Dr. Shen used everyday analogies to explain his concepts. With regard to lifestyle, he used one involving an object familiar to all of his clients: a car. He said that there were four kinds: one is good and well cared for, one is good and overused, one is poor and well cared for, and the other is poor and poorly cared for.

Obviously, the good car that is well cared for will be the best. However, the point he was making was that the poor car that is well cared for will be better than the good car that is neglected.
The ‘quality of the car’, I consider the ‘terrain’, and the care of car (which includes what we do with it) as the ‘stress’. We are not all born equal: we each have a different a ‘quality of car’. This is part of our ‘terrain’, upon which life (the provider of our ‘stress’) plays out. Terrain represents the totality of an organism, from what is inherited, to what is done with that inheritance through the entirety of life, in all dimensions: physical, mental, emotional and spiritual.

Central to this discussion is the fact that Chinese medicine has knowledge of terrain, and that has allowed it to achieve management and treatment modalities to influence terrain from ‘cradle to grave’. Within recorded history, Chinese medicine has from its inception concerned itself with evaluating and managing the functional status of physiology: the Qi, Blood, Essence, and body fluids, to which I refer as terrain.

In Western medicine we have the rough equivalent, the immune system, about which we continue to make amazing discoveries, but of which we have little understanding how to influence. Because of this, the thrust and focus of biomedicine is on eliminating or ameliorating the stresses. Fundamental to achieving a sophisticated and accurate evaluation of the terrain was, and still is, the development of methods to measure the ‘normal’ state and deviations thereof, using touch (the pulse, palpation of channels and abdomen), looking (tongue, eyes, colour), asking, and listening. Having a baseline of ‘normality’ allows us to detect, with the modalities just mentioned, the slightest deviation, and to access the development of disharmony that leads to disease at its earliest stage. Thus, my emphasis on sophisticated diagnosis is ineluctable to consistent success in clinical outcomes and prevention.

Within the Chinese medical community and society, stress has been the accepted consequence of fate. However, in Western civilizations, with rise of biological science, stress has taken a more prominent adversarial role in the pathogenesis of disease, against which we are committed to do battle. In the event of an attack from what the Chinese would call an External Pathogenic Factor and biomedicine would call a virus or bacteria, the thrust in the West is to destroy the invader, while in the East the focus has been primarily to strengthen the defender – the Qi, Blood, Essence and body fluids – while attenuating the invader.

In the nineteenth century, this difference reached its apogee in a monumental struggle between Louis Pasteur, who designated stress – the bacteria – as the key issue, and two other scientists, Claude Bernard and Antoine Béchamp. Unlike Pasteur, they designated the key issue as ‘Le Milieu Intérieur’ (internal environment), or terrain. This is equivalent to the Qi, Blood, Essence and body fluids long studied collectively as the critical medical concern by the Chinese. The ramifications of this struggle escalate to this day; destroying the stressor is at the centre of biomedical research and practice with a strong financial incentive from the pharmaceutical companies. Little progress, relatively speaking, has been made in our ability to influence and strengthen the immune system. This is true despite the fact that Pasteur may have recanted his germ theory before his death.

The concept of terrain is essential to our ultimate goal, which is to know and to help an Individual, and to help him know and help himself.