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Philosophical and Practical Precepts

The following is a basis to a paper written by James Middleton for presentation at international conferences. Compiled from the lectures of Professor Wong Lun (OAM), Director of the Academy of Traditional Chinese Medicine Australia. The paper seeks to present a basic over-view of philosophical and practical precepts, also to illuminate the actuality of an ongoing and dynamic ancient tradition of medicine.

A statement from the Chinese medical classic, Huang Di Nei Jing

A healthy life depends on a harmonious and balanced interaction between Xing, physical and Shen, spirit.  When a person becomes sick – in whatever context - it represents a breakdown of this relationship; either physical, Xing or Spirit, Shen is leading the cause. 

The advanced physician can define the cause of sickness; is the cause from a break down of physical health, or from matters relating to the mental/emotional aspects of Spirit, or are both responsible for the breakdown of health; in TCM practice, this sets the foundation for the diagnosis and the treatment that follows.

Professor Wong Lun has practiced and researched the classical writings of TCM for over sixty years.

“I travelled the world for three years from 1969 to 1972. The purpose was to continue my research on the persona of old cultures and to understand more about the history of ancient medicines. I wrote numerous articles and a book on these subjects. Included within this book were descriptions of the origins of the ancient medicines of Egypt, Persia, Babylon, the Greeks and hypocrites, as well as the origins of surgical operations. In China I found an old book of Anatomy with hand drawn diagrams. In one isolated place I saw a woman who had come into our camp, she was eight feet tall. Her young son was with her; he was already six feet tall. I tried to talk to her about her people, but she ran away. I found so many interesting facts about ancient human beings and the cultures that existed before the age of writing. People change and adapt according to where and how they live, their physical size will vary, diet and temperament will also vary. Some will have a long life and some only a short life, all according to the endless combinations of physical and emotional environments”.

I would like to explain something about the heritage of TCM and what it is I think China has to share with the modern world. Even though I am now at a high age, I still keep my health and continue to help and teach people. I came to Australia in 1973 with the hope of sharing my culture. I opened a TCM college and research clinic in Melbourne, the continuation of the work I began in Hong Kong in 1958. Since that time and before, I have sought to explain to TCM practitioners about the practicality of combining the five arts of TCM into an integrated medical treatment i.e. Wu Da Liao Fa. And to help all people learn about the importance of the balance between the physical, Xing and spirit, Shen, i.e. Xing Shen He Yi.

The purpose of this study is for the relief of suffering, and to present time tested precepts to fulfil the quest for long, healthy and happy lives. The effort towards the attainment of long healthy robust lives is not new. I would like to remind people of a conversation that took place in the earliest days of writing.

Chinese Emperor Huang-Di (the Yellow Emperor) questions Daoist medical master Qi Bo

The following conversation paraphrases a famous excerpt from Chinese historical literature. The Yellow Emperor Huang Di, questions Daoist master Qi Bo, in matters concerning medicine, natural health and longevity, thus forming the body of work immortalised within Huang Di Nei Jing, the great classic of TCM internal medicine that has pervaded the art of medicine in China for thousands of years.
Compiled 2,300-2,800 years ago.

Emperor Huang-Di says to Qi Bo; "I have heard that in the time of our ancestors common life expectancy was one hundred years. Now, in our own time, people reach only fifty years of age before starting to run down, what's wrong? Why is our time so different".

Qi Bo replies: The people of the old time clearly understood union with the Dao, the Way of Life. They were able to practise Daoist precepts such as Yin/Yang and Yi Jing theory in order to balance and harmonise their lives to nature’s way. Thus, they formulated practices such as Dao-in Bi, techniques combining stretching, massage and breathing exercises to promote energy flow, and meditation to stabilise the mind and harmonise with the greater universe. They ate a balanced diet at regular times, arose and retired at regular hours and all of this in accord with changing seasons and personal lifestyle. Daily activities were governed to balance work and rest, neither to consistently overwork Xing, form, or Shen, mental/emotional resources. They knew how to balance one with the other (Xing and Shen), never allowing prolonged depletion of either. This is why they were able to live happily for over one hundred years.

Wrong thinking and wrong action is all from ignorance of a correct way. Many people simply suffer from overwork, thereby creating any of the five taxations, without knowing how to recover well enough, before doing it again. Overindulgence, over sex, over work (in which ever form) and a resulting lack of sense of purpose, will cause loss of balance between a person’s Yin and Yang. This is why our people in this time begin to run down at only fifty years of age". Paraphrase of Professor Wong’s lecture 19/5/02

As the above conversation indicates, knowledge regarding natural life and health and longevity has passed to us from the old culture. From a lineage reaching back in time to the ages before writing developed.  Further, from ancient concepts regarding the study of nature, (Nature Dao) originated the foundation principles of TCM medical practice. From teachers and medical scholars such as Fu Xi, Guang Cheng Zhi, Yu Huang Da Di, Hong Jun Lao Zi, all of who enunciated principles concerning the lore of nature and how these precepts directly relate to human beings.

In the interest of general education, I would like present a brief overview of a few of these basic concepts. Some of which our Australian people might have heard something about.

Yin/Yang Theory

There are many, many kinds of Dao - great cycle or way of life. The basic meaning of Dao is the way to connect with the pre-existing order and underlying intelligence of natural life. Natural life harmonises and adapts to the constant changing of Yin and Yang. Throughout life, Yin and Yang need to change and rebalance continually, thus maintaining health. The various schools of Dao contain the same kinds of thoughts, but the principles to achieve balance vary considerably. Nature Dao, study of nature, is to constantly identify and follow the natural way of human life – where all aspects are balanced, neither excess (Yang) nor deficiency (Yin) are prolonged, being neither consistently too strong or too weak.

Why study concepts such as Yin/Yang theory? Yin/Yang education facilitates a subliminal and conscious structure for reasoning, evoking logical insight of nature’s way and actions related to a healthy way of life. From this, people in relationships can become balanced; also, the relationship with all matters concerning our world can become more consciously balanced.

What are Yin and Yang, and how is Yin/Yang related to Wu Ji, Tai Ji, Ba Gua and Yi Jing?

Wu Ji means no end – it is everywhere and implies that all in existence is contained within Wu Ji. The term is used to denote the great void or the great ultimate, or that which exists as, and beyond, the physical body.
We may also contract the idea of Wu Ji to define any unknown construct. For example, draw a straight line and write Yin at the beginning and Yang at the end. We now think of this line as a microcosm of Wu Ji. The changing Yin/Yang character from movement between the maximum Yin degree at one polarity, to the maximum Yang degree at the opposite polarity is Tai Ji. Tai Ji defines Yin/Yang changing; it is the movement pre-existing within Wu Ji.

A line does not carry any variation of character from one end to the other, but nature and the universe do. Nature displays hot to cold, wet to dry, light to dark, weak and strong, large and small, masculine and feminine, loud and soft, extroverted and introverted, icecaps and the equator, hostile and passive, happy and sad, black to white, fearful and brave, internal and external, earth and heaven, quantum and particle.  These name a few of the vast array of opposite polarities that exist in Yin/Yang relationship to each other. Here we name the opposite extremes, but existing between polarities are degrees in between. If we write hot, representing Yang at one end of this line and cold, representing Yin at the other end, then this defines the Wu Ji of this relationship. The half waypoint represents a half Yin and half Yang character, which indicate neither hot or cold.
Yin and Yang declare the two polarity forces of Wu Ji. The ancients further divided Wu Ji, from two into four, from four to eight, and from eight to 64. Formal delineations of Wu Ji occur when increasing the number of lines of Yin and Yang. Doubling the two images and the two lines of Yin/Yang creates the four images termed Si Xiang. Si Xiang means four corners. Yin/Yang changing within Wu Ji now separates into four basic forces. Each force displays an individual Yin/Yang characteristic.

We double the images and the lines of Si Xiang, four corners,to form the eight-sided Ba Gua. Si Xiang has particular application in medical study.  Ba Gua has particular application to the study of planet earth’s eight fundamental attributes and directional influences.
Within the movement of Tai Ji and along Wu Ji from Yang to Yin, it is further divided into 64 individual forces, each with its own interpretation. This occurs when the Ba Gua lines are multiplied in the same way. These segments form the images that make up the 64 hexagrams of Yi Jing, (known in the west as I Ching).

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Photo: The city of Lanzhou is bisected by the mighty Yellow river, said by all to be the giver of life. A woman and her baby resides on the bank as a symbol of the life giving nectar offered by the river, in this otherwise dry harsh clay soil environment.

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Photo: The junction of the vast mountain range of Kong Tong that overlooks the homeland of The Yellow Emperor Huang Di. This place is an ancient site of the oldest known Nature Daoist settlement (a very difficult climb) and is said to be where Zhang San Feng resided. He is credited as being father of Daoist Tai Chi Quan.

Through the vehicle of Yin and Yang, Tai Ji, Si Xiang, Ba Gua and Yi Jing, we deduce the flow between and define the fundamental character/influence of any position between Yin and Yang. Any life, medical condition, emotional, psychological, geological, or atmospheric situation within the universe can be classified by Yin/Yang and when more experienced, further delineated to form Yi Jing. From this kind of education/awareness, we become more able to deduce the Yin/Yang influences upon us and logically define where we stand within Wu Ji at any time, place or situation. The important purpose of this work is first to recognise, and then to balance excessive Yang with a Yin influence or vice versa.

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Yin Yang Symbol, also known as Tai Chi Symbol

Xing Shen Yi Xue

Physical and spirit balance each other, unity of form and Spirit. The whole person separates into these two fundamental aspects, which must combine together for health and long life. If they do not combine appropriately, a person will become sick. This principle has roots reaching back 16,000 years, there are indications that knowledge of this principal goes back even before this.
Xing (physical) Shen (spirit) medicine embraces the understanding that psychosomatic and psychological illness is not a separate stream of theory from mainstream TCM therapy. Ancient China’s understanding of the relationship between body and spirit is very clear, offering practical explanations for the way diseases occur and further, how vital it is to understand fully the way psychological state affects the physical body, and how the physical body affects the psychological state.

Concept of Xing-Shen Medicine

Xing represents the physical - physique, or body. Shen, the subtle body, consisting of all the mental activity of the mind, all emotional feelings, and feelings related to life’s purpose, here for simplicity termed spirit. Regarding the inter-connectedness of body and spirit, references can be found within the earliest medical and philosophical works. For example, the Huang-Di-Nei-Jing expounds this relationship. 
It states that; "the body is the home of the spirit. The spirit is the master of the physical”. The spirit attaches itself to the body and the biological and physiological phenomena are the signs of the “Shen” (spirit,) manifesting itself. 1997 Paraphrase -Lanzhou International Conference of TCM, Xing Shen Medicine.

Physiological Basis Of Xing-Shen Medicine

In TCM, great attention is always given to the close relationship between mental and emotional activities and physical health. The theory espouses that unity of Xing and Shen (spirit and body) together make up holistic health. To strengthen the body, one must strengthen the spirit. Further, great emphasis is placed on the essential guiding role played by appropriate regulation of spirit in daily life.
Huang-Di-Nei-Jing further states, in the quest for health and longevity, one can be healthy and free from disease only when a person cultivates physical essence, (the foundation of the bone marrow, each organ is also said to have essence) and uses Qi, vital energy, wisely, and takes care to nurture the mental/emotional state of spirit. Thus can people be full of vigour with every physical organ and associated system remaining vibrant, henceforth, able to function properly over a long natural life span.
On the other hand, an imbalance within a person’s spirit may result in a variety of diseases. As again stated in the Huang-Di-Nei-Jing, it is known that all diseases arise from a disorder of Qi (reckless movement, stagnation or blockage of the internal energy dynamic). Anger/stress forces the Qi to rise, excessive sadness or excitation brings the Qi down, terror/fear confuses the flow of Qi, grief depletes the Qi, and anxiety causes the Qi to stagnate. 
Anger/stress harms the liver, excessive excitation or sadness harms the heart, anxiety harms the spleen, grief harms the lung, and fear/fright harms the kidney. In brief, loss of harmony-balance within Shen (subtle body) causes deleterious movement of the Qi (vital energy) greatly affecting ones Xing (physical) health.
On the other hand, if the physical body is weak due to under development, then the earthly base/root of spirit, being the physical body, cannot provide a strong foundation for the life pursuits of a wholesome spirit. It is often the case that problems occur because the physical body is too weak, or too easily exhausted via misuse or poor diligence. Many people in our society have this as their main problem.

Applying Principals Of Xing-Shen Medicine For Prevention Of Diseases

TCM suggests that the prevention of disease is more important than the treatment of disease. According to Xing/Shen medicine, the following principals are vital for the prevention of disease.

  1. Adjusting mental emotional activities to nourish the heart and promote tranquillity.
  2. Living life with a sense of regularity, setting a proper balance between work and rest.
  3. Participating in physical activities, taking part in appropriate physical cultivation according to age and temperament.
  4. Adopting self-massage techniques, breathing exercises and Qi building exercises for health care.
  5. Careful attention regarding diet.

Tian Ren He Di, Unity of Heaven, Life, People and Earth

Tian is heaven, Ren is centre, life (or in-between heaven and earth), Di is earth and He means unity. Here we will see why the ancients separated nature into three distinct categories. 

Tian divides heavenly influences into nine categories.
The six basic natures pervading heaven are: Feng – wind, Han – cold, Shi – damp, Zao – dry, Shu – summer heat, Huo – fire. All of these natural phenomena cause disturbance or changes to physical entities i.e. to Yi, earth and Ren, life. They combine together, i.e., wind cold, dry heat, etc., or give effect individually. Tian influences can manifest three basic conditions within Ren, a person: Re, heat, Xu, weakness/vacuity, and Shi, excess/replete. Tian influences assert changes to Ren, life, thereby demanding ongoing adaptation from Xing, form, and Shen, spirit, in order to maintain natural health.

Ren refers to life – all living entities between heaven and earth. 
In order to maximise potential for good health and long life, we need to understand how Xing, form, and Shen, spirit, combine to defend against the evil attack (pathological penetration) of Feng – wind, Han – cold, Shi – damp, Zao – dry, Shu – summer heat, or Huo – fire, or they will disturb a person. This study is fully contained within TCM theory.

Diis earth; earth is the ground/centre, for the interplay arena of Wu Xing, the five elements.

Wu Xing, five-element phase theory

The elements are: fire, water, earth, metal and wood. The Wu Xing, five-element phase theory, is structured to enunciate earth’s Yin/Yang changing. This is the cyclical movement/changing between the elements of earth; how they effect, give rise to, balance and support each other. They illuminate all aspects related to earth’s elemental Yin/Yang make up and changing. 

In TCM theory, each organ system of the body is associated with an elemental phase according to its fundamental character. That is, the heart is known as The King of Fire – the heart’s vigorous pumping action generates heat (relative to the other organ systems) and is therefore associated with fire (Yang); whole-body fluid regulation by the kidneys is more subdued and associates kidneys with water (Yin); liver – wood; lungs – metal; and spleen – earth. As external nature is obviously mirrored in the make up of the earth of a human body, application of the five-element phase theory defines how the body organ systems coordinate, balance, support and potentially attack each other.

The above Tian, heavenly influences, and Di, earth’s elemental physical building blocks, all cause changing upon the Xing, form, and the body’s condition can effect upon Shen, spirit. Ren, people, are also affected by life circumstances apart from those of heavenly or earthly influences. Conditions of Shen, spirit, can have an effect upon Xing, body (form). These influences may include depressive environmental surrounds, work conditions, emotional and family relationships, social and political environments, etc. Understanding how Xing, form, and Shen, spirit, combine and how the above can disturb a person will provide understanding. The study of TCM includes all of these concepts.

The next step onward from understanding the individual characteristics of the above three divisions, is how to understand the profound overall relationship dynamic between Tian, heaven, Ren, people or living entities between heaven and earth, and Di, earth’s elements, and how they combine/interrelate in totality. The Ba Gua correlation of symbols was created to enunciate this quest. 

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Photos; Julie performing the Wu Gong long form, prior to Professor Wong’s physical arts students receiving Tai Chi and Wu Gong grading certificates, froms the Taiwan Martial arts Association. The Taiwan government certifies these awards.

Tai Ji Quan, Wu Gong and Tang Sou.

Knowledge gained from the physical arts. These present the diligent student with insight regarding, Qi (vital energy), Spirit, and physical form and structure. How Qi connects the Spirit to the physical body via the meridian system, how spirit leads Qi and form etc.

Ru-Yi, TCM Medical Literate

Archaeological studies and literary pointers indicate origins of the study of natures lore i.e. nature Dao principles, may reach back as far as 16,000 years. We can, through this vast transmigration of time, today understand concepts such as Yin and Yang and realise why they are always relevant to people, no matter from which age.
For example, regarding the cycle of night and day, Yang time is from sun up to sun down. The sun causing light and heat to increase natural activity by warming the earth, is a typically Yang function. Night is considered Yin time due to the darkness and relative coolness and is naturally more appropriate for recovery, rest and sleep. Regarding people, in relationship to earths daily cycle of night through day, and the best way to govern our own finite personal resources, Yang time is naturally the best for activity and working, Yin time the best time to restore and rest. When rest and work balance each other, longevity will be enhanced and health will not suffer with this as a cause. A person of Ru Yi will understand a vast range of natural principles, like the one above, and how they affect the well being of people.

Shi Liao – diet

Creating logical adjustment of food intake in accordance with the prevailing seasonal influences and personal health condition. The first level of common knowledge in the old time was concerning the use of food as a means to maintain the balance of Yin and Yang. Apart from the maintenance of general health, adjustment of diet is employed in the early stage of any sickness. The first approach was to adjust lifestyle and diet and eat foods that would balance the condition and to cut out foods detrimental to the condition. This approach was more often than not enough to restore health. If this were not enough, only then would the stronger remedies of herbal medicine and acupuncture be employed. As the common people were mostly dependant upon prevention for health, this knowledge became highly refined and a fully integrated part of Chinese culture.

From these, and other foundation principles addressing natural human life and the way of nature and change, we transpose and apply them to medical theory and the treatment of people, always aware that each era creates its own unique problems. The study of elemental change, social, cultural and emotional environments within the framework of ancient and well understood knowledge, will lead the practitioner to a deeper understanding of the patient and to a more effective result.

I have now practiced and researched TCM for over sixty years. Because of what I have learned from my studies and experience, and supported by the classic writings, I have been practicing a holistic method combining the five main therapies into an integrated form of treatment, termed Wu Da Liao Fa. TCM should not be limited to only one or two disciplines. It is best to combine the disciplines, applying the appropriate method to exactly match the patient’s presentation. I have found the combination of methods to be the best way to quickly and effectively help the patient gain a dynamic result.

  • If the problem stems from the internal material substance of the body, organs etc. herbs become the main treatment for balancing a person. 
  • If the problem stems from a meridian, we use the meridian Qi to correct the balance. I.e. acupuncture.
  • If the problem stems from a tightening, or twisting of the muscles and tendons at a superficial level, we use massage and the specialised methods of Wu Yi to help. 
  • If a person’s diet is either too weak (Yin) or too strong (Yang), for example, due to excess of rich foods, wrong food at the wrong time, poor appetite, or if a person is recovering from sickness. We utilise dietary therapy - Shi Liao, as a tool. If the body is run down then a person should not only rely on herbs, an appropriate diet is required to build up or balance the body again.
  • If a person’s lifestyle or work practices always require overuse of one side of the body, the body will show one side is overdeveloped and the other side under developed in comparison. Or, if a person has poor postural habits in their lifestyle. We need to offer physical exercise therapy - Ti Liao in order for the appropriate exercise to balance the Qi and blood circulation of the body. This will release the pressure on those parts of the body accepting the daily stress from strained postural equilibrium.
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Photo; Wendy's turn

Wu De Hui, Martial Arts Moral Ethics Association

In martial arts training, the strongest arm can win and hurt so many people. I don't like this. Being gifted with a strong arm alone does not make a fine leader or necessarily a fine human being. A person needs to be balanced. When people learn the martial arts they must have De, moral training, to calm them. If they do not, then all they evolve in their character is a tendency for cruelty. Cruelty, misery and destructive rebound behaviours live in the same house; thus is a person destroyed. True masters and the precepts taught within the great martial traditions never allow the martial arts purpose to win/kill to control character. To retain a natural human purity/tranquillity of spirit, and to move toward a sublime inner state, then De, moralintelligence, must control character. When a person has De, self and natural human nature are balanced. The Wu De Hui is the style of martial arts I teach at my school. De, moral intelligence, is included not only in the title Wu De Hui, but is an integral part of the training. In any field, prowess without De, moral virtue, will only lead the practitioner into trouble and deny them the opportunity to develop their natural human nature, which is much more than the fruit that stems from prowess alone.

The basic level of training teaches us to correct bad habits that create postural flaws and internal pressure. Only then can physical activity in all circumstances be performed with maximum efficiency, without disruption of Qi or blood flow throughout the whole body, including organs, or even through a single joint. When this training reaches a higher standard, it is difficult to suffer ills from the effects of normal ageing.

This is part of the culture Professor Wong has offered to the modern generations. The seeds of this training begin with the practice of slow Tai Ji Quan. The slow, precise movement teaches co-ordination of breath with movement. This strengthens the breath and builds Qi (vital energy). Emphasis is upon correct positioning of body for the maximum advantage of natural meridian pathways. Each position will lead the Qi through a particular pathway and when you can feel the Qi, you can learn how to keep internal and external postural integrity in all life circumstances. This is Qi training.

Wu Gong physical art’s training is termed Li - internal energy and Jing - co-ordination training. This comprises the strong martial style exercises. Wu Gong strengthens all parts of the physical structure. Emphasis is to eventually be able to concentrate and organise energy to be focused upon a single point. The initial stages of this style of development, is to understand and strengthen every part of the body, to use and co-ordinate every part, all according to age.

Nature Dao

Nature Dao training is associated with study concerning the Lore of Nature and matters relating to development of a wholesome spirit, (not to be confused with any form of religious practice or worship). The course is open to any person who has completed 3 years of Tai Ji and for TCM students. This is a further step on from Tai Ji and Wu Gong physical arts. The Dao course is high-level training for development of mind, Spirit and physical co ordination. This includes how to quieten and concentrate the mind and develop all aspects related to spirit.  It includes the teaching of self-healing techniques and meditation.

The effect upon the body and mind when we train in the above ways is to build up all the individual parts that together make up the whole person. The combined totality of this development is called Dan. Nei Dan is the co ordination of the whole person into a balanced unified whole. Medical practitioners are the instructors of these courses; all emphasis is upon the development and strengthening of holistic health.

Over the years Professor Wong has trained many teachers in these exacting and exciting arts. There is no competitive aspect, young and old perform the training according to age and physical make up. Many patients are directed towards the physical arts for the required need of making them stronger and as a practical aid for prevention. The co ordination of the physical and healing arts is all a part of the original Chinese Medical tradition.

Our aim is not only to treat the prevailing sickness and not worry about the future. Our purpose must be two fold, to treat sickness and to prevent the next oncoming sickness. This is why, over time, everybody must deepen his or her knowledge. People should try to seek a stream of unfolding natural self-cultivation and become skilled enough to recognise and thereby prevent the subtle progressions of disharmony. These people will be able to actively engage in the practice of prevention and finally be able to attain a healthy happy life of at least one hundred years.

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Photo; Professor Shu holding a fine example of the Dang Gui root. A visit to the most famous growing region for this herb, located south of Lanzhou. Academy tour 1997.

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Photo.   Lanzhou college of T.C.M. Ebony acupuncture man, said to be 1,000 years old on display in the college museum.

Rationale and Associated Case Study Presentation

The following presentation is the continuation of a paper James Middleton presented in China several years ago.  Since that time the patient referred to in the case study has continued to improve in health, his case is fascinating to follow and record.  The paper in its entirety is a preparation for a future conference, it is not intended in any way as a testimonial, advertisement or any of the like.  Rather, the case study seeks to support the rationale presented in the first pages, being the main thrust of this presentation.  The presentation is directed towards an audience (Australia and overseas) consisting of the broad range of Chinese Medical professionals.  As the diversity of TCM treatment methods vary considerably, the purpose is to illustrate the benefits of the skilful combination of the five arts of Traditional Chinese Medicine, termed Wu Da Liao Fa and the specialised methods of Wu Yi, the later emanating from knowledge gained by the ancient martial arts traditions. 

This said, the paper layout defines a classical approach, and therefore becomes informative for anyone wondering, what is Traditional Chinese Medicine?  And is why it is on this web site.  Due to the complexity of this case, any interested reader will be able to grasp the depth of understanding/view, integral within the logical layout of; TCM Symptoms Explanation, Diagnosis and Treatment Principle, Treatment Formula, and how each mechanism of disharmony is clearly explained and dealt with.  They will also gather how the western medical explanation is fully integrated to compliment the overview and as an aid for further understanding.

Also revealed is the way treatment is in no way standardised. Calling upon a vast range of tools and tactics, treatment is adjusted according to presentation.  This is in keeping with the TCM principle of deciding the imperative - whether to treat prevailing symptoms or the underlying causes.  Of course, ultimately both must be dealt with.

The paper is a compilation of strategies employed over many years and is condensed, it is not intended as a precise treatment record.  Eg. It is extremely rare to do as much in a single treatment as might appear upon reading.

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Photo. James Middleton, paper presentation, Lanzhou College of T.C.M.
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The Wu Da Liao Fa and the Treatment of Cystic Fibrosis

By James Middleton
Practitioner, Academy of Traditional Chinese Medicine Australia
Email; info@jamesmiddleton.net

  1. Details
    Mr P.G. 27 years of age, when health allows is a professional chartered accountant, first consultation arranged 27/1/98
  2. History
    Cystic Fibrosis diagnosed shortly after birth. At fourteen years of age diagnosed with diabetes –(Xiao Tiao) and Asthma. Periodically since that time Bronchiectasis, Pneumonia several times, Deep vein Thrombosis, Bowel obstruction. He has required hospitalisation two to four times a year for as long as he can remember.

    Medication; Ventolin, Atrovent, Hypertonic Saline, Flixotide, Efexor, Digestive enzymes, Ciprofloxacin.
  3. Zheng Hou - Clinical presentation

    At this first consultation his complaint was chronic symptoms, a lot of green and yellow phlegm in the chest and a constant cough, feels tight and cold in the chest and is short of breath, bowels irregular fluctuating between one-week diarrhoea and one week constipation. Depression and is on prescribed anti depressants. He fears another attack of pneumonia. He expressed a fear for the future and that his prognosis was poor.

    The pulse was generally wiry (Xian) and slippery (Hua). Proximal pulse on the right side Fei position was weak (Xu). The pulses of the left wrist were also deep (Chen)

    The tongue demonstrates a normal shape, thin pale, pale on the heart and lung region, white coat and wet from the region of stomach and spleen all the way to the root. Blue veins show at the base underneath the tongue.

    The eyes show blue sclera, sharp and fine red capillaries rise upward from the lower rim within the sclera and from the outside corners.

    Appetite; good.

    Sleep, difficult to fall asleep and difficult to rise in mornings.

    Bowels, good.

    Back, ache and pain lower back and lower abdomen

    Upon exertion.Upon examination of postural integrity it was noted that;

    1. Pronounced lordosis of the spine.
    2. Compression of Thoracic vertebrae T3 - T6.
    3. Shoulders tilt forward with the right side further forward.
    4. The Thoracic spine reveals a lateral curve to the right side, main curvature occurring between T3. – T.9. Lumbar spine compensates leaning to the left side, between L.2 – L.4.
  4. Zheng Xi - Syndrome Analysis, Symptoms Explanation

    The original condition of Cystic Fibrosis is thought to be an inherited disorder of the exocrine glands, causing these glands to produce abnormally thick secretions of mucus and an increase of organic and enzymatic constituents of saliva, with accompanying overactivity of the auto immune system. Thickened secretions cause obstruction of airways, which lead to distal infections, which become chronic unless the obstruction is relieved. The glands most affected are those in the pancreas, respiratory system and the sweat glands. The earliest manifestation is meconium ileus, an obstruction of the small bowel. Thrust of western treatment is to manage the condition. There is no known cure and treatment is directed at prevention of respiratory infection, which is most frequently the cause of death.

    In T.C.M. terms we see involvement from contributing factors. It is plausible the further diagnosis of Diabetes, Bronchiectasis, deep vein thrombosis and bowel obstruction stem from the continuing effects of his bodies battle with Cystic Fibrosis. It may be assumed the original pathology is caused by phlegm turbidity and water rheum (Tan Zhou Shui Yin), reacting to each other within the fluid mechanisms associated with the lungs and the Spleen. In this situation when the fluids (Jin Ye) are not functioning properly creates pernicious accumulation of phlegm and water (Tan Yin Xie Qi).

    We understand the body to be holistic in nature with each organ system being related and interdependent. Therefore the chronic presence of pathogenic Tan Yin Xie Qi since birth has caused affect to her natural growth apart from the obvious assault upon the systems directly related to the spleen and lungs and is probably responsible for breakdown in the other three organ systems namely;

    • Kidney Spleen depletion - Diabetes,
    • Lung Heart - fear, difficult sleep, poor peripheral circulation i.e. deep vein leg thrombosis,
    • Liver - emotional fluctuations (depression).

    Thus we find effects within all of the five Yin organs (Wu Zang). The presenting clinical pathology will manifest numerous symptoms whenever his normal Qi (Zheng Qi - overall vitality) is depleted/overwhelmed by any prevailing pernicious influence (Xie Qi) in time, seasons, or place. I.E. social, seasonal or professional stresses, diet - which explains the broad range of symptoms he may present with and now exhibits. This explains the generally Xian pulse.

    The patients Hua pulse; sticky wet white tongue coat, copious amounts of expectorated phlegm, constant cough and no energy indicates the centre warmer (Liver Spleen and Stomach) initially presents as centre warmer replete (Zhong Jiao Shi) and changes to Centre Qi insufficiency (Zhong Qi Bu Zu) thus the transportation and transformation (Yun Hua) function of the spleen Qi does not operate normally. This explains why his body easily develops collected water (Ting Shui) progressing to generating damp (Shi), damp gathering thickens becoming phlegm damp (Tan Shi), causing phlegm congestion and Qi stagnation, this is the source of the impaired depurative down bearing of the lung, hence explaining the cough (Ke Sou).

    The spleen transformation and transportation (Yun Hua) function is inhibited by phlegm damp (Tan Shi). This means the upward movement of spleen Qi to lung is also inhibited, the character of the rising Qi is pervaded by a pernicious phlegm (Tan Yin) resulting in cough (Ke Sou), Bronchial constriction and blocking the function of lung Qi dissemination. And as the situation is prolonged and chronic, leads to weakening lung function (Fei Xu), as indicated by the blue sclera of the eyes and the Xu pulse on the lung position. Lung deficiency (Fei Xu) will affect the ability of the kidney to grasp the lung Qi (Na Qi function), eventually also weakening the Kidneys. This explains the Asthma type breathing (Xiao) and fatigue symptoms. These symptoms occur in people harbouring a lot of internal phlegm (Nei Tan) in the body and in the lungs or Bronchi, altogether explaining why he is short of breath, has a feeling of oppression of the chest and needs to cough up a lot of phlegm in order to relieve these symptoms.

    The struggle between the bodies overall vitality, normal Qi (Zheng Qi) and chronic phlegm rheum (Fu Tan Yin) sluggish in the lungs causes heat to build up in the lungs and further thickens the phlegm thus explaining the ever-present thick yellow phlegm (chronic infection of the lungs) which can move to become clumped and further baked (Huo Tan), thus explaining the green phlegm. During times when his overall vitality is low (Zheng Qi Xu), and accompanied by an attack from an external or internal pathogens (Wai or Nei Xie Qi i.e. Wai Gan Feng Han or Re), seasonal factors, or when he does not eat properly or suffers emotional stresses or overworks, all exacerbates the chronic condition leading to Pneumonia, Bronchiectasis, bowel obstruction etc. and at these times causes him grievous concern for his own life. It is noted his yearly hospital visits fall either at the time of winter changing to spring or autumn changing to winter.

    Note, to protect him in Sept. Oct. do not allow heat to build up in the centre Warmer (Zhong Jiao) i.e. reduce (Xie), the stomach and Bladder meridians.

    To protect him in May and June, avoid dryness/heat gathering within the upper warmer (Shang Jiao) reduce (Xie), Per. and large intestine meridians.

    The transformation and transportation (Pi Yun Hua) function does not only describe the upward movement of Qi to the lungs, but also the corresponding down bearing of the stomach Qi. The downward movement of turbid Qi, including substances, (Zhou Qi) through the stomach and intestines will also be poor, thus contributing to the build up of disharmony within both. The continuing struggle with the bodies normal Qi (Zheng Qi) causes fluctuation between diarrhoea and constipation, he also says bowel regulation is worse whenever he is on the stronger medications.

    The three-left side Chen - deep, pulses indicate that the Yang Qi is hindered from spreading outward. The integrity of skeletal structure is likely to be the cause.
  5. Zhi Ze - Treatment Principle

    Down bear counter flow and transform the damp (Jiang Yi Hua Shi)

    Diffuse the lung, stop the cough and calm the dyspnea (Xuan Fei Zhi Ke Ping Chuan, dyspnea).

    Fortify the spleen, transform the phlegm and calm the dyspnea (Jian Pi Hua Tan Ping Chuan, dyspnea).

    Clear heat, diffuse the lung and stop the cough (Qing Re Xuan Fei Zhi Ke).
  6. Zhi Liao - Treatment

    The initial approach was to release/relieve any prevailing pressure of structural arrangement. This is to cause effect upon structure, i.e. all joints and the musculoskeletal system utilising the specialist methods of Wu Yi, in order to gauge its impact upon the signs and symptoms. To this end;

    1. The lateral leaning of the upper and lower spine was adjusted in the standing position by placing the patients right arm across her chest grasping the opposite shoulder, and the left arm grasping the right shoulder and providing firm traction. Subsequent to this manoeuvre she was standing straight as demonstrated by comparing the parallel line at the posterior border of the shoulder blades.
    2. The obvious Thoracic 3. and T.6.disharmony was addressed in the standing position.. Patient was asked to interlock his fingers behind his head and place her feet wide apart. Firm traction was applied causing extension to the compressed vertebrae and associated structures.
    3. In the supine position, patient was placed on his side and traction was applied causing a stretch to extend from the right shoulder to the right hip, to release the obvious compression of the Lumber Vertebrae and associated structures.
    4. Both legs and arms were rotated throughout their natural arcs and all joints checked for integrity.

    Note. At no juncture was pressure applied upon any single point or his body placed in an unnatural position

    The above three methods of traction attempts too relieve over all postural pressure and ease misalignment of natural arrangement, including lessor joints and associated structures i.e. musculature and tendons. The main feature at this point was the immediate relief of the cold, tight sensation pervading his chest.

    The Chen level pulse on the left wrist disappeared and pulses on both sides strengthened. We can assume the correction of arrangement released the inhibition of Yang Qi spread throughout the major meridians, particularly; Zu Tai Yang (Bladder) and Du Mai (Governing Vessel), Zu Tai Yang Jing Jin, and Shao Yang Ming (Lg. Intestine) etc.

    Treatment continued with;

    1. Massage of the whole back and neck to loosen the muscles and tendons, and invigorate the superficial circulation.
    2. Spooning (Gua Sha) Jia Ji to clear blood stasis (Xue Yu of the Zu Tai Yang Jing Jin).
    3. Two line spooning (Guasha) from Feishu - Bl. 13, to Pishu - Bl. 21, to clear blood stasis (Xue Yu from Zu Tai Yang) meridian.
    4. Cupping. Small cup slide up and down the spine, especially T.3. -T.6. Clear blood stasis – Xue Yu of the Du Mai meridian.
    5. Huo Guan - Cupping; Dazhui - Du.14, to drain wind and heat (Xie Feng Re). Feishu - Bl. 13. Pishu - Bl. 21. Shenshu - Bl. 24.
    6. Gua Sha – spooning; Very light as region is very tender, at Zhong Fu – Lu. 1, and Yun Men – Lu. 2. Free and disinhibit the lung Qi and to rectify the joints (Tong Li Fei Qi and Li Guan Jie).
    7. Ba Sha – pinching; At Shanzhong - Ren. 18, to loosen the chest and disinhibit the Qi (Kuan Xiong Li Qi)
    8. Huo Guan - Cupping; Daheng - Sp. 15. Tianshu - St. 25. Zhongwan - C.V. 13. Zhangmen - Liv. 13, to course the liver and rectify the Qi and disinhibit stagnant accumulation (Shu Gan Li Qi and Hua Ji Zhi).
  7. Acupuncture - Zhen; Qu Fang - Formula

    1. Bleed one drop from Dazhui - Du.16. to drain wind and heat (Xie Feng Re).
    2. Bleed first fingertips and the thumbs to reduce the heat toxin (infection) within lung and Lg. Intestine (Xie Re Du, Fei and Da Chang).
    3. Reduce (Xie) tactic both sides, Tiaokou - St. 38. Bu tactic Chize - Lu. 5. Lieque - Lu. 7.
    4. Needle in and out at Tiantu - Ren. 22.

    After this procedure both left and right pulses were balanced. The Xian and Hua pulse character was much less apparent. The lung (Fei) pulse was still the weakest pulse.

    The main feature at this point was the immediate release of pressure from his chest and complete relief from breathlessness, he reported being able to take a deep and full breath without coughing.

    Perhaps even more important was an immediate easing of the acute symptoms of breathlessness, tight chest and coughing, which would normally lead him to hospitalisation and stronger medication. We can assume the immediate dynamic effect of the treatment is caused by the improved communication between the upper, middle and lower warmers (San Jiao). I.e. to clear Blood stasis and Qi stagnation (Xue Yu Qi Zhi), blocking at the diaphragm, plus the diffusion of the lung Qi (Xuan Fei) to down bear counter flow and transform the phlegm (Jiang Yi Hua Shi).
  8. Herbal Formula

    1. Ren Shen Ge Jie San:
      To boost the Qi and clear the lung (Yi Qi Qing Fei)
      Alleviate cough and stabilise panting (Zhi Ke Ding Chuan)
    2. Qing Qi Hua Tan Wan:
      Clear heat and Transform phlegm (Qing Re Hua Tan)
      Disinhibit the Qi and suppress cough (Li Qi Zhi Ke)

Conclusion

Since his first visit in Jan 1998 P.G. has only needed three days of hospitalisation on one occasion, this was due to an allergic reaction and not due to Cystic Fibrosis. Our strategy has been such that he comes in for treatment at the first sign of any problem. Our goal being to recover his symptoms before needing hospitalisation or stronger medications (which deplete him even though they help him), at these times he perhaps needs two or three sessions in one or two weeks. Treatment is always directed at the prevailing presentation. During times when he is feeling well and happy there is little urgency regarding regular treatments or herbal medications.

There is however an encouraged urgency regarding daily practice of a whole body basic exercise regime, (as prescribed by any academy of T.C.M. medical practitioner) including four different kinds of breathing exercises, also advice regarding lifestyle and dietary guidelines. Altogether, this approach increases his understanding about every part of the body, how to use and strengthen every part and how to coordinate every part, all aimed at fulfilling the principle of making the physical body and spirit stronger. His progress in health has been steady and sure. Lung function tests show an increase in volume and all signs are positive. His medication regime has dramatically reduced and he and his partner are looking forward to a bright future.

Over the years we have employed many variations of method and technique. Below is one grouping of the variations of Acupuncture points commonly employed.

Qu Fang - Main Formula

Use lung - Fei, Renmai, Bladder - Pangguang and Wei – stomach meridians.

Chize - Lu. 5. Lieque - Lu. 7. Tiantu - Ren. 22. Shanzhong – Ren. 17. Qihai - Ren 6. Feishu - Bl. 14. Shenshu - Bl. 23. Tiaokou - St. 38

The above is a commonly employed main formula, to be specific to the condition we will need to adjust according to Jia Jian – adjustments.

Fang Yi - Formula Explanation.

  • Lung meridian; Chizi - Lu. 5. Lieque - Lu. 7. Shu Feng Jie Biao and Xuan Fei Zhi Ke - course the wind and resolve the exterior and diffuse the lung and stop cough.
  • Ren Mai meridian; Tiantu - Ren. 22. Shanzhong - Ren. 17. Qihai - Ren 6. Hua Tan Ping Chuan - transform phlegm calm the panting.
  • Chize - Lu. 5. Feishu - Bl. 13. Xuan Fei Hua Tan and Ping Chuan - diffuse the lung, transform phlegm and calm panting.
  • Qihai - Ren 6. Shenshu - Bl. 24. Xuan Fei Na Qi Ping Chuan - diffuse the lung, aid Qi absorbs ion and calm the panting. The reason we need to aid Qi absorbs ion - Na Qi, is because of either a lung or kidney problem. The kidney acts to draw the lung Qi down to be grasped by the kidney Qi, to assist this function we employ Shenshu - Bl. 24.
  • Fenglong - St. 40. Lead Qi downwards, transform phlegm and dampness - Jiang Qi Hua Tan and Shi, clear phlegm from the lung and alleviate cough and wheezing - Hua Tan Xuan Fei Zhi Ke.

The whole formula acts to Jian Pi Xuan Fei Hua Tan Zhi Ke and Ping Chuan - diffuse the lung, transform the phlegm, stop cough and calm panting.

Jia Jian - adjustments, add to the main formula.

If cause is wind cold - Feng Han.

Add, Hegu L.I.-4. Fengmen - Bl. 12.

To Xing Wen Jie Biao, - pungent and warm exterior resolving. These two points have a similar effect as with the herbal function. After adding the above points, the function of the whole formula is Xuan Fei Zhi Ke Ping Chuan – diffuse the lung, stop the cough and calm the panting.

If cause is wind heat - Feng Re.

Add, Dazhui - Du.14. Quchi - L.I. 11.

To Qing Re Xuan Fei Zhi Ke - clear heat diffuse the lung stop cough.

If cause is phlegm - Tan.

Add, Feishu - Bl. 13. Fenglong - St. 40.

To Jian Pi Hua Tan Ping Chuan - fortify the spleen, transform the phlegm and calm the panting.

If cause is liver fire - Gan Huo.

Add, Ganshu - Bl. 18. Taichong - Liv. 3.

Apply a reduce - Xie, tactic to reduce the fire, to Zhi Ke Ping Chuan - stop the cough and calm the panting.

Fenglong - St. 40. Is on the stomach Yang Ming Jing, this point will help clear the centre warmer Qi.

Also ease shortness of breath - Chuan Ni, copious phlegm and oppression in the chest.

 

Acknowledgments; Professor Wong Lun for the education he has disseminated.

The first pages describing the rationale for Wu Da Liao Fa were from a presentation in China in 1997 titled; The Wu Da Liao Fa - an illustrative exposition, written and presented by Rafael Vavala. He is a senior clinical Practitioner, senior martial arts instructor and a scribe for the Academy of T.C.M. Australia.

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