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Dr Li Xin

Dr Claudine Mérer

TRADITIONAL CHINESE MEDICINE

BACK TO THE SOURCES

FOR A MODERN APPROACH

ACKNOWLEDGEMENTS

This book would have never come out without the contribution of many people, to whom we would like to extend our profound gratitude!

I, Li Xin, will always be most grateful to my teachers: Mr.Ren lin, who gave me my very first important lesson about TCM; Pr.Song zuo ming, from whom I learned the traditional way of thinking and training; Pr.Gong shu sheng, who gave me a comprehensive view of Chinese medicine; Pr. Ge qi, who guided me back to learning Chinese medicine, Pr.Li hui ji and Pr.Wu cheng with whom I learned the basis of psycho-somatic (Body-Mind) medicine. Without them, my understanding and practice of TCM to day would never have been the same.

I would like to thank Mr.Zhang Xiao Tong, and Miss Liu Ming, director of Beijing Cui Yueli Chinese Medicine Research Centre, for giving me a chance to practise in a traditional way, and to the Ping Xin Tang Clinic, where I spent almost 4 years seeing patients, and tasting materia medica. All the cases discussed in this book come from my experience there.

Many thanks also to Mr.Qin Chao Ying, Miss Liang Wei Na, Mr.He Xiao He, Mr.Duan Ke Sheng, and Mr.Wang Shan, founders of the Yanhuang hospital where I learned a lot.

I very much appreciated the offer of the St. John’s Health Clinic in Shanghai to allow me a very flexible time of practice. Without it I could not have finished this book.

I would also like to extend my sincere thanks to many friends for their contribution: Dr James Heinritz who was the first to read the whole manuscript and gave us encouragement and advices; Dr Sylvie Hu who shared with us her deep understanding of Acupuncture and introduced us to the very enlightening work of Dr Jacques Pialoux; Dr Jacques Pialoux for giving us permission to publish one of his figures; Miss Zhai Jing Hui, who helped me correct the prescription’s dosages from the source of the original books; Miss Sun Hao, our designer of most of the figures and illustrations; Mr. Li Yue who helped me find precise English words.

To Dr Xu Wen Bo, Dr Xu Wen Bing, Dr Liu Jie, Dr Lin Yang who shared my experience: we worked and progressed together.

And I, Claudine Merer, would like to thank Michael McIntyre and Mazin al-khafaji, my teachers of Chinese Herbal Medicine. I extend my gratitude to my dear friend, Mrs Susan de Talancé, whose help correcting english for the manuscript was most valuable and to Homeira Abrishami and Carine Desmonteix whose very professional editing touch transformed the manuscript into a real book. My great respect and gratitude go to my mentor and friend Jacques Pialoux.

Many thanks to both our families

Sincere thanks to our patients

And best wishes to everyone

PREFACE

I met Li Xin in November 2002.

I had lived in Beijing only 6 months and everything was still new.

Having a background of Doctor in Western medicine and Traditional Chinese medicine (TCM), I was asked to give a conference on TCM for the expatriate community of the Beijing International Society. As a follow up to the conference, I wanted to give the audience the opportunity to visit a TCM clinic in Beijing. By chance, I met Li Xin who offered to guide us around the private TCM clinic where he was working.

Although he was very young (32 years old) I could sense a deep and personal understanding of TCM and a particularly developed sensitivity. This is what I was looking for, after a few disappointing experiences in various TCM hospitals of Beijing. He kindly offered me to sit in when he was treating patients, and although I was thrilled, my very poor understanding of Chinese language drastically limited the experience! I decided that I should first learn some Chinese!

During the following year, we met on several occasions, discussed and compared our views on TCM.

He told me how he started studying at Beijing TCM University (北京中医药大学) in 1988, and was even nominated “Huang Di Neijing (黄帝内经) representative of the class” in 1989! At the time he didn’t really understand the book’s contents and lost interest in TCM. In 1990 he tried a year of western medicine. Although he was very interested in physiology, explained in a scientific way, he realised that western therapy didn’t provide all the answers and was totally lacking in some areas, and he went back to studying TCM.

In 1991, he met his first teacher, Mr.Ren.

Mr Ren was over 40 at the time, a Master of Martial Arts, and visiting Li Xin’s university for a week. Li Xin offered him his room and was very impressed to see him meditate every night and look so much younger than he was.

One day, following a generous gesture by Li Xin, Mr Ren invited him to come to the medical school library. At the entrance was a statue of Zhang Zhong Jing (张仲景), author of Shang Han Za Bing Lun (伤寒杂病论). Mr Ren asked Li Xin to bow to Zhang Zhong Jing, and then bow to him, according to Chinese tradition. He then told him: “TCM is very simple: in front of a patient just ask yourself: is this patient warm, cold, in excess or in deficiency?” On their way back, he spoke again: “The secret of a formula lies in the fact that only three to five ingredients are important. If there are many ingredients, either it was meant to confuse other doctors, or the author of the prescription didn’t have a clear understanding himself!” The two never met again, but these few words were enough to make Li xin believe in TCM and set him in a new direction.

Subsequently, he spent most of his time in the library, and rarely went to TCM lectures. He studied Huang Di Neijing (黄帝内经), Shang Han Lun (伤寒论), and the books of famous doctors of different dynasties such as Li Dong Yuan (李东垣), Zhang Zi He (张子和), Zhu Dan Xi (朱丹溪), Zhang Yuan Su (张元素), Zhang Jing Yue (张景岳), Xue Ji (薛己) from Song and Yuan Dynasties.

Learning from ancient books was a difficult task, not only because of the use of old language, but mainly because of the metaphoric way the ancients used to express themselves. When an artist draws a picture, you have to grasp the feelings behind it, beyond the performance and style of the artist. Ancient doctors had their own way to express their thoughts, and it is essential to understand the meaning hidden behind the words.

In Li Dong Yuan’s “Pi Wei Lun” (脾胃论), it is written that the main principle of a prescription is: “Bu xie zai wei, sui shi huan qi” (补泻在味, 随时换气) which translates literally as “Tonify, sedate comes from the taste, cold and warm depend on this moment”. This means that when we treat a patient it is more important to understand the taste of the herb used (sedating or tonifying), than its nature (warm or cold). We find the same principle written in the Huang Di Neijing (黄帝内经).

Li Xin graduated with honours in 1993.

During the following two years he wanted to stay closer to home, and became a TCM teacher in a medical school in Jiang Su province. He started practicing meditation and Tai Ji Chuan, teaching himself how to purify the shen and open the channels.

From 1995 to 1997, he came back to Beijing and worked in health schools and a Medical Science Development centre, practising and teaching TCM, and giving lectures.

In 1997 he joined the Beijng Yan Huang hospital, the best and largest private TCM club in Beijing where he provided medical services for senior government officials. He was the health manager and magazine editor of the club and trained young therapists in acupuncture, massage and meditation. More than 30 of the best specialists in TCM, with government’s agreement, were practising in this club. With them, Li Xin enlarged his experience and deepened his understanding.

He met his second Teacher, Professor Song Zuo Min, an expert in paediatrics and internal diseases. Professor Song was over 80, he had been a student of the most famous doctor in Beijing, Dr Kong Bo Hua, from the Kong Zi family. With Pr Song, Li Xin learned the principle of tonifying Jing and regulating Qi Ji by using light dosage and light taste.

When we met in 2002 he was also working part time at the Ping Xin Tang clinic and, a year later, sitting with him, I was able to see how precise his method was, how different from my own experience and understanding and how effective his treatments proved to be, even in the most difficult cases.

Gradually, it became important to try to keep his personal approach alive and better known to those seeking to reach the essence of TCM, in the simple way described in ancient books. In September 2004 the idea of this book was born!

INTRODUCTION

This book is not meant to be a treatise of TCM, as most of the principles are well known to all practitioners of TCM. It is not a reference book. It is a dialogue between “Ancient and Modern traditions” which reveals an original approach to methods of diagnosis and treatments, always seeking to attain the essential and to transform complexity into simplicity. “Performed with a clear mind, a treatment will give a clear and fast result”. But what looks very simple is in fact very difficult to grasp. Li Xin captures the whole of a person, beyond the initial appearance of patterns of disharmony, like an artist captures the soul of a landscape beyond its appearance, which we see as a reality.

Such an approach is already beyond the first degree of understanding and practising TCM, which is mostly based on recognising patterns of disharmony and actively trying to correct them. Instead of focusing on “the part”, which will reveal “the whole”, Li xin looks directly at “the whole”.

Only ancient sources of knowledge will bring us to this understanding. We are talking about the Books and Compilations written before the Tang or Song Dynasty (10th century AD). Li Xin believes that after the Song Dynasty, only a few doctors were following the principles of the Huang Di Neijing(黄帝内经).The “four level system” (“wei qi ying xue” 卫气营血) and “the three burners system” (“san jiao” 三焦), whose prescriptions are based on the taste and direction of the herbs, are the only treaties adding some real value after the Han Dynasty.

“It is with a thorough knowledge of the ancient books:” Huang Di Neijing” (compiled by the 1st or 2d century AD), “Shang Han Lun” (written by Zhang Zhong Jing during the late Han Dynasty, 3d century AD), ” Shen Nong Ben zhao jing” (edited by Ge Hong in the Tang Dynasty but coming from ancient sources), that one can learn to use the basic concepts, and develop one’s own practice of TCM. It is then possible to read all the other books without being lost in the battles of schools, and create one’s own formulae. “Knowing the personality of each herb, which, instead of having a fixed function (as we usually know it) will express itself in a different way according to the situation, is essential” says Li Xin.

Modern books tend to teach us how to recognise a pattern of disharmony (liver yang rising, heart blood deficiency, damp-heat invading Spleen) and treat the manifestation of disease. The function of the organ prevails and it can lead to a systemisation close to what we find in western medicine. The “Huang Di Neijing” teaches us to see the patient as a whole: what are his resources (Jing, Qi, Shen and Xing 精气神形)? How good are his basic body functions (sleep, appetite, bowel movement, urination, sweating, motion and exercises)? How does he interact with himself, nature, society, and spiritual realm? “Zhi chang da bian”(知常达变), “understand the normal state, reach the abnormal”. Knowing, the “normal state” of that particular patient, we are then able to appreciate and feel the reaction of the body to a pathogenic factor, expressed by symptoms, understand where it is taking place (Shen, Jing, Qi or Xue level 精神气血) and predict the evolution of the disease. The emphasis is on the overall energy state of the patient rather than the function of the zang-fu (organs). In difficult and complex diseases, this approach will be more efficient.

In this book, we’ll demonstrate how to appreciate the main resources of the body, and make a diagnosis in four steps.

We shall then talk about therapeutic approaches. The use of herbs and prescriptions will make up most of this section. We shall introduce different classifications of herbs, according to the Emperor Shennong 神农 (upper, middle and lower levels 上中下三品) and then according to Li Xin’s own experience, based on the taste and direction of the herbs. A discussion of some of the most famous prescriptions will follow, looking at their overall function (open or gather), their overall direction, (up or down, inside or outside), their overall nature (warm or cold, light or heavy).

“Know the essence, one word is enough” 知其要者, 一言而终 “If you don’t know the essence, there are all kinds of possibilities” 不知其要, 流散无穷; says the Huang Di Neijing. “The top secret lies in the dosage of each ingredient of the prescription”, is another important old TCM saying.

Finally we’ll look at how Li Xin uses Acupuncture, following the same strategic principles used in herbal treatment: open or gather, up or down, stimulate or sedate. But what is fascinating, is his ability to intuitively apprehend the pattern, instantly feel the movement of Qi in the patient at the insertion of a needle, finding himself in the resonance of Qi between himself and the patient. This is the “secret” accessible to particularly sensitive consciousness, the ultimate art of Chinese medicine which cannot be taught, but can grow with meditation practice and experience.

THEORY

Understanding the normal energy state of a patient, and how it reacts when confronted to a pathogenic factor

Chapter 1 : Definitions of the four substances, Zhen Qi, Qi Ji, and Bing Ji

CLAUDINE : Li Xin, in the first chapter of this book, could you describe your vision of TCM and your understanding of the physiology of the human being: what is it made of, how does it work and how does it become ill or out of balance?

LI XIN : TCM considers that a human being is made of four main resources: Jing (Essence), Qi (Energy), Shen (Spirit or Mental) and Xing (Body structure). These constituents will produce Zhen Qi or “True” Qi. Zhen Qi is responsible for the movements of transformation and transportation which maintain a state of balance (and health) in the body when it is functioning “normally”. The notion of “normality” does not necessarily mean “ideal balance”, it means that, at that particular time, the body functions without the interference of a pathogenic factor. This function of Zhen Qi is called “Qi Ji”(气机): It tells us about the dynamics existing between the different substances, which is essential to diagnosis.

If a pathogenic factor (Xie Qi-邪气) interferes with the normal function of the body, there will be a “fight” (Bing Ji-病机), translated by symptoms.

It is very important to understand what are the four main resources of the body, and what Zhen Qi, Qi Ji (气机) and Bing Ji (病机) represent.

C : This is a vision shared by every standard teaching book.

LX : Yes, of course, as far as the understanding of TCM physiology is concerned. But, too often, standard teaching books base their theory and therapeutic strategy on disease. Ancient books base their theory and therapeutic strategy on the energy state of the patient. Having understood the energy state of the patient, we can then act as “the second doctor”, observe, provoke, or assist “the first doctor” who is nothing other than the patient’s own body and Qi. If treatment is disease based, there is a risk of taking the “first doctor’s” place and acting in a wrong direction.

C : Then, what are the four resources or substances of the body: Jing, Qi, Shen and Xing?

LX : The four main constituents (resources) are:

— XING (形), the structure of the body (affected by exercises, injuries…)

— JING (精), the Essence, dependant on two main factors:

• our genetic factors, or the potential with which we are born,

• a balanced and healthy way of life, which can help preserve Jing in quality and quantity, and thus, give us a longer and healthier life.

• Jing is, in fact, the basis of Qi, Shen and Xing.

— QI (气), Energy, dependant on our environment (food and air), and on our interaction with nature, money, people, power, and beliefs. In usual modern teaching books, it is said that human Qi comes from three main parts: kidney Jing, Stomach Qi, and Lung Qi. This is a question of terminology. In fact Qi is the constituent of the whole universe and the human body interferes with it at all levels (sex, social relations, money, nature…) Everything in the world can be considered a different form of Energy, and interactions are taking place all the time between these different aspects or “forms” of Qi, including human’s Qi.

— SHEN (神), Spirit, has two aspects:

• it reflects our state of mind and mental activity,

• it reflects our intuition, our natural abilities, and the way our body works.

Figure 1 : The production of Zhen Qi from Yuan Qi and Qing Qi

Jing produces Qi, Qi produces Shen but Shen influences Jing and Qi.

Jing produces Yuan Qi, which can be considered as the Yang part of Jing. Yuan Qi together with Wei Qi (stomach Qi or middle Qi) and Qing Qi (lung Qi or air Qi) assist in the production of Zhen Qi (or “true Qi”) which will then circulate in the channels (figure 1).

C : So, Zhen Qi represents the energy directly usable by the body?

LX : Zhen Qi is the energy which helps the body perform, it is the energy which sustains all functions of transportation and transformation. It is divided into, Wei Qi (卫气 the defense energy), Ying Qi (营气 the nutritive Qi), channel Qi (经络之气) and Zang and Fu Qi (organs Qi 脏腑之气), like liver Qi, or bladder Qi, etc. As we said, Zhen Qi comes mainly from Yuan Qi (元气) and stomach Qi (胃气 Wei Qi). But Zhen Qi is also part of the energy of the Universe. Human beings are like a container which is filled with this energy. Each individual will absorb energy and live on a different level according to his own way of life. Eating habits are important (some people eat a lot of food and will absorb less Qi from another source of energy); social interactions: love, power, money, discussions and talks can all be nourishing or depleting. Nature and environment may fill someone with strong positive energy (mountains, countryside, pure fresh air) or deplete it (polluted atmosphere of large cities). The practice of meditation and living a spiritual life replenishes energy. There are different ways of making up Zhen Qi !

Zhen Qi is the result of the resources of the body which are the necessary support, or substratum (the “Yin “part of Qi), for the body function (Yang part of Qi). Figure 1 explains how Zhen Qi comes into being

To appreciate the quality of Zhen Qi, we use the first step in the diagnosis method detailed in the next chapter.

C : Zhen Qi would be like our “current account” in the” bank of Qi”. We can add to it or spend it.

LX : Quite right! In the “bank of Qi”, Jing (精) Yuan Qi (元气) is our “capital”, Zhen Qi is our “current account”. Everyday we eat food, and nourish stomach Qi, and thus, add “cash” to the current account for everyday use. If we damage stomach Qi, Zhen Qi will be weak. It will be difficult to perform daily exchanges without digging into the “capital”, Yuan Qi. Then, Yuan Qi will be damaged, and consequently Jing will be affected.This is why Chinese doctors pay great attention to stomach Qi.

C : Can you tell us more about Qi Ji (气机)?

LX : Qi Ji (气机) corresponds to the normal movements of Qi in the normal body. It is the way Zhen Qi transports, transforms, communicates and circulates Jing, Qi and Shen.

Zhen Qi is what we can use to live.

Qi ji will bring Zhen Qi to the surface and defend the body against pathogenic factors coming from outside. It will also be responsible for bowel movements (middle Qi strong enough and open), and for sweating and urination (by insuring a good function of Sanjiao 三焦). Finally it has an important role in the system of Channels and Collaterals, providing a good circulation of Qi, and thus nourishing the whole body.

When we talk about Qi Ji (气机) it means the normal performance of Zhen Qi. The body is not disturbed by pathogenic factors of any kind.

In ancient China, it was called the original state of the body. In the Taoist’s classic” Dao De Jing “(道德经), it is said that only babies and great masters who have been practising meditation for a long time in a secluded life, away from society and any influence, can keep their Qi Ji pure. Meaning by this that nobody is really healthy, we, human beings are all sick!

In TCM, keeping Qi Ji in good order, requires that Shen is in a normal state, soft, tender, relaxed and concentrated, with not too many thoughts and desires. Jing is strong enough and stored in kidneys. Stomach Qi is normal, and the Channels and Collaterals are open. There are no pathogenic factors inside the body, no blockage at any level, no deficiency or excess at any level. This is what we call “Chang”, “normal”(常).

Nowadays, people use their brain too much; this is the main reason for Qi consumption and disturbed Qi ji.

C : Qi ji corresponds to the normal movement of Zhen Qi in a normal state of the body. You mentioned the role of Zhen Qi on the surface, in bowel movements, sweating and urination. Does this indicate the main directions of Qi Ji used by Zhen Qi?

LX : Right. When we are talking about general movement of Qi, it is based on the principle of “Shen Jiang Chu Ru (升降出入)”= “floating, down, outwards and inwards”. These are the four possible directions of the movement of Qi in the body (Qi Ji). In different pathological situations, the body adjusts the balance naturally by moving Zhen Qi in one or another of these four directions. This is very important to understand, as it will determine the whole strategy for treatment. The prescription should follow the direction naturally chosen by the body.

One should also remember that the first principle of life is: “He-Kai (合-开)” = “gather-disperse”. For exemple, at night, energy (Qi Ji) automatically gathers inside (He 合) and during the day it disperses (kai 开).

To appreciate the way Qi Ji works, we use the second step (san jiao or “3 levels”), in the diagnosis method detailed in the next chapter.

C : Before we go any further, could you please clarify one point? What is what we usually refer to as “liver Qi”, “Spleen Qi”, “Bladder Qi”…etc, in relation to Zhen Qi and Qi ji?

LX : If we just consider the functional aspect of Zang and Fu, we talk about, Zong Qi 宗气(which insures heart function, blood circulation and breathing), Fei Qi 肺气 (lung Qi), and Gan Qi 肝气 (liver Qi)…etc. It means that we can use the word “Qi” to refer to any function of any part of the body (this is what modern teaching books do), or the supportive substance of the function of any part of the body. So it can be confusing. What I think is important, is the dynamic relationship between the different resources of Qi, what we call Qi Ji. So I usually pay attention to Yuan Qi, Wei Qi (stomach Qi), Qing Qi (lung Qi), Jing Qi..., the resources of the body, rather than the functions of Zang and Fu (Fei Qi, Gan Qi…), which, in fact will result in the production of Zhen Qi. Paying attention to the function of the Zang-Fu is more related to a western way of thinking.

C : Thank you Li Xin, this explains why we shall not hear much about the functions of the Zang-Fu in this book!

We have now assessed the four substances, Zhen Qi and Qi Ji. We understand the “normal energy state” of the patient. According to the Huang Di Neijing, “Know the normal, then you know the abnormal”, it should then be easy to understand Bing Ji?

LX : Bing Ji is the result of the fight between, Zhen Qi, and a pathogenic factor. This pathogenic factor may be external (cold, heat, wind, dryness, humidity) and is called Xie Qi (邪气), or internal (often emotional) and causes imbalance or blockages of Qi or Xue (blood) at some level of the body. Bing Ji will manifest itself in symptoms. Sometimes, Xie Qi, (邪气) is very strong and can influence Qi Ji.

To appreciate the strength of Bing Ji, and where it is taking place, we use the 8 principles method of diagnosis, described in the next chapter.

Chapter 2 : Methods of diagnosis to appreciate the quality of the four substances, Zhen Qi, Qi Ji, and Bing Ji

C : How do you proceed to establish a diagnosis, to have a clear idea about what you call “the normal energy state” of a patient and his reaction as a “first doctor”?

First step: the resources

LX : In this first step we appreciate the quality of “the base”, or centre: Jing (精) and Yuan Qi (元气), and the quality of the middle: Zhen Qi Wei Qi (胃气).

Jing &Yuan Qi: the centre (base)

Jing &Yuan Qi belong to kidney, water, sexual activity, and govern Shen Qi (spirit). It cannot be in excess.

In case of deficiency, there will be a sensation of emptiness or cold in the abdomen, dry skin, thin hair, poor eye sight, painful or cold lower back, urinary frequency at night; for women a watery discharge, short periods with thin little blood; for men sexual deficiency.

If Jing Qi &Yuan Qi are low, they cannot control Qi and there will be watery eyes, or clear nasal discharge. Jing deficiency induces Shen Qi deficiency leading to poor memory, & poor concentration, sensitivity and irritability.

On examination, the abdomen feels empty with no “bounce” and it gives a sensation of cold. Sometimes, the flesh appears “hollow” on both sides of the ankles or in the hands (between thumb and index fingers).There is no “glow” on the face, the colour of the skin is dull. The tongue is thin, pale, soft, sinking with no strength to move. Coating is normal.

The pulse is tight, weak and thin.

To regulate Jing we use sweet, sour or salty herbs, and animal products. If the condition is not too cold, we use herbs like, Bajitian (巴戟天), Duzhong (杜仲), Tusizi (菟丝子), Roucong rong (肉苁蓉). If it is really cold, we use Fuzi (附子), Rougui (肉桂), Yingyanghuo (淫羊藿). In general, we nourrish by using the “wei”(味) aspect of the herbs using herbs which have more “wei (味)” than Qi (气), or using more dosage, a longer cooking time, dark colour, heavier products (see chapter: “treatment with herbal medicine”).

To regulate Yuan Qi, we use herbs like Renshen (人参), Zaoxintu (灶心土)

Zhen Qi (Wei Qi) (胃气): the middle

When we treat a patient, we mainly treat at the “Wei Qi” (Stomach Qi) level, the “current account” level. Wei Qi is related to Jing Qi, and to the “fighting Qi”. Every day, it provides nourishment to all the organs and channels. It is the main support of Zhen Qi. This is why we assimilate Wei Qi and Zhen Qi in our method of diagnosis to appreciate “the middle”.

Wei Qi (Zhen Qi) can be in a state of excess or deficiency.

If Wei Qi (Zhen Qi) is deficient, there will be: poor appetite, loose stools or diarrhoea, aversion to cold drinks or food, the tongue might be normal or “flabby” in case of a long term disease.

If Wei Qi (Zhen Qi) is in excess, there will be a strong appetite, constipation, gas, a desire for cold drinks, sometimes a bad smell in the mouth, or even an infection in the mouth or throat, which is a sign of “fire”, or pimples on the face. The tongue will have a thick dirty yellowish coating.

Pulse is also important when looking at Qi level. It appears weak when deficient, thin and tight when seriously deficient.

An impression of fullness in the abdomen can be found in both excess and deficiency.

To regulate Wei Qi, we use herbs which are slightly pungent (not too much) and bitter, “xiang” 香 (flavour) herbs, whose direction of action is not too much out and not too much down. We never use decoctions, dark, thick, or with a strong taste at Qi level.

In case of deficiency: use Baizhu (白术), Fuling (茯苓), Chenpi (陈皮). If really weak: Dangshen (党参), Huangqi (黄芪) Lian zi (莲子),

If cold (cannot drink cold water): Ganjiang (干姜), Shufuzi (熟附子). If there are loose stools, Lianzi (莲子), Biandou (扁豆).

In case of excess: if constipation, use Dafupi (大腹皮), Hou po (厚朴), and if thick coating and bad smell, use Dahuang (大黄). In case of general excessive heat, use Shigao (石膏), or Huashi (滑石), which, unlike what is usually believed, do not damage Wei Qi, as they have no taste.

To strengthen Zhen Qi we can also use moxa, hot compress, nei gong massage, meditation, and sleep.

Always check that the surface and the channels are open.

Channels have a transportation role and when we treat Pi (Spleen), we have to insure that transportation is possible. Make sure that hands and feet are not cold, and that perspiration is normal. If not, use herbs to open the surface or the channels (see next paragraph).

Note: hands and feet cold can be the result of either Yang Qi deficiency or blockage of the surface or channels. Check the pulse on the left side to appreciate Kidney Yin. If Jing is deficient (pulse tight, thin and weak), do not open strongly.

Second step: Qi Ji or the San Jiao

This is the “function” level to appreciate Qi ji.

The different functions of Zhen Qi can be assessed at three levels. The three levels allow us to understand how “the first doctor” is functioning. They provide us with three important pieces of information:

— how is Zhen Qi functioning (or how is Qi ji),

— what is the body’s reaction when Zhen Qi and Xie Qi (pathogenic factor) are struggling (Bing Ji) and where this is taking place,

— are the channels and the surface open or not.

The Huang Di Neijing says: “Jin cha bing ji zhi suo zai er tiao zhi 谨察病机之所在而调之” which means: “we have to make clear where Bing Ji is”. Looking at the three levels, is using a systematic way of diagnosis, to know where “Bing Ji” (or fight) is taking place (surface, channels, Fu organs, Zang organs), and in which direction it is going. If the direction is clear (up: sweating, fear of cold, or down: diarrhoea) it means that the resources are good, the channels are not seriously blocked and we just assist the process . If the direction is not clear, we have to provoke “Ji” by tonifying and opening out (if Bing Ji is at Qi level) or opening down (if Bing Ji is at xue level).

The three “San Jiao levels” manifest as:

— sweating, which reflects the surface level (Shang Jiao),

— bowel movement, which gives us information about the level of the Fu organs (Zhong Jiao: is the middle open or blocked?

— urination, which reflects the level of the Zang organs (Xia Jiao), the way Yuan Qi 元气 is moving in the San Jiao.

C : Can you elaborate upon these three levels? It seems that we look at it from a “biao-li” (表里) perspective (superficial, middle and deep levels) rather than a distinction between upper, middle and lower parts of the body with their corresponding organs?

LX : Yes, and this is one aspect of what we call “San Jiao”. But “Biao” is also Upper Jiao (lung), Middle Jiao (Stomach, liver, spleen) is more “li” and Lower Jiao (Kidney) is even more “li”. In this perspective, lung, stomach, liver, spleen and kidney are not seen as an anatomical structure but as a name for the different levels of the body‘s operative system (Biao or Li). (see Fig. 2 and 4)

To evaluate each level we ask very simple key questions:

Level 1 — Surface level (Shang Jiao) : is there sweating or not? Are the fingers and toes warm or not?

If there is no sweating, from a “Qi Ji” perspective, it means that the surface level is closed, or the resources of the function of sweating (blood, body fluids and jing) are not sufficient. From a “Bing Ji” perspective, it means that the pathogenic factor cannot go away from the surface, which is not open. We have to open the surface by using pungent, warm or cold herbs (zai qi) or slighty bitter herbs (zai xue).

Figure 2 : This illustration presents how San Jiao works from the deeper part of the body to the superficial part. (Li-Biao)

Figure 3 : The movement of Qi from the upper to the lower part of the body

Figure 4 : The movement of Zhen Qi in the six levels of the body

— if the person has a strong constitution (Jing Qi, 精气, Yuan Qi 元气, and Wei Qi 胃气 strong), use strong herbs like Mahuang (麻黄), Xixin (细辛),

— if the person has an average constitution, use Fangfeng (防风), Jingjie (荆芥)with a light wei, 味.

— if the person has a weak constitution, use Suye (苏叶), Huoxiang (藿香), Xiangru (香薷) whose xing 性 and wei, 味, are light

Another way to open the surface is to do exercises, use foot massage, cupping, gua sha (scraping), or jingluo massage.

If the fingers are cold, at this level it means that the surface is closed, but it may also be due to Kidney Yang deficiency. To find out, we refer to the first step of diagnosis and the evaluation of Jing and Yuan Qi.

C : What is your definition of sweating?

LX : “sweating” could be spontaneous sweating, night sweating, more or less sweating than usual for a particular person, more or less sweating than somebody else in the same situation. They all have different significations. It is a good symptom to assess the progress of a disease. At surface level we are not considering spontaneous or night sweating.

Level 2— Fu level (Zhong Jiao): is there constipation or not?

In case of constipation, from a “Qi ji” perspective, Fu level is closed, the middle is blocked.

From a “Bing Ji” perspective, the way down for Xie Qi to be evacuated is not open. If Bing Ji is at Qi or Xue level, we have to open this level, as it might be the best exit for Xie Qi. At this level, we do not consider the function of transformation, taking place in the middle, already assessed with “Zhen Qi”; we only consider the function of transportation via the Fu organs and the meridians and collaterals. But a blockage could be due to stomach Qi (Zhen Qi) deficiency.

— If the person is strong, use Dahuang (大黄), Houpo (厚朴), Da chengqi (大承气), Xiaochengqi (小承气).

— If the person is not so strong, use Houpo (厚朴), Dafupi (大腹皮), Baizhu (白术), Fuling (茯苓), Chenpi (陈皮).

— If the person is weak, with Qi deficiency, use Dang shen (党参), Dazao (大枣), Huangqi (黄芪).

— If the person is weak with Jing deficiency, use Bajitian (巴戟天), Roucongrong (肉苁蓉), Shudihuang (熟地黄), as their wei is strong, good at tonifying Jing.

To open at Fu level we can also use exercises, foot massage, jin luo massage

C : you said previously that we always have to ensure that the surface and the middle are open when we treat a patient. Do you mean that you systematically use herbs to that effect?

LX : We do not open the surface and Fu level only when a person is very deficient, because we need to gather the energy in first, and, in that case, to open the surface and Fu level, we can only use tonifying herbs. In any other case we have to open the surface and Fu level, to make a way out to Xie Qi, in whatever direction the “first doctor” (Qi Ji) wants to act. In the treatment of chronic cases, San Jiao is like a locked box; it is only when we open the lid that we can reach what has been locked inside (pathogenic factors), sometimes for many years! But one needs to have enough strength to open the lid!

Level 3— Zang level (Xia Jiao): How is urination?

From a “Qi Ji” perspective, urination is a reflection of Yuan Qi (strong enough or not), and San Jiao (open or not): this is what we call “Shui Dao” 水道 or “water metabolism”. At this level, we are deep in the body; there is a process of both transformation and transportation taking place (involving Yuan Qi, Zang organ’s function + deep meridians and collaterals). Zhen Qi splits into Wei Qi (defence energy) and Ying Qi (nourishing energy), and circulates in the whole body via the meridian system.

“Shui Dao” can be compared to a central heating system.Yuan Qi is the boiler in charge of heating the water (from food and Jin and Ye), transforming it into steam: “Shui Qi” 水气 (Essence of water or water Energy), and pumping it into the piping system of San Jiao (the surface, the channels and collaterals). The heating, transforming and pumping actions, are called “Qi Hua” 气化, which can be translated as: the transformation of water and food, from their original material form, into energy, ready to be used by the Zang –Fu, and distributed by the meridian system.The Huang Di Neijing says: “the essence of water (or food) in the stomach should be transported to the lung by the spleen and from the lung to the Shui Dao, all the channels and the whole body”.

This “central heating system” has another function: not only to nourish the whole body, but, by the movement of water-energy exchange (at, what we would call, “cell level” in western medicine), clear it of negative energy.

C : As a “central heating system”, could we say that San Jiao and Yuan Qi are also responsible for the regulation of body temperature? Like a good central heating system provides the optimum temperature for a comfortable environment?

LX : I cannot answer this question clearly. But we know that people with Yuan Qi deficiency have a low temperature. I can also recall several cases of patients with acute high fever which could not be controlled by Shigao or Huanglian, Huangqin or any western medicine and responded to Fuzi, Rougui, Wumei, Shengdi, Shudi, Renshen, all meant to gather and restore Yuan Qi.

C : San Jiao is sometimes called the “triple heater” and sometimes called “the triple warmer”; what does it mean?

LX : Chinese people do not use these expressions. We just call it “San Jiao”. The Huang Di Neijing says: “Shang Jiao Ru Wu, Zhong Jiao Ru Ou, Xia Jiao Ru Du” (上焦如雾、中焦如沤、下焦如渎) which means: “the Upper Jiao is like a fog (spread over the surface), Middle Jiao is like a fermentation pot, (food and water can be digested in it), Lower Jiao is like a drain (getting rid of dirty water via urination)”. San Jiao, from this perspective, is a unit, which gives three possible directions to Qi Ji: go up to the surface, gather in the middle, go down via bowel movement and urination, with the help of the meridian system, the surface (skin), digestive tract and urinary tract. But it is also a unit of, reception, heating, and transformation of Qi (the fermentation pot), with the help of the function of the Zang–Fu See fig. 3;

The expression “triple heater” might refer to the “Yang” part of San Jiao in charge of the reception of “raw” energies, the movements of Qi Ji and the transfer of Ying Qi and Wei Qi into the meridian system.The expression “triple warmer” might refer to the “Yin” aspect of San Jiao, the functions of heating and transforming Qi, with the help of the function of the Zang-Fu (fermentation pot).

But this distinction is not necessary. We just need to know that “San Jiao” is a unit covering, from the periphery to the centre, the whole function of the body: reception, heating and transforming Qi, transferring Ying Qi and Wei Qi to the meridian system, and getting rid of waste. This is “Shui Dao”, “The Way of water”. It is the body’s “factory”, where Zhen Qi is manufactured before being transferred to the meridian system as Ying Qi and Wei Qi. If the “factory” (San Jiao) is not open, no new energy can come in and no manufactured product or waste can come out. The factory cannot operate. These two aspects: communication with the outside, and transformation inside, have to be in good order. Our second step in the method of diagnosis enables us to see if San Jiao is in good order, and if not, where we can help it (surface, middle or urination).

C : Can you give me any practical applications of San Jiao seen as a unit?

LX : Let’s look at three ancient principles, as an application of San Jiao’s work:

Since water metabolism is linked to the surface by Fei Qi (lung qi), opening the surface is sometimes used to promote urination or vice versa.

In the Qing dynasty, The “Wen Bing Xue Shuo” (a medical school for treating diseases with high fever) stated: “Tong Yang bu zai wen, er zai li xiao bian 通阳不在温, 而在利小便. “Opening the Yang qi (of San Jiao), or the channels is not always achieved by the use of warm herbs, but also with herbs that promote urination”.

To treat water retention or oedema, another possibility is: “Ti hu jie gai 提壶揭盖” which means: “open the lid (Fei Qi, surface) to help the water out.” If you choose to open Fei Qi (surface), in order to open urination, use Mahuang (麻黄), Suye (苏叶), Xing ren (杏仁).

The Huang Di Neijing also says: “Da xiao bu li, ji zhe zhi qi biao”大小不利, 急则治其标 “if bowels and urination are not open, the most urgent is to open them”, “huan zhe zhi qi ben 缓则治其本” “if the condition is not an emergency, at a deeper level, treat the root”.

Sometimes, the patient has no difficulty with urination, but it looks as if Yang Qi is blocked, the metabolism is not good, with symptoms of cold limbs, a heavy feeling in the body, tiredness, and the use of tonifying medicine causes heat. We can, then, use the principle of Tong Yang bu zai wen, er zai li xiao bian 通阳不在温, 而在利小便, and prescribe Cheqiancao (车前草), Huashi (滑石), Fuling (茯苓), to promote urination and consequently open Yang Qi.

In practice, if there is a urination problem, first stimulate urination, then tonify kidney.

C : What about “Bing Ji” at this level?

LX : From a “Bing Ji” perspective, if the Zang organs’ function is disturbed, transformation and transportation will be disturbed and this will be reflected in the water metabolism and urination.

Urination is also a way out for dampness blocked in the channels and internal organs. Cystitis and kidney stones might be a manifestation.

C : Making sure that the inner channels (reflected by bowel movement and urination), and the surface are open seems to be the number one therapeutic principle?

LX : Yes, as discussed before. Only when Jing is deficient, we need to gather first and I would like to add: tonify the middle (stomach qi) and pacify Shen are also fundamental if required. If Shen is not stable, patients will have many “fake” symptoms that we do not need to address.

C : At this deeper level, the treatment needs a longer time to act than in the two previous levels, where changes appear within a few days of treatment.

LX : Yes because at this level we are dealing with a combination of factors and we have to “catch ji” (seize the right opportunity), and treat; this will clarify the situation, then we “catch ji” again, treat …and so on till we have reached the root of the problem! Of course, it can take some time!

Third step: Shen or the balance of Yin and Yang

C : We haven’t talked about Shen in the method of diagnosis! And it takes such a large place in the patient’s life! Is there a third step?

LX : Absolutely, and we are just coming to it. We’ll start again with Huang Di Neijing: “Tian Dan Xu Wu, Zhen Qi Cong Zhi, Jing Shen Nei Shou, Bing An Cong Lai”, 恬淡虚无, 真气从之, 精神内守, 病安从来, “if people lived in a happy, quiet, detached state, without excessive will power, Zhen Qi will follow it’s original course; if Jing and Shen are gathered and concentrated, diseases cannot develop”. So Shen is a “way of being”. Good harmonisation of the operations taking place in steps one and two depends on Shen and allows Qi Ji to move in the direction of Nature. In the books, it is called: Yin & Yang Ping Heng, the balance of Yin and Yang.

The simple question to ask is: how is the patient’s sleep?

(Difficulty falling asleep, waking up frequently, having vivid dreams, waking up early in the morning)

The balance of Yin & Yang is reflected in sleep and its quality. When the surface is open and the pathogenic factor gone, we can restore the balance of Yin & Yang, we can “rebuild”.

When somebody has difficulty falling asleep, it means that Yang Qi (or Shen Qi) cannot descend to the Yin-Xue level, either because Yin-Xue is deficient or Yang Qi is too strong (over worked, overuse of computer, long time habit of going to sleep late, too many thoughts). In this case: we have to start treatment by using minerals to lower Yang Qi: Muli (牡蛎), Huashi (滑石), Shengshigao (生石膏), Cishi (磁石).

Waking up early usually happens when one doesn’t have a solution for a problem perceived as important: Qi is under stress. The mind needs relaxing. So we use light and slightly sweet and sour herbs, Zhuye (竹叶) Zhuru (竹茹), Wumei (乌梅)

Vivid dreams means that the spirit is confused. The patient is doing too much, meeting too many people, thinking too much with no direction for his actions and thoughts. Use heavy stones, bitter, astringent strong herbs. Shengtieluo (生铁落), Zishiying (紫石英), Daizheshi (代赭石).

C : So, Shen and the balance of Yin and Yang are interdependent. If Yin and Yang are off balance, Shen will be disturbed and vice-versa? The quality of sleep is one way to appreciate Shen but what other ways do we have?

LX : If Yin and Yang are off balance, Shen will be disturbed, and vice-versa. Shen is the spiritual part of the body, the balance of Yin and Yang is just an indicator of the body’s function. There are many symptoms reflecting the state of Shen: nervousness, anxiety, depression, lack of concentration, being over sensitive, feeling easily scared… All these symptoms denote a disturbed Shen. But the feeling that the doctor senses from the patient’s Shen is probably the most important diagnosis factor. We shall discuss this in more detail in the chapter concerning Acupuncture.

C : We have talked about Jing, Qi, Shen, Zhen Qi, Qi Ji, what about Xing?

LX : Imagine that we are in a theatre, watching a play, with a fight at the centre of the play. Xing is the stage, Zhen Qi and Xie Qi are the two main actors (powers in presence). The symptoms are the performance which is taking place on stage (appearing on the body or Xing). On stage, things are constantly changing. You can choose only to look at each symptom happening on stage (Xing) and concentrate on the details of the performance, but you will then easily lose track of the general “plot”, the intention of the author, the situation of the play (in place and time), which is “Bing Ji”. If you grasp “Bing Ji”, you can then follow the mind of the author (“first doctor”) and predict the outcome. You should ask yourself these questions: where is the fight happening? what is the direction, the normal direction being Qi Ji? Does the patient have enough resources to follow the normal direction? This depends on Jing, Qi, Shen, and stomach Qi, the condition of the channels, the San Jiao. If the patient has a problem, the fight might develop in the wrong direction. Is this due to a lack of resources? If it is the case, we tonify and support the resources of the patient, which is quite easy. But diseases are seldom as simple as that! We have to find out if there is a pathogenic factor, fighting at which level: Qi, Xue, Channels, Zang or Fu organ? Then we follow the body’s direction by supporting the resources or inducing sweating, bowel movement, or urination. If there is no pathogenic factor, but just an imbalance of Qi or Xue, we can also help to readjust them. This is quite easy: we make sure that the resources are not deficient, and that the patient has good digestion, normal sweating, normal bowel movement, urination, and sleep.

C : Very interesting play indeed, and a good way to summarise the whole process of diagnosis! It shows clearly how one can concentrate on the details of the performance on stage (Xing) and use symptomatic treatment, or understand the dynamics of the play and act as a “director” in the traditional way of the old classics.

Now, what do “Body Fluids” (Jin and Ye) mean to you?

LX : The Body Fluids (津液) (Jin and Ye) belong to the Yin aspect of Jing and stomach Qi. It is not so important to discuss these terms in TCM physiology, as they are directly dependant on Jing and Stomach Qi.

Likewise, an ancient text says: “Jing Xue Tong Yuan, Gan Shen Tong Yuan” 精血同源, 肝肾同源 = “Jing and Xue are the same, Jing belongs to Shen (kidney), Xue belongs to Gan (liver)”.

For exemple, blood deficiency is not a basic problem, it is the result of either middle Qi (Zhong Jiao or stomach Qi) Xu or Xia Jiao Jing Xu (Jing deficiency), or a blockage in Zhong Jiao, or a blockage in the channels or the microcirculation. We have to find out what is the primary problem.

C : After the first three steps, we know what are the resources of the patient (strong or weak Jing Qi and Zhen Qi), where the fight with Xie Qi (if any) is taking place (surface, middle, Fu, Zang), and in which direction the “first doctor” wants to fight (upwards by sweating, downwards via bowel movements or urination). What do “the 8 principles” add to the picture?

Fourth step: The eight principles of diagnosis of disease

LX : Ba Gang Bian Zhen 八纲辨证, or the 8 principles of diagnosis of disease are:

1. Xu-Shi (deficiency-excess) 虚实

2. Han-Re (cold-warm) 寒热

3. Biao-Li (exterior-interior) 表里

4. Yin-Yang (zai qi-zai xue) 阴阳

This method of diagnosis enables us to find out more about Bing Ji: where it takes place (biao-li), if the fight is strong or weak (shi-xu) and if it belongs to Yang or Yin (zai qi, zai xue)

Is it a xu (deficiency) or shi (excess) condition? is there a fight or not? How strong is the fight?

Does it take place at Qi level (zai qi, surface, Yang) or blood level (zai xue, deep, Yin). With a common cold, a “zai qi” condition will be: sneezing, feeling cold, rhinitis, cough with or without phlegm, fever. A “Zai xue” condition will be: red skin, pimples, rash, swollen tonsils, pneumonia, fever.

Does it belong to biao (external disease) or li (internal disease). This covers two meanings: does “Bing Ji” belong to the exterior or interior (zai qi or zai xue), and is the fight heading towards the exterior or the interior (progression or potential of the disease). It does not care whether the pathogenic factor comes from the exterior or the interior, as the aggression might have happened in the past, sometimes a long time ago. The important thing is now, at this moment or during this period, where is the fight, and is the direction normal or abnormal?

Is the condition of a cold (han) or a warm (re) nature?

This is not so important. It is just another detail of the performance of “the play”, like turning the volume of the sound up or down. In most cases, the condition is cool and warm herbs are used. If Zhen Qi and Xie Qi (pathogenic factor) are both strong, the condition will often be hot, and we use cool herbs until the condition reverts to “Du” (balance). Cold herbs such as Shigao (石膏), are used only in cases of high fever

The identification of patterns according to the 8 principles was already discussed in Huang Di Neijing (黄帝内经) and in Shang Han Lun (伤寒论). It is the theoretical basis for all method of diagnosis and is applicable in every case. It helps us to simplify the various manifestations of disease to the relevant essentials.

C : Could you give us a clinical example to illustrate these three steps of diagnosis: evaluation of the resources (Jing, Yuan Qi and Zhen Qi), the three levels or “San Jiao” step and the eight principles?

LX : We could take the example of arthritis, commonly seen in practice:

Acute and chronic phases can transform into each other. They are two different aspects of one river.

In an acute phase with swollen, hot, red and painful joints, the problem appears local but it reflects the condition of the whole body and will affect the whole body. It is not so important to determine if the pathogenic factor “Xie Qi” is wind, heat, cold, dampness, or phlegm or if there is Qi or blood stagnation. To look at how the whole body works is a more direct approach. We evaluate Jing Qi and Zhen Qi (as described earlier on), then we find out if the condition is:

1. Xu or Shi (deficiency or excess): generally in an acute stage, it is a “shi” condition, but it can be xu. We look at how long the fight can be sustained. If there are already signs of “xu” (either stomach Xu or kidney Xu) we use 5% tonifying herbs: sweet or sour, and cool or warm.

2. Han or Re: in our example it is a “Re” condition. We use cool or cold herbs: in a zai qi situation, we use, Huashi (滑石), Shen Shigao (生石膏), Cishi (磁石); in a zai xue situation, we use Huanglian (黄连), Huangbai (黄柏), Dahuang (大黄).

3. Biao or Li: If there is constipation, a menstruation problem, if the joints are swollen, and the condition has been there for many years, it is “li”. If there is neck stiffness, rhinitis, aversion to cold, if the joints are stiff and a little painful: it is “biao”. In presence of both “biao” and “li” we first address “biao” (which usually represents at least 60%) Biao means that we have to open, and pungent herbs are essential.

4. zai qi or zai xue: it is more likely to be “zai xue” when joints are swollen. In a zai xue situation, we use bitter herbs.

In a chronic phase: we have sometimes a “shi” but mostly a “xu” condition. The other parameters would be more or less the same as in the acute stage, but the “fight” is not strong.

Treatment: we are in the presence of a “re”, “zai-xue” condition, so we use cool bitter herbs.

If it seems that “the first doctor” wants to open up onto the surface (symptoms of “biao”) we have to help him first with pungent herbs, herbal bath, Jing Luo massage. If one of the main symptoms is constipation, we open down, choosing herbs according to the state of Zhen Qi and Jing Qi. If the joints are very swollen and hot and there are general symptoms of heat in the body (fever, desire for cold drinks...), we use Shigao (石膏), Dahuang (大黄), Cishi (磁石), Huashi (滑石). If there are signs of “xu”, we use 5% tonifying herbs (to promote kidney or stomach Qi according to symptoms). In general, it is beneficial to use Baizhu (白术) and Fuling (茯苓) together with cold bitter herbs, to protect the stomach. In case of Jing deficiency, we use cool or warm tonifying herbs.

If the condition is han (cold), there is no fight, no serious pain, no swollen joints, it is a case of deficiency and we should provoke a fight by using tonifying herbs, but control the possible secondary manifestations.

C : The second, third and fourth steps of diagnosis (the San Jiao, Shen and the 8 principles), seem to overlap in practice, one adding more information to the other. Don’t we come back to the utmost importance of the 8 principles as a basis of all TCM diagnosis?

LX : The 8 principles constitute the best method of diagnosis to understand and treat Bing Ji. It is the best “software” when facing an abnormal situation. Any disease or imbalance can be clarified by this method, which is certainly the basis of all TCM diagnosis. It may seem very simple, but in practice, it is not so easy to make it clear.

Xu-shi (deficiency-excess) indicates how powerful Zhen Qi is, Han-re (cold-warm) tells us if, at a given moment, the condition of the patient is in excess or not.

Biao-li (exterior-interior) helps us decide if we are going to use more pungent or bitter, heavy or light herbs.

Yin-Yang: follows from the above principles: biao-re-shi belong to Yang, li-han-xu belong to Yin, but it is more important to pay attention to the “zai qi-zai xue: zai qi belongs to Yang, zai xue belongs to Yin.

C : Is it to simplify, or because you use a more direct approach, that you do not differenciate syndromes according to the theory of Zang-Fu? In other words, can we “simplify” (like a mathematical equation) the theory of Zang-Fu into the eight principles? Or do you consider that the theory of Zang-Fu leads to a “disease” based approach rather than an “energy state” approach?

LX : We can “simplify” the theory of Zang-Fu into the eight principles and the four substances. For example: liver yin xu comes from Jing xu; liver qi stagnation is the consequence of zhong jiao excess; liver fire comes either from heart fire or kidney fire, which comes back to Jing deficiency or a Shen being too strong. I think that Zang-Fu differentiation of syndromes is over rated in practice. In my opinion, it is not the best theory that TCM has to offer and it is not the best way to practice, because it leads to a “disease” based approach, easy to follow with a symptomatic treatment. Using the Zang-Fu differentiation of syndromes, we treat “isolated islands”; using the eight principles we have a comprehensive picture of the ocean and its underlying relief.

C : Do the Huang Di Neijing or the Shang Han Lun actually describe the Zang-Fu and their physiological functions in details?

LX : Yes, they describe the normal and abnormal functions of the Zang-Fu but did not invent the Zang-Fu Bian Zhen (differentiation of diseases according to the Zang-Fu). They pay more attention to Ji 机 (opportunity), Shi 势 (direction), Du 度 (proper manifestation, balance). The theory of Zang-Fu Bian Zhen comes from the Ming Dynasty.

Chapter 3 : More discussions about Bing Ji

C : I would like to go back to the notion of disease and its etiology.

LX : First, I would say that disease comes from a struggle between Zhen Qi (which is the reflection of our structure, essence, social interactions, state of mind, balance with our environment), and the pathogenic factors: the 6 evils (climatic factors) and the 7 emotions: Xie Qi and Qi Qing 七情.

— If Zhen Qi is strong and the pathogenic factor is strong, it creates a “shi” condition (excess); Bing ji is strong. We have to sedate.

— If Zhen Qi is strong and the pathogenic factor weak: the disease is mild. We wait and watch. Or, if necessary, we assist the action taking place according to the level where it is taking place, using, for example, cool, bitter or fragrant herbs.

— If Zhen Qi is weak and the pathogenic factor strong, this creates a serious condition of both xu (deficiency) and shi (excess); we have to tonify and at the same time open, control and sedate excess pathogenic factors.

— If Zhen Qi is weak and the pathogenic factor is weak: it creates a xu condition, with no fight. We have to provoke “ji”, create a crisis, in order to solve the problem and return to a normal state of “Du” (balance). The pathogenic factor will first manifest as an aggravation of the symptoms which we can then treat.

Next, I would like to emphasize the role of Shen in the cause of diseases:

The Huang Di Neijing says: “Shen bu shi (神不使), Shen you yu (神有余)”. If Shen is too weak, it cannot control the situation, Qi stagnates (Shen bu shi). If Shen is too strong, it is over controlling, Qi moves too fast and consumes Jing (Shen you yu). Negative thoughts aggravate a state of “shen you yu”.

In general, Shen bing (disease of Shen) induces Qi bing (disease of Qi) which in turn will induce Jing bing (disease of Jing). Serious diseases are due to Shen bing. They are difficult to treat. Shen could often be compared to an inadapted and saturated software filled with old family traumas, professional problems, emotional difficulties. This software is unsuitable and cannot circulate new information. It needs to be changed. Serious diseases occur when one cannot change the software. If Shen changes then Qi changes and one can recover a state of balance.

In all cases of cancer, the channels are blocked not only by a pathogenic factor but also by an overcontrolling and unbalanced Shen.

It is easy to tonify or open, but not easy to treat Shen (meditation, psychotherapy)

C : How do you regard acute or chronic disease?

LX : Differenciation between acute and chronic disease is misleading: we are changing constantly from an acute to a chronic stage and vice versa, as Yang transforms into Yin and Yin into Yang. When there is imbalance between Yin and Yang we may have an opportunity to act and bring the Qi back to a state of balance.

This is called “catching ji” (the chance of possible transformation). Using sedation or stimulation (according to the Yin-Yang state of the body) will enable Qi to move back to a state of balance (or Du).

Sometimes, Qi is in a state of “false” balance. The body gets used to it, and does not fight anymore to try to recover a real state of balance (like a crooked antalgic position adopted in low back pain). The “first doctor” has given up! It is then important to create “ji”, using very warm or very draining herbs, for example. This will uncover the problem, solve it and move Qi towards a new state of “real “balance. But it is difficult to “catch Ji”. One has to have a precise feeling and knowledge of the different levels. During the Shang Han Lun (伤寒论) period, doctors were very good at “catching ji”. This is reflected in the formulae created at that time.

TCM is as effective in the treatment of acute and chronic diseases. In an acute stage, the defensive Qi rises to the surface, while Yuan and Jing Qi stay deep inside the body. It is very easy to control.

C : Are you saying that, in order to recover a state of “shi (势)” (right direction of action) in chronic disease, we should “catch ji (机)” create an opportunity for treatment, provoke the fight, wake up the “first doctor”. Only then is the real problem revealed and the patient can be treated effectively?

LX : Yes. In chronic diseases, there is no fight because Zhen Qi is weak. Pathogenic factors stay in the body: maybe on the surface, maybe at blood level, maybe in the channels, or possibly in other parts of the body like the large back muscles, or deeper, in the internal organs (lungs, liver, stomach, or intestines). The patient will not feel any uncomfortable symptoms. But when Zhen Qi, improves with time, place, relationships, change of mind, food, medecines, etc., then there will be a fight between the old pathogenic factors and Zhen Qi, and symptoms will appear at the place where the pathogenic factors were blocked or in the direction of the fight.

For example, every year, there are many patients suffering from chronic bronchitis, with cough, phlegm, fever and a high level of white blood cells. This usually happens when their Zhen Qi is getting stronger. In TCM theory, it is the result of an uncompleted fight taking place. The doctor should: first, and most importantly, catch ji (机), take advantage of the new strength of Zhen Qi, help the fight towards completion and treat the root; second, follow the “Shi” (势), the direction taken by the fight: to the surface or down (bowel movement); third, control the reaction of the body, and keep the fight within an acceptable level. Fever, cough, phlegm, and sweating, are all side effects of the fight; it is a normal reaction, and it will disappear at the end of the fight. What we should not do is to stop all the reactions, suppress all the symptoms: this would give a wrong direction to the treatment, it would disturb the “Shi” and loose the ji (机). What we can do is control the reaction of the body, keep the fight under an acceptable level (Hua Shi and Shi gao are good to that effect); the first doctor is doing it’s job, the body has it’s own wisdom. We should respect it. We should just have a clear understanding of what is the “Shi”, the “Ji” and the “Du”.

In most chronic diseases, we need to create a chance, provoke the fight, wake up the “first doctor” by using warm, opening and activating herbs. When there is a fight, “Shi”, “Ji” and “Du” will be clear, then it’s easy to “move the pieces on the chessboard!”

This principle is commonly used in the treatment of chronic skin diseases and chronic infections of the muscles. Doctors will use “Fuzi 附子”, “Huangqi 黄芪”, “Dangshen 党参”, “Mahuang 麻黄” to create a fight. It is called: “Yin Zheng Zhuan Yang” (阴证转阳), which means: “help the Yin condition change into a Yang condition” (enough Qi and Xue, fighting symptoms are active and the direction of the fight is clear).

C : Another way to look at this is to observe “flu-like” symptoms. Are they due to “catching cold” recently, or can they reflect the reactivation of an old fight?

LX : Both are possible. It is interesting to note that many manifestations of “flu like symptoms” are not necessarily due to “catching cold” but could also be due to food stagnation, too much dampness or cold in the muscles, or any chronic disease when the “Xie Qi” is escaping from a “trapped inside” situation to a “moving out” situation, which is a good sign that Zhen Qi has improved or the channels are opening. Whether the problem comes from food, mind, inside or outside, when “the first doctor” is “activated”, he will manifest himself with flu like symptoms, if the direction leads to the surface.

“Catching cold” can be the manifestation of the beginning of any disease. Any disease will have a chance to fight at the surface level. In a chronic condition, to fight at the surface means that there is a chance to help the pathogenic factors trapped inside, get out. In “Wen Bing” 温病 theory, they say that when the heat is at Ying/Xue 营血 level, we should use herbs like “Qinghao 青蒿”, “Bohe 薄荷”, ”Suye 苏叶”, to help the heat leave the body through the surface. This principle is called: “Tou Re Zhuan Qi” (透热转气).

So, “Catching cold”, is sometimes the chance to “Catch Ji” in an unclear situation.

TCM treats the “normal state”, which should be communicating with outside. Open the surface is then the first step to treat a patient unless he suffers from serious kidney Jing or Qi deficiency or strong blockage in the middle (use Dahuang 大黄). All the herbs working at surface level are not necessarily used to treat Xie Qi (pathogenic factor) on the surface and help sweating, but can be used to open, as a first step to treat any disease; Chaihu (柴胡) is one of them.

Many books referring to “San Jiao” say that: sweating is to open San Jiao from the surface, and bowel movement is to open San Jiao from the middle. Urination is also to open San Jiao, but at Qi level; it connects to the surface and internal organs. Choosing the level where you want to open depends on the direction taken by the “first doctor”.

C : How do you recognise if a disease is serious or mild?

LX : The Huang Di Neijing talks about “Chang” 常, a normal reaction and “Ni” 逆, an abnormal reaction. A Chang situation will not be serious; a “Ni” situation will be much more difficult to treat and sometimes fatal.

If the direction of Bing Qi is following Qi Ji, it is what we call “Chang”, a normal reaction. For example, if after catching cold, the direction of Bing Qi is towards the surface, Zhen Qi is strong enough, the fight will follow “Chang”, and the disease will subside by itself.

If the direction of Bing Qi is not following Qi Ji, it is what we call “Ni” an abnormal reaction. For example a cold with bronchitis, or even, pyelonephritis and cystitis indicates that Xie Qi is in excess. The fight will not follow “Chang”, the disease will appear as a deficiency of Zhen Qi, when, in reality, it is an excess of Xie Qi. The doctor should find out what is the right direction (open the surface), treat at the suitable level to help evacuate the pathogenic factors and pay attention to the body resources: Jing and Qi. This is more difficult to treat and more serious.

Chapter 4 : Examination of the patient

C : We have seen that questioning the patient is fundamental to establish a diagnosis, according to the three steps and eight principles. What about examination of the patient. What is the most important: observation of the colour, palpation of the abdomen and of the channels, examination of the tongue, or pulse diagnosis?

LX : The most important thing, before you ask for details, is to have an idea of the patient’s condition. The patient comes in, complaining of unconfortable feelings and tells you about his symptoms and medical history; you are watching and listening, quiet and concentrated; you can then have a comprehensive feeling of “Shen 神, Qi 气, and Jing 精, of the fight between Zhen Qi 真气 and Xie Qi 邪气, and its direction”; you know if it is an uncompleted fight or a new one. When you have already sensed the situation, with your first impression, you can then confirm your diagnosis by using the four steps method of diagnosis, to ensure that your strategy and treatment will be more precise.

C : The Huang Di Neijing says: “Du qi se, cha qi mu, zhi qi san fu; yi qi xing, yin qi dong jing, zhi qi xie zheng” 睹其色, 察其目, 知其散复, 一其形, 因其动静, 知其邪正, which can be translated as “Watch the colour of the skin, watch the eyes, you will know if Qi is spread out or gathered; watch the body, if it is still or moving, you will recognise evil Qi and Zhen Qi”. Can you explain what it means?

LX : When you observe the patient’s face, you look at the colour and the glow of the skin, and you look at the eyes: do they shine or not?

The “glow” of the skin and eyes is very important: if it is good, the patient has “Shen”, the Qi is spread out, the problem is not severe: we are in a “Chang” situation. If the skin is dull without a glow, it is a long term problem, the reaction of Zhen Qi is not strong enough, the “Shen” is low and Qi is abdormally gathered. We are in a “Ni” situation. It is much more difficult to treat.

The colour of the skin gives more indications about Qi Ji and Xie Qi. White indicates cold, pain or Qi xu; dark blue means cold, pain, or blood stagnation; redish means heat or Qi shi (excess); black means cold, water retention or Qi moving slowly; yellow means Qi xu, Spleen or Stomach xu (deficiency).

If the colour looks as if concentrated in one spot, Qi is gathered, in the corresponding area. I have observed that when there is a dark spot in between the eyes, there is a heart problem (angina); if the tip of the nose is dark, there is cold in the stomach; dark rings under the eyes mean Jing deficiency or liver and kidney channels are tight; a child with a pale face and no glow is usually suffering from spleen or kidney deficiency; a child with blue rings under the eyes and in between the eyes is usually very sensitive, scared at night with a weak Shen. Nowadays, people who use computers all the time will first appear with a very shiny face, which means that Shen and Jing are going out, then with a dark and dry face, which means Jing deficiency.

If the colour of the palms of the hands is yellowish and dull, it indicates Jing deficiency.

If the muscles are tight, Qi is strongly gathered but the inner channels are not well open.

If the patient does not move and has a withdrawn posture, Zhen Qi is probably deficient and Shen low. If he is agitated, it is more likely to be due to heat in the internal organs or to the presence of Xie Qi. These are good examples illustrating what the Huang Di Neijing wanted to say, but, in your opinion, the general feeling emanating from a person is more important than the detailed description of the colour of the skin or eyes.

LX : Yes, It is a “shortcut” based on experience but it is of course the result of a detailed observation!

C : Can you say something about tongue diagnosis?

LX : Tongue is a very good observation tool: it is a mirror of the body’s condition and not necessarily the pathogenic factors. It is a good reflection of a “xu or shi” condition rather than a “han or re” condition.

In general, the tongue’s shape is the mirror of the internal organs and the deep level of the body (xue level). If the tongue is weak and small, it reflects deficiency, or overgathered resources; if it is quite big, as if immersed in water for a long time, it looks pale and slightly swollen (teeth marks), it means water retention: most of the time it corresponds to Yang deficiency, but sometimes to Qi stagnation or Jing deficiency; it is the picture of “emptiness”, ungathered resources. When the tongue appears weak, then the internal organs and the deep muscles might be in the same state.

The coating of the tongue reflects the recent condition of Qi Ji: if the coating is thick, it means that Qi is blocked; it might be due to a dysfunction of the stomach, or the presence of cold blocking the surface and also blocking the circulation of San Jiao. The circulation of San Jiao may also be blocked due to Qi deficiency. So, when you see a heavy coating, it only means that San Jiao’s circulation is blocked. Further examination of the patient will reveal why. It is not necessarily due to heat, cold or a stomach problem. It does not always reflect the presence of a pathogenic factor.

C : But I thought that the colour and the thickness of the coating were a good indication of the presence of a pathogenic factor: thick and white indicates cold, thick and yellow indicates heat, thick and black indicates extreme cold or heat depending on whether the tongue is wet or not.

LX : The tongue reflects the condition of the body and the way it functions: the Qi Ji. The shape of the tongue indicates the basic condition of the body; the coating indicates recent changes in Qi ji. Never try to diagnose pathogenic factors by just looking at the tongue.

C : This is something to remember! And last, but not least, pulse diagnosis.

LX : When examining the pulse, we should bear in mind the three levels of the pulse (Tian, Di and Ren) 天、地、人 and the two principles (Du-Ji 度-机, and Xiang Yin 相应).

The three levels:

1. Tian = heaven, it varies according to time, and in particular the four seasons, or the day and night cycle. It is important to appreciate if the patient’s pulse is following the right time and the right season. It might be the first thing to correct. In Huang Di Neijing it is written “Mai de si shi zhi shun, yue bing wu ta; mai fan si shi, yue nan yi.” 脉得四时之顺, 曰病无他; 脉反四时, 曰难已. = “If the pulse follows the four seasons, in case of disease, it is not a problem; if the pulse does not follow the four seasons, (in case of disease) it cannot recover”.

• In spring time, the pulse should be long and soft;

• in summer time, it should be like a fish floating at the surface of the water, with the feeling of being open;

• in autumn, it is sinking in;

• in winter, it should be deep, and give a feeling of gathering.

In the day time, it is more superficial than at night.

2. Di = earth, it varies according to the place: for example, people from the South of China will have a soft and fast pulse, while people from the North will have a strong and deep pulse.

3. Ren = people. There are two states at this level;

• In a healthy state, the pulse will vary according to gender, age and constitution. Women have a deeper pulse than men; older people have a weaker pulse than the young; an overweight person has a slow, deep and strong pulse (like a “winter pulse”), a thin one has a fast, floating and light pulse (like a “summer pulse”).

• In a state of disease, the pulse should be in tune with the type of disease (Chang 常). For example, if one catches a cold or fever, the pulse should be floating and strong: this is a normal reaction as the Qi goes up and out to the surface. If it is weak and deep it is an abnormal reaction (Shi Chang 失常 or Ni 逆), and the disease is more serious. In case of diarrhoea, the pulse should be deep and weak as the Qi goes down and out (Chang 常). If the pulse is strong and superficial, it means that Yang Qi is going out and the essence is lost: the person will be in danger (Shi Chang 失常, or Ni 逆).

The two principles:

1. The first principle is: Ji 机-Du 度

Ji 机 is in relation with time and space: now, where and what; it means that it should be as expected at a particular time or in a particular relationship.

Du 度 is what is actually taking place in a particular situation (or relationship); it should be balanced, not too strong, not too weak, not too much and not too little.

For example: we are in a room discussing TCM; if the teacher is talking and the student listening, there is Ji, but if the student is giving the lecture or if the teacher talks about cooking we loose Ji, or if the teacher talks too much, or not enough, we loose Du.

2. The second principle is: Xiang Yin 相应

If in a special Ji 机, there is proper Du 度, then we have Xiang Ying 相应, or harmony, coordination. For example if one catches a cold and the pulse is floating and strong, there is “Xiang Ying”. Or, as we mentioned above, if an overweight person has a slow, deep and strong pulse (like a “winter pulse), this is Xiang Ying.

C : In practice, when taking the pulse, do you feel it as a whole? Do you pay attention to each location of the pulse (the 12 pulses), each one giving you information about the energy state of the corresponding organ?

LX : The pulse needs to be interpreted dynamically rather than mechanically.

Feeling the pulse is like listening to a musical concert, we should be able to appreciate what is in harmony, what is not, how Qi is flowing, what is the relationship between Yin and Yang. Every one has his own normal state, and is changing constantly: Zhen Qi and Xie Qi fight, and in this “Ji” there is “Xiang Ying” or not (“bu xiang ying”).

The diagnostic approach consists of knowing what the normal state of a patient (point zero) is and then appreciating how the actual state differs from it: “zhi chang da bian” 知常达变.

It is more important to appreciate the pulse globally than at each location:

— is it strong or weak, this will indicate if a fight is happening or not, or if Zhen Qi is strong or not,

— is it superficial or deep, this will indicate if the fight is taking place at the surface level or not, and will also show the direction of the fight,

— is it tight or relaxed, this will indicate if the fight is strong or not, if the resources are enough or not and if the channels are blocked or not. It is important to remember that in general, if the right side is tight, it means that there is cold or Zhen Qi is in a state of deficiency. If the left side is tight, it means that Jing Qi is deficient,

— is it fast or slow, sometimes it indicates if it is a warm or cold condition.

Taking the pulse, one should always think of these three aspects: Tian-Di-Ren, Ji-Du, global examination of the pulse. But pulse examination is only one tool; it is not everything in the diagnosis process. Symptoms, and observation of the patient can give us a feeling of the patient’s condition and the pulse examination will then add more information. We should always combine the four methods of examination techniques: questionning, listening, observation, and palpation to reach the right conclusion.

C : So, Li Xin, how do you “feel” a patient, what do you rely on? In the clinic, it looks as though “you know” more or less right away what’s going on, as soon as the patient comes in!

LX : I feel and examine the patient in four steps.

When the patient comes in, before he says anything about his symptoms, I have already a feeling of his basic condition. I feel if the Shen 神 is stable or not, if the Jing 精 is strong enough, and if Qi Ji 气机 is in a normal condition, if it is following the direction of Bing Ji or not. Then I feel if there is Xie Qi 邪气: cold, dampness, blood stagnation, food stagnation, fire… and where it stays: inside or outside at surface level.

Then I start asking questions and watch his appearance, his response, the state of his spirit. I talk with the patient to confirm my feeling about his She 神 and Jing 精. I ask him about his sleep, appetite, sweating, bowel movement and urination, which will give me information about QiJi 气机 and Bing Ji .

I ask questions about the history of the disease: all the symptoms and feelings will help reconstruct the story like following a river from the source, observing the force of the current, the changes of direction, the progression of the fight.

This will take us to the present situation: how are the resources, are they strong enough to continue fighting? Are the channels open or not, what kind of pathogenic factor is fighting? This will determine the strategy of the treatment: open or gather, tonify or sedate, open the channels at which level? And according to the pathogenic factor: induce sweating (if cold), sweating and urination (if dampness), diarrhoea (if damp-heat or food stagnation).

To be able to “know” at different levels (feeling, examination, questioning), one needs practice, not only in the clinic but within oneself. It is important to “clean” oneself well enough to become a mirror of what is happening and then everything will appear clearly. Meditation is the key to clarity.

Summary of the first part

C : To sum up this first part on the theory of TCM, we could say that we talked about:

1. How to understand the normal energy state of a patient, and appreciate the four substances: (Xing 形, Qi 气, Shen 神 and Jing 精), Zhen Qi 真气 and Qi Ji 气机 with the first (resources) and second (San Jiao) steps of diagnosis.

2. What is taking place in the presence of a pathogenic factor, and how to appreciate Xie Qi 邪气 and Bing Ji with the second (San jiao 三焦), and third (Shen 神) steps of diagnosis and the eight principles.

3. How to, examine a patient, feel the pulse, and feel “the atmosphere”.

You also gave us a few “tips” about how to tackle the difficulties of treatment. Before we go on in detail with herbal treatment and acupuncture in the next parts of the book, what are the main general principles of treatment, in TCM, that every practitioner should definitely keep in mind?

LX : Some of my favourite quotes are:

— “Ding Qi Shen 定其神, Shen Qi Shi 审其势”, “Wo Qi Du 握其度”, “Li Qi Xing 利其行”, “Gu Qi Ben 固其本” = “help the spirit to stay stable” “help the first doctor and follow the direction that he wants to take”, “Help control the reaction of the body, keep the fight at an acceptable level”, “help speed up the fight”, “Strengthen the root” (at least 5% to 8%).

— “Tong Yin Tong Yong 通因通用” = if the body wants to open, we have to open (ex: use Dahuang 大黄in case of diarrhoea, when there is a blockage in the middle and the direction is to open from the middle)

— “Se Yin Se Yong 塞因塞用” = if there is blockage (like constipation) because of deficiency of middle Qi or Jing, we use tonifying methods.

— “Qi Zai Biao Zhe, Han Er Fa Zhi 其在表者, 汗而发之” = if evil is at the surface level, and the right direction of the fight is opening up, it will disappear by sweating

— “Qi Zai Li Zhe, Gong Er Xia Zhi” 其在里者, 攻而下之 = if Bing Ji is inside, we have to open down vigourously.

— “Da xiao bu li, ji zhe zhi qi biao, 大小不利, 急治其标” = if bowels and urination are not open, the emergency is first to open them, “huan zhe zhi qi ben 缓则治其本” = at a deeper level, treat the root.

— “Biao Jie Li Zi He 表解里自和” = if you open the surface, the interior will automatically open.

— If the condition lies in both biao and li, in general, address biao first (but biao and li are just the two sides of a coin).

— “Li Jie Biao Zi He 里解表自和”= if you open the interior, the surface will automatically clear up.

— “Fu Di Chou Xin 釜底抽薪”= If there is not enough water in the pot, take off wood (fire), (for ex: induce diarrhoea in case of high fever due to a blockage in the intestine, food stagnation, heat, and dampness).

— Wei bu he ze wo bu an 胃不和则卧不安 = if the middle is not good, shen and sleep are not good.

— Yin Re Xia Xing 引热下行, If there is fire inside with a strong blockage, do not open the surface too much, it will increase the manifestation of fire, but open down via urination or bowel movement (follow the principle: “Li Jie Biao Zi He”).

C : They all talk about direction?

LX : Yes, acting in the right direction is the key to success! Herbs should be used according to their qualities (qi气, or wei 味) which give the direction of their action; needles will guide energy in one direction or another. It is more important to pay attention to the direction of the disease than individual symptoms.

TREATMENT WITH HERBS

Chapter 1 : History and fundamental classic books of herbal medicine

C : Shall we start with some historical background? Which books do you consider the main fundamental classics discussing herbal medicine?

LX : There are three fundamental classics discussing herbal medicine:

— The Huang Di Neijing 黄帝内经, (Yellow emperor’s Inner Classic), in two parts: the Su Wen 素问, (Basic Questions) and the Ling Shu 灵枢, (Spiritual Axis)

— The Shennong Ben Cao Jing 神农本草经, (Shennong‘s classic of herbal medicine)

— The Shang Han Za Bing Lun 伤寒杂病论, (Discussion of Cold induced Disorders and Miscellaneous Diseases), in two parts: Shang Han Lun 伤寒论, (Discussion of Cold induced Disorders) and Jin Gui Yao Lue 金匮要略, (Synopsis of prescriptions of the golden chamber).

But we can also add two interesting small books: “Pi Wei Lun” 脾胃论 (Treatise of the spleen and stomach) and “Wei Bing Tiao Bian” 温病条辨 (differentiation of treatment of febrile diseases).

C : Shennong 神农, and Huang Di 黄帝, were two emperors, considered to embody the early memories of ancient China. As often in Chinese stories, historical facts and legends intermingle. From what I have read and heard, Shennong and Huang Di appear to be mythical figures and we don’t really know who wrote their books. They could be a compilation written by a few different doctors.

According to the legend, Shennong was the Emperor of the Yans who lived near the Yellow River. One day, a Phoenix was flying over the country and dropped a plant with nine ears. Shennong picked it up and planted it. It grew a beautiful fruit and everyone who ate it became much stronger. So Shennong started cultivating the plant and it was called “cereal”. This is how the Yan Emperor changed his name to “Shennong” which means “the Great Cultivator”. He was very famous for his contribution to agriculture and medicine but we cannot find anything written about him in historical archives. His book might well be a compilation of several works from Doctors of Qin and Han dynasties.

LX : Yes, this is true and explains why these very ancient books are sometimes quite obscure, and written in an allegoric way difficult to decrypt!

On the other hand, Shang Han Lun 伤寒论, is a practical handbook written after Huang Di Neijing 黄帝内经, and Shennong Ben Cao Jing 神农本草经. It is written in a comprehensible way like a “recipe book”.

C : Could you first tell us more about the famous Huang Di Neijing?

LX : The Huang Di Neijing is a dialogue between the emperor Huang Di and his personal doctors: Qi Bo, Lei Gong, and others, written in the late Qin, Han Dynasties (1st or 2nd century AD).

It has two main parts: the Su Wen and the Ling Shu.

The Su Wen (Basic Questions) was edited by Dr Wang Bing during the Tang Dynasty. Before that time, it was kept secret and only passed on from masters to very special disciples. It talks about TCM physiology, the normal energy state of the body and how ancient people used to live according to Nature and in harmony with their surroundings. It also discussed how the body reacts when a pathological factor is attacking, pulse feeling, and treatment principles of herbal medicine and acupuncture.

The Ling Shu (Spiritual Axis) was lost until the Song Dynasty, when Shi Song 史菘 rediscovered the book which had been in his family ever since the Han Dynasty! He then passed it on to the medical profession. It has 81 chapters mostly about acupuncture points and channels, and talks about diseases and their treatment with acupuncture. (For more details on Huang Di Neijing, Ling Shu, see annexe 2).

C : What does he say about herbal treatment? Did anything in particular influence your way of thinking?

LX : In Su Wen, chapter 5, Huang Di Neijing describes the properties of herbs, their “qi” (气) and their “wei” (味), how these properties determine the direction of their action and their relation to Yin and Yang. Briefly, “qi” (气) is the nature of the herb: cold, hot, cool, or warm; wei (味) is its taste: sour, bitter, sweet, pungent, or salty. The properties of a herb are based on its wei (味). Its ability to tonify, sedate, go upward, downward, gather or open, depends on proper concentration of wei (味).

As I said before, for me, this is fundamental, the secret key to a good herbal prescription.

C : I know very little about the emperor Shennong’s work. What is special about his teaching?

LX : According to the legend, Shennong was the first Emperor to develop and write about agriculture, animal farming, and medicine.

He probably lived before the emperor Huang Di, but it is not very sure! The book “Shen Nong Ben Cao Jing” is dated from 206-23 BC.

The legend tells us about the origins of TCM, how it was discovered and tested. This information did not derive from trial and error in an attempt to survive but from Shennong’s personal experiments with the herbs, tasted one by one. The story says that he could taste up to 70 in one day! The Emperor Shennong had the ability to feel and describe their effect on himself, their “qi” and their “wei” .He tasted a great number of them; the legend talks about “Shennong Chang Bai Cao” (神农尝百草) = “Shennong taste of 100 herbs”.

But what is most interesting in this book is the classification of the herbs. It divided 305 herbs into three categories: “Shang Yao” 上药 (medicine of above), “Zhong Yao” 中药 (medicine of the middle) and “Xia Yao” 下药 (medicine of below).

The “Shang Yao”上药 herbs were also considered to be the “Jun” 君 or “king” medicines; the “Zhong Yao” 中药, the “Cheng” 臣 or “minister” medicines; and the “Xia Yao” 下药, the “Zuo” 佐 and “Shi” 使 or “assistant “and “messenger” medicines .The “king, minister, assistant and messenger herbs” 君臣佐使 metaphor is different from the one used in modern books. At various times in the history of TCM these metaphors were used in accordance with Confucian principles interpreted in different ways. Every herb in Shennong’s classification can be a “king” or an “assistant” in different prescriptions.

The interest in this particular classification is that it gives us a clear understanding of how safe is a particular herb, of how long we can prescribe it, of any side effects and the direction of its action. It is simple and does not give too many indications for each herb. It remains very accurate in its indications.

C : Can you give us a description of the 3 categories of herbs?

LX : First, the Shang Yao 上药 group. It consists of 120 Jun Yao 君药 (“king herbs”) and their characteristics are:

“Zhu yang ming yi ying Tian” 主养命以应天, = “in charge of nourishing life, follow heaven Qi”

“Wu du. Duo fu, jiu fu, bu shang ren” 无毒, 多服久服不伤人, = “not poisonous. Can be taken in large doses, for a long time without harming people”

“Yu qing shen yi qi, bu lao yan nian zhe, ben shang jing” 欲轻身益气不老延年者, 本上经 = “if you want to clear the body and tonify Qi, have an anti-aging effect and give longevity, use these 120 herbs.”

It is important to remember that “Shang Ping” 上药 is related to “yang ming” 养命 (preserve life). Ming also means the essence of life. It always has a supporting action, and can be taken for a long time. In this category we find herbs which have more qi or wei, depending on the herb, but are not too strong. Mostly, they gather and restore Essence, even if they can open at some level, the basic function is to gather and keep. I consider the most useful ones to be:

Ba ji tian 巴戟天, Bai ji li 白蒺藜, Bai zhu 白术, Cang zhu 苍术, Chang pu 菖蒲, Da zao 大枣, Dan shen 丹参, Di fu zi 地肤子, Di huang 地黄, Dong guo ren 冬瓜仁, Du zhong 杜仲, E jiao 阿胶, Fang feng 防风, Fuling 茯苓, Gan cao 甘草, Gou qi zi 枸杞子, Gui ban 龟板, Hua shi 滑石, Huang lian 黄连, Huang qi 黄芪, Hong jin tian 红景天, Ju hua 菊花, Jue ming zi 决明子, Lin zhi 灵芝, Long dan cao 龙胆草, Long gu 龙骨, Luo bu 萝卜, Mai dong 麦冬, Mang xiao 芒硝, Muli 牡蛎, Niuxi 牛膝, Nu zhen zi 女贞子, Ou jie 藕节, Pu huang 蒲黄, Ren shen 人参, Rou rong cong 肉苁蓉, Sang ji sheng 桑寄生, Sang piao xiao 桑螵蛸, Sha shen 沙参, Shan yao 山药, She xiang 麝香, Shi hu 石斛, Suan zao ren 酸枣仁, Tian dong 天冬, Tian ma 天麻, Tu shi zi 菟丝子, Wu wei zi 五味子, Xi xin 细辛, Yin chen 茵陈, Yi yi ren 薏苡仁, Yu zhu 玉竹, Ze xie 泽泻, Zhi shi ying 紫石英…

Then, the Zhong Yao group: it consists of 120 Cheng Yao 臣药 (“minister herbs”), with the following characteristics:

“Zhu Yang Xing Yi Ying Ren; Wu Du You Du; Zhen Zhuo Qi Yi” 主养性以应人, 无毒, 有毒, 斟酌其宜, = “In charge of nourishing the constitution, follow the people’s nature; can be poisonous or not poisonous; use them if necessary.

“Yu E Bing Bu Xu Lei Zhe, Beng Zhong Jing” 欲遏病补虚羸者, 本中经 = “to control the disease, to tonify serious deficiency, use the Zhong herbs”

Zhong Ping is related to Yang Xing 养性 (the people’s nature). We use the herbs of this category to balance the energies of the person, only if it is necessary. Their “qi & wei “are stronger than in the “Shang Yao” 上药 group. They mostly open at different levels. The basic function is to sedate and move. In this group we find:

Bai mao gen 白茅根, Bai he百合, Bai zhi 白芷, Bai xuan pi 白鲜皮, Bei mu 贝母, Bi xie 萆薢, Bie jia 鳖甲, Chai hu 柴胡, Ci shi 磁石, Danggui 当归, Di yu 地榆, Fang ji 防己, Ge gen 葛根, Gao ben 藁本, Gan jiang 干姜, Gou qi zi 枸杞子, Gua lou 栝楼, Hai zao 海藻, He tao ren 核桃仁, Hou po 厚朴, Huang bai 黄柏, Huang qin 黄芩, Kuan dong hua 款冬花, Ku shen 苦参, Ling yang jiao 羚羊角, Long yan 龙眼, Lu rong 鹿茸, Ma huang 麻黄, Mu dan pi 牡丹皮, Qing jiao 秦艽, Qing pi 青皮, Qu mai 瞿麦, Sang bai pi 桑白皮, Shan zhu yu 山茱萸, Shao yao 芍药, Chuan xiong 川芎, Shi gao 石膏, Shu jiao 蜀椒, Tong cao 通草, Wu jia pi 五加皮, Wu mei 乌梅, Wu zhu yu 吴茱萸, Xing ren 杏仁, Xuan shen 玄参, Yang qi shi 阳起石, Yin yang huo 淫羊霍, Ze lan 泽兰, Zi yuan 紫苑, Zhi mu 知母, Zhi shi 枳实, Zhi zi 栀子, Zhu ling 猪苓,

Finally, the “Xia Yao” group: it consists of 125 “Zuo”佐 and “Shi Yao” 使药 (assistant and messenger) herbs, which are:

“Zhu Zhi Bing Yi Ying Di, Duo Du, Bu Ke Jiu Fu” 主治病以应地, 多毒, 不可久服 = “used for the treatment of disease, follow the earth, mostly poisonous (strong qi and wei), cannot be taken for a long time”.

“Yu Chu Han Re Xie Qi, Po Ji Ju Yu Ji Zhe, Ben Xia Jing” 欲除寒热邪气、破积聚、愈疾者, 本下经 = “if you want to dispel cold and hot evil Qi, remove and open the blockages (zai xing 在形, zai xue 在血, at deep level), cure the disease, follow the xia jing”.

Xia Yao is related to Zhi Bing which means attack the disease.

The herbs are poisonous, act quickly to kill the disease but also attack the body. They should not be taken for a long time. They are much stronger than in the two previous categories.

Examples of this group are:

Bai tou rong 白头翁, Bai ji 白芨, Ban xia 半夏, Bian xu 扁蓄, Da huang 大黄, Da yan 大盐 (salt), Dai zhe shi 代赭石, Fu zi 附子, Jie geng 桔梗, Lian qiao 连翘, Sheng tie luo 生铁落 (iron), Shui zhi 水蛭 (leech insect), Tian xiong 天雄, Ting li zi 葶苈子, Wu gong 蜈蚣, Wu ling zhi 五灵脂, Wu tou 乌头, Xia ku cao 夏枯草.

C : It is indeed very interesting and also surprising to find some of the herbs in an unexpected category! I am thinking of Long dan cao 龙胆草, and Xi xin 细辛, which I would have never thought could belong to the safe, long term herbs of the Shang ping category; or Ban xia 半夏, and Jie geng 桔梗 being so poisonous! Do you believe it is still reliable?

LX : The Emperor Shennong‘s classification of herbs follows a Taoist way of thinking based on Shen and Qi.

“Shang Yao” herbs give a feeling of stability of Shen and Qi. We find many stones, and herbs to nourish Jing, in this category. They are meant to bring the person back to a normal basic state, to keep Jing and Shen stable.

“Zhong Yao” herbs regulate Qi and Xue at Qi and Xue level, tonify or sedate Bing Ji, follow the direction of Qi ji. It is the level of regulation.

“Xia Yao”herbs change the direction of Qi Ji, attack pathogenic factors. It treats at the “substantial level” and stirs up a real “revolution”. It acts powerfully and fast, but has toxic side effects.

This might be the reason why we find some of the herbs in an unexpected category? I don’t know.

I would still describe the herbs I have tasted as the Emperor Shennong did! For example, Mai men dong is, nowadays, considered to be “slightly cold” in nature. Shen Long describes it as “warm”. Tasting it, I also feel that it has a warm nature.

Nowadays, doctors use herbs not according to their taste and nature (wei and qi), but according to their function: dispel cold, heat, or toxins, help urination or bowel movement, relieve cough, or move blood...

In ancient times, doctors did not practice like today. They watched Qi. They knew what the normal Qi movement (Qi Ji-气机) should be, and found out where the abnormal Qi movement (Bing Ji-病机) was taking place. Their diagnosis and treatment strategy was based on: deficiency or excess, upwards or downwards, gather or open, at Qi or Xue level… So, for them, it was important to know if a herb was heavy or light, would keep or move, go up or down, gather or open, act at the surface or at deep level, was warm or cold. These properties are expressed by the qi and the wei, and the dosage of each herb.

Shennong ben cao jing (神农本草经) tells us: 凡欲治病, 先察其源, 先候病机. 五脏未虚, 六腑未竭, 血脉未乱, 精神未散, 服药必活. 若病已成, 可得半愈. 病势已过, 命将难全.

“When treating a patient, first find out what is the basic condition, and watch Bing Ji . If the five Zang and six Fu are not seriously deficient, the channels are not seriously imbalanced, the Jing and Shen are not scattered, and with a proper medical treatment the patient should be saved. If the disease has penetrated deeply, became a part of the body and spirit, it might be cured in 50% of cases. If the “Shi” of the disease is lost, it is very difficult to treat, the patient may die.”

C : What does “the Shi of the disease is lost” mean?

LX : Shi(势), means the actual situation of the patient, and the direction taken by the fight between Zhen Qi 真气, and Xie Qi 邪气. When we talk about the “Shi” of a disease being lost, it means that the resources for the fight are gone (Jing, Qi, Shen 精气神), the patient is not in a condition to recover and the doctor has little latitude and time to do anything to help.

C : And now, Shang Han Za Bing Lun!

LX : Shang Han Za Bing Lun was written by Dr Zhang Zhong Jing in the later Han Dynasty. It consists of two books: Shang Han Lun 伤寒论, which describes external diseases, and Jin Gui Yao Lue 金匮要略, (Synopsis of prescriptions of the golden chamber) which describes internally generated diseases.

Dr Zhang Zhong Jing‘s ability to use the “qi and wei” of the herbs according to the level of the disease (Qi, Xue, Jing) was particularly remarkable.

He lived in the Northern part of China (Henan Province) and the famous Shang Han Lun, which means “Discussion of Cold induced Disorders”, describes the six stages of penetration of cold diseases in the body.

The six stages are: Tai yang-Yang ming-Shao yang (Yang aspect), Tai yin-Shao yin-Jue yin (Yin aspect). If the disease stays in the three Yang levels, it means that Zhen Qi is not deficient, pathogenic factors are at the surface and Yang level, the fight and reaction of the body is positive. If it penetrates in the three Yin levels, it means that Zhen Qi is deficient, pathogenic factors are deep in the Yin level, and the fight and reaction of the body are weak. Different patients react with different symptoms, so Dr Zhang used the Tai Yang-Yang ming-Shao yang and Tai yin-Shao yin-Jue yin’s classification to make a clear diagnosis, at each stage of the disease adjusting Shi 势 (direction), Ji 机(opportunity, chance), and Du 度(balance), with appropriate qi, wei and dosage of the herbs.

Shang Han Lun is a very practical and clear book compared to the Huang Di Neijing which is more allegoric. It tells us exactly what to do, when and how to do it, with precise instructions* (see annexe 3 for more details). If you read and learn Shang Han Lun, you will have a clear understanding of the different levels of penetration of diseases and how the body reacts. If you also understand the “qi and wei” of the herbs, then you will be able to understand clearly every other doctors ‘ideas, with a sort of “shortcut” to their way of thinking and prescriptions. Most of the famous written prescriptions come from personal experience, but if you understand Shang Han Lun you will immediately recognise the logic behind them.

C : You also mentioned “Pi Wei Lun” as being one of your treasured books!

LX : Yes, it was written during the Yuan Dynasty (about 14th century) by Dr Li Dong Yuan.

Dr Li Dong Yuan was a student of Dr Zhang Yuan Shu, who was the first doctor to express clearly the principle of “qi and wei” of the herbs in his treatments. It was well described in previous books (like in the Huang Di Neijing), but never really used as a main principle. Dr Zhang wrote “Zhen Zhu Nang 珍珠囊, (a bag of pearls)”.

Li Dong Yuan studied medicine because his mother died after numerous unsuccessful treatments, and he wanted to find alternatives. He wrote “Pi Wei Lun”, a very short book which, basically, says: “when the middle Qi is weak, the energy of the body loses its original direction and goes either upwards (warm, sweating) or downwards (diarrhoea, low back pain).” At the time, invasions and wars were very common and frequent in China, and, consequently, people suffered from malnutrition and weak stomach Qi. Dr Li Dong Yuan started a school of thought based on “strengthening the middle”. His main theory was: “Shen Jiang Fu Chen” 升降浮沉, which means: “Up and down open and gather (in the middle)”. He also used the qi and wei of the herbs as the main principle of treatment, paying attention to the direction of the disease rather than individual symptoms. Although it was already mentioned in the “Huang Di Neijing”, it was he who believed in the “personality” of herbs and how to use it. He was also good in his practice of acupuncture and moxas.

His own body was not strong, and consequently his prescriptions are usually mild but have a very good combination of herbs. Nowadays his prescriptions are mainly used for elderly people with weak stomach and spleen Qi, like “Bu Zhong Yi Qi Tang.”

C : What is the contribution of “Wen Bing Tiao Bian”?

LX : Wen Bing Tiao Bian, written by Dr Wu Ju Tong, teaches us to treat diseases with fever in a simple way.

Before him, doctors did not really know how to treat fever. They used pungent and warm herbs (Ma huang, Jing jie, Fangfeng, Shi gao…) and added Huang lian, Huang qin, Huang bo. A prescription based on this principle is warm and bitter, and the taste (wei) is too heavy. It will not go to the surface but too deep inside, and is not effective in the treatment of damp-heat.

Wen Bing Tiao Bian describes another way: “Wei Ku, Wei Xin” which means “slightly bitter, slightly pungent”, choosing herbs of a cool nature. The light taste and dosage will be good at adjusting Qi ji.

If the herbs used were too bitter and too pungent, as prescribed by previous doctors, more herbs had to be added to counteract the side effects, and the prescription became very complicated.

This principle of “wei ku, wei xin” is simple and follows Bing Ji and Qi Ji.

These four books are published together and called: “Zhong Yi Si Bu Jing Dian” 中医四部经典 or “TCM four books of classics”. They all describe how to use the “qi and wei” of herbs in the same way. Shang Han Lun specialised in diseases due to cold attacking the body, and Wen Bing Tiao Bian in diseases due to heat attacking the body. If you master the principles described in these books, you can treat all disease external and internal, following the dynamic system of the body.

I should also mention the “Nan Jin” 难经, a very short book among the classics. 81 questions are answered about various aspect of TCM described in the Huang Di Neijing, in particular pulse diagnosis. I shall not emphasise it as it really comes from the Huang Di Neijing.

Chapter 2 : Properties of the herbs; their “qi and wei”

C : If I master only these two principles: how to use the qi and wei of the herbs and follow Qi ji and Bing ji, I believe I will become a good practitioner of TCM herbal medicine!

In a previous chapter you told us about Qi ji and Bing ji, let’s now talk about “qi and wei”!

LX : Each herb used in TCM has two parts: “qi” and “wei”.

“Qi” refers to the active part, the Yang part, the Qi part, the light part of the herb. It also refers to the nature, “warm, cool, hot, cold” of the herb. The herb is used in small dosage, cooked for little time, sometimes added at the end of the decoction or prepared with alcohol, to get the “qi” aspect of the herb. Its effect is to open the channels and move blood and Qi higher up.

“Wei” refers to the Yin aspect of the herb, with a strong taste (sour, bitter, sweet, pungent, salty), dark colour, cooked for a long time and concentrated. Its effect is to tonify the essence and blood (ex: Shu di huang, Rou cong rong, Ba ji tian), sedate or gather the internal energy, move the Qi Ji downward.

C : So the “qi” and “wei” of a particular herb depend on its “own personality” (nature and taste) and the way it is cooked in the decoction?

LX : Exactly. I would like to add something important: every herb which has a similar “qi” and “wei” can be substituted for another. This gives great flexibility when writing a prescription, especially if we do not have access to all the herbs we would like to use!

C : “Herbs with more “qi” open the channels and move blood and Qi, herbs with more “wei” tonify, gather, and bring the energy down. What about minerals and animal products? Do we also talk about “qi” and “wei” for them?

LX : Yes. Most animal products have more “wei” than herbs; they treat Jing and Xue levels. Some tonify and nourish, others open and clear blood toxins.

All minerals and shells control Qi and Shen (ex: Ci shi, Mu li, Hua shi, Shi gao, Zhu sha, Dai zhi shi, Zhao xin tu). We use their “qi” aspect. There is a theory which claims that minerals damage stomach Qi, which is not true. In fact, if it is used in the form of powder, without being cooked in water, it might damage stomach Qi. But if it is cooked in water, this decoction will not damage stomach Qi.

C : The “qi” and “wei” of a herb gives us the direction taken by an individual herb: up to the surface, down, gathering, opening in etc… Does a prescription also have a “qi” and a “wei”?

LX : Yes. The patient will describe the taste of the prescription and you will know its general direction, without looking at the ingredients!

C : Based on the “qi” and “wei” of the herbs what general principles are useful to remember?

LX : I shall quote the Huang Di Neijing (Su Wen), as it was the first book to talk about “qi and wei”.

“Xing Bu Zu Zhe, Wen Zhi Yi Qi “ 形不足者, 温之以气 = “If the body structure is weaker than normal, warm with the “qi” of the herb”. We use herbs which work at Qi level, we use their Yang aspect, at a small dosage, 10-15gr, and cooked for little time.

“Jing Bu Zu Zhe, Bu Zhi Yi Wei” 精不足者, 补之以味 = “If the essence is not strong enough, nourish or tonify, with the “wei” aspect of the herb whether it is cold or warm”. We use more dosage, cook for a longer time, use heavy ingredients like roots, animal products, seeds, herbs of a dark or black colour.

“Yang Hua Qi, Yin Cheng Xing” 阳化气, 阴成形 = “All that is Yang transfers, moves and promotes Qi, all that is Yin keeps, manufactures, and gathers.

“Yang Wei Qi, Yin Wei Wei” 阳为气, 阴为味 = “The qi aspect of herbs belong to Yang, the wei aspect of herbs belong to Yin”.

“Wei Gui Xing, Xing Gui Qi, Qi Gui Jing, Jing Gui Hua” 味归形, 形归气, 气归精, 精归化 = “wei (aspect of the herb) benefits Xing (the structure of the body), Xing benefits Qi, Qi benefits Jing, as a result, Jing will perform transportation and transformation (because Jing produces Qi)”.

“Wei Shang Qi, Qi Shang Jing” 味伤气, 气伤精 = “Excess wei (in the herb) will damage Qi; excess qi (in the herb) will damage Jing.

“Yin Wei Chu Xia Qiao, Yang Qi Chu Shang Qiao” 阴味出下窍, 阳气出上窍 = “The Yin, wei (in the herb) will go down from lower orifices (anus and urethra), the Yang, qi (in the herb) opens up to the upper orifices”.

“Qing Yang Fa Cou Li, Zhuo Yin Zou Wu Zang” 清阳发腠理, 浊阴走五脏= “qi” (yang) will open the surface, use “wei” (yin) to enter and gather the five Zang.

Or: “Qing Yang Shi Si Zhi, Zhuo Yin Gui Liu Fu” 清阳实四肢, 浊阴归六腑 = “Clear Yang (or qi) will strengthens the four limbs (same meaning as open the surface), heavy Yin (wei) promotes the six Fu (enter and gather).

“Wei Hou Zhe, Wei Yin. Bo Zhe Wei Yin Zhong Zhi Yang, Qi Hou Zhe Wei Yang. Bo Zhe Wei Yang Zhong Zhi Yin” 味厚者, 为阴, 薄者为阴中之阳, 气厚者为阳, 薄者为阳中之阴 = “A strong wei is Yin, a weaker wei is Yang within Yin (comparatively more Yang), A strong qi is Yang, a weaker qi is Yin within Yang (comparatively more Yin)”.

“Wei Hou Ze Xie, Bo Ze Tong. Qi Bo Ze Fa Xie, Hou Ze Fa Re” 味厚则泄, 薄则通, 气薄则发泄, 厚则发热= “Herbs with strong “wei” work mainly by opening downwards (ex: Da huang, Mang xiao), herbs with weaker ‘wei” open the channels inside and outside (ex: Chai hu). Herbs with weaker “qi” open the surface and the interior (inducing sweating like Fu ling). Herbs with strong “qi” warm (ex: Fu zi)”.

“Xin Gan Fa San Wei Yang, Suan Ku Yong Xie Wei Yin, Xian Wei Yong Xie Wei Yin, Dan wei Shen Xie Wei Yang“辛甘发散为阳, 酸苦涌泄为阴, 咸味涌泄为阴, 淡味渗泄为阳 = “All the pungent or sweet herbs or those with an outward function belong to Yang. All the sour and bitter herbs will induce vomiting and diarrhoea and belong to Yin. All the salty herbs will induce vomiting and diarrhoea and belong to Yin. All the herbs with a neutral taste diffuse and drain and belong to Yang.

Belong to Yang: xing (pungent), gan (sweet), dan (neutral)

Belong to Yin: suan (sour), ku (bitter) and xian (salty)

I would like to add a few more quotes which are not from to Huang Di Neijing but are also very useful:

“Da Fang Xiang” 大方向= “To know the direction of the prescription is the most important thing”.

“Gao Dian Zhi Shang, Wei Feng Ke Ji” 高巅之上, 唯风可及 = “For diseases affecting the top part of the body, only wind (pungent) can help”.

“Bu chuan zhi mi, zai yu ji liang” 不传之秘, 在于剂量 = “The top secret lies in the dosage of each ingredient of the formula”.

“Kai he zhi dao” 开合之道 = “Opening or gathering are the basic directions of a formula”.

“Hou Bao zhi yong” 厚薄之用 = “The basic character of an herb or a formula is thick or pure”.

Chapter 3 : Classification of herbs according to Li Xin

C : The Emperor Shennong left us a classification of herbs in three groups: “Shang Yao, Zhong Yao, and Xia Yao”.Those who are particularly interested in the detailed description of the most commonly used herbs, according to Shennong, can refer to the annexe 1 on the subject .

Now, before we start discussing prescriptions, could you give us a classification of the herbs according to Li Xin, based, of course, on the herbs that you commonly use, their “qi and wei”, and their direction! It will help us understand the dynamics of a prescription.

LX : What I suggest is a sort of guide, in table form, which follows the diagnosis steps, described in the theory, and tells us at first glance what to use, at which level (Xia Jiao, Zhong Jiao, and Shang Jiao), and in which direction.

In each level, I shall differentiate the herbs according to their direction of action, and give for each of them their taste, nature and particular “personality”. If we have a clear idea of the state of the resources, Qi ji, and Bing ji, then, with the help of these tables, it will be easy to prescribe a formula.

But, I repeat, this is a personnal practical guide, and does not claim to replace existing classifications or be exhaustive! The use of each herb will depend on the patient’s own sensitivity. For example Chuan lian zi could be used at Qi level for one patient, but for a weaker patient it could reach directly Xue level! We use Fuling, Fo shou, He ye (Qi level) for a sensitive patient with a weak stomach, instead of Xiang fu, Lai fu zi or Hou po, which also work at Qi level, but will reach too deep a level in a weak patient.

Xia Jiao level

We have two main groups of herbs: herbs that gather, and herbs that open.

Herbs that gather have three subdivisions: gather Jing, gather Yin, and gather Qi.

Herbs that open have three subdivisions: open the whole body, open at deep Xue level, open urination.

Herbs working at Xiajiao 下焦, level.

Support the resources, gather and open deeply at the root, bring Qi Ji down

Gather 聚

Gather Jing 聚精

Tusizi 菟丝子

Semen cuscutae

pungent, sweet, neutral.

“Gives ambition”

Opens the collaterals and upwards, good for patients with blocked-fire. Use with caution.

Bajitian 巴戟天

Radix morindae officinalis

Sweet, pungent, warm.

“The cold deficient arthritis herb”

warms Yang and opens outside.

Shanyao 山药

Radix dioscoreae oppositae

Sweet, neutral.

“The Jing Qi metabolism supporter”

Condenses Qi, gathers++; keeps Zhen Qi in a good operative atmosphere; belongs also to Zhong Jiao.

Shanzhuyu 山茱萸

Fructus corni officinalis

Sour, warm.

“The emergency gathering herb”

Roucongrong 肉苁蓉

Herba cistanches

Sweet, slightly warm.

“The dry river rescuer”

Adds water quickly, improves humidity level.

Gouqizi 枸杞子

Fructus lycii chinensis

Sweet, warm.

“Adds coal to the fire”

A bit “sticky”, consolidates Yang Qi.

Guiban 龟板

Plastrum testudinis

Salty, neutral.

“Peaceful Jing stability”

Strongly condenses Yuan Qi, Gathers+++, stabilises Shen.

Sheng Du zhong 生杜仲

Cortex eucommiae ulmoidis

Bitter, cool.

“The low-back friend”

Gathers Yuan Qi.

Heshouwu 何首乌

Radix polygoni multiflori

bitter, warm.

“Gentle detoxifier of Xue level” Detoxifies Xue level, opens the muscles.

Sangjisheng 桑寄生

Ramus loranthi seu visci

Bitter, neutral,

“Smooth internal Jing Qi flow with stability”

Opens the channels, disperses wind-dampness, helps digestion.

Shudihuang 熟地黄

Radix rhemanniae

Sweet, slightly bitter and warm.

“The gentle water provider”

Condenses Yuan Qi, but induces unwanted heat. Suggest the use of small dosage or very large 30-60 gr for a Roucongrong effect.

Bairenshen 白人参

Radix ginseng (white)

Sweet, sour, slightly cool.

“Calm and happiness”

Stabilises Shen, consolidates Jing.

Wuweizi 五味子

Fructus schisandrae chinensis

sour, pungent, warm.

“Gentle warmth and strength dispenser”

Astringent, consolidates essence, tonifies every level of the body.

Gather 聚

Gather Yin 聚阴

Cool blood-heat 多去血热

Shengdi 生地

Radix rhemanniae glutinosae

Bitter, sour, cool.

“Stability of Xue”

Supports metabolism of Jing Xue, clears blood toxins, nourishes Yin.

Xuanshen 玄参

Radix scrophulariae ningpoensis

Bitter, sweet, cool.

“Gently moves and purifies Xue level”.

Maidong 麦冬

Tuber ophiopogonis japonica

Sweet, neutral.

“The middle Qi strengthener”,

Supports the fluids.

Tiandong 天冬

Tuber asparagi cochinchinensis

Sweet, cool.

“The sharp cool knife”

Clears the mind, and fire; the coolest of this category.

Nuzhenzi 女贞子

Fructus ligustri lucidi

sweet, sour, cool;

“Warm toxic arthritis herb”

Condenses Yin; does not move.

Shashen 沙参

Radix glehniae littoralis

Sweet, neutral.

“Gentle stomach fluids nourishment”

Smoothes stomach Yin.

Shihu 石斛,

Herba dendrobii

Sweet, bitter, cool.

“Peaceful presence against evil”

Gathers in Zhong Jiao and Shang Jiao, then goes back to the root; taken for a long time, it can bring a feeling of “wholeness”.

Yuzhu 玉竹

Rhizoma polygonati odorati

Neutral taste, slightly warm.

“Trouble”

Strengthens the lung; gives an uncomfortable feeling of instability.

Huafen 花粉

Radix trichosenthis

Bitter, sweet, neutral.

“The cow boy of the stomach”

Improves stomach fluids; dissolves lumps; creates a feeling of unsatisfaction.

Sangshen 桑椹

Fructus mori albae

Sweet, sour, cool.

“The pure Yin supporter”

Nourishing Yin, fast action; does not create heat.

Baihe 百合

Bulbus Lilii

Sweet, neutral.

“The healer of lungs and sadness”

Condenses Yi Qi, opens the chest, brings quietness; nourishes the lungs (stronger than Yuzhu).

Hanliancao 旱莲草

Herba ecliptae prostratae

Sour, bitter, neutral.

“Peaceful clarity under the shade”

Stablises the Shen, clears deficient heat.

Gather 聚

Gather Qi 聚气

Minerals: Also gather Shen 矿物类:多镇定安神

Shengmuli 生牡蛎

Concha ostreae

Salty, cool,

”The powerful thought controller”

Consolidates Qi +++, clears the mind; strong downwards effect; holds Qi.

Shenglonggu生龙骨

Os draconis

Sweet, neutral.

“The simple relaxer”

Gathers to the root; relaxes Qi and Shen.

Zaoxintu 灶心土

Terra flava usta

Bitter, warm.

“The support from the earth”

Gathers and warms Zhong and Xia Jiao; improves courage.

Zhenzhumu 珍珠母,

Magarita

Neutral taste, cool.

“The watch yourself guide”

Clears the mind; relaxes the head; clarifies confusion; calms down.

Cishi 磁石

Magnetitum

Pungent, cool.

“The unpredictable wave of energy”

Stabilizes the mind; brings balance back (dizziness, vertigo); treats arthritis.

Zibeichi 紫贝齿

Sweet, neutral.

“The brave warrior remedy”

Gives strong will power and courage, and a clear vision.

Shijueming 石决明,

Concha haliotidis

Salty, neutral.

“The TCM Valium”

pure sedative effect, no action on Qi Ji or clarifying thoughts.

ZhuSha 朱砂

Cinnabaris

Sweet, cool.

“The great refresher to restore freedom”

Brings light and energy and the power to accept the outside world, the surrender of one’s ego. Treats deep fears and nightmares.

Open 开

Whole body 作用于全身

Help Yuan Qi circulate in the whole body (San Jiao) and in the channels. Some gather Yuan Qi. 守元气或助元气运行十二经络及三焦

Fuzi 附子

Radix aconiti carmichaeli praeparata

Pungent, hot.

“The midday inner sun”

Warms the centre (Zhong & Xia Jiao) and from there the whole body; opens the whole body keeping the centre gathered. Treats fear.

Xixin 细辛

Herba asari cum radice

Pungent, warm.

“The warm double sided sword” (good and damaging).

Mildly opens but with loss of energy especially from the chest. Used when there is strong blockage with cold and blood stagnation in the collaterals. Use with caution.

Guizhi 桂枝

Ramulus cinnamomi cassiae

Pungent, sweet, warm.

“The channel warmer”

Warms the channels and collaterals, mainly upper part of the body; upward direction.

Rougui 肉桂

Cortex cinnamomi cassiae

Pungent, sweet, hot.

“The fire place”

Gathers, warms Yuan Qi and keeps it stable, does not open or move strongly.

Buguzhi 补骨脂

Fructus psoraleae corylifoliae

Bitter, pungent, hot.

“The kidney heat lighter”

Pushes warm energy upwards and outside, leaving Xia Jiao empty. Helps kidney fire rise. Use with caution.

Dongchongxiacao 冬虫夏草

Cordyceps sinensis

Salty, sweet, warm.

“The youth provider”

One of the most expensive herbs. Comes from Tibet and Mongolia; caterpillar fungus. Warms but does not waste Jing; fast effect; does not move but gives a feeling of lively energy.

Hongshen 红参

Radix ginseng

Sweet, bitter, warm.

“The winter sun”

Improves warmth in the whole body but does not move.

Lujiaojiao 鹿角胶

Colla cornu cervi

Salty, sweet, warm.

“The over stimulator”.

Lifts Yang Qi in Du mai, then warms and activates the whole body, leaving Xia Jiao empty. Use with caution.

Yinyanghuo 淫羊藿

Herba epimedii

Sweet, bitter, warm.

“The morning sun”

Penetrates well and can move; opens to lead the cold and dampness out.

Renshen 人参

Radix Ginseng

Sweet, bitter, cool.

“The Yuan Qi reviver”

Gathers and condenses Xia Jiao and Zhong Jiao; protects the Spirit; improves intelligence and memory;

See also Zhong Jiao level.

Hongjingtian 红景天

Bitter, slightly warm.

“The supportive friend”

Gives energy as if coming from outside; supports each internal organ without interfering.

Chenxiang 沉香

Lignum aquilariae

Sweet, flavoured, warm.

“Xia Jiao Qi manager”

Regulates Xia Jiao Qi, gathers ++; helps Qi come down; not a warmer.

Open 开

Deep Xue level 作用于深层血分

Insects & Animals

Biejia 鳖甲

Carapax amydae sinensis

Salty, bitter, cool.

“The cool cleaner”

Downward direction; releases stagnation in the liver, and helps pathogenic factors out; attacks; may induce Jing deficiency and uncomfortable feeling.

Ejiao 阿胶

Gelatinum asini

Sweet, salty, neutral; soft.

“The real deep nourisher and mover, the woman’s friend”

Good and fast at nourishing Jing & Xue (quality and quantity); gently moves blood.

Wugong 蜈蚣

Scolopendra subspinipes

Centipede, pungent, warm.

“The ruthless general”

Belongs to wind, fast and strong to open inside and outside; treats headaches but may induce headache and dizziness, and uncomfortable feeling; will waste Qi.

Quanxie 全蝎

Buthus martensi (scorpion)

Sweet, pungent, neutral.

“The clear adjuster”

Calms down, mildly moves, tonifies Qi and gives a confortable feeling of stability.

Zhechong 蟅虫

Eupolyphagae seu opisthoplatiae

Pungent, bitter, cool.

“The miracle medicine for dysmenorrhoea”

(with blood stagnation);

Has a definite direction downwards; acts especially in the central part of the body; cleans, does not tonify.

Yangqishi 阳起石

Actinolitum

Salty, warm.

“The heavy unpopular initiator of blood level reform”

Powerful and thicker than Zhechong; moves blood stagnation in Xia Jiao but also supports and condenses energy in Xia Jiao and lower part of the body.

Niuxi 牛膝,

Radix achyranthis bidentatae

Bitter, sour, slightly warm.

“The weak low-back and legs opener”

strengthens bones and tendons; downward direction to the feet; slow long term effect; leads cold dampness down and out; slows down Qi movement;

Taoren 桃仁

Semen persicae

Bitter, warm.

“The Qi and Xue agitator”

Moves Qi in Xue; functions at each level of the whole body; opens the chest; does not nourish.

Shuizhi 水蛭,

Leech

Sweet, bitter, cool.

“The greatest blood stagnation remover”

Ruxiang 乳香;

Gummi olibanum (frankincense), Pungent, warm, very bad taste.

“Good governor of blood”

Smooth effect and can keep Qi stable; opens widely at Xue level so that the blood will move naturally.

Moyao 没药

Myrrha

Sweet, bitter, slightly warm; gathers ++.

“A good house keeper for blood”

Can reach a deeper level; often used with Ru Xiang to control the opening effect and regulate blood.

Hupo 琥珀,

Succinum (amber)

Salty, neutral

“The essence of peaceful tiger”

Stabilises Hun & Po; clarifies the mind; performs in Xia Jiao to regulate blood; opens the collaterals; helps cold, heat & wind out; downward direction; best treatment for haematuria with pain.

Kunbu 昆布,

Thallus algae

Salty, cool.

“Nice cool nourishment”

Soft gathering effect downwards; nourishing; slow long term effect.

Haizao 海藻

Herba sargassii

Salty, cool.

“Rebellion in the deep sea “

Powerful action; adds energy which does not follow Qi Ji. Belongs to deep Xue level, not Xia Jao; also gives many directions to Qi & Xue, but cannot go through the collaterals and channels, inducing pressure; should be used with opening herbs.

Mangxiao 芒硝

Mirabilitum

Salty, cool.

“The fast eliminator”

Works also at Zhong Jiao level; strong downward direction; opens the bowels; clears toxins; high dosages induce diarrhoea and vomiting (over 6 gr per day); use with caution.

Open 开

Water metabolism 水道

Yiyiren 薏苡仁

Semen coicis lachrymal-jobi

Sweet, cool.

“The moody but reliable diuretic”

May induce mind turbulence, swings of mood; if used for a long time consolidates the middle, strengthens the muscles and skin; removes cold and dampness from the muscles; Helps urination ++.

Qumai 瞿麦

Herba dianthi

Sweet, cold.

“The blood cooler diuretic”

Soft action at deep Xue level; strengthens the middle; removes blood heat via urination and collaterals; Helps urination +.

Tongcao 通草

Medulla tetrapanacis papyriferi

Neutral, very light, floating.

“The San Jiao steam keeper“

Clears the mind, opens the chest; gives a feeling of happiness and satisfaction; increases energy level naturally. Keeps Jing and Qi stable. Helps urination +.

Dongguapi 冬瓜皮

Cortex fructus benincasae hispidae

Bitter, neutral.

“The San Jiao Qi opener”

Like Zhuling, fast at helping urination; acts more at the surface level, not as deep as Zhuling; gentle herb; two directions: surface and down via urination; Helps urination +++.

Baimaogeng 白茅根

Rhizoma imperatae cylindricae

Sweet, cool.

“The SanJjiao steam enhancer”

A bit like Tongcao but thicker; works at deep Xue level; opens the four limbs Downward direction; slightly tonifies Qi. Helps urination +.

Cheqiancao 车前草

Herba plantaginis Sweet, neutral, floating.

“The Shui Dao smooth flow”

Induces smooth and light flow of Qi which opens the whole body. Helps urination +.

Cheqianzi 车前子

Semen plantaginis

Sweet, neutral.

“The gentle waterfall”

Heavier than the previous one; gathers, condenses Jing, keeps it inside; downward action; helps urination ++.

Zexie 泽泻

Rhizoma alismatis plantago-aquaticae Sweet, cool.

“The dam of Xia jiao”

Acts at deep Xue level; and on deep water metabolism; helps urination but keeps Jing in; gathers Qi to Xia Jiao; Helps urination +.

Zhuling 猪苓

Sclerotium polypori umbellati

Bitter, neutral.

“The water flush”

Strongest at opening water metabolism; acts very fast and can remove Qi and water; acts at deep Xue level; if taken for a long time, may induce Jing and Qi xu; Helps urination +++.

Huashi 滑石

Talcum

Sweet, cool.

“The San Jiao lubricant”

Stone with a floating effect; can support and tonify Qi; leads heat down via urination and clears heat from the mind; supports inside and opens outside; good for children, and also for dampness; quickly clears San Jiao. Helps urination ++.

Note: “+” indicates the power of action.

Zhong Jiao level

In this group, we differenciate four categories: herbs that gather in Zhong Jiao, herbs that open Zhong Jiao, herbs with a strong downward direction and herbs with a lifting effect (upward direction). In each group, we list herbs working at Qi level, and herbs working at Xue level.

Herbs working at Zhong Jiao (中焦) level have a role of transportation, food-water transformation, and help Qi Ji in an upward or downward direction

QI LEVEL, 气分

Gather 合

Shanyao 山药

Radix dioscoreae oppositae

Sweet, neutral.

“The Jing Qi metabolism supporter”

See Xia Jiao level.

Kezi 柯子

Fructus terminaliae chebulae

Bitter, sweet, warm.

“The high protector”

Condenses, gathers Jing, Qi and Shen, gives energy and protection, stabilizes the mind; activates stomach Qi.

Ganjiang 干姜

Rhizoma zingiberis officinalis

Pungent, hot.

“The warm stomach keeper”

Stable, does not move Qi; warms stomach and lungs.

Renshen 人参

Radix ginseng

Sweet, slightly bitter, cool.

“The Yuan Qi reviver”

See also Xia Jiao level; can treat thirst.

Baibiandou 白扁豆

Semen dolichoris lablab

Sweet, neutral.

“The stomach Qi supporter”

Condenses stomach Qi and gives pure Qi to the whole body in a very gentle and natural way; does not move Qi.

Gather 合

Jingmi 粳米

Rice

Sweet, neutral.

“Best stomach Qi and Yin provider”

Moves Qi gently.

Maiya 麦芽

Fructus ordei vulgaris germinantus

Sweet, cool.

“The stomach’s alarm clock”

Nourishes and reactivates stomach Qi; cools; condenses stomach Qi; downward direction.

Guya 谷芽

Fructus oryzae sativae germinantus

Sweet, slightly warm.

“Peaceful youth”

Like Maiya, but gathers, condenses and warms more; it can tonify; upward direction.

Dazao 大枣

Fructus zizyphi jujubae

Sweet, warm.

“Good dessert”

Tonifies Qi and Xue; sticky; if stomach Qi is blocked, use with caution.

Fuling 茯苓

Sclerotium poriae cocos

Neutral, slightly bitter.

“Hidden power”

Like Tongcao, it creates a floating atmosphere to help the stomach Qi work properly; if large dosage, it will lower Qi and clear the mind; courage booster.

Xiyangshen 西洋参

Radix panacis quinquefolii

Sweet, bitter, cool.

“The body stimulator”

Produces Jin-Ye; gives energy to mind and lungs; if taken when one is very busy, accelerates the movement of Qi in Shang Jiao; if taken at a quiet time, it gathers and calms down.

Lianzi 莲子

Semen nelumbinis nuciferae

Sweet, neutral.

“The pillar of the middle”

Condenses Qi; strongly gathers in Zhong Jiao and Xia Jiao; highly stable.

Sharen 砂仁

Fructus seu semen amomi

Sweet, pungent, warm.

“The warm companion”

Gathers stomach Qi, warms, moves gently.

Gather 合

Gancao 甘草

Radix glycyrrhizae uralensis

Sweet, cool.

“The great harmonizer”

at Shen level, facilitates acceptance; at Qi level relaxes the stomach; detoxifies poisonous medicine.

Shanzha 山楂

Fructus crataegi

Sour, sweet, warm.

”The slow promotor of Zhong Jiao”. Tonifies and moves Qi and blood, also works at Xue level; sticky.

XUE LEVEL

Some herbs also belong to “Xia Jiao”, 血分

Gather 合

Huanglian 黄连

Rhizoma coptidis

Bitter, cool.

“The cool dad”

Condenses; cools the mind; calms down; stabilizes Qi & Xue; strengthens the middle; Does not sedate.

Huangbai 黄柏

Cortex phellodendri

Slightly bitter, pungent, cool.

“The downward opener”

Opens through to the limbs; helps all pathogenic factors out; also acting at Qi level; then keeps energy stable & protects Yuan Qi.

Longdancao 龙胆草

Radix gentianae scabrae

Bitter, cold.

“The Dr agon’s Gall Bladder”

Clears Shen and Qi by strongly concentrating it. Works at a high level: strengthens the Spirit, treats fear and nervousness; Dispels dampness.

E jiao 阿胶

Gelatinum asini

Salty, sweet warm.

“The women’s friend”

Tonifies blood; nourishes Zong Jiao when dry; see Xia Jiao level.

Gather 合

Zaoxintu 灶心土

Terra flava usta

Pungent, slightly warm.

“The support from the earth”

See Xia Jiao level.

Suzi 苏子

Fructus perillae frutescentis

Sweet, bitter warm.

“The weak lungs friend”

Tonifies and strengthens Zhong Jiao & Shang Jiao; gathers & keeps lung Qi; dispels phlegm; does not sedate.

Baiguo 白果

Semen ginkgo bilobae

Sweet, slightly pungent, neutral.

“The cool gentleman”

Creates an atmosphere for Zhen Qi to work well in Shang Jiao & Zhong Jiao; gently regulates and moves Zhen Qi towards the surface; do not take high dosages for a long time.

Suanzaoren 酸枣仁

Semen ziziphi spinosae

Sweet, flavoured, neutral.

“The blessing herb”

Gathers Zhen Qi and brings it down; relaxes & harmonises Shen; smoothes Shang Jiao; keeps a peaceful atmosphere.

Maziren 麻子仁

Semen cannabis sativae

Sweet, flavoured, neutral.

“The great lubricant”

Gives a feeling of peace and satisfaction.

Wuzhuyu 吴茱萸

Fructus evodiae rutaecarpae

Bitter, pungent, hot.

“The warm energy field armour”

Very Wide energy+++; treats cold; warms and regulates the middle and Xia Jiao; protects the energy field.

QI LEVEL 气分

Open, 开

Foshou 佛手

Fructus citri sarcodactylis

Sweet, pungent, warm.

“The best regulator of Zhong Jiao”

It naturally opens Zhong Jiao helping the circulation of Qi in the whole body.

Changpu 菖蒲

Rhizoma acori graminei

Pungent, sweet, warm.

“The widener”

Upward direction; Opens to the surface, opens the orifices, awakens Shen, opens the whole body; keeps the energy field wide ++.

Chenpi 陈皮

Pericarpium citri reticulatae

Pungent, bitter, warm.

“The old care taker of Zhong Jiao”

Opens the middle; activates the stomach; moves Qi down; opens the chest.

Baizhu 白术

Rhizoma atractylodis macrocephalae

Bitter, slightly sweet, cool.

“The Lord of the Earth”

Gathers and strengthens the middle; also opens the surface to let the pathogenic factor out.

Cangzhu 苍术

Rhizoma atractylodis

Pungent, bitter, warm.

”The dampness specialist”

Opens the surface ++.

Qing pi 青皮

Pericarpium citri reticulatae viride

Bitter, pungent, warm.

“The hurricane of Zhong Jiao”

Like Foshou, but more powerful; can perform at Xue level; strong downward action on Qi.

Muxiang 木香

Radix saussureae seu vladimiriae

Pungent, sweet, warm.

“The warm-hearted herb”

Like Foshou but thicker; protects and stabilizes Shen and Qi; treats insomnia and fear.

Chuanlianzi 川楝子

Fructus meliae toosendan

Bitter, pungent, cool.

“The liver channel regulator”

Also works at Xue and Xia Jiao level; stronger than Chengxiang at regulating Qi; cools down.

Open 开

Fuling 茯苓

See above in the Zhong Jiao” gather” section.

Pei lan 佩兰

Herba eupatorii fortunei

Slightly bitter, cool.

“Keeps the Zhong Jiao’s atmosphere moving”

Creates a good environment for Zhen Qi’s work +.

Sugeng 苏梗

Ramulus perillae frutescentis

Slightly sweet & bitter, warm.

“The middle opener”

Similar to Peilan but stronger and warm; very good at opening chest and middle Qi.

Zhuru 竹茹

Caulis bambusae in taeniis

Sweet, neutral

“Fresh bamboo shade”

Also similar to Peilan but does not reach the surface; leads heat downwards; harmonises stomach like Gancao.

Chai hu 柴胡

Radix Bupleuri, Chinese Thorowax Root

Bitter, neutral

“The refresher”

Opens stagnation of Qi in the surface, in Shang Jiao and Zhong Jiao; slightly removes blood stagnation.

Weilingxian 威灵仙

Radix clemetidis chinensis

Neutral, cool

“The door opening San Jiao”

Opens San Jiao, channels and collaterals; opens the surface, helps bowels & urination; also works at Xue level; removes stagnation of Qi.

XUE LEVEL

Some herbs also belong to “Xia Jiao” 血分

Open 开

Danggui 当归

Radix angelicae sinensis

Pungent sweet, bitter warm.

“The women’s herb”

In large doses, it gathers & tonifies blood & Qi; in small doses, it moves them; leads pathogenic factors to the surface, goes through the whole body; but too much will induce heat.

Xiangfu 香附

Rhizoma cyperi rotundi

Pungent, slightly bitter, warm.

“The liver’s ambassador”

The best mover & regulator; calms down; strengthens Qi of the whole body.

Aiye 艾叶

Folium artemisiae

Sweet, pungent, warm.

“The love provider”

Widens the energy field ++; protects, clarifies, equalizes; creates a smooth atmosphere in Xue level.

Puhuang 蒲黄

Pollen typhae

Neutral, warm.

“The Xue level organizer”

Removes blood stagnation but also gathers Qi in the middle; cools heat; creates a smooth atmosphere in Xue level.

Xiakucao 夏枯草

Spica prunellae vulgaris

Slightly bitter, sweet, pungent, cool.

“The Siberian wind”

Goes deep into Xue level; eliminates tumors; in large doses it is “like a surgeon’s knife”, in small doses, it clarifies & lightens what is heavy.

Hupo 琥珀

Succinum

Salty, neutral.

“The essence of peaceful tiger”

See Xia Jiao level.

Yinchen 茵陈

Herba artemesiae capillaris

Slightly bitter, sweet, neutral.

“The herb to tidy Zhong Jiao”

Creates a favorable atmosphere for removal of food and blood stagnation; strengthens the middle; clears dirty energy from the middle.

Open 开

Xueyutan 血余炭

Crinis carbonisatus

Bitter, slightly salty, warm.

“The good fairy of blood”

A combition of Shuizhi and Ejiao, which can gather, and move fast and deep and in the whole body; it clarifies Shen, Qi & Xue.

Danshen 丹参

Radix salviae miltiorrhizae

Slightly pungent, sweet, bitter, cool.

“The blood palace official”

Removes blood stagnation, nourishes, cools and relaxes the blood level; strengthens Qi and Xue; dispels cold.

Zhizi 栀子

Fructus gardeniae jasminoidis

Bitter, pungent, cold

“Cool wise inner beauty”

Similar to Zhiqiao, but at Xue level; cools down and clarifies; light wei.

Gualoupi 栝楼皮

Pericarpium trichosantis

Bitter, sweet, cool

“The inflexible warrior”. Heavy and thick; condenses Qi; moves stagnation of Qi and Xue down; quite powerful; removes phlegm from the chest; helps sleeping.

Guizhi 桂枝

Ramulus cinnamomi cassiae

Pungent, sweet, warm

“The channel warmer”

Moves Qi up and down; dispels cold; opens the channels; strengthens heart and Spirit; not too hot; see also Shang Jiao.

Sanqi 三七

Radix pseudoginseng

Sweet, bitter, cool

“Whole body’s Xue level servant”

General clarifier at Xue level; cleans dirty energy; removes blood stagnation; cools blood; tonifies blood.

QI LEVEL, 气分

Down 降

Dafupi 大腹皮

Pericarpium arecae catechu

Slightly pungent, sweet, bitter, cool.

“The messenger who moves and connects”

Opens the whole body, goes to skin and muscle level; also acts at Xue level.

Jineijin 鸡内金

Endithelium corneum gigeraiae galli

Sweet, salty, warm.

“The deep and weak stagnation crusher”

Gives energy; also acts at Xue level; removes “solid” stagnation (tumor, stones, severe blood stagnation); warms and tonifies the middle.

Houpo 厚朴

Cortex magnoliae officinalis

Pungent, slightly bitter, warm.

“The Zhong Jiao lubricant”

Nourishes and moves stomach Qi; also acts at Xue level; opens the chest; helps pathogenic factors out via bowel movement.

Lizhihe 荔枝核

Semen litchi chinensis

Bitter, pungent, warm.

“The falling stone”

Nourishes blood; the seeds strongly & quickly lead Qi down; also regulates Xia Jiao Qi.

XUE LEVEL

Some herbs also belong to “Xia Jiao” 血分

Down 降

Dahuang 大黄

Rhizoma rhei

Bitter, cold.

“The general who breaks resistance”

Best herb to open in Xue level; Strong downward effect in Xue level but, also from Shang Jiao to Xia Jiao; used in case of strong blockage in Qi or Xue level. Cools fire.

Jiujun 酒军

Prepared Dahuang

Bitter, pungent, warm

“The gentle general”

Milder action than Dahuang but can act on microcirculation in cases of blood stagnation.

Laifuzi, 莱菔子

Semen raphani sativi

Bitter, pungent, warm.

“Renshen killer”;

Stronger “qi” & “wei” than Suzi; treats heavy phlegm in lung and food stagnation; bad taste; do not use with Renshen.

Zhishi 枳实

Fructus citri seu ponciri immaturus

Bitter, sour, pungent, cool.

“Bottle brush”

Clears down blocked intestine and also Qi.

Baishao 白芍

Radix paeoniae lactiflorae

Sour, bitter, cooL.

“The maintenance man”

Enlarges middle Qi and keeps it stable; can gather Yin Qi into the middle; more tonifying than Chishao. Moves Qi aspect of Blood.

Chishao 赤芍

Radix paeoniae rubra

Sour, bitter, cool.

“Moving deep water”

Moves blood and Qi deeply down in the middle, channels and collaterals; clears the mind.

Binglang 槟榔

Semen arecae catechu

Bitter, pungent, warm.

“The cutter of Qi and Xue stagnation”

Can remove blood and food stagnation. Brings Qi down; also gathers Qi; can focus on tumors and thick blood stagnation.

Down 降

Daizheshi 代赭石

Haematitum

Sweet, warm.

“The Xue level softener”

Tonifies the middle; warms and softens Qi; brings it down; can protect the Spirit from negative energy; moves Blood stagnation, but not at as deep a level as Chishao.

Jiegeng, 桔梗

Radix platycodi

Grandiflori

Pungent, bitter, warm

“Phlegm disolver”

Not only lifts up and treats phlegm, but also detoxifies the intestines, and acts at Xue level.

QI LEVEL

These herbs mostly also belong to “Shang Jiao” 气分

Lift 升

Huangqi 黄芪

Radix astragali

Sweet, warm,

“The stimulator of Zhong Jiao”

Strengthens energy and power; warms the muscles and skin; tonifies Qi & Xue.

Huoxiang 藿香

Herba agastaches seu pogostemi

Pungent, warm.

“The middle gentle breeze ”

Dispels wind and dampness from the surface; connects Zhong Jiao & Shang Jiao.

Suye, 苏叶

Folium perillae frutescentis

Pungent, warm

“Warm summer air”

Creates an atmosphere for stomach Qi to perform well; also good for summer dampness and cold.

Heye 荷叶

Folium nelumbinis nuciferae

Sweet, cool.

“Cool summer air”

Creates an atmosphere for stomach Qi to perform well; also good for summer dampness.

Fuxiaomai 浮小麦

Semen tritici aestivi Levis

Sweet, neutral.

“La mongolfière” (hot air balloon)

Tonifies Qi; strengthens San Jiao; warms the surface; strong upward direction.

Lift 升

Fangfeng 防风

Radix ladebourilleae sesloidis

Sweet, pungent, warm.

“The equalizer”.

The softer and balanced opener for all directions;

See also in Zhong Jiao.

Gegen 葛根

Radix puerariae

Slightly bitter, neutral.

“The Yang Ming’s messenger”

Smoothly opens the channels in the upper part of the body; tonifies and lifts Qi in the Yang Ming channels.

Shengma, 升麻

Rhizoma cimicifugae

Slightly bitter, cool.

“ Awakening and connecting Yang Ming biao and li”

Clears heat, opens blockages and detoxifies Yang Ming “Jing (channels) and Fu”. Slight wei. Very good for blockages in Yang Ming.

Chuanxiong, 川芎

Radix ligustici wallichii

Pungent, warm.

“The headache herb”

Upward direction; tonifies and warms Qi: beware of “shang huo” (fire upward); at suitable dosage, can open and relax muscles, channels and collaterals.

Shang Jiao level

In Shang Jiao, we differenciate between herbs working at Qi level (pure surface), and herbs working at “Xue” level (deep surface). The herbs in the second group belong to Qi level but also have a function at Xue level and can lead to Xue level.

In each group, we have the herbs which are warm and open+++, and those which are cold and open less.

Herbs working at Shang Jiao(上焦)level:

open and protect, connect interior to exterior,

lead Qi Ji in an upward direction

PURE SURFACE 表层气分

Open

+

+++

warm

温开

Mahuang 麻黄

Herba ephedrae

Bitter, pungent, warm.

“The San jiao communication agent”

Brings Qi up but also outward and down. Opens the collaterals (chronic diseases) .Induces heavy sweating, use with caution if the middle is empty.

Huoxiang 藿香

Herba agastaches seu pogostemi

Pungent and warm.

“The middle gentle breeze”

Opens the surface by dispelling cold and dampness; but adds heat; (see also zhong Jiao herbs).

Fangfeng 防风

Radix ladebourilleae sesloidis

Sweet, pungent, warm.

“The equalizer”.

The softer and balanced opener for all directions;

See also in Zhong Jiao.

Suye 苏叶

Follium perillae frutescentis

Pungent, warm.

“The fish lover’s protector”

Milder than Huoxiang for dispelling cold and dampness. Clear upward direction. Used with fresh fish and crabs to dispel cold (like ginger). Keeps a balanced atmosphere in Shang Jiao.

See also in Zhong Jiao.

Sugeng 苏梗

Ramulus perillae frutescentis

Slightly pungent, sweet, warm.

“The middle opener”

Gently opens and connects Zhong Jiao with Shang Jiao and then the surface. Clarifies Qi ji. Keeps a balanced atmosphere in these 3 levels.

See also in Zhong Jiao.

Open

+

+++

warm

温开

Shengjiang, 生姜

Rhizoma zingiberis officinalis recens

Pungent and warm.

“The comfortable stomach’s friend”

Dispels cold and phlegm. Warms the stomach, lung and surface, detoxify poison (fish).

Xiangru 香薷

Herba helsholtziae splendentis

Slightly pungent and warm.

“The soft Mahuang”

opens in all directions; softer than Fangfeng;

Qianghuo 羌活

Rhizoma and radix notopterygii

Pungent, warm

“The surface wind”

Moves Qi, opens channels & collaterals, stronger than Mahuang for this effect.

Open and cold

凉开

Shengshigao 生石膏

Gypsum

Pungent, sweet, cold

“The fever specialist”

Cools and brings down heat and fire in Qi and Spirit level; Opens the surface; does not damage the middle.

Qinghao 青蒿

Herba artemisiae apiaceae

Slightly bitter, sour, & cool

“The shao yang Xue level specialist”

Opens the surface but also reaches Xue level: can take the heat in Xue level and lead it out. Cools down Qi ji and keeps it open.

Zhuye 竹叶

Herba lophatheri gracilis

Sweet, neutral, cool

“The clever cooling sieve”

Leads heat from lungs and heart downwards via urination. Treats diarrhoea.

Bohe 薄荷

Herba menthae

Pungent, cool.

“The head refresher”

Large dosage will warm Shang Jiao; small dosage clarifies the head; upward direction; stimulates stomach Qi

Open and cold

凉开

Chantui 蝉蜕

Periostracum cicadae

Sweet, salty and slightly cool.

“The surface liberator”

Very efficient and safe opener of the head and surface; clears the mind, calms; treats convulsions in children; brings rash to the surface.

Juhua 菊花

Flos chrysanthemi morifolii

Sweet, slightly pungent, bitter and cool.

“The Yin blooming flower”

Keeps a balanced atmosphere in Yin level; nourishes Yin; cools down fire; unblocks the surface by relaxing channels and collaterals; slightly tonifies Shang Jiao and Zhong Jiao. Do not use in case of phlegm and food stagnation.

Sangye 桑叶

Folium mori albae

Bitter, slightly pungent, sweet & neutral.

“The leaf in a cool gathering”

Dispels wind, and heat, but not very strongly; clears the mind; cool and nourishing.

Lugen 芦根

Rhizoma phragmitis communis

Sweet, neutral and cool.

“The natural adjustor of fluids and Qi”

Maintains and gathers Qi in Shang Jiao; preserves the fluids and Qi Ji; gradually tonifies lung and the whole body’s Qi.

Peilan 佩兰

Herba eupatorii fortunei

Slightly sweet and bitter, neutral.

“Keeps Zhong Jiao’s atmosphere moving”

Keeps a balanced atmosphere in Zhong Jiao and Shang Jiao; has a gentle floating action bringing dampness to the surface; opens the surface and the middle; rebuilds “sheng & jiang” (up and down directions) in the middle; connects San Jiao and helps urination.

DEEP SURFACE 表层血分

Open

+++

warm

温开

Jingjie 荆芥,

Herba seu flos schizonepetae tenuifoliae

Pungent, warm

“The safe sweeper of the surface”

Good at dispelling cold and wind, without adding heat; clears the channels and the surface; opens collaterals at Xue level. Acts at surface level more than Fangfeng.

Baizhi 白芷

Radix angelicae

Pungent, strong flavour, warm.

“The skin beautifyer”

Warms the channels, collaterals, muscles and skin; relaxes headache and nose blocked by cold; good for leucorrhoea; very good for chronic skin ulcers.

Guizhi 桂枝

Ramulus cinnamomi cassiae

Pungent, sweet, warm

“The channel warmer”

Moves Qi up and down; dispels cold; opens the channels; strengthens heart and Spirit; not too hot;

See also in Zhong Jiao.

Xingren 杏仁

Semen pruni armeniacae

Bitter, pungent, warm.

“The downward grinder of Shang Jiao”

Brings lung Qi down, but adds heat and can block Qi Ji. Also acts at Xue level; clears phlegm if used with Mahuang. Thick and heavy taste.

Banxia 半夏

Rhizoma pinelliae ternatae

Pungent, warm

“The blocked phlegm specialist”

Opens the surface; dispels cold, wind and phlegm; opens the chest; warms and gently tonifies the stomach; dissolves tumours.

Aiye 艾叶

Folium artemisiae

Pungent, sweet, slightly bitter, warm.

“The provider of love”

Expends energy in the whole body and all directions; warms and balances the channels and collaterals; relaxes body and mind; protects the energy of the Spirit; benefits women; Works in decoction, moxa or external use.

See also in Zhong Jiao.

Open

+++

warm

Cangzhu 苍术

Rhizoma atractylodis

Pungent, bitter, warm.

“The dampness specialist”

Opens the surface ++, see also in Zhong Jiao.

Open and cold

凉开

Fuping 浮萍

Herba lemnae seu spirodelae

Slightly bitter, cool

The measles herb”

Light taste opens by floating the energy upward; helps the toxins of “luo” go out.

Lianqiao 连翘

Fructus forsythiae suspensae

Slightly pungent, bitter, cool.

“The magical remedy for skin heat problems”.

Better than Jingjie at “sweeping” but not as strong as Chantui; dispels wind and toxins. Opens the surface widely. Clears heat in the upper part of the body.

Jinyinhua, 金银花

Flos lonicerae japonicae

Bitter, sweet, cold.

“The inflammation specialist”

Cools down heat in Xue level and collaterals. Small dosages clear wind and heat. Detoxifies the body.

Rendongteng 忍冬藤

Slightly bitter and pungent, cool.

“The deep surface reliever”

The stem of Jinyinhua; opens the surface widely; dispels heat and wind.

Huangqin 黄芩

Radix scutellariae baicalensis

Slightly bitter, cool.

“The cooling breeze of Shang Jiao”

Milder than Jinyinhua; gently opens Shang Jiao and the surface; dispels wind, heat and phlegm. Opens the chest; calms the mind; treats wind heat in the head.

Pugongying 公英

Herba taraxaci mongolici cum radice

Sweet, bitter, cold.

“The fire brigade”

Very smooth action in deep Xue level to clear heat. Quickly detoxifies poisons. Dissolves tumours. Treats blood stagnation with a nourishing action.

Open and cold

凉开

Niubangzi 牛蒡子,

Fructus arctii lappae

Slightly bitter and sweet, pungent, cold

“The drill of heat”

Treats heat blocked in the upper part of the body (sore throat, swollen lymph nodes). But has no strong moving action. Cools but does not open. Should be used with” an opener”.

Sangbaipi 桑白皮

Cortex mori albae radicis

Sweet, slightly pungent, cool

“The conqueror of lung heat”

Cools down Shang Jiao heat; opens the chest, dissolves phlegm; helps urination; calms the mind; leads heat and phlegm down.

Yimucao 益母草

Herba leonuri heterophylli

Slightly pungent, sweet, bitter, neutral.

“The evil hunter”

No clear action; helps Qi float to the surface to dispel wind and heat; helps urination to lead heat out; slightly tonifies and warms Qi; Taken during a long time may cause confusion and unhappiness; not so beneficial for women but good at fighting “evils” (pathogenic factors).

C : To summarise, can we say that:

— In Shang Jiao, to open the surface we use herbs with more “qi” than “wei”, and pungent or light taste.

— In Zhong Jiao, in order to strengthen Zhen Qi, we use sweet, bitter, warm herbs, or “wei ku 微苦, wei xin 微辛” (little bitter and litte pungent) with more “qi” than “wei”. If the treatment is too bitter it tends to consolidate, it will go down too much.If it is too pungent it will go up too much. If there is a blockage at Xue level, to open and sedate, we use bitter or pungent herbs with more “wei” than “qi”. If there is a blockage at Qi level, we use herbs with more “qi” than “wei”. In general, the taste of the herbs used at Zhong Jiao level is stronger than those used at Shang Jiao level;

— In Xia Jiao, we use herbs with strong “wei”: sweet, sour, bitter or salty, which gather or move at deep Xue level. Warm herbs should predominate if Kidney Yang Qi is deficient (Fu zi, Rou gui), cool herbs if Kidney Yin is deficient, neutral or less warm herbs if Jing is deficient.

LX : Yes, this gives us a very clear understanding of the use of herbs at the three levels: Shang Jiao, Zhong Jiao and Xia Jiao.

C : What are your favourite herbs?

LX : The four main herbs in the hands of a TCM doctor of herbal medicine are: Renshen, Mahuang, Dahuang, and Fuzi.

Renshen increases the cash flow of “the company”; if there is enough money, the company is strong and Mahuang will act as a great public relation (opens) to advertise; Dahuang eliminates debts and gets rid of inefficient employees; Fuzi is a source of inspiration and promotes activity and creativity in the company.

I also like to use four warm herbs: Fuzi, Rougui (or Guizhi), Ganjiang, and Yinyanghuo. Fuzi works for the whole body, it opens widely but promoting the center, it works on Xia Jiao. Rougui works also on Xia Jiao but with a milder effect; it is good for Heart Yang Qi. Ganjiang works on Zhong Jiao and the lungs. Yinyanghuo works on Zhong Jiao and Xia jiao, which can open and reach the surface.

C : And how do we treat “Shen”? Do we regulate Xia Jiao or Zhong Jiao and add heavy minerals like Longgu, and Muli?

LX : Yes. Shen’s balance depends on Jing, and Zhen Qi. We can add heavy minerals to sedate and bring the energy down. But we can also use acupuncture, psychotherapy and meditation effectively.

This table summarise the main herbs that we can use to treat Shen.

Gather Jing-Qi

Some Xia Jiao herbs like

Wuweizi 五味子

Shanzhuyu 山茱萸

Tusizi 菟丝子

Renshen 人参

Minerals or shells

Shenglonggu 生龙骨

Zaoxintu 灶心土

Shengmuli 生牡蛎

Clear thoughts from the mind

Shengtieluo 生铁落

Shijueming 石决明

Zhenzhumu 珍珠母

Houpu 厚朴

Protect from external influences: treat fear

Shengzishiying 生紫石英

Daizheshi 代赭石

Zhusha 朱砂

Zibeichi 紫贝齿

Changpu 菖蒲

Lingzhi 灵芝

Aiye 艾叶

Muxiang 木香

Guizhi 桂枝

Fuzi 附子

Chapter 4 : Prescriptions

C : Can we follow a similar classification when we look at famous classical prescriptions?

LX : Certainly! I would like to present a classification of prescriptions, in only four categories, according to their action on the centre, the middle (tonify or sedate), the surface, and on water metabolism (San Jiao), following again the four steps of our theory. I chose famous prescriptions written in all dynasties and not only at the time of “the classics”. But, faithful to the Huang Di Neijing, I will present them with emphasise on their direction of action according to their taste, rather than their indications.

We shall see how vitally important is the dosage of the herbs.

I know of a contemporary doctor who uses almost exclusively “Xiao Chai Hu Tang” 小柴胡汤, for any conditions. He only modifies the dosage of the herbs, with some additions or substractions, according to the patient’s particular situation! Some of his students, who did not notice these modifications of dosage, were rather disturbed and could not understand how he would always prescribe the same formula in very different conditions and have good results!

Finally, we should always remember that all these formulae were used in different dynasties and Doctors prescribed them with different dosage units: “Zhu, Liang, Fen, Qian, Jin, Dou, Sheng, He” 铢, 两, 分, 钱, 斤, 斗, 升, 合, which did not always represent the same amount in each dynasty: this is a source of confusion. They were also prepared under different forms: “wan丸” or “Dan 丹” (pill), “San 散” (powder), or “Tang 汤” (decoction). In the description of the formulae, I used first the original dosage as indicated in the ancient books and, in brackets, the modern dosage in grams, easier to use nowadays. In any case they are mainly an indication of the proportion of each ingredient in the prescription, in order to help the TCM practitioner establish his own prescription. You will notice that all the Pill or Powder forms (“wan”, ”dan” or “san”) have much higher dosages than decoctions (“tang”), as they were often prepared for three months at a time. In case of pill or powder form, the ingredients are grounded together as powder and 1-3gr of powder or 6-9gr of pills is taken as a dose usually with warm water.

Xia Jiao level

C : First, let’s look at Xia Jiao, the basis.

LX : If we want to treat at Xia Jiao level, we have, at our disposal, prescriptions which belong to the Yin aspect of Xia Jiao, darker in colour with a strong “wei”, and those which belong to the Yang aspect, lighter in colour with a balanced “qi” and “wei” or a lighter “wei”, which focuses on tonifying Yang only. In both groups, we’ll have subdivisions and we shall see in details their most representative prescriptions.

1. Prescriptions working to reinforce Xia Jiao Yin

Yin deficiency with Yang excess:

The pillar of this category is:

Liu Wei Di Huang Wan

Originally, it comes from: “Xiao Er Yao Zheng Zhi Jue” = “The principle of the herbs used in paediatrics”, written by Dr Qian Yi in the Song Dynasty.

At that time, it was used to sedate Kidney (Xie Shen). There was a formula to sedate each of the Zang organs: “Xie shen wan” to sedate Kidney (Liu Wei Di Huang), “Xie bai san” to sedate Lungs, “Xie qin san”, to sedate Liver, “Xie huang san”, to sedate Spleen. Nowadays, we use “Liu Wei Di Huang” to tonify Kidney.

It has: Shudihuang 8 qian (24g) (bitter, sour, cold), Shanyao 4 qian (12g) (sweet, not warm, not cold), Shanzhuyu 4 qian (12g) (sour, warm), Fuling 3 qian (9g) (neutral), Zexie 3 qian (9g) (salty, cool), Mudanpi 3 qian (9g) (bitter, pungent cool).

The whole nature of this prescription is cool, the taste is heavy “wei hou”, and the direction down. It tonifies, gathers in Xia Jiao (Dan Tian) and opens urination.

In traditional theory, to restore Jing, we should use cool, bitter herbs. If we use warm herbs, it will deplete Jing and not restore it.

Modifications of Liu Wei Di Huang:

Zhi Bai Di Huang Wan: Liu Wei + zhi mu 6-9g (sweet and cold) and Hangbai 6-9g (bitter and cold): same function as Liu Wei with a stronger gathering and downward effect in Xia Jiao. It works on the deficient heat by its gathering effect and a stronger direction downwards.

Qi Ju Di Huang Wan: Liu Wei + Gouqizi 9g and Juhua 6g: a bit warmer.

Du Qi Wan: Liu Wei + Wuweizi 9g: helps gathering even more.

These Prescriptions cannot be used for people with a weak Stomach Qi (diarrhoea, cannot take cold food, low appetite, poor digestion, pale face, cold limbs) because of their heavy taste and cool herbs.

It says: “Pi Wei Hou Tian Zhi Ben, Shen Wei Xian Tian Zhi Ben” 脾为后天之本, 肾为先天之本 = “Spleen and Stomach are the roots of hou tian (post heaven Qi), Kidney is the root of xian tian (pre-heaven Qi)”.

By experience, if somebody is “hou tian xu” and “xian tian xu”, we have to correct “hou tian” first because the herbs used to correct “xian tian” will induce loose bowels, uncomfortable stomach and symptoms of fire rising up. Before using a prescription to tonify Kidney, we have to tonify and open the middle and open the channels. Mudanpi, Zexie, Fuling are used for this purpose.

Yin-Jing deficiency:

The prescriptions of this category reinforce the basic substances, Jing and Yin but, in general, do not move strongly.

The three main representatives are: Zuo Gui Wan, Er Zhi Wan, and Wu Zi Yan Zong Wan.

Zuo Gui Wan

Comes from “Jing Yue Quan Shu “= “The Collected Treatrise of Zhang Jing-Yue”, by, Dr Zhang Jing Yue, Ming dynasty.

It has: Shudihuang 8 liang (240g), Shanyao 4 liang (120g), Shanzhuyu 4 liang (120g), Niuxi 3 liang (90g), Tusizi 4 liang (120g), Gouqizi 4 liang (120g), Lujiao 4 liang (120g), Guijiao 4 liang (120g)

Shudi, Niuxi, Tusizi, Gouqizi, Lujiao, Guijiao are all warm and gathering herbs. They restore Jing.

Niuxi also works at Xue or Jing level with a strong action downwards.

Shanyao works at Qi level and restores Kidney and Spleen Qi.

This prescription has a heavy taste, “wei zhong”, and its tonifying and gathering effects are even stronger than Liu Wei Di Huang Wan. But to take this formula, people must have a strong Qi: “wei zhong” formulae must be moved by strong Qi. The stomach Qi should be good and the channels must be opened (even if deficient).

This formula is particularly good for people who have weak legs, as its action goes down to the feet. The action of Liu Wei Di Huang goes down to Dantian but not to the feet.

It is a powder, which explains relatively higher dosages as explained before.

Er Zhi Wan

Comes from the “Yi Fang Ji Jie” = “explanation of medical formulae”, by Dr Wang Ang, Qing dynasty.

It has only 2 herbs: Nuzhenzi and Hanliancao (no fixed dosage).They are both “yin zhong zhi yin” (yin within yin), and cool herbs. They have the long term effect of keeping, supporting and restoring Jing, with a strong action downwards.

Sometimes, Sangshen is added to the prescription (also yin zhong zhi yin herb)

It is commonly used for middle age women.

Wu Zi Yan Zong Wan

Comes from the Standards of Patterns and Treatments, by Dr Wang Kentang, Ming dynasty

It has five seeds: Wuweizi 1 liang (30g), Cheqianzi 2 liang (60g), Tusizi 8 liang (240g), Gouqizi 8 liang (240g), Fupenzi 4 liang (120g).

All gather Kidney Qi and are slighly warm.

We can also add two prescriptions mentionned in Shang Han Lun:

— Huang lian E Jiao Tang: Which has: Huanglian 4 liang (120g), Huangqin 2 liang (60g), Ejiao 3 liang (90g), Shaoyao 2 liang (60g), Jizihuang (egg yolk) 2 yolks. Cold and tonify Yin; the coldest of the five prescriptions.

— Zhu Fu Tang: With: pig’s skin 1 jin (250g), honey 1 sheng (200ml) and wheat flour 5 he (90g). Neutral and nourishes yin

Yin-Qi deficiency:

The prescriptions in this category benefit Yin and Jing, but also move and transfer in different directions. There are numerous famous prescriptions which can be used to this effect and address a great variety of cases.

Jin Suo Gu Jing Wan = “Metal lock pill to stabilize the essence”

It comes from “Yi Fang Ji Jie” =” Collected Explanations on Medicinal Prescription”, by Dr Wang Ang, Qing dynasty.

It has: Shayuanjili 2 liang (60g), Qianshi 2 liang (60g): gather Kidney

Lianzi 2 liang (60g): gathers Spleen

Longgu 1 liang (30g), Muli 1 liang (30g), Lianxu 2 liang (60g): just gather.

This formula strongly gathers (“Gu Se” 固涩), from inside and outside. All the herbs restore Jing.

In ancient times, it was used for men, very weak with impotence, chronic spermatorrhea, and low back ache.

If the person is not too weak, cannot keep or control Yin & Jing, but also has fire, use Zhi Bai Di Huang Wan

Tian Wang Bu Xin Dan

Comes from: “She Sheng Mi Pou”= “Secret Analysis of Health Cultivation”, Dr Hong Ji, Ming dynasty.

This formula has:

Renshen 5 qian (15g), Fuling 5 qian (15g): work at Qi level

Shengdi 4 liang (120g), Wuweizi 5 qian (15g), Maidong 2 liang (60g), Tiandong 2 liang (60g), Baiziren 2 liang (60g), Suanzaoren 2 liang (60g): work at Yin level

Danggui 2 liang (60g), Danshen 5 qian (15g), Xuanshen 5 qian (15g): work at Xue level

Yuanzhi 5 qian (15g), Jiegeng 5 qian (15g): open the channels

This prescription works on both Zhong Jiao (Qi and Xue level) and Xia Jiao (Yin and Yang level). It is warm, gathers in Xia Jiao and opens Qi and Xue in Zhong Jiao in order to use Yin.

Tian Ma Gou Teng Yin

Comes from: “Za Bing Zheng Zhi Xinyi”=“New understanding of the treatment of diseases” by Dr Hu Guangci, 1958.

This formula is classically put into the “extinguish internal wind” category. But it has many herbs to gather Jing.

It has: Shijueming 18g, Zhufushen 9g: minerals neutral with a downwards action; Zhizi 9g, Huangqin 9g: bitter, down and open the microcirculation. Zhizi also promotes urination.

Yimucao 9g, Duzhong 9g, Sangjishen 9g, Niuxi 12g, Yejiaoteng 9g: warm, gather Jing

Tianma 9g, Gouteng 12g: strong action down, clears excess thoughts and mental activity, keeps the mind steady.

Altogether, this prescription gathers Jing, with a strong downward action at Qi level. If Jing is deficient, Shen cannot control and it will result in headaches, high blood pressure, insomnia, anxiety… It is often used for middle age women.

Instead of Zhizi, we could use herbs cool, slightly bitter, and opening down like: Xiakucao or Juhua.

If there is water retention, we add: Weilingxian, Zixie, or Cangzhu.

If there is Qi deficiency, we add: Huangqi, Dangshen,

In case of dampness, we add: Fangfeng, Baizhi, Jingjie (based on the ancient principle that wind helps remove dampness)

If we need more effect to sedate the mind, we can use Shentieluo (iron).

In the Huang Di Nei Jing, iron was used to treat manic disorders. It works at Qi level and will not damage the interior.

Dang Gui Liu Huang Tang

It comes from “Lan Shi Mi Cang” or “secrets from the orchid Chamber”, and was written by Dr Li Dong Yuan, during the Jin-Yuan Dynasty (13-14th century)

It has: Danggui, Shengdihuang, Shudihuang, Huangqin, Huangliang, Huangbai (equal dosage for each of them, 9 to 15g), Huangqi (double dosage).

It is similar to Zhi Bai Di Huang Wan, but more bitter and heavier. It is cool, gathers and tonifies Yin.

Danggui opens inside and Huangqi also gathers when used with other gathering herbs.

It is not used very often.

Shi Hu Ye Guang Wan

It comes from “Yuanji Qiwei”= “back to the chance of understanding the truth”, by Dr Ni Weide, Yuan dynasty.

It has four groups of herbs:

— Renshen 2 liang (60g), Fuling 2 liang (60g), Shanyao 7.5 qian (23g), Gancao 0.5 liang (15g): tonify Qi and open the middle

— Fangfeng 0.5 liang (15g), Juhua 7.5 qian (23g) (pungent, cool), Xingren 7.5 qian (23g) (pungent, warm, bitter, opens the surface and lung), Baijili 0.5 liang (15g) (pungent, bitter), Zhiqiao 0.5 liang (15g) (bitter, pungent, cool, acts at Qi level): these herbs open the surface and leads the prescription up.

— Tiandong 2 liang (60g), Maidong 1 liang (30g), Shudi 1 liang (30g), Shengdi 1 liang (30g), Tusizi 7.5 qian (23g), Gouqizi 7.5 qian (23g), Wuweizi 0.5 liang (15g), Shihu 0.5 liang (15g), Roucongrong 0.5 liang (15g): These herbs work at Jing level, tonify Kidney Yin and Yang (“wei zhong”)

— Huanglian 0.5 liang (15g), Xijiao 0.5 liang (15g), Lingyangjiao 0.5 liang (15g): bitter, cool herbs with a downward action. They act at Xue level.

This formula has been used, classically, for visual disorders. Ancient theories say that most visual problems are due to fire. It is not necessarily internal fire of the whole body, but it could be fire due to emotional troubles, or “Qi deficiency fire” due to over stimulation of the eyes (computers, TV etc..). The last group of herbs (Huanglian, Xijiao, Lingyangjiao) cools fire from the mind and channels, the second group leads the prescription upwards.

This formula can treat many problems, other than visual disorders.

If stomach Qi is strong, we can omit the first group of herbs.

Qi Bao Mei Ran Dan = “seven-treasure pill for beautiful whiskers”.

It comes from “Yi Fang Ji Jie” or ‘Collected Explanations on Medicinal Prescription”, by Dr Wang Ang, Qing dynasty.

It has: Heshouwu, chi and bai (red and white), altogether 1 jin (480g), Fuling 8 liang (240g), Niuxi 8 liang (240g), Gouqizi 8 liang (240g), Tusizi 8 liang (240g), Buguzhi 4 liang (120g) (tonifies Kidney Yang, “activates fire”), Danggui 8 liang (240g).

It is quite warm.

Buguzhi, helps using the gathering effect of the other herbs by activating the fire in Dantian. If this is not necessary, we can replace it by Wuweizi.

Professor Gong Shu Sheng (from the pharmacology department. of Beijing TCM University) did a lot of research on this formula, and concluded that it is very beneficial for middle age women, to help them cope with hormonal imbalance. It is more effective than Liu Wei Di Huang Wan.

Wu Mei Wan

It comes from Shang Han lun (Jue Yin level).

It has: Wumei 300 pcs (480g), Xixin 6 liang (180g), Ganjiang 10 liang (300g), Huanglian 16 liang (480g), Danggui 4 liang (120g), Fuzi 6 liang (180g), Shujiao 4 liang (120g), Guizhi 6 liang (180g), Renshen 6 liang (180g), Huangbai 6 liang (180g).

This prescription first gathers: Wumei, Fuzi, Renshen, Ganjiang.

Then it opens Yang Qi at Xia Jiao level: Xixin, Guizhi, Danggui.

Huanglian and Huangbai (bitter) consolidate the effect of the previous herbs and are not in the prescription to treat heat.

In the condition addressed by this formula, the signs of heat are not due to the presence of a pathogenic factor but to serious Yin deficiency. This leads to Yang rising. As heat, produced by this Yin-Yang imbalance, cannot go out via the blocked channels, it generates a sore throat. To treat it, one needs to gather and open at Xia Jiao level.

Grind all the ingredients as powder and make a pill with honey. Take a 9 gr dose 2-3 times a day.

2. Prescriptions working to reinforce Xia Jiao Yang.

The decoctions are lighter in colour and taste than in the previous group.

Work on Yang deficiency

Si Ni Tang

Fuzi 1 pc, Ganjiang 1.5 qian (4.5g), Zhigancao 2 qian (6g).

They are all very warm, tonify Yang and open the whole body (Fuzi, Xixin, Ganjiang). Fu Zi Li Zhong Wan, Si Ni Tang and Fu Zi Tang also gather and consolidate the middle (Renshen, Baizhu, Fuling, Zhigancao); Ma Huang Tang has a strong upward direction.

Symptoms of cold

Here are four prescriptions from Shang Han Lun:

Fu Zi Li Zhong Wan:

Renshen 1 liang (30g), Ganjiang 1 liang (30g), Baizhu 1 liang (30g), Zhigancao 1 liang (30g), Fuzi 1 liang (30g).

Fu Zi Tang:

Fuzi 2 pcs, Fuling 3 qian (9g), Renshen 2 qian (6g), Baizhu 4 qian (12g), Shaoyao 3 qian (9g).

Ma Huang Fu Zi Xi Xin Tang:

Mahuang 2 qian (6g), Fuzi 1pc (9gr), Xixin 2 qian (6g).

Work on Yang &Jing deficiency

You Gui Wan

Comes from “Jing Yue Quan Shu “= “The Collected Treatrise of Zhang Jing-Yue”, Dr Zhang Jing Yue, Ming dynasty.

This formula is very similar to Zuo Gui Wan (tonify yin and Jing) with, in addition: Fuzi and Rougui.

It has: Shudi 8 liang (240g), Shanzhuyu 3 liang (90g), Shanyao

4 liang (120g), Gouqizi 4 liang (120g), Tusizi 4 liang (120g), Duzhong 4 liang (120g), Lujiaojiao 4 liang (120g), Danggui 3 liang (90g) + Fuzi 2~6 liang (60~180g) and Rougui 2~4 liang (60~120g).

It is used for people with Jing deficiency and “Shen Yang Xu” (kidney Yang deficiency) presenting with: cold, water retention, loose stools, downwards symptoms. It tonifies Jing and Yang, and gathers in Xia Jiao.

Grind the ingredients into powder and make small pills with honey. Take 9-15g pills 2-3 times daily;

Work on Yang & Qi deficiency

These prescriptions benefit Jing, belong to the Yang aspect of Jing and move it.

Some are heavy in colour and taste. Theyl are all from Shang Han Lun:

Jin Gui Shen Qi Wan

This formula is similar to Liu Wei Di Huang. + Fuzi and Guizhi

It has: Shengdi 8 qian (24g), Shanzhuyu 4 qian (12g), Shanyao 4 qian (12g), Zexie 3 qian (9g), Fuling 3 qian (9g), Mudanpi 3 qian (9g) + Fuzi 1 qian (3g) & Guizhi 1 qian (3g).

It is used to treat Kidney Yin deficiency with also Kidney Yang deficiency. It does not tonify Kidney Yang as much as You Gui Wan, but it moves Yang.

Grind the ingredients into powder and make small pills with honey. Take 6-9g pill 1-2 times a day

Others are lighter:

Ma Huang Sheng Ma Tang:

Mahuang 2.5liang (7.5g), Shengma 1liang and 1fen (3.7g), Danggui 1 liang and 1fen (3.7g), Zhimu 18zhu (2g), Huangqin 18zhu (2g), Yuzhu 18zhu (2g), Shaoyao 6zhu (1g), Tianmendong 6zhu (1g), Guizhi 6zhu (1g), Fuling 6zhu (1g), Zhigancao 6zhu (1g), Shigao 6zhu (1g), Baizhu 6zhu (1g), Ganjiang 6zhu (1g).

This prescription has a very strong “qi” with a very high dosage of Mahuang and Shengma; it is good to reharmonise Qi. The other herbs are meant to “keep”, and wait for the right time to catch “Ji”. It is used when the limbs are cold, there is a lot of diarrhoea, no energy, and a sore throat due to real pathogenic factor. The pulse indicates serious deficiency. A very high proportion dosage of Mahuang and Shengma is used to change the direction of Bing Ji (upwards) in order to stop the diarrhoea. But as a whole, it is not a strong decoction. Using Warm and gathering herbs to stop the diarrhoea would, in this case, increase heat and aggravate the sore throat.

If the sore throat clears up and the diarrhoea stops, then we can gather more strongly.

C : What would you like to say to summarise the main principles of actions of the prescriptions working at Xia Jiao level?

LX : The following tables will be a very useful and practical tool, to compare these prescriptions, their nature, functions and directions of action.

Xia jiao下焦

Prescriptions to reinforce Xia Jiao Yin: taste heavy, colour dark

cool

warm

tonify yin

sedate yang

gather in xia jiao

open xia jiao

upward direction

downward direction

Yin deficiency with Yang excess

Liu Wei Di Huang Wan

六味地黄丸

+

–

+

+

+

++

–

+

Zhi Bo Di Huang Wan

知柏地黄丸

++

–

++

++

++

+

–

++

Qi Ju Di Huang Wan

杞菊地黄丸

+ –

+ –

++

+–

+–

+

+

+–

Du Qi Wan 都气丸

+ –

+

++

++

–

–

+

Yin-Jing Deficiency

Zuo Gui Wan 左归丸

+

–

+++

–

+++

–

–

+

Er Zhi Wan 二至丸

++

–

++

–

+

–

–

+++

Wu Zi Yan Zong Wan

五子衍宗丸

+

+

–

++

+

–

++

Huang Lian E Jiao Tang

黄连阿胶汤

+++

–

++

+

+–

–

–

++

Zhu Fu Tang 猪肤汤

+

–

+

–

+–

–

–

+–

Yin-Qi Deficency

Jin Suo Gu Jing Wan

金锁固精丸

+

+ –

+

–

++

–

–

++

Tian Wang Bu Xin Dan

天王补心丸

–

++

++

–

+

++

++

+–

Tian Ma Gou Teng Yin

天麻钩藤饮

++

–

+

++

++

+

+++

Dang Gui Liu Huang Tang

当归六黄汤

++

–

+++

++

++

+

+

++

Shi Hu Ye Guang Wan

石斛夜光丸

++

–

++

++

++

+

+–

++

Qi Bao Mei Ran Dan 七宝美髯丹

–

+++

++

–

+

+–

++

+–

Wu Mei Wan 乌梅丸

–

+ –

+ –

–

+++

++

+–

+–

Xia jiao下焦

Prescriptions to reinforce Xia Jiao Yang: taste light, colour light

cool

warm

tonify

yang

sedate

cold evil

gather in xia jiao

open xia jiao

upward direction

down-ward direction

Pure yang Deficiency

Fu Zi Li Zhong Wan 附子理中丸

–

+

++

+

++

+–

++

+

Fu Zi Tang 附子汤

–

++

+

+–

++

+–

–

–

Ma Huang Fu Zi Xi Xin Tang

麻黄附子细辛汤

–

+++

+++

+++

–

+++

+++

–

Si Ni Tang 四逆汤

–

+++

+++

++

++

+

+–

+

Yang-Jing Deficiency

You Gui Wan 右归丸

–

+

++

+

++

–

+

++

Yang-Qi Deficiency

Jin Gui Shen Qi Wan

金匮肾气丸

–

++

++

++

++

+

–

++

Ma Huang Sheng Ma Tang

麻黄升麻汤

+

+ –

+ –

–

+

+–

+

–

All the prescriptions working in Xia Jiao when the condition is purely “Yin xu” are cold, gather and go down. They all have a heavy taste and can damage the stomach, if taken for a long time.

The leader of this group is: “Liu Wei Di Huang Wan”. If we want a cooler formula we use “Zhi Bo Di Huang Wan”; a little warmer and more gathering formula, we use “Du Qi Wan”; a formula with more moving action: “Qi Ju Di Huang Wan”;

If we need to tonify Yin and Jing, “Zuo Gui Wan” is the strongest;

If we need a prescription more cold and less gathering (Jing xu not so severe), we can use “Huang Liang E Jiao Tang”; If we also need to address cold, we use “Wu Zi Yan Zong Tang”, the only one of this group a little warmer (+), it also has a good gathering effect and can open a little. “Zhu Fu Tang” and” Er Zhi Wan” have a “pure Jing” action: they do not create heat and are not sticky, which is an advantage for long term treatment, but they do not gather as much as “Zuo Gui Wan” or” Wu Zi Yan Zong Wan”. For symptoms of menopause, use “Er Zhi Wan” or “Huang Lian E Jiao Tang” which are cold, with a stronger downward effect.

In the “Yin and Qi deficiency” group, we first look at their nature; for exemple: “Tian Wang Bu Xin Wan” is warm; “Tian Ma Gou Teng Yin”, “Shi Hu Ye Guang Wan” are cold with a strong downward action.

“Jin Suo Gu Jing Wan” focuses on Jing, do not move and do not open;

“Wu Mei Wan” is very special: it provides Yin Qi and Yang Qi, uses sour taste to gather them together, and then acts as a switch to get it into action; it is used in real deficiency to give the body a “ji” to come back.

In Yang deficiency,

The basic prescription is “You Gui Wan”.

If, in an emergency situation, we want to quickly tonify Yang Qi, we use “Si Ni Tang” or “Ma Huang Fuzi Xi Xin Tang”; but only if there is no Yin or Jing deficiency can we use “Ma Huang Fu Zi Xi Xin Tang”, otherwise the body energy will become completely empty! It is very fast at sedating cold.

“Fu Zi Li Zhong Wan” also warms the middle. “Jin Gui Shen Qi” is used when we do not need so much gathering or tonifying effect but we need to open urination.

“Ma Huang Sheng Ma Tang” maintains Yin and relaxes Yang in very sick people who also need to get blocked heat out (very seldom used).

Zhong Jiao level

C : And now, if “Bing Ji” is taking place in Zhong Jiao, how do we use the classical prescriptions?

LX : In Zhong Jiao, “Bing Ji” may be at Qi level or Xue level. We are, of course, talking about “Bing Ji” and not symptoms, which might not all necessarily belong to Zhong Jiao. At both Qi and Xue level, we have at our disposal, prescriptions which tonify the middle and others which sedate.

We shall first discuss the prescriptions with a tonifying effect at Qi, and Xue level

1. Prescriptions working to tonify or benefit Zhong Jiao

Work on Zhong Jiao deficiency tonify Qi

Si Jun Zi Tang

“The four gentlemen decoction”, is the base of most of the prescriptions in this category and of 70% of my own prescriptions!

This prescription comes from the book: “Tai Ping Hui Min He Ji Ju Fang” = “Imperial Grace Formulary of the Tai ping era” (Imperial Medical Department: 1078-1085). At that time, it was compulsory for all doctors to use exclusively the formulae written in this book and edited by the government.

It is called “the four gentlemen decoction” because it has four herbs which are gentle and in harmony with each other.

Renshen, Baizhu, Fuling, Gancao. Same dosage for each herb: 3-9 g.

The Prescription is first sweet and warm, second bitter. Originally, the dosage was the same for each herb (3-9 g).

It is meant to tonify “middle Qi”, if the channels are open and there is no internal fire (if internal fire, do not use Renshen). It gathers Qi inside, improves middle Qi and improves digestion. Renshen also gathers Qi to Dantian.

This famous and simple prescription has a few variations, if we need to open as well as gather inside, or if we need a stronger warming effect:

If there is phlegm, we add two herbs to open out: Chenpi and Banxia (quite pungent, open the surface): this is “Liu Jun Zi Tang”.

If there is stagnation at Qi level, we add two more herbs to the previous ones: Sharen and Muxiang: this is “Xiang Sha Liu Jun Zi Tang”

If the surface is really blocked or cold, we use Fangfeng, Chaihu, Jingjie: very good for old people who suffer from recurrent external cold. If even more blockage and cold, use Mahuang

Shen Ling Bai Zhu San

This prescription also comes from the “Tai Ping Hui Min He Ji Ju Fang”.

It has: Si Jun Zi Tang each herb 2 jin (1000 g)

with Shanyao 2 jin (1000 g), Lianzi 1 jin (500g), Baibiandou 1.5 jin (750g), Yiyiren 1 jin (500g), which are all seeds or roots and help the gathering function of the prescription

Sharen 1 jin (500 g), Jiegeng 1 jin (500 g), which are warm and move Qi .

The whole formula consolidates more (“gu 固”) than “Si Jun Zi Tang”.

In practice, if the digestive function is low, use “Si Jun Zi Tang”. If, in addition, there is loose bowel movement, diarrhoea, difficulty in the absorption of food, feeling “full” very quickly, use “Shen Ling Bai zhu Tang”. To enhance even further the gathering function, add Wuweizi which gathers into Dantian.

The ingredients are grounded into powder and taken as a 6g dose with warm water.

Li Zhong Wan

Comes from “Shang Han Lun”. It has four herbs: Renshen, Ganjiang, Baizhu, and Zhigancao. 3 qian (9g) of each herb

Ganjiang replaces Fuling, so the prescription is warmer than “Si Jun Zi Tang”.

It is the best prescription if there is vomiting and stomach ache with cold in the stomach.

In ancient times, they said that Ganjiang “Shou Er Bu Zou 守而不走: keeps in and do not move”. Although it is pungent and hot, it is not like Danggui, Fuzi, Huangqi, Xiangfu, which, like alcool, move Qi and warm. Ganjiang (like Lianzi) keeps in. Its effect is not very strong but lasts for a long time. It is very useful for people whose stomach Qi is deficient but easily react by opening out: the “shou” (gathering) aspect of Ganjiang will be good.

In the treatment of diarrhoea, if there is cold and Qi xu, ” Li Zhong Wan” will act quickly to stop the pain and the diarrhoea. After a few days, ”Shen Ling Baizhu “will be prescribed to restore, but it doesn’t act as quickly as” Li Zhong Wan”.

If we add Fuzi, we have “Fuzi Li Zhong Tang”, which comes from “San Yin Ji Yi Bing Zheng Fang Lun”= “the prescription theory of three causes”, by Dr Cheng Yan, Song dynasty.

This prescription is very warm and cannot be used for a long time. It really belongs to “Xia Jiao Yang”, as we have seen previously.

Bu Zhong Yi Qi Tang

Comes from “Pi Wei Lun” = “Discussion of the spleen and stomach”, written by Dr Li Gao in Jin dynasty.

It has: Renshen 3 fen (9g), Baizhu 3 fen (9g), Zhigancao 5 fen (15g) + Huangqi 0.5~1qian (15~30g), Danggui 2 fen (6g), Jupi 3 fen (9g), Shengma 3 fen (9g), Chaihu 3 fen (9g).

It tonifies stomach Qi but has also a powerful moving action (“zou”), especially in the upward direction. Because of relatively low dosages of Renshen, Baizhu and Zhigancao, it doesn’t gather so much.

Bu Zhong Yi Qi should not be used for people who have a tendency to create internal heat which goes easily upwards, or for people whose mind is too active and who cannot sleep.

Dang Gui Bu Xue Tang

Comes from “Secret Storing of Blue Room” written by Dr Li Gao in Jin dynasty.

It has only two herbs: Huangqi 1 liang (30g) and Danggui 2 qian (6g).

It is supposed to address blood deficiency, but the main dosage is for Huangqi which tonifies middle Qi. If this formula addresses Qi xu, why use Danggui, which tonify blood and opens?

Only a person whith Qi deficiency and blocked channels can use this prescription.

It helps the Jing to move up and transform into blood and then circulate in the body.

Jing can transform into Xue, and Zhong Jiao Qi can produce Xue.

This formula can help these two transformations, and circulate the result.

Xiao Chai Hu Tang

Comes from “Shang Han Lun”.

It is a very useful prescription, especially for children, who may have a good Shen and Qi, good channels but a weak middle Qi.

It has: Chaihu 8 qian (24g), Banxia 0.5 sheng (9g) which are pungent and open up slightly. The classic dosage of Banxia is 24 g but it is too high for modern patients and I use only 9g

Huangqin 3 qian (9g) is bitter, not cold, not warm, goes down and cools: it can control symptoms of fever induced by the other herbs

Renshen 3 qian (9g), Gancao 3 qian (9g), Shengjiang 3 qian (9g), and Dazao 12 pcs are sweet and warm, and tonify.

It is used in Shao Yang level of Shang Han Lun: Zhen Qi is weak, the pathogenic factor is weak, the fight is not strong, the pathogenic factor stays in “biao”, and the interior (“li”) is not strong enough to help moving it out.

After taking this prescription, “Shang Jiao De Tong, Jin Ye De Xia, Wei Qi Ying He, Shen Ji Ran Han Chu Er Jie” 上焦得通, 津液得下, 卫气因和, 身濈然汗出而解 = “The upper jiao is open, the fluids go down, stomach Qi is balanced and in harmony, the whole body is soft, there is comfortable sweating and the problem disappears”.

Gui Zhi Gan Cao Tang, and Gan Cao Gan Jiang Tang:

Also come from Shang Han Lun. Both gather Qi or Yang. They are often used to correct the effect of a wrong treatment. Gancao 4 qian (12g) Ganjiang 2 qian (6g) Tang is used when middle Qi becomes deficient: it increases the gathering effect in the middle, Guizhi 4 qian (12g), Gancao 2 qian (6g) Tang is used when Yang is going out: it tonifies Yang Qi.

Wu Zhu Yu Tang

Also comes from Shang Han Lun. It has:

Wuzhuyu 1 sheng (3g), Renshen 3 qian (9g), Shengjiang 6 qian (18g), Dazao 12 pcs.

Wuzhuyu is bitter, pungent and warm

Renshen and Dazao gather Qi in. This prescription adjusts Qi Ji rather than warms. It is “the” prescription in case of an emergency due to cold in the middle with pain and vomiting.

Work on Zhong Jiao deficiency tonifies Xue.

In this category, we have prescriptions which belong to Yin-Xue (deep and do not move so much) and others which belong to Qi –Xue (moves more).

Zhong Jiao Yin-Xue deficiency

Si Wu tang

Comes from Taiping Huimin Heji Jufang

Originally this formula was made of four herbs with the same dosage:

Danggui, Chuanxiong, Baishao, Shudi (9 to 12 g)

It is part of Ba Zhen Tang (the Eight-Treasure decoction) which tonifies Qi in order to provide Xue.

Si Wu Tang mainly moves.

It was good to tonify blood, in the Song dynasty. But nowadays, women do not suffer so much from blood xu and blood stagnation, but more from Jing xu. If they take this formula, they might develop rashes, or mennorhagia, or other signs of heat.

Zhi Gan Cao Tang

Comes from Shang Han Lun

It has: Renshen 2 qian (6g), Guizhi 3 qian (9g), Gancao 4 qian (12g), Shengjiang 3 qian (9g), Dazao 30pcs, Shengdi 16 qian (48g: large dose), Ejiao 2 qian (6g), Maidong 0.5 sheng (10g), Huomaren 0.5 sheng (10g).

All ingredients are prepared with alcohol.

This prescription does not really work on Zhong Jiao (no Baizhu, Fuling), nor on Kidney, but it works on “Xue-Mai” level.

“Xue-Mai” is, traditionally, considered to have two main aspects:

— the Yang aspect which corresponds to Jing Luo Qi (channel Qi) and belongs to Xing Qi (the structure)

— the Yin aspect, which corresponds to Jing-Xue, or the inside of the channels, the fluids (Jin Ye), also called “outside Yin”.

If Jing is deficient, Yin is also deficient, the “outside Yin” (or channel Yin) will not be sufficient. This channel Yin corresponds to the microcirculation, or the deep circulation inside the organs. The Japanese call it “muscle level”

To reach this level, we cannot use herbs too pungent, too warm, or too gathering. The goal is to restore Jing Qi, not necessarily in the Kidney but in the other internal organs where there is blood stagnation. We have to promote the energy and restore Jing in the concerned organs and then move it in the “Xue-Mai” level, which does not respond to sweating, draining down or promote urination.

People, at “Xue-Mai” level may suffer from heart problems, or liver problems or bad circulation. They might have a rash like in cirrhosis (stellar angioma).

This formula is meant to balance (“He-Jie 和解”) at Xue level.

The main dosage is for Zhigancao (tonify Qi).

Guizhi is there to promote and open, and remove blood stagnation in the deep circulation. Not to tonify.

shengdihuang is also there to remove blood stasis and not to tonify.

All the herbs are not in the formula to “keep” but to gently move.

The whole prescription is meant to move within the interior.

Gui Zhi Tang

It comes from Shang Han Lun. It belongs to both Zhong Jiao and Shang Jiao.It has: Guizhi 3 qian (9g), Shaoyao 3 qian (9g), Zhigancao 2 qian (6g), Shengjiang 3 qian (9g), Dazao 12 pcs.

It is sweet, slightly bitter and warm. Although it gathers Qi-Xue and moves, we put it in this section (rather than with Qi-Xue deficiency), because there are many variations of this prescription used at this level (Yin-Xue deficiency).

Gui Zhi jia Shao Yao tang: is more sour and cool (Shaoyao), so it gathers more and tonifies Xue.

Gui Zhi jia Shao Yao Ren Shen Xin Jia tang: plus Renshen, Shaoyao to tonify Qi and gather even more.

Wen Jing Tang

It comes from:” Essentials from the Golden Cabinet”, written by Dr Zhang Zhongjing, Eastern Han dynasty

It has: Wuzhuyu 3 qian (9g), Danggui 3 qian (9g), Chuanxiong 2 qian (6g), Shaoyao 2 qian (6g), Renshen 2 qian (6g), Guizhi 2 qian (6g), Ejiao 2 qian (6g), Danpi 2 qian (6g), Sheng jang 2 qian (6g), Gancao 2 qian (6g), Banxia 0.5 sheng (6g), Maidong 3 qian (9g).

It first sedates and opens, second, tonifies and warms. Its direction is downward. It is very good for dysmenorrhoea, irregular menstruation, infertility, due to cold and blood stagnation.

Shao Yao Gan Cao Tang, It comes from Shang Han Lun.

It has: Shaoyao 4 qian (12g), Gancao 4 qian (12g) The opposite of Guizhi Gan Cao Tang or Gan Jiang Gan Cao Tang. In Shang Han Lun, it was used to gather Yin after gathering Yang with Gui Zhi Gan Cao Tang.

Xiao Jian Zhong Tang: Comes from Shang Han Lun. It belongs to Zhong Jiao, strongly tonifies Xue and gathers by using more Shao yao, and Yitang 1 sheng.

It has: Guizhi 3 qian (9g), Shaoyao 6 qian (18g), Zhigancao 2 qian (6g), Shengjiang 3 qian (9g), Dazao 12 pcs and Yitang (sugar) 1sheng (30g).

Zhong Jiao Qi-Xue Deficiency

In this subdivision we find prescriptions which work both on Qi (move) and Xue (nourish or gather) level.

Xiao Yao San

The whole prescription is sweet, pungent, and a little bitter. The direction is upward and outward.

Comes from “Tai Ping Hui Min He Ji Ju Fang “

It has: Baizhu 1 liang (30g), Fuling 1 liang (30g), Gancao 5 qian (15g: tonify middle Qi

Danggui 1 liang (30g), Baishao 1 liang (30g): tonify middle Xue

Chaihu 1 liang (30g), Bohe a few, Shengjiang 1 pc: open

It tonifies Zhong Jiao more than Xiao Chai Hu Tang.

It is a good prescription for people who have a low Wei Qi, no fire, and no blockage. For exemple, old people weak, with no apetite, anemia and who often catch cold.

Note: Danggui is very pungent and do not gather!

Gui Pi Tang

Comes from “Ji Sheng Fang” = “Recipes for Saving Lives”, written by Dr Yan Yonghe in Southern Song dynasty.

It has: Huangqi 1liang (30g), Renshen 0.5 liang (15g), Baizhu 1 liang (30g), Fushen 1 liang (30g), Gancao 2.5 qian (7.5g), Sheng jjang 5 pcs, Dazao 1 pc: promote the middle and move

Danggui 1qian (3g), Longyanrou 1 liang (30g), Suanzaoren 1 liang (30g), nourish Yin,

Muxiang 0.5 liang (15g), Yuanzhi 1qian (3g): moving herbs.

This formula is used for people with a weak stomach Qi, with cold and no fire. It works more at Qi level, than Xue level

It is good for insomnia due to deficiency of middle Qi (lots of symptoms of stomach Qi xu), or for women with dysmennorhea, and blood deficiency. It restores the colour of the face.

Ba Zhen Tang

It is Si Wu Tang + Si Jun Zi Tang,

It comes from “Zheng Ti Lei Yao” or “essentials for correcting the body”, in Ming dynasty;

It is a well balanced formula to tonify Qi and Xue. No special direction.

— Dang Gui Liu Huang Tang: also see Xia Jiao Yin and Qi deficiency

Strongly tonifies Qi and Xue. Cools, gathers and brings Xue downward.

— Gui Zhi qu Gui jia Fuling Bai Zhu Tang

Similar to Xiao Yao San, but milder with less upward direction (no Guizhi, no Chaihu).

C : In Zhong Jiao, Bing Ji is often due to an excess situation: we need to sedate or /and open. What do we use and when?

2. Prescriptions working to sedate Zhong Jiao at Yang or Xue level

LX : In an excess situation we can be faced with a problem of a “Yang” or “non–substantial” type (Qi level), or of a “Yin” “substantial” type (Xue level). In the first case we are dealing with a “functional” problem, when in the second case, we have to treat real “matter” (strong constipation, for exemple). In the treatment, the difference will be in the taste: light or heavy.

Let’s look at the prescriptions addressing the “Yang” type (Qi level):

Zhong Jiao excess: sedate Yang type (Qi level)

All formulae come from Shang Han Lun.

Bai Hu Tang

It has: Shigao 16 qian (48g), Zhimu 6 qian (18g), Gancao 2 qian (6g), Jingmi (rice) 6 he (9g).

It works at a Yang Ming level (Qi level) when there is high fever and heat. But it still addresses the surface. It is good to use with Yin Qiao San or Xiao Chai Hu Tang or Tian Ma Gou Teng Yin. It is cool but do not damage the stomach. Shigao is sweet and pungent: it has the ability to clear the heat and open the surface.

Bai Hu jia Ren Shen Tang

Is a variation of the previous one. Adding Renshen 3 qian (9g), we change the “Ji” of the prescription: it gathers Qi in, instead of cooling down. We use it when, in summer, people suffer from external heat with sweating, tiredness, fever, thirst. Shen and Qi are dispersed, and the person is nervous and needs to gather and cool down.

Da Huang Huang Lian Xie Xin Tang

It is not a decoction but is used as a tea: all the herbs are put in hot water, and taken straight out of it (infusion time very short). This avoids getting a heavy taste of Dahuang 2 qian (6g) and Huanglian 2 qian (6g). Its action is deeper (does not act on the surface) and milder than Bai Hu Tang. It cools down middle Qi but do not damage it.

Fu Zi Xie Xin Tang

It is Da Huang Lian Xie Xin Tang (Dahuang 2 qian (6g), Huanglian 1 qian (3g) + Fuzi 1pc and Huangqin 1 qian (3g)

Same preparation as above, but Fuzi is cooked separately, and then added to the tea. It is used when the middle is cold and blocked by “non substantial” Qi. Dahuang and Huangqin bring Qi strongly down and open; Fuzi promotes and tonifies the middle.

Zhi Zi Chi tang

Zhizi 14 pcs and Daochi 4 he (25g).

It is used when there is Zhong Jiao deficiency and evil heat staying in Zhong and Shang Jiao. It has a similar action to “Ma Huang Sheng Ma Tang” in Xia Jiao level. It “creates a good atmosphere” in Zhong Jiao to set Qi Ji in the right direction

Zhong Jiao: “Qi within Xue” excess

Huo Xiang Zheng Qi San

Comes from:“Tai Ping Hui Min He Ji Ju Fang”

It has: Huoxiang 3 liang (90g), Zisu 1 liang (30g), Baizhi 1 liang (30g), Banxia 2 liang (60g), Chenpi 2 liang (60g), Jiegeng 2 liang (60g): pungent ++, bitter, warm.

Dafupi 1 liang (30g), Baizhu 2 liang (60g), Houpo 2 liang (60g): Bitter +, pungent, warm,

Fuling 1 liang (30g), Gancao 2.5 liang (75g), Shengjiang 3 pcs, Dazao 1 pc: tonify and warm Wei Qi (very often used in the ancient times), and give a good taste to the prescription.

Grind the ingredient into powder and take a 3-6 g dose each time.

In modern books, it is classified in the “transform dampness” category, but it was not the case originally, and it can be used for problems other than dampness.

This formula is first pungent (opens up and outside), second bitter (opens and go down), and third it gathers Qi a little.

Its first action is to open the surface. It is very good for cold stomach following catching cold with cold food. But also, by opening the surface, it moves internal stagnation (Biao Jie Li Zi He 表解里自和).

If the person is not too weak, we don’t need the “gathering“herbs: Fuling, Gancao, Dazao, Shenjiang; if not too cold, we can take off, Baizhi, Dazao, and Shenjiang.

If there is fire blocking the channels and no fight, by using this prescription, the warm herbs will trigger very uncomfortable symptoms of heat: add Zhuye, Cheqiancao, Huashi, Shengshigao to control it.

If the middle is blocked inside (constipation, mouth ulcers, thick coating), do not use Gancao, Dazao (which tonify) but more Houpo, Dafupi, and add Dahuang.

The short coming of this prescription is that Fuling is the only herb promoting urination. If we want more effect on dampness, we have to add, Yiyiren or Cheqiancao.

We cannot use this prescription if the person’s surface is already open especially when there is fire (outward and upward directions). We have to follow the principle: “Da Fang Xiang” =” the direction in which a prescription works is the most important factor”.

Ping Wei San

This prescription comes from the “Tai Ping Hui Min He Ji Ju Fang” of Song Dynasty.

It has: Cangzhu 5 jin (2500 g), Houpo 3jin and 2 liang (1560 g), Chenpi 3 jin and 2 liang (1560 g), which open a little up and down, but less than the previous one, and Gancao 3 liang (300 g), Dazao 2 pcs, Shengjiang 2 pcs, to tonify a little but, again, not as much as Huo Xiang Zhen Qi Tang.

It is like the small brother of Huo Xiang Zheng Qi Tang.

It is also a powder and we grind all the herbs together into powder and take a 6 to 9 g dose each time with some Dazao and Shengjiang.

At the time of Tai Ping Hui Min He Ji Ju Fang, doctors believed in: “Xin Xiang Wen Zao: pungent flavor warms dryness”. After the Song Dynasty, Dr Zhu Dan Xi didn’t like this principle. He said that pungent can consume Yin, and wrote: “Ju Fang Fa Hui: my own understanding of Ju Fang” and he preferred to use “Er Miao Wan” (Huangbai and Cangzhu).

I, personnaly, think that “Xin Xiang Wen Zao” is very efficient but should not be used for a long time.

In case of an emergency (stomach ache, vomiting) it works faster and better than “Si Jun Zi Tang”, which can be prescribed afterwards to tonify the middle if the person is weak.

In summary: if a person is really weak, use “Si Jun Zi Tang”, if this person needs more opening, use “Ping Wei San” or “Huo Xiang Zheng Qi Tang”, if the person has more symptoms of cold use “Wu Zhu Yu Tang”.

Ban Xia Hou Po Tang

Comes from “Jin Gui Yao Lue” = “Essentials from the golden cabinet”.

It has: Banxia 1 sheng (12g), Fuling 4 qian (12g), Houpo 3 qian (9g), Shengjiang 5 qian (15g), Zisuye 2 qian (6g),

It is warm pungent and goes outwards in the four directions.

Fuling, Shengjiang and Banxia, have very high dosages and promote the middle (stomach).

Fuling and Houpo go down; Banxia, Suye, Shengjiang go up.

It is good for “mei he qi” (plum–pit qi), but also for stomach problems, and asthma when the stomach is blocked.

This formula is not meant to gather or tonify, but only to open and regulate.

Ge Geng Qin Lian Tang

Comes from Shang Han Lun.

Gegen 8 qian (24g), Gancao 2 qian (6g), Huangqin 3 qian (9g), Huanglian 3 qian (9g).

This prescription is cool and bitter. It gathers to stop diarrhoea due to Zhong Jiao deficiency, and has an upward direction.

In Shang Han Lun time it was not used to clear damp-heat (as used today), but to gather.

Da Chai Hu Tang

Comes from Shang Han Lun

It has: Chaihu 8 qian (24g), Banxia 0.5 sheng (9g), Huangqin 3 qian (9g), Shengjiang 5 qian (15g), Dazao 12 pcs (= Xiao Chai Hu tang less Ren Shen) which opens the surface and works at Qi level,

Plus: Zhishi 4 pcs, Dahuang 2 qian (6g), Baishao 3 qian (9g) which opens down at Xue level.

It is very good when a patient, who is blocked inside with internal heat and whose surface is not open, catches cold. The effect of the formula is not to clear cold or heat but to open. Blockage creates heat.

If there is fever or if we feel that taking this prescription will induce fever, add Shigao.

The most simplified formula, with a similar effect, would be: Chaihu (up, pungent, cold), Dahuang (down, bitter cold) and Banxia (open the middle, and chest, warm and up).

Si Ni San

Comes also from Shang Han Lun.

It has: Gancao, Zhishi, Baishao, Chaihu. Same dosage for each herb (7.5g)

The direction is mainly down and a little out (Chaihu)

It is used at Shao Yin level, although it is cold and bitter.

At this level it can happen that xu (deficiency) transforms into shi (excess) and zai xue moves to zai qi. At this precise time of transformation, we can use this prescription, just for a few days, to sedate Qi blocked in the middle.

Zhong Jiao: “Xue within Xue” excess

Da Cheng Qi Tang

This prescription comes from “Shang Han Lun”.

It has: Dahuang 4 qian (12g), Mangxiao 3 he (9g), Zhishi 5 pcs (12g), Houpo 8 qian (24g).

It is very bitter and the direction of the prescription is strongly and only downwards.

It is very good for treating fever at Xue level (and not Qi level), any disease with Xue or Fire stagnation (manic disease) or stagnation of a pathogenic factor in the tissues (boils).

Mangxiao is salty and cold. Salty herbs can remove lumps (adenopathy, non cancerous tumors,…)

Xiao Cheng Qi Tang

Comes also from “Shang Han Lun”.

It has: Dahuang 4 qian (12g), Zhishi 3 pcs (9g) and Houpo 2 qian (6g) but no Mangxiao

Mangxiao is stronger than Dahuang at inducing diarrhoea.

Da Cheng Qi works at Xue level when Xiao Cheng Qi works both at Xue and Qi level. It is used if Qi is blocked in the middle but the whole body is not that blocked.

Note: some Doctors specialized in the treatment of stroke use “San Hua Tang”: Dahuang, Houpo, Zhishi and Qianghuo (which is very pungent and warm to open outside).

It has very good results in stroke (close type) if the patient has a strong constitution and constipation.

Da Huang Fu Zi Tang

Comes from “Jing Gui Yao Lue”= “Essentials from the Golden Cabinet”

It has: Dahuang 3 qian (9g), Fuzi 3 pcs (9g) and Xixin 2 qian (6g). This prescription is together “cold” and “hot”. Fuzi (pungent ++ and bitter) opens and gathers inside, Xixin opens ++, and Dahuang leads the prescription down.

It is used when the patient has a cold constitution (low energy, water retention, feeling cold) but is now blocked in the middle, or blocked in the uterus (dysmenorrhoea), or blocked at Zang Fu level (non cancerous tumour) or blocked in the channels and hypochondria. Even if there is no constipation (diarrhoea might even be present), if the body is blocked with pain and the pathogenic factor wants to go down, this prescription can be used effectively.

Dahuang gives the direction and Fuzi and Xixin only activate the process .If Bing Ji is strong, it will lead the pathogenic factor down and out.

I would like to emphasise one important principle: If you cannot decide which is the natural way out for the pathogenic factor, WAIT. A wrong move can kill! It is a better strategy to create a crisis, which will clarify the direction of Bing Ji, and then act.

C : As a summary of the prescriptions which regulate Zhong Jiao, one can also use the following tables.

LX : Yes, it will be a clear and practical summary. Remember that, in TCM treatment, the first step is to ensure that middle Qi (or stomach Qi) is strong enough and open! It is very important to pay a particular attention to the treatment of Zhong Jiao, and this practical table should help us remember how to do it.

Zhong Jiao Deficiency 中焦虚

Qi-Deficiency

cool

warm

tonify

qi

sedate the middle

gather in the middle

open the middle

upward direction

downward direction

Si Jun Zi Tang 四君子汤

–

+

+

–

+

+–

–

–

Liu Jun Zi Tang 六君子汤

–

+

+ –

+

+–

+

–

–

Xiang Sha Liu Jun Zi Tang

香砂六君子汤

–

+

+ –

+

+–

++

+–

+

Shen Ling Bai Shu Wan

参苓白术丸

–

+ –

+ –

+–

++

+–

–

+–

Li Zhong Wan 理中丸

–

++

++

–

++

–

–

–

Fu Zi Li Zhong Wan

附子理中丸

–

+++

+++

–

+++

–

+

–

Bu Zhong Yi Qi Wan

补中益气丸

–

++

+++

–

+–

++

+++

–

Dang Gui Bu Xue Tang

当归补血汤

–

++

+++

–

–

+

++

–

Xiao Chai Hu Tang 小柴胡汤

+ –

–

+ –

+

–

++

+

+–

Gui Zhi Gan Cao Tang

桂枝甘草汤

–

+

+

–

+

+–

+–

–

Gan Cao Gan Jiang Tang

甘草干姜汤

–

+

+

–

++

–

–

–

Wu Zhu Yu Tang 吴茱萸汤

–

+++

+++

++

+

++

+

++

Zhong Jiao Deficiency 中焦虚

Xue Deficiency

Xue-yin Deficiency

cool

warm

tonify

xue-yin

sedate

blood

stagnation

gather and

stabilise xue-yin

open

channels

&

collaterals

upward

direction

downward direction

Si Wu Tang 四物汤

–

++

+

++

+

++

+

+

Zhi Gan Cao tang 炙甘草汤

–

+ –

+++

–

++

+

–

++

Gui Zhi Tang 桂枝汤

–

+

+

+

+

++

++

+–

Gui Zhi Jia Shao Yao Tang

桂枝加芍药汤

–

+ –

++

++

++

+–

–

++

Gui Zhi Jia Shao Yao Ren Shen Xin Jia Tang

桂枝加芍药人参新加汤

–

++

+++

+

+++

+–

+

+

Wen Jing Tang 温经汤

–

++

+

+++

–

+++

+

++

Shao yao Gan Cao Tang

芍药甘草汤

+ –

–

++

+–

+++

–

–

+++

Xiao Jian Zhong Tang

小建中汤

–

++

+++

–

+++

+–

+–

++

Zhong Jiao Deficiency 中焦虚

Xue-Qi Deficiency

cool

warm

tonify

xue and qi

sedate

blood

stagnation

gather in zhong jiao

open

zhong

jiao

upward

direction

downward direction

Xiao Yao San 逍遥散

–

+

+

+

+–

++

+

+–

Gui Pi Wan 归脾丸

–

+++

+++

–

+++

–

–

–

Ba Zhen Tang 八珍汤

–

++

++

–

++

+–

+–

–

Dang Gui Liu Huang Tang

当归六黄汤

++

+–

+++

–

++

–

+

++

Gui Zhi qu Gui Jia Fu Ling Bai Shu Tang

桂枝去桂加茯苓白术汤

–

+–

+–

+

+–

++

–

+

In the Qi deficiency group, the basic prescription is “Si Jun Zi Tang”.

If we want to open or move more, we use “Liu Jun Zi Tang” or “Xiang Sha Liu Jun Zi Tang”.

If we want to gather or warm more, we use: “Fu Zi Li Zhong Tang” or “Li zhong Tang”.

If we want to open and lead the prescription upward, we use “Bu Zhong Yi Qi Tang”

If we want an upward direction and more tonifying action, we use “Dang Gui Bu Xue Tang”.

If we want to connect Zhong Jiao and the surface, we use, “Xiao Chai Hu Tang” (mainly opens)

If there is strong cold and rebellious Qi upwards, and the middle is blocked, we use: “Wu Zhu Yu Tang”.

In the Xue and Yin Deficiency group, the basic prescription is: “Si Wu Tang” (warms, moves and sedates blood stagnation).

If we want to move blood stagnation even more, we use: “Wen Jing tang” (opens the middle +++)

If we want less moving and tonifying effect but an upward direction, we use: “Gui Zhi Tang”

If we want to tonify and gather Xue and Yin more efficiently, we use: “Xiao Jian Zhong Tang”, “Gui Zhi Jia Shao Yao Ren Shen Xin Jia Tang” or “Zhi Gan Cao Tang”.

If we want a stronger cooling and gathering action and a downward direction, we use: “Shao Yao Gan Cao Tang”.

In the Xue and Qi deficiency group, the basic prescription is: “Ba Zhen Tang” (tonifies Qi and Xue).

If we want a stronger warming and gathering effect, we use: “Gui Pi Wan”.

If we want a heavy taste, cool but stronger at tonifying Xue and Qi, we use: “Dang Gui Liu Huang Tang”.

If we want to open up and down, we use: “Xiao Yao San”.

Zhong Jiao Excess 中焦实

(H: Heavy. Heavy taste, deeper, xue level — L: Light. Light taste, Qi level

cool

taste

tonify

sedate

gather

open

upward direction

down-ward direction

Qi Excess

Bai Hu Tang 白虎汤

++

L

–

+++

–

++

+–

+++

Bai Hu Jia Ren Shen Tang

白虎加人参汤

+

L

+

+–

+

+–

+–

+

Da Huang Huang Lian Xie Xin Tang 大黄黄连泻心汤

++

L

–

++

–

++

–

++

Fu Zi Xie Xin Tang

附子泻心汤

+ –

L

+

+

+

++

–

+

Zhi Zi Chi Tang 栀子豉汤

+ –

H

–

+

–

+

++

–

Qi within Xue Excess

Huo Xiang Zheng Qi San

藿香正气散

–

H

–

+++

–

+++

+++

+–

Ping Wei San 平胃散

–

H

–

++

–

++

+

++

Ban Xia Hou Pu Tang半夏厚朴汤

–

L

–

+

–

++

++

+

Ge Gen Qin Lian Tang葛根芩连汤

++

H

–

+

++–

+

++

+

Da Chai Hu Tang大柴胡汤

+

H

+–

+++

–

+++

+++

Si Ni San四逆散

+ –

L

–

+

–

+–

+

Xue within xue Excess

Da Cheng Qi Tang 大承气汤

+++

H

–

+++

–

+++

–

+++

Xiao Cheng Qi Tang小承气汤

++

H

–

++

–

++

–

++

Da Huang Fu Zi Tang大黄附子汤

+

H

+–

++

–

+++

–

+

The prescriptions in bold are the basic prescriptions for each category.

In the group of Zhong Jiao Qi excess, the basic prescription is “Bai Hu Tang”: cold, sedates, and goes down.

If we want to tonify and gather a little more with less cold, sedating and downward action, we choose “Bai Hu jia Ren ShenTang”

If we want a maximum action of cold, sedating, and opening down, we use “Da Huang Huang Lian Xie Xin Tang”.

If we need to warm the middle, for example after using “Da Huang Huang Lian Xie Xin Tang”, we select: “Fu Zi Xie Xin Tang”.

When heat is blocked in the middle, and we need an upward action to lead it out via the surface, we use: “Zhi Zi Chi Tang”

In the group of Zhong Jiao Qi within Xue excess, the basic prescription is: “Ping Wei San”.

To open more and up, we use “Huo Xiang Zheng Qi Tang”

To open down and cool, we choose “Da Chai Hu Tang

If we need to cool even more and gather with less opening action, we use “Ge Gen Qin Lian Tang”

In the group of Zhong Jiao Xue within Xue excess, the basic prescription is “Da Cheng Qi tang”: cold with a strong sedating downward action.

If we want a milder action, we use “Xiao Cheng Qi Tang”. If we want to open strongly and warm, we choose “Da Huang Fu Zi Tang.

Shang Jiao level

LX : Let’s now look at Shang Jiao.

The prescriptions classicaly working at this level may belong “purely” to Shang Jiao, or belong to Shang Jiao and Zhong Jiao (deep surface) or even belong to Shang Jiao with Jing or Yang deficiency.

In any case, we use these prescriptions to direct Bing Ji (or the pathogenic factor) out via the surface.

We shall discuss the main prescriptions found in each of these categories.

1. Prescriptions working purely at Shang Jiao level

Ma Huang Tang

is certainly the leader.

It comes from Shang Han Lun, designed for excess cold.

It has: Mahuang 3 qian (9g), Guizhi 2 qian (6g), Xingren 70 pcs (9-12g), Zhigancao 1 qian (3g). It is, globally, pungent, warm, with an upward direction

It is used when a strong cold pathogenic factor has penetrated the surface. The whole body aches, there is no sweating, and the surface is not open.

Mahuang has a strong outward, opening action. It is like a sun!

Guizhi helps the opening action, promotes the movement of Qi in the channels (works at Qi level) and also moves Qi at Xue level.

Xingren is bitter pungent and warm. Because of its bitter taste, it moves Qi inside but not strongly.

Globally, the action of this prescription is out, opening the surface and up.

Ma Xing Shi Gan Tang

Also comes from Shang Han Lun

It has: Mahuang 4 qian (12g), Shigao 0.5 sheng (18g), Xingren 50 pcs (12g), Gancao 2 qian (6g)

It is “Xin Liang Jie Biao = pungent, cold, open the surface”

This formulae, has a strong dosage for this effect (stronger than Yin Qiao San).

Like other prescriptions from the Han and Tang dynasties, it is meant for “pure diseases” and it acts in a very “pure way”.

It is similar to Ma Huang Tang, but instead of Guizhi supporting the effect of Mahuang (pungent), it is Shigao. Shigao also treats heat at Qi level (cold).

Whether the herb is warm (Mahuang) or cold (Shigao), they are first pungent and their action is to open the surface.

Xingren is slightly bitter, warm and pungent. It brings Shang Jiao Qi down and opens. Altogether, this formulae is to open out and clear heat from the lungs.

Da Qing Long Tang

Comes From Shang Han Lun. It has:

Mahuang 6 qian (18g), Guizhi 2 qian (6g), Gancao 2 qian (6g), Xingren 40 pcs, Shengjiang 3 qian (9g), Dazao 12 pcs, Shengshigao (a piece of an egg size, about 30g)

The patient is blocked at surface level and is fighting with the pathogenic factor: there is pain, and no sweating. Yang Qi is in excess: the patient is feeling nervous. We use Shigao which is pungent, sweet, cold and acts at Qi level. It has a strong opening action.

Yin Qiao San

Comes from “Wen Bing Tiao Bian”, = “Systematic differentiation of warm diseases”

It is, in thoughts, similar to Ma Huang Tang but it was designed during the Qing Dynasty and in the South of China. Its action is: out, cold and up to Shang Jiao.

It has: Jinyinhua 1 liang (10g), Lianqiao 1 liang (10g), Bohe 6 qian (6g), Zhuye 4 qian (4g), Niubangzi 6 qian (6g): cold, bitter or pungent

Jiegeng 6 qian (6g), Dandouchi 5 qian (5g), Jingjie 4 qian (6g): warm, bitter or pungent

If used in powder form, take the old classic dosage in liang and qian, make a powder and use one 6-9gr dose of the mixture. If used as a decoction, take the modern dosages indicated in grams.

It is very effective in case of a sore throat, and cough in a young person who is not blocked in the middle. If the middle is blocked or if the surface is seriously blocked, it will not be strong enough. We have to use Mahuang, or Chaihu.

Sang Ju Ye

Comes also from” Wen Bing Tiao Bian”.

It has: Sangye 2 qian and 5 fen (7.5g), Juhua 1 qian (3g), Bohe 8 fen (2.4g), Lugen 2 qian (6g), Gancao 8 fen (2.4g), Lianqiao 1 qian and 5 fen (4.5g) + Jiegeng 2 qian (6g) and Xingren 2 qian (6g) which act on Shang Jiao.

It is less powerful than Yin Qiao San but, in practice, very similar. Yin Qiao San is more suitable for heat blocked in the throat or surface and Sang Ju Yin, to open in mild cases.

Ding Chuan Tang

Comes from: “She Sheng Zhong Miao Fang” = “Nostrum of Health Cultivation”., written by Dr Zhang Shiche in Ming dynasty.

It is similar to Ma Huang Tang but more complex.

It has: Mahuang 3 qian (9g), Xingren 1qian and 5fen (4.5g), Banxia 3 qian (9g), Suzi 2 qian (6g), Kuandonghua 3 qian (9g): to open the surface

And: Sangbaipi 3 qian (9g), Huangqin 1 qian and 5 fen (4.5g): bitter and cold

Gancao 1 qian (3g), Baiguo 21 pcs to tonify lung Qi.

The main direction is to open the surface.

It is often used for asthma.

2. Prescriptions working at Shang Jiao and Zhong Jiao level(deep surface):

The leader, here, is Gui Zhi Tang.

It also comes from Shang Han Lun.

It has: Guizhi 3 qian (9g), Baishao 3 qian (9g), Shengjiang 3 qian (9g), Dazao 12 pcs, Gancao 2 qian (6g)

It is sweet (tonify), pungent, a little sour.

It is used when the surface is already open, there is sweating, but the body is not strong enough to expel the pathogenic cold. This prescription tonifies the middle (Zhong Jiao) at Qi and Xue level, so that Qi and Xue can rise to the surface. As the surface is already open, they can push the pathogenic cold out.

During Shang Han Lun time, it was recommended to take a warm rice pudding after taking Gui Zhi Tang to promote the action of the formula. Half an hour later the body was expected to show signs of sweating, more like a sensation of sweating, rather than a visible sweat. That was a good sign.

Too much sweating was not a good sign. By experience, after expelling the pathogenic cold, the weak patient was asked to rest and to take a prescription to tonify the middle like” Bu Zhong Yi Qi Tang”, or”Gui Pi Tang” or “Si Zun Zi Tang”.

Gui Zhi Tang is also a good prescription for women who catch cold, after giving birth or during menstruation.

Note: Gui Pi Tang or Gui Zhi Tang can both be used for problems such as poor memory, pale face, insomnia…. They are both, sweet, pungent and warm. Although they have different herbs, their qi and wei are the same. The real difference is that Gui Pi Tang opens the stomach (with Baizhu, Muxiang, Fuling) and also works at Xue level. It is used for people who are deficient at a deeper level than Gui Zhi Tang.

There are many variations of Gui Zhi Tang:

Gui Zhi jia Ge Gen Tang

Used when there is strong back and neck stiffness. It sedates cold and has an upward direction to open the channels.

Gui Zhi Ma Huang Ge ban Tang

Upward direction and open the surface are the main effects, plus a mild tonification of surface Qi.

Gui Zhi er Ma Huang yi Tang

Used when there is alternative chills and fever with sweating. Much milder than the two previous ones.

Gui Zhi er yue bi yi Tang

A bit cold, opens more than Gui Zhi Tang

Shang Han Lun says: “In the presence of Tai Yang Bing with more fever than chills, and a very weak pulse, there is no Yang Qi. Do not use “Fa Han” (inducing sweating technique), use Gui Zhi er yue bi yi Tang:

Guizhi 18 zhu (2.5g), Shaoyao 18 zhu (2.5g), Shigao 24 zhu (3g), Mahuang 18 zhu (2.5g), Gancao 18 zhu (2.5g), Shengjiang 1 or 2g, Dazao 4 pcs. Note: “zhu” is a very small dosage; this prescription opens the surface but slightly.

Gui Zhi jia Hou Po Xing Ren Tang

Used when there is also asthma (more downward effect).

Ge Gen Tang

Has the same ingredients and dosages as Gui Zhi jia Ge Gen Tang, but the cooking method is different. As a result, Ge Gen Tang will emphasise “sweating” (Mahuang and Gegen more concentrated) and Gui Zhi jia Ge Gen tang will emphasise “open the surface”.

Ge Gen jia Ban Xia Tang

Warmer than the previous ones .Will be used when there is vomiting and the surface is not open. Banxia will treat vomiting but the general direction is still upward.

We also have in this category:

Su Zi Jiang Qi Tang

Comes from “Taiping Huimin Heji Jufang”,

It has: Suzi 3 qian (9g), Banxia 3 qian (9g), Danggui 1.5 qian (4.5g), Gancao 2 qian (6g), Houpo 1 qian (3g), Qianhu 1 qian (3g), Rougui 1.5 qian (4.5g).

It warms and tonifies. The main direction is not so much to open the surface (no Mahuang, Xingren or Sangbaipi) but to warm the middle (Rougui) and to open down (Houpo). Rougui and Danggui are here only to promote Qi.

It is used when the pathogenic factor has no chance to go away via the surface (which is already open), and there is a blockage inside and a weak and cold Zhong Jiao.

Chai Hu Gui Zhi Tang

Comes from Shang Han Lun

It is Xiao Chai Hu Tang (already discussed in the section: “prescriptions to tonify Zhong Jiao Qi”) + Gui Zhi and Bai Shao.

Chaihu 4 qian (12g), Guizhi 1.5 qian (4.5g), Shengjiang 1.5 qian (4.5g), Banxia 2.5 he (6g), Renshen 1.5 qian (4.5g), Baishao1.5 qian (4.5g), Dazao 6pcs are pungent, sweet, and warm, Huangqin 1.5 qian (4.5g) is bitter and cold

All together, this formula is first pungent, second sweet, third bitter, and then warm and up. It opens the surface and is similar to Gui Zhi Tang but it also has Huangqin to control heat, Banxia to control dampness and phlegm, and Chaihu which raises the prescription up. It is a good, harmonising, formula, milder at opening the surface than Gui Zhi Tang.

It is used for people whose disease is “less pure”, more complex: they come with not only pathogenic cold, but other disturbances.

3. Prescriptions working at Shang Jiao level with Jing or Yang deficiency.

Ma Huang Fu Zi Tang

Gui Zhi jia Fu Zi Tang

Gui Zhi qu Shao Yao jia Fu Zi Tang

They all add Fuzi, to gather more in Xia Jiao and warm. “Ma Huang Fu Zi Tang” is mainly used to open the surface and get the pathogenic cold out. “Guizhi jia Fuzi Tang” tonifies and gathers more than Gui Zhi tang. “Gui Zhi qu Shao Yao jia Fu Zi Tang” gathers even more in Xia Jiao.

Xiao Qing Long Tang

It has : Mahuang 3 qian (9g), Shaoyao 3 qian (9g), Xixin 3 qian (9g), Ganjiang 3 qian (9g), Zhigancao 3 qian (9g), Guizhi 3 qian (9g), Wuweizi 0.5 sheng (5g), Banxia 0.5 sheng (9g);

Note: one “sheng” correspond to a full pot of ingredient. As Wuweizi is lighter than Banxia, its corresponding dosage in grams is lighter.

Shaoyao and Wuweizi are sour and act at Xue level. The taste of Xiao Qing Long and Gui Zhi Tang is similar, but Gui Zhi Tang is used when there is no Xie Qi (pathogenic factor), or if the surface is not blocked. Xiao Qing long is used when there is Xie Qi, the surface is blocked and there is internal deficiency, San Jiao does not move well and produces nausea, fever, cough, thirst, difficult urination or diarrhoea, which, in Chinese, is called “Shui Qi”. Here again, this prescription treats the movement of Qi and not the symptoms.

C : Treatment at Shang Jiao level is simple: if “pure” (floating pulse, aversion to cold, pain in back and neck, no sweating) we use Ma Huang Tang or a variation of it; if there is no sweating and deficiency or blockage in the middle, we use Gui Zhi Tang or a variation of it. If there is also Yang deficiency (cold++, weak pulse), we add Fuzi to Ma Huang Tang or Gui Zhi Tang. And if there is Jing deficiency we add appropriate tonifying herbs. The difficulty lies in the ability to recognise Bing Ji and where it is taking place. Shang Han Lun is indeed a precious and detailed guide into this, somehow, complex puzzle! (see annexe three for more details)

LX : At first, yes it may appear difficult, but with method and experience, this diagnostic difficulty can be easily overcome.

Shangjiao上焦

Pure surface

cool

warm

tonify

sedate evil

gather

open

upward

downward

Ma Huang Tang 麻黄汤

–

++

–

Cold

–

+++

++

–

Ma Xing Shi Gan Tang

麻杏石甘汤

++

–

–

Cold & heat

–

++

+

+–

Da Qing Long Tang

大青龙汤

+++

–

–

Cold & heat

–

+++

+++

+

Yin Qiao San 银翘散

++

+ –

–

Wind & heat

–

++

++

–

Sang Ju Ye 桑菊饮

+

–

–

Wind & heat

–

+

+

–

Ding Chuan Tang 定喘汤

+

+

+

Heat & phlegm

+

++

+

++

Deep surface

cool

warm

tonify qi

sedate cold

gather

open

upward

downward

Gui Zhi Tang 桂枝汤

–

++

++

+–

++

+–

+–

–

Gui Zhi Jia Ge Gen Tang

桂枝加葛根汤

–

++

+

++

++

+

++

–

Gui Zhi Ma Huang Ge Ban Tang

桂枝麻黄各半汤

–

+

+

+

–

++

+++

–

Gui Zhi er Ma Huang Yi Yang Tang

桂枝二麻黄一汤

–

+ –

+

+–

–

+

++

–

Gui Zhi Er Yue Bi Yi Yang Tang

桂枝二越婢一汤

+ –

–

+ –

+

+

++

++

–

Gui Zhi jia Hou Pu Xing Ren Tang

桂枝加厚朴杏仁汤

–

+

+ –

+

+–

+

+

+–

Ge Gen Tang 葛根汤

–

+

++

++

+–

+

++

–

Ge Gen jia Ban Xia Tang

葛根加半夏汤

–

++

+–

++

–

+

++

–

Su Zi Jiang Qi Tang

苏子降气汤

–

++

++

+–

+

+

+

+

Chai Hu Gui Zhi Tang

柴胡桂枝汤

–

+–

+

+–

+–

+

+

–

Jing or Yang Deficiency

cool

warm

tonify jing or yang

sedate colgf

gather

open

upward

downward

Ma Huang Fu Zi Tang

麻黄 附子汤

–

+

+

+++

–

+++

–

Gui Zhi Jia Fu Zi Tang

桂枝加附子汤

–

++

+++

+

+++

+

+

–

Gui Zhi qu Shao Yao jia Fu Zi Tang

桂枝去芍药加附子汤

–

+++

++

++

++

++

++

–

Xiao Qing Long Tang

小青龙汤

–

++

+

++

+

++

+++

+

San Jiao level, or water metabolism

LX : We are now reaching the last group of our classification: prescriptions working on water metabolism or “San Jiao Shui Dao” 三焦水道.

As explained in the “Theory of TCM”, San Jiao functions as a “central heating” to transfer water into Shui Qi 水气 (Water Qi) and, in order to “maintain” or “repair” it we have a few options: repair the boiler (Xia Jiao), adjust the quantity and quality of water (Zhong Jiao) or unblock the piping system (surface, channels and collaterals).

We have four categories in this last group: open Shui Dao directly, open Shang Jiao, open Zhong Jiao, and open Xia Jiao.

1. Prescriptions opening Shui Dao directly:

Three options:

Open at Shang Jiao level with Wu Ling San

It works well to harmonise water metabolism when excessive sweating induced a temporary deficiency of Yang.

It has; Guizhi ½ liang (8g), Fuling 18 zhu (10g), Zexie 1 liang 6 zhu (18g) Zhuling 18 zhu (10g), Baizhu 18 zhu (10g), in a powder form and very small dosages (5-6 g). It works very fast to open Shang Jiao and diffuse water.

Open at Zhong Jiao level with Zhuling Tang

It has: Zhuling, Fuling, Zexie, Ejiao, Huashi all 1 liang (15g). We use this prescription if a patient is “Yang Ming bing”. It gathers and sedates and helps Shui Dao more strongly.

Open at Xia Jiao level with Zhen Wu Tang

It has: Fuling 3 qian (9g), Shaoyao 3 qian (9g), Shengjiang 3 qian (9g), Baizhu 2 qian (6g), Fuzi 1pc (9g).

It is warmer and more tonifying. It belongs to Shao Yin Bing of Shang Han Lun (see annexe 3).

2. Prescriptions opening Shang Jiao for San Jiao Shui Dao:

We use Ma Huang Tang (see above Shang Jiao pure surface), following the principle: “Biao Jie Li Zi He 表解里自和, = “if you open the surface, the interior will automatically open”; or “Ti hu jie gai 提壶揭盖” which means: “open the lid (fei qi, surface) to help the Water Qi 水气 out.”

3. Prescriptions opening Zhong Jiao for San Jiao Shui Dao:

We use Ling Gui Zhu Gan Tang:

Fuling 4 qian (12g), Guizhi 3 qian (9g), Baizhu 2 qian (6g), Gancao 2 qian (6g)

It is similar to Wu Ling San but more tonifying and gathering.

4. Prescriptions opening Xia Jiao for urination:

We use Jing Gui Shen Qi Wan: It has: Shengdi 8 liang (240g), Shanzhuyu 4 liang (120g), Shanyao 4 liang (120g), Zexie 3 liang (90g), Fuling 3 liang (90g), Mudanpi 3 liang (90g) + Fuzi 1 liang (30g) & Guizhi 1 liang (30g).

Grind all the ingredients into powder and mix it with honey to make small pills. Take a 6 to 9 g dose of pills twice a day.

It is used when there is Kidney Yin deficiency with also Kidney Yang deficiency. It has the ability to move Yang (Fu Zi), and thus open Shui Dao.

C : And now, a simple comparative vision of the prescriptions with this last table.

Water Metabolism (San Jiao Shui Dao 三焦水道)

Open Shui Dao directly

cool

warm

tonify qi

sedate shui qi

gather

open

upward

downward

Wu Ling San 五苓散

Open at shang jiao

–

+–

+

+

–

++

+

+

Zhu Ling Tang 猪苓汤

Open at zhong jiao

+–

–

+–

++

+–

+–

–

++

Zhen Wu Tang 真武汤

Open at xia jiao

–

++

+

+++

+–

++

+–

++

Open Shang Jiao for San Jiao Shui Dao

Ma Huang Tang 麻黄汤

–

+

+

+++

–

+++

+++

–

Open Zhong Jiao for San Jiao Shui Dao

Ling Gui Zhu Gan Tang 苓桂术甘汤

–

+

++

+–

++

+–

+

+

Open Xia Jiao for San Jiao Shui Dao

Jin Gui Shen Qi Wan 金匮肾气丸

–

+++

+++

++

+++

+–

–

+++

Clinical example

C : Could you give us a particularly interesting clinical exemple, to illustrate how to use herbal treatment efficiently in a very complex chronic disease. It will illustrate what we learned about the resources of the body, Qi ji, Bing Ji and paying a special attention to “catching ji”.

LX : I shall present the case of MR X… a high level manager in IT, born in 1968.

He came to see me for the first time on the 21st of May 2004.

He had been suffering from severe mouth inflammation (ulcers, gums inflammation and satellite lymph nodes inflammation) for four years. He was treated by western medicine in various hospitals, including an ENT hospital, mainly with antibiotics and cortisone to no effect, for two years. He then consulted TCM doctors at the TCM Beijing University clinic for two years and was prescribed very bitter formulae to cool heat and detoxify poisons, with no positive effect and, as a result, developed a very weak stomach.

He also suffered from inflammation deep in the muscles and connective tissues of both legs which manifested as dark red skin with ulcers and a bad smelly discharge in some places, as well as swollen legs. This condition did not have any clear diagnosis in western medicine. It had been coming and going for about ten years, without ever clearing up. He suspected that he might have contracted an infection prior to the development of this chronic condition.

He was a very busy and stressed man, with high responsibilities, working long hours and travelling a lot. He obviously had strong unexpressed emotions of frustration.

First consultation on the 21st of May 2004

He complained of a very painful and inflamed mouth, he could hardly eat; he was thirsty with a dry mouth; he suffered from insomnia with many vivid dreams, and night sweating; he felt pressure in his eyes and is vision was not clear; he had a lot of gas and complained of stomach ache; his feet were cold.

On examination, the tongue coating was thick, of a dark yellowish colour, with an irregular distribution like a geographical map: all signs of toxic dampness and serious damage in Zhong Jiao. The right pulse was fast and strong, floating and bouncing; the left pulse was tight: all signs of Yin xu and Yang heat.

He had taken cold and bitter medicines for too long and could no longer tolerate them because of his very weak stomach. The question was: how could we then relieve the heat and pain in the mouth? Instead of using the heavy method, the “Lun Gun Zi 抡棍子” way of “sweeping a big stick around” (see conclusion of the chapter on herbal medicine), we chose the light and wise way of “Qing Xuan Shu Tou 轻宣疏透”: open Zhong Jiao, lead the heat out via urination, use sweet cold herbs to cool the heat at Qi level and use Renshen, Fuzi, Ganjiang to strengthens the middle.

The prescription was: Jiujun 6, Dafupi 6, Gancao 10, Huashi 12, Shengshigao 15, Tufuling, 20, Lianqiao 6, Baimaogen 20, Yiyiren 15, Peilan 10 Baizhu 10, Ganjiang 6, Shufuzi 6, Renshen 6, Shengduzhong 15.

Only Jiujun, Dafupi, Lianqiao are bitter, with a very small dosage; all the other herbs are sweet, neutral or slightly bitter.

No acupuncture that day, as he did not have time.

First month of treatment

He came back 6 days later, feeling much better; his mouth had improved a lot; he did not have any more diarrhoea after drinking milk; the left pulse was softer.

He came twice a week for a month; the prescription was similar, gradually adding more gathering herbs such as Wuweizi and Wumei and Heye to open more.

Because he was short of time, we started acupuncture only on the 4th of June, aiming at opening the Yang Ming with Susantly (ST 36), Hegu (LI 4), Fenglong (ST 40); opening Yin with Taichong (LIV 3), Rangu (KID 2); clearing the heat and calming down the Shen with Shangxing (DU 23).

Second Month of treatment

On the 18th of June, I added herbs to open the surface: Mahuang 6 and Shengma 12. It was too early, and the mouth infection flared up again severely, the left pulse became tight again, and he could not sleep. Jing was still too deficient and the deep reason for his mouth inflammation was in fact Jing deficiency. But, as middle Qi was also weak and full of toxic heat, we could not yet start to nourish Yin and Jing.

Even adding “Zhi Bo Di Huang” could not control the situation.

The positive effect had been to open the surface, which was a good preparation for the future of the treatment.

Third month of treatment

We went back to the first principle of “Qing Xuan Shu Tou”, using prescriptions similar to the first one, gradually adding more herbs to gather Xia Jiao, like Huangbai 10, Shengdihuang 10. The mouth infection came back under control and his appetite improved.

Acupuncture aimed at clearing toxic heat and opening the middle and the channels I used Dazhui (DU 14), Mingmeng (DU 4), Fengfu (DU 16), Fengchi (GB 20), Zhongwan (REN 12), Guanyuan (REN 4), Huangshu (KID 16).

The tongue coating improved, and was less thick indicating that just a little dampness remained. The left pulse, instead of tight, became deep soft and slow. The colour of the skin of the legs turned to a lighter red.

Fourth, and fifth months of treatment

I prescribed feet and leg baths with: Dahuang 20, Huangqi 30, Guizhi 20, Lianqiao 15, Baizhi 20, Jingjie 20, Wutou 15, Yinhua 9, Tougucao 30, Muxiang 20, Moyao 20, that he used for three weeks, three or four times a week.

At the same time, he was still taking daily decoctions based on our first principle of treatment: “Qing Xuan Shu Tou”.

During the following two months, he travelled a lot and came less frequently. His stomach was much stronger. I could use more bitter herbs, cool, and slightly pungent, to open and cool down the heat, and sweet and bitter herbs to nourish Yin.

The basic formula for these three months had a heavier taste to reach and gather at a deep Xue level.

Qinghao 12, Biejia 10, Zhimu 9, Shengdihuang 10, Xuanshen 20, Heshuwu 15, Shengdahuang 6, Baimaogen 25, Shenggancao 15, Chuansanjia 9, Shengshigao 15, Shudihuang 15, Lianqiao 12, Rougui 6, Shanzhuyu 15, Chaobaizhu 12.

He noticed that inflammation of his mouth would flare up only when he ate crab, sea food, or lamb, when he flew long distances or did not have enough sleep. We then used the first month principle of opening San Jiao and clearing heat via urination to control the condition.

After two or three months and despite a lot of travelling, the tongue became normal; the eczema in the inguinal area cleared up completely; he was sleeping well; his mind and spirit were calm; the legs still had a deep red colour but there were no signs of active inflammation anymore.

On the 15th October 2004

He came after a 20 hours flight! The inflammation on the legs was starting up again but the mouth was OK; the tongue was clear; the left pulse smooth; the right pulse a little tight but softer, indicating that Yin had come back to a normal state but Yang was still not good and Qi was also deficient. The powerful bouncing pulse that we could feel at the first consultation was in fact a manifestation of Xie Qi (pathogenic factor) and not of Zhen Qi. Now that a lot of Xie Qi was gone, and the channels were open, we could feel the Qi deficiency.

Today we had a “Ji” to gather the middle, as Xie Qi was not so strong and the channels and the middle were open (tongue clear, good holiday).

The prescription was: Fuling 12, Baizhu 10, Shengmuli 25, Heye 10, Wumei 3pcs, Shengdihuang 10, Shudihuang 10, Lugen 15, Maogen 15, Lianzi 25, Xuanshen 10, Shenghuangqi 6, Chenpi 6, Rendongteng 12, Shenggancao 6.

It had a very good effect.

On the 1st November 2004

He reported that the mouth inflammation was much better than it had ever been; the left leg had been clear for one month (first time ever), and there were only a few red spots on the right leg; the red colour on both legs was much lighter. He had no more low back pain or cold feet (essence gathered); his spirit and mind were quite stable. When mouth inflammation flared up (wrong food, tiredness or long flight), it was very mild and could be controlled in a few days instead of weeks.

On the 26th November 2004

As Jing (Essence), Shen (Spirit) and Qi were well gathered, it was a “Ji” to attack the deep blockage.

I used a very simple formula: Shengdahuang 20, Mangxiao 6, Zhuru 3, to strongly open the blockage in Xue level and Zhong Jiao.

It was on a Friday. On the Saturday he had abdominal pain and passed loose stools four times. On the Sunday: no pain but black stools with a very bad smell three times. On the Monday: a little bit of pain, diarrhoea of black stools twice.

After this treatment, it was time to gather again.

I used a prescription based on “Si Jun Zi Tang” with additions of sweet and sour herbs:

Baizhu 10, Fuling 30, Gancao (10) + Shanyao 15, Zaoxintou 30, Shengmuli 25, Wumei 3pcs, Ganjiang 6, Yuzhu 10, Lianqiao 6, Yinhua 3, Danshen 6, Huafen 10, Biejia 9, Dafupi 10, Shengdihuang 10, Shudihuang 10.

His urination became normal for the first time since his first visit in May (San Jiao circulation well open and Yuan Qi strong enough), and he gained weight.

On the 21st of December 2004

Jing, Shen and Qi were still strong and balanced; but there were still pathogenic factors (heat and dampness) deep in the body, indicated by a very thick and white coating on the tongue. His right pulse was smooth and soft but the left pulse was tight, bouncing and powerful, which indicates that there was still a deep blockage at Xue level.

There was another “ji” to attack pathogenic factors

I used “San Wu Xia Bai San”: a formula from the Tang Dynasty with: Jiegeng, Beimu and Badou.

Badou is a very toxic herb which was used as a poison during the Tang Dynasty. It induces very strong diarrhoea. Instead of being cold, like most of the purgative herbs, it is hot, as if it was Dahuang and Fuzi together. It is now banned in China and very difficult to find. But with the right indication, catching “ji” at the right time it can clear very deep and old blockages from the middle and Xue level, much better than any other herb.

Following one dose of this prescription, he had diarrhoea for two days, six or seven times per day. But then he felt very clear in mind, body and muscles. The colour of his face became clear and light. There was no swelling, no itchiness, and no redness on his legs. For the first time his feet were sweating: an indication that Yin Qi and Yang Qi were connected.

After such strong treatment, we needed to support the middle. He did not look weak so he did not need “Si Jun Zi tang” and I prescribed:

Baizhu 12, Dafupi 12, Jiujun 9, Binglang 9, Rendongteng 15, Niuxi 10, Shengshigao 20, Lianqiao 6, Cheqiancao 10, Pugongyin 10, Biejia 10, Guizhi 3. For five days.

On the 4th January 2005

His mouth was clear, even after travelling for two weeks: the best it had been in years!

Now Qi and Jing were well gathered; the surface, the channels and the middle were open; we could treat his real problem: deep heat in Xue level.

I used bitter herbs, lots of them but in small dosage, in order to have an action which would not go directly downward but slowly down the channels and collaterals to clear the heat from all parts of the body.

Shengdahuang 5, Huangqin 6, Huanglian 6, Huangbo 9, Huangqi 15, Shengdihuang 15, Shudihuang 15, Zhimu 6, Shanyao 12, Huafen 15, Bairenshen 3, Paojiang (dry ginger) 5, Lianzi 15, Biejia 9, Banxia 10, Fuling 30, Wugong 1pc.

Fuling 30, Lianzi 15, Shanyao 12, Huafen 15 were added to “create a favourable environment for the other herbs”.

Biejia 9 to open at deep xue level

Banxia 10, to open dampness

Wugong 1pc, to open the channels and collaterals

Dahuang, to break through “substantial blockage” at deep Xue level.

The result was excellent. Since then, he has been coming occasionally for a follow up of his treatment, and is feeling well.

In this case, we had several “ji” to catch. The first one to gather or open: we had to gather Yuan Qi and open softly from the middle; the second one was to direct Xie Qi and guide Qi Ji to the right direction: we chose bowel movement and urination with a slighly pungent taste to open the channels; the third one was to tonify the middle (when the channels were open and Xie Qi not so strong); the fourth and fifth “Ji” were to strongly attack pathogenic factor (down), when Jing, Qi and Shen were balanced. Only then we could start using long term herbs to tonify Jing, regulate the middle and expel heat, which was still present after ten years of inflammation in the body. We managed to bring back Qi Ji in a normal direction. Prescriptions of herbal medicine were the essential part of the treatment. Acupuncture helped opening the process and calming down the Shen, but was secondary.

C : Excellent illustration of how difficult chronic cases can still be helped by the direct approach of your method of diagnosis and a treatment, based on the resources of the body, the understanding of Qi Ji, and Bing Ji, the direction of action of the herbs in the prescriptions, and most of all, the ability to “catch Ji”.

We are coming to the end of our discussion of treatment with herbal medicine. Can you give us a few words on external applications.

LX : Altough it was already used at the time of the Huang Di Neijing, only one book was written on the subject: “Li Yu Pian Wen 理瀹骈文” by Dr Wu Shi Ji 吴师机 from the Qing Dynasty. It is also based on the qi and the wei of the herbs.

We can use external applications as a general stimulation; we choose pungent and warm herbs which penetrate the skin (for exemple, Tougucao, Wutou, Guizhi…….). We can add them to a bath, to open and gather; or put them directly on an acupuncture point, in a cream based form, for an effect similar to moxa, dry acupuncture or magnetic stimulation: for example on the navel (Ren 8), Yong Quan (Kid 1), or Lao Gong (P8).

Creams may be used locally to treat skin diseases (玉红膏 Yuhonggao, 黑膏药 Heigaoyao).

Patches are also used for traumatic injuries with herbs like Dahuang, Jinyinhua, Sanqi,…

Conclusion of the second part

C : As a conclusion, I would like to review a few important issues, developed in this second part:

— The importance of “catching ji”

— The importance of the dosage of the herbs

— The importance of the cooking instructions

LX : These are, indeed, important issues. I shall review them one by one:

1. “Catching Ji”, is of the utmost importance before writing a prescription: what is happening at this precise moment is the key to a good treatment. But this requires the constant attention of the doctor to the patient, especially in acute cases when “Ji” changes very quickly and prescriptions have to be changed accordingly. In ancient times, it was the right way to practice. But, nowadays, doctors rarely see their patients every day, and hardly ever, every hour (except in situations when the patient is in hospital). It is difficult to follow and catch “ji”. As a rule, at the beginning of an acute disease, one should not give the same prescription for more than three or four days, without reviewing the situation, until the condition is stable. Long Term tonifying formulae can be safely taken for one to two weeks, and even longer, without any modification.

2. The dosage of the herbs:

• Can modify completely the effect of a particular herb in a prescription

• Gives the taste and the direction of the prescription.

Let’s take two examples: one example of a single herb: Renshen, and one example of a formula: “Xiao Chai Hu Tang”.

— Ren Shen:

To tonify we use large doses of Renshen: 10-20g, only for people who do not have internal heat or blockages.

To calm the mind or gather, we use small doses: 3-5 g (same action as Wuweizi)

To support and guide the action of other herbs, we use small doses: ex: Renshen + Guizhi together will increase Guizhi’s ability to lead the prescription outwards. Renshen + Hopou together will help Ho Pou to lead the effect downwards. Renshen + Gancao will increase the gathering effect of Gancao.

To counteract negative effects of a particular herb, we use small doses: ex: Renshen + Mahuang, Renshen will hold and counteract the Mahuang’s effect of depleting the middle.

— “Xiao Chai HuTang”:

If we use the classic dosages: Chaihu 6, Huangqin 3, Renshen 3, Banxia ½, Shenggancao 3, Shengjiang 3, Dazao 12 pcs, the whole prescription is sweet, pungent, and a little bitter, and belongs to Yang Qi level.The direction is upward and outward.

If we add Guizhi 3 and Baishao 3 (“Guizhi Chai Hu Tang”), the prescription will reach “Xue” level, with the same upward direction but stronger and warmer. If we increase the dosage of Baishao to 10-15, the taste becomes heavier, and the direction will go down to Yin level.

If the patient is catching cold, we eliminate Renshen and Dazao (too “sticky” and tonifying), increase the dosage of Banxia, and Shengjiang to open the surface with more pungent herbs;

If, catching cold, the patient has also fever and sore throat we triple the dosage of the cooling herb Huangqin (“deep surface” level), keep Chaihu as it is, and eliminate the other herbs.

If the patient is coughing with much dirty phlegm, we eliminate Renshen and Dazao (too “sticky” and tonifying), increase the dosage of Banxia, Shengjiang and the cooling herb Huangqin (“deep surface” level), the direction is still upward but more opening in Qi level.

If the patient is suffering from “Middle Qi deficiency” with mild fever, thirst and dry throat, vomiting, and feeling nervous, we lower the dosage of Renshen, Chaihu and Shengjiang, increase the dosage of Gancao and Huangqin to softly regulate the middle level and cool. The direction is neutral and stays in the middle.

If the patient is “Shao Yang” with tidal fever, constipation, epigastric pain, vomiting, feeling nervous, we eliminate Renshen and Gancao and add Zhishi and Dahuang (“Da Chai Hu Tang”) to open the middle, etc.

In general, I think that nowadays, dosages of the herbs are too high, and we tend to use many herbs. It might come from the fact that patients, in ancient times, had more “clear” disease than modern patients. We are dealing with complexity, but we should try to address one problem at a time (the dominant one, “catching ji”) rather than targeting them all at once and confusing the picture! This is what my first teacher Mr Ren was trying to tell me!

3. The cooking instructions will also influence “qi” and “wei” and might change the aim of the prescription. As a general rule, pungent herbs are cooked for a short time at the end of the cooking time, to keep their “qi”. Shells are cooked for a long time (if not in a powder form). But if we look at “Gui Zhi jia Ge Gen Tang” and “Ge gen Tang”, for example; the ingredients are the same, the dosages are the same, but the cooking is different. In “Gui Zhi jia Ge Gen Tang”, we use 10 shen of water, and first cook Mahuang and Gegen until only 8 shen of liquid remains; then add the other ingredients, and cook until only 3 shen are left. In “Ge Gen Tang”, we also cook Mahuang and Gegen first in 10 shen of water, but wait till only 4 shen of liquid is left; then add the other ingredients and wait till 3 shen of liquid is left. In the second case, we have more “wei” of Mahuang and Gegen, and more “qi” of Guizhi, Shengjiang, Gancao, Dazao, Shaoyao. It will induce heavier sweating. The first case was meant to open the surface rather than induce sweating.

C : Do you have a simple way to show how the prescriptions work on San Jiao according to their taste, cooking time, dosage and colour?

LX : Yes. You can look at this simple table:

Shang Jiao上焦

Zhong Jiao中焦

Xia Jiao下焦

More Qi than Wei

Qi and Wei balanced

More Wei than Qi

Light taste

Middle taste

Strong taste

Cook less time

Cook normal time

Cook for a longer time

Total dosage is light

Total dosage is normal

Total dosage is heavy

Taste is fragrant

and clear

Taste is complex

Taste is heavy

Colour is light

Colour is medium

Colour is dark

Take after meal

Take after meal

Take before meal

Opens the surface

Opens & gathers

Gathers Jing-Yin

Open the channels

Regulates zhong jiao, Qi & Xue level

Opens Yang-Qi

Qi level

Connects shang jiao & zhong jiao

Xue level

C : You mentioned your first teacher Mr Ren who encouraged you to catch ji and limit the number of herbs in one prescription. What was the main teaching of your second teacher, Pr Song?

LX : Pr Song used to tell me that there were two different ways of using herbs:

— The first way is the “Lun Gun Zi”, “The sweeping a big stick around” way, using Mahuang, Huangliang, Huangbo, Dahuang… If it hits the right place, it is wonderfully effective, almost magic. But if it does not, it can create a lot of damage. It was a very good method to use at the time of “Shang Han Lun” when diseases were very clear. Nowadays it works well in the case of acute diseases when the doctor has a clear diagnosis and is good at catching “ji”. But this method cannot be used with sensitive patients, or when “xu and shi” (deficiency and excess) are not clear.

— The second and more subtle way is based on: Qing Xuan Shu Tou 轻宣疏透”: use a light taste (Qing) to have an upward action and open the surface (Xuan); open the middle (Shu) and connect the San Jiao (Tou). This can be used very effectively at Qi level, but also Xue level. “Qian Zhen Yi Jing 潜镇益精”: use minerals to help Yang Qi go back into Yin (Qian); Calm the mind (Zhen); Gather the Essence (Yi Jing). Or “Qin Ling Rou Hua 轻灵柔化”: help the body to solve its own problem with light, soft, tender and fast working herbs. Like in a family situation when a problem needs solving internally, we should just support the process gently with no strong intervention (like tonifying, opening or gathering)

This method is very appropriate when we are facing patients with complex diseases due to a confused Shen, centered in the upper part of the body; a Jing deficiency due to overuse of computer and a stressfull life style disconnected from nature; or /and dampness and food stagnation. We need to calm the Shen, open the middle and nourish Jing.

C : In ancient China, could we say that each dynasty with its own historical, geographical and socio-cultural characteristics, developed corresponding diseases, which could explain the rise of new schools of prescriptions?

LX : Before the time of Shang Han Lun, people lived according to Nature, their Shen was clear but they were vulnerable to climatic factors. Consequently, people’s Zhen Qi and Xie Qi were clear, the direction of Qi Ji was clear. Ma Huang Tang, Gui Zhi Tang, Da Cheng Qi Tang, Xia Cheng Qi Tang, Da Chai Hu or Xiao Chai Hu Tang could treat almost every condition. Doctors were following the ancient principals using the character or original information of each herb rather than their function used nowadays. It was the real “qi and wei” period.

At the time of Sun Si Miao, in the Tang Dynasty, the prescriptions were similar but more complicated. They were also following the same ancient principals. Their focus was on the unsubstantial level of the body, they treated Spirit, and Qi directly. Sun’s book “Qian Jin Yao Fang 千金要方” teaches us this ancient way. Doctors, at that time, could still communicate with nature, and feel the different materia medica. They were able to treat the body-soul from the root and follow the changes of nature.

During the Song Dynasty, the arts and thoughts were highly developed. Social sciences and philosophy controlled people’s free mind. Most doctors used their mind predominantly and were learning more and more from books and from their experience rather than from their “heart”. As they lost their connection with nature and the ability to feel the herbs, they had to rely on their experience. From the time of Song dynasty (A.D. 960), the ancient style of Chinese Medicine gradually transformed into the style which we are familiar with to day.

The government itself edited many large formulae books such as “Tai Ping Hui Min He Ji Ju Fang”《太平惠民合剂局方》, which became the official foundation of the national medical educational system.

People enjoyed life, eating too much and wanting too much. At that time, the Hans were also constantly under the threat of the Mongols pushing them southwards. They tended to suffer from weakness of the middle, and were successfully treated with “Pi Wei Lun”. The author, Dr Li Dong Yuan 李东垣, and his Master, Dr Zhang Yuan Su 张元素 were the best doctors at that time, and were still following the ancient Chinese medicine principals. Their books are very important. Another famous doctor, Zhu Dan Xi 朱丹溪 focused more on the problem of blockages due to dampness, heat and phlegm of the whole body with Kidney deficiency (due to sexual overactivity and emotional problems) and created formulae like “Er Miao San”. Dr Zhang Cong Zheng 张从正 specialised in the treatment of detoxification and opening via sweating, vomiting and diarrhoea.

The Ming Dynasty was a time of “containment”: farmers had to stay on their land; trading by sea, except for officials, was forbidden; The Great Wall was rebuilt and extended; China was “blocked” and consequently, it seemed that people suffered from a blockage of “San Jiao”. “Bian Zhen Lun Zhi”, differentiation of symptoms according to the Zang-Fu, was very popular at that time. It was far away from ancient principals of Chinese medicine. Most doctors wrote large books based mainly on their own experience.

At the end of the Ming Dynasty, before the Manchus conquered the Hans, they were many rebellions among the farmers, severely repressed by local chiefs like Li Zhi Sheng in Shanxi province or Zhang Xiang Zhong in Si Chuan province. Sometimes the population of entire villages was killed and the bodies left without burial. Epidemic diseases flourished, with high fever. The “Wen Bing Xue Shuo 温病学说” appeared at that time.

During the Qing Dynasty, under the domination of the Manchus, there was a severe censorship. People could not express their feelings freely and I think that the constitution of Chinese people was very different from the time of the Han or Tang Dynasty. Their mind was more complex, people concentrated their studies on the Kong Fu Zi’s classic in order to get good scores, apply for a high ranked official posting and make a good living. When control from the society is troo strong, it deprives people of free thinking and feeling and, consequently, it leads to diseases due to heart fire, fever, and dampness. Although most scholars had already lost the essence of ancient TCM, the “Wen Bing Tiao Bian, which explains how to use the principle of “Qing Xuan Shu Tou” (see above, Dr Song) and “qi and wei”, was written at that time and is a really good book; people were treated with Yin Qiao San, Huo Xiang zheng Qi Tang, Sang Ju Yin.

In the early 20th century, the “Mingguo” period, western medicine ideas came to China and Zhang Xi Chun 张锡纯 wrote: “Yi Xue Zhong Zhong Can Xi Lu 医学衷中参西录”, “On the base of TCM, take advantage of western medicine”, which opened a new era in TCM.

So, yes, we can say that with each dynasty came new situations, which engendered new types of disease and, consequently, new treatments. Nowadays we cannot treat people exactly as described in the Shang Han Lun. We have to adjust to the particular problems of our modern society, but whatever the problems, the main principles remain the same, and that is what we have to remember. Catch “Ji”, Know the “qi” and “wei” of the prescription, and you will act in the right direction, for a successful treatment!

TREATMENT WITH ACUPUNTURE, MOXIBUSTION, CUPPING AND MASSAGE

Chapter 1: The Role of acupuncture in TCM

C : You said that you are first an herbalist by training and in your heart. How do you value acupuncture? How does it complement the action of the herbs? Do you consider it essential in your treatment of a patient?

LX : Herbs work in the whole body’s circulation. A doctor acts like a central government who has a general plan to implement through different bodies or ministries; herbal treatment induces action and results for the whole nation. Sometimes parts of the nation resist and block the realisation of the plan or governors are just incapable of implementing it. In that case, an emergency plan has to be made, with a team working locally on a more specific problem concerning a particular area. Acupuncture is very good at that. By using his own Shen, and Qi combined with the Qi of Nature, a doctor can unblock a system very quickly, directing Qi where it needs to go.

Herbs balance, clean, and move in a general direction. Acupuncture unblocks, guides Qi directly to the point. Herbs open general functions: blood, sweating, urination, bowels; acupuncture can open local “small doors”.

Another essential effect of acupuncture is its action on Shen. It has a very fast and efficient calming effect on Shen and will correct “fake symptoms”. Only a few herbs have an effect on Shen: minerals, seeds, heavy and sour substances.

Herbs are particularly useful for “unclear” people, with pathogenic factors like phlegm, dampness, fire…or suffering from deficiency, especially Jing deficiency. For “clear” people, acupuncture is the first treatment and will work fast.

In other words, acupuncture is not only used for the treatment of disease but also for the prevention of disease, keeping people healthy and even improving their health. Herbs have a good effect on Jing, Xue and Qi level, acupuncture on Qi and Shen level.

C : I was told that, in the general population, 10% will react very well and fast to acupuncture, 10% not at all, and the rest of the population somewhere in between. Is there a link with the notion of “clear”, “unclear” or “mixed”?

LX : We find, in Huang Di Nei Jing-Ling Shu 黄帝内经-灵枢, Tong Tian 通天 chapter 72, a division of the population into five different categories:

— Tai yin 太阴 people have too much Yin. Their skin is heavy. They like to take things for themselves rather than give away. They do not express their feelings. They usually are negative people with a “small heart”. They are not receptive to acupuncture.

— Shaoyin 少阴 people have more Yin than Yang. They are jealous, suspicious; never think that what they have or receive is good enough. Their Qi and Xue are easily empty. They can be receptive to acupuncture but one should not use strong manipulation for them.

— Tai yang 太阳 people have too much Yang. They like to show off, and do not think of other people. They are too open, and often suffer from Yin deficiency. Acupuncture should be used cautiously as, if their Yin is empty, it may be dangerous!

— Shao yang 少阳 people have more Yang than Yin. They are open people who like to attract attention. They do not like to lose face and have a complex of superiority. They have a tendency to suffer from empty Qi. They have a good reaction to acupuncture but one has to be careful not to deplete their Qi.

— Yin yang he ping 阴阳和平 people (he ping means peace), are of course the best candidates but they rarely need to come and see a doctor. They naturally follow the rules of nature and harmony in their daily life regarding the seasons, body functions (food, exercise, sex), emotions, “they will not fall ill and live a very long life”, says Qi Bo 歧伯 in Huang Di Neijing chapter 9!

Chapter 2: The great rules of acupuncture according to Huang Di Neijing

C : If different types of people react to acupuncture in different ways, what does the “Huang Di Neijing” 黄帝内经, say about doctors practicing acupuncture? Are there any particular rules they should follow for a better result in their treatment?

LX : The Huang Di Neijing says: there are five principles a good acupuncturist should follow:

1. Zhi Shen 治神 = have the skill and power to control and use his spirit and mind

2. Yang Sheng 养生= look after his own body

3. Zhi Du Yao Wei Zhen 知毒药为真= know about the true medicine

4. Zhi Zhi Bian Shi Da Xiao 知制砭石大小= prepare suitable needles, big and small

5. Zhi Zang Fu Xue Qi Zhi Zhen 知脏腑血气之诊 = use the principles of diagnosis to know the state of Qi and Xue of the internal organs.

C : It seems that according to the “Huang Di Neijing” 黄帝内经, a good acupuncturist needs to”cultivate” himself as much as he should be familiar with the principles of TCM. Does that mean that acupuncture can be performed at different levels according to the abilities of the doctor to “cultivate” himself?

LX : Yes, this is very important. From the point of view of Huang Di Neijing, we consider that there are three levels of practice of acupuncture:

1. Know how and when to use the needles: this is the first or beginner level, to be able to memorise the location and function of the meridian points and the principles of diagnosis and treatment. Know how to use the nine kinds of needles and their manipulation techniques

2. Know how to read the pulse: This level requires more experience and skill. In ancient times, doctors used “San Bu Jiu Hou 三部九候”, ” three parts, nine pulses” which refers to the nine places where the pulse used to be felt, (3 on the head, 3 on the arm, 3 on the leg), then find the imbalance indicating which channel is in deficiency, and which is in excess. It is very rare, today, to find a doctor who masters the art of taking the pulse.

3. Know with the Shen 神 or Heart: A lot of information cannot be apprehended by the five senses, the examination of the body and the intellect, but by the “Shen” 神. An accomplished doctor can feel with his heart the work of the needles he uses, “like a sunshine coming into darkness, or a wind pushing away a cloud” 若风之吹云, 明乎若见苍天 (Huang Di Neijing-Ling Shu 黄帝内经-灵枢 chapter 1). Initially, taking the nine pulses can be used as a tool. But it is through meditation that a good doctor will be in total harmony with the patient and the forces of Nature.

This explains why Doctors (and the result of their treatments!) are all different. They work at different levels according to their abilities.

To be a good acupuncturist, self training is very important. Practicing meditation, giving massages (to improve feeling sensations and power of energy), and intensive body exercise are all necessary. Meditation can improve sensitivity and intuition, and help feeling from the heart, and not only with the five senses. All the informations about energy, emotional state, pathogenic factors (cold, heat, dampness----), is readily available. Depending how sensitive you are, how “clear” you are, you will perceive them or not. Using logic alone, a doctor will not be able to perceive pathogenic factors, deficiency or excess in the ancient traditional way, the direct way.

Massage (“Nei Gong An Mo 内功按摩 = use your inner energy to adjust the patient’s energy”) can help the doctor to feel the body, the energy level, the channels and points, and also pathogenic factors, what they are and how deep they lie (for details, see section on “treatment with massage”)

C : Can you explain further how you “Know” with the Shen or Heart?

LX : In Huang Di Neijing, it is said:

— “Fa Tian Zi Di” 法天则地 = “Follow the law of Heaven and Earth”

— “Sui Ying Er Dong” 随应而动 = “Follow the reaction and act”

— “He Zhi Zhe Rou Xiang 和之者若响; Sui Zhi Zhe Rou Yin 随之者若影” = “Follow the resonance like a stick on the drum. It is like the shadow following you.

This means that if the treatment is performed well, the result will be very clear and very fast. It will be like the work of “the Dao or Nature”. Only if the doctor is able to connect his Spirit and energy with Heaven and Earth will he convey that energy to the patient and the result will be clear and fast.

C : Is it what is called “catching ji”, in “Huang Di Neijing-Ling Shu”, chapter 1.

LX : Right, in “Huang Di Neijing-Ling Shu”, chapter 1, it is written that, “An ordinary doctor pays attention to the points and the joints of the body, but a good doctor can catch “ji”, the movement of “ji” in the atmosphere; when it comes, it feels like something clear, quiet and light, it cannot be expected, when it leaves, it cannot be controlled.”粗守关, 上守机, 机之动, 不离其空 空中之机, 清静而微, 其来不可迎, 其往不可追.

“Ji” 机 in ancient Chinese character means “chance” or “this moment”. The Qi of the patient is always changing and moving, it has its own way of working. What a doctor can do is to follow and help it; he should practise according to the energy change of each moment. It is like playing chess: the patient is like an ongoing game, you feel the whole situation, then insert one needle; the body energy reacts immediately, then you insert a second, and so on. You also need time and patience to wait and watch, this is called catching “Ji”.

It could also be compared to fishing; you have to react immediately when the fish bites! Another image is fighting: you cannot depend only on your eyes, ears, or brain logic; you react intuitively. In all cases, of course, it is important to know before hand how to play, to fish, or to fight, in order to win!

C : You said earlier that the result also depends on the type of patient, if he/she is “clear” or not. Will a doctor, who is able to work at the third level, have the same “clear and fast result” with an “unclear patient”?

LX : Two factors have to be taken into consideration:

1. At which level the patient is “unclear”. If it is at Shen 神 or Qi 气 level, the treatment will be very effective. If it is at Xue (血-blood) or Xie (邪-evils) level, it will take more time.

2. How “clear” is the doctor himself. In the Huang Di Neijing 黄帝内经 it is said that the doctor should use his own energy and Spirit to adjust the patient’s abnormal or imbalanced energy and Spirit. So the most important factor is how “clear”, how “powerful” the doctor is!

Chapter 3: Acupuncture in practice

C : How does it work in practice?

LX : You mean, what is taking place during a consultation?

C : Yes

Diagnosis and preparation: Xin Fa

Methods of diagnosis

LX : First of all, during the entire consultation, “Zhi Shen” 治神 = the Shen 神 of the doctor and the patient should be connected.

Second: “Wu Zang Yi Ding, Jiu Hou Yi Bei, Hou Nai Cun Zhen”, 五脏已定, 九侯已备, 后乃存针 = after understanding the five Zang (organs) and the nine pulses, then use the needles”. The doctor uses the methods of diagnosis described in the first chapter in order to understand the energy state of the patient, and where the problem lies: Zai Shen (神-spirit), Zai Qi (气-energy), Zai Xue (血-blood), Zai Jing (精-essence).

Pulse examination and observation of the patient are very important. In Huang Di Neijing-Ling Shu, chapter 1 it is written: “watch the colour of the skin, watch the eyes, you will know if Qi is spread out or gathered; watch the body, if it still or moving, you will recognise evil Qi and Zhen Qi” 睹其色, 察其目, 知其散复；一其形, 听其动静, 知其邪正.

Then the doctor decides if he needs to gather or open, bring the energy from Yang (up, back, outside) to Yin (down, front, inside) or vice versa, the needle being a guide for the transfer of energy. “Liu Zhen Yi Zhi Qi 留针以致气 = insert the needle somewhere and Qi will gather around it”. As we said before, Shen and Qi levels can be adjusted with acupuncture. Xue and Jing level are better treated with the adjunction of herbal formulae.

All this is standard teaching of acupuncture

Preparation: Xin Fa

LX : And then the “Huang Di Neijing” goes on saying:

— When using the needles: “Zhong Mai Bu Jian 众脉不见, = forget about the pulses”. “Zhong Xiong Fu Wen 众凶弗闻, = Do not focus on the patient’s symptoms”. “Wai Nei Xiang De 外内相得, = Outside, inside are the same”; you, the patient and what surrounds you are one.

— “Wu Yi Xing Xian 无以形先, = Never follow the symptoms of the patient first”

— “Ke Wan Wang Lai 可玩往来, = You are relaxed and totally concentrated on what you are doing, like playing a game.”

This is what we call “Xin Fa” or “the law of the heart”

Insertion and manipulation of the needles: Shou Fa

Insertion

C : How do you decide where to insert the first needle?

LX : The patient lies on the couch. You stand by his side and look into his eyes to make him quiet, and guide his awareness towards the needle. Your mind already knows what to do and you must try to be in that special moment of connection: “Wai Nei Xiang De 外内相得, outside, inside are the same”. Your concentration is in your heart, as if you were immersed in peaceful music. You are completely relaxed. You feel, either in your body or directly with your “consciousness” where the first needle should be placed.

C : In other words, as you described it well earlier, you are “catching Ji”. Is this first needle very important?

LX : Yes, as it will direct the flow of energy towards the “channel” where it should be flowing.

C : And then, what happens?

LX : After the insertion of the first needle, standing still, with an empty mind, you feel in yourself what happened to the energy flow of the patient. You might need to consolidate the action of the first needle, with the insertion of a second one, acting in the same direction (gathering or opening, bringing the flow of energy more up or down, calming the “Shen” spirit), or complete it by a change of direction and effect . The procedure is the same for each needle, till you feel that the energy of the patient is flowing the way it should be, “like the wind blowing the clouds away, clear so that you see the sky” 效之信, 若风之吹云, 明乎若见苍天, 刺之道毕矣, (Huang Di Neijing-Ling Shu, chapter 1)

You then leave the needles in place for about 45 minutes, and in a quiet environment, connected with “Nature”, the healing process will take place.

C : How deep do you insert the needle?

LX : The Huang Di Neijing, answers in “Ling shu”, chapter 9:

The depth of insertion depends on the energy state of the patient and the season. In winter, the energy circulation is very deep, and the insertion of the needle should be deep to reach it. In summer, it should be more superficial. For some people at a particular time, a deep insertion will sedate; for another person, it will tonify.

For an overweight person, insertion should be deep, for a thin person, insertion should be more superficial. If the Qi is powerful and fast, use small needles and do not insert the needle too deep (small needle is enough for powerful Qi); if the Qi is rough and slow, use long needles and insert more deeply (it will stimulate the flow of Qi).

We find again in Huang di Neijing: “Gu Zhen Xian Mai Ze Xie Qi Chu, Zhen Zhong Mai Zhe Zuo Qi Chu, Zhen Tai Sheng Ze Xie Qi Fan Ceng Bing Yi” 故针陷脉则邪气出, 针中脉则浊气出, 针太深则邪气反沉, 病益, which means: “if the insertion of the needle is superficial, Xie Qi will go out; if the insertion is medium deep, negative energy will go out; if the insertion is deep Xie Qi goes down inside and the patient might get seriously ill.” So the depth of insertion of the needle will also depend on what you want to treat.

In any case, you know that you have reached the right depth when Qi “grasps” the needle.

C : Is the depth indicated, often very precisely, in manuals describing the location of the points, only a guide line for the beginner to be respected for anatomical and safety reasons?

LX : Of course, for a beginner, the first thing is to be able to insert the needle safely. He will improve with practice. The more you practice the more you will realise that what you need to locate is not the point, but the place where the strongest pathogenic factor lies, where there is a situation of Qi excess or deficiency, and where Zhen Qi is blocked. The “where” is the exact point to use to readjust the energetic balance at that time. It is called “Huo Xue 活穴”= “the active point”. Books describe “Si Xue 死穴” the map of all the points.

When you insert the needle, sometimes you can feel that the first direction of your insertion is not right, you need to pull it up slightly, and find a new direction of insertion. This cannot be discussed in books, but can be improved if you practice with sensitivity, awareness, patience and concentration.

C : With a western scientific approach, we give an anatomical description of an acupuncture point: it can be located in the skin or muscle and corresponds to a specific place particularly rich in nerve extremities, small vessels, and metabolic substances. It is energy conductive, and will react more strongly to stimulation, via the nervous system. This is “Si Xue”? What would be your definition of an acupuncture point?

LX : To quote the Huang Di Neijing, I would see it as:” the place where Shen and Qi of the patient meet and from there go in and out, it does not mean skin, muscle, tendon or bone”. This is a more dynamic approach; this is “Huo Xue”.

Acupuncture sensation: De Qi

C : I would like to go back to the sensation of “Qi grasping the needle”, which tells you that you have reached the right place, Is this what is called “Qi Zhi”?

LX : Yes, but Qi Zhi is more than this. It includes different kinds of feelings:

1. The patient feels better

2. At the point of insertion, the patient feels numbness, pain, or soreness or a sensation going through the channels.

3. The doctor feels that the needle he is holding in his hand has been “grasped”.

4. The doctor feels that the energy of the patient is changing, moving, improving, reducing…

5. The doctor feels the Shen (神-spirit) of the patient clear or calmed.

6. The doctor feels his own Shen (神-spirit) clear or calmed.

7. The doctor feels the atmosphere of the room clear or bright.

In modern books, only 1, 2, 3 are discussed. We need to train ourselves to be able to perceive 4, 5, 6, and 7

C : Your description of 1, 2, and 3 corresponds to what I call “De Qi” or “acupuncture sensation”. I understand now that the patient’s perception of “De Qi” is not necessarily all that matters. The doctor’s perception of”De Qi”is also fundamental to the success of treatment!

LX : Exactly! In practice, there are different ways of feeling “De Qi”. For example, often, if a patient is suffering from cold blocked inside the body, a sensation of cold will be felt by the doctor just above the needle, up to 50cm above it. It is a good sign that cold is released from the interior and is moving out. Or sometimes, if there is pain after the insertion of the needle, it means that cold tightens around the needle. It is then better to use moxa.

The “De Qi” sensation classically described by the patient (numbness, heat, heaviness, sensation along the channel …), is not all that important to the success of the treatment. What is important is not only what the doctor feels and observes after the needle insertion (we are going back to the feeling of “the wind blowing the clouds away, clear like you see the sky”), but also changes observed in the patient:” Yin Qi Yi Zhang, Er Mu Cong Ming, Fan Ci Zhe Xue Qi Bu Xing 音与气彰, 耳目聪明, 反此者气不行 which means: “sound of the voice, glow of the face and eyes, hearing should be clear (or at least show some changes), if not, Qi and Xue have not been changed”.

Manipulation

C : How do you manipulate the needle? Is it an important part of the procedure?

LX : Needle manipulation, as we know it today, was popularly used in the Song Dynasty. There are lots of manipulation techniques called “Shou Fa 手法. Shou Fa refers to any manipulations used during and after insertion of the needle in a chosen point.

In Huang Di Neijing 黄帝内经, manipulation techniques are also mentioned but it is not an important aspect.

If we assemble all the techniques described in the Huang Di Neijing 黄帝内经 we find five “laws”:

1. Zhen Fa: the law of Needles 针法,

2. Xue Fa: the law of Points 穴法

3. Ci Fa: the law for Insertion strategy 刺法

4. Shou Fa: the law of Manipulation 手法,

5. Xin Fa: the law of Heart 心法.

My suggestion is to pay more attention to “Xin Fa”, because “Shou Fa” is in fact “Xin Fa”.The law of Heart is the essential part of Huang Di Neijing 黄帝内经 It should be present at every step of the treatment, and guide it.

In Song Dynasty, most of the doctors used “Shou Fa” but Dr Wang Ji 汪机, wrote a book called “Zhen Jiu Wen Du 针灸问对”= “Questions on Acupuncture and Moxibustion”. In this book, Dr Wang Ji says that manipulation of the needle is not that important. He emphasises the strategy in an acupuncture treatment: Ci Fa, Xue Fa, and Zhen Fa, rather than Shou fa and Xin Fa. This is what most practitioners follow nowadays.

C : Manipulating the needle in order to sedate or tonify is, then, part of “Shou Fa” and “Xin Fa”? Can you explain what you mean by this?

LX : The Huang Di Neijing 黄帝内经, in Lin shu 灵枢, chapter 1, tells us that in order to tonify, one should insert the needle slowly and retrieve it quickly, closing the skin with the left hand; in order to sedate, one should insert the needle quickly and retrieve it slowly without closing the skin. 徐而疾则实, 疾而徐则虚. This is “Shou Fa”, and what modern books will also teach you.

But in addition, the Huang Di Neijing also talks about the will of the doctor to support or sedate, like adding something with their own mind if it feels empty, or taking something out if it feels in excess. 言实与虚, 若有若无, 察后与先, 若存若亡, 为虚与实, 若得若失.

Using their awareness, they should feel Qi coming and going, as if something was here at the point and is not anymore or the other way round. With their mind they can support the process or not: this is “Xin Fa”. (See annexe “Huang Di Neijing” for more details). Shou Fa can be practiced well not only with the guidance of Zhen Fa, Xue Fa, Ci Fa but also if Xin Fa is mastered.

In order to sedate or tonify, understanding the basic condition of the patient is fundamental. We have to know if the condition is xu or shi.

C: Don’t you think that every doctor, even a beginner uses “Xin Fa” intuitively?

LX: We all have intuition, but we may be controlled and confused by our minds. There are two systems governing our thoughts: the mind, which is the result of our social and cultural education, and intuition. Everybody can use intuition, and it can be trained by meditation, practising massage (Nei Gong An mo) and moxibustion. It is sometimes much easier for beginners to use their intuition, as they are less burdened with many years of logical thinking and accumulation of intellectual knowledge. That could explain spectacular results that we often have as beginners and that we call “beginner’s luck”! Young recent practionners will have the handicap of limited life experience and will lack the deep understanding of an older doctor. Any level of practice is right but Huang Di Neijing tells us that, by being more aware of “Xin Fa”, we can have a deeper understanding of what acupuncture is all about.

Acupuncture strategy and action of the points: Ci Fa and Xue Fa

C : We have talked about, Shou Fa (insertion and manipulation), and Xin Fa (using the Heart). What about Ci Fa (strategy) and Xue Fa (action of the points)? Do you follow any particular rules with classical combinations of points: Yuan-Luo points, Back-shu, Front-Mu points, five shu points, Mother-Son relationship, eight influential points, local and remote points etc…?

LX : Although I use all these different approaches, of course, I am not attached to any particular rules. As I said earlier, I first base my treatment on the movement of energy I want to induce, and I adjust it according to my own perception of what is actually happening in the patient’s energy field, and not on what particular effect a combination of points is supposed to have. But I believe that if a doctor has a deep knowledge of “Xue Fa” (action of the points) and “Zhen Fa” (the law of Needles-针法), together with “Xin Fa” (the law of Heart-心法), then the result should be even better and faster .But my own knowledge of “Xue Fa” is limited ! I need time to read more about “Xue Fa” and practice accordingly.

Huang Di Nejing says: “Tai Yang Wei Kai, Yang Ming Wei He, Shao Yang Wei Shu 太阳为开, 阳明为阖, 少阳为枢”, which means: “Tai Yang and Tai Yin open, Yang Ming and Shao Yin gather, Shao Yang and Jue Yin move and transform”. This is a basic principle I like to follow, regarding the action of the channels when the middle is not deficient. (See fig. 6)

TaiYang 太阳——TaiYin 太阴 Open 开

YangMing 阳明——ShaoYin 少阴 gather 合

ShaoYang 少阳——JueYin 厥阴 Move 运行,

Transform 转化, connect 联系

Figure 6: action of the meridians of acupuncture

on the movements of qi 经络运行特点

C : Can you give us a clinical example?

LX : A women came to me with a right facial palsy. She had it for two days. She was a hard working women, carrying heavy bags going on a business trip; her sleep was poor, she was talking a lot; her face was reddish, a bit swollen on the right side. Her pulse was rapid and floating, her tongue coating very heavy. She belonged to “wind-fire”. I felt that her “mind fire” was going out too much, she needed to calm down and “gather”. I first used yintang (extra), followed by Taichong (LIV 3), Taixi (KID 3), and Zusanly (ST 36). This was meant to bring the energy down, gather, and clarify the situation between Xie Qi and Zheng Qi. After 20 minutes, the pulse was much more settled, and she felt cooler. The red face was a “fake” symptom.

I then used Hegu (LI 4), Dazhui (DU 14), Fengshi (GB 20), and Quanliao (SI 18), to open. I could feel cold, and not heat, coming out (cold had transformed into heat). Twenty minutes later, she felt relaxed particularly in her face, and the feeling of heat was gone. The facial paralysis looked 80% better.

The main principle in this case was, first, to gather the energy in and down, second, to open and sedate. It was not to follow the rules of points or channels, nor the symptoms or principles of diagnosis. It was dependant on that particular moment, what the energy state was, and after each needle insertion, how it was working. That’s what I call “catching Ji”.

C : So, from your own experience, you use certain points for a particular action, in the context of “catching Ji”?

LX : Yes, of course. But, on the whole, I am more interested in the direction of their action than their effect on a particular organ (Zang or Fu) or structure (muscle, bone, skin…).

From my own experience, I can say, for example, that Zhongwan (REN 12), Guanyuan (REN 4), Mingmen (DU 4), Shenshu (UB 23) are very good points to “gather” energy in. In general, all the Mu-front points gather and concentrate the energy inside. Back-shu points tonify in “xu” condition and open in “shi” condition. If the deep channels are not open, use the Ren Mai, the Du Mai and Hua Tuo Jia Ji.

Use Yin points to bring Xue and Zang energy down and open, for example: Gong sun (SP 4), Sanyinjiao (SP 6), Neiguan (P 6); and use Yang points to open out like Zusanly (ST 36), Waiguan (TR 5), Yanglingquan (GB 34), or Quchi (LI 11).

All the points located below the elbow or knee open: only Taixi (KID 3) can also “gather”.

Points located on the hands and feet open the whole channel. Points located on the forearms and legs help the internal Qi to go down to the hands and feet; they also help to bring pathogenic factors out (ex: Waiguan (TR 5), Qiuxu (GB 40).

Points can be used together. For example if I feel that Zusanly (ST 36) is full and big but not blocked (not painful), and Sanyinjiao (SP 6) is deficient, I use SP 6 alone, energy will flow from Yang (in excess) to Yin (in deficiency); but if Zusanly is painful, we need to puncture it first, in order to open it before using Sanyinjiao.

C : More specifically, are there certain points that you like to use for a particular reason that you have learned from your teachers or directly from your own observations?

LX : Shangxing (DU 23) and Yintang (extra point), are used to get rid of excess energy generated by an over active mind.

Baihui (DU 20), brings the energy down and opens out (good for stress, insomnia…), concentrates and strengthens energy.

Taichong (LIV 3) is very good for problems taking place at “Xue level”. Opens and sedates.

Taichong (LIV 3), Sanyinjiao (SP 6), Xuehai (SP 10) have a direct action on blood stagnation

Taichong and Hegu (LI 4) together, open the “4 gates”, or the whole body.

Hegu is connected with the whole surface of the body (in relation with Wei Qi). It is also used to tonify the large intestine like Dahuang or Houpo.

Taixi (KID 3) tonifies and gathers, grasps Qi down.

Sanyinjiao (SP 6) is used for low Qi, low Jing, opens the channel, opens in and down, directs the Yang energy towards the Yin.

Lieque (LU 7) opens out and connects with the lower part of the body.

Shenmai (UB 62), opening point of the Yangqiao extra channel, is like Mahuang Tang: if one has enough energy, it opens out quickly and widely. Zhan zu (UB 2) works in a similar way, but to use Zhan zu, the energy has to be opened down, in order to receive this extra energy from above.

Dazhui (DU 14) is a “jie” point or “knot” point. It brings Yang Qi outside. “Jie” points can be used if the channels are not open. Other examples of “jie” points are: Tianzhu (UB 10), Fengfu (DU 16), Feng Chi (GB 20), Zusanly (St 36), Gong suan (SP 4) or Hegu (LI 4).

Shanzhong (REN 17) is useful when emotions are blocked and the patient is easily scared.

Tiantu (REN 22) is also good for this effect.

Neiguan (P 6) opens the chest, opens inside and Qi level; spreads Qi in the arms when there is not enough energy in the arms and too much in the chest.

Yinlingquan (SP 9) is very good at opening the Zang organs when they are blocked. It leads the energy down to the feet, if Taichong or Gongsuan are not efficient.

C : It all comes back to: “open outside, open inside, gather, bring Qi down or up, from Yang to Yin etc…rather than addressing symptoms or patterns of disease. It seems rather simplified! If I take, for example, Taichong (LIV 3), I read in the Beijing “essentials of traditionnal acupuncture”: “softens the liver, increases Qi and blood circulation, dissipates liver Yang and liver fire”; and its indications “uterine bleeding, hernia, enuresis, pain in the anterior aspect of the medial malleolus, fullness of the hypochondriac region, infantile convulsion, epilepsy, headache, vertigo, insomnia”! By simply remembering “opens the whole channel (located on the foot), works very well at Xue level, and sedates excessive energy at Shen (Spirit) level”, you will, in fact, include all the disorders mentioned in modern books?

LX : Yes! As a comparison, I think the doctor has to work like an official in charge of sorting out the whole city’s traffic jam. In front of him, there is a big screen showing traffic conditions in the entire city. He should focus on the whole system and the main roads. If he acts from the perspective of the policemen posted at various crossroads, things will not improve and might even get worse. It is better to look at the screen, have a comprehensive view and then place the first policeman (needle) at a strategic point. Traffic will then start to flow. You should feel it immediately and then place the next one. When each policeman is at the right place (or point), the whole situation will change and the traffic jam will be solved.

C : In your method of regulation, is there a place for the five elements theory? Do you use the eight extra channels?

LX : I never used the eight extra channels in practice before we discussed the subject with Dr Juan and you told me that it could be used very effectively, especially when the disease seems complex. In April 2005, I began to use the opening points of the eight extra channels.

I feel that it really has a powerful effect: the Shenmai-Houxi (UB 62-SI 3) combination is good to open Qi; the Zhaohai-Lieque (KID 6-LU 7) combination is good to gather Yin energy inside and help balance Yin energy, connecting the upper and lower parts of the body; the Gongsun-Neiguan (SP4-P6) combination is good to open internal organs and lead dampness and blood stagnation out. The Qiuxu-Waiguan (GB 41-TR 5) combination is good for the balance of Yang Qi, connecting the upper and lower Yang, like opening a gate.

As far as the five elements theory is concerned, I do not master it. I need time to learn about it. I think it is very important if you use it with “Wu Yun Liu Qi” (five earthly elements and six heavenly Qi 五运六气), base of the calendar, and the organisation of time and space. But it is highly technical! The Emperor Huang Di described “Wu Yun Liu Qi” but its application in medical practice as the theory of the five elements (or, rather, the five movements), was particularly used during the Song dynasty.

In China today, there are schools of acupuncture only based on the theory of the 5 elements, called “Zi Wu Liu Zhu 子午流注” or “the 24th flow of Qi”. Dr Ni Yong Li specialised in this field. I met her in 1998. Since then, she has made great progress in the understanding of the ancient “Wu Yun Liu Qi.” The more discussions I have with her, the more I find out that what I know about it is only small parts of the Huang Di Neijing. She is now training students in the US.

As I said previously, with the example of the high official in charge of the traffic, I base my treatment on the regulation of the movements of Yin and Yang in the whole body, the Channels and Collaterals and what I feel is happening at the time.

C : In fact, if I refer to the excellent diagram of Jacques Pialoux from the foundation of Cornelius Celsus, in his book called “Guide of Acupuncture and moxibustion”, you concentrate your attention on what is happening “upstream” and find a way to regulate Yin and Yang from upstream: support the four substances, in order to have a strong Zhen Qi; use the San Jiao as a mean to understand Qi Ji, and open it where it needs to be opened to assist Qi ji. You then work, at the periphery, directly on the channels and collaterals for a good circulation of Qi and a good balance of Yin and Yang.

Alternatively you could concentrate your attention “downstream”:

— Either in the “middle line” where the eight extra meridians receive Zhen Qi prepared in San Jiao and distribute it to the meridians, collaterals and organs. In that case, you would act directly on the “reservoirs” of Qi, blood, Yin and Yang, opening or closing the “valves” depending on where the energy is needed. This corresponds exactly to the feeling you described, when you started using the eight extra meridians.

— Or you could also act mainly at the periphery where the energy is used. And there we find two different aspects of the use of Zhen Qi:

• One which follows the seasonal adaptation of the body, and corresponds to the function of the ten Zang and Fu organs, linked two by two in the organisation of the “five elements of earth” (called “the internal use of Qi” by Mr Pialoux; the Chinese school of “Zi Wu Liu Zhu” would probably act almost exclusively at this level.

• The other which follows the body’s adaptation to the daily cycle, and corresponds to the twelve meridians (including pericardium and San Jiao), responding to the “six qualities of Heaven, or six heavenly Qi” which are: cold, heat humidity, dryness, wind, and damp heat (called “the external use of Qi” by Mr Pialoux). This “daily cycle” method of adaptation, linked to the “six heavenly qi” in a situation of disease, in fact, follows the six levels of penetration described in. Shang Han Lun! (see diagram below).

LX : So everything makes sense! If seen from only one angle you may think that one method of regulation (five elements, eight extras meridians, Yin Yang regulation) is unique and separated from the others. If seen as a whole, the energetic system of the human body includes every single one. We choose the most appropriate method, depending on where we want to act: the basic substances, the transformation of energies in San Jiao, the distribution centre (eight extras meridians), the periphery according to the seasonal or daily atmospheric adaptation.

Refering to Mr Pialoux’s diagram, I suppose that my method works “upstream”, as you say, with the external peripheral use of the meridians .That might explain why I never used the eight extra meridians and the five elements up till now!

C : What about the theories described for herbal treatment, like Shang Han Lun, Wen Bing Jiao Bian, The theory of the three Burners, are they applicable to acupuncture?

LX : The Shang Han Lun is used in both acupuncture and herbal medicine because Zhang Zhong Jin practiced both and his diagnosis is based on Qi Ji and how it can transfer from “biao to li” and vice versa. The other theories came into being after the Song Dynasty, when doctors were more experienced in herbal medicine and wrote books for herbal medicine. Today there is much confusion because people mix up the theories applicable to herbal treatment and to acupuncture.

They are really different. In general, books about herbal medicine describe “Bing Qi”and pathogenic factors very well. Books about acupuncture are better at teaching the four substances and “Qi Ji”.

If you read Huang Di Neijing 黄帝内经, you will understand. Never use herbal theory, like Zang Fu Bian Zheng 脏腑辩证 = (internal organ), Liu Ying Bian Zheng 六淫辩证 (Six Evils), or the theory of the three burners 三焦 for acupuncture. All these theories belong to Bian Zheng Lun Zhi 辩证论治, which deal with herbal medicine.

For acupuncture read and use Huang Di Neijing 黄帝内经 (Zhen Fa, Ci Fa, Xue Fa, Shou Fa, Xin fa), Zhen Jiu Jia Yi Jing 针灸甲乙经, Zhen jiu Da Cheng 针灸大成 (Comprehensive achievement of acupuncture and moxibustion), written in the Ming Dynasty, and “Zhen Jiu Mi Yan” 针灸密验 (Secret experience of acupuncture and moxibustion), written by Dr Pang Jing Shan and Dr Fei Jiu Zhi, contemporary doctors (very good for Xue Fa, and Ci Fa), and finally “Zhu Shi Tou Zhen Xue” 朱氏头针学 (scalp acupuncture of Dr Zhu), very good on Xue Fa, Shou Fa and Xin Fa.

TCM focuses on Qi, the energy. Everything in this world has a particular energy. Medical theories tell us how to use herbs and minerals to adjust the patient’s energy; acupuncture theories tell us how to use our own energy, the energy of the universe to adjust the patient’s energy: needles are just means to help connecting.

Practical clinical examples

C : In a western acupuncture practice, more than 50% of the patients suffer from acute or chronic pain. What is your definition of pain?

LX : The cause of pain may be at different levels. We should ask ourselves these questions:

1. Are there pathogenic factors or not, at Qi or Xue level, in the internal organs or outside in the limbs, in the surface or in the muscles?

2. Is the patient in excess or in deficiency? Often, either there is no pathogenic factor involved or it is not the main problem. The main problem is an imbalanced energy state leading to deficiency in some parts, and excess in other parts of the body.

3. Is pain a local problem, or it is a symptom of the whole body’s imbalance? If it is related to other channels or internal organs, it is more complex.

4. Is the patient’s Shen stable or not? If the Shen is unstable, pain may be a fake problem, or may be perceived as more serious than it really is.

C : Can you give us clinical examples of your approach and treatment of pain?

LX : I shall give you a few examples of chronic and acute pain:

A case of chronic pain: polymyalgia rheumatica

Mid-2003, a western lady came to see me, suffering from polymyalgia rheumatica for three years. She had pain and stiffness in the lower back, shoulders, and hips, which was worse when she was tired or did not sleep well. She was over fifty, thin, with a small appetite, and irregular bowel movements. Her pulse was thin and weak but fast. Her tongue was reddish and thin. She had also been suffering from eczema on the legs for over fifteen years.

It was a typical case of Jing deficiency, with heat. The pain was due to a lack of nourishment related to this deficiency. So, in the first two months, I used sweet, sour, and cool medicine to tonify Jing and Qi, such as Nuzhenzi, Hanliancao, Roucongrong, Shengduzhong, with a taste not too strong, and a small dosage, as her stomach Qi was weak; I added Renshen, Baizhu, Fuling to tonify stomach Qi and Baimaogen, Heye, Cheqiancao for the heat. In her case, the use of herbal medicine was an absolute necessity. In Huang Di Nejing 黄帝内经, it is written that, if Yin and Yang are all deficient, we should use sweet medicine, because there is not enough Qi to regulate.

At the same time, I used the points: Guanyuan (Ren 4), Zhongwan (Ren 12), Shen shu (UB 23), Taixi (Kid 3), Taichong (Liv 3), to gather and tonify Yin . After two months of treatment, the pain was relieved, her appetite and sleep improved.

In a second stage, as her stomach Qi was stronger, I could use stronger herbs to tonify Jing and Qi: Huangqi, Heshouwu, Shengdi, Lianzi, Shanyao, the taste of the prescription was heavier than before, because her stomach Qi could take it.

The acupuncture points used were almost the same as in the first stage, but I added opening points for the heat and eczema: Qiuxu (GB 40), Zusanli (ST 36), Yanglingquan (GB34), and A Shi points (painful extra meridian points) on the feet, where the eczema was. After that, her pain was almost gone, and she gained weight.

During the first six months, she came twice a week, then, as she had to travel a lot, once a week for a year. In the last six months, she came only once every one to two months, taking herbal medicine in pill form such as: Shen Ling Bai Zhu, Bu Zhong Yi Qi Wan, Jin Gui Shen Qi, Zhi Bai Di Huang, between appointments.

Before she came to see me, she had also been taking hormone replacement therapy (HRT) for more than ten years, as she had an early menopause. Before TCM treatment, if she stopped HRT, she would immediately suffer from hot flushes, nervousness, and skin problems. After six months of TCM treatment, she stopped HRT: it is now the third year without any withdrawal symptoms, the eczema on the right leg has disappeared, on the left side it has reduced a lot. She has been completely pain free and did not need any treatment in the last six months.

A case of acute tension headache

In 2004, I saw a middle aged man who suffered from severe acute left occipital headache. He had a CT scan, an MRI, but nothing abnormal was found. He took painkillers for three days; at each time, the pain was relieved for 2-3 hours, but would then come back. It was a sharp pain, and he could hardly work or sleep. The pulse was thin and weak, he felt thirsty and hot in the head; the tongue was reddish with a lack of coating which indicates Jing and Xue deficiency. It is the same basic condition as the first example, so the prescription was almost the same, I only used more minerals such as Shengshijueming, Shengmuli, Shengshigao, to gather and bring downward the floating heat.

The acupuncture points used were: Fengchi (GB 20), Taixi (Kid 3), Taichong (Liv 3), Guanyuan (Ren 4), Shenshu (UB 23), to gather and bring the energy downwards. The first treatment was very successful and the pain was relieved immediately. After two months of treatment, with the help of Dr Liu jie, an expert in massage who adjusted his imbalanced “Jing-jin 经筋” (muscles and tendons system), the patient recovered completely. This experience gave him total confidence in Chinese Medicine, and until now, every month or two he comes for acupuncture treatment as a reliable method to keep well.

Acute low back pain

is a common complaint. Acupuncture is very effective. If it is a deficiency type, we can use local points to gather Qi, such as, Mingmen (DU 4), Shenshu (UB 23), Qihai (REN 6) or Guanyuan (REN 4). If it is an excess type, Zhanzhu (UB 2), Shenmai (UB 62), Houxi (SI 3), Renzhong (REN 26) which is very painful, Chenshan (UB 57), Weizhong (UB 40) are best. In that case, ask the patient to move very slowly (stand up and sit down, rotate the low back, bend forward), while manipulating the needles regularly. It is, then, better to have the patient sitting on a chair, and Chenshan and Weizhong are not so convenient to use. In a case of chronic deficiency, I also use Chenshan (UB 57) to tonify. Acute low back pain is not always due to muscle or soft tissues problem. it might be due to the blockage of channel Qi. In this case, there is no excess or deficiency in the body, and no pathogenic factor involved, only a blockage in the channel.

A man came to see me suffering from low back pain for one week. It was not the first time but he could find no reason for it, and this time it was more serious. He was a strong and powerful man. His face was a little red, he certainly had enough Qi and Xue. I used only Taichong (Liv 3) bilateral. This was very effective, as it was a typical case of Qi blocked in the whole body. Taichong is very good at opening Qi.

A case of shoulder pain

Chronic shoulder pain is very common among people in their fifties. When I was a student in 1993, a middle aged man came in, seeking help for his shoulder. He had already been treated for four months. The local skin was red and swollen, with marks of numerous needles and cupping. I tried to use the beginning-destination points: Hegu (LI 4)-Yingxiang (LI 20) of Hand Yang Ming, or Zhongzhu (TR 3)-Sizhukong (TR 23) of Hand Shao Yang, or Houxi (SI 3)-Tinggong (SI 19) of Hand Tai Yang, according to the localisation of the pain in the shoulder. I manipulated the two needles together, and asked him to move his shoulder, slowly, as far as he could. It was so effective that I used this principle to treat more than twelve patients and it became the subject of my graduation paper.

Sprained ankles in sport injuries

Ankle injuries are also a cause of acute pain among youngsters. When I was a teacher in a medical school in 1994, the boys played basketball and volleyball; this caused lots of ankle injuries, affecting mainly the external part of the ankle (GB channel). I used the following procedure to treat them:

— Fengchi (GB 20), when inserting the needle, I asked them to turn the ankle, which quickly relieved swelling and pain,

— Xiaxi (GB 43) or Qiuxu (GB 40), manipulating together with Fengchi,

— If it did not work, I used Yanglingquan (GB 34).

If the inner ankle was affected, I used Yinlinquan (SP 9) and local points.

In all cases, if the joint was very swollen, I used local points on the other side: this is called “Miu ci 缪刺” in Huang Di Neijing.

In “clear people”, which is often the case with young people, regulating the channels and collaterals is usually enough, as their basic energies are well balanced.

C : Another source of concern for many patients in the west is gaining weight. What is your understanding of this problem? Do you have “miraculous cures”?

LX : In TCM, we differentiate two kinds of over-weight people: the excessive energy type, and the deficient energy type. I have some experience with the second type. Many middle aged women put on weight or cannot keep their body shape because they do not have enough energy to gather, and thus their body structure becomes loose, like an empty ball. Low energy also causes low circulation of Qi in the channels, and thus dampness, wind, and cold accumulate in the body. The principle of treatment is not to sedate, but to tonify, tonify Yuan Qi, warm the body; and then, open to eliminate wind, cold and dampness.

We can use points in the Ren and Du channels: Mingmen (DU 4), Shenshu (UB 23), Guanyuan (REN 4), Qihai (REN 6), Zhongwan (REN 12), to gather; Zusanli (ST 36) or Waiguan (TR 5), to open. Useful herbs are: Tu Si Zi, Yin Yang Huo, Ze Xie, Chai Hu, and Cang Zhu.

Modern techniques of acupuncture

C : Before we close this chapter on acupuncture I would like you to say a few words about electrical stimulation, or ear acupuncture. Do you ever use these modern techniques? I have never seen you do it.

LX : I never use Ear acupuncture; it does not really fit with my own quest of Qi! But I know it really works. What is your experience of it?

C : I had the opportunity to take part in the first research studies of Dr Nogier the famous French doctor was the pioneer in the development of this field.

I have always used it, in its most simple reflex way, and I find it extremely effective when there is a very specific problem, responding to one corresponding point in the ear: sprained ankle, very well defined back or neck pain, vomiting (use stomach point), or even to lose weight or stop smoking, as long as will power and proper changes of habits are also respected! It is an effective symptomatic treatment in many cases, sometimes very spectacular!

Dr Nogier later developed a more sophisticated approach based on different frequency waves in the ear and an auriculo-cardiac reflex as a diagnostic tool. Dr Nogier called it “auriculo-medicine”. This is very complex and a whole subject by itself; it can treat many problems and reharmonise the energy fields of the body; it, then, goes far beyond symptomatic treatment. For more information, you can refer to his books indicated in the bibliography.

LX : As far as the use of electrical stimulation is concerned, scientists in China are doing a lot of research on the frequencies of electrical stimulation. I believe that low frequencies tonify, support, reinforce; and high frequencies disperse and sedate. If the intensity used is too strong or the treatment too long the energy will be disturbed.

C : High frequencies (50 to 100 hertz) act at bone marrow or segmental level in the spine (“gate control theory of Melzack and Wall). Low frequencies (2-4 hertz) work at brain level, stimulating the “Diffuse Noxious Inhibitory Control (DNIC) mechanism, and the production of endorphins and other neuro-mediators, with more long term effects. But if the intensity is too strong, the stimulation will become very painful and if it is too long (more than 20-25 minutes), it will release substances in the brain which will counteract the effect of endorphins! Nowadays, most of the electro stimulation appliances combine these two levels of frequencies and can achieve good results in the treatment of pain, especially chronic pain, neurogenic pain, per and post operative pain, and heroin addiction. It is a great tool to use, for a similar effect to a strong, fast, sustained and very tiring manipulation of the needles!

LX : I think that what would be very interesting is to go beyond this primary application of electro stimulation, and follow scientists in their research on individual frequencies. We could then adjust the disturbed energy of each patient, by “reinjecting” him with his own basic normal frequency, and “forcing” the disturbed energy back to normal. Music could be one of the means of readjusting frequencies!

This would be a real revolution in acupuncture treatment!

C : Fascinating indeed! But I believe that we are not so far from this! It might already be more developed than we are aware of, especially with the use of music. “Musicotherapy” is already applied to treat many disorders, listening to music of different frequencies. Dr Tomatis, in France, has also devoted his life to research in this field. Finding a simple test to mesure individual frequencies and a simple tool to “reinject” them to the patient, would be revolutionary.

Chapter 4: Moxibustion

C : In the Beijing “Essentials of Chinese Acupuncture”, it is written that moxibustion” has the properties of warming and removing obstruction of the channels, eliminating cold and damp and thus promoting normal functioning of the organs”. What is your opinion?

LX : Moxibustion’s main action is “Gathering”

It is not used to disperse cold; but cold and deficiency often go together and moxibustion is, then, a good indication. Moxibustion, in ancient times was even used very successfully with symptoms of heat: for example it was used directly, with garlic, on cellulitis to “gather”, collect the pathogenic factor and help it out.

Acupuncture is much better at sedating and opening, moxibustion is good at gathering. So I use it mainly on the Mu-front points, Back-Shu points, front of the body (middle and low abdomen) and points like Taixi (Kid 3), Yongquan (Kid 1) or Mingmen (DU 4).

Moxibustion on Gaohuanshu (UB 43) and on the navel (with salt and Fuzi) can be used to treat very sick patients with low grade fever due to Jing and Xue deficiency.

Another special indication of moxibustion is also at a “Spirit” level. It says that “AiYe(moxa), can dispel Xie Qi and Ghosts”

C : Can you give us a few clinical examples?

LX : I treated a man with very high blood pressure, dizziness, sore throat, a feeling of heat in the face, very thirsty, but with cold feet and legs, frequency of urination (every hour at night), low back pain and pain at Chengshan (UB 57). This is a typical case of Kidney deficiency and despite the symptoms of heat (deficient heat), I used moxa on Taixi (KID 3), Yongquan (KID 1), Shenshu (UB 23) and Mingmen (DU 4) very successfully.

Another case can illustrate the use of moxa in diseases at a “Spirit” level:

A 26 years old girl was suffering from a serious vaginal infection, treated with numerous antibiotics to no effect. She was very thin, very cold, and could not sleep as she was very afraid of “ghosts” that she could feel at night in her room. She was treated by a very famous acupuncturist with the technique of “Huo Zhen” (which consists of using a very long needle, whose extremity is heated in a flame till it becomes red, and then very quickly puncture a few points: it is very good to disperse cold and blood stagnation, a very “sedative” technique). This famous doctor obviously focused on “evil” but to no effect for two months. She, then, came to see me and I treated her with Moxas on Mingmen (DU 4), Shenshu (UB 23), Guanyuan (REN 4), Zhiyang (DU 9), and Xinshu (UB 14), Nei Gong Anmo (massage) and a prescription of Fuzi Li Zhong Wan + Tusizi. After two weeks, she could sleep, was no longer afraid, and the infection improved.

Moxa is very efficient in depression which often comes from Qi deficiency.

C : Is there any advice you could give us to practice moxibustion?

LX : When giving moxa, you should be centered, relaxed, concentrated, with no fear or nervousness. This will help the patient to be quiet. You can connect with Spiritual Energy if you wish. You should stay ten to fifteen minutes on each point.

The weather is also an important factor. Do not give moxa (or practice acupuncture) if there is a storm, heavy rain or wind which can make you feel uncomfortable.

C : Any other absolute contraindications, like fever?

LX : In my opinion only a “Yang Ming” type fever is a contraindication to moxibustion.

I Shall give you an interesting example of fever treated with moxa.One night, a friend called me to say that her husband had fever, I asked her a few questions to make sure that there was no sore throat, constipation, or big thirst (Yang Ming), and find out if he had been very busy and had less sleep than usual, which was the case. I prescribed Fu Zi Li Zhong Wan and moxa on Zhongwan (REN 12) and Guanyuan (REN 4), to gather the energy in. His fever was about 38° C .He was going to take medicines to open the surface and clear heat, which would have been the wrong direction! The next day the fever was down and he felt much better and went to work as usual. In cases like this, fever is an indication that Zhen Qi is going out and moxibustion is a very good treatment. Nowadays, many children have this sort of fever.

C : The good thing about moxa is that it can be used easily at home by the patient himself.

LX : Yes. And it is very useful as a preventive treatment.

For old people, moxibustion on Shenshu (UB 23), Mingmen (DU 4), Guanyuan (REN 4) and Zhongwan (REN 12), helps to gather Zhen Qi and promote Yang Qi, this was already indicated in the book of “Bian Que Xin Shen” 扁鹊心书, written by Dr Dou Cai 窦材 in the Song dynasty.

Moxibustion on Zusanli (ST36), and Neiguan (P6) helps to release Qi blocked inside. This was indicated in the book of “Qian Jin Yao Fang” 千金要方, written by Dr Sun Si Miao 孙思邈 in the Tang dynasty.

I also use moxa on Guanyuan (REN 4) or Mingmen (DU 4) for middle aged women in pre or post-menopause: twice a week if used as a prevention of menopausal symptoms, every day to treat them. It is particularly good when Yang Qi is low.

They are all very effective and safe preventive treatments.

Chapter 5: Cupping

C : Personally, I do not like to use cupping, but I can see that Chinese, especially elderly people, love it and they all ask for it! What is the magic effect of cupping?

LX : Old people in China find it very comfortable; they feel that it relieves pain and heaviness! And it is not a strong treatment.

Cupping is used for the surface. Depending on the number of cups you use, the effect will be different: use one cup to gather, several cups to open. It is faster than acupuncture at opening the surface.

In acute cases, you have to “catch ji”. For example, if the patient has just caught cold, you can use cupping to open and let the pathogenic factor out. At the beginning of a very itchy skin problem, you can also use cupping, as the pathogenic factor is still at surface level.

In chronic cases, you can use cupping to help open and push the pathogenic factor out. But you must first gather enough energy inside, with moxa, acupuncture or herbal treatment, to support the process. Otherwise when opening the surface, Qi will escape and cause deficiency inside the body.

C : You once said in the clinic that, if the colour of the skin is dark after cupping, it means that toxins, cold or blood stagnation have been released?

LX : This is not absolutely correct as the colour depends mainly on the force of the vacuum and the length of time you leave the cup in place!

The effect on pathogenic factors is much stronger if you use cupping with bleeding (puncturing the area of cupping a few times with a small triangular needle, before placing the cup). This technique is used for very strong pathogenic factors, floating fire, for example.

C : Where do you place the cups? Are there particular rules?

LX : You should follow basic acupuncture principles. For example:

If the middle is weak, do not cup on the limbs (it will open too much and create more deficiency inside) or on the back above the 7th dorsal vertebra (or it might lift Qi up too much and induce dizziness)

If you want to gather or tonify, do not use too many cups

If the middle is deficient with diarrhoea, you can use a single cup on the navel: it will gather energy and feel very comfortable. If Kidney is deficient, you can use a single cup on Mingmen (DU 4)

Usually to treat the upper part of the body, use a cup on Dazhui (DU 14).

C : Can you illustrate this with a clinical example?

LX : This young man, 17 years old, was one of my very first patients!

He was thin and very fit. For a few weeks, every night between eight and ten pm, he suffered from severe urticaria, very itchy; and then it disappeared!

My diagnosis was: Stomach Qi deficiency (very thin patient), and blockage in the middle. Heat or dampness was trapped inside and could not get out because of the blockage and weakness of the middle. It came up to the surface at night and induced severe itching, but could not be expelled and went down in again…and so on.

I prescribed: in the morning, Fang Feng Tong Sheng 防风通圣 (which includes Dahuang 大黄, Mangxiao 芒硝, Fangfeng 防风, Guizhi 桂枝, Huanglian 黄连, Huangqin 黄芩, among other herbs), to open out and down via bowels and urination; at midday, “Bu Zhong Yi Qi Tang” 补中益气汤, to open the middle, slightly tonify the stomach, move stomach Qi up and outside to the surface; and at night he used cupping on the navel (Ren 8) for thirty minutes to gather more energy.

He was cured in one week.

Chapter 6: Massage: An Mo, Nei gong

C : “An mo” (push, move) also called “tui na” (push forward, pull or grasp) or “massage” has always played an important role in Chinese Medicine. Chinese techniques are less well known in the West, where western methods are used.

I have noticed that there are many different ways of practising “An Mo”, and for having tried myself on several occasions, I find them mostly very painful! But I still enjoy my weekly foot massage, which I find very relaxing and good at moving Qi. I have rarely seen you practice “An Mo” at the clinic! What do you think of the benefit of “An Mo” and of the different techniques?

LX : I used to practice “An Mo” and teach it to students. It is a very good technique for doctors to learn how to feel the resources of the patient: Jing, Qi, Shen and Xing, and also the blockages and the presence of Xie Qi: cold, dampness, heat. It increases the doctor’s sensitivity. But it is a long process, and in my clinic I do not have time to do it anymore!

In China we have three main types of massage: Zheng Gu An Mo 正骨按摩, Jing Luo An Mo 经络按摩 and Nei Gong An Mo 内功按摩

— Zheng Gu An Mo: uses lots of different techniques of pushing, pulling, stroking, with the hand or the fingers, and bone manipulation. It is not necessarily strong, but very technical. It is used for injuries of the muscles, tendons or bones, and focuses mainly on one part of the body, the injured part. It works well and fast.

— Jing Luo An Mo: or channels massage. This technique is not as complex as Zheng Gu An Mo. It is used for internal diseases and general health massage. It is very popular.

These two kinds of massage, pay more attention to “Li”力, the force, “Xing”形, the structure, and “Shou Fa”手法, the manipulation technique. Various schools will teach you different techniques.

C : I spent one month in the Beijing massage hospital to learn these techniques. I found them very different from western techniques, apart from bone manipulations “ban fa”, which are similar. They are powerful and effective but my Chinese patients complained about my poor “li”, not strong enough for them! I was under the impression that it would take me months or years to develop enough strength in my hands, before I could perform properly! Nei Gong An Mo might be more suitable in that case?

LX : Nei Gong An Mo is to massage what “Xin Fa”心法, is to acupuncture. It means “internal movement”. It can use all the different techniques of the two previous types of massage, but differently: it pays attention to “Shen” 神 and “Qi”气 (rather than “Xing”形 and “Li”力). With his own “Shen” and “Qi” the doctor adjusts the patient’s “Shen” and “Qi”, using different type of manipulations with more or less strength. He can give priority at any time to “Li” (strength), “Qi” (energy) or “Shen” (spirit).

A patient with low Qi will probably require more “Li”; but working at “Qi level” with a patient who has enough Qi, you can increase his level of Qi even more. You can then guide the patient’s Qi to open the channels, disperse “Xie Qi”, and reinforce the weak parts. In 1998, when I was in Yanhuang hospital, Dr Wu Ding Huan showed me the way to manipulation in Nei Gong An Mo. Although he was more than 80 years old at the time, he never seemed to be tired, even after a half day’s practise. He was the student of the late Qing Dynasty emperor’s doctor. When he was practising, the patient felt no pain and he used very light strength, because his teacher was used to the emperor who did not want any kind of pain!.

He also told me this principle of traditional massage:”During manipulation, the hand should feel the Qi from the structure, then the sensation comes directly from the heart; the hands are moving following the feeling of the heart”. This principle is called “performance by the hand” but depends on the heart一旦临证, 机触於外, 巧生于内, 手随心转, 法从手出. It comes from the “Yi Zong Jin Jian” 医宗金鉴 by Dr Wu Qian, 吴谦, Qing dynasty (1739-1742).

C : What kind of patient do you treat with Nei Gong An Mo?

LX : Any kind, really. You have to know how to adjust your massage to each case.

C : I guess that Nei Gong is your way of practising massage. Can you tell me how you proceed?

LX : First of all, you have to prepare yourself, be relaxed, in a comfortable position, so that you will not get tired. Your hands, in particular, have to be relaxed to assess and follow the Qi of the patient, to be able to “catch ji”! During the whole massage, you do not lose contact with the patient’s Qi, you follow it like a “bouncing ball”, to guide and stimulate it, increasing it (with your Qi and Shen), moving it. You can start with the back: Mingmen up to the upper back, and move to the limbs and extremities, the face, the abdomen, to assess areas of excess and deficiency, areas of blockage, feel if there is “Xie Qi”. You can push the area using your body weight, increasing Qi if there is deficiency, getting it out if there is excess, by using your Qi and your Shen. The strength of your push will depend on the patient’s Qi, if it is deep or superficial, if it is in excess or in deficiency: you have to follow where it is. If you want to use your Qi and Shen, it is important to stay long enough in one place, not moving too much and too quickly. If you are relaxed, the patient will feel relaxed and might even fall asleep during the massage.

Like in acupuncture, if the treatment is going in the right direction, you should be able to notice a change in the patient: a blocked area opening, a deficiency replenished… Sometimes this might provoke a crisis, as a necessary step. Massage, like meditation, will help the patient going down deeper and deeper within himself, from the physical to the emotional and the “Heart” level, allowing blocked emotions to be released. This is a positive step!

C : Do you often find the same patterns of blockages?

LX : Common blockages are found in:

— Dazhui (DU 14) and Zhiyang (DU 9), when middle Qi is deficient,

— Yintang (extra), when people are over self conscious.

— Fengchi (GB 20), Fengfu (DU 16), Tianzhu (UB10), when people are thinking too much.

— Quanliao (SI18), when there is a lot of tension in the face and head

— Along the tibial bone, when there is blockage with excess;

— Xuanzhong (GB39) when there is blockage with deficiency,

— Zhubin (KID 9), or Yinlingquan (SP 9) when Yin is blocked

— Zhongwan (REN 12), when the Fu organs are blocked

— Neiguan (P6), when the patient has been under long term continuous stress without any relief

— Shanzhong (REN 17), in case of sadness

— Tiantu (REN 22), in case of suppressed anger

— Juque (REN 14), in case of sadness with a lot of crying. It is good to use moxa in that case

C : What about fear, how does it manifest itself?

LX : Fear does not manifest itself as a blockage; it will induce Jing and Shen deficiency, and tension in the channels (and muscles). We can use Baihui (DU 20), Taixi (KID 3), or Zhiyang (DU 9) to relieve it.

Yintang (extra) is also very useful for people who have strong controlling minds: it will direct the strong Qi blocked in Yintang, to the whole body.

C : Practising An Mo in general and Nei Gong An Mo, in particular, doctors’ hands are the means of energy transfer, instead of needles. Do you have to be specially trained in order to keep your own level of energy up without being completely drained by this transfer of energy?

LX : To practice An mo you have to train at different levels:

— Train your strength with body building, and also special exercises for the fingers to be able to perform certain techniques with enough “li” but keeping the hands perfectly relaxed (Gu Shang An Mo).

— Train your Qi, with Qi gong exercises (see chapter on Qi gong and meditation). With intensive daily training, some doctors are building enough energy in their own “Dantian” (centre of energy) to use “Wai Qi”, direct emission of Qi to the patient, even at a distance!

— Train your Shen with meditation, especially to practice Nei Gong An Mo.

Ideally, it would be even better to act as a canal of transmission of energy coming directly from Heaven and Earth to the patient without giving out your own energy. Training at Shen and Spiritual level is the key! If a doctor can empty his mind, he will act as a canal of energy and guide the patient’s own Qi to heal himself; that way, he will not give away his own energy.

C : How do you protect yourself against negative energy coming from the patient?

LX : A good way is to use bags of salt before giving An Mo to the patient. You heat five kgs of salt in a pan, divide it into five parts, put it in five thick cotton bags and on the patient over two layers of towels. You place the bags on Mingmen (DU 4), Dazhui (DU 14), Chengshan (UB 57) bilateral, and Gaohuangshu (UB 43). It is very comfortable for the patient and will “wake up” the whole body before the massage; a bit similar to a “Ma Huang Tang” or “Bu Zhong Yi Qi Tang” effect. Like moxas, it will absorb negative energies and protect the doctor.

But a doctor should also overcome the fear of negative energy. This is necessary to become a good Chinese doctor.

C : Just a word on foot massage. It is very popular in China, and widely used by both Chinese and foreigners. The theory of reflexology is easily accepted by modern people, what is the opinion of TCM doctors?

LX : Nowadays, with modern transports, people have less opportunity to use their feet. This is a common cause of blockage in the legs and feet. In addition, the over use of mind causes Jing and Qi to go upwards. Foot massage is a good way to bring Qi and Shen down, and help to gather Jing. This is the reason why foot massage helps sleep and relaxation. Because it opens the channels in the legs, it also helps improve digestion, and menstruation.

It is a good preventive and curative treatment.

MEDITATION AND QIGONG

C : During our discussions, the word “meditation”, 静坐 came back very regularly. For the Doctor, it is the basis and support of “Xin Fa”心法, (treatment with the heart). For the patient, it is a way to understand the different levels of “functioning” of a human being. It is a key to our “software”, our Shen, which often has to be modified, in order to improve our health, well being, and compassion. I suggest that we start from the beginning: what are our different levels? Who is the “real me”?

LX : When we are born, we have a body and a “Heart”. The “Heart” is like a glass which contains the soul. The Buddhists believe that this container, the “Heart” is passed on to us from generation to generation, like a “collective consciousness” or at least a “family consciousness”. It is the “pre-Heaven Shen” 先天神. What is inside the glass is me, my soul.

The stimulations, and contacts with the outside world influence our body and Heart and create sensations (physical and emotional), which will evolve into thoughts and, finally actions. If this process is governed by the “Heart” (and soul) we are in harmony with ourselves. But with time, the stimulations of the outside world become predominant and create a sort of habitual behavior dictating our sensations, emotions and thoughts, that we could call “post-Heaven Shen” 后天神. We lose touch with our “Heart”, the core of our being. We think that life is about relationships with our job, our family and everyone around us, with power, money, sex, fame…etc. Over the years, we develop a “software” which tells us how to react in such and such situation. We are not even conscious that this is the “dictatorship” of a self written software, well anchored in the “post-Heaven Shen”!

But this is not “us”. The “dictatorship” of sensations-emotions-thoughts-actions creates weaknesses and fear.

Meditation will help us see clearly that sensations, thoughts and actions are only a certain level of operation. But it is not the “true” me. We have to go deeper to reach the “Heart” and then the soul. When we reach the “Heart”, we can change “the software”: our lives will be governed by the “Heart” and soul and not by the influences of the outside world. We feel at peace and our health will improve. We know what we can create and do with our life, in harmony with what we cannot change, our “pre-heaven Shen” 先天神, or “Heart”.

C : TCM talks about the “five shens”: Shen, Hun, Po, Yi, Zhi 神魂魄意志, which belong to the five organs. What is their relation with the “pre-Heaven Shen” 先天神 and the “post-Heaven Shen” 后天神?

LX : I wrote my postgraduate paper about this particular aspect of TCM! In Ling Shu chapter “Ben shen 本神”, it is written that: Heaven gives human “De 德” (virtue), Earth gives human “Qi”, the movement and collection of “De” and “Qi” creates life. The original support of life is called “Jing”, Jing is coming from both female and male, which gather together and create “Shen” (the Spirit), “Hun” is the Yang aspect of the Spirit (it is coming and going with Shen), “Po” is the Yin aspect of the spirit (linked to Jing)

Figure 7: sensations-emotions-thoughts-action

We use our mind (“post-Heaven Shen”) to apprehend the outside world. “Yi” is thought: the memory and result of what is taking place in the mind; “Zhi” is the will of “Yi”. So it is clear that Hun and Po belong to “pre-Heaven Shen” 先天神, and Zhi and Yi belong to “post-Heaven Shen” 后天神. Shen controls Hun-Po and Zhi-Yi. In TCM, when these are balanced, it is the foundation of a good health. If we reduce the power of Zhi-Yi, Hun-Po will perform naturally, and in harmony, under the direction of Shen.

C : In relation to the five organs, Hun belongs to liver, Po to lung, Zhi to kidney, Yi to spleen, and Shen to heart. How relevant is it in practice? Does it mean, for example, that if Hun is disturbed, it will be reflected in the liver function? Or that, by treating the lung, Po will benefit?

LX : In fact this relation Shen-Hun-Po-Zhi-Yi with the five zangs was invented to fit the theory of the five elements. Taoists treated the five “Shens” in a spiritual way. Minerals can bring the energy of Zhi and Yi down and gather Hun and Po, and “Shen nong Ben Cao Jing” mentions specific herbs for the adjustment of Hun, Po, Zhi or Yi (Mu xiang, Chang pu, see annexe 1). But they cannot be adjusted just by the mean of the five zangs. In the first chapter of Huang Di Neijing, we read “Tian Dan Xu Wu, Zhen Qi Cong Zi; Jing Shen Nei Shou, Bing An Cong Lai 恬淡虚无, 真气从之, 精神内守, 病安从来”, “Keep the mind (Yi) empty with no will (zhi), Zhen Qi will follow the way of Nature; Keep Jing and Shen directed towards the inside, diseases cannot enter”, which means that first follow the “pre-Heaven” law: no Zhi-Yi, second, follow the “post-Heaven” law: if you have to use Zhi-Yi, keep it to a minimum and direct it towards the inside in order to protect the body against Xie Qi. Meditation is another way to harmonise the five “shens”.

C : What methods of Meditation do you advocate to reach the Heart and the soul, the “real me”?

LX : The first step is to take a distance from our habits, look at them, recognise them as they are; understand how our “software” is operating to dictate our behavior. Every religion teaches this.

Everyday, take time to sit quietly in a good but comfortable position, if possible with a straight back. Just be there; let thoughts pass by without making any judgment; see them for what they are; they are part of you but they are not “You”. Relax the mind, ignore its dictatorship, but do not “scold” it, which is another way to stay attached to it. Hold the position as long as you can, and little by little, you will reach a deeper and deeper level of yourself. When you reach the “Heart”, the “Heart” will open and your awareness and compassion will increase. It is a very simple, but also very long process, the work of a lifetime! However, the results on your well being will be fast.

Prayer is another way to reach the “Heart”.

C : In ancient Chinese Tradition, The Taoist masters were practising Qi Gong to increase their longevity, and even find “immortality”. What did that mean and what is left of this practice in China to day?

LX : Qi Gong is a very old practice indeed. Documented in the Huang Di Neijing 黄帝内经, as a way to harmonise the human being with Nature, it is also advocated in “Jing Gui Yao Lue” 金匮要略, (“the Essentials of the Golden Cabinet”) of Zhang Zhong Jing 张仲景, as an excellent preventive treatment of diseases. The idea was similar to what I described for meditation: to keep “pre-Heaven Shen” 先天神, and “post-Heaven Shen” 后天神, in contact and harmony. Today, the practice of Qi Gong is part of TCM teaching, but only few doctors continue with a daily practice. However, worldwide, the number of people practicing Qi Gong has increased tremendously.

I do not have much experience with Qi Gong. I usually practice simple sitting meditation. But I guess that “Xin Fa” is also a kind of Qi Gong practice. What is your experience?

C : I came across Qi Gong in 1990, in France, when I studied at the IEQG (Institut Europeen de Qi Gong), and have been very interested in it ever since.

They are numerous forms of Qi Gong which fall into two main categories: external (Dao Yin Qi Gong 导引气功) and internal (Nei Guan Qi Gong 内观气功). Dao Yin Qi Gong aims at controlling the mind, controlling breathing and a smooth circulation of Qi in the channels, using muscular activity and concentration. Nei guan Qi Gong is less accessible and aims at “cultivating” the inner Qi from Dantian 丹田, the center, the Hara of the Japanese. This inner Qi is like your soul, or inner child. If it grows in you, it will give you” Immortality” (according to Taoist tradition). It also increases the power of Qi that one can use directly in martial arts or give to a patient, sometimes even at distance! This is now called “wai qi” 外气, and is under much scientific research, to try to explain what it is and what it can do.

LX : As I said, this could be a sort of “Xin Fa” as long as it is performed with a sincere and open “Heart”! What kind of Qi gong do you practice?

C : At present, my practice is mainly based on the Dao Yin exercises of master Zhang from Beijing University of Sports and Physical Education. They are excellent exercises to improve the circulation of Qi in the different channels, and harmonise the corresponding Zang and Fu organs; some exercise are specially designed for one particular Zang-Fu (and corresponding channel), others aim at balancing the over whole energy of the body. They are easy to perform and very powerful.

I can also recommend the Taoist based exercises of “the Inner Smile”, the” five sounds” and” the microcosmic circulation” by master Mantak Chia (see annexe for bibliography). These exercices belong to “Nei Guan” (”internal alchemy”), and may be used in a spiritual way or as a great modern tool to “transform stress into vitality” (title of one of master Chia’s books).

All forms of Qi gong are excellent to increase well being and prevent diseases, but they may also be part of the treatment of diseases at an emotional and organic level. I guess that these exercises are certainly described in many other Chinese books of Qi Gong, in a similar way, and with various applications.

LX : It is true that modern people are constantly using their brains and are very much under the influence of “the seven emotions”, much more than ancient people. We call this “over use of Zhi Yi, then Hun Po is disturbed.” As a result the energy concentrates in the upper part of the body and leaves the lower part empty; the Zang-Fu suffer from excess or deficiency, and cannot nourish the substances. Qi gong exercises can prevent and treat disorders of Qi, of Shen and even replenish Jing. It is really of great value!

C : Yes, modern research has proved that people who practice Qi Gong regularly for more than five years have a significant increase in longevity, they are much healthier in their body and mind. But remember that practicing Qi Gong is not only a technique; it is a way of life! One has to aim at total harmony with Nature and Society, which regulate Human life.

LX : Is one form of Qi Gong better than the other? What would you recommend to a beginner?

C : They are all very good! It is probably safer to start with Dao Yin Qi Gong. But, depending on what you are looking for: improving your health if you are older, increasing your inner Qi, if you practice massage, training your brain and intellect, you will choose to practice different set of exercises. However, bear in mind two important things:

— Do not try to learn too many exercises: as Lin Zhongpeng, director of the China Qi Gong Academy in Beijing says: “one stick is enough to help you walk up the hill, do not burden yourself with a bundle of them on your back”! Keep to one exercise for a long time: you will not achieve anything by changing too often to a new one!

— Keep your practice simple: the “Book of Changes 易经” says: “Truth under Heaven comes from simple and easy things”! For example, the very basic position of “embracing the tree” gives a strong feeling of grounding, even to beginners. When Shen calms down, one will be aware of inner peace. A strong feeling of Qi will be present in” Dantian” and towards “Laogong” (P8). In a “Qi Gong” treatment, it is from Laogong (and also Zhongchong, P9) that it can be directly transmitted to the patient: acupuncture but without needles! l also enjoy the “eight pieces of silk”(八段锦) or “Ba Duan Jin”, a very ancient set of eight simple exercises which brings a complete harmony of Yin and Yang in the channels and the entire body. One can practice nothing but “Ba Duan Jin” all one’s life and be perfectly healthy and happy!

LX : Whatever we choose, sitting meditation doing nothing, praying, or more active Qi Gong exercises, their aim is to quieten and relax the mind, concentrate, go deeper and deeper to reach the “Heart”. Only then we can really open to the outside world instead of being dominated by it. Consequently, our awareness, compassion and sensitivity will increase for our well being, and a better use of our tremendous potential of energy and, for us doctors, a better treatment of our patients.

CONCLUSION

We reach the end of this long Journey through the Classics with a feeling of joy and fulfilment. The spirit of TCM is still alive, and can very well be the centre of our modern lives.

Environment, people, techniques, diseases are much more complicated now than they used to be at the time of the Huang Di Neijing! In a world where multi media and computers are kings, people often misuse their minds and are disconnected from the realities of Nature. Consequently, their “Shen” is disturbed and induces diseases which are more and more complex and difficult to treat. But Nature is unchanged, and if we live by its rhythms, we might recover a sense of balance; we may be able to put our intelligence and modern techniques at the service of “Du” (balance) and Harmony.

Our approach simplifies, reaches directly the core of the problem, sometimes provokes it (catching Ji), before possibly solving it. It works on the dynamics of the body. The clinical cases described are a clear illustration, inspired directly by the classics and adjusted to our modern way of life.

In this book we learn how to be a skilled herbalist, according to the classical experts and “the Direct Way”! All the theories found in modern teaching books are based on the principles found in the Classics’, but the emphasis is different. We hope that this book can help to:

— Know what are the four substances: Jing (Yuan Qi), Shen, Qi, and Xing and how to evaluate their quality and quantity with the first step of diagnosis

— Know how QiJi (the function of Zhen Qi) is working and understand the role of “San Jiao”, using the second step of diagnosis.

— Know how to appreciate “Shen” and the balance of Yin and Yang, with the third step of diagnosis.

— Know where Bing Ji (the fight), if any, is taking place, and evaluate its strength, using the second step and the eight principles of diagnosis.

— Know the herbs by their “qi” (properties) and their “wei” (taste), which will give us their direction of action. Our new classification of herbs enables us, at a glance, to understand at which level (Shang Jiao, Zhong Jiao, Xia Jiao) each of the herbs selected are acting, in which direction, and for what purpose.

— Know how to elaborate a prescription, which can be based on classic ones, and modified by paying a particular attention to the dosage of the herbs and the cooking instructions. Dosage and cooking instructions are crucial to the taste, and therefore, the direction of action of the whole prescription. One may even use only one or two basic classical prescriptions in one’s whole practice, modify the taste and, consequently, the direction of action of that prescription according to the need of the patient, and get excellent results!

— Keep a prescription as simple as possible, remembering what Li Xin’s first teacher said: “in a prescription, only three to five ingredients are important, all the rest is meant to confuse or denotes a confused mind”.

— Always follow the direction of action indicated by “the first Doctor”, the “Qi Ji” of the patient.

This book also shows the way to become a high level acupuncturist. According to the Huang Di Neijing 黄帝内经 a doctor should follow:

— five principles:

1. Zhi Shen 治神 = have the skill and power to control and use his spirit and mind

2. Yang Sheng 养生 = look after his own body

3. Zhi Du Yao Wei Zheng 知毒药为真 = know about the true medicine.

4. Zhi Zhi Bian Shi Da Xiao 知制砭石大小 = prepare suitable needles, big and small (“Zhen Fa”, the law of needles 针法).

5. Zhi Zang Fu Xue Qi Zhi Zhen 知脏腑血气之诊 = use the principles of diagnosis to know the state of Qi and Xue of the internal organs.

— And five laws:

1. “Zhen fa”, the law of needles 针法;

2. “Xue Fa”, the law of points 穴法;

3. “Ci Fa”, the law of insertion’s strategy 刺法.

4. “Shou Fa”, the law of manipulation 手法;

5. “Xin Fa”, the law of the Heart 心法.

What is important, among these principles and laws, according to the ancient teachings, is the emphasis on “the use of spirit and mind”, “Xin Fa” the law of Heart.

To better understand the use of spirit and mind, we also read in the Huang Di Neijing: “Zhong Mai Bu Jian 众脉不见 Zhong Xiang Fu Wen 众凶弗闻 Wai Nei Xiang De 外内相得 = “forget about the pulses; do not focus on the patient’s symptoms; outside, inside are the same; yourself, the patient and what surrounds you are one”. “Ke Wan Wang Lai” 可玩往来= “You are relaxed and totally concentrated on what you are doing”.

In other words, after establishing a diagnosis, using our awareness, we should feel the Qi of the patient coming and going, catch “ji”, insert the needle just at the right time, and regulate the Qi of the patient with our minds. In our modern world, this is a way of practising acupuncture which has been forgotten. “Xue Fa”, the law of points, and “Ci Fa”, the law of strategy have taken over “Xin Fa”, the law of the Heart.

Most acupuncturists today use logic thinking predominantly and do not know how to use the “Heart” which leads to the direct feeling of the movements of Qi. Well planned strategy replaces the art of “catching Ji”. Of course, there will be results in any case, as “strategy” was developed by experienced doctors with “higher awareness” and who knew how to “catch Ji”. But to practice directly at this higher level requires long training of one’s Mind and Spirit with meditation, or Qi Gong, for example. This is the real adventure of Acupuncture, the secret of the old Masters! We believe there are no other secrets.

The current tendency is to try to understand and explain TCM (Traditionnal Chinese Medicine) with the scientific approach of the western world. This is very beneficial, for the recognition of TCM as a valuable form of treatment. It proves how this ancient way of thinking, based on the intuition and the feeling of “Qi”, was accurate and is now confirmed by bio-electrical and physical tests. This is of great intellectual interest. Progress in neurobiology can lead to further development of TCM, as well asTCM (acupuncture) can open new ways in the field of research in neurobiology. Western techniques of diagnosis are also an invaluable complement to traditional pulse and tongue diagnosis.

But, in our opinion, we should absolutely avoid “westernisation” of TCM, herbal medicine and acupuncture, in order to retain its essence and effectiveness. The use of herbal medicine for ready made symptomatic treatments following western scientific principles, or acupuncture as a sort of sophisticated technique of peripheral stimulation, will not do justice to their real potential. It shall not only denaturise the wise concepts from which they were born, but limit their effectiveness. “Render to Western Medicine what belongs to Western Medicine and to TCM what belongs to TCM”. In their different ways both are extremely valuable; they tend to work at different levels, approaching diseases from a different angle and may be wonderfully complementary. Western Medicine is more and more technical; TCM should keep to its traditional understanding and feeling of the movements of Qi. The Huang Di Neijing and the other Classics can still show us the “Direct Way”. We hope, with this book, to be humble messengers of their subtle and wise teachings.

You might say: “TCM, over centuries of evolution, has always progressed by seeking new ways to solve new problems due to a different environment and consequent new pathologies. Our modern times have seen fantastic changes. What’s the point of taking us back thousands years!” Yes, but evolution sometimes springs directly from deep roots, from a shoot at the bottom of the trunk. Considering the discoveries of modern physics, our time might be ready for a new development in the more subtle world of Qi.

Bearing this in mind, let’s go back again to the classics and find out! Treating “Shen” might well be the challenge!

ANNEXES

Annexe 1:

Classification of Herbs according to Shennong Ben Cao Jing

Examples of a few herbs (41) and their effects according to Shennong.

The translation of Chinese is litteral on purpose, to keep the feeling of the text.

The Notes in Italic are from Dr Li Xin

— Sheng Tie Luo (生铁落, Iron): zhong ping 《本经》中品『气味』辛, 平, 无毒.

Pungent, neutral, non poisonous.

“Feng re e chuang ying ju chang jia. Jie qi zai pi fu zhong” 『主治』风热恶疮, 疡疽疮痂, 疥气在皮肤中. = “wind hot, gets rid of infections in skin and muscles on the surface. Treats scabies in the skin”.

Treats prolapses (bladder, uterus, intestine); removes blood stagnation, clears toxic heat in blood calms down the Spirit.

Note: It can go very deep and at the same time move. It does not damage the stomach.

In ancient times, it was used for manic disorders. We use it for skin infections when Huangbai (黄柏) might be too strong and the infection “zai qi” and not “zai xue”.

— Zi Shi Ying (紫石英): shang ping 《本经》上品.

Sweet, warm, non poisonous. 『气味』甘, 温, 无毒. “Xin fu ke ni xie qi, bu bu zhu; nu zi feng han zai zi gong, jue yun shi nian wu zi.” 『主治』心腹咳逆邪气, 补不足; 女子风寒在子宫, 绝孕十年无子. = “evils in epigastria and abdomen, feeling cough, energy upwards, tonifies deficiency; for women with wind and cold in the uterus who haven’t had a baby in ten years”

“Jiu fu wen zhong. Qing shen yan nian 久服温中, 轻身延年” = Taken for a long time, warms the middle, clears heat from the body and brings longevity”

— Sheng Shi Gao (生石膏) zhong ping 《本经》中品

Pungent, cool, non poisonous. 『气味』辛, 微寒, 无毒.

“zhong feng han re, xin xia ni qi jin cuan, kou gan she jiao bu de xi, fu zhong jian tong, cu xie gui, chan ru, jing chuang”, 『主治』中风寒热, 心下逆气惊喘, 口干舌焦不得息, 腹中坚痛, 除邪鬼, 产乳, 金创 = “catch wind, cold or warm, from under the chest, qi goes upwards (nervous, scared, asthma), dry mouth and tongue, cannot breathe fixed pain in abdomen, used against evils and ghosts, post partum injuries: vulvae or breast infection”.

Note: Nowadays Shi Gao is considered a “cold herb”, and used to treat heat. In fact it is not that cold and only acts at Qi and Spirit level. It will not influence blood and organs, and so it doesn’t damage the body. It can even be used when a person has caught cold and has no fever but it feels like there is heat at Qi or Spirit level.

— Hua Shi (滑石 )shang ping 《本经》上品

Sweet, cold, non poisonous. 『气味』甘, 寒, 无毒.

“Shen re xie pi, nu zi ru nan, long bi, li xiao bian, dang wei zhong ji ju han re, yi jing qi, jin fu qing shen nai ji chang nian” 『主治』身热泄澼, 女子乳难, 癃闭. 利小便, 荡胃中积聚寒热, 益精气. 久服轻身、耐饥, 长年.” = “treats heat (via urination) and loose stool. Used for women with blocked lactation, it helps urination; removes stagnant cold and heat from the stomach; supplies Jing Qi; Taken for a long time clears the body which doesn’t feel hungry and brings longevity”

Note: It is good at opening San Jiao (internal channels).

Nowadays, it is used in a similar way, to get rid of heat via urination, but not so much to treat breast infection and stomach problems like in the ancient time.

— Gan Cao (甘草) shang ping 《本经》上品

Sweet, neutral, non poisonous. 『气味』甘, 平, 无毒.

“Wu zang liu fu han re xie qi, jian jing gu zhang ji rou, bei li qi, jing chuang zhong jie du. Jiu fu qing shen yan nian” 『主治』五脏六腑寒热邪气, 坚筋骨, 长肌肉, 倍力, 金创, 尰, 解毒, 久服轻身延年 = “removes cold –hot evils from the five Zang and six Fu (internal organs); increases the strength of tendons, bones and muscles; treats injuries with swelling, anti-toxic; taken for a long time clears the body and brings longevity”

Note: Its other name is “Guo Lao” which means “balance”.

In ancient times, it was used to treat cough and digestive problems caused by a mild pathogenic factor, not from a direct action, but by helping “the first doctor”. It is very good to tonify qi and blood.

It was also used to keep the balance of internal organs when they appeared cold or warm.

Nowadays it is mainly used as “guolao” to harmonise the prescription.

— Ren Shen (人参)shang ping《本经》上品

Sweet, a little cold, non poisonous.『气味』甘, 微寒, 无毒. “Bu wu zang, An jing shen, Ding hun po. Zhi jin ji, chu xie qi, ming mu, kai xin, yi zhi.Jiu fu qing shen yan nian” 『主治』补五脏, 安精神, 定魂魄, 止惊悸, 除邪气, 明目, 开心益智, 久服轻身延年. = “Tonify the five Zang, stabilizes Jing and Shen, Stabilises Hun and Po, stops anxiety, palpitations, mind instability, fights spiritual evil, brightens the eyes and opens the heart, releases the emotion, increases intelligence. Taken for a long time, clears the body and brings longevity”.

Note: Ren Shen increases Qi and is one of very few herbs which can increase Yuan Qi (goes to a very deep level). It gathers, keeps and calms down. It is very good for people who have a deficiency of Zhen Qi. 80% of symptoms are due to a deficit of Qi.

Dosage and combination with other herbs is very important, it is the “secret” of a good prescription:

1. To tonify we use large doses: 10-20gr, only for people who do not have internal heat or blockages.

2. To calm down or gather, we use small doses 3-5gr (same action as Wu wei zi 五味子)

3. To support and guide the action of other herbs, we use small doses: ex: Ren Shen + Guizhi 桂枝 together will increase Guizhi’s ability to lead the prescription in and outwards. Ren shen + Ho Pou 厚朴 together will help Ho Pou lead the prescription downwards. Ren Shen + Gan Cao 甘草 will increase the gathering effect of Gan Cao.

4. To counteract negative effects of a particular herb: ex: Ren Shen + Mahuang 麻黄, Ren shen will hold and counteract the Mahuang’s effect of depleting middle Qi.

Nowadays, Ren Shen is mainly used as a Qi tonic. In ancient times it was mainly used to treat mind and spirit.

Ren Shen (like Gan Cao) is a “real gentleman”: not too strong and always ready to help!

The 4 main herbs used by a doctor of TCM herbal medicine are: Ren shen 人参, Ma huang 麻黄, Da huang 大黄, and Fu zi 附子.

Ren shen increases the money of the company; if there is enough money, Mahuang is the advertiser and great public relation (opens); Da huang gets rid of inefficient employees and debts; Fuzi is inspiring and promotes the activity of the company. Should not be used with Laifuzi.

— Rou Cong Rong (肉苁蓉) Shang ping 《本经》上品.

Sweet, warm, non poisonous. 『气味』甘, 微温, 无毒.

“Wu lao qi shang, bu zhong, chu jin zhong han re tong, yang wu zang, qiang yin, yi jing qi, duo zi, fu ren zhen jia. Jin fu qing shen” 『主治』五劳七伤, 补中, 除茎中寒热痛, 养五脏, 强阴, 益精气, 多子, 妇人癥瘕. 久服轻身. = “five over-use, seven damages, tonify the middle, treats heat, cold and pain in men’s sexual organs, nourishes the five organs, reinforces Yin, increases essence, helps birth, treats fibroids and tumours in women. Taken for a long time clears the body”.

Note: It tonifies and nourishes Jing directly, and also gathers.

Everybody can take it except if they have deficient Qi in the middle (diarrhoea, cold stomach). It has a good taste.

Used in a similar way nowadays.

— Zhu (术) shang ping 《本经》上品

Sweet, warm, non poisonous. 『气味』甘, 温, 无毒.

In ancient time Bai zhu and Cang zhu were both called Zhu. Cang zhu has a stronger taste.

“Feng han shi bi, si ji, Jin dan, Zhi han chu re, xiao shi, Jiu fu qing shen, yan nian bu ji” 『主治』风寒湿痹, 死肌, 痉疸, 止汗除热, 消食. 久服轻身, 延年不饥. = “Used if wind cold dampness blocks the muscles (numbness, paralysis), treats jaundice; stops sweating, clears heat and helps digestion. Taken for a long time clears the body and the feeling of hunger and brings longevity”.

Note: In ancient times, it was not use to tonify Qi or Spleen, but to open. In the presence of dampness, cold or food stagnation in the middle or cold, wind or dampness on the surface, it could transform dampness and dry it up.

Baizhu can be used for almost every patient, except if they have internal heat or are really blocked in the middle (then use Da huang). Bai zhu is like Dang gui, but Bai zhu works at Qi and surface level and can connect with the whole body. Dang gui works at xue level. Used for a long time it will clear the body.

Do not use for very thin people or Yin deficient people, as these people usually benefit from a bit of dampness!

— Yin Yang Huo (淫羊藿) also called Xian Ling Pi: zhong ping《本经》中品

Pungent, cool, non poisonous. 『气味』辛, 寒, 无毒.

“Yin wei jue shang, Jin zhong tong, Li xiao bian, Yi qi li, Qiang zhi” 『主治』阴痿, 绝伤, 茎中痛, 利小便. 益气力, 强志. = “used for impotence, severe injury; penis pain; helps urination; increases energy and strength; increases will power”.

Note: Ben Jing says that this herb is pungent and cold, but Li Shi Zhen (李时珍) says that it is pungent, sweet fragrant and warm. Li Xin thinks that the second is right.

It is very good to treat cold and damp obstruction due to Kidney and Spleen Yang deficiency: water retention in women, low back pain with cold. Many doctors use it to treat menstrual problem but nowadays women suffer more from Yin deficiency than Yang deficiency and It is not always suitable.

Note: Li Xin often uses four warm herbs: Fu zi, Rougui or Guizhi, Gan jiang 干姜, Yin Yang Huo: Fuzi works for the whole body, it opens and promotes, works on Xia Jiao; Rougui works also on Xia Jiao but with a milder effect. It is good for Heart Yang Qi; Ganjiang works on Zhong Jiao and the lungs; Yin Yang Huo, works on Zhong Jiao and Xia Jiao.

— Chai Hu (柴胡) shang ping 《本经》上品

Bitter, neutral, non poisonous. 『气味』苦, 平, 无毒.

“Xin fu chang wei zhong jie qi, Yin shi ji ju, Han re xie qi, Tui cheng zhi xing. Jiu fu qing shen, ming mu yi jing” 『主治』心腹肠胃中结气、饮食积聚、寒热邪气, 推陈致新, 久服轻身、明目、益精. = “Treats Zhong Jiao, if there is internal blockage of energy in the stomach or intestine, food stagnation for a long time, cold or hot pathogenic factor, it removes the old pattern and brings new energy. Taken for a long time it clears the body, brightens the eyes and increases Essence”.

Note: Chai hu is good to open the surface and open inside. It is suitable for almost everybody.

Many manifestations of “flu like symptoms” are not necessarily due to catching cold from outside but could also be due to food stagnation, dampness in exces, cold in the muscles, or, in chronic disease, when “Xie Qi” is going out from a “trapped inside” situation to a “going out” situation (which is a good sign). Whether the problem comes from food, mind, inside or outside, when “the first doctor” is “activated”, he will manifest himself with flu like symptoms.

“Catching cold” is the manifestation of the beginning of any disease.

TCM treats the “normal state” which should be communicating with the outside. Open the surface is then the first step to take in order to treat a patient unless he suffers from serious Kidney Qi deficiency or strong blockage in the middle (use Da huang). All the herbs working at surface level are not necessarily to treat Xie Qi (evil) on the surface and help sweating, but can be used to open, as a first step in the treatment of any disease. Chai hu is one of them.

— Zhi Mu (知母) zhong ping 《本经》中品

Bitter, cold, not poisonous. 『气味』苦, 寒, 无毒.

“Xiao ke re zhong, chu xie qi, zhi ti fu zhong, xia shui, bu bu zu, yi qi.” 『主治』消渴热中, 除邪气, 肢体浮肿, 下水, 补不足, 益气. = “mainly used for “wasting and thirsting” heat in the middle, dispels evil, water retention in the limbs, helps urination (water down), tonifies deficiency, increases energy.”

Note: Diabetes belongs to “wasting and thirsting” disease.

Fu zhong refers here to water retention in the face or limbs (Shui Zhong 水肿). In practice, a swollen face is not always true water retention but may be “Qi Zhong 气肿”. It is a consequence of Kidney Jing deficiency which cannot perform its gathering function.

Zhi Mu mainly gathers Kidney and its direction of action is downwards.

— Dan Shen (丹参) Shang ping 《本经》上品

Bitter, a little cold, non poisonous. 『气味』苦, 微寒, 无毒.

“Xin fu xie qi, chang ming you you ru zou shui, han re ji ju, po zheng chu jia, zhi fan man, yi qi” 『主治』心腹邪气, 肠鸣幽幽如走水, 寒热积聚, 破癥除瘕, 止烦满, 益气. = “used when evil is in the middle and chest, water in the intestines makes noises, serious blockage with cold and heat, it can destroy masses and get rid of blockages (which feel like a lump), can stop the feeling of oppression in the chest due to anxiety (cannot breathe), increases energy”.

Note: “xin” 心 in ancient times, referred to the chest in general and not only the heart.

— Huang Lian (黄连) shang ping 《本经》上品

Bitter, cold, non poisonous. 『气味』苦, 寒, 无毒.

“Re qi, mu tong zi shang qi chu, ming mu, chang pi fu tong xia li, fu ren ying zhong zhong tong. jiu fu ling ren bu wang” 『主治』热气, 目痛, 眦伤泣出, 明目, 肠澼腹痛下利, 妇人阴中肿痛. 久服令人不忘. = “used when there is “heat qi” (which means that the whole body feels warm and the atmosphere feels warm), and eyes are painful, it clears inflammation in the two corners of the eyes, it makes eye sight clear, used for infectious and non infectious diarrhoea abdominal pain, inflammation or infection of the vagina in women, if taken for a long time improves memory.”

Note: It is a good medicine to treat heat or fire at xue level, either upper, middle or lower jiao.

Because it is bitter, used with a small dosage (1gr), it can gather and tonify stomach Qi, according to the “fan zuo”= “use the opposite “principle. The secret is in the dosage.

— Huang Qin (黄芩) zhong ping 《本经》中品

Bitter, neutral, non poisonous. 『气味』苦, 平, 无毒.

“Zhu re huang dan, chang pi, xie li, zhu shui, xia xue bi, e chuang, ju shi, huo yang” 『主治』诸热黄疸, 肠澼泄利, 逐水, 下血闭, 恶疮疽蚀, 火疡. = used for “all kinds of heat, jaundice, diarrhoea infectious or not, helps urination (strong effect), amenorrhea due to blood stagnation, serious infection or inflammation of the skin, muscle (Qi level), bones (xue level), in a Yang (fight) or Yin (no fight) state, with pain and rapid evolution like fire”.

Note: It has a lighter taste than Huang lian

— Yin Chen Hao (茵陈蒿) shang ping 《本经》上品

Bitter, neutral, a little cold, non poisonous. 『气味』苦, 平, 微寒, 无毒. “Feng shi han re xie qi, re jie huang dan, jiu fu qing shen, yi qi, nai lao. ” 『主治』风寒湿热邪气, 热结黄疸. 久服轻身益气耐老.

“For jaundice of the “heat type”, wind damp cold heat evil. Taken for a long time it clears the body, increase essence and has an anti-aging effect”.

— Fang Feng (防风) shang ping 《本经》上品

Sweet, warm, non poisonous . 『气味』甘, 温, 无毒.

“Da feng, tou xuan tong, wu feng, feng xie mu mang wu suo jian, feng xing zhou Shen, gu jie teng tong, fan man, jiu fu qing shen” 『主治』大风头眩痛, 恶风, 风邪目盲无所见, 风行周身, 骨节疼痛, 烦满. 久服轻身 = used for “leprosy, headache and dizziness sensitive to wind, eyes blind, can see nothing because of wind evil, wind going through the whole body makes bones, joints and tendons ache, feeling nervous or fullness of the chest, taken for a long time lightens the body”

Note: It is a good medicine to open. It is sweet, not pungent so not too strong. It stays at the surface and cannot enter inside like Chai hu.

In spring time it is good to use Fang feng and Chai hu to open.

— Dang gui (当归) zhong ping 《本经》中品

Bitter, warm, non poisonous. 『气味』苦, 温, 无毒.

“Ke ni shang qi, wen nue, han re xi xi zai pi fu zhong, fu ren lou xia jue zi, zhu e chuang yang, jin chuang, zhu yin zhi.” 『主治』咳逆上气, 温疟热洗洗在皮肤中, 妇人漏下绝子, 诸恶疮疡, 金创, 主饮之. = used for “cough due to rebellious Qi, cold and heat shivering in the skin coming and going, women still bleeding after menstruation (meno-methrorrhagia), sterility, all kind of serious infection or inflammation of the Yang type, traumatic injuries, taken as a decoction.”

Note: In practice Dang gui works also well in a “Yin “state.

— Chuan Xiong (川芎) shang ping 《本经》上品

Pungent, neutral, non poisonous. 『气味』辛, 温, 无毒.

“zhong feng ru nao tou tong, han bi jin luan huan ji, jin chuang, fu ren xue bi wu zi.” 『主治』中风入脑头痛, 寒痹筋挛缓急, 金创, 妇人血闭无子. = used for “wind entering the brain, giving headaches, cold blocked in the body affecting the tendons with spasm or flaccidity, traumatic injury, amenorrhea and sterility in women”.

Note: It opens the surface and opens inside, it moves blood up and down, in and out.

— Shao Yao (芍药) zhong ping 《本经》中品

Bitter, neutral, non poisonous. 『气味』苦, 平, 无毒.

“Xie qi fu tong, chu xue bi, puo jian ji, han re shan jia, zhi tong, li xiao bian, yi qi.” 『主治』邪气腹痛, 除血痹, 破坚积, 寒热疝瘕, 止痛, 利小便, 益气. = used for “evil giving abdominal pain; it removes blockage and pain due to blood stagnation, it strongly dissipates hard blockages in the digestive system or abdomen, cold and heat hernia (Qi blocked like a lump), stops pain, helps urination, increases energy”

Note: Works only at Xue level.

in the ancient time, inguinal hernia was considered to be due to cold in the liver channel.

— Mu Xiang (木香) shang ping 《本经》上品

Pungent, warm, non poisonous. 『气味』辛, 温, 无毒.

“ Xie qi, pi du yi wen gui, qiang zhi, zhu lin lu. Jiu fu bum eng wu yan mei” 『主治』邪气, 辟毒疫温鬼, 强志, 主淋露. 久服不梦寤魇寐. = “can be used against any evil, protects against poisonous, contagious ghost, strengthens “zhi” (will power belonging to Kidney), in charge of difficult urination (cannot finish urination, Qi level). Taken for a long time will regulate sleep, no dreams, no nightmares, no frequent awakening”

Note: It is very good for children who cry at night with fear and pain.

— Jing Jie (荆芥 )zhong ping 《本经》中品

Pungent, warm, non poisonous. 『气味』辛, 温, 无毒.

“Han re shu lou, lei li sheng chuang, po jie jue qi, xia yu xue, chu shi bi.” 『主治』寒热, 鼠瘘, 瘰疬生疮, 破结聚气, 下瘀血, 除湿痹. = used for “cold, hot nodules in the neck, lymph nodes swollen and inflamed, strongly opens Qi stagnation and gathers, moves blood stagnation downwards, treats dampness and pain in the joints”.

Note: “shu lou” (rat whole) refers to either enlarged lymph glands in the neck or enlargement or nodules of the thyroid gland (like a goitre).

“Shu lou” and “Lei li” are the result of Qi stagnation; at first, they belong to Qi level, then to Qi and Xue level when serious.

Like Chai hu, Jing jie can open inside. It can strongly clear blood and Qi stagnation.

— Ju Hua (菊花) shang ping 《本经》上品

Bitter, neutral, non poisonous. 『气味』苦, 平, 无毒.

“Zhu feng tou xuan zhong tong, mu yu tuo, lei chu, pi fu si ji, e feng shi bi. Jiu fu li xue qi, qing shen nai lao yan nian.” 『主治』诸风头眩肿痛, 目欲脱, 泪出, 皮肤死肌, 恶风湿痹. 久服利气血, 轻身耐老延年. Used for “all kinds of wind, dizziness, pain and swollen sensation in the head, eyes “popping out” because of pain, excessive tears, numbness in skin and muscles, serious arthritis (dampness and wind). Taken for a long time helps the circulation of Qi and blood, lightens the body, slows down ageing process and brings longevity”.

— Xia Ku Cao (夏枯草) xia ping 《本经》下品

Bitter, pungent, cold, non poisonous. 『气味』苦, 辛, 寒, 无毒.

“Han re lei li, shu lou tou chuang, po zheng, san ying jie qi, jiao zhong shi bi, qing shen.” 『主治』寒热瘰疬, 鼠瘘头疮, 破癥, 散瘿结气, 脚肿湿痹. 轻身.” Used for “cold or hot lymph nodes, inflammation of neck lumps or nodules, breaks up lumps due to stagnation, resolves goitre, feet bi with swelling and dampness, clears the body.”

Note: Xia ku cao is very good for pre-menstrual breast pain (Qi level).

Bi, means blockage in bones, tendons, muscles or shin by deficiency of energy or the attacking of wind, cold, dampness or heat.

— Ma huang (麻黄) zhong ping 《本经》中品

Bitter, warm, non poisonous. 『气味』苦, 温, 无毒.

“zhong feng shang han tou tong, wen nue, fa biao chu han, qu xie re qi, zhi ke ni shang qi, chu han re, po zheng jian ji ju” 『主治』中风伤寒头痛, 温疟, 发表出汗, 去邪热气, 止咳逆上气, 除寒热, 破癥坚积聚. used for wind attacking, cold headache, alternative chills and heat, opens the surface and induces sweating, treats pathogenic heat. Stops coughing and brings rebellious Qi down. Disperses cold and heat, breaks up serious lumps due to stagnation.

Note: Using a small dosage, it can break up strong stagnation at Xue level, food stagnation in the stomach or intestine, Qi stagnation in the abdomen and hypochondriac region; this is a very important effect.

— Sheng di huang (生地黄) shang ping 《本经》上品

Sweet, cold, non poisonous. 『气味』甘, 寒, 无毒.

“shang zhong, zhu xue bi, tian gu sui, zhang ji rou. Zuo tang chu han re ji ju, chu bi, liao zhe die jue jin. Jiu fu qing shen bu lao, sheng zhe you liang” 『主治』伤中, 逐血痹, 填骨髓, 长肌肉. 做汤, 除寒热积聚, 除痹. 疗折跌绝筋. 久服轻身不老. used for “Any disease which injures the middle, very strong action to remove blood stagnation, increases bone mineralization, helps to develop muscles. Taken as a decoction it can disperse cold, heat, food and Qi stagnation. Treats Bi syndrome and fractures of the bones, repairs serious injuries of the tendons. Taken for a long time clears the body, using fresh Sheng di huang is much better.”

Note: Fresh means not dry, just digged out of the ground.

— Niu Xi (牛膝) shang ping 《本经》上品

Bitter, sour, slightly sweet (good taste!), not poisonous. 『气味』苦、酸, 平, 无毒.

“Han shi wei bi, si zhi ju luan, xi tong bu ke qu shen, zhu xue qi, shang re huo lan, duo tai. Jiu fu qing shen nai lao.” 『主治』寒湿瘘痹, 四肢拘挛, 膝痛不可屈伸, 逐血气, 伤热火烂, 堕胎. 久服轻身耐老. “Cold and dampness accumulated in weak muscles, spasm in the four limbs with blockage and pain, knees cannot bend or straighten, removes stagnation of blood and Qi, treats strong infections due to fire, stops pregnancy (induces miscarriage). Lightens the body, has an anti-ageing effect.”

Note: it is not tonifying and doesn’t have a downward direction. It is good to remove stagnation, especially at Xue level. it also nourishes a little bit;

Caution as it can induce “shang huo” (symptoms of fire going up).

— Mai Dong (麦冬) shang ping 《本经》上品

sweet, neutral, non poisonous. 『气味』甘, 平, 无毒.

“xin fu jie qi, shang zhong, shang bao, wei luo mai jue, lei shou duan qi. Jiu fu qing shen bu lao bu ji.” 『主治』心腹结气, 伤中伤饱, 胃络脉绝, 羸瘦短气. 久服轻身, 不老, 不饥.

“Qi blocked in the chest or abdomen; middle (or stomach) damaged by excess food; collateral channels of the stomach completely blocked (nothing goes through); very serious weakness and emaciated body; shortness of breath. Taken for a long time lightens the body, the body will not grow old or be hungry.”

Note: It is very good at tonifying the stomach. It tonifies Yin but also Qi. It is stronger than Lian zi for this effect. Using a metaphor we can say that “Mai dong makes the seed of a flower grow, Lian zi is like changing the water to keep the flower blooming for a longer time and Huang qi makes the flower more beautiful”

— Jue Ming Zi (决明子) shang ping 《本经》上品

salty, neutral, non poisonous. 『气味』咸, 平, 无毒.

“qing mang, mu yin, fu chi, bai mo, yan chi lei chu, jiu fu yi jing guang, qing shen” 『主治』青盲, 目淫肤赤白膜, 眼赤痛, 泪出. 久服益精光, 轻身.

Treats all sorts of eye diseases “glaucoma, puffy eyes, red or white cornea, eye becomes red with tears (conjunctivitis). Taken for a long time improves vision and lightens the body.”

— Che Qian Zi (车前子) shang ping 《本经》 上品

Sweet, cold, non poisonous. 『气味』甘, 寒, 无毒.

“Qi long. zhi tong, li shui dao xiao bian, chu shi bi. Jiu fu, qing shen nai lao.” 『主治』气癃, 止痛. 利水道小便, 除湿痹. 久服轻身耐老.

“Cannot pass water because of Qi stagnation, stops pain, promotes the function of San Jiao to induce urination, removes bi dampness. Taken for a long time, keeps the body young and light”.

Note: Nowadays we know that, by opening San Jiao and leading Qi down and out, it can also treat cough.

— Lian Qiao (连翘) xia ping 《本经》下品

Bitter, neutral, non poisonous. 『气味』苦, 平, 无毒.

“Han re, shu lou, luo li, yong zhong e chuang, ying liu, jie re, gu du.” 『主治』寒热鼠瘘, 瘰疬痈肿, 恶疮瘿瘤, 结热蛊毒.

“Hot or cold neck lymph nodes, infection in the muscles and in the body surface (swollen), goitre, lymph nodes in any part of the body, blocked fire poison like in insect bites (spider, snake, scorpion or centipede bites).”

Notes: the Chinese character “Gu” means “wizard”. In ancient times wizards used to put the most poisonous insects alive together in a ball where they were fighting to death. The victorious insect would have absorbed all the poisonous powers of the others and the wizard would then connect with this power spiritually and use it to hurt somebody with black magic: it was called: “gu du” (蛊毒).

Xia ping medicines are used when a disease is due to a very strong “Xie Qi” (邪气) and is located deep in the body: it is a serious disease difficult to treat and it is then necessary to use “du yao 毒药”, poisonous medicines, to treat it.

— Ban Xia (半夏) xia ping 《本经》下品

Fragrant, neutral, poisonous. 『气味』辛, 平, 有毒.

“Shang han han re, xin xia jian, xiong zhang ke ni, tou xuan, yan hou zhong tong, chang ming, xia qi zhi han” 『主治』伤寒寒热, 心下坚, 胸胀咳逆, 头眩, 咽喉肿痛, 肠鸣, 下气止汗. “Catch cold, cold or warm, upper abdomen feels hard, chest like a ball with cough and breathlessness, dizziness, throat swollen and painful, intestines moving and noisy, helps Qi go down, stops sweating”.

— Tu si zi (菟丝子) shang ping 《本经》上品

Pungent, sweet, neutral, non poisonous. 『气味』辛、甘, 平, 无毒.

“Zhu xu jue shang, bu bu zu, yi qi li, fei jian ren” 『主治』主续绝伤, 补不足, 益气力, 肥健人.

“Repairs serious damages, tonifies deficiency, strengthens power, helps gaining weight”

Notes Tu Si Zi tonifies Kidney. It is more warm and moving than Yin Yang Huo 淫羊藿. It has less effect on Jing than Rou Cong Rong (not as warm and “keeping”). It does not influence digestion.

With He Shu Wu and Yin Yang Huo, it is very good to treat wrinkles of the face. It is also used for men with sexual deficiency.

— Wu wei zi (五味子) shang ping 《本经》上品

Sour, warm,non poisonous. 『气味』酸, 温, 无毒.

“Yi qi, ke ni shang qi, lao shang lei shou, bu bu zu, qiang yin, yi nan zi jing” 『主治』益气, 咳逆上气, 劳伤羸瘦, 补不足, 强阴, 益男子精.

“Tonifies Qi, treats cough due to rebellious Qi going upwards, serious weakness and emaciated body because of being overtired, tonifies deficiency, reinforces Yin aspect of the body and benefits men’s essence”.

Note: Wu wei zi is good at opening and tonifying deficiency. If there is sweating and breathlessness, use high doses to gather strongly; if there is deficiency and the surface is closed, use small dosages to avoid the effect of blocking the channels.

Note: “Lao shang” means “Wu lao” and “Qi shang”. “wu lao” or “five kinds of tiredness” correspond to:

• too much use of eyes damages the blood,

• too much lay down damages the qi,

• too much sitting damages the muscle,

• too much standing damages the bone,

• too much walking damages the tendon.

“Qi shang”or “seven kinds of damage”correspond to: overfeeding impairs the spleen, anger causes Qi to go upwards and impairs liver; heavy loads or prolonged stay in damp places injures kidney; catching cold or drinking cold injures lung, overuse of mind injures Shen (Spirit); wind, rain, cold, damp-heat external climatic factors damage the body structure; great shock or fear injure will power”.

— Gua lou gen (栝楼) (also called Tian hua fen): zhong ping 《本经》中品.

Bitter, cold, non poisonous. 『气味』苦, 寒, 无毒.

“Xiao ke, shen re, fan man da re, bu xu an zhong, xu jue shang”. 『主治』消渴, 身热烦满, 大热. 补虚安中, 续绝伤.

“Diabetes, body warm, very hot fullness of the chest, cannot concentrate, no patience, tonifies deficiency, pacifies the middle, and repairs serious damages”.

— Ge gen (葛根) zhong ping 《本经》中品

Sweet, fragrant, neutral, non poisonous. 『气味』甘、辛, 平, 无毒.

“Xiao ke, shen da re, ou tu, zhu bi, qi yin qi, jie zhu du” 『主治』消渴, 身大热, 呕吐, 诸痹, 起阴气, 解诸毒.

“Diabetes, body very hot, nausea vomiting, all kind of bi syndrome, lifts Yin Qi upwards, clears all kind of poisons”

Note: Good to use in the summer.

— Tian men dong (天门冬) shang ping 《本经》上品

Bitter, neutral, non poisonous. 『气味』苦, 平, 无毒.

“Zhu bao feng shi pian bi, qiang gu sui, sha san chong, qu fu shi. Jiu fu qing shen yi qi yan nian, gu ji” 『主治』诸暴风湿偏痹, 强骨髓, 杀三虫, 去伏尸. 久服轻身益气延年.

“All kinds of strong wind dampness in one side (like in hemiplegia), strengthens the marrow, treats the three kinds of spiritual evils, removes ghosts. Taken for a long time the body will be light and not hungry.”

Note: Shen Nong Ben Cao was written at a time when Taoism was predominant and a main source of inspiration. “Spiritual evils and ghosts” refer to the influence of negative spiritual energies which existed at an unsubstantial level.

— Ze xie (泽泻) shang ping 《本经》上品

Sweet, cold, not poisonous. 『气味』甘, 寒, 无毒.

Feng han shi bi, ru nan, yang wu zang, yi qi li, fei jian, xiao shui. jiu fu, er mu cong ming, bu ji, yang nian, qing shen, mian sheng guang, neng xing shui shang” 『主治』风寒湿痹, 乳难, 养五脏, 益气力, 肥健, 消水. 久服耳目聪明, 不饥, 延年轻身, 面生光, 能行水上.

“Wind cold damp bi, deficient lactation, nourishes the five Zang, strengthens Qi, helps gaining weight, removes water, taken for a long time clears eyes and ears, no feeling of hunger, increases longevity, lightens the body, brightens the face, one can walk on the surface of the water.”

Note: very good herb to help open down via urination, like Fuling, Hua Shi, or Zhu Ye. Used if Qi level is blocked, with water retention, a weak stomach, and dizziness. Xi Xin would be too strong and cause dizziness, Hou Po could damage the stomach; it is better to use herbs that open down via urination.

Ze xie can open San Jiao but also gathers in Xia jiao. When there is water retention and dizziness, a good combination is Ze xie and Fuling.

— Chang Pu (菖蒲) shang ping 《本经》上品

Pungent, warm, not poisonous. 『气味』辛, 温, 无毒.

“Feng han shi bi, ke ni shang qi, kai xin kong, bu wu zang, tong jiu qiao, ming er mu, chu yin sheng. Zhu er long, yong chuang, wen chang wei, zhi xiao bian li. Jiu fu qing shen, bu wang bu mi huo, yan nian. Yi xin zhi, gao zhi bu lao” 『主治』风寒湿痹, 咳逆上气, 开心孔, 补五脏, 通九窍, 明耳目, 出音声. 主耳聋痈疮, 温肠胃, 止小便利. 久服轻身, 不忘不迷惑, 延年. 益心智, 高志不老.

“Wind cold damp bi, cough and rebellious Qi upwards, clears the mind, tonifies the five zangs, opens the nine 9 orifices, clears eyes and ears, treats aphasia. In charge of deafness, good for infections of skin or muscles, warms intestine and stomach, stops frequency of urination. Taken for a long time lightens the body, gives a good memory, no confusion and longevity, increases intelligence and will power, not old.”

Notes: it is used, nowadays for Alzheimer disease and cerebral palsy.

It is traditionally used as an incense to keep a room clear and protected from insects and evils. On “Duan wu jie” 端午节 day, people use Chang Pu, Cang Zhu and Ai Ye together at 12:00 noon to clear their house. Chinese also use small silk bags filled with those three herbs to put at the four corners of their beds or in their luggage when they travel.

Appendices: Three examples of important herbs and their effects described after Shen nong

— Zao Shen Tou (灶心土 earth): xiapin 《别录》下品

(First used in Tang Dynasty “ming yi bie lu”名医别录)

Pungent, slightly warm, not poisonous. 『气味』辛, 微温, 无毒.

Fu ren beng zhong tu xue, zhi ke ni xue, en shen hu tai, xiao er ye di. 『主治』妇人崩中吐血, 止咳逆血, 妊娠护胎, 小儿夜啼.

Treats cough, women bleeding, bleeding from the stomach and intestine. Good “to keep the foetus” in habitual miscarriage when the energy cannot gather and there is cold. Also used for children scared at night.

— He shou wu (何首乌) from Song Dynasty

Bitter, acerbity, a little warm, not poisonous. 『气味』苦, 涩, 微温, 无毒.

“Lei li, xiao yong zhong, liao tou mian feng chuang, zhi wu zhi, zhi xin tong, yi xue qi,hei zi fa, yue yan se, jiu fu zhang jin gu, yi jing sui, yan nian bu lao.Yi zhi fu ren chan hou,ji dai xia zhu ji. Jiu fu ling ren you zi”. 『主治』瘰疬, 消痈肿, 疗头面风疮, 治五痔, 止心痛, 益血气, 黑髭发, 悦颜色. 久服长筋骨, 益精髓, 延年不老. 亦治妇人产后及带下诸疾. 久服令人有子.

“Lymph nodes in the neck, acute inflammation in skin or muscles, eczema of head and face, haemorrhoids, cardiac pain, tonifies blood and Qi, blackens hair and beard, beauty of the face, if taken for a long time strengthens bones and tendons, reinforces Jing and marrow, increases longevity. Also treats women after delivery or if they have a problem of discharge. Taken for a long time, helps fertility.”

Notes: He Shu Wu belongs to the second way used to tonify Jing, “the Emperor way”. It is the main herb of this category with Niu Xi.

It was used a lot during the Ming Dynasty, and appears in the formula called “the seven jewels for the beauty of hair and beard””Qi bao mei ran dan” 七宝美髯丹, with: He Shu Wu 何首乌, Bai shi wu 白首乌, Bai Fuling 白茯苓, Niuxi 牛膝, Dang gui 当归, Gou qi zi 枸杞子, Tu si zi 菟丝子, Bu gu zhi 补骨脂.

There are two kinds of He Shu Wu: Chi Shu Wu, which tonifies Jing and blood (has more “female hormones” effect), and Bai Shu Wu, which tonifies Qi (has more “male hormones” effect)

From experience, He Shu Wu tonifies Kidney but not as much as Bai ji tian, Rou cong rong, Tu si zi, Du Zhong or Niu Xi. It works more like Sheng Di Huang: a bit cool and also moves blood (stronger than Sheng Di to that effect). More than a “tonifyer” it is a “reformer”, used when there is deficiency and the need to remove a pathogenic factor trapped deep inside the body. It also helps bowel movements and treats skin and muscles inflammation (moving blood). It is very good for gastric acidity and other stomach problems.

— Wei ling xian (威灵仙) also from Song Dynasty

Bitter, warm, not poisonous. 『气味』苦, 温, 无毒.

“Zhu feng, xuan tong wu zang, qu fu nei len zhi, xin ge tan shui, jiu ji zheng jia, xuan pi qi kuai, pang guang su nong e shui, yao xi leng teng, liao she shang. Jiu fu wu you wen yi nue” 『主治』诸风, 宣通五脏, 去腹内冷滞, 心膈痰水, 久积症瘕, 痃癖气块, 膀胱宿脓恶水, 腰膝冷痛, 疗折伤. 久服无有温疫疟.

“All kinds of “wind” problems, opens the five internal organs to the surface (like Ma huang but not so strong), removes cold and stagnation in the abdomen, phlegm and water in the epigastria and chest (lungs or pleura), congealed Qi (feels like a tumour but is not a tumour), small lumps at Qi level, long term pus and dirty water in the bladder (refers to body toxins eliminated via urination); low back and knee cold and painful, bone fractures, Taken for a long time protects against epidemics and “alternating chills and fever” (malaria).”

Notes: “Wei Ling Xian” means literally: “general efficient magic” It can open all the ways: surface, urination, bowel, Qi and Xue levels.

Wei Ling Xian and Yin Yang Huo together can treat Bi syndrome effectively.

Wei Ling Xian with Bai Zhu and Zhi Xie make a good combination to lose weight.

Annexe 2:

Huang Di Neijing Lin Shu

黄帝内经, 灵枢

Lin Shu is made of eighty one chapters. Introducing many TCM theories and anatomical descriptions of the channels, organs and acupuncture points, it describes the technical aspect of acupuncture treatment: “Zhen Fa” 针法, which kind of needle to use and when, “Shou Fa” 手法 how to manipulate the needle, “Xue Fa” 穴法 the actions of the points, “Ci Fa” 刺法 the strategy of treatment and “Xin Fa” 心法 or “Shen Fa”神法 the way of the “Heart”, the way of the Spirit .

This is a major reference book for acupuncture treatment. Many doctors in later dynasties relied on it and went on describing in more details “Zhen Fa”, “Shou Fa” “Xue Fa” and “Ci Fa”. Only “Xin Fa” is very special to the Lin Shu of Huang Di Nejing. It is not often quoted nowadays. This is why we wanted to translate extracts talking about “Xin Fa” which were accessible to us, and not too obscure for readers particularly interested in it. The translation is very literal on purpose. We have added comments in italic when necessary for the comprehension of the text.

Chapter 1 : Jiu Zhen Shi Er Yuan

(nine kinds of needles, twelve Yuan points)

九针十二原第一

1. Inserting a needle, and catching “ji”

Article I “Xiao zhen zhi yao. Yi cheng er nan ru. Cu shou xing, Shang shou shen”

小针之要, 易陈而难入, 粗守形, 上守神,

= “The small needle principle is easy to describe but difficult to do. A doctor who is not careful pays attention to the body, a superior (good) doctor pays attention to the Shen”.

Article II “Ci zhi wei, zai su chi, Cu Chu shou guan, shang shou ji”

刺之微, 在速迟, 粗守关, 上守机,

= “The feeling at the insertion of the needle depends on fast or slow insertion.A doctor who is not careful pays attention to the location of the point, a good doctor catches ji”.

“Ji zhi dong, bu li qi kong; kong zhong zhi ji, qing jing er wei; qi lai bu ke feng, qi wang bu ke zui”

机之动, 不离其空, 空中之机, 清静而微, 其来不可逢, 其往不可追.

= “The changing of ji gives an atmosphere; Qi, in this atmosphere, is quiet, clear and weak like a mirror; waiting (to insert the needle) it might not come, where it goes (when it is gone) you cannot catch”.

Note: It means that what is important is to catch “it” or the opportunity in the atmosphere and just at the right time insert the needle.

Article III “Zhi Ji zhi dao zhe, bu ke gua yi fa”

知机之道者, 不可挂以发,

= “A doctor who knows how to find “ji”, a hair on his hand will disturb him”.

Article IV “Bu zhi ji dao, kou zhi bu fa”

不知机道, 叩之不发,

= “If you do not understand “ji”, trying hard will not work”.

Article V “Zhi qi wang lai, yao yu zhi qi”

知其往来, 要与之期,

= “You know it comes and goes, you know when it does”.

Article VI “Cu zhi yin hu, miao zai gong du you zhi”

粗之暗乎, 妙哉工独有之.

= “Uncareful doctor misses it, this feeling, only a good doctor will have”

“Ci zhi er qi bu zhi; wu wen qi shu; ci zhi er qi zhi, nai qu zhi, wu fu zhen. Ci zhi yao, qi zhi er you xiao”.

刺之而气不至, 无问其数；刺之而气至, 乃去之, 勿复针. 刺之要, 气至而有效,

= “When you insert a needle and there is no reaction (or change), do not count how many needles you insert; if you insert a needle and feel a reaction, then you can stop (inserting needles”).

“Xiao zhi xin, ruo feng zhi cui yun, ming hu ruo jian cang tian; ci zhi dao bi ye”

效之信, 若风之吹云, 明乎若见苍天, 刺之道毕矣.

= “What is a reaction, it is like the wind blowing the clouds away, clear so that you see the sky. This is how insertion of needles will be successful”.

Note: this means that “De Qi” is not necessarily a reaction of the patient at the insertion of a needle in a particular point but the feeling of the doctor at the insertion of a needle.

“Chi zhen zhi dao. Jian zhe wei bao; zheng zhi zhi ci, wu zhen zuo you; shen zai qiu hao, shu yi bing zhe; shen shi xue mai, ci zhi wu yi”.

持针之道, 坚者为宝, 正指直刺, 无针左右, 神在秋毫, 属意病者, 审视血脉, 刺之无殆.

= “The principle of using needles. Be strong (hand and mind); insert straight to the point, not to the side left or right; your Spirit is conscious of even the smallest thing around you, you should concentrate on the patient; pay attention to the blood vessels, only like this it will be safe”.

“Fang ci zhi shi, bi zai xuan yang, ji yu liang heng; shen shu wu qu; zhi bing cun wang”

方刺之时, 必在悬阳, 及与两衡, 神属勿去, 知病存亡.

= “At the moment of needle insertion, your mind should be in the third eye (or heart for others), look into the patient’s eyes to make him/her quiet; your concentration is here and do not leave; then you know if the disease exists or not”.

Article VII “Fu qi zhi zai mai ye, xie qi zai shang, zuo qi zai zhong, qing qi zai xia”

夫气之在脉也, 邪气在上, 浊气在中, 清气在下.

= “This is how Qi circulates in the channel: evil Qi at the surface, negative Qi in the middle, clear Qi in the deepest part”.

“Gu zhen xian mai zhe xie qi chu; zhen zhong mai zhe zuo qi chu; zhen tai shen ze xie qi fan chen, bing yi”

故针陷脉则邪气出, 针中脉则浊气出, 针太深则邪气反沉, 病益

= “If insertion is superficial, evil Qi will go out; if insertion is in the middle, negative Qi will go out; if insertion is deep, evil Qi will go down deeper; the disease will be serious”.

2. Sedating and supporting: “Shou Fa” (and “Xin Fa”)

“Ni er duo zhi, wu de wu xu. Zui er ji zhi, wu de wu shi; Ying zhi sui zhi, yi yi he zhi. Zhen dao bi yi.”

逆而夺之, 恶得无虚, 追而济之, 恶得无实, 迎之随之, 以意和之, 针道毕矣.

= “Against a feeling of excess, how can you not sedate? Follow the tendency of deficiency, support it to grow stronger. Move against or follow (sedate or support), balance with your mind. This is the law of acupuncture”.

Article VIII “Fan yong zhen zhe, xu zhe shi zhi, man zhe xie zhi, xie sheng zhe xu zhi”

凡用针者, 虚则实之, 满则泄之, 邪胜则虚之.

= “When you use a needle, deficiency should be supported, excess should be sedated, you should get rid of long standing evil, if evil is too strong make it weaker”.

“Da Yao” yue: xu er ji zhe shi, ji er xu zhe xu”

大要曰：徐而疾则实, 疾而徐则虚.

= “The “Da Yao” says: if you insert the needle slowly and take it off quickly it will support, if you insert it quickly and take it off slowly it will sedate”.

“Yan xu yu shi, ruo you ruo wu, cha hou yu xian, ruo cun ruo wang, wei xu Yu shi, ruo de ruo shi”

言实与虚, 若有若无, 察后与先, 若存若亡, 为虚与实, 若得若失

= “When we talk about excess and deficiency, it means that it feels like if there was something or nothing (around the needle). Doing acupuncture with your awareness, you will feel that Qi is coming and going, it is like if something was there and is not anymore, or the other way round, the result of your willing action to support or sedate feels like adding something or taking something off”.

“Xu shi zhi yao, jiu zhen zui miao, bu xie zhi shi, yi zhen wei zhi”

虚实之要, 九针最妙, 补泻之时, 以针为之.

=”To sedate or support, using a needle is the best way, when you sedate or support, you should use a needle”.

“Xie yue: bi chi nei zhi, fang er chu zhi, pai yang de zhen, xie qi de xie”

泻曰：必持内之, 放而出之, 排阳得针, 邪气得泄.

= “How to sedate: insert the needle, “liberate” Xie Qi, help it out, at the same time, Yang Qi will rise and replace it, and Xie Qi can be expulsed”.

“An er ying zhen, shi wei nei wen, xue bu de san, qi bu de chu ye”

按而引针, 是谓内温, 血不得散, 气不得出也.

= “If you close the skin when you take off the needle, Yang Qi will stay inside, blood will not leave (no bleeding), Qi will not go out.

“Bu yue sui zhi, sui zhi yi ruo wang zhi, ruo xing ruo an, ru wen meng zhi, ru liu ru huan, qu ru xuan jue, lin zuo shu you, qi qi gu zhi, wai men yi bi, zhong qi nai shi, bi wu liu xue, ji qu zhu zhi”.

补曰随之, 随之意若妄之, 若行若按, 如蚊虻止, 如留如还, 去如弦绝, 令左属右, 其气故止, 外门已闭, 中气乃实, 必无留血, 急取诛之.

= “Support means follow it, follow (sui) means that one should be very relaxed, sometimes it feels like you are moving, sometimes you stay still, it should be light like a mosquito’s bite, stay there and wait, take off the needle very quickly with the right hand, close the skin with the left hand. If you do this, Qi will stay inside, the outside door will be closed, middle Qi will be stronger, but you should be careful not to induce bleeding, your action should be fast with no bleeding”.

Note: this last “paragraph” refers to techniques used to deal with Xie Qi and not the general body’s condition.

“Gu ye: pi rou jing mai ge you suo chu; bing ge you suo yi; ge bu tong xing; ge yi ren qi suo yi. Wu shi wu xu; sun bu zu er yi you yu, shi wei zhong bing, bing yi shen”

故曰：皮肉筋脉各有所处, 病各有所宜, 各不同形, 各以任其所宜. 无实无虚, 损不足而益有余, 是谓重病, 病益甚.

= “So it says: skin, muscles, tendons, channels lie at different levels; different diseases lie at different depth; they have different significations; for different problems, use suitable different treatments. Do not increase excess conditions, do not deplete deficient conditions, or you will make the disease worse and more serious”.

“Du qi se, cha qi mu, zhi qi san fu; yi qi xing, tin qi dong jing, zhi qi xie zheng”.

睹其色, 察其目, 知其散复；一其形, 听其动静, 知其邪正.

= “Watch the colour of the skin, watch the eyes, you will know if Qi is spread out or gathered; watch the body, if it is still or moving, you will recognise evil Qi and Zheng Qi.

“You zhu tui zhi, zuo chi er yu zhi; qi zhi er qu zhi”.

右主推之, 左持而御之, 气至而去之.

= “The right hand is in charge of inserting the needle, the left hand helps guiding it; when you feel “qi zhi” (qi sensation) you can take out the needle”.

3. More general principles

“Jie zhi jiao, san bai liu shi wu hui; zhi qi yao zhe, yi yan er zhong, bu zhi qi yao, liu san wu qiong”.

节之交, 三百六十五会, 知其要者, 一言而终, 不知其要, 流散无穷,

= “There are 365 acupuncture points; If you know the (shen) principle, one word is enough, if you do not know the (shen) principle, you will create confusion”

“Suo yan jie zhe, shen qi zhi suo you xing chu ru ye; fei pi rou jin gu ye”.

所言节者, 神气之所游行出入也, 非皮肉筋骨也.

= “When we talk about a “point” we are referring to the place where Shen and Qi (of the patient) are going to meet and from there go in and out; it doesn’t mean skin, muscle, tendon or bone”.

“Fan jiang yong zhen, bi xian zhen mai, shi qi zhi ju yi, na ke yi zhi ye”;

凡将用针, 必先诊脉, 视气之剧易, 乃可以治也.

= “Before using a needle, first feel the pulse, decide if you are going to treat or not depending if Qi is good or bad, then you can treat”;

“Wu zang zhi qi yi jue yu nei, er yong zhen zhe fan shi qi wai, shi wei zhong jie, zhong jie bi si; qi si ye jing; zhi zhi zhe, ze fan qi qi, qu ye yu ying”

五藏之气已绝于内, 而用针者反实其外, 是谓重竭, 重竭必死, 其死也静, 治之者辄反其气, 取腋与膺；

= “When the five Zangs are empty inside, but the doctor uses a needle to reinforce outside (limbs), it will make it “twice empty” (leading empty Qi from inside to outside, increases emptiness inside). The “twice empty” patient will die. He will die peacefully; to treat this condition, the doctor should help Qi to gather back inside, use point on either side of the chest and the axilla”.

“Wu zang zhi qi yi jue yu wai, er yong zhen zhe fan shi qi nei, shi wei ni jue, ni jue ze bi si, qi si ye zao; zhi zhi zhe, fan qu si mo”.

五藏之气已绝于外, 而用针者反实其内, 是谓逆厥, 逆厥则必死, 其死也躁, 治之者, 反取四末.

= “When the five Zangs’ Qi is empty outside (gathered too much), but the doctor uses needles to gather more inside, wrong direction, the limbs will become cold and the patient will die very agitated; to treat this condition, the doctor should use points on hands and feet (to open)”.

Chapter 5: Gen Jie (Root and Destination) 根结第五

“Qi hua ze chu ji, qi se ze chu chi; Qi han ze zhen xiao er ru qian, qi se ze zhen da er ru shen; shen ze yu liu, qian ze yu ji; Yi ci guan zi, ci bu yi zhe shen yi liu zhi, ci da ren zhe wei yi xu zhi, ci jie yin qi biao han hua li ye”.

气滑则出疾, 其气涩则出迟, 气悍则针小而入浅, 气涩则针大而入深, 深则欲留, 浅则欲疾. 以此观之, 刺布衣者深以留之, 刺大人者微以徐之, 此皆因气骠悍滑利也.

= “If Qi moves very fast, do not leave the needle too long, if Qi moves not so fast, leave the needle longer; If Qi is powerful and fast, use small needles and do not insert deeply, if Qi is rough and slow, use a big needle and insert deeply, if deep insertion, keep the needle in longer, if superficial insertion, keep the needle in shorter. Following this principle, we know that for an ordinary person insertion of needle should be deep and left in for a long time, while for a high rank person it should be more superficial and left in for a short time, because their Qi is strong, brave, fast and smooth (more “clear”)”.

“Gu yue yong zhen zhi yao, zai yu zhi tiao; tiao yin yu yang, jing qi nai guang, he xing yu qi, shi shen nei cang”.

故曰用针之要, 在于知调, 调阴与阳, 精气乃光, 合形与气, 使神内藏.

= “So the important principle of needle insertion lies in adjusting the balance between Yin and Yang; balancing Yin and Yang will make Jing (essence) shining and bright, help Qi be suitable to the type of body, restore Shen (gather inside)”.

“Gu yue: shang gong ping qi, zhong gong luan jing, xia gong jue qi wei sheng. Gu yue xia gong bu ke bu shen ye”.

故曰上工平气, 中工乱经, 下工绝气危生. 故曰下工不可不慎也

= “So we say: a good doctor balances Qi, an ordinary doctor disturbs the channel Qi, and a bad doctor empties Qi and damages life. So we say, bad doctor you have to be careful”.

Chapter 8: Ben Shen (Shen: the basis) 本神第八

The five substances: Jing, Shen, Hun, Po, Yi, Zhi

“Huang Di wen Qi Bo: fan ci zhi fa, xian bi ben yu shen. Xue, mai, ying, qi, jing shen, ci wu zang zhi suo cang ye, zhi qi yin yi, li zang ze jing shi; hun po fei yang, zhi yi huang luan; zhi lu qu shen zhe”;

黄帝问于岐伯曰：凡刺之法, 先必本于神. 血、脉、营、气、精神, 此五藏之所藏也, 至其淫佚, 离藏则精失、魂魄飞扬、志意恍乱、智虑去身者,

“Huang Di asked Qi Bo: In all acupuncture principles, first the root must come from Shen. Blood, channels, Ying, Qi, Jingshen, all are restored by the five organs; if the emotions or an over powerful mind are repressed, the five substances will be disconnected from the organs and lead to a deficiency of essence; Hun and Po will spread out (instead of staying inside), Zhi (power, direction) and Yi (thoughts) will be confused, intelligence and planning will be out of use”;

“He Yin Er Ran Hu? Tian zhi zui yu? Ren zhi guo hu? He wei de, qi, sheng, jing, shen, hun, po, xin, yi, zhi, si, zhi, lu? Qing wen qi gu”

何因而然乎？天之罪与？人之过乎？何谓德、气、生、精、神、魂、魄、心、意、志、思、智、虑？请问其故.

“What is the reason? Is it due to Nature? Is it a mistake of humans themselves? What means De, Qi, Sheng, Jing, Shen, Hun, Po, Xin, Yi, Zhi, si, zhi, lu? Please give me an answer”.

“Qi Bo da yue: tian zhi zai wo zhe de ye, di zhi zai wo zhe qi ye; de liu qi bo er sheng zhe ye. Gu sheng zhi lai wei zhi jing, liang jing xiang bo wei zhi shen; sui shen wang lai zhe wei zhi hun, bing jing er chu ru zhe wei zhi po”.

岐伯答曰：天之在我者德也, 地之在我者气也, 德流气薄而生者也. 故生之来谓之精, 两精相搏谓之神, 随神往来者谓之魂, 并精而出入者谓之魄,

= “Qi Bo answered: heaven gives human virtue (De), Earth gives human Qi; virtue and Qi get together and become active. The beginning of life (Sheng) is Jing; an interaction between male and female Jing will be transformed into Shen; what comes and goes from Shen is called “Hun”; what comes and goes out from Jing is called “Po”.

“Suo yi ren wu zhe wei zhi xin, xin you suo yi wei zhi yi, yi zhi suo cun wei zhi zhi, yin zhi er cun bian wei zhi si, yin si er yuan mu wei zhi lu, yin lu er chu wu wei zhi zhi

所以任物者谓之心, 心有所忆谓之意, 意之所存谓之志, 因志而存变谓之思, 因思而远慕谓之虑, 因虑而处物谓之智.

= “What makes us recognise things around us (awareness) is called “Xin” (heart), what is memorized in the heart is called “Yi” (thoughts), the thoughts that we save, we call “Zhi”, when we use “Zhi” properly (plan for immediate action), we call it “Si”, long term planning or strategy is called “lu”; when we have a strategy to manage everything, it is called “Zhi” (intelligence”).

“Gu zhi zhe zhi yang sheng ye, bi shun si shi er shi han shu, he xi nu er an ju chu, jie yin yang er tiao gang rou, ru shi ze pi xie bu zhi, chang sheng jiu shi”.

故智者之养生也, 必顺四时而适寒暑, 和喜怒而安居处, 节阴阳而调刚柔, 如是则僻邪不至, 长生久视.

= “So, to stay healthy, intelligent people must follow the four seasons, adapt to cold and warm weather, adjust their emotions (happy or angry), live in a relaxed place, use sexual activity properly, adjust Yin and Yang, following these rules, they will not fall ill, they will get longevity”.

“Shi gu chu ti si lu zhe ze shang shen; shen shang ze kong ju liu yin er bu zhi. Yin bei ai dong zhong zhe, jie jue er shi sheng. Xi le zhe, shen dan san er bu cang. Chou you zhe, qi bi sai er bu xing. Sheng nu zhe, mi huo er bu zhi. Kong ju zhe, shen dang dan er bu shou”.

是故怵惕思虑者则伤神, 神伤则恐惧流淫而不止. 因悲哀动中者, 竭绝而失生. 喜乐者, 神惮散而不藏. 愁忧者, 气闭塞而不行. 盛怒者, 迷惑而不治. 恐惧者, 神荡惮而不收.

= “So, being nervous, easily scared, thinking too much about future strategies will damage “Shen”; if “Shen” is damaged one will feel even more scared and loose his essence endlessly. Too much sadness will affect the middle, use it up, and end one’s life. Too much happiness pushes “Shen” out, it cannot be restored. Worrying will block Qi which cannot move freely anymore. Strong anger confuses the mind. Fear makes “Shen” unstable, scattered out, unable to gather”.

“Shi gu wu zang zhu cang jing zhe ye, bu ke shang, shang ze shi shou er yin xu; yin xu ze wu qi; wu qi ze si yi. Shi gu yong zhen zhe, cha guan bing ren zhi tai, yi zhi jing, shen, hun, po zhi cun wang de shi zhi yi, wu zhe yi shang, zhen bu ke yi zhi zhi ye”.

是故五藏主藏精者也, 不可伤, 伤则失守而阴虚, 阴虚则无气, 无气则死矣. 是故用针者, 察观病人之态, 以知精神魂魄之存亡得失之意, 五者以伤, 针不可以治之也.

= “So the five organs are in charge of restoring “Jing”, they should not be damaged, if they are damaged, they lose their abilities to gather and restore, and will induce “Jing” deficiency; “Jing” deficiency will lead to empty Qi; if Qi is empty, the patient will die. So the acupuncturist should watch the patient’s expression to appreciate “Jing”, “Shen”, “Hun”, and “Po”. Are they good or empty, do they have any deficiency? If the five substances have been damaged, acupuncture cannot be used”.

Chapter 9: Zhong Shi (End and Beginning) 终始第九

Ci Fa, or how to use the needles, the strategy.

“Suo wei ping ren zhe bu bing, bu bing zhe, mai kou ren ying ying si shi ye, shang xia xiang ying er ju wang lai ye; liu jing zhi mai bu jie dong ye; ben mo zhi han wen zhi xiang shou si ye; xing rou xue qi bi xiang chen ye, shi wei ping ren”.

所谓平人者不病, 不病者, 脉口人迎应四时也, 上下相应而俱往来也, 六经之脉不结动也, 本末之寒温之相守司也, 形肉血气必相称也, 是谓平人.

= “We call “balanced” people (ping ren), people whose pulse follows the four seasons, up and down, comes and goes according to the season. The six channels are not blocked or too bouncing. Whether the middle, hands and feet are warm or cold, it will correspond to their constitution. The body structure, the muscles are in line with the internal Qi and Xue. This is called “ping ren”.

“Fan ci zhi dao, qi tiao er zhi, bu yin xie yang, yin qi yi zhang, er mu cong ming, fan ci zhe xue qi bu xing”

凡刺之道, 气调而止, 补阴泻阳, 音气益彰, 耳目聪明, 反此者血气不行.

= “One needling principle is that when Qi is balanced, stop needling. If you support or sedate Yin or Yang, the sound of the voice, the complexion’s glow, the eyes, the hearing should clear (or at least change); If not, Qi and Xue have not been changed”.

“Chun qi zai hao mao, xia qi zai pi fu, qiu qi zai fen rou, dong qi zai jin gu; ci ci bing zhe ge yi qi shi wei qi . Gu ci fei ren zhe, yi qiu dong zhi qi; ci shou ren zhe, yi chun xia zhi qi. Bing tong zhe yin ye, tong er yi shou an zhi bu de zhe yin ye, shen ci zhi. Yang zhe yang ye, qian ci zhi, bing Zai shang zhe yang ye, bing zai xia zhe yin ye”.

春气在毫毛，夏气在皮肤，秋气在分肉，冬气在筋骨，刺此病者各以其时为齐. 故刺肥人者，以秋冬之齐：刺瘦人者，以春夏之齐. 病痛者阴也，痛而以手按之不得者阴也，深刺之. 痒者阳也，浅刺之. 病在上者阳也，病在下者阴也.

= “In spring, Qi is in the body hair, in summer it is in the skin, in autumn in the muscles and in winter in the tendons and bones; using acupuncture, one should think of the four seasons as a principle. For a fat person, follow autumn and winter, for a thin person, follow spring and summer. If a patient feels pain and you cannot find this pain on pressure, it belongs to Yin, insert the needle deeply. If it is itchy, it belongs to Yang, insert the needle more superficially. Diseases of the upper or middle part of the body (chest, stomach) belong to Yang. Diseases of the lower part of the body belong to Yin”.

“Fan ci zhi fa, bi cha qi xing qi; xing rou wei tuo, shao qi er mai you zao, zao jue zhe, bi wei miu ci zhi, san qi ke shou, ju qi ke bu.

Shen ju jing chu, zhan shen wang lai, bi hu se you hun po bu san, zhuan yi yi shen; jing qi bu fen, wu wen ren shen, yi shou qi jing, bi yi qi shen, ling zhi zai zhen, qian er liu zhi, wei er fu zhi, yi yi qi shen, qi zhi nai xiu. Nan nei nu wai, jian ju wu chu, jin shou wu nei, shi wei de qi”.

凡刺之法，必察其形气，形肉未脱，少气而脉又躁，躁厥者，必为缪刺之，散气可收，聚气可布. 深居静处，占神往来，闭户塞牖，魂魄不散，专意一神；精气不分，毋闻人声，以收其精，必一其神，令志在针，浅而留之，微而浮之，以移其神，气至乃休. 男内女外，坚拒匆出，谨守勿内，是谓得气.

= “This is a principle of acupuncture: first look at the patient’s Xing and Qi; if the structure and the muscles are not damaged (weak), but the breathing is shallow (energy is weak) and the pulse bouncing (Jing and Xue deficiency), the patient’s spirit is always in movement, his/ her hands and feet are cold (deficiency), use “miao ci”acupuncture (on the other side).

If Qi is spread out, we can gather it and then distribute it: stay in a quiet place deep inside, very focussed; feel the patient’s Shen come and go, ask him to close doors and windows (meaning eyes and ears), so that Hun and Po will not go out, help the patient to concentrate his mind on the needle to gather his Shen; Do not differentiate Jing and Qi of the patient (it is not important at that moment), do not allow people around to make noise and disturb the patient. You gather his/ her Jing; by concentrating on his/ her Shen, you help the patient to concentrate on the needle; Insert the needle very superficially and wait; if you move the needle, do it very slightly (like a mosquito bite) and upwards, this can bring back the Shen of the patient back inside; when you feel that it is inside, this is called “qi zhi”, you can stop manipulating. The Shen (of the patient) is inside, the Essence (of the patient) contains it, (the doctor should do nothing but) strongly protect it from going out, strictly hold to keep it as it is, this is called “De Qi”.

Note about “Miao Ci”: In the “Su Wen “63, the Miao Ci Lun (theory) is described. It says that when an evil attacks the body, it first stays in the skin and hair; if it does not leave, it will go deeper in the small collaterals; if it does not leave, it will go in the luo mai (collaterals) and then in the Jing Mai (channels). The disease is then in relation with the Fu organs and evil can spread to the stomach and intestine, Yin and Yang of the body will be affected. This is the right order of progression of a disease. What is called “miao ci” is when evil attacks skin and hair, goes deeper into the small collaterals but the “luo mai” blocks the area and evil does not enter into the channels. It becomes “ji bing” 奇病 or “strange disease”. Usually this ji bing travels superficially from left to right, up and down and do not stay long in the same place (as it would be if evil had penetrated the channels) . In that case it is indicated to use the other side of the manifestation of disease when using acupuncture.

“Fan ci zhi jin, xin nei wu ci, xin ci wu nei. Yi zui wu ci, yi ci wu zui. Xin nu wu ci, yi ci wu nu. Xin lao wu ci, yi ci wu lao. Yi bao wu ci, yi ci wu bao. Yi ji wu ci, yi ci wu ji. Yi ke wu ci, yi ci wu ke”.

凡刺之禁：新内勿刺, 新刺勿内. 已醉勿刺, 已刺勿.

醉. 新怒勿刺, 已刺勿怒. 新劳勿刺, 已刺勿劳. 已

饱勿刺, 已刺勿饱. 已饥勿刺, 已刺勿饥. 已渴勿

刺, 已刺勿渴.

“Acupuncture contraindications (prohibitions): No acupuncture before or after sexual intercourse. No acupuncture before or after drunkenness. No acupuncture before or after anger, before or after heavy physical work, before or after a big meal, before or after being hungry or thirsty”.

“Da jing da kong, bi ding qi qi, nai ci zhi. Cheng che lai zhe, wo er xiu zhi, ru shi qing nai ci zhi. bu xing lai zhe, zuo er xiu zhi, ru xing shi li qing nai ci zhi. Fang ci shi er jin zhe, qi mai luan qi san, ni qi ying wei, jing qi bu ci, yin er ci zhi, ze yang bing ru yu yin, yin bing chu wei yang, ze xie qi fu sheng”.

大惊大恐, 必定其气, 乃刺之. 乘车来者, 卧而休之, 如食顷乃刺之. 步行来者, 坐而休之, 如行十里顷乃刺之. 凡此十二禁者, 其脉乱气散, 逆其营卫, 经气不次, 因而刺之, 则阳病入于阴, 阴病出为阳, 则邪气复生.

“(In case of) A big fear and strong anger first keep the Qi (of the patient) steady before doing acupuncture. If a patient comes by carriage, he should first lie down to have a rest for a while, the time of a meal; if he walks to the clinic, he needs more time to rest, the time of five kilometre’s walk. In all these cases the Shen should be prepared before acupuncture because the patient’s pulse is not clear and his spirit is out, his Ying and Wei are in other places (wrong place), the channels Qi does not follow its normal way. If we do acupuncture in this condition, the “Yang bing” will enter Yin and the”Yin bing” will come to Yang, and evils will become more serious”.

“Cu gong bu cha, shi wei fa shen; xing ti yin yi, nai xiao nao sui, jing ye bu hua, tuo qi wu wei, shi wei shi qi ye”

粗工不察, 是谓伐身；形体淫佚, 乃消脑髓, 津液不化, 脱其五味, 是谓失气也.

“A bad doctor do not know this; this is called “Fa Shen”, damage patient’s life; because Ying Qi and Wei Qi are confused, his body will be damaged (by acupuncture), brain and marrow will comsumpt, Jin and Ye (fluids) cannot be distributed to the whole body, five tastes (essence of food) cannot be absorbed and distributed, this is called lost Qi”.

Note: If somebody is in a very bad emotional state like strong anger, it is not good to use acupuncture. But you can use acupuncture to “gather” a mind scattered by fear. It is also good for sadness, worrying, anxiety, but if somebody is crying, it is better to use massage first and acupuncture only when the patient calms down.

Chapter 47: Ben Zang (The root of internal organs) 本藏第四十七

“Ren zhi xue qi jing shen zhe, suo yi fen sheng er zhou yu xing ming zhe; jing mai zhe, suo yi xing xue qi er ying yin yang, ru jin gu, li guan jie zhe; wei qi zhe, suo yi wen fen rou, cong pi fu, fei cou li, si guan he zhe ye; zhi yi zhe, suo yi yu jing shen, shou hun po, shi han wen, he xi nu zhe ye”,

人之血气精神者, 所以奉生而周于性命者也. 经脉者, 所以行血气而营阴阳, 濡筋骨, 利关节者也. 卫气者, 所以温分肉, 充皮肤, 肥腠理, 司关合者也. 志意者, 所以御精神, 收魂魄, 适寒温, 和喜怒者也.

“The Xue, Qi, Jing, Shen of a person support life; channels and collaterals, which are moving blood and Qi, help Yin and Yang circulate and nourish bones and tendons, make the joints soft and supple. Defensive Qi (Wei Qi) warms the muscles, fills the skin, nourishes the subcutaneous tissues, it is in charge of opening and closing the surface; Zhi and Yi (thoughts and will) adjust Jing and Shen, gather Hun and Po, regulate temperature (warm or cold) adjust happiness and anger”.

“Xue he ze jing mai liu xing, ying fu yin yang, jin gu qiang jing, guan jie qing li yi. Wei qi he ze fen rou jie li, pi fu tiao rou, chou li zhi mi yi; Zhi yi he ze jing shen zhuan zhi, hun po bu san, huinu bu qi, wu zang bu shou xie ye;han wen he ze liu fu hua gu, feng bi bu zuo, jing mai tong li, zhi jie de an yi; ci ren zhi chang ping ye”.

血和则经脉流行, 营复阴阳, 筋骨强劲, 关节清利矣. 卫气和则分肉解利, 皮肤调柔, 腠理致密矣, 志意和则精神专直, 魂魄不散, 悔怒不起, 五藏不受邪矣. 寒温和则六府化谷, 风痹不作, 经脉通利, 肢节得安矣. 此人之常平也.

“If Xue is in normal condition, the channels’ circulation is normal, following the day and night cycle; the tendons and bones are strong, the joints are soft; if “Wei Qi” is in normal condition, the muscles are relaxed, the skin is soft, the “chou li” (subcutaneous tissue) is thick (like a strong door against Xie Qi); if “Zhi, Yi” are normal, the Spirit can concentrate and is strong, Hun and Po are gathered, not influenced by outside, people will not be prone to regrets or anger, the five Zang cannot be attacked by evils. If people can regulate warmth and cold, the six Fu can digest food, the wind cannot attack and block the channels which are open, the body feels comfortable”.

“Wu zang zhe, suo yi chang jing shen xue qi hun po zhe ye, liu fu zhe, suo yi hua shui gu er xing jin ye zhe ye. Ci ren zhi suo yi ju shou yu tian ye, wu yu zhi xian bu xiao, wu yi xiang yi ye”.

五藏者, 所以藏精神血气魂魄者也. 六府者, 所以化水谷而行津液者也. 此人之所以具受于天也, 无愚智贤不肖, 无以相倚也.

“The five Zang restore Jing, Shen, Xue, Qi, Hun and Po (all what is Yin), the six Fu digest food and water, transport Jin and Ye (body fluids), All these (Jing, Xue, Qi, Zhi, Yi, Hun, Po) come from Nature, whether one is foolish, clever, kind, or bad, but the Zang-Fu are different for everybody: big or small, tight or soft, thick or thin, high or low, and this can influence diseases external or internal .

Note: it goes on giving examples for each organ

Chapter 54: Tian nian (Natural age) 天年第五十四

“Shi shen zhe si; De shen zhe sheng”

失神者死, 得神者生

“If Shen is lost, the patient will die; if Shen comes back, the patient will live”

Chapter 67: Xing Zhen (The Reaction to Acupuncture) 行针第六十七

“Chong yang zhi ren, qi shen yi dong, qi qi yi wang ye.”

重阳之人, 其神易动, 其气易往也.

Is about how people react to acupuncture; “Yang type” will react quickly, “Yin type” will react slowly and need stronger stimulation.

Note: already translated in the Chapter of acupuncture treatment.

Chapter 68: Shang Ge (above the diaphragm) 上隔第六十八

“Tian dan wu wei, nai neng xing Qi”.

恬淡无为, 乃能行气.

“Happiness, detachment, no will of action, Qi can move”.

Chapter 73: Guan Neng (Different Abilities) 官能第七十三

A suitable student

“De qi ren nai chuan, fei qi ren wu yan”.

得其人乃传, 非其人勿言

“You can teach suitable students, do not say anything to an unsuitable student”

“Yong zhen zhi li, bi zhi xing qi zhi suo zai, zuo you, Shang xia, yin yang biao li, xue qi duo shao, xing zhi shun ni, chu ru zhi he. Mou fa you guo”.

用针之理, 必知形气之所在, 左右上下, 阴阳表里, 血气多少, 行之逆顺, 出入之合, 谋伐有过.

“Conditions for a doctor to use acupuncture; you should understand the Qi of the body, where it is, left or right, up or down in Yin or Yang, inside or on the surface, how much Xue or Qi there is (deficiency or excess), if the movement of Qi is in a normal or abnormal direction, the point from where Xue and Qi can go in and out following the normal direction. Think about adjusting abnormality”.

“Yong zhen zhi fu, bi you fa ze, shang shi tian guan, xia si ba zheng, yi bi qi xie, er guan bai xing, shen yu xu shi, wu fan qi xie, shi de tian zhi lu, yu sui zhi xu, jiu er bu sheng, fan shou qi yang. Gu yue, bi zhi tian ji, nai yan zhen yi. Fa yu wang gu, yan yu lai jin, guan yu yao ming, tong yu wuqiong, cu zhi suo bu jian, liang gong zhi suo gui, mo zhi qi qing, ruo shen fang fu”.

用针之服, 必有法则, 上视天光, 下司八正, 以辟奇邪, 而观百姓, 审于虚实, 无犯其邪. 是得天之露, 遇岁之虚, 救而不胜, 反受其殃, 放日：必知天忌, 乃言针意. 法于往古, 验于来今, 观于窈冥, 通于无穷, 粗之所不见, 良工之所贵, 莫知其形, 若神仿佛.

“Before using the needles you should follow the law, see the light of heaven and the eight climatic factors of the earth according to the seasons, avoid “qi xie” (strange evil, which means not conform to the season), watch all different people, pay attention to their “xu” and “shi” (deficiency and excess), and help them not to be attacked by “Xie Qi”. If you are confronted to a strange epidemic of six qi (not conform to the season) with a deficiency of the five movements (each year is different according to the calendar), even if you do your best, you will not be successful because it belongs to Nature. So it is said that you should know what to avoid every year before you use acupuncture. You can follow the teaching of old knowledge, use this experience and test it in your daily practice; if you get your awareness from another world (follow your spiritual guide) your knowledge will be unlimited. A bad doctor cannot see, but this is what a good doctor pays attention to. Nobody knows its shape; it is just a feeling in your mind”.

“Xie qi zhi zhong ren ye, sa xi dong xing, zheng xie zhi zhong ren ye wei, xian jian yu se, bu zhi yu qi shen, ruo you ruo wu, ruo wang ruo chun, you xing wu xing, mo zhi qi qing”.

邪气之中人也, 洒淅动形. 正邪之中人也微, 先见于色, 不知于其身, 若有若无, 若亡若存, 有形无形, 莫知其情.

“When Xie Qi attacks a person, its body will shiver. When Zheng Xie attacks a person, the colour of his face will change slightly, but there is no uncomfortable feeling in the body. To the doctor, it is not clear if there is something or not, if it has left or is still there, if it is substantial or not. Nobody can be clear about it”.

Note: Huang Di Neijing believed that evils or Xie Qi (cold, wind, dryness, fire, dampness) came from eight different directions and were of two different kinds: if they came from a direction conform to the season, it was called Zheng Xie and did not deeply damage the body; if they came from a direction abnormal for the season, it was called Ji xie and could damage the body more deeply.

“Shi gu shang gong zhi qu qi, nai jiu qi meng ya, xia gong shou qi yi cheng, yin bai qi xing”.

是故上工之取气；乃救其萌芽；下工守其已成, 因败其形.

“Shi gu gong zhi yong zhen ye, zhi qi zhi suo zai, er shouqi men hu, ming yu tiao qi, bu xie suo zai, xu ji zhi yi, suo qu zhi chu”.

是故工之用针也, 知气之所在, 而守其门户, 明于调气, 补泻所在, 徐疾之意, 所取之处.

“In that case, a good doctor “catches ji” and can save the person at the very beginning (when the seed is growing). A bad doctor focuses on where the disease was and will damage the patient. So a good acupuncturist knows where Qi is, which door should be open, which one should be closed; he knows how to adjust Qi, where he should tonify, where he should sedate, when to manipulate the needle slowly and lightly or quickly and strongly, and where to insert the needle”.

“Xie bi yong yuan, qie er zhuan zhi, qi qi nai xing, ji er xu chu, xie qi nai chu, shen er ying zhi, yao da qi xue, qi chu nai ji.

Bu bi yong fang, wai ying qi pi, ling dang qi meng, zuo ying qi shu, you tui qi fu, wei xuan er xu tui zhi, bi duan yi zheng, an yi jing, jian xin wu xie, yu wei yi liu, qi xia er ji chu zhi, tui qi pi, gai qi wai meng, zhen qi nai chun, yong zhen zhi yao, wu wang qi shen”.

泻必用员, 切而转之, 其气乃行, 疾而徐出, 邪气乃出, 伸而迎之, 摇大其穴, 气出乃疾.

补必用方, 外引其皮, 令当其门, 左引其枢, 右推其肤, 微旋而徐推之, 必端以正, 安以静, 坚心无解, 欲微以留, 气下而疾出之, 推其皮, 盖其外门, 真气乃存. 用针之要, 无忘其神.

“To sedate Xie Qi, one should use the principle of “moving in circle”. After insertion of the needle, you twinge it, then Qi will be moving, you insert quickly and move it out slowly and Xie Qi will go out. Insertion should reach Xie Qi and face it; then, opening the point (enlarging it) will help Xie qi move out more. To tonify, one should use the principle of “stability”: your right hand holds the needle above the skin (where the point lies); with your left hand you stretch the skin, then you insert very slowly twirling the needle, very steady. You should be straight and stable (body and mind), steady and quite; your heart should be strong without loosing this state; use your will to bring energy in; when you feel Qi really inside, you should remove the needle quickly and close the skin, close the outside door so that Zhen Qi can stay inside. When doing acupuncture, one thing is very important: never forget Shen”!

“Lei gong wen yu huang di yue: (Zhen lun) yue: de qi ren nai chuan, fei qi ren wu yan, he yi zhi qi ke chuan?Huang di yue: ge de qi ren, ren zhi qi neng, gu neng ming qi shi.

Lei gong yue:yuan wen guan neng nai he, Huang di yue: ming mu zhe, ke shi si se, cong er zhe, ke si ting yin, jie ji ci yu zhe, ke si chuan lun, yu xu er an jing, shou qiao er xin shen di zhe, ke si xing zhen ai, li xue qi er tiao zhu ni shun, cha yin yang er jian zhu fang;huan jie rou jin er xin he tiao zhe, ke si dao ying xing qi; ji du yan yu qin ren zhe, ke shi tuo yong zhou bing; zhua ku shou du, wei shi shan shang zhe, ke shi an ji yi bi. ge de qi neng, fang nai ke xing, qi ming nai zhang. Bu de qi ren, qi gong bu cheng, qi shi wu ming.

雷公问于黄帝曰：《针论》曰：得其人乃传, 非其人勿言. 何以知其可传？黄帝曰：各得其人, 任之其能, 故能明其事.

雷公日：愿闻官能奈何？黄帝曰：明目者, 可使视色. 聪耳者, 可使听音. 捷疾辞语者, 可使传论；语徐而安静, 手巧而心审谛者, 可使行针艾, 理血气而调诸逆顺, 察阴阳而兼诸方. 缓节柔筋而心和调者, 可使导引行气. 疾毒言语轻人者, 可使唾痈咒病. 爪苦手毒, 为事善伤者, 可使按积抑痹. 各得其能, 方乃可行, 其名乃彰. 不得其人, 其功不成, 其师无名.

“Lei Gong asked Huang Di, in the book of Zhen Lun: A suitable student you can teach, an unsuitable student do not teach. How do you know who can be taught? Huang Di answered: you should find different students, teach them and develop their own abilities, so that the student can learn.

Lei Gong asked: I hope to learn about what to teach according to the ability of the student. Huang Di says: If he has good eyes, let him observe the colour of the skin, if he has a clear hearing let him listen to the sounds, if he has good language abilities, let him teach the theory. These sorts of students can learn acupuncture and moxa. The student who speaks slowly and is quiet, with good hand agility, a mind that can concentrate and feel small changes, you can teach him acupuncture and moxa: this student can adjust Qi and Xue, and the abnormal direction of Qi flow, this student can also balancee Yin and Yang with herbs. If a student has soft joints, tendons and heart, and a good posture, this student can learn “Dao yin xing qi” (Qi Gong). A student who speaks very fast, sharply and has a tendency to lower others (bad and strong energy), this student, teach him to treat diseases by “words” or “saliva” (spreading saliva on the wound of somebody). [Note: this bad energy is also very strong and can reach the disease without any touch!]. Another type of students, very clumsy, is very good for the treatment of “Bi syndrome” and internal blood stagnation with cold, using their hands.

You should find different students, use their different abilities, and then you can teach different techniques. Then you can be famous! If you cannot find a suitable student, who do not have suitable abilities, then you cannot be famous”!

“Gu yue : de qi ren nai yan, fei qi ren wu chuan, ci zhi wei ye.shou du zhe, ke shi shi an gui, zhi gui yu qi xia, er an qi shang, wu shi ri er si yi. Shou gan zhe, fu sheng ru gu ye”.

故曰：得其人乃言, 非其人勿传, 此之谓也. 手毒者, 可使试按龟, 置龟于器下而按其上, 五十日而死矣；手甘者, 复生如故也.

“So it is said: a suitable student you can teach, an unsuitable student do not teach. This is what it means. If you do not know if he (the student) has a strong hand, you can test him: take a turtle and cover it with a pot; ask the student to place his hand over the pot fifty days. If the turtle dies, he has the power, and is the student you need. If his hand does not have the power, the turtle will live”!

Chapter 80: Da Huo (severe confusion) 大惑论

“Gu shen lao ze hun po san, zhi yi luan”.

故神劳则魂魄散, 志意乱.

“If you use your mind too much, Hun and Po will escape, Yi and Zhi will be damaged”.

Annexe 3: Shang Han Lun (伤寒论)

Notes

— We selected small parts of Shang Han Lun in order to learn how ancient doctors were “catching Ji”, how to follow the body’s direction of action (Shi), and which modifications should be done to recover a state of balance (Du).

— The translation is as litteral as possible.

— The dosages used are in modern grams. Please check Shang Han Lun’s text books for further information on ancient dosages.

— Numbers in front of each small paragraph follow the Chinese edition of Shang Han Lun.

— The notes in italic are from Dr Li Xin.

Preface by Dr Zhang Zhong Jin

Every time I think of Dr Bian Que, from the Guo country, who could diagnose the King’s Qi, just by looking at the colour of his face, it gives me great emotion, and I realise how excellent this doctor was.

I am surprised that, nowadays, people are not interested in medicine and its development. Medicine can treat the disease of a king as well as a family member, it can save the poor and the sad, it can preserve our lives and keep us healthy.

People want honours and power; they like to be in the presence of important men (VIP), they only think of honours and money. They pay more attention to insignificant things and have lost their roots. Although their external appearance is beautiful, inside they are empty. But when the skin is destroyed, where does hair grow?

If they are suddenly attacked by evils, suffer from a serious disease, they are scared and afraid. They bend their knees and bow to the witch doctor who tells them that it is their fate and nothing can be done. Or they put their life and fortune into the hands of ordinary doctors who give them all the wrong treatments. Oh my God! The body has died, the spirit is gone, and they have gone to another world from where they cannot come back! Crying is useless!

The whole country is confused; nobody is aware of what is important, nobody takes care of their life. If people get power and honours, what is the use of it? They cannot love and know others; they cannot love and know themselves. They keep having accidents and bad luck, living in the wrong place. They have lost the sense of themselves and of the world, aimless like a puppet. It is so sad! All these people chasing after empty glory! They do not build roots; they forget their body to follow external matters. It is as dangerous as walking in an ice valley !

My family counts numerous members, more than two hundred people. From the year of Jain An, in no more than ten years, two third have died: “shang han” (cold) was the cause in 70% of cases.

When I thought about all these people who died, and no one could save them, I started to study the old classics very seriously and learn from different schools: “Shu wen” 素问, “Jiu juan” 九卷 (Lin shu 灵枢), “Ba shi yin nan”八十一难 (Nan jing 难经), “Yin yang da lun” 阴阳大论 (now lost), “Tai lu yao lu” 胎胪药录 (also lost), and “Ping mai bian zheng” 平脉辨证 (pulse feeling differenciation, also lost). And I wrote “Shang Han Zha Bing lun” 伤寒杂病论 16 chapters. Although I cannot say that it can treat every disease, it can help you understand the origin of any disease. If you can understand what I have discovered, it is sufficient.

The universe is made of five elements which are the base of the movement of everything. Human beings follow these five movements, so they have five organs, their channels, collaterals and points all interacting with Yin and Yang. This is magic, luminous, very deep and subtile; they all transform into each other indefinitely.

If one is not highly intelligent and aware, how can one discover this? In early ancient times there was Huang Di, Qi Bo, Bo Gao, Lei Gong, Shao Shu, Shao Shi, Zhong Wen. Later there was Chang Shang, Bian Que. In the Han Dynasty there was Gong Chen, Yang Qin and Cang Gong. After them, I have never heard of a good Doctor.

When I watch doctors, nowadays, they do not study the meaning of the classics to develop their own knowledge; they just use their family techniques and always keep following their old habits. When they make a diagnosis, they just talk with the patient for a few minutes and write down a prescription. If they take the pulse, they are in such a hurry that they feel “chun” (1st position) and not “chi” (3rd position); they touch the hands but not the feet; they do not feel “ren yin” (carotid artery) and “fu yang” (pedial artery); they do not touch the “san bu” (head, hands and feet), and do not wait for 50 pulsations. Their examination is done in such a hurry that they do not even pay attention to the colour of the face, as if they were looking at the patient through a tube. It is then difficult to know who is going to die and who can be saved.

Kong Fu Zi said that the best way is to know medicine from birth (innate knowledge); the second way is to learn and know (as much as possible); the third way is to know a lot and remember a lot. I am interested in medicine and I hope that I can practice according to those principles.

论曰：余每览越人入虢之诊, 望齐侯之色, 未尝不慨然叹其才秀也. 怪当今居世之士, 曾不留神医药, 精究方术, 上以疗君亲之疾, 下以救贫贱之厄, 中以保身长全, 以养其生, 但竞逐荣势, 企踵权豪, 孜孜汲汲, 惟名利是务, 崇饰其末, 忽弃其本, 华其外, 而悴其内, 皮之不存, 毛将安附焉. 卒然遭邪风之气, 婴非常之疾, 患及祸至, 而方震栗, 降志屈节, 钦望巫祝, 告穷归天, 束手受败, 赉百年之寿命, 持至贵之重器, 委付凡医, 恣其所措, 咄嗟呜呼！厥身已毙, 神明消灭, 变为异物, 幽潜重泉, 徒为啼泣, 痛夫！举世昏迷, 莫能觉悟, 不惜其命, 若是轻生, 彼何荣势之云哉！而进不能爱人知人, 退不能爱身知己, 遇灾值祸, 身居厄地, 蒙蒙昧昧, 蠢若游魂. 哀乎！趋世之士, 驰竞浮华, 不固根本, 忘躯徇物, 危若冰谷, 至于是也. 余宗族素多, 向余二百, 建安纪年以来, 犹未十稔, 其死亡者, 三分有二, 伤寒十居其七. 感往昔之沦丧, 伤横夭之莫救, 乃勤求古训, 博采众方, 撰用素问、九卷、八十一难、阴阳大论、胎胪药录, 并平脉辨证, 为伤寒杂病论合十六卷, 虽未能尽愈诸病, 庶可以见病知源, 若能寻余所集, 思过半矣. 夫天布五行, 以运万类, 人禀五常, 以有五脏, 经络府俞, 阴阳会通, 玄冥幽微, 变化难极, 自非才高识妙, 岂能探其理致哉！上古有神农、黄帝、岐伯、伯高、雷公、少俞、少师、仲文, 中世有长桑、扁鹊, 汉有公乘阳庆及仓公, 下此以往, 未之闻也. 观今之医, 不念思求经旨, 以演其所知, 各承家技, 终始顺旧, 省疾问病, 务在口给, 相对斯须, 便处汤药, 按寸不及尺, 握手不及足, 人迎趺阳, 三部不参, 动数发息, 不满五十, 短期未知决诊, 九候曾无仿佛, 明堂阙庭, 尽不见察, 所谓窥管而已. 夫欲视死别生, 实为难矣. 孔子云, 生而知之者上, 学则亚之, 多闻博浅, 知之次也. 余宿尚方术, 请事斯语.

First Section: Tai Yang

Diagnosis of disease in Taiyang level of penetration: pulse, symptoms, appropriate treatment.

1. In Taiyang, the pulse is floating, head and neck are stiff and painful, the patient is sensitive to cold.

1. 太阳之为病, 脉浮、头项强痛而恶寒.

2. If the pulse is soft, with fever, sweating and sensitivity to wind, we call it “zhong feng” (attacked by wind).

2. 太阳病, 发热、汗出、恶风、脉缓者, 名为中风.

3. If the pulse is tight, with or without fever, but the patient is very sensitive to cold with pain in the whole body and a feeling of nausea, we call it “shang han” (attacked by cold).

3. 太阳病, 或已发热, 或未发热, 必恶寒、体痛、呕逆、脉阴阳俱紧者, 名为伤寒.

4. On the first day “shang han” will have an influence on Taiyang level; if the pulse is calm, it will not transform; if there is vomiting, nervousness, a hurried and fast pulse, it will transform and go to a deeper level.

4. 伤寒一日, 太阳受之. 脉若静者, 为不传；颇欲吐, 若躁烦, 脉数急者, 为传也.

5. On the second and third day of “shang han”, if we do not find symptoms of Yangming or Shaoyang, it means that “Shang han” is staying in Taiyang level and did not transform.

5. 伤寒二三日, 阳明、少阳证不见者, 为不传也.

(In both cases, use a treatment to induce sweating)

6. In Taiyang Bing, we have” zhong feng”,” shang han”, and also “wen bing”.

If there is fever, thirst and no sensitivity to cold, this is “wen bing” (attacked by heat).

In that case, if we use sweating, this will induce serious heat in the body, it is “feng wen”, a wrong treatment: the Yin and Yang pulse are floating, with spontaneous sweating, heavy feeling in the body, sleepiness, noisy breathing, difficulty speaking.

If we use “xia treatment” (inducing diarrhoea), it will cause difficulties in urination, with even loss of control, staring eyes with no “Shen”. If we then use hot compress or moxa, the body will become yellowish. In serious cases it will lead to convulsions.

If we use fire, this is also a wrong treatment; it is “ni” (against the right direction, or the flow). If “ni” treatment is repeated, the patient will die.

太阳病, 发热而渴, 不恶寒者, 为温病. 若发汗已, 身灼热者, 名风温. 风温为病, 脉阴阳俱浮、自汗出、身重、多眠睡、鼻息必鼾、语言难出；若被下者, 小便不利、直视失溲；若被火者, 微发黄色, 剧则如惊痫, 时瘛疭；若火熏之, 一逆尚引日, 再逆促命期.

Note: The treatment should be slightly bitter, slightly pungent, to open the surface and cool down; if it is too pungent, the energy will go out which will make the patient feel even more hot, sleepy and heavy.

7. If there is fever and sensitivity to cold, it belongs to Yang (surface).

If there is no fever but only sensitivity to cold, it belongs to Yin (interior: Taiyin, Shaoyin or Jueyin)

7. 病有发热恶寒者, 发于阳也；无热恶寒者, 发于阴也.

11. If there is very high fever with prostration, and the patient likes to wear more clothes, it means that there is heat in the skin but cold in the marrows: it belongs to interior cold.

If the body is cold but the patient does not want to wear more clothes, it means that there is cold at the surface but heat in the marrows.

11. 病人身大热, 反欲得衣者, 热在皮肤, 寒在骨髓也；身大寒, 反不欲近衣者, 寒在皮肤, 热在骨髓也.

12. In case of Taiyang zhong Feng (attacked by wind) with: a Yang pulse floating (right side) and a Yin pulse weak (left side), or a superficial pulse floating and a deep pulse weak; mild fever, sweating, sensitivity to cold and wind, slightly blocked nose, a bit nauseated; it means that the fight (bing ji) is not very strong. We use “Gui Zhi Tang”: Guizhi 9, Shaoyao 9, Zhigancao 6, Shengjiang 9, Dazao 12 pcs.

12. 太阳中风, 阳浮而阴弱, 阳浮者, 热自发；阴弱者, 汗自出. 啬啬恶寒, 淅淅恶风, 翕翕发热, 鼻鸣干呕者, 桂枝汤主之. 方一. 桂枝(去皮, 三两) 芍药(三两) 甘草(炙, 二两) 生姜(切, 三两) 大枣(擘, 十二枚)

Note: this prescription is sweet, sour, and not too pungent. It strengthens the middle, Yin and Yang, Qi and Xue. As the channels and the surface are open (sweating), strengthening the body will help clearing zhong feng. It belongs to “xu zheng”: not too strong but no blockages at any level.

When taking this prescription, avoid cold, fresh, sticky food, alcohol, meat, pungent food, and cheese.

禁生冷、粘滑、肉面、五辛、酒酪、臭恶等物.

14. In case of Tai Yang Bing, when the whole back and neck are very stiff, with sweating and sensitivity to wind, use Gui Zhi + Ge Gen Tang: Gegen 12, Mahuang 9, Shaoyao 6, Shengjiang 9, Zhigancao 6, Dazao 12pcs, Guizhi 6.

14. 太阳病, 项背强几几, 反汗出恶风者, 桂枝加葛根汤主之. 方三. 葛根(四两) 麻黄(去节, 三两) 芍药(二两) 生姜(切, 三两) 甘草(炙, 二两) 大枣(擘, 十二枚) 桂枝(去皮, 二两)

Note: In this case, the middle is still weak inside but we need to open the surface which is blocked (back and neck stiff).

16. In case of Tai Yang Bing for three days, if we have used “fa han” (open and sweating), or tried to induce vomiting, or diarrhoea, or use “Wen Zhen” (moxas with needles) to no effect: the pulse is still floating, the patient has headache and stiff neck; it means that the disease does not belong to Tai Yang Bing but “Huai Bing” (wrong disease, or odd disease). Do not use Gui Zhi Tang, “Guan Qi mai Zhen, Zhi fan he ni, Sui zhen zi zhi”= “watch the pulse and symptoms; if you know that it leads to a wrong direction, follow the right direction of treatment”. If the pulse is floating and tight, with no sweating but fever, do not use Gui Zhi tang, otherwise the fever will get higher and higher.

16. 太阳病三日, 已发汗, 若吐、若下、若温针, 仍不解者, 此为坏病, 桂枝不中与之也. 观其脉证, 知犯何逆, 随证治之. 桂枝本为解肌, 若其人脉浮紧、发热、汗不出者, 不可与之也.

Note: We should always remember this: if open and weak, use Gui Zhi tang, if not open, do not use it.

20. Tai Yang Bing: after “fa han” (open and sweating).

If the patient, after “fa han”, cannot stop sweating, is sensitive to wind, has difficulty in urination, limbs a bit tight, and cannot bend or stretch easily, prescribe Gui Zhi Jia Fu zi Tang. Gui Zhi tang same dosage + Fu zi 10.

20. 太阳病, 发汗, 遂漏不止, 其人恶风, 小便难, 四肢微急, 难以屈伸者, 桂枝加附子汤主之. 方七. 桂枝(去皮, 三两) 芍药(三两) 甘草(炙, 三两) 生姜(切, 三两) 大枣(擘, 十二枚) 附子(一枚, 炮, 去皮, 破八片)

Note: Interior and exterior are weak, we need to gather (we use Fuzi).

21. Tai Yang Bing: “xia” (open the middle via bowel movement)

If, after “xia” treatment, the pulse is small, fast with fullness of the chest, use Gui Zhi qu (without) Shao Yao Tang.

21. 太阳病, 下之后, 脉促、胸满者, 桂枝去芍药汤主之.

Note: In this case, interior is empty with some Yang Qi deficiency. Shaoyao is sour, bitter and cold: it goes to the wrong direction, do not use it.

22. Tai Yang Bing: “xia zhi hou”

If after “xia”, the patient is feeling cold, use Gui Zhi qu (without) Shao Yao Jia (add) Fu zi 10 tang.

22. 若微恶寒者, 桂枝去芍药加附子汤主之.

Note: It is stronger to tonify Yang, but not Yin. It addresses Yang xu and opens

23. Tai Yang Bing:

If after 8-9 days, the patient has alternative chills and fever with more fever than chills, no vomiting, normal bowel movement, but chills and fever every day two or three times. If the pulse is slow and soft, it will recover. But if the pulse is soft and the patient sensitive to cold, there is deficiency of Yin and Yang. We should not induce “fa han”, “xia” or vomiting. If the face is reddish (like in fever), and there is no sweating, even slight, the body itches (Yang rising to the surface), use Gui Zhi Ma Huang Ge Ban Tang (Gui Zhi Tang and Ma Huang Tang half and half).

23. 太阳病, 得之八九日, 如疟状, 发热恶寒, 热多寒少, 其人不呕, 清便欲自可, 一日二三度发. 脉微缓者, 为欲愈也；脉微而恶寒者, 此阴阳俱虚, 不可更发汗、更下、更吐也；面色反有热色者, 未欲解也, 以其不能得小汗出, 身必痒, 宜桂枝麻黄各半汤.

Note: it will help Yang go out slightly, and act as if re-opening San jiao

24. Tai Yang Bing:

If at the beginning of the disease, we used Gui Zhi Tang but the patient is feeling nervous, and there are no signs of recovery, first use acupuncture: Feng Chi (GB20), Feng Fu (DU 16), then take Gui Zhi Tang; it will recover.

24. 太阳病, 初服桂枝汤, 反烦, 不解者, 先刺风池、风府, 却与桂枝汤则愈.

Note: acupuncture will open the blocked channel.

25. If after taking Gui Zhi Tang, the pulse is big and fast the patient is sweating a lot, continue to give Gui Zhi Tang.

If then, the patient develops alternative chills and fever every day, twice a day, and if there is sweating, it will recover; use Gui Zhi er Ma Huang yi Tang (two Gui Zhi Tang for one Ma Huang Tang).

25. 服桂枝汤, 大汗出, 脉洪大者, 与桂枝汤, 如前法. 若形似疟, 一日再发者, 汗出必解, 宜桂枝二麻黄一汤.

Note: Ma Huang is there to help the evil cold out and not to open the surface too much.

26. If after taking Gui Zhi Tang, the patient is sweating a lot and the pulse is big and fast (like the previous case), but the patient is also very thirsty even if drinking a lot, prescribe Bai Hu jia Ren Shen Tang: Zhimu 18, Shigao 24, Gancao 6, Renshen 9 + Jin mi 20 (rice).

26. 服桂枝汤, 大汗出后, 大烦渴不解, 脉洪大者, 白虎加人参汤主之. 方十三. 知母(六两) 石膏(碎, 绵裹, 一斤) 甘草(炙, 二两) 粳米(六合) 人参(三两)

Note: In that case, cold has transformed into internal heat with deficiency inside (due to heavy sweating). The patient is very thirsty, we use Renshen and Jin mi.

27. Tai Yang Bing with more fever than chills, and a very weak pulse. There is no Yang Qi. Do not use “fa han” (induce sweating), use Gui Zhi er Yue Bi yi Tang: Guizhi 18 zhu, Shaoyao 18 zhu, Mahuang 18 zhu, Gancao 18 zhu, Shengjiang 1 or 2, Dazao 4 pcs.

27. 太阳病, 发热恶寒, 热多寒少, 脉微弱者, 此无阳也. 不可发汗, 宜桂枝二越婢一汤. 方十四. 桂枝(去皮) 芍药 麻黄 甘草(炙, 各十八铢) 大枣(擘, 四枚) 生姜(切, 一两二铢) 石膏(碎, 绵裹, 二十四铢)

Note: “zhu” is a very small dosage: 6 zhu = 1 fen; 1 fen = 0, 3125 gr. When we do not specify the unit, it means that we use grams.

28. Tai Yang Bing:

If after taking Gui Zhi Tang or after “xia” treatment (induce diarrhoea), there is still headache, stiff and painful neck, slight fever, no sweating, but fullness and pain in the epigastria and difficult urination, use Gui Zhi qu Gui jia Fuling Baizhu Tang: Shaoyao 9, Gancao 6, Shengjiang 9, Baizhu 9, Fuling 9, Dazao 12pcs. If it opens urination, it will recover.

28. 服桂枝汤, 或下之, 仍头项强痛、翕翕发热、无汗、心下满微痛、小便不利者, 桂枝去桂加茯苓白术汤主之. 方十五. 芍药(三两) 甘草(炙, 二两) 生姜(切) 白术 茯苓(各三两) 大枣(擘, 十二枚) 上六味, 以水八升, 煮取三升, 去滓, 温服一升, 小便利则愈.

Note: In that case, the cold pathogen has no chance to go out again, but it was originally not very strong. So we take out Gui Zhi, and we strengthen the stomach, open San Jiao and help urination with Baizhu and Fuling.

29. Tai Yang: shang han (attacked by cold)

The pulse is floating, there is automatic sweating, urinary frequency, nervousness, a little bit of chills, tense feet.

Note: There is deficiency inside and Qi does not reach down.

If we give Gui zhi Tang, it will be a wrong treatment.

Note: It strengthens the middle but it will lead to the surface which is the wrong direction.

What might happen is:

— Either the patient will have cold feet and hands, a very dry throat, serious uncontrolling movements and vomiting, (as middle Qi will rise upwards.) We, then, have to use Gan Cao 12, Gan Jiang 6 Tang, to gather Yang and also recover Yang Qi. If the patient comes back, his hands and feet become warm, then we can give Shao Yao 12, Gan Cao 12, Tang and the feet will be able to stretch again (rebuilt Yin).

Note: This is an emergency case. At the time of Shang Han Lun, people mainly suffered from Qi deficiency, and not Jing deficiency, so Gan Cao Gan Jiang Tang was sufficient to rebuilt Yang Qi. Nowadays, diseases are more complex, we would probably have to use Renshen, Guiban, Duzhong, etc.

— Or, following the wrong prescription of Gui Zhi Tang, stomach Qi will become imbalanced (blocked), and the patient will be confused. We then prescribe Tiao Wei Cheng Qi Tang: Dahuang 12, Gancao 6, Mangxiao 5, to unblock the middle.

Note: This reaction means that Gui Zhi and Sheng Jiang were too warm for somebody who had already some internal heat, Gui Zhi Tang increased the heat.

— A third possibility, with the wrong treatment of Gui Zhi Tang, is to use stronger “fa han” or misuse acupuncture with moxas (fire at the wrong time). This would be three times wrong! We then have to use Si Ni Tang: Gancao 6, Ganjiang 5, Fuzi 10.

Note: This presciption will gather much more effectively than Gan Cao Gan Jiang Tang.

29. 伤寒脉浮、自汗出、小便数、心烦、微恶寒、脚挛急, 反与桂枝, 欲攻其表, 此误也. 得之便厥、咽中干、烦躁吐逆者, 作甘草干姜汤与之, 以复其阳. 若厥愈足温者, 更作芍药甘草汤与之, 其脚即伸；若胃气不和谵语者, 少与调胃承气汤；若重发汗, 复加烧针者, 四逆汤主之. 方十六. 甘草干姜汤方： 甘草(炙, 四两) 干姜(二两) 上二味, 以水三升, 煮取一升五合, 去滓, 分温再服. 芍药甘草汤方： 白芍药 甘草(炙, 各四两) 上二味, 以水三升, 煮取一升五合, 去滓, 分温再服. 调胃承气汤方： 大黄(去皮, 清酒洗, 四两) 甘草(炙, 二两) 芒硝(半升) 上三味, 以水三升, 煮取一升, 去滓, 内芒硝, 更上火微煮令沸, 少少温服之. 四逆汤方： 甘草(炙, 二两) 干姜(一两半) 附子(生用, 去皮, 破八片, 一枚) 上三味, 以水三升, 煮取一升二合, 去滓, 分温再服. 强人可大附子一枚、干姜三两.

30. The patient had symptoms and signs of “Tai Yang zhong feng” and after taking Gui Zhi Tang became more seriously ill (feet cold, very dry throat, spasm in the legs, confusion) as you predicted, in the middle of the night, the legs will stretch and the feet became warm. How could you know that this would happen?

The pulse was floating and big; floating means wind, big means deficiency. This patient was suffering from a little bit of wind heat with internal deficiency; Yang Qi could not reach the extremities of the legs. This condition did not belong to “Tai Yang zhong feng”. But the doctor by using Gui Zhi Tang + Fuzi with more Guizhi, induced a lot more sweating and Fuzi opens the channel too much, consequently, Yang became seriously deficient.

This is why this patient had to take Gan Cao Gan Jiang only, to rebuild Yang Qi. In the middle of the night, Yang Qi came back and the feet became warm. But Yin Qi did not come back yet and the patient needed Shaoyao to rebuild Yin Qi. Then the legs could stretch again!

In the second case, Fuzi had induced a blockage in the middle with constipation and confusion. The prescription was then Tiao Wei Cheng Qi Tang to open the middle.

30. 问曰：证象阳旦, 按法治之而增剧, 厥逆、咽中干、两胫拘急而谵语. 师曰：言夜半手足当温, 两脚当伸. 后如师言, 何以知此？答曰：寸口脉浮而大；浮为风, 大为虚, 风则生微热, 虚则两胫挛. 病形象桂枝, 因加附子参其间, 增桂令汗出, 附子温经, 亡阳故也. 厥逆、咽中干、烦躁、阳明内结、谵语烦乱, 更饮甘草干姜汤, 夜半阳气还, 两足当热, 胫尚微拘急, 重与芍药甘草汤, 尔乃胫伸；以承气汤微溏, 则止其谵语. 故知病可愈.

31. The patient is complaining of: serious back and neck stiffness, sensitivity to cold, no sweating.

We use Gegen Tang: Gui zhi Tang (same dosages) + Gegen 12 Ma Huang 9.

Note: This is the same prescription as for the Tai Yang condition seen above (number 14) with stiff back and neck, sensitivity to wind and sweating, but the cooking instructions are different. In the previous case, we use ten shen of water, and first cook Mahuang and Gegen till only eight shen of liquid remains; then add the other ingredients, and cook till only three shen is left.

In this case, we also cook Mahuang and Gegen first in ten shen of water, but wait till only four shen of liquid is left; then add the other ingredients and wait till three shen of liquid is left. In the second case, we have more “wei” of Mahuang and Gegen, It will induce stronger sweating. The first prescription has more “qi” of Guizhi, Shengjiang, GancCao, DazZao, ShaoyYao, less “wei” of Mahuang and Gegen: it is meant to slightly open the surface rather than induce sweating.

31. 太阳病, 项背强几几、无汗、恶风, 葛根汤主之. 方一. 葛根(四两) 麻黄(去节, 三两) 桂枝(去皮, 二两) 生姜(切, 三两) 甘草(炙, 二两) 芍药(二两) 大枣(擘, 十二枚) 上七味, 以水一斗, 先煮麻黄、葛根, 减二升, 去白沫, 内诸药, 煮取三升, 去滓, 温服一升, 覆取微似汗.

32. “He Bing” means that two levels are concerned; for example, if the surface and the middle are involved, we call the disease: Tai Yang and Yang Ming He Bing. In this case we may have Tai Yang symptoms + diarrhoea.

32. 太阳与阳明合病者, 必自下利, 葛根汤主之.

Note: Diarrhoea indicates that “Bing Ji” moves in the wrong direction and does not follow QiJi. We use Gegen Tang to guide Bing Ji to the right direction, and Xie Qi can then go out via the surface. “Ni Liu Wan Zhou”, “take the boat against the river flow”.

33. If we have Tai Yang and Yang Ming He Ping but with vomiting instead of diarrhoea, we use Gegen jia Ban Xai Tang, which is Gegen Tang + Banxia 9, Shengjiang 6 (instead of 9).

33. 太阳与阳明合病, 不下利, 但呕者, 葛根加半夏汤主之. 方三. 葛根(四两) 麻黄(去节, 三两) 甘草(炙, 二两) 芍药(二两) 桂枝(去皮, 二两) 生姜(切, 二两) 半夏(洗, 半升) 大枣(擘, 十二枚)

Note: Banxia will treat vomiting, but the direction of the whole prescription is still upward. We do not treat the middle. Tai Yang is predominant with stiff back, fear of cold, pulse floating, no sweating, which means that the surface is not open. We must, first, open the surface.

Even if the direction goes downward, in most cases we have to use 20% of herbs to open the surface.

34. If a patient has symptoms and signs of Tai Yang Bing zhong feng, the prescription should be Gui Zhi Tang.

But if the treatment used was “xia” and the patient develops diarrhoea which cannot stop, a weak and fast pulse, asthma, and sweating, with still symptoms of a blockage at surface level (stiffness and pain in the back, fear of cold), we must use Gegen Huang Qin Huang Liang Tang Gegen 18, Gancao 6, Huangqin 9, Huangliang 9.

34. 太阳病, 桂枝证, 医反下之, 利遂不止, 脉促者, 表未解也；喘而汗出者, 葛根黄芩黄连汤主之. 方四. (促, 一作纵) 葛根(半斤) 甘草(炙, 二两) 黄芩(三两) 黄连(三两)

Note: Here, Huangqin and Huangliang are not used to treat infection but to consolidate the middle and bring Qi down (asthma). The main direction, given by Ge gen, is upwards, but the prescription follows the direction of the middle’s Qi Ji which is up and down.

35. If there is Tai Yang Bing with headache, fever, general pain in the body, low back pain, pain in the joints, asthma, sensitivity to wind, no sweating, we use Ma Huang Tang: Mahuang 9, Guizhi 6, Gancao 3, Xingren 70 pcs.

35. 太阳病, 头痛、发热、身疼、腰痛、骨节疼痛、恶风、无汗而喘者, 麻黄汤主之. 方五. 麻黄(去节, 三两) 桂枝(去皮, 二两) 甘草(炙, 一两) 杏仁(去皮尖, 七十个)

Note: This prescription is used for pain, (which means that there is a serious blockage), and no sweating. The blockage creates pain and fever. Guizhi is used to stimulate the whole body, with a small dosage to help the action of Mahuang. There is a strong opening direction. In this case, cold is strong and Zhen Qi is strong; so the fight is strong and creates a lot of pain.

36. Tai Yang and Yang Ming He Bing with asthma and fullness of the chest.

We cannot induce diarrhoea, as it belongs to Tai Yang, so we use Ma Huang Tang.

36. 太阳与阳明合病, 喘而胸满者, 不可下, 宜麻黄汤.

37. Tai Yang Bing (usual symptoms) for ten days. The pulse is floating and thin (Qi xu, Xue xu); the patient feels always sleepy (which indicates that the patient will gather Qi and Xue himself with sleep). Wait without doing anything.

But if there is fullness in the chest, and pain in the hypochondria (sides) we can use Xiao Chai Hu Tang.

If the pulse is still floating but not thin (BingJi is still there, and the patient very strong), use Ma Huang Tang.

37. 太阳病, 十日以去, 脉浮细而嗜卧者, 外已解也. 设胸满胁痛者, 与小柴胡汤；脉但浮者, 与麻黄汤.

38. If Tai Yang zhong feng, but the pulse is floating and tight, the body is painful with chills and fever but no sweating, and the patient feels nervous. Use Da Qing Long Tang: Mahuang 18, Guizhi 6, Gancao 6, Xingren 40 pcs, Shengjiang 9, Dazao 10 pcs, Shenshigao 30 (a piece of an egg size). If there is weak pulse, sweat, sensitivity to cold, it means deficiency and we cannot give Da Qing Long, otherwise the patient will have cold limbs, muscular twitching and cramps; it’s Ni (wrong direction).

38. 太阳中风, 脉浮紧、发热、恶寒、身疼痛、 不汗出而烦躁者, 大青龙汤主之；若脉微弱, 汗出恶风者, 不可服之. 服之则厥逆、筋惕肉 瞤, 此为逆也. 大青龙汤方. 方八. 麻黄(去节, 六两) 桂枝(去皮, 二两) 甘草(炙, 二两) 杏仁(去皮尖, 四十枚) 生姜(切, 三两) 大枣(擘, 十枚) 石膏(如鸡子大, 碎).

Note: The patient is blocked at surface level and is fighting with the pathogenic factor: pain, no sweating. Yang Qi is in excess: feeling nervous. We use Shigao which is pungent, sweet, cold and acts at Qi level.

39. Shang han (attacked by cold)

The pulse is floating and slow, there is no pain but a heavy feeling in the body (pathogenic factor is dampness and not cold), sometimes relaxed but no signs of Shaoyin (pulse thin and weak, feeling sleepy). We use Da Qing Long Tang to open (“fa zhi”).

39. 伤寒, 脉浮缓, 身不疼, 但重, 乍有轻时, 无少阴证者, 大青龙汤发之.

Note:there is no real fight taking place, no pathogenic cold attacking the body but dampness coming from inside and a blocked surface.

Da Qing Long is not only used to treat the symptoms of fever, but to open. Shang Han Lun focuses on treating “Ji”. It considers all the different symptoms as a reaction of the whole body. It is interested in the direction of action: open-change-gather, up or down.

40. Shang han, the surface is blocked and there is “Shui Qi” (or water qi in the epigastria): nausea, fever, cough, or moderate thirst, or mild diarrhoea, or difficult urination, or some difficulty swallowing, or fullness of the lower part of the abdomen, or asthma.

We use Xiao Qing Long Tang: Mahuang 9, Shaoyao 9, Xixin 9, Ganjiang 9, Zhigancao 9, Guizhi 9, Wuweizi 9, Banxia 9.

Note: Da Qing Long Tang acts mainly at Qi level with a strong opening action and Shigao to cool down. Xiao Qing Long Tang does not have such a strong opening action as Shaoyao and Wuweizi are sour and act at Xue level. The taste of Xiao Qing Long and Gui Zhi Tang is similar, but Gui Zhi Tang is used when there is no Xie Qi, or if the surface is not blocked. Xiao Qing Long is used when there is Xie Qi, the surface is blocked and there is internal deficiency, San Jiao does not move well and produces nausea fever, cough, thirst or diarrhoea.

This prescription treats the movement of Qi and not the symptoms.

If the patient is thirsty: take off Banxia, add Gualougen 9.

If there is diarrhoea: take off Mahuang, add Raohua.

If swallowing is difficult: take off Mahuang, add Fuzi.

If there is asthma: take off Mahuang, add Xingren.

If urination is difficult: take off Mahuang add Fuling.

When the main problem is internal weakness, take off Mahuang and add something more specific.

40. 伤寒, 表不解, 心下有水气, 干呕、发热而咳, 或渴, 或利, 或噎, 或小便不利、少腹满, 或喘者, 小青龙汤主之. 方十. 麻黄(去节) 芍药 细辛 干姜 甘草(炙) 桂枝(去皮, 各三两) 五味子(半升) 半夏(洗, 半升). 若渴, 去半夏, 加栝蒌根三两；若微利, 去麻黄, 加荛花, 如一鸡子, 熬令赤色；若噎者, 去麻黄, 加附子一枚, 炮；若小便不利、少腹满者, 去麻黄, 加茯苓四两；若喘, 去麻黄, 加杏仁半升, 去皮尖.

41. Shang han, Qi deficiency, Shui Qi in the epigastria (Xin Xia): with cough, a bit of asthma, fever but no thirst.

We use Xiao Qing Long Tang. If after taking this prescription, the patient becomes thirsty, it means that cold is going out and he will recover.

41. 伤寒, 心下有水气, 咳有微喘、发热不渴. 服汤已, 渴者, 此寒去欲解也, 小青龙汤主之.

Note: being thirsty or not is not a symptom to be treated. To be thirsty means that Yang Qi is good and that the circulation in San Jiao is smooth. It is a symptom which indicates that the situation is changing: Ji.

42. Tai Yang Bing, if the surface symptoms are not relieved, the surface is still blocked but the pulse is floating and weak, we should prescribe Gui Zhi Tang to help sweating and strengthen the middle.

42. 太阳病, 外证未解, 脉浮弱者, 当以汗解, 宜桂枝汤.

43. If Tai Yang Bing has been treated with “xia” (using Dahuang, Mangxiao, Badou, Qianyouzi, Daji, Yuanhua..), and the patient develops asthma, it means that the surface is still blocked. Use Gui Zhi Tang + Houpo 6 Xingren 6 Tang.

43. 太阳病, 下之微喘者, 表未解故也, 桂枝加厚朴杏子汤主之. 方十三. 桂枝(去皮, 三两) 甘草(炙, 二两) 生姜(切, 三两) 芍药(三两) 大枣(擘, 十二枚) 厚朴(炙, 去皮, 二两) 杏仁(五十枚, 去皮尖)

Note: In ancient times, “xia” treatment was easily available like nowadays “OTC medicines”. People often bought it as a first self medication treatment when they felt uncomfortable: they believed that it was good to get rid of poisons!

44. Tai Yang Bing, the surface is not open, we cannot use “xia” as it is the wrong direction. Then use Gui Zhi Tang.

44. 太阳病, 外证未解, 不可下也, 下之为逆；欲解外者, 宜桂枝汤.

Note: Ma Huang Tang could also be used.

45. Tai Yang Bing, treated first with “fa han” (open and sweating), which did not work; then with “xia”, but the pulse is still floating (which means that there is still a problem at surface level); we must open the surface and use Gui Zhi Tang.

45. 太阳病, 先发汗不解, 而复下之, 脉浮者不愈. 浮为在外, 而反下之, 故令不愈. 今脉浮, 故在外, 当须解外则愈, 宜桂枝汤.

46.Tai Yang Bing with: pulse floating and tight, no sweating, fever, pain in the body for 8-9 days, the surface is still blocked we have to use a “fa han” method (open and sweating), with Ma Huang Tang. If after sweating the symptoms are a bit relieved but the patient feels nervous, and has a blurred vision, it is a serious case; the patient has strong Yang Qi and the fight might be sustained. If the nose bleeds, then the patient will recover.

46. 太阳病, 脉浮紧、无汗、发热、身疼痛, 八九日不解, 表证仍在, 此当发其汗. 服药已微除, 其人发烦目瞑, 剧者必衄, 衄乃解. 所以然者, 阳气重故也. 麻黄汤主之.

Note: Nose bleeding may be due to either heat at Qi level, in that case use Shigao, Huashi, Baimaogen, Zuye, Shengtieluo (iron); or heat at Xue level, in that case use San Huang Xie Xing Tang; or an excess of Yang Qi with a blockage at surface level and strong fight, in that case use Ma Huang Tang.

47.Tai Yang Bing with pulse floating and tight, fever, no sweating. If there is nose bleeding, the patient will recover. (Only young people will have this chance.)

47. 太阳病, 脉浮紧, 发热, 身无汗, 自衄者愈.

48. If Tai Yang and Yang Ming He Bing. The problem is first in Tai Yang level: we use a “fa han” method; but the sweating might not be sufficient and the problem will transfer to Yang Ming level with automatic sweating, no sensitivity to cold. If there are still Tai Yang symptoms or signs, we cannot use “xia” treatment, it would be “ni”, the wrong direction; we can use herbs with a mild effect at inducing sweating.

If the face is reddish, it means that Yang Qi is blocked at surface level and cannot be released; we have to open the surface. If sweating is not sufficient, Yang Qi will still be blocked at surface level and we have to induce sweating again otherwise the patient will become nervous and uncomfortable with moving pains difficult to locate, shortness of breath, and will not be able to lie down. This is due to inadequate sweating; if we can induce more sweating, he will recover.

How do we know that there is not enough sweating? Because the pulse is not smooth, there are some irregularities.

48. 二阳并病, 太阳初得病时, 发其汗, 汗先出不彻, 因转属阳明, 续自微汗出, 不恶寒. 若太阳病证不罢者, 不可下, 下之为逆；如此可小发汗. 设面色缘缘正赤者, 阳气怫郁在表, 当解之熏之；若发汗不彻, 不足言, 阳气怫郁不得越, 当汗不汗, 其人躁烦, 不知痛处, 乍在腹中, 乍在四肢, 按之不可得, 其人短气但坐, 以汗出不彻故也, 更发汗则愈. 何以知汗出不彻, 以脉涩故知也.

Note: “fa han yao” is not necessarily used to induce sweating and open (as indicated by its literal translation). It is meant to be used at surface level. Sweating is only a sign that the surface is open. “fa han yao” helps San Jiao’s circulation when it is blocked at surface level. It also benefits the channels. For example, it can be used for arthritis when there is no sweating and the channels are blocked.

49. If the pulse is floating and fast, we should induce sweating and the patient will recover. If we use “xia” treatment (wrong direction), the patient will become heavy, will have palpitations; we cannot induce sweating then because we have lost “ji” (the opportunity) of inducing sweating. “xia” treatment created a deficiency inside the body, the direction leading towards the surface is lost; we have to wait for exterior and interior qi to come back and balance of body fluid, then spontaneous sweating will happen, then the patient will recover.

49. 脉浮数者, 法当汗出而愈. 若下之, 身重、心悸者, 不可发汗, 当自汗出乃解. 所以然者, 尺中脉微, 此里虚. 须表里实, 津液自和, 便自汗出愈.

50. If the pulse is floating and tight, in general, there is also pain in the body. We should use “fa han yao”. But if the pulse is very slow at kidney left position, it means that Yin Qi and Xue are deficient, and we cannot use “fa han yao”.

50. 脉浮紧者, 法当身疼痛, 宜以汗解之；假令尺中迟者, 不可发汗. 何以知然, 以荣气不足, 血少故也.

51. If the pulse is floating, the problem is at surface level, we can use a sweating method like Ma Huang Tang.

51. 脉浮者, 病在表, 可发汗, 宜麻黄汤.

52. If the pulse is floating and fast, we can use a sweating method. We use Ma Huang Tang.

52. 脉浮而数者, 可发汗, 宜麻黄汤.

53. If the patient has spontaneous sweating; he has enough Yin Qi but Wei Qi is not in harmony with Yin Qi: Yin Qi is in the channels and Wei Qi outside the channels. We can use treatment inducing sweating to harmonise Yin and Wei.

53. 病常自汗出者, 此为荣气和. 荣气和者, 外不谐, 以卫气不共荣气谐和故尔. 以荣行脉中, 卫行脉外. 复发其汗, 荣卫和则愈.

54. If the patient has no problems at Zang-Fu level but is always suffering from low grade fever and spontaneous sweating, it is due to a dysfunction of Wei Qi; we can use sweating herbs (Gui Zhi Tang) before the patient is sweating, then he will recover.

54. 病人脏无他病, 时发热、自汗出, 而不愈者, 此卫气不和也. 先其时发汗则愈, 宜桂枝汤.

Note: In that case, you have to be sure that the patient has no dampness, digestive problem or any “unclear” disease, otherwise this will get worse. Using Gui Zhi Tang would be good to thin sensitive women with cold hands and feet (surface blocked).

55. Shang han (attacked by cold), pulse floating and tight, no sweating medicine which leads to nose bleeding, use Ma Huang Tang.

55. 伤寒脉浮紧, 不发汗, 因致衄者, 麻黄汤主之.

56. Shang han, with constipation, headache and fever for 6-7 days, use Cheng Qi Tang (to clarify).

If urination is clear, we know that the problem is not internal, but still at surface level: we should use “fa han”. If there is headache, there should also be nose bleed, we use Gui Zhi Tang.

56. 伤寒不大便六七日, 头痛有热者, 与承气汤；其小便清 (一云大便清)者, 知不在里, 仍在表也, 当须发汗；若头痛者必衄. 宜桂枝汤.

Note: In a case like this, with “fa han”, we can treat constipation and headache.

57. Shang han, after “fa han” the surface is open and the symptoms are gone; but half a day later, they come back, and the patient feels nervous; if the pulse is floating and fast, we can “fa han” again with Gui Zhi Tang.

57. 伤寒发汗已解, 半日许复烦, 脉浮数者, 可更发汗, 宜桂枝汤.

58. In any disease, if “fa han” or “xia” or “inducing vomiting” methods of treatment have been used and have induced blood or Jing Ye deficiency, if the patient can balance his own Yin and Yang, he will recover.(Otherwise, it is a dangerous situation.)

58. 凡病, 若发汗, 若吐, 若下, 若亡血, 亡津液. 阴阳自和者, 必自愈.

59. After a serious diarrhoea induced by treatment, if we use “fa han” and there is difficult urination, it means that Jin and Ye are deficient. It does not need to be treated; wait till the patient’s urination is normal again; it will recover by itself.

59. 大下之后, 复发汗, 小便不利者, 亡津液也. 勿治之, 得小便利, 必自愈.

60. After diarrhoea and then “fa han” treatment, if the patient has chills and the pulse is weak and thin, it means that the surface is weak (because of “fa han”) and there is also internal deficiency (because of “xia”).

60. 下之后, 复发汗, 必振寒、脉微细. 所以然者, 以内外俱虚故也.

61. After diarrhoea, and then “fa han”, if the patient feels nervous during day time and cannot go to sleep but calms down at night; there is no vomiting, no thirst, no surface symptoms, no fever, and the pulse is deep and weak, use Ganjiang 6 Fuzi 9 Tang.

61. 下之后, 复发汗, 昼日烦躁不得眠, 夜而安静, 不呕、不渴, 无表证, 脉沉微, 身无大热者, 干姜附子汤主之. 方二十四. 干姜(一两) 附子(生用, 去皮, 切八片, 一枚)

Note: This patient has internal deficiency and “Yin zhen” (lack of Yang): the prescription is meant to gather inside.

62. After “fa han” if there is pain in the body, and the pulse is deep and slow, use Gui Zhi Xing Jia Tang: Guizhi 9, Shaoyao 12, Gancao 6, Renshen 9, Dazao 12pcs, Shengjiang 12.

62. 发汗后, 身疼痛, 脉沉迟者, 桂枝加芍药生姜各一两人参三两新加汤主之. 方二十五. 桂枝(去皮, 三两) 芍药(四两) 甘草(炙, 二两) 人参(三两) 大枣(擘, 十二枚) 生姜(四两)

Note: This prescription is: qi warm, wei thick. Pungent, sweet, warm and a bit sour and bitter: it will gather inside.

63. If after “fa han” the patient cannot use “Gui Zhi Tang”, but is sweating, has asthma, no high fever (may be mild fever), use Ma Xing Shi Gan Tang: Mahuang 12, Xingren 10, Gancao 6, Shigao 30.

63. 发汗后, 不可更行桂枝汤. 汗出而喘, 无大热者, 可与麻黄杏仁甘草石膏汤. 方二十六. 麻黄(去节, 四两) 杏仁(去皮尖, 五十个) 甘草(炙, 二两) 石膏(碎, 绵裹, 半斤)

Note: This patient has heat trapped inside. After “fa han”, there are no signs of deficiency but the heat has increased and is gone upwards.

Ma Huang is a bit bitter, pungent warm; if used with Guizhi, the direction will be up; if used with Shigao, Xingren, the direction will be down.

This prescription is used only if there is no deficiency.

64. Too much “fa han”. The patient puts his hands in the middle of the chest; in the epigastria (Xin Xia) there is a feeling of palpitation; he wishes that something was pressing on his chest.

Use Gui Zhi Gan Cao Tang (only Guizhi 12 and Gancao 6).

64. 发汗过多, 其人叉手自冒心, 心下悸欲得按者, 桂枝甘草汤主之. 方二十七. 桂枝 (去皮, 四两) 甘草(炙, 二两)

Note: In this case, after “Fa han”, Yang Qi was going out, this prescription will bring it back in.

65. After “fa han” the patient has a feeling of “palpitation” below the navel and “rebellious Qi” going upwards. Use: Fuling 18, Guizhi 12, Gancao 6, Dazao 15 pcs, Tang

65. 发汗后, 其人脐下悸者, 欲作奔豚, 茯苓桂枝甘草大枣汤主之. 方二十八. 茯苓(半斤) 桂枝(去皮, 四两) 甘草(炙, 二两) 大枣(擘, 十五枚)

Note: In this case “fa han” induced an imbalance in “Yuan Qi”. It is not really that Yuan Qi is empty but it is going up to the wrong place: we need to bring it back to where it belongs. To this effect, we do not use minerals (meant to calm down the Shen), but Fuling, which is neutral and perfect to put San Jiao back in the right direction. Fuling is not used here to promote urination but to act on San Jiao.

When cooking the decoction, in order to rebuild San Jiao, we must turn it with a spoon to get air into it; turn it till there are 1000 bubbles at the surface, then it is ready! this is called “gan lan shui” (“activated” water).

Many clinical situations like heart problems, palpitations, nervousness, high blood pressure, insomnia, “running up piglets” of the middle age woman, could be due to Jing or Yuan Qi deficiency but also, just to San Jiao moving in the wrong direction, without real deficiency.

66. If after “fa han” the patient has an impression of fullness in the abdomen, use Hopou 15, Shengjiang 9, Banxia 9, Gancao 6, Renshen 3 Tang.

66. 发汗后, 腹胀满者, 厚朴生姜半夏甘草人参汤主之. 方二十九. 厚朴(炙, 去皮, 半斤) 生姜(切, 半斤) 半夏(洗, 半升) 甘草(二两) 人参(一两)

Note: In this case, “fa han” induced deficiency and a change in the normal direction of the movement of Spleen and Stomach Qi. We have to restore the direction: down and slightly up.

67. Shang han: if after giving a “vomiting” or a “xia” treatment, the patient has a feeling of fullness in the epigastria, with Qi going up to the chest, dizziness when standing up, and his pulse is deep (inside) and stiff (deficiency), we should not use “fa han”. It would be a treatment “twice wrong”: the patient would be shaking;

Note: “fa han”, in that case, would interrupt the flow in the channels, inside and outside would be empty, and the patient would shake.

We use a formula to rebuild the middle:

Ling Gui Zhu Gan Tang: Fuling 12, Guizhi 9, Baizhu 6, Gancao 6.

67. 伤寒, 若吐、若下后, 心下逆满、气上冲胸、起则头眩、脉沉紧, 发汗则动经, 身为振振摇者, 茯苓桂枝白术甘草汤主之. 方三十. 茯苓(四两) 桂枝(去皮, 三两) 白术 甘草(炙, 各二两)

Note: We do not use Renshen, Baishao, Dazao or Wuweizi, because they work at “Xue” level and it is better to start treatment at Qi level. Only when Qi is rebuilt, we can reconsider the treatment.

At the time of Shang Han Lun, people mainly suffered from acute problems; even if there was a degree of internal deficiency, the disease belonged to Tai Yang and had to be treated at this level. This explains why most of the formulae indicated for Tai Yang level are so light.

68. If after “fa han”, the symptoms persist with sensitivity to cold, it is a case of deficiency. We use: Shaoyao 9, Gancao 9, Shufuzi 12 Tang, to gather and bring Yin and Yang back together again.

68. 发汗病不解, 反恶寒者, 虚故也, 芍药甘草附子汤主之. 方三十一. 芍药 甘草(炙, 各三两) 附子(炮, 去皮, 破八片, 一枚)

69. After “fa han”, if we use “xia” treatment and the symptoms are still there, with in addition nervousness, we have induced deficiency. We use Fuling Si Ni Tang: Fuling 12, Renshen 3, Shengfuzi 10, Gancao 6, Ganjiang 4, 5.

69. 发汗, 若下之, 病仍不解, 烦躁者, 茯苓四逆汤主之. 方三十二. 茯苓(四两) 人参(一两) 附子(生用, 去皮, 破八片, 一枚) 甘草(炙, 二两) 干姜(一两半)

Note: In this case, there is real emptiness; the pulse is important to make the diagnosis, together with the appearance of the patient and our own feeling. We have to ask ourselves: is there real emptiness or only rebellious Qi? This patient is weaker than the one in case 65. But if the patient in 65 had received the wrong treatment, he could have become like 69: first wrong direction, then real deficiency.

70. After “fa han” if the patient is sensitive to cold, it is due to deficiency; if sensitive to heat, it is due to excess, then we have to harmonise Wei (stomach) Qi and use Tiao Wei Cheng Qi Tang: Dahuang 12, Mangxiao 6, Gancao 6

70. 发汗后, 恶寒者, 虚故也；不恶寒, 但热者, 实也, 当和胃气, 与调胃承气汤. 方三十三. (玉函云：与小承气汤. ) 芒硝(半升) 甘草(炙, 二两) 大黄(去皮, 清酒洗, 四两)

71. Tai Yang Bing, after “fa han” the patient is sweating a lot, suffers from dryness in the stomach, is very thirsty and wants to drink, cannot sleep; give him frequent drinks in small quantity: it will help harmonising stomach Qi and the patient will recover. If the pulse is floating, there is difficult urination, mild fever, and thirst; use Wuling San: Zhuling 6, Zexie 12, Baizhu 6, Fuling10 zhu, Guizhi 5. In powder. Every time take 3-6 gr.

71. 太阳病, 发汗后, 大汗出、胃中干、烦躁不得眠, 欲得饮水者, 少少与饮之, 令胃气和则愈；若脉浮、小便不利、微热、消渴者, 五苓散主之. 方三十四. 猪苓(去皮, 十八铢) 泽泻(一两六铢) 白术(十八铢) 茯苓(十八铢) 桂枝(去皮, 半两) 上五味, 捣为散, 以白饮和服方寸匕, 日三服.

Note: this is a very light prescription, with very low dosage, meant to rebuild San jiao; San Jiao is not moving properly (difficult urination, thirst). If the patient takes the decoction 3 times a day with warm water and starts sweating, then he will recover.

72. If after “fa han”, the pulse is floating and fast and the patient is nervous and thirsty, use Wuling San.

72. 发汗已, 脉浮数、烦渴者, 五苓散主之.

73. Shang han: if the patient is sweating and thirsty: use Wuling San; if the patient is not thirsty: use Fuling Gan Cao Tang: Fuling 6, Guizhi 6, Gancao 3, Shengjiang 9.

73. 伤寒, 汗出而渴者, 五苓散主之；不渴者, 茯苓甘草汤主之. 方三十六. 茯苓 (二两) 桂枝 (去皮, 二两) 甘草 (炙, 一两) 生姜 (切, 三两)

Note: Wuling San is used for all San Jiao: it will help urination and, warming the channel Qi, it will benefit water metabolism of the whole body (thirsty). Fuling Gan cao Tang is for middle and upper Jiao.

74. Zhong feng; fever, after 6-7 days, the patient is still blocked and nervous with symptoms from biao and li (outside and inside), he is thirsty and wants to drink but vomits after drinking (shui ni). Use Wuling San.

74. 中风, 发热六七日不解而烦, 有表里证, 渴欲饮水, 水入则吐者, 名曰水逆, 五苓散主之.

Note: zhong feng is not as strong as shang han, blockage is not as strong. Here the patient is very thirsty but also vomiting: San Jiao cannot move properly. We use Wuling san to circulate San Jiao.

76. After “fa han” if the patient cannot swallow the decoction or even water, this is a “ni” situation (wrong direction). If we use “fa han” again, it will lead to non stop vomiting and diarrhoea.

After “fa han” and vomiting or “xia treatment”. We have three possibilities:

— The patient is weak, nervous, cannot go to sleep, change is mind all the time about what he likes and dislikes, with a deep feeling of regret in his heart. Use Zhi Zi Chi Tang: Zhizi 12, Douchi 10.

Note: Some teaching books will tell you that this prescription will induce vomiting and then the patient will feel better. I do not agree! This patient has floating heat: Zhizi can treat the surface of floating heat, bring it down via urination, and clear floating heat from San Jiao. Douchi is acting at “middle” level: it can consolidate the middle and help Zhizi move San Jiao and clear the heat downwards.

— The patient is short of breath. Use Zhi Zi Gan Cao Chi Tang: same as above + Gancao 6.

— The patient is still vomiting; use Zhi Zi Sheng Jiang 15 Chi Tang.

If after any of these three prescriptions, the patient is still vomiting, stop all treatment.

76. 发汗后, 水药不得入口, 为逆. 若更发汗, 必吐下不止. 发汗、吐下后, 虚烦不得眠；若剧者, 必反复颠倒, 心中懊憹, 栀子豉汤主之；若少气者, 栀子甘草豉汤主之；若呕者, 栀子生姜豉汤主之. 方三十八. 栀子豉汤方： 栀子(擘, 十四个) 香豉(绵裹, 四合) 上二味, 以水四升, 先煮栀子, 得二升半, 内豉, 煮取一升半, 去滓, 分为二服, 温进一服, 得吐者, 止后服. 栀子甘草豉汤方： 栀子(擘, 十四个) 甘草(炙, 二两) 香豉(绵裹, 四合) 上三味, 以水四升, 先煮栀子、甘草, 取二升半, 内豉, 煮取一升半, 去滓, 分二服. 温进一服, 得吐者, 止后服. 栀子生姜豉汤方： 栀子(擘, 十四个) 生姜(五两) 香豉(绵裹, 四合) 上三味, 以水四升, 先煮栀子、生姜, 取二升半, 内豉, 煮取一升半, 去滓, 分二服. 温进一服, 得吐者, 止后服.

154. In Tai Yang:

Fullness in the epigastria which has no resistance under pressure (zai qi and not zai xue), pulse floating in the second position: we use Xie Xing Tang: Da Huang 6, Huang Lian 3, Huang qin 3

154. 心下痞, 按之濡, 其脉关上浮者, 大黄黄连泻心汤主之. 方十七. 大黄 (二两) 黄连 (一两)

155. But if there is fullness in the epigastria with sweating and sensitivity to cold: We use Fu Zi Xie Xing Tang: Dahuang 6, Huanglian 3, Huangqin 3, Fuzi 10.

155. 心下痞, 而复恶寒、汗出者, 附子泻心汤主之. 方十八. 大黄 (二两) 黄连(一两) 黄芩(一两) 附子(炮, 去皮破, 别煮取汁, 一枚)

Note: In these two formulae, we use the “qi of the herbs”; just pour water over them and drink them as a tea; but in the second one, Fuzi is prepared and cooked first, then the water is added to the rest. If the disease was “zai xue”, we would use Dahuang but cooked, to have the “wei” of Dahuang rather than the “qi”.

Second Section: Yang Ming

It manifests as stomach excess.

181. Why does a patient enter Yang Ming level?

If in Tai Yang level, “fa han” (induce sweating), “xia” (induce diarrhoea), or “li xiao bian” (open urination) create “Jin ye xu” (deficiency of fluids), Stomach becomes dry and “Bing Ji” transfers to Stomach with a manifestation of excess in the middle, constipation or difficult bowel movement.

181. 问曰：何缘得阳明病, 答曰：太阳病, 若发汗、若下、若利小便, 此亡津液, 胃中干燥, 因转属阳明. 不更衣, 内实大便难者, 此名阳明也.

182. In Yang Ming level, what are the other possible symptoms?

It should be: heat in the body, spontaneous sweating, no sensitivity to cold, but sensitivity to heat.

182. 问曰：阳明病外证云何？答曰：身热、汗自出、不恶寒反恶热也.

185. In Tai Yang level, if we induce sweating but it does not open the surface well enough, the problem will transfer to Yang Ming;

Note: the heat (from inside or from cold transforming into heat, or produced by the fight between heat inside and cold outside) cannot go out.

At the beginning we have “shang han” (Tai Yang cold) with fever, no sweating, vomiting, cannot eat. Sweating happens, Tai Yang can transfer into Yang Ming.

185. 本太阳, 初得病时, 发其汗, 汗先出不彻, 因转属阳明也. 伤寒发热、无汗、呕不能食、而反汗出濈濈然者, 是转属阳明也

186. ”Shang han” for three days; “Yang Ming Mai Da” = pulse bigger like in Yang Ming;

186. 伤寒三日, 阳明脉大.

187. “Shang han” with a soft and slow pulse, hand and feet warm; if it belonged to “Tai Yin”, the skin should be yellow.

In this case, if urination is normal, the skin won’t be yellow.

If the disease goes on for 7-8 days, the bowel movement will become very hard, and the disease belongs to Yang Ming.

187. 伤寒脉浮而缓, 手足自温者, 是为系在太阴. 太阴者, 身当发黄；若小便自利者, 不能发黄；至七八日, 大便硬者, 为阳明病也.

Note: the skin becomes yellow only if urination is difficult and dampness cannot go out. The bowels become hard if Qi is gathered or blocked in the middle: Ji changed from Taiyang to Yang Ming.

203. Yang Ming Bing: At the beginning there was spontaneous sweating but the doctor induced strong “fa han” (wrong treatment). However, the disease recovered but the patient still feels slightly uncomfortable with mind instability and constipation. This is due to excess sweating taking off the fluids (Jin/Ye); Stomach dried up inducing constipation. The doctor should then ask about the frequency of urination. If it used to be 3-4 times a day but is now only twice a day, the doctor knows that bowels will open again as, with less frequent urination, the fluids will go back to the Stomach and, consequently, bowels will open.

203．阳明病, 本自汗出. 医更重发汗, 病已瘥, 尚微烦不了了者, 此必大便硬故也. 以亡津液, 胃中干燥, 故令大便硬. 当问其小便日几行, 若本小便日三四行, 今日再行, 故知大便不久出. 今为小便数少, 以津液当还入胃中, 故知不久必大便也.

Note: In Yang Ming Bing, it is important to protect the fluids.

207. Yang Ming Bing: The patient is not vomiting, but has constipation, is feeling uncomfortable and nervous with heat. Use Tiao Wei Cheng Qi Tang: Dahuang 12, Mangxiao 6, Gancao 4.

207. 阳明病, 不吐、不下、心烦者, 可与调胃承气汤. 方一. 甘草(炙, 二两) 芒硝(半斤) 大黄(清酒洗, 四两)

Note: This prescription is used when the disease is more at Xue level, to adjust it.

208. Yang Ming Bing: slow pulse, sweating, not sensitive to cold, heavy feeling in the body, short of breath, fullness in abdomen, “asthma type breathing”, fever coming and going. There is a chance that the surface will open (sweating and enough energy in the middle); we can “Gong Li” (attack the interior).

— If hands and feet are sweating a lot, bowel movement is already very hard, Da Cheng Qi tang: Dahuang 12, Houpo 18, Zhishi 10, Mangxiao 6.

Note: excess is at its maximum, it is a “ji” (chance) to use Da Cheng Qi Tang as the surface is open and there is enough energy inside.

— If lots of sweating, a little fever, sensitive to cold: the surface is not open, the fever is not coming and going, do not use Da Cheng Qi tang, (as the original direction should be upward).

— If the abdomen is very big and full with constipation, we use Xiao Cheng Qi Tang to harmonise Wei Qi (stomach Qi). We should not induce strong diarrhoea (the disease is more at Qi level than Xue level). Xiao Cheng Qi tang: Dahuang 12, Houpo 6, Zhishi 3 .

208. 阳明病, 脉迟, 虽汗出不恶寒者, 其身必重, 短气, 腹满而喘, 有潮热者, 此外欲解, 可攻里也. 手足濈然汗出者, 此大便已硬也, 大承气汤主之；若汗多, 微发热恶寒者, 外未解也；其热不潮, 未可与承气汤；若腹大满不通者, 可与小承气汤, 微和胃气, 勿令至大泄下.

大承气汤. 方二. 大黄(酒洗, 四两) 厚朴(炙, 去皮, 半斤) 枳实(炙, 五枚) 芒硝(三合)

小承气汤方： 大黄(酒洗, 四两) 厚朴(去皮, 炙, 二两) 枳实(大者, 炙, 三枚)

209. Yang Ming Bing:

Stable fever, bowel movement a little hard, use Da Cheng Qi Tang. If bowel movement is very hard, do not use Da Cheng Qi Tang.

Indeed, if there has been constipation for 6-7 days, how do we know if the patient has really hard and dry stool or if there is only a “stopper”? We use a small dose of Xiao Cheng Qi tang.

If then gaz is coming out, it means that there is real hard stool and we can use Da Cheng Qi tang.

If there is no gas, it means that there is first a “stopper” of hard stool and then loose stool; we cannot “attack” with Da Cheng Qi Tang otherwise the patient will feel “full” and will not be able to eat. The patient wants to drink water, but when he takes water in the mouth, he cannot swallow it and feels nauseated,

Note: stomach Qi weak.

If there is fever, the stools must be hard and in less quantity: we use Xiao Cheng Qi tang to harmonise.

If there is no gas, we never use Da Cheng Qi Tang.

209. 阳明病, 潮热、大便微硬者, 可与大承气汤；不硬者, 不可与之. 若不大便六七日, 恐有燥屎, 欲知之法, 少与小承气汤, 汤入腹中, 转失气者, 此有燥屎也, 乃可攻之；若不转失气者, 此但初头硬, 后必溏, 不可攻之, 攻之必胀满不能食也. 欲饮水者, 与水则哕, 其后发热者, 必大便复硬而少也, 以小承气汤和之；不转失气者, 慎不可攻也.

212. Shang han:

Vomiting or diarrhoea were induced by treatment with no recovery; the patient has: constipation for 5-6 days or even more than 10 days, high fever at noon, no sensitivity to cold; he speaks to himself or, if it is more serious, cannot recognise people; has uncontrolled movements of the hands, staring eyes, nervousness, mild asthma. If the pulse is like a string, the patient will live. If the pulse is rough, he will die. If the pulse is weak, the patient speaks to himself and has fever, we use Da Cheng Qi Tang. If after one dose the bowels open, stop the treatment.

212. 伤寒若吐、若下后不解, 不大便五六日, 上至十余日, 日晡所发潮热, 不恶寒, 独语如见鬼状；若剧者, 发则不识人, 循衣摸床, 惕而不安, 微喘直视, 脉弦者生, 涩者死. 微者, 但发热谵语者, 大承气汤主之. 若一服利, 则止后服.

213. Yang Ming Bing:

Sweating a lot, “JinYe” outside, Stomach dry, stool hard, the patient speaks to himself: use Xiao Cheng Qi Tang. If after one dose, the patient stops speaking to himself, do not take more.

213. 阳明病, 其人多汗, 以津液外出, 胃中燥, 大便必硬, 硬则谵语, 小承气汤主之. 若一服谵语止者, 更莫复服.

214. Yang Ming Bing:

The patient speaks to himself, has stable fever, the pulse is smooth and fast, use Xiao Cheng Qi Tang. If after one dose there is movement in the abdomen and gaz, take another dose. If there is no movement do not take another dose.

If the second day there is still constipation, the pulse is weak and rough, it means that there is deficiency in the middle; it is difficult to treat, do not use Cheng Qi Tang.

214. 阳明病, 谵语、发潮热、脉滑而疾者, 小承气汤主之. 因与承气汤一升, 腹中转气者, 更服一升；若不转气者, 勿更与之. 明日又不大便, 脉反微涩者, 里虚也, 为难治, 不可更与承气汤也.

219. Tai Yang, Yang Ming, Shao Yang he Bing:

(3 levels all suffered).

Fullness of abdomen, the body feels heavy, the patient cannot turn right or left, no taste in the mouth, the face looks dirty, the patient speaks to himself, cannot control urination.

If “fa han” (wrong treatment), the condition will become worse, the patient will speak to himself.

If “xia”, the forehead will be sweating but the hands and feet will become cold.

If sweating spontaneously, we use Bai Hu Tang: Shigao 30, Zhimu 18, Gancao 6, Jing Mi 30.

219. 三阳合病, 腹满、身重, 难以转侧, 口不仁、面垢 (又作枯, 一云向经)谵语、遗尿. 发汗, 则谵语；下之, 则额上生汗、手足逆冷；若自汗出者, 白虎汤主之. 方九. 知母(六两) 石膏(碎, 一斤) 甘草(炙, 二两) 粳米(六合)

Note: The condition belongs to Yang Ming Qi level: we do not use sweating, and we do not use Da Cheng Qi.

220. Er Yang Bing Bing (Tai yang and Yang Ming).

Tai Yang stage is over but there is fever, sweating of the hands and feet, constipation, and the patient speaks to himself: we use Da Cheng Qi Tang.

220. 二阳并病, 太阳证罢, 但发潮热, 手足漐漐汗出、大便难而谵语者, 下之则愈, 宜大承气汤.

222. The patient is thirsty, wants to drink water, mouth and tongue are very dry; we use Bai Hu jia Ren Shen 9 Tang. The disease is at Qi level and it looks as if there is not enough energy.

222. 若渴欲饮水, 口干舌燥者, 白虎加人参汤主之. 方十二. 知母(六两) 石膏(碎, 一斤) 甘草(炙, 二两) 粳米(六合) 人参(三两)

223. If the patient has fever, is thirsty and wants to drink, his pulse is floating, urination is difficult; we use Zhuling Tang: Zhuling, Fuling, Zexie, Ejiao (donkey’s skin), Hua Shi. All 3 gr.

223. 若脉浮、发热、渴欲饮水、小便不利者, 猪苓汤主之. 方十三. 猪苓(去皮) 茯苓 泽泻 阿胶 滑石(碎, 各一两)

Note: it opens San Jiao via urination which gathers and regulates Zhong Jiao .

So, we have four ways to treat heat: via the surface; at Xue level with Da Cheng Qi tang; at Qi level with Shi Gao; via urination with Zhuling Tang.

224. Yang Ming Bing:

Sweating a lot, thirsty; The patient cannot take Zhuling Tang as there is lots of sweating inducing fluid loss and a dry Stomach, Zhu ling Tang would increase fluid loss;

224. 阳明病, 汗出多而渴者, 不可与猪苓汤. 以汗多胃中燥, 猪苓汤复利其小便故也.

Note: We use Bai Hu jia Ren Shen Tang.

229. Yang Ming Bing transferred to Shao Yang Bing:

Tidal fever, loose stool, normal urination, fullness in the chest and hypochondria we use Xiao Chai Hu Tang Chaihu 18, Huangqin 9, Renshen 9, Banxia 9, Gancao 9, Shengjiang 9, Dazao 12 pcs.

229. 阳明病, 发潮热、大便溏、小便自可、胸胁满不去者, 与小柴胡汤. 方十六. 柴胡(半斤) 黄芩(三两) 人参(三两) 半夏(洗, 半升) 甘草(炙, 三两) 生姜(切, 三两) 大枣(擘, 十二枚)

230. Yang Ming Bing:

Fullness and hard feeling in hypochondria, constipation, vomiting, whitish tongue coating (cold or weak): we use Xiao Chai Hu tang.

The effect of Xiao Chai Hu Tang, will be: “Shang Jiao De Tong” = Shang Jiao open; “Jing Ye De Xia”= fluids go down; “Wei Qi Yin He”= stomach Qi thus harmonised; “Shen Ji ran Han Chu”= the body soft and sweating will release Bing Ji.

230. 阳明病, 胁下硬满, 不大便而呕, 舌上白苔者, 可与小柴胡汤. 上焦得通, 津液得下, 胃气因和, 身濈然汗出而解.

Note: the whitish coating makes the difference between Da Cheng Qi tang and Xiao Chai Hu. In case of stomach excess, the tongue will be either red with no coating or there will be yellowish coating dry and irregular, sometimes more concentrated on some part of the tongue: we, then, use Da Cheng Qi.

251. The patient has been uncomfortable for 2-3 days; there is no “Tai Yang” or “Shao Yang” symptoms, the pulse is weak, the patient is nervous and has a feeling of something hard in the epigastria;

On the 4th-5th day, he can eat a little: we can give him a small dose of Xiao Cheng Qi Tang to calm him down and clarify the disease.

On the 6th day, he can take Xiao Cheng Qi Tang.

If on the 6th and 7th day there is still constipation, not enough urination, the patient cannot eat, stool is first hard then loose, we cannot use Da Cheng Qi Tang which would induce loose stool. Only if urination is normal and stool is hard we can use Da Cheng Qi Tang.

251. 得病二三日, 脉弱, 无太阳柴胡证, 烦躁、心下硬；至四五日, 虽能食, 以小承气汤, 少少与, 微和之, 令小安；至六日, 与承气汤一升. 若不大便六七日, 小便少者, 虽不受食, 但初头硬, 后必溏, 未定成硬, 攻之必溏；须小便利, 屎定硬, 乃可攻之, 宜大承气汤.

Note: This is a good example to learn how to “catch ji”.

Third Section: Shao Yang:

263. Characteristics: bitter taste in mouth, dry throat, dizziness

263. 少阳之为病, 口苦、咽干、目眩也.

264. Shao Yang, catch cold:

The patient is suffering from: hearing impairement, reddish eyes, fullness of the chest, and is feeling nervous.

We cannot induce vomiting or diarrhoea, as it might give palpitations and make the patient “startle” easily.

264. 少阳中风, 两耳无所闻、目赤、胸中满而烦者, 不可吐下, 吐下则悸而惊.

Note: the symptoms seem to be in the channels.

96. Shang han 5-6 days, zhong feng (wind):

Cold and fever come and go; fullness in the chest and hypochondria;

Plus: no appetite, unexplained discomfort in the heart, vomiting easily

Or: chest uncomfortable but no vomiting

Or: over thirsty

Or: abdominal pain

Or: hard feeling in both sides

Or: palpitations in epigastria and difficult urination

Or: Slight fever and no thirst

Or: cough

We use Xiao Chai Hu tang: Chaihu 18, Huangqin 9, Renshen 9, Banxia 9, Gancao 9, Shengjiang 9, Dazao 12pcs.

96. 伤寒五六日中风, 往来寒热, 胸胁苦满、嘿嘿不欲饮食、心烦喜呕, 或胸中烦而不呕, 或渴, 或腹中痛, 或胁下痞硬, 或心下悸、小便不利, 或不渴、身有微热, 或咳者, 小柴胡汤主之. 方四十八. 柴胡(半斤) 黄芩(三两) 人参(三两) 半夏(洗, 半升) 甘草(炙) 生姜(切, 各三两) 大枣(擘, 十二枚)

97. If blood is weak, Qi is exhausted, skin and muscles are open, evils can penetrate the body.

Evil fights with Zhen Qi blocked in the hypochondria: this will induce fullness in both sides; when evil and Zhen Qi fight, cold and fever alternate following a specific cycle (which depends on the time when Zhen Qi is up to the surface or down inside the body); there is no appetite; The Qi Ji of Zang and Fu is blocked so the pain will be in the abdomen.

97 血弱、气尽, 腠理开, 邪气因入, 与正气相搏, 结于胁下. 正邪分争, 往来寒热, 休作有时, 嘿嘿不欲饮食, 脏腑相连, 其痛必下, 邪高痛下, 故使呕也, 小柴胡汤主之.

Note: When there is cold on the surface, but a blockage inside, there is vomiting (Ji upwards).

103. Tai Yang Bing: after more than ten days, the doctor induces “xia” two or three times. 4-5 days after the treatment, if there is a “Shao Yang” condition, we can use Xiao Chai Hu Tang; if the vomiting does not stop and there is a feeling of emptiness in the epigastria with nervousness, the middle is blocked. We use Da Chai Hu Tang: Xiao Chai Hu without Renshen and Gancao, plus Zhishi 9 and Dahuang 6.

Note: Xiao Chai Hu works well at Qi level; Da Chai Hu works at Qi level and opens blockages in the middle; Da Chai Hu + Shigao is very good to treat fever, nowadays, especially for children who eat too much.

103. 太阳病, 过经十余日, 反二、三下之. 后四、五日, 柴胡证仍在者, 先与小柴胡. 呕不止、心下急、郁郁微烦者, 为未解也, 与大柴胡汤下之则愈. 方五十三. 柴胡(半斤) 黄芩(三两) 芍药(三两) 半夏(洗, 半升) 生姜(切, 五两) 枳实(炙, 四枚) 大枣(擘, 十二枚)……加大黄二两.

267. If a patient had induced vomiting, “xia”, “fa han”, moxa treatment, and is, then, speaking to himself, this is not a “Chai Hu” condition (or “shao Yang condition). It is an abnormal condition (huai bing).

“Zhi fan he ni, yi fa zhi zhi”= “watch and understand what kind of abnormal condition it is, follow its principle and treat”

267. 若已吐、下、发汗、温针, 谵语, 柴胡汤证罢, 此为坏病. 知犯何逆, 以法治之.

Notes: A disease at “Shao Yang” level may:

— Either belong to the channels, with symptoms like: bitter taste, vomiting, uncomfortable feelings …

— Or be due to weak blood and Qi allowing the penetration of a pathogenic factor, and inducing a fight which is not strong enough and will block in one place.

The main difference with Tai Yang and Yang Ming levels, is that in the first two levels, Qi Ji is moving the body as an entire unit; in Shao Yang some parts are moving, others are not, and the condition will easily transfer to Tai Yin level.

Fourth section: Tai Yin

273. Characteristics: Fullness in abdomen, vomiting, eating but food stagnation, spontaneous diarrhoea, frequent abdominal pain.

If “xia” treatment is prescribed, there will be hard blockage in the abdomen.

273. 太阴之为病, 腹满而吐, 食不下, 自利益甚, 时腹自痛. 若下之, 必胸下结硬.

277. Tai Yin:

If the patient is suffering from spontaneous diarrhoea due to cold in internal organs, we should warm the interior using a prescription based on “Si Ni Tang”.

277. 自利、不渴者, 属太阴, 以其脏有寒故也, 当温之. 宜服四逆辈.

279. At the beginning it was a “Tai yang” condition, but the doctor prescribed a “xia” treatment;

— If the patient develops frequent abdominal pain with fullness. It has transfered to “Tai Yin”. We use “Gui Zhi jia Shao Yao Tang”. Gui Zhi Tang add Shaoyao 6

Note: This prescription goes down and gathers.

— If the patient suffers from abdominal pain of the shi (excess) type (more painful with pressure), we use Gui Zhi jia Da Huang Tang. Gui Zhi Tang add Shaoyao 6 Dahuang 6

279. 本太阳病, 医反下之, 因尔腹满时痛者, 属太阴也, 桂枝加芍药汤主之；大实痛者, 桂枝加大黄汤主之. 方三. 桂枝加芍药汤方： 桂枝(去皮, 三两) 芍药(六两) 甘草(炙, 二两) 大枣(擘, 十二枚) 生姜(切, 三两) 上五味, 以水七升, 煮取三升, 去滓, 温分三服. 本云桂枝汤, 今加芍药. 桂枝加大黄汤方： 桂枝(去皮, 三两) 大黄(二两) 芍药(六两) 生姜(切, 三两) 甘草(炙, 二两) 大枣(擘, 十二枚) 上六味, 以水七升, 煮取三升, 去滓, 温服一升, 日三服.

280. Tai Yin:

Usually the patient has a weak pulse, frequent loose stools or diarrhoea. If we have to use Shaoyao or Dahuang, we should use small dosages, as, if Stomach Qi is weak, it is easy to move bowels with small dosages.

280. 太阴为病, 脉弱, 其人续自便利, 设当行大黄、芍药者, 宜减之, 以其人胃气弱, 易动故也.

Fifth Section: Shao Yin

281. Characteristics: pulse weak and thin; the patient feels sleepy (Yang is going).

281. 少阴之为病, 脉微细, 但欲寐也.

282. Shao Yin:

The patient has nausea but does not vomit; his heart feels uncomfortable; he is sleepy; after 5-6 days he has diarrhoea and is thirsty. This is Shao Yin. He feels weak and deficient, and wants to drink a lot of water to save himself; if his urine has a clear colour, it is certainly “Shao Yin Bing”: the deficiency in “Xia Jao” and the cold cannot transform water, so the normal yellow colour becomes watery clear.

282. 少阴病, 欲吐不吐, 心烦但欲寐, 五六日自利而渴者, 属少阴也. 虚故引水自救；若小便色白者, 少阴病形悉具；小便白者, 以下焦虚有寒, 不能制水, 故令色白也.

283. The patient’s pulse is stiff in Yin and Yang and he is sweating. It means that Yang is going out; it belongs to Shao Yin. The patient will have a sore throat, diarrhoea and vomiting.

283. 病人脉阴阳俱紧, 反汗出者, 亡阳也. 此属少阴, 法当咽痛而复吐利.

285. Shao Yin Bing:

The pulse is thin, deep and fast: it is an internal problem; there is never sweating.

285. 少阴病, 脉细沉数, 病为在里, 不可发汗.

286. Shao Yin Bing:

The pulse is weak. Do not induce sweating or it will lead to an escape of Yang. If Yang is already deficient, the third position of the pulse, right and left, is weak and rough: do not “xia” (induce diarrhoea).

286. 少阴病, 脉微, 不可发汗, 亡阳故也. 阳已虚, 尺脉弱涩者, 复不可下之.

287. Shao Yin Bing:

The pulse feels like a violin string; after 7-8 days there is spontaneous diarrhoea; if suddenly the pulse becomes weak, hands and feet become warm, the “string feeling” of the pulse disappears, it will recover. Although there might be nervousness and diarrhoea, the patient will recover by himself. Do not treat.

287. 少阴病, 脉紧, 至七八日自下利, 脉暴微, 手足反温, 脉紧反去者, 为欲解也, 虽烦、下利, 必自愈.

Note: cold is blocked inside, so the pulse feels like a violin string. If this abnormal Shao Yin pulse goes back to being weak, it means that the body is rebalancing itself. It is normal, at this level, to have the possibility to recover without treatment.

294. Shao Yin Bing:

The limbs are cold, no sweating. If the doctor induces sweating, it will damage “Xue” level; the patient will bleed from the nose, the mouth or the ears. The upper part of the body is empty, the lower part is cold; it is difficult to treat;

294. 少阴病, 但厥, 无汗, 而强发之, 必动其血. 未知从何道出, 或从口鼻, 或从目出者, 是名下厥上竭, 为难治.

Note: if we use strong sweating, it will destroy Yang even more and we shall not be able to control the bleeding.

295. Shao Yin Bing:

Sensitive to cold, body huddled up with cold, diarrhoea, hand and feet cold: it is difficult to treat.

295. 少阴病, 恶寒、身踡而利、手足逆冷者, 不治.

300. Shao Yin Bing:

Pulse weak, thin, and deep; only wants to lie down in bed, sweating, not nervous (Yang Qi is inside but weak). After 5-6 days, if there is diarrhoea, the patient is nervous, cannot lie down or go to sleep, he will die (Yang Qi cannot gather, and escapes outside).

300. 少阴病, 脉微细沉、但欲卧、汗出不烦、自欲吐, 至五六日自利, 复烦躁不得卧寐者, 死.

296. Shao Yin Bing:

Diarrhoea, vomiting, nervous, cold limbs: the patient will die

296. 少阴病, 吐、利、躁烦、四逆者, 死.

301. At the beginning, the patient is not cold but has a little bit of fever, pulse deep; we use: “Mahuang 6 Fuzi 10 Xixin 6 Tang”.

301. 少阴病始得之, 反发热, 脉沉者, 麻黄细辛附子汤主之. 方一. 麻黄 (去节, 二两) 细辛(二两) 附子(炮, 去皮, 破八片, 一枚)

302. Shao Yin Bing:

2-3 days of Shao Yin Bing. We use “Mahuang 6, Fuzi 10, Gancao 9, Tang” to induce light sweating and clarify the situation, because the patient did not have vomiting or diarrhoea .

302. 少阴病, 得之二三日, 麻黄附子甘草汤微发汗. 以二三日无里证, 故微发汗也. 方二. 麻黄 (去节, 二两) 甘草 (炙, 二两) 附子 (炮, 去皮, 破八片, 一枚)

303. 2-3 days of Shao Yin Bing, the patient feels nervous and cannot sleep. We use Huang Lian E Jiao Tang: Huanglian 4, Huangqin 2, Shaoyao 2, Ejiao 3, egg yolk 2 pcs.

303. 少阴病, 得之二三日以上, 心中烦、不得卧, 黄连阿胶汤主之. 方三. 黄连 (四两) 黄芩 (二两) 芍药 (二两) 鸡子黄(二枚) 阿胶 (一云三挺, 三两)

Note: Yang Qi is going out and we need to gather it back in again. After gathering we can use Si Ni Tang.

304. One or two days of Shao Yin Bing: the mouth is OK, not dry, no bitter taste in mouth; the back is sensitive to cold. We use moxa and Fu Zi Tang: Fuzi 20, Fuling 9, Renshen 9, Baizhu 12, Shaoyao 9.

304. 少阴病, 得之一二日, 口中和, 其背恶寒者, 当灸之, 附子汤主之. 方四. 附子 (炮, 去皮, 破八片, 二枚) 茯苓 (三两) 人参 (二两) 白术 (四两) 芍药 (三两)

306. Diarrhoea with dark blood; we use Tao Hua Tang: Chishizhi (mineral), Ganjiang, Jinmi (rice). We first cook the ingredients together till the rice is cooked; then we add more Chishizi powder before eating it. It has a strong gathering effect.

306. 少阴病, 下利便脓血者, 桃花汤主之. 方六. 赤石脂 (一斤, 一半全用, 一半筛末) 干姜 (一两) 粳米 (一升) 上三味, 以水七升, 煮米令熟, 去滓. 温服七合, 内赤石脂末方寸匕, 日三服.

309. Vomiting, diarrhoea, hands and feet cold, nervous, no control; we use “Wu Zhu Yu tang”: Wuzhuyu 18, Renshen 6, Shengjiang 18, Dazao 12 pieces.

309. 少阴病, 吐利, 手足逆冷, 烦躁欲死者, 吴茱萸汤主之. 方八. 吴茱萸 (一升) 人参 (二两) 生姜 (切, 六两) 大枣 (擘, 十二枚)

Note: Wu Zhu Yu is bitter, pungent, and warm. Renshen and Dazao gather in Qi level. The problem here is that “Qi Ji” goes up and down and is confused; this prescription is more to adjust “Qi Ji” than to warm.

When we treat diarrhoea and vomiting, we have to know if we are at Qi or Xue level. If there is infection (xue level) with fever, heat in the large intestine, smelly bad diarrhoea, we use Huang Qin, Huanglian, Huangbai, Shaoyao. If there is a watery diarrhoea, common in summer, it is similar to loose stools and belong to Tai Yin Bing: Yang Qi is deficient, or Yang Qi cannot circulate; this is clear and easy to treat with “Fu Zi Li Zhong Wan”: Fuzi, Ganjiang, Baizhu, Fuling, Gancao. Or with “Wu Ling San”: Guizhi, Fuling, Zexie, Zhulin, Baizhu. If there is diarrhoea due to dampness, without sweating, do not use “Huo Xiang Zhen Qi tang (which goes 80% up to the surface and 20% down), but use Dahuang, Houpo, Dafupi, Muxiang, Shengcangzhu, to follow the direction of Bing Ji, where the evil should go (down), we can add Fuling, Baizhu to support it.

310. Diarrhoea, sore throat, fullness of the chest, nervous; we use “Zhu Fu Tang”: skin of pig, honey, wheat flour to gather Yin.

310. 少阴病, 下利、咽痛、胸满、心烦, 猪肤汤主之. 方九. 猪肤 (一斤) 上一味, 以水一斗, 煮取五升, 去滓, 加白蜜一升, 白粉五合, 熬香, 和令相得, 温, 分六服.

316. 2-3 days with no clear symptoms but the patient does not recover; then after 4-5 days, the patient has abdominal pain and difficult urination, heavy limbs with pain and diarrhoea (“Shui Qi” = water qi, it is not dampness). There could also be cough, or no difficulty in urination, or diarrhoea, or vomiting.

In any case, we use Zhen Wu Tang: Fuling 9, Shaoyao 9, Baizhu 6, Shengjiang 9, Fuzi 10. And we add Wuweizi, Xixin, Ganjiang if there is cough; we take off Fuling if there is no difficulty in urination; we take off Shaoyao and add Ganjiang if there is diarrhoea; we add Shengjiang and take off Fuzi if there is vomiting.

316. 少阴病, 二三日不已, 至四五日, 腹痛、小便不利, 四肢沉重疼痛, 自下利者, 此为有水气. 其人或咳, 或小便利, 或下利, 或呕者, 真武汤主之. 方十五. 茯苓(三两) 芍药(三两) 白术(二两) 生姜(切, 三两) 附子(炮, 去皮, 破八片, 一枚) 上五味, 以水八升, 煮取三升, 去滓. 温服七合, 日三服. 若咳者, 加五味子半升, 细辛一两, 干姜一两；若小便利者, 去茯苓；若下利者, 去芍药, 加干姜二两；若呕者, 去附子, 加生姜, 足前为半斤.

Note: The prescriptions to adjust water metabolism are:

— Wu Ling San working at Yang level

— Zhen Wu tang: Fuzi, Shaoyao, working at Yin level

— Zhu Lin Tang: Ejiao, Huashi, Zhuling, Fuling, Zexie; also working at middle level.

If we go back to 71, we used “Wu Ling San”: Guizhi, Fuling, Zexie, Zhuling, Baizhu, as a powder form. Symptoms and signs meant that too much sweating lead Yang Qi to escape, and created a temporarily Yang Qi xu. Water metabolism needed to be harmonised and Wu Ling San (powder) acts very fast to open and diffuse water metabolism (Shang Jiao, Yang level).

But if we have real Yang Qi xu, present for a long time with water metabolism not moving well, we use “Zhen Wu tang”: Fuzi and Shaoyao working at Shao Yin level.

318. Shao Yin Bing:

Hands and feet are cold and there is cough, palpitations or difficult urination, abdominal pain or diarrhoea and a feeling of heavy intestine wearing down, we use; Si Ni San: Gancao, Zhishi, Chaihu, Shaoyao, same dosage into powder, 6 gr each time.

318. 少阴病, 四逆, 其人或咳、或悸、或小便不利、或腹中痛、或泄利下重者, 四逆散主之. 方十七. 甘草(炙) 枳实(破, 水渍, 炙干) 柴胡 芍药 上四味, 各十分, 捣筛, 白饮和服方寸匕, 日三服.

Note: This is not a direct treatment; it does not belong to Shao Yin but Qi level. In this case, it is not clear if the disease is at Qi or Xue level. At some point, the Shao Yin patient might have the “ji” to be treated at Qi level.

319. Diarrhoea 6-7 days, cough, vomiting, thirsty, nervous, cannot go to sleep. We use Zhu Ling Tang: Zhuling, Fuling, Zexie, Huashi, and Ejiao.

319. 少阴病, 下利六七日, 咳而呕、渴, 心烦、不得眠者, 猪苓汤主之. 方十八. 猪苓(去皮) 茯苓 阿胶 泽泻 滑石(各一两)

Note: This will gather Yin and move middle Qi.

320. Shao Yin Bing:

2-3 days dry mouth, dry throat, we need to quickly “xia” with Da Chen Qi Tang;

320. 少阴病, 得之二三日, 口燥咽干者, 急下之, 宜大承气汤.

Note: we have a “ji” to “xia”. Normally, in Shao Yin Bing we cannot “xia” or “fa han”; it is only when there is “ji” that we can do it.

Sixth Section: Jue Yin

326. Characteristics: the patient is thirsty, drinks a lot but is still thirsty; Qi is going upward, like a “push” in the heart; there is pain and a feeling of heat in the epigastria; hunger but no appetite; if the patient eats he will vomit.

If we use “xia” it will induce diarrhoea non stop.

326. 厥阴之为病, 消渴, 气上撞心, 心中疼热, 饥而不欲食, 食则吐蛔, 下之利不止.

329. If the patient is thirsty and wants to drink, give him water in very small quantities. The condition might recover by itself.

329. 厥阴病, 渴欲饮水者, 少少与之愈.

334. Shang han:

First hand and feet are cold, then fever appears;

If diarrhoea: it will stop by itself;

If sweating, and sore throat: the sore throat will become severe;

If fever, and no sweating: the diarrhoea will stop by itself;

If diarrhoea does not stop, it will be with blood;

If diarrhoea is with blood, the sore throat will not be severe.

334. 伤寒, 先厥后发热, 下利必自止. 而反汗出, 咽中痛者, 其喉为痹. 发热无汗, 而利必自止；若不止, 必便脓血. 便脓血者, 其喉不痹.

Note: in Jue Yin there is cold but also heat in a weak body; the channels are blocked so hand and feet are cold. Jue Yin diseases have pathogenic factors (Xie Qi), when Shao Yin diseases do not always have Xie Qi. San Jiao is blocked so there is no way out.

If there is fever: it means that Yang Qi can go out upwards and diarrhoea will stop.

If there are sweating and sore throat: Yang Qi is out, the sore throat will become worse; we need to gather.

If there is fever and no sweating, it means that Yang Qi has become stronger, so the diarrhoea will stop by itself

If diarrhoea does not stop, it means that the body has no Yang Qi to recover, it will reach a deep level, and the diarrhoea will have blood

If there is diarrhoea with blood, the heat is going downwards, the sore throat will not be severe.

337. In Jue Yin, every case is the result of Yin Qi and Yang Qi not connecting. So the feet and hands are seriously cold. It is called “Jue”.

337. 凡厥者, 阴阳气不相顺接, 便为厥. 厥者, 手足逆冷者是也.

Notes: In Tai yin and Shao Yin, it is clear that there is cold inside but no blockages; in Jue Yin it is blocked: we have both “xu” and “shi”, and it is difficult to treat.

335. Shang han for 1-2 days or 4-5 days:

The patient has Jue (very cold hands and feet), later he will have fever. If he first has fever, later he will have cold hands and feet. If the “Jue” condition is severe, there will be high fever; if the “Jue” condition is mild, the fever will be mild. In “Jue” we should use “xia” if we have a “ji”, like a blockage in the intestines. If we induce wrong sweating, the patient’s mouth will become swollen with blisters.

335. 伤寒一二日至四五日厥者, 必发热；前热者, 后必厥. 厥深者热亦深, 厥微者热亦微. 厥应下之, 而反发汗者, 必口伤烂赤.

Note: Here we have QiJi changing, Yin-Yang, Xu-Shi can transform into each other quickly; the body will recover or die. We have to know how to make the difference between a blockage by excess or by deficiency. The history of the disease will usually tell us; sometimes it is obviously a “shi” condition like in “Yang Ming” diseases.

338. Shang han:

The pulse is weak and “Jue” like (deep and rough); for 7-8 days, the skin has been cold, the patient nervous, he cannot calm down. This is “zang jue” and not “hui jue” (worms). If the patient is “hui jue”, he will vomit worms, it is clear.

Now, the patient has calmed down but is still often nervous: this indicates cold in the Zangs. We use “Wu Mei Wan”: Wumei 300pcs, Xixin 18, Ganjiang 30, Huanglian 48, Danggui 12, Fuzi 18, Shujiao 12, Guizhi 18, Renshen 18, Huangbai 18.

Cooking instructions: put Wumei in vinegar for a whole night to get rid of the bitter taste. Cook Wumei and Jimi together till the rice is cooked; make a “puree” of it, add the uncooked powder of the other ingredients and honey.

338. 伤寒脉微而厥, 至七八日肤冷, 其人躁, 无暂安时者, 此为脏厥, 非蛔厥也. 蛔厥者, 其人当吐蛔. 今病者静, 而复时烦者, 此为脏寒. 蛔上入其膈, 故烦, 须臾复止；得食而呕, 又烦者, 蛔闻食臭出, 其人常自吐蛔. 蛔厥者, 乌梅丸主之. 又主久利. 方一. 乌梅(三百枚) 细辛(六两) 干姜(十两) 黄连(十六两) 当归(四两) 附子(炮, 去皮, 六两) 蜀椒(出汗, 四两) 桂枝(去皮, 六两) 人参(六两) 黄柏(六两) 上十味, 异捣筛, 合治之. 以苦酒渍乌梅一宿, 去核, 蒸之五斗米下, 饭熟捣成泥, 和药令相得. 内臼中, 与蜜杵二千下, 丸如梧桐子大.

Note: this prescription first gathers: Wumei, Fuzi, Renshen, Ganjiang; Xixin, Guizhi Danggui open Yang Qi at Xia Jiao level; Huanglian, Huangbai consolidate (bitter taste) and are not here to treat heat .

The signs of heat are not due to a pathogenic factor but to real Yin deficiency, so Yang goes up and gives a sore throat because the heat produced by the Yin-Yang imbalance cannot go out via the blocked channels. With this prescription, we strongly gather Yang inside and open it. That way it will help Qi move in the channels, treat cold limbs, and reconnect the Yin and Yang channels.

357. Shang han 6-7 days:

Strong “xia” treatment leads hands and feet to become cold (“jue”), and the pulse, at the first position, deep and slow; second and third positions of the pulse cannot be felt; cold limbs, the throat is uncomfortable; the patient is coughing out dirty phlegm with blood from the throat; diarrhoea cannot stop. This is difficult to treat. We use “Ma Huang Sheng Ma Tang”: Mahuang 2 ½ liang, Shengma 1 liang 1fen, Danggui 1 liang 1 fen, Zhimu 18 zhu, Huangqin 18 zhu, Yuzhu 18 zhu, Shaoyao 6 zhu, Tainmendong 6 zhu, Guizhi 6 zhu, Fuling 6 zhu, Zhigancao 6 zhu, Shigao 6 zhu, Baizhu 6 zhu, Ganjiang 6 zhu.

357．伤寒六七日, 大下后, 寸脉沉而迟, 手足厥逆, 下部脉不至, 喉咽不利, 唾脓血, 泄利不止者, 为难治. 麻黄升麻汤主之. 方九. 麻黄 (去节, 二两半) 升麻 (一两一分) 当归(一两一分) 知母 (十八铢) 黄芩 (十八铢) 葳蕤 (一作菖蒲, 十八铢) 芍药 (六铢) 天门冬(去心, 六铢) 桂枝 (去皮, 六铢) 茯苓 (六铢) 甘草 (炙, 六铢) 石膏 (碎, 绵裹, 六铢) 白术 (六铢) 干姜 (六铢)

Note: usually, to stop diarrhoea, we use warm and gathering herbs; but in this case we cannot use them because of the sore throat and the heat, which will get much worse. The upward direction of this prescription will “lift” diarrhoea and stop it, with a high dosage of Mahuang and Shengma. The other herbs will just support the process and “keep”. This formula has a very strong Qi and is good to harmonise Qi.

After taking it, if the sore throat and the diarrhoea stop, we can increase the gathering action.

GLOSSARY

By alphabetical order

BIAO 表: external, peripheral, superficial (compared with Li)

Bing JI 病机 : fight between Zhen Qi and a pathogenic factor

CONDENSE 合: means concentrate Qi or Jing, without adding to it.

CHANG 常: right or normal direction (of Qi ji or Bing Ji)

DU 度: balance

GATHER 收: means get Qi or Xue, Yin or Yang together again, when it has been dispersed.

JI 机: the chance, the opportunity, the right time (to treat or provoke a reaction)

JIN & YE 津液: fluids

JING 精: the Essence, which comes from “pre-Heaven” Qi

JING LUO 经络: channels

LI 里: internal, deep in the body (compared to Biao)

MOVE 行: put into movement or action Qi, Xue, Yin or Yang, when they are stagnant or slow.

NI 逆: wrong or opposite direction (of Qi Ji or Bing Ji)

OPEN 开: addresses an area which is blocked and do not allow free movement anymore: Shang Jiao (or surface), Zhong Jiao, Xia Jiao, Zang-Fu (organs), channels and collaterals, Qi level or Xue level.

QI 气: energy, life principle, subtle and active part of Xue.

QI JI 气机: function of Zhen Qi; allows nutritive and defensive Qi to reach every part and tissues of the body following the main directions (up & down, inside & outside).

SHEN 神: Spirit, comes from Jing and Qi; should be in charge of Zhen Qi and Qi ji for a balance of Yin and Yang.

SHI 势: the direction taken by Qi Ji or Bing Ji when there is a fight between Zhen Qi and Xie Qi.

TONIFY 补: add more Qi or Xue, Yin, Yang, or Jing.

XIANG YING 相应: harmony, coordination

XIE QI 邪气: external pathogenic factor, usually a climatic factor: cold, heat, dryness, humidity, wind, and damp-heat.

XING 形: structure of the body (flesh, muscles, bones, tendons, marrows)

XUE 血:blood

YUAN QI 元气: Yang part of Jing; belongs to “pre-Heaven” Qi; takes part in the transformation of food and air (“post-Heaven” Qi) into Zhen Qi.

ZHEN QI 真气: results from the transformation of food and air (“post-Heaven” Qi) into Qi directly usable by the body; will split in two parts: Wei Qi or defensive energy, and Ying Qi or nutritive energy, and circulates in the channels and collaterals.

INDEX OF THE HERBS

With their Chinese and Latin names, by alphabetical order and with their place in the classification tables

A

Aiye 艾叶: folium artemisiae, Zhong Jiao, open Xue level, and Shang Jiao, deep surface.

B

Baibiandou 白扁豆: semen dolichoris lablab, Zhong Jiao, gather Qi level.

Baiguo 白果: semen gingko bilobae, Zhong Jiao, gather Xue level.

Baihe 百合: Bulbus Lillii, Xia Jiao, gather Yin.

Baimaogen 白茅根: rhizoma imperatae cylindrae, Xia Jiao, open water metabolism.

Bairenshen 白人参: radix ginseng, Xia Jiao, gatherJing.

Baishao 白芍: radix paeoniae lactiflorae, Zhong Jiao, down Xue level.

Baizhi 白芷: radix angelicae, Shang Jiao deep surface.

Baizhu 白术: rhizoma atractylodis macrocephalae, Zhong Jiao, open Qi level.

Bajitian 巴戟天: radix morindae officinalis, Xia Jiao, gather Jing.

Banxia 半夏: rhizome pinelliae ternatae, Shang jiao, deep surface.

Biejia 鳖甲: carapax amydae sinensis, Xia Jiao, open deep Xue level.

Binglang 槟榔: semen arecae cathechu, Zhong Jiao, down, Xue level.

Bohe 薄荷: herba menthae, Shang Jiao pure surface.

Buguzhi 补骨脂: fructus psoraleare corylifoliae, Xia Jiao open the whole body.

C

Cangzhu 苍术: rhizoma atractylodis, Zhong Jiao, open Qi level, and Shang Jiao, deep surface.

Chaihu 柴胡: radix bupleuri chinensis, Zhong Jiao, open Qi level.

Changpu 菖蒲: rhizoma acori graminei, Zhong Jiao, open Qi level.

Chantui 蝉蜕: periostracum cicadae, Shang Jiao, pure surface.

Chenpi 陈皮: pericarpium citri reticulatae, Zhong Jiao, open Qi level.

Cheqiancao 车前草: herba plantaginis, Xia Jiao open water metabolism.

Cheqianzi 车前子: semen plantaginis, Xia Jiao open water metabolism.

Chenxiang 沉香: lignum aquilariae, Xia Jiao, open the whole body.

Chishao 赤芍: radix paeoniae rubra, Zhong Jiao, down, Xue level.

Chuanlianzi 川楝子: fructus meliae toosendan, Zhong Jiao, open Qi level.

Chuanxiong 川穹: radix ligustici wallichii, Zhong Jiao, lift, Xue level.

Cishi 磁石: magnetitum, Xia Jiao, gather Qi.

D

Dafupi 大腹皮: pericarpium arecae catechu, Zhong Jiao, down Qi level.

Daizheshi 代赭石: haematitum, Zhong Jiao, down, Xue level.

Dahuang 大黄: rhizome rhei, Zhong Jiao, down, Xue level.

Danggui 当归: radix angelicae sinensis, Zhong Jiao, open Xue level.

Danshen 丹参: radix salviae miltiorrhizae, Zhong Jiao open Xue level.

Dazao 大枣: fructus zizyphi jujubae, Zhong Jiao, gather Qi level.

Dongchongxiacao 冬虫夏草: cordyceps sinensis, Xia Jiao, open the whole body.

Dongguapi 冬瓜皮: cortex fructus benincasare hispidae, Xia Jiao open water metabolism.

E

Ejiao 阿胶: gelatinum asini, Xia Jiao, open deep Xue level, and Zhong Jiao gather Xue level.

F

Fang feng 防风: radix ladebouriellae sesloidis, Zhong Jiao, lift, Qi level and Shang Jiao pure surface.

Foshou 佛手: fructus citri sarkodactylis, Zhong Jiao, open Qi level.

Fuling 茯苓: sclerotium poriae cocos, Zhong Jiao, gather Qi level.

Fuping 浮萍: herba lemnae seu spirodelae, Shang Jiao deep surface.

Fuxiaomai 浮小麦: radix tritici aestivi Lewis, Zhong Jiao, lift, Qi level.

Fuzi 附子: radix aconi carmichaeli praeparata, Xia Jiao, open the whole body.

G

Gancao 甘草: radix glucyrrhicae uralensis, Zhong Jiao gather Qi level.

Ganjiang 干姜: rhizome zingiberis officinalis, Zhong Jiao, gather Qi level.

Gegen 葛根: radix puerariae, Zhong Jiao, lift, Xue level.

Gouqizi 枸杞子: fructus lycii chinensis, Xia Jiao, gather Jing.

Gualoupi 瓜蒌皮: pericarpium trichosantris, Zhong Jiao, open Xue level.

Guiban 龟板: plastrum testudinis, Xia Jiao, gather Jing.

Guizhi 桂枝: ramulus cinnamomi cassiae, Xia Jiao, open the whole body, Zhong Jiao, open Xue level, and Shang Jiao deep surface.

Guya 谷芽: fructus oryzae sativae germinantus, Zhong Jiao, gather Qi level.

H

Hanliancao 旱莲草: herba eclipsae prostratae, Xia Jiao, gather Yin.

Haizao 海藻: herba sargassii, Xia Jiao, open deep Xue level.

Heshouwu 何首乌: radix polygoni multiflori, Xia Jiao, gather Jing.

Heye 荷叶: folium nelumbinis nuciferae, Zhong Jiao, lift, Qi level.

Hongjingtian 红景天: Xia Jiao, open the whole body.

Hongshen 红参: radix ginseng, Xia Jiao, gather Jing.

Houpu 厚朴: cortex magnoliae officinalis, Zhong Jiao, down, Qi level.

Huafen 花粉: radix trichosentis, Xia Jiao, gather Yin.

Huangbai 黄柏: cortex phelodendri, Zhong Jiao, gather, Xue level.

Huanglian 黄连: rhizome coptidis, Zhong Jiao, gather, Xue level.

Huangqi 黄芪: radix astragali, Zhong Jiao, lift, Qi level.

Huangqin 黄芩: radix scutellariae baicalensis, Shang Jiao deep surface.

Huashi 滑石: talcum, Xia Jiao, open water metabolism.

Huoxiang 藿香: herba agastaches seu pogostemi, Zhong Jiao, lift, Qi level and Shang Jiao pure surface.

Hupo 琥珀: succitum, Xia Jiao, open deep Xue level, and Zhong Jiao, open Xue level.

J

Jiegeng 桔梗: radix platycodi grandiflori, Zhong Jiao, down, Xue level.

Jineijin 鸡内金: endothelium corneum gigeraiae galli, Zhong Jiao, down, Qi level.

Jingjie 荆芥: herba seu flos schizonepetae tenuifoliae, Shang Jiao, deep surface.

Jinyinhua 金银花: flos lonicerae japonicae, Shang Jiao deep surface.

Jingmi 粳米: rice, Zhong Jiao, gather Qi level,.

Jiujun 粳米: prepared Dahuang, Zhong Jiao, down, Xue level.

Juhua 菊花: flos chrysanthemi moriflorii, Shang Jiao, pure surface.

K

Kezi 菊花: fructus terminalae chebulae, Zhong Jiao, gather Qi level.

Kunbu 昆布: thalus algae, Xia Jiao, open deep Xue level.

L

Laifuzi 莱菔子: semen raphani sativi, Zhong Jiao, down, Xue level.

Lianzi 莲子: semen nelumbinis nuciferae, Zhong Jiao, gather Qi level.

Lianqiao 连翘: Fructus forsythiae suspensiae, Shang Jiao, deep surface.

Lizhihe 荔枝核: semen litchi sinensis, Zhong Jiao, down, Qi level.

Longdancao 龙胆草: radix gentianae scabrae, Zhong Jiao, gather Xue level.

Lugen 芦根: rhizoma fragmitis communis, Shang Jiao pure surface.

Lujiaojiao 鹿角胶: colla cornu cervi, Xia Jiao, open the whole body.

M

Mahuang 麻黄: herba ephedrae, Shang Jiao pure surface.

Maidong 麦冬: tuber ophiopogonis japonica, Xia Jiao, gather Yin.

Maiya 麦芽: fructus ordei vulgaris germinantus, Zhong Jiao, gather Qi level.

Mangxiao 芒硝: mirabilitum, Xia Jiao, open deep Xue level.

Maziren 麻子仁: semen cannabis sativae, Zhong Jiao, gather Xue level.

Moyao 没药: myrrha, Xia Jiao, open deep Xue level.

Muxiang 木香: radix saussureae seu vladimiriae, Zhong Jiao, open Qi level.

N

Niubangzi 牛蒡子: fructus arctii lapae, Shang Jiao, deep surface.

Niuxi 牛膝: radix achyrantis bidentatae, Xia Jiao, open deep Xue level.

Nuzhenzi 女贞子: fructus ligustri lucidi, Xia Jiao, gather Yin.

P

Peilan 佩兰: herba eupatorii fortunei, Zhong Jiao, open Qi level, and Shang Jiao pure surface.

Pugongying 蒲公英: herba tarxaci mongolici cum radice, Shang Jiao, deep surface.

Puhuang 蒲黄: pollen typhae, Zhong Jiao, open Xue level.

Q

Qianghuo 羌活: rhizoma and radix notopterygii, Shang Jiao, pure surface.

Qinghao 青蒿: herba artemisiae apiaceae, Shang Jiao, pure surface.

Qingpi 青皮: pericarpium citri reticulatae viride, Zhong Jiao, open Qi level.

Quanxie 全蝎: buthus martensi, Xia Jiao, open deep Xue level.

Qumai 瞿麦: herba dianti, Xia Jiao, open water metabolism.

R

Rendongteng 忍冬藤: Shang Jiao, deep surface.

Renshen 人参:radix ginseng, Zhong Jiao, gather Qi level.

Roucongrong 肉苁蓉: herba cistanches, Xia Jiao, gather Jing.

Rougui 肉桂: cortex cinnamomi cassiae, Xai Jiao, open the whole body.

Ruxiang 乳香: gummi olibanum, Xia Jiao, open deep Xue level.

S

Sangbaipi 桑白皮: cortex mori albae radicis, Shang Jiao, deep surface.

Sangjisheng 桑寄生: ramus loranthi seu visci, Xia Jiao, gather Jing.

Sangshen 桑葚: fructus mori albae, Xia Jiao, gather Yin.

Sangye 桑叶: folium mori albae, Shang Jiao, pure surface.

Sanqi 三七: radix pseudoginseng, Zhong Jiao, open Xue level.

Shanyao 山药: radix dioscoreae oppositae, Xia Jiao, gather Jing, and Zhong Jiao, gather Qi level.

Shanzha 山楂: fructus crataegi, Zhong Jiao, gather Qi level.

Shanzhuyu 山茱萸: fructus corni officinalis, Xia jiao, gather Jing.

Sharen 砂仁: fructus seu semen amomi, Zhong Jiao gather Qi level.

Shashen 沙参: radix glehniae littoralis, Xia Jiao, gather Yin.

Shengdi 生地: radix rhemanniae glutinosae, Xia Jiao, gather Yin.

Shengduzhong 生杜仲: cortex eucommiae ulmoidis, Xia Jiao, gather Jing.

Shengjiang 生姜: rhizoma zingiberis officinalis recens, Shang Jiao pure surface.

Shenglonggu 生龙骨: os draconis, Xia Jiao, gather Qi.

Shengma 升麻: rhizoma cimicifugae, Zhong Jiao, lift, Xue level.

Shengmuli 生牡蛎: concha ostreae, Xia Jiao, gather Qi.

Shengshigao 生石膏: gypsum, Shang Jiao, pure surface.

Shihu 石斛: herba dendrobii, Xia Jiao, gather Yin.

Shijueming 石决明: concha haliotidis, Xia Jiao, gather Qi.

Shudihuang 熟地黄: radix rhemanniae, Xia Jiao, gather Jing.

Shuizhi 水蛭: leech, Xia Jiao, open deep Xue level.

Suanzaoren 酸枣仁: semen ziziphi spinosae, Zhong Jiao gather Xue level.

Sugeng 苏梗: ramulus perillae frutescentis, Shang Jiao, pure surface and Zhong Jiao, open the whole body.

Suye 苏叶: folium perillae frutescentis, Zhong Jiao, lift, Qi level and Shang Jiao, pure surface.

Suzi 苏子: fructus perillae frutescentis, Zhong Jiao, gather Xue level.

T

Taoren 桃仁: semen persicae, Xia Jiao, open deep Xue level.

Tiandong 天冬: tuber asparagi cochenchinensis, Xia Jiao, gather Yin.

Tongcao 通草: medulla tetrapanacis papyriferi, Xia Jiao, open water metabolism.

Tusizi 菟丝子: semen cuscutae, Xia Jiao, gather Jing.

W

Weilingxian 威灵仙: radix clemetidis chinensis, Zhong Jiao, down, Qi level.

Wugong 蜈蚣: scolopendra subspinipes centipede, Xai Jiao, open deep Xue level.

Wuweizi 五味子: fructus schizandrae chinensis, Xia Jiao, gather Jing.

Wuzhuyu 吴茱萸: fructus evodiae rutaecarpae, Zhong Jiao gather Xue level.

X

Xiakucao 夏枯草: spica prunellae vulgaris, Zhong Jiao, open Xue level.

Xiangfu 香附: rhizoma cyperi rofundi, Zhong Jiao, open Xue level.

Xiangru 香薷: herba helsholtziae splendentis, Shang Jiao, pure surface.

Xingren 杏仁: semen pruni armeniacae, Shang Jiao, deep surface.

Xixin 细辛: herba asari cum radice, Xia Jiao, open the whole body.

Xiyangshen 西洋参: radix panacis quinquefolii, Zhong Jiao gather Qi level.

Xuanshen 玄参: radix scrophulariae ningponensis, Xia Jiao, gather Yin.

Xueyutan 血余炭: crinis carbonisatus, Zhong Jiao, open Xue level.

Y

Yangqishi 阳起石: actinolitum, Xia Jiao, open deep Xue level.

Yimucao 益母草: herba leonuri heterophylli, Shang Jiao, deep surface.

Yinchen 茵陈: herba artemisiae capillaries, Zhong Jiao, open Xue level.

Yinyanghuo 淫羊藿: herba epimedii, Xia Jiao, open the whole body.

Yiyiren 薏苡仁: semen coicis lacrymal-jobi, Xia Jiao, open water metabolism.

Yuzhu 玉竹: rhizoma polygonati odorati, Xia Jiao, gather Yin.

Z

Zaoxintu 灶心土: terra flava usta, Xia Jiao, gather Qi.

Zexie 泽泻: rhizoma alismatis plantago-aquaticae, Xia Jiao, open water metabolism.

Zhechong 䗪虫: eupolyphagae seu opisthoplatiae, Xia Jiao, open deep Xue level.

Zhenzhumu 珍珠母: margarita, Xia Jiao, gather Qi.

Zhiqiao 枳壳: fructus citri seu ponciri, Zhong Jiao, lift, Qi level.

Zhishi 枳实: fructus citri seu ponciri immaturus, Zhong Jiao, down Xue level.

Zhizi 栀子: fructus gardeniae jasminoidis, Zhong Jiao, open Xue level.

Zhusha 朱砂: cinnabaris, Xia Jiao, gather Qi.

Zhuling 猪苓: sclerotium polypori umbellate, Xia Jiao, open water metabolism.

Zhuru 竹茹: caulis bambusae in taeniis, Zhong Jiao, open Qi level.

Zhuye 竹叶: herba lophatheri gracilis, Shang Jiao, pure surface.

Zibeichi 紫贝齿: Xia Jiao, gather Qi.

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