MODULE 1

I. IMPORTANT HISTORICAL EVENTS IN TRADITIONAL CHINESE MEDICINE

Traditional Chinese Medicine is a type of traditional medicine that originated in

ancient China, that uses a unique medical system to diagnose, treat and prevent illness.
The modalities of treatment also differ than with other traditional medicines such as
Japanese Kampo, Korean medicine, etc. Let me enumerate some of the important
historical events and doctors and their contributions in the field of medicine.

During the Shang Dynasty (1600 to 1046 B.C), invention of wine became popular
because of its effect on the human body. Doctors then discovered that in small amounts,
this can have a stimulating effect, while in huge amounts, it has an anesthetic effect. I
am sure you have noticed this when you have tried to drink alcoholic beverages. In
small amounts, a person becomes talkative and hyperactive. It is the reason why serving
alcohol is common during parties. Huge amounts could bring a person to lose his
sensibilities. Aside from this, the doctors discovered the use of alcohol as solvents when
concocting medicinal herbs. It is said that the alcohol can increase the potency and
hasten the effect of the medicine when ingested. And because of this, the practice of
decoction became a norm in the Traditional Chinese Medicine.
Between the Warring states period and the Han Dynasty, the first medical book
entitled “Huang Di Nei Jing” or the “Emperor’s Inner cannon” came out. This is known
in the history of TCM as the most ancient medical book. During this time, the basic
foundations of Traditional Chinese Medicine were already established in this book.
Then during the Han dynasty, Shen Nong 神农 wrote the first pharmacological
book on medicinal herbs. It was through his works when poisonous herbs were
discovered.
Then during the Sui dynasty, Chao Yuan Fang 巢元方 introduced the “General
treatise on Pathology & Symptomatology of Diseases” 诸病源候论. This is the book
where diseases where now subdivided into the different fields of medicine such as
Internal Medicine, Pediatrics, Surgery, etc.
Then by the time of the Song dynasty, Qian Yi 钱乙 wrote about the “Therapeusis
of Pediatric diseases”. He was known for his contributions in the treatment of childhood
diseases.
Then in the Jin and Yuan dynasty, 4 notable physicians namely: Liu Wan Su 刘完
素，Zhang Cong Zheng or Zhang Zi He 张子和， Li Gao or Li Dong Yuan 李东垣,
and Zhu Zhen Heng made great contributions in the field of medicine. Liu Wan Su said
that a serious disease should be considered if a patient manifests with fever in the
presence of inflammation. In the western medicine point of view, this is true. A lot of
deaths due to Sepsis or Septicemia, patients have continuously high fever accompanied
by severe inflammation in the body such as pneumonia, etc. Aside from this, he
promoted the “Cold school of Medicine” wherein the use of herbs that would promote
cooling the body as a form of treatment in diseases that causes fever. This is the reason
why even in Western medicine, increase fluid intake is promoted in patients suffering
from fever because it can help bring down the body temperature. Next is Zhang Zi He
张子和 or Zhang Cong Zheng who is known for his theory on the “6 doors and 3
methods”. He said that the 6 doors refer to the summer heat, dampness, fire, dryness,
cold and wind. These climatic conditions are doors that can lead to certain diseases.
And the 3 methods that he was referring to are: sweating, vomiting, and purging. Zhang
Zi He said that to treat diseases one can promote sweating, vomiting and / or purging.
Thus, this was called “the Purgation school of thought”. This is especially true when
we are dealing with diseases like for example food poisoning. To treat this, our body
needs to remove the unpleasant substance from the body which can be in the form of
vomiting, and in some cases, patients develop diarrhea. Next is Li Gao or Li Dong
Yuan 李东垣，who became popular for his “Treatise on the Spleen and stomach”,
wherein he said that the organs spleen and stomach get injured by a inappropriate
lifestyle. This can cause a decline in one’s vitality and eventually lead to disease
formation. He also said that strong emotions such as anger, joy, sadness, and grief could
seriously affect a person’s Qi. And when the flow of Qi becomes affected, it could lead
to disease. This is the earliest mention of mental health problems in the field of
medicine. Then came Zhu Zhen Heng or Zhu Dan Xi 朱丹溪 who is known for his
“Yin Nourishing School of thought”. He said when an imbalance in the Yin and Yang
occurs in the human body, it is usually the Yang that is in excess while the Yin is
deficient most of the time. Thus, to treat this one must nourish the Yin to bring about
the balance back in the human body and purge or remove the fire that is causing the
excessive Yang.
Then in the Ming and Qing Dynasties, further development of TCM led to the
“Theory of Pestilential factors” by Wu You Ke 吴又可. According to him, there are
pests in this world that once it enters the body thru the mouth and nose, it can cause
disease. The pests he was referring to were not the extreme climactic changes or
excessive emotions but pests such as bacteria, parasites, etc., which in the Western
medicine are also considered substances that can cause disease. He said that this pest
is not like the extreme climatic changes where it enters the body thru the skin. These
pests can be inhaled or ingested and can cause a disease. Another notable contribution
during this time is from Ye Gui or Ye Tian Shi 叶天士。 His famous work is about
febrile diseases wherein he said that a person undergoes 4 stages, namely: Wei 卫，Qi
气，Ying 营 and lastly blood 血. He said that disease occurs when there’s a break in
the sanitation or 卫 Wei, and if this disease continues to progress, it can go to the next
stage Qi 气，wherein the patient feels there is loss of vitality and vigor, feels weak.
After this, as the febrile disease progresses, it leads to the Ying 营 stage where the
patient loses appetite to eat. And if these continues, the disease can move to the last
stage of Xue 血 blood where the pests that is causing the disease is now circulating all
over the body infecting almost all the organs inside. Using this principle of the 4 stages
 of febrile diseases, it emphasizes how important early diagnosis and treatment is the
key to prevent a patient from reaching the last stage where death could be imminent.
Then came the Qing dynasty, where Wang Qing Ren 王清任 popularized the theory
on pathogenesis due to blood stagnation. He said that disease can develop in a person
if the blood is not circulating properly or stagnating. In western medicine, this is a well
recognize concept of disease development. In fact, in western medicine they apply the
use of blood thinners to patients who are in danger of suffering from stroke. In diabetic
foot, the problem of a dying foot is due to poor blood perfusion in the area which
usually leads to amputation.

II. TRADITIONAL CHINESE DIAGNOSTICS

Traditional Chinese diagnostics refers to the science of making a diagnosis on the
health of a patient based on inquiry, inspection, auscultation, palpation, and pulse-
feeling.
a. INQUIRY:
• Patient’s name, age, sex, marital status, nationality, occupation
• Pertinent past history
• Major complaint or reason why they saw a doctor
• Onset, duration, and progress of symptoms, treatment adopted if any
• Ask for presence of chill, fever, perspiration, pain
• Bowel movement, urination history
• State of diet, sense of taste, hearing, sense of smell, sense of thirst
• Menstrual history; obstetrical history (for female patients)
• Sleep history or patterns; hobbies, habits, family history
b. INSPECTION
• Mental faculty:
i. sound health and vigorous spirit is a sign of abundant Qi
ii. Weak body and lack of vitality is a sign of declining Qi
iii. This is usually reflected on the patient’s spirit, consciousness,
language, breathing, patterns of movement and reaction.
• Vigorous spirit: attentive; sparkling in the eyes, lustrous
face, full consciousness, natural expression and posture,
easy breathing, sharp responses
• Lack of vitality: patient appears spiritless with dull eyes,
slow movements, shortness of breath, and feeble voice,
weariness, and sleepiness
• Loss of vitality: dull look in the eyes, lusterless
complexion, apathetic expression, lassitude, sluggish
response, coma, delirium, sudden loss of consciousness,
urinary and fecal incontinence.
 • Pseudo-vitality: refers to false appearance of vitality;
patient switches from very low spirits to very high spirits;
face is pale and lusterless
• Mental disturbance: includes irritability, delirium, depressive psychosis,
mania, and epilepsy.
i. Depressive psychosis: apathetic expression, dementia, abnormal
behavior, muttering to oneself, unreasonable crying and
laughing.
ii. Mania: restlessness, shouting, excessive motor activity and
violent behavior.
• Complexion: color and luster of the face reflects the condition of the Qi
and blood
i. Healthy complexion: 2 categories of color:
• Chief color: unchanged in life
• Secondary color: changes under the influence of climate,
sports/exercise, emotions, and type of work.
ii. Sickly complexion:
• Favorable color: morbid color on the patient’s face but
still has luster
• Unfavorable color: complexion dull and shriveled
without luster
• 5 basic colors:
i. Blue: suggests cold syndrome, excess
syndrome, blood stasis
ii. Red: suggests heat syndrome or floating
Yang syndrome
iii. Yellow: implies deficiency syndrome or
dampness syndrome
iv. White: implies cold syndrome, deficiency
and loss of blood
v. Black: retention of fluid, blood stasis and
pain
• Physique: whether the body is strong or weak or emaciated and whether
there is any deformity
i. Bones:
• Strong: big and sturdy
• Weak: thin and fragile
ii. Chest (heart and lungs)
• Strong: wide and thick
• Weak: narrow or deformed
iii. Muscles (spleen)
• Strong: plump and powerful
 • Weak: thin or edematous
iv. Skin and hair (lungs)
• Strong: smooth and shining
• Weak: withered
v. Tendons, nails (liver)
• Strong: moving freely, glossy
• Weak: impaired motion, thin, flexible, spasm, withered
and pale
vi. Obese or emaciated
• Obese is often someone suffering from Yang deficiency
and lack of Qi
• Emaciated: suffers from insufficient essence, blood, and
fluid together with exuberant fire due to Yin deficiency
vii. Deformity: refers to chicken breast and kyphosis
• Patterns of movement: observe for quiescent or dynamic patterns of
movement and characteristic patterns of movement
i. Motion is of Yang aspect
ii. Quiescent is of Yin aspect
• Excess syndrome of Yang-Heat:
• Patient tosses and turns on his bed, likes to lie on
his back and face outward, dislikes to cover him,
refuses heating
• Excess of Yin-cold
• Sluggish movement, prefers lying down, likes to
face inward when lying on the bed, wears more
clothes
iii. Abnormal body movement: violent or sudden movement, tremor,
hemiplegia, deviation of eye and mouth, slurring of speck,
coughing, shortness of breath
iv. There are patterns of movement that indicates a critical
condition:
• Waving one’s hand unconsciously, fumbling and picking
at bed or clothes
• Straight or upward staring or staring at somebody
• Tongue inspection:
i. Tongue coating
ii. Color
iii. Degree of moisture
iv. Shape
v. Luster
vi. Presence of tremors
vii. Presence of deviation
• Shape of the head and hair
i. Shape of the head
ii. Motion of the head
iii. Fontanels
iv. Hair color, luster, coverage and denseness
v. Observation of eyes
• Eyes
i. Vigorous spirit: attentive, sparkle in eyes, good vision,
dexterous movement of eyeballs
ii. Loss of vitality: spiritless, dull and blurred eyes with clumsy
movement
• Ear is the window of the kidney
i. Change of color: luster, white, black, red
ii. Shape: thick and big; think and small: swollen
iii. Excretion or fluid discharge: dry ear discharge or mucoid
• Nose serves as the window of the lung
i. Changes of color: white, red, blue, etc.
ii. Shape: swollen, sunken, presence of acne, etc. flaring of the
nares
• Lips are the mirror of the spleen.
i. Change of the color
ii. Moisture and dryness
iii. Shape
iv. Deviation of the lips
v. Presence of tremor
• Teeth are the extension of the bones and that the bones are dominated
by the kidneys.
i. Color
ii. Moisture
iii. Shape
• Gums
i. Change of color
ii. Presence or absence of swelling
iii. Presence of bleeding or hemorrhage
• Throat
i. Changes in the color
ii. Shape
iii. Presence of membrane or discharge or plaque adhered on the
surface of the throat
• Neck
i. Look for signs of swelling, like:
• Goiter: enlargement of the thyroid gland; swelling in
front of the neck
 • Scrofula: bead-like enlargement on both sides of the
neck; inflamed lymph node
• External genitalia and anus are also observed for signs of swelling,
redness, presence of a discharge coming out of the opening, presence or
skin tags, worms, wart. In the case of the scrotum for males,
transparency of the scrotum is also observed.
• Skin is dominated by the lungs.
i. Change of color: red, round, flat rashes or elevations
ii. Moisture
iii. Skin turgor or elasticity
iv. Presence of eruptions or rashes
v. Presence of swelling
• Excretions versus Secretions
i. Secretions include sputum, vomitus, eye discharge or tearing,
ear discharge, nasal discharge, urethral discharge
• Take note of the thickness or thinness of the discharge or
viscosity
• Vomitus: color, amount; shape
ii. Excretions include
• Feces: color, moisture, consistency
• Urine: clarity, color, presence of blood
c. Auscultation is a method of gathering data from the sound of the voice and from
breathing.
• Patient’s voice when talking
• Respiration
• Coughing
• Vomiting
• Hiccup
• Belching
• Sighing
• Sneezing
• Borborygmus or sound from the movement of the intestines
d. Olfaction
• Odor of the patient
i. Odor from the mouth
ii. Smell of sweat
iii. Odor from the nose
iv. Foul odor from the body
• Odor of the ward
i. At the initial stage of pestilence, a fetid odor can be smelled.
• In a mild case: odor fills the bed
• In a severe case: odor fills the room
 e. Pulse taking and palpation
• Pulsation is the process where the circulation of the Qi and blood along
the meridians and the blood vessels are assessed. Pulsation is produced
by the heart beating
• Best time to take the pulse is early morning because it is less affected
by intake of food and other physical activities. Environment should be
quiet. Loud noise could affect the mood or emotion of the patient and
thereby affect the pulses
• Position of the patient when pulses are taken is when the patient is sitting
down or lying on the bed on his back with the forearms and hand
extended and the palms facing up.
i. Volume and quality of blood play an important role
ii. Depth of pulse:
• Floating pulse: location of the disease is in the Exterior
• Deep: location of disease is in the Interior
iii. Nature of disease
• Slow and rapid pulses or speed of the pulses reflect the
nature of the disease
• Slow pulse: cold syndrome
• Rapid pulse: heat syndrome
iv. Rate of pulsation: one cycle of inhalation and exhalation of the
physician consist of 1 breath.
• Normal = 4 to 5 beats in one breath
• Slow rate = 3 betas in one breath
• Rapid rate + 6 beats in one breath
f. Palpation is a diagnostic procedure in which the physician touches some parts
of a patient’s body to detect local abnormal changes, thereby to determine the
site, nature, and condition of a disease.
• 3 ways:
i. Touching refers to a feeling a part of the body; detects
temperature, degree of moisture
ii. Stroking refers to passing of hands over some parts of the body
to detect swelling, local sensation or tenderness, shape, and size
of the swelling.
iii. Pressing refers to pushing firmly and steadily against some parts
of the body to detect tenderness in the deeper area, the shape,
quality, and size of the swelling. A perfect example is the self-
breast examination in women.
Sources:
Zhanwen Liu, Liang Liu (2010) Essentials of Chinese Medicine vol. 1 to 3. Springer.
Men Jiu Zhang, Guo Lei (2020). A General Introduction to Traditional Chinese Medicine. Chapter
1 pp 1 to 15. CRC press.