Therapeutic principles and therapeutic methods are different. The former guides the latter and the latter specifies the former. Their difference is relative. In fact, some minor therapeutic principles are quite similar to certain major therapeutic methods and vice versa. The so-called "major therapeutic method" in clinic can be taken both as a therapeutic method and a therapeutic principle.
Therapeutic principles are decided according to the concept of holism and treatment based on syndrome differentiation, clinically guiding the composition of prescriptions and the selection of herbs.
Concentrating treatment on the root cause
Treating biao in emergency
This means to treat the secondly symptoms first and then deal with the root cause in emergency. These symptoms are usually acute and bring on great suffering to the patients, or threaten life or tend to transmit and change. If they are overlooked, the pathological conditions may be aggravated or make it difficult to treat "ben".
Clinically the following symptoms can be regarded as acute symptoms requiring immediate treatment: massive hemorrhage, extremely high temperature, sharp pain, violent vomiting or diarrhea, constipation and anuria, severe abdominal distension and fullness, serious ascites and edema, dyspnea and inhibited respiration, and mania, etc. In any case immediate measures should be taken to deal with these acute symptoms no matter what disease it is.
Treating biao in emergency does not contradict concentrating treatment on the root cause. The former paves the way for the latter. When acute symptoms are relieved, treatment can be concentrated on the root cause. In fact treating biao in emergenoy is an emergent treatment. For mild cases, the treatment should certainly focus on the root cause.
Clinically you may encounter disease marked by emergency or non-emergency of both the biao. In any case simple treatment of the biao or the ben is ineffective. The right way to deal with this case is to focus the treatment on both the ben and the biao. For example, impairment of yin by pathogenic heat and exhaustion of yin-fluid are the ben, while abdominal fullness, hardness and pain as well as retention of dry feces are the biao. This disease is ob'4ously marked by emergency of both the biao and the ben. So the treatment of purgation and nourishing yin has to be resorted to in order to relieve abdominal fullness, hardness and pain, eliminate constipation and restore yin-fluid. If a weak person is attacked by exogenous pathogenic factors, simple treatment of supporting healthy qi to consolidate constitution cannot remove exogenous pathogenic factors, while simple treatment of eliminating pathogenic factors and the biao will further exhaust healthy qi. The right way to deal with this problem is to treat the ben and the biao simultaneously by means of supporting healthy qi and relieving the superficies.
"Ben" (root) and "biao" (branch) are two relatively opposite concepts with varied connotations in different cases. In exogenous diseases, the invasion of pathogenic factors is ben and the disorder of visceral qi and blood is biao. In endogenous diseases, the disorder of visceral qi and blood is ben and the clinical "manifestations are biao. In terms of etiology and symptoms, the cause of disease is ben and the symptoms are biao. In terms of the sequence of diseases, old disease and primary disease are ben while new disease and secondary disease are biao. In the expression "concentrating treatment on the root cause", "ben" emphasizes the cause of disease while "biao" refers to the clinical manifestations.
Concentrating treatment on the root cause means to find the root cause of a disease and focus the treatment on it because the root cause is responsible for the emergence of syndrome. For this reason the process of searching root cause is the same as that of syndrome differentiation. That is why treatment based on syndrome differentiation becomes a typical feature of TCM.
For each disease, there are various symptoms, but the root cause is just one. If you find the root cause, you can successfully treat any disease no matter how complicated it is. If you cannot find the root cause of a disease, it is very hard for you achieve successful treatment. Take headache for example. It may be caused by exogenous factors or endogenous factors. Only when the root cause is found can it be successfully treated. Exogenous headache can be treated by external relief therapy with acrid and warm herbs if it is caused by pathogenic wind-cold or by external relief therapy with acrid and cool herbs if it is caused by wind-heat. Endogenous headache may be caused by insufficiency of yin-blood, blockage of vessels, upward disturbance of phlegm-dampness and hyperactivity of liver-yang. So different therapeutic methods have to be used to deal with endogenous headache due to different causes, such as nourishing yin and invigorating blood, activating blood to resolve stasis, drying dampness and resolving phlegm, and soothing the liver and suppressing yang, etc.
Contrary treatment is just the opposite of routine treatment. The latter refers to treatment opposite to the nature of disease, suitable for the treatment of a majority of diseases. For example, treating cold syndrome with heat herbs, treating heat syndrome with cold herbs, treating deficiency syndrome with tonic herbs and treating excess syndrome with herbs for eliminating pathogenic factors are all routine therapeutic methods that are opposite to the nature of disease and agree with the principle of concentrating treating on the root cause.
Contrary treatment means treating disease according to its false manifestations. The false manifestations of a disease do not agree with the nature of the disease. Cares should be taken to find the root cause and not be puzzled by the false manifestations. Since contrary treatment just agrees with the false manifestations, it is in fact opposite to the nature of the disease. In this sense contrary treatment is also a kind of routine treatment.
Routine treatment is an inhibiting therapy while contrary treatment is an inducing therapy. For example, emetic therapy, instead of the therapy for stopping vomiting, is used to treat nausea and vomiting caused by retention of phlegm in the upper energizer; purgation, instead of the therapy for stopping diarrhea, is used to treat diarrhea due to accumulation of dampness in the lower energizer. Contrary treatment also can be used to treat disease at the initial stage with predominant pathogenic factors which cannot be treated by inhibiting therapy.
The following are some of the commonly used contrary therapeutic methods.
Treating false heat syndrome with hot-natured herbs. That means to use hot-natured herbs to treat disease with false heat symptoms. This therapy can be used to treat syndrome of real cold and false heat due to exuberant internal cold that drives yang outward. Take the case of extreme deficiency of kidney-yang and exuberance of internal cold for example. It is marked by cold feet and hands on the one hand, and no aversion to cold and reddish complexion on the other. These manifestations actually indicate predominance of cold drives yang floating outside. Since the root cause is internal exuberance of yin- cold, warm herbs should be used to treat real cold. When the real cold is eliminated, false heat disappears naturally.
Treating false cold syndrome with cold-natured herbs. That means to treat disease with false cold symptoms with cold-natured herbs. This therapy can be used to treat syndrome of real heat and false cold due to exuberance of internal heat that drives yin outside. Take syncope in febrile disease for example. Though there are symptoms of high fever, dysphoria, thirst and preference for cold water, but the four limbs are cold and the pulse is deep. It is a syndrome caused by deep latent heat that prevents yang from extending to the external. Since exuberance of internal heat is the root cause, cold herbs must be used to treat real heat. When the real heat is eliminated, false cold disappears naturally.
Treating blockage with tonic herbs. This therapy can be used to treat syndrome of real deficiency and false excess due to hypofunction of the viscera caused by decline of qi and blood. Take abdominal distension in patients with spleen deficiency, constipation in old people due to deficiency of qi and blood and amenorrhea due to exhaustion of blood for example. These syndromes are all marked by real deficiency and false excess and cannot be treated by purgation. Instead, nourishing therapy should be used to promote the flow of qi and blood, invigorate the functions of the viscera and dredge the meridians and collaterals.
Treating outthrust with dredging therapy. This therapy can be used to treat outthrust syndrome due to internal accumulation of pathogenic factors. For example, sweating due to attack of pathogenic wind, diarrhea due to food retention, sudden uterine bleeding due to blood stasis and urgent and frequent urination are all outthrust syndromes of excess in nature. However, they cannot be simply treated by astringing therapy, otherwise pathogenic factors will be retained inside. The right way to deal with them is to induce the pathogenic factors to leave the body with dredging therapy.
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