html xmlns=”http://www.w3.org/1999/xhtml” xmlns:bk=”http://www.elsevier.com/xml/bk/dtd” xmlns:ops=”http://www.idpf.org/2007/ops” xml:lang=”en”>
6. Treatment differentiation
General concepts of treatment
This chapter deals with the basic principles of making a decision about which treatment methods and prescriptions to use. This decision is reached by following the guidance of the TCM holistic concepts about differentiation of the syndromes. The principle of treatment differs from the method of the treatment, as the former refers to the rules of the treatment, whereas the latter refers to the steps of the treatment, which are determined by the principle of treatment. For instance, all kinds of pain, as a rule, are caused by conflict between the anti-pathogenic Qi and pathogenic factors, so the basic principle of treatment is to regulate the anti-pathogenic Qi and eliminate the pathogenic factors. Following the guidance of this principle, the general treatment method would be to nourish the Qi, tonify the Yang, circulate the Qi and Blood, and so on. However, in practice there are various different types of pain with rather complicated pathologies, and differences in severity and intensity, as well as in the seasons, the exact circumstances and the constitution of patients, so it is impossible that just one or a few fixed treatment methods will treat all kinds of pain. The only way to obtain good therapeutic results, therefore, is to master a number of other principles of treatment, which include:
• searching for the root cause and secondary symptoms
• supporting the anti-pathogenic Qi and expelling the pathogenic factors
• regulating Yin and Yang
• determining the treatment in accordance with climate and season, geographical location and individual constitution.
Searching for the root cause and secondary symptoms
The concepts of the root cause and secondary symptoms can have different meanings, but here they mainly refer to the nature and primary aspect of the pain, and the phenomena associated with the pain. Pain should be assessed clinically to determine the primary and the secondary aspects, the root cause, the symptoms, whether acute or chronic so as to ascertain the main contradictions, and then should be treated accordingly. Generally speaking, the root cause should be treated first, and the secondary symptoms second. For instance, if a headache is caused by invasion of External Cold, the root treatment would be to dispel the External factor and promote the circulation of Qi and Blood in the head, and this would be done first of all. However, if the secondary symptoms are acute and severe, they would be treated first. Again taking headache as an example, if headache is very severe, treatment should first aim to sedate the pain and only afterwards to dispel the Cold. If both the symptoms and the root cause are serious, they should be treated simultaneously.
Supporting the anti-pathogenic Qi and expelling pathogenic factors
The occurrence of pain, according to TCM theory, is an indication of a process of struggle between the anti-pathogenic Qi and pathogenic factors, so strengthening the anti-pathogenic Qi to defeat the pathogenic factors is the correct method of curing the pain. Strengthening the anti-pathogenic Qi means improving the body’s resistance and building up its energy. Once resistance against pathogenic factors is increased, the pathogenic factors are naturally eliminated.
Clinically, the condition both of the anti-pathogenic Qi and of the pathogenic factors should be observed carefully, in order to determine whether to strengthen the body resistance or to eliminate the pathogenic factors first. If a patient has weak resistance and low energy but the pathogenic factors are not yet very strong, the body resistance and energy are strengthened first. If a patient is suffering from Excessive pathogenic factors but the body resistance and energy have not yet been damaged, the primary task is to eliminate the pathogenic factors. But some patients have weak body resistance and low energy and the pathogenic factors are also overwhelming, so in these cases both methods need to be employed simultaneously.
Regulating Yin and Yang
The occurrence of pain is, fundamentally speaking, caused by an imbalance of Yin and Yang, either an Excess or Deficiency. So it is very clear that treatment also needs to restore the balance between Yin and Yang.
Clinically, Excess of Yin makes Yang suffer, and Excess of Yang makes Yin suffer. For such Excess of Yin or Yang, the best treatment is to reduce or remove the Excess. But whilst correcting this Excess, attention should also be paid to whether a corresponding Yin or Yang Deficiency exists. If one of these is deficient, the treatment given should be either simultaneous Yang reduction and Yin reinforcement, or Yin reduction and Yang reinforcement.
Also a Deficiency of Yin or Yang may cause failure of the other to be controlled, leading to a state of Deficient-Heat or Deficient-Cold. Treatment in this case should be given to reinforce either Yin or Yang so as to eliminate Deficient-Heat or Deficient-Cold. If there is a Deficiency of both Yin and Yang then the treatment needs to tonify both Yin and Yang simultaneously.
Determining the treatment in accordance with climate and season, geographical location and individual constitution
Climatic and seasonal conditions
It was stated in the Ling Shu (1963, p. 27) that in spring the pathogenic factors are most likely to attack the superficial layer. In summer, they are most likely to attack the skin. In autumn, they are most likely to attack the muscles. In winter, they are most likely to attack the Tendons and Bones. When treating such disorders, the clinician should ensure that the techniques used are consistent with the seasons. Generally speaking, in spring and summer the climate is relatively warm, and the Yang Qi of the body is floating at the superficial level of the body, so shallow acupuncture is applied. If herbs are used during these seasons then herbs that are very pungent and warm and have a strong dispelling action should be avoided. But the climate in autumn and winter is colder and the skin pores are closed, the Yang Qi of the body remains deep inside, so the deeper acupuncture is better, and if herbs are applied then those that are relatively pungent and warm and strong in their action should be prescribed in preference.
Geographical location
The therapeutic method used should be appropriate to the geographical location. Climate and lifestyle vary in different regions, so do the body’s physiological activities and pathological changes, therefore methods of treatment should be varied in accordance with the region. For instance, the weather in Belgium and Holland is relative cold and humid compared to that in China, so many people suffer from Cold Bi and Damp Bi. In this climate, dispelling the Cold and elimination of the Damp are of relatively greater importance in the treatment determination. In China, very strong manipulation of the needle is often used in patients who have pain caused by Excessive factors; however, if this were used in the West it would cause a bad reaction for many patients, so the even method is used instead of strong needle manipulation.
Individual constitution
TCM treatment also varies according to a person’s age, sex and personal constitutional condition, which is quite logical. For instance, men and women are different in constitution – women have menstruation and pregnancy, so called ‘Yin body’, while men have more Yang, so-called ‘Yang body, so the treatment method should vary accordingly. Most women will not be able to stand strong herbal treatment and strong manipulation of the needle. A difference also exists between adults and children.
Therapeutic steps
In modern medicine, there are three usual methods of treating pain:
1. Remove the causes of the pain, such as an ulcer or abscess.
2. Alleviate the pain by reducing or stopping transmission of the pain impulses from the affected region – for instance, by administration of sedatives, or electricity. Antidepressants are often used as an adjunctive treatment; originally they were used only to treat depression, but studies have shown that these medications can alleviate pain in certain situations (Antkiewicz-Michaluk et al. 1991, Ardid & Guilbaud 1992, Ardid et al. 1992, Bank 1994, Danysz et al. 1986). Furthermore, they may have the added benefit of helping the patient to sleep at night. Also anti-seizure medication may help relieve certain types of pain by reducing abnormal electrical discharges in damaged nerves.
3. Reduce reception of the impression of pain in the brain by use of drugs.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
