• Thanh Nguyen

Methods of treatment

There are eight therapeutic strategies [major categories]: sweating, vomiting, purging, harmonizing, warming, clearing, dissolving, and tonifying:

o Sweating: induces mild sweat by ventilating and dispersing LU qi, and regulating and harmonizing the ying and wei levels. Sweating is primarily used to expel pathogenic factors at the exterior (skin) level. Clinical applications include: common cold, influenza, early stages of measles, acute edema (especially above the waist), abscesses and sores with fever and chills, etc.

o Vomiting: induces emesis to elminate phlegm, stagnant food, or toxic materials from the throat, chest and diaphragm, or epigastrium. However, since this method induces qi to move upward and outward, utilization of this results in concurrent vomiting and sweating.

o Purging (draining downward): cleanses the stomach and intestines, induces defecation, and eliminates pathogenic accumulation from the body such as stagnant food, dry stools, cold/hot accumulation, blood stasis, phlegm stagnation, water stagnation, parasitic infestation, etc.

o Harmonizing: regulates and accords complicated patterns of disease that affect multiple parts of the body. Generally used to treat shaoyang syndrome, LR/SP disharmony, etc.

o Warming: warms the interior, dispels cold, restores yang, and unblocks the channels and collaterals. It’s usually used to treat the presence of cold affecting the normal functions of zang fu organs, or stagnation of cold blocking the channels and collaterals.

o Clearing: clears heat, purges fire and cools the blood to treat diseases characterized by warmth, heat, fire, and toxins. It’s also used in cases of heat with complications, such as damp-heat and yin xu fire.

o Reducing (dissolving): dissolves and disperses hardnesses and nodules to treat accumulation and stagnation of various substances, such as food, qi, blood, phlegm, water, and parasites. It is different from purging, which is generally used for acute and excess conditions, reducing is usually employed to address chronic condition characterized by both deficiency and excess.

o Tonifying: nourishes, enriches, supplements, and benefits qi, blood, yin, and yang in the zang fu organs. Tonifying must be used with caution in individuals with concurreny exterior excess and interior deficiency[1].

Treatment strategies/methods of Chinese herbs and herbal formulas are identified by identifying the treatment principle. In order to ustilize the correct method, one must be able to correctly identify the pattern of the disease, otherwise there will be a risk of prescribing the incorrect formula, which may or may not lead to the worsening of symptoms. It’s important to remember that “the formula is derived from the strategy, and the strategy arises from the pattern.” For example, a patient suffering from excess heat versus deficient heat would call for different treatments: one to clear excess heat, while the other need to get tonified in order to resolve that deficient heat.

Once the pattern is identified, then one could consider the treatment principles (of which there are several in CCM):

o Root (ben – the cause) and branch (biao – the manifestation) of a disease. Generally, with acute disorders, treat the branch; with chronic disorders, treat the root. There are also cases where the root and branch could be treated simultaneously – in cases where the patient is weak and the pathogenic influence is strong.

o Normal treatment (zheng zhi) – to treat using things of the opposite nature of the disease: treat cold with heat, treat heat with cold, stagnation by promoting movement, etc.

o Contrary treatment (fan zhi) – for example, treating heat presentation with a warming formula, because the true underlying cause of the heat is cold – si ni tang for instance. Another type of contrary treatment doesn’t necessarily involve “false” symptoms, but simple represent a treatment that’s different from the norm of antagonistic treatment.

o Different treatments for the same disease, or same treatment for different diseases – this depends on the underlying of the disease; if there’s 2 different presensations but caused by the same underlying cause, it could be treated with the same formula, and vice versa.

o One must also take into consideration the season, the environment, and the individual in order to give the most effective treatnents[2]

While there are many ways to categorize formulas, they are often categorized by their functions. The first system to group medicinals substances and formulas by functional categories was first done by Chen Cang-Qi from the Tang dynasty. The original book was lost, but the portion about the categories was preserved in Li Shi-Zhen’s Comprehensive Outline of the Materia Medica. The ten types of formulas are as follow (from Bensky):

However, later, in the Qing dynasty, Wang Ang derived another comprehensive system, seeing that 10 categories were not enough to encompass everything. Wang divided formulas in 22 categories, including categories such as: dispel wind, dispel cold, eliminate phlegm, kill parasites, etc.[3]

While some herbs could be used in their original form, many required processing in order to maximize their benefits. There are 7 main purposes for herb preparation and processing:

o To enhance or alter therapeutic actions – herbs may be processed with honey, vinegar or grain-based liquor, steamed, baked, roasted, or charred to ashes, or cooked for greater/lesser periods of time.

  • § Honey enhances the moisturizing effect of an herb, vinegar facilitates entrance to the LR and treatment of LR disorders, dry-fried incrases the warmth of the herb, harmonizes and moderates therapeutic effects, and facilitates extraction of active constituents.

o To minimize loss of active components – aromatic herbs are generally cooked for shorter amount of time

o To maximize extraction of constituents – some herbs are cooked for prolonged period of time (such as renshen)

o To reduce side effect and/or toxicity – raw herbs such as Chuanwu and Caowu are toxic and should be processed with Gancao to reduce toxicity and minimize side effects

o To increase surface area and facilitate extraction – minerals, seeds, and shells must be crushed

o To prevent spoilage and prolong shelf life – most plant-based herbs or moisture-sensitive substances need to be dried completely prior to storage. Some are soaked in liquor to make herbal wine; the alcohol make an effective solvent to extract active constituents as well as a preservative

o To clean herbs prior to ingestion – to remove dirt, contamination, odor, and inactive components[4]

There are more details and specifics in relation to herbal processing, which will not be discussed in this article.

Some of the concerns with the processing of medicinals, is that when something is so often processed, people tend to forget the benefits of its original form, and that it could be difficult to find the unprocessed form of an herb, as it is almost always processed. For example, the more common form of gan cao is zhi gan cao (honey-fried), which makes it warmer, however, raw gan cao is much better at detoxing, so it is improtant to always note the preferred form of an herb within a formula in order for the formula to serve its purpose correctly.

Different herbs are grown in different regions of China; they are named in various manners: based on geographic location, based on plant life cycles, based on specific parts, on smell and taste, etc. When it comes to place of origin, it is important to know where an herb comes from in order to understand the properties of that herb, as well as to distinguish from another similar herb but from a different region. For example, Sichuan province is commonly abbreviated as chuan. Herbs such as Chuan xiong, Chuan wu, Chuan niu xi, Chuan lian zi, and Chuan bei mu, are most effective if grown and harvested in Sichuan. In Zhejiang province (abbreviated as zhe or hang), there are Zhe bei mu and Hang Ju hua. Henan province is abbreviated as huai, some herbs coming from there are Huai niu xi, Huai shan yao, Huai ju hua. Even though they are “similar”, their properties are slightly different. Take Chuan bei mu and Zhe bei mu for example: while Chuan bei mu is bitter, sweet, slightly cold, zhe bei mu is bitter and cold, and their actions are also slightly different. Regardless, with the increasing demand for herbs nowadays, it is more difficult to obtain an herb from its original climate and often times the herbs need to be cultivated elsewhere, which may reduce its effectiveness or alter its properties.[5]

Additionally, there’s also compass reference in the name of the herb: dong (east), xi (west), nan (south), and bei (north). Such herbs include (but not limited to): Bei sha shen, Bei ban lan gen, Nan sha shen, Nan gua zi, Dong yang shen, Xi yang shen, Xi gua, etc[6].

Classical references such as Suwen 5 and 74 tell us the duality nature of everything, that Yin and Yang always exist together, never by itself. Therefore, when one is out of balance, it affects the other. Moreover, yin and yang are constantly transforming into each other, leading to the progression of diseases. With that understanding, it is important to remember the relationship between Yin and Yang as well as their transformation, so that in the course of treatment, we do not harm one another. For instance, if the pattern is shown to be a Stomach excess, the treatment principle would be to drain the excess, but it should be done in such a way that the Spleen is protected and not harmed from too much draining. As practitioners, we need to be one step ahead of the disease, so that we are able to prevent further damage rather than only temporarily fixing and patching things up once an illness arises.

[1] Chen J, Chen T. Chinese Herbal Formulas And Applications. City of Industry, Calif.: Art of Medicine Press; 2009:9-11. [2] Scheid, Volker, Dan Bensky, Andrew Ellis, and Randall Barolet. Chinese Herbal Medicine: Formulas and Strategies. 2nd ed. Seattle, WA: Eastland Press, 2009

[3]Scheid, Volker, Dan Bensky, Andrew Ellis, and Randall Barolet. Chinese Herbal Medicine: Formulas and Strategies. 2nd ed. Seattle, WA: Eastland Press, 2009

[4] Chen, John K., and Tina T. Chen Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press,Inc., 2004:11-13. [5] Chen, John K., and Tina T. Chen Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press,Inc., 2004:3-9.

[6] Bensky, Dan, Steven Clavey, Erich Stoger, and Andrew Gamble. Chinese Herbal Medicine: Materia Medica. Third edition. Seattle, WA: Eastland Press, 2004.

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