“Treat the Root” Is Correct, But “the Root Lies in Yin and Yang” Is Not Necessarily Right

The Huangdi Neijing says that “in treating disease, one must seek its root.” This statement is entirely correct: to treat disease, one must indeed find the fundamental cause. But it also says “the root lies in yin and yang,” and this statement is quite problematic.

Leaving aside for a moment that TCM’s yin and yang are a very vague concept, the root of disease alone is by no something that yin and yang can sum up. For example, AIDS is caused by the HIV virus, and malaria by the Plasmodium parasite. If one uses “yin and yang” to describe AIDS and malaria, one cannot describe them clearly. Using yin and yang to explain the causes of AIDS and malaria is pure nonsense and utterly unconvincing.

Yet TCM’s system of syndrome differentiation and treatment is built on a theoretical system based on yin and yang. The root of this theoretical system is itself problematic, and when it is used to guide clinical practice, many problems arise. The four natures and five flavors of traditional Chinese materia medica are also classified under the overarching principle of yin and yang. Among the four natures, warmth and heat belong to yang, and cold and cool belong to yin; among the five flavors, pungent, sweet, and bland belong to yang, while sour, bitter, and salty belong to yin.

TCM holds that correcting the imbalance of yin and yang in the human body can cure disease. Thus Chinese herbs, by their yin- or yang-leaning natures, correct yin- or yang-leaning pathological changes in the body and thereby exert their effect. The foundation of this argument is flawed, and it has led many of us into a circle from which we cannot get out.

In studying Chinese materia medica, one should study its medicinal actions first and the four natures and five flavors second. In clinical prescribing, one should likewise rely primarily on the actions of the herbs, using the four natures and five flavors only as a reference. If one takes the four natures and five flavors as the root and the medicinal actions as secondary, that is putting the cart before the horse.

The summaries of the actions of Chinese herbs by generations of TCM pharmacologists have also been continually advancing. The actions of Chinese herbs were all observed in practice; as practice has accumulated, those actions have been continually broadened and refined, which is very helpful in guiding our prescribing.

Traditional TCM’s descriptions of the actions of herbs mainly revolve around what observable symptoms an herb can resolve, so the terms describing herbal actions are all “syndrome-directed”—for example, releasing the exterior and clearing heat, or soothing the liver and regulating qi. This also makes the greatest feature of traditional TCM treatment its syndrome differentiation and treatment.

But the original method of syndrome differentiation was nowhere near as complex as today’s. In its early stage, TCM’s syndrome-differentiation thinking was very plain. The earliest TCM simply looked at what symptoms a patient had and then used whatever herb resolved those corresponding symptoms.

Treating disease according to this syndrome-differentiation thinking achieves symptom-directed prescribing, and it has an immediate effect in relieving the patient’s condition and improving clinical symptoms. So the traditional syndrome-differentiation thinking, whose main purpose was symptom-directed prescribing, has a certain practical value.

But relative to the stubbornness of disease, medicine has always been infantile—not only ancient medicine, but modern medicine as well. There are still many diseases that leave physicians helpless. Therefore medical workers have always striven to think about the causes of disease, to seek better ways to resolve them, and to improve clinical outcomes.

About two or three thousand years ago, the Hundred Schools of Thought in China exerted a tremendous influence on Chinese culture and science, and afterward yin-yang and the five phases were incorporated into the TCM theoretical system. The Huangdi Neijing is the product of combining yin-yang and five-phase thought with TCM theory, but using yin-yang and five-phase thought to interpret the all-encompassing range of human disease plainly has great shortcomings.

Some TCM physicians influenced by Daoist thought summarized “inner evidence” and “outer evidence” experiences that came entirely from their own subjective consciousness as medical laws, without experimental verification. Afterward, many unquestioning followers who disliked thinking championed these almost fantastical theories, which gradually made TCM increasingly detached from reality.

Liang Qichao said that Buddhism is notoriously hard to master; in fact, the difficulty of mastering TCM is even greater than that of mastering Buddhism. Today, when we study TCM, we need to sift for gold in the sand. In the overwhelming mass of TCM classics there are of course many precious therapeutic experiences, but there are also many erroneous things that easily mislead the TCM learner—“my eyes were originally straight, but because of my teacher I went blind.”

Metaphysically discoursing on “yin at peace and yang well-secured, the spirit is in harmony” is simple and sounds very reasonable and persuasive, but such abstract theories are insufficient to radically cure diseases as plainly unrelated to yin-yang balance as AIDS and malaria, nor can they readily have an effect on cancer. In practice, searching for drugs that truly combat the HIV virus, Plasmodium, and cancer is the genuine act of “treating the disease by seeking its root.”

The greatness of Professor Tu Youyou lies precisely in the fact that, using modern pharmaceutical extraction technology, she isolated artemisinin from the traditional Chinese herb Qinghao (Artemisia annua), which has a 100% cure rate against Plasmodium. For malaria, artemisinin can truly be called the root-treating drug. Correcting the excess or deficiency of yin and yang can never achieve what artemisinin achieves.

The present and future research direction of Chinese medicine should focus on studying the actions of drugs and the symptom-directed therapeutic effects that drug combinations can achieve.