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Support the Right and Expel the Evil

1. Concept of Supporting the Right and Expelling the Evil

(1) Supporting the Right: The principle of supporting the right qi to cure disease involves using medicines or other therapies that assist the right qi, along with appropriate nutrition and functional exercises, to enhance the body’s constitution, improve resistance to disease, and expel evil qi, thereby overcoming illness and restoring health.

(2) Expelling the Evil: Expelling the evil is the principle of eliminating pathogenic factors to cure disease, which involves using medicines or other therapies to remove pathogenic factors, achieving the goal of expelling evil and restoring health. The principle of “draining the excess” is a specific application of this principle.2. Application of Supporting the Right and Expelling the Evil: Supporting the right and expelling the evil are two interrelated aspects; supporting the right is aimed at expelling the evil. By enhancing the right qi, the evil is driven out, thus restoring health, known as “when the right is strong, the evil is expelled by itself.” Expelling the evil is aimed at supporting the right, eliminating pathogenic factors to protect the right qi and restore health, known as “when the evil is gone, the right is naturally secure.” Supporting the right and expelling the evil complement each other. Therefore, when applying the principle of supporting the right and expelling the evil, one must carefully analyze the comparative strength of the right and evil, distinguish the primary and secondary, and decide whether to support the right or expel the evil, or determine the order of supporting the right and expelling the evil. Generally, supporting the right is used for deficiency syndromes; expelling the evil is used for excess syndromes; if it is a mixed deficiency-excess syndrome, both supporting the right and expelling the evil should be used, but this does not mean equal measures of both; rather, it is necessary to clarify the primary and secondary urgency of deficiency and excess to determine the priority and order of supporting the right and expelling the evil. In summary, the principle should be “support the right without leaving evil, expel the evil without harming the right.”Specific Situations are as Follows:(1) Supporting the Right: Supporting the right is suitable for deficiency syndromes where the right is primarily deficient and the evil is not strong. For example, in cases of qi deficiency or yang deficiency, it is advisable to use methods to tonify qi and strengthen yang; in cases of yin deficiency or blood deficiency, it is advisable to use methods to nourish yin and tonify blood.(2) Expelling the Evil: This is suitable for excess syndromes where the evil is primarily strong and the right is not deficient. Common clinical methods such as sweating, vomiting, purging, clearing heat, promoting diuresis, guiding digestion, moving qi, and invigorating blood are all guided by this principle, formulated according to the different conditions of the evil qi.(3) Attack First, Then Supplement: This means to expel the evil first and then support the right. It is suitable for cases where the evil is strong and the right is deficient, but the right qi can still withstand the attack, with the primary contradiction being the strong evil. If one also considers supporting the right, it may assist the evil. For example, in cases of bleeding due to blood stasis, if the stasis is not removed, the bleeding will not stop, so one should first invigorate blood and resolve stasis, and then proceed to tonify blood.(4) Supplement First, Then Attack: This means to support the right first and then expel the evil. It is suitable for mixed deficiency-excess syndromes where the right qi is deficient and cannot withstand an attack. In this case, expelling the evil first would further harm the right qi, so one must first use tonifying methods to support the right, allowing the right qi to gradually recover to a level that can withstand an attack before expelling the evil, to avoid unexpected incidents. For example, in cases of abdominal distension, when the primary contradiction is the deficiency of the right qi and the right qi cannot withstand an attack, one must first support the right, and when the right qi has adequately recovered and can withstand an attack, then expel the evil to avoid complications.(5) Combined Attack and Supplement: This means to use both supporting the right and expelling the evil. It is suitable for cases where both the right is deficient and the evil is strong, but neither is particularly severe. In specific applications, one must distinguish the primary relationship between deficiency and excess, and apply flexibly. For example, if the primary contradiction is deficiency of the right, using only tonifying methods may still retain the evil, while only attacking the evil may easily harm the right. In this case, one should primarily support the right while also expelling the evil. For example, in cases of qi deficiency with a cold, one should primarily tonify qi while also releasing the exterior. If the primary contradiction is the strong evil, then only attacking the evil may easily harm the right, while only tonifying the right may easily retain the evil. In this case, the treatment should primarily expel the evil while also supporting the right.Principle of Primary and Secondary1. Concept of Primary and Secondary: The primary refers to branches and twigs, not the root; the secondary refers to the roots and foundations. Generally speaking, in the doctor-patient relationship, the patient is primary, and the doctor is secondary; in the relationship between evil and right, the right qi of the body is primary, and the pathogenic evil qi is secondary; in the relationship between cause and symptoms, the cause is primary, and the symptoms are secondary; in the order of diseases, the old disease is primary, and the new disease is secondary; in terms of the location of diseases, internal diseases are primary, and external diseases are secondary; in terms of essence and phenomenon, essence is primary, and phenomenon is secondary. It can be seen that the primary and secondary are not absolute, but relative and conditional. In clinical diseases, the principle of “treat the secondary urgently, treat the primary slowly” is adopted according to the different primary and secondary relationships, to achieve the goal of treating the disease at its root, which is the basic principle of primary and secondary. The theory of primary and secondary is of great significance for correctly analyzing the condition, distinguishing the primary and secondary, and providing appropriate treatment.2. Application of the Theory of Primary and Secondary in Treatment:(1) Treat the Primary Slowly: The principle of treating the primary slowly generally applies to chronic diseases, or when the disease is improving, the right qi is already deficient, and the evil has not yet been completely eliminated. For example, in cases of internal injury, the onset is gradual, and the qi and blood of the organs have declined, so it is necessary to wait for the organs to be sufficiently replenished before the right qi can gradually recover. Therefore, treatment should be slow and not rushed. Hence, “treat the main condition slowly, treat the secondary condition urgently” (from Suwen).(2) Treat the Secondary Urgently: The principle of treating the secondary urgently generally applies to acute diseases that are very severe, or when certain symptoms that threaten life appear during the progression of the disease. For example, in the case of acute diseases, it is not advisable to be slow; when the pathogenic evil has not deeply invaded, it is urgent to treat it to eliminate the evil, so that the right qi is not harmed, and the patient can easily recover. Hence, “when chronic diseases are combined with acute diseases, the first thing to treat is the chronic disease” (from Jin Kui Yao Lue). For example, in cases of significant blood loss, the bleeding is the secondary, and the cause of the bleeding is the primary, but the situation is urgent, so it is often prioritized to stop the bleeding as the primary task, and after the bleeding stops, treat the cause of the bleeding to address the primary issue. Additionally, “treat the primary condition first, then the secondary condition”; “if there is difficulty in urination or defecation, treat the secondary condition” (from Suwen). The primary condition is the main, and the secondary condition is the secondary; all diseases should first treat the primary condition, but only in the cases of difficulty in urination or defecation should the secondary condition be treated first. Because in cases of abdominal fullness, the evil is in the stomach. If the stomach is full, then the qi and food cannot circulate, and the organs will lose their nourishment, leading to a more urgent condition, so the secondary condition should be treated first. This is called treating the secondary condition, but in reality, it is treating the root of the organs, which is also treating the primary condition. However, in cases of difficulty in urination or defecation, if it is a general condition, it can be handled according to the situation, and it is not necessary to treat it first. It must be pointed out that the principle of “treat the secondary condition urgently, treat the primary condition slowly” cannot be absolute. In urgent situations, it may also be necessary to treat the primary condition, such as in cases of yang collapse, where urgent methods to restore yang are used, which is treating the primary condition; after significant blood loss, when qi is lost with the blood, urgent methods such as using Dong Shen Tang to tonify qi and stabilize the collapse are also treating the primary condition. Regardless of primary or secondary, the fundamental principle is to treat the urgent condition first. At the same time, in slow situations, it is not impossible to treat the secondary condition; for example, in cases of spleen deficiency and qi stagnation, using regulating qi medicines along with treating the secondary condition is more effective than simply tonifying the spleen.(3) Treating Both Primary and Secondary: This means to consider both the primary and secondary. Treating both primary and secondary is suitable for situations where both the primary and secondary conditions are urgent. For example, in cases of dysentery, where the inability to eat is due to deficiency of the right qi (primary), and persistent diarrhea is due to strong evil (secondary). In this case, both the primary and secondary are urgent, and it is necessary to use both tonifying medicines and medicines to clear and transform damp-heat simultaneously, which is treating both primary and secondary. Similarly, in cases of spleen deficiency and qi stagnation, the spleen deficiency is the primary, and the qi stagnation is the secondary; one should use Ren Shen, Bai Zhu, Fu Ling, and Gan Cao to tonify the spleen and qi to treat the primary, while also using Mu Xiang, Sha Ren, and Chen Pi to regulate qi and relieve stagnation to treat the secondary. The principle of treating both primary and secondary is widely applicable, such as in the use of Shen Su Yin for both tonifying and dispersing, Zhi Zhu Wan for both reducing and tonifying, and Zeng Ye Cheng Qi Tang for both attacking and tonifying. According to the needs of the condition, treating both primary and secondary not only does not contradict but can also complement each other. In summary, generally speaking, for diseases that develop slowly, one should treat the primary; for diseases that develop rapidly, one should first treat the secondary; for cases where both are urgent, one should treat both primary and secondary. In clinical practice, one must approach diseases with a dynamic perspective, adeptly grasping the main contradictions to determine the order and urgency of treatment. Hence, it is said: “Carefully observe the urgency and adjust accordingly. The urgent should be treated alone, while the less urgent can be treated together” (from Suwen, Discussion on Primary and Secondary Diseases).Correct Treatment and Reverse Treatment1. Correct Treatment(1) Concept: Correct treatment refers to a treatment principle that treats the disease contrary to its symptomatic nature, hence also known as “reverse treatment.” Correct treatment is one of the most commonly used treatment principles in clinical practice.(2) Application: It is suitable for diseases where the essence and phenomenon are consistent. Since diseases can be classified into cold, heat, deficiency, and excess, the methods of correct treatment include treating cold with heat, treating heat with cold, supplementing deficiency, and draining excess.① Treating Cold with Heat: This refers to treating cold-type diseases that present cold symptoms with warm and hot medicines, i.e., using heat to treat cold. For example, for exterior cold syndrome, one uses pungent warm methods to release the exterior; for interior cold syndrome, one uses pungent hot methods to warm the interior, etc.② Treating Heat with Cold: This refers to treating heat-type diseases that present heat symptoms with cold medicines, i.e., using cold to treat heat. For example, for exterior heat syndrome, one uses pungent cool methods to release the exterior; for interior heat syndrome, one uses bitter cold methods to clear heat.③ Supplementing Deficiency: This refers to treating deficiency syndromes that present deficiency symptoms with tonifying medicines. For example, for yang deficiency syndrome, one uses methods to strengthen yang; for yin deficiency syndrome, one uses methods to nourish yin.④ Draining Excess: This refers to treating excess syndromes that present excess symptoms with draining methods, i.e., draining the evil. For example, for food stagnation syndrome, one uses digestive methods; for water retention syndrome, one uses methods to drain water; for blood stasis syndrome, one uses methods to invigorate blood and resolve stasis; for parasitic accumulation syndrome, one uses methods to expel parasites.2. Reverse Treatment(1) Concept: Reverse treatment refers to a treatment principle that follows the disease’s false appearance. This involves using medicines or measures that align with the disease’s false appearance, hence also known as “following treatment.” Essentially, it is a method of treatment guided by the principle of treating the disease at its root, thus still adhering to the principle of “treating the disease at its root.”(2) Application: It is suitable for diseases where the symptoms and essence are not completely consistent. In clinical practice, it generally includes the following:① Using Heat for False Heat: This refers to using warm medicines to treat diseases that present false heat symptoms. It is suitable for true cold with false heat, i.e., internal cold is strong, and the yang is constrained externally, resulting in true cold internally and false heat externally. When treating, one targets the essence of the disease, using warm medicines to treat the true cold; once the true cold is resolved, the false heat will also disappear. This method is an example of using heat to treat heat. For example, in cases of internal cold with constrained yang, due to internal cold being strong, the yang qi is constrained externally, clinically presenting with symptoms of true cold such as diarrhea, cold extremities, and a weak pulse, while also showing false heat symptoms such as fever and flushed face. Since the essence is cold and the heat symptoms are false, one cannot use the method of “treating heat with cold” but should use warm medicines to treat the true cold, allowing the yang qi to recover, and the false heat will also disappear.② Using Cold for False Cold: This refers to using cold medicines to treat diseases that present false cold symptoms. It is suitable for true heat that is strong, with the yang being constrained externally, resulting in true heat internally and false cold externally. For example, in cases of heat stroke, due to internal heat being strong, the external symptoms may show cold extremities, but the essence of the disease is heat, so one should use cold medicines to treat the true heat, allowing the false cold to disappear.③ Using Tonics for Obstruction: This refers to using tonifying medicines to treat diseases that present symptoms of obstruction. It is suitable for true deficiency leading to obstruction. For example, in cases of spleen and stomach weakness, where the qi mechanism is disrupted, leading to abdominal distension, one should use methods to tonify the spleen and benefit the stomach to restore the normal function of the spleen and stomach, allowing the qi mechanism to return to normal.④ Using Laxatives for Obstruction: This refers to using laxative medicines to treat diseases that present symptoms of obstruction. It is suitable for true deficiency with false excess. For example, in cases of food stagnation leading to diarrhea, one should use digestive methods; in cases of bleeding due to blood stasis, one should use methods to invigorate blood and resolve stasis. This method of using laxatives for obstruction is an example of using laxatives for obstruction. Both correct treatment and reverse treatment target the essence of the disease and belong to the category of treating the disease at its root. However, the concepts of correct treatment and reverse treatment differ, and in terms of the nature, efficacy, and relationship between the medicines used and the essence and symptoms of the disease, there is a distinction between reverse and following treatment. Additionally, their applicable diseases differ:For diseases where the essence and clinical manifestations are consistent, use correct treatment; for diseases where the essence and clinical manifestations are not completely consistent, use reverse treatment. In clinical practice, most diseases have consistent essence and symptoms, thus correct treatment is the most commonly used treatment principle.Adjusting Yin and Yang1. Concept: Adjusting yin and yang refers to the principle of reducing excess and supplementing deficiencies in response to changes in the body’s yin and yang. This aims to restore a relatively balanced state. Fundamentally, diseases arise from the disruption of the coordination and balance between yin and yang, resulting in excess or deficiency. Therefore, adjusting yin and yang, “with balance as the goal,” is the fundamental principle of TCM in treating diseases.2. Application:(1) Reducing Excess: Reducing excess, also known as reducing excess, refers to diseases where either yin or yang is excessively strong, which should be treated using methods of “draining the excess.”① Suppressing Excess Yang: “Excess yang leads to heat,” resulting in excess heat syndrome, which should be treated by clearing and draining excess yang heat, following the principle of “treating heat with cold.”② Reducing Excess Yin: For excess yin leading to cold syndrome, one should warm and disperse the 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 yin, if the opposite side is deficient, one should also consider supplementing the deficiency.(2) Supplementing Deficiency: Supplementing deficiency refers to the principle of treating diseases with deficiency by using methods of “supplementing the deficiency.” There are distinctions between yin deficiency, yang deficiency, and deficiency of both yin and yang, and the treatment principles include nourishing yin, tonifying yang, and supplementing both yin and yang.① Treating Yang Disease with Yin, Treating Yin Disease with Yang: Treating yang disease with yin is suitable for yin deficiency syndromes, while treating yin disease with yang is suitable for yang deficiency syndromes. “Yin deficiency leads to heat” results in deficiency heat syndrome, which should be treated by nourishing yin to control yang excess. “Yang deficiency leads to cold” results in deficiency cold syndrome, which should be treated by supplementing yang for yang deficiency and nourishing yin for yin deficiency to restore balance.② Seeking Yin within Yang, Seeking Yang within Yin: According to the theory of interdependence of yin and yang, when treating yin deficiency, one should appropriately add tonifying yang medicines to the nourishing yin formula, known as “seeking yin within yang.” When treating yang deficiency, one should appropriately add nourishing yin medicines to the tonifying yang formula, known as “seeking yang within yin.” Since yang is supported by yin, it can generate endless transformations, and yin is elevated by yang, it can provide an unending source. Therefore, when treating blood deficiency, one often adds tonifying qi medicines to the blood tonifying formula; when treating qi deficiency, one often adds blood tonifying medicines to the qi tonifying formula.③ Supplementing Both Yin and Yang: 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. In treatment, both yin and yang should be supplemented. Since yin and yang are the overarching principles of differentiation, various pathological changes 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 deficiency, and draining excess all fall within the scope of adjusting yin and yang.Harmonizing Qi and Blood1. Concept: Qi and blood are the foundation of life; all diseases affect qi and blood. Therefore, “the key to treating diseases lies in understanding qi and blood” (from Yi Lin Gai Cuo). Harmonizing qi and blood refers to the principle of using “draining the excess and supplementing the deficiency” based on the insufficiency of qi and blood and their respective functional abnormalities, as well as the pathological changes of qi and blood interacting with each other, to ensure that qi flows smoothly and blood is harmonized. This is an important principle in TCM for treating diseases, suitable for conditions of qi and blood imbalance.2. Application:(1) Treatment Principles for Qi Disorders: Traditional Chinese medicine believes that qi has the functions of warming, transforming, promoting, defending, and holding. Qi is omnipresent, and any imbalance can lead to various diseases. The site of qi imbalance is where the disease lies. Therefore, treatment must focus on regulating qi, and there are many methods to regulate qi, such as what is stated in “Du Yi Sui Bi: On 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 secure it; if it is stagnant inside, flow and disperse it.” Broadly speaking, methods such as warming, cooling, and even massage, acupuncture, and diet all fall under the category of regulating qi. The treatment principles for qi disorders can be summarized as follows: qi deficiency should be supplemented, qi stagnation should be soothed, qi sinking should be elevated, qi counterflow should be descended, qi collapse should be secured, and qi obstruction should be opened.① Qi Deficiency Should Be Supplemented: Qi deficiency refers to the pathological change of insufficient original qi, weakened organ function, and low resistance to disease. The lungs govern the qi of the body, and the spleen is the foundation of postnatal qi, the source of qi and blood generation. Therefore, tonifying qi primarily focuses on supplementing the qi of the spleen and lungs, especially emphasizing the cultivation of middle qi. The original essence relies on the physiological function of the kidneys to store essence to fully exert its physiological effects. Therefore, in cases of extreme qi deficiency, one should also start from tonifying the kidneys. Qi is the commander of blood, and blood is the mother of qi; the two are interdependent. Therefore, tonifying qi often combines with tonifying 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, one should also use methods to tonify yang. Tonifying qi medicines can easily lead to stagnation; generally, in cases of internal phlegm and dampness, they should not be used. However, if necessary, tonifying qi can be combined with methods to resolve phlegm and eliminate dampness. Additionally, if qi deficiency leads to distension, one should also use methods to regulate qi.② Qi Stagnation Should Be Soothed: Qi stagnation refers to the stagnation and obstruction of qi flow. This often results from emotional disturbances, phlegm and dampness accumulation, or blood stasis, which affects the flow of qi, 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 Dan Xi Xin Fa). The rise and fall of qi in the human body are often related to the functions of the liver (which governs smooth flow), lungs (which govern descent), spleen (which governs elevation), stomach (which governs descent), and small and large intestines (which govern secretion and conduction). Thus, qi stagnation is often associated with dysfunction of the liver, lungs, spleen, and stomach. The liver governs smooth flow and regulates qi; if the liver fails to regulate, qi becomes stagnant. Therefore, diseases of qi stagnation often begin with liver qi stagnation. Treatment for qi stagnation must focus on regulating and moving qi. The terms regulating qi, soothing qi, and moving qi may differ in name and weight, but they all aim to “soothe qi to restore balance.” Since qi stagnation can occur in the body, in the organs, due to cold, heat, deficiency, or excess, one should not simply break or move qi; rather, it 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 to relieve dryness without causing stagnation, and use dispersing methods without forcing growth. Soothing qi medicines are mostly pungent and aromatic; large doses or prolonged use can consume qi, disperse qi, and deplete fluids, so caution should be exercised in cases of blood deficiency, yin deficiency, and 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 congenital insufficiency or prolonged illness leading to weakness, causing damage to the organs’ support and the regulation of qi and fluids, leading to various symptoms of qi sinking. Sinking should be elevated; therefore, methods to elevate qi should be used. Elevating qi is primarily used for cases of middle qi sinking, presenting symptoms such as sunken fontanelle, drooping eyelids, prolapse, persistent diarrhea, and unstable pregnancy. ④ Qi Counterflow Should Be Descended: Qi counterflow refers to the abnormal rise of qi in the organs. Qi counterflow is often seen in the lungs, stomach, and liver. Lung qi counterflow leads to cough and chest tightness; stomach qi counterflow leads to nausea and belching; liver qi counterflow leads to headaches, dizziness, and fullness in the chest and flanks, and may even lead to fainting; kidney qi (conception qi) counterflow leads to rebellious qi. Qi counterflow should be descended, as it is said: “When qi is counterflowing in the organs, it should be treated by harmonizing qi first” (from Jing Yue Quan Shu, Blood Disorders). Descending qi is also known as harmonizing qi and balancing qi. Qi counterflow is primarily due to excess, but there can also be deficiency. The method of descending qi is suitable for excess syndromes and should be used temporarily, not for prolonged treatment. If the counterflow is due to deficiency, one should supplement the deficiency, allowing the qi to descend naturally, and not use descending medicines.⑤ Qi Collapse Should Be Secured: Qi collapse refers to the weakened internal holding and securing 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 fluids, the functions of the organs decline, and the mutual support of yin and yang is lost, leading to the risk of collapse and death. There are degrees of collapse, so in clinical practice, there are distinctions between deficiency collapse and sudden collapse. Symptoms such as excessive sweating, loss of yang, uncontrollable seminal discharge, persistent diarrhea, loose stools, involuntary urination, and chronic cough with loss of fluids all belong to qi collapse. Deficiency should be supplemented, and astringent methods can secure the collapse. Therefore, in cases of qi collapse, one should add astringent substances to the methods of tonifying qi and securing the root. In cases of sudden collapse, astringent methods are ineffective; one should supplement yang and assist yin, allowing yin to secure yang and using astringent methods in conjunction with tonifying methods, also considering the cold or heat of the condition. Since qi is yang, the treatment for qi collapse often involves warming and tonifying, along with astringent methods.⑥ Qi Obstruction Should Be Opened: Qi obstruction occurs due to external obstruction by turbid evils or extreme qi stagnation, leading to sudden fainting and loss of consciousness. Clinically, it is characterized by sudden fainting and loss of consciousness, often accompanied by cold extremities. Obstruction should be opened; if the clear orifices are obstructed, leading to fainting, this is also known as opening the orifices. There are warm and cool methods for opening the orifices. Qi obstruction can be classified as either deficiency or excess; if it is excess, the evil has not diminished, and the right is weak, treatment should focus on opening the obstruction. If it is deficiency, it is a case of internal closure and external escape, and one should supplement qi and nourish blood to restore the collapse. One should not simply use pungent and aromatic medicines to open the orifices without distinguishing between deficiency and excess, to avoid the pitfalls of mixing deficiency and excess.(2) Treatment Principles for Blood Disorders: Blood is the essence of food and fluids, 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. Blood 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, with treatment principles varying between tonifying, moving, stopping, and cooling.① Blood Deficiency Should Be Supplemented: Blood deficiency refers to insufficient blood or reduced nourishing function of blood. The heart governs blood, the liver stores blood, the spleen produces and governs blood, and kidney essence can transform into blood, so 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 cases of severe blood deficiency, tonifying blood formulas often include qi tonifying medicines to achieve the effect of tonifying qi and generating blood. Blood deficiency and yin deficiency often influence each other, so for blood deficiency with concurrent yin deficiency, it is common to combine with nourishing yin products to enhance the effect. Blood tonifying medicines are often rich and can hinder digestion, so 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 spleen-strengthening and stomach-harmonizing medicines to avoid promoting dampness and harming the spleen, affecting the healthy function of the spleen and stomach.② Blood Collapse Should Be Secured: Continuous bleeding, excessive menstrual flow, and significant blood loss all belong to blood collapse, which should be treated with astringent methods to secure the collapse. Since collapse leads to dispersion and not gathering, astringent and warming products should be used to restrain the loss. When treating blood collapse, it is essential to add qi tonifying medicines to the astringent medicines. For example, in cases of significant blood loss, one should also use methods to secure the collapse and benefit qi. Qi can move blood, and blood can carry qi, so blood collapse inevitably leads to qi collapse, which is not merely blood collapse, and may even lead to the risk of losing both yin and yang.③ Blood Stasis Should Be Moved: Blood stasis refers to the pathological state of slow and unflowing blood. “For blood that is solid, it should be resolved” (from Suwen, Discussion on Yin and Yang). Stasis should be moved, and the key is to resolve stasis. 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, it is essential to accurately grasp the diagnostic indicators of blood stasis and distinguish the location of the disease, whether it is internal or external, the nature of the disease, whether it is cold or heat, and the severity of the disease, whether it is deficiency or excess, to achieve the desired effect. While invigorating blood and resolving stasis is the 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, distinguishing between severity. One should not indiscriminately break stasis and attack, as this may lead to quick results but can harm the right qi.Understanding Medicinal Properties: The effects of methods to invigorate blood and resolve stasis are reflected through the properties of the medicines and formulas used. Therefore, it is essential to understand the characteristics of the medicines. First, treating cold with heat and treating heat with cold are fundamental principles in TCM. The causes of blood stasis can be classified into cold and heat. “Blood that is affected by cold will congeal into clots,” and “blood that is affected by heat will boil into clots” (from Yi Lin Gai Cuo). Therefore, one should select medicines based on their cold, heat, warm, or cool properties. Second, medicines for invigorating blood and resolving stasis not only have the common effects of promoting blood flow, regulating blood qi, and eliminating stagnation, but each medicine may also have additional effects such as moving qi, nourishing blood, cooling blood, stopping bleeding, resolving symptoms, unblocking meridians, promoting diuresis, healing injuries, and treating abscesses. Third, certain medicines for invigorating blood and resolving stasis are sensitive to specific diseases or locations. For example, San Leng and E Zhu are used to resolve masses, while Huang Yao Zi and Liu Ji Nu are used to treat 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 the liver, Ze Lan is used. Understanding these medicinal properties allows for appropriate selection and formulation.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 and moving qi, tonifying qi and nourishing blood, stopping bleeding and resolving symptoms, cooling blood and 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 blood flow, or inherent yang deficiency leading to internal cold, resulting in stagnation of qi and blood, characterized by cold pain. Warming and dispersing medicines should be used to unblock the meridians and activate circulation, combined with blood-moving and warming products.⑤ Blood Heat Should Be Cooled: Blood heat refers to the excessive heat in the organs, which forces heat into the blood, or the invasion of warm heat evils into the blood, characterized by bleeding and heat symptoms. Since heat should be treated with cold, blood heat is often treated with cooling and blood-stopping products. Blood that is cooled will congeal, and blood that is warmed will flow, so when using cooling and blood-stopping medicines, one should stop at the right moment and not overdose. In cases of bleeding with significant stasis, one should not simply use large doses of cold and cooling blood-stopping medicines; if necessary, one should combine with invigorating blood and moving blood medicines to avoid leaving behind stasis. Excessive heat will harm yin, so in addition to combining with cooling and blood-stopping products that have nourishing yin effects, one can also add nourishing yin medicines.⑥ Bleeding Should Be Stopped: Any blood that does not follow the normal path, whether it overflows from the mouth or nose, or descends from the two yin, or overflows from the skin, is referred to as bleeding: bleeding should be stopped. Correctly applying methods to stop bleeding 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 caused by fire and qi” (from Jing Yue Quan Shu, Blood Disorders): qi is the commander of blood, and blood follows qi. Either excessive fire leads to qi counterflow and blood overflow, or cold leads to qi stagnation and blood stasis, and there may also be qi deficiency with cold. However, bleeding is mostly associated with heat. Additionally, internal stasis can obstruct blood flow, leading to blood not following its normal path, which can also cause bleeding. The pathogenesis of bleeding is primarily based on qi, encompassing cold, heat, deficiency, and excess. Stopping bleeding must also distinguishthe location of the bleeding, as coughing blood, epistaxis, hematemesis, hematochezia, 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, which is known as “ceasing treatment upon seeing blood.” It is advisable to avoid using large doses of cold and astringent medicines; in the initial stages of bleeding, one should avoid using large doses of cooling and blood-stopping medicines, as cold and cooling medicines should not be used for prolonged periods to prevent internal stasis, which can harm spleen yang. If the spleen is harmed, blood will not return to the meridians. It is also crucial to avoid solely using astringent and blood-stopping products, especially in cases of bleeding with concurrent blood stasis, to avoid “closing the door to the enemy.””> Regarding the use of charcoal for stopping bleeding: charcoal is an important measure in TCM for treating bleeding. It is often said that “red meets black to stop bleeding,” but one should not use charcoal indiscriminately for bleeding without distinguishing between the nature of the disease, whether it is deficiency or excess, and the properties of the medicines, whether they are cold or hot. The general rules for using charcoal to stop bleeding are:For bleeding due to excess heat, one should use bitter cold medicines to directly counteract the fire; once the heat is cleared, the blood will naturally settle. For bleeding due to deficiency heat, one should nourish yin, clear heat, and reduce fire, using sweet cold and salty cold to nourish yin and clear heat. Charcoal, being bitter and cold, may harm fluids and deplete liquids, so it is not advisable to use charcoal. For bleeding due to deficiency cold, one should use warming methods, while cold and cooling medicines are not suitable. In cases of mixed cold and heat, or when both deficiency and excess are present, the treatment should consider both cold and heat, and both deficiency and excess, with blood-stopping agents being used regardless of whether they are cold or hot, and can be used in charcoal form. In clinical practice, the use of charcoal to stop bleeding must weigh the pros and cons, and correct usage can reflect the wonderful effects of charcoal in stopping bleeding.(3) Treatment Principles for Qi and Blood Disorders: Qi and blood are interdependent; qi deficiency leads to blood weakness, qi stagnation leads to blood stasis, qi sinking leads to blood descent, and qi counterflow leads to blood disorder. Qi warms and blood flows; if qi is diseased, blood cannot act independently, thus it also becomes diseased. Therefore, the theory of treating qi disorders must also include blood treatment. This is the theoretical basis for treating qi disorders with blood treatment. In summary, treating qi without treating blood is not a complete treatment. For qi deficiency, one should “seek qi within essence”; for qi stagnation, one should also consider the consumption of yin blood; for qi counterflow, one should seek harmony between qi and blood: these are important principles for treating qi disorders.② Treating Blood Disorders with Qi: Blood disorders will inevitably affect qi; if blood is deficient, qi will also be weak; if blood is stagnant, qi will also be stagnant; if blood collapses, qi will also escape, leading to the risk of losing both yin and yang. Therefore, the relationship between qi and blood is very close, and they are mutually dependent. Thus, treatment should adjust the relationship between the two to restore normalcy.① Treating Qi Disorders with Blood: Qi and blood are mutually supportive; qi deficiency leads to blood weakness, qi stagnation leads to blood stasis, qi sinking leads to blood descent, and qi counterflow leads to blood disorder. Therefore, when treating blood disorders, one must also treat qi. The treatment principles can be summarized as follows: “If qi is diseased, blood will also be diseased; therefore, treating qi must also include blood treatment” (from Yi Jia Si Yao). In clinical practice, one should consider the overall situation, harmonize yin and yang, and ensure that yin is balanced with yang, and qi is adjusted with blood, so that the disease can heal itself.Adjusting the Organs1. Concept: The human body is an organic whole; the organs coordinate with each other physiologically and influence each other pathologically. A disease in one organ can affect others, and a disease in another organ can also impact the original organ. Therefore, adjusting the organs means that when treating organ diseases, one must consider the imbalance of yin, yang, qi, and blood in each organ, and also pay attention to adjusting the relationships between the organs to restore balance. This is the basic principle of adjusting the organs.2. Application:(1) Adjusting the Yin, Yang, Qi, and Blood of the Organs: The organs are the center of life activities; the yin, yang, qi, and blood of the organs are the foundation of life activities. The imbalance of yin, yang, qi, and blood in the organs is the basis for pathological changes in the organs. Therefore, adjusting the yin, yang, qi, and blood of the organs is the basic principle of adjusting the organs. The physiological functions of the organs differ, and the pathological changes of their yin, yang, qi, and blood imbalances are also not identical. Therefore, treatment should be based on the pathological changes of the organs, whether they are deficient or excessive, cold or hot, and should be supplemented or drained accordingly. For example, the liver governs smooth flow and stores blood, with blood as its body and qi as its function, and it is characterized by upward movement. Its pathological features often include excess liver qi and liver yang, while liver yin and blood are often insufficient. If the liver is too strong, qi stagnation can transform into fire, leading to blood deficiency and heat, and wind can arise. Therefore, the treatment of liver diseases focuses on regulating qi, tonifying blood, and harmonizing blood, combined with clearing, nourishing, and calming the liver based on the cause.(2) Adapting to the Physiological Characteristics of the Organs: The five organs store essence and qi without dispersing, while the six organs transform substances without storing. The yin-yang and five-element properties of the organs, the rules of qi movement, and the seasonal responses, as well as their preferences and aversions, differ. Therefore, adjusting the organs must align with their characteristics. For example, the spleen and stomach belong to the earth; 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 elevation, and elevation is harmonious, while the stomach qi governs descent, and descent is balanced. Therefore, when treating the spleen, it is often advisable to use sweet and warm medicines to assist its upward movement, while being cautious with cold and damp medicines to avoid harming yang. When treating the stomach, it is common to use sweet and cold medicines to promote descent, while being cautious with warm and drying products to avoid harming its yin.(3) Coordinating the Relationships Between the Organs:① Adjusting Based on the Five Elements’ Generating and Overcoming Relationships: The treatment principles mainly include “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 the heart for liver excess and draining the stomach for heart excess all belong to the principle of “draining the child.”Adjusting Based on the Five Elements’ Overcoming Relationships: The treatment principles mainly include “suppressing the strong and supporting the weak.” For example, if wood and fire harm metal, one can use methods to support metal and balance wood, which is suppressing the strong; if liver deficiency affects the spleen and stomach, this is wood not supporting earth, and treatment should harmonize the liver and strengthen the spleen to enhance both functions, which is supporting the weak. Adjusting wood to suppress earth and balancing north and south are examples of applying both principles with distinctions.Adjusting Based on the Five Elements’ Transformative Relationships: Within the five elements, there is mutual generation and overcoming, and they mutually influence and restrict each other, creating a continuous cycle. Therefore, when adjusting the functions of the organs based on the five elements, it is necessary to not only supplement the mother and drain the child, suppress the strong and support the weak, but also to combine these approaches to adjust the relationships between the relevant organs. For example, wood overcomes earth, earth generates metal, and metal overcomes wood; thus, one should both suppress wood and support earth, while also enriching earth to generate metal, balancing the two.② Adjusting Based on the Theory of Mutual Containment of the Five Organs: The five elements mutually contain each other, and the five elements correspond to the five organs, while the five organs mutually contain each other. One organ governs the five organs, and the five organs unify into one organ. Any physiological function is regulated by the five organs collectively, with distinctions between primary and secondary. For example, regarding respiratory function, the lungs govern respiration, but the lungs govern exhalation, the kidneys govern inhalation, and the liver regulates the smooth flow of qi, allowing for appropriate ascent and descent. The spleen governs the transformation of food and fluids, participating in the generation of vital qi; the heart governs blood vessels and houses the spirit, with blood nourishing qi, and the heart’s spirit also regulates respiration. Therefore, all five organs participate in regulating respiration, especially the lungs, spleen, and kidneys. Thus, when respiratory function is disrupted, the focus should be on treating the lungs, spleen, and kidneys.③ Adjusting Based on the Mutual Relationships Between the Organs: The coordination between the organs reflects the relationship of yin and yang, as well as the relationship between exterior and interior. The organs move qi to the organs, and the organs transmit essence to the organs. Physiologically, they coordinate with each other, while pathologically, they influence each other and transform into one another. Therefore, when treating organ diseases, in addition to directly treating the affected organ, one can also use the theory of mutual relationships between the organs to treat either the organ or the organ, or treat both simultaneously.Organ Diseases Treated by the Organ: For example, the heart corresponds to the small intestine; in cases of heart fire, one can directly drain heart fire while also unblocking the small intestine, allowing the heat from the heart to be expelled from below, thus reducing heart fire. Similarly, if the liver is excessive, one can drain the gallbladder, and if the spleen is excessive, one can drain the stomach, which is the principle of treating the organ before treating the organ.Organ Diseases Treated by the Organ: For example, the kidneys correspond to the bladder; if the bladder’s qi transformation function is abnormal, leading to water metabolism disorders, treating the kidneys will also treat the bladder. If there is constipation due to obstruction of the organ’s qi, one should also lower the pathogenic qi to allow the organ’s qi to flow smoothly, leading to spontaneous bowel movements.Simultaneous Treatment of Organs: While organ diseases can be treated by treating the organ or the organ, in clinical practice, simultaneous treatment of both organs is often employed. For example, the spleen and stomach work together; their intake and movement complement each other, and their elevation and descent are interdependent. Therefore, spleen diseases will affect the stomach, and stomach diseases will also impact the spleen. Thus, in clinical practice, the spleen and stomach are often treated together. Excess should be drained from the organ, while deficiency should be supplemented in the organ. The six organs transform substances without storing them, using movement for function and descent for harmony, while the five organs store essence and qi without dispersing, valuing storage. Both the five and six organs can manifest as excess syndromes, which should be drained. For example, in cases of excess heat in the stomach and intestines, one can use Cheng Qi to clear the heat from the stomach and intestines. Excess in the five organs can also be drained through the six organs to expel evils, such as in cases of damp heat in the liver channel, which can be cleared through the intestines and promote urination to expel damp heat. Deficiency in the five organs should be supplemented, and deficiency in the six organs can also be treated by supplementing the five organs to support the right. For example, if the bladder’s qi transformation is weak, leading to frequent urination, one should often treat the kidneys to secure the qi. If the small intestine’s function of separating clear from turbid is low, one should also treat the spleen and kidneys, etc.Considering Time, Place, and Individual Differences: The occurrence, development, and outcome of diseases are influenced by various factors, such as climate changes, geographical environment, and individual physical differences. Therefore, when treating diseases, it is essential to consider these factors and analyze the specific situation to adopt appropriate treatment methods:1. Adjusting According to Time:(1) Concept: The changes in seasonal climate have a certain impact on the physiological functions and pathological changes of the human body. The principle of considering treatment and medication based on the characteristics of different seasonal climates is known as adjusting according to time.(2) Application: Throughout the year, there are changes in cold and heat, so when treating diseases, one should consider the current climatic conditions. For example, in spring and summer, as the climate transitions from warm to hot, yang qi rises, and the body’s pores open. Even if one contracts wind-cold, one should be cautious in using strong sweating agents like Ma Huang and Gui Zhi to avoid excessive opening and depleting qi and yin. In autumn and winter, as the climate transitions from cool to cold, yang is strong and yin is weak, and the body’s pores become tight, so if there is a heat syndrome, one should also be cautious in using cold medicines like Shi Gao and Bo He to prevent excessive cold from harming yang. Therefore, it is said: “Use warmth to avoid warmth, use heat to avoid heat, use coolness to avoid coolness, and use cold to avoid cold” (from Suwen, Discussion on the Six Elements).2. Adjusting According to Place:(1) Concept: The principle of considering treatment and medication based on the characteristics of different geographical environments is known as adjusting according to place.(2) Application: Different geographical environments, due to varying climatic conditions and living habits, lead to differences in physiological activities and disease characteristics. Therefore, treatment and medication should also differ. For example, in the northwest region of China, where the terrain is high and cold, diseases are often cold, and treatment should be warm; in the southeast region, where the terrain is low and warm, diseases are often heat, and treatment should be cold. Even the same disease may require different treatment methods based on regional characteristics. For instance, when using Ma Huang and Gui Zhi to treat wind-cold, in the severe cold of the northwest, the dosage can be slightly higher, while in the warm southeast, the dosage should be slightly lower. Additionally, certain regions may have endemic diseases that should also be taken into account during treatment.3. Adjusting According to Individuals:(1) Concept: The principle of considering treatment and medication based on the different characteristics of patients, such as age, gender, constitution, and lifestyle, is known as adjusting according to individuals.(2) Application: When treating, one should not view the disease in isolation but should consider the overall condition of the patient. For example:① Age: Different ages have different physiological functions and disease characteristics. Elderly individuals often have weakened qi and blood, and their physiological functions decline, leading to more deficiency syndromes or a combination of deficiency and excess. When treating deficiency syndromes, one should tonify, while for excess syndromes, one should also consider the formula to avoid harming the right qi. Young children have abundant vitality but may have weak qi and blood, and their organs are delicate. Since infants cannot care for themselves, they often suffer from irregular feeding and temperature imbalances, so caution should be exercised when using strong or tonifying agents. Generally, the dosage of medicines must also be adjusted according to age.② Gender: Males and females have different physiological characteristics, especially for women during menstruation, pregnancy, and postpartum periods, where treatment and medication must be considered carefully. For example, during pregnancy, it is advisable to avoid or use caution with strong purgatives, blood-breaking agents, and toxic medicines that may harm the fetus, and postpartum considerations should include qi and blood deficiency and lochia.③ Constitution: In terms of constitution, due to individual differences in innate endowment and postnatal nurturing, individual qualities vary in strength and weakness, as well as in cold and heat tendencies, and some may have chronic diseases. Therefore, even with the same disease, treatment and medication should differ. For example, individuals with strong yang should be cautious with warm and hot medicines, while those with excessive yin should be cautious with cold and cooling medicines. Other factors, such as the patient’s occupation and working conditions, may also relate to the occurrence of certain diseases and should be considered during diagnosis and treatment. The principles of adjusting according to time, place, and individuals fully reflect the holistic view of TCM and the principles of differentiation and treatment in practical applications. It is essential to view issues comprehensively and analyze specific situations accordingly.

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