Four Doctors: Four Doctrines.

By Snohomish Brown December 4, 2010

Dr. Yueying Li - TCM Classics Final Paper

The second focuses more on pulse diagnosis and needling treatments. in the formation of Traditional Chinese Medicine. calendars and astronomy. superhuman legendary characters. Since its existence today demonstrates how innovative editors were able to preserve the works of ancient authors. with some of the concepts found in this work dating as far back as the third.One of China’s most venerated culture heroes. Paul Unschuld’s scholarly work on the subject verifies that the passages were organized into eighty-one discourses. The sovereignty of the Heart was related to as the Ruler of a Kingdom and the steps to good health reflected the steps to good government and proper social conduct. many of the social/political fundamentals expressed by Confucianism and Daoism. . Analogously. agriculture. deeper analysis of its many differences in style and tone of the various passages confirms that it was probably written rather disjointedly and then later gathered and compiled during the first or second century B. the health of the system. is believed to have lived nearly five thousand years ago in northwest China where the modern HeBei province is now known. illustrates how the management of the human organism in Chinese Medicine reflects how the government of society was viewed during this time. is considered to be the Father of Chinese Civilization. the five phases of elemental and seasonal correspondences and gives some examples of the six kinds of pathogenic qi. Methods of preserving health emphasized the importance of following the course of nature and harmonizing one’s self with the various changes in the seasons. were acknowledged for bestowing ancient medical knowledge when. whose full name was Gongsun Xuanyuan. Stagnation or vacuity of Qi in any organ or channel could result in pain or illness as well. many people accepted and believed in explanations of disease that included demonic intrusion. or the Yellow Emperor. animal husbandry. such as the Yellow Emperor. Huang Di. Huang Di. He is credited with the implementation of writing. Unschuld’s commentary illustrates how a system of medicine emerging from this work mirrored. as the Chinese used terms Zheng and Xie respectively to connote certain types of Qi in the body. Disease was identified according to the kind of pathogenic Qi that engendered it. The practice of attributing scripture to deified sources was not uncommon in those days and with the theory in mind that “ordinary people often venerate the old and despise the new”. specifically a reversal of Qi movement or blockage within a specific conduit. However. or other natural environmental agents. bugs. The idea that something in the body could be labeled as “proper” or “unorthodox”. depends upon every part playing its proper role and communication flowing freely among its separate parts. The first one covers the basics of yin and yang theory. at least in principle. Epidemiology and illness according to the Su Wen and Ling Shu are described in terms of conditions associated with vessel pathology. During the Warring States period of China. and the invention of boats. Even the theories of vessel physiology and pathology seemed to parallel the sociopolitical transition from a period of Chinese History where external attack constituted the most dangerous threat to a period when the maintenance of the system of government gained highest priority. whether wind. but instead from many compiling authors working together. Some copies of the Huang Di Nei Jing have survived partially as one of two parts called the Su Wen or Basic Questions and the Ling Shu or Spiritual Pivot. in fact these teachings derive not from a single common source. perhaps the most significant of these Ancient Classics of Chinese Medicine is the Huang Di Nei Jing. whether it is that of the government or of the human body. or cold or damp or some combination of the three. carts. added to and later revised over the course of history by such notables as Wang Bing and Gao Baoheng.C..

simply because they stike deeper into the body affecting the organs that protect and store Blood. illness will continue to follow. Interpretations of this phrase indicate the supreme importance of this work and it would seem that the same is therefore also true of the Nei Jing. Any Yang stage illness. emesis. which became popular hundreds of years later. when the evil Qi has done whatever damage it can and then leaves. with no chills present. His motivation for helping others resulted in the recording of 113 herbal formulas. During the Tang Dynasty there was a Doctor of considerable renowned named Zhang Zhong Jing (150-219 AD) whose distinguished talents came as a result of such hard work and precise judgment. Jue Yin syndromes are described as a cold/ heat mixed deficiency with upper heat and lower cold. Shang Han Lun (Treatise on Febrile Disease) and Jin Gui Yao Lue (Essentials of the Golden Cabinet). and dissolution. This is analogous to the body being compared to a building which has been damaged by fire. it has affected the body to the point that it has lost its balance and become deficient. many of which are still used today. Jing and Yin. Tai Yin is identified by vomiting and diarrhea. After that came the Shao Yang stage with alternating chills and fever. Any practitioner of Chinese medicine will attest to the fact of the indispensible nature of these works. All subsequent innovations of TCM theory relied upon these works for their foundation and especially in the case of He Jian or Fire Doctrine. cold limbs. His student Wang Shu He (201-280 AD) compiled many of the bamboo strips he used to diagnose patients and published the work we know today as the Shang Han Za Bing Lun. One of his main contributions to Chinese Medical Theory included the differentiation and identification of six stages of Cold Injury. . which was a sign of superiority. according to the Nei Jing. including: diaphoresis. and pulse. Its walls being burned through are no longer able to prevent Evil Qi from penetrating into the interior and so unless there is repair made to the structure. termed Tai Yang. indicating one of the three Yang stages of illness. and Jue Yin by chest congestion. The first stage and most external of invasions to the body. The three Yin stages were differentiated according to specific symptoms. sweat. either from external influence or endogenous causes. can easily progress directly to one of the Yin stages of disease. There is an old saying that goes: “The study of Chinese Medicine begins with San Han Lun and ends with San Han Lun”. cleansing. The Yin stages refer to the Zang organs. He relied upon the identification of fever type to differentiate between the six stages and described them accordingly.Later developments in Chinese Medicine were made possible by those individuals who studied these classics. abdominal pain and congestion. purgation. the fire and water organs respectively and this stage of illness represents the failure of the body to adequately convert cold and heat according to constitutional types of deficiency. so does the coldness of the limbs. wind and shen disturbance. hunger with no desire to eat and vomiting of worms after eating. Tai Yin stage illnesses most resemble Spleen deficiency or cases of extreme dampness. composed of two parts. thirst. and also as the fever increases. During the course of any illness. at this point. In order to treat these conditions he used eight basic methods in various combinations based on the specific presentation. were typified by chills and fever. Zhang Zhong Jing lived during the time of a great epidemic and witnessed over half of his relatives die. into three yang stages and three yin. Shao Yin by feeble pulse and drowsiness. harmonization. His intention was to link the body through the surface to the core as one body and one system. warming. Shao Yin refers to Heart and Kidney deficiency. His differentiation helps to explain how pathogenic influences. The next stage was termed Yang Ming stage and featured four bigs: fever. nourishing. at first reside in the Qi of the Fu organs (bowels) negatively affecting their function. Many of them who devoted their lives to becoming doctors were able to prevent diseases before they occurred.

Many of his books survive and some have even been translated into English. treating “from the Heart” and showing deep compassion to all of his patients regardless of social or economic status. Also. one who had inherited the teachings of his Master Liu Wan Su and who was erudite in the theories of Zhang Cong Zheng. his treatment methods underlined the importance of nourishing yin. but soon after he successfully treated his previous Master. at age 13 he was able to treat her successfully from what he had studied in the classical medical texts. His focus was on eliminating “evil Qi”. Dan Xi quickly learned these and applied himself to understanding their use. Luo Zi-di was such a Master. He was well known for his bedside manner. his practice began to grow very quickly. He believed that Yang is always in excess and that Yin is always deficient and that this was the primary underlying factor influencing most imbalances leading to disease. there could be no recovery. at age 40 he wholeheartedly began to study the art of Medicine. refusing to see him even after several attempts. He took the theories of damp heat from his predecessors in the North and using his own observations and thoughtful application was able to treat these conditions even in the South where damp heat can be overwhelming and people are treated for fire conditions often. He studied the work of Zhang. he chose to pursue a career in politics instead and sought to learn from a well known professor of ethics and philosophy. intelligence and humility to such a degree that he agreed to accept him as a pupil and finally passed along all of his learning to him. especially where toxins. extreme emotions can engender heat pathology. his teacher became very ill and believed that without the help of an illustrious doctor. Dan Xi was exceptionally bright even as a child and when his mother became ill. . One certain doctor who drew from the experience of many Masters before him was Dr. he did not allow his practice to be confined by their theories. As the story goes. Inspired by the possibility of helping many people and perhaps motivated by the recent death of his father. One day. He asked his student Dan Xi if he would not condescend to learn Medicine instead so that he might be able to treat him. wife and other family members. His approach to treatment differed greatly from the mechanical rote application of formulas used by his contemporaries and this attracted much criticism at first. Therefore. During the Song Dynasty contemporaries of Dan Xi had published a collection of formulas nearly 300 in number and nearly all of the practitioners at that time believed that rote memorization and application of these were the most effective methods of treatment. Zhu. Today we continue to follow his innovative treatment methods which remain true to the Heart of TCM and we rely upon his work to connect our contemporary medicine with that of the Ancient Classics. He soon became proficient in the ancient doctrines and returned home. formulas or explanation of pathogenesis without adding his own insights and new findings. In spite of this early success. Unfortunately for Dan Xi.The basic premise of this theory indicates that all of the six pathogenic Qi may transform into fire. Eventually Luo Zi-di was impressed by Dan Xi’s persistence. fluids and blood. Dan Xi (Zhu. Cong Zheng and Liu He Jian using both of their doctrines concerning Fire pathology to treat disease. Zhen Heng). A harmful tendency to mechanically employ ancient “dead” formulas rather than basing treatment upon the proper identification of patterns concerned Dan Xi and he sought a true Master in distant lands. heat or fire cause deficiency in the body. he was eccentric too and often cold to visitors. but he doubted the validity of their use in every instance and considered that perhaps a deeper understanding of the Classics would truly make him a better doctor. Dan Xi is highly revered even by contemporary standards. While still maintaining respect for the ancient sages.

Dr. Ye Tian Shi was extremely influential in this area and Wen Bing Doctrine owes much to his innovative theories. the nature of Wen Bing disease. If the Kidney is the Root of Qi. the Liver and Kidneys represent Yang within Yin and Yin within Yin respectively and naturally their energies tend to be descending. He was not averse to using diaphoretics. In the treatment of miscellaneous disease. he used four basic formulas to treat imbalances and modified them according to the six environmental excesses. In TCM. but often would modify these methods with herbs that also nurtured the yin. They are both considered Yang and so naturally their energies tend to be ascending and we use descending activities and treatments to balance them. without any root. In this way he demonstrated his true mastery of TCM by using one formula to treat 20 ailments instead of his contemporaries using 20 formulas to affect a single disease. normal adrenal functions help with this process. Blood. which in turn commands the Blood. let us consider the various organs and their functions. he advanced the theory that Qi. This practice in TCM has established its reputation as a form of preventative medicine. wealth or fame constituted the display of yang or fire. Qi is ascending (yang) and meanwhile Blood is descending (yin). travels upward instead. He postulated that in most cases. the regular breath helps to move the Kidney Qi up and the Lung Qi comes down as the Kidney grasps it. Zhang Zhong Jing had mentioned under the heading of Tai Yang disease. emetics. perhaps the most widely noted is his method of differentiation of Warm Disease into four stages or levels: Wei. These four stages identify the . In contrast to the theories developed and practiced by Dan Xi. Although there are many of his contributions to TCM. According to Dan Xi. Conversely. and keeping them in balance helps to maintain health. but did not elaborate on it much further. acts a bit like our contemporary understanding of electricity. for which he is also well known. Phlegm and Depression are the four key points to analyze so as to determine a diseases pattern and focused on how these engender excesses of the six environmental Qi patterns to produce a formula to treat them. thought and desire for sex. He even also advocated the use of warming medicinal herbs to treat damp heat. Wen Bing (Febrile Disease) Doctrine emphasizes a different set of theories to explain etiology and disease pathology than previously postulated. This meant to him that Blood is more stable since it is more like substance or material than Qi which is more subtle and to us. It was not until nearly 1300 years later that we find a few doctors seeking to expound upon this kind of pathology. but this did not prevent him from also using other methods made popular by other doctors. including labor. how does the Lung Qi meet with it? In the Dan Tien area (Ren 4). internal or external. it is common to hear one say that Blood carries the Qi. he stated that fire is called Sovereign Fire when it is generated by the interaction of form and qi and that fire generated from vacuity and emptiness caused by the necessity to maintain life. To illustrate this idea. From a TCM perspective. so we use ascending activities and exercise our Liver and Kidney energies to pull them upward. Qi. The stirring of this fire never fails to disturb the balance between yin and yang and so Dan Xi held that the supplementation of yin is necessary in almost every case. During the Han dynasty. or purgatives. becomes observable in movement and should be called Ministerial Fire. they actually control and regulate each other. Furthermore. and Xue. Ying. Based on this idea.His discussion of the Ministerial Fire held that any movement. Dan Xi elaborated and further developed the theories introduced by Li Dong Yuan especially in regards to the ascending and descending functions of the Spleen and Stomach respectively. Dan Xi was well known for his yin supplementing formulas. Otherwise there is wheezing since the Lung energy. Heart and Lung represent Yang within Yang and Yin within Yang respectively.

The formula used at this stage is from Shang Han Lun. it stands to reason that new practitioners would be well served to heed this knowledge and apply it appropriately. The symptoms of Qi level heat include the four bigs mentioned earlier: fever. Blood deficiency. In this case. with high fever and/or coma. called Xi Jia Di Huang Tang. Treatment must focus on clearing the heat which has penetrated to the nutritive level and assist it out through the Qi level. and protecting the yin fluids. it is clear that the theories of TCM have been building slowly upon the innovations and exceptional brightness of those who studied the classics as well as their contemporaries. Whereas. in the Wei stage the treatment method is to disperse the lung Qi and dispel the exterior is pungent and cool herbs as the pathogen is interfering with Lung function and the body’s ability to protect itself. It is important to understand and recognize these stages as distinct since treatment methods vary depending upon how much damage has been done. severe heat. Although there are several types of heat pathogen identified and they are further differentiated according to wind. For example. and out of the body. For this one might use Qing Yin Tang and modify it accordingly. it is still of vital importance to understand the Classics of this tradition. New translations of ancient texts are becoming available too and as the field is constantly growing. dry and warm-heat pathogens. His discussion of wind conditions developed from an idea of his that hyperactivity of Yang leads to wind pathology. damp. learning from both equally well. one would likely employ the formula Bai Hu Tang to treat insubstantial heat or San Qi Tang to treat substantial heat. before they appear by keeping the channels unblocked. treatment must focus on clearing heat. At the Xue Stage. promoting free flow of qi and blood before they become stagnant and cause problems. there is still much to learn and research in the area of TCM. Yin Qiao San or San Ju Yin are used for the Wei level or treating the Lung respectively. Ye Tian Shi was also influential in other ways too. To do this. Also his idea that chronic diseases affect the collaterals have encouraged many doctors who specialize in preventative medicine to treat against the formation of cancers early on. Treatment at this stage follows a similar method as before but also with the added need to stop bleeding. Ying stage symptoms are differentiated by a fever that worsens at night as the heat pathogen consumes the ying-yin and disturbs the mind. Warm disease is characterized by its contagious nature of being transmitted by nose or mouth. also the patterns of its progression and clinical manifestation clearly qualify it as distinct from other types of ailments. expelling and purging warm evils and heat. produce dryness and damage the yin and can be further differentiated in to Warm-heat type or Damp-heat type. but there must be a proper understanding and recognition of the patterns in nature that have been observed and successfully treated in order for success to follow and new innovations to work. summer. Treating the individual rather than the disease seems to be one of the most important lessons in this process.course of various warm pathogens as they cause fever. the heat has entered the blood and caused bleeding symptoms. sweat. He gave other causes for generation of wind too. including Liver Yang rising. These stages measure the progress of a heat pathogen as it progresses from the exterior deeper into the interior. and also Yin deficiency as causal factors engendering pathogenic wind. thirst and pulse and no chills as indicated by Wei level heat. . Ye Tian Shi identified four stages according to the type of fever being presented when these kinds of pathogen attack the body. In summary. removing deposits. At the Qi level.

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