Founder’s note: Here is an article in three parts from two third year students in the classical Chinese medicine program at NCNM. They wrote this paper, and the accompanying presentation, as part of their Chinese herbal training. Welcome, Josh Park and Munleen Soni (gradutated 2017!)
In our first post, we discussed the Chinese hopping vampire or Jiangshi and how it differs from it’s Western counterpart, the Nosferatu, in seeking Qi rather than blood.
Perhaps this difference symbolizes a general difference in orientation between two disciplines. Biomedicine focuses on the physical structure and the presence or absence of biochemical markers. Chinese medicine focuses on patterns of the Qi-dynamic in between the physical and energetic anatomy.
Despite the emphasis on energy manipulation, Chinese medicine does make conceptual distinctions between energy and matter, evidenced by the notion of Qi and Blood. Though discussed as two unique entities – the more kinetic and energetic (Qi) versus the more dense and material (Blood), exist on a continuum. To account for this diversity, Chinese medicine employs a wide range of strategies. Certain formulas target the material while others are oriented toward affecting energy or function. Per their differing desires, the Jiangshi and Nosferatu would be treated differently.
The Development of Tonification
Introduced in the first post, the strategy of tonification (Ba Fa) comprises one of the eight major principle treatment patterns in contemporary practice. First developed during the Song dynasty, this approach was brought to its fullest development by Li Dong Yuan of the Jing-Yuan dynasties. He popularized Bu Zhong Yi Qi Tang (Tonify the Middle to Augment the Qi Decoction) for tonifying Qi. This formula exemplifies Li’s emphasis on using sweet and warming herbs to boost the spleen, which became the basis for the Pi Wei Lun current of Chinese medicine. The Pi Wei Lun school focuses on treating through the Earth, emphasizing the role of digestion for health.
A Brief History of Tonification
Earth’s centrality backdrops the current use of tonification. In practice, the physician begins with identifying a region or set of vital substances (either Qi or Blood; Yin or Yang) that are hypofunctioning and require support; a process that often focuses on the abdomen. Common indications for tonification include recovery from chronic illness or the presence of a degenerative disorder. As a result, the patient’s overall state is considered to be weak and unable to contend with or expel pathogenic influences. Therefore supporting that the spleen/stomach and the Middle Jiao’s production of Qi and Blood should lead to improved metabolic and immunologic performance.
Tonifying Formulas – note the prevalence of spleen Qi Xu as an indication!
Classically, tonification was never mentioned alone, but always in conjunction with dispersion. Possibly influenced by trends in modern dietetics, there is a tendency to regard tonics as being universally appropriate. However, in Chinese medicine, tonics are responsible for causing particular shifts. Namely, that of amplifying specific physiological processes. In this respect, tonifying is similar to DNA amplification, i.e., when a particular sequence is transcribed, a resultant set of proteins are generated to perform the intended function.
Each type of Qi represents a unique set of physiological functions within a closed circuit. Therefore, inducing hyperactivity in one area may lead to exhaustion in another area. In effect, symptoms of excess activity may include disruption of homeostasis (e.g., excess fluids) or the development of a susceptible pathogen for each organ that is hyperfunctioning. In cases of preexisting conditions, such as stagnation, this must be addressed before the body can accept tonification. Tonifying indiscriminately will only worsen a situation, similar to revving the engine when a car is stuck in the mud!
With this understanding of tonification in mind, let’s return to our friend, the Jiangshi, and try to determine with tonification (Qi or Blood) is the right strategy for him.
Two Approaches To Blood Deficiency
A brief HPI: Current vampire patient presents with pale complexion, extreme rigidity of all limbs, cold temperature due to post-mortem state. Pulse is not within safe palpating limits, tongue is beyond safe visual inspection.
Assessment: Blood Deficiency
Plan: Tx Blood Tonic Rx
First on our list is Si Wu Tang – the premiere Blood Tonifying formula, comprised of four herbs, divisible into two groups of opposing but equal character. Bai Shao and Shu Di Huang are considered to be ‘Blood in the Blood’ herbs; thick, cloying substances which are primarily nourishing in nature. Paired with two ‘Qi in the Blood’ herbs, Danggui and Chuan Xiong; dynamic substances which are more invigorating and warming in nature.
Breakdown of Si Wu Tang
There is a certain elegant simplicity here, with both groups of herbs balancing each other. In the contemporary practice of Chinese medicine, Si Wu Tang is often taken as a base formula for Blood deficiency which can be modified accordingly, depending on the situation, e.g., if there is heat with irregular periods, add Huang Lian; if there is phlegm and leucorrhea, add Ban Xia and Chen Pi, and so on. The operative idea seems to be that Si Wu Tang replenishes the Blood, and additional herbs will do other things, such as clearing heat or transforming phlegm. Si Wu Tang then is seen as a general ‘tonic’.
Origin of Si Wu Tang
Developed post-classically (most likely in the Song dynasty), it is widely accepted that Si Wu Tang derives from a classical, Han dynasty formula. Specifically, a permutation of Jiao Ai Tang, used to treat post-partum bleeding per the Jing Gui Yao Lue. Jiao Ai Tang includes the same core four ingredients of Si Wu Tang, but adds E Jiao and Ai Ye, as well as Gan Cao to harmonize the action of all the ingredients. E Jiao is included for its hemostatic properties, while Ai Ye warms and moves to prevent the accumulation of stasis. Unlike Si Wu Tang, which is for a general Blood deficiency presentation, Jiao Ai Tang is for a very specific situation, one of post-partum bleeding.
Insofar as Si Wu Tang has become the favored Blood tonifying formula, it represents a development that interprets all cases of Blood deficiency as analogous to cases of physical blood loss, paralleling Li Dong Yuan’s logic to treat a lack of Qi; when blood volume is insufficient resolve by increasing endogenous fluid production. To promote the formation of denser substances, deploy thick, viscous herbs like shu dihuang. This perfectly illustrates the goal of tonification: to increase the quantity of depleted stock.
However, there are other Han-dynasty formulas that treat Blood patterns but apply a more process oriented framework. An example of this would be Danggui Sini Tang, whose indications include a thin pulse “verging on expiry” and reversal cold of the limbs. This also describes a case of Blood deficiency, but the solution isn’t to simply flood the patient with sticky, cloying medicinals. Rather, it is to optimize the flow of Blood by warming the channels and unblocking the vessels. Although this formula contains nourishing herbs like danggui and baishao, the strategy is essentially one of mobilization, rather than tonification. In other words, this case of Blood deficiency should not be understood as a lack of volume, but in terms of poor circulation.
We can see from this comparison that tonification is focused on the most downstream product – fluid production. Increasing the material components of Blood without changing the quality of flow will only yield a limited number of results. A comprehensive approach like that of Danggui Sini Tang would include altering vasotonicity and volume flow rate so that areas lacking Blood will be nourished and areas with inappropriate pooling, fluids will recirculate back to the spleen for ongoing transformation.
Continue to Part 3