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Principle of treatment
治则 〔治则〕zhì zé
Any of the numerous general principles applied to devise an appropriate treatment strategy.
Principles of treatment are contrasted with more finely distinguished
(治法 zhì fǎ), which are used for specific states and qì, blood, yīn-yáng, and disease evils. These are discussed under Medicinal Therapy and Acumoxatherapy below.
| Principles of Treatment |
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Seeking the Root
A guiding principle of Chinese medicines is:
(治病必求于本 zhì bìng qì qiú yú běn). Amidst a confusing welter of signs, the practitioner must grasp the essential nature of any illness. The term root
stands in opposition to tip
(also called branch
). The root
is the nature of the illness, while the tip is the symptoms. Sometimes root
refers to the state of right qì, while tip
refers to the presence of evil qì. Very often, root
means the primary aspect of a complex disease state, while tip
refers to the secondary aspect. See root and tip.
The essential nature of the illness It is important to address the essential nature of the patient’s illness. If a patient suffers from cough, it is pointless to indiscriminately select medicinals known to cure cough. The practitioner must determine, for example, whether the cough forms part of a heat pattern or a cold pattern so that she can choose cold-natured medicinals for a heat pattern or warm-natured medicinals for a cold pattern.
The primary aspect of illness: When the patient has a complex condition, it is important to determine which aspect is the most salient. For instance, in yáng vacuity causing phlegm-rheum, the practitioner must determine whether the yáng vacuity or the phlegm-rheum is the more pressing problem. Knowing how to prioritize treatment of the underlying factors that allowed the disease to occur (root) and the treatment of the secondary condition (the tip) is one of the finer skills of Chinese medicine.
(急则治标 jí zé zhì biāo)In acute conditions, treat the tip
(缓则至本 huǎn zé zhì běn)In chronic conditions, treat the root
Treating Illness Before It Arises
The notion of treating disease before it arises
(治未病 zhì wèi bìng), which appears in the Sù Wèn, implies two things: Prevent illness from arising before it appears; prevent mutations after it has arisen
(未病先防, 既病防变 wèi bìng xiān fang, jì bìng fáng biàn). Here, mutation
refers to unfavorable changes in the patient’s condition. The idea is to spot the signs of illness before any major symptoms appear and to forestall further developments. It involves understanding the constitution of a patient, which may give clues to likely susceptibilities. The importance of this principle is stressed by the Nàn Jīng (77th Difficulty), which states, The superior practitioner treats illness before it arises
(上工治未病 shàng gōng zhì wèi bìng).
Supplementing Insufficiency and Reducing Superabundance
This twofold principle is often referred to as: vacuity is treated by supplementing
(虚者补之 xū zhě bǔ zhī) and repletion is treated by draining
(实者泻之 shí zhě xiè zhī), also phrased as supplementing the insufficiency
(补其不足 bǔ qí bù zú) and reducing the superabundance
(损其有余 sǔn qí yǒu yú). When something (qì, blood, fluids) is lacking in the body, the treatment aims to restore it; and when the body is burdened with an excess of something (cold, heat, dampness, phlegm, etc.), the treatment is to remove it. This dual principle is chief of all the fundamental principles of treatment because it is crucial to the successful treatment of any condition.
In acupuncture, supplementation and drainage are the two basic classes of stimuli that can be produced using needles and moxa to treat vacuity and repletion. In medicinal therapy, some medicinals have specific actions of supplementing qì, blood, yīn or yáng, often acting on specific bowels and viscera or body parts. Most other medicinals producing diverse effects essentially all reduce superabundance. These include resolving the exterior (which often entails making the patient sweat), clearing heat and draining fire, moving qì to relieve qì stagnation, quickening the blood and transforming stasis in the treatment of blood stasis, and dispelling dampness, phlegm, and stagnating food, to mention just a few. In medicinal therapy, the term draining
is used to denote specific methods only in the context of draining fire; it does not have the meaning of a basic method of treatment that it has in acupuncture.
Dispelling Evil and Supporting Right
The term dispelling evil
means reducing superabundance, while supporting right
means supplementing insufficiency. Dispelling evil
(祛邪 qū xié) is sometimes referred to as
or offensive treatment.
(扶正 fú zhèng) is also called supplementation
(补益 bǔ yì). Discussion of dispelling evil and supporting right as basic principles of treatment usually concerns the circumstances under which the two principles are applied.
Repletion patterns are treated by dispelling evil, while vacuity patterns are treated by supporting right qì. To dispel evil, different methods are used depending on the nature of the evil and its location. The main methods are resolving the exterior; clearing heat; precipitation (purgation); dispelling phlegm; transforming dampness; disinhibiting water; rectifying qì; and transforming stasis. Supporting right qì involves different methods depending on the aspect of the body that is weak. The main right-supporting methods are supplementing qì; supplementing yáng; supplementing blood; and engendering liquid.
Many conditions involve repletion and vacuity. Furthermore, treatments designed to dispel evil may damage some aspect of right qì. Hence, both supplementation and attack can form part of a single treatment strategy. Usually, one treatment is performed before the other. In such cases, it is important to determine which treatment to apply first.
Attack followed by supplementation: The principle of attack followed by supplementation
(先攻后补 xiān gōng hòu bǔ) is applied where the most urgent need is to eliminate the evil, that is, where the evil is just starting to develop and the right qì can withstand the attack. In such cases, the immediate use of supplementation to deal with the vacuity would
(闭门留蔻 bì mén liú kòu), that is,
(恋邪 liàn xié).
A good example is yáng brightness (yáng míng) disease characterized by constipation. In this condition, exuberant heat damages the fluids of the body, making the stool hard and dry. Because the heat is the cause of the damage to fluids, it is necessary to address the heat first. The appropriate treatment is draining-precipitation, which drains the heat of the large intestine and flushes out the dry stool. This treatment is also damaging to the fluids, so it is important to follow up the attack
with a supplementing treatment to help repair the damage to the fluids.
Supplementation followed by attack: The principle of supplementation followed by attack
(先补后攻 xiān bǔ hòu gōng) is applied when the main need is to safeguard right qì, that is, when the evil has already wrought major damage on right qì. In such cases, if treatment starts with efforts to remove the evil, it will further damage right qì. At best, the outcome will be the removal of the evil leaving vacuity of right, a situation often described as
(贼去城空 zéi qù chéng kōng). At worst, not even the evil will be removed.
The application of this principle is seen, for example, in patients with worm accumulations that have persisted for a long time to cause major vacuity of right qì. In such cases, treatment to fortify the spleen and harmonize the stomach must be given before treatment to dispel worms and disperse accumulations.
Simultaneous supplementation and attack: The principle of simultaneous supplementation and attack
(攻补兼施 gōng bǔ jiān shī) is applied in vacuity-repletion complexes in which evil repletion and vacuity of right qì are equally severe. In such cases, exclusive use of supplementing right would only detain the evil, while exclusive use of dispelling evil would only damage right qì. Depending on the preponderance of vacuity of right or evil repletion, the emphasis of treatment can be placed on either supplementation or attack.
An example of this occurs in warm disease, when exuberant evil has already damaged yīn humor, causing vigorous heat effusion, with heart vexation, thirst, and dry mouth and tongue. In this specific case, the treatment is clearing heat combined with supplementing yīn humor, with the emphasis on clearing heat.
Adjusting Yīn and Yáng
When determining treatment, it is not sufficient simply to decide when to dispel evil and when to support right. The practitioner must also pay attention to
(调整阴阳 tiáo zhěng yīn yáng),
which is also called
(调整阴阳盛衰 tiáo zhěng yīn yáng shèng shuāi).
A cold evil causing an exterior pattern can often be treated simply by dispelling the (yīn) evil, using má huáng tāng (Ephedra Decoction) to resolve the exterior. Some situations, however, are more complicated. For example, kidney yáng giving rise to yáng vacuity water flood calls not only for action to eliminate the cold water but also for action to warm kidney yáng. Similarly, a simple interior heat pattern can be treated by clearing interior heat, using a formula such as bái hǔ tāng (White Tiger Decoction). By contrast, intense stomach fire exacerbated by kidney yīn vacuity requires action not only to drain the fire but also to supplement kidney yīn, using a formula such as yù nǚ jiān (Jade Lady Brew).
(阴中求阳 yīn zhōng qiú yáng) and seeking yīn within yáng
(阳中求阴 yáng zhōng qiú yīn).
For example, zuǒ guī wán (Left-Restoring [Kidney Yīn] Pill), which is used to treated insufficiency of kidney yīn, contains yīn-supplementing agents, which are complemented by lù jiǎo (Cervi Cornu), tù sī zǐ (Cuscutae Semen), and other yáng-supplementing agents (seeking yīn within yáng). Yòu guī wán (Right-Restoring [Life Gate] Pill), which treats kidney yáng vacuity, comprises mainly yáng-supplementing agents, but these are complemented by shú dì huáng (Rehmanniae Radix Praeparata), gǒu qǐ zǐ (Lycii Fructus), and other yīn-supplementing agents (seeking yáng within yīn). In both cases, the principle of seeking yīn within yáng or yáng within yīn is secondary to that of directly supplementing the insufficiency.
Straight Treatment and Paradoxical Treatment
Straight treatment (正治 zhèng zhì) is by far the most commonly used. It includes the two-fold principle of vacuity is treated by supplementing
and repletion is treated by draining.
It also includes the principle of treating cold with heat (hot-natured medicinals) and treating heat with cold (cold-natured medicinals).
Paradoxical treatment (反治 fǎn zhì) is the opposite of straight treatment. It involves treating a condition by a method that logically would exacerbate it. It includes the following:
Treating heat with heat
(热因热用 rè yīn rè yòng)Treating cold with cold
(寒因寒用 hán yīn hán yòng)Treating the stopped by stopping
(塞因塞用 sāi yīn sāi yòng)Treating the free by freeing
(通因通用 tōng yīn tōng yòng)
Paradoxical treatment is only a seemingly opposite principle, since it is only applied when there are false signs, that is, signs that do not represent the true nature of the condition. For example, in exuberant heat occurring in externally contracted disease, there may be false cold signs, such as aversion to cold and shivering. In this case, the heat is the true condition, while the aversion to cold and shivering give a false impression of cold. This condition is treated with heat-clearing toxin-resolving agents. Although it seems as if cold-natured agents are used to treat a cold condition, they in fact address the true nature of the condition.
Action According to Time, Place, and Person
The most effective treatment is one that takes account of time (season), place (local environmental conditions and customs), and person (the individual’s state of health). This is called
(因时因地因人 yīn shí yīn dì yīn rén).
When these factors are taken into consideration, a given morbid condition may be treated in different ways. This is the principle of
(or
同病异治 tóng bìng yì zhì).
Action according to time means determining treatment according to season. In spring and summer, the temperature rises, yáng qì moves upward and outward, and the interstices become loose and open, allowing the discharge of sweat. At this time, external contraction of wind-cold must be treated with care. Warm acrid effusing and dispersing medicines, such as má huáng (Ephedrae Herba) and guì zhī (Cinnamomi Ramulus), should be used more sparingly than in autumn or winter, otherwise they may cause excessive discharge of sweat that can damage qì and yīn. In autumn and winter, the temperature drops, the interstices of the body close, and yáng qì withdraws and hides within the body. At such times, a heat pattern must be treated with care; cold or cool medicines such as shí gāo (Gypsum Fibrosum) or bò hé (Menthae Herba) should be used only sparingly if damage to yáng is to be prevented.
Action according to place means determining treatment according to the climate and the customs of a locality. In the high mountains of the North-West of China, the climate is cold, so here warm acrid medicinals are more frequently used than in other places. The South-East is less mountainous and much warmer; hence cold bitter agents are used more frequently than in other places.
Action according to person means determining treatment according to age, sex, and the constitution of the patient.
Age: Infants and children have great vitality, but their qì and blood are still relatively weak, and their bowels and viscera are delicate. Infants, in particular, are unable to care for themselves, and so tend to suffer from imbalances of hunger and satiety and excesses of warmth and cold.
Older patients tend toward qì vacuity and blood vacuity. They suffer from vacuity patterns or complexes of right vacuity and evil repletion, rather than simple evil repletion. Thus, when treating the elderly, supplementation is especially important. When treating their repletion patterns, the practitioner must take care not to damage right qì.
Gender: Women have menstrual periods and give birth. When treating women, it is important to choose treatments carefully, so as to avoid potential problems. For example, during pregnancy, toxic medicinals, drastic precipitating medicinals, blood-breaking medicinals, and slippery and disinhibiting medicinals, as well as mobile and penetrating medicinals, are contraindicated or should be used with care. Examples include
- precipitating medicinals, such as dà huáng (Rhei Radix et Rhizoma);
- blood-breaking medicinals, such as é zhú (Curcumae Rhizoma);
- toxic medicinals, such as fù zǐ (Aconiti Radix Lateralis Praeparata); and
- mobile and penetrating medicinals, such as shè xiāng (Moschus).
Also, blood-quickening and blood-breaking medicinals must be prescribed appropriately in accordance with the menstrual cycle. Vigorously moving the blood during menstruation may cause excessive bleeding and result in blood depletion. Some practitioners prescribe different formulas for different phases of the menstrual cycle.
Helping Things Along Their Course
Sù Wèn (Chapter 5): What is high is brought up and out; what is low is drawn out and exhausted; center fullness is treated by draining in the inner body…
其高者，因而越之；其下者，引而竭之；中满者，写之于内…。 Qí gāo zhě, yīn ér yuè zhī; qí xià zhě, yǐn ér jié zhī; zhōng mǎn zhě, xiě zhī yú nèi.... These principles are all instances of helping things along their course.
Treat Until Harmony is Restored
The goal of treatment is to eliminate imbalances in the body and restore harmony. The Sù Wèn(Chapter 5), states, Observe closely where [imbalances of] yīn and yáng lie and regulate them, until harmony is restored
(谨察阴阳所在而调之﹐以平为期 jǐn chá yīn yáng suǒ zì ér tiáo zhī, yǐ píng wéi qī). Imbalances of yīn and yáng
here means yīn-yáng surfeits and deficits, disharmony of qì and blood, disturbances of upbearing and downbearing, and impairment of bowel and visceral functions. In any case, treatment must be administered until the harmony is restored.
The Shāng Hán Lùn On Cold Damage
) states a similar principle:
(中病即止 zhòng bìng jí zhǐ), which emphasizes the inadvisability of continuing treatment after harmony has been restored.
A general rule guiding selecting methods of treatment. A major principle of treatment especial in the modern practice of Chinese medicine is identifying patterns and determining treatment, by which treatment addresses illness as reflected in clinical signs rather than addressing a single isolated cause. This principle notably includes like treatment of unlike disease, unlike treatment of like disease and act(ion) according to time, act(ion) according to place, and act(ion) according to person and is actually reflected in most principles of treatment. However, the most important procedural principle is to treat disease, it is necessary to seek 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 tip, or treating the root and tip simultaneously is decided by secondary principles that include in acute conditions treat the tip and in chronic conditions treat the root. Conditions involving evils require a decision on whether to dispel the evil and support right (see dispelling evil and supporting right), such as attack followed by supplementation, supplementation followed by attack, or simultaneous supplementation and attack. All disease can be seen in terms of yīn and yáng and hence all treatment can be viewed in terms of the restoration of the yīn-yáng balance, which involves either righting of yīn and yáng surfeits or righting of yīn and yáng 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 includes: treating heat with heat and treating cold with cold. Paradoxical treatment is not strictly contrary to straight treatment, since, for example, cold is treated with cold only when the cold signs are false. Finally, 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 qì.
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