Theoretical Approach to Classical Chinese Medicine – Macrocosmic Dimension

“It is clear that we must obtain knowledge of the primary causes, because it is when we think that we understand its primary cause that we claim to know each particular thing.” In the topic of being a scientist, Aristotle expounded the differences between a craftsman or a wiseman. Craftsman is the one who has had experiences but not the wherefore. He further explained that master craftsmen are superior in wisdom because they possess a theory and know the causes [1]. The ‘ultimate reason why’ used to be relevant to ‘a cause and principle’. Sometimes, we refer this ultimate reason to epistemology, the root of knowledge. 

It is also true that most knowledge of Traditional Chinese Medicine (TCM) was derived from our ancient wiseman who gave the concept of yin-yang teachings in Neijing. The basic form of yin-yang in TCM was mainly separated two parts: macrocosmic and microcosmic dimensions which had been documented and illustrated by Dr. M. Porkert. This article will explain the usage of the macrocosmic dimension in TCM and further applications clinically like acupuncture. 

TCM view showed that human-universe is a form of unification and living beings are affected by changings in our environment. It is a topic of macrocosmic being instructed in Huang-Di-Neijing which explained how this unification be created [2]. There are multiple models were simulated from nature in form of yin-yang and could be formulated based on its circadian rhythmic characteristics. Furthermore, in TCM history, clinical applications have been developed based on these macrocosmic models. This article will clarify some useful models, clinical application such as acupuncture and its theoretical basis. TCM has been coexisted with us for over two thousand years which is not only an issue of empirical experiences but also must be enriched in some sort of conventional theories as in Neijing and all others. Obviously, TCM has had its own theory commitment, and it takes time to prove this knowledgeable value in scientific aspects contemporarily.

• Inductive Reasoning from nature (Figure 1) 

Dating back to B.C. 500, ancient great Chinese philosopher Confucius and Laozi was the founder of Confucianism and Taoism. Preliminarily, Chinese civilization has been started more than 5000 years. In the meantime, there was a wise master named Fuxi () who had invented the well-known Trigrams () which was the inventor and cofounder of I-Ching (). 

Hereby, I reiterate its importance, Confucius said that “Phenomenological representation of the nature by vision revealed of destiny, whilst wiseman undisclosed these representations” () and this phenomenological disclosure thinking [3] which contemporarily named it as ziangxi (). Ancient history was clarified that Fuxi had been observed the representations of the nature and summarized his thinking in one pictorial Trigrams which was further developed the knowledge of I-Ching afterwards. 

Dr. Porkert quoted that “Chinese medicine, like the other sciences, defines data on the basis of the inductive and synthetic mode of cognition” [2 page 1]. When Fuxi had been explored the nature, there was a binary combination referring to yin-yang and gave the pictorial Trigrams. No one knows the process of how Fuxi made such a knowledgeable Trigrams yin-yang which had been conveying to the root of Chinese medicine while people are still using today. 

The yin-yang teaching of I-Ching has had an extensive view in multiple purposes, while Huang-Di-Neijing was specified in Chinese medicinal theory, clinical diagnosis and treatment. Apparently, inductive cognition was given by Fuxi and further clinical applications have been deduced hieratically forming TCM its human-universe nature.

 Figure 1: Illustration of ancient wise-man Fuxi 3000 B.C. who deduced Trigram I-Ching from nature.

• Comments on some concurrent TCM research topics 

Reviewing some frequently used search engine such as ScienceDirect (SDOL), Ovid Medline, etc. from sources of the last decade, I found that not so many scientific papers available expounding detail about TCM concepts and theories in lieu of empirical practices. Concurrently, researchers dedicate their effort, it does not give a right direction based on the fact that ancient TCM has had its own strong theory foundation [4]. Nowadays, TCM issues spreading worldwide, used to focus on the measurable part: herbal pharmaceutical intervention, public health statistical analysis, integrative western medicine consensus, evidence-based medicine and so forth. Undoubtedly, these scientific researching topics and its dedications to TCM is great. Nevertheless, if someone wants to delve into Chinese medicine including acupuncture, its theoretical thinking should be clarified. It is a good idea to grasp the core concept of ancient TCM because of its originated characteristics and thereafter integrated to scientific research issues. It is easy to lead astray to the root of yin-yang in classical Chinese Medicine. For instance, the diagram of TaiChi, it is so simple to interpret to its black is yin and white is yang. Nevertheless, yin is substance and yang is qi from the point view of Neijing, likewise, yin is body and yang is soul [5,6]. Therefore, it is not as simple as a black and white subject matter. 

Nevertheless, it is my attempt to introduce TCM from the perspective of dynamic yin-yang about Neijing and make use Dr. Porkert’s fantastic book as a major reference which focus on building up the theoretical foundation [2]. This foundation has the root based on yin-yang and the topics on macrocosmic, orbisiconography, and microcosmic dimension which is concerning about human body qi functions. Dr. Porkert used to be one of the prestigious European scholars who understood and probed into classical TCM studies fluently and deeply. The content of his manuscript about macrocosmic dimensions is the core concept of Neijing on the subjects of five movements and six qi (wu-yun liu-qi ) which used to be expressed in the form of schematic models [5,6].

• Extrinsic factors in the perspective of TCM 

All living things on earth must be corresponded and coexisted in our nature. While the Earth circulates universe giving positional dimensions : East, West, South, North, Upward, Downward which is called liu-he() giving the relationship of the TCM macrocosmic atmospheric influences (liu-qi/six-qi): wind, cold, summer heat, dampness, dryness and fire. These six-qi is completely matched to seasonal climate changes . Thus, it is reasonable to accept that these six-qi either gives benefit to us or harmfulness to our body because of their deficiency or redundance status (e.g. winter-cold is not cold enough, or extremely cold). 

Naturally, winter is cold, summer is hot and heat, autumn is dryness, summer rain is dampness, spring is windy. How does it build up the medical doctrines in TCM It is a matter of the root which is yin-yang. It has been explained in detail by teachings of Hetu, Tai Chi, and Neijing [3]. Seasonal changes of our nature can fit into the yin-yang system in the form of six-qi. The following paragraph will further discuss how six-qi fit into the yin-yang model and further explain its clinical applications. 

• Structuralized and symbolized yin-yang with six atmospheric influences (liu-qi) 

Six qi (liu-qi) become a form in the universe to correspond to our body. The structure of yin-yang transformation will be: (spring-wind ,wood, yang-in-yin, yifle liven{}), (summer-juvenile-fire, young-fire, yang-in-yang, yimi-prig{}), (summer-heat-fire , mature-fire, yang-in-yang, yami-mig{}), (long-summer-dampness , central-earth, yima-huhu{}), (autumn-dryness , metal, yang-in-yin, spleya metar{}), (winter-coldness , water, yin-in-yin, yama-aqual{}). This quadric domain will be matching as: (season, five-element, yin-yang, symbolization) respectively. These symbolization English translations were transcribed from Dr. Porkert[2 page 65]. This subset of yin-yang used to be called the three-yin and three-yang systems() in terms of TCM.

Symbolization which plays an important roles in formulations and calculations, such as yin-yang, five-elements, three-yin and three-yang, ten-celestial stems (), and twelve-terrestrial branches () [2 pages 60-67]. All these are our symbols used to correspond amidst TCM to the macrocosmic dimension. Since, yin-yang is the root of TCM which should be cast back to transcript our perspective in yin-yang. Four seasons are in cyclic changes such as day-night, years after years and millennium after millennium. Basically, they are predictable based on their circadian rhythmic characteristics from the doctrine of Neijing. From the doctrine of wu-yun liu-qi, epidemic diseases are more likely to occur during the 60-year Chinese calendar with fire-dominant retrieving from an ancient TCM classical literature documented 1000 years ago [7]. There is a statistical analysis delved into the incidence rate of epidemic infectious diseases from 184-1983 in China which divided 30-year as a unit totally 1800 years. Thereafter, the results found that during the wood-fire calendar year whichever epidemic events more likely to occur [8,9]. This wood-fire gives impact on infectious disease because wind promote to fire and fire itself is energetic to pathogen. It is common that if outer fire (Qi ) added to earth-surface fire (Yun) used to arouse infectious disease. 

The evidence of historical census and theoretical TCM matching are valuable to mankind health issues and further proves that macro- and micro-cosmic aspect is appliable to approximate the evidence. Medical history in China showed that epidemic diseases, which had been broken out with highly fatality in each dynasty, data and outcomes, could easily be found in historical documentaries because it used to be a matter of life and death. The aim of this paper is going to discuss more about the knowledge on macrocosmic dimension issues. 

• Clinical Considerations Based on Macrocosmic Influences 

Environment, pathogen, immunity, which are the triad affects each other and gives healthiness from nowadays public health perspective [10]. Overall, it is the idea of relevant adaptation of human body to natural environment(tian ren xiangying ) in TCM. Being a subject matter of healthiness, it can be summarized as follows: yin-yang as a whole system, which corresponds human-universe as in nature and supplies energy to us, affects our health in redundancy or deficiency manner. TCM ancestors found that seasonal changings are predictable because of their regular 60-year circadian rhythm and thereafter environmental changes and pathogen causing diseases can be postulated too. Finally, TCM medical doctor can prevent and treat diseases based on the theory of ‘tian ren xiang-ying’ and accumulated clinical empirical experiences has long been accomplished over two thousand years [11,12]. 

There are two human-universe considerations available: 1. the circadian rhythmic changes whichever gives a picture of seasonal climatic arrival based on six-qi. For example, humidity is high which means dampness is heavy and a lot of patients with rheumatism will be getting worse. This exterior dampness may affect the splenic-earth function [3] in our body whenever the splenic system is strong enough to get rid of this invasion. There is a vast of teachings in Neijing talking about these seasonal rhythmic changes affecting human body [5,6]. Moreover, TCM doctor treat disease with a perspective much different from western medicine. Dampness gave the opportunity to rheumatism is just an example from above. Clinically, there are so many diversities of illnesses due to we treat yin-yang five-elements combinations dynamically. 2. Well trained TCM doctor habitually sense the climate status encountering in the clinic and knows how to managing and treating the human-universe unison situation. That means in the macrocosmic world affects the microcosmic system in our body arousing a defensive mechanism naturally whichever TCM physician should assemble them into clinical diagnosis and treatment. Macrocosmic dimension pertains to change the microcosmic status and our body will be responded simultaneously likewise: visceral organs (orbisiconography ), yin-yang qi, channels collaterals (), and ‘defensive energy vital energy nutrients and blood system’ (wei qi ying xue) involved. All these components constitute the microcosmic world which corresponds to the universal macrocosmic changes accordingly (Figure 2).

 Figure 2: From macrocosmic to Microcosmic dimensions.

Chinese calendar of year month day hour entities has had the attributes of yin-yang so that it can integrate to the TCM system easily. Thus, seasonal change has already been signified the whole year around. From the perspective of macrocosmic world, there are two sets of numbers which used to give a 60-year calendar with yin-yang diversity (). Finally, the conventional five element and six-qi form the subsets of TCM can also been joined into the celestial and terrestrial numerical system (Figure 3). In this paragraph, how this macrocosmic system which was constructed and composed with the formulate-numbered yin-yang will be explained in detail stepwise. 

• Bare facts 

• 60-Year as a unit cycle
• Ten celestial Stems and Twelve Terrestrial Branches dissecting this 60-year into yin-yang symbolization: celestial and terrestrial
• Ten celestial Stems() [2 page 61]

1 (chia,); 2 (i, ); 3 (ping, ); 4 (ting, ); 5 (wu, );

6 (chi, ); 7 (keng, ); 8 (hsin, ); 9 (jen, ); 10 (kuei, )

• Twelve Terrestrial Branches () [2 page 61]

1 (tzu, ); 2 (chou, ); 3 (yin, ); 4 (mao, ); 5 (chen, ); 6 (szu, );

7 (wu, ); 8 (wei, ); 9 (shen, ); 10 (yu, ) 11 (hsu, ); 12 (hai, )

• Joining the above celestial and terrestrial systems in numbers

Odd number is yang:          1,3,5,7,9,11

Even number is yin:            2,4,6,8,10,12

Only Even or Odd number sets are allowed coupling then cut 12x10 down halve to 60-year

Formation: (1 Chia  , 1 tzu ); (1 Chia  , 3 yin)

                                Coupling OddChia-tzu() Chia-yin() 

                                Coupling Eveni-chou()i-mao() 

• The 60-year Chinese lunar calendar established 2000-year ago has been still using today [2 Page 63]
• Five-Elements coupling (Figure 2)

Wood : (ting , jen ) ; (szu , hai )

Fire : (wu , kuei, ) ; (tzu , wu )

Fire : (wu , kuei, ) (yin , shen )

Earth : (chia , chi ) ; (chou , wei )

Metal : (i , keng ) ; (mao , yu )

Water : (ping , shen ) ; (chen , hsu )

Model I: The Ten Celestial Stems combination [2 Page 64]

Model II: The Twelve Terrestrial Branches matching [2 Page 73]

• A paradigm of these symbols in circular form and interrelationships

Ten Celestial Stems combinations transform into the five-element (Figure 3)

 Figure 3: Paradigm of yin-yang transformation to five elements by combining Ten Celestial Stems.

Hot in summer and cold in winter give the normal seasonal climate. However, there will be exceptions: cold and wet in summer, hotness incidence in winter. Although we can predict seasonal changes correctly, an event with normal, redundant, and deficient climatic situation could be occurred abruptly. 

The point view of macrocosmic dimension based on our universe has had its own rhythm of regularity within this 60-year cycle then which is able to be predicted its changes yearly and seasonally. Actually, Chinese calendar used to be divided into 24 seasonally sections () still using today. Is this rhythmic change affecting us on Earth? The answer is affirmative and even affect our health accordingly. Among the basics of TCM there are six-qi () ,which are generated from movement of the universe, embedded and corresponded with our body. Since then, we have the knowledge of macrocosmic and microcosmic dimensions which gives the consolidate idea of human-universe union. Five elements and six-qi can be matched into the combination of the ten celestial stems and twelve terrestrial branches whichever regular climatic changes will be predictable and applicable to treating diseases [13]. There has had statistical databank available regularly due to incidence of pandemic disorder in our living world is commonly happened and someone may want to do some research on it. There were two interesting papers talked about the climate change in southern China Wuxi. The one collected temperature statistical data from Wuxi Meteorological Bureau during 1958 to 2018, totally 60 years which matched into the Chinese calendar. The conclusion showed that the coincidence rate between the actual meteorological data and the deduction of six climatic factors was 100% [14]. Another paper from the same group of researchers in Wuxi, they had collected 30262 cases and compared the incidence rate of pandemic influenza with the postulations from wu-yun liu-qi, interval 2020 to 2022 duration 2 years [15]. This paper mentioned about the yun-qi calculations concisely was really a good example for beginner to learn. The conclusion showed that incidence of influenza is closely related to the factors of ‘Cold ’ and ‘Wind ’ in five circuits. It also concluded that the year ‘qi offenses yun ( which named Tianxing ’) is a highly correlated with influenza occurrence [6]. 

Nevertheless, the ten celestial stems and six-qi joined together can form a huge system and become the core concept of TCM. In this article, usage of these components will be focused on the macrocosmic dimension only. 

All these mystery in nature forming the TCM medical knowledge which has already been documented in Neijing. From theoretical teaching of the universe to postulating epidemic diseases, it has been a long way to go in order to prove its consistence whenever in Chinese history it is highly compatible with as above mentioned. Struggle to survive which is the motto to people living in the universe, TCM emphasizes on building the relationship between the microcosmic human body onto the macrocosmic world in detail. How does it interpretate between the micro and macrocosmic world? There was a good example of ancient famous yun-qi () model which elicited as a form of universe-human union and applied to treating diabetic-patient effectively [16].

 Figure 4: Combination of 10-celestial & 12-terrestrial form 60-year cycle.

Based on the concept of the macrocosmic dimensions, human-universe union give the idea of systemic correspondence between the outside and inside world of our body by means of yin-yang. There is an ancient skill in acupuncture which has been using for 800 years called midnight-noon and ebb-flow doctrine (ZiWuLiuZhu) and it is still passing on today [17,18]. The development of this system was based on the circadian rhythm of the Ten celestial Stems and Twelve Terrestrial Branches hour-day-month-year changes (Figure 4). Since this system is very complicated but the idea is good for us to learn about the advanced yin-yang applications in acupuncture and daily clinical uses [6 pages 413-425]. In order to make it simple, a concept of ten celestial changes with five combinations (WuMenShiBan) will be given as an example.

• What is this main idea about?

• It was widely used in ancient acupuncturist 

Starting from the Sung Dynasty (A.D. 900), TCM doctor developed a method of acupuncture based on WuMenShiBan which was a part of ZiWuLiuZhu and a method of practicing acupuncture based on the Neijing. There are 66 acupoint openings among the 12 channels. All of these acupoints located beyond the elbow and knee joints (Table 1). Thus, these acupoint is easy to locate and based on strong theoretical background so that treatment protocol used to be highly recommended in the old time.

Table 1: Context of the Five Shu Points totally 66 points in 12 Channels.

Table 2 gives a picture of the five elements. Qi energy from atmosphere to each channel into our body. Yin channels start from wood and Yang channel from metal.

 Table 2: The Five Shu Points match into Five Elements.

Table 3 describes the status of Qi flowing through the Five Shu Points. Jing () located at the tips of the fingers or toes which represent Qi just emerging and weak usually treating mental disorders and irritability. Xing’s () Qi flowing is smooth usually treating febrile disease. Shu () represents Qi transportation which usually treating rheumatism. Jing () represents Qi passing through which are used for treating cough, asthma, disorders of the throat. He () represents Qi aggregation at this point which is used for treating gastrointestinal and bowel symptoms. 

Table 3: Qi flows through The Five Shu Points.

• Clinical notes for acupuncturist 

“If, then, a man has the theory without the experience, and recognizes the universal but does not know the individual? For men of experience know that the thing is so, but do not know why, while the others know the 'why' and the cause.” [1] Aristotle mentioned. Theory should be worked well with experiences then perfection can be achieved. The above teachings for the notions in the macrocosmic world which by experience further application in acupuncture will be clarified with the sense of usefulness. 

The concept of Wu Men Shi Ban () tells us about Qi flows through our body via the Five Shu Points by the 12 cardinal channels. Each point is safe, easy-to-use and with potential alleviate effectiveness. As in table 3, the Shu Points has already been fit into the five elements model which means all 12 channels can be grouped together. As in table 2, all Jing () shu-point is different between yin and yang, while yin-channel start with wood and yang-channel will be metal. When calculation is carried out, we should remember this rule otherwise it will give a result with big mistake.

Method I: Husband-Wife pairing () derived from Ten Celestial Stems 

For instances, (chia, is yang wood) , (chi, is yin earth); when this yang-wood and yin-earth combine together which will transform into Earth so we call it chia-chi transforming Earth () that is a kind of husband-wife relationship. In acupuncture, when patient with splenic sickness (earth), we may choose the liver and splenic two channels together to treat epigastric discomfort based on this method. Likewise, in spring-rainy season, spring belongs to Liver whilst rainy dampness (chia,  is yang wood) and rain is dampness (chi,  is yin earth). Thus, gives us the idea of treating dampness in our body with Liver-Splenic channel combination that is derived from method I with macrocosmic concern. 

When treating patient with Gall-Bladder (G.B.) channel illness, we may choose G.B. channel acupoints and give booster effectiveness by adding a Splenic channel acupoint. Treating knee joint arthralgia, we may choose Yanglinquan (G.B.34) as the acupoint based on the concept from the above paragraph chia-chi combination then Yinlingquan(Sp.9) will be added as a husband-wife pair. It is because G.B is yang-wood and we want to choose a yin-earth acupoint [6]. 

Method II: Mother-child relationship in Five Shu points 

Based on the five elements insufficiency and hyperfunction theory, it can make use in the Shu points. This mother-child relationship states that: if hyperfunction is occurred, based on mother-child relationship, treating the “child” can alleviate this hyperfunctions. On the other hand, if insufficiency is occurred then tonifying its “mother” can benefit to this situation. 

For instance, a patient with dizziness, headache due to wood () hyperfunction which uprise with wind-fire on top of cephalic part. Physician may treat the G.B. channel which specifically choose G.B 38. In table 1, Yangfu (G.B. 38) is the Jing () of the G.B. channel and Jing is fire (table 2). Based on mother-child theory, this hyperfunction of wood redundancy can be alleviated effectively by dispelling its child heart-fire with this acupoint G.B. 38. 

On the other hand, when wood is in insufficiency status, especially patient with a depressive mood. We want to arouse the G.B. channel in order to benefit to yang-wood. Logically, Xiaxi(G.B. 43) is the best choice because it is the water Xing() among G.B. channel which represent water can promote the yang-wood. Therefore, it is extremely effective to treat diseases with depressive emotion. 

Examples in Method I and II is an exceptional event of Wu Men Shi Ban which is expandable and applies to those 66 acupoints amongst 12 channels.

The idea of Wu Men Shi Ban is not just applicable for selecting acupoints. It is useful for further applying yin-yang and the five elements to treat diseases. Seasonal change has had three upcoming events: normal, over or under. Season itself has had its characteristics the six-qi. This six-qi enter into our body to benefit the five visceral organs through the Jing () acupoint. Our ancestor discovered that yin-jing is attributed to wood and yang-jing is metal (Table 3). Obviously, this universal six-qi from the outside world refers to the macrocosmic system which is closely connected to our body. From macrocosmic to microcosmic, (orbisiconography) is another system whichever gives the most important concept of correspondence in classical Chinese medicine [2]. 

Postulation is inevitable in our medical world. Orthodox western medicine is in its scientific measure wherever will be radiology, histology, anatomy, laboratory, microorganism, surgical instrument, etc. Encountering with patients out-patient or in-patient, medical doctor used to meet so many uncertainties in treatment. Therefore, promote medicine to scientific level like those in physics, chemistry, microbiology is impossible so that medicine is marginal scientific only. 

Being a TCM doctor, one who frequently put so many yin-yang five-element stuff to build the clinical knowledge and seems much more difficult to grasp medicine quantitively (X-ray, Laboratory, etc.). Is scientific concern really useful in all area of medicine? I doubt about that because of treating diseases itself is not scientific at all as mentioned above. TCM has its long medical history, I know its treatment power and strong suggest TCM physician claiming the theoretical mind in the aspect of yin-yang, it is essential.

Modern epidemiology has a triangular relationship referring to host-pathogen-environment triad [10]. There is a concise explanation of the mechanism how climate change affecting our health plays an important role to our environment which may give the opportunity of the influenza virus to affecting our immunological system and causing vast epidemic contagious diseases. Overall, climate change is not only boosted the prevalence rate of infectious diseases but also allergic diseases such as dermatitis, rhinitis, asthma, etc. [19]. Concurrent study showed that temperature and relative humidity have had great impact on the incidence of epidemic influenza [20]. 

The concept of human-universe union gives a big picture of macrocosmic dimension of TCM which has been applied to clinical treatment with the modern idea of holistic medicine. Holism attains the potential ability of our body communicating with external environmental factors such as climate changes, seasonal variety, and surrounding environments. On the whole, environmental situations may affect immunity of our body which further explained the point view of this paper from the perspective of modern immunology. 

It is easy to learn TCM by its over simplified models but difficult to understand the cause and first principles about these models. Likewise, TCM practitioner and TCM students must already familiar with the paradigm of the five-element model [3] which just a tip of the iceberg and its theoretical foundation is complicated, deductible and expandible. Classical Chinese medicine was induced from our nature to steadfast its theoretical basis and afterwards deduced to clinical uses. Therefore, studying classical Chinese medicine should have the dual concepts of induction and deduction cojoin together in mind [4]. Ancient TCM physician considered human being as a whole which lives on Earth among the Universe. Clinically, it is patient oriented that means a patient as a whole including: human-universe, medical knowledge and medical physicians themselves. Nevertheless, there is a premise whichever emphasized on both the Globalization showed that TCM theory and empirical clinical practices are able to meet the need of treating diseases but with controversy [4]. The problem is what the treatment reality of TCM will be, relating to humanity health now and then. Basically, TCM has had its concern which is different from the point view of orthodox occidental medicine and can alleviate most problem in the out-patient clinic by herbal medication and acupuncture. 

In ancient Chinese history, we have had precise documentation of epidemic diseases recorded because of its contagious violence that killing so many people. In this paper, elicit wu-yun liu-qi () to delve into the idea of circadian rhythm theory which is part of the TaiChi-yin-yang (). Through this wu-yun liu-qi model, it is a good example to understand the usage of yin-yang theoretically and clinically which is expandible to deep learning and thinking of classical TCM. Through the simplified Wu Men Shi Ban model as the above Method I and II which also gives a good example to apply the macrocosmic thinking to practice classical TCM acupuncture. 

Most country in Asia today, TCM is authorized officially to practice medicine with educational certification and license. The differences between scientific aspect of western medicine and long historical empirical experience of Chinese medicine are huge and they both can treat patient effectively but in a different way and view. Both of them are knowledgeable and learnable and if they can work together, perhaps it could create a new medical era prospectively.

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