Paper presented at the 7th World Congress of Chinese Medicine, Hague, 2nd October 2010
Health regulation through Syndrome Differentiation is the essence of Chinese Medicine. Through the Four Diagnosis Methods, the Chinese physician determines the body’s current reaction state in relation to the disorder patterns of the patient. Zang Fu relationships and the state of Qi, blood and body fluids in terms of Yin and Yang balance are important guiding principles for treatment. In Chinese Medicine this process is known as regulating the body to achieve health, to fight against disease and assist anti-aging. In this paper we are examining the analytical process of dialectical syndrome differentiation in terms of Zang Fu dysfunctions. We will also consider the importance of the relationship of Qi, blood and body fluids as well as anti-aging treatment with Chinese herbal medicine, acupuncture and Chinese lifestyle medicine in achieving health cultivation. The paper will also discuss the relationship between internal health and external vitality. In doing so, we will discuss the unique clinical experience of Chinese medicine for rejuvenation and the recovery of vitality.
Syndrome Differentiation, Zang Fu, Four Diagnosis Methods, Eight Principles, Qi, blood and body fluid, health regulation, anti-aging
中医的精华在于其养生之道，在辨证施治的过程中调理脏腑与气血关系，用四诊八纲来诊断病人的证状，以阴阳平衡和五行脏腑关系来作为治疗的指导原则是 现有医学中的独特方法。无论是日常保健、疾病治疗或抗衰老都围绕中医的基础理论，经过长期的临床应用得出非凡的疗效。此报告论述了脏腑辨证分析过程中的养 生治疗文化，同时也考查了人体气、血、液的中医概念对抗衰老的作用；提出中药、针灸和生活医学综合为一体的整体治疗观，表现内在和外表在中医治疗中的互相 关系，建立中医在治疗和抗衰老中的突出优势。
The Yellow Emperor Classic of Internal Medicine defines the superior physicians as those who practise preventative medicine and prolong longevity whereas the inferior physicians will have to cope with curing diseases. Health regulation and anti-aging therapy work hand-in-hand according to the guiding principles of Chinese medicine. Acupuncture and lifestyle medicine are therefore integral to the practice of Chinese herbal medicine, together they form the essential treatment technique for the physician after correct diagnosis and Syndrome Differentiation have been applied.
In Western medicine anti-ageing consists of the prevention of deterioration of cells, tissues and organs in the body’s functionality. In Chinese medicine, to achieve anti-aging is to prolong the person’s lifespan according to what is naturally given by “Heaven” (Tian Ming or Tian Nian). According to ancient Chinese medical classics human natural lifespan should be 120 years or over. The decline of ‘Tianqui’ (天魁) which in Chinese medicine is the substance for growth, maturity and reproduction begins in women at the age of 49 years and in men at the age of 64 years. This explains the beginning of menopause for women on average of 49 years or over. And for men their sexual function will decline from the age of 64 years and over. According to some of the Western calculations human lifespan can reach between 110 years and 175 years. In Chinese medicine the determining factors are related to ‘Zang-fu’ ( 脏腑), Qi (气 ) and blood and body fluid functions in each person. The Chinese medicine physician makes a judgement of these functions in terms of Syndrome Differentiation according to Chinese medicine’s fundamental principles of Yin and Yang imbalances, pathological factors of deficiency and excess within the body, and the blockage of meridians in blood stasis as well as the weakening function in the transformation of Qi, blood and body fluid. This approach significantly differs from Western cell biology and its theory of free radicals as a cause of the aging process. The Chinese medical interpretation of lifestyle medicine in the form ‘Yang Sheng’ (养生) which means cultivating or preserving the essence of life, is the essence of Chinese medicine for the superior physician as described in the Yellow Emperor Classics of Internal Medicine.
Zang Fu Relationships in Anti-Aging
Chinese medicine places importance in the functional relationship amongst the Zang-Fu organs. Zang organs are: kidney, spleen, liver, lung and heart, and their corresponding Fu organs are: urine bladder, stomach, gallbladder, large intestines and small intestines respectively. These organs form a Five Elements relationship that acts upon each other in the laws of visceral generation and restraint. The dysfunction of one organ affects the function of another organ when imbalances occur due to either external pathogenic invasion or internal deficiency. Emotional factors, poor diet, maladjustment of work and rest or the blockage of meridians are some of the factors that cause imbalances. The clinical function of the physician is to restore the balances, tonify deficiencies, detoxify excesses and improve the smooth flow of Qi, blood and body fluid. The physician would achieve this by using Chinese herbal therapy, acupuncture and Yang Sheng (养生) therapy which would include soft tissue Tuina, diet and exercise therapy such as Qi Cong and Tai Chi. In order to regain vitality or to promote vitality for rejuvenation the physician needs to have a deep understanding of Zang Fu and the corresponding clinical experience in recovering the normal functioning of Zang Fu.
Kidney is the organ that stores both the congenital essence and the acquired essence which is the source of Qi and blood. Ageing process tends to deplete both the Yin and Yang Qi stored in the kidney for the body’s vital functions. The tendency for women over the age of 49 years and for men over the age of 64 years to be deficient in kidney Qi is the reason why a Chinese physician begins anti-aging treatment for older people with the tonification of the kidney. There are many TCM formulations such as Liu Wei Di Huang Wan (六味地黄丸 ) and Er Xian Tang (二仙汤 ) for kidney deficiency which can be used in conjunction with syndrome acupuncture points relating to the kidney such as KI 3, KI 6, BL 23 and CV 6. However, the kidney requires the spleen and the stomach to function properly and constantly replenish its acquired essence. The symptoms for the decline of the kidney Qi are the whitening of the hair, frequent back pain, loss of memory and tinnitus indicating kidney deficiency. The patient usually has a red tongue with less coating and a thready, rapid or sometimes weak pulse. In any anti-aging treatment the physician should examine the kidney in relation to the functions of spleen, stomach and the liver.
Spleen Qi deficiency is a common syndrome in the Chinese medicine patterns. The spleen is prone to cold, heat and dampness caused by improper diet. The spleen can also be affected by emotional factors caused by the stagnation of the liver Qi. The Zang Fu relationship between the liver, spleen and kidney is an important consideration for stress, depression, tiredness as well as eating disorders. Spleen dysfunction can eventually lead to blood deficiency and chronic problems due to Qi deficiency. In the cosmetic therapy of the face it is essential to address the patient’s spleen deficiency to improve complexion and vitality. The patient usually has a pale tongue with puffy teeth marks and either a white coating or greasy coating. The pulse is usually weak and/or deep. The Chinese herbal formulae for spleen deficiency are selected according to the technique of Syndrome Differentiation, with classical formulae such as Si Jun Zi Tang (四君子汤) and Bu Zhong Yi Qi Tang (补中益气汤) commonly used. Acupuncture points such as SP 6 and SP 10, ST 36 and CV 6 are being commonly used. Again, syndrome acupuncture point selection should be applied according to differentiation.
Liver’s function in dominating the dispersion of Qi and regulating its functional activity as well as regulating the distribution of blood makes it the mother organ of the Five Elements. Liver generates Qi and therefore the blockage of Qi will affect its function before any other organs which will cause dysfunction in the regulation of blood. Emotional stimulant tends to affect the liver causing liver Qi stagnation which in turn affects both the heart and the spleen. With the heart it may cause heart Yin deficiency which will result in insomnia or with the spleen it may affect the spleen’s ability to transform food and water into acquired essence necessary for the nourishment of muscles and limbs and in turn cause kidney Qi deficiency and chronic tiredness. The liver is an important organ for anti-ageing treatment especially in regulating the psychosomatic problems of the patient during revitalisation. The patient could develop flaring heat that is indicated by a red tongue with taut and rapid pulse, otherwise there is a thin and white tongue coating and a taut pulse in general cases. TCM formulae Xiao Yao San (逍遥散) are generally being used with a combination of other remedies according to Syndrome Differentiation. Likewise acupuncture point selection should also be based on the same process, generally LR 3, BL 18 and ST 36 are being used.
The important feature of the heart as a Zang organ is its dominating function in the governance of mental activities, in addition to controlling blood circulation throughout the meridians and the body. Any dysfunction in the heart will manifest itself on the face whereas the dysfunction of the lungs may manifest symptoms on the skin. Together heart and lung are important organs for skin and facial rejuvenation. The common syndrome is the deficiency of heart Yin and blood which may cause insomnia and lack of mental concentration. The common formulae for this condition are Tian Wang Bu Xin Dan (天王补心丹) which is a well-known classical formulae for nourishing both heart Yin and blood in order to calm the mind. The patient should have a red tongue with less coating, thready and rapid pulse. Acupuncture points PC 6, HT 7, BL 15 and SP 6 are commonly used in syndrome acupuncture. When the heart is deficient, generally it will also cause deficiency of the spleen and the patient might experience gynaecological problems such as dysmenorrhoea and infertility. Oedema may also be a sign of this syndrome. In this case both the heart and the spleen should be nourished and in case of fatigue and insomnia, Qi and blood should be nourished as well by selecting an additional formula to tonify Qi and blood. Acupuncture points such as BL 17, SP 6, ST 6 and CV 6 should be used as well.
Beside dominating respiration, the lungs also activate the dispersion of the body’s water passage. Lungs are therefore an important Zang organ for skin rejuvenation. Symptoms of redness on the nose – such as brandy nose – are indicative of dysfunction in the lungs and in the large intestine which is its corresponding Fu organ. The emotion that causes damage to the lungs is ‘sorrow’, while ‘over-joy’ causes problems with the heart and ‘fear’ damages the kidney and causes urine problems. Lungs tend to be accumulative of flame and heat and are prone to the attack of pathogenic dryness or wind-cold. In the case of dryness we should use herbs to clear away dryness, and moisten the lungs with classical formulae of Qing Zao Jiu Fei Tang (清燥救肺汤) which contains loquat and Xing Ren (杏仁) to sooth the cough and moisten dry throat and nostrils. The patient should have a red and dry tongue with thready and weak pulse, acupuncture points LU 5, LU 7 and LI 4 should be selected along with other syndrome points. In case of heat in the lungs which can cause accumulation of phlegm that manifests in chronic bronchitis or asthma, a TCM formulae containing Ginko nut and Sang Bai Pi in the name of Ding Chuan Tang can be used with syndrome acupuncture points such as LU 7. LI 11, ST 40 and GV 14. The patient should have a yellow greasy tongue with slippery and rapid pulse.
Zang organs described above are usually paired with their corresponding Fu organs as follows: liver with gallbladder, heart with small intestine, spleen with stomach, lung with large intestine and kidney with urinary bladder. When considering health regulation and anti-aging treatment, the physician has to use the Zang organ in conjunction with the Fu organs according to Syndrome Differentiation. The holistic relationship between all the Zang and Fu organs is vital for the treatment of the individual patient and requires a deep understanding from the physician. We must also consider another organ which is the Triple Energiser (三焦), which is responsible for the transformation and transportation of the water metabolism of the body. All the Zang Fu organs are linked by meridians of the body in the pattern of networks that define Chinese medicine. The understanding of the travel features of the meridians is also necessary to understand the web of relationships within Chinese medicine. Understanding treatment, health regulation and anti-ageing as a holistic relationship is what distinguishes a thinking physician from a technical doctor.
Qi, Blood and Body Fluid
Qi is the basic material that empowers life. According to Chinese medicine, without Qi the body is dead. Qi is promoting, defending, consolidating and transforming and without it the blood will not flow. Hence the dictum in Chinese medicine “When there is blockage of Qi, there is pain” and “When Qi moves, blood moves”. In order to remove blood stasis, Chinese physician must invigorate the flow of Qi. However, blood is the source of Qi. It is a material that nourishes the body and supports mental activities while body fluid moistens the various parts of the body. Qi, blood and body fluid come from the transformation of food and drink that is performed through the functions of the spleen, stomach and large and small intestine. The acquired essence is being stored in the kidneys together with congenital essence which the person inherits from their parents. The interaction of the body’s Qi with the primordial Qi of the environment explains the pathogenesis of Chinese medicine. Chinese medicine also observes the pattern of changes in the body and summarises the causes of diseases, its aetiology gives rise to Syndrome Differentiation. In the process, the causes are divided into ‘exogenous’ and ‘endogenous’, and the manifestations into ‘deficiency’ and ‘excess’. On this basis the Eight Principles of Differentiation have been established and used by physicians in the past 2000 years in the clinical practice of Chinese medicine. Anti-ageing and rejuvenation treatment are therefore an integral part of Chinese clinical medicine and are used in conjunction with treatment of diseases within disciplines such as andrology, gynaecology, oncology and metabolic diseases.
This is an expanding field of medicine which is linked with healthcare for the promotion of wellbeing and lifestyle medicine. Comprehensive research is now being carried out internationally by experts both in the East and West. However, an integrative approach is necessary to bring about the best in both medicines. The author of this paper is currently conducting a programme of research as well as educational courses in the field of anti-ageing and health regulation. With the team of specialists at the AcuMedic Centre (London) under the sponsorship of the Chinese Medical Institute & Register (CMIR) the author is engaging collaboration with experts and institutions in China and other countries for developing the syndrome approach in acupuncture and Chinese herbal medicine treatment. Anti-ageing is part of the degree and postgraduate educational courses that CMIR is organising in collaboration with the Beijing University of Chinese Medicine, the Guang Zhou University of Chinese Medicine and the Guang Xi Medical University in the UK and China.
Professor Man Fong Mei, Chairman, CMIR
30th March 2010, London, UK