Record | Issue 882, January 20, 2021 Update: Daily simple records on WeChat public account: Jingfang Diary Total word count: 12000 Reading time: 15 minutes
Today is the 882nd day of my diary. I: Li Cheng, Dong Hai, Jin Yi, An Xiang, good evening. Today we discuss the clinical application of warming and supporting Yang.
1. Why is there an increasing number of people with Yang deficiency today? Li Cheng: It is mainly related to modern unhealthy lifestyles, such as staying up late, excessive drinking, air conditioning, cold drinks, lack of sunlight, and misuse of cold medicines, all of which can damage Yang Qi. An Xiang: Overexertion. I: Nowadays, many people overindulge in rich and greasy foods. In my clinic, there are many cases of metabolic diseases, especially among the obese population. Dong Hai: Why is there an increasing number of people with Yang deficiency? Due to unhealthy lifestyles and high stress, the number of sub-healthy individuals is increasing, and among them, Yang deficiency with cold and dampness is predominant. Common causes can be divided into the following points:
1. Congenital insufficiency, weak constitution: If there is congenital insufficiency combined with insufficient postnatal endowment, the body becomes weak and Yang deficient.
2. Insufficient clothing, skin exposed to cold: Spending long periods in low-temperature air-conditioned rooms in summer or wearing thin clothing in winter can lead to the invasion of cold Yin Qi, depleting Yang Qi.
3. Preference for cold foods damages the spleen and stomach: Overindulging in cold fruits and drinks requires the spleen and stomach to constantly mobilize Yang Qi to resolve and balance this cold Qi, which is a significant consumption. In autumn and winter, when external Yin Qi predominates, the organs that were consumed in summer must mobilize more Yang Qi to adapt and balance with the external environment, leading to the gradual appearance of Yang deficiency symptoms.
4. Overwork and staying up late damage fluids and deplete Qi: In today’s society, people often stay up late, disrupting the natural rhythm of Yang Qi’s rise and fall. At night, Yang Qi should be collected and return to its original position. Staying up late prevents Yang Qi from returning, disrupting its flow, and the body must consume more Yang Qi to maintain balance.
5. Excessive use of cold medicines and intravenous treatments can damage Yang Qi: Overuse of intravenous fluids, antibiotics, and heat-clearing detoxifying medicines can harm Yang Qi.
6. Excessive sexual activity damages kidney Yang: Unrestrained sexual activity, frequent fantasies, and excessive consumption of kidney essence lead to kidney essence deficiency. The “Jingyue Quanshu – On the Sources of Deficiency Diseases” states: “Excessive sexual desire often leads to exhaustion.” “Strong essence leads to strong spirit; strong spirit leads to longevity; weak essence leads to weak Qi; weak Qi leads to early death.”
7. Emotional issues, worries, anger, and frustration harm Yin and disturb Yang: When the body experiences long-term negative emotions and repressed psychological states (liver Qi stagnation), Yang Qi must constantly counteract this downward suppressive pressure, and at the same time, Yang Qi is suppressed, leading to irregular rise and fall, thus failing to warm and promote.
8. Improper exercise, excessive sweating, and Yang Qi dispersing outward: Sweating leads to Qi descending; excessive sweating harms Yang. Yang deficiency has a weak ability to retain, and after excessive sweating, Yang Qi disperses outward, worsening the condition.
I: This is closely related to irregular eating habits. Li Cheng: Most people today have Yang deficiency; it is just a matter of how deficient they are. Jin Yi: With the rapid pace of social life, work, and life pressures, staying up late, dietary habits, and climate changes inevitably lead to Yang deficiency. The improper use of medications is a significant reason; when patients have a fever, they are often given large amounts of antibiotics and hormones, and excessive cold medicines lead to significant damage to Yang Qi. Modern air conditioning is also a factor; in summer, Yang Qi is expressed outward, strong externally but weak internally. We should pay attention to protecting Yang Qi. In hot summer environments, the body’s pores open, and when suddenly entering an air-conditioned environment, cold pathogens can invade through the open pores, leading to symptoms such as aversion to cold, fever, headache, dizziness, sore throat, and runny nose. Cold pathogens invading the interior can cause abdominal pain and diarrhea. Therefore, improper use of air conditioning is a significant reason for Yang deficiency. Ancient people lived well without air conditioning. Since air conditioning appeared, cold and dampness frequently invade the body. For example, in hot summer, moving from an air-conditioned room to the outside heat, and then back into an air-conditioned environment repeatedly compresses cold Qi into the body, leading to many Yang deficiency diseases.
Jin Yi: Staying up late, drinking, and using air conditioning are the biggest problems. An Xiang: Can overeating also lead to Yang deficiency? I: Long-term dietary issues are a major problem affecting the middle burner, spleen, and stomach. Dong Hai: I believe the main reason is still related to lifestyle habits. Li Cheng: Therefore, when using medications, even if the patient clearly has heat, we must protect Yang Qi while using heat-clearing medicines. Or after clearing heat, we should support Yang to consolidate. I: @An Xiang, it can damage the spleen and stomach, leading to obesity and dampness. Jin Yi: The master is right; if the spleen and stomach’s ascending and descending functions are impaired, our Yang Qi will also be affected. Li Cheng: Eating too many cold foods. Li Cheng: Merchants advocate eating more fruits. Fruits are also cold foods. An Xiang: @Lin Jiaming, how do Yang deficient people sleep poorly? Li Cheng: It should be in moderation. Dong Hai: Yes, yes, cold and greasy diets, staying up late can all lead to Yang Qi damage. I: @Lin Li Cheng, this is something I didn’t pay attention to before. When we studied classical formulas, how do we conclude after the patient’s symptoms improve? Previously, I thought of using the Four Reversal Method to consolidate. Jin Yi: In the theory of circular motion, our spleen and stomach are the driving force of the axis. If this axis has problems, the wheel will not turn, and if it doesn’t turn, the body will have problems, even death. Dong Hai: @Zhou An, Yang deficiency leads to floating Yang disturbing the heart spirit. I: Now that I have learned, I understand that we must always protect Yang Qi and the spleen and stomach, leaving no hidden pathogens. An Xiang: @Dong Hai TCM, is Yang Qi unable to descend? I: @Lin Li Cheng, yes, especially in children after illness, particularly those with colds and coughs, eating fruits leads to lingering symptoms; even if they seem to improve temporarily, they are prone to relapse. An Xiang: Hmm. I: The root cause is still the spleen and stomach; if spleen Yang is not nourished well, it cannot transform well. Coupled with sudden weather changes, symptoms of deficiency and excess can appear, leading to external pathogens invading the interior. Jin Yi: In hospitals, most outpatient treatments often involve antibiotics and hormones, especially the abuse of cold medicines, such as Qingkailing injection, Yinzhi Huang injection, and Shuanghuanglian injection, all of which harm our Yang Qi. Dong Hai: Yang deficiency leads to Yin excess, blocking Yang externally. Yin and Yang are in conflict; let’s listen to the master’s analysis. I: @Jin Yi, this is also a common cause; we need to pay attention to iatrogenic factors. Dong Hai: Nowadays, many clinical cases, especially in children, fever and colds are not entirely Yang diseases; there are also many cases of Shaoyin and Taiyin. An Xiang: This is indeed a great opportunity for fame @Dong Hai TCM. Dong Hai: Excessive sexual activity is also a major reason, my third disciple. Jin Yi: Some cases are truly unexpected; for a small Qinglong Decoction syndrome, with a fever of 39 degrees, they immediately prescribed Qingkailing. Their concept is that Qingkailing reduces fever, which is truly frightening. Dong Hai: The key is that most of them need to use hormones. Dong Hai: Doctors and parents, in order to see results, have made hormone use a common practice. An Xiang: @Lin Jiaming, I have Yang deficiency and poor sleep; how do you explain this medically? I: Yang deficient people sleep poorly; how do you explain this? Insomnia occurs because Yang does not enter Yin; the rise and fall of Yin and Yang are problematic, and floating Yang rises, so we need to descend it back. On one hand, we need to replenish what is lacking; on the other hand, we need to descend. Zhenwu Decoction, Si Ni Decoction, and Fuzi Lizhong Decoction, along with three stones, cinnamon have a chance. I: The separation of Yin and Yang is also one aspect, as Dong Hai said. Jin Yi: Yang deficient people cannot sleep; my understanding is that Yang does not enter Yin. I: @TCM Mo Jin Yi, insomnia is all about this pathogenesis. An Xiang: @Lin Jiaming, which three stones? Magnetite, dragon bone, and oyster? I: This also requires attention to the entire pathway issue; everyone used to say that the Six Meridians’ disease thinking. I: @Zhou Anxiang, yes, I send it every day; you didn’t pay attention, too busy. Jin Yi: The so-called Yang entering Yin leads to sleep; Yang exiting Yin leads to insomnia. So Yang deficiency can lead to insomnia. I: @TCM Mo Jin Yi, yes. Dong Hai: Yes, the spleen and stomach are the central axis, and the twelve meridians are the wheels. I: @Dong Hai TCM, thinking and applying it in conjunction with the Six Meridians has opened up my thinking. I: Everyone should also pay attention to their bodies; being too busy leads to a lack of exercise. Jin Yi: @Lin Jiaming, Master, you also, for us, you have given too much. Dong Hai: Whether in a fog or clarity, it seems to be understood, but still not grasping the essentials @Lin Jiaming. I: It may also be Yang Qi deficiency, Qi and blood circulation is not smooth, spleen and stomach weakness, and abnormal transformation. I: Movement generates Yang. Jin Yi: Previously, we did not understand supporting Yang; for patients with tumors and those undergoing chemotherapy, Yangming should still focus on clearing Yangming. This is also very frightening. Li Cheng: Based on the Six Meridians’ differentiation, we must pay attention to supporting Yang; this is something I need to focus on in the future. I: Yellow tongue coating, red tip; previously, we thought this was Yangming, neglecting the root cause. Dong Hai: In the past two days, I also noticed this point in the prescriptions sent by the master; the master often uses Si Ni and Si Jun as a base. I: This needs attention for follow-up. I: @Dong Hai TCM, most of the cases seen here are chronic diseases, long-term diseases, and complex critical conditions; I have particularly noticed that the symptoms of the three Yangs are indeed not obvious. Dong Hai: Yellow tongue coating, red tip; previously, we thought this was Yangming, neglecting the root cause. The master, does this also need to check if the tongue quality is enlarged and the pulse condition @Lin Jiaming? Dong Hai: Yes, yes. Jin Yi: In fact, our predecessors also emphasized Yang, for example, our Si Ni generation; in Yangming disease, sweating should not be easily induced. For a tight floating pulse, use Ma Huang Decoction; for a floating and relaxed pulse, use Gui Zhi Decoction. The Ma Huang Decoction syndrome indicates that our Yang Qi is not damaged, so sweating can be induced. I: Yes, listen to today’s recording; the master gave an example: in winter, cow dung is warm inside, but it is indeed rotten. Jin Yi: In fact, our predecessor Zhang Zhongjing also emphasized Yang, for example, our Si Ni generation; in Yangming disease, sweating should not be easily induced. For a tight floating pulse, use Ma Huang Decoction; for a floating and relaxed pulse, use Gui Zhi Decoction. The Ma Huang Decoction syndrome indicates that our Yang Qi is not damaged, so sweating can be induced. I: This so-called heat is fundamentally cold and damp. I: Does anyone have any additional comments on the causes? I: If not, let’s move on to the second topic. I: Question 2: What is the basis for Yang being the master and Yin being the subordinate? (Find it in the classics, such as the Inner Canon, Treatise on Cold Damage, and the Book of Changes.) I: I have heard this more when reading books on supporting Yang. I: Everyone can take a look and share their thoughts. Dong Hai: Previously encountered Jueyin disease, mainly using Wumei Pill syndrome; I used Wumei Pill once recently with the master’s thinking, Si Ni and Si Jun added Wumei and Huanglian, and the follow-up felt the effect was good. I: @Dong Hai TCM, perhaps this patient fundamentally still has cold and dampness in the middle burner. I: Being able to learn and apply immediately is great. An Xiang: @Dong Hai TCM, impressive. Jin Yi: Thank you very much to the master for coming out to study; in fact, the master is also leading us in our studies. Thank you very much to the master for coming out to study with us; the master’s sharing is like being there in person. I: Yang Qi is like the sun and the sky; if it loses its place, it will shorten life and not shine. Jin Yi: The basis for Yang being the master and Yin being the subordinate comes from the Book of Changes, the Inner Canon, and the Treatise on Cold Damage. The concept of Yang being the master and Yin being the subordinate has three basic supports, the most famous and rigid being the “Suwen” stating, “Yang generates, Yin grows; Yang kills, Yin hides,” and the above supporting theoretical core is symmetrically reflected in the “True Transmission of Medical Principles” and “Lectures on Supporting Yang” with two passages: “When Yang moves one inch, Yin moves one inch; when Yang stops for a moment, Yin stops for a moment. Yang is the master of Yin.” “The theory of Yin and Yang exists in the relationship of Yang being the master and Yin being the subordinate; Yang Qi is the driving force of life activities in the body.” In the Inner Canon, we see many places emphasizing Yang Qi, especially in the familiar “Theory of Vital Qi Connecting to Heaven,” which states: “Yang Qi is like the sun and the sky; if it loses its place, it will shorten life and not shine.” Therefore, human life is based on Yang; what sustains life is this Yang Qi. If Yang Qi is not harmed, diseases will naturally not occur; if Yang Qi is harmed, various Yin will arise. The foundation of life lies in establishing fire; the treatment of diseases lies in using fire to eliminate Yin.” This is the theoretical core of the Supporting Yang school, and the core concept is that “Yang is the master, and Yin is the subordinate” in the human body. In TCM, Yin refers to the body, while Yang refers to the energy possessed by the body. A person’s life is a process of Yang Qi decline. If the body loses Yang Qi, it becomes an empty shell and will die; therefore, Yang Qi is crucial for the body. The Yang Qi in the human body is like the sun in the sky; if there is no sun in the sky, there is no life on earth. If a person loses Yang Qi, life will cease. Those with abundant Yang Qi can keep evil Qi outside the body; various difficult and chronic diseases or critical patients are mostly due to weak Yang Qi, allowing various external cold Qi to invade the body. Unhealthy lifestyles and excessive use of cold medicines lead to the depletion of Yang Qi; therefore, protecting Yang Qi is essential for health, which is the essence of Yang being the master and Yin being the subordinate. Dong Hai: Yes, Master, cold and dampness in the middle burner, dampness transforms into heat. I: The Book of Changes also states: “Great is the Qian Yuan, all things are initiated, thus governing heaven; utmost is the Kun Yuan, all things are born, thus following heaven.” Therefore, Kun is governed by Qian, and Qian is the pure Yang hexagram, while Kun is the pure Yin hexagram; thus, Yin is governed by Yang. Li Cheng: Yang being the master and Yin being the subordinate is a viewpoint advocated by the classics, indicating the importance of Yang Qi. The “Suwen – Theory of Vital Qi Connecting to Heaven” states: “Yang Qi is like the sun; if it loses its place, it will shorten life and not shine.” This means that Yang Qi is like the sun, and all things depend on the sun for survival, while the human body relies on Yang Qi for survival. Yang Qi is the driving force for the organs and systems to survive; without Yang Qi, a person will die. The “Huangdi Neijing” as a classic of TCM reflects the ancient physicians’ emphasis on Yang Qi. The thoughts of the “Huangdi Neijing” are also influenced by the “Book of Changes.” The “Book of Changes” proposes the theory of Yin and Yang, superficially stating that Yin and Yang are equally important, but it also states: “Qi is the filling of life; what has form is born from what is formless.” Yang is formless Qi, while Yin is the tangible substance; “what has form is born from what is formless,” indicating that the generation of Yin relies on the promotion of Yang Qi. Everything in the universe is transformed from formless to tangible. Therefore, we can see the importance of Yang Qi! I: @TCM Mo Jin Yi, you have thought a lot and prepared well. I: @Li Cheng, reading from the Inner Canon and the Book of Changes is also a good interpretation. I: In fact, I think there is a saying that summarizes it well. I: All things grow relying on the sun. Jin Yi: @Lin Jiaming, Master, please correct me if I am wrong. Dong Hai: The “Huangdi Neijing” mentions several major relationships in the theory of Yin and Yang, including the opposition and restriction of Yin and Yang, mutual roots and mutual use, growth and decline balance, and mutual transformation, but the balance of Yin and Yang is not an absolute balance; it is a dynamic balance relationship that objectively exists with Yang as the master and Yin as the subordinate. Although the “Huangdi Neijing” pursues “Yin is balanced, Yang is secret,” valuing harmony, it also has a clear view of supporting Yang. For example, “Yang Qi is like the sun and the sky; if it loses its place, it will shorten life and not shine; therefore, the operation of heaven should be bright with sunlight,” emphasizing that Yang Qi is like the sun in the sky; only with continuous operation and shining on the earth can all things survive. The “Suwen – The Great Discussion on Yin and Yang” states: “Yin is internal, Yang is its guardian; Yang is external, Yin is its servant; Yin and Yang are the way of heaven and earth, the framework of all things, the parents of change, the source of life and death, and the abode of the spirit.” Furthermore, the “Suwen – Theory of Vital Qi Connecting to Heaven” states: “In all matters of Yin and Yang, Yang must be solid and secure; if the two are not harmonious, it is like spring without autumn, like winter without summer; thus, harmonizing them is the way of the sage,” emphasizing that Yang Qi, as the foundation of life, must be sealed and guarded, and should not be easily leaked. The “Suwen – Theory of Vital Qi Connecting to Heaven” states: “Yang Qi is like the sun and the sky; if it loses its place, it will shorten life and not shine; therefore, the operation of heaven should be bright with sunlight,” “Yang generates, Yin grows; Yang kills, Yin hides; Yang transforms Qi, Yin forms shape…” From this, we can see the importance of Yang Qi for human life activities. By carefully understanding the thoughts of the “Inner Canon” on the theory of Yin and Yang, it is not difficult to see that there exists a relationship of mutual roots and mutual existence between Yin and Yang, but this relationship is not an absolutely equal relationship; it is an objective reality where Yang is dominant, leading, and initiating, while Yin is subordinate, being led and initiated. Ke Qin in the “Commentary on the Treatise on Cold Damage” states: “Where there is Yang, there is life; where there is no Yang, there is death…” Chinese classical culture advocates the view of Yang being the master and Yin being the subordinate, believing that the growth, aging, illness, and recovery of life are closely related to the rise and fall of Yang Qi. The “Book of Changes – Commentary” states: “Great is the Qian Yuan! All things are initiated, thus governing heaven; utmost is the Kun Yuan, all things are born, thus following heaven,” clearly pointing out that the Qi of Qian Yuan is the root of all things’ growth, manifesting in heaven and forming in the earth; the image is Yang, and the form is Yin, with Yin following Yang. Zheng Qinan’s academic thought is deeply influenced by the theory of the “Book of Changes”; in his “Medical Method Roundabout” and “True Transmission of Medical Principles,” he mentions: “A person lives on a breath of Qi, which is Yang and fire; without this fire, one cannot live,” “Yang is the master of Yin; when Yang Qi flows, Yin Qi does not stagnate; when Yang Qi is insufficient, there is slight stagnation, and hundreds of diseases arise.” I: Why does it not say that all things grow relying on water and soil? I: Implementing this in families, work, and careers, everyone has deep experiences and thoughts about the role of Yang. Dong Hai: If we do not work hard, we do not deserve the master’s efforts. Dong Hai: All things grow relying on the sun @Lin Jiaming. Lin Jiaming [TCM 21 years]: In our daily lives, we are constantly feeling Yin and Yang, living under the guidance of Yin and Yang, under the great way of Yin and Yang, living, exercising, learning, and growing. The entire growth and transformation of life is a process of Yin and Yang conversion, which we mainly understand from life. An Xiang: @Lin Jiaming [TCM 21 years], this is easy to understand. Lin Jiaming [TCM 21 years]: How do we feel Yin and Yang? In the natural way, in the world, we feel Yin and Yang, which is actually a process of conversion of Yin and Yang, just like the four seasons of spring, summer, autumn, and winter, and the day is also divided into four seasons of spring, summer, autumn, and winter, morning is spring, noon is summer, afternoon is autumn, and night is winter; this is also the four seasons of a year. This is the way of Yin and Yang. Lin Jiaming [TCM 21 years]: After feeling the changes of Yin and Yang in daily life, we implement them in life; the great way is simple. Ah Jin Yi: Master, regarding Yang being the master and Yin being the subordinate, I really lack understanding and do not have a clear grasp. Dong Hai: Ke Qin in the “Commentary on the Treatise on Cold Damage” states: “Where there is Yang, there is life; where there is no Yang, there is death…” Chinese classical culture advocates the view of Yang being the master and Yin being the subordinate, believing that the growth, aging, illness, and recovery of life are closely related to the rise and fall of Yang Qi. @TCM Mo Jin Yi. I: @TCM Mo Jin Yi, slowly understand from family life; for example, men need to work harder, take on responsibilities, and earn more money to play the role of Yang; otherwise, Yin will take effect, leading to men feeling more suppressed, and the changes in Yin and Yang will lead to Yang not being in charge. Jin Yi: Master, after you said this, I understand, so all things cannot lack Yang. I: A family, a department, a country are all like this; striving towards Yang, Yang moves, Yang warms, Yang promotes, and Yang creates. I: Does anyone have any questions? Or is there still confusion? You can think about it later in clinical practice. I: Question 3: What are the clinical manifestations and identification of Yang deficiency? Jin Yi: This is also what we refer to in the Six Meridians differentiation of the three Yin diseases. Li Cheng: Yang deficiency presents with symptoms of deficiency and cold, commonly including aversion to cold, cold hands and feet, intolerance to winter, decreased resistance, fear of wind, and susceptibility to colds, pale complexion without luster, soft muscles, or obesity, edema, abdominal pain, fear of cold in the abdomen, inability to eat cold foods, poor appetite, diarrhea, frequent urination, clear urine, and long urination. Cold pain in the waist, worsening with cold. Palpitations, fatigue, pale complexion, enlarged tongue, teeth marks on the edges, pale tongue, and white coating. I: Through symptoms, diet, bowel movements, tongue, and pulse, it should not be difficult to identify. Dong Hai: Yang deficiency symptoms: fatigue, aversion to cold, cold extremities; clear and long urination, frequent urination; thin and loose stools, undigested food; weakness in the waist and knees, sweating with movement; decreased libido, impotence, premature ejaculation; pale, enlarged, tender tongue, white and moist coating, and weak, fine pulse. Jin Yi: The opposite of Yang deficiency is what we call Yin syndrome, where the body’s functions are depressed, which corresponds to all the feminine, decaying, static, internal guarding, descending, heavy, turbid, cold, tangible, dark, material, condensing, moistening, suppressing, and evil Qi phenomena, such as various chronic patients, tumor patients, and those after radiotherapy and chemotherapy, whose symptoms often present as cold intolerance, poor spirit, weak pulse, cold knees and joints, cold hands and feet, clear and long urination, loose stools, dysmenorrhea, amenorrhea with reduced menstrual flow, impotence, and premature ejaculation, etc. Dong Hai: The symptoms of Yang deficiency are clinically easy to diagnose; the difficulty lies in identifying the root cause after Yang deficiency and cold dampness transform into heat. I: @Dong Hai TCM, yes, just as you said, the thinking of mixed cold and heat treatment. An Xiang: It has turned into Jueyin disease, my second disciple. Dong Hai: In the past, it was really hard to understand; without this thinking, after the master taught this supporting Yang, I felt my thinking has opened up a lot in the past two days. I: When we encounter such patients, should we clear heat? How much heat should we clear? I: @An Xiang, Jueyin disease is not that simple. Jin Yi: @Dong Hai TCM, I also feel the same way. I: @Dong Hai TCM, I think this reasoning and method of treatment, the middle burner Taiyin’s rotating power was something I previously overlooked. I: @Dong Hai TCM, it is indeed not just supporting Yang; there is a difference from supporting Yang. Dong Hai: Yes, Master, I have not encountered the master’s academic approach before; the rotating power of the middle burner Taiyin was indeed not considered before. Jin Yi: @Lin Jiaming, we cannot overlook our Six Meridians differentiation. I: Cold and heat are both considered; one is above, and one is below. Simply clearing the upper and warming the lower while neglecting the root cause leads to this thinking. It integrates the Six Meridians. An Xiang: @Lin Jiaming, yes. Dong Hai: The master has spoken clearly. I: @Dong Hai TCM, is it like this? I: I have been thinking about this issue for the past few days. Dong Hai: In the past two days, I have also been considering what the master said about Wumei Pill. I: Where is the root cause? How does it come, and how does it go? I seem to have slowly found the answer in the past few days. Jin Yi: @Dong Hai TCM, the Wumei is for descending the fire. Dong Hai: Perhaps using Si Ni and Si Jun plus Wumei and Huanglian may be better than using Wumei alone. An Xiang: Supporting Yang is added. I: Does anyone have any questions? Let’s speed up a bit. Dong Hai: In the past two days, I had a patient who used this thinking; let’s see the effect. I: Question 4: How to support Yang? What medicines to use to support Yang? What should be noted? Share your experiences and insights. Dong Hai: Acupuncture: Supplementing the Du Meridian to support Yang. The Du Meridian is the sea of Yang, and the Mingmen point is located above it; therefore, for those with congenital Yang deficiency, nourishing the Yang of the Du Meridian can help support the true fire of the kidneys. Chinese medicine: Use warming herbs such as Fuzi (Aconite), Ganjiang (Dried Ginger), Rougui (Cinnamon), and Wuzhuyu (Evodia) to support Yang Qi, with formulas like Si Ni Decoction. Precautions: 1. Patients with Yang heat excess, clinically presenting with red face, delirium, irritability, reduced urination with red color, red tongue with yellow coating, or rapid and strong pulse, pregnant women, and those with Yin deficiency and internal heat should avoid or use cautiously. 2. In terms of compatibility, Fuzi and Wutou should not be used with Banxia, Guolou, Beimu, and Bailian. 3. After taking the medicine, pay attention to asking the patient about their sleep, urination, and activity state; if the patient experiences insomnia, abnormal urination, or agitation, the medicine should be stopped. 4. The boiling time is an important factor affecting the toxicity of Fuzi; it should be boiled for a long time. 5. When using warming herbs, it is advisable to start with a small amount and gradually increase the dosage, stopping when the desired effect is achieved. Li Cheng: The two main methods of supporting Yang are to open Yang and supplement Yang. When Qi movement is obstructed, and evil Qi is stagnant, it can lead to Yang Qi not being distributed, resulting in Yang deficiency symptoms. At this time, unblocking Qi movement, eliminating evil Qi, and promoting Yang Qi is essential. On the other hand, if Yang Qi is deficient, it should be warmed and supplemented. Therefore, supporting Yang medicines include those that open Yang and those that regulate Qi movement and eliminate evil Qi. Supporting Yang medicines include Fuzi, Ganjiang, Rougui, Duzhong, Buzhong, and Roucongrong, etc. Yang deficiency is mainly due to spleen and kidney Yang deficiency, using warming Yang medicines, and it is important to add calming and descending medicines to ensure Yang Qi can descend to the spleen and kidneys, preventing it from floating upward and causing “excess heat” symptoms, such as Longgu (Dragon Bone), Muli (Oyster Shell), Shizhi (Magnetite), Guiban (Tortoise Shell), and Bie Jia (Soft-shelled Turtle). Jin Yi: Supporting Yang, of course, first requires differentiation, which is what we refer to in the Six Meridians differentiation of Yin syndromes, such as Shaoyin, Taiyin, and Jueyin. In Yin syndromes, the body’s functions are depressed, and there is no Yang Qi to promote the body’s functions; thus, treatment must use Yang supplementation and support. Supporting Yang medicines are mostly Fuzi, Ganjiang, and Xianlingpi. Warming Yang, we will all use Fuzi; Fuzi is an indispensable herb for warming and supporting Yang. Fuzi is a toxic herb, and it is precisely because this toxicity is needed to warm Yang; when using Fuzi, one must master the method of preparing Fuzi. Not all diseases require warming Yang in clinical practice. The treatment of diseases generally involves warming the cold and cooling the heat. For example, in Yang syndromes, Yangming heat syndrome is evident, such as in the Da Chengqi Decoction syndrome, Baihu Decoction with Ren Shen, etc. I: Li Cheng, this is well explained. I: Opening Yang, this thinking is good. I: This question, I am still constantly summarizing and thinking about how to extend from the Six Meridians. How to pay attention to the ratio of medicines. Dong Hai: Yesterday, I read a report; supporting Yang involves both warming Yang and opening Yang, as well as descending Yang. Jin Yi: @Lin Jiaming, is descending Yang our Sha Ren (Amomum) and Rougui (Cinnamon)? Dong Hai: The three stones commonly used by the master are @TCM Mo Jin Yi. I: @TCM Mo Jin Yi, the three stones also have a descending effect. I: Previously, I only used them for insomnia and mental issues. I: Now I understand that there is a lot to consider. I: Others have problems; when something goes wrong, I ask every patient in the clinic, and they won’t know. I: Including the common saying of excess heat, taste issues, and unpleasantness. Dong Hai: Master, after you come down, please share your insights and experiences with us! Jin Yi: @Lin Jiaming, I am still quite confused about the issue of using Fuzi. I: This question can be reserved for later clinical thinking and application summary. I: Next time, we can do a special topic; if there are confusions, that would be good. I: Question 5: In daily health care, how should we protect Yang Qi? Jin Yi: In daily life, irregular schedules, excessive fatigue, and overeating cold foods can deplete our Yang Qi, leading to physical weakness and multiple diseases. To protect Yang Qi, maintain Yang Qi, and reduce excessive consumption of Yang Qi, this is essential for health. In daily life, how should we protect Yang Qi? Try to use fewer cold and Yang-damaging Chinese medicines, including antibiotics and hormones; avoid staying up late, and maintain regular daily routines. When a person is ill, it means there is a problem with Yang; Yang Qi is the best medicine for the body, and the primary treatment for diseases is to support Yang. Most modern people have insufficient Yang Qi, and Yang Qi in the body has the ability to resist diseases. So how do we protect Yang? For example, moxibustion, going to bed early and rising early, not being tired of the sun, maintaining sufficient spirit, and avoiding the invasion of wind, cold, and dampness. In daily diet, avoid using cold and Yang-damaging medicines, and appropriately take Yang-replenishing medicines, such as Si Ni Decoction. Dong Hai: @TCM Mo Jin Yi, I tried Fuzi; a few days ago, I boiled 30g of Fuzi and took it for five days. According to the master’s thinking, there was no reaction; the premise is that I feel I have a Taiyin constitution. Jin Yi: The quality of Fuzi taken from the pharmaceutical company is too poor now. An Xiang: @Dong Hai TCM, no way, you are also Taiyin? Jin Yi: The size of my fingernail. Jin Yi: 30 grams is no problem at all. Dong Hai: I feel I am Taiyin. I: @TCM Mo Jin Yi, yes. Dong Hai: Previously, it was only 10-15g. In daily health care, how should we protect Yang Qi? Follow the four seasons for health, maintain regular schedules, and have a balanced diet. 1. Focus on health preservation and prevent diseases: TCM theory states, “Nourish Yang in spring and summer, nourish Yin in autumn and winter;” “Heaven and man correspond,” and humans are in harmony with nature. Following natural laws, strive to achieve “spring growth, summer flourishing, autumn harvest, winter storage,” so that Yang Qi can be maximally preserved. 2. Get appropriate sunlight: In the morning from 9-10 am and in the afternoon from 4-5 pm, expose the back for 15-20 minutes (in winter, the time can be extended appropriately, and in summer, it can be shortened). If there are sunburns or other conditions unsuitable for sunlight, avoid exposure. 3. Soak feet in warm water or massage the Yongquan point: Kidney Yang is the source of Yang Qi in the body, easily damaged and difficult to recover. “The kidney meridian emerges from Yongquan, which is at the sole of the foot.” This point is the first point of the foot Shaoyin kidney meridian, connecting the internal and external meridians of the kidney, so during leisure time, you can massage the Yongquan point. 4. Dress warmly and avoid wind and cold: Regardless of the season, it is essential to pay attention to warmth to avoid damaging Yang Qi. Avoid prioritizing style over warmth; do not expose yourself to wind after exercise or sweating; in hot summer, do not set the air conditioning temperature too low. 5. Dietary moderation: Eat fewer cold and raw foods. Those with Yang deficiency should drink more warm water and eat more warming foods to nourish spleen and stomach Yang Qi. You can usually consume warming foods such as beef and lamb. 6. Moderate exercise: “Movement generates Yang, stillness nourishes Yin.” Choose exercise methods according to individual physical strength and allocate exercise volume reasonably; walking, jogging, doing exercises, swimming, playing ball, etc., are all acceptable. Increase outdoor activities, engage in aerobic exercises, and try to get more sunlight, allowing the body to directly connect with nature. 7. Regulate emotions and be cautious in daily life. The “Huangdi Neijing” states: “Calm and empty, true Qi follows; spirit kept within, where does illness come from?” Look down on fame and fortune, maintain a cheerful mood; daily life should be regular, not arbitrarily disrupting the biological clock, striving for good routines in diet, sleep, and bowel movements. Li Cheng: I also want to try Fuzi; it is essential to be able to buy raw Fuzi. I: Everyone has said quite well. I will explain from another perspective about what can elevate Yang, including speaking well and seeing well. If we use kind words to encourage those around us, this can also elevate Yang. You can inspire others, provide support and trust; this is kind speech. There is a saying: “A kind word warms three winters,” meaning that if we use our warm and encouraging ways to support others, we can also elevate our Yang Qi. If we see well, we get close to nature, enter nature, and exchange our energy with heaven and earth; this is kind vision. When we reduce complaints, resentment, and hatred, we can let Yang truly emerge from our hearts. This is heart Yang, great Yang; this Yang truly arises from our inner selves, filled with joy and happiness. Doing good can also nourish, so we should do our best to help those around us, not in a grand way but in small ways within our capacity. Everyone can be a light in someone else’s eyes. You can also be a light, illuminating others; we should not look down on ourselves or feel inferior, thinking we are worthless; it is not like that. As long as we dare to grow ourselves, we can truly find a way to love ourselves. Li Cheng: In daily health care, how should we protect Yang Qi? 1. Avoid wind and cold; pay attention to warmth when going out; in winter, sleep early, rise late, and get more sunlight. 2. Avoid taking cold and raw items, such as cold medicines and cold teas. 3. Regulate emotions to allow Yang Qi to reach. 4. Regularly consume warming supplements: medicinal dishes (Angelica and Ginger Lamb Soup, Si Ni Decoction), pepper, ginger, leeks, longan, etc. I: Joy elevates Yang; the joy we speak of is a state of life, maintaining a joyful heart, so that when we encounter many things, we can truly face and view them. This kind of joy is a treasure in our lives; this joy does not depend on others, on material things, or on what others give us. When we truly find a way to love ourselves, the joy that flows from our hearts is true joy. If everyone has experienced fasting and light fasting, they can feel this true joy. We say that generating Yang Qi is the best way to change fate; we should feel it with our hearts and do it with our hearts. An Xiang: @Lin Jiaming, too brilliant. Dong Hai: @Lin Jiaming, the master said it very well. An Xiang: @Lin Jiaming, it is a cost-free way to replenish Yang, accompanying us for a lifetime. I: Truly elevating Yang Qi from the depths of the heart is particularly difficult and requires a long process. I: Truly nourishing. Jin Yi: Heart, liver, spleen, lung, and kidney deficiencies are all treated with Si Ni Decoction. I: Tonight’s last topic. I: Question 6: Summarize a case of using warming and supporting Yang to treat a disease. Dong Hai: Summarize a case of using warming and supporting Yang to treat a disease. A 30-year-old male patient. Chief complaint: Gastric distension and pain, headache for more than 10 years, worsening for a week. The patient reports that he has a weak constitution; when exposed to cold, the stomach feels distended and painful, with unformed stools, and when exposed to wind, he experiences headaches, nasal congestion, and clear nasal discharge. He has been using medications for many years with unsatisfactory results. Current symptoms: fatigue, sweating, aversion to wind, nasal congestion, stiff neck, headache, knee joint pain, discomfort in the stomach, distension, pain, belching, sighing, dry mouth and bitter taste upon waking, irritability, poor sleep, and vivid dreams, yellow urine, and loose stools. The tongue is pale and enlarged, with a thin white coating, and the pulse is weak and thin. This case has mixed symptoms; he has used Chaihu, Guizhi, Jiang, Wumei Pill, Huangqi Jianzhong, etc., but the results have not been ideal. Please guide me, Master. The master said: When encountering such complex situations in clinical practice, when we have changed many formulas and sometimes feel helpless, we may ultimately return to the perspective of warming Taiyin. In the future, you will encounter many such complex and difficult diseases; when considering Shaoyang, Yangming, and Jueyin, if the effects are not good, you can go straight to warming Taiyin and provide a thought of supporting Yang and warming Yang. Prescription: Go straight to the point and warm and supplement Taiyin. Poria (selected) 20g, Bai Shao (selected) 15g, Bai Zhu (selected) 20g, Pao Fuzi (first boiled) 15g, Sheng Jiang 15g, Dang Shen (selected) 15g, Zhi Gan Cao (selected) 10g, Gan Jiang (selected) 10g, Gui Zhi (selected) 15g, Sheng Longgu (selected) (first boiled) 45g, Sheng Muli (first boiled) 45g, 7 doses. After taking 7 doses, the patient’s symptoms significantly improved. The above formula was adjusted to increase the amount of Fuzi to 20g and Ganjiang to 15g, and he took another seven doses, with 70-80% of the symptoms disappearing. Previously, I had always been afraid to use Fuzi, Ganjiang, and Xixin, using very small amounts, resulting in many cases not achieving results. Under the master’s guidance, I have gradually developed a great interest in supporting Yang and have become familiar with many aspects. Recently, I have achieved good clinical results using the supporting Yang academic approach. I: A 65-year-old female patient, palpitations, and anxiety for 30 years, worsening for 10 days. The patient reports that for 30 years, she has experienced palpitations, anxiety, shortness of breath, fatigue, and a feeling of impending death. After local treatment, symptoms improved but recurred. Ten days ago, the symptoms reappeared, with palpitations, anxiety, shortness of breath, fatigue, and stiff fingers before sleep, aversion to wind and cold. Due to palpitations, the patient is greatly troubled in life and dares not dance. After sweating, palpitations become more pronounced, with a feeling of suffocation, no dry mouth or bitter taste, no dizziness, loose stools, pale tongue with white greasy coating, and weak pulse. Six Meridians differentiation: Taiyang and Taiyin combined disease, heart Yang deficiency, heart Yang not vibrating, water and phlegm rising to the heart causing palpitations, cold condensing in the meridians causing stiff fingers and aversion to wind and cold as Taiyang surface symptoms. The tongue and pulse reflect the internal deficiency of water and cold condensation. Proposed formula: Gui Zhi Gan Cao Long Gu Mu Li Decoction, Dang Gui Si Ni Decoction. Gui Zhi 15g, Gan Cao 10g, Long Gu 10g (first boiled), Mu Li 10g (first boiled), Dang Gui 20g, Chi Shao 15g, Xixin 6g, Bai Shao 15g, Tong Cao 10g, Poria 15g, and Bai Zhu 12g. Four doses, one dose per day, boiled in water for oral administration. May 23, second diagnosis: The patient reports significant improvement in symptoms, with reduced palpitations and anxiety, aversion to wind and cold has disappeared, and fatigue is self-reported. The tongue is the same as before, and the pulse is weak. Gui Zhi 15g, Gan Cao 10g, Long Gu 10g (three bags first boiled), Mu Li 10g (three bags first boiled), Dang Gui 20g, Chi Shao 15g, Bai Shao 15g, Poria 15g, and Huangqi 30g, Hong Shen 10g (cooked). Three doses, one dose per day, boiled in water for oral administration. May 26, third diagnosis: The patient no longer experiences significant palpitations or anxiety while doing housework, and the stiffness in the fingers has improved. Fatigue has significantly improved, and outdoor activities are no longer restricted. The lips are dark, the tongue is white and slippery, and the pulse is weak and thin. Gui Zhi 15g, Gan Cao 10g, Long Gu 10g (three bags first boiled), Mu Li 10g (three bags first boiled), Dang Gui 20g, Chi Shao 15g, Bai Shao 15g, Poria 15g, Cang Zhu 15g, Huangqi 30g, Gan Jiang 10g, Hong Shen 10g (cooked). Three doses, one dose per day, boiled in water for oral administration. The patient has shown significant improvement through TCM treatment, with palpitations and anxiety caused by heart Yang not vibrating, water and dampness stagnating internally, and some blood stasis but not severe. The entire process focused on tonifying Qi, warming Yang, and transforming dampness, with symptoms improving step by step. Jin Yi: Using Fuzi Lizhong Decoction, Jie Geng Decoction, and Jin Gui Shen Qi Wan to treat a case of recurrent tonsillitis with fever. Xie, male, 33 years old, workshop technician. Initial diagnosis on November 6, 2020. Recurrent sore throat and fever for more than a year. The patient reports that a slight intake of hot food leads to sore throat and fever. Usually, his stools are loose, and he feels cold, has dry mouth with no desire to drink, no bitter taste, and normal appetite. During each episode, he visits clinics and hospitals, where he is given Amoxicillin, cephalosporins, and intravenous fluids, and has taken cold-clearing Chinese medicines such as honeysuckle, forsythia, Huangqin, and Platycodon, but not only did he not improve, but he also worsened, causing great suffering. Current symptoms: good spirit, slightly overweight, sore throat, aversion to cold, lower back pain, dry mouth with no desire to drink, cold abdomen, loose stools, no bitter taste, normal appetite, tonsils appear atrophic with white secretions on the surface, pale red tongue, enlarged tongue with teeth marks, white coating, and weak pulse. Four diagnoses combined: Jueyin disease, cold in the middle, and Yang fire not descending. Treatment should warm the middle and descend Yang. Proposed formula: Lizhong Decoction, Jin Gui Shen Qi Wan, Jie Geng Decoction with Sha Ren, Rougui, and Ba Jitian. Dang Shen 15g, Gan Jiang 15g, Zhi Gan Cao 15g, Bai Zhu 20g, Shu Di Huang 20g, Shan Zhu Yu 20g, Poria 30g, Dan Pi 15g, Gui Zhi 15g, Fuzi 15g, Jie Geng 10g, Ba Jitian 20g, Sha Ren 6g (added later), Rougui 6g (added later). Seven doses, boiled in water for oral administration. November 15, second diagnosis: Sore throat significantly improved, no fever, lower back pain improved, aversion to cold, dry mouth with no desire to drink, loose stools, no bitter taste, normal appetite, tonsils appear atrophic with no secretions, pale red tongue, enlarged tongue with teeth marks, white coating, and weak pulse. Continue with the above formula: Dang Shen 15g, Gan Jiang 15g, Zhi Gan Cao 15g, Bai Zhu 20g, Shu Di Huang 20g, Shan Zhu Yu 20g, Poria 30g, Dan Pi 15g, Gui Zhi 15g, Fuzi 15g, Jie Geng 10g, Ba Jitian 20g, Sha Ren 6g (added later), Rougui 6g (added later). Seven doses, boiled in water for oral administration. November 25, third diagnosis: Sore throat significantly improved, accompanied by poor sleep, no fever, no lower back pain, aversion to cold improved, no dry mouth, loose stools still present, no bitter taste, normal appetite, tonsils appear atrophic with no secretions, pale red tongue, slightly enlarged tongue, no teeth marks, white coating, and weak pulse. Four diagnoses combined: Taiyin disease, treatment should warm the middle, gather, and calm the spirit. Proposed formula: Fuzi Lizhong Decoction, Jie Geng, with Long Gu, Mu Li, and He Shou Wu. Fuzi 20g, Dang Shen 15g, Gan Jiang 15g, Zhi Gan Cao 15g, Jie Geng 15g, Poria 30g, Fu Shen 20g, Long Gu 30g, Mu Li 30g, He Shou Wu 30g. Seven doses, boiled in water for oral administration. After taking the above seven doses, sore throat and fever have not recurred, stools have improved, and lower back pain and fatigue have improved. This is a case of chronic tonsillitis treated with supporting Yang and warming Yang in clinical practice. The patient had a course of more than a year, and after repeated use of antibiotics and cold medicines, which are damaging to Yang Qi, not only did he not improve, but he also worsened. Now, using Six Meridians differentiation, the treatment of warming Yang and supporting Yang has led to no recurrence of sore throat. Dong Hai: Master, what is the specific difference between this supporting Yang and the master’s academic approach? Jin Yi: @Dong Hai TCM, we should understand the essence of Yang being the master and Yin being the subordinate. Li Cheng: Huang, female, 55 years old, initial diagnosis on April 25, 2020, numbness in both upper limbs for 2 years, joint pain in all four limbs for 1 month. Cold body, cold hands and feet, fear of wind, fear of heat, easy sweating, poor appetite, slightly poor sleep, can sleep for 5-6 hours, many dreams, daytime fatigue, weak waist and legs. Weak pulse, dark tongue, white coating. Gui Zhi 25g, Bai Shao 25g, Zhi Gan Cao 10g, Poria 30g, Cang Zhu 15g, Fuzi 20g (first boiled for 30 minutes), Huangqi 40g, Jixueteng 20g, Xixin 6g, Sheng Jiang 4 slices, Da Zao 4 pieces. Four doses, one dose per day, boiled in water for oral administration. Second diagnosis: Upper limb numbness and joint pain improved by about half, normal appetite, sleep normal, tongue and pulse as before. Increase Fuzi to 30g, Jixueteng to 30g, and take 7 doses, one dose per day, boiled in water for oral administration. After follow-up by phone, all symptoms have basically disappeared, and no further medication is needed. Tonight, we will discuss here. Thank you everyone for participating and preparing. Let’s continue to walk this long and distant road together with determination.