Therapeutic Methods

Therapeutic Methods

Treatment

Acupuncture

Herbology

Massage

Qigong

• Prevention is meant taking certain measures to avoid the occurrence and progress of diseases. • TCM has always attached great importance to prevention. As early as in Essential Question, the preventive thought of "preventive treatment of diseases" was advanced. • This theory involves two aspects: preventive treatment before the occurrence of diseases and preventing deterioration after the occurrence of diseases.

• “put prevention first” is one of the four great policies of the medical and health work in China. • And it is also a principle of preventing the occurrence and the progression of a disease in TCM.

Preventive Treatment of Disease • It refers to taking various measures to prevent diseases from occurring. • The occurrence of a disease is related to both pathogenic factors and health Qi. • The former is the important condition for the occurrence of a disease, which the deficiency of the latter is the intrinsic factor for the occurrence of a disease. • Therefore, preventive treatment of a disease must start with both strengthening the resistance inside the body and preventing pathogens from invading the human body.

• Basic Questions States:" The body with health Qi is never attacked by pathogenic factors." • To prevent the disease from occurring the following preventive measures must be taken.

1.Strengthening health Qi's capacity to resist

pathogens • Regulating mental activities to maintain the Health • Keeping regular hours • Doing regular physical exercises • Using drug prophylaxis and providing artificial immunization 2. Defending the body against pathogens • Keeping away from six exogenous pathogens • Avoiding various infectious diseases and trauma • Developing hygienic habits and preventing environmental pollution, as well as water and food contamination

Preventing the deterioration of disease • Though prevention prior to the occurrence of a disease is the best policy, timely diagnosis and effective treatment to control the deterioration of disease is also important. • Therefore, once a disease occurs, it should be early treated so as to cure it in its initial stage. • Ye Tianshi, a famous practitioner of the Qing Dynasty, advised:" Be sure to treat the parts which the pathogens have not involved yet." • This is also an important method of preventing the disease from further deteriorating.

Principles of Treatment • To study TCM treatment, attention should be paid to the therapeutic principles which must be followed in the treatment of disease. • They are formed under the guidance of holistic concept and treatment based on syndrome differentiation, and they have the guiding significance for establishment of the therapeutic principles and prescriptions of a recipe.

• Therapeutic principles differ from therapeutic methods. • The former refer to the general principles for guiding therapeutic methods, • while the latter are the concrete methods of treatment under the guide of the therapeutic principles. • There are different kinds of therapeutic principles in TCM.

For example • treatment aiming at the primary cause of a disease, • strengthening health Qi and eliminating pathogenic factors, • readjusting Yin and Yang, • regulating the Zang-Fu's functions, • regulating Qi-blood • treatment in accordance with the three factors (climate, locality and individual).

Treatment aiming at the root cause of a disease • By treatment aiming at the root cause of a disease is meant treating a disease on the basis of its root cause. • It is not until the fundamental cause of a disease is found out that it is possible to get to the essence of the problem and to make a proper treatment. • Basic Questions points out, " In treating search for the its root cause of a disease in treatment. " • When treatment aiming at the root cause of a disease is used clinically, routine treatment or contrary treatment and treating the primary (ben) and or treating the secondary (biao ) must be dealt with correctly.

Routine treatment • includes the following methods:  treating cold syndrome with hot natured drug,  treating heat syndrome with cold natured drug,  treating deficiency syndrome by replenishment,  treating excess syndrome by purgation

Contrary treatment • has the following methods: 2. treating pseudo-heat syndrome with hotnatured drugs, 3. treating pseudo-cold syndrome with coldnatured drugs, 4. treating obstruction-syndrome with tonification 5. treating diarrhea with purgation.

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Treatment of the primary and the secondary includes the following methods: 2. treating the secondary for emergency, 3. treating the primary for chronic cases 4. treating both the primary and the secondary aspects.

Strengthening health Qi and Eliminating Pathogens • Strengthening health Qi is to increase body resistance. • Since victory or failure in the struggle between health Qi and pathogens determines the aggravation or alleviation of a disease, one of the important principles in clinical treatment is to change the relative strength of health Qi and pathogens. • In so doing, the disease will take a turn for the better.

• Eliminating pathogens means getting rid of pathogenic factors to facilitate and recover the strength of health Qi. • Therefore, eliminating pathogens, like strengthening health Qi, is also one of the important principles clinically.

• They have the following methods: 2. driving out pathogens first and then strengthening health Qi, 3. strengthening health Qi first and then eliminating pathogens 4. strengthening health Qi and eliminating pathogens simultaneously.

• Strengthening health Qi and eliminating pathogens supplement each other: • the former helps the elimination of pathogenic factors and the latter helps strengthening health Qi. • So, clinically, they should be applied in the light of the variations of the cases.

Readjusting Yin and Yang • The imbalance of Yin and Yang is the basic pathogenesis of many diseases, therefore, regulating relative excess or insufficiency of Yin and Yang, remedying defects to rectify abuses and restoring relative balance of Yin and Yang are one of the basic principles in clinical treatment. • To restore their balance Yin and Yang are usually regulated by means of removing the relative excess or invigorating the relative deficiency. • Since Yin and Yang are the changes may be summarized as the imbalance of Yin and Yang .

• Besides, regulating Zang-Fu's functions and Qi-blood relationship are also two important therapeutic principles. • Space lacks for a detailed description of it.

Treatment in Accordance with Three Factors (climate, locality and individual) • This is the therapeutic principle that TCM adopts in treating diseases. • The occurrence, development and changes of a disease are involved by various factors, including the climate, geographical environment, the patient's constitution, sex and age etc. • Therefore, when treating a disease, the doctor must take the three conditions into account, and make a concrete analysis of concrete conditions and deal with them in different ways, thereby working out an appropriate therapeutic method.

Chinese medicinal Herbs

• There is a great variety of Chinese materia medica, including plants, animal parts and minerals. • Among these materials, flowers, herbs and trees are the ones most frequently used, that is why Chinese materia medica is called Chinese medicinal herbs.

flowers

rose

chrysanthemum

Herbs

bamboo

Trees

cassia twigs

Animal parts

turtle shell

minerals

gypsum

Four properties and five tastes • The Chinese medicinal herbs are characterized by four properties (cold, heat, warm and cool) and five tastes (sour, bitter, sweet, acrid or pungent-spicy and salty). • These terms describe the therapeutic significance and energetic characteristics of the actions of herbs.

Four properties • Ancient’s physicians discovered that a particular property could induce certain therapeutic effects.

For example • Herbs like gypsum ( 石膏 ), chrysanthemum( 菊 花 ), relieve heat syndromes and are characterized by cool or cold nature. • Herbs such as cassia twigs ( 肉桂 ), which relieve cold syndromes, are characterized by warm or hot nature. • Herbs whose properties are neither cold nor hot are termed neutral, such as Poria ( 茯 苓 ).

Five tastes • • • • •

Sour Bitter Sweet Acrid or pungent-spicy Salty

Pungent spicy herbs • Pungent spicy herbs could disperse and promote Qi flow and invigorate blood. For instance • Ginger ( 生姜 ) relieves exterior syndrome by inducing sweating • Safflower ( 红花 ) invigorates the blood

Sweet herbs • Sweet herbs have the function of tonify, harmonize and moderate. For example, • Ginseng ( 人参 ) replenishes Qi; • Longan ( 龙眼肉 ) nourishes blood • Licorice root ( 甘草 ) moderates pain and harmonizes the actions of other herbs.

Sour herbs • Sour herbs have the function of absorb and control. For instance, • pomegranate rind ( 石榴皮 ) can stop diarrhea.

• dragon’s bone ( 龙骨 ) and oyster shell ( 牡 蛎 ) are used for spontaneous sweating;

Bitter herbs • Bitter herbs have the function of reduce and dry. For example, • rhubarb ( 大黄 ) is used to move stool and reduce heat

• phellodendron bark ( 黄柏 ) dry dampness and tonify yin.

Salty herbs • Salty herbs have the function of soften hardness and purge stool. For example, • Mirabilite ( 芒硝 ) is used for constipation

• Based on these primary considerations, the ancient physicians generalized the actions of herbs into five tastes. • Herbs that have a dispersing function are pungent-spicy • herbs that tonify are sweet; and soon on.

• Consequently, the tastes of herbs described in the classical Chinese Materia Medica are only approximate. For example, • the “pungent” taste of pueraria root ( 葛根 ) • the “sweet” taste of gypsum ( 石膏 ) • the “salty” taste of scrophularia ( 玄参 ) • are not inline with their actual taste in the mouth. • More inline with their function.

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The four properties and the five tastes, these two characteristics are used to describe the complicated actions of the herb. 2. Ginger ( 生姜 ) is pungent-spicy and warm. It disperses wind and cold. 3. Lily bulb ( 百合 ) is sweet and cold. It promotes the production of body fluids. 4. Ginseng ( 人参 ) is sweet and warm. It replenishes Qi.

Ascending, descending, floating and sinking action • The functional tendencies of herbs are marked by ascending, descending, floating and sinking. • This is a clinically useful categorization method.

Ascending Floating

Descending Sinking

Ascending and floating actions • Herbs with ascending and floating actions are used to promote sweating, raise Yang, and cause vomiting and open the orifices.

Example • Ginger • The action is upward.

Descending and sinking actions • Herbs with descending and sinking actions are used to regulate Qi, promote urination and defecation, subdue Yang and calm the mind.

Examples • Rhubarb ( 大黄 ) • The action is downward.

• Herb parts such as flowers and leaves that are light in quality have the functions of ascending and floating; • Herbs or substances that are heavy in quality such as seeds, fruits and minerals have the functions of descending and sinking.

• In addition, processing and preparation may change the taste and property and influence the functional tendencies. For example, • frying causes an ascending function; • processing with ginger causes a dispersing function; • preparing with salt causes a downward function.

• In general, the functional tendency of an herb is related to its taste, property, quality and processing. • Herbs featured as ascending and floating must be pungent-spicy or sweet in taste as well as warm or hot in property, • while herbs characterized by descending and sinking must be bitter, sour or salty in taste and cool or cold in property.

• Li Shizhe, a well known doctor in the Ming Dynasty once described the relationships this way:  "Sour or salty herbs have no function of ascending,  pungent-spicy or sweet herbs have no function of descending,  cold herbs have no function of floating  and hot herbs have no function of sinking."

Selective for meridians • An herb may selectively act upon a particular part of the body to relieve pathogenic changes in specific meridians and organs. • The meridians that an herb enters depend on the corresponding symptoms to be relieved by it.

For example • Ephedra ( 麻黄 ) promotes sweating, relieve asthma and improve urination. • It is indicated for fever, chills and absence of sweating due to invasion by exogenous pathogenic wind and cold, dysuria, edema and so on. • Judged by the above indications and analyzed in accordance with the theories of the Zang-Fu organs and meridians, it can be determined that the herbs would enter the lung and urinary bladder meridians.

• Jujube ( 大枣 ) tonifies Qi in the spleen and stomach. • It is indicated for poor appetite and loose stool due to weakness of the spleen and stomach. • So we deduce that the herb enters the meridian of the spleen and stomach.

Toxicity or Nontoxic • In the Chinese Materia Medica, the words "toxic, nontoxic, strongly toxic or slightly toxic” often appear. • The toxicity of herbs and substances can cause reactions as well as adverse effects on tissues. • Nontoxic herbs are moderate in nature and, generally speaking, do not have any side-effects.

• For example, jujube ( 大枣 ) and Poria ( 茯 苓 ) are nontoxic herbs, • while prepared aconite root ( 附子 ) is toxic herbs.

Eight basic therapeutic methods • Traditional methods fall into eight categories. • These methods are commonly used in clinical treatment.

 diaphoresis ——exterior      

syndrome emesis ——excess syndrome purgation ——excess syndrome resolution ——excess syndrome reinforcing —— deficiency syndrome warming ——cold syndrome heat-cleaning ——heat syndrome

 mediation ——half-exterior and half-interior

Diaphoresis • also known as exterior relieving method, is a therapeutic method used to open the muscular interstices and relieve exterior syndrome with herbs, • which can relieve the exterior and induce sweating. • This method is mainly used to treat exogenous disease at the early stage with the symptoms of chills and fever, headache, whitish tongue coating and superficial pulse, etc.

Application • Diaphoresis is either induced by herbs acrid in taste and warm in nature or by herbs acrid in taste and cool in nature.

Application • herbs acrid in taste and • warm in nature is applicable to diseases caused by exogenous wind-cold, like ginger;

Application • herbs acrid in taste and cool in nature is applicable to diseases caused by exogenous wind-heat and warmdryness, like chrysanthemum.

Emesis • is a therapeutic method used to direct pathogenic factors or toxic materials to come out of the body through the mouth. • Emetic therapy is usually used to treat excess syndrome with urgency to vomit out things retained inside.

• Emesis is a therapeutic method used for emergency. • Proper use will have immediate effect, while wrong application tends to damage healthy Qi. • So great cares must be taken in using this therapy.

• Emesis is usually forbidden to being used to treat the patient with critical illness, various types of hemorrhage and dyspnea; • or to be used to treat deficiency of Qi and blood in the aged and young as well as pregnant and postpartum woman.

Purgation • is a therapeutic method used to discharge feces, eliminate retention of substance and fluid inside the body and relieve accumulation of excess-heat with the prescriptions and herbs effective for catharsis. • Purgation therapy is usually used to treat excess syndrome.

Application • •

What can Aloe do? Aloe is is a herb which have function of Purgation, it is used to discharge feces

Clinically purgation is divided into five types: 1. 2. 3. 4. 5.

cold purgation, applicable to interior excess-heat syndrome; warm purgation, applicable to retention of cold in the stomach and intestines; dispelling water, applicable to excess syndrome of water; moistening purgation, applicable to insufficiency of fluid in the intestines and constipation due to loss of yin and deficiency of blood; e1iminating stasis, applicable to retention of stagnant heat in the lower energizer, or the patients with dry blood inside ,blood stasis and strong constitution.

Resolution • is a therapeutic method used to remove the retention of food and eliminate stagnation with herbs effective for promoting digestion. • This therapy is mainly used to treat chronic abdominal mass due to disorder of Qi and blood, improper diet, phlegm and retention of fluid. • is usually used to treat excess syndrome.

Example •

Hawthorn is a herb which have function of Resolution, it is used to used to remove the retention of food and effective for promoting digestion.

Reinforcing therapy • is a therapeutic method used to treat deficiency syndrome by means of supplementing essence, blood and body fluid with the prescriptions and herbs effective for tonifying and reinforcing the body. • This therapy is mainly used to treat deficiency syndrome of Qi, blood, Yin and Yang, such as physical weakness, spiritual lassitude, loss of blood and body fluid.

Clinically invigorating therapy is divided into four types: •

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Invigorating Qi, applicable to syndromes caused by Qi-deficiency; For example, ginseng can invigorate health Qi to treat the Qideficiency syndrome

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Tonifing blood, applicable to syndromes caused by blood-deficiency; Longan invigorate blood to treat the blood-deficiency syndrome

• Invigorating Yin, applicable to syndromes caused by deficiency of essence or insufficiency of body fluid; • For example, lily

• Invigorating Yang, applicable to syndromes caused by deficiency of the spleen-Yang and kidney-Yang. • For example, walnut

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Warming therapy • known as cold-eliminating therapy, is a therapeutic method used to eliminate pathogenic cold and invigorate Yang-Qi with the prescriptions and herbs warm and hot in nature. • Warming therapy is usually used to treat cold syndrome.

• This therapeutic method is mainly used to treat interior cold syndrome, such as excess-cold syndrome due to invasion of pathogenic cold into the viscera and interior exuberance of yin-cold. • It is also applicable to excess-cold syndrome due to endogenous cold resulting from deficiency of Yang-Qi. For this purpose, it is usually used in combination with the therapy for improving deficiency.

Cinnamon

Heat-clearing therapy • is a therapeutic method used to clear away heat by means of reducing fire, removing toxin and cooling blood with the prescriptions and herbs cold and cool in nature. • Heat-clearing therapy is usually used to treat heat syndrome.

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This therapy is mainly used to treat interior excess-heat syndrome. Leaves of bamboo

Mediation • is a therapeutic method used for eliminating pathogenic factors and supporting healthy Qi. • Half-exterior and half-interior syndrome

Treatment based on syndrome differentiation • The therapeutic methods mentioned above are the basic ones generalized according to the eight principles. • Since pathological conditions are complicated, the use of these methods in clinical treatment has to be made the basis of syndrome differentiation.

Traditional Chinese Medical Prescriptions

• The art of prescriptions (also known as recipes or formulas) in TCM has undergone significant change through the centuries. • The prescriptions in TCM are not merely collections of medicinal substances in which the actions of one herb are simply added to those of another in a cumulative fashion. • They are complex recipes of interrelated substances, each of which affects the actions of the others in the prescription. • It is this complex interaction, which makes the prescriptions so effective, but also makes them more difficult to study.

• Every medicinal substance has its strengths and its shortcomings. • An effective prescription is one in which the substances are carefully balanced to accentuate the strengths and reduce the side-effects. • The combination of substances in a prescription creates a new therapeutic agent that can treat conditions more effectively and completely than a single substance.

• Constructing an effective prescription involves more than simply putting ingredients together to obtain a certain effect. • One needs an organizing principle to guide the construction so that the ingredients are combined in an optimal fashion. • The orderly arrangement of ingredients in a prescription is called a hierarchy.

• Traditional Chinese society was always very conscious of rank, which revolved in the first instance around the emperor and his court. • For this reason, the terms used to signify the importance or rank of the ingredients in a prescription reflect those used in the royal court.

• The four ranks of ingredients in the hierarchy of a prescription are  King Herb - The herb which is directed to and has the strongest effect on the most important imbalance/pathology  Minister Herb - This herb is directed to the main imbalance/pathology and to the secondary imbalance/pathology

 Assistant Herb - there are three types:  Helpful Assistant - strengthens the effect of the King  Corrective Assistant - reduces or eliminates the harsh or toxic effects of the King and/or Minister herbs  Opposing Assistant - decreases the effect of the King. This role is mostly used for complex combinations of imbalances/pathologies.  Guide Herb - focuses actions of the other herbs on a particular organ, channel or region of the body.

• For example

symptoms • • • • • • • • • •

Breathlessness weak voice spontaneous sweating poor or no appetite Tiredness loose stools Pulse: empty, Tongue: somewhat faded in color dislike of speaking pale complexion

Question • Is there an Excess syndrome?  NO/YES • What is Deficient in this situation?  Health Qi/ Pathogenic factors • Which Treatment Principle do you choose?  Invigoration/Purgation

SI JUN ZI TANG ROLES AND PROPERTIES OF INGREDIENTS • King – 人参 - Ginseng King Actions: tonifies Source Qi, tonifies Lung & Spleen Qi. • Minister – 白术 - White Attractylodes Minister Actions: Tonifies Qi, tonifies Spleen, Resolves Damp. • Assistant – 茯苓 - Poria Assistant Actions: Drain damp, tonifies Spleen. • Guide – 甘草 - Licorice Root Guide Actions: enters all 12 main channels, harmonizes herb combinations (mitigates harsh effects), tonifies Spleen.

Review • Traditional methods fall into eight categories. • Four properties and five tastes • The functional tendencies of herbs are marked by ascending, descending, floating and sinking. • Traditional Chinese Medical Prescriptions