Many people consult Traditional Chinese Medicine (TCM) practitioners who diagnose them with Yang deficiency. Do you know that treating Yang deficiency is not simple? Let’s explore how TCM treats Yang deficiency.
It is important to understand that warming Yang, tonifying Yang, and unblocking Yang are common 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 herbs. Based on the principles of TCM, we will clarify and analyze these methods.
Warming Yang
Warming Yang involves using 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 the Suwen, “On the Correspondence of Yin and Yang”) and “Yang deficiency leads to external cold” (from the Suwen, “On Regulating the Menstrual Cycle”). The basic treatment principles are “warm the cold” (from the Suwen, “On the True Essentials”) and “treat cold with warm herbs” (from the Shennong Bencao Jing).
Cold syndromes can be classified into exterior and interior, deficiency and excess.
Exterior cold is often caused by external cold, manifesting as cold pathogens attacking the exterior, such as in cases of Taiyang cold damage or wind-cold colds. In such cases, warming and dispersing the exterior is necessary, using herbs like 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 (Siler and Ephedra Decoction). If the cold enters the meridians, as in cold bi syndrome, the treatment should warm the meridians and disperse the 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 cold is often due to cold pathogens entering the interior, such as cold pathogens causing stomach pain, Yin cold causing chest bi, or cold obstructing the liver meridian causing abdominal pain. 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 and Cyperus Pill), Li Zhong Tang (Regulate the Middle Decoction), and Gua Lou Xie Bai Bai Jiu Tang (Trichosanthes and Chinese Chive Wine Decoction). Deficiency cold is due to insufficient Yang Qi, and treatment should focus on warming and tonifying, referring to the section on “tonifying Yang”.
Tonifying Yang
Tonifying Yang involves using sweet, warm, or salty warm herbs to nourish Yang Qi in treating Yang deficiency syndromes, falling under the category of “tonifying the deficient”. Yang deficiency means insufficient Yang Qi (which can be understood as a decrease in quantity or a low level), often resulting from congenital insufficiency or prolonged illness leading to depletion, frequently representing a further development of Qi deficiency, manifesting as a state of reduced function. Conditions such as heart failure, kidney failure, and hypothyroidism in modern medicine can be observed in this context. Since kidney Yang is the source of all Yang in the body, and the Yang Qi of the organs arises from it, tonifying Yang often focuses on warming and tonifying kidney Yang.
Yang deficiency manifests differently depending on the affected organs. For instance, heart Yang deficiency may present with palpitations, chest tightness, and shortness of breath, especially upon exertion; lung Yang deficiency may show symptoms like weak cough, 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 symptoms like lower back and knee soreness, clear urine, loose stools, impotence, pale tongue with white coating, and weak pulse. However, a common and distinctive manifestation is the presence of cold intolerance and cold extremities, along with a tendency for symptoms to worsen in cold conditions, all based on Qi deficiency (fatigue and weakness).
In certain specific situations, Yang deficiency as a pathological basis can also lead to the following transformations: the production of pathological products, such as blood stasis due to insufficient movement, or phlegm accumulation due to insufficient warming, leading to further complications like water retention affecting the heart and lungs, resulting in palpitations, shortness of breath, swelling, coldness, and cyanosis; phlegm obstruction can lead to vomiting or dizziness.
If excessive sweating depletes heart Yang, and the cold and dampness from the kidneys rises, it can lead to the condition known as “running piglet disease”, where clinical manifestations include initial abdominal pulsation, followed by upward counterflow of Qi, anxiety, cold extremities, white greasy tongue coating, and tight pulse.
Due to deficiency leading to heat, clinical manifestations may include low-grade fever with a desire for warmth, cold intolerance, fatigue, dizziness, and weakness in the lower back and knees, which is due to spleen and kidney Yang deficiency, with fire not returning to its source; or there may be a rosy complexion on the cheeks, fluctuating and unstable, with cold extremities, and a floating or weak pulse, which is due to deficiency of the lower source, with true Yang floating and escaping, leading to the condition of true cold and false heat.
Severe Yang depletion can lead to collapse, where Yang Qi is severely depleted and lost, presenting with profuse cold sweat, weak breathing, clear diarrhea, cold extremities, and a faint pulse, which is a critical condition of Yang depletion.
Treatment for Yang deficiency should focus on warming and tonifying. The key points for herbal use include: using warming herbs like 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). Use Qi tonifying herbs like Huang Qi (Astragalus) and Dang Shen (Codonopsis) to change the foundation of Yang deficiency, with formulas like Huang Qi Jian Zhong Tang (Astragalus Middle Strengthening Decoction) and Bu Yang Huan Wu Tang (Tonify Yang and Restore Five Decoction).
Warming and tonifying kidney Yang is the most fundamental method to elevate Yang Qi levels, commonly used herbs include Lu Rong (Deer Antler), Yin Yang Huo (Epimedium), Ba Ji 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 Spirit Pill) and Tu Si Zi Wan (Cuscuta Pill). When Yang Qi is weak, and Yin cold is prevalent, leading to signs of Yang depletion, treatment should focus on reviving Yang and rescuing the reverse, urgently using warming and tonifying methods, such as Si Ni Tang (Frigid Extremities Decoction) and Shen Fu Tang (Ginseng and Aconite Decoction). “Those who are adept at tonifying Yang must seek Yang within Yin, for when Yang receives assistance from Yin, it can generate and transform endlessly,” as Zhang Jingyue insightfully stated, understanding the principle of the interdependence of Yin and Yang.
Unblocking Yang
Unblocking Yang involves using pungent warm or hot herbs to treat the obstruction of Yang Qi.
Yang Qi is characterized by its flowing and dispersing nature, which has a warming and nourishing effect. 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 floating tight pulse, this is due to invasion by wind-cold and obstruction of Wei Yang;
If symptoms include chest pain, severe cold pain, chest tightness, palpitations, and in severe cases, shortness of breath and inability to lie flat, with a pale complexion, cold extremities, white tongue coating, and a thin, weak pulse, this is often due to insufficient chest Yang, with Yin cold invading, causing cold stagnation and Qi obstruction;
If clinical manifestations include chest tightness and pain as if suffocated, shortness of breath, excessive phlegm, dizziness, nausea, poor appetite, heavy limbs, and obesity, this indicates phlegm stagnation obstructing the chest, preventing Yang from dispersing;
If clinical manifestations include epigastric fullness, gurgling sounds in the stomach, vomiting clear phlegm, or water that is immediately vomited, with a preference for warmth and aversion to cold, or “back cold like a palm” (from the Jin Gui Yao Lue), thirst without desire to drink, dizziness, and loose stools, with a white slippery tongue coating and a thin, slippery pulse, this is due to overconsumption of cold foods, excessive use of cold herbs, or prolonged illness damaging the spleen, leading to water retention obstructing Yang.
To treat Yang obstruction, the method should be to unblock Yang. How to unblock Yang? Ye Tianshi pointed out: “To eliminate turbid Yin, one must urgently unblock Yang.” He also stated: “To unblock Yang, pungent heat must be used,” meaning 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 flow.
If due to cold stagnation, warming and dispersing should be used, with herbs like Gui Zhi, Xie Bai (Garlic Chives), Xi Xin, and Bai Jiu (White Wine), using formulas like Gua Lou Xie Bai Bai Jiu Tang with modifications; if due to obstruction of Wei Yang, pungent warmth should be used, with herbs like Ma Huang, Gui Zhi, Jing Jie, and Fang Feng, using formulas like Ma Huang Tang and Jing Fang Bai Du San with modifications; if due to phlegm obstruction, phlegm should be transformed and unblocked, with herbs like Gua Lou, Xie Bai, and Ban Xia (Pinellia), using formulas like Gua Lou Xie Bai Ban Xia Tang with modifications; if due to cold dampness or fluid retention, warming and transforming should be used, with 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 Tong Cao (Tetrapanax), using formulas like Wei Ling Tang (Poria Decoction), Ling Gui Zhu Gan Tang (Poria, Cinnamon, and Licorice Decoction), and Xiao Ban Xia Tang (Minor Pinellia Decoction). In clinical experience, Gui Zhi can often be used as a general herb for unblocking Yang.
In addition to commonly using pungent and warming methods to unblock Yang, Ye Tianshi also proposed methods for unblocking Yang in warm diseases. In his “On Warm Diseases”, he stated: “In warm diseases, rescuing 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 Republican physician Chen Guangsong explained: “Promoting urination allows the dampness in the three jiaos to reach the bladder and be eliminated, thus dissipating the dampness and turbid Qi, allowing the heat evil to penetrate, and Yang Qi to be unblocked.” Mr. Pu Fuzhou 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 the three methods of warming Yang, tonifying Yang, and unblocking Yang each have their specific applications, yet they are distinct. Only by thoroughly understanding their meanings can they be appropriately applied.
