Xiao Dou Dou
For those who strive against the current
Treatment Principle One: Balancing Yin and Yang
The so-called balancing of Yin and Yang refers to the principle of reducing excess and supplementing deficiencies in response to the changes in the body’s Yin and Yang. This aims to restore Yin and Yang to a relatively balanced state.
Fundamentally, the occurrence of disease in the human body is a result of the disruption of the coordination and balance between Yin and Yang, leading to excess and deficiency. Therefore, balancing Yin and Yang, “with balance as the goal,” is the fundamental principle of TCM in treating diseases.
(1) Reducing Excess
Reducing excess, also known as reducing excess Yang, refers to the treatment of conditions where either Yin or Yang is excessively strong, using the method of “draining the excess.”
① Suppressing Excess Yang: For conditions of excess heat caused by excessive Yang, one should clear and drain Yang heat, following the principle of “treating heat with cold.”
② Reducing Excess Yin: For conditions of excess cold caused by excessive Yin, one should warm and disperse Yin cold, following the principle of “treating cold with heat.”
Since Yin and Yang are interdependent, “excess Yin leads to Yang disease” and “excess Yang leads to Yin disease.” In cases of excess in one aspect of Yin and Yang, if the opposite aspect is deficient, one should also address the deficiency by supporting Yang or nourishing Yin.
(2) Supplementing Deficiency
Deficiency refers to conditions where Yin or Yang is deficient, and the principle of treatment is to “supplement the deficiency.” Diseases can be classified into Yin deficiency, Yang deficiency, and both Yin and Yang deficiency, each requiring different treatment strategies of nourishing Yin, supplementing Yang, or both.
① Treating Yang disease with Yin, and Yin disease with Yang: Treating Yang disease with Yin is suitable for conditions of Yin deficiency, while treating Yin disease with Yang is suitable for conditions of Yang deficiency. For “Yin deficiency leading to heat,” the principle of “treating Yang disease with Yin” is applied, nourishing Yin to control excessive Yang. For “Yang deficiency leading to cold,” the principle of “treating Yin disease with Yang” is applied, where Yin deficiency is supplemented with Yin and Yang deficiency is supplemented with Yang, aiming for balance.
② Seeking Yin within Yang, and Yang within Yin: According to the theory of interdependence of Yin and Yang, in clinical practice, when treating Yin deficiency, one may appropriately add Yang-supplementing herbs to Yin-nourishing formulas, known as “seeking Yin within Yang.” When treating Yang deficiency, one may appropriately add Yin-nourishing herbs to Yang-supporting formulas, known as “seeking Yang within Yin.” Because Yang is supported by Yin, it can generate boundless transformations, and Yin is elevated by Yang, leading to an inexhaustible source. Therefore, in clinical practice, when treating blood deficiency, blood-supplementing formulas often include Qi-supplementing herbs; when treating Qi deficiency, Qi-supplementing formulas often include blood-supplementing herbs.
③ Interdependence of Yin and Yang, dual supplementation: Since Yin and Yang are interdependent, Yin deficiency can affect Yang, and Yang deficiency can affect Yin, leading to conditions of both Yin and Yang deficiency. Treatment should involve dual supplementation of Yin and Yang. Since Yin and Yang are the overarching principles of differentiation, various pathological changes of diseases can be summarized as imbalances of Yin and Yang. Therefore, broadly speaking, methods such as releasing the exterior, attacking the interior, elevating the clear, descending the turbid, supplementing the deficient, and draining the excess all fall within the scope of adjusting Yin and Yang.
Treatment Principle Two: Harmonizing Qi and Blood
Life is based on Qi and Blood, and all diseases affect Qi and Blood. Therefore, “the key to treating diseases lies in understanding Qi and Blood” (from “Medical Forest Corrections”). Harmonizing Qi and Blood is based on the insufficiency of Qi and Blood and their respective functional abnormalities, as well as the pathological changes of Qi and Blood’s mutual functions, following the principle of “draining the excess and supplementing the deficiency” to ensure smooth Qi and harmonious Blood. This is an important principle in TCM for treating diseases, suitable for conditions of Qi and Blood imbalance.
Qi is Yang, and Blood is Yin. The generation and movement of Qi and Blood depend on the normal physiological activities of the organs and meridians, so harmonizing Qi and Blood must also closely integrate with adjusting Yin and Yang and regulating the organs.
(1) Treatment of Qi Disorders
Traditional Chinese medicine believes that Qi has the functions of warming, transforming, promoting, defending, and holding. Qi’s influence is pervasive; any imbalance can lead to various diseases. The site of Qi imbalance is the root of the disease. Therefore, treatment must focus on adjusting Qi, and there are many methods to adjust Qi. As stated in “Notes on Medical Reading: The Theory of Ascending and Descending”: “If Qi is excessive above, suppress and descend it; if it is trapped below, elevate and lift it; if it is scattered outside, gather and solidify it; if it is blocked inside, flow and disperse it.” Broadly speaking, methods such as warming, cooling, and even massage, acupuncture, and dietary adjustments all belong to the category of Qi adjustment. In summary, the treatment of Qi disorders is as follows: Qi deficiency should be supplemented, Qi stagnation should be relieved, Qi sinking should be elevated, Qi counterflow should be descended, Qi collapse should be solidified, and Qi blockage should be opened.
① Qi deficiency should be supplemented: Qi deficiency refers to the pathological changes of insufficient original Qi, weakened organ function, and reduced resistance to disease. The lungs govern Qi for the entire body, and the spleen is the foundation of postnatal Qi, the source of Qi and Blood generation. Therefore, supplementing Qi primarily involves replenishing the Qi of the spleen and lungs, especially focusing on nurturing the middle Qi. The original essence Qi relies on the physiological function of the kidneys to store essence Qi to fully exert its physiological effects. Therefore, in cases of extreme Qi deficiency, one must also start from supplementing the kidneys.
Qi is the commander of Blood, and Blood is the mother of Qi; the two are interdependent. Therefore, supplementing Qi often combines with supplementing Blood: Qi deficiency is a gradual manifestation of Yang deficiency, and Yang deficiency is the extreme of Qi deficiency. Thus, in cases of extreme Qi deficiency, it should also be used in conjunction with Yang supplementation.
Qi-supplementing herbs can easily cause stagnation; generally, those with internal phlegm-dampness should avoid using them. However, if necessary, Qi supplementation can be combined with phlegm-transforming and damp-dispelling methods. Additionally, if Qi deficiency leads to distension and fullness, the method of “using obstruction to treat obstruction” should also include some Qi-regulating herbs.
② Qi stagnation should be relieved: Qi stagnation refers to the obstruction and lack of smooth flow of Qi. This often results from emotional disturbances, phlegm-damp food accumulation, or blood stasis, affecting the flow of Qi and leading to dysfunction of certain organs and meridians. Therefore, it is said: “When Qi and Blood are harmonious, no diseases arise; when there is stagnation, various diseases occur” (from “Danxi’s Heart Method”). The rise and fall of Qi in the human body are often related to the liver’s role in regulating and dispersing, the lungs’ role in descending and dispersing, the spleen’s role in ascending and clarifying, the stomach’s role in descending and turbid, and the small and large intestines’ roles in separating and transmitting. Therefore, Qi stagnation is often associated with dysfunction of the lungs, liver, spleen, and stomach. The liver governs dispersal; if the liver fails to regulate, Qi stagnates. Thus, diseases of Qi stagnation often begin with liver Qi stagnation.
To treat Qi stagnation, one must regulate and move Qi. The terms “adjusting Qi,” “smoothing Qi,” “regulating Qi,” “benefiting Qi,” and “moving Qi” may differ in name and severity, but they all aim to “smooth Qi and restore balance.”
Since Qi stagnation may occur in the body, organs, due to cold, heat, deficiency, or excess, one should not simply break or move Qi indiscriminately. Treatment should be adjusted according to the cold, heat, deficiency, or excess of the organs and meridians. Use bitter cold to drain heat without harming the stomach, use pungent warmth to regulate Qi without breaking it, use moistening and lubricating without causing dampness, and use dispersing without forcing growth.
Most Qi-regulating herbs are pungent and aromatic; large doses or prolonged use can consume Qi, disperse Qi, and deplete body fluids, so caution is needed for those with Blood deficiency, Yin deficiency, or excessive heat.
③ Qi sinking should be elevated: Qi sinking refers to the pathological change where Qi is unable to rise and instead sinks, losing its ability to hold. This often results from insufficient constitution or prolonged illness leading to weakened organ support and the inability to maintain the integrity of Qi and fluids, causing various symptoms of Qi sinking. To elevate sinking Qi, one should use methods to raise Qi. This method is mainly used for cases of middle Qi sinking, presenting symptoms such as sunken fontanelle, drooping eyelids, prolapse of the rectum, continuous diarrhea, and instability of the Chong and Ren meridians leading to abnormal bleeding, discharge, and fetal movement.
④ Qi counterflow should be descended: Qi counterflow refers to the pathological change where the Qi of the organs rises abnormally. Qi counterflow is commonly seen in the lungs, stomach, and liver. When lung Qi counterflows, it leads to cough and chest tightness; when stomach Qi counterflows, it leads to nausea and belching; when liver Qi counterflows, it leads to headaches, dizziness, and fullness in the chest and flanks, and may even lead to fainting; when kidney Qi (Chong Qi) counterflows, it leads to running piglet syndrome. To treat Qi counterflow, one should descend Qi, as stated: “When Qi counterflows in the organs… one should first smooth the Qi” (from “Complete Book of Jingyue: Blood Disorders”). Descending Qi is also known as smoothing Qi and balancing Qi. Qi counterflow above is primarily due to excess, but there can also be deficiency. The method of descending Qi is suitable for excess conditions and should be used temporarily, not for prolonged treatment. If the counterflow is due to deficiency, one should supplement the deficiency, and Qi will naturally descend; one should not use descending Qi products.
⑤ Qi collapse should be solidified: Qi collapse refers to the weakened internal holding and solidifying function of Qi, leading to the external escape of Qi. This often results from extreme Qi deficiency. Due to severe depletion of Qi, Blood, and body fluids, the functions of the organs decline, and Yin and Yang lose their mutual support, leading to the risk of collapse and danger. There are degrees of collapse, so in clinical practice, there are distinctions between deficiency collapse and sudden collapse. Symptoms such as sweating leading to Yang loss, uncontrollable seminal discharge, persistent diarrhea, loose stools, involuntary urination, and prolonged cough leading to fluid loss all fall under Qi collapse. For deficiency, one should supplement; for leakage, one should solidify. Therefore, in cases of Qi collapse, one should often add astringent herbs to the Qi-supplementing and solidifying formulas to both supplement and astringe. In cases of sudden collapse, solidification and astringency are ineffective; one should supplement Yang and assist Yin to solidify Yang. The astringent method is often used in conjunction with the supplementing method, and should be adjusted according to the cold or heat of the condition.
⑥ Qi blockage should be opened: Qi blockage occurs due to external obstruction from turbid evils or extreme Qi stagnation, leading to sudden fainting. Clinically, it is characterized by sudden loss of consciousness or accompanied by cold limbs. When there is blockage, one should open it; if the clear orifices are blocked, leading to fainting, it is also known as opening the orifices. Opening the orifices can be done with warming or cooling methods. Qi blockage can be classified as deficiency or excess; for excess, the evil has not diminished, and the righteous Qi is weak, so treatment should focus on opening the blockage. For deficiency, it is a case of internal blockage and external escape, and one should supplement Qi and nourish Blood to restore Yang and solidify the escape. One should not simply use pungent and aromatic herbs to open the orifices without distinguishing between deficiency and excess, to avoid the pitfalls of treating deficiency with excess and vice versa.
(2) Treatment of Blood Disorders
Blood is the essence of food and water, originating from the middle burner, produced by the spleen, distributed by the lungs, governed by the heart, stored in the liver, and transformed by the kidneys. It nourishes, moistens, harmonizes the five organs, and maintains normal life activities. Clinically, blood disorders can be classified into Blood deficiency, Blood stasis, bleeding, Blood cold, and Blood heat, each requiring different treatment approaches of supplementation, movement, stopping, or cooling.
① Blood deficiency should be supplemented: Blood deficiency refers to the pathological change of insufficient blood or reduced nourishing function of blood. The heart governs blood, the liver stores blood, the spleen produces and governs blood, and the kidney essence can transform into blood. Therefore, Blood deficiency is closely related to the heart, liver, spleen, and kidneys. Qi is Yang, and Blood is Yin; Qi can generate Blood, and Blood can carry Qi. According to the theory of Yang generating Yin, in severe cases of Blood deficiency, Qi-supplementing herbs are often included in Blood-supplementing formulas to achieve the effect of supplementing Qi and generating Blood. Blood deficiency and Yin deficiency often influence each other, so for Blood deficiency with concurrent Yin deficiency, Yin-nourishing herbs are often added to enhance the effect.
Blood-supplementing herbs are often rich and cloying, which can hinder digestion. Therefore, caution should be exercised in cases of damp stagnation in the middle burner, abdominal distension, reduced appetite, and loose stools. If necessary, they should be used in conjunction with herbs that strengthen the spleen and harmonize the stomach to avoid promoting dampness and harming the spleen, affecting the healthy movement of the spleen and stomach.
② Blood collapse should be solidified: Continuous bleeding, abnormal uterine bleeding, and significant hemorrhage all fall under Blood collapse, which requires astringency to solidify the escape. Anything that escapes is scattered and not collected, so astringent and warming herbs should be used to restrain the loss. When treating Blood collapse, Qi-supplementing herbs should be added to the astringent herbs. In cases of significant blood loss, one should also use methods to solidify the escape and benefit Qi. Qi can move Blood, and Blood can carry Qi; therefore, Blood collapse inevitably leads to Qi collapse, meaning Qi escapes with Blood loss, and in severe cases, both Yin and Yang may be lost.
③ Blood stasis should be moved: Blood stasis refers to the pathological state of slow and unflowing blood. “For blood that is stagnant, it should be resolved” (from “The Yellow Emperor’s Classic of Internal Medicine: The Great Treatise on Yin and Yang”). The principle of resolving stasis is to move it. When using methods to invigorate blood and resolve stasis, the following principles should be noted:
Accurate differentiation: When using methods to invigorate blood and resolve stasis, one must not only correctly grasp the diagnostic indications of blood stasis but also distinguish the location of the disease in the organs, meridians, and the nature of the disease as cold or heat, and whether it is deficient or excessive, to achieve the desired effect. While invigorating blood and resolving stasis is a general principle for treating blood stasis, blood stasis can vary in severity. Therefore, invigorating blood and resolving stasis can be categorized into “harmonizing blood and moving stasis,” “invigorating blood and resolving stasis,” and “breaking blood and expelling stasis.” Generally, one should follow the order of light to heavy, starting with harmonizing blood and moving stasis, then invigorating blood and resolving stasis, and finally breaking blood and expelling stasis. One should not indiscriminately break stasis, as this may lead to quick results but can harm the righteous Qi.
Understanding the properties of herbs: The effects of invigorating blood and resolving stasis are manifested through herbs and formulas with these properties. Therefore, it is essential to understand the characteristics of the herbs. First, treat cold with heat and heat with cold, which is a fundamental principle in TCM. The causes of blood stasis can be classified as cold or heat. “Cold causes blood to congeal into clots,” and “heat causes blood to boil into clots” (from “Medical Forest Corrections”). Therefore, herbs should be selected based on their cold, heat, warm, or cool properties. Second, invigorating blood and resolving stasis herbs not only have the common effects of promoting blood circulation, regulating blood Qi, and removing stagnation but also have additional effects such as moving Qi, nourishing Blood, cooling Blood, stopping bleeding, resolving masses, unblocking collaterals, promoting urination, healing injuries, and treating abscesses. Third, certain invigorating blood and resolving stasis herbs are sensitive to specific diseases or pathological locations. For example, San Leng and E Zhu are effective for resolving masses, while Huang Yao Zi and Liu Ji Nu are effective for treating lumps. For blood stasis in the upper body, Chuan Xiong is used; for the lower body, Niu Xi is used; for blood stasis in the heart, Yu Jin is used; and for blood stasis in the liver, Ze Lan is used. Understanding these properties allows for appropriate selection and formulation of herbs.
Familiarity with combinations: Blood stasis is often caused by multiple factors, so invigorating blood and resolving stasis must be combined with other therapies based on differentiation results to fully exert its effects. Common combinations include regulating Qi, invigorating Qi, supplementing and nourishing Blood, stopping bleeding, cooling blood, warming the meridians, and clearing heat and detoxifying.
④ Blood cold should be warmed: Blood cold refers to the invasion of cold evils into the meridians, leading to obstruction of Qi and Blood flow, or inherent Yang deficiency causing internal cold, resulting in stagnation of Qi and Blood, characterized by cold pain. Warming the meridians and dispersing cold herbs should be used to promote circulation and invigorate Blood.
⑤ Blood heat should be cooled: Blood heat is a pathological change characterized by excessive heat in the organs, forcing heat into the blood, or the invasion of warm evils into the blood, characterized by bleeding and heat symptoms. Heat should be treated with cold; therefore, blood heat is often treated with cooling and blood-stopping herbs. Blood congeals when cold and flows when warm; thus, cooling and blood-stopping herbs should be used judiciously, and excessive doses should be avoided. If bleeding occurs with significant stasis, one should not simply use large doses of cold and cooling blood-stopping herbs; instead, one should combine them with invigorating blood and moving blood herbs to avoid leaving behind stasis. Excessive heat can harm Yin, so in addition to combining cooling and blood-stopping herbs with Yin-nourishing properties, Yin-nourishing herbs can also be added.
⑥ Bleeding should be stopped: Any blood that does not follow the normal path, whether overflowing from the mouth or nose, or discharging from the lower orifices, is referred to as bleeding. Bleeding should be treated with hemostatic methods. Correctly applying hemostatic methods requires attention to the following points:
Distinguishing the causes and nature of bleeding: The causes of bleeding are often related to fire and Qi. “The movement of blood is due to fire and Qi” (from “Complete Book of Jingyue: Blood Disorders”). Qi is the commander of Blood, and Blood follows Qi. Bleeding can occur due to excessive fire causing Qi to counterflow, or cold causing Qi stagnation and blood stasis. There may also be cases of Qi deficiency with cold. However, bleeding is mostly associated with heat. Additionally, internal blood stasis can obstruct the flow of blood, leading to bleeding. The pathogenesis of bleeding is primarily governed by Qi, encompassing cold, heat, deficiency, and excess.
Stopping bleeding must also consider the site of bleeding, as coughing blood, epistaxis, hematemesis, melena, hematuria, and vaginal bleeding not only differ in terms of cold, heat, deficiency, and excess but also involve different organs. Therefore, stopping bleeding must be treated according to differentiation; one should not simply stop bleeding indiscriminately, as the saying goes, “when blood is seen, stop treating blood.” Avoid using large doses of cold and cooling herbs or astringents indiscriminately. Although bleeding is often associated with heat, in the early stages of bleeding, one should avoid using large doses of cooling and blood-stopping herbs, and cold herbs should not be used for prolonged periods to prevent internal stasis, which can harm the spleen’s Yang. If the spleen is damaged, blood will not return to the meridians. It is also crucial to avoid solely using astringent herbs for bleeding, especially in cases of concurrent blood stasis.
Using charcoal for stopping bleeding is an important measure in TCM. It is often said that “red meets black to stop bleeding,” but one should not use charcoal indiscriminately for all bleeding without distinguishing between deficiency and excess, or the cold and heat of the herbs. The general principle for using charcoal to stop bleeding is as follows: for bleeding due to excess heat, bitter cold herbs should be used to directly counteract the fire; once the heat is cleared, the blood will naturally stabilize. For bleeding due to deficiency heat, one should nourish Yin, clear heat, and reduce fire using sweet and cold herbs. Charcoal, being bitter and dry, can harm body fluids, so it should be used cautiously. For bleeding due to deficiency cold, warming herbs should be used, while cold and cooling herbs are not suitable. In cases of mixed cold and heat, or concurrent deficiency and excess, the treatment should balance both cold and heat, and both deficiency and excess, allowing for the use of charcoal for both cold and heat herbs. In clinical practice, the benefits and drawbacks of using charcoal for stopping bleeding must be weighed, and correct usage can reflect the effectiveness of charcoal in stopping bleeding.
(3) Simultaneous Treatment of Qi and Blood
Qi cannot harmonize without Blood, and Blood cannot move without Qi. Qi is Yang, and Blood is Yin; one Yin and one Yang, interdependent. Due to the close relationship between Qi and Blood, they physiologically depend on each other and pathologically influence each other, leading to simultaneous diseases of Qi and Blood. Qi has the functions of warming, generating, promoting, and governing Blood. Qi deficiency leads to Blood deficiency, and weakened warming and promoting functions lead to Blood stasis. If Qi is not regulated, Blood will also be affected. Similarly, Blood disorders can also affect Qi; for instance, Blood deficiency cannot carry Qi, leading to reduced Qi, Blood stasis can lead to Qi stagnation, and Blood collapse can lead to Qi escape, even resulting in the danger of losing both Yin and Yang.
When the relationship between Qi and Blood is disordered, it often manifests as simultaneous diseases of Qi and Blood. Therefore, treatment should adjust the relationship between the two, restoring the normal state of Qi and Blood.
① Treating Qi disorders with Blood: Qi and Blood mutually support each other; Qi deficiency leads to weak Blood, Qi stagnation leads to Blood stasis, Qi sinking leads to Blood descent, and Qi counterflow leads to Blood disorder. Therefore, when Qi is diseased, Blood cannot act independently, and thus it also becomes diseased. This is the theoretical basis for treating Qi disorders with Blood. In summary, treating Qi without treating Blood is not effective. Qi deficiency should seek “essence within Qi,” Qi stagnation should consider the consumption of Yin and Blood, and Qi counterflow should seek harmony between Qi and Blood. This is an important principle in treating Qi disorders.
② Treating Blood disorders with Qi: When Qi is diseased, Blood must also be affected; when Blood is diseased, Qi must also be harmed. Qi and Blood must be harmonious; when one is diseased, the other is also diseased. However, “Qi is primary, and Blood is secondary; Qi is heavy, and Blood is light” (from “True Transmission of Medicine: Qi and Blood”). Therefore, “both Qi and Blood are essential, but supplementing Qi should precede supplementing Blood; both Yin and Yang are needed, but nourishing Yang should precede nourishing Yin” (from “Essential Readings in Medicine: Theories of Water, Fire, Yin, and Yang”). This applies to the treatment of deficiency syndromes, emphasizing that treating Blood must also involve treating Qi. When Qi is regulated, Blood disorders can begin to heal.
Blood deficiency should be treated by supplementing Qi, and Blood will naturally be generated. The method of supplementing Blood deficiency focuses on strengthening the spleen, benefiting Qi, warming and nourishing heart Qi, and supplementing kidney Qi. This is because the spleen can promote movement, ensuring sufficient transformation, and the blood vessels can be filled; the heart generates blood, and the essence of food and water relies on the warmth of heart Yang to transform into blood.
③ Moving Blood stasis by adjusting Qi: Kidney Yang is the source of all Yang in the body, and kidney essence relies on the transformation of true fire to become blood. When Blood is stagnant, moving Qi will naturally adjust the Blood. If Qi is not moving, Blood will not flow. When Qi moves, Blood moves; when Qi stagnates, Blood also stagnates. Therefore, treating Blood stasis must emphasize adjusting Qi. Since both Qi deficiency and Qi stagnation can lead to stasis, and the movement of Blood is closely related to the heart, lungs, liver, and spleen, adjusting Qi involves soothing liver Qi, regulating lung Qi, warming and promoting heart Qi, and nourishing and benefiting original Qi. Among these, adjusting liver Qi is the most important. The liver governs dispersal, regulates Qi, and promotes the movement of Qi and Blood. If liver Qi is stagnant, it will lead to Blood stasis. Therefore, one must use liver-soothing and Qi-regulating herbs to unblock Qi; when Qi moves, Blood will also move, preventing stasis.
When Blood overflows, adjusting Qi will naturally stop the bleeding. Blood follows Qi; when Qi is harmonious, Blood will flow smoothly; when Qi is counterflowing, Blood will also flow abnormally. Qi deficiency, Qi excess, Qi cold, and Qi heat all fall under the category of Qi disharmony. Therefore, treating Blood must involve adjusting Qi; when Qi is harmonious, Blood will stabilize.
In summary, Qi and Blood mutually support each other; Qi is primary, and Blood is secondary. Qi is the bellows, and Blood is like waves. Therefore, “if Qi disease affects Blood, treat Qi first; if Blood disease affects Qi, treat Blood first” (from “Essential Readings in Medicine: Principles of Differentiation and Treatment”). In clinical practice, one should consider the overall situation, harmonize Yin and Yang, and balance Qi and Blood to facilitate recovery from disease.
Treatment Principle Three: Regulating the Organs
The human body is an organic whole; the organs, as well as the relationships between organs and bowels, physiologically coordinate and mutually support each other, and pathologically influence each other. A disease in one organ can affect others, and a disease in another organ can also impact the original organ. Therefore, regulating the organs involves considering the Yin and Yang, Qi and Blood imbalances of each organ and bowel, while also paying attention to adjusting the relationships between the organs to restore balance. This is the fundamental principle of regulating the organs.
(1) Adjusting Yin and Yang, Qi and Blood
The organs are the centers of life activities, and the Yin and Yang, Qi and Blood of the organs are fundamental to life activities. The imbalance of Yin and Yang, Qi and Blood in the organs is the basis for pathological changes in the organs. Therefore, adjusting the Yin and Yang, Qi and Blood of the organs is the basic principle of organ regulation.
The physiological functions of the organs differ, and the pathological changes of their Yin and Yang, Qi and Blood imbalances are also not uniform. Therefore, treatment should be based on the pathological changes of the organs, whether deficient or excessive, cold or hot, and should involve supplementing deficiencies or draining excesses, warming cold or cooling heat. For example, the liver governs dispersal and stores blood, with blood as its substance and Qi as its function, primarily promoting upward movement. Its pathological characteristics often include excess liver Qi and liver Yang, while liver Yin and blood are often insufficient. If the liver is too strong, it can lead to Qi stagnation and fire, and blood deficiency can generate heat and wind. Therefore, the treatment of liver diseases focuses on regulating Qi, supplementing Blood, and harmonizing Blood, combined with clearing, nourishing, and calming the liver based on the cause.
(2) Adapting to Physiological Characteristics
The five organs store essence and Qi without leaking, while the six bowels transform substances without storing. The Yin and Yang, Five Elements attributes, Qi movement, seasonal responses, and preferences and aversions of the organs differ, so adjusting the organs must align with their characteristics. For example, the spleen and stomach belong to the Earth element; the spleen is Yin Earth, and excessive Yang can harm it; the stomach is Yang Earth, and excessive Yin can harm it. The spleen prefers dryness and dislikes dampness, while the stomach prefers moisture and dislikes dryness. The spleen Qi governs upward movement, while the stomach Qi governs downward movement. Therefore, treatment of the spleen often involves sweet and warm herbs to assist its upward movement, while caution should be exercised with Yin-cold herbs to avoid promoting dampness and harming Yang. Treatment of the stomach often involves sweet and cold herbs to promote downward movement, while caution should be exercised with warming and drying herbs to avoid harming its Yin.
(3) Coordinating Organ Relationships
① Regulating through the Five Elements: Adjusting according to the generative cycle of the Five Elements involves two main treatment principles: “supplementing the mother” and “draining the child.” Nourishing water to support wood, enriching earth to generate metal, benefiting fire to supplement earth, and generating metal to nourish water all belong to the principle of “supplementing the mother”; while draining heart for liver excess and draining stomach for heart excess belong to the principle of “draining the child.”
Adjusting according to the controlling cycle of the Five Elements involves two main treatment principles: suppressing the strong and supporting the weak. For example, when wood and fire harm metal, one can use methods to support metal and suppress wood, which is suppressing the strong; when liver deficiency affects the spleen and stomach, this is wood not dispersing earth, and treatment should involve harmonizing the liver and strengthening the spleen to enhance both functions, which is supporting the weak. Adjustments such as suppressing wood to support earth and draining the south to supplement the north involve a combination of both methods, with a distinction between primary and secondary.
Adjusting according to the generative and controlling relationships of the Five Elements: The Five Elements mutually generate and control each other, creating a cycle of interaction. Therefore, when adjusting organ functions based on the Five Elements, it is essential to not only supplement the mother and drain the child but also to suppress the strong and support the weak, and to adjust the relationships between related organs. For example, wood controls earth, earth generates metal, and metal controls wood; thus, one should both suppress wood and support earth, while also nourishing earth to generate metal, balancing both control and generation.
② Mutual Containment of the Five Organs: The Five Elements correspond to the Five Organs, and the Five Organs mutually contain each other. One organ governs the five organs, and the five organs unify into one. Any physiological function is regulated by the collective action of the five organs, with distinctions between primary and secondary. For instance, regarding respiratory function, the lungs govern respiration, but the lungs expel Qi, the kidneys receive Qi, and the liver regulates Qi to ensure appropriate rise and fall, while the spleen governs the transformation of food essence and participates in generating the original Qi. The heart governs blood vessels and houses the spirit; blood is the mother of Qi, and heart blood nourishes Qi, while the heart spirit regulates respiration. Therefore, all five organs participate in regulating respiration, with the lungs, spleen, and kidneys being particularly important. Thus, when respiratory function is disordered, the focus is often on treating the lungs, spleen, and kidneys.
③ Coordinating Organ and Bowel Relationships: The cooperation between the organs and bowels reflects the relationship of Yin and Yang, as well as the correspondence between exterior and interior. The organs move Qi to the bowels, and the bowels transmit essence to the organs. Physiologically, they coordinate with each other, and pathologically, they influence each other and undergo mutual transformation. Therefore, when treating organ and bowel disorders, in addition to directly treating the affected organ or bowel, one can also apply the theory of organ and bowel correspondence, treating organ diseases with bowel treatments, bowel diseases with organ treatments, or simultaneous treatment of both.
Treating organ diseases with bowel treatments: For example, the heart corresponds to the small intestine; in cases of heart fire flaring up, one can directly drain heart fire while unblocking the small intestine, allowing the heat from the heart to be expelled from below, thus lowering heart fire. This is an example of treating the organ by first treating the bowel.
Treating bowel diseases with organ treatments: For example, the kidneys correspond to the bladder; when the bladder’s Qi transformation function is abnormal, leading to water metabolism disorders, treating the kidneys will also treat the bladder. In cases of constipation, if the bowel Qi is obstructed, one can also lower the pathogenic Qi to allow the bowel Qi to flow smoothly, leading to spontaneous bowel movements.
Simultaneous treatment of organ and bowel: Although organ diseases can be treated with bowel treatments and vice versa, in clinical practice, simultaneous treatment of both is often employed. For example, the spleen and stomach work together; their intake and movement are mutually beneficial, and their dryness and dampness complement each other. Therefore, spleen diseases will inevitably affect the stomach, and stomach diseases will also impact the spleen. Thus, in clinical practice, treatment of both the spleen and stomach is common.
Draining the bowels and supplementing the organs: The six bowels transform substances without storing, using movement for function and descent for harmony, while the five organs store essence and Qi without leaking, valuing storage. Both the five organs and six bowels can manifest as excess conditions, which should be drained. For example, in cases of excess in the six bowels, one can drain the bowels to expel evils, such as using purgatives for heat accumulation in the intestines. Excess in the five organs can also be drained through the bowels to expel evils; for instance, damp-heat in the liver channel can be expelled through the intestines and promote urination to eliminate damp-heat. The deficiency of the five organs should be supplemented, and the deficiency of the six bowels can also be supported by supplementing the organs. For example, if the bladder’s Qi transformation is weak, leading to frequent urination or incontinence, treatment often involves supplementing the kidneys to solidify and retain Qi. If the small intestine’s function of separating clear from turbid is low, treatment often involves the spleen and kidneys.