Systemic thinking and Chinese medicine – a relational exercise

Rebecca Ewert, Georg Ivanovas

Abstract: Western medical thinking is characterized by a morphological thinking embedded in a clear-cut concept of cause and effect. However, this approach neglects relational and systemic aspects. It was systemic psychotherapy that first introduced such aspects into medical discourse. On the other side, Chinese medicine was always obliged to a more systemic thinking. This paper highlights some of the similarities between systemic psychotherapy and Chinese medicine.

This paper has the purpose to demonstrate some systemic concepts of Chinese medicine which are similarly found in general systems theory and in systemic psychotherapy.

Chinese medicine is based on the concept of a 'life force' called CHI. CHI is the basic energy inherent in all things. Without CHI stars would not shine. It creates weather and it circulates in the body (Hammer: 79). But as such it cannot be measured (Worsley: 79). Only its effects can be observed.

This is a so-called vitalistic idea. Bertalanffy, in his General systems theory, tried several times to explain the differences between systems theory and the vitalistic approach, but never convincingly. Terms like sexual energy or the aim to survive are vitalistic concepts as well. Or, they are, at least explanatory principles according to Bateson (Bateson 38-58). Such vitalistic concepts are necessary as there is yet no scientific theory of the living.

In using the word CHI we would like to explain what call the relational aspects of Chinese medicine.

The pictogram for CHI

is composed of

steam or vapour and (uncooked) rice

Therefore CHI (life energy) reads: steam over rice.

This is, of course, only an analogy. But such pictures are the basis for Chinese thinking. As in the West such analogies are mainly found in poems, Chinese language and thinking seems poetic to us. But for the Chinese it is not poetic but their normal way of thinking.

The inherent relational aspects shall be demonstrated with the help of a reflection by Heinz von Foerster. Von Foerster maintained that computing in the semantic area is different than computing in the mathematical field (Foerster/Bröcker: 329-331). A word, an idea or a concept is always embedded in a net of other elements. Von Foerster compares it with an octopus having a lot of tentacles which represent relational possibilities. A word like horse can be an animal or a device for gymnastics. So the meaning of a word or an expression changes according to the context. Bateson called this the relation between frame and content (Bateson: 177-193). In poetry, normally words are used in such a way that different relational aspects remain possible, whereas a Western scientific text leaves no room for interpretation. The latter leads to exactness, the former opens possibilities for connections.

The 4th axiom by Watzlawick et. al. on communication is concerned with the two possibilities: Human beings communicate both digitally and analogically. Digital language has a highly complex and powerful logical syntax but lacks adequate semantics in the field of relationship, while analogic language possesses the semantics but has no adequate syntax for the unambiguous definition of the nature of relationship (Watzlawick et al: 66-67).

This concerns not only communication but has to be seen more generally, as the following examples demonstrate.

Blood sugar testing is often done with test sticks. Depending on the blood sugar level, the colour of the stick changes. With a reference table, the blood sugar can be estimated approximately (analogical method). The stick can as well be inserted into a machine. The machine then gives an exact value, let’s say 132. For the same procedure there exists an analogical and a digital possibility. However, the digital result of the machine is not more exact than the eye (Kleesiek 2003), but normally it is considered as more precise than the eyes approximate (120-140).

That is, digital results seem to be more scientific than analogical. However, the relational aspect is lost. Similarly we have two possibilities to a watch, an analogical and a digital form. The digital has more to do with exactness; therefore it is used in films for time bombs. Analogical watches are more used for appointments.

Another example would be the outcome of a race. The digital result on the scoreboard is a clear and precise list. A photograph of the finish line does often not provide such a decisive impression. But it shows the relation between the athletes.

These two examples might give a first feeling for the differences between an analogical and a digital medical thinking.

In the West an organ like the liver has a defined anatomy and physiology which can be disturbed leading to a certain kind of pathology like hepatitis, cirrhosis, fibrosis or other. Everything is clearly digitalized and neatly categorized.

The Chinese approach is different. The Chinese liver (GAN) might have local swellings, tensions or pains. But a disturbance of the liver might lead to problems in the digestion (constipation, diarrhoea), often accompanied by certain desires or aversions for food (fat or sour food). Although such symptoms are also somehow connected in Western medicine, they would not be seen as a liver symptom. But for Chinese medicine the liver (GAN) is responsible for many other issues. It makes the body smell sour, it involves all symptoms of the circulation, e.g., pulsating in the head with headache. Furthermore, GAN influences muscles and tendons, alters their expression including tension, cramps of the legs and tendonitis. Every organ has also a related organ, and in the case of the liver it is the eye. So all kind of ocular symptoms are a liver sign. That is, a bad diet overloading the liver might lead to eye problems. GAN is also connected to certain emotions, especially to anger and flexibility in thinking and in behaviour.

We see here a major difference between the two approaches: Western medicine is mainly structural, Chinese medicine is mainly functional. Therefore, for the Chinese the disease of an organ (ZANG-XIANG) is not only an alteration of the organ itself. It includes every sign the alteration provokes. ZANG-XIANG has been translated as ‘reflectoral and algetical signs of an inner organ’ (König/Wancura, 1983: 13). By that it comprises not only objective signs and subjective feelings (König/Wancura, 1979: 121), but all vegetative impacts, neuromuscular relations, the representation on body surface and corresponding emotions as well (König/Wancura, 1979: 216).

These are (in Western terms) not only somatic, psychological and psychosomatic aspects. The Chinese diagnosis includes the semiotic aspect as well. Semiotics is concerned with symbols and their influence. People with ‘a broken heart’ who suffer from emotional stress might develop a distinct form of heart symptoms (Ebert 2005). Although this might be explained by stress hormones it involves also a semiotic aspect: We all know what a broken heart is and that the heart is the centre of love and compassion. So this very knowledge alters the expression of stress or even is able to create stress.

Whereas for Chinese medicine all this is an expression of the same organ, in Western medicine these are different subjects treated by different specialisations. The physician is mainly concerned with the anatomical and physiological aspect. Reichian psychotherapy and bioenergetics are concerned with the functional aspect, although they seem to match best the Chinese concept of organs. But they still miss the semiotic aspect which is mainly covered by psychoanalysis or Jungian psychotherapy.

What we see here is actually the split between body and mind, between objective and subjective that is inexistent in Chinese medicine.

In systemic psychotherapy some concepts as Minuchin’s ‘conjoined physiology’ (Minuchin/Fishman: 12-13), or the concept of family somatics (Kröger/Altmeyer 2000) go in this direction, but they are not comprehensive. On the other side, systemic psychotherapy goes beyond the limitations of a theoretical ‘individual’ and includes the nearer environment. This is also the case with Chinese medicine, but in a different way.

The handling of the symptoms is quite similar to systemic psychotherapy, especially to the strategic approach. Chinese medicine is very much based on the observed and uttered symptoms. The felt reality is of main importance (König/Wancura, 1979: 188). Furthermore some causal factors are taken into account such as the outer factors heat, cold, fire, wind, dryness, dampness and the inner factors joy, fear, anxiety, worry, anger, grief. However, these factors are interrelated and basically – just as in systemic psychotherapy - digital distinction of cause and effect is as inexistent in Chinese medicine.

For example, cold and fear are correlated with each other, such that a fearful person will be more susceptible to a disease from cold than a less timid one, and excessive exposure to cold can trigger fearfulness. That is, the causal connection becomes relative, as each factor is not only cause, but effect as well. That is, the cause and the reactional type are equated (König/Wancura, 1979: 185): Only a cold type suffers from cold, only an angry type develops anger. A disease can only arise after the inner balance was lost in the first place, and thus only an ill person becomes ill. Basically, the loss of harmony is already the disease.

The signs and symptoms are but hints for the real nature of the disease (Hammer: 44) which help to decide on the correct therapy (König/Wancura, 1979: 122). In order to do this all symptoms (observed and felt) are investigated with the logical operators Yin and Yang. The two represent the ‘sunny’ side or the ‘shady’ side of a situation. Nothing is yin or yang; the terms characterize a relation.

This relation is described for example according to the 5 elements.

The elements fire, earth, metal, water, wood represent the cyclic rhythm of nature in which all living is embedded. Therefore their circular organisation is a blueprint to understand all processes connected to CHI. Thus, the processes in humans can be described in the same manner. We have here an ‘energetic’ structure, or better: a relational pattern.

According to the theory of the 5 elements energy circles from one element to the next in a clockwise direction. Through this “nourishing” (sheng) cycle, every element is linked to the two adjoining ones.

Chinese medicine describes the relation between these elements through an analogy of the family. The element or meridian that nourishes the next is called the ‘Mother’ and the element or meridian that receives this energy is called the ‘Son’ or ‘Child’.

If the mother is disturbed (and thus can’t properly nourish its child), then the child becomes sick. This might cause the ‘grandmother’ to become sick in turn, like a worrying grandparent who feels they cannot do anything to make the grandchild get better. This is the frame in which every therapy is designed.

The ‘Mother-and-Child-Rule’, for example, says that if the mother is in excess (has too much energy) the child has to be sedated and if the child is in deficiency (too little energy) the mother has to be tonified. If in such a case the child is treated the mother becomes even worse (Worsley: 48)

Another strong dynamic between the elements is the “controlling” (ko) cycle, through which every element is related to the two opposite elements in the circle: Too much water will extinguish a fire, while no “watery” restriction at all will cause it to flare up and then consume itself. A grandparent who spoils their grandchild rotten will cause trouble to their own child because the grandchild will act up to her mother afterwards. A grandparent that is too strict with their grandchild will make it very needy towards its mother, at least for a while.

Through these two cycles, every element is linked directly to every other element and thus can balance or imbalance the whole system.

These examples demonstrate that in Chinese medicine every phenomenon is seen in an energetic way that is embedded in a relational structure. It might be accidental that it uses the terminology of a family. However, this and other rules (husband-wife-rule) resemble strikingly the circular causalities of family therapy including certain therapeutic strategies. Also the conclusions on how to change a pathological pattern are not so different.


Ebert J (2005): A broken heart harms your health,, accessed 5.4.05

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Kleesiek K (2003): Unzureichende Qualität patientennaher Glucosebestimmungen: Ringversuche offenbaren erhebliche Unterschiede zwischen den benutzten Geräten. Dtsch Arztebl 100: A 2454–2455

König G, Wancura I (1979): Praxis und Theorie der neuen Chinesischen Akupunktur - Band 1, Maudrich, Wien

König G, Wancura I (1983): Praxis und Theorie der neuen Chinesischen Akupunktur – Band II, Maurich, Wien

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Worsley JR (1982): Talking about acupuncture in New York, College of traditional Acupuncture, Leamington Spa. Side citation from the German translation Was ist Akupunktur, Neue Erde, Saarbrücken, 2000


Ewert R, Ivanovas G (2005): Systemic thinking and Chinese medicine – a relational exercise, 3rd Grek Conference of Systemic Therapy,gemeinsam mit: Rebecca Ewert, 3. Πανελλήνιο Συνέδριο στη Συστεμική Θεραπία Heraklio 21.-23.10.2005

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