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All Courses by Ni Haixia
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Complete Guide to TCM Treatment of Common Diseases
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External pathogenic diseases have been debated for over 2000 years. One faction believes in Cold Damage (Shanghan), while the other supports Warm Diseases (Wenbing), leading to endless arguments. Now, from a clinical perspective, there is no need for debate. Treat Cold Damage according to the Six Meridians of Cold Damage; treat Warm Diseases according to Warm Disease principles, focusing on Wei, Qi, Ying, and Blood, as well as the Upper, Middle, and Lower Jiao. Everything should start from clinical practice, and we should avoid excessive debate. A characteristic of TCM is that it often leads to theoretical discussions, resulting in hundreds of books that mislead students. After I mentioned this, an elder asked me: “Old Shen, it’s easy for you to say, but how do you differentiate external pathogenic diseases?” I had long prepared for such questions. I replied: “How do you distinguish external pathogenic diseases?” I said: “It’s simple.” There are four indicators. To differentiate between external pathogenic Wind-Cold and Wind-Heat, consider these four indicators:
The first is the tongue and pulse, which are crucial.
If the tongue coating is thin and white, and the pulse is floating and tight, that indicates Wind-Cold. This is the key. If you see a thin white coating and a floating tight pulse, it is Wind-Cold; if the coating is thin and yellow, and the pulse is floating and rapid, that indicates Wind-Heat. This is easy to differentiate. When examining external pathogenic diseases, if the pulse is floating and rapid, and the tongue coating is thin and yellow, it is Wind-Heat; if the coating is thin and white, and the pulse is floating and tight, it is Wind-Cold. This is the first indicator.
The second indicator is based on cough and phlegm.
External pathogenic diseases primarily affect the lungs, so patients will definitely exhibit cough and phlegm. Of course, when discussing cough and phlegm, we should not differentiate by color but by quality. If the cough is thin or foamy, it indicates Wind-Cold, regardless of whether it is yellow or white; if the phlegm is thick, regardless of color, it indicates Wind-Heat. This is easy to distinguish! When a patient coughs, just ask whether the phlegm is thin or thick; thin indicates Wind-Cold, thick indicates Wind-Heat, making it easy to identify.
The third indicator is based on sweating and pain.
Sweating and pain! If there is no sweating, and the patient has a headache or joint pain, that indicates Wind-Cold; if there is sweating and a sore throat, that indicates Wind-Heat. This is also easy to differentiate! The location of the patient’s pain and whether they sweat or not can be easily determined by asking.
The last indicator is based on cold and heat.
If the patient is very sensitive to cold and has a mild fever (below 38.5 degrees Celsius), it is definitely Wind-Cold; if they are slightly sensitive to cold but have a high fever (above 39 degrees Celsius), it is Wind-Heat. These four indicators clearly differentiate between Wind-Cold and Wind-Heat. Especially the tongue coating and pulse provide a clear distinction for external pathogenic diseases. If it is Wind-Cold, treat it with warming and dispersing methods; if it is Wind-Heat, treat it according to Warm Disease principles focusing on Wei, Qi, Ying, Blood, and the Three Jiao, using cooling and dispersing methods. This treatment principle becomes clear, right?
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For warming and dispersing, we currently do not use Ma Huang Tang (Ephedra Decoction). I suggest using Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Powder).
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For cooling and dispersing, we can use Sang Ju Yin (Mulberry Leaf and Chrysanthemum Drink) or Yin Qiao San (Honeysuckle and Forsythia Powder).
This clearly distinguishes between Wind-Cold and Wind-Heat.
However, treating external pathogenic diseases requires three additional measures:
The first is to disperse the exterior.
Since external pathogenic diseases enter through the mouth and nose, and invade the superficial layers, if you do not disperse the exterior, the external pathogens cannot be expelled. You must disperse the exterior. What herbs can be used to disperse the exterior?Chuan Xiong (Ligusticum), Jie Geng (Platycodon), Bo He (Mint), Chan Yi (Cicada Slough), Sang Bai Pi (Mulberry Root Bark). These dispersing herbs should be used according to whether it is Wind-Cold or Wind-Heat. For example, use Chuan Xiong for Wind-Cold and Chan Yi for Wind-Heat. It is essential to disperse the exterior! Adding one or two dispersing herbs can significantly enhance the efficacy. Fang Feng (Siler) can also be used, as it is definitely included in Jing Fang Bai Du San. In addition to this, you should also consider treating external pathogenic diseases based on Wind-Cold and Wind-Heat, and disperse the exterior using the herbs I just mentioned. This is the first measure to improve efficacy.
The second is to promote diuresis.
External pathogens need to be expelled. How do we promote diuresis? By using diuretic and moistening herbs. This way, regardless of whether it is Wind-Cold or Wind-Heat, the external pathogens cannot be retained. After dispersing, promote diuresis through diuretic and moistening herbs. What herbs can be used for diuresis? The main ones are:Che Qian Cao (Plantago), Ze Lan (Lycopus), Bai Hua She She Cao (Hedyotis), Sheng Yi Yi Ren (Job’s Tears). These diuretic herbs help expel pathogens through diuresis. For moistening the intestines, what herbs can be used? Use: Lai Fu Zi (Radish Seed), Cao Jue Ming (Cassia Seed), Quan Gua Lou (Trichosanthes), Tao Ren (Peach Kernel). This second method for treating external pathogenic diseases is called promoting diuresis.
The third method is to support the righteous Qi.
This is what the ancients taught us. Whether it is external pathogens or not, to eliminate external pathogens, we must support the righteous Qi. The most representative formula is Shen Su Yin (Ginseng and Perilla Drink), but I prefer not to use Dang Shen (Codonopsis). Why? Because Dang Shen only tonifies Qi, and it is not as effective as Sheng Huang Qi (Raw Astragalus). Sheng Huang Qi can tonify Qi, stabilize the exterior, and expel toxins. It tonifies Qi, stabilizes the exterior, and expels toxins, making Sheng Huang Qi more comprehensive than Dang Shen. Just add one herb, do not add too much, or you will expel the pathogens. Alternatively, you can use Xian He Cao (Agrimony). Use 15g of Sheng Huang Qi and 10g of Xian He Cao.
This is the general principle for treating external pathogenic diseases. Then, based on whether it is a bacterial or viral infection, adjust the treatment accordingly.
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If it is a bacterial infection, add a Pu Gong Ying (Dandelion);
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If it is a viral infection, add a Ban Lan Gen (Isatis Root).
The third category is summer dampness.
In this season, colds may not clearly present as Wind-Cold or Wind-Heat; rather, patients with external pathogenic diseases may have a greasy tongue coating, whether it is white, thick, or yellow. If the coating is greasy, you should consider dampness as the main factor. Do not solely attribute it to Wind-Heat or Wind-Cold. If there is dampness, when expelling pathogens, you should use the theory of the Three Jiao.
The first is San Ren Tang (Three Nut Decoction). Use Xing Ren (Apricot Kernel) for the upper Jiao, Cao Ren (Cardamom) for the middle Jiao, and Sheng Yi Yi Ren (Job’s Tears) for the lower Jiao. Xing Ren, Cao Ren, and Sheng Yi Yi Ren promote diuresis across the Three Jiao.
The second is that you must add herbs to clear summer heat. Two herbs for clearing summer heat are: one is Huo Xiang (Agastache). Huo Xiang is a seasonal herb used only in June, July, and August; it is rarely used at other times, making it a seasonal medication for clearing summer heat. I rarely use Pei Lan (Eupatorium), as it is not as effective as Huo Xiang; just using Huo Xiang is sufficient. The second herb for clearing summer heat is Liuyi San (Six-to-One Powder). Do you know Liuyi San? It consists of Hua Shi (Talc) and Gan Cao (Licorice) in a 6:1 ratio. However, you must wrap Liuyi San in a lotus leaf. The lotus leaf, which is the leaf of the lotus flower in summer, should be used with 30g of Liuyi San, wrapped in a lotus leaf and tied with string, but the lotus leaf should be pricked with a needle to allow steam to escape. This is also a very good remedy for clearing summer heat and treating external pathogenic diseases. So, the entire discussion on external pathogenic diseases clarifies the distinction between Wind-Cold and Wind-Heat. Adding the measures of dispersing the exterior, promoting diuresis, and supporting the righteous Qi, while paying attention to summer dampness, will generally suffice for treating external pathogenic diseases.
This is how it is in clinical practice, and it is particularly effective. However, do not simply rely on Western medicine’s antiviral treatments; that approach is ineffective, especially for those with greasy tongues, as antiviral treatments are even less effective. Adding Ban Lan Gen is sufficient; absolutely do not use Guan Zhong (Cynanchum), as it is particularly bitter and cold, harming the stomach. Of course, I also mentioned that for children, regardless of the season, do not forget to use Bao He Wan (Preserving Harmony Pill) to regulate digestion and the stomach; this is the key to enhancing efficacy. Thus, whether it is external pathogenic diseases, internal injuries, deficiency or excess, Wind-Cold, Wind-Heat, or summer dampness, it is not difficult at all. Therefore, TCM, when I explain it, seems particularly simple. Differentiating based on the tongue, thin coating for kidney regulation, and greasy coating for phlegm and blood stasis treatment. Clearly distinguishing the four main symptoms of external pathogenic diseases. Dispersing the exterior, promoting diuresis, and supporting the righteous Qi. You can say that the efficacy is 70-80%. However, as a doctor, you must be cautious; do not let your head get hot and think your efficacy is perfect. Patients who return for follow-up visits are effective; those who do not return are ineffective. You should have already considered that those patients who do not return indicate that your skills are not 100%, and you must continue to study. Additionally, do not boast about yourself; be humble.