Abstract: In modern clinical practice, we often encounter many patients with chronic, complex disorders, such as chronic fatigue, multiple sclerosis, lupus, allergies, gynecological disorders, asthma, arthritis and cancer. Many TCM practitioners using the tools of their education find their diagnoses turning out like run-on sentences, lacking any way to create a coherent and consistent diagnosis. Dr. Li Dong-yuan, author of the Pi Wei Lun/ Treatise on the Spleen and Stomach, was an expert in designing elegant diagnosis and treatment strategies utilizing acumoxatherapy, herbal medicine and dietetics. Based on the central prominence of the spleen/stomach, Dr. Li also made use of wu-xing/five phase principles and Chinese calendrical calculation in his diagnosis and treatment plans. In this article, we will discuss the influence of his work on the present day practice of Chinese Medicine.
I was originally trained in a standard TCM style in acupuncture college in the late 70's and early 80's. There were few textbooks available in English, so I supplemented my education as much as possible with such works as Henry Lu's translations of the classical texts . As many practitioners of Chinese medicine have discovered, actual practice of an Eastern medical discipline is both more discerning and complex than anything in the modern TCM textbooks. Rarely will a patient profile be adequately explained by an eight parameters pattern diagnosis (yin/yang, hot/cold, internal/external, vacuity/repletion). Instead, the practitioner will find symptom complexes characterized by combinations of vacuity and excess, yin depletion with damp stasis, blood stasis, heat in the upper jiao and cold in the lower jiao. The eight parameters pattern diagnosis is simple but limited, lacking a sense of interactive dynamics when used without the five phases, six channels, three burners or four levels pattern diagnoses.1 My experience was that trying to fit my patients into the box of the eight parameters, was that a great deal of information about the patient had to be ignored if it did not fit in. Unfortunately, some of that information was essential and held the key to the case.
As my practice developed, many of my patients were seeking help for complex, chronic auto-immune disorders. In the 1980's, chronic fatigue syndrome began to appear, along with lupus and multiple sclerosis. At the time, neither the biomedical or Chinese medical literature available in English translation adequately addressed these conditions. Over time, I learned to look to the classical Chinese medical literature for answers to my clinical problems.
In 1990, I picked up a copy of the Treatise on the Spleen and Stomach by Li Dong-yuan, published by Blue Poppy Press, one of the first titles in their Great Masters series. The first chapter I opened up to was "Diseases in the Different Seasons". I sat down and read the first paragraph:
Although this is a extensive description of a very complex disorder, I immediately recognized the syndrome described in the text as being quite similar to multiple sclerosis, considered to be a modern condition connected with stress and environmental pollution. Until I found this book, I was frustrated in my attempts to find any comprehensive information on multiple sclerosis from either a biomedical or Chinese medical point of view. The few articles on the subject (in the Journal of the American College of Traditional Chinese Medicine) described this condition as a syndrome of the du channel, and favored acupuncture and moxabustion applied to that channel directly. The biomedical literature described the symptom picture, but all treatment was, at best, experimental and symptomatic, and at worst, toxic.
I was inspired by my discovery, after so many years of fruitlessly seeking effective treatment, and began to adapt Dr. Li's methods with many of my patients. I found the emphasis on the spleen/stomach and earth phase in line with my background in macrobiotic philosophy2. Equally impressive were his herbal prescriptions, such as Huang qi ren shen tang/Astragalus and Ginseng Decoction3, quoted above in the text.
This prescription was the first formula I decided to release as part of the Alembic Herbals line, after using it successfully with patients for several years (now called Rejuvenate and Regulate Formula). Alembic Herbals product line was designed to expose practitioners to a series of great prescriptions written by the great Chinese herbal physicians such as Li Dong-yuan. I later added another one of Dr. Li's prescriptions, qing shu yi qi tang/Clear Summerheat and Augment the Qi Decoction (released as Qing Shu Formula). For more in-depth information on these prescriptions, please see the Alembic Herbals handbook. These and the other formulas in the Alembic Herbals, including several more to appear in the months to come, are designed to raise the standards of herbal practice by making such prescriptions available with the information that informs their use.
The essence of Dong-yuan diagnosis
During the Mongol invasion of China, epidemics of influenza, with fever, gastrointestinal distress and respiratory symptoms were endemic in northern cities near the Great Wall. The physicians of the time treated the people with cold, heat clearing prescriptions without benefit. Dr. Li pointed out that with the extreme stress and grief of war, loss of life, impure water, and inadequate food or shelter, that the epidemics were caused by depletion, and that people needed supplementation to overcome the epidemic evils. The main prescription he chose was bu zhong yi qi tang/Supplement the Middle and Augment the Qi Decoction, available from K'an Herb Co. as Arouse Vigor4.
One definition of zheng qi/correct qi as ëthat which distinguishes the self from non-self', similar to the definition given by modern immunologists of the immune system. Li Dong-yuan concentrated primarily on the internal state of a patient, and the dynamic interaction of the zang fu through the five phase relationships. First, he reasoned, the spleen/stomach and original qi had to be supplemented with sweet warm medicinals such as ren shen/rx. ginseng and bai zhu/rx. atractylodes. Interestingly, sweet warm medicinals, according to Chinese medical theory, clear pathogenic heat from the body as well (for example, Wu Ju-tong's Systematic Differentiation of Warm Diseases, mentions gui zhi tang/Cinnamon Twig Decoction to clear surface warm heat conditions). Secondly, Dong-yuan used cool pungent medicinals such as chai hu/rx. bupleurum and sheng ma /rx. cimicifuga to raise clear yang and downbear turbid yin. Thirdly, if necessary, bitter cold medicinals to directly clear heat, such as huang qin/rx. scutellaria baicalensis and huang bai/rx. phellodendron. Finally, add medicinals to treat any other symptoms that are part of the total pattern, such as blood stasis, lung yin vacuity, or turbid dampness.
Often times, what may appear as external pathogenic qi (wind/cold, wind/heat) is actually internal vacuity of the spleen, liver or kidney, causing weak defensive and constructive qi. This can lead to so-called allergic reactions, with sinus, skin, or digestive flareups, along with achiness in the joints. The pulse may be floating, but underneath is weak. To treat such patterns only with surface-relieving ingredients will further weaken the interior and prevent the resolution of the condition.
The concept of yin fire
A central concept of significance in the Spleen/Stomach School is yin huo/yin fire. A combination of poor diet, irregular lifestyle and emotional strain damage the function of the spleen and stomach. Damaged spleen qi fails to raise the clear yang and descend the turbid yin, leading to a buildup of dampness in the lower burner. The clear yang sinks, stagnates, transforming to heat. Depressive heat and emotional agitation stirs up the ming men/ministerial fire, which counterflows upwards causing heat in the upper burner.
This scenario leads to the commonly observed phenomenon of heart fire and lung heat (heat in the upper jiao) concurrent with middle jiao/spleen yang vacuity damp, and cold vacuity with damp heat or blood stasis in the lower jiao, possibly with kidney qi vacuity as well. This pattern is common in gynecological disorders, candidiasis, irritable bowel disorders, and a wide range of autoimmune disorders. It is very common in patients who are on long-term use of medications such as prednisone, antibiotics, or birth control pills. As this pattern progresses, the yuan qi/original qi will be depleted, and can lead to a increasingly complex, deep-seated disorder.
I hope this survey of Li Dong-yuan's work can provide inspiration to develop a framework in which we can treat the paradoxical, knotted symptom patterns of chronic disorders as a totality, rather than attacking isolated symptoms, relieving some and aggravating others. The use of coherent, well-designed prescriptions containing complementary antagonistic ingredients restore equlibrium of yin and yang, strengthen the correct qi and original qi, and disperse pathogens without depleting the strength of the patient. Perhaps the medical philsophy and prescriptions of Li Dong-yuan will help restore health to our chronically diseased patient population.
1. wu xing bian zheng/five phase pattern diagnosis:
studying the interactions of the viscera and channels via the five phases
2. Macrobiotics, the philosophy of health developed by George Ohsawa, was largely inspired by his studies of Chinese medicine. A direct link to Ohsawa was the 18th century Japanese physician, Ekiken Kaibara, who developed many of the dietary principles adapted by macrobiotics and called Dong-yuan's work the ìroyal road of medicine.î Treatise on the Spleen and Stomach places much emphasis on the role of proper diet as the basis of good health, and is clearly a central pillar of dietetics in Chinese medicine.
3. The ingredients of this prescription are:
4. The ingredients of bu zhong yi qi tang
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