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Introduction
The eight strategies (Ba Fa) were originally recorded in the Nei Jing Su Wen. It wasn’t until the Qing dynasty that Dr Cheng Zhong-Ling organized and categorized the eight basic strategies known as the ‘Eight Methods in Therapy’ (Yi Men Ba Fa) (Williams 1992, p28) and recorded them in the
‘Medical Revelations’ (Yi Xue Xin Wu).
The eight strategies are categorised according to their therapeutic action and are shown below.
- Sweating (Han Fa)
- Vomiting (Tu Fa)
- Draining Downward (Xia Fa)
- Harmonizing (He Fa)
- Warming (Wen Fa)
- Clearing (Qing Fa)
- Reducing (Xiao Fa)
- Tonifying (Bu Fa)
In Traditional Chinese Medicine (TCM), diagnosis and treatment are based on an overall analysis of signs and symptoms, aetiology, the nature and location of the illness, the patient’s Qi level (weak or strong) and their constitution (Bian Zheng Lun Zhi). The practitioner will then make a syndrome differentiation and use the eight methods to conduct a treatment strategy.
Discussion
Sweating – Han Fa
The sweating strategy induces perspiration to aid in the regulation of lung Qi. This facilitates interaction between the nutritive (Ying) and protective (Wei) Qi allowing for the release of pathogens from the exterior of the body. It is used in patients with wind-heat or cold. Pungent warm formulas are used to release the exterior (Ma Huang Tang), and pungent cool formulas are used to release the exterior (Yin Qiao San).
If sweating is induced in a patient suffering from an exterior syndrome, then it should be only for a short period of time after which the patient should feel better. If sweating, whether diseased or medicinal, lasts too long or is excessive it will then injure Yin.
Applications:
- Externally-contracted exterior excess conditions
- Rashes
- Acute oedema which is more severe in the upper part of the body
- Early-stage pain and swelling from wind-damp
- Skin disorders caused by wind
- Diseases that are working their way out from the interior
Vomiting – Tu Fa
This strategy uses herbs that over-stimulate the stomach to induce vomiting. It is rarely used today except in acute interior full (excess, shi) conditions and is used in emergency or life-threatening conditions (Yi 2000, p19). This is because it injures Yin and the stomach due to its violent action and should therefore only be used in strong patients. When it is used it induces vomiting to quickly remove stagnation of food, phlegm or poisonous materials from either the stomach, throat or oesophagus. An example of a vomiting inducing formula is Gua Di San.
Applications:
Phlegm stuck in the throat
Phlegm accumulation in the chest
Food stagnation in the stomach
Ingestion of poisons
Draining Downwards – Xia Fa
This strategy induces defecation to purge the bowels by irritating or stimulating the intestines to treat interior full (excess, shi) conditions. For example to drain heat and move stools (Da Cheng Qi Tang), warm the Yang and guide out accumulation (San Wu Bei Ji Wan), moisten the intestines and unblock the bowels (Ma Zi Ren Wan), and drive out excess water (Shi Zao Tang).
Draining downward formulas (purgatives) are used to treat constipation, certain febrile diseases and certain gynaecological disorders. It should, however, be used with caution during pregnancy, parturition and menstruation.
Applications:
- Constipation
- Dried faeces in the intestines
- Heat accumulation
- Cold accumulation
- Excess water
- Blood build up
Harmonising – He Fa
This strategy is used to harmonize the different levels of the body and the Zangfu organs. Harmonising can both expel pathogenic factors as well as tonify the upright Qi (Zheng Qi). It is used to harmonise the ShaoYang (Xiao Chai Hu Tang) when the pathogen lies half-way between the interior and exterior of the body, harmonise the Zangfu organs that are affected simultaneously, for example the liver and spleen (Si Ni San), and the intestines and stomach (Ban Xia Xie Xin Tang). It is also used for complex conditions such as heat with cold or emptiness with fullness.
Applications:
- Half interior-half exterior (ShaoYang) disorders
- Malarial
- Depression
- Dysmenorrhoea
- Epigastric focal distention
Warming – Wen Fa
This strategy is used to warm the Yang. It is used to eliminate pathogenic cold conditions of both fullness (excess, shi) and emptiness (deficiency, xu) in either the interior or exterior. For example, to warm the channels and disperse cold (Dang Gui Si Ni Tang), warm the middle jiao and dispel cold (Li Zhong Wan), restore and revive the devastated Yang (Si Ni Tang), and warm the menses and dispel cold (Wen Jing Tang). It can also be used to treat malabsorption syndromes and certain gynaecological disorders.
Applications:
- Cold in the channels
- Cold attacking the middle jiao
- Cold with devastated Yang
Clearing Heat – Qing Fa
This strategy is used to clear heat or cool the heat in the body. It eliminates pathogenic heat or drains the fire from the body’s interior in full (shi) or empty (xu) conditions. For example, to clear heat from the Qi level (Bai Hu Tang), clear the Ying level and cool the blood (Qing Ying Tang), drain the fire and relieve toxicity (Huang Lian Jie Du Tang), and clear heat from the Zangfu organs (Qing Wei San).
Applications:
- Interior heat
- Heat in the Zangfu organs
Tonifying – Bu Fa
This strategy is used to either tonify, restore, supplement or replenish emptiness, deficiency or weakness of the body’s Qi, Blood, Yin, Yang, fluids, essence or any of the Zangfu organs. For example, to tonify Qi and replenish the spleen (Si Jun Zi Tang), tonify the blood (Si Wu Tang), tonify the Yin (Liu Wei Di Huang Wan) or tonify the Yang (Jin Gui Shen Qi Wan).
Applications:
- Deficiency of Qi, Blood, Yin or Yang
- Deficiency of the Zangfu organs
Reducing – Xiao Fa
This strategy is used to reduce, dissolve or eliminate accumulation. For example, chronic conditions resulting from the accumulation of hard and swollen substances such as blood (Xue Fu Zhu Yu Tang), phlegm (Er Chen Tang) or food stagnation (Bao He Wan); Qi stagnation (Yue Ju Wan); abscesses (Wu Ling San) and parasites (Wu Mei Wan).
Applications:
- Qi stagnation
- Blood stasis
- Food stagnation
- Phlegm
- Abscesses
- Parasites
References
Bensky, D. & Barolet, R. (1990). Formulas & Strategies. Seattle: Eastland Press, Inc.
Williams, J.E. (1992). ‘Herbal Prescriptions Corresponding to the Eight Methods’, Journal of Chinese Medicine, May, p28-31.
Yi, Q. (2000). The Traditional Chinese Medicine Formula Study Guide. Boulder: Snow Lotus Press.