The 11 Treatment Methods in TCM

• Sweating "Releasing the Surface" Method
• Vomiting Method
• Purging (Xei) Method
• Harmonizing Method
• Warming Method
• Clearing Method same as Cold Method (Clear Heat)
• Tonifying Method - Nourishing Method (Bu Fa)
• Remove Congestion Method
• Astringing Method
• Invigorating the Blood, Removing or Breaking Blood Stagnation Method
• Regulating the Qi Method

1. Sweating Method (a.k.a. - Releasing the Surface & Releasing the Exterior)

1. Exterior-Cold-Excess patterns
   Herbs: Spicy warm herbs to release the surface, such as Ginger
   Other: Drink hot water and cover with blankets when sleeping, hot bath or private sauna. Anything that causes the patient to sweat (without too much exertion).
2. Exterior-Heat-Excess patterns
   This condition is the same as Wind-Heat invasions or the Wen Bing's Wei Stage of Warm Heat.
   Herbs: Cool herbs to release the surface (e.g., mint, honeysuckle, chrysanthiemum). These herbs cause the skin's pores to open slightly to expel the Evil Qi, just by sweating.
3. Wind-Water pattern
   Wind-Water, or Feng Shui is a pattern with acute edema occurring (this is different from edema due to Kidney disease patterns). Causes include allergic reactions but also acute nephritis. This pattern can be seen in pediatric cases
   Herbs: herbs that release the surface. Sweating can clear out the edema.
4. Skin Rashes of Exterior type pattern
   Skin rashes such as measles, chicken pox, or allergic reactions, such as hives.
   Herbs: Spicy warm or cool herbs to release the surface.

Precautions for Releasing the Exterior:

• Use only when the when the diagnosis is an exterior condition. If the cause it interior, releasing the surface (sweating) can only weaken the patient. The sweating will have no affect on the disease as it is already deep.
• Must limit sweating to appropriate amount. If there is too much sweating then the patient will display signs of feeling cold, have a deficient pulse or even a rapid pulse from causing the yin to collapse. If there is not enough sweating, the ailment will still be present. Determining the right amount will depend upon the practitioner's clinic experience
• Contraindicated if the patient is already sweating, vomiting, bleeding or has diarrhea. These conditions will injury the patients body fluids. And releasing the surface will only injury it more
• Contraindicated if the patient is too young or too old. As strong sweating when the patient's constitution is too weak may cause them to go into shock.

2. Vomiting Method

1. Food Stagnation due to overeating.
2. Ingestion of Toxins/Poisons.
3. Phlegm obstructing airways
   
   Herbs: In this treatment methods, herbs that induce vomiting are used. Salty water can be used to "tickle" the throat.

3. Purging (Xei) Method

There is a saying in an older Chinese medical text which states:

Da Huang is one of the primary herbs used for the purging method as it induces bowel movements. The saying refers to people using Ginseng inappropriately (e.g., self medication) causing their deaths (a hero with a dark side). Too much tonifying, or tonifying when it is inappropriate can kill, but people still like the idea of tonifying. On the other hand few people give Da Huang, or the purging method, credit for saving many lives. People don't like purging so few people realize the importance of the Purging method (the unsung hero). This method is used mainly to purge fire and clear heat.

1. Fever, headache, sweating, abdominal pain, bloating ana constipation. Strong and rapid pulse. Red Tongue body with yellow coat, This is pattern of internal, excess, heat. purging method can be used in this example to clear heat. The heat will be expelled from the body through the bowel movements. If there is even more heat symptoms, then this treatment method can be combined with the Clear Heat method.
2. Heat in the Blood.
   This pattern involves excess heat causing hemorrhages. For example, heat in the upper body can result in nose bleeds (epistaxis), coughing up of blood (hemoptysis), or vomiting of blood (hematemesis). The purging method can be used to draw the heat down and out through the elimination. This method can effectively stop bleeding even though the Stop Bleeding method isn't used.
3. Damp-Heat Diarrhea.
   The pattern is identified by foul odor elimination with small amounts of mucus (Dysentery). There may be small amounts of blood. The patient cannot really finish eliminating so the Purging method is used to cleanse and clear the Damp-Heat Evil.
4. Turbid Water Retention
   The Purging method can be used only for an Excess condition (not for
   Deficiency). Purging draws the excess water out of the body through the
   bowel movement.
5. Amenorrhea, or Dysmenorrhea due to Qi/Blood Stagnation
   Purging can be used to break down Qi and/or Blood stagnation. After purging the menses will then resume.
6. Lubricating Purging- Mild.
   Thus method involves using herbs rich in oils (i.e., nuts, seeds) which serve as a laxatives. This method is employed when using the cathartics is too harsh.
   Purging is extremely effective for Yangming Fu Syndromes!

Precautions for the Purging Method:

• This method is contraindicated if the Evil is on the Exterior. Purging will only cause the patient to lose body fluid and will not expel the Evil.
• This method is contraindicated if the Evil is between the Interior and Exterior. Again because Purging treats interior excess conditions, this method is not effective for patterns that are between the interior and exterior for example in Shaoyang Syndromes.
• This method is contraindicated if the patient is too young or too old. This method is very taxing on the body so if they are already deficiency, purging can only cause more deficiency.
• This method is very much contraindicated during pregnancy. May cause miscarriage.
• This method is also contraindicated during the menses. Can cause heavier bleeding.
• When using this method, restrict use to 1 or 2 times. Otherwise, too much purging will cause deficiency.

4. Harmonizing Method

1. Used for Half Interior, Half Exterior (Shaoyang) Syndromes. For example: common cold, flu, malaria where symptoms correspond with the Shaoyang syndrome.
   Herbs: spicy cool herbs to release the surface and also herbs to tonify the Spleen deficiency.
2. Used for disharmony between the internal organs. For example: in syndromes such as Liver invading the Spleen or Stomach, Premenstrual Syndrome, hepatitis, digestive function disorders, liver function disorders, often for female disorders.
3. Used as a last resort. If none of the other treatment methods are effective, you can resort to this method.

Precautions for the Harmonizing Method:

• Take caution in correctly identifying that this condition is between the Interior and Exterior. As this method is not advisable if the condition is on the exterior or in the interior.
• Also take care not to be careless in just using this method. As opposed to making a through diagnosis.
  

5. Warming Method

1. Used to Save the Yang in the case of Yang Collapse. This methods brings back the Yang in severe Yang deficiency.
   Symptoms: In Yang Collapse the patient may have the following symptoms: poor shen, cold touch (whole body), pallor, cold sweat, slow-weak-irregular pulse. This is also described as the separation of Yin and Yang (rather serious).
   Herbs: Strong Yang tonifying herbs to save the Yang. Such as Korean ginseng, or dried ginger.
   Other: In this circumstances, keep the patient warm (increase room temperature). Moxa acupuncture points: Du-20 Baihui and St-36 Zusanli or use warm needle technique.
2. Also used to Tonify the Yang in cases of Yang Deficiency. This is similar to condition A but less serious. Most common application is for Middle Jiao Cold Deficient patterns (Spleen and Stomach affected).
   Symptoms include: cold diarrhea (diarrhea without heat signs), cramping and pain in abdomen, undigested food in elimination, increase pain with ingestion of cold foods, low energy/fatigue, bloating, poor appetite, nausea and vomiting.
   Herbs: warm, hot herbs to tonify the yang (e.g., ginger, peppers). Other: needle and moxa Ren-12 Zhongwan and St-36 Zusanli.
3. Used for Cold/Stagnation of Channel Qi. Cold and pain on specific parts of the body.
   Herbs: May use herb plaster or pepper oil in affect areas.
   Other: Use needle and moxa on acupuncture points in the affected area.
4. Used to Warm Kidney Yang. In conditions when the "Life-Gate Fire" is not strong enough there may other associated patterns which complicate the Yang deficiency. Such as "dirty water" edema (due to Kidney deficiency), urinary dysfunction, or reproductive dysfunction.
   
   This method is used to tonify the Kidney Yang to treat associated symptoms. Can use Kidney Back-Shu points or Du channel points or Kidney channel points.

Precautions for the Warming Method:

• Make sure the patient has no hemorrhaging. Especially due to excessive heat, but also due to Yin deficiency problems. Warming method will worsen the bleeding.
• Make sure the patient does not have false cold symptoms. In cases of extreme heat, false symptoms may arise. You must make sure this is not the case as the Warming method will worsen these cases.
• Floating Yang. The warming method i not appropriate because this is a heat (deficient) problem.
  

6. Clearing Method (a.k.a. - Cold Method & Clear Heat Method)

1. Used to Clear Heat specifically, and for detoxification
   Use for syndromes where there is Heat and Toxins on the interior of the body (Toxin is not exactly the same as in Western Medicine). Includes conditions such as toxemia and septicemia;
   Symptoms include: fever, dermatitis, or bronchitis.
   Herbs: honeysuckle, dandelion, chrysanthemum; their use is similar that that of Western medicine's aspirin and antibiotics.
2. Used to Treat Qi Stage Warm Heat (Wen Bing) or Yangming Heat
   (Shang Han Lun).
   Note that this is for Yangming channel conditions where the "four Big's" are present (big fever, thirst, pulse, sweat). Otherwise if it is the Yangming Fu syndrome (constipation) then use the Purging method.
   Acupuncture: LI-11 Quchi and other cooling points.
   Other: Apply ice to armpits, forehead.
3. Used to treat Heat in the Blood at the Wei, Qi and Ying levels.
   For symptoms such as skin rashes, fever (esp. nighttime fever), and bleeding in some areas of the body.
4. Used to Clear Damp Heat
   For example, Lower Jiao Damp Heat will have symptoms such as fever, red face , cloudy urine accompanied by burning sensation and urgency, diarrhea, red tongue with yellow greasy coating.
   Herbs: to clear heat and dry dampness.
5. Used to Clear Deficient Heat (Yin Deficiency)
   Deficiency heat symptoms include: Low grade fever, thirst, night sweating, malar flush, etc. We use this method combined with Yin tonification.

Precautions for the Clearing Method:

• Make sure this is true heat as opposed to false heat and true cold. If it is true cold do NOT use the Clearing Heat method.
• Do NOT use this method for too long. Otherwise you may damage the Yang Qi and will cause further complication to the disease pattern.

7. Tonifying Method (a.k.a. - Nourishing Method, 'Bu Fa')

1. Used to Tonify Qi
   For Qi deficiency syndromes and related syndromes such as Qi Sinking, etc.. Appropriate herbs include: Dang Shen, ginseng, Huang Qi.
2. Use to Tonify Yang Similar to tonifying Qi but including temperature thus also warming as well. Herbs include: peppers, cinnamon bark, dry ginger, and treated ginseng.
3. Use to Tonify Blood
   Used for blood deficiency conditions the most obvious being anemia. However tonifying blood may be appropriate for various menstrual dysfunctions so long is it is related to blood deficiency. Appropriate herbs include Dang Gu
4. Use to Tonify Yin
   One aspect of Yin is body fluids. So Yin deficiency shows up as dryness issues such as dry skin, mouth, eyes. Blood is also part of Yin as well. So Blood deficiency pattern can progress into Yin deficiency. Appropriate herbs include American Ginseng (Xi yang shen) which can tonify body fluids as well.

Precautions for the Tonifying Method:

• Do not tonify when there is an exterior disease present. The idea is that if you tonify (the interior) while there is an exterior Evil, you run the risk of leading the Evil into the interior.
• Do not tonify when there is an excess Heat pattern present. Tonifying when there is a fever will likely worsen the fever. Like adding fuel to a fire.
• Do not tonify if there is an excess type pain. Again if you tonify when there is pain due to Qi stagnation it will increase the pain (like increasing the pressure without unblocking the obstruction).
• There are cases where the patient may be so deficient, that they are unable to tolerate tonification methods. For example, the Spleen is so weak that the digestive tract is unable to handle the stronger herbs. Furthermore doing so may weaken them more (i.e., lower their appetite, etc). This is analogous to feeding someone who has been starving for a long period. They would not be able to tolerate rich foods. Start with simple foods and build up from there.
• Tonification must be done over longer periods compared to other treatment methods. Just using it a few days will not be effective. So it is important to monitor the treatment as well as to avoid abuse of tonification.

Comparison with Western Medicine (When to use Tonification):

1. Hormonal Problems
   Appropriate for conditions such as deficient adrenal glands (Addison's diseases) where the Kidney is Yang Deficient. Hypothyroidism is similar to Yang deficiency. Hyperthyroidism is similar to Yin deficiency.
2. Asthma
   For asthma due to deficient Kidney and Lung it may be appropriate to tonify these organs.
3. Organ Prolapse
   Tonify the Zhong Qi, Middle Qi and Spleen Qi for condition such as hernia (NOT always), prolapsing uterus, rectum, etc..
4. Bone Diseases
   Including arthritis, broken bones, osteoporosis (the Kidneys control the bone so tonify the Kidneys).
5. Immune System Problems
   Tonify the Lungs Qi to benefit the Immune system. For conditions such as AIDS, Epstein Barr Virus.
6. Cancer
   May be appropriate for some types of Cancer (difficult to treat).
   Tonify the Zheng Qi, but must also Break Stagnation and Dissolve Phlegm.
7. Anemia
   May also be difficult to treat as it may be due to lack of marrow function; if so then tonify the Kidney and Spleen to treat this condition.
   Overall the Tonification method is used frequently in the clinic, especially for people with chronic illnesses.

8. Remove Congestion Method

1. Use to Treat Food Stagnation.
   Can be due to poor digestion or overeating causing bloating, nausea,
   vomiting, diarrhea. Food Stagnation herbs are used specifically for these conditions.
2. Use to Treat Phlegm Congestion
   This is not the same as the Western notion of phlegm. It includes but is not limited to the sputum we expectorate. Nodules, fatty tumors, swollen glands are consider phlegm under the skin.
   Acupuncture: Turtle needling technique.
3. Use to Drain Dampness and Transform (Dissolve) Phlegm (also Clear Heat).

Where there is Dampness present, the patient may feel very tired and heavy. Dampness can also be complicated by Heat. And if it persists long enough can turn into phlegm.

Examples: Lower Jiao Damp Heat can look like a urinary tract infection (UTI). For this condition you need to promote water (circulation and elimination) and remove dampness. Upper Jiao Dampness can manifest as Meniere's disease where there is vertigo, dizziness due to Damp congestion. Again this is treated by promoting water movement and draining Dampness.

Precautions for the Remove Congestion Method:

• Removing Congestion and Purging are methods used to treat Excess conditions. If the onset of the condition is acute, use the Purging method not the Remove Congestion method. Remove Congestion is not as strong but nor is it as harsh as Purging.
• Contraindicated for Deficiency conditions.

9. Astringing Method

1. Used to Stop Sweating (Astringe Sweating).
   For Qi Deficient sweating also tonify Qi.
   For Yin Deficient Sweating also tonify the Yin.
2. Used to Stop Coughing (Astringe the Lungs)
   By astringing the Lung, this can stop chronic coughs.
3. Used to Stop Diarrhea (Astringe the Intestines)
   Use to stop chronic types of diarrhea, also can stop prolapse of the large intestines.
4. Used to Stop Urination (Astringe the Bladder)
   Use for bed wetting or too frequent urination (day or night).
5. Used to Stop Spermatorrhea (Astringe the Jing)
   Also for premature ejaculation.
6. Used to Stop Leukorrhea (Astringe the Belt Channel/Dai Mai) Also appropriate for excess menstrual bleeding.
7. Used to Stop Hemorrhage (Astringe the Blood).
   Used for chronic bleeding conditions such as hemophilia

Precautions for the Astringing Method:

Do NOT use for acute Excess condition. This both will lock in any evils so you must be sure there is no excess condition (such as heat, wind, etc..). Generally you would combine this treatment method with the Tonifying treatment method. The tonification treats the root of problem while Stringing treats the symptoms.

10. Invigorating the Blood Method (a.k.a. - Removing or Breaking Blood Stagnation)

1. Used to Regulate the Qi and Vitalize the Blood.
   Qi is the leader of the Blood, so some kinds of Blood Stagnation are caused by Qi stagnation and congestion. For example Liver Qi Stagnation produces PMS symptoms (painful menstruation). This method is good for many female problems.
2. Used to Warm the Channels and Vitalize the Blood.
   Blood stagnation can be caused by Cold Evil. One of the obvious symptoms of blood stagnation is sharp pain, pain that is somewhat alleviated by
   warmth. For this condition, can use moxa and acupuncture to treat as well.
3. Used for certain kinds of Wind Problems which cause Blood Stagnation.
   Generally Internal Wind is caused by Excess Heat. However, Blood stagnation can also cause Internal Wind. For example a stroke due to Blood stagnation can cause Wind symptoms (paralysis), as can trauma.
4. Used to stop Bleeding due to Blood Stagnation.
   Blood stagnation can cause Bleeding. In such cases, the Stop Bleed method does not work because of the stagnation. For example, tissue left behind an abortion, or after delivery can cause uterine bleeding.
5. Used in Cancer conditions.
   Blood stagnation is considered one of the Evils that contribute to cancer. Cancers that have blood stagnation qualities (purple coloration, fixed stabbing pain, mass/tumor) can be addressed using the treatment method.

Precautions for the Invigorating Blood Method:

• Do NOT use this method during the patient's period. This will cause excessive bleeding.
• Do not use this during pregnancy. As you may cause bleeding and a miscarriage.
• Do not use this method for long periods. Otherwise you may break down the blood, affecting the Qi, resulting in deficiency patterns.
  

11. Regulating the Qi Method

1. Used for Qi Stagnation
   Use herbs and acupuncture to move the Qi to break up the stagnation. In this pattern exercising can help too.
2. Use for Rebellious Qi
   Can be used for Lung or Stomach Qi rising up. In both cases the Qi normally descends. When the Qi rebels, it ascends producing symptoms. In the Lungs you have coughing, and in the Stomach you have belching or vomiting.
   Use herbs and acupuncture points that direct the Qi downwards.

Precautions for the Regulating the Qi Method:

• Regulating method may spread the Qi to much weakening the Qi.
  Consider adding Qi tonifying method, or making sure that the patient is not too Qi deficient.
• Contraindicated when patient is Yin/Blood deficient.
  Herbs that regulate the Qi are spicy and dry. This method will dry out the body aggravating the Yin/Blood deficiency.