Do You Believe in Qi?

We acupuncturists are in a pickle. On the one hand, we want so much to be accepted by the modern world, by science, by the medical community, and by the insurance companies that reimburse us. So we gather respectable-sounding research that validates the things we do, we learn orthopedic testing and ICD-9 codes, some of us even wear white lab coats. On the other hand, we cannot escape the fact that the foundation of our medicine is an invisible “energy” – qi – that is not only not scientifically demonstrated to exist; we ourselves squabble about what it is and what it isn’t. Do you believe in qi? This is a very important philosophical and epistemological question, one that every single one of us acupuncturists would do well to ponder.

There are those who argue that there’s no problem to begin with, that qi is simply air and jingluo the blood vessels; that the ancient Chinese were scientists first and foremost, that there is no need to debate this since, clearly, the ancient Chinese view of health and illness fits very closely to that of modern science. I call this the “It’s Just Air, Nerves, Muscles, and Blood, Stupid” school of thought, perhaps best exemplified by Donald E. (“Deke”) Kendall. I don’t doubt that Mr. Kendall is an excellent teacher and practitioner, and I think that his Dao of Chinese Medicine is a beautiful book. And I think it’s great to have research that shows how acupuncture affects the afferent and efferent nerve pathways, or whatever. But I also think it’s the height of arrogance for Kendall to proclaim that he has finally figured out what those ancient Chinese were really talking about. “Mysteries of Chinese Medicine Finally Revealed!” boasts the order form for his book. Does he really think that everyone including the Chinese had it wrong all this time, and that he has singlehandedly set the record straight? Or does he have an agenda that is distorting his critical faculties? I believe that the answer is “Yes,” on all counts. Mr. Kendall is so invested in integrating East Asian medicine with Western medicine that he has convinced himself that the concepts behind acupuncture, when viewed through the cipher that he provides, are basically identical to concepts from Western physiology.

I believe that words such as qi, xue, jing, shen, zangfu and jingluo have been problematical from the translator’s point of view precisely because they are embedded in a cultural and medical worldview that is intrinsically different - extremely different - from the Western scientific worldview. The problem is not that French acupuncture pioneer Soulie de Morant willy-nilly decided to call qi “energy;” the problem is that qi is a term that has no exact Western equivalent, a term that in the context of acupuncture could justifiably be thought of as a kind of energy. Does it help you in your practice to think of qi as the same thing as the air you breathe or the oxygen that is diffused in your blood? I don’t think so; you probably have an understanding of qi, learned from your teachers, your textbooks, and your clinical experience, as the stuff/non-stuff that animates and constitutes your being, flows through channels in the body, and can be affected with thin metal needles. The main advantage of the Kendall model is that it allows us to sidestep any discussion of the essential differences between Western and East Asian medicine when communicating with people who are not familiar with what we do. This is fine as far as it goes, if your main goal is impressing the chief orthopedist you're having lunch with, or an insurance company representative. My problem with Deke Kendall is not that I disagree with him; my problem with him is that I believe he is misrepresenting East Asian medicine.

But the opposite of redefining our medicine in Western terms – accepting wholesale the concepts of East Asian medicine as literal truth – is also unappealing to me. I don’t believe that I have three hun spirits living in my liver and seven po souls inhabiting my lungs. I don’t think that the categorization of anything and everything into a five phase scheme is necessarily meaningful or productive. And I don’t believe in qi. Or maybe I should say, I don’t believe that qi is any one kind of substance or force or energy or anything like that. Rather, it seems to me that the word “qi” is a descriptor of reality, so that whenever there is a sense of movement or animation, the ancient Chinese evoked qi in their word for it. So whether we are talking about the weather, physical forces, emotions, or bodily or mental functions, “qi” is a handy way to refer to that sense of movement. The Japanese language inherited many of these qi words and phrases from Chinese, and to this day we talk about tenki (“heaven’s qi,” or weather), denki (“electric qi” or electricity), tanki (“short qi” or short temper), and kichigai (“changed qi” or craziness). It’s almost like the English word ending “-ation,” as in “condensation” or “manifestation,” indicating that some sort of process is going on. If some Chinese guy announced publicly his discovery that "-ation" actually means “air,” you’d think he was an imbecile. To argue whether or not “-ation” actually exists is just as meaningless.

One of the things that makes acupuncture so great is that it is based so solidly on empirical observation, on real-time sense data in practitioner and patient, on noticing even minute changes in felt bodily sensations and movement – that is to say, changes in qi. When you feel your patient’s pulse turn from jagged to smooth, that is feeling qi. When you feel a pulsing electrical tingle between your fingers as you hold a needle against your patient’s skin, that is feeling qi. When your patient feels an opening and softening in the chest when you needle a point on the wrist, that is feeling qi. Who cares what qi “really is?” That’s not even the most important question. If we ask instead why it’s so important for us to pin it down, to define it and isolate it, we come to the root of what is wrong with the Western paradigm.

Do you believe in qi? I suspect that most of us do because we are vital beings who cannot help but notice the vitality that flows around and through us. The ancient Chinese noticed this too, and kept meticulous records about the changes wrought via their interactions with this vitality. The five phases, the pairing of yin and yang channels, the order of the transport points, the midnight/noon method, the husband/wife relationship, the “direction” of different zangfu organs, the “qi clock,” the Nei Jing, the Nan Jing – these are all codified records of their observations and experiments. Let’s not pretend that our medicine is something that it isn’t. Let’s instead honor what it actually is, and practice it as well as we can.

Post script: for my most recent (2015) take on this subject, see my article "The Problem with Qi: Vitalism, Science and the Soul of Traditional Chinese Medicine" in the Journal of Chinese Medicine.