Inheriting the fire of Qi Huang, a public account with substance and warmth.
Ai Yu Xiang Tang
Warming Yang, Supplementing Yang, and Unblocking Yang are commonly used methods for treating conditions related to Yang Qi. In practice, due to unclear understanding of their connotations or the properties of corresponding herbal formulas, misuse or confusion of these treatment methods often occurs, leading to inconsistencies in theory, method, formula, and medicine. Here, based on the principles of Traditional Chinese Medicine (TCM), we will analyze and clarify these methods.
Warming Yang
Warming Yang refers to the use of warm and hot properties of herbal formulas to support Yang Qi in treating cold syndromes. The causes of cold syndromes are primarily “excess Yin leads to cold” (from Suwen: Yin Yang Ying Xiang Da Lun) and “Yang deficiency leads to external cold” (from Suwen: Tiao Jing Lun). The basic treatment principles are “warm the cold” (from Suwen: Zhi Zhen Yao Da Lun) and “treat cold with warm herbs” (from Shen Nong Ben Cao Jing). Cold syndromes can be classified into exterior and interior, deficiency and excess. Exterior cold is often caused by external cold, manifesting as cold evil attacking the exterior, such as in the cases of Taiyang cold damage or wind-cold flu. This should be treated with warm acrid herbs, such as Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), Jing Jie (Schizonepeta), and Fang Feng (Siler), with formulas like Ma Huang Tang (Ephedra Decoction) and Jing Fang Bai Du San (Schizonepeta and Siler Powder). If cold enters the meridians, as in cold bi syndrome, the treatment should warm the meridians and disperse cold, using herbs like Gui Zhi, Xi Xin (Asarum), Chuan Wu (Aconite), and Qiang Huo (Notopterygium), with formulas like Dang Gui Si Ni Tang (Tangkuei Decoction for Frigid Extremities) and Wu Tou Tang (Aconite Decoction). Interior cold can be either excess or deficiency; excess is often due to cold evil entering the interior, such as stomach pain from cold evil in the stomach, chest bi from Yin cold stagnation, or abdominal pain from cold obstructing the liver meridian. The treatment should warm Yang and disperse cold, using herbs like Gui Zhi, Xi Xin, Gan Jiang (Dried Ginger), and Gao Liang Jiang (Galanga), with formulas like Liang Fu Wan (Galanga Pill), Li Zhong Tang (Regulate the Middle Decoction), Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes and Garlic Wine Decoction), and Wen Gan Jian (Warm the Liver Decoction). Deficiency cold is due to insufficient Yang Qi, and treatment should focus on warming and supplementing, referring to the section on “Supplementing Yang.”
Supplementing Yang
Supplementing Yang involves using sweet, warm, or salty warm herbs to nourish Yang Qi in treating Yang deficiency syndromes, falling under the category of “supplement the deficient.” Yang deficiency means insufficient Yang Qi (which can be understood as a decrease in quantity or level), often resulting from congenital insufficiency or prolonged illness, and is frequently a further development of Qi deficiency, presenting a state of functional decline. In Western medicine, this can be seen in conditions like heart failure, kidney failure, and hypothyroidism. Since kidney Yang is the source of all Yang in the body, and the Yang Qi of the organs originates from it, supplementing Yang often focuses on warming and supplementing kidney Yang. Yang deficiency manifests differently depending on the involved organs. For example, heart Yang deficiency may present with palpitations, chest tightness, and shortness of breath, especially upon exertion; lung Yang deficiency may show as weak cough and shortness of breath, spontaneous sweating, aversion to wind, and susceptibility to colds; spleen Yang deficiency may present with abdominal distension, especially noticeable in the afternoon, preference for warmth and pressure, poor appetite, and loose stools; kidney Yang deficiency may show as lower back and knee soreness, clear urine, loose stools, impotence, pale tongue with white coating, and weak pulse. However, a common and specific manifestation is the presence of cold limbs and a tendency for symptoms to worsen in cold conditions, on a foundation of Qi deficiency (fatigue and weakness). In certain specific situations, Yang deficiency as a pathological basis may also present the following variations: ①leading to the production of pathological products, such as insufficient movement leading to blood stasis, inability to warm leading to phlegm retention, and water stagnation, which can further lead to other pathological changes, such as water retention affecting the heart and lung, causing palpitations, shortness of breath, swelling, coldness, and cyanosis; phlegm retention can lead to vomiting or dizziness. If excessive sweating damages heart Yang, kidney Yin cold water can ascend and cause the condition of “ben tun” (running piglet syndrome), clinically presenting with initial abdominal pulsation, followed by counterflow Qi rising, anxiety, cold limbs, white greasy tongue, and tight pulse. ②heat due to deficiency, clinically presenting as fever (often low-grade) with a desire for warmth, coldness, fatigue, dizziness, and soreness in the lower back and knees; this is due to spleen and kidney Yang deficiency, with fire not returning to its source; or it may present with pale red cheeks that fluctuate, coldness in the lower limbs, and a pulse that is floating and large or thin and weak, due to deficiency of the lower source and true Yang floating away, resulting in true cold and false heat. ③loss of Yang leading to collapse, where Yang Qi is severely depleted, leading to loss of containment and collapse, clinically presenting with profuse cold sweat, weak breathing, clear diarrhea, cold limbs, and a pulse that is weak and nearly absent; this is a critical condition of Yang loss. Treatment for Yang deficiency should use warming and supplementing methods, with specific medication points: ①use warm herbs, such as Fu Zi (Aconite), Rou Gui (Cinnamon), and Pao Jiang (Processed Ginger) to support Yang Qi, with formulas like Li Zhong Tang (Regulate the Middle Decoction) and Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction). ②use Qi supplementing herbs, such as Huang Qi (Astragalus) and Dang Shen (Codonopsis) to change the basis of Yang deficiency, with formulas like Huang Qi Jian Zhong Tang (Astragalus Middle-Strengthening Decoction) and Bu Yang Huan Wu Tang (Tonifying Yang and Restoring Five Decoction). ③warming and supplementing kidney Yang is the fundamental method to elevate Yang Qi levels, commonly used herbs include Lu Rong (Deer Antler), Yin Yang Huo (Epimedium), Ba Jiao Tian (Morinda), Xian Mao (Curculigo), Du Zhong (Eucommia), Suo Yang (Cynomorium), Rou Cong Rong (Cistanche), and Bu Guo Zhi (Psoralea), with formulas like Si Shen Wan (Four God Pill) and Tu Si Zi Wan (Cuscuta Pill). ④when Yang Qi is weak, and Yin cold is excessive, leading to signs of Yang loss, urgent warming and supplementing should be applied, using formulas like Si Ni Tang (Frigid Extremities Decoction) and Shen Fu Tang (Ginseng and Aconite Decoction). ⑤“Those who are good at supplementing Yang must seek Yang within Yin, so that Yang can receive assistance from Yin, and endless transformation can occur”, as Zhang Jingyue profoundly understood the principle of the interdependence of Yin and Yang, he proposed this insightful observation.
Unblocking Yang
Unblocking Yang involves using warm acrid or hot herbs to treat the obstruction of Yang Qi. Yang Qi is characterized by flow and diffusion, providing warmth. When the body encounters pathological factors such as cold, phlegm, fluids, water, or dampness, Yang Qi can easily be obstructed, making it difficult to flow. If clinical manifestations include chills and fever, body aches, and a tight floating pulse, this is due to wind-cold invasion and cold obstructing Wei Yang; if there is chest pain, severe cold pain, chest tightness, palpitations, and in severe cases, shortness of breath and inability to lie flat, with pale complexion, cold limbs, white tongue coating, and thin pulse, this is often due to insufficient chest Yang, with Yin cold invading, cold congealing Qi stagnation, and obstruction of chest Yang; if clinical manifestations include chest tightness and pain, shortness of breath, excessive phlegm, dizziness, nausea, poor appetite, heavy limbs, and obesity, with greasy tongue coating and slippery pulse, this indicates phlegm turbidity stagnation in the chest, obstructing Yang; if clinical manifestations include epigastric fullness, gurgling sounds in the stomach, vomiting clear phlegm, or water that is immediately vomited, with preference for warmth and aversion to cold, or “back cold like a palm” (from Jin Kui Yao Lue), thirst without desire to drink, dizziness, and loose stools, with white slippery tongue coating and thin and slippery pulse, this indicates overconsumption of cold foods, excessive use of cold herbs, or prolonged illness damaging the spleen, leading to water stagnation obstructing Yang.To treat Yang obstruction, the method should be to unblock Yang. How to unblock Yang? Ye Tian Shi pointed out: “To eliminate turbid Yin, one must urgently unblock Yang.” He also stated: “To unblock Yang, one must use warm acrid herbs.” This means that unblocking Yang must be based on warming Yang. Specifically, unblocking Yang requires identifying the cause of Yang obstruction. Once the cause is removed, Yang Qi will naturally unblock. If due to cold congealing, one should warm and disperse it, using herbs like Gui Zhi, Xie Bai (Garlic Chives), Xi Xin, and Bai Jiu (White Wine), with formulas like Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes and Garlic Chives Wine Decoction) adjusted accordingly; if due to cold obstructing Wei Yang, one should use warm acrid herbs to unblock, using herbs like Ma Huang, Gui Zhi, Jing Jie, and Fang Feng, with formulas like Ma Huang Tang (Ephedra Decoction) and Jing Fang Bai Du San (Schizonepeta and Siler Powder) adjusted accordingly; if due to phlegm obstruction, one should transform phlegm to unblock, using herbs like Gua Lou, Xie Bai, and Ban Xia (Pinellia), with formulas like Gua Lou Xie Bai Ban Xia Tang (Trichosanthes, Garlic Chives, and Pinellia Decoction) adjusted accordingly; if due to cold dampness or fluid stagnation, one should warm and transform it, using herbs like Fu Ling (Poria), Bai Zhu (Atractylodes), Gui Zhi, Ze Xie (Alisma), Ban Xia, Bai Dou Kou (White Cardamom), Hou Po (Magnolia Bark), and Cao Guo (Tsaoko), with formulas like Wei Ling Tang (Stomach Poria Decoction), Ling Gui Zhu Gan Tang (Poria, Cinnamon, and Atractylodes Decoction), and Xiao Ban Xia Tang (Minor Pinellia Decoction). From my clinical experience, Gui Zhi can be used as a general herb for unblocking Yang. In addition to commonly using warm acrid and warming methods to unblock Yang, Ye Tian Shi also proposed methods for unblocking Yang in warm diseases. In his Wen Re Lun, he stated: “In warm diseases, saving Yin is relatively easy, but unblocking Yang is the most difficult… Unblocking Yang does not rely on warming, but on promoting urination.” In this regard, late Qing and early Republic physician Chen Guang Song explained: “Promoting urination allows the dampness in the three jiao to reach the bladder and be eliminated, thus dispelling the dampness and turbid Qi, allowing heat evil to penetrate and Yang Qi to unblock.” Mr. Pu Fu Zhou summarized this as “lightness to unblock Yang.” This is a common variation, but the principle of resolving Yang obstruction remains consistent.
From the above, it can be seen that Warming Yang, Supplementing Yang, and Unblocking Yang each have their own applications, with differences within similarities. Only by thoroughly understanding their meanings can they be appropriately applied.
Summary
Cold syndromes, whether deficiency or excess, should be treated with warming Yang, using primarily warm acrid or hot herbs. However, for excess cold, warming and dispersing is appropriate, while for deficiency cold, warming and supplementing is suitable, and for Yang obstruction, warming and unblocking is necessary.Yang Qi deficiency can be classified into relative and absolute. Absolute refers to Yang Qi deficiency, which involves constitution or internal environment. Relative refers to excessive Yin cold or obstruction of Yang Qi, where the quantity of Yang Qi has not decreased but is hindered in distribution.Both excess and deficiency cold present with aversion to cold. Generally, aversion to cold (lessened by warmth) indicates Yang deficiency, while fear of cold (not lessened by warmth) indicates Yang obstruction. However, it is not easy to distinguish these in clinical practice. I believe that grasping the following points may make it easier to differentiate: cold in normal times indicates Yang deficiency, while cold during illness indicates Yang obstruction; cold throughout the body indicates Yang deficiency, while cold in specific areas indicates Yang obstruction.Warming Yang herbs that are warm or hot focus on supporting or stimulating Yang Qi, which can be seen as external heat, like the heating of a furnace; when present, it warms, and when absent, it cools. Using these can quickly restore Yang Qi and expel Yin cold evil, but prolonged use can easily deplete Yin fluids, so they should only be used temporarily. Zhang Jingyue listed Fu Zi as one of the “Four Essentials of Medicine,” and the fire god school physician Zhu Wei Ju even called Fu Zi “the leader of all medicines,” due to its great heat, intense nature, and distinct personality, which can often quickly stimulate and release Yang Qi when Yin is excessively strong or Yang is excessively weak, just like the sun shining in the sky, dispelling the Yin mist.Supplementing Yang herbs focus on replenishing the source of Yang Qi and restoring its quality and quantity, which can be seen as internal heat. In other words, supplementing Yang means to replenish or synthesize the Yang substances within the body. This is a slow process, but once Yang Qi is restored, it can fundamentally correct the Yang deficiency constitution or change the internal environment of Yang deficiency. It is like a battery charging; once full, it will greatly increase its power. This is as Wang Bing said: “Nourish the source of fire to dispel Yin mist.”Modern research suggests that many Yang substances and neurotransmitters are related; warming Yang herbs primarily promote the release of neurotransmitters for immediate effects, while supplementing Yang herbs mainly synthesize neurotransmitter reserves for gradual release. This may help in understanding the differences between warming Yang and supplementing Yang.This is for clinical reference only; non-professional doctors should not attempt acupuncture or medication.
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Ai Yu Xiang Tang
Copyright Statement：Edited by Yi Dan, Proofread by Feng Tu / Based on publicly available online materialsCopyright belongs to the original author
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