The statement of a treatment principle (zhi ze) is a standard step in the practice of professional Chinese medicine in China. These principles are written down right after the patient’s presenting patterns and before the treatment plan. As such, they are a part of the patient’s written file for every visit (or at least every time the patient’s pattern discrimination and, therefore, treatment changes). It is said that the treatment principles are the bridge between the pattern discrimination and the treatment. Unfortunately, in the West, we do not always have a good understanding of the hows and whys of using these treatment principles. On the one hand, this may be due to linguistic issues. On the other, it may be due to a lack of understanding the clinical utility of this extra step between the diagnosis and the treatment. However, if we understand how to state treatment principles correctly and then how to use them as the directions for erecting our treatment plan, they become an extremely useful tool for insuring that our treatment truly represents or manifests our pattern discrimination. The pattern discrimination tells us what is out of balance in our patient. The treatment principles tell us what we need to do in order to restore balance. Once we understand what, in theory, we need to do with the patient, then it should be relatively easy to create a concrete method of achieving those ends using whatever modality is most appropriate. In terms of acupuncture-moxibustion, once we have stated the treatment principles, we know that we should use 1-2 points to accomplish each stated principle. We may also know whether needling, moxa, bleeding, tuina, or some other modality is the best approach. Then, when looking back over our treatment plan or formula, we can check whether each point or method is or is not warranted by the stated treatment principles. Basically, stating treatment principles is a method for turning the abstract pattern discrimination into a concrete treatment plan. It allows for more precision in point/method choice and administration technique as well as for peer review by our teachers, mentors, and co-professionals.

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In Chinese medicine in China, patterns and their related treatment principles are professionally agreed upon can only be stated in only a few standard ways. As such, there are right and wrong treatment principles for each pattern and there are standard ways of stating each of these principles. Further, the method of stating these principles is based on the idiosyncracies of the Chinese language. This means that the ways Chinese state these principles in Chinese is a function of the structure and rhythms of the Chinese language. For instance, treatment principles are most commonly stated in four word phrases where each phrases has two parts, each part made up of two Chinese words. Thus, jian pi bu qi (fortify [the] spleen [and] supplement [the] qi) is the most commonly used treatment principle for remedying the pattern of spleen qi vacuity weakness (pi qi xu ruo). In this case, the words in brackets [ ] have been added to the English translation to make the principles grammatically correct In English. However, literally, the phrase reads, “fortify spleen supplement qi.”

Then, if there is more than a single pattern present, the next pattern stated is given its own treatment principles in the same way. Thus we move from the predominant or most important pattern to the least dominant or important pattern. For instance, if we say that a patient’s presenting patterns are a combination of spleen qi vacuity weakness complicated by damp accumulation along with blood vacuity and blood stasis, then there is the assumption that spleen qi vacuity weakness is the most important pattern or the root of the condition, damp accumulation is second in clinical importance, blood vacuity is third in importance, and blood stasis is fourth in importance. This ranking in descending order of importance is then faithfully reflected in the statement of the treatment principles which then become: (1) fortify the spleen and supplement (or boost) the qi,

(2) eliminate dampness,

(3) nourish the blood, and

(4) quicken the blood.

This ranking gives the practitioner a very clear understanding of how much weight they should give to each part of the treatment when it comes to selecting points or methods of treatment. In general, we will tend to select more points (or herbal medicinals) for the most important treatment principles and fewer points for the least important treatment principles.

In some cases, we may need to add an extra treatment principle to the end of the list, which is related to an acute or serious symptom. Commonly, these treatment principles call for the immediate stoppage of an outflow of pure substance which, allowed to continue, would lead to a relatively speedy decline in qi, blood, yin, and/or yang. Such outflows include massive sweating, diarrhea, vomiting, bleeding, persistent vaginal discharge, polyuria, and spermatorrhea. Stopping pain (zhi tong) also warrants its own acute terminal treatment principle. When such an acute terminal treatment principle is added at the end of a list of treatment principles, then we must be sure that one or more points in the treatment plan or formula do, in fact, directly and reliably address that symptom or condition.

This whole process, tied as it is so closely to the Chinese language, is often not well understood by Western students and practitioners of Chinese medicine. However, it is my experience that the more we try to understand this professional terminology and apply this step-by-step methodology of moving from pattern discrimination to treatment principles to treatment plan, the easier it becomes to compose acupuncture-moxibustion or herbal medicinal formulas and the more clinically accurate and effective those formulas are. Therefore, I highly recommend always stating the requisite treatment principles after stating the patient’s pattern discrimination and before erecting a treatment plan. I always try to state the treatment principles in the same order as the patterns, and also try to use professionally accurate standard terms for the treatment principles.

In order to help all of us learn this process, below is a partial list of common Chinese medical patterns with standard treatment principles. In the book Sticking to the Point, we give a much longer list, followed by two chapters that give commonly used acupoints for most of these treatment principles. I hope readers find this to be helpful. Just a note: all terminology used here is based on A Practical Dictionary of Chinese Medicine by Nigel Wiseman and Feng Ye. Thanks for reading!

Treatment principles correlated to patterns

Qi vacuity: Supplement the qi

Blood vacuity: Either supplement or nourish the blood

Yin vacuity: Either supplement, nourish, or enrich yin

Yang vacuity: Either supplement, warm, or invigorate yang

Blood vacuity: Nourish or supplement and regulate the blood

Blood stasis: Quicken the blood and transform or dispel stasis

Blood stasis in the network vessels: Quicken the blood and free the flow or open the network vessels

Blood heat: Clear heat, cool the blood, and stop bleeding

Phlegm dampness: Transform phlegm and dry dampness, rectify the qi and harmonize the center

Phlegm nodulation or binding: Transform phlegm, scatter nodulation or binding, and/or soften the hard

Damp heat: Clear heat and eliminate dampness

Heat toxins: Clear heat and resolve toxins

Cold striking the channels and network vessels: Warm the channels and scatter cold

Wind damp impediment: Dispel wind and eliminate dampness, free the flow of impediment and stop pain

Damp heat impediment: Clear heat and eliminate dampness, free the flow of impediment and stop pain

Cough: Stop coughing

Diarrhea: Stop diarrhea

Bleeding: Stop bleeding

Vomiting: Stop vomiting

Sweating: Stop sweating

Pain: Stop or stabilize pain

Irregular menstruation: Regulate the menses

Restless fetal stirring: Quiet the fetus

Constipation: Free the flow of the stools

Disquieted spirit: Quiet, calm, still, and/or settle the spirit

Insomnia: Quiet the sleep

Syncope: Arouse the spirit

Dampness: Eliminate, transform, dry, seep, or disinhibit dampness

Dryness: Moisten dryness and/or engender fluids

Exterior contraction: Resolve the exterior

Interior repletion: Drain the interior

Interior cold: Warm the interior

Externally contracted wind: Course or dispel wind

Internally engendered wind: Extinguish or track down wind

Liver depression qi stagnation: Course the liver and rectify the qi

Liver-spleen disharmony: Harmonize the liver and spleen

Liver-stomach disharmony: Harmonize the liver and stomach

Liver depression-depressive or transformative heat: Course the liver and rectify the qi, resolve depression and clear heat

Liver-stomach depressive heat: Clear the liver and stomach, resolve depression and downbear counterflow or harmonize the stomach

Liver depression and blood vacuity: Harmonize the liver

Ascendant liver yang hyperactivity: Clear the liver and subdue yang or subdue yang and downbear counterflow

Upward flaming of liver fire: Clear the liver and drain fire

Internal stirring of liver wind: Settle the liver and extinguish wind

Liver blood insufficiency or vacuity: Relax or emolliate the liver and nourish the blood

Liver blood-kidney yin vacuity: Nourish the liver and enrich the kidneys

Yin vacuity-yang hyperactivity: Enrich yin and subdue yang

Liver-gallbladder damp heat: Clear heat and eliminate dampness from the liver and gallbladder

Cold stagnating in the liver vessels: Warm the liver and scatter cold, rectify the qi and stop pain

Heart qi vacuity: Supplement the heart qi

Heart blood vacuity: Supplement heart blood

Heart-spleen dual vacuity: Fortify the spleen and nourish the heart, supplement the qi and blood

Heart-gallbladder qi vacuity: Fortify the spleen and nourish the heart, transform phlegm and rectify the qi

Heart fire effulgence: Clear the heart and drain fire

Phlegm confounding the heart orifices: Transform phlegm and open the orifices

Spleen qi vacuity: Fortify the spleen and supplement or boost the qi

Spleen qi downward fall: Fortify the spleen, boost the qi, and lift the fallen

Spleen vacuity with stomach heat: Fortify the spleen and clear the stomach and/or harmonize the center

Spleen-kidney yang vacuity: Fortify the spleen and boost the qi, supplement the kidneys and invigorate yang

Spleen vacuity with damp encumbrance: Fortify the spleen and eliminate dampness

Damp heat smoldering in the spleen: Clear heat and disinhibit dampness

Food stagnation in the stomach duct: Disperse accumulation and/or abduct stagnation

Stomach qi counterflowing upward: Harmonize the stomach and/or downbear counterflow

Wind cold raiding the lungs: Course wind and scatter cold, diffuse the lungs and stop coughing

Wind heat attacking the lungs: Course wind and clear heat, diffuse the lungs and transform phlegm

Wind dryness damaging the lungs: Course wind and clear the lungs, moisten dryness and stop coughing

Phlegm heat depressing the lungs: Transform phlegm and clear heat, loosen the chest and resolve depression

Lung heat smoldering and exuberance: Clear the lungs and drain fire

Phlegm turbidity obstructing the lungs: Transform phlegm and dry dampness, fortify the spleen and stop coughing

Lung qi vacuity: Supplement the lungs and boost the qi

Lung-spleen dual vacuity: Fortify the spleen and boost the qi, supplement earth to engender metal

Lung dryness with simultaneous phlegm: Moisten the lungs and clear heat, rectify the qi and transform phlegm

Lung yin vacuity: Enrich yin and moisten the lungs

Lung qi and yin dual vacuity: Clear heat and moisten dryness, supplement the qi and nourish yin

Large intestine damp heat: Clear heat, transform dampness, and free the flow of the stools

Large intestine fluid dryness: Nourish the blood, moisten dryness, and free the flow of the stools

Kidney qi vacuity: Supplement the kidneys and boost the qi

Kidneys not securing the essence: Supplement the kidneys and secure the essence

Kidney yang vacuity: Supplement the kidneys and warm or invigorate yang

Kidney yin vacuity: Supplement the kidneys and enrich or nourish yin

Kidney essence insufficiency: Supplement the kidneys and fill, foster, or boost the essence

Urinary bladder damp heat: Clear heat, disinhibit dampness, and free the flow of strangury

This article was excerpted and condensed from Sticking to the Point: An Approach to TCM Acupuncture Therapy by Bob Flaws and Honora Lee Wolfe, Blue Poppy Press, 2008.