Introduction A summary of the experiences of ancient Chinese in their struggles against diseases. Is an important part of the Chinese culture. It had.

Fundamental Theory of TCM

Introduction

A summary of the experiences of ancient Chinese in their struggles against diseases.

Is an important part of the Chinese culture.It had a unique and integral theoretical system.It belongs to the category of life science and an

important part of world medicine.

Initiation and Development of TCM Theoretical System

(1) An accumulation of long period of medical experience:

- Yin dynasty （殷代） recorded disease names such as Tinnitus （耳鸣） , Insomnia （不眠） , Zhengjia 症瘕(concretion), Jie 疖 (scabies)and etc ；- Early Qin dynasty （先秦） recorded 38 kinds of diseases ；-Han dynasty recorded 52 kinds of diseases （五十二病方） , more than 100 names of disease were mentioned.


(2) Influence of ancient philosophical thinking:- Life is a unity of opposites of yin-yang and in a endlessly developmental and changeable process, and illnesses can be both prevented and treated.

-Build up a basis to expound the major theoretical problems such as the relationship between man and nature, the essence of life & health and disease.


(3) Infiltration of ancient natural science

-Astronomy 天文学 , calendar 历法学 , meteorology 气象学 , geography 地理学 , acoustics 声学 , agronomy 农学 , mathematics数学 and art of war 兵法；

All taken by the ancient medical experts as the technique and means in researching the phenomena of human life and the prevention and treatment of disease.

Initiation of Theoretical System

(1) Huangdi’s Inner Classic of Medicine(黄帝内经）- It is the earliest medical classic extant in

China.-Writing started in the Spring-Autumn Warring

States （春秋战国） and completed in the middle-late stage of the Western Han Dynasty. （西汉）

-It is completed by many medical experts through collection, sorting out and synchronizing.

Main Contents of <Huangdi Nei Jing>

In tissue structure, the records of the lengths of skeleton and the sizes and volumes of internal organs are basically consistent with those revealed in modern anatomy.

The systematic recognition of blood circulation, multiple functions of human internal organs in physiology and pathology dictates the establishment of TCM and thinking model.

Main Contents of <Huangdi Nei Jing>

A methodological basis for four diagnostic techniques of inspection 望 , olfaction 闻；嗅 - ausculation, inquiry 问 and palpation 切 is laid;

Overall consideration of both exogenous and endogenous pathogenic factors in diagnosis is emphasized.

All these theories have been effectively guiding the clinical practice.

<Classic on Medical Problems>《难经》或《八十一难》Was written approximately before the East

Han dynasty.

A Q & A model is used to expound the contents of viscera 脏腑 , meridians 经络 , pulse lore 脉学 , pathology 病理 and acupuncture technique. 针法

The basic theory is taken as its main contents and symptoms of diseases are also analyzed.

Treatise on Cold Pathogenic and Miscellaneous Diseases 《伤寒杂病论》

Written by Zhang Zhongjing 张仲景 at the end of East Han dynasty 东汉 .

Summed up the diagnosis and treatment of cold pathogenic and miscellaneous disease.

Theory, principle, formula and medicinal are all given, laying a basis for the development of clinical medicine in later ages.

Treatise on Cold Pathogenic and Miscellaneous Diseases 《伤寒杂病论》

This outstanding work is termed as “the ancestor of formula” 方书之祖 .

The book establishes system of treatment determination based on syndrome differentiation 辨证论治 in Chinese medicine 。

It was later divided into two parts of <Shang Han Lun> 《伤寒论》 and <Jin Gui Yao Lue> 《金匮要略》

Shennong’s Classic of Medicinal Herbs 《神农本草经》

Was compiled approximately at the Han dynasty.It is the earliest monograph of materia medica in

China.365 kinds of herbs are recorded, and divided

into three grades （三品） of upper, middle and lower agents.

The upper grade are mainly used for strengthening physical health to correspond with the heaven 应天 , the ones of middle grade to correspond with man 应人 , and the ones of lower grade to correspond with the earth 应地 .

Shennong’s Classic of Medicinal Herbs 《神农本草经》

Four natures （ cold 寒 , hot 热 , warm 温 and cool凉 ), five flavors (sour 酸 , bitter 苦 , sweet 甘 , acrid 辛 and salty 咸 ) and seven conditions of ingredients in prescription (single effect 单行 , mutual accentuation相须 , mutual enhancement 相使 , mutual counteraction 相畏 , mutual antagonism 相恶 , mutual suppression 相反 and mutual incompatibility 相杀 ) were introduced.

This book is the important mark of establishment of theoretical system of Chinese pharmacy.

Properties & Flavours

Each Herb is assigned its own property ( 性 ) and flavour ( 味 ).

Four Properties◦HOT, WARM, COOL and COLD

Five Flavours◦Sour, Bitter, Sweet, Acrid (pungent,

spicy) and Salty

Four Properties – 四性• They represent varying degrees of

hot and cold. Warm less than hot, cool less than cold.

• Sorted out according to the different actions of the drugs on human body and their therapeutic effects. Drugs for heat syndrome have a cold and cool property; whereas those for cold syndrome have a hot or warm property.

Five Flavours – Sour 酸• Sour: astringent and prevent or reverse the

abnormal leakage of fluids and energy. • Indications: sweating due to debility,

chronic cough, chronic diarrhea, enuresis, frequent micturition.

Five Flavours – Bitter 苦• BITTER: drain and dry• Indications: used for syndromes of

pathogenic fire, cough with dyspnea, vomiting, constipation due to heat of excess type, damp-heat syndrome.

Five Flavours – Sweet 甘• SWEET: tonify, harmonize and

moisten, • Indications: effective in treating

syndromes of deficiency type, dry cough, constipation due to dry intestine, various pains, detoxication.

Five Flavours – Acrid 辛• ACRID: disperse and move• Indications: superficial and mild

illnesses due to affection by exopathogens, stagnation of vital energy, blood stasis.

Five Flavours – Salty 咸• SALTY: purge and soften• Indications: treating dry stool and

constipation, scrofula, goiter, mass in the abdomen, edema, dysuria.

Four Actions – 升降浮沉• Refer to the upward (LIFTING),

downward (LOWERING), outward (FLOATING) or inward (SINKING) directions in which drugs tend to act on the body.

Four Actions – 升浮Lifting and floating: upward and outward

actions are used for elevating Yang, relieving exterior syndromes by diaphoresis, dispelling, superficial wind and cold, inducing vomiting, causing resuscitation.

Four Actions – 降沉Lowering and sinking: downward and

inward actions, used for clearing heat, purgation, promoting micturition, removing dampness, checking the exuberance of Yang, sending down an adverse flow of qi to stop vomiting, relieving cough and asthma, improving digestion, removing stagnated food, tranquilizing the mind with heavy properties.

Channel Tropism – 归经• Refers to a drug’s selective therapeutic effects on

a certain part / system of the body.• Based on the theory of viscera and the theory of

channels and collaterals.• Used in conjunction with the theories of four

properties and five flavours.

Ginger – 生姜

Ginger (Zingiber officinale) Acrid, Warm; Acts on spleen,

stomach, heart and lung.Indications: Gastric and abdominal

cold pain, nausea, vomiting, diarrhoea etc. Retention of cold phlegm in the lung. Detoxify seafood, yam etc.

Development of Theoretical System of Chinese Medicine

1. Period of the Jin 晋 , Sui 隋 and Tang 唐 Dynasties:

- Comprehensive development during these stages.

1.1 Jin dynasty <Mai Jing> ( Pulse Classic 《脉经》 )- The conditions of 24 pulses and their indicating syndromes are expounded by Wang Shuhe 王叔和- It is the earliest monograph of pulse lore extant in China


1.2 <Zhen Jiu Jia Yi Jing>(Classic of Acupuncture and Moxibustion 《针灸甲乙经》 )- Compiled by well known scholar Huang Pumi 皇甫谧 through sorting out the expounding of meridians, points and acupuncture methods in Su Wen(Plain Questions 《素问》 ) and Ling Shu （《灵枢》 )

-Is the earliest monograph of acupuncture.


1.3 <Zhou Hou Bei Ji Fang>(Handbook of prescriptions for Emergency) 《肘后备急方》

- written by Ge Hong 葛洪- some infectious diseases such as smallpox 天花 and measles 麻疹 can be diagnosed according to their pathogenic features and clinical manifestations.


1.4 Sui dynasty Zhu Bing Yuan Hou Lun (General Treatise on Causes and Manifestations of All Diseases 《诸病源候论》 )

-known as Bing Yuan 《病源》 (Causes of Diseases) or Cao Shi Bing Yuan 《巢氏病源》(Cao’s Causes of Diseases)for short, compiled by Cao Yuanfang 巢元方。

Is a representative work of studying pathogens and manifestations of diseases.

-The pathogenic factors and manifestations of diseases in various clinical subjects are described, and the recognition and description are mostly correct.


1.5 Tang dynasty, Bei Ji Qian Jin Yao Fang《备急千金要方》 ( A Supplement to Recipes for Emergent Use Worth a Thousand Gold) and Qian Jin Yi Fang 《千金翼方》 (A supplement to Recipes for Worth a Thousand Gold) compiled by Sun Simiao 孙思邈

-Monumental works on medicinals and prescriptions


1.6 Tang dynasty, Wai Tai Mi Yao 《外台秘要》(Arcane Essentials from the Imperial Library)

- written by Wang Tao 王焘 are all the handed down prescription books that record the effective formulas of well-known physicians and their various therapeutic measures.


(2) Period of the Song 宋 , Jin 金 and Yuan 元 dynasties:

- An active atmosphere that all school of thoughts strive to surface;

- -various schools’ unique academic views greatly enriched the medical theories and practice.


2.1 Song dynastic Chen Wuze 陈无择in his work of San Yin Ji Yi Bing Zheng Fang Lun《三因极一病证方论》(Treatise on Three Categories of Pathogenic Factors and prescriptions) put forth the well known theory of three categories of Disease causes三因学说”.

-He summarized the disease causes as 3 respects: Endogenous cause内因 is injury by the seven emotions（ Anger，Grief， Fear， Shock， Worry， Joy ，Over-thinking）

;

Development of Theoretical System of Chinese MedicineExognous cause 外因 by six climatic

pathogens 六淫 ; and non-endo-exogenous cause 不内外因 are improper diet, injury of qi by loudly crying 叫呼伤气 , wounds by insects and animals 虫兽所伤 , poisonings 中毒 , incised wounds 金疮 , injuries from falls and heavy load 跌损 , drowning 压溺 , etc

A progression for Chinese medicine etiology and is consistent with clinical conditions.

Deeply influences the thinking model of etiological recognition in later ages.


2.2 Qian Yi 钱乙 who is respectively called “ the father of pediatrics 儿科之父” is the forerunner in visceral diagnosis and treatment 脏腑证治 , is recorded in the book of Xiao Er yao Zheng Zhi Jue (Key to Therapeutics of Children’s Diseases 《小儿要证直诀》 ). He also had relatively clearly recognized and diagnosed some eruptive disease such as measles and smallpox.


2.3 Jin,Yuan dynastiesMany medical schools with their own

features in the Jin and Yan dynasties came out, among them the most representative physicians are Liu Wansu 刘完素 , Zhang CongZheng 张从正 , Li Dongyuan 李东垣 and Zhu Danxi 朱丹溪 , called respectively in late ages “four great physicians in the Jin and Yuan dynasties 金元四大家” .


2.3.1Liu Wansu 刘完素 raised the theory that diseases mostly arise from “fire”, believing that “exogenously contracted six climatic agents would transformed into fire” “ 六气皆从火化” and “extremely hyperactivtiy of the five emotions cal all lead to production of the fire 五志过极皆能化火” .

Therefore he preferred to use cold and cool medicinals and prescriptions in treatment of disease, and he is later named the “school of cold medicine 寒凉派”


2.4 Zhang CongZheng 张从正 held that a person’s illness is mainly caused by invasion of pathogenic qi 邪气内侵 - so he advocated that elimination of pathogenic qi is the key matter in treatment of disease.

His therapies are mainly diaphoresis 汗 , emesis 吐 and purgation 下 in order to eliminate the pathogen and safeguard the vital 祛邪安正 and he is known as the “school of eliminating pathogen 攻邪派 .


2.5 Li Dongyuan 李东垣 believed that the occurrence of disease is mostly related to the endogenous injury of the spleen and stomach 脾胃内伤 . If the spleen and stomach get disordered, many diseases will appear consequently. Thus he is noted as the “school of strengthening the earth 补土派” .


2.6 Zhu Danxi 朱丹溪 blended the opinions of the 3 schools of Liu,Zhang and Li and he was good at diagnosis and treatment of miscellaneous diseases, with many original ideas. He believed the basic pathological change of diseases is that “yang is ever excessive while yin is ever in deficiency 阳有余而阴不足” and advocated the remedies of nourishing yin and reducing fire so he is regarded as the “school of nourishing yin 养阴派 .


3. Period of the Ming 明 and Qing 清 dynastiesTCM had gone into a new stage in investigation

of infectious diseases.

3.1Wu Youke 吴又可 , in his work of Wen Yi Lun 《瘟疫论》 (Treatise on Pestilence) set forth the theory of pestilential qi 戾气” , holding that the pathogens of ‘pestilence’ are a noxious qi rather than wind, cold, summer-heat and dampness. The way of infection is through the mouth and nose and is a great breakthrough in etiology of warm diseases 温病 .


3.2 Up to the Qing dynasty, famous physicians of warm disease Yie Tianshi 叶天士 , Xue Sehngbai 薛生白 , Wu Jutong 吴鞠通 and Wang Mengying 王孟英 systematically summarised the relative research achievements.

They created the norm of treatment of warm diseases

based on syndrome differentiation taking the defensive-qi-nutritive-blood levels 卫气营血 and the three jiao levels as the core 三角为核心 , thus forming a complete theoretical system for warm diseases in their causes.

Cardinal Characteristics of Theoretical System of Chinese Medicine

1. Concept of Holism (Wholeness整体观念 )1.1 The human body is an organic whole in which all constituent parts are *structurally inseparable;* functionally coordinative ;* interactive, and* pathologically inter-influencing

Cardinal Characteristics of Theoretical System of TCM

1. Concept of Holism (Wholeness整体观念 )Human body as an organic whole 人体是

一个有机的整体Close relation of man with its surroundings

人与环境密切相关- Unity of man and nature 人与自然的统一性-Close relation of man to society 人与社会关系密切

Cardinal Characteristics of Theoretical System of TCM2. Human Body as an Organic Whole

*The human body is composed of several viscera and tissues, each of them has its own different functions.

*The integral unity forms by taking the five Zang viscera as its center, combining with the six Fu-viscera to link such tissues and organs of the whole body as the five body constituents, sense organs, orifices, four limbs and the bones to be an organic whole through the connection of meridian system

Cardinal Characteristics of Theoretical System of TCMUnity of man and nature:

- When the natural changes directly or indirectly influence the human body, it will result in a corresponding reaction.

-if the reaction is within the physiological range, that is an adaptable regulation physiologically; if it is beyond physiological range, that is pathological reaction.

Cardinal Characteristics of Theoretical System of TCMClose relation of man to society:

-Social advance helps to increase average human lifespan;

-environmental pollution, food safety, traffic accidents, employment difficulty, stress and anxiety also posed risks to human health.

Distinct differences between TCM & Western Medicine

Chinese Medicine Western Medicine

Macroscopic thinking with relevant adaptation of the human body to natural environment

Microcosmic thinking within the limits of human being

Observing the human body dynamically

Relatively static study

Emphasizes the spirit Emphasizes the body

Strength in curing functional diseases Strength in curing organic diseases

Emphasizing on stimulating the premunition of the human body

Emphasizing on medicine to cure illness of the human body

Natural medicines with less side effects

Pharmaceuticals with more side effects used

Emphasizes in clinical practice Emphasizes in laboratory research

Treatment Determination based on Syndrome Differentiation ( 辨证论治）

Syndrome differentiation is to analyze, differentiate and recognize the syndrome of a disease.( 辨证）

Treatment determination is to consider and formulate the corresponding therapeutic principle and method according to the result of syndrome differentiation. （论治）

Treatment Determination based on Syndrome Differentiation ( 辨证论治）

Syndrome differentiation is the prerequisite and basis for determining the treatment.

Treatment determination is the means and method for treating disease and to check whether the syndrome differentiation is correct or not.

Disease, Symptom and Syndrome

Disease 证 means a complete morbid process including specific cause, mode of onset, typical clinical presentation.

For example, common cold, malaria , stroke , cancer and etc


Symptom 症状 is a discomfort felt subjectively by the patient.

Eg ， pain, dizziness, nausea and lassitude


Syndrome 证型 is pathological summary in a given stage of a disease in its course made by the doctor.

Eg wind-cold风寒 , wind-heat风热 , stagnant fluid痰饮 , stagnant blood瘀血 and etc


The occurrence and development of any disease are ever presented by a certain symptoms and signs.

Symptoms and signs are the basic elements for a disease to manifest externally.

They are basis for diagnosis clinically, but not a conclusion of diagnosis.

The conclusion that can reveal the essence of a disease is syndrome.


TCM demands a doctor to view the relationship between disease and syndrome dialectically.

Several different syndromes can be summarized in a disease, and the same syndrome can be analyzed in different diseases.同病异治，异病同治

Introduction A summary of the experiences of ancient Chinese in their struggles against diseases. Is an important part of the Chinese culture. It had.

Documents

main contents of main

miscellaneous diseases

integral theoretical

kinds of diseases

yin dynasty

western han dynasty

symptoms of diseases

contents of viscera