by Bob Flaws

Last week I had dinner with a Tibetan friend of mine from Amdo who speaks both Tibetan and Chinese and whose grandfather practiced Tibetan medicine. During the course of our conversation, my friend asked me about the differences between Chinese and Tibetan medicines. I began by saying that Chinese medicine has yin and yang while Tibetan medicine has the three gunas (wind, bile, and phlegm). I went on to say that the Chinese five "elements" are different from the Tibetan five elements. We then spent a good part of the evening discussing the differences between these seemingly identical concepts in the two medicines. Thinking about our conversation over the weekend, I thought it was worthy of a blog since it covers something that many Westerners persist in misunderstanding (due to wrong terminology).

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In Tibetan, the five elements are called jung-wa nga. They are space, wind, water, fire, and earth. These five are considered the elemental building blocks of the phenomenal world. As such, they are kinds of substances which have both subtle and gross aspects. Sometimes, Tibetans only talk about four elements, jung-wa shi, in which case leaving out space. In all probability, the Tibetans got this system of the four (or five) elements from Greco-Roman (Galenic) medicine via Persia (Tib. Ta-zig). During the formative years of written Tibetan medicine in the ninth century, the Tibetan king, Trisong Deutsen, invited doctors from all the surrounding countries and especially India, Persia, and China to teach their various specialties and approaches. These foreign doctors also wrote books in Tibetan on their systems which still exist to this day. Interestingly, the Persian doctor's name was phoneticized in Tibetan as Galenos or a follower of Galen. Over time, the Tibetans combined various parts of these foreign systems with their indigenous practices and beliefs to form what has now come to be known as traditional Tibetan medicine (TTM), for instance adopting the three gunas from Indian Ayurvedic medicine and the five viscera and six bowels from Chinese medicine. In any case, my point here is that the Tibetan four or five elements are probably derived from the Galenic four elements and are truly seen in Tibetan medicine (and Tibetan Buddhism) as elemental substances.

In contradistinction, in Chinese medicine, we have the five phases or wu xing 五行. Unfortunately, when Westerners such as Matteo Ricci first came across these, they immediately related them to what they already knew -- the Galenic four elements, and, therefore, they called the wu xing the five "elements." However, in Chinese medicine, the five phases are not seen as elemental substances but rather as five stages in the birth, growth, maturation, decline, and death of any and all things in the phenomenal world. This is a huge and very important difference between these two theories or concepts. On the one hand, we have a building-block system of elements and, on the other, we have a dynamic system of phases or stages of change yi 易. As practitioners of Chinese medicine, I believe it is very important for us to be clear that, in our system, we are talking about stages of change and not elemental substances. The problem is that we, as a profession, persist (now for more than 25 years since Nigel Wiseman coined the term "five phases") in calling the five phases the five elements.

So this is an open call to readers of this blog. Please, let's stop calling the wu xing by the wrong name. Words do make a difference, and it's not all good. If one uses the wrong word, this fosters the wrong concept. Each time we find ourselves about to say or write the "five elements," we need to check ourselves and say or write the "five phases" instead. This is not a difficult thing to do. All it takes is the will to do it and some presence of mind. If we made this one small linguistic change on a consistent basis, within a couple-few years, it would be firmly entrenched within our profession. So please, just say no to the "five elements" and say yes to the "five phases." Just this one little change will improve all our understanding of Chinese medicine. Since our medicine is based on the concept of change, surely this little change is not too much to ask.

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