The Dark Warrior Guide to Chinese Medicine

The Dark Warrior Guide to Chinese Medicine 玄武中医指南 Volume II Basic Concepts of Pathology John E. Pirog 1 The Dark Warrior Guide to Chinese Medicine Volume II Basic Concepts of Pathology © John Pirog 2016 2 Preface to Volume II This second volume of Dark Warrior continues where the first left off. Having learned how the body behaves when it functions normally, we will now explore what happens when it is ill. You will soon find that the arrangement of subject matter in this volume is quite different from that of standard Chinese medical texts. Decades of teaching experience has shown me that Chinese medicine is easier to learn if it is sequenced as it is here. You will get the most out of Dark Warrior, therefore, if you read it like a novel, from start to finish, without skipping chapters or jumping ahead. Each new idea is explained when it is first introduced, and later chapters build on ideas previously covered. But while my pedagogy is designed for Western learning styles, I have taken pains to ensure that the ideas in Dark Warrior are representative of Chinese medicine as it is taught in China. I have used the vocabulary developed by Wiseman and his collaborators to establish a clear pedigree between translated technical terms and their Chinese- language originals. To make translatability even clearer, I have included the character whenever an important technical term is introduced. In a very few instances I have changed the Wiseman translation; these exceptions can be found in the appendix in the back of the book. If a deeper understanding of Chinese terminology is desired, I strongly urge the reader to obtain a copy of Wiseman’s Practical Dictionary of Chinese Medicine, 3rd edition (Paradigm 2010). The Practical Dictionary is also available as an iPhone or Android app from Pleco Software. 3 Table of Contents 14. Introduction to Chinese Medical Pathology …………………….…… 5 15. The Causes of Disease……………………………………..….………………. 9 16. The External Causes of Disease………………………….…..……………. 12 17. The Seven Affects….…………………………………………….……………… 20 18. The Neutral Causes of Disease ……………………………………………. 32 19. Introduction to the Eight Principles…………………….………..…….. 35 20. Introduction to Pulse Examination …………………………….……….. 43 21. Introduction to Tongue Examination …………………………….……. 53 22. Basic Deficiencies ………………………………………………….…….…….. 63 23. The Six Environmental Excesses in Detail……………………….…… 71 24. Bì Patterns ………………………………………………………………………... 96 25. Desertion Patterns ……………………………………………………………… 100 26. Qi Stagnation and Blood Stasis ………………………………………….. 103 27. Phlegm……………………………………………………………………………… 108 Appendix: List of Changed Translations of Wiseman Terms ……… 104 4 Chapter 14 Introduction to Chinese Medical Pathology Disease vs. Pattern meaning within Chinese medical theory. Rather than being separate from the In modern Western medicine, the physician symptoms, the pattern is existentially examines his or her patient with the goal of dependent on them. Pattern “a” is the sum of establishing the presence of a specific symptoms “x” plus “y” plus “z.” In Chinese disease. Once recognized, this disease is the medicine, it is this disease pattern which acts key to finding a remedy, since it is the cause as the proper target of therapy. of—and yet separate from—the symptoms that have brought the patient to the clinic: Disease “a” causes symptoms “x,” “y” and “z.” Let us take, for example, the disease known as streptococcal pharyngitis or “strep throat.” A patient presenting with sore throat, fever, headache, and malaise would likely have a throat culture taken and a positive presence of Streptococcus pyogenes would confirm strep throat. The important Figure 14.1 factor here is that the sore throat, fever and malaise do not constitute the disease but are The process known as pattern symptoms of the disease: The actual disease differentiation (辨证)—the Chinese medical entity is S. pyogenes infection and it is this infection that is the proper target of counterpart of Western diagnosis—is rather treatment (see Figure 14.1). like putting together a jigsaw puzzle or distinguishing a constellation in a starry sky. In Chinese medicine the physician It is a mental exercise that requires thorough examines his patient with the goal of memorization of the symptoms that form each pattern and the ability to perceive them discerning something called a “pattern” (症) in the data uncovered by traditional or “disease pattern;” (病证). Not quite the examination techniques. same as a disease, a pattern is a constellation of symptoms that come together to form a clinical picture that has 5 In modern Chinese clinical practice there by the demands of its own treatment model are about 100-200 commonly used patterns and each makes sense within that model. and each is connected with specific Identifying a causal microorganism is categories of herbs, herb formulas, and necessary if one were to treat with acupuncture points. Once the pattern is antibiotics; identifying a traditional Chinese known the treatment is expected to follow medical pattern is necessary if one were to naturally in a process known as “basing treat with herbs and acupuncture. treatment on patterns” (辨证论治). In modern China, Western and traditional Since it is the total symptom picture that Chinese diagnoses typically exist side by identifies the pattern, it is usually necessary side in the patient’s chart and the treatment to look for details that might not matter in a often involves both Western and traditional Western diagnosis. Let us take, for example, Chinese medicine. But if this integrative our strep throat patient exhibiting the usual approach is to do justice to the demands of signs of sore throat, headache, fever, and both systems, all practitioners must malaise. A Chinese medical practitioner understand that any one Western disease might note that the fever occurs together state could manifest as many different with a slight chilly sensation; that the patient patterns and any one pattern could be is sweating; that the tongue body is red with present in a host of different diseases. a yellow coat and that the pulse is floating (浮) and fast. All these signs point to a Let us again take streptococcal pharyngitis pattern referred to as “wind-heat” (风热) as an example. Depending on the total symptom picture, a number of different (see Figure 14.2) patterns could be present themselves. If a patient has pus at the back of the throat, a pattern of “toxic heat” (热毒) is present; if scarlet fever develops, it indicates heat in the yíng aspect (营分热). If a patient presents with a sore throat and fever but no chilly sensations it suggests exuberant lung- stomach heat (肺胃热盛). If there is cough with thick yellow phlegm it indicates phlegm heat (痰热). If the sore throat is chronic and there is night sweat and recurring fever in the late afternoon it Figure 14.2 肺阴虚 indicates lung yin deficiency ( ) (see These two formal “diagnoses,” Figure 14.3). streptococcal pharyngitis and wind-heat, are not necessarily at odds with each other. Each Even if all patients with the above is a pathological statement made necessary presentations were to test positive for S. 6 pyogenes, the Chinese medical treatment (不孕) and nasal congestion (鼻塞). Any would be different for each one. Most one of these conditions could be caused by traditional practitioners would argue that a several distinct disease entities within the treatment that does not match the disease biomedical model. Likewise, each could be pattern is not likely to be effective and could associated with several different Chinese in fact cause harm. medical patterns. In either case, whether the disease state is defined traditionally or biomedically, treatment must always be based on the pattern. Figure 14.3 But we can take this idea one step further: Any given pattern could be present in many Figure 14.4 different biomedically-defined diseases. In addition to streptococcal pharyngitis, the The Process of Examination symptoms that distinguish wind-heat could be present in a wide range of infectious One of the hallmarks of traditional Chinese illnesses such as cytomegalovirus, Epstein- medicine is its nearly exclusive reliance on Barr virus, rhinovirus and haemophilus diagnostic evidence that can be gleaned influenzae, to name a few (see Figure 14.4). from the physician’s five senses. There were This dissociation between disease and no thermometers, sphygmomanometers, pattern is summarized in the aphorism, “One weight scales, lab tests or x-ray images pattern, many diseases; one disease, many available to the pre-modern Chinese patterns.” physician. Disease-pattern differentiation depended entirely on the unaided It should be pointed out that the above examination of the patient in a process that principles apply even when the disease in came to be referred to as the four question is not a strictly defined biomedical examinations ( 四诊). These consisted of entity. In traditional contexts the word visual inspection (望诊), listening/smelling 病疾 “disease” ( or ) often refers to (闻诊), inquiry (问诊) and palpation (切诊). symptomatically-defined disorders such as The four examinations continue to be the dysentery (痢疾), jaundice (黄疸), infertility 7 primary basis for Chinese pattern symptomatic phenomena used to establish differentiation today. the pattern. The four-examination process usually The examination ends with palpation, i.e., begins with visual inspection, where the the use of the hands or fingers to probe physician takes note of the patient’s overall specific diagnostic regions of the patient’s physical appearance, posture and movement; body. While palpatory signs can be found on as well as their “spirit” (神)—their speech, the chest, abdomen and extremities, in eye contact and overall self-expression. standard practice palpation is usually Visual inspection might include, where restricted to pulse examination. This final appropriate, an examination of the skin, hair, assessment is one of the skills for which eyes, mouth and throat. One of the most Chinese medicine has become famous.

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