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The Importance of Branch Treatment in TCM
by Todd Luger, L.Ac.
As we all know, in crafting an herbal treatment strategy, one must consider
the relative emphasis of root versus branch. In order to do this, we must
be clear about the terms. Wiseman in the Practical Dictionary uses root and tip for biao ben. His definition, which essentially comes from the zhong yi da ci dian (grand dictionary of chinese medicine), is contextual.
1. the cause of the disease is the root; the observable changes are the tip: this could mean the root is any pattern (excess or deficient or hot or cold) and the tip is the patients complaints (symptoms)
2. the imbalance of the zheng (correct/right) qi is the root, while evil is
the tip: this could mean any pattern of deficiency that led to an excess
such as spleen xu damp
3. the primary condition is the root and the secondary condition caused by
the primary is the tip: this could mean any pattern that comes first (whether excess, deficient, hot or cold) could be considered the root and the
secondary pattern caused by the primary pattern (whether excess, deficient,
hot or cold) the tip: this could mean dampheat is the root and yin xu the
branch or spleen xu is the root and dampheat and/or yin xu the branch
As students will tell you, these contextual differences lead to
difficulty in writing exam questions. So as an aside to teachers, one
should very clearly state to students in what context one is using root and
tip each time one uses these terms.
The context in which I am using these terms here is number 1, in which the
branch I refer to is the patient's perceived source of suffering, such as
cough or bleeding (as opposed to the doctor's labeling of a pattern or
pathomechanism explaining those symptoms).
I believe such branch treatment is actually underaddressed in the american
practice of herbology. while it is perhaps overaddressed in the practice
of acupuncture, especially pain management. In fact, many people may
believe that herbs are most effective for root treatment like spleen or
kidney xu or liver qi depression. While acupuncture yields the most
benefit in acute symptom relief. I believe this is largely because people
have utilized relatively low dose patent medicines for much of their herbal
treatments. In fact, chinese herbal medicine was most well known for much
of the past for its effectiveness in acute complaints, a theme that
underlies Liu's warm diseases book. However, as even patent advocates like Will Maclean have noted, dosage is the key to the effective use of patents
in acute illness or severe symptoms. Will, I believe, would in fact agree
that decoction is the best way to deliver the high dosages necessary in
very severe symptoms. However as both of us agreed, there are equivalent
ways to deliver high enough doses (for example, powdered extracts like KPC
or extract capsules like BP). So the questions are how important is branch
treatment and how to accomplish it effectively.
1. Can daily reinforcement of sx relief be accomplished with acupuncute once weekly?
2. Does compliance with therapy over the long haul for most patients demands
rapid symptom relief at the outset. treating the branch insures patients
will stick around to have the root rectified as well
3. Is relief of suffering my main job?
I think so. it is not primarily to teach or philosophize
or psychoanalyze my patients. Certainly in the long run, some or all of
that may be necessary from me or others, but at the outset, suffering alone
is my focus. I do not believe CHM will ever make much headway in the
mainstream if we ignore this essential motivation of patients - to feel
relief now. Once you demonstrate the power of CM, patients will stick
around to learn how to live, etc. Most of our patients are not that
openminded to begin with or perhaps my role in a conservative city in a
college clinic gives me a slice of life that I did not see when I was in
elite private practice.
4. But even more critical from our professional perspective is the drain
on the root by the branch. It is very hard for the root to recover when
certain branch sx are prominent:
a. How does one recover one's qi and blood without stopping bleeding first?
b. How does one recover one's lung qi without stopping cough first?
c. How does one recover their yin and blood while diarrhea persists?
d. How does one clear dampheat while constipation binds?
e. How does the patient gain the motivation to heal while they suffer
intensely?
While I find acupuncture to bring palliative relief in all these cases
under some circumstances, I find the effects short lived in chronic
conditions. While I will not reject that acupuncture alone could possibly
"heal" some of these chronic conditions over time, I am merely talking here
about whether a weekly acupuncture treatment would typically give enough
round the clock symptoms relief for acute or severe symptoms in a way that
would satisfy my 4 criteria above. I will not speak for those who may have
skills in this area superior to myself, but I would have to give an
unequivocal no to this question. I do not believe weekly acupuncture would
be sufficient in many acute cases to either give the degree or duration of
relief I feel necessary to both relieve the patient's suffering, but also
protect their roots. thus using herbs to address the branch right from the
outset is essential. In some cases, the branch treatment should be the
sole heavily emphasized treatment. In others, it should be part of a
carefully crafted complex of strategies.
I personally use raw herbs for such complaints and I believe my relatively
high rate of compliance with my patients on raw herbs is due largely to my
insuring the branch is always adequately addressed at the outset. However
I have used very high doses of seven forests products in the past with
decent results in severe symptoms.