Dispersion and Rejection: My Understanding of TCM Therapeutic Principles
A healthy body does not fall ill without external stimuli. Whether these stimuli are what TCM calls internal, external, or non-internal-non-external causes, or what Western medicine calls viruses, bacteria, and mutant cells, their action 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 adverse effects of harmful stimuli on the body and restore the body's normal metabolism.
Western medicine attempts to kill viruses, bacteria, and mutant cells in order to restore health. TCM instead emphasizes making use of the body's natural capacity for dispersion (shuxie) and rejection (paiyi), expelling various pathogenic factors out of the body through multiple pathways. Once the pathogenic factors are expelled, the body naturally recovers its health; there is no need for a grand, exterminating campaign to destroy viruses, bacteria, and mutant cells one by one.
To date, the various drugs humans have invented to exterminate viruses, bacteria, and mutant cells are mostly toxic to normal human cells and tissues. It is the classic "kill one thousand enemies, lose eight hundred of one's own." A sick person is already deficient; excessively slaughtering normal cells or damaging important organs often means the patient dies not of the disease but of the medicine. Data show that in China, as many as 200,000 patients die each year from taking the wrong medicine.
Therefore TCM therapeutic principles differ from Western medicine. TCM emphasizes restoring the body's capacity for dispersion and rejection. The three great TCM methods of expelling pathogens—sweating (han), emesis (tu), and purgation (xia)—are all rejection processes: through sweating, inducing vomiting, and promoting urination and defecation, pathogenic factors are expelled from the body. Even if a slight remnant of pathogen remains, the body's normal immunity and dispersion capacity can drive it off completely. That is why using Dahuang (Rhubarb) for unremitting diarrhea and dysentery can surprisingly have a miraculous effect. TCM treatment often emphasizes spreading and unfurling the qi mechanism, restoring the normal ascending and descending functions of the zang-fu organs. This ascending-descending function that TCM emphasizes is very close to the metabolic function of the human body discovered by modern biological science.
The Japanese practitioner Yumoto Kyuzo summarized the body's pathogenic factors as three poisons: water poison, food poison, and blood poison. In Yumoto's view, the key to treating disease lies in expelling these three poisons from the body. As to what exact toxins these three poisons contain—on the one hand, the ancients did not have advanced chemistry and could not identify them in detail; on the other hand, there was no need. The human body is a gift from nature, which has provided countless orifices: the traditional seven orifices, plus the sweat glands, are all the body's finest organs of dispersion and rejection. As long as one uses suitable methods to promote the expulsion of various pathogenic factors through the sweat glands, the mouth, and the excretory organs, the disease will naturally resolve. To this day, for acute drug poisoning, inducing vomiting, inducing diarrhea, and promoting diuresis remain the top choices of physicians, whether TCM or Western.
TCM's supporting-the-right (fu zheng) therapy, in my view, is also designed to promote the body's normal dispersion and rejection capacities. In a person long ill and weak, the zang-fu organs and even the sweat glands cannot function normally, and dispersion and rejection decline. If one forcibly applies emetics, diuretics, diaphoretics, and laxatives, the patient will easily suffer severe loss of fluids, blood, and nutrients, becoming even weaker. Seeing such patients, one should use tonifying herbs or foods to strengthen the normal transformation and transportation of the zang-fu organs; then the patient's nature-given capacity for dispersion and rejection can also recover, and viruses can be gradually expelled.
For such patients, even if the pathogen is so heavy that emetics, diuretics, diaphoretics, and laxatives must be applied, one must strictly control the measure—what TCM emphasizes as "stop once the disease is reached" (zhong bing ji zhi): one strike succeeds, do not pursue the routed foe. Even if remnant pathogen remains in the body, one may only slowly regulate it, expelling it gradually through normal urination, defecation, and sweat glands. One must not be impatient for quick success, causing the body to lose too much fluid, blood, and nutrients in a short time, so that the right qi is weakened, immune function impaired, and the disease worsens—even to the point of endangering life. Throughout the generations, renowned physicians have emphasized that once the patient's qi mechanism is unfurled and ascending-descending functions recover, the medicine should be reduced or stopped; the remainder can be expelled entirely through diet control and increased exercise.
The medical sage Zhang Zhongjing had unique insights on the sweating method. In his Shanghan Lun (Treatise on Cold Damage), he repeatedly emphasizes that one must not sweat excessively; only a slight, faint sweat should appear. If a patient sweats profusely, he instructs the physician to dust the patient with powder to stop the excessive sweating. If the patient is already sweating, he says the patient "need not finish the dose"—already-decocted but unfinished medicine should be thrown away. This shows how cautious Zhang Zhongjing was on this point. And once the patient showed signs of the pathogen exiting, Zhang Zhongjing considered the patient "about to resolve"—that the patient already had a sign of self-recovery. At that point he either advised the patient to self-regulate or used light, gentle medicine to gently guide the body's own dispersion and rejection process forward.
Guizhi Tang (Cinnamon Twig Decoction), the first formula in the Shanghan Lun, is deeply meaningful. It is the medical sage setting an example for later generations; in many clauses of the Shanghan Lun, Zhang Zhongjing notes that the patient should be regulated according to the Guizhi Tang method. Guizhi Tang is not distinguished by sweating. The great modern clinician Li Shimiao even holds that Guizhi Tang is not a diaphoretic exterior-releasing formula at all, but merely a harmonizing, tonifying formula that regulates the construction and defense (ying-wei) (see Li Shimiao's Hanfa Linzheng Fawei). In clinical practice, Old Li found that plain Guizhi Tang cannot produce sweat by itself; it must rely on two auxiliary sweating measures—"drinking warm congee" and "covering warmly"—before the patient can show a faint sweat. This argument is quite awakening.
Thinking more deeply, one readily sees that Zhang Zhongjing, in treating disease, greatly valued the role of natural therapies beyond drugs. He used only a small amount of medicine as an aid, relying on natural therapies for the rest, to restore the patient's normal rejection and dispersion functions. Under the Wuling San (Five-Ingredient Powder with Poria) clause for promoting urination, Zhang Zhongjing also emphasizes that the patient should drink much warm water; a faint sweat will appear and the disease can resolve. Such auxiliary non-drug therapies abound in Zhang Zhongjing's Shanghan Lun. The human body itself is the best medicine; a physician who does not know how to use the human body to treat disease is not a brilliant physician.
Thus the skilled physician treats disease like cooking a small fish: must observe carefully, repeatedly verify, then use medicine cautiously—not over-medicating, not using heavy medicine for a light illness. The crude physician does the opposite, applying attack and tonification without measure, causing the patient's qi mechanism to be thrown into chaos, ascending-descending deranged, and the body's own dispersion and rejection capacities blocked, while blindly hoping that medicinal force alone will fight the pathogen. I ask: among all the medicines humans have invented to this day, is there really one that can effortlessly exterminate pathogens to the last? If so, cancer and AIDS would have been overcome long ago.
Since the Republican era, there has been a clamor to "abolish the medicine, preserve the drugs" of TCM. This is a prejudiced cry, deeply influenced by the natural sciences such as physics and chemistry, without the slightest reflection on TCM's medical principles. Drugs that kill cancer cells and AIDS viruses in vitro have long been countless; but why can these achievements of natural science not be applied to the human body? Because of the caution born of the rat-and-vessel problem: anything with one benefit must have one harm; what can kill viruses and mutant cells can also kill people. If humanity is to overcome the torment of various diseases, it cannot keep going further and further down this mechanistic road.
Principle, method, formula, and drugs—this is a sequential, progressively transforming relationship. First in place is the medical principle; once the principle is understood, the choice of treatment method, prescription, and drugs all become assured. If one understands this principle, then treating disease need not be fixed to one method, and prescriptions and drugs need not be fixed to one formula; as long as they all have the effect of restoring the patient's blocked dispersion and rejection capacities to normal, they are fully interchangeable. I have seen many famous doctors treat cancer using drugs that are not currently popular anti-cancer drugs, yet their results far exceed those of the anti-cancer 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 in one rush?