Dispersal and Expulsion: My Understanding of the Fundamental Therapeutic Principles of Chinese Medicine

This is an earlier article I wrote, reorganized and republished today. When I wrote it, my clinical experience was not as rich as it is now, and I inevitably leaned toward Chinese medicine while undervaluing Western medicine, so the article has its flaws. But my humble view also has some merit. So, without undue modesty, I set out these fragmentary opinions for experts to correct.

A healthy body does not fall ill without external stimuli. Whether those stimuli are, in Chinese medicine terms, internal causes, external causes, or causes neither internal nor external, or in Western medicine terms, viruses, bacteria, and mutated cells, their effect on the body is harmful. It is precisely because of these harmful stimuli that people fall ill.

The fundamental purpose of medicine is to correct the harmful effects of these stimuli on the body and bring the body back to normal metabolic function.

Western medicine tries to kill viruses, bacteria, and mutated cells in order to restore health. Chinese medicine places more emphasis on using the body's natural ability to disperse and expel, expelling the various pathogenic factors from the body through multiple routes. Once the pathogenic factors are expelled, the body naturally returns to health; there is no need for an all-out campaign to hunt down and destroy every virus, bacterium, and mutated cell.

So far, most of the drugs humanity has invented to exterminate viruses, bacteria, and mutated cells have toxic side effects on the body's normal cells and tissues. It is the old saying: kill a thousand of the enemy and lose eight hundred of your own. People who are already ill are weak; over-aggressive killing of normal cells or damage to the body's vital organs often means the patient does not die of the disease but of the medicine. Data show that in China as many as 150,000 patients die each year because they took the wrong medicine.

Therefore the therapeutic principles of Chinese medicine differ from those of Western medicine. Chinese medicine is good at using the body's dispersal and expulsion ability to restore health. The three great methods of Chinese medicine for driving out evil—sweating, vomiting, and purging—are all expulsion processes. Through sweating, inducing vomiting, and promoting urination and defecation, the pathogenic factors are expelled; even if some remnant evil remains in the body, the body's normal immunity and dispersal ability can drive it off completely. That is why using rhubarb (Dahuang) to treat persistent dysentery can surprisingly work wonderfully. In treating illness, Chinese medicine often stresses spreading and smoothing the movement of qi, so that the upbearing and downbearing functions of the zang-fu organs return to normal. The upbearing and downbearing function Chinese medicine stresses is very close to the metabolic function that modern biological science has discovered in the human body.

The Japanese scholar Tabuchi Kyushin summarized the pathogenic factors in the body as three poisons: water poison, food poison, and blood poison. According to Tabuchi, the key to treating illness lies in expelling these three poisons from the body. As for what toxins are actually contained in these three poisons: first, the ancients did not have advanced chemical knowledge and could not identify them carefully; second, there was no need to. The human body is a gift of nature, and nature has set countless openings for it: the traditional seven orifices, the sweat glands, and so on, are all the body's finest dispersal and expulsion organs. As long as we use certain means to prompt the various pathogenic factors to be discharged from the body's sweat glands, mouth, and excretory organs, the illness will naturally cease! To this day, for acute drug poisoning, inducing vomiting, inducing purgation, and promoting diuresis remain doctors' best choices, whether in Chinese or Western medicine.

In my view, Chinese medicine's support-the-righteous-qi therapy is also designed to promote the body's normal dispersal and expulsion ability. People who have been ill long and are weak have zang-fu organs and even sweat glands that cannot function normally, so their dispersal and expulsion ability declines; if you forcibly treat them with emetics, diuretics, diaphoretics, and purgatives, you can easily cause severe loss of fluids, blood, and nutrients, leaving them even weaker. If you see such patients and use tonifying herbs or foods to strengthen the normal transformative function of their zang-fu organs, then the dispersal and expulsion ability they were granted by nature can also recover, and the viruses can be gradually expelled.

For such patients, even if the pathogenic evil is so heavy that vomiting, diuresis, sweating, and purgation must be used, the measure must be strictly controlled—what Chinese medicine calls stopping the medicine once the disease is checked: one successful strike, no pursuit of the routed enemy. Even if remnant evil still remains in the body, it can only be slowly regulated, gradually expelled through normal urination, defecation, and sweat glands. One must not be impatient for success and cause the body to lose too much fluid, blood, and nutrients in a short time, so that the righteous qi weakens and immune function is damaged, and the condition instead worsens, even to the point of life being in danger. That is why famous physicians through the ages have all stressed that once a patient's qi movement is spreading smoothly and the upbearing/downbearing function has returned to normal, the medicine should be reduced or stopped; the remaining evil can be expelled entirely by controlling the diet and increasing exercise.

The medical sage Zhang Zhongjing had a unique grasp of the sweating method. His Shanghan Lun repeatedly stresses that one must not sweat excessively, only achieve a faint, slight sweating; if a patient is seen sweating profusely, the physician is told to dust them with powder to stop the uncontrolled sweating. If the patient is already sweating, the patient need not finish the dose; medicine already decocted but not yet drunk should be thrown away. One can see how extremely cautious Zhang Zhongjing was on this point. And once a patient showed signs of the evil leaving, Zhongjing judged that the patient was about to recover—that the patient already had the seed of self-healing. At that point he either advised the patient to regulate himself, or used mild, gentle medicine to guide the process slightly, speeding up the body's own dispersal and expulsion.

That Guizhi Decoction (Cinnamon Twig Decoction) is the first formula in the Shanghan Lun is deeply meaningful. It is Zhang Zhongjing setting an example for later generations; under many entries of the Shanghan Lun, Zhang notes that the patient should be regulated according to the method of Guizhi Decoction. Guizhi Decoction is not known for inducing sweating; the great modern clinician Li Shimao even held that Guizhi Decoction is not a diaphoretic exterior-releasing formula at all, but merely a tonifying formula that harmonizes the ying and wei (for the relevant discussion, see Li Shimao's Sweating Method in Clinical Practice). In clinical practice, Old Li found that Guizhi Decoction alone cannot induce sweating; it must rely on the two auxiliary sweating measures of drinking warm congee and covering warmly before the patient achieves faint, slight sweating. This view is truly eye-opening.

Thinking more deeply, it is not hard to see that Zhang Zhongjing, in treating illness, attached great importance to the role of natural therapies beyond the medicine. He used only a small amount of medicine as an aid, relying otherwise on natural therapy to restore the patient's normal expulsion and dispersal function. Under the entry for Wuling Powder (Five-Ingredient Powder with Poria), the diuretic formula, Zhang Zhongjing also stresses that the patient should drink more warm water, so that a slight sweat brings resolution. Such adjunctive therapies beyond the medicine are everywhere in the Shanghan Lun. The human body is the best medicine; a doctor who does not know how to use the body's own function to treat illness will not be an outstanding doctor.

So a skilled physician treats illness like cooking a small fish: he must observe carefully, verify repeatedly, then use medicine cautiously, neither over-medicating nor using heavy medicine for a light illness. A rough physician does the opposite, using attacking or tonifying measures without restraint, causing the patient's qi movement to become disordered and the upbearing/downbearing to fail, blocking the body's own dispersal and expulsion ability, and blindly hoping to rely on the power of medicine to fight the pathogenic evil. Let me ask: among all the medicines humans have invented to this day, is there truly one that can easily exterminate the pathogenic evil completely? If so, cancer and AIDS would have been overcome by humans long ago.

Since the Republican era, there have been loud calls to abolish Chinese medicine while keeping its drugs. These are extremist remarks deeply influenced by the natural sciences such as physics and chemistry, without any thought given to the medical principles of Chinese medicine. Drugs that kill cancer cells and the AIDS virus in vitro have long been countless, yet why cannot these fruits of natural science be used in the human body? Because of the constraint of fearing harm to the target: anything with an advantage has a disadvantage; what can kill viruses and mutated cells can also kill people. If humanity is to overcome the suffering of various diseases, it cannot go further and further down this mechanistic road.

Principle, method, formula, and medicine: this is a relationship of decreasing order. What comes first is the medical principle; once the principle is understood, the choice of treatment method, prescription, and medication all become clear. If you understand this principle, treating illness need not be fixed to one method, and prescriptions and medication need not be fixed to one drug. As long as they all have the effect of restoring the patient's obstructed dispersal and expulsion ability to normal, they are fully interchangeable.

I have seen many famous doctors treating cancer with drugs that are not the popular anticancer drugs of the day, yet their outcomes are far better than those of the anticancer drugs people rave about; the reason lies precisely here. Rather than killing cancer cells one by one, why not open a channel for them and let them pour out of the body?