TCM Treatment of Chronic Illness

b2120 Principles of Chinese Medicine: A Modern Interpretation “9x6”
Chapter 10
Treatment of Chronic Illnesses

by NATIONAL UNIVERSITY OF SINGAPORE on 12/04/17. For personal use only.
The good physician treats the disease; the great

Principles of Chinese Medicine Downloaded from www.worldscientific.com
physician treats the patient who has the disease.

William Osler
TCM is used extensively in East Asian countries, and to some extent

in Australia, Europe and North America, as complementary treat-
ment for certain chronic illnesses. In less acute cases, it is also used
as an alternative to Western treatments.
To illustrate how TCM methods are applied to some common
chronic illnesses, we examine briefly its use in coronary heart dis-
ease, strokes, digestive disorders and irritable bowel syndrome,
depression and cancer. These conditions have been chosen because
TCM treatment in each case provides an interesting complement or
alternative, or a combination of both, to Western medicine. TCM
physicians regularly encounter patients who may not have found
satisfactory results with Western medicine for such ailments and
seek complementary or alternative treatments.
The objective here is not to demonstrate the viability of TCM
methods — this would in any case require elaborate and complex
clinical trials — but rather to show how TCM methods, centred on
patient syndromes rather than on disease, have been used in a wide
variety of clinical work and, where possible, offer a biomedical
interpretation of why these methods might have brought relief to
patients.
175
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176 Principles of Chinese Medicine: A Modern Interpretation
10.1 Coronary Heart Disease

In most instances coronary heart disease involves the narrowing of
blood vessels supplying nutrients and oxygen to the heart. This nar-
rowing is caused by dietary, genetic, ageing and lifestyle factors with
build-up of fatty plaque on arterial walls. Angina pain can occur
when blood supply is inadequate and cardiac arrest when there is
constriction or blockage.
TCM interprets coronary heart disease as an impediment to or

blockage of the free flow of qi and blood. The condition is classified

under ‘chest blockage with heart pain’ (xiongbi xintong 㜨ⰩᗳⰋ)
in TCM textbooks and attributed to one or more of seven underly-
ing syndromes, of which the most common are deficiency of heart-qi
and blood stasis.205
The syndrome of ‘deficiency of heart-qi ’ is identified by symp-
toms of dull pain in the chest, heart palpitations, shortness of breath
which worsens upon exertion, fatigue and sweating without exertion;
the tongue is pale and slightly swollen, with tooth indentations and
thin white fur; the pulse is slow, weak and thready or slow and irregu-
lar. The syndrome of ‘blood stasis’ has symptoms of stabbing pain or
angina pains in the chest, sometimes spreading to the back and
shoulders; it can be accompanied by prolonged ‘chest oppression’;
the tongue is dark with ecchymosis (bluish-black marks) and thin
fur; pulse is wiry and astringent, or rapid and intermittent/irregular.
In the absence of other syndromes associataed with heart disease,
the first syndrome of deficient heart-qi is consistent with early or
mild coronary heart disease. Blood stasis syndrome is usually found
in more advanced stages of the disease when significant atheroscle-
rosis has set in. Deficiency of heart-qi usually occurs in the early
stages, and the additional syndrome of blood stasis sets in as the
disease progresses, hence we can regard qi deficiency as the root
205
In Chinese, the syndromes are ᗳ≄н䏣, and ⰰ㹰Ⱙ䱫, ᗳ䱤ҿ亪, Ⱐ⍺䰝䱫.
See, for example, a detailed description of TCM treatments for heart disease may be found
in Becker et al. (2005).
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Treatment of Chronic Illnesses 177
syndrome and blood stasis as the consequent syndrome of disease

progression.
Accordingly, TCM treatment for the first syndrome consists of
strengthening the body’s qi level and promoting (regulating) its flow
through qigong and taiji exercises, as well as diets containing
foods and herbs that tonify qi, such as American ginseng (xiyangshen
㾯⌻৲), wild yam (huaishan ␞ኡ) Astragalus (huangqi 哴㣚),
Panax Ginsena (renshen Ӫ৲), Radix Condonopsis (dangshen ‫ފ‬৲)
and Radix Notogingseng (sanqi йг). A typical prescription formu-

lation, appropriately modified to suit each patient’s condition,

would be Baoyuan Tang ‫⊔ݳ؍‬combined with Ganmaidazao Tang
⭈哖བྷᷓ⊔. The first uses ginseng and Astragalus as the main com-
ponents for boosting qi levels. The latter uses Fructus Tritici Aestivi
(xiaomai ሿ哖 or wheat) as the monarch herb to nourish heart-yin
and roasted liquorice (zhigancao ⛉⭈㥹) as the minister herb to
promote flow along the heart meridian, invigorating the heart and
tranquilising the mind.206
For the second syndrome, TCM treatment would typically
encourage the consumption of foods and herbs that improve blood
circulation and reduce blood stasis. These would include Radix
Salviae Miltiorrhizae (danshen ѩ৲), hawthorn berries (shanzha
ኡὲ), red yeast rice (hongqumi 㓒ᴢ㊣), Rhizoma Chuanxiong
(chuanxiong ᐍ㢾), Flos Catharmi (honghua 㓒㣡), Semen Persicae
(taoren ṳӱ), black fungus vegetable, turmeric and pomegranate
fruit.207 In biomedical terms, these herbs are known to have mild
vasodilating effects, rendering transient improved blood flow and
symptomatic relief from angina pains. In the TCM framework, such
vasodilating effects are only symptoms of more lasting changes
brought about by ‘resolving blood stasis’, a claim which implies
slower build-up of plaque and less impediment to blood flow.
206
The “monarch” herb in the main one and the “minister” herbs play the chief supporting
function. See Chapter 6.
207
Noted advocate of natural healing, Andrew Weil (M.D.) recommends the regular
consumption of black fungus for coronary heart health. See Weil (1995:166).
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A typical prescription for blood stasis syndrome in the chest is

the ‘Decoction for Removing Blood Stasis in the Chest’ (Xuefu
Zhuyu Tang 㹰ᓌ䙀ⰰ⊔). This formulation contains 11 herbs, with
honghua and taoren as monarch drugs, and chuanxiong as one of the
minister drugs. In recent years the classical Chinese formulation
‘Danshen Dripping Pills” (Fufang Danshen Diwan ༽ᯩѩ৲┤Ѩ)
for alleviating blood stasis and improving blood flow has completed
Phase 2 FDA trials and is awaiting final approval for use in the treat-
ment of coronary heart disease. This formulation contains danshen,

sanqi and Borneolum Syntheticum (bingpian ߠ⡷).

A combination of blood stasis and qi deficiency has been used to
explain restenosis of coronary arteries after patients received stents
in their coronary arteries. Some success has been claimed for pre-
venting restenosis by putting such patients on formulations pro-
moting qi and resolving blood stasis.208 It combines tonification for
heart qi using ginseng and astragalus, reducing blood stasis with
chuanxiong (Sichuan lovage fruit), safflower, and taoren (peach
seed), and alleviating blockages using gualou (snake gourd fruit).
Interpretation
Compared to Western treatments using the nitrates for vasodilation,
blood thinners (like aspirin) to reduce the risk of blood clots, and
surgical interventions like angioplasty and bypass surgery, TCM
treatments are slower and cannot deal effectively with acute angina
or emergency situations of coronary infarction. But they could be
useful either as complementary treatment or as an alternative to
surgical intervention.
TCM treatments, with proper medical advice recognising drug
contraindications and the condition of the patient, can and are
being administered alongside Western treatments. TCM approaches
208
See the work of Fu Yalong and his colleagues at Beijing’s Guanganmen Clinic: http://
www.bj.xinhuanet.com/hbpd/health/jdt/2014-09/03/c_1112313492.htm, retrieved 28th
Feb 2015
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to management of heart conditions using medicated diets and

Chinese exercises can complement Western methods such as main-
taining low cholesterol levels, exercises for cardiovascular fitness, and
a diet rich in fibre and low in saturated and trans fats, with emphasis
on fresh fruits and vegetables to promote endothelial health.
A biomedical explanation of the usefulness of TCM therapies
for coronary heart disease would point to the possible effect of
herbs and Chinese exercises on improving blood circulation and
inhibiting the progression of atherosclerosis. The TCM approach

has some similarity to that of a new school of biomedical cardi-

ologists, sometimes referred to as ‘integrated cardiologists’, who are
doing pioneering work in using diet and supplements that go
beyond conventional tools of cholesterol reduction, blood-thinning,
vasodilation with drugs, and surgical intervention to prevent cardiac
events and enhance cardiac health.
Some cardiologists advocate a de-emphasis of cholesterol
reduction and point to other equally or more important risk factors
like excessive lipoprotein(a) and homocystein and low levels of
CoQ10. Others focus on food, particularly a vegetarian and low-oil
diet. Research on TCM herbs point to a possible connection between
herbs used for coronary heart disease and the improvement of
endothelial health and reduction of inflammation that are critical to
prevention and therapy for coronary heart disease.209 The use of foods,
supplements and herbs to improve the health of arterial walls suggest
an encouraging convergence between the methods of integrative
cardiologists and those of TCM for treating coronary heart disease.
10.2 Hypertension and Stroke

With ageing, atherosclerosis sets in as arteries narrow with plaque
on their walls. The likelihood of suffering a stroke rises almost
209
See, for example, Sinatra and Roberts (2007), Campbell and Campbell (2004), and
Esselstyn (2008). On yellow ginger or turmeric (curcumin) for heart health, see, for exam-
ple, Akazawa et al. (2012) and Sinatra (2012).
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exponentially after the age of 65. Both Western medicine and TCM
treat patients to prevent strokes and, if a stroke has occurred, to
ameliorate its effects and improve quality of life. The approaches
taken by the two systems of medicine appear radically different, but
in fact have underlying commonalities.
Of the two major kinds of strokes, the ischaemic stroke and the
haemorrhagic stroke, the former is by far the more common, being
precipitated by sudden impeded blood flow in an artery of the brain.
This could be caused by clotting at the artery (thrombosis), or a

detached clot from another location — usually the heart or the

carotid artery — that lodges itself within the artery (embolism),
cutting off oxygen supply to part of the brain. A haemorrhagic
stroke results from rupture of an artery wall, leading to cerebral
haemorrhage, and it is commonly correlated with degenerative dis-
ease of the arteries and hypertension. The use of blood thinners like
warfarin can also raise the risk of a haemorrhagic stroke.
Western medicine attributes strokes to a combination of risk
factors, which may include hypertension, smoking, excessive choles-
terol (LDL) levels, and diabetes. Heart arrhythmia in the form of
atrial fibrillation can also produce clots that travel to the brain.
TCM views that the underlying conditions predisposing a per-
son to strokes involve the endogenous wind (feng) pathogen; hence
the Chinese term for stroke is zhong feng, or “attack by wind”.
Endogenous wind may arise from one or more of several factors,
which include (a) weakness of yin and blood giving rise to liver heat
and wind; (b) overwork and strain stirring up liver wind; (c) inap-
propriate diet that creates warm phlegm in the spleen, generating
endogenous wind; (d) emotional stress particularly anger triggering
fire and the production of harmful wind.210
A large number of TCM syndrome combinations are associated
with strokes, depending on the nature of the stroke and the stage of
progression, whether at the onset, in the immediate aftermath, or
210
These standard explanations may be found in textbooks like Zhou (2007:304–310).
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during the longer term debilitated phase of the patient. At the onset
and immediate aftermath stage, hyperactivity of liver-yang, phlegm
with wind, and stirring of liver wind (ganfeng neidong 㛍仾޵ࣘ)
are the common syndromes; at the later recovery stages, phlegm and
blood stasis are often present, and the patient may suffer from severe
qi deficiency and weakness of the liver and kidney.
Tianma Gouteng Yin (ཙ哫䫙㰔侞) with suitable variations to
suit the patient is most often used in the early stages whilst tonics
with ingredients added for resolving blood stasis such as Buyang

Huanwu Tang (㺕䱣䘈ӄ⊔) are administered in the recovery stages.

Thus, treatment of these TCM syndromes associated with strokes
follows the principle of customising therapy to the syndrome and
the constitution of the patient.
Treatment usually combines herbal prescriptions, acupuncture
and tuina, and is continually varied as the internal state of the
patient changes and new syndromes are exhibited. TCM theory
explains that acupuncture helps the rehabilitation process by
enhancing flow of qi and blood in the body, leading to better recov-
ery of motor skills and overall physical functioning by inducing
beneficial changes in the blood flow to the brain. Common points
used in post-stroke acupuncture treatment include taichong ཚߢ
hegu ਸ䉧 renzhong Ӫѝˈbaihui ⲮՊˈsanyinjiao й䱤Ӕ
neiguan ޵‫ˈޣ‬yanglingquan 䱣䲥⋹ and quchi ᴢ⊐. These acu-
points can also be used in the treatment of hypertension.
Exercises like qigong and taijiquan, for patients with sufficient
mobility, are believed to enhance recovery from post-stroke disabili-
ties. Social interaction within qigong groups may also help to
improve patient morale and nurture the positive emotions that
facilitate recovery.
Interpretation
Western medical explanations for stroke revolve around vascular
impediments to blood flow and the contribution of diet, lifestyle
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and hypertension to precipitating cerebral thrombosis or embolism.

TCM explanations centre on the TCM gan (liver) where endogenous
wind may form as a result of deficiencies and imbalances in the body.
These differing explanations are not necessarily incompatible; instead
they represent alternative models for prevention and therapy.
Hypertension has a central role as the dominant risk factor in
Western medical explanations for stroke. The causes of hyperten-
sion are complex: risk factors like diabetes, high dietary salt intake
and emotional stress are well established but many cases of hyper-
tension are idiopathic and a significant percentage of patients with

the condition do not respond to drug treatment.
The TCM syndrome of hyperactivity of liver-yang, which can
lead to endogenous wind, has some resemblance to hypertension
although wider in scope. It can be brought about by stress and emo-
tional factors, but also by blood, yin and/or qi deficiencies, and the
presence of phlegm. In this respect, TCM theory presents a wider
menu of preventive measures for stroke that revolve around diet,
emotional management, exercises to improve qi and blood levels/
flows. TCM diagnosis of syndromes and body constitutions that
predispose a person to stroke could possibly make the claim to offer-
ing a comprehensive prevention regimen by prescribing therapies to
resolve or mitigate these syndromes.
A similar scenario prevails in the treatment of strokes. Western
treatments rely heavily on blood coagulants like warfarin to prevent
recurrence and on physiotherapy for rehabilitation. Chinese treat-
ments directly address the prevailing syndromes at each stage of the
evolution of the illness. In the early aftermath of a stroke, there is an
emphasis on calming endogenous wind, in the later stages, the focus
is on resolving phlegm and blood stasis, while in the rehabilitation
and recovery phase, this shifts to tonics for qi, blood and the yin of
the liver and kidney. Chinese exercises work on improving blood
and qi circulation, postural robustness and joint mobility, less on
building muscular strength.
It would appear that a combination of Western and Chinese
treatments can secure better results for the patient than a strict
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adherence to one regimen. When treatments are combined, there

must be appropriate cognisance of drug compatibility. For example,
some Chinese herbs have mild anticoagulant properties that may
excessively enhance the effect of Western anticoagulant drugs.
10.3 Digestive Disorders and the Irritable Bowel Syndrome

Li Dongyuan (ᵾьී) of the Jin-Yuan dynasties focused on care of
the digestive system for health and longevity. In TCM theory, diges-
tion is largely captured by the pi (㝮) organ, translated as the ‘spleen’.

However, the pi in TCM has little in common with the spleen of
modern physiology. The TCM spleen governs the processing and
transforming food into nutrients that feed other organs and the rest
of the body, pairing with the wei 㛳 (stomach) in its work. Damage
to the spleen and stomach, in Li Dongyuan’s framework, is the root
cause of most illnesses.
The spleen in TCM nourishes the body and replenishes the store
of qi, blood and essence or jing in the vital organs. Growth and
development in TCM theory are governed mainly by the shen 㛮
(kidney). By providing nutrients to the shen to replenish the store of
qi and jing, the pi serves as the foundation of postnatal health (hou-
tianzhiben ਾཙѻᵜ). In addition, because of its direct supporting
function for the lung as laid out in the five-element model, treating
the spleen in clinical practice is sometimes the preferred route for
the treatment of lung disorders. For example, chronic cough due to
weak lung-qi, accompanied by white phlegm, poor appetite and
fatigue, can be treated with spleen tonics. This nexus between the
digestive system and the lung is important in TCM medical practice
as chronic lung conditions would be deemed to be difficult to treat
unless the digestive system (pi) was kept in good functioning order.
Adequate qi and its smooth flow are vital to the normal func-
tions of the spleen. In TCM theory, spleen functions are inhibited
by dampness, which is characterised by ‘stickiness’ that impedes the
flow of qi, resulting in qi stagnation in the abdomen. With weak qi
and/or qi stagnation, dampness accumulates further, food is not
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properly digested, and there could be resultant generation and accu-

mulation of phlegm. Improper diet such as oily and fried foods and
brooding accompanied by anxiety are the leading factors that dam-
age the spleen, resulting in gastrointestinal disorders such as poor
appetite, bloated abdomen, wind, loose stools, and the discomforts
of the irritable bowel syndrome. The high incidence of digestive
disorders in high-stress societies like New York, Beijing and Singapore
may well be associated with stressful lifestyles that harm the spleen.
Herbal supplements used to strengthen spleen functions

include dried tangerine peels (chenpi 䱸Ⳟ), sharen (⸲ӱ) and

banxia (ॺ༿) which are thought to smoothen the flow of spleen-
qi and resolve dampness and phlegm; dangshen (‫ފ‬৲), wild yam
(shanyao ኡ㦟), huangqi (哴㣚) and red dates (dazao བྷᷓ) are
used to tonify spleen-qi. These herbs can be used as food ingredi-
ents for spleen-healthy meals, although sharen and banxia are not
so tasty and tend to be used more in medical prescriptions. A deli-
cious and nourishing rice porridge with huangqi, red dates and
wild yam is sometimes used to maintain healthy functioning of the
spleen and stomach.
Common formulations for spleen disorders include Sijunzi Tang,
Shenling Baizhu San, and Xiangsha Liujunzi Tang.211 These formula-
tions combine qi tonics with qi regulation and removal of dampness.
Irritable bowel syndrome

The Irritable Bowel Syndrome (IBS) is a recurrent condition with
abdominal pains and constipation and/or diarrhoea, often with
bloating of the abdomen and dyspepsia. There is no detectable
structural disease. It can continue for years. The condition is often
associated with stress or anxiety and may follow an episode of intes-
tinal infection. From the point of view of Western medicine, “the
cause is unknown”.212
211
See Chapter 7 and Annex 2.
212
Oxford Concise Medical Dictionary (2007:380).
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TCM regards IBS (changyijizonghezheng 㛐᱃◰㔬ਸᖱ) as a

condition associated with imbalances and/or stagnation in the
spleen. It is not a disease in its own right, but one of several mani-
festations of imbalance and qi stagnation in the spleen. This could
take the form of dampness in the spleen when spleen-qi is weak or
does not flow properly, the result of improper diet or exposure to
the dampness pathogen. It can also be the consequence of an
‘exuberant’ liver over-restraining the spleen (ganwangchengpi
㛍ᰪ҈㝮), a situation implied by the five-element model, causing

the spleen to malfunction in its digestive role. The exuberant liver

is often the result of stress and anxiety, causing stagnation in liver-
qi flow and progressing to ‘liver fire’. IBS is frequently encountered
in TCM practice especially among city dwellers in high-stress
environments. Stress harms the liver, stoking exuberance and fire.
Excessive consumption of fried and high-fat foods that are
difficult to digest make a veritable breeding ground for spleen
dampness.
TCM treatment for IBS comprises mainly resolving spleen
dampness with herbs and formulations like Xiangsha Liujunzi Tang,
or calming the liver with Xiaoyaosan with variations customised to
the condition of the patient.213 IBS-like conditions are frequently
encountered in TCM clinical work and there is considerable anecdo-
tal evidence of the efficacy of TCM treatments. Some clinical trials
have claimed success with such treatments.214
Interpretation
If clinical trials indicate a high rate of success of TCM treatments for
digestive disorders and IBS and related disorders, then biomedical
explanations for the mechanisms of these treatment would present
interesting research opportunities.
213
See Chapter 7 for a description of Xiangsha Liujunzi Tang and Annex 2 on Xiaoyaosan.
214
For example, Bensoussan et al. (1998).
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For example, TCM therapy for digestive problems is often directed

at the common condition described earlier of‘spleen dampness’. But
what exactly is spleen dampness in biomedical terms?
In TCM, it is a syndrome, a physiological condition defined by a
pattern or constellation of symptoms. In the spleen dampness syn-
drome, the symptoms include poor digestion, stomach bloating, a
slippery pulse, lassitude and sticky white fur on the tongue. It is one
of the syndromes that is associated with IBS.
For the biomedical scientist, spleen dampness should be regarded

as whatever physiological condition underlies these same symp-

toms. Determining the exact nature of this physiological condition
in biomedical reductionist terms is an area for research. Whether or
not there is a unique set of biomarkers associated with the condition
is not clear, as was pointed out in Chapter 8.
It is plausible that Chinese medicine found from clinical experi-
mentation and experience that certain herbs and formulations
could bring relief to the spleen dampness syndrome. These herbs
were then classified as dampness-resolving medications.
Future biomedical clinical trials and pharmacological research
may well reveal explanatory mechanisms for the therapeutic action
of these herbs. Such findings would not conflict with TCM theory,
but should be seen as providing a biomedical framework for
explaining the action of these herbs in relieving the kind of digestive
problem that TCM has termed ‘spleen dampness’.
As with most TCM therapies, the main scientific issue in com-
mon with biomedicine is proven efficacy, not theoretical explana-
tions of why these therapies work. The former satisfies the patient’s
need for a cure, which is what medicine sets out to achieve; the
latter satisfies the scientist if it accords with the theoretical model
(biomedical or TCM) with which he works.
10.4 Depression
Depression in Western medicine is a mood disorder “characterised
by the pervasive and persistent presence of core and somatic symptoms
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on most days for at least two weeks.”215 Core symptoms include

impairment of motivation, energy and enjoyment, impaired memory,
insomnia, loss of appetite and libido, and mood swings. A definitive
diagnosis of clinical depression is difficult because symptoms vary
greatly across individuals.
Western medicine views genetics, chronic illnesses and stress as
possible underlying causes of depression. Depressive states may be
accompanied by low levels of neurotransmitters in the parasympathetic
nervous system. Treatment makes extensive use of anti-depressants,

cognitive behavioural therapy and/or psychotherapy.

TCM does not have an exact equivalent of depression as an ill-
ness. The word yu 䛱 means stagnation or the absence of smooth
flow of qi in the body and the TCM term yubing 䛱⯵ refers to a
group of conditions arising from blocked flows of qi and/or blood
in the body, leading to a variety of symptoms ranging from sadness
and anxiety to vile tempers and autism. Yubing does not therefore
correspond exactly to the Western medical meaning of depression
and is best viewed as a class of syndromes, many of them exhibiting
the symptoms associated with depression in biomedicine.
A common cause of qi stagnation in TCM theory is the emo-
tional factor. Excessive anger and emotional stress leads to stagna-
tion of liver-qi, which may progress into liver fire. Anxiety may
result in the stagnation of spleen-qi, which in turn may encourage
production of dampness and phlegm that further impede the flow
of qi. Among menopausal and post-partum women who tend to be
low in yin and qi, weakness or deficiency of blood and nourishment
to the heart are commonly encountered. Depression-like symptoms
include frequent abrupt mood swings, paranoia, anxiety and panic
attacks.
The TCM approach to treatment of yubing involves identifying
the blockages and imbalances and resolving them with herbal medi-
cations and/or acupuncture to restore qi flow. For mild cases, herbs
with soothing and calming effects, targeting the particular syndrome
215
Oxford Concise Medical Dictionary (2007:195).
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exhibited by the patient, may be helpful. Herbs that help to improve

qi flows include Radix Bupleuri (chaihu Ḥ㜑), Rhizoma Cyperi
(xiang fu 俉䱴), Citrus Medica (foshou ֋᡻), Cortex Albiziae
(hehuanpi ਸ⅒Ⳟ) and Rosa Rugosa (meiguihua ⧛⪠㣡). A simple
recipe for calming with a drink of herbal tea uses rose and jasmine
flowers, which have the actions of soothing the liver and dispersing
qi stagnation of the liver, thereby alleviating symptoms such as chest
tightness, tension and anxiety.
Common prescriptions used in treating depression include

Chaihushugansan Ḥ㜑⮿㛍ᮓ, Xiaoyaosan 䘽䚕ᮓ for alleviating

depression associated with blocked qi flows in the TCM ‘liver’ (gan)
whereas Ganmaidazao Tang ⭈哖བྷᷓ⊔is generally used in blood
deficiency syndrome commonly seen in menopausal or post-partum
women with frequent mood swings.
Interpretation
A biomedical interpretation of the claimed therapeutic effects of
TCM treatments for depression may lie in the effects of these herbs
sustaining healthy levels of neurotransmitters in the parasympa-
thetic nervous system. For example the seed of Ziziphus Spinosa Hu
(suanzaoren 䞨ᷓӱ) has been found to be related to melatonin, a
derivative of serotonin which is a key neurotransmitter for calming
the body. Such explanations are likely to be incomplete, as the res-
toration of smooth qi flows in TCM implies a better functioning in
general of physiological processes in the body — improved motil-
ity in digestion, enhanced sleep quality and a higher level of energy;
these combine to produce a better feeling of well-being, encourag-
ing the patient’s own mind to overcome depressive moods.
Chinese exercises like qigong involving breathing, meditation and
relaxed movements are thought to promote the flow of qi and has
traditionally been one way of countering depression. A recent clini-
cal trial involving daily doses of the popular depressant Zoloft against
patients taking a walk three times a week showed that the latter gave
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better therapeutic results (Ilardi 2013). This seems to suggest that the
Chinese concept of promoting qi flow, through either qigong or plain
walking exercises, can provide a viable alternative to medications, for
at least some forms of depression.
10.5 Cancer
The mechanism of growth and spread of cancer cells, after malig-
nant tumours have developed in the body, has been extensively

researched, but the underlying reason that cancerous tumours first

appear in a human body does not appear to be well understood by
biomedical science.216 Certain cancer risk factors have been reason-
ably well established, such as smoking, environmental pollution,
high-fat diets, carcinogens in foods and, in a few cases to specific
microbiological agents like the human papilloma virus in cervical
cancer and the helicobacter pyloris bacterium in stomach cancer.
At a more basic level, inflammation has been associated with the
onset of malignant tumours, as suggested by recent studies. For
example, the anti-inflammatory effects of blood serum high density
lipoprotein (HDL) was found to be related to lower incidence of
cancer.217
TCM does not deal with cancer as a disease or a syndrome, and
does not have a comprehensive theory explaining the origins of can-
cer and the principles of therapy for this family of diseases. Chinese
216
See, for example, Agus (2012), Le Fanu (2011).
217
“The clear association between inflammation and cancer is real and has many examples.
One of the most exciting recent studies was published in the June 22, 2010, issue of the
Journal of the American College of Cardiology. The analysis of two dozen randomized,
controlled trials that were studying therapies for cholesterol found that each 10 mg/ dl
higher increment of HDL cholesterol (the good cholesterol) was associated with a relative
36 percent lower risk of cancer. The researchers were quick to note that these association
studies cannot prove cause and effect, although it’s been suggested that HDL may have
anti-inflammatory and antioxidant properties that could potentially fight cancer.” Agus
(2012), Chapter 9: “Hot and Heavy”, section entitled “Inflammation’s Path of Destruction”.
b2120_Ch-10.indd 189 6/8/2015 4:14:20 PM

medical classics describe conditions that are similar to those found

in cancer patients.
The Neijing states in the Suwen that “cough from the lungs,
breathlesses and gasping, sometimes even with spitting out of
blood….the pallor of the face is floating as with the reverse flow of
qi (≄䘶)”, likely a depiction of the symptoms of late stage lung
cancer. It attributed the disease to one or more syndromes: toxins in
the lung (䛚∂‫ץ‬㛪), accumulation of phlegm and dampness in the
lungs (Ⱐ⒯޵㚊), and deficiency of healthy qi (↓≄޵㲊).

Breast cancer has been recorded from early historical times.

Chao Yuanfang of the Sui dnasty described Shi Yong (⸣⯸) as a
tumor that “can be felt definitely, with a root. The core and the
surface are closely bonding, with slight pain but without heat. It is
as hard as a stone.” In the Yuan dynasty, Zhu Danxi writing about
the disease explained that “the accumulation of depression or anger
consumes spleen qi, and thus liver qi cannot be controlled and is
reversed upward to form a tumor like a big chess piece, without pain
or itching.”218
On the etiology and pathogenesis of breast cancer, Chinese
medicine differentiates between the influence of external factors on
“patients with weak constitutions attacked by the pathogen of wind
and cold leading to blood stasis” and those of internal emotional
factors underlying liver depression with qi stagnation “harming the
spleen and leading to disorders of qi and blood circulation and of
organ functions.219
Some Western physicians emphasize lifestyle as the most impor-
tant root cause of cancer and other chronic illnesses. Ilardi (2013)
depicts diseases ranging from cancer to depression as “diseases of
civilisation”, arguing that Man was evolved in nature with natural
218
Chao Yuanfang of the Sui dynasty writing in 610AD about shi yong (⸣⯸) in Treatise on
the Pathogenesis and Manifestations of All Disease.s Ge Zhi Yu Lun (an Inquiry into the
Properties of Things) (1347 AD). See Yu and Hong (2012), 94
219
Yu and Hong (2012), 95
b2120_Ch-10.indd 190 6/8/2015 4:14:20 PM

foods and a high level of physical activity in daily life. Without

electricity and household appliances, daily tasks were done by hand,
and without trains and motor vehicles, our forefathers relied on
their feet, keeping their bones, sinews and cardiovascular system in
shape. Stress was largely confined to the occasional threat from a
wild animal, which would typically be short and intense, lasting for
minutes, to for which we developed the fight-or-flight response of
the sympathetic nervous system. All this was replaced in modern
civilization with processed foods, little exercise other than short

bursts in the gymnasium, and prolonged work and social stresses

lasting months and years that wreak havoc on the para-sympathetic
nervous system.220
This is precisely the lifestyle that health preservation methods in
Chinese life cultivation or yangsheng (ޫ⭏) warn against.
From the point of view of TCM theory, the formation of a
cancerous tumour, its development and its eventual spread to other
parts of the body has its origin in the loss of balance between yin
and yang, manifested in disorders involving the struggle between
pathogens and healthy qi, and in excess and deficiency syndromes.
Such disorders can be brought about by external environmental and
internal (emotional and dietary) factors that predispose the body to
them.
For the prevention and treatment of cancers, there are lessons to
be drawn from Chinese wisdom in yangsheng, which revolves
around balance and smooth flows in the body achieved through
moderation and appropriateness of diet, qigong breathing exercises,
regularity in living habits, and management of emotions. My con-
jecture is that inflammation as understood in biomedical science is
intimately related to TCM notions of yin-yang imbalance and
impeded flows of qi and blood. The key to elucidating the cause of
cancer and its prevention may well lie in researching the biomedical
equivalent of imbalance and impeded flows as depicted in TCM
220
Ilardi (2010, 2013).
b2120_Ch-10.indd 191 6/8/2015 4:14:20 PM

theory, and its prevention through balance and regulation of qi and

blood as encapsulated in Chinese yangsheng.
To use an invidious analogy, cancerous tumours in the body are
like terrorism that emerges in troubled and dysfunctional societies.
One can use potent chemicals and radiation to kill cancer cells, or
surgery to remove the tumours, but they re-emerge after some time
if conditions in the body continue to foster cancer cell growth, just as
killing destroying terrorists with powerful military arsenal eliminates
them from the scene for some time. But they appear again often in
stronger fighting form because the social conditions remain or have

been exacerbated by the military operations.
Even for early-stage cancers of which the patient is deemed
cured after medical intervention, there is always a possibility of a
relapse if the patient’s lifestyle continues to be unhealthy. However
the episode of cancer may have been a wake-up call, spurring him
into cultivating life somewhat the TCM way, one of regularity, pru-
dent diet, appropriate exercise and emotional calm, thereby gaining a
better chance of longterm freedom from the disease. If the disharmo-
nies of society that breed terrorism are resolved after the initial phase
of terrorist activity has been quelled and social order returns, there is
a much better chance that terrorism has truly been banished.
10.6 Conclusion
In all the five cases above, TCM provides both complementary and
alternative treatments to common chronic illnesses, working largely
from the vantage point of restoring imbalances in the body system
and encouraging the body’s own healing powers to ameliorate the
symptoms or bring about recovery. It is patient- centric in the sense
of addressing directly the nature of the underlying syndromes
present and adapting to changing syndromes as the illnesses evolve
and progress in each patient.
Millions of patients around the world receive TCM treatments
to relieve their sufferings and many more practise its system of
b2120_Ch-10.indd 192 6/24/2015 6:37:42 AM

health cultivation based on balance and natural flows in the body.

Despite its ancient origins, TCM has shown remarkable resilience in
preserving a healthcare role in modern scientific societies. This is
unlikely to be attributable entirely to the power of superstition or
the placebo effect. More plausibly, it is a reflection of Chinese medi-
cine having captured some essential aspects of health framed within
a holistic view of human physiology that is not readily accessible to
reductionist perspectives of biomedicine.
TCM treatments should be carefully and rigorously researched.

Its more contentious claims should be scientifically and critically

assessed and its efficacious aspects better understood and prudently
applied. It may well help to make modern medicine whole.
For now we see through a glass darkly;
but then face to face:
Now I know in part;
but then I shall know fully.
I Corinthians
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TCM Treatment of Chronic Illness

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b2120 Principles of Chinese Medicine: A Modern Interpretation “9x6”

Treatment of Chronic Illnesses

The good physician treats the disease; the great

physician treats the patient who has the disease.

TCM is used extensively in East Asian countries, and to some extent

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176 Principles of Chinese Medicine: A Modern Interpretation

10.1 Coronary Heart Disease

TCM interprets coronary heart disease as an impediment to or

blockage of the free flow of qi and blood. The condition is classified

b2120_Ch-10.indd 176 6/8/2015 4:14:19 PM

Treatment of Chronic Illnesses 177

syndrome and blood stasis as the consequent syndrome of disease

and Radix Notogingseng (sanqi йг). A typical prescription formu-

lation, appropriately modified to suit each patient’s condition,

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178 Principles of Chinese Medicine: A Modern Interpretation

A typical prescription for blood stasis syndrome in the chest is

ment of coronary heart disease. This formulation contains danshen,

sanqi and Borneolum Syntheticum (bingpian ߠ⡷).

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Treatment of Chronic Illnesses 179

to management of heart conditions using medicated diets and

inhibiting the progression of atherosclerosis. The TCM approach

has some similarity to that of a new school of biomedical cardi-

10.2 Hypertension and Stroke

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180 Principles of Chinese Medicine: A Modern Interpretation

This could be caused by clotting at the artery (thrombosis), or a

detached clot from another location — usually the heart or the

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Treatment of Chronic Illnesses 181

with ingredients added for resolving blood stasis such as Buyang

Huanwu Tang (㺕䱣䘈ӄ⊔) are administered in the recovery stages.

b2120_Ch-10.indd 181 6/8/2015 4:14:20 PM

182 Principles of Chinese Medicine: A Modern Interpretation

and hypertension to precipitating cerebral thrombosis or embolism.

tension are idiopathic and a significant percentage of patients with

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Treatment of Chronic Illnesses 183

adherence to one regimen. When treatments are combined, there

10.3 Digestive Disorders and the Irritable Bowel Syndrome

tion is largely captured by the pi (㝮) organ, translated as the ‘spleen’.

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184 Principles of Chinese Medicine: A Modern Interpretation

properly digested, and there could be resultant generation and accu-

Herbal supplements used to strengthen spleen functions

include dried tangerine peels (chenpi 䱸Ⳟ), sharen (⸲ӱ) and

Irritable bowel syndrome

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Treatment of Chronic Illnesses 185

TCM regards IBS (changyijizonghezheng 㛐᱃◰㔬ਸᖱ) as a

㛍ᰪ҈㝮), a situation implied by the five-element model, causing

the spleen to malfunction in its digestive role. The exuberant liver

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186 Principles of Chinese Medicine: A Modern Interpretation

For example, TCM therapy for digestive problems is often directed

For the biomedical scientist, spleen dampness should be regarded

as whatever physiological condition underlies these same symp-

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Treatment of Chronic Illnesses 187

on most days for at least two weeks.”215 Core symptoms include

nervous system. Treatment makes extensive use of anti-depressants,