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FENG: The Meaning of Wind in Chinese Medicine with special attention to acupoint fengchi (GB-20) by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon A term in the field of traditional Chinese medicine that causes considerable difficulty for modern practitioners is wind (feng). It is known as:
The use of this term feng is so widespread and mysterious that a modern text on the underlying meaning of acupuncture point names is titled: “Grasping the Wind (1).” Certainly, to understand basic Chinese medical thinking sufficiently to carry out an Oriental medicine practice, one must grasp the meaning of wind. A difficulty with the term wind is that it is widely and freely used in the Orient in relation to health and disease, while it has no equivalent meaning or implication for Westerners in the medical field. A patient unfamiliar with the use of the term may be told, “your condition involves wind,” or this treatment is for “wind-heat.” The puzzling reference to a weather condition may call for explanation. An appropriate depiction of the Chinese concept can set the stage for better appreciation of the Chinese tradition. On the other hand, an unacceptable depiction can lead to even greater suspicion of the foreign concepts employed in the sometimes bizarre medical tradition that includes cupping, blood letting, inserting over a dozen needles in the body, and ingestion of large combinations of herbs. One approach that has been taken in describing wind in relation to disease is to rely on a strict interpretation of wind as a “pernicious influence:” that exposure to windy weather can cause disease. Another approach is to use an analogy, such as that when symptoms appear in different parts of the body at different times, this suggests movement that is like the wind, so there is a “wind disease.” The best explanation for wind may come from dividing its role in the medical system into two: etiology (cause of disease) and manifestation (characteristics of disease), each of which can be separately described. The purpose of this article is to reveal the basis of the Chinese concept and suggest a modern description. Before delineating the historical development of the term wind and its representation as a pictograph, applications of the term in traditional Chinese medicine, as it comes to us today, may be of value:
In the field of modern medicine, a number of causative factors have been identified for the “wind” disorders of concern, including infectious agents, neurological problems, and autoimmune diseases. Despite progress in scientific analysis, the reason that a disease has arisen in any individual may remain difficult to pin down; further, the manifestations among different patients varies, sometimes markedly. None of the modern explanations for the cause or manifestation of the diseases and disorders inherently contradicts the traditional Chinese concept that they are caused by wind or somehow involve wind, but the explanations do seem more detailed and up to date. The availability of modern explanations raises the question of how useful the ancient terminology is when it comes to understanding the disease and deciding upon the method of treatment. Thus, it is important to get a sense of how much reliance there is upon the basic concept of wind in the Chinese system. THE CHARACTER FOR FENG: Insights into meaningThe Chinese character feng, is usually explained on the basis of the conjunction of two pictographs. One of them depicts an insect (chong; originally hui, a type of snake; see Figure 1), which is placed inside the character fan, which means the origin (see Figure 2). The resulting character (see Figure 3) is explained in an ancient Chinese text describing the meaning of written characters (2), the Shuowen Jiezi (ca. 120 A.D.). It makes reference to the Chinese idea: “when the wind blows, insects are born.” In this interpretation, the character feng represents the origin of insects, but it also means exactly what it means in the West, namely a weather condition: the movement of the air. The simplified version of the character (Figure 4) retains the meaning of a weather condition, movement of the air, to this day. Fengbiao is a weather vane (used for measuring wind direction), fengche is a windmill, and fengshan is an electric fan. Perhaps the image of flying insects, some of which appear rather suddenly as the seasons change and which might seem to come along the path of the wind, gave rise to the notion that the wind was their origin. There are also ideas in ancient Chinese literature that wind “resides” in caves before it explodes out as gusts in the atmosphere, and caves are where some insects congregate in large numbers. Insects and other small crawling animals would have been viewed negatively, as a source of destruction; similarly, the wind is often a destructive force. Therefore, the connection between insects and wind may have found its way into the development of written characters as a result of several conceptual connections drawn between the two.
The manifestation of the wind, particularly its direction, was long considered important. In particular, it was observed that the wind conditions at each seasonal change (e.g., from winter to spring) and at mid-season seemed to have a different fundamental nature, and so there were, all together, eight winds that were specified. The type of wind that was actually encountered at any of these eight points in the year was thought to have prognostic value for a variety of outcomes, including crop yields. The concept that wind was a pathological agent appears to have correlated with divination practices. In ancient times, the eight winds were related to the bagua (the 8 triagrams of the Yijing) and they came from the eight directions, such as northeast, northwest, etc. In the Lingshu(3), the influences of these winds were categorized as follows:
According to the Lingshu, the adverse influence was so great that “the sages avoided the winds like avoiding arrows and stones.” In particular, they were concerned about sudden death from what corresponds in the traditional descriptions to a stroke (zhongfeng). Zhongfeng, meaning struck [penetrated] by wind, is mentioned in the Huangdi Neijing (Suwen and Lingshu), Shanghan Lun, and Jingui Yaolue, where the descriptions often, though not always, suggest a stroke; in modern Chinese medicine, zhongfeng still means stroke. This zhongfeng is a dominant concern about the effect of wind for centuries, into the modern era. AVOIDING WIND AND ITS EFFECTSHow did the sages avoid the winds? This is not overtly outlined in the Lingshu or in other sources. Originally, various rituals and incantations may have been the methods relied upon (4). A reading of traditional literature will show that avoiding the wind could mean not having any exposure to blowing air (especially when the body was in certain conditions, such as sleep) and not allowing oneself to become susceptible to the influence of wind (as occurs when one has drunk too much wine or eaten rich food). Gao Ling, a 16th century medical scholar, warned against summer time practice of sleeping outdoors under the stars, as noxious wind could invade the body; he also recommended that cracks in the home be filled in to avoid drafts, especially in summer. A perspective on the early Chinese understanding of wind may be gleaned from the art of fengshui (literally: wind and water), sometimes translated as “geomancy.” Wind is generally considered a malevolent force. According to Eva Wong (14), these are guidelines for avoiding adverse influences of wind:
Thus, like the sages mentioned in the Lingshu, we are all cautioned to avoid the wind by not living in a place that is exposed to severe wind or wind occurring on a regular basis. As an example of how Chinese physicians view windy weather as a cause of disease, in a 1994 teaching round at the Beijing Institute of Acupuncture and Moxibustion (15), a case was presented in which a female patient had headaches since she was 10 years old. The author explains: On the eve of spring festival, when people were celebrating on the grassland, she suddenly felt a severe headache that made her fall to the ground, possibly because of pathogenic wind and cold.... Falling to the ground (apoplexy) is characteristic of zhongfeng, which, in this case is probably not a stroke, but some other cerebral event. That this occurred at the spring festival may be of significance, because this is the time of one of the eight winds, and the weather is still cold. In a review of methods of health preservation presented by the Beijing College of Traditional Chinese Medicine in 1982 (16), it is said that: One should not sleep in a draft lest one be attacked by evil wind during sound sleep. This is true even in the very hot summer season. The mention of “even in” hot summer conditions is important because in much of the traditional literature the conjunction of wind and cold (as in the previous example) is considered to be the main wind-related pathology; wind and heat are also problematic. Today, it is common to hear Western acupuncturists caution patients to avoid sitting in the cold draft of air conditioning vents, a recommendation based on this traditional Chinese reasoning. When it comes to avoiding the influence of wind, that is, not being adversely affected if one is exposed to wind, then these are steps to be taken:
The reference to hollow wind or its hollow evil in the Lingshu goes back to the process of divination. As explained by Unschuld (4): If the wind on these days [the divination days, such as first day of each season] came from the direction in which Taiyi [the head of the demon spirits] happened to be residing, it was the so-called wind of repletion and was considered an auspicious omen. If the wind blew from the opposite direction [being the wind of depletion; hollow], it was regarded as an unfavorable sign. This “hollow” (or “deficiency”) wind had an adverse effect on crops, weather, and the health of humans. As to the latter, the Lingshu states further: Eight are the winds. For the winds, man has the eight joints of the legs and arms [hip, knee, shoulder, and elbow]. The eight primaries, the beginning and middle of each season [four seasons], can possess hollow winds. These eight winds can injure man. When sheltered in the inner being, they make deep rheumatism in the bones, and may be released among the loins, the backbone, the joints, and in the area between the skin and flesh. Therefore, to cure with acupuncture, one must use the needles with a long body and a sharp tip. This can be used to grasp the deep evil and distant rheumatism. That is, these long sharp needles can grasp the wind, hence the title of the acupuncture book. There is also another traditional Chinese reference to wind that should be considered in order to fully understand the context in which the term is used medically. Around 200 A.D., a book called Fengsu Tongyi was published; the term feng in the title is the same as that for wind, but the compound fengsu means manners and customs (7). In the preface to the book, the author discusses the meanings of feng and su: Feng includes such things as the warmth or coldness of the air, the treacherousness or gentleness of the land, the perfection or imperfection of waters and springs, the toughness or suppleness of wood and fibers. Su includes those classes of beings with blood in them.... From this explanation, one can see that feng had the connotation of a quality, nature, or characteristic; thus it has a meaning somewhat similar to that of qi. Unschuld has argued that the concept of wind in Chinese medicine was, in fact, a transitional one (4): previously, the main pathological phenomena were evil spirits and ghosts, and, later, the main pathological phenomena were the six qi (of which wind is one). The term feng is still used to suggest qualities and influences in several modern expressions: fengdu is bearing, manner, behavior; fenghua is to change or reform by example; fengsu still means customs and manners; fengtu means the local climate or natural features. The importance of feng among the six qi (environmental qualities that have influence) that appears in subsequent medical texts implies that feng and qi were viewed in somewhat similar fashion. OTHER PORTRAYALS OF THE PATHOLOGY OF WINDWhile the Lingshu focuses on the eight winds, in the Suwen (5) there is a chapter devoted to the pathological effects of wind based on the Five Elements. Thus, there is a depiction of wind influences on each of the internal organs. As an example, it is said that: Kidney wind manifests as excess sweating and aversion to wind. There is a dull gray cast to the face and swelling of the eyes. The face may even have a charcoal hue. There is back pain and an inability to straighten. There may be obstruction of the urinary tract. One should look for a dark black color and hue in the flesh. Here, as is also found in the 4th century book Zhong Zang Jing (17), are the common correspondences of the five element system; black color is associated with the water element, the kidney, lower back, and urinary obstruction. Wind causes obstruction, stiffness, and accumulation. In this same chapter, it is said that: Wind is the cause of many illnesses. Once it penetrates the body, its nature is dynamic and changeable, and it has many pathological manifestations. But the cause is always the same: pathogenic wind attacking the body. Once wind enters the body it can cause a progression or transmission of disease. For example, in the Suwen, it is said that: “When wind travels from the yangming channel into the stomach, it then follows the channel up to the eyes.” Depending on whether the person is obese or thin, this movement to the eyes will result in yellowing or constant tearing, respectively. The dynamism mentioned here involves transmission of disease from one site to another, along a certain path that is set down explicitly, rather than random movement. This particular route of transmission from stomach to eyes is elaborated in the Yinhai Jingwei, a 7th century ophthalmology text attributed to Sun Simiao: In the case of the condition called ‘wind pulls the lower lid outward,’ spleen and stomach have received wind, and this poison accumulates and becomes manifest at the upper and lower lids. When the lower lid is affected by wind, its skin tightens, and when the spleen is affected by wind, the muscle flesh is blocked...Irrespective of the four seasons, tears flow because the earth yields and cannot dike the water any longer. Water accumulates at the lower lid, which appears soggy and rotten. The excess fluid is related to the weakening of the stomach and spleen by the action of wind on those organs. The earth element is imaged as a dike that controls the flow of water. In a situation that is evidently related to having a stroke, it is explained in this same text that: When, after excessive drinking [of alcohol] and eating one sits or lies facing the wind longing for cool air, one’s right or left side may suddenly receive wind, which pulls one’s mouth and one eye into a slanting position....in serious cases, one side of the body fails to follow one’s will. Here, it is explained that exposure to wind serves as a trigger to the ailment; it is not a strong wind, nor a wind from the wrong direction, but rather a gentle breeze that one longs for to cool a body overheated by food and drink. Nonetheless, the gentle breeze either contains some evil component that causes a severe reaction or it becomes malevolent simply by combination with internal factors that are pathological. The text recommends various topical treatments, such as ointment to rub the wind away, scraping the affected side of the body (i.e., the technique known as guasha), burning moxa, and applying a poultice of magnetite. In explanation of how the wind causes the deviation of eye and mouth it is said that: “they were drawn that way because the liver conduit has received wind-evil; this causes the tendons to become tardy and to shrink and lose their swiftness.” The adverse influence of wine and rich food is mentioned also by Zhu Danxi (18). In a short chapter on wind damage, a single case is relayed in which “a male who was addicted to wine felt fatigued because of having worn thin clothing in face of wind cold.” In his chapter on head wind, he describes a person being susceptible to this condition “who used to take fat meat and fine grains.” As opposed to these cases of excess due to food and drink, in the text Zhubing Yuanhou Lun (610 A.D.), the chapter on fengbihou (wind and bi disease) also points to deficiency (depletion); it is said that (6): The three influences of wind, cold, and dampness arrive together, unite, and constitute bi illness. Its appearance is such that the muscles and flesh turn clumsy and thick. Occasionally one may feel pain. The human body may receive wind-evil if the pores have opened because of depletion. When the illness affects the yang regions of the body, it is called wind; if it affects the yin regions, it is called bi. If both yin and yang regions of the body are affected at once, one speaks of a wind-bi illness. As indicated here, openness of the pores resulting from an internal depletion is what allows the wind to cause disease. The wind illness is the one that affects the yang region, which includes the back and upper part of the body (example: shoulders), while bi syndrome is the name given to a similar disorder that affects the yin portion of the body, which includes the front and lower part of the body (e.g., knees). This division between wind and bi is not followed in most modern texts, though it is sometimes stated in passing. Most often, a bi syndrome is described as one in which wind is accompanied by another pathological factor, such as dampness and/or cold; the impact is a blockage, which then causes the various symptoms. In a discussion of facial paralysis (mainly Bell’s palsy), the following depiction of wind entering deficient meridians is presented (23): According to TCM theory, this disease results from derangement of zangfu, deficiency of vital qi, and feebleness of channels and collaterals [jingluo]; all this allows the invasion of exogenous pathogenic wind-cold, leading to stagnancy of qi, blood stasis, and excessive atony of the yangming channels. PROGRESSION OF THE CONCEPTSLater in the development of Chinese medical literature, the nature and role of wind was described somewhat differently than in any of the previous texts. For example, the emphasis on the eight winds or on the direct influence of wind on each of the five viscera is no longer prevalent; internal wind, distinct from external wind, becomes an issue of importance. It is mentioned in the 18th century text, Yixue Yuanliu Lun, that the influence of wind from the outside can induce a wind from the inside, and together these produce a heat syndrome (8): When wind enters the conduits and the network vessels, internal winds and the wind intruding from the outside excite each other until suddenly phlegm-fire emerges and causes obstructions. In such a situation, there is no other way but to first expel the wind from the body, then cool the phlegm-fire, and, finally, harmonize the body’s qi and blood. As a result, the conduits and vessels will gradually become passable again. The book’s author, Xu Dajun, further explains the progressive course of a wind-induced ailment, which is from skin to lungs, and the complex treatment needed to fully resolve the disorder: The fact is that the illnesses of harm caused by wind start from the skin and its hair to enter the lung. The lung is a delicate viscus; it is compatible with neither hot nor cold....As the proverb goes, ‘If one does not pay attention to harm caused by wind, the illness will change to fatigue.’ Well said! But how to conduct treatment? First, the wind is to be expelled with drugs like perilla leaf and schizonepeta. Second the phlegm is to be dissolved with drugs like pinellia and fritillaria; third the qi is to be brought down with herbs like perilla seed and peucedanum. Fourth the ying and wei qi are to be harmonized with drugs like cinnamon twig and peony. Fifth, the body’s liquids are to be enriched with drugs like trichosanthes seed and scrophularia. Sixth, the blood is to be nourished with drugs like tang-kuei and gelatin. Seventh, the fire is to be cooled with drugs like scute and gardenia. Eighth, the lungs are to be regulated with drugs like morus bark and arctium. MODERN CHINESE DESCRIPTIONS OF WINDModern sources of information on Chinese medicine reveal the difficulties of relying on traditional terms, making use of them giving a cursory definition. For example, in the Advanced Textbook of Traditional Chinese Medicine and Pharmacology (9), wind is included as one of the six external factors and its influence is summarized this way as being very important, yet not subject of detailed analysis: Pathogenic wind is the leading cause of many diseases. Of the six excesses, wind is the primary exogenous pathogenic factor, since cold, damp, dryness, and heat may all depend on wind to attack the body. Here, the exogenous wind is the carrier for other exogenous factors to help them penetrate the surface of the body and cause disease. As to the internal wind, according to the textbook, this is one of the “five evils” (the others being internal cold, damp, dryness, and fire). The internal wind is described as being closely related to the liver, having four causative factors:
Internal wind is said to be the cause of tremor, dizziness, and spasm; it is the primary factor in Parkinson’s disease, for example (26). It is said to be a common problem of old age, because deficiency of yin natural develops with aging, giving rise to liver yang agitation, which can produce internal wind. Unlike the description centuries ago, there is no mention in modern texts of the internal wind being stirred up by the exogenous wind. There is some tendency in modern guides to Chinese medicine to use a simple analogy to explain wind and thereby avoid some of the difficult questions raised by the historical and cultural usage of the term. The analogy basically goes like this: wind occurs in gusts and is characterized by rapid changes; symptoms and diseases that have similar character, namely arising suddenly or involving rapid change and movement, are wind diseases. With this analogy, experience of an acute ailment, a headache or the common cold, for example, and experience of excessive movement, as with Parkinson’s, falls into the wind category. Having a stroke will also fit, because of its sudden onset. Paralysis, considered a type of wind disease in the Chinese system, is more difficult to explain. For example, in a modern discussion of wind as one of the causes of disease, it is said that (27): “Wind is characterized by constant movement, causing abnormal motion or rigidity of the trunk or limbs.” This doesn’t seem to make sense, since the wind characteristic is not related to rigidity. But the analogy system then works this way: diseases characterized by excessive movement, or by the opposite extreme, restricted movement, are of the same type, namely wind diseases. The traditional view, however, was that when wind enters the body it could impede the function of the muscles (perhaps directly or systemically be afflicting the spleen that controls the muscles), and thereby cause paralysis. The method of analogy for wind is perhaps best stated in Manual of Dermatology in Chinese Medicine: The etiology and symptomotology of wind-related disorders reflect the characteristics of wind as a force of nature. Wind is a yang excess characterized by an ‘opening up,’ and by an upward and outward nature. Wind diseases usually affect the upper body first, producing sores and ulcers of the head and face. Wind has the propensity to move and change, thus there is usually no predictable location for diseases caused by wind. Urticaria, known in Chinese as ‘wind-type concealed rash,’ is such a skin condition. Diseases caused by wind are characterized by rapid onset and resolution, and a short course; a propensity to move about, without a fixed location in the body; itching (in skin disorders); a tendency to attack the surface of the body and the head; an aversion to wind; and, like the spreading and dispersing nature of wind itself, by the opening of the pores, with sweating. Gone from such explanations are the ideas of eight winds, the influence of wind direction on disease, the association of wind with each of the organs, progression of wind disease from skin to lungs, and numerous other concepts about wind that belong to the Chinese tradition. The system of simple analogy removes any need to describe how wind might cause an ailment and replaces that with a classification scheme: if the ailment has the nature of yang (opening, upward, outward, movement, change), then it is a wind illness. Although the term etiology is mentioned in the description above, it is an aspect that is, in fact, entirely deleted from the explanation. Wind becomes, instead, a label for certain diseases. An attempt to explain the apparent disparity among traditional texts describing wind invading the surface of the body, via the meridians, and wind entering the internal organs (zangfu) was made by a professor at the Academy of Traditional Chinese Medicine in response to questions about the cause of wind-stroke (25). He indicated that: Zhang Zhongjing [author of Shanghan Lun] had already offered his classification method [for wind diseases], i.e. ‘Invasion of collaterals by pathogenic factors leads to numbness of the skin; invasion of the channels leads to paralysis of limbs; invasion of fu organs leads to unconsciousness; and that of the zang organs to aphasia and leaking of salivation.’ This method of classification is still being used. In our clinical practice, the distinction between involvement of the zangfu organs and that of the channels and collaterals lies mainly in whether there is a coma, which suggests involvement of the former [zangfu], otherwise, the latter [meridians]. It can be seen here that in modern practice if someone experiences a stroke, it is labeled a wind disease, and then if it causes a coma it is labeled a wind disease affecting the zangfu. This is labeling, rather than an understanding of etiology, and it is simply retention of a term from 2,000 years ago. The above quoted comments were delivered after several doctors at the Academy analyzed a particular case of wind-stroke (Western diagnosis: cerebral thrombosis) and came up with the following causative factors, none of which involved invasion of wind into meridians or zangfu:
In this brief discussion of the case, four of the five zang organs (all but the lungs) are said to be involved. Exuberant liver yang and heart yang are said to be the immediate causative factors, with liver wind (internal wind) brought into play briefly among the numerous factors. In this patient, because there was no coma, it was to be treated as a case of jingluo being affected by wind. One can observe that these experts at China’s leading Academy are clearly having difficulty translating a case of “being hit by wind” (wind stroke) into a coherent traditional medical analysis, requiring them to bring in diet, emotion, mental activity, physical position at the job, yin and yang, qi, blood, essence, moisture and phlegm, heat and wind, zangfu and jingluo—nearly the whole of the medical system terminology. Thus, the difficulties are not merely those of translation into Western languages, but are also inherent in the traditional Chinese analysis of cause and manifestation of disease. Indeed, one may conclude from an examination of the literature that the nature of wind remains poorly understood though widely invoked. In the book Chinese Medical Terminology (10), Frank Liu and Liu Yan Mau (who studied Western and Traditional Chinese Medicine, respectively) expressed their frustration with the cavalier use of the term by Chinese doctors: Again, as in the case of qi, feng—wind—may also be regarded as being entirely immaterial, perhaps only more so. Nobody, of course, has even been able to demonstrate what wind is! Adoption of the term may well have been based on the inherent nature of the word wind: indefinite, indeterminable, wandering and changeable. It is listed as the number one climatic evil. When Chinese doctors are confronted with symptoms of malaise (especially feelings of discomfort on the part of the patient) without clear signs of a particular disease, they often attribute such to wind—some sort of evil air. There are, of course, specific maladies which doctors do point out, though quite unintelligibly to the layman, as the effects of ill wind: fainting spells, convulsions, epileptoid tremor, palsy trembling, paralysis agitans (Parkinson’s disease), etc. Most pains, like severe headache, are the inevitable accompaniment of feng. A stroke is to be the invasion of evil wind into the brain, causing immediate swooning and unconsciousness. One of the more familiar ailments associated with wind is fengshi, which may be rheumatism or a type of arthritis caused by the evil wind dampness. The common cold, and even influenza, are spoken of as evil wind injuries. And, eczema is but manifestation of the devilish damp wind that has succeeded to get out of the body by eruption through the skin. PROPOSAL FOR AN APPROPRIATE INTERPRETATION OF WINDIt may be necessary to explain the term wind by first explicitly dividing it into two different areas of concern. This is not unlike dividing external and internal wind, but the basis of the division is different. On the one hand, wind is a term used to describe etiology of disease and, on the other, it is a term used to describe the nature of a disease that has occurred. There is a linkage between the two, but it is a tenuous one, so it may be best to minimize the connection. As to disease causation, the term wind serves best for unexplained etiology rather than as a specific explanation. Western physicians and researchers may state that “the cause of [disease name] is not known,” and this is regarded as an honest and valid, if not very satisfying, explanation for several diseases. Sometimes the term idiopathic is used in such cases, and it is as though something has “come out of the air” to cause the disease, while a more complex explanation is presumed to await the results of further research. The Chinese physician can state that the cause of a disease or symptom pattern is wind, which is also deemed valid (within the tradition) and can only seem satisfying if one accepts “wind” as a specific etiologic agent (e.g., windy weather caused the disease). Thus, if a person suddenly passes out, it can be said—without fear of contradiction—that he or she has been “struck by wind” (zhongfeng). On the other hand, if a detailed medical examination shows that this person has clogged arteries (atherosclerosis), rapid platelet aggregation (sticky blood), high blood pressure, and evidence of a blood clot in the brain leading to ischemia (death of local tissues), then it would be better to say that the person has suffered from a stoke due to a blood clot. The latter explanation is better because there is little doubt as to the factors that contributed to the fainting. If this person, as the one described above from the ophthalmology text, had been eating a rich meal and drinking too much wine, one might feel satisfied that the effect of this meal was to thicken the blood and lead to the clot, and the supposed effect of the cool breeze sought thereafter might well be ignored. On the other hand, in the absence of knowledge of how a stroke occurs, one seeks a causative agent, and wind has been invoked throughout the pre-modern era. At first, this use of the term wind to mean unexplained etiology may seem like an evasion of the problem at hand: namely, the Chinese postulated a specific cause of disease, called wind, but we are having difficulty pinning it down: therefore, we bypass the issue by not pinning it down. After all, it would be difficult in modern times to explain the pathological role of “hollow winds coming from a direction other than that in which Taiyi resides.” So, instead, we remove the specificity of wind altogether (a resolution that is tidy but evasive). This possible resolution of the problem may coincide quite well with the actual interpretation that has been put forth in China. The Chinese system of medicine may not, at any time, have intended wind to designate a specific entity in terms of its nature, quality, source, and action. It was always a great unknown: immaterial, changing, and causing all kinds of havoc. The southwest wind which, according to the Lingshu, affected the muscles and caused weakness, was not necessarily a wind from the southwest that a person was exposed to and then suffered this disease. Instead, the wind from the southwest was blowing on a certain day and this predicted that ailments characterized by muscular weakness were going to be more prevalent during the coming months, just as it predicted the crop yields (something like seeing a groundhog’s shadow on groundhog’s day, and deducing the future weather patterns). In texts that associated wind ailments with the spring (as per the five element system), it is almost always stated that such ailments are more prevalent during the spring, but that they are not limited to this time period. The disorder may be induced during the spring, but not show up at any time of year or show up during the next season. A person who was said to be “struck by wind”, having suddenly suffered fainting or paralysis, could have been affected on a day when the wind was still, because the Chinese did not intend that the “wind evil” was always a specific entity, such as a gust of wind, but was, instead, some unknown entity that had been carried by the wind. While individual commentators have tried to pin down what this term really meant, or how wind really behaved, the diversity of opinions (such as described in this article) merely reflect the fundamental difficulty of grasping the wind. Therefore, when explaining wind to a patient who is curious about your diagnosis and treatment strategy, it might suffice to say that: “The nature of your disease suggests that it involves what has been called wind, namely some unknown etiologic agent. The treatment strategy, in such cases, usually involves nourishing deficiencies (mainly qi, blood, and yin) to make less room for such an agent to impose itself, and including herbs that ‘dispel’ or ‘settle’ wind. The ‘wind-dispelling’ herbs have the properties of improving circulation, relaxing tension, alleviating pain, and reducing inflammation. The wind-settling herbs have the properties of inhibiting excessive nervous energy, relieving spasms, and relaxing tension. These actions are likely to produce some benefits regardless of the specific cause that can not, at this time, be identified more precisely.” It is probably of no benefit to describe a case that is clearly influenza as “wind-heat” or a case that is clearly the common cold as “wind-cold,” because the shift in naming does not enlighten one as to the cause or nature of the disease. The idea of wind exposure does not correlate with the recommendation of better hand washing. A case that presents like influenza but can not be identified, could be called wind-heat without appearing to dismiss all the developments of modern medicine that might otherwise give it a specific cause. Such an explanation is no worse than saying, as a modern physician might: “it is probably a viral infection, but I can’t be sure.” As a description for diseases (rather than their cause), those that have an unpredictable, changing course might be said to have the characteristic of wind. Sensitivity of the skin to slight touch would also fit in this category, since the light touch is like the blowing wind and the disorder comes and goes depending on the presence of the stimulus. The reason for the variation remains unknown, so this explanation, as with that for etiology, fits the concept of a description for the unexplainable. The Chinese physicians that write about wind do not make the claim that by using herbs that treat wind disorders, such diseases will change from an unpredictable course to one that is fixed or regular as a result of suppressing or dispelling the wind. Instead, the underlying suggestion is that if a disorder is changeable, then the wind-dispelling or wind suppressing herbs will help it go away. Disorders that have the characteristic of changing their site of symptom manifestation or which come and go are thought to generally involve those aspects of the physiology that can change easily, such as the nervous system and the immune system. Such disorders usually do not involve structural changes, as this would imply a fixed disease location. Thus, herbs that calm the nervous system and reduce hyperactivity of the immune system (perhaps relieving inflammation) would be the ones most likely to be of assistance. Using a disease description such as wind is of value so long as treatments that have been traditionally defined as treating wind conditions actually benefit the people who have such diseases. Unless any of these herbal actions are entirely inappropriate to the disease treatment, these explanations should suffice to continue use of the term wind in modern practice, if one so chooses. On the other hand, it is not an essential term. Here is a presentation of trigeminal neuralgia from the Journal of Traditional Chinese Medicine (19) that depicts a wind-like illness but circumvents using the word wind: Trigeminal neuralgia is characterized by severe paroxysmal pain in the area of trigeminal distribution that feels like cutting with a knife, an electric shock, the pricking of a needle, or burning. The onset is usually precipitated by brushing the teeth, washing the face, speaking, or eating food. The duration of attack is short, from a few seconds to several minutes. The etiology is unknown and the onsets can be frequent. The traditional description is that one possible cause is invasion of wind and heat (the heat component has to do with the burning sensation that is produced); the coming and going of the disorder in a short time and easy triggering of attacks is characteristic of wind diseases. Although the area of pain is fixed, the site of pain may wander within that area. In the above description, instead of using the term wind, the etiology is said to be unknown and the manifestations are simply listed. Practitioners who rely on the term wind to describe disease conditions should be very familiar with the herbs and acupuncture points that are said to treat the conditions. (Go to link http://www.itmonline.org/articles/feng/feng.htm to finish reading.) |
