How to Carry Out Pattern-Discernment Treatment
How does one carry out pattern-discernment and treatment in the clinic? Elder Liu offers these views:
(1) What is biàn zhèng (pattern-discernment)?
Biàn: includes both distinguishing and analyzing.
Zhèng (pattern): a synthesis and grouping of a set of symptoms.
Biàn zhèng: using the objective material gained by the four diagnostic methods (the zhèng manifestations), and applying TCM theory (three causes, four diagnoses, six channels, eight principles, zàng and fǔ, qi and blood, and so on) to analyze and discern — thereby grasping the cause, the pathology, the pathomechanism, the location, while attending to the disease's developmental tendency and the rise-and-fall of right qi and evil qi.
(2) What is shī zhì (treatment-application)?
Shī zhì is, on the base of biàn zhèng, choosing the matching method, formula, and drugs for the different patterns. Pattern-discernment is the basis of treatment; treatment is the aim of pattern-discernment. Biàn zhèng lùn zhì differs both from symptomatic treatment and from Western disease-based treatment; it links the body's inner connections with the developmental laws of disease. It may be called etiological therapy.
(3) How to do biàn zhèng lùn zhì
1. Discern the disease site.
Every illness has its cause and its site, with corresponding pathomechanism. The disease site may be exterior or interior, zang or fu, qi or blood, upper jiao or lower jiao, taiyang or yangming — these are the location. The Neijing says: "That which is high, lift and discharge; that which is low, intercept; that in the middle, drain through the inside…"
2. Discern the cause.
(1) Cold pattern caused by cold.
(2) Heat pattern caused by heat — for example phlegm-heat smoldering in the lung and phlegm-heat steaming the lung have different mechanisms at the same site.
(3) Deficiency pattern caused by deficiency — for example spleen-deficiency diarrhea and damp-heat injuring the spleen differ in cause at the same site.
(4) Excess pattern caused by excess — for example yangming excess and gastrointestinal stagnation, same cause and same site.
The Neijing says: "Cold, heat it; heat, cool it." — etiological therapy in essence.
In Chinese medicine, cause and site refer to the comprehensive reflection of pathological change within the body, especially in the zang-fu. Site does not mean only where a local symptom appears; it refers to the synthesis of a symptom group. For example, in blood-deficient dizziness the site is the head but the cause is blood deficiency. In exterior-deficient spontaneous sweating with cold-aversion, the site is the exterior, the cause is qi deficiency. There are also cases of identical cause-and-site: hypertension and hepatitis may both present a liver-and-kidney yin-deficiency pattern.
3. Discern the pathomechanism.
Example: lung's diffusing — upward, outward, ruling ascent, ruling dispersal.
Lung's descending — downward, inward, ruling descent, ruling astringency.
Qing su (clearing-purging) — clearing qi and purging downward. Qing run (clearing-moistening) — nourishing yin, clearing heat, moistening lung, stopping cough.
Example: pattern-based treatment for lung-system disease.
From nose and throat above to the lung organ below, there is the differentiation of exterior-interior, cold-heat, deficiency-excess. Methods include diffusing the lung's blockage, descending the lung qi, clearing the lung heat, draining lung excess, moistening lung dryness, warming lung cold, astringing lung yin, supplementing lung deficiency — in sum, no more than discerning deficiency and excess.
Lung-excess patterns: when the evil qi is exuberant there is excess; excess means evil is present.
(1) Wind-cold blocking the lung:
Wind is the cause; cold is the nature; blocking is the mechanism; lung is the site.
Main signs: fever or no fever, chill or cold-aversion, headache and body ache, stuffy nose with runny discharge, cough with phlegm, the phlegm thin-white or foamy, tongue not red, thin white coat, floating pulse.
Pattern-discernment: cold-evil binding the exterior; lung losing diffusing and outward-thrust.
Method: scatter cold and release the exterior, diffuse lung and stop cough.
Formula: Xing Su San.
Formula notes: through diffusing and descending the lung qi, using supplement-and-drain together, treating root-and-branch together — supporting the right and expelling the evil.
Suye with shengjiang: warmly pungent to release sweat and the exterior, warmly scatter wind-cold, transform phlegm and stop cough; qianhu with jiegeng: diffuse lung and stop cough; zhiqiao with xingren: descend qi and stop cough; fuling, huahong, banxia: drain damp and transform phlegm, with the aid of spleen-tonifying; gancao with dazao: tonify the spleen and harmonize the middle.
Elder Liu commonly uses in the clinic: jingjie with fangfeng: dispel wind and release the exterior; xingren with jiegeng: diffuse and descend the lung qi; ganjiang with xixin: warmly scatter lung and stomach; suzi with baijiezi: descend qi and transform phlegm.
(2) Phlegm-heat smoldering in the lung (or lung-and-stomach heat-exuberance):
Main signs: fever with sweat that does not relieve, cough heavier with rapid panting and chest oppression, flaring of the nostrils, yellow-sticky phlegm, or yellow nasal discharge, thirst and dry throat, scant red urine and dry stool, sore swollen throat, red tongue with redder tip and edges, slightly thick yellow coat, slippery-rapid pulse (or surging-rapid).
Pattern-discernment: phlegm-heat smoldering in the lung, lung's clearing losing its purging.
Therapeutic principle: clear and drain lung and stomach, stop cough and calm panting, transform phlegm.
Formulas:
Mild: Sangju Yin with modifications.
Severe: Maxing Shigan Tang plus Beimu Gualou San.
Where lung-and-stomach heat-exuberance is marked, Xiao Cheng Qi Tang may be used.
For severe heat with sore swollen throat and exuberant lung-and-stomach heat, Puji Xiaodu Yin with modifications.