Author of this article
Professor Liu Maocai’s Inheritance Studio of Famous TCM Doctors, Brain Disease Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Lingnan Lin Xiaquan School: Zheng Chunye
Professor Liu Maocai is a renowned TCM physician in Guangdong Province, chief professor of TCM internal medicine (neurology), and doctoral supervisor. With over fifty years of clinical teaching experience, his academic thought system and clinical experience are invaluable assets to traditional Chinese medicine.
Professor Liu believes that the pathogenesis of TCM neurological disorders is often characterized by “deficiency of the root and excess of the branch”. Therefore, during treatment, it is essential to assess the urgency of “deficiency” and “excess”, and the differential relationship between “attack” and “tonification”. He places great emphasis on the treatment method of combining both attack and tonification, which is widely applied in clinical practice and often runs through the entire treatment of diseases. I am fortunate to have studied under Professor Liu Maocai, and my clinical observations have yielded significant insights. Here, I will analyze and explore his diagnostic and therapeutic approaches in common TCM neurological disorders such as stroke, vertigo, headache, and dementia.
Stroke
The classification of stroke syndromes has always been complex, with various causes and pathogenesis influenced by numerous factors, leading to an excessive number of clinical classifications that lack a unified standard, making it difficult to grasp clinically and inconvenient for efficacy evaluation and academic exchange. Therefore, establishing concise and feasible diagnostic criteria can simplify complex clinical situations. Professor Liu believes that regardless of whether it is hemorrhagic or ischemic stroke, there are six pathological bases: wind, fire, phlegm, stasis, qi, and deficiency. Based on his rich clinical experience, Professor Liu often divides stroke syndromes into deficiency and excess types, and the internal organs into closed and open syndromes. For excess syndromes of the meridians, the main treatment methods include calming the liver, resolving phlegm, breaking stasis, and unblocking the bowels; for deficiency syndromes, the main methods are tonifying qi, nourishing blood, and promoting the flow of meridians. For closed syndromes of the internal organs, the treatment focuses on clearing heat and calming the liver, resolving phlegm and opening the orifices, while for open syndromes, the methods include returning yang to rescue the reverse and supporting the righteous qi. Whether it is yin or yang syndromes, the treatment always involves addressing both deficiency and excess, combining attack and tonification. Professor Liu often uses Huang Qi (Astragalus) for its effects of tonifying qi and uplifting yang, nourishing the brain qi, and allowing the yang qi to expand, thus enabling the spirit to function; he employs Ban Xia (Pinellia), Zhi Ban Xia (Rhizoma Pinelliae), Gua Lou (Trichosanthes), Tian Zhu Huang (Bamboo Shavings), and Zhu Ru (Bamboo Shavings) to resolve phlegm and open the orifices; for breaking stasis and unblocking the vessels, he frequently uses Dang Gui (Angelica), Chuan Xiong (Szechuan Lovage), Tao Ren (Peach Kernel), Hong Hua (Safflower), and Ji Xue Teng (Spatholobus) and often employs Mu Dan Pi (Moutan Root), Mao Dong Qing (Wintergreen), Dan Shen (Salvia), and Yi Mu Cao (Chinese Motherwort) to clear heat and cool the blood, preventing evil heat from forcing the blood away from the meridians, allowing the heat to retreat and the blood to settle, or transforming fire into toxins, causing re-bleeding and other complications.
In addition, Professor Liu places special emphasis on the method of unblocking the bowels. He developed the Tong Fu Xing Shen Capsule, composed of Fan Xie Ye (Senna Leaf), Hu Zhang (Polygonum Cuspidatum), artificial Niuhuang (Cattle Gallstone) powder, Tian Zhu Huang (Bamboo Shavings), and Gua Lou Ren (Trichosanthes Fruit), which is suitable for the yang closed syndrome or yin closed syndrome of phlegm accumulation and obstruction of the bowels. Clinical studies have shown that rectal infusion of Tong Fu Xing Shen Liquid is an effective method for treating acute confusion in cerebral hemorrhage. This disease often initially presents with phlegm and stasis as the main pathological features, and the treatment focuses on resolving phlegm, breaking stasis, and unblocking the bowels, emphasizing unblocking as the primary method. During the recovery phase, there is often a predominance of deficiency and stasis, and the treatment emphasizes tonifying qi and blood, nourishing the liver and kidneys, while also resolving phlegm and breaking stasis, achieving a balanced approach of attack and tonification, which consistently yields good clinical results.
Vertigo
Professor Liu summarizes the diagnostic and treatment experiences of predecessors regarding vertigo, and through long-term clinical practice, he believes that vertigo is primarily characterized by “deficiency of the root” with accompanying “excess of the branch”. “Deficiency of the root” refers to the depletion of original qi, insufficient qi and blood, and deficiency of liver and kidney, leading to a lack of nourishment for the brain; “excess of the branch” refers to phlegm turbidity and blood stasis obstructing the brain orifices, preventing the clear yang qi from spreading; conversely, qi deficiency leads to impaired transportation, promoting the generation of stubborn phlegm and stagnant blood, creating a mutually causal relationship. Therefore, in clinical practice, he advocates “combining tonification with unblocking, supporting the righteous qi while expelling evil, and treating both phlegm and stasis together”. On the basis of tonifying qi and blood, he often uses blood-activating and meridian-unblocking herbs, such as Mao Dong Qing (Wintergreen), Dan Shen (Salvia), Yi Mu Cao (Chinese Motherwort), Hu Zhang (Polygonum Cuspidatum), Di Long (Earthworm), Tian Ma (Gastrodia), Gou Teng (Uncaria), Ban Xia (Pinellia), Zhi Ban Xia (Rhizoma Pinelliae), Tian Zhu Huang (Bamboo Shavings), Shi Ge Pu (Reed), Zhu Ru (Bamboo Shavings), and Yu Jin (Curcuma), while also not forgetting to address the root causes by tonifying both the spleen and kidneys to nourish and transform, benefiting the brain and enriching the marrow, achieving the goal of supporting the righteous qi and expelling evil. For this purpose, he often uses Huang Qi (Astragalus) to tonify qi and generate blood, Dang Shen (Codonopsis) to tonify qi and generate fluids, and Du Zhong (Eucommia), Niuxi (Achyranthes), Shan Zhu Yu (Cornus), Bai Shao (White Peony), and Nu Zhen Zi (Ligustrum) to tonify the liver and kidneys, often achieving good results.
Headache
Professor Liu believes that the three major pathogenesis of internal injury headache are “pain due to obstruction”, “pain due to lack of nourishment”, and “disturbance of the brain spirit”. The causes of “pain due to obstruction” are relatively complex and can be caused by the six excesses, seven emotions, external injuries, chronic diseases, etc., leading to poor circulation of qi and blood, resulting in headaches; “pain due to lack of nourishment” may arise from qi deficiency failing to raise the clear yang, blood deficiency leading to lack of nourishment for the head, or insufficient kidney essence resulting in a lack of nourishment for the marrow, with the above two often occurring simultaneously and mutually influencing each other, both of which can disturb the brain spirit, leading to headaches. In treatment, Professor Liu often considers these three aspects when prescribing. For the pathogenesis of “obstruction”, he commonly uses Quan Xie (Scorpion), Wu Gong (Centipede), Chuan Xiong (Szechuan Lovage), Dan Shen (Salvia), Wei Ling Xian (Clematis), Bai Zhi (Angelica Dahurica), Ju Hua (Chrysanthemum), Gao Ben (Ligularia), Qiang Huo (Notopterygium), Ge Gen (Pueraria), and Chai Hu (Bupleurum) to dispel wind, invigorate blood, and unblock the orifices, attacking the pathogenic factors; for “lack of nourishment”, he often uses Huang Qi (Astragalus), Dang Shen (Codonopsis), Bai Shao (White Peony), Shan Zhu Yu (Cornus), Du Zhong (Eucommia), Niuxi (Achyranthes), and Ji Xue Teng (Spatholobus) to tonify qi and blood, nourish the liver and kidneys, and replenish what is lacking; for “disturbance of the brain spirit”, he often combines He Huan Pi (Albizia), Yu Jin (Curcuma), Fu Xiao Mai (Einkorn), Suan Zao Ren (Sour Jujube Seed), and Yuan Zhi (Polygala) in his prescriptions.
Dementia
Professor Liu believes that the main pathogenesis of this syndrome is the deficiency of qi, blood, and essence, leading to a lack of nourishment for the marrow and brain, along with the internal obstruction of wind, fire, phlegm, and stasis, which disturb the clear orifices, resulting in the loss of cognitive function and memory, manifesting as symptoms of dementia such as sluggish thinking and forgetfulness. Based on this pathological characteristic, Professor Liu employs a method of greatly tonifying qi and blood, combined with resolving phlegm and invigorating blood to unblock the meridians. He heavily uses Huang Qi (Astragalus) to greatly tonify qi and blood, while also incorporating Shu Di Huang (Rehmannia), He Shou Wu (Fo-Ti), Du Zhong (Eucommia), Niuxi (Achyranthes), Tu Si Zi (Cuscuta), and Rou Cong Rong (Cistanches) to benefit essence and fill the marrow, along with Ban Xia (Pinellia), Shi Ge Pu (Reed), and Yuan Zhi (Polygala) to resolve phlegm and open the orifices. In clinical practice, this approach has shown certain efficacy. Additionally, Professor Liu also favors the Chi Fu Kang Oral Liquid developed by Guangdong Provincial Hospital of Traditional Chinese Medicine, which contains Huang Qi (Astragalus), Bian Tiao Shen (Bian Tiao Ginseng), and Dang Gui (Angelica) to tonify qi and blood, combined with Zi He Che (Placenta), Ba Jiao Tian (Morinda), and He Shou Wu (Fo-Ti) to nourish the kidneys and replenish essence, along with Ban Xia (Pinellia), Shi Ge Pu (Reed), and Yuan Zhi (Polygala) to resolve phlegm and awaken the mind, addressing both the symptoms and root causes, achieving the effect of enhancing cognition and awakening the mind. In clinical trials, Chi Fu Kang has shown better improvement rates in patients’ dizziness, limb motor function, sleep, and bowel and bladder dysfunction compared to the control group, although it performed slightly worse in language expression. It also has the effect of lowering cholesterol and triglycerides in the blood while increasing high-density lipoprotein levels. Furthermore, animal experiments have shown that Chi Fu Kang can improve learning and memory impairments in experimental animals to varying degrees.
Epilepsy
The phlegm turbidity evil is the root cause of epilepsy, which interacts with wind, fire, and stasis to obstruct the meridians, cloud the clear orifices, and disturb the spirit. Professor Liu believes that “to treat epilepsy, one must first treat phlegm”; resolving phlegm and extinguishing wind is an important principle in the treatment of epilepsy. Clinically, he often uses Zhi Ban Xia (Rhizoma Pinelliae), Ban Xia (Pinellia), Tian Ma (Gastrodia), and Bai Fu Zi (Prepared Strychnos) to eliminate phlegm, along with Di Long (Earthworm) and Wu Gong (Centipede) to extinguish wind and unblock the meridians, often combined with Shui Niu Jiao (Water Buffalo Horn) to extinguish wind and stop convulsions. However, repeated seizures inevitably deplete the righteous qi. As noted by predecessors, tonifying deficiency can stabilize epilepsy. Professor Liu also believes that chronic and unhealed epilepsy often belongs to deficiency syndromes, so in clinical practice, he often establishes methods of nourishing blood, extinguishing wind, and strengthening the spleen to resolve phlegm. He has also developed the Yi Nao An Capsule (tablet) based on the treatment experiences of famous TCM physician Lin Xiaquan in Guangdong Province, using Tian Ma (Gastrodia), Quan Xie (Scorpion), and Dang Gui (Angelica) as the main ingredients, achieving the effects of nourishing blood, extinguishing wind, invigorating blood, unblocking the meridians, resolving phlegm, calming seizures, and alleviating pain for the treatment of epilepsy. Early experimental studies have confirmed that Yi Nao An Capsule can exert an anti-epileptic effect. Therefore, during the treatment of epilepsy, Professor Liu often combines decoctions with Yi Nao An Capsule, using the capsule for long-term administration and the decoction intermittently, enhancing the efficacy during frequent seizures.
Conclusion
The types of TCM neurological diseases are vast, with clinical manifestations that vary widely and are influenced by numerous factors. However, upon deeper investigation into their pathogenesis, most can be characterized by “deficiency of the root and excess of the branch”, involving the internal organs, particularly the liver, spleen, and kidneys. “Deficiency of the root” often results from spleen deficiency leading to insufficient qi and blood production and deficiency of the liver and kidney yin, causing essential substances to fail to nourish the brain marrow and the clear orifices to lose nourishment; “excess of the branch” often arises from insufficient liver and kidney yin, where yin deficiency fails to restrain yang, leading to excessive liver yang disturbing the spirit; additionally, due to spleen deficiency and impaired transportation, phlegm dampness is generated, or blood circulation is weak, leading to stasis over time, resulting in phlegm and stagnant blood obstructing the meridians. Once the body’s righteous qi is insufficient or encounters the six excesses, it can lead to the interaction of wind, fire, phlegm, and stasis, obstructing the brain vessels, resulting in conditions such as stroke, headache, vertigo, dementia, and epilepsy.
Professor Liu Maocai focuses on this primary pathological feature, skillfully employing the method of combining attack and tonification in clinical practice, attacking phlegm and stasis, unblocking the bowels, and clearing heat while emphasizing the tonification of qi and blood, and nourishing the liver and kidneys. Especially in cases where deficiency leads to excess, he advocates for timely expulsion of evil without insisting on complete eradication, particularly for internally generated evils, often “weakening the majority and stopping there”. As long as there are no obvious contraindications, he will use tonifying and supportive herbs as early as possible. Furthermore, Professor Liu points out that supporting the righteous qi and tonifying deficiency is a long-term process. We should adhere to the treatment philosophy of “aiming for balance”, not forcing a return to previous “robustness”, but allowing the body to achieve a new balance under new conditions, striving for stability and effectiveness in prescribing, and avoiding disruption of the stable state of qi, blood, yin, and yang.
