, Ki and Liv (as you can see the Liv-Qi is still part of the picture). In WM terms the problem is caused only by the Liv organ tissue degeneration and can be treated with Liver transplant in serious cases or diuresis. If you mix the two approaches you might be tempted to define the problem as “structurally” related to the Liv and needle just BL18. However, from the CM perspective you might want to address the disruption of the Sp-Qi which is a function of its Jing stored in the organ and call for action BL20. (Please note that the 2 points given are extreme simplifications)

      In conclusion my points are that

      1. the description of the process (its narrative) is more important than the assessment of the problem in terms of “functional/Qi and structural/organ-tissues” which in my opinion describe the relationship between movement/transformation and the material substrate where change takes place (as per the metaphor Jingqi=horse shenqi=rider)
      2. using WM descriptions, although it is sometimes necessary, can lead to misunderstandings and ambiguities.
      1. Thank you very much for taking the time to give a detailed reply and clarify things further.
        Best wishes :^)

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