Treatments in Correspondence to Seasons, Geographical Envircnment and Individuality
IV. Treatments in Correspondence to Seasons, Geographical Envircnment and Individuality
1.Treatment in Correspondence to Seasons
The climates of the four seasons can, to a certain degree, influence the physiological functions and pathological changes of the body. To select recipes and drugs according to the characteristics of the climates of different seasons is the main meaning of the principle of "treatment in correspondence to seasons. " Generally speaking, from spring to summer, the temperature increases, and yang-qi in the natural world ascends more and more; and the interstitial space of the tissues become correspondingly looser. So when treating exogenous cold syndrome in spring and summer, drugs that are hot in nature and pungent in taste should be utilized cautiously so as not to disperse outward the genuine-qi excessively. In autumn and winter, the temperature decreases, and yin is predominant, while yang is comparatively insufficient. The interstitial space of the tissues are correspondingly tighter, and yang-qi deepens. So when treating exogenous cold syndrome in autumn and winter, drugs that are cold in property and bitter in flavor should not be administered, otherwise the drugs may impair the body's yang-qi. So it is said in Chapter 71 in Plain Questions: "Don't apply drugs of cold nature in cold weather; don't apply drugs of a cool property in cool weather; don't apply drugs of a warm property in warm weather; and don't apply drugs of a hot property in hot weather. Food also should be used according to this principle. "
Summer-heat is only seen in its own season. It is frequently combined with dampness. So, in treating diseases due to pathogenic summer heat, one should clear away rammer heat and eliminate dampness. In autumn, the weather is dry; so for the treatment of syndromes due to dryness of autumn, one should administer drugs pungent in taste and cool in property to moisten the dryness. The application mentioned above differs from that in the treatments of syndromes due to wind-warm of spring and syndromes due wind-cold of winter. Syndromes due to wind-warm should be treated with drugs pungent in taste and of a cool property to dispel the superficial evils; while those due to windcold should be treated with drugs pungent in taste and of a warm property.
2. Treatment in Correspondence to Geographical Environment
This principle refers to the need to adopt recipes and drugs according to the geographic characteristics of different localities. The human body's physiologic activities and pathogenic changes vary with geographic heights, climates in different localities, and with the living habits of individuals who live in different areas. So therapeutic measures should be suited to these particular conditions.
For example, the northwestern highlands of China are cold and dry, rainfall there is light, and its residents have strong constitutions and are accustomed to diets of meat and milk. So the diseases from which the residents suffer usually are exterior cold syndromes with interior heat, and treatment should be aimed at dispersing the exterior cold and clearing away the interior heat. In the southeastern lowland areas of China, the residency is near the sea and is low in altitude; the weather there is warm or hot, the rainfall there is heavy, the residents' constitution generally are weak, and the interstitial space of tissues are loose. So diseases from which these residents suffer are usually carbuncle, and they also are susceptible to exogenous evils and internal cold-syndrome because their yang-qi disperses outward excessively. When treating these kinds of diseases, one should restrain the dispersing qi and warm the interior of the body. So it is said in Chapter 70 in Plain Questions: Earth differs altitude; chmates differ m temperature. Those who live in high altitude have constitutions of a cold type; those in low plains have constitutions of a hot type," and, "To disperse the evil-qi and cool the body when treating a north-western people; to restrain and warm the genuine-qi when treating a southeastern patient.'
Different doctors of traditional Chinese medicine may treat a specific type of disease with several different therapeutic methods which can achieve the same curative effects.This is due to the fact that the patients live in different regions and they respond to different therapies. So it is said in Chapter 12 in Plain Questions: "Why are diseases of the same type treated with different therapeutic methods and all of them are cured? The answer is that the geographic environment makes this happen. " For example, in the frigid zone of northwest China, there is a larger dosage of drugs pungent in taste and warm in property, and Chinese ephedra and cassia twig are often used. In the temperate zone of southeast China, the dosage of these drugs used in recipes is lower, and Schizonepeta and ledebouriella root are usually used. The application of these types of drugs also reflects the characteristics of geography and climate in different localities.
3. Treatment in Correspondence to Individuality
To administer drugs according to the patient's age, sex, constitution and living
habits constitutes the principle of "treatment in correspondence to individuality. "
1) Age: Persons of different age differ in physiological conditions and in their contents of blood and qi. Therefore, treatments differ among them. In elderly people,
whose qi and blood are deficient, bodily functions are declining, syndromes of deficiency,or syndromes of deficiency with excess evil, are commonly seen. So the method of strengthening the genuine-qi should be applied to replenish the deficiency, while the dispersing method should be cautiously used. The dosage of herbs for the elderly must lower than that for younger patients, in order to avoid impairing the genuine-qi If children, whose body functions are very active, but whose viscera are tender and delicate, do not have enough qi and blood, pathogenesis can change very rapidly and syndromes can transform easily into opposite types. Furthermore, infants and children cannot care for themselves, and they are susceptible to illnesses due to improper diet or climate changes.Thus in treatment of children's diseases, drastic drugs are contraindicated, tonics should be applied less frequently, and dosages must be kept low. It is said in Treatments Based on Ages, in one section of the Treatise on Pestilence: "If the patient is old, drastic herbs are seriously contraindicated. If Purging decoction is needed, one-tenth of the dosage commonly used would be enough. If ginseng and bighead achactylodes rhizome are needed, ten-fold of the dosage commonly used would work well. Since in old people the nutrient-qi and the defense-qi are insufficient, the genuine-qi is weak, easily damaged, and hard to recover. Old people are not like younger patients, whose body functions of qi and blood reproduction are active. Only when the evils are removed, will the genuine-qi quickly recover. So purgatives should be cautiously administered for old patients; and tonics should not be rashly used for youth. These herbs mustn't be applied mechanically, because it must be remembered that there are some conditions in which old people have strong constitutions and younger patients have delicate constitutions. " In these cases, doctors ought to administer drugs according to the specific condition of the patient. Too hrge a dosage may damage the genuine-qi; while too low a dosage will not cure disease.
2) Sex: Physiology differs between males and female. Women experience menstruation, leucorrhoea, pregnancy, and delivery. So clinicians should pay attention to these characteristics in clinical practice. For example, drastic herbs such as those with the effects of purging excess, breaking blood stasis, or those with characteristics of slipperiness, a rushing property, or toxic, are contraindicated or must carefully used in pregnant patients.
3) Constitution: Patients' constitutions may be strong or weak, or hot or cold, and these differences may be innate or acquired. Generally speaking, recipes warm or hot in property should be carefully used on patients with yang-excess or yin-deficiency constitutions; those which are cool or cold in nature should be carefully utilized on patients with yang-deficiency or yin-excess constitutions. Since patients' constitutions may be different, they should be treated separately although they suffer the same disease.
There are additional factors such as profession, working conditions, emotions,
habits, etc. , which also may be related to the development of diseases; doctors should pay attention to these as well.
To sum up the above discussion, it is important to remember that the principle of suiting measures to individuals requires doctors to treat the human body as a whole, to notice characteristics of different patients and not to consider diseases in isolation. The principle of suiting measures to seasons and geographical environment emphasizes the influences of natural environments on the human body. All of these principles embody the holistic concept of TCM. These principles also reflect the steadiness and flexibility of clinical practice. Only by comprehensively understanding diseases, by objectively analyzing concrete conditions, and by suiting measures to seasons, localities and individuals, can the desired curative effects be achieved.
