TRADITIONAL CHINESE MEDICINE DOCTORS, DIAGNOSIS AND TREATMENT

FOUR PROPERTIES AND FIVE FLAVORS OF TRADITIONAL CHINESE MEDICINE

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Treatment by Chinese medicine doctor One key belief of Traditional Chinese Medicine (TCM) is that the body consists of opposite but complementary qualities, or yin and yang, that maintain its healthy balance. Treatments based on four properties and five flavors are thought to promote balance. The Four Properties are: 1) Cold; 2) Cool; 3) Warm; and 4) Hot, with Neutral regarded as a state of balance. Herbs are labeled hot or cold for their ability to treat ailments considered related to either cold (yin) or heat (yang). Yang (hot) herbs treat yin (cold) conditions, such as chills. Yin (cold) herbs treat yang (hot) ailments, such as swelling. [Source: National Geographic, January 2019]

The Five Flavors refers to different flavors believed to have specific healing properties and abilities to target specific body areas and organs. They are
1) Salty: Stimulates sweating, blood circulation;
2) Sweet: Aids bowel movements
3) Spicy: Reduces heat
4) Bitter: Relieves pain
)5 Sour: Stops sweating, coughing, and diarrhea

Treatments can be medicines taken internally or treatments applied externally. National Geographic showed a two-month-old baby in Chengdu being bathed in an herbal solution meant to detoxify and cool the body during the humid summer months. The treatment ascribes to the Chinese philosophy of maintaining the body’s overall well-being, not just treating ailments after they’ve surfaced. At the Chengdu University of Traditional Chinese Medicine hospital, twin sisters were treated with medicinal patches containing a formula of herbal medicine used as a seasonal treatment to expel heat from the body during summer. [Source: National Geographic, January 2019]

According to the National Palace Museum, Taipei: “In traditional Chinese medicine, problems such as skin abscesses, sores, boils, incision wounds, ulcerated sores, orthopedic traumas, burns and frostbite fall under "external medicine" because the symptoms are manifested externally and are often visible or palpable. The texts that deal with these problems include “Liu Juanzi Zhi Yongju Shenxian Yilun” (“Liu Juanzi's Abscess Treatment Formulas Bequeathed by Immortals”), “Weiji Baoshu” (“The Treasured Book of Health Promotion”), “Jiyan Beiju Fang” (“Collection of Proven Formulas for Abscesses of the Back”), and “Yuzuan Yizong Jinjian” (“Imperial Edition of the Golden Standard of Medicine”). They provide an overview of how people in ancient times treated external symptoms using medicine, acupuncture and anesthetics, as well as surgical procedures such as scraping, cutting, puncturing and bone-setting. [Source: National Palace Museum, Taipei, npm.gov.tw]

Traditional Chinese Medicine Doctors

China has 1.1 million certified doctors of Western medicine, versus 186,947 traditional practitioners according to the New York Times in 2015. In 1981 there were reportedly 516,000 senior physicians trained in Western medicine and 290,000 senior physicians trained in traditional Chinese medicine. For instance, physicians trained in Western medicine have been somewhat reluctant to accept "unscientific" traditional practices, and traditional practitioners have sought to preserve authority in their own sphere. Although Chinese medical schools that provided training in Western medicine also provided some instruction in traditional medicine, relatively few physicians were regarded as competent in both areas in the mid- 1980s.[Source: Library of Congress]

TCM doctors are expected to: 1) Diagnose Patient based on the belief that each patient is unique and people suffering from the same symptoms may receive significantly different prescriptions; and 2) Gather Ingredients after a practitioner identifies a patient’s ailment through an extensive examination that can include checking the pulse and tongue. [Source: National Geographic, January 2019]

Traditional medicine doctors in Asia are licensed by the government. Doctors and pharmacists practicing Chinese medicine have to attend medical school and pass exams just like doctors who practice Western medicine. In mainland China, Taiwan, Hong Kong, South Korea, Japan, Vietnam there are special medical schools to train doctors in Traditional Chinese Medicine (TCM) or the local equivalents.

Ian Johnson wrote in the New York Times: “One senior practitioner is Hu Xin, 61, who began learning herbal medicine 50 years ago from his father. He later went to university, earning advanced degrees, but said that any good herbalist has to study the classics, some of which date back 2,000 years. Sitting in his small consultation room at the end of a long morning, Dr. Hu had just treated 14 patients with serious ailments like intestinal inflammation, ovarian cysts, menstrual cramps and chronic bronchitis. [Source: Ian Johnson, New York Times, October 10, 2015]

Traditional Chinese Medicine Diagnosis

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Pulse taking Diagnosis in traditional Chinese medicine is primarily made by history taking and a complex system of twelve or twenty-four different pulses. It is based almost exclusively on the doctor’s questions, observations and the skillful taking of the pulse.

Typical associations made by Chinese doctors: 1) Weak Heart: Palpitations, dizziness, faintness, feeling of panic. 2) Weak Kidney: Impotence, sexual dysfunction. 3) Weak Nervous System: Headaches, malaise, inability to concentrate. 4) Weak Stomach or Liver: Indigestion Om (translated "I'm Skinny"): Means "I'm sickly". 5) Fire/Hot: Dark urine, flatulence, constipation. 6) Air/Wind/Cold: Too much air can cause illness such as myalgia, cough, headache and nausea.

In his paper “Traditional Vietnamese Medicine: Historical Perspective and Current Usage,” Hue Chan Thai wrote: “Dong Y practitioners typically assess patient’s Qi and Blood by taking a medical history, observing the patient’s affects, and by feeling her pulses and examining the shape, size, and color of her tongue. By examining the pulses and tongue, a picture of disharmony between different elements within one’s body can be pieced together. For example, red spots on the tip of the tongue indicate that the person has a yang type of condition. Someone with poor digestion will tend to have a swollen tongue with multiple tooth marks. All disorders are described in terms of disharmonies between elements or between organs. For example, a patient with digestion problems may carry a diagnosis of Liver stagnation that impacts on the Pancreas’ function. Important comparisons in this area can be made between Eastern and Western approaches. In the East, diagnoses and treatments are more conceptual i.e. Wood overacting on Earth instead of stress or indigestion. However, behind this simplicity lie keen observations of ailment patterns (i.e. emotional stress often affect digestion). Dong Y practitioners mostly focus their therapies on correcting syndromes rather than individual complaints. It utilizes food, herbs, minerals, acupuncture, and exercises with the goal of providing long-lasting effects. [Source: Hue Chan Thai, ND, MSA, University of Washington, August 1, 2003. Last Reviewed: September 20, 2011]

Examination by a Chinese Medicine Doctor

A Chinese medicine doctor diagnoses a patient by looking into his face, eyes, tongue, ears and nose and by listening to the voice and feeling the pulse and skin. Treatment usually involves acupuncture, qi gong, meditation, dietary changes and herbal remedies.

Some doctors look at the face for negative differences in the teeth, hair and ears. The nose is examined for problems with the lungs. Heart problems are diagnosed with the tongue. Liver problems are checked by examining the color of the skin. Some doctors carefully check the iris of the eye. Smell is also important in Chinese medicine, One doctor said, "For example, the smell of a patient who has cancer is different from the one who has had stroke."

After an examination a Chinese doctor might declare that a patient’s insomnia is caused by an “energy leak” from the heart. As one doctor explained to Newsweek, “The heart governs the mind. You have too many thoughts. You can’t get them out of your brain when you sleep.” Peptic ulcers are said to be caused by “deficient yin of the stomach” or “damp heart affecting the spleen” or “disharmony of the liver invading the spleen.”

Chinese Doctor and the Pulse

Chinese medicine doctors examine their patients pulses and tongues as Western doctors do but what they usually find is different than what Western doctors find. Chinese medicine doctors have identified more than 30 different kinds of pulses, including slippery, full, floating, rapid, slow, thready, empty, leisurely, irregular and regularly irregular. Tongues can be diagnosed as slippery, dry, pale, greasy, having a thick coating or having no coating at all.

There are 12 different pulses for each of 12 identified major organs. Describing his own treatment, journalist Rick Weiss wrote in the Washington Post, "Ming carried no stethoscope, ordered no tests and didn't tap my knees with a chrome-plated hammer. Instead, he looked at my tongue. Then squeezed my fingernails. Then he felt my pulse at each wrist, sensing not just the rush of blood in my arteries but the subtle pulsing of 12 different signals, unrecognized by modern science, that in Chinese medicine are said to provide information about all the various organ systems in the body."

A critic of Chinese medicine Professor Zhang Gongyao told the Times of London, “What exactly is the pulse” Do they hear the flow of blood, or is it the heartbeat, the breath and the softness of the blood vessels? Some doctors boast they can even tell a woman is pregnant from here pulse. The biggest problem is there is no standard.”

Treatments in Traditional Chinese Medicine

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Chinese medicine store in Los Angeles in 1901 Traditional Chinese Medicine (TCM) treatments include the oral and topical administration of herbal medicines as well as the stimulation of a series of surface points with needles (acupuncture) or burning moxa (moxibustion). Massage techniques are also used, and doctors avoid cutting into the body. Remedies to right the imbalance include snake gallbladder, powdered deer antlers, and rhinoceros horn, as well as hundreds of different combinations of herbs. Practitioners of these treatments have traditionally included both professionals and literati-amateurs, and they developed an extensive literature of manuals and pharmacopoeias.

Traditional Chinese Medicine doctors say that Chinese medicine almost never uses individual plants or minerals. The most sophisticated part of Chinese medicine, Liu Changhua, a professor of history at the China Academy of Chinese Medical Sciences told the New York Times involves formulas of 10 to 20 herbs or minerals that a practitioner adjusts weekly after a consultation with a patient. And yet almost no research has been done on how these formulas actually interact with the body, he said.“ [Source: Ian Johnson, New York Times, October 10, 2015]

With fever, the body is at risk for becoming too cold, so one is dressed warmly, cold foods are avoided (fresh fruits and vegetables), and fluid intake is restricted. Neutral foods (rice, eggs, chicken broth, teas and sweats) can be eaten.

Preparation and Prescription of Traditional Chinese Medicines

Depending on the prescription, an herb may be processed in various ways to extract its healing properties in their proper potency. The msot commonly used tools are the medicine grinder, boiling pot and mortar and pestle. According to National Geographic: The Paozhi (processing) stage distills herbs to their essence by crushing, roasting, burning, or frying to eliminate impurities. The grinder is sometimes used on soft herbs, like mint, the mortar and pestle on hard ones. The herbs are steadily boiled, often for hours, causing a chemical change believed to blend their healing properties. [Source: National Geographic, January 2019]

A traditional prescription consisting of pills, powder, tea or patch is designed to target specific parts of the body and to bring the patient’s entire system back into balance. Generic remedies can be sold as pills or in packets, but some say teas from raw herbs are more effective. The medicine is consumed in a broth or tea of reed roots or applied as a patch at acupuncture points along or at the end of meridian, a pathway in the body where energy is said to flow.

1) Monarchs are principal ingredients target the immediate cause and symptoms of the disease.
2) Assistants treat secondary symptoms, eliminate toxins, and optimize the effects of the other herbs.
3) Guides are not always necessary in prescriptions. These herbs help deliver ingredients to targeted areas.
4) Ministers are herbs that are said to enhance the monarch’s effects and also target underlying symptoms.

According to the National Palace Museum, Taipei: “Bencao, or "materia medica," is the umbrella term for pharmacology in ancient China and can be divided into classes including cao (herbal plants), gu (grains), cai (vegetables), guo (fruits), mu (trees), chong (insects, amphibians and reptiles), lin (fishes) and jie (animals with a shell) as well as qin (fowls), shou (beasts), jinshi (metals and minerals), shui (water), tu (earth), huo (fire), fuqi (textiles and tools) and ren (humans). Medical practitioners would look at the patients' symptoms and make prescriptions using one or more ingredients. [Source: National Palace Museum, Taipei, npm.gov.tw]

Starting in the 7th century, Japan received an influx of medical texts and knowledge from China, and beginning in the 15th century, interaction between China and Korea in the medical field also stepped up. As a result of this exchange, Japan and Korea started to turn out pharmacological compendia and medical texts based on recipes from Chinese medical books. Among these are medical classics such as “Jingshi Zhenglei Daguan Bencao” (“Pharmacopoeia of the Daguan Reign”) and “Bencao Gangmu” (“The Compendium of Materia Medica”), as well as precious artifacts such as illustrations of herbal medicine and horse bezoars, which were ingredients in Chinese medicine. In addition, Japanese texts including “Yakushushō” (“Annotations of Medical Plants”) and “Honzō Wamyō” (“Japanese Names of Medical Herbs”), as well as Korean titles such as “Uibang Yuchwi” (“Classified Collection of Medical Prescriptions”) and “Hyangyak Jibseongbang” (“Compendium of Folk Medical Prescriptions”) are testament to the far-reaching influence and dissemination of traditional Chinese medicine.

Taking Chinese Herbal Medicines

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Diabetes medicine Herbal prescriptions, many dating back millennia, are a big part of traditional Chinese medicine. Formulas may consist of a single herb or many and are customized based on a patient’s condition, age, gender, and body type. Apothecaries such as the Chengdu Tongrentang traditional pharmacy fill herbal prescriptions, dividing the mixtures into single doses that are folded into paper envelopes. At home, patients brew these into a tea to drink.

Most Asian medicines are sold in little packets and then mixed with water and boiled in pan. In Korea medicines are often mixed into pumpkin soup. Many pharmacies mix up special brews in their own kitchens and then pour them into thermoses for delivery to people's homes on bicycle. The recipe for Yinqiao, a 10-herb treatment for the common cold consists of 1) Fructus Forsythiae, 2) Flos Lonicerae, 3) Radix Platycodonis, 4) Herba Menthae, 5) Herba Lophatheri, 6) Radix Glycyrrhizae, 7) Herba Schizonepetae, 8) Fermented soybean, 9) Fructus arctii, and 10) Rhizoma Phragmitis

Some herbal remedied are applied topically. Some Chinese treats upset stomachs by rubbing things like White Flower Oil on their head and stomach. Skin balms such as "sticky dog skin plaster" (now with a dog skin substitute) are used to treat sore muscles. "Tiger balm" from Hong Kong is a salve that can be used as cure all for anything. [Source: Lonely Planet]

Many Chinese herbal medicines have a bitter taste. Foreigners often prefer to take them in gelatin capsules because they can't stand the taste. Sneezing powders are prescribed for stomach ailments as way of releasing pressure.

Hot and Cold Foods and Traditional Asian Medicine

In her paper "Nutrition and Fasting in Vietnamese Culture, " Janet Tu wrote: "Many Vietnamese — especially of the older generation — believe in the Chinese yin/yang categorization of food, in which foods are considered either yang — "hot," or yin — "cold." In this system, "hot" foods such as mango, beef and garlic, may lead to an excess of heat in the body, causing ailments such as pimples, nosebleeds and rashes. Overconsumption of "cold" foods such as melons, greens or pork, may lead to chilliness, abdominal pain or diarrhea. They believe that sickness arises when the body's yin/yang balance is off, and will try to remedy the imbalance by eating the appropriate hot or cold food. According to the yin/yang system, in the first month after a Vietnamese woman has a baby, she shouldn't have any cold foods. [Source: "Nutrition and Fasting in Vietnamese Culture" Janet Tu, March 28, 2001 |*|]

In his paper “Traditional Vietnamese Medicine: Historical Perspective and Current Usage,” Hue Chan Thai wrote: ““Vietnamese commonly refer to food property as hot or cold, which does not necessarily refer to temperature or spiciness. Instead, they refer to the effects that the food has on the body. For example, eating a plate of French fries can cause a person to feel very thirsty. Due to this effect on the body, fried foods are considered a hot food. Dried, deep fried or very rich foods (high sugar/fat content foods) are considered hot food. [Source: Hue Chan Thai, ND, MSA, University of Washington, August 1, 2003. Last Reviewed: September 20, 2011 \=]

Symptoms of hot and cold: 1) Signs and symptoms of excessive heat: Thirst for cold drinks, fever, red face, red eyes, canker sores, irritibility, insomnia, constipation, yellow urine, and yellow or green discharge. 2) Signs and Symptoms of excessive cold: Cold, pain, cramps, diarrhea. Cooling food: 1) Fruits: watermelon apple, pears, persimmon, cantalope, citrus; 2) Vegetables: cucumber, asparagus, squash, cabbages, rooty-vegetables lettuce; 3) Grains and Legumes: mung beans, sprouts, tofu, barley, millet, (Rice-neutral); 4) Others: yogurt, peppermint, dandelion, cilantro. \=\

Artworks and Calligraphy Related to Traditional Chinese Medicine

“Brewing Medicine” is an ink and colors on paper handscroll measuring 28.8 x 119.6 centimeters by the Ming dynasty artist Tang Yin (1470-1524). According to the National Palace Museum, Taipei: “This painting shows a medicinalist seated under pine trees with a young attendant taking care of a stove, fanning the flames to brew a concoction. Although the figures are sparingly drawn, the characterization is complete. The brushwork for the rocks and tree trunks is lively as it twists and turns. The pine needles and distant mountains are done with light shades of ink washes that make them appear moist and full of the potential for life, serving as an apt reflection of the idea behind preparing medicine. Tang Yin in his late years suffered from a lung ailment and, according to his inscription at the end of this scroll and the colophon by Zhu Yunming commending the skills of a doctor named Lu Yuezhi, we know that this work was done by Tang around the age of 49 in appreciation of Lu providing him with medicine to treat his problem. Tang Yin (style name Bohu, sobriquet Liuru jushi), a native of Wuxian (Suzhou), came in first place in the Nanjing civil service examinations of 1498. Skilled in poetry, painting, and calligraphy, he is ranked as one of the Four Ming Masters. [Source: National Palace Museum, Taipei, npm.gov.tw]

“Kidney Qi" Bolus” is an ink on paper calligraphy in an Album leaf measuring 26.5 x 31.1 centimeters by the Jin dynasty artist Wang Xianzhi (344-386). This work from the Chunhua Pavilion Modelbooks is an engraving based on a letter originally written by Wang Xianzhi in running script entitled "Kidney 'Qi' Bolus," in which Wang describes his observations on the efficacy of this medicine in ball form and "astraglia radix." Kidney "qi" bolus is also called "'Rehmanniae' bolus of eight ingredients" and traces back to Discourse on Harm from Cold and Various Diseases by the Eastern Han "Sage Doctor" Zhang Zhongjing (ca. 150-219). One of the most famous prescriptions in traditional Chinese medicine, it has been highly praised since early times, being used in various applications. The "'Rehmanniae' bolus of eight ingredients" seen today, along with the famous "'Rehmanniae' bolus for improving eyesight" and "'Rehmanniae' bolus with 'lycii' and 'chrysanthemi'," are derivatives of the "Kidney 'qi' bolus" recipe. Wang Xianzhi's (style name Zijing) ancestral origins were in Langya (modern Linyi, Shandong). The son of the "Sage Calligrapher," Wang Xizhi (303-361), in calligraphy the two of them were known as the "Two Wangs."

Image Sources: Tqnyc; All Posters com; ; Wikipedia; Compassionate Dragon Healing; Accupuncture Products; Iron Palm Arts; WWF; Ciao Su Nature Products; South Aquaculture

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

Last updated September 2022