The ancient concepts of Chinese Medicine by Dr (TCM) Attilio D'Alberto Download History The history of traditional Chinese medicine dates back thousands of years and is clouded in an ancient culture, which has survived time, religion, politics and war. One of the most important shifts in theory came from the transcendental texts of the I Ching. It was from there that the theories of Qi movement within nature derived: the theory of Yin and Yang. This theory represents the duality of our universe: water, fire, descending, rising, contraction and expansion etc, where Yin and Yang are in a constant state of dynamic transformation, interplay and balance. It is a philosophical concept in constant flux, therefore it is never fixed, but in a state of continuous mutual change, consumption and support. Chinese Medicine has been more notably concerned with the nature of the cosmos in relationship to the human being. In ancient China, medicine changed its explanations of disease and healing from a transcendental basis to one in which the natural elements were governed within the law of the cosmos. It is not surprising that there are twelve major meridian channels which correspond to the months in a year and the 365 acupuncture points which relate to the number of days in a year. The first written text, the Huang Dei Nei Jing Su Wen first appeared around 200BCE. Chinese theory was orientated greatly and politically with the shifting of views from Daoism to Confucianism to Buddhism to Communism. However, at the heart of this continual adaptation to its social, cultural, religious and political surroundings, lie four major classical texts, the Huang Di Nei Jing Su Wen (Yellow Emperor's Classic of Medicine), the Shen Nong Ben Cao (Divine Husbandman's Materia Medica), the Nan Jing (Canon of Problems) and the Shang Han Lun (Treatise on Cold-Damage Disorders). Herbal medicine, acupuncture, gua sha, moxibustion and cupping make up the healing system of Chinese medicine. The literature discussing these different styles is vast and out of the scope of this paper. Therefore, the focus shall be restricted to Chinese herbal medicine. Diagnostic procedures The Five Phases is one of the most important theories in Chinese medicine. It forms the cornerstone of Zangfu interaction (figure 1). For example, the Heart is Fire and generates Earth, the Spleen. Earth in turn generates Metal, the Lung, thus the Spleen is the mother of the Lung as well as being the son of the Heart. A patient's signs and symptoms are broken down and categorised into a pattern differentiation (Bianzheng). This allows the physician to understand which organ(s) are disharmonised, the pattern and movement of the disharmony from one organ to another and its origin. The internal organs are divided according to Yin and Yang. The hollow, empty organs (Fu) are Yang, Large Intestine, Urinary Bladder, Gallbladder, Stomach and Small Intestine, whilst the full (Zang) organs are Yin, for example the Heart, Liver, Spleen, Lung and Kidney. Together they are known as the Zangfu. Each Yin organ is paired with a Yang organ. Disease pathology is categorised according to Wu Xing (Five Phase theory); metal, water, wood, fire and earth. Each Zangfu presents not only a phase, but also a colour, emotion, animal, planet, season, etc. Figure 1. The generating sequence of the Five Phases. Within Five Phase theory is the controlling sequence. Here each of the Five Phases controls the next (figure 2). For example, Water controls Fire, Fire controls Metal, Metal controls Wood, etc. The third sequence is known as the insulting sequence (figure 2). Here, the controlling sequence is reversed, so Wood insults Metal, Metal insults Fire and Fire insults Water. Figure 2. The controlling and insulting sequence of the Five Phases. A patient's signs and symptoms correspond to identifiable patterns that illustrate a particular organ disharmony as well as the nature of the disharmony, falling within one of the eight principles, whether it is with the organ's Yin or Yang aspect, Xu (Deficiency, Emptiness) or Shi (Excess, Fullness), or whether the disharmony involves the Nei (Interior) or Wai (Exterior) part of the body or whether it is a Re (Hot) or Han (Cold) pattern. Chinese medicine focuses chiefly on the differences of the pathogenesis, that being the syndrome rather than the disease itself. From there a treatment strategy (Lunzhi) is used to treat either the branch (Biao) (often the presenting symptoms) or the root (Ben) cause, or both. A number of pathogenic factors cause or trigger disease: extremes in the environment, when the six normal climatic conditions (Feng-Wind, Re-Heat, Han-Cold, Shi-Damp, Shu-Summerheat and Zao-Dryness) transform into the Liu Xie (Six Climatic Evils). Chinese medicine also recognises other pathogenic factors, including Du (Toxins), Dieda (Trauma), Chong (Parasites) and Wen Bing (Febrile Diseases) and Li (Pestilence). Lifestyle factors also play an important role in the formation of a disharmony. They include diet, sexual activity, exercise, emotions, etc. Treatment Strategies The Huang Di Nei Jing Su Wen was the first text to record the treatment strategies used in Chinese herbal medicine. It wasn't until the Qing (1644-1911) dynasty that the physician Cheng Zhong-Ling organised and categorised the eight basic strategies known as the Yimen Bafa (Eight Methods in Therapy) and recorded them in the classical text, 'Yixue Xinwu' ('Medical Revelations'). The eight strategies are categorised according to their therapeutic action. Han Fa (Sweating) Tu Fa (Vomiting) Xia Fa (Draining Downward, Purgation, Diuresis) He Fa (Harmonizing) Wen Fa (Warming) Qing Fa (Clearing) Xie Fa (Draining, Reducing) Bu Fa (Reinforcing, Tonifying) Han Fa (Sweating) The sweating strategy induces perspiration to regulate the Lung Qi. This facilitates interaction between the Ying (Nutritive) and Wei (Protective) Qi, allowing for the release of pathogens from the exterior of the body. It is used in patients with Wind-Heat or Cold patterns. Tu Fa (Vomiting) Vomiting is rarely used today except in acute Neishi (Interior Full, Excess) conditions or in emergency or life-threatening conditions. Its violent action injures Yin and the stomach and should therefore only be used in patients with a strong constitution. Xia Fa (Draining Downward, Purgation, Diuresis) This strategy induces defecation to purge the bowels by irritating or stimulating the intestines to treat Neishi (Interior Full, Excess) conditions. For example to either drain Heat and move stools, Warm the Yang and guide out accumulation, moisten the intestines and unblock the bowels or drive out excessive water. He Fa (Harmonising) Harmonising can expel pathogenic factors and also tonify the Zheng Qi (Genuine Qi). It is used to harmonise the Shao Yang (Little Yang) when the pathogen lays half-way between the Waishen and Neishen (Exterior and Interior of the body), or harmonise the Zangfu organs that are affected simultaneously. It is also used for complex conditions such as Hot and Cold combinations or those that present with Emptiness with Fullness. Wen Fa (Warming) This strategy is used to warm the Yang. It is used to eliminate pathogenic Cold conditions of both Shi (Excess, Fullness) and Xu (Deficiency, Emptiness) in either the Interior or Exterior of the body. For example, to Warm the channels and disperse Cold, restore and revive the devastated Yang and Warm the menses and dispel Cold. Formulation of herbal prescriptions Once a pattern differentiation has been concluded and an appropriate treatment plan formulated, the practitioner must select from the vast array of herbal formulas and individual herbs to create a balanced prescription to meet the unique needs of the patient. Herbal formulas are strong, fast acting and can be modified to meet any requirements. They are the preferred method of choice for most practitioners. Powders, pills and tablets are a lot easier to administer but are weaker and cannot be modified as easily. All formulas use a hierarchy that divides up the importance of each herb and its relevant function. The emperor (king or chief) has the greatest effect upon the principal pattern or disease. The minister (deputy) aids the emperor and treats coexisting symptoms. The assistant reinforces the emperor and minister, treats less important coexisting symptoms and moderates the adverse effects of the emperor and minister. The envoy (messenger, guide) guides the formula to a particular channel and harmonises the other ingredients. Herbal formulas are made up of herbs, minerals and animal products. As formulas have actions, indications, contraindications and dosages so do the individual medicines that make up the formula. However, individual medicines have more characteristics than formulas, including five different tastes (acrid, sweet, bitter, sour, salty and bland), properties (hot, cold, warm, cool and neutral), antagonist, agonist and Zangfu channel aspects. There are over 5000 different individual medicines. Individual medicines can be made up of root, bark, leaf, flower, fruit, peel, sap, resin, or combinations. Evaluation of safety The safety of herbal medicine has been controversial in recent years. Some notable bans have been placed upon certain herbs. This has arisen chiefly from unqualified persons selling Chinese herbs in various forms on the open market without the use of Chinese theory, diagnostics or treatment strategies. As statutory regulation sweeps through many countries, the standards of herbal medicine shall improve, placing restrictions on those prescribing herbs. As this happens, calls for the reintroduction of banned herbs can begin. Other issues of safety include the efficacy of individual medicines and those of formulas. As each and every formula is tailor made to the exact needs of the patient's disharmony, it does not allow itself to be effectively tested using the standard research protocols of randomised controlled trials (RCTs). However, in certain instances where certain disorders are treated using a standard formula, often available in pill form, tests can be conducted. In such instances, researchers test a formula's effectiveness without including the theories of Chinese medicine. For example, in allopathic medicine a headache is treated using a common analgesic. In Chinese medicine, headaches are further categorised into ten different syndromes, each one having a unique diagnosis, treatment strategy and corresponding formula. The inclusion and exclusion criterion set in all RCT's does not take these further categorisations into account. Therefore, results end up being muddled and flawed. Conclusions Chinese medicine is as vibrant and useful today in our multicultural society as it was thousands of years ago in ancient China. For those interested in Chinese medicine's theories, a good place to start is by reading this book: Kaptchuk, T. (2000). The Web that has no Weaver: Understanding: Chinese Medicine.