Treating the Root, and Distinguishing the Primary vs Secondary and Urgent vs Less Urgent
Section 2 Principles of Treatment
Over long periods of clinical practice, doctors of traditional Chinese medicine throughout the ages have accumulated a wealth of clinical experience, and have deeply understood the rules regarding the occurrence and development of diseases. Relying upon this understanding, they have created a complete system of theories and methods of differentiation and treatment of diseases. Differentiation and treatment of a case consists of two processes: one is to apply the theories of TCM to analyze the symptoms; and based upon this diagnosis, the other, and more important process, is to formulate appropriate principles of treatment, choose suitable therapeutic methods, and administer effective medicines or other therapeutic measures. In clinical practice, the determination of the principles of treatment and the choosing of therapeutic methods are significant for the achievement of curative effects.
Principles of treatment refer to the rules about treatments of diseases. They are for mulated under the concept of integrity and the concept of treating diseases depending on the differentiation of symptoms and signs. So the principles of treatment are of universa significance for choosing methods and prescribing medicine in all clinical specialties.
Principles of treatment differ from concrete therapeutic methods, as the former are general instructions for the treatment of all kind of diseases, while the latter are concrete methods against a particular disease or a specific sort of disease; the former guides the adoption of the latter. So therapeutic methods are subordinate to principles of treatment.For example, strengthening the genuine-qi to eliminate the evil-qi is a universal principle of treatment for all diseases because the pathological generalities of all diseases include a struggle between the genuine-qi and the evils, and the wax and wane changes of yin and yang. Being instructed by this general principle, doctors can adopt concrete strengthening methods such as invigorating qi, nourishing yin, replenishing blood, tonifying yang, and so on, as well as eliminating methods such as diaphoresis, emesis, purgation and the clearing method. It is thus clear that there are close internal relations between the principles of treatment and therapeutic methods. It is erroneous to confuse them with each other.
Symptoms and signs of diseases are varied, their pathogenesis are complicated, and patients' conditions are different in their degrees of seriousness. Furthermore, there are many factors such as time, the patient's residence, age, and individual constitution which may influence the state of illness. It therefore is necessary to explore the causes of disease and grasp its essence through differentiating its complicated and changeable appearances, and then to determine the therapeutic method according to the cause of disease. This entails regulating the body's yin-yang state, and restoring the balance. Only through this can good effects be achieved.
There are six main principles of treatment: treating the root of disease; strengthening the genuine-qi to eliminate the evil-qi; regulating yin and yang; regulating the viscera's functions; regulating qi; and treating patients in accordance with the Three Factors.
I. Treating the Root, and Distinguishing the Primary vs Secondary and Urgent vs Less Urgent
1. Distinguishing Root vs Branch, Urgent vs less Urgent
Treating the "root" of disease means to search for the underlying causes of disease and administer therapeutic methods against it. This principle is a basic one in treatment based on syndrome differentiation.
"Root" is opposite to "Branch. " In the process of the occurrence and development of a disease, there are always primary and secondary contradictions; and the primary contradiction or the primary aspect of a contradiction is the "root," while the secondary contradiction or the secondary aspect of a contradiction is, comparatively speaking, the"branch. " The "root" has a dominating effect on the "branch"; while the "branch" is subdominant to the "root". So "root" and "branch" are comparative concepts; they have a variety of meanings and can be used to indicate the relations between primary and secondary contradictions, or the primary and secondary aspect of a contradiction in any pathogenic process. For example, when the genuine-qi and evil-qi are being discussed,the genuine-qi is "root" while the evil-qi is "branch"; when the cause of disease and its symptoms are discussed, the cause is "root" while its symptoms are "branch"; when pathological sites discussed, viscera's pathogenic change is "root," while that in the superficial parts of the body are "branch"; when the order of occurrence of diseases is discussed, o1d illness is "root"; while newly occurring illness is "branch"; and finally, primary illness is "root," while secondary illness is "branch".
The occurrence and development of a disease can manifest by its symptoms, but symptoms are only the appearance of the disease rather than its essence. Only by completely collecting, deeply understanding, and comprehensively analyzing the clinical mate rial can one see through the appearance to the essence, find the underlying causes and adopt suitable therapeutic methods. For example, headache can be induced by various causes such as exogenous evils, blood deficiency, phlegm-dampness, blood stasis, ascendant excessive liver-yang, and so on. So when treating headache, one can not simple use analgesic method; the right way is to search for the underlying causes of the headache by comprehensively analyzing the clinical materials, and then to adopt the method of dispelling superficial evils, enriching the blood, drying dampness, and resolving phlegm, activating blood circulation, and removing blood stasis, or subduing liver-yang respectively.
Treating the root of disease refers to three aspects: ˘Ů treating the branch first in emergency cases;˘Útreating the root in less urgent cases; and ˘Ű treating both root and branch simultaneously.
1) Treating Branch First in Emergency Cases
The primary contradiction or the primary aspect of a contradiction is root, not branch. Usually treating the root of a disease is the cardinal principle. But in some corn plicated and variable cases, the primary (root) and the secondary (branch) may transform into each other, and some conditions should be treated first or immediately, while some conditions can be dealt with afterward. For instance, if a serious complication takes place in the developing process of a disease, this complication, although a branch, is an emergency and should be resolved promptly; otherwise it will endanger the patient's life or hinder the treatment of the root (the primary disease). In this condition, doctors ought to apply the principle of treating the branch first in emergency cases. For example, in massive hemorrhage, emergency measures must be taken to stop the bleeding first regardless of the cause. Only when the bleeding is stopped and the patient's condition relieved,can one treat the root, that is, to try to remove the cause. Another example is a patient with a chronic disease who has a newly suffered exogenous evil. In this condition, if the newly developed disease is urgent, one must dispel the exogenous evil (treating the branch) first; and only when the exogenous syndrome is cured, can one treat the chronic disease (treating the root). It is notable that treating branch in emergency cases is an expedient measure; but treating the root is the measure taken to eradicate the disease.
Treating the branch in emergency cases can relieve an urgent condition, or can cure the newly-developed illness, and this is of much help to the treatment of root, so its purpose is still to further the treatment of the root. However, the methods of treating the branch only can be used temporarily, otherwise they may damage the body's genuine-qi.
2) Treating the Root in Less Urgent Cases
This principle means that in ordinary conditions, doctors must seize the essence of a disease, administer treatment against the root cause of the disease, and resolve the basic contradiction. For instance, pulmonary tuberculosis is, according to TCM theories, a syndrome with symptoms such as cough, low fever, dry mouth and throat, hot sensation in the five centers, red cheek and night sweat. These symptoms are induced by yin deficiency and endogenous heat, and by the deficiency fire injuring the lung. The symptoms are branch, while yin deficiency, endogenous heat, and the lung injured by fire are root.S0 for treating this syndrome, one ought to nourish yin and moisten the lung, to resolve the contradiction of yin deficiency, rather than attempting to remove phlegm and relieve the cough. Only by improving the body's resistance to disease, can this syndrome be cured.
3) Treating Branch and Root Simultaneously
This principle is also commonly used in clinical practice. When both branch condition and root condition are serious and urgent, one should treat the root and, at the same time, treat the branch. For example, febrile disease with exogenous heat invades into the interior of the body, leading to interior syndrome which lasts for a long period of time and consumes body fluid. These pathogenic changes induce symptoms such as fullness, hardness, and pain in the abdomen, constipation, fever, dry mouth and chapped lips, and scorched coating of the tongue. In this case, the genuine-qi is deficient, the evil is excessive, and both the branch condition and root condition is urgent, so one should give consideration to both the root and branch, by administering both purgative therapy and yinnourishing therapy at the same time. That is to treat the root by purging the excess heat,and to treat the branch by nourishing yin and replenishing the body fluid. Otherwise, if only purgative therapy is used, it will damage the body fluid further; and if only nourishing therapy used, it will not eliminate the excessive heat in the interior. Furthermore, to purge the excessive heat has the effect of saving body fluid, and can help the purgation ("adding water to sail the boat"). So combining these two therapies, treating branch and root simultaneously, with the two measures supplementing each other, makes it possible to achieve the objective of removing the evil and replenishing the body fluid.
Another example is dysentery, which usually has symptoms such as abdominal pain, mucous bloody stool, tenesmus, yellow greasy coating of the tongue, and a rapid slippery pulse. The cause of this disease, the root, is dampn-heat. So the method of clearing away damp-heat should be taken to treat the root; but at the same time, one should adopt a therapy of soothing the intestines and regulating qi to relieve the abdominal pain and tenesmus, because these symptoms are severe. There are other examples as well such as interior syndrome with a complication of exterior syndrome, which is caused by exogenous evil, and persistent exterior syndrome with a complication of interior syndrome. In these conditions, exterior syndrome and interior syndrome coexist in the same patient, and both are urgent and should be treated at the same time.
It must be pointed out that these two principles, treating branch first in emergency cases and treating root in less urgent cases, should not be applied in a mechanical way.Sometimes, the root of a disease also should be treated in emergency cases, for instance,in syndrome of yang depletion, the method of restoring yang urgently is taken to rescue the patient from collapse, and this is the treatment of root; when dealing with exhaustion of qi which occurs after massive hemorrhage, the method of replenishing qi is taken to stop bleeding, and this is also treatment of root. On the other hand, in less urgent cases,it is not forbidden to treat branch. Treating branch sometimes can help the treatment root. Generally speaking, to treat what is urgent is a basic principle, regardless of branch and root. In clinical practice, to recognize the transformation of branch and root, and then to seize the primary contradiction or the primary aspect of a contradiction, and to treat disease from the root, is most important.
2. Routine Treatment and Contrary Treatment
In Chapter 74 in Plain Questions, two principles are raised: "Use routine treatment against the nature of a disease; use contrary treatment according to the nature of a disease. " Both of these two principles are concrete reflections of the basic principle of treating diseases from the root.
Routine treatment refers to the treatment by which clinicians, through analyzing the symptoms and signs, and based upon differentiating the diseases' essences of cold, heat,deficiency or excess, use recipes opposite to the nature of the disease. For example, drugs of hot nature are used for cold syndromes, drugs of cold nature are used for heat syndromes, reinforcement is used for deficiency syndromes, and reduction is used for excess syndromes. This is why the treatment against the nature is called routine treatment, and also called "allotherapy. " It is the most commonly used therapy because the appearances of most diseases are consistent with their essences. For example, cold syndromes show appearances of cold characteristics; deficiency syndromes show appearances of deficiency characteristics, and excess syndromes show appearances of excess characteristics.
In some cases, especially those which are complicated and serious, the appearance of the disease may be not consistent with its pathogenic essence, and false appearances may be seen; clinicians thus must see through the false appearances to the essences and treat them, rather than simply administer therapeutic methods to treat cold syndromes when seeing cold appearances, or simply administer drugs to treat heat syndrome when seeing heat appearances. For example, in certain cases of exogenous febrile diseases, yin is expelled from the interior part of the body to the exterior of the body by exuberant yang when internal heat is extremely excessive, and the symptoms look like cold syndrome. These are pseudo-cold appearances, and excess heat is the essence of the disease. So drugs of cold nature are still needed for treatment. This application is called"using medicines of cold nature to treat pseudo-cold syndrome. "
In the cases of prostration syndrome with yang depletion, yang is expelled from the interior of the body to the exterior by exuberant yin when internal cold is extremely exrecessive. The symptoms look like appearances of heat syndrome. The cold symptoms are the essence of the disease. So drugs of a hot nature are still needed for the treatment. This application is called "using medicines of hot nature to treat pseudo-heat syndrome. "
In certain cases of spleen deficiency and dysfunction, the method of strengthening the spleen and replenishing qi is taken to treat the fullness and distention in the epigastrium and abdomen, since these symptoms are not caused by water-dampness or food retention. This is an example of using tonifying therapy to "open" a "blockage," so this application is also called "to block up for a blockage. "
In the case of diarrhea due to the failure of spleen to transport its essence, which is caused by food retention, recipes with the effects of removing and purging the retaining food should be administered in order to achieve a cure, rather than anti-diarrhea medicines. This application is also called "to drain for a drain. "
The principles mentioned above, e.g. , using medicines of cold nature to treat pseudo-cold syndrome, using medicines of hot nature to treat pseudo-heat syndrome, to block up for a blockage, and to drain for a drain, reflect the method of using drugs agreeing with the nature of disease in treatment. This method differs from ordinary or routine treatment, so it is called "contrary treatment" or "homo-therapy. " In fact, the contrary treatment is, in its essence, the same as routine treatment, for the appearances with which treatment is in accordance are false ones. Contrary treatment is also treatment against the essences of diseases, and it accords with the principle of treating diseases from the roots.
In addition, there is still another method, routine treatment with contrary adjuvant,which was also put into the category of contrary treatment in some works by ancient doctors. It is usually used in the case of extreme heat syndrome or cold syndrome in which vomit appears as a reaction of refusal between the disease and the medicine taken by the patient. In order to prevent this kind of reaction and bring the medicine into full play, a small amount of contrary adjuvant drugs of hot nature (or cold nature) are added into a recipe of extreme cold nature (or hot nature). Since "like attracts like," the disease could not refuse the medicines. In fact, the contrary adjuvant is included in recipe-organizing and medicine-taking, and it belongs to the scope of formula-ology. It will not be discussed in detail in this work.
