17th May, 2021

The Deterministic Undertones of Traditional Chinese Medicine
By Jonathan Bluestein


Traditional Chinese Medicine makes many suppositions which may incline us to believe, that the human condition is somewhat or even fully 'predetermined'. What are these suppositions, in theory and in actual medical practice? Do these ideas imply that TCM is a deterministic form of medicine? Such important questions shall be explored thoroughly in this article, using fascinating examples which are seldom discussed in the profession. 

One of the defining characteristics of TCM is that, as a system, it does not limit itself to Medicine. Rather, TCM is the medical application of much broader Chinese theories about Nature and Existence. These theories are rife throughout Traditional Chinese Culture, in the Arts, the Martial Arts, Architecture, Politics, Religion, Feng Shui, and many other areas of study and engagement. TCM therefore, albeit being an enormous body of knowledge, is just one branch of a much bigger tree.

Being so, TCM is rooted in the idea that things in Nature and Existence are Synchronous. Meaning, that TCM does not entirely subscribe to the notion of linear cause and effect. Instead, every thing which exists is like a leaf in a body of water, and anything which disturbs the water affects the movement of all the leaves. Although the ripples of the effect take time to manifest and reveal themselves to the eye, in actuality all leaves are affected instantaneously, from the first moment that, say, a rock fell into the water. They are all interconnected through the water. In the human body, the water would be the Qi, and the leaves would be the channels, the organs and even the emotions and the psyche, etc.

The idea of Synchronicity is intrinsically connected with the questions of Free Choice and Free Will. Why is that? Wherein we assume that all things are interconnected via instantaneous effect, then how can we choose?


In this context, think about the cycle of the Wu Xing (Five Phases), for instance. We can look at Kidney deficiency, and ask ourselves - what is the root of this? Perhaps we say, that the Lungs failed to nourish the Kidneys. But the Kidneys nourish the Liver, which nourishes the Heart, which nourishes the Spleen, which nourishes the Lung, which nourish... the Kidneys? So is there not a paradox of synchronicity here, wherein the Kidney are themselves a part of the interconnected cycle which failed them?

Even with so-called 'external causes', we have a philosophical trap laid out for us. Suppose again that we are dealing with deficient Kidneys. Suppose this time that the main cause of deficiency had been excessive sexual activity (male patient). But then, can we not point out to the fact that excessive sexual activity is primarily affected by the drives, emotions and hormones related to the function of the Kidneys, and also of the Heart, which the Kidneys ought to regulate?...


In the actual medical practice, we can identify roots and branches, and treat accordingly. But in thinking of energetic cycles and karmic processes, it would appear that, with the majority of cases, the dysfunction somehow feeds itself, or is even directly or indirectly involved in the creation of its own existence. Such is a paradox of Free Choice and Free Will, because it would appear that TCM implies that these things are almost inevitable.

But the examples do not stop there. Because TCM is a system of Synchronicity, this philosophical and energetic debacle haunts all aspects of it. 

Another prime case in point is that of how TCM understands the balance between 'Nature' and 'Nurture'. Each person is understood to have two types of energetic systems, broadly speaking: Inborn qualities (Xian Tian Qi), which manifest as the Constitutional Qi (Yuan Qi) and also as Jing, and the acquired qualities (Hou Tian Qi), which present themselves as the Qi manufactured by the Lungs, Spleen, etc, as well as the regeneration of Blood.

There is a long-running debate, whether things like Yuan Qi and Jing could be replenished in a very meaningful way. It is unclear, for example, if by tonifying them a person can survive 20 years longer, or even 5 years longer, than he or she were 'destined' to live.
Additionally, there is the accompanying notion of an 'inborn constitution', affected by some organs systems which are innately more dominant than others. It is claimed that such an inborn constitution cannot be changed during one's lifetime.

So here again we have commentary, already found in the classical texts and persistent and readily approved of to this day, about how one could hardly change, or not at all affect, inborn tendencies and inclinations. Yet he overall message is not entirely deterministic with such examples, because it is also understood that the how the Xian Tian will manifest and express itself, is dependent on the Hou Tian, and the latter is governed by the individual and his or her choices. But does the individual have control over their choices? The answer might be unclear, in light of the earlier examples, of how the cycle of the Wu Xing is to a degree almost a 'self-fulfilling prophecy'. 

Thus far, I wrote about this problem from the microcosm of the human body. Let us now think of this challenge of Free Will and Free Choice from the point of view of the macrocosm of the heavens. 

The human body is made of systems which are related to numbers. For example:  1 (body/mind), 2 (Yin and Yang), 3 (Treasures / Sections / Jiao), 4 (Si Xiang), 5 (Phases), 6 (Layers / Qi), 8 (Ba Gua / Extraordinary Channels), 10 (Pairs of 5 / Celestial Stems), 12 (Regular Channels), etc. The traditional Chinese thought is that all of these systems in the human body, and their numerical expressions, are a reflections of the Heavens. 'As above, so below'.

Every human being goes through cycles of 10 and 12 years. Every year, in the body in every relatively healthy human being, one of the 10 organs is more dominant in its activity, and one of the 12 regular channels is more dominant in its activity. The next year, the dominance would transition to the next organ and channel in the sequence. But which organ and channel are dominant during one's first year alive? This is determined by the year and date one was born, and how the celestial bodies - Earth and the other planets in the solar system - were aligned during that time. We should ask - is that not deterministic?


Making things even more complicated and perplexing... we could say that a human being was conceived by a woman and a man joining together. This couple were brought together because of a common interest of some sort. There was attraction between those people, whether positive or negative. The attraction is affected by how they look and behave. How they look and behave is affected in many ways by their inborn circumstances, which again are thought to be affected by the Heavens. Is it then implied, that the Heavens also directed the birth of the human to begin with?...

For those who believe that everything in existence is the Will of God, and that human beings are only his instruments, such a thing is not confusing. From that point of view, it makes sense completely. However, if one believes that God provides humans with Free Will and Free Choice, or for those who do not believe in the reign of the Divine, these are difficult problems to contend with.

The investigation of Free Will, is furthermore associated with the debate over whether the innate nature of the human creature is good or bad. This question too, has been discussed endlessly throughout history, in many cultures and civilizations. I would like to make an interesting case and argument about it, from the point of view of Traditional Chinese Medicine.

Amongst the Chinese, this debate was famously spearheaded by two of their most famous scholars and philosophers - the Confucians Mengzi (Mencius) and Shunzi. They had to discuss this and argue over it, because their intellectual forefather, Kongzi (Confucius), did not outright comment on this issue, at least not in the written works which documented his teachings.

Mengzi was of the opinion, that all humans have a good and pure heart from birth. They are inclined to do positive things, if possible. Mengzi famous gave the example of a child who was trapped in a water well. He claimed that if any person passed by the well and could take the child out of it, none would refuse the gesture.

Unlike him, Shunzi believed that humans are from birth, inclined to be vicious and malicious. Shunzi was adamant, however, that good and proper education could rehabilitate almost any person, making them into moral and upright individuals.

It is interesting to note here, how both views are deterministic in their view of the innate human condition, even though both scholar believed that an education can positively or negatively change someone's character. This is somewhat in line with how TCM considers Xian Tian Qi and Hou Tian Qi.

But what is the point of view of TCM on this? A consistent belief cannot be pointed to, as TCM is a body of knowledge spanning thousands of years, and millions of doctors. Yet it is possible for me to at least examine one example from the practice, which I find to be quite charming. It comes to us from the formula Xiao Yao San, which has been around since the 12th century of the Common Era.

At surface level, Xiao Yao San (and its several variants) is an exceedingly useful formula for the treatment of Liver Qi Stagnation invading the Spleen, which may cause dozens of different symptoms. Such is the simple clinical understanding of this formula. But there is also a more nuanced, psycho-spiritual comprehension of what this formula can do.

The name of the formula itself is taken from the Daoist classic of Zhuanzi, and means: 'easy-going', or 'free and unfettered'. The short story where this name is mentioned, tells of a tree (wood phase) which gnarly, crooked, ugly, and overall unfit for use by humans in any way, shape or form. However, because the tree is of no use, it can be safe and long-lived, and is not threatened by the axes of people. Such is also a metaphor for the Liver in the context of this formula. The stagnant Liver causes problems with relationships, primarily through excessive anger and the formation of an overly-stubborn personality which is inflexible. Yet with the formula, the Liver (wood phase; tree) can assume a nature which 'does not invite the axe'. The person becomes more flexible in his mindset, which causes the 'tree' to initially appear ugly, with twisted roots and branches. But in that seemingly-awkward form is a flexibility body and mind relative to circumstances, which keeps the person safe from harm - internal and external. 

There is furthermore an understanding, that Xiao Yao San, when prescribed to that right type of patient, can help such a person restore aspects Ziran - their natural Self. By first relaxing the Liver's stagnation, and then pacifying it, this formula brings a person into a state of being 'at ease with himself'. This naturally manifests an attitude which is Xiao Yao - 'easy-going', or 'free and unfettered'. This essentially modifies a person into someone who is inclined to be kinder, gentler, nicer, and perhaps even more empathetic, and certainly less inclined towards conflict. All of this, relative to one's already extant constitution. 

Such ideas about the formula Xiao Yao San, imply that major streams of thought in TCM do think in-line with the ideas of Menzi about human nature. The existence of this formula and what it can do, suggest that underneath the serious mantle of any adult is a kind-hearted child, and this original nature may manifest if the conditions are given for it to flourish.


Does that mean, that we are born good, and choose to be bad? Or that circumstances make us bad, and then with herbal medicines we can again choose to be good? Or perhaps, the herbal medicines predispose us towards a condition, without choice?...

It may be argued that we have some choice, in that Xiao Yao San does not work on everyone long-term, even it was initially successful. A person may have been very angry, and after 6 months of on and off taking Xiao Yao San, he became mellow and kind. But then, two years later, he is angry again, and even more so than before. Another patient who was treated for the shorter duration of 3 months, managed to sustain the behavioural and emotion shift for decades to come. Do these examples not imply, that choice of how one perceives the world and engages with it, intermingle with the effects of the herbal medicine?... We may never have a concrete and 'scientific' answer, as such questions are not fit for 'peer-reviewed studies'. 

Where is the choice, anyway? Some of the sillier scientists still believe that it is in the brain. They association of brain activity with memories and choice, is akin to a person who sees fish in a lake and assumes their were created by water, because they are there.

I reject what is still today the mainstream scientific point of view, that the brain is the sole sovereign over choice-making. TCM agrees with me of course, as our medicine sees the Five Aspects of Shen (Wu Shen) as being a complex of systems, with psychological, spiritual and biological components, all determining human action together. 

I also personally believe in the theories of professor Rupert Sheldrake concerning the existance of Morphic Fields. His idea is that consciousness, and even our biological blueprints, exist outside of the body in some ether, like a cloud-server to which a computer reaches out for information. The brain in that sense is a computer and an antenna, but information, such as memories or consciousness, are not in the brain - they are merely accessed by it. This theory is complex, and I do not wish to elaborate on it here. I have written more about it in my book, Exceptional Ideas About Humanity

In the final consideration of things, we are left with only a partial answer to the question, of whether TCM is fully deterministic, or only in part. My personal view on this, is that TCM manifests in principle a key idiom in the Jewish culture from which I come:

"Everything is preordained, yet permission is granted".

This seeming contradiction examplifies the healthy view many traditionally-minded Jews have towards the questions of Free Will and Free Choice. One is born with a set number of paths which he or she could follow, and cannot change those paths or opt to have others - that is Xian Tian Qi. However, within that scope of possibilities, one also has the ability to choose from amongst the paths, and the progression between them - that is Hou Tian Qi.

What a man or a woman are left with is, essentially, being the CEOs of their own destiny. They chart the course broadly, making choices and decisions which direct and redirect the path. But the majority of the flow, is beyond their control. Perhaps, the measure of choice left to us is small, akin to a car driver which may merely opt for either a left or a right turn, at every junction. But the amalgamation of such choices over a lifetime, makes for an immense difference in the world.