Taiji Luo Wanxiang
(1) Supporting the Right and Expelling the Evil
1. Concept of Supporting the Right and Expelling the Evil
(1) Supporting the Right: The principle of supporting the right qi to cure disease involves using medications that assist the right qi or other therapies, along with appropriate nutrition and functional exercises, to enhance the body’s constitution, improve resistance to disease, and expel evil qi, thereby overcoming illness and restoring health.
(2) Expelling the Evil: The principle of expelling the evil involves eliminating pathogenic factors to cure disease, utilizing medications or other therapies to remove the evil qi, achieving the goal of expelling the evil and restoring health. The principle of “draining the excess” is a specific application of this principle.
2. Application of Supporting the Right and Expelling the Evil:
Supporting the right and expelling the evil are two interrelated aspects; supporting the right is aimed at expelling the evil. By enhancing the right qi, the evil is driven out, thus restoring health, known as “when the right is strong, the evil is expelled by itself.”
Expelling the evil is aimed at supporting the right, eliminating pathogenic factors to protect the right qi and restore health, known as “when the evil is gone, the right is naturally secure.”
Supporting the right and expelling the evil complement each other. Therefore, when applying the principle of supporting the right and expelling the evil, one must carefully analyze the comparative strength of the right and evil, distinguish the primary and secondary, and decide whether to support the right or expel the evil, or determine the order of supporting the right and expelling the evil.
Generally, supporting the right is used for deficiency syndromes; expelling the evil is used for excess syndromes. If it is a mixed deficiency-excess syndrome, both supporting the right and expelling the evil should be used, but this does not mean equal measures; rather, it is necessary to clarify the primary and secondary urgency of deficiency and excess to determine the priority of supporting the right and expelling the evil. In summary, the principle should be “support the right without leaving the evil, expel the evil without harming the right.”
Specific situations are as follows:
(1) Supporting the Right: Supporting the right is suitable for deficiency syndromes where the right is primarily deficient and the evil is not strong. For example, in cases of qi deficiency or yang deficiency, one should adopt methods to tonify qi and strengthen yang; in cases of yin deficiency or blood deficiency, one should adopt methods to nourish yin and tonify blood.
(2) Expelling the Evil: This is suitable for excess syndromes where the evil is primarily strong and the right is not deficient. Common clinical methods such as sweating, vomiting, purging, clearing heat, promoting diuresis, guiding digestion, moving qi, and invigorating blood are all guided by this principle, formulated according to the different conditions of the evil qi.
(3) Attack First, Then Supplement: This means to first expel the evil and then support the right. It is suitable for cases where the evil is strong and the right is deficient, but the right qi can still withstand the attack, with the evil being the main contradiction. If one also supports the right, it may actually assist the evil. For example, in cases of bleeding due to blood stasis, if the stasis is not resolved, the bleeding will not stop, so one should first invigorate blood and resolve stasis, and then proceed to tonify blood.
(4) Supplement First, Then Attack: This means to first support the right and then expel the evil. It is suitable for mixed deficiency-excess syndromes where the right qi is weak and cannot withstand an attack. In this case, expelling the evil first would further harm the right qi, so one must first use tonifying methods to support the right, allowing the right qi to gradually recover to a level that can withstand an attack before expelling the evil, to avoid unexpected incidents. For example, in cases of abdominal distension, when the main contradiction is the weakness of the right qi, and the right qi cannot withstand an attack, one must first support the right, and when the right qi has adequately recovered and can withstand an attack, then expel the evil to avoid complications.
(5) Concurrent Attack and Supplement: This means to use both supporting the right and expelling the evil together. It is suitable for cases where both the right is deficient and the evil is strong, but neither is particularly severe. In specific applications, one must distinguish the primary relationship between deficiency and excess and apply flexibly. For example, if the primary contradiction is deficiency of the right, simply using tonifying methods may still retain the evil, while simply attacking the evil may easily harm the right. In this case, one should primarily support the right while also expelling the evil. For example, in cases of qi deficiency with a cold, one should primarily tonify qi while also releasing the exterior. If the primary contradiction is the strength of the evil, simply attacking the evil may easily harm the right, while simply tonifying the right may easily retain the evil. In this case, the treatment should primarily expel the evil while also supporting the right.
(2) Priority of Symptoms and Root Causes
1. Concept of Priority of Symptoms and Root Causes: The “symptoms” refer to branches and twigs, not the roots; the “root” refers to the fundamental basis of plants. Generally speaking, in the doctor-patient relationship, the patient is the root, and the doctor is the symptom; in the relationship of evil and right, the right qi of the body is the root, and the pathogenic evil qi is the symptom; in the relationship of cause and symptoms, the cause is the root, and the symptoms are the symptoms; in the order of diseases, the old disease is the root, and the new disease is the symptom; in terms of the location of diseases, the disease in the internal is the root, and the disease in the external is the symptom; in terms of phenomena and essence, the essence is the root, and the phenomenon is the symptom. It can be seen that the relationship between symptoms and root causes is not absolute but relative and conditional. In clinical practice, the principle of “treating symptoms urgently and treating root causes gradually” is adopted according to the different priorities of symptoms and root causes in clinical diseases, to achieve the goal of treating diseases by addressing the root causes. This is the basic principle of the priority of symptoms and root causes. The theory of symptoms and root causes is of great guiding significance for correctly analyzing the condition, distinguishing the primary and secondary, and providing appropriate treatment.
2. Application of the Theory of Symptoms and Root Causes in Treatment
(1) Gradual Treatment of Root Causes: The principle of gradual treatment of root causes generally applies to chronic diseases or when the disease is improving, the right qi is already weak, and the evil has not yet been completely eliminated. For example, in cases of internal injury, the onset is gradual, and the qi and blood of the organs have declined, so it is necessary to wait for the qi and blood of the organs to be sufficiently replenished before the right qi can gradually recover. Therefore, treatment should be gradual, and one should not seek quick results. Hence, “treat the main condition gradually, treat the secondary condition urgently” (from Suwen, Treatise on Symptoms and Root Causes).
(2) Urgent Treatment of Symptoms: The principle of urgent treatment of symptoms generally applies to acute diseases that are very serious or when certain symptoms that threaten life appear during the progression of the disease. For example, in the case of acute diseases, one should not delay; when the pathogenic evil has not deeply penetrated, one should urgently treat to eliminate the evil. Once the evil is expelled, the right qi will not be harmed, and the patient will recover easily. Hence, “when chronic diseases are combined with acute diseases, the first priority is to treat the chronic disease” (from Jin Kui Yao Lue). For example, in cases of significant blood loss, the bleeding is the symptom, and the cause of the bleeding is the root, but the situation is critical, so stopping the bleeding is often the first priority. After the bleeding stops, one can then treat the cause of the bleeding to address the root. Additionally, “treat the symptoms that arise after the disease first” and “for issues of small and large bowel dysfunction, treat the symptoms first” (from Suwen, Treatise on Symptoms and Root Causes). The prior disease is the root, and the subsequent disease is the symptom; all diseases should first treat the root, except for the two symptoms of bowel dysfunction, which should first treat the symptoms. In cases of bowel fullness, the evil is in the stomach. If the stomach is full, then the qi of medications and food cannot circulate, and the organs will lose their nourishment, leading to a more urgent condition, so the symptoms should be treated first. This is called treating symptoms, but in reality, it is treating the root of the organs, which is also treating the root. In cases of significant bowel dysfunction, since the two bowels are not functioning, the condition is critical, and although it is a symptomatic disease, it must be treated first. However, it should be noted that bowel dysfunction should be treated as an urgent condition, such as in cases of “guan ge”. If it is a general condition, it can be handled appropriately and does not necessarily need to be treated first.
It must be pointed out that the principle of “urgent treatment of symptoms and gradual treatment of root causes” should not be absolute. In urgent situations, one may also need to treat the root, such as in cases of yang collapse and extreme deficiency, where urgent methods to restore yang are used, which is also treating the root; after significant blood loss, when qi is lost with blood, urgent use of Du Shen Tang to tonify qi and stabilize the collapse is also treating the root. Regardless of symptoms or root, the principle of treating the urgent first is fundamental.
At the same time, in gradual situations, it is not impossible to treat symptoms. For example, in patients with spleen deficiency and qi stagnation, using qi-regulating herbs to also treat symptoms is different from simply tonifying the spleen.
(3) Simultaneous Treatment of Symptoms and Root Causes: This means to consider both symptoms and root causes. Simultaneous treatment of symptoms and root causes is suitable when both the symptoms and root causes are urgent. For example, in cases of dysentery, the inability to eat is due to deficiency of the right qi (root), while continuous diarrhea is due to excess evil qi (symptom). In this case, both the symptoms and root causes are urgent, and one must use both tonifying herbs and clearing damp-heat herbs simultaneously, which is simultaneous treatment of symptoms and root causes. Additionally, in patients with spleen deficiency and qi stagnation, the spleen deficiency is the root, and the qi stagnation is the symptom. One should use Ren Shen, Bai Zhu, Fu Ling, and Gan Cao to tonify the spleen and qi to treat the root, while also using Mu Xiang, Sha Ren, and Chen Pi to regulate qi and relieve stagnation to treat the symptoms. The principle of simultaneous treatment of symptoms and root causes is widely applicable, such as in the use of Shen Su Yin for both tonifying and dispersing, Zhi Zhu Wan for both reducing and tonifying, and Zeng Ye Cheng Qi Tang for both attacking and tonifying. According to the needs of the condition, simultaneous treatment of symptoms and root causes not only does not contradict but can also complement each other.
In summary, generally speaking, for conditions that develop slowly, one should treat the root; for conditions that develop rapidly, one should first treat the symptoms; and for cases where both are urgent, one should treat both simultaneously. In clinical practice, one must approach diseases with a dynamic perspective, adeptly grasping the main contradictions to determine the order and urgency of treatment. Hence, it is said: “Carefully observe the intervals, and adjust accordingly. Intervals are simultaneous, while urgency requires independent action” (from Suwen, Treatise on Symptoms and Root Causes).
The basic principles of treating diseases in Traditional Chinese Medicine have been summarized for you, with both positive and negative treatments being interrelated, demonstrating the sincerity of great physicians.
(3) Positive and Negative Treatments
1. Positive Treatment
(1) Concept: Positive treatment refers to a treatment principle that goes against the nature of the symptoms, hence also known as “reverse treatment.” Positive treatment is the most commonly used treatment principle in clinical practice.
(2) Application: It is suitable for diseases where the essence and phenomena are consistent. Since the nature of diseases varies between cold, heat, deficiency, and excess, the methods of positive treatment also differ: treating cold with heat, treating heat with cold, supplementing deficiency, and draining excess.
① Treating Cold with Heat: This refers to treating cold-type diseases that present cold symptoms with warm and hot medications, such as using warm acrid herbs for exterior cold and hot acrid herbs for interior cold.
② Treating Heat with Cold: This refers to treating heat-type diseases that present heat symptoms with cold and cool medications, such as using cool acrid herbs for exterior heat and bitter cold herbs for interior heat.
③ Supplementing Deficiency: This refers to treating deficiency-type diseases that present deficiency symptoms with tonifying medications. For example, using methods to strengthen yang for yang deficiency and methods to nourish yin for yin deficiency.
④ Draining Excess: This refers to treating excess-type diseases that present excess symptoms with draining methods to eliminate the evil. For example, using digestive methods for food stagnation, draining water for fluid retention, invigorating blood for blood stasis, and expelling parasites for parasitic accumulation.
2. Negative Treatment
(1) Concept: Negative treatment refers to a treatment principle that follows the false appearance of the disease. This involves using medications or measures that align with the false appearance of the disease, hence also known as “following treatment.” Essentially, it is a method of treatment guided by the principle of treating the root of the disease, thus still adhering to the principle of “treating the root of the disease.”
(2) Application: It is suitable for diseases where the symptoms and essence are not completely consistent. In clinical practice, it generally includes the following:
① Using Heat for False Heat: This refers to using hot medications to treat diseases that present false heat symptoms. It is suitable for true cold with false heat, where internal cold is strong, and the yang is constrained externally, resulting in true cold internally and false heat externally. When treating, one should use hot medications to address the true cold; once the true cold is resolved, the false heat will also disappear. This method is an example of using heat to treat heat.
For example, in cases of internal cold with constrained yang, due to internal cold being strong, the yang qi is constrained externally, clinically presenting with true cold symptoms such as diarrhea with clear stools, cold extremities, and a weak pulse, while also showing false heat symptoms such as fever and flushed face. Since the essence is cold and the symptoms are false, one should not use the method of “treating heat with cold” but rather apply warm medications to treat the true cold. Once the internal cold is resolved, the constrained yang will recover, and the false heat will also disappear, which is the specific application of “using heat to treat heat.”
② Using Cold for False Cold: This refers to using cold medications to treat diseases that present false cold symptoms. It is suitable for true heat with false cold symptoms, such as heat stroke, where internal heat is strong, and the yang is constrained externally, resulting in false cold symptoms such as cold extremities, while the essence of the disease is true heat. Therefore, one should use cold medications to treat the true heat, and the false cold will naturally disappear. This method is an example of using cold to treat cold.
③ Using Supplementation for Obstruction: This refers to using tonifying medications to treat diseases that present symptoms of obstruction. It is suitable for true deficiency leading to obstruction. For example, in cases of spleen and stomach weakness, where the qi mechanism is disrupted, leading to abdominal distension, one should adopt methods to tonify the spleen and benefit the stomach to restore the normal function of the spleen and stomach, allowing the qi mechanism to function properly, thus alleviating the abdominal distension. This method of using supplementation to open obstructions is known as using supplementation for obstruction.
④ Using Unblocking for Obstruction: This refers to using unblocking medications to treat diseases that present symptoms of obstruction. It is suitable for true symptoms of obstruction. For example, in cases of food stagnation leading to diarrhea, one should use digestive methods; in cases of bleeding due to blood stasis, one should use methods to invigorate blood and resolve stasis. This method of using unblocking to treat obstruction is known as using unblocking for obstruction.
Positive and negative treatments both target the essence of the disease and belong to the category of treating the root of the disease. However, the concepts of positive and negative treatments differ, and in terms of the properties, effects, and relationships between the medications used and the essence and symptoms of the disease, there is a distinction between reverse and follow. Additionally, their applicable diseases differ: for diseases where the essence and clinical manifestations are consistent, positive treatment is used; for diseases where the essence and clinical manifestations are not completely consistent, negative treatment is suitable. In clinical practice, most diseases have a consistent essence and symptoms, thus positive treatment is the most commonly used treatment principle.
The basic principles of treating diseases in Traditional Chinese Medicine have been summarized for you, with both positive and negative treatments being interrelated, demonstrating the sincerity of great physicians.
(4) Adjusting Yin and Yang
1. Concept: Adjusting yin and yang refers to addressing the changes in the body’s yin and yang that are excessively strong or weak, adopting the principle of reducing the excess and supplementing the deficiency, to restore yin and yang to a relatively balanced state. Fundamentally, the occurrence of disease in the human body is a result of the disruption of the coordination and balance between yin and yang, leading to excess or deficiency. Therefore, adjusting yin and yang, “with balance as the goal,” is the fundamental principle of Traditional Chinese Medicine in treating diseases.
2. Application
(1) Reducing the Excess: Reducing the excess, also known as reducing the excessively strong, refers to diseases where either yin or yang is excessively strong, which should be treated using the method of “draining the excess.”
① Suppressing Excess Yang: For excess heat caused by excessive yang, one should apply methods to clear and drain the excess yang heat, treating heat with cold.
② Reducing Excess Yin: For excess cold caused by excessive yin, one should warm and disperse the excess yin cold, treating cold with heat.
Since yin and yang are interdependent, “excessive yin leads to yang disease” and “excessive yang leads to yin disease.” In cases of excessive yin and yang, if one side is excessively weak, one should also address the deficiency by using methods to support yang or nourish yin.
(2) Supplementing the Deficiency: Supplementing the deficiency refers to treating diseases where yin and yang are deficient by using the method of “supplementing the deficiency.” There are distinctions between yin deficiency, yang deficiency, and deficiency of both yin and yang, and the treatment principles include nourishing yin, tonifying yang, and supplementing both yin and yang.
① Treating Yang Disease with Yin: Treating yang disease with yin is suitable for yin deficiency. Treating yin disease with yang is suitable for yang deficiency. For example, in cases of “yin deficiency leads to heat,” the principle of treating yang disease with yin is applied, nourishing yin to control the excessive yang. For “yang deficiency leads to cold,” the principle of treating yin disease with yang is applied, where yin deficiency is supplemented with yin and yang deficiency is supplemented with yang to achieve balance.
② Seeking Yin within Yang and Seeking Yang within Yin: According to the theory of interdependence of yin and yang, in clinical practice, when treating yin deficiency, appropriate yang tonics are added to the yin tonics, known as “seeking yin within yang.” When treating yang deficiency, appropriate yin tonics are added to the yang tonics, known as “seeking yang within yin.” Since yang is supported by yin, it can generate endless transformations, and yin is elevated by yang, it can provide an inexhaustible source. Therefore, in clinical practice, when treating blood deficiency, tonics for qi are often added to blood tonics; when treating qi deficiency, blood tonics are often added to qi tonics.
③ Supplementing Both Yin and Yang: Since yin and yang are interdependent, yin deficiency can affect yang, and yang deficiency can affect yin, leading to diseases of both yin and yang deficiency. In treatment, both yin and yang should be supplemented. Since yin and yang are the overarching principles of differentiation, various pathological changes of diseases can be summarized by the imbalance of yin and yang. Therefore, broadly speaking, methods such as releasing the exterior, attacking the interior, elevating the clear, descending the turbid, supplementing the deficiency, and draining the excess all fall within the scope of adjusting yin and yang.
(5) Harmonizing Qi and Blood
1. Concept: The essence of life is based on qi and blood, and all diseases affect qi and blood. Therefore, “the key to treating diseases lies in understanding qi and blood” (from Yi Lin Gai Cuo). Harmonizing qi and blood refers to addressing the deficiencies of qi and blood and their respective functional abnormalities, as well as the pathological changes of the dysfunction of qi and blood, adopting the principle of “draining the excess and supplementing the deficiency” to ensure smooth qi and harmonious blood. This is an important principle in Traditional Chinese Medicine for treating diseases, suitable for conditions of qi and blood imbalance.
2. Application: Qi is yang, and blood is yin. The generation and movement of qi and blood depend on the normal physiological activities of the organs and meridians, so harmonizing qi and blood must also closely integrate with adjusting yin and yang and regulating the organs.
(1) Treatment Principles for Qi Disorders: Traditional Chinese Medicine believes that qi has the functions of warming, transforming, promoting, defending, and consolidating. Qi is omnipresent, and any imbalance can lead to various diseases. The areas where qi is unbalanced are the root of the disease. Therefore, treatment must focus on regulating qi, and there are many methods to regulate qi, such as what is stated in the “Reading Medical Essays: On Ascending and Descending”: “If qi is excessive above, suppress and descend it; if it is trapped below, elevate and lift it; if it is scattered outside, gather and consolidate it; if it is stagnant inside, flow and disperse it.” Broadly speaking, methods such as warming, cooling, and even massage, acupuncture, and dietary adjustments all fall under the category of regulating qi.
The treatment principles for qi disorders can be summarized as follows: qi deficiency should be supplemented, qi stagnation should be unblocked, qi sinking should be elevated, qi counterflow should be descended, qi collapse should be stabilized, and qi obstruction should be opened.
① Qi Deficiency Should Be Supplemented: Qi deficiency refers to the pathological change of insufficient original qi, weakened organ function, and low resistance to disease. The lungs govern the qi of the body, and the spleen is the source of postnatal qi and blood generation. Therefore, tonifying qi primarily involves supplementing the qi of the spleen and lungs, especially focusing on nurturing the middle qi. The original essence relies on the physiological function of the kidneys to store essence to fully exert its physiological effects. Therefore, in cases of extreme qi deficiency, one should also start from tonifying the kidneys.
Qi is the commander of blood, and blood is the mother of qi; they are interdependent. Therefore, tonifying qi is often combined with tonifying blood: qi deficiency is a gradual manifestation of yang deficiency, and yang deficiency is the extreme of qi deficiency. Thus, in cases of extreme qi deficiency, it should be combined with tonifying yang. Tonifying qi herbs can easily lead to stagnation; generally, in cases of internal phlegm-dampness, they should not be used, but if necessary, tonifying qi can be combined with phlegm-dissolving and damp-dispelling methods. Additionally, if qi deficiency leads to abdominal distension, the method of using supplementation to open obstruction should also include some qi-regulating herbs.
② Qi Stagnation Should Be Unblocked: Qi stagnation refers to the obstruction and stagnation of qi flow. This often results from emotional disturbances, phlegm-dampness, food accumulation, or blood stasis, which hinder the flow of qi, leading to dysfunction of certain organs and meridians. Therefore, it is said: “When qi and blood are harmonious, no diseases arise; when there is stagnation, various diseases occur” (from Dan Xi Xin Fa). The rise and fall of qi in the human body are often related to the functions of the liver, lungs, spleen, stomach, and the small and large intestines. Therefore, qi stagnation is often associated with dysfunction of the liver, lungs, spleen, and stomach. The liver governs the smooth flow of qi; if the liver fails to regulate, qi stagnation occurs. Thus, when treating qi stagnation, one must regulate and move qi. The terms regulating qi, soothing qi, and moving qi, although differing in name and emphasis, all aim to achieve the goal of “unblocking qi to restore balance.”
Since qi stagnation can occur in the body, in the organs, due to cold, heat, deficiency, or excess, one should not simply break or move qi indiscriminately. Treatment should be adjusted according to the cold, heat, deficiency, or excess of the organs and meridians. Use bitter cold to drain heat without harming the stomach, use warm acrid to regulate qi without breaking it, use moistening and lubricating without causing stagnation, and use dispersing without forcing growth.
Unblocking herbs are mostly acrid and dry; large doses or prolonged use can consume qi, disperse qi, and deplete fluids, so they should be used cautiously in cases of blood deficiency, yin deficiency, and excessive heat.
③ Qi Sinking Should Be Elevated: Qi sinking refers to the pathological change where qi is weak and unable to rise, leading to sinking and loss of control. This often results from insufficient constitution or prolonged illness, causing damage to the organs’ support and the control of qi and fluids. When the qi is sinking, it should be elevated. The methods for elevating qi are mainly used for cases of middle qi sinking, presenting symptoms such as sunken fontanelle, drooping eyelids, prolapse of the rectum, continuous diarrhea, and instability of the Chong and Ren vessels leading to bleeding and discharge. In these cases, one should use methods to elevate qi.
④ Qi Counterflow Should Be Descended: Qi counterflow refers to the abnormal rise of qi in the organs. Qi counterflow is often seen in the lungs, stomach, and liver. When lung qi counterflows, it leads to cough and chest tightness; when stomach qi counterflows, it leads to nausea and belching; when liver qi counterflows, it leads to headaches and dizziness, and in severe cases, fainting; when kidney qi (Chong qi) counterflows, it leads to rebellious qi. When qi counterflows, it should be descended, known as “descending qi” or “regulating qi.” Qi counterflow is primarily due to excess, but there can also be deficiency. The method of descending qi is suitable for excess syndromes and should be used temporarily, not as a long-term strategy. If the counterflow is due to deficiency, one should supplement the deficiency, and the qi will descend naturally without using descending medications.
⑤ Qi Collapse Should Be Stabilized: Qi collapse refers to the weakened ability of qi to maintain its internal control, leading to the external escape of qi. This often results from extreme qi deficiency. Due to severe depletion of qi, blood, and fluids, the functions of the organs decline, and the mutual dependence of yin and yang is disrupted, leading to the risk of collapse and death. There are degrees of collapse, so in clinical practice, there are distinctions between deficiency collapse and sudden collapse. Symptoms such as sweating leading to loss of yang, uncontrollable seminal discharge, continuous diarrhea, loose stools, involuntary urination, and chronic cough leading to loss of fluids all fall under qi collapse. Deficiency should be supplemented, and loose stools can be stabilized. Therefore, in cases of qi collapse, one should add astringent herbs to the tonifying herbs to stabilize the collapse. In cases of sudden collapse, astringents are ineffective, and one should supplement yang and assist yin to stabilize the yang and prevent collapse. Astringent methods are often combined with tonifying methods, and depending on the condition, they can be used with warming or cooling methods.
⑥ Qi Obstruction Should Be Opened: Qi obstruction occurs due to external obstruction by turbid evils or extreme qi stagnation, leading to sudden fainting. Clinically, it is characterized by sudden loss of consciousness or accompanied by cold extremities. When there is obstruction, one should open it. If the obstruction is due to closed orifices leading to fainting, it is also known as opening the orifices. There are warm and cool methods for opening the orifices. Qi obstruction can be classified as either excess or deficiency; if it is excess, the evil has not diminished, and the right is weak, treatment should focus on opening the obstruction. If it is deficiency, it is a case of internal closure and external escape, and one should supplement qi and nourish blood to restore the collapse. One should not simply use acrid and dispersing herbs indiscriminately to avoid the pitfalls of treating deficiency with excess.
(2) Treatment Principles for Blood Disorders: Blood is the essence of food and fluids, originating from the middle jiao, produced by the spleen, distributed by the lungs, governed by the heart, stored in the liver, and transformed by the kidneys. It functions to nourish, moisten, and harmonize the five organs, maintaining normal life activities. Clinically, blood disorders can be classified into blood deficiency, blood stasis, bleeding, blood cold, and blood heat. The treatment principles vary between supplementation, movement, stopping, and cooling.
① Blood Deficiency Should Be Supplemented: Blood deficiency refers to insufficient blood or reduced nourishing function of blood. The heart governs blood, the liver stores blood, the spleen produces and governs blood, and the kidney essence can transform into blood, so blood deficiency is closely related to the heart, liver, spleen, and kidneys. Qi is yang, and blood is yin; qi can generate blood, and blood can carry qi. According to the theory of yang generating yin, in cases of severe blood deficiency, blood tonics are often combined with qi tonics to achieve the effect of tonifying qi and generating blood. Blood deficiency and yin deficiency often have a reciprocal relationship, so for blood deficiency with concurrent yin deficiency, it is common to combine with yin tonics to enhance the effect.
Blood tonics are often nourishing and can hinder digestion, so they should be used cautiously in cases of damp stagnation in the middle jiao, abdominal distension, and reduced appetite. If they must be used, they should be combined with herbs that strengthen the spleen and harmonize the stomach to avoid promoting dampness and harming the spleen, affecting the healthy movement of the spleen and stomach.
② Blood Loss Should Be Stabilized: Continuous bleeding, such as in cases of menorrhagia, uterine bleeding, or significant blood loss, is classified as blood loss, and astringents should be used to stabilize the loss. Since loss leads to dispersion and not to collection, astringent and warming herbs should be used to restrain the loss. When treating blood loss, it is important to add qi tonics to the astringent herbs. For example, in cases of significant blood loss, one should use methods to stabilize the loss and tonify qi. Qi can move blood, and blood can carry qi, so blood loss will inevitably lead to qi loss, not just blood loss, and in severe cases, it can lead to the loss of both yin and yang.
③ Blood Stasis Should Be Moved: Blood stasis refers to the pathological state of slow and unflowing blood. “For blood that is stagnant, it should be resolved” (from Suwen, On Yin and Yang). The principle of resolving blood stasis is to invigorate blood and resolve stasis. When using methods to invigorate blood and resolve stasis, the following principles should be noted:
Accurate Differentiation: When using methods to invigorate blood and resolve stasis, it is essential to accurately diagnose the indications for blood stasis and distinguish the location of the disease, whether it is in the exterior or interior, the organs or meridians, the nature of the disease, whether it is cold or heat, and the severity of the disease, to achieve the desired effect. While invigorating blood and resolving stasis is a general principle for treating blood stasis, blood stasis can vary in severity. Therefore, invigorating blood and resolving stasis can be categorized into “harmonizing blood and moving stasis,” “invigorating blood and resolving stasis,” and “breaking blood and expelling stasis.” Generally, one should follow the order of light to heavy, starting with harmonizing blood and moving stasis, then invigorating blood and resolving stasis, and finally breaking blood and expelling stasis. One should not indiscriminately break stasis, as this may lead to quick results but can harm the right qi.
Understanding the Properties of Herbs: The effects of methods to invigorate blood and resolve stasis are reflected through the properties of the herbs and formulas used. Therefore, it is essential to understand the characteristics of the herbs. First, treat cold with heat and heat with cold, which is a basic principle in Traditional Chinese Medicine. Blood stasis can be caused by cold or heat. “Cold causes blood to congeal, and heat causes blood to boil” (from Yi Lin Gai Cuo). Therefore, herbs should be selected based on their cold, heat, or neutral properties. Second, while herbs for invigorating blood and resolving stasis generally have the common effect of promoting blood flow, each herb may also have additional effects such as moving qi, nourishing blood, cooling blood, stopping bleeding, resolving symptoms, unblocking channels, promoting diuresis, healing injuries, and treating abscesses. Third, certain herbs for invigorating blood and resolving stasis are sensitive to specific diseases or locations. For example, San Leng and E Zhu are effective for resolving masses, while Huang Yao Zi and Liu Ji Nu are effective for treating lumps. For blood stasis in the upper body, Chuan Xiong is used, while for the lower body, Niu Xi is used. For blood stasis in the heart, Yu Jin is used, and for the liver, Ze Lan is used. Understanding these properties allows for appropriate selection and formulation of herbs.
Familiarity with Combinations: Blood stasis is often caused by multiple factors, so invigorating blood and resolving stasis must be combined with other therapies based on the differentiation results to fully exert its effects. Common combinations include regulating qi and moving qi, tonifying qi and nourishing qi, tonifying blood and nourishing blood, stopping bleeding and resolving symptoms, cooling blood and warming the meridians, and clearing heat and detoxifying.
④ Blood Cold Should Be Warmed: Blood cold refers to the invasion of cold evils into the meridians, leading to obstruction of blood flow, or inherent yang deficiency leading to internal cold, resulting in stagnation of qi and blood, characterized by cold pain. Warming and dispersing herbs should be used to open the meridians and activate the collaterals, combined with blood-harmonizing herbs.
⑤ Blood Heat Should Be Cooled: Blood heat refers to the excessive heat in the organs, which forces heat into the blood, or the invasion of warm heat evils into the blood. This is characterized by bleeding and heat symptoms. Therefore, cooling and blood-cooling herbs should be used to treat blood heat: blood coagulates when cold and flows when warm. Therefore, when using cooling and blood-cooling herbs, the dosage should be appropriate, and one should not overuse them. If there is significant stasis, one should not simply use large doses of cooling and blood-cooling herbs; if necessary, combine with invigorating blood and moving blood herbs to avoid leaving behind stasis. Excessive heat can harm yin, so in addition to combining with cooling and blood-cooling herbs that have nourishing yin properties, one can also add herbs that nourish yin.
The basic principles of treating diseases in Traditional Chinese Medicine have been summarized for you, with both positive and negative treatments being interrelated, demonstrating the sincerity of great physicians.
⑥ Stopping Bleeding: Any blood that does not follow the normal path, whether it overflows from the mouth or nose, or exits from the two lower orifices, or overflows from the skin, is classified as bleeding: bleeding should be stopped. Correctly applying methods to stop bleeding requires attention to the following points:
Distinguishing the Causes and Nature of Bleeding: The causes of bleeding are often related to fire and qi. “The movement of blood is due to fire and qi” (from Jing Yue Quan Shu, Blood Disorders): qi is the commander of blood, and blood follows qi. Either excessive fire can cause qi to rebel and blood to overflow, or cold can cause qi to stagnate and blood to coagulate. There may also be cases of qi deficiency with cold, but bleeding is mostly associated with heat. Additionally, internal blood stasis can obstruct the flow of blood, leading to bleeding. The pathogenesis of bleeding is primarily related to qi, encompassing cold, heat, deficiency, and excess.
Stopping bleeding must also distinguish the location of the bleeding, as coughing blood, epistaxis, hematemesis, melena, hematuria, and vaginal bleeding not only differ in terms of cold, heat, deficiency, and excess but also involve different organs. Therefore, stopping bleeding must be treated according to differentiation; one should not simply stop bleeding, which is known as “seeing blood and stopping treatment.” Avoid using large doses of cooling or astringent herbs: although bleeding is mostly associated with heat, in the early stages of bleeding, one should avoid using large doses of cooling and blood-stopping herbs, as cold and cooling herbs should not be used for long periods to prevent internal stasis and damage to the spleen yang. If the spleen is damaged, blood will not return to the meridians. It is also important to avoid simply using astringent herbs for bleeding, especially in cases of concurrent blood stasis, to prevent “closing the door to the enemy.” Regarding the use of charcoal for stopping bleeding: charcoal is an important measure in Traditional Chinese Medicine for treating bleeding. It is often said that “red meets black to stop bleeding,” but one should not use charcoal indiscriminately for bleeding without distinguishing the nature of the disease or the properties of the herbs.
The general principles for using charcoal to stop bleeding are as follows: for bleeding due to excess heat, one should use bitter cold herbs to directly counteract the fire; once the heat is cleared, the blood will naturally stabilize. For bleeding due to deficiency heat, one should nourish yin, clear heat, and reduce fire using sweet and cold herbs. Charcoal, being bitter and cold, can deplete fluids, so it should not be used in cases of deficiency cold. In cases of mixed cold and heat, or when both deficiency and excess are present, the treatment should consider both cold and heat, and both deficiency and excess should be addressed. The methods for stopping bleeding can include both cold and hot herbs, which can be used in charcoal form. When using charcoal to stop bleeding, one must weigh the pros and cons, and correct usage can reflect the wonderful effects of charcoal in stopping bleeding.
(3) Treatment Principles for Qi and Blood Disorders: Qi and blood are interdependent; qi cannot exist without blood, and blood cannot flow without qi. Qi is yang, and blood is yin; one yin and one yang support each other. Due to the close relationship between qi and blood, they are physiologically interdependent and pathologically mutually influential, leading to simultaneous disorders of qi and blood. Qi has the functions of warming, generating, promoting, and governing blood. Qi deficiency leads to blood weakness, qi stagnation leads to blood stasis, qi sinking leads to blood descent, and qi counterflow leads to blood chaos. This is the relationship between qi disorders and blood disorders. Similarly, blood disorders can also affect qi; for example, blood deficiency cannot carry qi, leading to a decrease in blood, blood stasis can lead to qi stagnation, and blood loss can lead to qi loss, even leading to the risk of losing both yin and yang.
When the relationship between qi and blood is disrupted, it often manifests as simultaneous disorders of qi and blood. Therefore, treatment should adjust the relationship between the two to restore the normal state of qi and blood.
① Treating Blood Disorders with Qi: Qi and blood are mutually supportive; qi deficiency leads to blood weakness, qi stagnation leads to blood stasis, qi sinking leads to blood descent, and qi counterflow leads to blood chaos. When qi is disordered, blood will also be affected. Therefore, it is said: “Qi is the commander of blood, and blood is the mother of qi; if qi is diseased, blood cannot act independently, thus it also becomes diseased” (from Yi Jia Si Yao). This is the theoretical basis for treating blood disorders with qi. In summary, treating qi without treating blood is not a complete treatment. In cases of qi deficiency, one should seek qi within essence; in cases of qi stagnation, one should also consider the consumption of yin and blood; in cases of qi counterflow, one should seek harmony between qi and blood. This is an important principle in treating qi disorders.
② Treating Qi Disorders with Blood: When qi is diseased, blood will also be affected, and when blood is diseased, qi will also be harmed. Qi and blood are interdependent; when they are harmonious, both are harmonious, and when they are diseased, both are diseased. However, “qi is primary, and blood is secondary; qi is heavy, and blood is light” (from Yi Xue Zhen Chuan, Qi and Blood). Therefore, “both qi and blood are necessary, but tonifying qi should precede tonifying blood; both yin and yang are needed, but nourishing yang should precede nourishing yin” (from Yi Zong Bi Du, Water and Fire, Yin and Yang). This, although referring to the treatment of deficiency syndromes, is a principle for treating blood disorders. In summary, treating blood must also treat qi; when qi is regulated, blood disorders can begin to heal.
Blood deficiency should be supplemented with qi, and blood will naturally be generated. The method of supplementing blood deficiency involves primarily tonifying the spleen and qi, warming and nourishing the heart qi, and tonifying the kidney qi. This is because the spleen can promote movement, ensuring sufficient transformation, and the blood vessels are filled; the heart generates blood, and the essence of food and fluids relies on the warmth of the heart yang to transform into blood.
The kidney yang is the source of all yang in the body, and kidney essence relies on the true fire for transformation to become blood. In cases of blood stasis, moving qi will naturally adjust the blood. If qi is not moving, blood will not flow. When qi flows, blood flows; when qi stagnates, blood also stagnates. Therefore, when treating blood stasis, it is essential to emphasize regulating qi. Since both qi deficiency and qi stagnation can lead to stasis, and the movement of blood is closely related to the heart, lungs, liver, and spleen, the methods of regulating qi include soothing liver qi, regulating lung qi, warming heart qi, and tonifying original qi.
In cases of blood overflow, adjusting qi will naturally stop the bleeding. Blood follows qi; when qi is harmonious, blood flows through the meridians; when qi is counterflowing, blood will also flow in reverse or sink. This includes qi deficiency, qi excess, qi cold, and qi heat, all of which fall under the category of qi imbalance. Therefore, when treating blood, one must also adjust qi; when qi is harmonious, blood will stabilize.
In summary, qi and blood are mutually supportive; qi is primary, and blood is secondary. Qi is the bellows, and blood is like waves. Therefore, “if there is a qi disorder that affects blood, treat the qi first; if there is a blood disorder that affects qi, treat the blood first” (from Yi Zong Bi Du, Principles of Differentiation and Treatment). In clinical practice, one should consider the overall situation, harmonize yin and yang, and ensure that yin is balanced with yang, and qi is adjusted with blood, so that the disease can heal naturally.
(6) Adjusting the Organs
1. Concept: The human body is an organic whole; the organs coordinate with each other physiologically and are mutually supportive. Pathologically, they also influence each other. A disease in one organ can affect others, and a disease in another organ can also impact the original organ. Therefore, adjusting the organs means that when treating organ disorders, one must consider the imbalance of yin, yang, qi, and blood in each organ, and also pay attention to adjusting the relationships between the organs to restore balance. This is the basic principle of adjusting the organs.
2. Application
(1) Adjusting the Yin, Yang, Qi, and Blood of the Organs: The organs are the centers of life activities, and the yin, yang, qi, and blood of the organs are the foundations of life activities. The imbalance of yin, yang, qi, and blood in the organs is the basis for pathological changes in the organs. Therefore, adjusting the yin, yang, qi, and blood of the organs is the basic principle of adjusting the organs.
The physiological functions of the organs differ, and the pathological changes of their yin, yang, qi, and blood imbalances are not identical. Therefore, treatment should be based on the pathological changes of the organs, whether they are deficient or excessive, cold or hot, and should adopt the principle of supplementing deficiencies and draining excesses, warming cold and cooling heat. For example, the liver governs smooth flow and stores blood, with blood as the body and qi as the function, and its nature is to promote upward movement. Its pathological characteristics often include excess liver qi and insufficient liver yin and blood. If the liver is too strong, it can lead to qi stagnation and fire, and blood deficiency can lead to heat and wind. Therefore, the treatment of liver disorders focuses on regulating qi, tonifying blood, and harmonizing blood, combined with clearing, nourishing, and calming the liver based on the cause.
(2) Adapting to the Physiological Characteristics of the Organs: The five organs store essence and qi without dispersing, while the six bowels transform substances without storing. The yin and yang properties of the organs, the rules of qi movement, the seasonal responses, and the preferences and aversions of the organs differ, so adjusting the organs must align with their characteristics. For example, the spleen and stomach belong to the earth; the spleen is yin earth, and excessive yang can harm it; the stomach is yang earth, and excessive yin can harm it. The spleen prefers dryness and dislikes dampness, while the stomach prefers moisture and dislikes dryness. The spleen qi governs upward movement, and the stomach qi governs downward movement. Therefore, when treating the spleen, it is often advisable to use sweet and warm herbs to assist its upward movement, while avoiding cold and damp herbs to prevent harming yang. When treating the stomach, it is common to use sweet and cold herbs to promote downward movement, while avoiding warm and dry herbs to prevent harming its yin.
(3) Coordinating the Relationships Between the Organs
① Adjusting According to the Five Elements’ Generative and Restrictive Relationships: The treatment principles mainly include “supplementing the mother” and “draining the child.” Nourishing water to support wood, nurturing earth to generate metal, benefiting fire to supplement earth, and generating metal to support water all belong to the principle of “supplementing the mother”; while draining the heart for liver excess and draining the stomach for heart excess all belong to the principle of “draining the child.”
Adjusting According to the Five Elements’ Restrictive Relationships: The treatment principles mainly include suppressing the strong and supporting the weak. For example, when wood and fire harm metal, one should use methods to support metal and drain wood, which is suppressing the strong; if liver deficiency affects the spleen and stomach, this is a case of wood not supporting earth, and treatment should harmonize the liver and strengthen the spleen to enhance the functions of both, which is supporting the weak. Adjusting the relationships between the two organs according to the five elements’ generative and restrictive relationships is essential for achieving balance.
② Adjusting According to the Theory of Mutual Containment of the Five Organs: The five elements are mutually contained, and the five elements correspond to the five organs, which are also mutually contained. One organ governs the five organs, and the five organs unify into one. Any physiological function is regulated by the five organs collectively, with distinctions between primary and secondary. For example, in terms of respiratory function, the lungs govern respiration, but the lungs expel qi, the kidneys receive qi, and the liver regulates the smooth flow of qi, allowing for appropriate rising and falling. The spleen governs the transformation of food and fluids, participating in the generation of qi; the heart governs blood vessels and houses the spirit, with blood nourishing qi, and the heart spirit being the master of respiratory regulation. Therefore, all five organs participate in regulating respiration, with the lungs, spleen, and kidneys being particularly important. Thus, when respiratory function is impaired, the treatment often focuses on the lungs, spleen, and kidneys.
③ Adjusting According to the Relationships Between the Organs and Bowels: The coordination between the organs and bowels reflects the relationship of yin and yang, as well as the relationship of exterior and interior. The organs move qi to the bowels, and the bowels transmit essence to the organs. Physiologically, they coordinate with each other, and pathologically, they influence each other, leading to mutual transformation. Therefore, when treating organ and bowel disorders, in addition to directly treating the affected organ or bowel, one can also apply the theory of organ-bowel relationships, treating organ diseases with bowel treatments, bowel diseases with organ treatments, or simultaneous treatment of both organs and bowels.
Organ diseases treated with bowel treatments: For example, when heart fire is inflamed, one can directly drain heart fire while promoting the function of the small intestine to expel the heat from the heart. This is an example of treating the organ by first treating the bowel.
Bowel diseases treated with organ treatments: For example, when kidney function is impaired, leading to water metabolism disorders, treating the kidneys can also treat the bladder. In cases of constipation due to bowel qi obstruction, one can also treat the lung qi to relieve the obstruction and promote bowel movement.
Simultaneous treatment of both organs and bowels: Although organ diseases can be treated with bowel treatments and vice versa, in clinical practice, simultaneous treatment of both organs and bowels is common. For example, the spleen and stomach work together; their intake and movement are mutually beneficial, and their dryness and dampness complement each other. Therefore, spleen diseases will affect the stomach, and stomach diseases will also impact the spleen. Thus, in clinical practice, the treatment of both the spleen and stomach is often performed together.
Excess should be drained from the bowels, while deficiency should be supplemented in the organs: The six bowels transform substances without storing, using movement for function and descent for harmony, while the five organs store essence and qi without dispersing, valuing storage. Both the five organs and six bowels can present as excess syndromes, which should be drained. This means that the six bowels should be drained to expel evils, such as in cases of yangming bowel excess, where purging methods are used to clear the heat from the stomach and intestines. The excess in the five organs can also be drained through the bowels to expel evils, such as in cases of liver damp-heat, which can be cleared through the intestines and promote urination to expel damp-heat. Deficiencies in the five organs should be supplemented, and deficiencies in the six bowels can also be treated by supplementing the organs to support the right. For example, in cases of bladder dysfunction leading to frequent urination, one should often treat the kidneys to stabilize the function. In cases of small intestine dysfunction, treatment often involves the spleen and kidneys.
The basic principles of treating diseases in Traditional Chinese Medicine have been summarized for you, with both positive and negative treatments being interrelated, demonstrating the sincerity of great physicians.
(7) Adapting to Time, Place, and Person
The occurrence, development, and outcome of diseases are influenced by various factors, such as climate changes, geographical environments, and individual differences in constitution. Therefore, when treating diseases, it is essential to consider these factors and analyze the specific situation to adopt appropriate treatment methods:
1. Adapting to Time
(1) Concept: The changes in seasonal climate have a certain impact on the physiological functions and pathological changes of the human body. The principle of considering treatment methods based on the characteristics of different seasonal climates is known as adapting to time.
(2) Application: Throughout the four seasons, there are changes in cold, heat, warmth, and coolness, so when treating diseases, one must consider the current climatic conditions. For example, in spring and summer, as the climate transitions from warm to hot, yang qi rises, and the body’s pores open. Even if one contracts wind-cold, one should be cautious in using strong sweating herbs like Ma Huang and Gui Zhi to avoid excessive opening and depleting qi and yin. In autumn and winter, as the climate transitions from cool to cold, yang declines, and the body’s pores become tight, so if there is a heat disease, one should also be cautious in using cold herbs like Shi Gao and Bo He to prevent harming yang with excessive cold. Therefore, it is said: “Use warmth to avoid warmth, use heat to avoid heat, use coolness to avoid coolness, and use cold to avoid cold” (from Suwen, Treatise on the Six Yuan Zheng Ji).
2. Adapting to Place
(1) Concept: The principle of considering treatment methods based on the characteristics of different geographical environments is known as adapting to place.
(2) Application: Different geographical environments, due to varying climatic conditions and lifestyle habits, lead to differences in physiological activities and disease characteristics. Therefore, treatment methods should also differ. For example, in the northwest region of China, where the terrain is high and cold, diseases are often cold, and treatment should be warm; in the southeast region, where the terrain is low and warm, diseases are often heat, and treatment should be cold. This illustrates that diseases differ by region, and treatment methods should also vary. Even for the same disease, treatment methods should consider the characteristics of different regions. For instance, when using Ma Huang and Gui Zhi to treat wind-cold, the dosage can be slightly higher in the severely cold northwest region, while in the warm southeast region, the dosage should be slightly lower. Additionally, certain regions have endemic diseases that should also be taken into account during treatment.
3. Adapting to Person
(1) Concept: The principle of considering treatment methods based on the different characteristics of patients, such as age, gender, constitution, and lifestyle habits, is known as adapting to person.
(2) Application: When treating, one should not view the disease in isolation but consider the overall condition of the patient. For example:
① Age: Different ages have different physiological functions and disease characteristics. Elderly individuals often have weakened qi and blood, and their resistance decreases, leading to more deficiency syndromes or a combination of deficiency and excess. When treating deficiency syndromes, one should tonify, while for excess syndromes, one should also consider the formula to avoid harming the right qi. Children have abundant vitality but may have weak qi and blood, and their organs are delicate. Additionally, infants and young children cannot care for themselves, often experiencing irregular feeding and temperature fluctuations. Therefore, when treating children, one should be cautious with harsh or tonifying medications. Generally, the dosage of medications must also be adjusted according to age.
② Gender: Males and females have different physiological characteristics, especially for women during menstruation, pregnancy, and postpartum periods, where treatment methods must be carefully considered. For example, during pregnancy, harsh purgatives, blood-breaking, or toxic medications should be avoided or used cautiously, and postpartum treatment should consider qi and blood deficiency and the condition of lochia.
③ Constitution: In terms of constitution, due to individual differences in innate endowment and postnatal nurturing, individuals may have varying strengths and weaknesses, as well as tendencies toward cold or heat, and may have certain chronic diseases. Therefore, even with the same disease, treatment methods should differ. For example, individuals with excessive yang should avoid warm and hot treatments, while those with excessive yin should avoid cold and cool treatments. Other factors, such as the patient’s occupation and working conditions, may also relate to the occurrence of certain diseases, which should be taken into account during diagnosis and treatment.
The principles of adapting to time, place, and person fully reflect the holistic view of Traditional Chinese Medicine and the principles of differentiation and treatment in practical applications. One must comprehensively analyze the situation and consider specific circumstances.
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