From the perspective of the human body, any disease can be categorized as either superficial (表, biao) or deep (里, li), or a combination of both.
In terms of the upper, middle, and lower jiao, it can be classified as the upper jiao (上焦, shang jiao), middle jiao (中焦, zhong jiao), and lower jiao (下焦, xia jiao). Therefore, any disease exists between the upper and lower jiao. According to TCM theory, the spleen (脾, pi) ascends while the stomach (胃, wei) descends, maintaining the energy exchange between the upper jiao (heart and lungs) and the lower jiao (liver and kidneys). The ascending spleen qi (脾气, pi qi) helps the kidney water (肾水, shen shui) to rise, while the descending stomach qi (胃气, wei qi) aids in lowering the heart fire (心火, xin huo) in the upper jiao. The interaction of heart fire and kidney water in the middle jiao supports the digestion of food. Additionally, the rise and fall of spleen and stomach also maintain the descent of turbid qi (浊气, zhuo qi) and the ascent of clear qi (清气, qing qi), which nourishes the heart, lungs, and brain while expelling turbid qi from the body. Therefore, diseases of the middle jiao (spleen and stomach) can affect the upper jiao (heart and lungs) and lower jiao (kidneys). If there is poor digestion in the spleen and stomach, it can lead to insomnia due to disharmony in the stomach, which should be treated from the perspective of the middle jiao.
There are also two scenarios where diseases of the upper jiao can affect the middle jiao, and problems in the middle jiao can subsequently impact the lower jiao, or vice versa.
For example, diseases of the heart, lungs, and brain often arise from the invasion of pathogenic qi (邪气, xie qi), which is often turbid qi. This can lead to symptoms such as coma and delirium. When digestive function is affected, it may result in constipation or diarrhea. The pathogenesis is often due to the inability of the pathogenic qi in the upper jiao to descend through the stomach qi, and the clear qi from the lower jiao cannot rise through the spleen qi. This results in the organs in the upper jiao being obstructed by pathogenic factors, and the lower jiao becoming mixed with clear and turbid qi, leading to the aforementioned symptoms. Therefore, treatment can involve clearing the pathogenic factors from the upper jiao or unblocking the bowels to assist the descent of stomach qi; when turbid qi descends, stomach qi will naturally rise. Thus, methods to clear turbid qi are often applied in severe cases involving the heart, brain, and lungs.
Additionally, when there is dysfunction in the lower jiao’s intestinal function leading to constipation, turbid qi cannot descend, and it may rise with the spleen qi to the heart and lungs, causing symptoms such as chest tightness and shortness of breath. In severe cases, this can lead to cardiovascular diseases. Therefore, maintaining smooth bowel movements to assist the descent of stomach qi is crucial. Since the rise and fall of spleen and stomach play a significant role in the communication between the upper and lower jiao, in clinical practice, when treatments for the upper and lower jiao are ineffective, treating the middle jiao can yield results. For instance, Banxia Xiexin Decoction (半夏泻心汤, Banxia Xiexin Tang) is used to treat insomnia, Chengqi Decoction (成气汤, Chengqi Tang) for stroke and myocardial infarction, and Buzhong Yiqi Decoction (补中益气汤, Buzhong Yiqi Tang) for constipation and diarrhea.
Therefore, when there is a lack of communication between the upper and lower jiao, we should consider treatment from the middle jiao.
When the upper and lower jiao are not communicating, treatment should focus on the middle jiao. How should we address the disharmony between the superficial and deep? From a TCM perspective, interior conditions can be treated through the upper three jiao, while exterior conditions require dispersing the exterior. However, the pathway between the superficial and deep lies in the Shaoyang (少阳, Shaoyang), which can transport the qi from the interior to the exterior to help the body resist pathogens. Similarly, if the pathogenic qi is strong, it can also enter the interior through the Shaoyang.
Thus, Shaoyang plays an important role in the relationship between the superficial and deep. Shaoyang can resolve exterior conditions, descend interior conditions, and harmonize. According to the Treatise on Febrile Diseases (伤寒论, Shanghan Lun), the representative formula for Shaoyang disease is Xiao Chai Hu Decoction (小柴胡汤, Xiao Chai Hu Tang), where Chai Hu (柴胡, Bupleurum) not only disperses the exterior but also enters the interior, promoting the transformation of old to new. Its combination with Huang Qin (黄芩, Scutellaria) harmonizes the Shaoyang. The combination of Chai Hu and Huang Qin can address the issues of superficial and deep, as well as half superficial and half deep. But why are Banxia (半夏, Pinellia) and Dangshen (党参, Codonopsis) included? Because the qi of the exterior comes from the qi of the interior; only when the interior qi is sufficient can the exterior and half superficial and half deep qi resist external pathogens. Therefore, it is necessary to use Ren Shen (人参, Ginseng), ginger, jujube, and licorice to nourish the interior qi to support the exterior qi. What role does Banxia play? This depends on the combination of Banxia and Huangqin, which opens the middle jiao and clears the turbid qi. When the middle jiao is free of pathogenic factors, the upper and lower jiao can communicate. Adding Ren Shen, ginger, jujube, and licorice to assist the qi, Chai Hu and Huang Qin can address the superficial and deep, as well as half superficial and half deep pathogenic factors. Thus, how could the disease not be treatable? In fact, Xiao Chai Hu Decoction is a formula that treats the entire body, addressing both superficial and deep, as well as upper and lower. This is why there is a school of thought known as the Xiao Chai Hu school in clinical practice, as Shaoyang is the pathway between the superficial and deep, allowing for the treatment of diseases from both aspects.
The middle jiao is the hub of the qi mechanism between the upper and lower parts of the body; Shaoyang is the hub of the qi mechanism between the superficial and deep.
Xiexin formulas (泻心剂, xiexin ji) are representative formulas that focus on the bitter descent and sweet harmonization, emphasizing the regulation of the body’s vertical qi mechanism.
Chaihu formulas (柴胡剂, chaihu ji) are representative formulas that focus on the bitter descent and sweet harmonization, emphasizing the regulation of the body’s horizontal qi mechanism.
In practical situations, careful differentiation of symptoms is still required.
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