Throughout the long history, our ancestors discovered that using heated stones for hot compresses and scraping could alleviate discomfort. They found that certain special stones had therapeutic effects on pain, leading to the use of sharp stone needles to pierce the body for treatment, and eventually to the use of Chinese herbal medicine. Traditional Chinese Medicine (TCM) has gradually developed numerous treatment methods, including bian (stone therapy), zheng (acupuncture), moxibustion, tui na (massage), tang yao (decoctions), cupping, dao yin (guiding exercises), and yi liao (psychotherapy). TCM differs from other traditional medical systems worldwide. In its development, ancestors summarized and proposed theories such as the meridian theory and organ theory based on practical experience, utilizing concepts of qi (vital energy), yin-yang, and the five elements to explain physiological and pathological conditions and treatment theories, making TCM a scientific system that combines theory and technique. Diseases can be classified as internal or external, and their severity varies. Medical techniques have their indications and contraindications, and methods should be applied according to the specific condition. This principle applies to both TCM and Western medicine. Each has its own range of applicable diseases and techniques, and they should not be confused. TCM emphasizes bian zheng shi zhi (syndrome differentiation and treatment), and its techniques are normal and ordinary, not miraculous. Therefore, medications, emotions, exercise, rest, and even environmental factors can all play a role in healing. 1. Bian (Stone Therapy) In ancient times, stone needles were used to pierce the skin for treatment. The method of using stone tools to eliminate diseases from the body is collectively referred to as bian, also known as bian shu (stone therapy). Bian therapy has a complete theoretical system centered on the theories of organs and meridians, emphasizing the whole and focusing on internal causes. It employs non-invasive gentle stimulation to strengthen the body’s defenses against diseases, harmonizing yin and yang, qi and blood, and organ functions to stabilize imbalances and restore physical and mental health. Bian therapy can be used for disease prevention, fitness, health maintenance, beauty, improving sub-health conditions, and treating certain diseases. Bian therapy has effects such as invigorating blood and qi, unblocking meridians, strengthening the body, and expelling pathogens.(1) Invigorating blood and qi: When the bian tool rubs against the skin, it stimulates the surface, causing redness and warmth, which penetrates through the skin to the meridians, blood vessels, and related organs. Stagnation of blood or qi gradually disperses under pathological conditions.(2) Unblocking meridians: Bian therapy applies various techniques to the body’s meridians, collaterals, muscles, skin, and acupoints, using the action of jing qi (meridian energy) to unblock the meridians, restore disordered organ functions, and strengthen the body.(3) Strengthening the body and expelling pathogens: Bian therapy achieves the goal of strengthening the body through invigorating blood and qi and unblocking meridians. Additionally, maintaining the muscles, skin, and other areas is also an important aspect of strengthening the body. Using a bian board to scrape or a bian ruler to tap helps expel pathological substances from the body.(4) Balancing yin and yang: The body’s physiology, organs, and meridians all have yin and yang. In pathological states, there is an imbalance of yin and yang, and the treatment goal is to harmonize them, avoiding excess or deficiency. The key to performing bian therapy lies in movement, as disharmony of qi and blood leads to pain. The techniques of point application, pressing, and rubbing all rely on the operator’s hand movements to achieve healing. 2. Zheng (Acupuncture) Zheng involves the use of needles for health maintenance and disease prevention. The indications for acupuncture are very broad, applicable across various fields such as internal medicine, surgery, gynecology, and pediatrics. Different acupoints are selected based on specific conditions, and acupuncture can be effective for painful conditions, functional disorders, and certain acute diseases. Acupuncture is a practical application of meridian theory and an important method for treating internal diseases externally. Its range of applicability is wide, with good effects and quick results. However, there are many contraindications; acupuncture does not supplement but rather consumes the body’s vital energy. When a patient’s vital energy is insufficient, treatment may not be effective. Acupuncture includes both the technique of needling and the therapeutic application of acupuncture. The technique of acupuncture can promote the sensation of needling and maintain and enhance it, harmonizing yin and yang, unblocking meridians, and supplementing deficiencies or draining excesses. Acupuncture techniques can be categorized into basic techniques, auxiliary techniques, and supplementing/draining techniques. Therapeutic applications include warming needle therapy, fire needle therapy, skin needle therapy, prickling therapy, and intradermal needle therapy. Basic techniques are commonly referred to as xing zhen (needling techniques). The main methods include twisting and lifting-inserting. Supplementing/draining techniques are the most commonly used methods during acupuncture, generally divided into following the and supplementing/draining, slow-fast supplementing/draining, lifting-inserting supplementing/draining, twisting supplementing/draining, breathing supplementing/draining, and opening-closing supplementing/draining. Auxiliary techniques can be divided into: (1) Techniques applied to the meridians where acupoints are located, mainly including following techniques and capturing techniques. (2) Techniques applied to filiform needles, mainly including tapping, scraping, shaking, rubbing, flying, and pounding. 3. Moxibustion Moxibustion, also known as ai jiu, refers to a treatment method that uses mugwort fluff as the main material, ignited and directly or indirectly applied to the body’s acupoints. A small amount of warm, aromatic herbs may also be added to enhance the therapeutic effect. Moxibustion can promote health, prevent diseases, and treat illnesses. It has effects such as warming the meridians, lifting yang, moving qi and invigorating blood, dispelling cold and dampness, reducing swelling, and rescuing from collapse. It is particularly suitable for chronic weakness and diseases caused by wind, cold, and dampness. Moxibustion can stimulate and enhance the body’s immune function, activate organ functions, boost metabolism, produce antibodies, and enhance the body’s resistance to diseases. Therefore, long-term application of moxibustion can lead to a sense of well-being, increased energy, and longevity. The characteristics of moxibustion are that it can both suppress excessive functions and stimulate weakened functions, leading to a balanced physiological state. Thus, moxibustion is a beneficial stimulus for the body, greatly enhancing physical fitness, and is applicable for both sick and healthy individuals, especially promoting the development of children. Its application is extensive. Due to its various forms and methods of application, moxibustion can be categorized into several types, including moxa stick moxibustion, moxa cone moxibustion, warming needle moxibustion, and warming moxibustion devices.1. Moxa cone moxibustion involves placing a moxa cone on an acupoint. It can be divided into direct moxibustion and indirect moxibustion. Direct moxibustion is further divided into scar moxibustion and non-scar moxibustion. Indirect moxibustion, also known as spaced moxibustion, uses materials such as ginger, garlic, salt, or aconite slices as barriers.2. Moxa stick moxibustion, also known as moxa roll moxibustion, commonly employs gentle moxibustion and sparrow pecking moxibustion.3. Warming needle moxibustion combines needling and moxibustion, suitable for conditions that require needle retention and moxibustion.4. Warming moxibustion devices are specially designed metal tubes used for moxibustion, also known as warming moxibustion tubes. They have effects of harmonizing qi and blood and warming the middle to dispel cold. When performing moxibustion, it is important to understand that patients may have different reactions and contraindications, as well as appropriate measures to take. 4. Tang Yao (Decoctions) Tang yao, also known as tang ye (decoction), refers to the method of boiling Chinese herbs in water, straining out the residue, and consuming the medicinal liquid. The pharmacology of Chinese herbs is discussed in “Hello, TCM (14) The Medicine of TCM.” TCM has both external and internal treatments, with decoctions being the primary method for internal treatment. Decoctions are quickly absorbed and have strong effects. They can be flexibly prescribed according to specific clinical conditions, making them the most widely used in practice. Decoctions are often composed of multiple herbs, which can promote and restrain each other, enhancing efficacy and moderating the properties of the herbs, fully utilizing the compatibility of the ingredients in TCM formulas. Decoctions are made by boiling herbs in water for a certain period, straining out the residue to create a liquid form, primarily for internal use, with some external applications for bathing, steaming, or gargling. It is one of the earliest and most widely used medical practices in TCM, playing a significant role in disease prevention and treatment. In “Hello, TCM (9) The Mechanism of Human Diseases,” it is mentioned that the mechanisms of human diseases include dysfunction of organs, abnormal transformation and movement of vital substances, dysfunction of meridians, and insufficient vital energy. TCM treats diseases with a holistic diagnosis, addressing both symptoms and root causes. Decoctions can regulate qi mechanisms, resolve blood stasis, expel pathogens, replenish vital energy, and enhance physical fitness. Decoctions meet the needs of TCM’s syndrome differentiation and treatment, allowing for flexible adjustments in prescription composition and dosage according to changes in the patient’s condition. The use of multiple herbs is beneficial for maximizing the multi-faceted and comprehensive effects of the ingredients. Water is used as a solvent, which is non-irritating and has no side effects. However, decoctions are prone to mold and fermentation and cannot be stored for long periods. Therefore, new forms of Chinese medicine, such as compound granules and oral liquids, have been developed to retain the advantages of decoctions while overcoming their disadvantages. The effectiveness of decoctions also depends on the timing of administration and temperature. Different herbs require specific timing for optimal effects, and taking decoctions at inappropriate times can reduce their efficacy. The timing of decoction administration is crucial for achieving the best therapeutic effects, aligning with the body’s rhythmic physiological changes and maximizing the utilization of the body’s active disease-fighting factors to enhance the medicinal power. Proper timing can also minimize adverse effects, as taking decoctions at inappropriate times can disrupt the body’s physiological rhythm, potentially leading to or exacerbating adverse reactions. Proper timing can also help restore disrupted physiological rhythms to normal, achieving therapeutic goals. Therefore, the importance of timing in decoction administration should not be overlooked. Decoction administration can be categorized into hot, warm, and cold consumption. Generally, diaphoretic and warming herbs are best taken warm; cold-reducing herbs, those for joint pain, and ulcer treatments are best taken hot; and heat-clearing and detoxifying herbs are best taken cold. When preparing decoctions, attention should be paid to: (1) Choosing the right cooking utensils. Clay pots are preferred, while iron, aluminum, and copper pots should be avoided. (2) Cooking methods. Soaking before boiling is recommended, and each dose should be boiled twice. It is best to cover the pot while boiling to prevent the loss of aroma and reduce efficacy. (3) Boiling times vary for different herbs. (4) The amount of liquid extracted should be determined based on the patient’s condition, age, and other specific factors. Chinese medicine has specific methods for pre-boiling, post-adding, wrapping, and direct consumption, and some herbs with special properties require specific preparation methods based on the condition. 5. Tui Na (Massage) Tui na refers to the use of hands to apply pressure on meridians and acupoints through techniques such as pushing, grasping, lifting, pinching, and rubbing for therapeutic purposes. Tui na is also known as “massage” and has various names such as “an qiao,” “qiao yin,” and “an wu.” Tui na is a non-pharmaceutical natural therapy and physical therapy. It typically involves the practitioner using their hands on the patient’s body surface, injured areas, discomfort locations, specific acupoints, and painful spots, employing diverse techniques such as pushing, grasping, pressing, rubbing, pinching, tapping, and more, aiming to unblock meridians, promote qi and blood circulation, relieve pain, expel pathogens, strengthen the body, and harmonize yin and yang. Tui na therapy is simple, effective, economical, and safe, making it popular among both practitioners and patients. It can be divided into health maintenance tui na, sports tui na, and medical tui na.The eight methods of tui na massage are warming, supplementing, unblocking, draining, sweating, harmonizing, dispersing, and clearing. The advantages of massage are numerous, easy to learn, simple to operate, economical and practical, and can replace medications. Massage can unblock meridians, allowing qi and blood to circulate, maintaining the balance of yin and yang in the body. Therefore, after massage, one may feel relaxed muscles, flexible joints, invigorated spirit, and reduced fatigue, which is crucial for maintaining health. There are two types of massage: active massage, also known as self-massage, which is a health maintenance method performed by oneself, and passive massage, which is performed by a practitioner on the patient, referred to as therapeutic massage in this article. Tui na has a wide range of applicable treatments, but there are many contraindications, and improper methods should be avoided. 6. Cupping Cupping involves using cups as tools to create negative pressure through methods such as fire or suction, causing them to adhere to the skin, resulting in localized bruising to achieve effects such as unblocking meridians, promoting qi and blood circulation, reducing swelling and pain, and dispelling wind and cold. Currently, various types of cupping tools are commonly used, including bamboo cups, glass cups, and suction cups. Cupping should be avoided in cases of high fever, convulsions, or spasms, as well as on areas with skin allergies or ulcers, thin muscles, uneven bones, or excessive hair. Caution should be exercised when applying cupping to the lower back and abdomen of pregnant women. 7. Dao Yin (Guiding Exercises) Dao yin refers to the method of performing limb movements and breathing exercises according to certain rules and methods to prevent diseases and maintain health. Dao yin includes both “guiding qi” and “guiding the body,” with the principle of “guiding qi to harmonize and guiding the body to soften.” Dao yin is not mysterious; familiar practices such as yi jin jing (muscle-changing classic), wǔ qín xì (five animal frolics), and ba duan jin (eight pieces of brocade) all fall under this category. The indications for dao yin therapy include “atrophy, numbness, cold, heat” and “stagnation of breath,” often combined with “an qiao” (massage) in clinical practice. The famous Eastern Han physician Zhang Zhongjing emphasized the treatment of limb “heaviness and stagnation” using “dao yin, breathing exercises, acupuncture, and topical applications” in his work “Jin Gui Yao Lue.” The “Zhong Zang Jing” states: “Dao yin can expel external pathogens from the joints”; “If one does not practice dao yin, it allows external pathogens to invade the joints, leading to stiffness and blockage.” The characteristics of ancient health-preserving dao yin are that it can be self-directed, does not require medication or injections, is simple to learn, promotes health, enhances physical fitness, and prevents and treats various chronic diseases and sub-health conditions. Dao yin is a form of self-exercise that prevents and eliminates diseases, truly embodying the principle of “retaining upright qi within, preventing evil from invading.” 8. Yi Liao (Psychotherapy) In TCM, during the diagnostic process of observation, listening, questioning, and palpation, the importance of psychological guidance in treating human diseases is emphasized, referred to as yi liao in TCM. Its basic principle is the theory that “mental illnesses require mental remedies.” TCM’s psychological treatment pays close attention to methods such as verbal guidance, empathy, and suggestive therapy, and has developed a unique and systematic theory of “overcoming emotions with emotions.” Humans have seven emotions, each corresponding to one of the five organs, and there exists a principle of dominance between emotions and organs. “Anger harms the liver, sadness overcomes anger”; “Joy harms the heart, fear overcomes joy”; “Worry harms the spleen, anger overcomes worry”; “Joy overcomes sorrow, sorrow harms the lungs”; “Fear harms the kidneys, worry overcomes fear.” TCM psychological therapy employs the concepts of yin-yang complementarity and the unity of opposites, adhering to the holistic view and dialectical treatment principles of TCM, consciously using one emotion to overcome the original psychological barrier. Emotional activities can influence the body’s yin, yang, qi, and blood. Prolonged and intense emotional stimuli can lead to the onset of diseases. TCM psychological therapy uses emotional biases to correct imbalances in yin, yang, qi, and blood, restoring a balanced and harmonious state, thus curing diseases and achieving therapeutic goals, known as emotional overcoming therapy. Specific methods include: (1) Anger therapy: Utilizing anger can often treat excessive worry leading to qi stagnation, and address issues of depression due to unresolved sorrow or excessive fear leading to cowardice and anxiety. (2) Joy therapy: Encouraging patients to feel joy or laughter, using positive and cheerful emotions to promote harmony between yin and yang and smooth qi and blood, thus treating diseases caused by sorrow, worry, and sadness. (3) Sadness therapy: Sadness can keep the mind alert, so this method can correct psychological extremes and positively influence disease treatment. (4) Calming the mind and clearing intentions therapy: Through sitting quietly or lying down, forgetting worries internally and calming external disturbances, not being disturbed by pain, allowing true qi to flow naturally, gradually dissipating pathogenic qi.Utilizing the seven emotions or the five elements’ generating and overcoming methods to treat emotional diseases is an effective approach. As the saying goes: “A calm heart leads to peace”; when we are not tense or troubled mentally, emotional diseases are less likely to occur. TCM encompasses various methods, with treatment approaches categorized as internal and external. Internal diseases are treated internally, while external diseases are treated externally, and there are also characteristics of treating internal diseases externally. Internal treatment in TCM includes the use of formulas, herbal teas, medicinal wines, and dietary therapy. Among internal treatments, the most distinctive is the herbal decoction therapy, with notable methods including the eight methods of sweating, vomiting, purging, warming, clearing, reducing, and supplementing. TCM formulas can consider multiple aspects in syndrome differentiation and treatment, providing comprehensive treatment that addresses both symptoms and root causes. External treatments in TCM are unique, rapid, and have a long history, characterized by simplicity, convenience, affordability, and effectiveness. The most distinctive external treatments include acupuncture, tui na, cupping, dao yin, and yi liao, as well as methods such as fumigation, application, plasters, navel therapy, and foot therapy. The treatment scope covers internal, external, gynecological, pediatric, orthopedic, dermatological, otorhinolaryngological, and anorectal conditions, and compared to internal treatments, they exhibit the principle of “different paths leading to the same goal, different methods achieving the same effect,” particularly for those who are unwilling or unable to take medication, and especially for critical conditions, highlighting their unique therapeutic effects, hence the saying “good doctors do not neglect external treatments.”
Why Did Ancients Refer to Medical Techniques as the “Art of Qi and Huang”?
TCM is often referred to as the “Art of Qi and Huang,” where Huang refers to the Yellow Emperor, and Qi refers to his minister Qi Bo. It is said that the Yellow Emperor often discussed medical issues with Qi Bo, Lei Gong, and other ministers, exploring the causes, diagnoses, and treatment principles of diseases, many of which are recorded in the medical classic “Huang Di Nei Jing” (The Yellow Emperor’s Inner Canon). Later generations, out of respect for the Yellow Emperor and Qi Bo, used the term “Qi Huang Zhi Shu” to refer to TCM, considering “Huang Di Nei Jing” as the source of TCM theory and the most authoritative classic in TCM. Even today, those engaged in TCM work often cite the discussions in “Huang Di Nei Jing.” Why is this ancient medical text called “Nei Jing”? Because the ancients often referred to books with certain rules that must be learned and mastered as “jing,” such as the Confucian “Six Classics,” Laozi’s “Dao De Jing,” and the educational “Three Character Classic.” As for “Nei,” it is a relative term to “Wai” (external), and there were records of “Huang Di Wai Jing” in ancient times, which have since been lost. This is similar to the naming conventions of “Han Shi Wai Zhuan,” “Han Shi Nei Zhuan,” and the “Inner and Outer Chapters” of “Zhuangzi,” and does not carry any profound meaning. The term “Nei Jing” with the Yellow Emperor’s name also signifies a return to the source, indicating that China’s medical culture has a long history, not implying that it is a work left by the Yellow Emperor or existed during his time. In fact, “Huang Di Nei Jing” is a work from after the Warring States period, approximately compiled during the Qin and Han dynasties, and it is neither from a single era nor authored by one person, but rather a collective achievement. “Huang Di Nei Jing” consists of two parts: “Su Wen” and “Ling Shu,” each with an introduction. “Su Wen” addresses the physiological and pathological issues of the human body, while “Ling Shu” primarily studies acupuncture techniques, hence also referred to as the “Acupuncture Classic.” The term “Ling” refers to essentials, and “Shu” refers to pivots; the main meaning of “Ling Shu” is that one must grasp the essential points of acupuncture techniques. As a classic medical text, “Huang Di Nei Jing” comprehensively constructs the theoretical system of TCM, laying the foundation for the development of TCM. Its content is vast and profound, making it challenging to grasp the key points due to its collective authorship. Therefore, later physicians organized and categorized the original text of “Huang Di Nei Jing” so that each category discusses issues of the same nature, allowing readers to focus on the main points. Many physicians have undertaken this organizing work, among which the work “Lei Jing” by Ming Dynasty physician Zhang Jingyue is particularly noteworthy. He re-edited the original text of “Huang Di Nei Jing,” categorizing it into 12 types based on different content, facilitating reference. According to Zhang Jingyue’s classification, the content of “Huang Di Nei Jing” generally includes the following 12 categories: theories of health preservation, theories of yin-yang and the five elements, theories of organ representation, theories of meridians, theories of essence, qi, blood, and body fluids, theories of disease etiology, theories of pathogenesis, theories of syndromes, theories of diagnosis, theories of treatment, theories of acupuncture and acupoints, and theories of the six qi and five movements. The content of “Huang Di Nei Jing” not only covers medical aspects but also involves philosophy, astronomy, meteorology, and calendars, using these theories to substantiate the medical principles of TCM. Therefore, the ancients referred to “Huang Di Nei Jing” as “exploring the heavens and earth, drawing from various things, and closely examining the human body,” meaning that it discusses medical issues related to human physiology and pathology in conjunction with various phenomena in the universe. This reflects the guiding philosophy of “harmony between heaven and humanity” and “the dynamic unity of the whole” in “Huang Di Nei Jing.” Thus, it is evident that “Huang Di Nei Jing” fundamentally differs from many other medical texts in that it is not merely a medical book. However, even from a purely medical perspective, its theoretical essence and brilliant achievements have not only nurtured generations of physicians, guiding clinical practice but have also positively influenced the development of medicine worldwide. For example, its discussions on surface anatomy, particularly the measurement of digestive tract length, are very close to Western medical data; it was the first to propose the concept of blood circulation and recognized the differences between systemic and pulmonary circulation. Such examples are numerous. Therefore, physicians throughout history have placed great importance on “Huang Di Nei Jing,” venerating it as the “ancestor of physicians,” making it a must-read classic for studying TCM. The text of “Huang Di Nei Jing” belongs to the ancient prose of the Qin and Han dynasties, and its literary style is comparable to that of rhapsody, thus having a significant impact on Han studies and culture in Chinese history, forming a part of traditional culture. Because of this, reading such a classic medical text can be quite challenging in terms of language, and therefore, physicians throughout history have provided varying degrees of annotations. For beginners, it is advisable to start with textbooks such as “Selected Readings from the Inner Canon” and gradually progress to improve understanding.