Founder’s note: Here is an article in three parts from two third year students in the classical Chinese medicine program at NCNM. They wrote this paper, and the accompanying presentation, as part of their Chinese herbal training.

Read: Part 1/ Part 2 / Part 3
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The Limits of Tonification

Indiscriminate application of tonifying formulas fails to provide justice to the full range of Chinese medicine. Modern practitioners utilize imprecise methods combining multiple formulas, with broad application, hoping to capture as many symptoms as possible. In order to offset the drag caused by rich Qi and Blood tonics, varying amounts of Qi and Blood movers are included such as the endless variations of Si Wu Tang.  In contrast, classical formulas were lower in dose, containing fewer herbs and aimed at a specific target – the most upstream step. Associated with Jueyin and Taiyang, Dang Gui Si Ni Tang resolves Blood pathology by operating at the level of Water to Wood.

A Third Approach

In Ling Shu, Chapter 4, the goal of an acupuncturist is to regulate the disharmonies of Yin and Yang, in this case Qi and Blood. Both the root and summit of any condition must be addressed otherwise the disease will continue to persist. To regulate, one must treat the beginning and ending; the formation and circulation of blood and energy.

This implies that there are multiple steps at which a physician can intervene.

Blood formation from Qi involves multiple physiologic networks differing in magnitude, e.g.,  Zang-Fu pairs, Channels and Phases. After ingestion of food and drink, the spleen and stomach mist Gu-Qi upward. Receiving Celestial Qi and fusing it with Gu Qi, the Lungs begin the creation Ying Qi (the nutritive aspect of Blood). Portions of warm kidney-Jing rises up to meet the heart which allows a fraction of Ying-Qi to be transformed into Blood.

The Classical Approach is More Comprehensive

TCM formulas emphasize a single treatment plan to operate on the Middle Jiao, by way of the spleen, stomach and portions of the liver. Proper function of the Upper Jiao requires that the Lower Jiao supply the necessary substrates. The kidneys and spleen manage inherited and acquired Jing, the extraordinary surplus potential energy that powers the entire system. While the kidneys store Jing in the form of marrow, the liver constitutes a reservoir of Blood within the Chong Mai. Similarly, the heart and lungs manage Blood which utilizes Jing, and is considered an extraordinary connective tissue.  While the liver maintains smooth flow globally, the spleen locally connects with the lungs by misting the precursor of Blood upward.

Aside from Ying Qi, the lung and kidneys consist of the upper and lower sources of water, the basis for all fluid formation. Water itself flows in the direction of more solutes, in the absence of a pulmonary pressure gradient, this would manifest as edema, stagnating over time. As Master of Qi, the lungs counteract this possibility by facilitating propulsion via the energetic force (Qi) inside the vessels. Blood flow rate is extrinsically affected by the heart, by governing vascular tone. Per Chapter 5 of the Su Wen, “Blood is said to follow Qi”, hence why the lung’s production of a motive force, Qi, can pull on Blood, propagating formation and circulation. Within Chapter 74 of the Su Wen, the Nineteen Lines concisely describe the etiology of disease.

Recall that Qi represents an energetic capacity, a dynamic.

If the liver and gallbladder fail to manage smooth flow, this sets up of a chain of compensatory reactions. In effect the kidneys are affected by a lack of warmth, causing constriction.  Muscular contraction contributes to vascular flow. If erratic, then the lungs, Master of Qi and 100 Vessels will be affected. Line three describes the formation of congestion and blockages due to pulmonary disruption. Reduced Qi flow lowers the amount of substrate to be transformed into Blood resulting in system wide aberrations.

Han Dynasty physician Zhang Zhong Jing understood the process causing pathology, for in the Jin Gui Yao Le, all diseases are said to originate from the lungs as “100 Union Disease.” While Taiyang is often associated with the kidneys, it may also refer to the lungs. Metal is the mother of Water whose child is Wood – implying the interrelationship between the lungs, kidneys, liver and heart. The heart is associated with all types of pain, including itching and sores. Nocioreception is considered a sign that an obstruction (dense blockage) is disrupting normal flow of Qi and Blood. Treatment should include a harmonizing herb like gui zhi in lieu of a heavy tonic. Dang Gui Si Ni Tang operates at all of these levels.

Effective treatment requires addressing the totality of a patient’s circumstance. Modern TCM-style practice fails to apply a comprehensive and personalized method, focusing only on downstream products.  Normal physiology is contingent on various cycles, whose steps follow a logical sequence. Practitioners like Zhang Zhong Jing recognized the body’s capacity to autoregulate itself, provided that a physician encourages the system to realign. Therefore, one need not focus on excretions but instead determine the causal factor leading to the evidence of disruption. Successful upstream intervention allows for an influential cascade, resolving all levels of deviation.