TCM: Both Basic and Applied Disciplines

TCM is of the characters of basic discipline in that it is a systematic study on the funda-mental laws of life itself. Based on the accumulation of a large amount of medical experiences and rational reflections on human physiology, pathology, diagnosis, and treatment, TCM has acquired a unique cognition on the general law of life formation and development, the re-lations between life activities and their external environment, the structures of the human body and their interrelationships, the physiological activities and pathological manifesta-tions of various organs, various pathogenic factors and their respective characteristics, as well as the pathogenesis and relevant therapeutic principles.

Life, according to The Classic of Internal Medicine, originates from the combination of parental essence, grows by unceasingly absorbing nutrients from the placenta, turns mature

2.2 The Disciplinary Properties of TCM 23 by inhaling fresh air through lungs, and transforms foods into nutrients for metabolism through the spleen and stomach. The abnormity of any of these processes may endanger human health and even cause death. The general laws of human growth are elaborated in The Classic of Internal Medicine. Females experience several growing stages with about seven years as a unit. At the age of seven, permanent teeth appear to replace deciduous ones and hair grows in a rapid speed; at the age of 14, with the arrival of menarche, female teenagers begin to have the physiological ability to reproduce; at the age of 21, growth slows down or even stops; at the age of 28, physiological functions are at their climax; at the age of 35, physiological functions start declining; at the age of 42, women begin to age with haggard faces and white hair appearing; and at the age of 49, reproductive function begins to fail with the reach of menopause. Males experience several growing stages with eight years as a unit. They begin to replace deciduous teeth with permanent teeth at the age of 8, have the ability to reproduce with the coming of occasional spermatorrhea at 16, stop growing at the age of 24, have the most powerful physiological functions at the age of 32, experience physiological decline at 40, start to age at 56, and enter the senescence phase at the age of 64.

The above understandings not only reflect the basic laws of human birth, growth, maturity, aging, and death, but also lay down the important criterions for an organism’s physical conditions, like hair growing and the reproductive function, which is still of highly scientific value until now. Based on these understandings, TCM explores the intrinsic mechanism of human growth and aging, and discovers that the life process is closely related to the

“tiangui” (Plain Questions). Such understandings shed great light on scientific research and clinical practice.

In addition to the exploration of life growth, TCM also investigates the pathogenesis.

The Classic of Internal Medicine reveals that disease results from the conflicts of the two aspects of a contradiction. Under normal circumstances, human beings have “healthy qi”

to protect themselves from pathogenic factors. However, the human body may be affected by various pathogenic factors, i.e. “evil qi.” Disease occurs when healthy qi fails to defeat evil qi. The struggle runs through the whole process of disease occurring and progressing.

This understanding macroscopically reveals the essence of diseases.

All the above show that TCM has paid attention to the study of the basic medical prob-lems, and has established its unique theoretic system. These all make TCM of the charac-teristics of basic discipline.

TCM’s features of applied discipline are shown in its applications in clinic, preventive medicine, pharmacology, diet therapy, and forensic medicine.

TCM’s clinical achievements are extremely prominent. As early as the Spring and Autumn Period, Bian Que (407–310 B.C.), a famous physician, managed to apply various effective techniques like stone needle, acupuncture, moxibustion, massage, medicine and surgery to cure various diseases in internal medicine, surgery, pediatrics, gynecology, ophthalmology, and otorhinolaryngology. In the 2nd century, Hua Tuo executed abdominal surgery using an herbal anesthesia, Mafei San, and was well-known for curing Cao Cao (the prime minister of Wei Leud State in the Han dynasty) of head wind-syndrome with acupuncture. Almost at the same time, Zhang Zhongjing came up with the theory of the six meridians to differentiate exogenous febrile diseases and the theory of zang-fu organs to distinguish miscellaneous diseases, which are widely used nowadays. Later, ancient physicians treated scabies and malignant ulcers with mercurial, and advocated nutritional therapy, e.g., using soybean and milk to treat beriberi; using animals’ liver to cure night blindness; using Sargassum to treat goiter; and applying brains of dogs suffering from rabies to wounds to prevent rabies in the 3rd century. All of these clinical practices have been proved reasonable and scientific by modern science.

24 Chapter 2 Theoretical System of TCM: Formation and Characters TCM also makes a great success in preventive medicine. Early in the Zhou dynasty (1046–

256 B.C.), hygienic systems were set up. In the Qin dynasty (221–206 B.C.), pesthouses for lepra came into being. In the Han dynasty (206 B.C.–220 A.D.), both “Daoyin exercise”

and “Five fauna-mimic frolics” were popular in physical training. The study of epidemic diseases reached a certain degree in the Eastern Jin dynasty (317–420 A.D.), when the earliest account of the cause, distribution, infection, and prevention of smallpox, cholera, and tsutsugamushi, etc., appeared. A case is that the living form, clinical characters, way of infection, prognosis, and measures of prevention of tsutsugamushi were precisely described by Ge Hong (1152–1237), 1,600 years earlier than that in Western medicine. In the Song dynasty (960–1279 A.D.), the technique of man-pox vaccination was proved effective in controlling the rage of smallpox, which contributed a great deal to the modern immunology.

In the field of pharmacology, the earliest national pharmacopoeia in the world was finished in the early years of the Tang dynasty (618–907 A.D.), 840 years earlier than Europe. And the most influential pharmacy monograph is The Compendium of Materia Medica, written by Li Shizhen (1518–1593) in the Ming dynasty (1368–1644 A.D.). Since then, it has been translated into many languages, and there are more than ten English editions.

As for diet therapy, Principles of Correct Diet⁴⁴appeared in the Yuan dynasty (581–1368 A.D.), elaborated various food taboos for pregnant women and daily healthcare, introduced the cooking techniques of high-nutrition foods, and also discussed nutrition therapy, food safety, and food poisoning. For its scientific values, the book was highly regarded by the famous British science and technology history scholar, Dr. Joseph Needham.

The forensic medicine in TCM is also outstanding. Early in the 10th century, the earliest books on forensic medicine appeared and by the Song dynasty (960–1279 A.D.), such books had been published in large volume. For example, Xi Yuan Lu,⁴⁵written by Song Ci (1186–

1249), was considered the first systematic forensic medical monograph in the world, which elaborated the dissection of the human body, autopsy, scene investigation, the cause of death appraisal, the analysis of poison used in suicide or murder, and the techniques in first aid and disintoxication. This book has been translated into Korean, Japanese, English, German, French, Dutch, and other languages, and has exerted great influence on the world of forensic medicine.

TCM is the product of medical practice and theoretical reflection, and therefore is charac-teristic of both basic discipline and applied discipline. These two characters are inseparable and mutual-promoting.

For one thing, basic theoretical study of medical problems is based on clinical observa-tion and practice. Theoretical reflecobserva-tions are promoted by specific problems in practice.

For example, through the long-term observation, ancient physicians realized that people in different regions differ in physiological functions and pathological changes because of the different geographical location, weather condition and living habit, and thus arrived at the theory of “treatment in accordance with local conditions,” namely, as for the same disease, patients in different regions should be treated differently. Besides, only in practice can the-oretical reflections be proved and verified. TCM adopts the concept of holism to observe life phenomena. It is a macroscopic perspective, stressing the inner and external connection between different things; it is also a dynamic perspective, observing its object as a changing one. Such cognitions of life cannot be obtained suddenly; they have experienced hundreds or even thousands of years of reflection and practical verification to make up the gap between theory and application.

For another, medical practice should be guided by medical theories, especially its updating achievements. For instance, without the guidance of the theory of meridians and collaterals as well as the theory of “meridian tropism of drugs,” the remarkable curative effect in acupuncture cannot be achieved. The theory of meridians and collaterals holds that since

2.2 The Disciplinary Properties of TCM 25 the meridians run along certain routes and pertain to certain viscera, there is a special relationship between different parts of a body and their internal organs. Take the headache for example. It may appear in different parts of the head, connected with different meridians:

pain in the forehead is related to the Yangming meridian; pain in both sides of the head is related to the Shaoyang meridian; and pain in the nape is often related to the Taiyang meridian. Such a fact lays the foundation for the correct and effective treatment. The theory of “meridian tropism of drugs” believes that each drug can enter one or more meridians, so based on syndrome differentiation, clinically drugs can be selected according to their state of “meridian tropism” to treat diseases so as to improve the curative effect. Again take headache for example. A headache concerning the Taiyang meridian should be treated with Rhizoma et Radix Notopterygii ; that in relation to the Yangming meridian should be treated with Radix Angelicae Dahuricae; and that concerning the Shaoyang meridian with Radix Bupleuri, because these drugs enter these meridians respectively. Only under theoretical guidance, can the safety and effect of these medical applications be guaranteed.

As for the relationship between basic research and application, for one thing, the ad-vancement of TCM in application depends on the new achievements in basic research. For another, the problems encountered in clinical application are the objects of study and im-petus in basic research, promoting the theoretical development of TCM.

CHAPTER 3

Clinical System of TCM: Formation and Development

Goals & Requirements

1. Motives of TCM’s development.

2. Earlier epistemology and therapeutic views of diseases.

3. Law of disease.

4. Law of symptom.

5. Law of prescription-and-syndrome-based medication.

6. Clinical practice of Treatment Based on Syndrome Differentiation (TSD).

7. Relationship between TCM’s theoretical system and clinical system.

Key Contents

Through the long-term accumulation of practical experiences and mutual promotion of theory and practice, TCM has developed into a relatively complete academic system. Its unique clinical system consists of four parts: medical theory, principle, prescription, and herb. A comprehensive understanding of its academic noumenon, TSD, its history and content, can further our cognition about TCM’s clinical system.

“Medical activities,” just as Ivan Petrovich Pavlov pointed out, “began with the birth of human beings.” That is, man’s cognition of the occurrence, development and treatment of diseases starts very early in human society. Such ancient medical fables as “Fuxi⁴⁶ tasted hundreds of herbs and made jiuzhen to rescue people from dying” (Age of Empires)⁴⁷ and

“traditional Chinese medicine appeared after Shennong tasted various herbs” (Shi Ji Gang Jian)⁴⁸show that medical knowledge in the ancient times originates from people’s productive activities and living practice. This chapter will turn to famous Chinese medical works to investigate how ancient Chinese come to learn disease and how TCM’s clinical system is formed.

3.1 Accumulation of Clinical Experiences 3.1.1 Primitive Cognition of Disease

The oracle bone script⁴⁹ found in Yinxu⁵⁰ bears the earliest record about how the an-cient Chinese learn about disease. The script shows that anan-cient people’s understanding of disease begins with their intuitionist cognition of single posture or superficial symptoms.

A case is that the symbol “ ” ( ), interpreted by Yang Shuda⁵¹ as “ ”(illness), is the icon of a person lying on the bed, and records with “ ” as one part have something to do with the symptoms of diseases. First, there are many hieroglyphs that depict the tume-faction of the breast, collare swelling, dizziness, nightmare, and so on. Second, there are some descriptions of the disease location such as “ ” (cephalic diseases), “ ” (oph-thalmic diseases), “ ” (aural diseases), “ ” (nasal diseases), “ ” (foot diseases), and “ ” (abdominal diseases), for the Chinese characters “ ”, “ ”, “ ”, “ ”, “ ”, and “ ” means head, eye, ear, nose, foot, and abdomen respectively. Third, there are many diseases recorded according to their main characteristics, such as “malaria,” “scabies,” “par-asitic infestation,” and “caries.” Ancient Chinese also gained some therapeutic experiences like pressing a tender spot with hands or puncturing the location of the illness with sharp tools to relieve pains.

28 Chapter 3 Clinical System of TCM: Formation and Development