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© 2011 Lorraine Wilcox L.Ac. Principles of Treatment 1 Week 1

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© 2011 Lorraine Wilcox L.Ac. Principles of Treatment 1 Week 1 Week 1: Principles of Treatment Chinese medicine is based on image ( 象 xiang ) that is conveyed through language. So before we discuss how to apply principles of treatment in the clinic, we need to discuss what is conveyed in a treatment principle and how it is expressed in the language of Chinese medicine. Principle of Treatment ( 治則 zhi ze ): A general rule guiding selection of methods of treatment. A major principle of treatment especially in the modern practice of Chinese medicine is determining treatment by the patterns identified , by which treatment addresses illness as reflected in clinical signs rather than addressing a single isolated cause. The principle notably includes: like treatment of unlike disease , unlike treatment of like disease and action according to time, place, and person and is actually reflected in most principles of treatment. However, the most important procedural principle is treating disease involves seeking its root , i.e., its essential nature and cause. When the root of a disease is determined and hence the nature of the imbalance is understood, the question of treating the root , treating the branch , or simultaneous treatment of root and branch is decided by secondary principles that include in acute conditions treat the branch and in moderate conditions treat the root . Conditions involving evils require a decision on whether to dispel the evil and support the right , such as attack followed by supplementation , supplementation followed by attack , or simultaneous supplementation and attack . All diseases can be seen in terms of yin and yang and hence all treatment can be viewed in terms of restoration of the yin-yang balance, which involves either righting of yin and yang surfeits or righting of yin and yang deficits. Furthermore, a distinction is made between straight treatment and paradoxical treatment . Most methods of treatment are straight treatment, e.g., heat is treated with cold , cold is treated with heat , vacuity is treated by supplementing , and repletion is treated by draining . Paradoxical treatment is not strictly contrary to straight treatment, since, for example, cold is treated with cold only when the signs are false. Finally, the principles of treatment include a number of warnings such as avoid the mistake of using heat against heat , avoid the mistake of using cold against cold , and do not harm stomach qi . From PDOCM, p463-4 Method of treatment ( 治法 zhi fa ): Any specific mode of intervention in one or more bodily process derived from a principle of treatment, e.g., “supplementing the blood” and “clearing heat and resolving toxin.” From PDOCM, p394 © 2011 Lorraine Wilcox L.Ac. Principles of Treatment 1 Major Principles of Treatment 辯證論治。 Determining treatment by the patterns identified : basing treatment on the pattern, not the disease. 辯病論治。 Determining treatment by the diseases identified : basing treatment on the disease, not the pattern. 異病同治。 Like treatment of unlike disease (Different diseases, same treatment): different diseases have the same treatment if they are due to the same pattern. 同病異治。 Unlike treatment of like disease (Same disease, different treatment): The same disease has different treatments if the pattern diagnosis is different. 治病必求于本。 Treating disease involves seeking its root : This is the major guiding principle of medicine. 治本 treating the root 治標 treating the branch the essential nature of the disease the symptoms the cause clinically observable changes right qi evil qi primary condition secondary conditions 急則治標。 In acute conditions treat the branch : Treat secondary manifestations when these are acute. For example, focus on stopping bleeding or night sweats, relieving intense pain, reducing high fever, etc. Not to do so puts the patient in danger and risks more damage to right qi. 緩則治本。 In moderate (or chronic) conditions treat the root : Treating the root will remove the cause of the disease and result in a cure. This is always done unless a specific symptom will cause more harm or greatly troubles the patient. 本標同治。 Simultaneous treatment of root and branch : In most cases we can treat root and branch simultaneously to cure the disease and at the same time make the patient feel better more quickly. 因時因地因人制宜。 Action according to time, place, and person : Determine what is appropriate treatment based on the time (season, phase of the moon, day or night, etc.), place (weather, climate, altitude, diet, geography, etc.), and patient (constitution, sex, age, lifestyle, history). 上工治未病。 The superior doctor treats when there is no disease : Prevention is better than treating disease. 正治 Straight treatment : The most common method of treatment. Counteracting or opposing the condition of the disease. Treating cold with heat, etc. 反治 Paradoxical treatment : An uncommon method of treatment. Treating false signs with medicinals of the same nature. Treating heat with heat. But this is only an illusion, as these signs are false. The hot medicinals oppose the underlying true coldness which somehow has manifested some false heat symptoms. © 2011 Lorraine Wilcox L.Ac. Principles of Treatment 2 Medium level principles 實則瀉之。 Repletion is treated by draining : when evils exist on the exterior or interior and right qi isn’t too weak. Remove or transform the evil. 瀉 (xie) draining : 氵 shows that this word is related to water. Draining literally means to flow , to cause to flow, or to drain . This can be a generic term for eliminating evils or stagnation by any means. Draining can also be a specific method to descend fire, or to make damp qi leave through the urine. Besides this, draining can refer to the hand technique in acupuncture used to treat repletion. 虛則補之。 Vacuity is treated by supplementing : supplement qi, blood, yin, yang, fluids, organs, etc. when right qi is weak and evils are not strong. 補法 (bu fa) supplementation : The method of increasing or strengthening any aspect of the body. The original meaning of the Chinese ideogram is to patch, repair or fill a gap, and this meaning is reflected in Chinese medicine. Like a patch, supplementation is applied to the aspect of the body that is weakened. Yin, yang, qi, and blood may all be supplemented; the organs that most commonly receive supplementation are the spleen and kidney. 祛邪 Dispel the evil : Any method of treating used to eliminate evils. 扶正 Support the right : Strengthening the body’s right qi so it can fight against the evils. Supporting the right and dispelling the evil can be used together, but one must determine which one to emphasize. 攻 (gong) Attack : Offensive therapy to forcefully make something leave the body. This includes sweating, vomiting, and inducing a bowel movement. The patient must be strong enough to withstand attack. 先攻後補。 Attack followed by supplementation : Destroy the evil first, then supplement when the evil is gone. This is for a strong evil, but right qi can withstand the attack. 先補後攻。 Supplementation followed by attack : Right qi is too weak to withstand an attack, so the patient must be strengthened before the evil can be attacked. 攻補兼施。 Simultaneous supplementation and attack : This can be used when both the evil and right are strong, or if evil is strong but the patient cannot withstand attacking treatment. 熱則寒之。 Heat is treated with cold : Use cool or cold medicinals to treat heat conditions. 寒則熱之。 Cold is treated with heat : Use warm or hot medicinals to treat cold conditions. 熱無犯熱。 Do not use heat against heat : Do not use hot medicinals when they are not needed, especially in the summer. 寒無犯寒。 Do not use cold against cold : Do not use cold medicinals when they are not needed, especially in the winter. 無實實虛虛。 Do not replenish repletion or evacuate vacuity . 無犯胃氣。 Do not harm stomach qi : Be careful of bitter and cold medicinals or inducing vomiting. If the qi of the middle jiao is healthy, the patient can recover. If you damage it, the patient cannot replenish post-heaven qi. 奪血者無汗。 If there is bleeding, do not sweat : 奪汗者無血。 If there is sweating, do not bleed : © 2011 Lorraine Wilcox L.Ac. Principles of Treatment 3 Specific Treatment Principles (Methods of Treatment) It is important to understand this language. Verbs often imply something specific. For example 祛風 (qu feng) dispel wind : eliminate externally contracted wind. 息風 (xi feng) extinguish wind : eliminate liver wind. If you didn’t know this, you might misunderstand what was being discussed. *** 解表 (jie biao) resolve the exterior : eliminate evils from the defensive exterior by inducing sweating. 解 (jie3) resolve : To terminate (disease patterns), eliminate (evils, especially those affecting the exterior), or free (parts of the body from evils). The meaning in everyday Chinese is to separate, untie, liberate, relieve, and dispel. In Chinese medicine, it is commonly found in the following phrases: resolve the exterior (liberate it from an evil); resolve the flesh (liberate them from an evil); resolve toxins (dispel); resolve depression (relieve, dispel); and resolve thirst (relieve). 汗法 (han fa) sweating : has the intent of resolving the exterior. 疏表 (shu biao) course the exterior : to free the exterior of evils without making the patient sweat. This is a more mild action. 疏 (shu1) course : to enhance flow (of qi, especially depressed liver qi); eliminate (evils such as wind in the exterior); to free (the exterior or channels from evils such as wind). Coursing the liver is the method used to restore hepatic free coursing, applied to binding depression of liver qi. The Chinese character means to dredge or comb, and open or well-spaced. 疏風泄熱 (shu feng xie re) course wind and discharge heat : used to treat exterior wind- heat with interior heat. 滋陰解表 (zi yin jie biao) enrich yin and resolve the exterior : to treat exterior patterns in patients with yin vacuity. 助陽解表 (zhu yang jie biao) reinforce yang and resolve the exterior : to treat exterior patterns in patients with yang vacuity.
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