Introduction: Today we will learn about Cheng Guopeng’s “Eight Methods”.
Throughout the history of Chinese medicine, various texts have recorded treatment methods, typically listing five or six methods. However, Cheng’s “Medical Insights” expands this to eight methods, significantly influencing the development of TCM treatment principles for future generations.
The opening of “Medical Insights: Eight Methods of Medicine” states: “The origins of diseases can be summarized by internal injuries and external pathogens. The nature of diseases can be categorized into cold, heat, deficiency, excess, exterior, interior, yin, and yang. The treatment methods can be summarized into eight: sweating, harmonizing, purging, resolving, vomiting, clearing, warming, and tonifying.”
In just a few words, this encapsulates the essence of differentiation and treatment, making it a concise summary.
For example:
01 Sweating Method
Cheng places great importance on the sweating method, believing that “all diseases arise from wind and cold, which first invade the exterior. If sweating is done correctly, what disease cannot be eliminated? If the sweating method is incorrect, the heavens will be at fault.”
The sweating method is divided into: tonifying yang deficiency to induce sweating, nourishing yin deficiency to induce sweating, clearing heat to induce sweating, warming the meridians to induce sweating in the presence of cold, and resolving food stagnation to induce sweating.
If the pathogen is severe and the body is strong, sweating should be vigorous; if the pathogen is mild and the body is weak, sweating should be gentle.
In cases of internal heat with deficiency, or during the late afternoon heat, sweating is not advisable. Those with urinary issues, skin lesions, blood loss, or conditions like Shaoyin cold, cold damage in Shaoyang, cold phlegm counterflow, dampness, rheumatism, damp-heat, and women experiencing menstruation should not sweat.
In cases of no sweating, one should promote sweating; in cases of excessive sweating, one should restrain it.
02 Harmonizing Method
Cheng believes that the harmonizing method is suitable for half-exterior, half-interior conditions of cold damage, but “the variations are endless.”
If the pathogen is in Shaoyang, being half-exterior and half-interior, one will see alternating cold and heat. If it leans towards the exterior, there will be more cold; if it leans towards the interior, there will be more heat.
For more cold, one should warm and harmonize; for more heat, one should clear and harmonize. For excess, one should resolve and harmonize; for deficiency, one should tonify and harmonize. If there are symptoms of Taiyang, one should harmonize the exterior.
If there are symptoms of Yangming, one should attack the interior to harmonize. If it leans towards yin, harmonizing should not be overly drying; if it leans towards yang, harmonizing should not be overly moist.
When the pathogen is in Shaoyang, the methods of sweating, vomiting, and purging should be avoided; only the harmonizing method is most appropriate.
03 Purging Method
Cheng believes that the purging method is used to expel pathogenic factors, and he highly praises Zhang Zihe’s purging method, stating, “By purging the pathogen, the righteous qi will recover.” He criticizes the fear of purging prevalent in the medical community and among patients, saying, “Every time purging is mentioned, it is viewed as a fearful path, and patients regard purging as poison, leading to critical heat conditions.”
For those with a strong body and excess pathogens, purging should be done urgently; for those with a weak body and excess pathogens, purging should be done gently. Gentle purging can include moistening, warming, guiding, or clearing methods, as well as combinations of tonifying and purging.
If there is fullness in the chest and abdomen, one should not approach; there are specific purging methods for chest fullness.
If there is hardness and pain in the lower abdomen with frequent urination, there are methods for purging retained blood. Among miscellaneous diseases, there are different purging methods for the elderly, those with chronic illnesses, postpartum women, and conditions like food stagnation, phlegm accumulation, water retention, and blood stasis.
Symptoms can be categorized into deficiency and excess, and the depth of the condition can vary.
04 Resolving Method
Cheng believes that resolving is about dispersing obstructions, stating, “Between the organs, meridians, and muscles, there should be nothing obstructing; if something appears, it must be resolved to restore balance.” He opposes the negligence of the resolving method by mediocre doctors, pointing out, “Doctors often regard the term ‘resolve’ as trivial, not realizing its complexities, which are more difficult than other methods.” He urges doctors to “study thoroughly and explore diligently.” One must first identify the source of accumulation, categorizing it into qi and blood, phlegm retention, water retention, pus, parasites, chronic illnesses, and various other conditions, each requiring different resolving methods. In cases of qi deficiency with fullness, one cannot resolve; in cases of spleen deficiency with edema, one should not resolve; in cases of severe yang deficiency, one should not resolve.
05 Vomiting Method
Cheng believes that the vomiting method is used to treat phlegm, food stagnation, and pus in the upper jiao. He laments that “modern doctors often place this method on a high shelf” and neglect its study, urging doctors to pay attention to it. Conditions like throat constriction and locked throat, where wind-phlegm and stagnant fire obstruct, should be urgently treated with vomiting; food stagnation causing chest fullness and pain should be treated with vomiting; phlegm retention causing dizziness, palpitations, sour regurgitation, and numbness in the limbs should be treated with vomiting.
For the elderly, weak, or postpartum women, those with excessive blood loss or emotional distress should not be vomited.
If the disease is in Shaoyang, with chest fullness and agitation, or in Shaoyin, with cold limbs, one should not vomit.
06 Clearing Method
Cheng believes that the clearing method is suitable for heat diseases, but there are differences between internally caused and externally contracted heat, requiring different treatments. Among the six excesses, except for middle cold and cold dampness, all are related to heat diseases. For wind-cold obstructing heat, one should disperse and clear; for summer heat injuring qi, one should tonify and clear; for damp-heat, one can disperse, drain, or clear; for dry-heat, one should moisten and clear; for food stagnation causing heat, one should resolve and clear. For externally contracted heat, cooling is the method of clearing. For internally caused heat, tonifying is the method of clearing. If emotions cause qi stagnation, leading to internal heat, one should open the stagnation to resolve it. In cases of severe deficiency of middle qi, with fever and fatigue, or in cases of yin deficiency with consumption, or when the fire of the mingmen is weak, one should not clear.
07 Warming Method
Warming refers to warming the interior. Cheng criticizes the prevailing medical trend of “overemphasizing warming tonics and strictly avoiding cold” and details various applications of warming methods. For cold obstruction and counterflow, abdominal fullness, and diarrhea, warming is appropriate; for cold dampness causing stiffness in the limbs, warming is appropriate; for those who consume cold drinks in summer and are suddenly exposed to cold, warming is also necessary.
In winter, for cold damage, warming disperses; for winter wind-cold, warming resolves; for cold phlegm obstruction, warming opens; for cold food injury, warming resolves; for sudden cold pain and blockage, warming purges; for those with deficiency and cold, warming tonifies.
When the fire of the mingmen is weak, one should warm but not excessively; one should tonify true yang.
If yin is excessive and obstructs yang, warming herbs will not be effective, and one should consider other methods.
Warming can be of different types: warming heat, preserving warmth, and the appropriate balance of light and heavy.
08 Tonifying Method
Cheng believes that the tonifying method refers to replenishing deficiencies, not limited to medicinal tonics, and includes the idea that “food tonics are better than medicinal tonics, and spiritual tonics are better than food tonics.”
Tonifying should address deficiencies, categorized into qi and blood, cold and heat, and organs.
If blood is lost, one should benefit qi; if qi is deficient, one should tonify fire; if yang is excessive, one should tonify with warmth; if yin is excessive, one should tonify with cooling; if there is deficiency with exterior pathogens, one should tonify while dispersing.
If there is deficiency with accumulation, one should tonify while resolving. If there is deficiency with heat accumulation, one should tonify while attacking. In cases of severe deficiency, one should tonify with caution. If the pathogenic factor is not completely resolved, even if the original qi is deficient, tonifying should be done gently.
In the absence of severe cold or heat symptoms, even if the body is weak, tonifying should be moderate. For spleen deficiency, one should adjust their diet and tonify appropriately. For lung deficiency, one should nourish the spleen and stomach, ensuring mutual support in tonification.
The application of the tonifying method must be tailored to the individual and the condition, which is the key to appropriateness.
Cheng summarizes, “Within one method, all eight methods are included; within the eight methods, countless methods are encompassed,” advising practitioners to apply them flexibly and not to be rigidly bound to one method while neglecting others.
These eight methods have been widely accepted and adopted by many practitioners in later generations.
Professor Ren Yingqiu commented on Cheng’s eight methods, stating: “Compared to Liu Wansuo, Zhang Congzheng, Zhang Jiebin, and Wang Qie’an, they are all more concise.”
Note: Specific treatments and medications should follow medical advice! This article is excerpted from “Collection of Medical Techniques from Famous Physicians of the Qing Dynasty,” edited by Xu Rongqing and Zhou Heng, published by China Medical Science and Technology Press, December 1994. This public account is used for academic exchange; if there is any infringement, please contact us for deletion, and please indicate the source when reprinting.
Qinglong’s Commentary: Essentially, this is a refinement and summary of the differentiation of the six diseases in cold damage theory, simply categorizing the three yin and three yang into yin and yang, while further dividing each disease into deficiency and excess, with treatment methods learning from the cold damage theory to summarize the treatment methods of cold damage!