Li
Dong Yuan’s Spleen and Stomach School
How Inappropriate Food And Drink Can Damage The Spleen And Stomach
Commentary by Dr. Michael Tierra, based on the
translation of the Pi Wei Lun, 2nd chapter by Yang Shou-Zhong and Li
Jian-Yong (publ. by Blue Poppy Press).
Besides the ancient traditions of Traditional Chinese
Medicine, based on the Yellow Emperor and the Nan Jing there have been subsequent
important schools of thought based on the practice of great masters that tended
to further define TCM principles in their unique ways. This has added to the
richness of the tradition. The Jin/Yuan dynasties (1115-1368 AD) gave rise to
four great masters, one of which was Li Gong Yuan. Each of these tends to deal
with conditions that are complex and characteristic of the various kinds of
problems that are seen clinically in our own time.
Li Dong Yuan, in his Pi Wei Lun treatise, based all diseases
and imbalances, including yin deficiency, on deficiency of the righteous qi of
the Spleen and Stomach represented by the Earth element. His work uniquely
offers an explanation for the nagging question of how to treat a combination of
Spleen and Stomach qi deficiency, which by necessity require the use of warm,
tonic herbs, along with yin deficiency, which by implication would aggravate yin
deficient fire or heat conditions. Usually this type of imbalance is seen with
the most complex and difficult cases and Li’s theory offers a principle for
treatment. It is interesting how his entire system of treatment is mostly based
around variations of Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang).
This exemplifies how a great formula is more than a treatment for a specific
condition, but represents an approach to treatment that can be modified in
innumerable ways to accommodate the imbalances of various diseases. In this
sense, the greatest Chinese herbalists do not use 100’s of different formulas,
but after spending years studying them, tend to limit their practice to a
handful of formulas that they understand and know very well, varying them
sometimes down to using only one or two herbs from the representative formula.
This creates a grounding frame of reference that is always useful when we are in
the midst of battling various complex diseases.
All students should continue to study numerous formulas and
herbs for several years, but keeping in mind that in working towards mastery (perhaps
after 20 or 30 years of practice), they may find a principled system such as Li
Dong Yuan’s Bu Zhong formula sufficient for understanding and treating most
diseases.
Can immoderate food and emotions adversely affect our
digestion?
The answer is yes.
The Stomach and Spleen are responsible for receiving and
transforming food and drink. Dietary irregularity and immoderate intake of
excessively sweet, cold or warm foods are able to damage the Stomach and the
Spleen. In addition the excessive joy, anger, worry and fear also adversely
affect the original or righteous Qi of the Stomach.
How can these cause diseases throughout the body?
When the Original or righteous qi of the Spleen and Stomach
are injured, its weakened state does not allow for nourishment of the organs and
extremities of the body. Food and drink then become a further stress and burden
on the body. Without nourishment the body struggles to continue, but it does so
by consuming its own inner resources. Running, as it were on adrenal energy,
rather than food energy. This auto-consumptive condition is called
yin-deficiency and leads to burn out. It occurs as a result of
over-stimulation of the sympathetic nervous system controlled by the adrenals,
which are part of Kidney Qi, and it is said that this yin deficient fire emanates
from the “lower burner.” This corresponding stress to act and function is
not part of the normal function of the body, but must be inspired as a result of
the mind which is governed by the Heart in TCM. Thus the yin fire that results
from malabsorption in the spleen and stomach is said to emanate from the Heart,
not directly, but by its minister, the pericardium which has a branch that
communicates with the lower warmer (that’s why some texts used to call the
pericardium: circulation-sex). When yin fire rises, it further vanquishes the
original qi of the Spleen and Stomach and instead of the qi of these organs
rising as they should (“the spleen has an ascending direction”) it descends
into the kidneys causing Kidney yin deficiency.
Thus, deficiency of the spleen can be seen to be the root of
yin deficiency and therefore to nourish yin, one must supplement the spleen.
This is the basis of Li Dong Yuan’s Spleen school, which was formulated during
the 12th century AD.
So what does this type of yin deficiency look like when it is caused by Spleen Qi deficiency?
First, there is abnormal upsurging
of qi, causing symptoms in the upper regions of the body. This is a
characteristic of yin deficiency and may include malar flush, facial skin
conditions, headache, fever, irritability, anxiousness, etc. It would also
manifest as shortness of breath because the kidneys are unable to grasp and
bring down the qi of the lungs. There would be a large and surging pulse and
incessant thirst. The incessant thirst is a symptom of yin deficiency, but the
large and surging pulse may be a sign of excess.
The reason for these symptoms is that grain qi or food qi
from the Spleen and Stomach must rise to the Lungs. This follows the pattern of
the five elements where earth (spleen-stomach) nurtures metal (lungs).
Essentially food energy gets stuck in the center causing bloating and swelling
of the abdomen. Remember the cause of this is blocking the qi of the spleen and
stomach as a result of excessively cold or hot food and drink and immoderate and
irregular eating habits.
The moving and transforming power of yang qi is blocked in
the abdomen or middle warmer and descending and uprising energy is blocked. This
is all caused by spleen and stomach qi deficiency.
Because the energy is blocked and deficient in the center,
this leaves the surface empty and vulnerable possibly giving rise to various
external invasions of cold, wind, damp, etc. The problem is that in order to
relieve external diseases, one usually promotes some type of eliminative or
depleting therapy such as sweating. However, this will in turn deplete the
deficiency spleen, which is at the center, causing the external deficiency and
vulnerability. Death is caused by either tonifying an excess or depleting a
deficiency.
Treatment strategy is to warm and tonify the center with spleen qi tonics and Qi moving herbs, while using cool herbs with an upbearing energy to drain deficiency Fire.
This is the basis of Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang), considered the major representative formula of the Li dong Yuan’s spleen school.
It consists of the following:
Astragalus, which raises righteous spleen qi and thus
empowers the immune system. 15 gms
Prepared licorice 6 gms
Ginseng 9 gms (this is generally removed if there are cough symptoms).
All of the above support and boost the original qi of the
Spleen.
Dang Gui 9 gms This is a blood tonic and nourishes the qi of the spleen.
Cimicifuga 3-6gms
Bupleurum 6-9gms
Both of these have a cool upbearing energy and cool yin fire.
Citrus peel 3-6 gms This further assists the spleen and stomach Qi by helping to circulate it.
This formula is normally recommended for prolapsed or sinking Qi but being the representative formula of Li dong Yuan’s spleen school it has a very wide range of application.
It is like a tool for correcting the cause of yin deficiency symptoms without resorting to cloying, hard to digest yin tonic herbs.
There are literally pages of herbs that are added to this basic formula according to various symptoms.
Abdominal Pain: add prepared licorice (more of it) and white peony root.
Aversion to cold with abdominal pain: add cinnamon twigs.
Aversion to heat with abdominal pain: add scutellaria and white peony
Summer heat symptoms: add the same as previous.
During cold season with abdominal pain with corresponding aversion to heat: add cinnamon twigs, white peony, raw licorice, white peony.
In the cold season with abdominal pain and no aversion to heat: use the above, but without white peony root, because it has a sour flavor and is cold. Instead of peony root: add alpiniae fruit or pinellia and fresh ginger.
For headaches add ligusticum: add Viticis.
For pain at the top of the head: add ligusticum sinensis (gao gen).
For severe headache: add asarum.
For various types of headaches all four of the above herbs can be added.
These are not effective for heat in the head.
For heat in the head one uses Clear the Portals Paste (Qing Kong Gao) consisting of Notopterygii, scutellaria, coptis, ledebouriella, bupleurum, ligusticum, licorice. This is ground into a powder and taken with green tea.
For pain below the umbilicus: add prepared rehmannia 3-6gms
If the pain does not go away: add cinnamon bark 3-6gms
The Yellow Emperor speaks of revengeful retaliation. In this case, this occurs when Earth (spleen-stomach) is empty and is then over dominated by Wood (liver and gall bladder). Because Metal (Lungs and large intestine) are not being nurtured by Earth (spleen-stomach), it wreaks vengeance on Wood (liver-gall bladder), causing disease. In this way an original cold, deficiency spleen is changed into a hot disease by the corresponding imbalance of the liver and lungs.
For qi stagnation in the chest: add Qing pi (Pericarpium viridis (green citrus peel) 3gms.
For pain in the body caused by dampness: add Poria five herb combination (Wu ling San), from which cinnamon twigs has been deleted.
If there is generalized pain throughout the body caused by
wind and dampness (some fibromyalgia cases may be in this category), do not use
Poria Five herbs but use Notopterygii, ledebouriella, ligusticum sinensis (Gao
Ben), 3 gms each and cimicifuga and Black atractylodes (cang zhu) 6 gms each.
For Dry stools: add the body of dang gui (not the tails) 9-15gms. Boil the standard formula and take it with a powder of miribilitum and licorice powder tea or powder.
This is stopped once the bowels start to move.
This is an important understanding since there are many instances of constipation caused not by excess but by qi and yin deficiency.
Chronic coughing with phlegm, delete ginseng. For early stage coughing use ginseng.
During the winter months when cold wind invades the body add ephedra. This is interesting because it further exemplifies how one formula with a strong overriding principle is adapted to treat practically all conditions, including superficial colds and flus, so long as the cause is seen as spleen qi and yin deficiency. (Personally I see this a lot in my clinic and the standard texts without Li’s Spleen school does not allow for treatment of Qi and yin deficiency together).
In very warm spring weather: add saxifrage and tussilago flowers.
For cough contracted in the summer months: add 32 pieces of schizandra berries and ophiopogon 3-6gms. If there is white glossy tongue fur, don’t add these.
In the absence of cough during the summer months (with of course spleen qi and yin deficiency): add ginseng with schizandra and ophiopogon in equal amounts to rescue the lungs from fire evils.
For a feeling of blockage just below the heart: add 3-6gms of coptis. If there is an inability to ingest food along with this feeling of blockage do not use coptis. For flank and chest pains: add bupleurum 3-6gms.
Acupuncture: for stomach disease with abdominal distention, pain in the center in the cardiac region and fullness of the chest, obstructed diaphragm, throat not allowing food and drink to pass down. Treat San Li (St. 36).