1. Principles for disease prevention and treatment Lecturer: QU Hongyan

2. Preventive principles

3. Principles for disease prevention and treatment are a general term for preventing and treating disease. Under the guidance of concept of holism and treatment based on syndrome differentiation, it refers to the criteria of preventing and treatment disease, and it is an important part of the basic theories of TCM.

4. Preventive principles These refer to the criteria of preventing the occurrence, development and transmission of disease made in accordance with the laws of the occurrence, development and transmission of disease. The earliest preventive thought, known as treating the undiseased was advanced in Huangdis canon of medicine.

5. 1 Prevention of the occurrence of disease 1 1 2 2 Prevention of development and transmission of disease 3 3 Prevention of the recurrence of disease Preventive principles

6. Prevention of the occurrence of disease It means that various measures should be taken in advance to prevent the occurrence of diseases. Health preservation Prevention of the invasion of pathogenic qi

7. Health preservation It means to cultivate life, aiming to direct people to take various regulative to build up constitutions,avoid disease, postpone the aging process, keep fit and prolong life span. Complying with nature Cultivating mental faculties Proper diet Moderate work and rest Proper living habits

8. Health preservation 1. Complying with nature According to the concept of holism, life activities of the human body must comply with the waning and waxing laws of yin and yang all along the four seasons; otherwise, diseases would occur. Therefore, psychological activities, living habits and diet are all required to be regulated consequently according to the seasonal changes.

9. Health preservation 2. Cultivating mental faculties It means to regulate psychological state, consciousness and mental activities to keep healthy physically and mentally. Psychological and Emotional changes Reflect the normal Psychological activities Build up constitutions resist disease, prolong life span Abnormal Psychological and emotional changes Qi movement of viscera will be affected and various diseases will follow subsequently

10. Health preservation 3. Moderate work and rest Suitable work, exercise and rest are essential for maintaining life and keeping fit. But overwork and over-rest will affect health and cause diseases. Therefore, health preservation and disease prevention mean both to avoid overwork, overstrain and sexual strain, and to avoid ove- rest.

11. Health preservation 4. Proper diet Regular, moderate, diverse and sanitary diet are taken in The human body will absorb necessary nutrient substances The normal growth and physiological function are maintained

12. Health preservation 5. Proper living habits Living habits include work, rest, living conditions, clothing, etc. According to seasonal changes and individual conditions, the work rest schedule should be set reasonably, and the living habits should be regulated appropriately; the living environments should be kept quiet, clean and comfortable; the clothing should be clean and comfortable, not too thin or too thick.

13. Prevention of the invasion of pathogenic qi Pathogenic qi is a major factor of causing disease and harming health. Attention should be paid to hygience, prevent environmental, water and food pollution Avoid the invasion of the pathogenic factors Attention should be paid to avoid accidental injuries

14. Prevention of the transmission and development of disease It means that effective measures of diagnosis and treatment should be taken the development and transmission of disease at the early stage of disease.

15. 1. Early diagnosis At the early stage, disease is easy to treat because it is mild and healthy qi has not declined yet. If not treated timely, disease will become complicated and worse because pathogenic qi is transmitted from the exterior into the interior and healthy qi is exhausted. Therefore, early diagnosis and treatment is the key to recovery, significant for preventing the transmission, development and aggravation of disease.

16. The development and transmission of any disease follow its unique rules. So according to these rules, "treating the unaffected area first", cutting off the transmission link of disease, is a major measure to prevent the development and aggravation of disease. e.g. Since liver disease is most likely to transmit to the spleen, measures should be taken to strengthen the spleen in the treatment of liver disease in order to prevent liver disease from transmitting to spleen. 2. Controlling transmission and development of disease

17. when the body has not yet completely restored to the normal state after disease is somewhat relieved or cured, disease easily recurs due to improper diet, emotional disturbance, etc. e.g. when just recovering from diarrhea, infants should have light food, as functions of the spleen and stomach have not completely restored to the normal state 3. Prevention of the recurrence of disease

18. Therapeutic principles

19. Some concepts Therapeutic principles are the criteria of treating all diseases. Therapies refer to the therapeutic rules and methods in accordance with various syndromes. Therapeutic methods are those specific for various syndromes, limited in the range of therapeutic rules, such as nourishing blood to induce tranquilization, and releasing superficies with pungent-warm drugs, etc.

20. Therapeutic rules are the criteria of classified treatment and give guidance to the therapeutic methods. Diaphoresis, emesis, purgation, mediating, warming, heat-clearing, resoluting and reinforcing

21. Searching for the fundamental of disease in treatment guidelines Therapeutic principles Routine treatment contrary treatment Treating fundamental aspect and incidental aspect Reinforcing the healthy and eliminating the pathogenic Regulating yin and yang Treatment in accordance with seasonal conditions, local conditions and patients individuality Therapeutic rules Eight therapeutic rules Therapies Therapeutic measures

22. Therapeutic principles Searching for the fundamental of disease in treatment Reinforcing the healthy and eliminating the pathogenic Regulating yin and yang Regulating qi and blood Treatment in accordance with seasonal conditions, local conditions and patient s individuality

23. Searching for the fundamental of disease in treatment It means to find the fundamental cause of a disease and focus the treatment on it. The nature of disease, refers to the pathogenesis and changes of yin-yang in a disease Routine treatment and contrary treatment Treating fundamental aspect and incidental aspect

24. Routine treatment It refers to the treatment of disease adverse to its manifestations, also known as adverse treatment. It is suitable for disease with nature in conformity with Its manifestations. Warm syndrome is marked by warm manifestations, Cold syndrome by cold manifestations, Deficiency syndrome by deficiency manifestations Excess syndrome by excess manifestations. e.g.

25. Routine treatment Treat cold with heat It means that the cold syndrome, with cold manifestations, should be treated with warming or hot formula. releasing superficies with pungent-warm drugs is used to treat wind- cold syndrome of exterior type. we apply pungent-hot drugs to warm interior and treat the interior clod syndrome e.g.

26. Routine treatment Treat heat with cold It means that the heat syndrome, with heat manifestations, should be treated with cold or cool formula. releasing superficies with pungent-cool drugs is used to treat wind- heat syndrome of exterior type. we treat heat accumulation in the stomach and intestines with bitter- cold drugs to relieving interior. e.g.

27. Routine treatment Treat deficiency with tonifying It refers to deficiency of healthy qi, with deficiency manifestations, should be treated with tonifying and replenishing formula. replenishing qi is used to treat the qi deficiency syndrome nourishing yin to treat the yin deficiency syndrome e.g.

28. Routine treatment Treat excess with purging It means that excess of pathogenic qi, with excess manifestations, should be treated with offensive purgative formula. dispelling retained water is used to treat internal retention of water promoting digestion and removing food stagnation to treat food stagnation e.g.

29. Routine treatment and contrary treatment contrary treatment It refers to the treatment of disease agreeable to its manifestations, also known as "agreeable treatment. It is applicable to complicated morbid states in which the nature of disease is not completely in conformity with its manifestations, or even marked by false manifestations.

30. contrary treatment Treat heat with heat it means that diseases with manifestations of false heat should be treated with warm or hot formula or measures. It is applicable to the syndrome of true cold with false heat caused by exuberant yin with repelled yang. Tong Mai Si Ni Decoction, a warm and hot formula, can deal with this condition e.g.

31. contrary treatment Treat cold with cold it means that diseases with manifestations of false cold should be treated with cold or cool formula or measures, it is applicable to the syndrome of true heat with false cold caused by exuberant yang with repelled yin. Bai Hu Decoction, a cold and cool formula, is used to treat heat syncope caused by exuberant internal yang with yin repelled externally. e.g.

32. contrary treatment Treat stuffiness with tonic It means that diseases with manifestations of stuffiness should be treated with tonifying and replenishing formula or measures, also known as"relieving stuffiness with tonic. It is applicable to the syndrome of stuffiness and stagnation caused by deficiency. Abdominal distension and fullness, caused by deficiency of spleen and stomach and qi stagnation, is treated by invigorating spleen and replenishing qi. Constipation due to qi deficiency is treated by replenishing qi

33. contrary treatment Treat diarrhea with purgative It means that diseases with manifestations of diarrhea should be treated with purgative formula or measures, It is applicable to the syndrome of diarrhea caused by stagnation of excess pathogens. dysentery caused by stagnation of damp-heat in the large intestine abdominal distension and fullness is treated by clearing heat and draining heat as well as promoting qi flow and relieving stagnation. When damp and heat are cleared away, diarrhea will be stopped spontaneously. e.g.

34. Treating fundamental aspect and incidental aspect Concepts of fundamental aspect and incidental aspect The fundamental and the incidental are two relatively opposite concepts. Their relationship is often used to generalize and explain the essence and the outward appearance. In the course of a disease, its fundamental aspect and incidental aspect are determined by the development of the disease. healthy qi is the fundamental aspect, and pathogenic qi the incidental aspect; the cause of disease is the fundamental aspect, and the symptoms incidental aspect; primary disease is the fundamental aspect, and secondary disease the incidental aspect. e.g.

35. Treating fundamental aspect and incidental aspect Application of treating fundamental aspect and incidental aspect treating fundamental aspect in case of lesser urgency Treating incidental aspect in case of urgency Treating both fundamental and incidental aspects

36. Treating fundamental aspect in case of lesser urgency For chronic disease or acute disease at the recovery stage treatment should be focused on the fundamental aspect of a disease, for the incidental aspect usually originates from the fundamental aspect. Take cough due to tuberculosis for example. Yin deficiency of the lung and kidney are the fundamental aspects, while cough is the incidental aspect. Therefore, it should be treated by nourishing yin of the lung and kidney, which is to treat the fundamental aspect. When yin fluid of the lung and kidney moistens,cough will he relieved naturally. e.g.

37. Treating incidental aspect in case of urgency When the incidental aspect of a disease is so urgent and serious that it affects the treatment of the fundamental aspect and endangers patient's life, treatment should be focused on it first. Hematorrhea of any reason should be treated by arresting bleeding first, which is to treat the incidental aspect. When bleeding is stopped, its fundamental aspect should be further searched for and treated later on. e.g.

38. Treating both fundamental aspect and incidental aspect When the incidental and fundamental aspects of a disease are both serious or both not urgent, treatment should be concentrated on both fundamental and incidental aspects. To a common cold caused by qi deficiency, qi deficiency is the fundamental aspect, and cold is the incidental aspect. Then simply replenishing qi will cause stagnation of pathogenic qi and cold cannot be cured; simply releasing superficies will impair healthy qi. So we should replenish qi and release superficies, can cold get relieved. e.g.

39. Reinforcing the healthy and eliminating the pathogenic Reinforcing the healthy It refers to tonify the healthy qi, build up constitutions, and improve the bodys resistance against disease and recovery ability. Eliminating the pathogenic It means to remove the pathogenic qi and to relieve the invasion and impairment of pathogenic qi. Treat deficiency by tonifying Treat excess by purging

40. Reinforcing the healthy Eliminating the pathogenic Prevent and dispel pathogenic qi Conserve and recover healthy qi On one hand:

41. On the other hand: Drugs of reinforcing the healthy Make the pathogenic qi retain in the body Drugs of eliminating the pathogenic Impair the healthy qi

42. Application of reinforcing the healthy and eliminating the pathogenic During the treatment, attention should be paid to differentiation what is primary from what is secondary and what is urgent from what is less urgent, so that reinforcing the healthy and eliminating the pathogenic can be taken up in order of importance and priority. Single application Combined application Alternate application

43. Reinforcing the healthy It is applicable to deficiency syndrome in which deficiency of healthy qi is the primary contradiction and meanwhile pathogenic is not exuberant. Single application Qi deficiency is treated by replenishing qi Eliminating the pathogenic It is applicable to excess syndrome in which exuberance of pathogenic qi is the primary contradiction and meanwhile healthy qi does no decline. Excess of exterior pathogens is treated by inducing sweating to release superficies

44. Reinforcing the healthy combined with eliminating the pathogenic It is applicable to syndromes with deficiency of healthy qi as the primary contradiction and exuberance of pathogenic qi as the secondary contradiction. combined application Eliminating the pathogenic combined with reinforcing the healthy It is applicable to syndromes with exuberance of pathogenic qi as the primary contradiction and deficiency of healthy qi as the secondary contradiction. damage of yin by heat should be treated by clearing away heat combined with nourishing yin

45. Reinforcing the healthy prior to eliminating the pathogenic It is applicable to syndromes of deficiency of healthy qi with excess of pathogenic qi, in which healthy qi cannot withstand attack. Alternate application Eliminating the pathogenic prior to reinforcing the healthy It is applicable to syndromes of excess of pathogenic qi with deficiency of healthy qi, in which pathogenic qi needs eliminating urgently and healthy qi can still withstand attack.

46. Regulating yin and yang Reducing excess Applicable to preponderance of yin or yang Supplementing Nourishing yin to restrict yang Applicable to yin deficiency Tonifying yang to restrict yin Applicable to yang deficiency Supplementing both yin and yang Applicable to deficiency of both yin and yang Treating yang for yin Applicable to deficiency of both yin and yang with yin deficiency as the primary contradiction Treating yin for yang Applicable to deficiency of both yin and yang with yang deficiency as the primary contradiction

47. Disorders of qi and blood will involve the whole body, while pathological changes of any part of the body will cause disorder of qi and blood. Therefore, it is an important therapeutic principle. Regulating qi and blood

48. It means that therapeutic principles should be determined according to seasonal, local and individual conditions, also known as treatment in accordance with three factors. Treatment in accordance with seasonal conditions, local conditions and patients individuality Treatment in accordance with seasonal conditions Treatment in accordance with local conditions Treatment in accordance with patients individuality