Besides the ancient traditions of Traditional Chinese Medicine based on the Huangdi Neijing and the Nan Jing, there have been subsequent important schools of thought based on the practice of great masters that further defined TCM principles in unique ways. Each of these tends to deal with conditions that are complex and characteristic of the various kinds of problems that are seen in the modern clinic. These schools have added to the richness of the tradition. One great master who came from the Jin/Yuan dynasties (1115-1368 ACE) was Li Dong Yuan.
In his Pi Wei Lun (Treatise on the Spleen and Stomach), Li Dong Yuan 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 offers a unique 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 attendant 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.
Yuan’s flagship formula representative of his approach are the many variations based Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang). This exemplifies how a great formula is more than a treatment for one 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 hundreds 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. Students of Chinese medicine can inch toward mastery keeping in mind that after studying numerous formulas and herbs for several years or even decades, they may find a principled system such as Li Dong Yuan’s Bu Zhong platform 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, excessive joy, anger, worry and fear also adversely affect the original or Righteous Qi of the Stomach.
How can these cause disease 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 function, but it does so by consuming its own inner resources, running on adrenal energy rather than food energy. This auto-consumptive condition is called Yin Deficiency and leads to burnout. 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 Fire as a result of Yin Deficiency emanates from the Lower Burner. The stress to act and function during burnout 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 Deficiency 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 (a clue as to why some texts used to call the Pericardium "Circulation-Sex"). When Yin Deficiency Fire rises, it further vanquishes the original Qi of the Spleen and Stomach, and instead of the Qi of the Spleen rising as it should, 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 could 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. Incessant thirst is a symptom of Yin Deficiency, but the large and surging pulse may be a sign of Heat.
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 (which rules the Spleen-Stomach) nurtures Metal (Lungs). Food energy gets stuck in the center causing bloating and swelling of the abdomen. Remember, this blocking of the Qi of the Spleen and Stomach is 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 also blocked.
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 already deficient Spleen. Death can result from 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 Li Dong Yuan’s Spleen school.
Bu Zhong Yi Qi Tang Ingredients and Their Functions
The following support and boost Spleen Qi:
15 g astragalus (huang qi) – raises Spleen Qi and thus empowers the immune system
6 g prepared licorice (zhi gan cao)
9 g ginseng (ren shen) – this is generally removed if there are cough symptoms
9 g dang gui – tonifies Blood
The next two herbs have an upbearing energy and cool Fire from Yin Deficiency.
3-6 g cimicifuga (sheng ma)
6-9 g bupleurum (chai hu)
To assist the Spleen and Stomach Qi by helping to circulate it, add
3-6 g citrus peel (chen pi)
Bu Zhong Yi Qi Tang is normally recommended for prolapsed or sinking Qi, but it has a very wide range of application. In fact, it can be used as a tool for correcting the cause of Yin Deficiency symptoms without resorting to cloying, hard to digest Yin tonic herbs. Dozens of herbs can be added to this basic formula according to various symptoms. Some are listed below.
Abdominal pain: additional prepared 3 g licorice (zhi gan cao) and 9g white peony root (bai shao)
Abdominal pain with aversion to cold: 6g cinnamon twigs (gui zhi)
Abdominal pain with aversion to heat:9g scutellaria (huang qin) and 9g white peony (bai shao)
Summer Heat symptoms: 9g scutellaria (huang qin) and 9g white peony (bai shao)
Abdominal pain with aversion to heat during cold season: 6g cinnamon twigs (gui zhi), 9g white peony (bai hao), raw licorice (gan cao)
Abdominal pain with no aversion to heat during cold season: cinnamon twigs 6g (gui zhi), 4 g raw licorice (gan cao), 4g alpiniae fruit (yi zhi ren) or 9g pinellia (ban xia), and 4g fresh ginger (sheng jiang).
Headaches: 6g Vitex fruit (man jing zi), 9g ligusticum (chuan xiong)
Pain at the top of the head: 9g Ligusticum sinensis (gao ben)
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 use Clear the Portals Paste, Qing Kong Gao).
Pain below the umbilicus: 10g prepared rehmannia (shu di). If the pain does not go away with shu di, add 6g cinnamon bark (rou gui).
Qi stagnation in the chest: 4g green citrus peel (qing pi)
Pain in the body caused by Dampness: Poria Five Herb Combination (Wu Ling San), minus cinnamon twigs
Generalized pain throughout the body caused by Wind and Dampness (some fibromyalgia cases may be in this category: do not use Wu Ling San, but use 3 g each Notopterygium (qiang huo), Ledebouriella (fang feng), Ligusticum sinensis (gao ben), and 6 g each cimicifuga (sheng ma) and black atractylodes (cang zhu).
Dry stools: add the body of dang gui (not the tails) 9-15 g. Boil the standard formula and take it with powders of 6g mirabilitum (mang xiao) and 4g licorice. This is stopped once the bowels start to move. Note: there are many instances of constipation caused not by Excess but by Qi and Yin deficiency.
Chronic coughing with phlegm: remove ginseng. For early stage coughing, keep ginseng as in original formula.
Cold Wind invasion during winter: Add 6g ephedra (ma huang). Note: this further exemplifies how one formula with a strong overarching principle can be adapted to treat practically all conditions, including superficial colds and flu, 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 do not allow for treatment of Qi and Yin deficiency together).
Cold Wind invasion in very warm spring weather: 4g saxifrage and 6g tussilago flowers
Cough contracted in the summer months: 9g schizandra berries (wu wei zi) and 3-6 g ophiopogon (mai men dong). If there is white glossy tongue fur, don’t add these.
Sensation of blockage just below the heart: coptis (huang lian), 3-6 g. Note: If there is an inability to ingest food along with this feeling of blockage, do not use coptis.
Flank and chest pains bupleurum (chai hu) 3-6 g