The Su Wen: Yin Yang Ying Xiang Da Lun states, “At the age of forty, the yin energy is already half diminished, and one’s vitality declines.” The Ling Shu: Tian Nian also suggests that at forty, one begins to age. In modern China, the average lifespan has increased, and many individuals over sixty do not exhibit signs of aging. However, a small number suffer from geriatric diseases, which often begin in middle age and persist into old age, with common conditions including hypertension, coronary heart disease, cerebral arteriosclerosis, chronic bronchitis, and prostate disorders.The Ling Shu: Tian Nian discusses the reasons for not achieving longevity, stating, “The five zang organs are all weak… the foundation is weak, the pulse is deficient, the flesh is not solid, and one suffers from frequent wind and cold, with deficient blood and qi, leading to a struggle between true and evil pathogens, resulting in premature death.” The Cihai cites the Zuo Zhuan: Kong Ying Da’s Commentary stating, “The upper longevity is one hundred and twenty years, the middle longevity is one hundred, and the lower longevity is eighty,” and further cites Du Yu’s Commentary stating, “The three types of longevity refer to upper, middle, and lower longevity, all of which are above eighty.” “Above eighty” undoubtedly indicates the elderly phase. The text suggests that “premature death” is due to disease. The formation of geriatric diseases, like any other disease, is a unity of internal and external causes, with internal causes being primary. This means that within geriatric diseases, there exists a contradiction of struggle between evil and righteousness. From the phrase “the pulse is not smooth,” we can infer that patients with geriatric diseases are affected not only by external evil qi such as frequent wind and cold but also by internal evils such as blood stasis, fluid retention, and food accumulation. The term “the pulse is not smooth” does not imply complete blockage but rather a lack of smoothness. The body’s metabolism relies entirely on the circulation of blood through the vessels; if the vessels are not smooth, the normal metabolic processes are inevitably weakened, leading to the failure of the old to be eliminated and the new to be generated, deepening the contradiction between deficiency and excess, and causing persistent illness. This constitutes a characteristic of geriatric diseases that distinguishes them from diseases in middle-aged and young individuals.
The Lü Shi Chun Qiu: Da Lan states, “Illness that lingers and breeds evil is due to the stagnation of essence and qi.” Zhu Danxi has a theory of “six stagnations.” Dai Yuanli states, “All illnesses should be treated by addressing stagnation.” The term “stagnation” is particularly closely related to geriatric diseases. It is said that “life depends on movement,” and a small number of elderly individuals, especially those with geriatric diseases, are limited in physical activity and do not engage in labor or exercise, leading to stagnation of blood and qi. If they blindly consume rich foods, the harm is even greater. The method to treat stagnation is primarily to “unblock.” The key to unblocking is to smooth the meridians.The Ling Shu: Jing Mai states, “The meridians are what can determine life and death, address all diseases, and regulate deficiency and excess; they must be smooth.” Furthermore, the Ling Shu: Jing Bie states, “The twelve meridians are the basis of life, the cause of disease, the means of treatment, and the origin of illness…” From this, it is clear that the method of smoothing the meridians is not limited to geriatric diseases. Observing the Su Wen: Re Lun, which states, “Treat by unblocking the zang meridians, and the illness will diminish,” indicates that the method of smoothing the meridians is not limited to chronic diseases either. Generally speaking, in the contradiction of struggle between evil and righteousness in geriatric diseases, the strength of righteousness is undoubtedly weaker. Therefore, in treatment, the focus should be on supporting righteousness, and the method of unblocking should be gentle rather than aggressive. However, Zhang Zihe once said, “When the stagnation is removed, the intestines and stomach are cleansed, the masses are resolved, and the nourishment and defense flourish,” indicating that within unblocking, there is also a nourishing effect. Even if righteousness prevails over evil, if one neglects the concept of “unblocking” in treatment, it is not easy to strengthen righteousness. The Su Wen: Ling Lan Mi Dian Lun states, “If the pathways are blocked and not smooth, the body will suffer greatly,” and the Jin Gui Yao Lue states, “If the five zang organs are smoothly connected, the person will be peaceful and harmonious,” which are profound thoughts.Case SharingCase 1In March 1981, a 61-year-old male with a history of hypertension for 8 years suddenly collapsed six months ago, appearing pale, sweating cold, and an ECG indicated left ventricular hypertrophy with strain. Serum cholesterol was 380 mg/dl (9.88 mmol/L). Upon examination, he experienced dizziness, tinnitus, double vision, inability to read or work, numbness in both hands, weakness in the lower limbs, a tendency to fall, intermittent chest pain, poor sleep, with a pulse that was deep and wiry, and a thin, greasy tongue coating. The diagnosis was a pattern of deficiency below and excess above, with concurrent heart and cerebrovascular disease. Treatment included tonifying the kidneys and nourishing essence, activating blood and calming the heart, using a modified Hejian Dihuang Decoction, warming the kidneys while adding Danshen (Salvia miltiorrhiza) and Puhuang (Typhae pollen) to invigorate blood, and Shou Wu (Polygonum multiflorum) and Ze Xie (Alisma orientale) to nourish the liver and reduce turbidity, lowering cholesterol, and using Ci Zhu Wan to settle floating yang and clarify the mind. Prescription: Sheng Di Huang (Rehmannia glutinosa) 15g, Shi Hu (Dendrobium) 20g (pre-boiled), Mai Dong (Ophiopogon) 9g, Shi Chang Pu (Acorus tatarinowii) 3g, Wu Wei Zi (Schisandra chinensis) 3g, Zhi Yuan Zhi (Polygala tenuifolia) 3g, Bai Fu Ling (Poria cocos) 20g, Bo He (Mentha haplocalyx) 5g (added at the end), Zhi Shou Wu 5g, Ze Xie 15g, Dan Shen 30g, Sheng Puhuang (Typhae pollen) 6g (wrapped for decoction), Ci Zhu Wan (wrapped for decoction) 3g. After taking 7 doses, his spirit improved significantly, lower limb movement became more stable, numbness in the hands decreased, double vision resolved, but occasional dizziness remained. The original formula had Bo He removed and Goji Berries added, and after taking for over ten doses, he stopped the Western antihypertensive medication Andapres. Blood pressure stabilized, dizziness and weakness in the feet significantly improved, and further treatment was given to clear excess above and tonify deficiency below. Prescription: Da Sheng Di Huang 15g, Shi Hu 15g (pre-boiled), Da Mai Dong 9g, Shi Chang Pu 3g, Zhi Yuan Zhi 4.5g, Ju Hua (Chrysanthemum) 15g, Dong Qing Zi (Ilex) 12g, Han Lian Cao (Eclipta prostrata) 9g, Jin Ying Zi (Rosae laevigatae) 9g, Zhi Gui Ban (pre-boiled) 9g, Sheng Mu Li (Oyster shell) 30g (pre-boiled), Gou Teng (Uncaria) 15g (added at the end). After 7 doses, he was able to read for 3 hours continuously.Case 2An elderly lady, 71 years old, came for consultation in April 1981. She experienced dizziness, blurred vision, a tendency to fall, occasional chest tightness and palpitations, right flank pain, and numbness in both hands. External examinations revealed gastric antrum inflammation, gallstones, left ventricular hypertrophy, and myocardial damage. Her tongue was dark, smooth with no coating, and her pulse was wiry on the left and deep and thin on the right. The diagnosis was liver yin deficiency, liver yang excess, and dysfunction of the Shao Yang pivot. Treatment focused on nourishing yin, calming the liver, activating blood, and benefiting the gallbladder. Prescription: Sha Shen (Adenophora) 9g, Mai Dong 9g, Yu Zhu (Polygonatum) 9g, Dan Shen 12g, Qing Hao (Artemisia annua) 6g, Huang Qin (Scutellaria baicalensis) 6g, Pu Gong Ying (Taraxacum) 12g, Xia Ku Cao (Prunella) 12g, Zhi Xiang Fu (Cyperus rotundus) 9g, Ju Ye Pi (Citrus reticulata) 6g, Ju Hua 9g, 7 doses. The formula included Sha Shen, Mai Dong, Ju Hua, and Xia Ku Cao to nourish yin and calm the liver, while Qing Hao and Huang Qin benefited the gallbladder, thereby enhancing the function of the Shao Yang pivot. Pu Gong Ying has a detoxifying function, combined with Yu Zhu to nourish stomach yin, aiming to change the gastric pathology. Left ventricular hypertrophy indicated that the heart was relying on compensatory mechanisms, thus Dan Shen was used to invigorate blood, and Xiang Fu to move qi and resolve blood stasis, allowing qi to flow and blood to move, thereby enhancing compensatory function. After taking the medicine, her appetite and spirit improved, and the original formula was modified to add Sheng Bai Shao (Paeonia lactiflora) 12g to nourish yin, and Gou Teng 15g (added at the end) to calm the liver. The ancients said, “Heavy to calm the weak,” where “weak” refers to deficiency. Dizziness and fatigue are signs of weakness, and deficiency cannot tolerate tonification, thus Ci Zhu Wan (wrapped for decoction) 6g was added for reinforcement. After taking the medicine, her symptoms alleviated, but dizziness persisted, reflecting the contradiction between deficiency and excess. The so-called deficiency is yin deficiency, which according to modern medical diagnosis, is insufficient blood supply to the head, thus 9g of Xuan Shen (Scrophularia) was added, 9g of Fen Ge Gen (Pueraria) and 9g of Niu Xi (Achyranthes) and 30g of Shi Jue Ming (Haliotis) (pre-boiled) were added. The four herbs combined may resolve the persistent dizziness. After a month of treatment with these modifications, the patient gradually improved from dizziness and a tendency to fall to being able to manage basic self-care. Statistics show that two-thirds of elderly individuals suffer from multiple chronic diseases. The above patient, at the age of seventy, had multiple organ diseases involving the heart, gallbladder, and stomach. This is naturally related to the decline of righteousness and the aging of tissues and organs, manifesting as liver yin deficiency, and further leading to liver yang excess, Shao Yang damp-heat retention, and blood stasis. For such geriatric chronic diseases, both the righteous and the evil must be considered simultaneously to achieve satisfactory results.Case 3An elderly woman, 64 years old. Since menopause, her body has gradually become plump, with occasional elevated blood pressure, accompanied by left-sided headaches, itchy eyes, shortness of breath upon exertion, and swelling in the feet by evening. For several years, she has had a peculiar ailment, feeling cold in the chest during winter while experiencing heat throughout the body, with a bitter taste in the mouth and occasional hunger. Upon diagnosis, her pulse was deep and slippery, her tongue was red with a thin greasy coating, indicating phlegm-heat accumulation in the chest. The ancients said: “If a disease persists without visible skin and hair deterioration, it is due to phlegm.” “Phlegm accumulation in the diaphragm causes back cold.” The patient, over sixty, has already lost more than half of her righteous qi, and phlegm turbidity is an internal evil qi, originally transformed from body fluids. If the disease persists, phlegm transforms into heat, and in winter, the cold can easily condense, leading to obstruction of qi and vessels, resulting in multiple symptoms. Therefore, she was advised to avoid rich foods and was treated with methods to clear phlegm-heat and promote blood and qi circulation. This expulsion of evil is also a means to stabilize righteousness. Prescription: The formula used was Wen Dan Tang to clear phlegm-heat, supplemented with Gui Zhi (Cinnamon twig), Dan Shen, Qian Cao (Rubia), and Ze Lan (Lycopus) to invigorate blood and open the meridians to benefit blood and qi, while Mai Ya (Barley) assisted in transforming phlegm, and Fu Ling (Poria) and Ze Xie promoted water metabolism and phlegm elimination. After taking the medicine, she vomited a small cup of phlegm, feeling immediate relief in the chest, and experienced hunger. She was advised to consume snow soup (water chestnut and jellyfish skin), and her headaches, itchy eyes, and cold sensation in the chest all disappeared. After further diagnosis and treatment adjustments twice, she reported a reduction in dandruff, improved spirit, and was able to engage in more strenuous household chores.
