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Part One: RADITIONAL- CHINESE MEDICINE WITH A LONG HISTORY
:
Traditional Chinese medicine ( TCM) has a history of several years. Its origin can be traced
back to remote antiquity.In a long course of struggling against diseases, TCM evolved into a
unique and integrated theoretical systcm of TCM. It is an important part of Chinese culture.
More than 2,000 years ago, came out Huangdi's Classic on Medicine( Huang Di Nei jing ),
which is the earliest medical classic extant in China. It consists of two partsBasic Questions
( Su Wen ) and Miraculous Pivot( Ling Shu ), each comprising) nine volumes, each of which,
in turn, contains nine chapters, totaling up to 162 chapters.The book gives a complete and
systematic exposition to the following various subjects : the relationship between man and
nature, the physiology and pathology of the human body, and the diagnosis, treatment and
prevention ot diseases. It also uses the theories of yin-yang and the five elements to deal fully
with the principles of treatment by differentiation of syndromes (TDS) according to the
climatic and seasonal conditions, geographical localities and individual constitution.
Hence( giving expression) to the holistic concept of taking the human body as an organic
whole and taking the human body with the surrounding environment as the integrity. It laid a
preliminary foundation for the theoretical formation of TCM. After Huangdi's Classic on
Medicine another classic of medicine, Classic on Medical Problems ( Nan Jing ), was given
birth to the world before the Eastern Han Dynasty. The book deals mainly with the basic
theory of TCM, such as physiology, pathology, diagnosis and treatment of diseases and so on.
It supplemented what Huangdi's Classic on Medicine lacked. From then on, many medical
schools and various classics on medicine were brought into being in succession, each having
its own strong points.
,
2000
9 9 162

Shen Nong's Herbal ( Shen Nong Ben Cao Jing ), also known as Classic on the Herbal (Ben
Cao Jing ) or The Herbal ( Ben Cao ), is the earliest book on materia medica in China, which
appeared in about the Qin-Han Period with its authorship unknown. Not only does it list 365

medicinal item among which 252 are herbs, 67 are animals, and 46 are minerals, but also
divides them into three grades according to their different properties and effects. The book
also gives a brief account of pharmacological theoriesprincipal (jun ), adjuvant (chen ),
assistant ( zuo ) and guide (shi ); harmony in seven emotions ( qi qing he he ), four properties
of medicinal herbs ( si qi ) and five tastes of medicinal herbs ( wu wei ).
()
365 ( 252 67 46 )

()
In the Han Dynasty (3rd century AD ), Zhang Zhongjing, an outstanding physician, wrote
Treatise on Febrile and Miscellaneous Diseases ( Shang Han Za Bing Lun ), which is divided
into two books by later generations, one is entitled " Treatise onFebrile Diseases", ( Shang
Han Lun ) , the other Synopsis of Prescriptions of Golden Cabinet (Jin Kui Yao Lue ) . The
book established the pnriciple of TDS(Treatment of Differentiation Syndromes Technical
Data System ), thereby laying a foundation for the development of clinical
medicine.
( 3 )

In the Western Jin Dynasty. Huang Fumi, a famous physician, compiled A-B Classic of
Acupuncture and Moxibustion (Zhen Jiu Jia Yi Jing ) The book consists of 12 volumes with
128 chapters, including 349 acupoints. It is the earliest extant work dealing exclusively with
acupuncture and moxibustion and one of the most influential works in the history of
acupuncture and moxibustion.
12 128 349

The Sui and Tang Dynasties came into their own in feudal economy and culture. In 610
AD, Chao Yuanfan et al. compiled General Treatise on the Etiology and Symptomology. The
book gave an extensive and minute description of the etiology and symptoms of various
diseases. It is the earliest extant classic on etiology and symptoms in China. In 657 AD, Su
Jing together with 20 other scholars, compiled Newly-Revised Materia Medica ( Xin Xiu Ben
Cao ) , which is the first pharmacopoeia sponsored officially in ancient China, and the earliest
pharmacopoeia in the world as well. Sun Simiao (581-682 AD) devoted all his life to writing
out the two books: Valuable Prescriptions for Emergencies (Bei Ji Qian Jin Yao Fang ) and
Supplement to Valuable Prescriptions ( Qian Jin Yi Fang) . The hooks deal with general

medical theory, materia medica, gynecology and obstetrics, pediatrics, acupuncture and
moxibustion, diet, health preservationand prescriptions for various branches of medicine.
Both books are recognized as representative works of medicine in the Tang Dynasty. Sun
Simiao was honored by later generations as "the king of herbal medicine".
610

657 20
( 581-682 )
.

In the Song Dynasty, more attention was paid to the education of TCM . The goverment set
up"the Imperial Medical Bureau" for training and bringing up qualified TCM workers. In
1057 AD, a special organ named "Bureau for Revising Meidical Books" was set up in order to
proofread and correct the medical books from preceding ages, and to publish them one after
another. The books revised have been handed down till now and are still the important
classics for China and other countries to study TCM.
1057
-

In the Jin and Yuan Dynasties, there appeared four medical schools represented by Liu
Wansu ( 1120-1200 AD ), Zhang Congzheng ( 1156-1228 AD), Li Gao ( l180-1251 AD) and
Zhu Zhenheng ( 1281-1358 AD). Among them, Liu Wansu believed that "fire and heat" were
the main causes of a variety of diseases, and that the diseases should be treated with drugs
cold and cool in nature. So he was known as "the school of cold and cool" by later
generations, Zhang Congzheng believed that all diseases were caused by exogenous
pathogenic factors invading the body, and advocated that pathogenic factors should be driven
out by methods of diaphoresis, emesis and purgation. So he was known as the "school of
purgation". The third school represented by Li Gao held that "Internal injuries of the spleen
and stomach will bring about various diseases". Therefore, he emphasizeed that the most
important thing, clinically, should be to warm and invigorate thespleen and stomach because
the spleen is attributed to the earth in the five elements. So he was regarded as the founder of
the "school of reinforcing the earth". And the fourth school was known as the "school of
nourishing yin" by founded Zhu Zhenheng. He believed: "Yang is usually redundant, while
yin is ever deficient". That is why the body "often has enough yang but not enough yin". So
he usually used the method to nourish yin and purge fire in clinical practice.

( 1120-1200)
( 1156-1228)( 1180-1251)( 1281-1358)

Li Shizhen (1518-1593 AD), a famous physician and pharmacologist in the Ming Dynasty,
wrote The Compendium of Materia Medica ( Ben Cao Gang Mu ). The book consists of 52
volumes with 1,892 medicinal herbs, including over 10,000 prescriptions and 1,000
illustrations of medicinal items. In addition, his book also deals with botany, zoology,
mineralogy, physics, astronomy, meteorology, etc. It is really a monumental work in Materia
Medica. It is a great contribution to the development of pharmacology both in China and all
over the world. During the same period, acupuncture and moxibustion reached their climax.
Many literature concerning acupuncture and moxibustion for the ages were summarized and
developed.
( 1518-1593 )
52 1892 10000 1000

Since the founding of New China, our government has paid great attention to inheriting and
developing the heritage of TCM and Materia Medica. A series of policies and measures have
been taken for developing TCM. In 1986, the State Administrative Bureau of TCM and
Materia Medica was established. This leading body is the guarantee of developing TCM and
Materia Medica smoothly. Never before has TCM been as prosperous as it is today. TCM has
experienced many vicissitudes of times but always remains evergreen. There is no doubt that
TCM will take its place in medical circles of the world as a completely new medicine.

1986

Part Two: SPECIFIC AND PROFOUND TCM

:
TCM, one of China's splendid cultural heritages, is the science dealing with human
physiology, pathology, diagnosis, treatment and prevention of diseases. TCM summed up the
experience of the Chinese people in their long struggle against diseases and, under the
influence of ancient naive materialism and dialectics, evolved into a unique, integral system
of medical theory through long clinical practice. During several thousand years it has made
great contributions to the promotion of health, the proliferation and prosperity of the Chinese
nation, and the enrichment and development of world medicine as well. The formation of the
theoretical system of TCM was greatly influenced by ancient Chinese materialism and
dialectics. The theoretical system takes the physiology and pathology of zang-fu organs and
meridians as its basis, and TDS as its diagnostic and therapeutic features.

TCM has its own specific understanding both in the physiological functions and
pathological changes of the human body and in the diagnosis and treatment of disease. TCM
regards the human body itself as an organic whole interconnected by zang-fu organs,
meridians and collaterals.And TCM also holds that the human body is closely related to the
outside world. In regard to the onset and development of a disease, TCM attaches great
importance to the endogenous pathogenic factors, namely the seven emotion, but it by no
means excludes the exogenous pathogenic factors, namely the six pathogens. In diagnosis,
TCM takes the four diagnostic methods ( inspection, auscultation ant olfaction,inquiry, pulsetaking and palpation as its principal tcchniques, eight principal syndromes as its general
guideline, and differentiation of syndrome according to the zang-fu theory, differentiation of
syndromes according to the six-meridian theory, and differentiation of syndromes according
to the theory of wei, qi, ying and xue as its basic theories of the differentiation of syndromes.
It also stresses the prevention and preventive treatment of disease, and puts forward such
therapeutic principles as "treatment aiding at the root cause of disease". "strengthening vital qi
and dispelling pathogens, regulating yin and yang and treating diseases in accordance with
three conditions" (i. e. the climatic and seasonal conditiont, geographic localities and the
patient's constitution).

()


()

These characteristicts, however, can be generalized as the holistic concept and treatment by
differentiation of syndromes (TDS)

l. The Holistic Concept 1.


By "the holistic concept" is meant a general idea of, on the one hand, the unity) and
integrity within the human body and, on the other, its close relationship with the outer world.
The human body is composed of various organs and tissues, each having its own distinct
function, which is a component part of the life activities of the whole body. And in TCM the
human body is regarded as an organic whole in which its constituent parts are inseparable in
structure, interrelated and interdependent in physiology, and mutually influential in pathology.
Meanwhile, man lives in nature, and nature provides the conditions indispensible to man's
survival. So it follows that the human body is bound to be affected directly or indirectly by
the changes of nature, to which the human body, in turn, makes corresponding responses.
TCM says: "Physicians have to know the law of nature and geographical conditions when
diagnosing and treating diseases." That's why TCM not only stresses the unity of the human
body itself but also attaches great importance to the interrelationship between the body and
nature in diagnosing and treating diseases.

2. Treatment by Differentiation of Syndromes 2.


TCM, on the other hand, is characterized by TDS. Differentiation means comprehensive
analysis, while syndrome refere to symptoms and signs. So differentiation of syndromes
implies that the patient's symptoms and signs collected by the four diagnostic methods are
analyzed and summarized so as to identify the etiology, nature and location of a disease, and
the relation between vital qi and pathogens, thereby determining what syndrome the disease
belongs to. By treatment is meant selecting the corresponding therapy according to the

outcome of differentiating syndromes. Taken as a whole, TDS means diagnosis and treatment
based on overall analysis of symptoms and signs.

As concerns the relationship between "disease" and "treatment", TCM takes two different
clinical ways on the basis of TDS. One is "treating the same disease with different therapies",
by which is meant that the same disease may manifest itself in different syndromes at
different stages or under different conditions. Therefore, the therapies of the same diease
should be adopted towards different therapies according to the patient's constitution, the
geographical environment, the climatic and seasonal changes. Take flu for example, it may be
caused by wind-cold wind-heat, summer-heat and dampness or other pathogens. So is
advisable to adopt dispersing wind-cold, eliminating wind-heat, clearing away summer-heat
and dampness respectively. The other is called "treating different diseases with the same
therapy", by which is meant that different diseases manifesting themselves in the same
syndrome may be treated with the same therapy. For example prolapse of the rectum due to
protracted diarrhea and hysteroptosis are two different diseases. However, if they are both
marked by themselves in the same syndrome of qi of sinking of the middle energizer, they can
be treated in the same therapy by lifting qi of the middie energizer. From the above it becomes
obvious that TCM does not focus its attention on similarities or dissimilarities between
diseases but on the differences between the syndromes. Generally speaking, the same
syndromes are treated with basically same therapies, while different syndromes with different
ones.

To sum up, the principle that different contradictions in essence are handled by different
methods in the course of development of a disease is the core of TDS.


Part Four: THE APPLICATION OF THE YIN-YANG THEORY
:
The yin-yang theory permeates all aspects of the theoretical system of TCM. The theory is
used to explain the organic structure, physiological function and pathological changes of the
human body. It also serves as a principle to guide clinical diagnosis

l . Explaining the Tissues and Structure of the Human Body 1.


The human body is an integrated whole. All its tissues and structures are organically
connected and may be classified as two opposite aspects-yin and yang. That is why Su wen
states,"Man, having a form, can not deviate from yin and yang." In terms of the anatomical
locations, the upper part of the body is yang and the lower part is yin; the exterior is yang and
the interior, yin; the back is yang and the abdomen, yin; the lateral aspects of the extremities
are yang and the medical aspects, yin. Concerning the zang-fu organs, the zang-organs store
but not discharge essence-qi and, therefore, they are yin; while the fu-organs transmit and
transform food into essence-qi but not store it, and, for this reason, they are yang.
Furthermore, each of the zang- or fu-organs can be redivided into yin and yang. For example,
heart-yin and heart-yang, kidney-yin and kidney-yang, stomach-yin and stomach-yang, etc.
As concerns yin and yang of the meridian-collateral system, there are two categories: yin
meridians and yang meridians; yin collaterals and yang collaterals. All of them are opposite
pairs. Thus, in line with the yin-yang theory, the unity of opposites between yin and yang exist
in the upper and lower, internal and external, front and back parts of the human body, and
within all the internal organs as well.

2. Explaining the Physiological Functions of the Human Body 2.


The yin-yang theory believes that the normal life activities of the human body result from
the harmonious relation of the unity of opposites between yin and yang. Take the relationship

between function and matter for example, function pertains to yang while matter, to yin.
Physiological activities of the body are based on matter. Without matter, there would be no
sustentation for function activities. And functional activities are the motive power for
producing matter. In other words, without functional activities, the metabolism of matter
would not be performed. In this way, yin and yang within the human body depend on each
other for existence. If yin and yang can't complement each other and become separated from
each other, life will come to an end. So Su Wen says:"The equilibrium of yin and yang makes
the vitality well-conserved; the divorce of yin and yang essence-qi exhausted."

3. Explaining the Pathological Changes 3.


TCM considers that the imbalance between yin and yang is one of the basic pathogenesis of
a disease. The occurrence and development of a disease are related to both the vital-qi and
pathogenic factors. Although the pathologlical changes which occur in diseases are
complicated and changeable, they can still be summarized as excess or deficiency of yin or
yang. To be more concrete, "yang excess leads to heat syndrome while yin excess causes cold
syndrome"; "yang deficiency results in cold syndrome while yin deficiency causes heat
syndromes"; "yang deficiency affects yin while yin deficiency affects yang."

4. Serving as the Guide to Diagnosis and Treatment 4.


As the imbalance between yin and yang is the root cause for the occurrence and
development of a disease, all clinical manifestations, no matter how complicated and
changeable they are, can be explained with the aid of yin-yang theory. So TCM holds, "A
skilled diagnostician, first of all, differentiates between yin and yang when observing the
complexion and feeling the pulse." In differentiating syndromes, although there are the eight
principal syndromes, namely, yin, yang, interior, exterior, cold, heat, deficiency and excess.
Yin and yang are regarded as the general principles among the eight ones. According to the
yin-yang theory, exterior, heat and excess pertain to yang; while interior, cold and deficiency
pertain to yin. When treating a disease, TCM first determines the therapeutic principles, and
then preponderance of yang belongs to excess-heat syndrome. It should be treated with cold-

natured drugs in order to inhibit excessive yang, i.e, to cool the heat. Cold syndrome caused
by preponderance of yin belongs to cold-excess syndrome. It should be treated with hotnatured drugs so as to restrain excessive yin, i.e., to heat the cold. As both syndromes above
are excess syndromes, this therapeutic principle is called "treating excess syndromes with the
purgation". Deficiency-cold syndrome caused by yang deficiency, should be treated with the
drugs warm and tonic in nature to relieve excessive yin. This is said in TCM, "restraining
predominant yin by reinforcing yang," also known as "treating yang for yin diseases." The
interior heat syndrome resulting from yin deficiency belongs to Deficiency-heat syndrome,
which should be treated with the drugs of nourishing yin and replenishing fluids so as to
restrict excessive yang, this is what is known in TCM, "restraining predominant yang by
strengthening (renal ) yin," also called "treating yin for yang diseases."
,

Zhang Jingyue thought that, in treating deficiency of yin or yang, drugs tonifying both yin
and yang should be used, because yin and yang are interdependent. Therefore, reducing the
excessive and replenish the deficient can adjust excess or deficiency between yin or yang and
restore the balance between them.

The yin-yang theory is used in not only determining diagnostic principles but summarizing
the nature, flavor and action of medicinal herbs. Thus providing a theoretical basis for the
clinical application of herbs.

In terms of the medicinal nature, herbs with cold nature belong to yin and those with warm
and hot nature pertain to yang. As concerns the flavors, herbs that are sour, bitter and salty
belong to yin and those that are acrid, sweet and bland pertain to yang. In terms of actions,
herbs with astringent, descending and sinking actions belong to yin, while those with

dispersing, ascending and floating actions pertain to yang.

To sum up, the principle of treatment should be established in the light of the excess or
deficiency of yin or yang, and then relevant() herbs should be selected according to the
attribution() of yin or yang and their functions. So and so only can imbalance of yin and
yang be put right, and eventually, the aim of curing diseases is attained.

Special phrases
treating...with... +
treating excess syndrome with purgation purging excess
treating deficiency syndrome with invigoration (or invigorating deficiency)
treating cold syndrome with hot-natured drugs( or heating the cold )
treating heat syndrome with cold-natured drugs( or cooling the heat )
Part Five: THE FIVEELEMENT THEORYNATURAL PHILOSOPHY IN
ANCIENT CHINA
:-
The five elements refer to wood, fire, earth, metal, and water and their motions. The five
element theory resulted from the observations and studies of the natural world by the ancient
Chinese people in the course of their lives and productive labor. Since ancient time, wood,
fire, earth, metal and water have been considered as basic substances to constitute the
universe and they are also indispensable for life. Zuo's Interpretation of the Spring and
Autumn Annals (Zuo Zhuan) says:" The five kinds of materials in nature are all used by
people. None of them cannot be dispensed with". Another classical work Shang shu states:
"water and fire are used for cooking, metal and wood are used for cultivating and earth gives
birth to all things, which are used by people." These five kinds of substances are of the
relationships of generation and restriction and are in constant motion and change. In TCM the
five-element theory, as a theoretical tool, is used to explain and expound different kinds of
medical problems by analogizing and deducing their properties and interrelations. It also used
to guide clinical diagnosis and treatment. The theory, like the theory of yin-yang, has become
an important component of the theoretical system of TCM.

Classification of Things in Light of the Five-Element Theory.


In ancient China, the five-element theory was unceasingly developed and gradually became
perfected. In time it came to recognize that everything in nature might be respectively
attributed to one of the five elements. For instance, wood has the nature of growing freely and
unfolding. So, anything that is similar to the characteristics is attributed to the category of
wood. Fire has the nature of flaring up. Thereby the things similar to the nature of fire are
classified into the attribute of fire. Earth has the nature of giving birth to all things. Thus,
those that possess the nature of earth are attributed to earth. Metal has the nature of purifying
and descending. Hence, those with the nature of metal can be attributed to metal category.
Water has the nature of moistening and flowing downwards. For this reason, the things that
have moistening, downward movement and coldness correspond to water. The following table
shows the classification of partial things according to the five-element theory.(See Tab. 1)

( 1)
Among the five-elements, there exist the relationships of generation, restriction,
subjugation and counterrestriction, and mutual affection between mother-organ and childorgan. Generation implies that one kind of thing can promote, aid or bring forth another, i. e.,
wood generates fire, fire generates earth, earth generates metal, metal generates water, and
water, in turn, generates wood. Each of the five elements contains the dual nature -"being
generated" and "generating". This relationship of the five elements is called the "motherchild" relationship. The element that generates is called the "mother", while the element that
is generated is called the "child". Take wood for example, because wood produces fire, it is
the mother of fire; but it is produced by water, so it's water's child.

Tab. 1 the Classification of Things According to the Five Elements 1.


Restriction means bringing under control or restraint.The order of restriction goes as
follows: wood restricts earth, earth does water, water does fire, fire does metal, and metal, in
turn, does wood. Any one of the five elements has two aspects-being restricted and restricting.
For example, the element restricting wood is metal, and the element that is restricted by wood
is earth.

Generation and restriction have the correlations inseparable in the five elements.And they
oppose each other and yet also complement each other.Without generation,there would be no
growth and development of things;without interrestriction there would be no balance and
coordination during development and change,and excessive growth would bring about
harm.For example,on the one hand,wood generates fire,and,on the other hand,it restrains
earth;while earth, in turn,generates metal and restricts water.Precisely because generation
resides in restriction and restriction resides in generation,the natural world and life processes
are full of vitality,on the one hand and excessive growth will not bring about harm on the
other hand.Thus,the relative balance maintained between generation and restriction ensures
normal growth and development of things.

That is, ecological equilibrium in nature and physiological balance in the human body
result from such relationships of generation and restriction. These relationships are illustrated
in the following figure.

Fig. 2 Relationship of generation and restriction (or subjugation) of the Five Elements 2.

However, once any one of the five elements becomes excessive or insufficient, there would
appear abnormal intergeneration and counter-restriction known as subjugation and counterrestriction (or reverse restriction). By subjugation is meant that one of the five elements
overacts upon another one when the latter is weak. Therefore, it is also called "double
restriction". For instance, excessive wood may over-restrict earth, resulting in insufficiency of
earth, so called wood subjugates earth. This is the abnormal manifestation of disorder of inter-

restriction among things.

Counter-restriction means that the strong bulliesthe weak. It is also a morbid condition in
which one element fails to restrict the other in the regular order, but in reverse order. It is clear
that the order of counter-restriction is just the opposite to that of inter-restriction. For
example, under normal conditions, metal should restrict wood, but in case of wood-qi excess,
or metal-qi deficiency, wood will counter-restrict metal instead of being restricted by metal,
which is known as "wood counter-restricts metal." Therefore, Su Wen states :"When qi of a
certain element is sufficient, it will encroach the restricted element and counter-restrict the
restricting element. When qi of a certain element is insufficient, it will be subjugated by the
restricting element and counter restricted by the restricted element," This is another
manifestation of the disturbance of the equilibrium between substances (see Fig. 3).

( 3)
Fig. 3 Relalionship of subjugation and Counterrestriction of the Five Elements 3.

"Affecting between mother and child" refers to abnormal intergeneration in the five
elements. The generated element is considered as the child, and the generating element as the
mother. Here "affecting" means having harmful influence, including both "the diseased
mother-organ affecting the child-organ" and "the diseased child-organ involving the motherorgan." The former is same as the order of intergeneration, and the latter is just the reverse
order of intergeneration. For instance, normally, water generates wood, which is called
"mother organ's disorder affecting its child-organ"; but abnormally, water involves wood,
which is called "child organ's disorder involving its mother organ" when wood affects water.
(See the following figure).

,
()
Fig. 4 Subjugation and Counter-restricting Among The Five Elements 4.
Special phrases

1.reinforcing the spleen (earth) to strengthen the lung (metal) 1.


2.failure of water (kidney) to nourish wood (or failure of the kidney to nourish the liver) 2.

3.five movements and six climates 3.


4.wood tending to spread out freely 4.
5.Depression of the liver (wood) generating fire 5.
6.fire of the liver (wood) impairing the lung (metal) 6.
7.fire tending to flare/flame upward 7.
8.excessive fire impairing the lung (metal) 8.
9.failure of fire to generate earth 9.
10.coordination between water (kidney) and fire (heart) 10.
11.incordination between the kidney (water) and the heart (fire) 11.
12."being restricted" and "restricting" 12.
Part Six: THE FIVE ZANG-ORGANTS-THE ORGANS OF PRODUCING AND
STORING ESSENCE-QI
:
The heart, Lungs, spleen, liver and kidneys are together known as the five zang-organs, whose
common physiological function is preducing and storing essence-qi. They store but not
eliminate essence-qi.

1. Heart 1.
The heart is situated in the chest, above the Diaphragm, and is enveloped by pericardium
externally. TCM believes(holds, think, find, consider, deem, judge, feel, take, make) that the
heart governs all the other zang-fu organs and, therefore, is a "monarch organ". The heart,
pertaining to fire in the five elements, consists of heart-yin, the material structures containing

the heart-blood, and heart-yang, the functional activities.As for physiological functions, the
heart is thought to, first, dominate blood and vessels since it is the motive force for blood
circulation. The blood vessels are the physical structures containing the blood. The blood
vessels are linked with the heart to form a closed system, and blood circulation is performed
by the cooperation of the heart and the blood vessels. Under the impulse of heart-qi, blood is
transported to all parts of the body for nutritive prupose. Thereby the condition of heart-qi and
the blood volume may be shown in both the pulse condition and the complexion. That's why
Basis Questions (Su Wen ) says, "The heart has its outward manifestation in the face or
complexion". As a result, whether heart-qi and heart-blood are sufficient or not can affect the
strength, rate and rhythm of the heart.

The heart houses the mind, also known as the heart dominating the mental activities. The
mind, in its broad meaning, refers to the outward manifestations of the life activities of the
whole body, and, in its narrow sense, to mental activities controlled by the heart, including
consciousness, spirit, thinking, etc. The zang-fu theory holds that mental activities and
thinking are to take the heart's functions as their basis. Spirit, consciousness, thinking,
memory and sleep are all related to the function of the heart in housing the mind. Therefore,
Miraculous Pivot (Ling Shu ) says, "The heart is the residence of the mind" and also, "The
heart takes on the performance of activities." The heart opens into(have one's specific body
opening ...be reflected on ...) the tongue. "Resuscitation", in TCM, means the close
relationship between a particular zang-organ and one of the sense organs in the structure,
physiology and pathology. So the heart, though being in the body, is connected with the
tongue by the heart-meridians. Through such a connection, whether the heart functions
normally or not can be clearly learnt from the tongue condition. In other words, the tongue
condition may show the physiological and pathological changes of the heart. So TCM holds:
"The tongue serves as the mirror( or body opening ) of the heart". In addition, the heart has its
outward manifestations in the face. The heart corresponds to joy in the emotions. (open into
have one's specific body opening ...be reflected on...)And its meridians connect with
associate with, be related to)the small intestine with which they are internally-externally
related.

Appendix: Pericardium
The pericardium, serving as the peripheral tissue surrounding the heart, plays a part in
protecting the heart When exogenous pathogenic factors attack the heart, the pericardium is
always the first to be attacked. The heart, if invaded by the pathogens, will be impaired and
diseases will ensue. For example, high fever, coma and red tongue are described as "heatpathogen attacking the pericardium," and, in fact, the clinical manifestations of the
pericardium invaded by exogenous pathogens are the same as those of the heart. For this
reason, the pericardium is usually regarded as an attachment to the heart.

2. Lungs 2.
The lungs, including the two lobes, one on the left and right separately, are situate in the
thorax. They are compared to the "canopy" becausea of its uppermost position among all the
zang-fu organs. They are also termed "delicate zang organs".

The lungs dominate qi and respiration. They are the place of exchange between the gases
inside and outside the body. Basic Question ( Su Wen ) says, "atmosphere communicating to
the lungs". The lungs also govern dispersing and descending, and regulates water passage, and
communicate with numerous vessels to coordinate functional activities of the whole body,
assisting the heart to adjust normal circulation of qi and blood. The lungs corresponds to
melancholy in the emotions and are related to the skin and hair externally. They open into the
nose and their conditions are reflected on vellum( ) hairs. In the meridian-collnteral
relation,the lungs and the large intestine are exteriorly-interiorly related because of
interconnecting-interpertaining of the Lung Meridianof Hand-Taiyin and the Large Intestine
Meridian of Hand-Yangming.


.
,

3. Spleen 3.
The spleen is located in the middle energizer, below the diaphragm. The spleen's meridians
connect with the stomach, with which it is exteriorly-interiorly related. TCM is widely
divergent from Western medicine in the understanding of the spleen. TCM holds it true that
the spleen is divided into spleen-yin, its material structures; spleen-yang, its functions; and
spleen-qi which merely refers to its functions, and that the spleen may be the main organ of
the digestive system. The spleen is of great importance because, for one thing, it controls
transporting and transforming food and water and, for another, it controls the blood of the
whole body. Thereby, keeping the blood circulating normally within the vessels to prevent it
from extravasating. The spleen is also viewed as the source for the production and
transformation of qi and blood, as is said in TCM, " The spleen is the foundation of postnatal
life".

4. Liver 4.
The liver is at the right hypochondriac region below the diaphragm in the upper abdomen.
The liver and gallbladder make a pair of zang-fu. The liver meridian connects with the
gallbladder to form an exteriorinterior relationship.

People are apt to associate the livcr with its functions of storing blood and governing
normal flow of qi. The former is concerned with the liver's capability in storing blood and
regulating the blood volume. A certain amount of blood stored in the liver can restrict liveryang hyperactivity so as to maintain the normal flow of qi. If the liver fails to function
normally in storing blood. Such pathological changes as liver-blood deficiency or bleeding
will occur. The liver also play a principal role in regulating the blood volume especially the
volume in the peripheral portion of the body. The latter, governing the normal flow of qi, is an

important link in regulating qi movement, promoting the circulation of blood and body, as
well as harmonizing emotional activities. The liver's another function is incarnated in its
regulating emotional activities, promoting digestion and absorption and keeping qi and blood
flowing normally. Besides the above, the liver are also closely related to the tendons, nails and
the eyes. It has its specific body opening in the eyes and its outward manifestation on the
nails.

5. kidney 5.
The kidneys, situated in the lumbar zone, one on either side of the spinal column, store the
congenital essence and are, therefore, considered as the "foundation of prenatal life". Their
main physiological functions are: storing essence; dominating growth, development and
reproduction; regulating water metabolism and receiving qi. The kidneys also take charge of
the bone and manufacturc marrow. Meanwhile, the kidneys have their conditioias revealed on
hairs and open into the ears and, the two"private parts"-urethra and anus. The kidneys'
meridians connect with the urinary bladder, with which they are internally-externally related.

Part Seven: THE SIX FU-ORGANS AND THE EXTRAORDINARY FU-ORGANS


:
TCM refers the gallbladder, the stomach, the large intestine, the small intestine, the urinary
bladder and the triple energizer to the six fu-organs. it is not only that, besides the functions of
their own, they are characterized by their common role ofdecomposing and digesting water
and food, and discharging the wastes, but that, in the process of digesting and absorbing food
and excreting the wastes, they are closely related to each other both physiologically and
pathologically. Their functional feather is excretion without storage and taking descending
and unobstruction as their normal functional state. TCM's rational knowledge of the
interrelationship of the six fu-organs is well grounded on ancient anatomical knowledge, the
observation of the physiological and pathological changes of the six fu-organs and the
summarization of long-term and rich medical experience.

Food entering the stomach is decomposed into chyme which after digested by the stomach,
is transported to the small intestine in which it is further digested by means of bile excreted by
the gallbladder. The small intestine "separates the clear from turbid".The clear, refers to food
essence, is transported and distributed to all parts of the body by the spleen; while the turbid is
the residues of water and food. Of them waste water goes into the kidney, and then into the
urinary bladder where it is turned into uruie to be excreted from the body. And the other is
conveyed to the large intestine where it is changed into feces and leaves the body via the anus.
In the whole process of the transportation and transformation of water and food, the triple
energizer dominates qi transformation and qi movement of the whole body.

The triple energizer is one ot the six fu-organs, and among all the zang-fu organs, it is the
largest fu-organ in the human body. Huangdi's Classic on Medicine holds: "The triple
energizer is separated from the zang-fu organs and yet is within the body. It encloses all
organs and is the largest one." And the book also advanced a viewpoint that "The triple
energizer exists in name only but is not the entity". Triple energizer has no exterior-interior
relationships with the zang-organs, it is therefore called "solitary fu-organ". Its main functions
are to pass various kinds of qi and to serve as the pathway for body fluid. It is divided into
three parts: the upper energizer, middle energizer and lower energizer. The triple energizer
with the related zang-fu organs, each having its own function to perform, accomplish jointly a
complicated physiological process in the digestion, absorption, distribution and excretion.

The upper energizer refers usually to the part above the diaphragm, including the heart,

lungs and head as well. Its main physiological function is to distribute essence-qi throughout
the body. In other words, in combination with the heart and the lung, the upper energizer
distributes essence-qi to the whole body to warm and nourish the skin and muscles, tendons
and bones. This function is described in Miraculous Pivot "The upper energizer resembles a
sprayer." This is a metaphor, which is used to describe the function of the upper energizer to
sprinkle fog-like cereal essence.

"
The middle energizer refers mainly to the abdorminal part between the diaphragm and
umbilicus, and includes such zang-fu organs as the spleen, stomach, liver and gallbladder. Its
main physiological functions are to decompose food and transform nutrient substances into qi
and blood, and to discharge the wastes and steam body fluid. This function is mentioned in
Miraculous Pivot: "The middle energizer is likened to a fermentation tun." By "fermentation
tun" is meant the place where food is decomposed and digested.

The lower energizer refers, generally, to the portion located below the stomach, including
the small intestine, large intestine, kidneys, urinary bladder. etc. Its main function is to
discharge food residuces and urine. So there is also a saying in Miraculous Pivot, "The lower
energizer works like a sewer." Here "sewer" is used to describe the function to excrete the
wastes. However, with the development of visceral manifestations (zang xiang), essence and
blood of the liver and kidney as well as primordial qi are generally attributed to the lower
energizer by later generations.

In short, the triple energizer dominates all kinds of qi and qi transformation of the human
body, and serves as the pathway for water. Therefore, Basic Questions says: "The triple
energizer, as the waterways, is an organ in charge of the water circulation, flowing along the
waterways."

While the six fu-organs transport and tranform water and food, the process of reception,
digestion, transportation and excretion are also in progress. The six fu-organs are usually in a
state of the alternations between emptiness and fullness. And they transform food into essence
but not store it. That's why TCM believes: " the six fu-organs function well when they are
unobstructruction, the unobstructed is the normal functional state for the six fu-organs; where
the regular descent is their normal functional activities."Pathologically, disorders among the
six fu-organs often affect each other. For instance, when body fluid is consumed because of
excessive heat in the stomach, the large intestine is bound to have trouble in transportation,
and, in consequence, constipation occurs. A disturbance of the large intestine in transmission
and transformation not only leads to the obstruction of the large intestine itself, but also
affects the regular descent of stomach-qi, causing repeated vomiting. A dominant gallbladder
fire often interferes with the stomach and results in vomiting bitter fluid.Dampness and heat
accumulated in the stomach and spleen burn and steam the liver and the gallbladder. This may
cause the bile to overflow, and give rise to jaundice.

Apart from the six fu-organs, there are the brain, marrow, bones, vessels, gallbladder and
uterus termed the "extraordinary fu-organs". Like the fu organs morphology, the extraordinary
fu-organs are mostly hollow but not the pathways for the digestion and excretion of cereal
food and, like the zang argans functionally, they also store essence-qi. With the exception of
the gallbladder, they have no exterior-interior relationships.

The brain is located in the skull and connects with the spinal marrow. It is the organ of
spirit, consciousness and thinking. Basic Question says: "The head is the house of
intelligence".( the head is the residence of intelligence)Li Shizhen of the Ming Dynasty
pointee out, "The brain is the seat of the mind", and the heart governs all funcctions of the
whole body, including mental activities. In the Qing Dynasty, Wang Qingren stated: "The
intelligence and memory onginate from the brain but not from the heart." And he also
considered: "Thinking, memory, vision, hearing, smelling and speaking are all controlled by
the brain." Although TCM has some knowledge of the brain's physiology and pathology, it

still ascribes the functions of the brain to the heart, the liver and respectively to the five zangorgans, and holds that spirit, consciousness and thinking are related to the five zang-organs.

The uterus, or womb(wu m), situated in the lower abdomen posterior to the urinary
bladder in women, is an inverted pear-shaped organ where menstruation occurs and the foetus
is bred. They are two complex physiological processes in which tiangui, a kind of refined
nutritious substance transformed from the kidney-essence, plays the most important role. Both
Chong and Ren meridians originate from the uterus. The uterus is also closely related to the
heart, liver and spleen, because normal menstruation and the nourishment of the foetus rely on
the blood dominated by the heart, stored by the liver and controlledby the spleen. Therefore
the dysfunction of the above organs will affect the normal functions of the uterus, bring about
menstrual disorder and sterility.

It should be pointed out that according to the theory of visceral manifestation, the names of
the zang-fu organs correspond to those of the modern human anatomy and refers to the
substantial internal organs. However, in the physiology and patholoty, the knowledge of TCM
differs greatly from that of western medicine, which has been learnt a lot from the above.

Part Eight: THE RELATIONSHIP BETWEEN THE ZANG-AND FU-ORGANS


:
While the relationship among the zang-fu organs is quite a complicated matter--so much so
that (so such an extent that )it deserves to be devoped a lot of pages, yet, thanks to TCM's
concise and brilliant summarization, it may just as well be briefed in a broad outline. In TCM,
the zang organs pertain to yin and are thought of as interior, while the fu-organs to yang and,
naturally enough, as exterior. The interior-exterior relationship between them is formed by the

connections of their meridians. This relationship as well as their physiological cooperation


and pathological interaction can be clearly seen in the interrelations between the heart and the
small intestine, the lung and the large intestinethe spleen and the stomach, the liver and the
gallbladder and the kidney and the urinary bladder.

The heart and the small intestine are connected by the heart meridian and the small intestine
meridian to form an exterior-interior relationship. Thus making the two pathologically related
to each other. The excessive heart-fire tends to go into the small intestine resulitng in oliguria,
burning pains during urination,etc. Conversely, the excessive heat in the small intestine may
go upward along the meridian to the heart and cause internal hyperactivity of heart-fire.
Leading to dysphoria, crimson tongue, oral ulceration and so on.

The lung and the large intestine form an exterior-interior relationship by mutual
connections of their meridians. The dispersing and deseending functions of the lung help the
large intestine to perform its transporting task. When the lung functions normally, the large
intestine does well. Conversely when the descending function of the lung qi do not work well,
it will affect the functionof the large intestine in transportation, causing difficult bowel
movements. On the other hand, loose stools and the stoppage of fu-qi may affect the descent
of lung-qi, giving rise to asthmatic cough and chest distress.

Both the stomach and the spleen lie in the middle energizerand are connected by their
meridians to form an exterior-interior relationship. The stomach governs the reception, while
the spleen governs the transportation and transformation. The relationship between the two is
that "the spleen conveys the booy fluid for the stomach". If pathogenic damp attacks the
spleen, it will injure the transporting and transforming functions of the spleen and affect the
reception and the descending action of the stomach, resulting in poor appetite, vomiting,

nausea and gastric distention. So the spleen and the stomach share out the work and cooperate
with each other to jointly accomplish the task of the digestion, absorption and distribution of
food. On the contrary, intemperance of food intake (improper diet)and dyspeptic retention of
the stomach will bring about both the dysfunction of the stomach in descent but that of the
spleen's transportation and transformation, causing such symptoms as abdominal distention,
diarrhea.

The gallbladder is attached to the liver, and they are connected by their meridians to form
an exterior-interior relationship. Bile derives from surplus qi of the liver. It is stored and
excreted by the gallbladder located under the liver. Only when the liver performs its function
successfully can bile be secreted, stored and excreted normally. On the other hand, when bile
is excreted properly, the liver can give full play to its function in regulating the normal flow of
qi. Conversely, when bile fails to be excreted normally, the liver function will be affected, too.
Therefore, the liver and gallbladder are closely related physiologically and pathologically. The
diseases of liver often involve the gallbladder and the contrary is also true. Therefore, the liver
and gallbladder cannot be completely separated physiologically and pathologically. For
example, excessive fire of both the liver and the gallbladder may present such symptoms as
qi-stagnation and heat-dampness.

The kidney and urinary bladder, like the other zang-fu organs, form an exterior-interior
relationship through their meridians. The kidneys control opening and closing, while the
urinarybladder governs storing and excreting urine. Both are related to water metablism.
Whether the function of the urinary bladder is normal or not depends on the sufficiency or
deficiency of kidney-qi. When kidney-qi is sufficient and its astringency is right, the urinary
bladder will open and close regularly, thus maintaining normal water metabolism. In case
kidney-qi is deficient, there will be the disturbance of its qi transformation and astrictive
action, causing the irregular opening and closing of the urinary bladder, manifested as dysuria,
incontinence of urine, enuresis and frequency of micturition.

So far the text has just briefly discussed the relationship between the five zang-and the six
fu-organs. To have a thorough understanding of their interrelations and the zang-fu theory, it
is also important to know the relationship between the five zang-organs and that between the
six fu-organs as well, which, as space is limited, have to be reluctantly parted with here.

In short, although the zang-and fu-organs have different physiological functions, there is a
close relationship between them in maintaining the normal functions of the body, and it is the
meridian-collateral system that makes them internally-externally interconnected. Without the
interconnecting pathways of the meridians and collaterals, each of the zang-fu organs would
become an isolated and static organ and unable to perform its functional activities. A case in
point to show the relationship is what is said in Basic Questions . "The zang-organs are all
connected with the meridians to perform the circulation of qi and blood."

Part Nine:THE ROOT OF LIFE-Qi


:
In TCM books, qi is always mentioned in the same breath with blood and body fluid, for they
are all the fundamental substances constituting the human body and maintaining its life
activities. However, among them qi is particularly important for the human body. That is why
TCM often explains the life activities of the human body in the viewpoint of qi. For this
reason, ZhangJingyue said: "Man's life relies entirely upon this qi." Classic onMedical
Problems states:"qi is ihe root of the human body; once the root is damaged, the stem and
leaves would turn withered". And, also, Basic Questions points out : "One's life is the
combination of qi of heaven and earth".

Qi in the human body is composed of congenital qi and acquired qi. The former is inherited
from one's parents before birth,the latter is derived from cereal essence transformed by the
spleen and stomach and fresh air inhaled from the natural world by the lung. Therefore, qi is a
combination of three kinds of factors. It is easy to see that the source or production of qi is
related to innate endowment, acquired nutrition and environmental conditions, and the actions
of the kidney, spleen, stomach, lung as well.

Congenital qi and acquired qi complement each other. Congenital qi is the material


foundation for the production of acquired qi, and acquired qi continuously supplements
congenital qi with nourishments. Both of them are, therefore, described as an interdependent
relation-congenital qi promoting acquired qi,which, in turn, nourishing congenital qi. There
are all kinds of qi and, their functions are too intricate to be expounded in a few words .To
provide a precise exposition, let's discuss them under six heads.

1 . Promoting Action of Qi 1.
Qi, as a sort of refined substance full of vigour, plays a promoting and activating role in the
growth and development of the human body, the physiological activities of the zang-fu organs
and meridians, the production and circulation of blood, as well as the production, distribution
and excretion of body fluid. If the above functions are weakened due to qi-deficiency, the
following pathologic changes will occur: tardy growth and development of the human body,
hypofunction of the zang-fu organs and meridians, stagnation of blood, fluid retention, etc.

2. Warming Action of Qi 2.
Whether man's body temperature is normal or not depends on the warming action of qi.
Classic on Medical Problerns says:" Qi is responsible for warming." Only through the
warming action of qi can all zang-fu organs meridiarns and other structures perform their
normal functional activities, and can such liquid substances as blood and body fluid circulate
normally. As the saying goes: " Blood flows in warmth, while it coagulates in cold."For
example, the insufficiency of yang-qi may impair the warming action of qi, causing an
aversion to cold, cold limbs. Lowered body temperature and so on. Conversely, qi excess may
result in the failure of qi to disperse heat, marked by preference for cold, fever, etc. Basic
Questions states, "Qi excess preduces heat, while qi deficiency produces cold."

3. Defending Action of Qi 3.
Qi has defending function to defend the body surface against the exogenous pathogens and
to combat with the invaded exogenous pathogens to drive them out of the body. The book
Basic Questions, therefore, states:" When vital qi exists in the body, the exogenous pathogens
can not attack the body." And " If the pathogens invade and occupy the body, qi-deficiency is
bound to ensue." Thereby leading to illness.

4. Controlling Action of Qi 4.
Qi also has controlling action, by which is meant the ability to control the liquid substances
and fix the internal organs in the body. This is shown in the following aspects:
(1) Keeping the blood flowing within the vessels to prevent it from extravasating without
reason.
(2) Controlling and regulating the secretion and excretion of sweat, urine, sperm, saliva,
gastrointestinal juices, etc , to maintain a relative balance of water metabolism.

(3) Firming the internal organs in their normal positions without prolapse.

(1)
(2)

(3)
If this action is impaired, hemorrhage, premature ejaculation, spontaneous sweating,
urinary incontinence, and spermatorrhea will occur. If this action fails to work normally,such
prolapses as gastroptosis, nephroptosis, hysteroptosis will be brought about.

The promoting and controlling actions of qi are the two aspects of mutual opposition and
mutual complement. Provided these two actions work harmoniously, blood circulation and
water metabolism can be normally carried on.

5 . Action of Qi Transformation
5.
Qi transformation may be defined as various kinds of changes brought about by the
movement of qi. Concretely speaking, it refers to the respective metabolism of essence, qi,
blood and body fluid and their reciprocal transformation. For instance, food is transformed
into qi, blood and body fluid; body fluid are converted into sweat and urine by metabolizing,
and the residues of food,after digestion and absorption, are turned into feces to be discharged
from the body. All these processes are all the specific manifeatations of the action of qi
transformation. If qi transformation is out of order, it will affect the digestion, absorpiion of
food, the metabolism and transformation of essence, blood and body fluid, the excretion of
sweat, urine and feces and so on .To put it briefly, qi transformation is actually the process in
which the substances in the body are metabolized and intertransformed. Although the above

five actions of qi differ from one another, they are indispensable to maintaining human life.
Their harmonious cooperation and mutual support ensure that the physiological activities are
completed smoothly.

The Movement of Qi is known as "qi ji", qi activity. Qi in the human body travels
throughout the body and reach all the zang-fu organs and meridians to promote and activate
the physiological activities of the human body.

Qi has four basic forms: ascending, descending, exiting and entering. These four forms are
the basis of human's life activities.Once these movements stop, it means that the life activities
ceaseand death ensues.

The ascending, descending, exiting and entering of qi are mainly embodied in the
physiological activities of the zang-fu organs, meridians and other processes of metabolism.
For example,the lung governs respiration, exhaling pertains to exiting, inhaling to entering;
and dispersing pertains to ascending, lowering to descending. The spleen sends the clear
upward and the stomach passes the turbid downward. So all kinds of physiological activities
in the human body, essentially, are reflected in the four movements of qi.

According to the sources, functions and distributions, qi is divided into four types:
primordial ( yuan qi), genuine qi (zhenqi) , pectoral qi (zong qi) , nutritive qi( ying qi) and
defensive qi(wei ai) .


l . Primordial qi, also known as genuine qi (zhen qi) is the most important of the four kinds
of qi. It is the primary motive force of life activities. Primordial qi derives from the congenital
essence stored in the kidney, and depends on the acquired essence regenerated by the spleen
and stomach. The book Miraculous Pivot makes it clear by saying, "Genuine qi (Zhen qi) is
inherited from heaven ( the parents) and combined with cereal essence to replenish the body."
1.

.
2. Pectoral qi is formed from a combination of the fresh air inhaled by the lung and the
cereal essence conveyed by the spleen and stornach. Pectoral qi performs two main functions.
One is traveling through the respiratory tract to prormote respiration and the sufficiency or
insufficiency of pectoral qi influences the conditions the voice. speech or breath and so on.
The other is running through the heart-meridians to promote the circulation of qi and blood.
The vicissitude of Pectoral qi is related to the flow of qi and blood, the body temperature and
the activities of the trunk and limbs, the visual and aural perceptibility, as well as the strength
and rhythm of the heart beat. 2.
,
,

3.Nutritive qi is the qi that circulates together with blood in the vessels. Nutritive qi
originates from the pure part of cereal essence transformed by the spleen and stomach and
bears responsibility for the blood production and the nutrition of the whole body. Nutritive qi
is considered as yin, so it is also called nutritive yin ( ying-yin) . 3.

4 . Defensive qi, like nutritive qi, comes from cereal essence,but, unlike nutritive qi, it runs
outside the blood vessels. Defensive qi has the following functions: protecting the body
surface against exogenous pathogens, controlling the opening and closing of the pores,
adjusting the excretion of sweat, warming and nourishing the zang-fu organs. muscles and the
skin with hairs, etc.,maintaining a relatively constant body temperature. It is given the name
"defensive qi" precisely because of its antiexogenouspathogenic action. Defensive qi belongs
to yang, so it has another name defensive yang ( wei-yang) ," which presents a strinking
contrast with ying-yin as mentioned above. 4.

THE TYPES OF QI AND THEIR MOVEMENTS

Types of Qi
Movement

Yuan Qi(Primordial Qi) starting from between the two kidneys, passing through trienergizer and circulating through the while body, inward to zang- and fu-organs and outward
to the muscles and skin.

Zong Qi(Pectoral Qi) stored in the chest and poured into the meridians of the heart and the
lung.

Ying Qi(Nutritive Qi) originating from tri-energizer, entering the meridians by way of the
lung, and circulating all over the body.

Wei Qi(Defensive Qi circulating outside but leaning against the meridians, vaporized to the
diaphragm and scattered in the chest, travelling between the skin and flesh.

Special phrases
As the saying goes, As=in the way thatas the story goes/runs
as the matter stands

as the case may be


as things are
as things run
Part Ten:BLOOD AND BODY FLUID-THE MATERIAL BASIS OF LIFE ACTIVITIES
:
Blood, circulating in the vessels, is a red liquid substance rich in nutrients. It is one of the
indispensable substances that constitute the human body and maintain its life activities. Blood
originates from cereal essence transformed by the spleen and stomach, and has the functions
of nourishing and moistening the whole body.

Nutritive qi and body fluid are thought of as the material basis of blood formation. As both
of them derive from cereal essence, the quality of the food intake and the conditions of the
spleen and the stomach are bound to have a direct bearing on blood formation. Either a longterm malnutrition or a lasting hypofunction of the spleen and stomach may cause insufficient
blood formation, resulting in blood deficiency. That's why TCM states" Reinforcing the
spleen and the stomach enables blood to develop spontaneously."

Normal blood circulation comes of the joint action of the heart, the lung, the spleen and the
liver. The heart-qi is the fundamental motive power to propel blood circulation. The lung is in
charge of qi of the whole body and, therefore, has an important bearing on the formation of
zong qi. When zong qi gets in the heart meridian, it may promote the movement of qi and
blood. The spleen may keep blood flowing within the vessels and prevent it from
extravasating. And the liver, besides its function of storing blood, adjusts the volume of blood
flow and maintain the normal flow of qi and blood. In case any one of the above organs fails
to work properly, abnormal blood circulation is certain to occur. The heart-qi deficiency, for
instance, may lead to heart-blood stagnation. The spleen-qi deficiency fails to control blood,
leading to bleeding, etc. The disturbance of qi flow of the liver and blood circulation may
bring about such pathological changes as blood stasis or swelling, abnormal menstruation,
dysmenorrhea or amenorrhea in women.

Blood circulates within the vessels, by which it is carried to the zang-fu organs internally
and to the skin, muscles, tendons and bones externally. It circulates ceaselessly Like a ring
without end to nourish and moisten all the organs and tissues. In this, normal physiological
activities are maintained. Basic Questions says:"The liver with blood is able to ensure normal
vision. the feet with blood are able to walk. the palms with blood are able to grip things, the
fingers with blood are able to grasp". "When discussing the relationship between blood and
the tendons, the bones and the joints, Miraculous Pivot points out:"When blood is normal, the
tendons and the bones are strong and the joints are nimble." Thus, it can be seen that the
sensation the the movement of the body never for a moment deviate from the nutrients
provided by blood.

Blood is also the material basis of mental activities. Sound mental activity results from
normal circulation and a sufficient supply of blood. So any blood trouble, whatever the causes
maybe, will bring about symptoms of mental activities varying in degrees. Basic Questions
advises people: " Qi and blood are the foundation for human mental activities and have to be
nursed with caution." And Miraculous Pivot informs us, " Harmonious blood vessels ensure a
vigorous spirit." These famous remarks show the close relationship between blood and mental
activities. Deficiency of blood, therefore, will cause mental disorder. For example, heartblood or liver-blood deficiency will lead to such symptoms as palpitation, insomnia and
dreaminess.

Body fluid is called jinye in TCM, including all kinds of fluids in the organs and tissues and
their secretions, such as gastricjuice, intestinal juice, nasal discharge, tears, sweat, urine and
so on. Just like qi and blood, body fluid is also one of the essential substances constituting the
human body and maintaining its life

jin and ye are always mentioned in the same breath because of the fact that, for one thing,
both of them derive from food and water transported and transformed by the spleen and
stomach. and for another, they can transform into each other. But they are actually different in
thickness, property, function and distribution. By and large, jin is the fluid which is clear and
thin and flows easily. It is distributed in the skin, muscles and orifices, furthermore, it
permeates the blood vessels to keep them moistened. Ye, on the contrary, is thick fluid with
flowing less easily. It is distributed in the joints, brain, marrow and internal organs to nourish
them. Jin and ye may transform into each other. These two fluids are hard to be separated
completely and, for this reason, they are jointly referred to as "jinye" (body fluid) . In case of
the impairment of jin or exhaustion of ye, the two must be identified in TDS.

The formation, distribution and excretion of body fluid are the complex physiological
process in which they are accomplished by the joint action of many organs. As is pointed out
in Basic Questions : "After food and drink enter the stomach, they are digested and
transformed into food essence and then, transmitted upward to the spleen, which disperses the
essence upward to the lung and the lung regulates water pathways downward to the urinary
bladder. And by doing so body fluid is finally disseminated to all parts of the body along all
the meridians and collaterals. " This description suggests that, 1) body fluid is formed from
food and water by digestion and absorption of the stomach, separating the clarity from the
turbidity of the small intestine and tramformation of the spleen; 2) the distribution and
excretion of body fluid are accomplished by the joint action of many zang-fu organ, such as
the transforming function of the spleen, the dispersing and descending function of the lung,
the steaming and ascending function of the kidney; and 3) body fluid takes triple energizer as
its passageway for distribution and excretion.

(1)

(2)
(3)
Body fluid bears two physiological functions: moistening and nourishing body fluid
distributed to the body surface moistens and nourishes the muscles and skin with hairs; body
fluid permeated through the body orifices moistens and protects the eyes, nose mouth and
other openings; body fluid infiltrated into the blood vessels nourishes and smooths them and
is also the basic component of blood; body fluid poured into the internal organs nourishes and
moistens them, and body fluid in the bone nourishes and moistens the bone marrow, spinal
cord and brain marrow.

Part Eleven:QI, BLOOD AND BODY FLUID OF MUTUAL CAUSALITY


:
Despite their differences in nature, form and function, qi, blood and body fluid have
something in common with each other. They are the basic materials that constitute the human
body and maintain life activities; they all derive from cereal essence; they, physiologically,
depend on each other for existence and restrain and utilize each other; they, pathologically, act
upon each other and have causality between them.

Qi and blood are closely related. Qi is the "commander" of blood, and blood is the "mother"
of qi. As the commander of blood, for one thing, qi is the motive power for blood formation,
or rather, it produces blood. Blood is formed from mutritive qi and body fluid, both of which
come from food and water. All these cannot be separated from the functions of qi. Blood
circulation depends on the propelling function of heart-qi. For another, qi controls blood and
keep it flowiing in the blood vessels without extravasation. This function of qi is performed
by spleen-qi. When qi is deficient, it fails to control blood, thus leading to hemorrhage. Blood
is referred to as the mother of qi because, on the one hand, blood is a carrier of qi; and on the

other, blood provides adequate nutrients for qi. Therefore, it is impossible for qi to exist
without its"mother", blood.

The relationship between qi and body fluid is rather similar to that between qi and blood.
This is shown in the following four aspects. First, qi produces body fluid. The formation,
distribution and excretion of body fluid depend upon all the movements of qi and its warming,
promoting and controlling functions. The existence of qi in the body not only depends upon
blood, but on body fluid which is formed from food essence by the functions of the stomach
and spleen. So, whether body fluid is adequate or inadequate depends upon the conditions of
spleen-qi and stomach-qi. Second, qi promotes the transportation of body fluid. The
movements of qi are the motivity for the transportation, and distribution of body fluid, and the
excretion of sweat and urine. Therefore, In case of deficiency of qi or dysfunction of qi,
disturbance of body fluid in transportation, distribution and excretion will occur. Thereby
leading to the stagnation of body fluid. Third, qi controls body fluid. Qi may control the
excretion of body fluid and maintain the balance of the metabolism of body fluid, In case qi
fails to control the excretion of body fluid some of body fluid will run off. Fourth, body fluid
is a carrier of qi.(Qi resides in body fluid, Body fluid serves as a carrier of qi) That is, body
fluid carries qi. Qi cannot exist without body fluid. This is the reason why the loss of body
fluid often damages qi. If qi fails to attach to body fluid, qi-deficiency and even qi prostration
will ensue. So the medical book Prescriptions of the Golden Cabinet says:"No one has perfect
qi after hidrosis, vomiting etc." Examples in point are:hidrosis, polyuria, enormous vomiting
and diarrhea cause great loss of body fluid, which, in turn, gives rise to qi colapse.

Blood and body fluid are liquids and, what's more, they both perform the nourishing and
moistening functions. Body fluid will become and important component of blood when
infiltrating into the blood vessels. As blood and body fluid originate from the essence of food
and water, they are known as "body fluid and blood are derived from a common source."
Recurrent or severe bleeding may do damage to body fluid, resulting in thirst, scanty urine
and dry skin. And severe consumption or loss of body fluid will affect the source of blood,
leading to the exhaustion of both blood and body fluid. For this reason, it is not advisable to
use diaphoretics for haemorrhagic patients, and the methods of breaking blood or pricking
blood should be avoided in treating patients with the inadequate of body fluid and hidrosis.
Miraculous Pivot states:" The patients lost bolld should avoid perspiring; while the patients
lost perspiration should avoid Losing blood." And "the first contraindication refers to
emaciated patients; the second to patients lost blood; the third to patients after severe
perspirationl;the fourth to patients after severe diarrheal and the fifth to patients of postpartum
hemorrhage. Purgation is contraindicated in all these cases."

To sum up, the close and complicated relationships between the three are often shown in
physiology and pathology, and are of great importance in TDS.

Part Twelve:MERIDIANS AND COLLATERALS-THE PATHWAYS TO LINK THE


WHOLE BODY (1)
: 1
The meridian-collateral theory is concerned with the physiological functions and the
pathological changes of the meridian-collateral system, and their relationships with zang-fu
organs. It is an important component of the theoretical system of TCM. And it is considered as
a theoretical basis of all clinical subjects of TCM, especially that of acupuncture,
moxibustion, tuina and qigong. Besides, it guides the clinical practice of other branches of
TCM.

The meridians and collaterals are pathways along which qi and blood circulate through the
whole body. The meridians are the major trunks of the meridian-collateral system and run
longitudinally within the body, while the collaterals are the branches of the meridians and are
reticularly distributed over the whole body. Hence, the meridians and collaterals, connecting
the zang-fu organs with extremities, the upper with the lower and the internal with ihe
external portions of the body, make all the body's organs and tissues an organic whole.

The Composition of the Meridian-Collateral System


The meridian-collateral system consists of meridians and collaterals as well as their
subsidiary parts. This system, internally, links the zang-fu organs and, externally, joins the
tendons, museles and skin.

The meridians are classified into three categories: the regular meridians and the extra
meridians and the divergent meridians. There are twelve regular meridians, namely the three
yin meridians as well as the three yang meridians of the hands and feet. They are known
collectively as "the twelve regular meridians", which are the main passages for qi and blood
circulation and start and terminate at given seats, run along fixed routes and meet indefinite
orders. They are directly connected with the relevant zang-fu organs. The eight extra
meridians are composed of Du,Ren, Chong, Dai, Yinqiao, Yangqiao, Yinwei and Yangwei
meridians. They are interlated with the twelve regular meridians and perform the functions of
dominating, connecting and adjusting the twelve regular meridians. And they are not directly
related to the internal organs in addition, the twelve divergent meridians are the extensions of
the twelve meridians. They originate from the limbs, run deeper into the zang-fu organs and
emerge from the shallow neck.
Their action is to enhance the Links between every pair of meridians exteriorly-interiorly
related in the twelve meridians and complement the organs and bodily areas to which the
regular meridians can not get.

The collaterals are the branches of the meridians. They are divided into three groups: the
divergent collaterals, superficial collaterals and tertiary collaterals. The divergent collaterals
are the larger and main collaterals. The divergent collaterals originate from the twelve
meridians as well as Du and Ren meridians respectively. Together with a large splenic
collateral, they are altogether "fifteen divergent collaterals". Their chief task is to strengthen
the links between every pair of meridians exteriorly-interiorly related on the body surface.
The superficial collaterals are ones that run through the surface layer of the human body, and
often emerge on the surface. And the tertiary collaterals refer to the smallest and the thinnest
ones of the whole body.

In addition, there are the subsidiary parts of the meridian system, including the twelve skin
zones and twelve musculature zones. Therefore, they are the parts that connect the twelve
meridians with the
superficial portions and the muscular portions of the body respectively. Considering the
important place of the twelve meridians and the eight extra meridians in the meridiancollateral system. we are going to take them as the main subject for discussion.

Tab. 2 The Nomenclature and Classification of the Twelve Meridians 2.

Tab.2 shows that every meridian consists of three parts. 2

1 ) Hand or foot:
(1)

The meridians starting or terminating at the hand are named "Hand", while those starting or
terminating at the foot are named "Foot". So the twelve meridians are divided into four
groups: three yin meridians of hand, three yang meridians of hand, three yin meridians of
foot, and three yang-meridians of foot. Each of the meridian is named according to the medial
or the lateral aspect of hand or foot, the names to which zang and fu pertain, and the nature of
yin or yang.

2 ) Yin or yang:
(2)
The meridians going in the medial aspect of the limbs are named "yin", whereas those in
the lateral aspects are named "yang". The medial aspect of the limbs is subdivided into the
anterior border, midline and the posterior border. And the yin meridians running through these
parts are named Taiyin,Jueyin and Shaoyin respectively. The lateral surface of the limbs is
also subdivided into the anterior border, the midline and the posterior border. And yang
meridians are termed "Yangming","Shaoyang", and "Taiyang".

3) Zang or fu:
(3)
The nomenclature of zang or fu is determined in the light of the nature to which zang or fu
pertains. For example, the meridian pertaining to the kidney is named the kidney meridian,
and the rest may be deduced by analogy.

To sum up, it is quite evident that there is no name that does not involve hand or foot, yin
or yang, zang-organ or fu-organ in the twelve meridian.(To Be Continued)


Part Thirteen:MERIDIANS AND COLLATERALS-THE PATHWAYS TO LINK THE
WHOLE BODY (2)
: 2
Courses, Connections, Distributions, Exterior-lnterior Relations and Flowing Order of the
Twelve Meridians

1. The Coursing and Connecting Law of the Twelve Meridians


1.
The coursing and connecting law of the twelve meridians is: the three yin meridians of the
hand travel from the chest to the end of the fingers where they connect with the three yang
meridians of the hand; the three yang meridians of the hand go up from the end of the fingers
to the head on which they connect with the three yang meridians of the foot; the three yang
meridians of the foot descend from the head to the the end of toes where they join the three
yin meridians of the foot; the three yin meridians of the foot ascend from the toes to the
abdomen and chest in which they meet the three yin meridians of the hand. Thus, the twelve
meridians are connected with each other, forming a circle like pathway along which yin and
yang smoothly circulate without terminus. See the following diagram.

Fig. 5 Flowing direction and Connecting Law of the Twelve Meridians 5.

It is clearly seen from fig. 5 that the three yang meridians of the hand terminate at the head
from which the three yang meridians of the foot start. The three yang meridians of the hand
and the foot meet at the head So, TCM says:"The head is the junction of all yang meridians"
5

2. Distributions and Exterior-Interior Relations of the Twelve Regular Meridians1)


Distributions 2.
The twelve meridians are distributed symmetrically on the left and right sides of the body
and run along their fixed courses. Distribution in the limbs: The medial aspect of the limbs
attributes to yin, the lateral to yang. Each limb is distributed by Taiyin and Yangming
meridians are on the anterior border, Shaoyin and Taiyang meridians are on the posterior
border, and Jueyin and Shaoyang meridians are on the midline.

Distribution on the head and face: Yangming meridians run through the face and forehead,
Taiyang meridians run through the cheek, vertex and occiput of the head and Shaoyang
meridians run through both sides of the head.

Distribution in the body trunk: The three yang meridians of hand run through the scapular
part. Among the three yang meridians of foot, Yangming meridians run in the front of the
trunk (thoracico-abdominal aspect), Taiyang meridians along the back (the dorsal aspect) , and
Shaoyang meridians along the sides. All the three yin meridians of the hand come out of the
axillae without exception, all the three yin meridians of foot run along the ventral aspect. The
meridians running through the ventral aspect from the medial to the lateral are, in turn, termed
Foot-Shaoyin, Foot-yangming, Foot-Taiyin and Foot-Jueyin(note: as regards the medial sides
of the two lower limbs, at 8cun (24cm) above the medial malleoli, Jueyin is located in
theanterior, Taiyin in the middle and Shaoyin in the posterior part.)

( 8 (24 ))
The Exterion-Interior Relations between the Twelve Meridians

The twelve regular meridians, connected with each other by the divergent meridians and

divergent collaterals, form six pairs of exterior-interior relationships. Their exterior-interior


relationships are as follows: the Large Intestine Meridian of Hand-yangming and the Lung
Meridian of Hand-Taiyin; the Tri-energizer Meridian of Hand-Shaoyang and the Pericardium
Meridian of Hand-Jueyin; the Small intestine Meridian of Hand-Taiyang and the Heart
Meridian of Hand-Shaoyin; the Stomach Meridian of Foot-yangming and the spleen Meridian
of Foot-Taiyin; the Gallbladder Meridian of foot-Shaoyang and the Liver Meridian of FootJueyin; and the Urinary Bladder Meridian of Foot-Taiyang and the Kidney meridian of FootShaoyin. The Taiyang meridianand Shaoyin meridian of foot are exteriorly-interiorly related,
and so are the Shaoyang meridian and the Jueyin meridian of foot,and the Yangming meridian
and Taiyin meridian of foot. These are called the"yin and yang of foot"; while the Taiyang
meridian and the Shaoyin meridian of hand are exteriorly-interiorly related, and so are the
Shaoyang and the Jueyin meridians, and the Yangming and the Taiyin meridians of hand.
These are called the"yin and yang of hand".

The exterior-interior relationship of the twelve meridians not only strengthen the
connection between each specific pair of meridians with exterion-interior relationship, but
also promote each pair of zang-fu with the exterior-interior relationship to coordinate each
other physiologically and influence each other pathologically. In treatment, acupoints of the
two meridians with the exterior-interior relationship may be alternatively used.

3) The Flowing Order of the Twelve Meridians

The circulation of qi and blood inside the Twelve meridians is like the circular movement
endlessly. Their circulation starts from the lung meridian of Hand-Taiyin, runs to the liver
meridian.

Part Fourteen:THE CAUSES TO INDUCE DISEASESETIOLOGY


:
Etiology is defined as various kinds of factors that cause diseases. As TCM sees it, etiology
mainly includs the six exogenous pathogens, pestilence,(epidemic pathogenc factors ) the
seven emotions, emotional frustration, improper diet, overwork, maladjustment between work
and rest, traumatic injuries, insect or animal bites, phlegm retention, blood stasis, etc. Zhang
ZhongJing of the Eastern Han Dynasty pointed out: "Despite numerous diseases, they would
not exceed three categories". Up to the Song Dynasty, Chen Wuze put forward the theory of
the three categories of etiologic factors i. e., exogenous pathogenic factors,
endogenouspathogenic factors and non-endo-exogenous pathogenic factors. To be more
specific, six pathogenic factors invading the body from the outside pertain to exogenous
pathogenic factors; the seven emotions directly involving the internal organs are attributed to
endogenous pathogenic factors; other pathogenic factors, such as improper diet, overwork,
traumatic injury, insect and animal bites, etc. , are said to be non-endo-exogenous pathogenic
factors. "The theory of the three categories of etiologic factors" caused strong repercussions in
later ages and promoted the research into the etiology.

In discerning etiology, besides having a sound knowledge of the objective conditions that
possibly lead to illness, TCM centers attention on the clinical manifestations of diseases, and
inquires into the etiology through analyzing the symptoms and signs so that a basis for
treatment and medications may be is provided. This method is called "seeking cause of
disease through differentiation of syndromes."The six exogenous factors are a general term
for wind, cold, summer-heat, damp, dryness and fire. Under normal conditions, they are six
climatic factors. TCM calls them the "six qi." They are not harmful to human beings but
rather are the essential conditions of the growth of all living things in nature. Thus, the six qi
will not cause diseases normally. However, when the six qi become too excessive or deficient,
or when the body's resistance is too weak to adapt itself to the abnormal changes, the six qi
will be changed into the pathogenic factors to attack the human body and cause diseases.
They, as such, are known as "six exogenous pathogens" (liu yin). Of the six exogenous
pathogens the five result from the dysfunction of the zang-fu organs rather than the
exogernous factors invading the body from the outside though they also have the symptoms
similar to wind, cold, dampness, dryness and fire.(Of...
a. Of the two the latter is far better than the former. b.
Of the 100 cases treated with this therapy, 60 are male and 40 female. ) In order to distinguish
them from the six exogenous pathogens, they are termed the "five endogenous pathogens",

i.e., the endogenous wind,endogenous cold, endogenous dampness, endogenous dryness and
endogenous fire.

The pathogenic features of the six exogenous pathogens are as follows.

(l) The six exogenous pathogens have close relationships with the seasonal changes and
living environment. For example, diseases caused by wind-pathogen mostly occur in spring;
summer-heat diseascs usually appear in summer; damp diseases often happen in later summer,
dry diseases arise most often in autumn and cold diseases are often seen in winter. And the
people who live in damp circumstances are susceptible to damp diseases, while the people
living under a high temperature are liable to contract fire or dryness diseases. (1)

(2) The six exogenous pathogens may singly invade the body by a single pathogen and
simultaneously and invade the body by more than two pathogen. For example, common cold
results frequently from pathogenic wind and cold; diarrhea is caused by pathogenic dampnese
and heat; bi-syndrome (arthralgia) is causcd by pathogenic wind, cold and dampness and so
on. (2)

(3) They may be transformed into each other. Examples are: pathogenic cold in the body
may be transformed into heat and prolonged summer-heat dampness may bring about dryness
and fire to impair yin. (3)

(4) The last featurc of the six exogenous pathogens is that they invade the human body via
the body surface or from the mouth and nose or through both concurrently. This is known
as"affection resulting from six exogenous pathogens." (4)

The seven emotions refer to the human mental activities. In TCM, they are classified into
seven classes: joy, anger, melancholy, anxiety, grief, fear and terror.They are the different
responses to the environmental stimuli in the human body in general circumstances, they
belong to the normal physiological activities and will not cause diseases. When sudden,
strong,long or protracted (prolonged)emotional stimuli go beyond the body's adaptability and
endurance, the emotional stimuli will become pathogenic factors, which cause dysfunction of
qi, blood and the zang-fu organs and imbalance of yin and yang, hence leading to diseases.
This is known as "internal injury caused by the seven".

The seven emotions are different from the six exogenous pathogens in causing diseases.
The six exogenous pathogens, as mentioned ahove, usually invade the body through the skin,
mouth and nose, and it is mostly exterior syndromes at the early stage of the onset. The seven
emotions, however, directly affect the corresponding zang-fu organs to bring on diseases
because a certain zang-fu organ is closely related to a certain emotional activity. (
to bring on ... a. Arthur returned home to be struck by another
blow. b. What have I done to deserve so much? c. He made a long speech only to show his
ignorance of the subject. )So TCM says, "Anger impairs the liver; excessive joy impairs the
heart; grief or melancholy impairs the lung, anxiety impairs tbe spleen, and fright or fear
impairs the kidney", The abnormal emotions mainly influence qi activity of the internal
organs, so as to cause the dysfunction in ascending and descending of qi. Concretely
speaking, "Anger causes the qi (to the liver)to ascend: joy makes the qi (of the heart) sluggish;
sorrow makes the qi (of the lung) consumed; fear induces the qi (ofthe kidney) to dissipate;
fright causes the disorder of the qi (of the heart) ; and anxiety brings about the depression of
the qi (of the spleen)." As concerns other pathogenic factors such as pestilence, improper diet,
maladjustment of work and rest, parasites, surgical trauma, phlegm retention, blood stasis,
etc,we have to, though they are of equal importance, give them upon account of limited space.

Special phrases

1.Pathogenic factors; pathogens 1.


2.exogenous pathogenic factors; (exogenous pathogenic) 2.
3.seasonal pathogenic factors (seasonal pathogens) 3.
4.pathogenic wind 4.
5.endogenous wind 5.
6.exogenous wind 6.
7.Wind is the first and foremost factor to cause various diseases 7.
8.Sudden spasm and rigidity of muscles result from wind. 8.
9.Vomiting with sour vomitus of spouting diarrhea with tenesmus is caused by wind. 9.

10.Abdominal distension is mainly related to heat 10.


11.visible phlegm 11.
12.invisible phlegm 12.
13.excess of sexual intercourse 13.
Part Fifteen: PATHOGENESIS
:
What is meant by pathogenesis? By pathogenesis is meant the mechanism of the occurrence,
development and outcome of diseases. The occurrence, development and outcome of diseases
are closely related both to the body's vital qi and to the nature of the pathogenic factors. When
the pathogens attack the human body, the body's vital qi is bound to rise against the
pathogens, forming the conflict between vital qi and pathogens. Their conflict is bound to
destroy the relative balance of yin and yang to cause the dysfunction of the zang-fu organs
and meridians, or the disturbance of qi and blood. Thus bringing about a variety of local or
general pathological changes. Notwithstanding various diseases and complicated clinical
manifestations, their changes of pathogenesis, in general, are inseparable from the excess or
deficiency between the vital-qi and the pathogens, the imbalance of yin and yang, or the
abnormably of qi and blood and the dysfunction of the zang-fu organs and meridians.

The conflict between the vital-qi and pathogens is not only related to the occurrence of a
disease, but also directly affects its development and final outcome. Meanwhile, it has a direct
influence on deficient or excessive changes of the syndromes in a certain sense, the processes
of many diseases are seen as those of the changes of excess and deficiency in the contest
between the vital-qi and pathogens. Therefore, vicissitudes of vital qi and pathogens are
considered to be one of the pathogenesises.

Basic Questions says "the exuberance of pathogens results in excess syndrome, while the
depletion of essence-qi may bring on deficiency syndrome." Excess refers to excess of
pathogens, or a pathogenic reaction with excessive pathogens as the principal aspect of the
contradiction.
That is to say, the pathogens are excessive, the vital qi is also strong. Clinically, a sort of
pathological reactions of excess ensue with the fierce and obvious struggle between vital qi
and pathogens, which is known as excess syndrome. It is mostly found in the early or middle
stage of diseases caused either by the six exogenous pathogens or by the phlegm retention,
undigested food, blood stasis, etc. , characterized by high fever, mania, high voice and coarse
breathing, abdominal pain with tenderness, obstructive urination and defecation, and full and
forceful pulse.

By deficiency syndrome is meant a syndrome caused by inadequate of vital qi, or a


pathological reaction with the deficiency of vital qi as the dominant factor of the
contradiction. That is, the vital qi become too deficient to resist pathogens because of the
dysfunctions of qi, blood, body fluid, zang-fu organ and meridians. Consequently, the conflict
of vital qi and pathogens may not produce intense pathological reaction and a series of

insufficient manifestations arise, so called deficiency syndrome. This types of syndrome is


mostly seen in patients with weak constitutions or in the later stage of a disease and in
different kinds of chronic cases, marked by lassitude, pallid complexion, palpitation, short
breath, spontaneous perspiration, night sweat feverish sensation in the chest, palms and soles
or aversion to cold, cold extremities, feeble pulse, etc.

The rise and fall of vital qi and pathogens can bring about mixed syndromes of excess and
deficiency in protracted and complicated diseases. Such syndromes have mainly two kinds of
pathological changes: deficiency syndromes mixed with excess ones and excess syndromes
mixed with deficiency ones. However, under some particular circumstances, there will be two
types of pathological changes: true excess syndrom with pseudo-deficiency symptoms and
true deficiency with pseudo-excess symptoms. The former is said to be "symptoms of pseudoexcess in extreme deficiency", while the latter is said to be "symptoms of pseudo-deficiency
in extreme excess". From the above, to identify a deficiency or excess syndrome of
pathogenesis we must see through the appearance to get at the essence and
so only can we not be misted by false phenomena and accurately grasp the changes of
excess or deficiency syndrome .

In the course of a disease, the conflict between vital qi and pathogens not only gives rise to
their deficiency or excess, but also causes the outcome of a disease. When vital qi prevails
over pathogens, the disease tends to improvement or even complete recovery. Otherwise,
when pathogens prevail over vital qi, the disease tends to deterioration or even life comes to
end.

In the course of occurrence, development and final outcome of a disease, disharmony of yin

and yang will occur under the action of pathogens, resulting in such pathological
manifestations as relative excess or deficiency of either yin or yang, mutual impairment,
repellence and depletion of yin and yang.

The Disturbance of qi and blood refers to a morbid state caused by deficiency and
dysfunction of qi and blood, and the breakdown of their interdependent relationship. Qi and
blood in the body are the material basis for the physiological activities of the zang-fu and
meridians. Therefore, their disturbance will inevitably affect the body's function to cause
diseases. Basic Questions states: "The disharmony between qi and blood will result in various
diseases". However, qi and blood are the products of the functions of the zang-fu organs.
Pathological changes of the zang-fu organs may not only lead to qi-blood disturbance, but
also affect qi and blood of the whole body. Thus, the pathogenesis of qi-blood disturbance,
like that of the rise and decline of vital qi and pathogens and the imbalance of yin and yang, is
not only the root cause of pathological changes of the zang-fu organs and meridians, but also
the basis for the analysis and research of the pathogenesis of various diseases.

The failure of qi activity refers to such pathological changes as qi stagnation, adverse flow
of qi, qi sinking, qi blockage and qi exhaustion due to disturbance in its ascending,
descending, exiting and entering. Ascending, descending, exiting and entering are the basic
form of qi movement, on which functional activities of the zang-fu organs and meridians as
well as the relation ships between the zang-fu organs and meridians, qi and blood, and yin and
yang depend to maintain their relative balance. Fort his reason, the disorder of qi activity may
bring about various morbid conditions involving the zang-fu organs, qi and blood, yin and
yang, exterior and interior, four limbs and nine orifices.

The disorder of blood includes deficient blood production, blood deficiency caused by

massive hemorrhage, over consumption of blood caused by prolonged illness, or dysfunction


of blood nourishment; it also includes the accelerated blood circulation caused by blood heat
and blood stasis caused by sluggish blood circulation.

The metabolism of body fluid is essentially the processes of continuous production,


distribution and excretion of body fluid. The disturbance of the metabolism means the
disturbance of distribution and the imbalance between production and excretion, thus causing
deficiency production of body fluid to form fluid retention in the body, So, normal
metabolism of body fluid is the basic condition maintaining normal distribution, production
and excretion. Normal production, distribution and excretion of body fluid are inseparable
from ascending, descending, exiting and entering movement of qi and its transforming
function. And also. they cannot be separated from the functions of the lung, spleen, liver,
kidney and the triple energizer.

The five endogenous pathogens refer to the pathological changes caused by the dysfunction
of qi, blood, body fluid and the zang-fu organs, namely endogenous wind, endogenous cold,
endogenous dryness endogenous fire and endogenous dampness. They are not pathogenic
factors; they are five comprehensive changes of pathogenesis.

Special phrases
1.The disharmony of qi and blood may cause various diseases. 1.

2.Heat-transformation, fire-transformation, wind-transformation, dryness-transformation,


dampness-transformation 2.
3.Insufficiency of vital qi is the intrinsic factor of the occurrence of disease. 3.

4.Pathogenic factors are the predominant factor of disease. 4.


Part Sixteen: THE FOUR DIAGNOSTIC METHODS-THE METHODS TO OBSERVE
AND DIAGNOSE DISEASES
:
The four diagnostic methods, namelv inspection, auscultation and olfaction, inquiry, and
pulse-taking and palpation, refer to the four basic procedures used in diagnosing a disease,
They are the presuppositions of correct differentiation and effective treatment in TCM.

When a disease occurs, there must be its abnormal outward manifestations from which the
pathological changes may be inferred, as is stated in Danxi's Experience on Medicine
( DanxiXin Fa) , "To want knowing the internal conditions of the body, the external
manifestations of the body should be observed ; to diagnose the external parts of the body
may also know the internal conditions. That is because the internal conditions of the body are
always reflected on the exterior of the body".The four diagnostic methods examine and learn
about the pathological conditions from different angle and aspect and find out the etiology
and pathogenesis, thereby providing the basis for TDS. The four methods are related to and
supplement one another. They cannot be separated from one another, each having its specific
function that cannot be substituted for the others. In clinical practice, only when the four
techniques are organically combined can a disease be understood all-sidedly. Thus, a correct
diagnosis can be made.

1. Inspection 1.
Inspection is the first diagnostic procedure by which the physician may observe the
patient's vitality, complexion, physical build, head, neck, five sense organs, skin, tongue,
external genitalia and anus on purpose so as to understand the condition of a disease. TCM
holds that the human body is an organic whole. The exterior of the body is closely related to
the internal organs. Take observation the vitality and complexion for examples, the vitality
refers to the general external manifestations of life activity of the human body, including
spirit, consciousness and thinking. And it is the outward sign of the conditions of qi and

blood, yin and yang, or the zang-fu organs. The vitality is manifested in manifold aspects,
such as eyesight, complexion, facial expressions, physical build, behavior and so on, among
which the expression of the eyes is the most important. This is because "all the vital essence
from the five zang and six fu organs converges into the eyes." From the observation of vitality
the physician may infer the abundance or inadequacy of the vital essence, analyze mildness or
the severeness of the disease and predict the prognosis of disease. It is quite evident that the
observation of vitality is of an important significance in diagnosing a disease. The
manifestations of vitality are as follows; being of vitality, pseudo-vitality, and loss of vitality.

The observation of complexion is a diagnostic method for inspecting the colour and lustre
of the face. TCM divides the facial colours into blue, yellow, red, pale and black, also known
as the "five colours", whose changes may indicates the nature and the location of a disease.
Generally speaking, red complexion indicates heat syndromes; white complexion indicates
cold and deficiency syndrome; yellow complexion deficiency and dampness syndromes; blue
complexion suggests pain and cold syndrome,blood stasis and convulsion; and black
complexion hints deficiency of the kidney, blood stasis and fluid retention. Inspection also
includes observation of the physical build. By the observation of sturdiness, weakness,
obesity or emaciation as well as the posture of the movement and stillness, different kinds of
diseases may he found out. And, in particular, the observation of the tongue is a unique
procedure in TCM diagnosis. It is used to observe the changes of the tongue proper and the
tongue coating so as to determine the abundance or decline of vital qi, tell the location of a
disease, distinguish the nature of pathogenic factors and infer the degree of seriousness of a
disease.

2. Auscultation and Olfaction 2.

Another diagnostic method is auscultation and olfaction. Auscultation means listening to


the patient's voice, speaking, respiration, coughing and moaning. By auscultation, the doctor
can not only learn about the changes of the phonatory organ, but also infer the pathological
changes of the internal organs. While olfaction means smelling the patient's odor of the
secretion and excretion. By and large, stench odor usually indicates heat syndromes of excess;
stinking() odor suggests cold syndromes of deficiency; and foul and sour odor implies
retention of food.

3. Inquiry
3.
This is a diagnostic method in which the patient or his companion are inquired to collect
the information concerning a disease. The content of inquiry includes the chief complaints,
present case history past history, life history, family history, as well as age, sex, native place,
occupation, address and so forth inquiry, though covering a wide range of topics, should be
conducted step by step in a planned way, with questions focused on the chief complaint and
the history of present disease. Therefore, when asking a patient. the physician should focus his
attention on the chief complaint to understand both the main reasons for the disease and
clearest, the most suffered symptoms of the patient. Besides, the physician should understand
the occurrence, progress, diagnosis and treatment of a disease through asking. Here is an
outline of inquiring about the present illness:

A. Asking about Chills and Fever A.


(a) . aversion to cold and heat
(a)

It means that the patient feels cold with a high temperature.

(b) . Alternate spell of chills and fever (b)


They are the manifestations of half exterior and half interior seen in shaoyang disease or
malaria.

(c). Chills without fever (c)


It implies that the patient only has an aversion to cold but no heat sensation or fever, which
is a sign of the deficiency and cold syndrome.

(d) Fever without chills (d)


This suggests that the patient with fever has a aversion to heat but not to cold, which
pertains to interior heat syndrome.

B. Asking about Perspiration


B.
This is a procedure for the physician to differentiate the conditions of interior and exterior,
heat and cold, deficiency and excess of a disease. Asking about perspiration includes the
presence of sweating, the location of sweating, the time of sweating and the amount of
sweating.

C. Asking about Diet and Appetite


C.

Asking diet and appetite may know the conditions of the spleen and stomach. It includes:
thirst and drinking appetite and amount of food taste.

D. Asking about Defecation and Urination D.


This is also a procedure in which the physician may learn whether the digestion and
absorption as well as fluid metabolism are normal or not, and also learn about frequency,
time, amount, quality, color, odor of defecation and urination and accompanied syndromes.

E. Questioning about Pain E.


(a) Asking about nature of the pain helps tell the cause and pathogenesis; (a)

(b) Asking about locality of the pain helps understand pathological changes of internal
organs and meridians; (b)
F. Questioning ahout Sleep F.
It refers to inquiring about insomnia, dreaminess and lethargy to know excess and
deficiency of yin and yang.

Besides, chest and abdomen, ears and eyes, women's diseases pediatric diseases may be
asked.

4. Pulse-taking and Palpation


4.
It is the fourth diagnostic methnd, including pulse-taking and, on the other, palpation of
different parts of the body. The former is a diagnostic procedure by which the physician may

feel the patient's radial arteries with the finger-tips to judge pulse condition, thus learning and
inferring the condition of illness. The latter is also a procedure by which the physician may
touch, feel, push and press certain parts of the body to detect local abnormal changes, thereby
determining the location and nature of the disease.

The location for feeling the pulse at present time is the patient's "cunkou", also named
"qikou", or "maikou". Cunkou refers to obvious pulsative place of the radial artery on both
sides of the wrist, and is divided into three regions: cun, guan and chi (inch, bar and cubit),
which, on the left hand, reflect respectively the conditions of the heart, liver and kidney and,
on the right hand, the conditions of the lung, the spleen, the stomach and the kidney. TCM
holds that each of the six regions for pulse-feeling corresponds to one of the internal organs
and reveals the pathologic changes of the relevant organ. For this reason, cunkou pulse-taking
is commonly accepted by practitioners through the ages and still used today. The pulse is
differentiated in terms of depth (superficial or deep), speed ( rapid or slow), strength (forceful
or weak), shape ( thick or thready, soft or hard) and rhythm. Different pulse condition indicate
different syndromes. For example, superficial pulse (fu mai), which is easily felt with gentle
touch, indicates exterior syndromes and is present at the early stage of exogenous diseases;
while deep pulse( chen mai), which is felt only by heavy pressure, indicates interior
syndromes, and so on.

Palpation may be conducted in three procedures: touching, stroking and pressing. Touching
is used to feel a certain part of the body, like the forehead or limbs with the fingers of palms,
thereby detecting the body temperature, dampness or dryness; stroking refers to examining
the patient's some parts of the body with the hands, e.g., a swelling, to learn the shape, size
and sensation of the swelling pressing means pushing and pressing over some parts of the
body with the hands, e. g. , the chest or abdomen, to make sure if they are tenderness, or have
any cakings when pressed.

Inspection, auscultation and olfaction, inquiry and pulse-taking and palpation are the four
diagnostic methods to understand the pathological conditions. They can not be separated, but
are related to and complement one another. In clinical practice only by combining the four can
a comprehensive and systematic understanding of the condition of a disease be gained,
thereby, making a correct diagnosis.

Part Seventeen: DIFFERENTIATlON OF SYNDROMESTHE PRECONDITION


FOR TREATMENT
:
Differentiation of syndromes (bian zheng) in TCM is a method to analyse and recognize the
syndrome of disease. In otherwords, it is also a process in which the location, nature,
occurrence and development of a disease as well as the condition of vital qi and pathogenic
factors are identified according to the clinical data obtained from the four diagnostic methods.
From the above it becomes obvious that differentiation of syndromes is the premise and
foundation of treatment. Correct differentiation and appropriate treatment are the prerequisite
for achieving the hoped-for results. There are a number of methods to differentiate syndromes
in TCM, such as differentiation of syndromes according to the eight principles; differentiation
of syndromes according to the theory of qi, blood and body fluid; differentiation of syndromes
according to tbe zang-fu theory; differentiation of syndromes according to the theory of six
meridians; differentiation of syndromes according to the theory of wei, qi, ying and xue, and
differentiation of syndromes according to the theory of triple energizer. Each method, while
having its own features and laying stress They should be applied flexibly and accurately so as
to understand a disease comprehensively, thereby providing the basis for treatment.

The eight principal syndromes, also known as "eight principles" (ba gang), refer to yin,
yang, exterior, interior, cold, heat, deficiency and excess. The differentiation of syndromes

according to the eight principles is the general guideline of TDS and important components of
TCM diagnostics. Complicated as the clinical manifestations of diseases may be, they are
classified under the eight principles. For example, the classification of syndromes-yin or
yang; the location of disease-exterior or interior; the nature of disease-cold or heat; and the
preponderance or discomfiture of vital qi and pathogens-deficiency of vital qi or excess of
pathogen. Differentiation of syndromes according to the eight principles generalizes the
intricate and volatile syndromes into four pairs: exterior and interior, cold and heat, deficiency
and excess, and yin and yang. Therefore, in the diagnostic process, the eight principles can
play a role in bring out the essentials.

Although this differentiating method classifies various syndromes into eight categories,
they are interrelated and inseparable from each other. For instance, the exterior syndrome and
interior syndrome are related to the cold, heat, deficiency and excess syndromes; the cold
syndrome and heat syndrome are related to the exterior, interior deficiency and excess
syndromes; the deficiency syndrome and excess syndrome are related to cold, heat, exterior
and interior syndromes. These pathologic changes do not occur singly, the exterior and
interior, cold and heat, deficiency and excess syndromes are usually found simultaneously.
For instance, the disease with both the exterior and interior syndromes; the deficiency
syndrome mingling with excess syndromes; intertwinement of the cold and heat syndromes.
Under certain conditions these syndromes are often transformed into one another. For
example, the exogenous pathogens may invade the interior and vice versa the cold syndrome
may be transformed into heat syndrome and vice versa; the deficiency syndrome may be
transformed into the excess syndrome and vice versa. With the progress of disease, some false
appearances contrary to its nature may appear. e. g. ,cold syndrome with pseudo-heat
symptoms and vice versa, deficiency syndrome with pseudo-excess symptoms and vice versa.
Thus, when applying differentiation of syndrome according to the eight principles, physicians
are required not only to have a masterly command of the characteristics of each syndrome, but
also to pay attention to their coexisting, interlacing, transforming, and true or false conditions,
so and so only can the disease be understood in an all-round way. Thereby, providing reliable
basis for treatment.

Yin and yang are a pair of principles used to summarize the other three pairs of principles
and are also the key principles in the eight principles. So the other three pairs of principles are
classified under either yin or yang. Exterior, heat and excess syndromes are classified into the
category of yang, while interior, cold and deficiency syndromes fall into the category of yin.
Yin syndrome is characterized by deficiency of yang-qi and excess of yin in the body. Yang
syndrome in characterized by the hyperactivity of yang-qi and hyperfunctions of the zang fuorgans, resulting from excess of yang-heat in the body. Yin and yang are also used to explain
the pathological changes of the zang-fu organ, eg. yin depletion, yang depletion, yin
deficiency and yang deficiency, etc.

Differentiation of syndromes according to the theory of qi, blood and body fluid is a
differentiating method to analyse and identify the pathological changes of qi, blood and body
fluid according to the theory of qi, blood and body fluid. Qi, blood, and body fluid, are the
material basis for the functional activities of the zang-fu organs, their formation and
circulation depend upon the normal functions of the zang fu organs. Therefore the
pathological changes of qi, blood and body fluid may bring about the dysfunction of the zangfu organs, and the dysfunction of the zang-fu organs will be bound to cause the pathological
changes of qi, blood and body fluid. Hence, both of them should closely coordinate and
complement each other. Qi has many syndromes, which are usually classified into four
classes: qi deficiency, qi sinking, qi stagnation and reversed flow of qi. As concerns blood
syndromes, TCM tends to group them under four heads: blood deficiency, blood stasis, heat in
blood and cold in blood. " Physiologically, they complement each other and, pathologically,
affect each other. Thereby, forming differentiation of syndromes of the same disease of qi and
blood. Clinically, there is qi stagnation and blood stasis, qi deficiency and blood loss,
deficiency of both qi and blood, qi deficiency and blood stasis, and qi prostration resulting
from hemorrhage. Syndromes of body fluid may be classified into two categories:
insufficiency of body fluid and water retention. Insufficiency of body fluid may cause the
clinical manifestations: dryness of the mouth and throat, dry lips and tongue, subsidence of
eyes, dry skin, scanty urine, constipation, a red tongue with scanty saliva and thready, rapid
pulse. Whereas, retention of water may form such pathological substances as water, dampness
and phlegm retention. Usually seen in edema, tympanites and phlegm-retention.

Differentiation of syndromes according to the theory of wei (defensive), qi (vital-qi), ying


(nutrient) and xue (blood) is a differentiating method applied to
analysing and differentiating exogenous febrile diseases. It was developed and created by
YeTianshi in the Qing Dynasty. It supplements the differentiation of syndromes by the theory
of the six meridians and enriches the differentiation of syndromes and treatment for
exogenous febrile diseases in TCM. This theory is the basis used to classify syndromes, to
identify transformation and determine treatment. The theory of wei, qi, ying and xue is of
great practical value because, for one thing, it generalizes the pathological changes of febrile
dis-eases as the four kinds of syndromes: weifen, qifen, yingfen and xuefen, for another, it
represents the four different stages: superficial or deep and mild or serious in the development
of exogenous febrile diseases. It is also believed as a law of the development and changes of
exogenous febrile diseases. Diseases of the wei and qi stages are mild and superficial,
whereas those of the ying and xue stages are deep and serious.

Differentiation of syndromes according to the zang-fu theories a differential method by


which symptoms and signs are analysed to clarity the cause, the location and nature of disease
as well as the conditions between vital qi and pathogens in light of the theories viscera figure
(manifestation) , yin yang and five elements. It is the basis of various hinds of differentiation
of syndromes and the basic diagnostic method of all clinical branches of TCM, and an
important component part of all differential system in TCM. Differentiation of syndromes
according to the theory of the zang-fu organs includes differentiating syndromes of zang-

organs diseases, fu-organ diseases and complicated diseases of both zang-organs with fuorgans.

Differentiation of syndromes acording to the theory of six meridians is a method of


differentiating exogenous diseases in TCM. It was put forward in Treatise on Febrile Diseases
by Zhang Zhonjing-a distinguished physician in the Eastern Han Dynasty. In Light of the yinyang theory, the syndromes of the six meridians may be divided into three yang syndromestaiyang, yangming and shaoyang and three yin syndromes-taiyin, shaoyin and Jueyin.
Thereby providing a basis for differential diagnosis and treatment. Six meridians syndromes
are the reflections of pathological changes in the zang-fu organs and meridians, among which
three yang syndromes take the pathological changes of the six fu organs as their basis, while
three yin syndromes take the pathological changes of the five zang organs as the their basis.

Besides differentiating syndrome in light of the theory of triple energizer is one of methods
of differential diagnosis for febrile diseases, put forward by Wu Jutong, a distinguished
physician of the Qing Dynasty. Wu Shi takes triple energizer as the guiding principle of
differentiation of syndromes of seasonal febrile disease in conjunction with differentiation of
syndromes according to the theory of wei, qi, ying and xue, to emphasizes the pathological
changes of the zang-fu organs related to triple energizer during the course of seasonal febrile
diseases the characteristics of syndromes and the law of transmission and transformation.
Seasonal febrile disease is a general term for all acute febrile diseases resulting from various
warm-heat pathogens in the four seasons. Differentiation of syndromes by the theory of triple
energizer is also the premise and foundation of treatment.

As a whole, conditions of differentiating syndromes are complex, what has been discussed
in this unit is only those common, typical differentiating syndromes, they should be applied

flexibly so as to decide the therapeutic principle on the basis of correct differentiating


syndromes.

Part Eighteen:PRINCIPLES OF PREVENTION AND TREATMENT


:
Prevention and treatment of disease are two principles that must be followed in TCM work.
Both of them are important components of the theoretical system of TCM.

I. Prevention I.
By prevention is meant taking certain measures to avoid the occurrence and progress of
diseases. TCM has always attached great importance to prevention. As early as in Huangdi's
Classic on Medicine, the preventive thought of "preventive treatment of diseases" was
advanced. This theory involves two aspects: preventive treatment before the occurrence of
diseases and preventing deterioration after the occurrence of diseases. Basic Questions states:"
Wise men always give the preventive treatment before a disease occurs and prevent a
disturbance before it starts. Not taking medicine until a disease comes on or not preventing
a disturbance until it starts is no different from not digging a well until one is thirsty or not
making weapons until a battle starts. Isn't that be too late?" After liberation, our government
put forward "put prevention first". It is one of the four great policies of the medical and health
work of China. And it is also a principle of preventing the occurrence and the progression of a
disease in TCM.

......

1. Preventive Treatment of Disease 1.


It refers to taking various measures to prevent diseases from occurring. The occurrence of a
disease is related to both pathogenic factors and vital qi. The former is the important condition
for the occurrence of a disease, which the deficiency of the latter is the intrinsic factor for the
occurrence of a disease. Therefore, preventive treatment of a disease must start with both

strengthening the resistance inside the body and preventing pathogens from invading the
human body. Basic Questions States:" The body with vital qi is never attacked by pathogenic
factors." To prevent the disease from occurring the following preventive measures mucs be
taken.

(1)Streagthening Vital Qi's Capacity to Resist Pathogens (1)


a. Regulating Mental Activities to Maintain the Health a.
b. Keeping regular hours b.
c. Doing regular physical exercises c.
d. Using drug prophylaxis and providing artificial immunization d.

(2) Defending the body against pathogens (2)


a. Keeping away from six exogenous pathogens and pestilence a.
b. Avoiding various infectious diseases and trauma b.
c. Developing hygienic habits and preventing environmental pollution, as well as water and
food contamination c.
2. Preventing the deterioration of disease
2.
Though prevention prior to the occurrence of a disease is the best policy, timely diagnosis
and effective treatment to control the deterioration of disease is also important. Therefore,
once a disease occurs, it should be early treated so as to cure it in its initial stage. Ye Tianshi, a
famous practitioner of the Qing Dynasty, advised:" Be sure to treat the parts which the
pathogens have not involved yet." This is also an important method of preventing the disease
from further deteriorating.

II. Principles of Treatment II.


To study TCM treatment, attention should be paid to the therapeutic principles which must
be followed in the treatment of disease. They are formed under the guidance of holistic
concept and TDS, and they have the guiding significance for establishment of the therapeutic
principles and prescriptions of a recipe. Therapeutic principles differ from therapeutic
methods. The former refer to the general principles for guiding therapeutic methods, while the
latter are the concrete methods of treatment under the guide of the therapeutic principles.
There are different kinds of therapeutic principles in TCM. For example, treatment aiming at
the primary cause of a disease, strengthening vital qi and eliminating pathogenic factors,
readjusting yin and yang, regulating the zangfu's functions, regulating qi-blood and treatment
in accordance with the three factors( Climate, locality and individual).

()
1. Treatment Aiming at the Root Cause of a Disease
1.
By treatment aiming at the root cause of a disease is meant treating a disease on the basis of
its root cause. It is not until the fundamental cause of a disease is found out that it is possible
to get to the essence of the problem and to make a proper treatment. Basic Questions points
out, " In treating search for the its root cause of a disease of a disease in treatment. " When
treatment aiming at the root cause of a disease is used clinically, routine treatment or contrary
treatment and treating the primary (ben) and or treating the secondary (biao ) must be dealt
with correctly.

Routine treatment includes the following methods: treating cold syndrome with hot natured

drug, treating heat syndrome with cold natured drug, treating deficiency syndrome by
replenishment, treating excess syndrome by purgation, etc.

Contrary treatment has the following methods: treating pseudo-heat syndrome with hotnatured drugs, treating pseudo-cold syndrome with cold-natured drugs, treating obstructionsyndrome with tonification and treating diarrhea with purgation.

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

2. Strengthening Vital Qi and Eliminating Pathogens. 2.


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

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

They have the following methods: driving out pathogens first and then strengthening vital
qi, strengthening vital qi first and then eliminating pathogens and strengthening vital qi and
eliminating pathogens simultaneously.

Strengthening vital qi and eliminating pathogens supplement each other: the former helps

the elimination of pathogenic factors and the latter helps strengthening vital qi. So, clinically,
they should be applied in the light of the variations of the cases.

3. Readjusting Yin and Yang. 3.


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

Besides, regulating zang-fu's functions and qi-blood relationship are also two important
therapeutic principles. Space lacks for a detailed description of it.

4. Treatment in Accordance with Three Factors (climate, locality and individual). 4.


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

Beside the above contents, we want to talk about therapeutic methods of TCM. Traditional
methods fall into eight categories.


a. Diaphoresis a.
One of the eight therapeutic methods, which is expelling superficial pathogens by opening
the pores of the skin, and regulating the function f ying and wei. It possesses the actions of
antipyretics, promoting eruption, reducing edema and rheumatism, etc.

b. Emesis b.
Emesis is a treatment to use emetics or physical stimulation to induce vomiting for the
removal of retained toxic substances in the throat, chest or stomach. But emesis is prohibited
for pregnant women and must be applied cautiously to the weak.

c. Purgation c.
This is the therapeutic method for eliminating the undigested food, potent excessive heat
and fluid by the application of potent or mild purgatives, generally classified into purgation
with cold natured drugs, that with warm natured drugs, that with lubricant natured drugs and
hydropathic therapy.

d. Mediation d.
It is a treatment to dispel the pathogenic factors of shaoyang ( half-exterior and half-interior
) and
regulate qi and blood of zang-fu organs by the application of drugs with actions of
dispersion and regulation, including relieving shaoyang disorder, dispersing stagnated liver-qi,
regulating the function of the liver and spleen or of the liver and stomach, etc.

e. Warming e.
Warming, as the term suggests, is a therapeutic method using drugs of warm and hot nature
to treat cold-syndrome, dispelling cold by warming middle energizer expelling and helps
recover yang, removes cold by warming and meridians, restoring yang from collapse and
regulating the blood vessels, etc.

f. Heat-Clearing f.
It is an effective method to clear away pathogenic heat and fire with drugs of cold and cool
nature, applicable to excess-heat syndromes.

g. Resolution g.
A therapeutic method for dispelling pathogenic sthenia by removing retained food and
masses due to stagnation of qi, blood stasis, phlegm, undigested food, including regulating the
flow of qi, promoting blood circulation, removing dampness through diuresis, dispelling
phlegm, etc.

h. Tonification h.
It's a therapeutic method for various kinds of deficiency syndromes due to insufficiency of
yin and yang, qi and blood, generally classified into invigorating qi, enriching blood,
invigorating yang, nourishing yin.

In clinical practice, any of the therapeutic methods mentioned above is unlikely to satisfy
the treatment of, especially, complicated cases, so, to keep all the aspects in view, two or more
are usually employed in coordination.