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All lessons   Module 1: Foundations   Lesson 13

Module 1   Lesson 13   Biao and Ben

From finding to treatment principle

Twenty findings, one patient: how do you arrive at one principle, and what do you treat first?

After this lesson you can work through a case in six steps, separate the Root from the Manifestation, and give two hypotheses for each case with the information that decides between them.

1 Gather complaints, history, tongue and pulse agreement: asking and listening best 2 Apply the Eight Principles Interior, Heat or Cold, Deficiency or Excess agreement between practitioners: fair 3 Name the pattern Zang-Fu; and Qi, Blood or Dampness agreement between practitioners: low 4 Separate Root and Manifestation ben and biao: what is cause, what is shown? acute: Manifestation; chronic: Root 5 Choose the principle for example move Qi or nourish Yin follows from pattern, Root, Manifestation 6 Derive points or formula working out the principle (lessons 14 to 17) formula follows the pattern; points do not
Schematic. The bottom line of each box is what research on agreement between practitioners says (step 7: Hua 2012, O'Brien 2009, Zhang 2005, Hogeboom 2001; abstracts only). "Points do not": practitioners choose very different points for the same patient.

Know by heart

  • The six steps. Gather; Eight Principles; pattern; Root and Manifestation; principle; points or formula. mnemonic: from broad to narrow; three Ps (pattern, principle, points), with Root and Manifestation in between.
  • Ben and biao. 本 ben is the Root; 标 biao is the Manifestation. mnemonic: 本 is tree 木 with a stroke at the foot; ben as in beneath, biao is what shows above ground.
  • The three rules. Acute: the Manifestation first (急则治标); chronic: the Root (缓则治本); often both at once (标本兼治).
  • Four pairs of ben and biao. Zheng qi versus xie qi; cause versus complaint; prior versus later illness; interior versus exterior. mnemonic: look up the Root's ZIP Code: Zheng qi, Interior, Prior illness, Cause.
  • Six chains, Root first. Kidney-Yin deficiency, then Liver-Yang rising; Spleen-Qi deficiency, then Dampness, then Phlegm; Qi stagnation, then Blood stasis; prolonged Heat, then Yin deficiency; Liver-Qi stagnation, then Liver invading the Spleen; Spleen-Qi deficiency, then Blood deficiency, then Heart-Blood deficiency. mnemonic: whatever comes first is the Root; Qi stagnation and Heat are the Excess conditions among the Roots.
  • Two axes. Root and Manifestation say what comes first; tonifying (bu) or draining (xie) says which direction. mnemonic: 闭门留寇, do not lock the door with the robber inside.
  • The format of a case answer. Red flag; hypothesis 1; hypothesis 2; what decides; for each hypothesis Root, Manifestation and principle.

The rest of this lesson is reference.

From finding to principle: Twenty findings, one patient: how do you arrive at one principle, and what do you treat first?
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Three practice questions from this lesson

Kidney-Yin deficiency and Liver-Yang rising in the same patient. What is the Root?
  1. Neither; they are unrelated
  2. Liver-Yang rising
  3. Kidney-Yin deficiency

Answer: Kidney-Yin deficiency. The Root in the deficiency, the Manifestation in the headache. The Yin no longer holds the Yang, so the Yang rises.

Spleen-Qi deficiency, Dampness and Phlegm. What is the Root here?
  1. The Phlegm, because it causes the complaints
  2. Dampness
  3. Spleen-Qi deficiency

Answer: Spleen-Qi deficiency. Spleen-Qi deficiency produces Dampness, Dampness produces Phlegm; the impaired transformation lets fluids accumulate. The Phlegm causes the complaints, but it is the Manifestation: if you only resolve Phlegm, you see it come back. That is why the principle in Damp-Phlegm is 'resolve Phlegm, tonify the Spleen': Manifestation and Root together (pattern 10).

Prolonged Heat has consumed the Yin. What is the Root?
  1. Neither; Heat and Yin deficiency are unrelated
  2. The Heat: an Excess can also be the Root
  3. The Yin deficiency, because Deficiency is always the Root

Answer: The Heat: an Excess can also be the Root. Prolonged Heat leads to Yin deficiency. The Root is what came first and causes the other; that can be an Excess. In practice you often treat both here: clear Heat and nourish Yin.

The rest of this lesson

In the course you get the step-by-step explanation, 37 case-based practice questions, 20 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 1: Foundations.

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