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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.



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