The Nearest Available Exit

Dear Patient,

In my recent podcast interview with Robert Hayden, DACM, LAc, we talked a bit about treatment methods in Traditional Chinese Medicine (TCM). We have eight of them, which we call the Ba Fa or Eight Methods. They are:

Sweating

Vomiting

Purging

Harmonizing

Warming

Clearing

Reducing

Tonifying

I’ve written about Harmonizing before—it’s a fine-tuning method of bringing disparate levels into balance. Tonifying means supplementing something that’s deficient—this could be qi, blood, yin or yang. Reducing is used to soften or dissolve masses or nodules. Warming is pretty much what it sounds like.

The remaining four methods—sweating, vomiting, purging and clearing—are aimed at what Robert calls “guiding a pathogen toward the nearest available exit.”

For thousands of years, Chinese medicine practitioners have recognized pathogenic invasion as a cause of disease. One of the oldest medical textbooks in the world, the Shang Han Lun or Treatise on Cold Damage, describes the progression of infectious disease—from the surface of the body on the skin, down to the deepest blood level. It was complied by Zhang Zhongjing at the end of the Han dynasty, around 200 CE (by contrast, the germ theory of disease wasn’t fully accepted by the Western medical establishment until the late 1800’s).

This understanding of pathogenic invasion is embedded in Chinese medicine treatment strategies. How the pathogen infiltrates, and where it lodges, determines the method for expelling it. The purging method is used for pathogens deep in the bowels. Sweating expels pathogens on the surface, through the pores of the skin. Clearing releases pathogens at the organ level. And vomiting is used for ingested poisons and toxins. We choose the path of least resistance to quickly expel the invading entity, with minimal damage to the body.

But notice that “kill the invading pathogen” is not one of the Eight Methods.

We humans share the earth with germs, microbes, parasites, fungi, and all sorts of other creatures that can make us sick. The TCM approach has never been to banish them from existence. We try to keep them out, and show them the door when they do invade, but eradication isn’t the goal.¹ Zhang Zhongjing and the other ancient doctors understood that we must learn how coexist with other forms of life that might do us harm.

We refer to these pathogenic factors as the evil qi or the exogenous causes of disease: wind, cold, heat, dampness, dryness and summer heat. We even recognize more supernatural types of invasion, such as ghost possession. But importantly, we also recognize that these interlopers have their place in the universe. They belong here in some way. Just not inside our bodies. And so we guide them toward the nearest available exit.

Love and gratitude,

Your Acupuncturist

1. Even though killing pathogens isn’t the goal, it’s true that many of our Chinese herbs have antibacterial, antiviral, antimicrobial properties. A famous example of this is Huang Lian (Chinese for “yellow threads”), or coptis rhizome. Huang Lian functions according to the Clearing method, and excels at clearing excess fire from the Stomach, for symptoms such as epigastric pain, belching, acid regurgitation and vomiting blood. (It’s also one of the most bitter substances in the materia medica. On my first day of herbs class in acupuncture school, our teacher had us take a sip of Huang Lian tea so we could taste how bitter it was. It was awful. Years later I subjected my own students to the same ritual—one never forgets their first taste of Huang Lian!)

Interestingly, Huang Lian contains berberine, a broad spectrum antibiotic and fungicide. Studies have shown that it’s as effective as synthetic antibiotics for bacillary dysentery, tuberculosis, scarlet fever and diphtheria. Huang Lian has been extensively researched, because for centuries it’s been used to treat stomach ulcers. In the 1980’s, doctors Barry J. Marshall and J. Robin Warren proved something that TCM doctors had long known: that stomach ulcers are caused an exogenous pathogenic factor.

It’s now a widely accepted fact that bacterial infection of H. pylori causes stomach ulcers and not by stress or bad diet as previously thought (although stress and bad diet certainly don’t help matters). Marshall and Warren hypothesized that H. pylori was the cause of stomach ulcers, but the medical establishment was firmly entrenched in the lifestyle theory as the culprit. People finally started taking them seriously when Marshall drank a culture of H. pylori and subsequently developed a peptic ulcer, thereby proving their theory. In 2005, Marshall and Warren were awarded a Nobel prize for their research. This why I like to say that Huang Lian was the inspiration for one of the great medical discoveries of the 20th century. It does indeed kill H. pylori. But that was never the point.