1. Warming Yang and Promoting Water MetabolismLi Lao believes: “Drinking is an evil of Yin; when Yin is excessive, Yang becomes weak, and Yang cannot circulate, leading to the meridians being constricted and the pulse being string-like.” Therefore, those with weak Yang and string-like pulse who suffer from symptoms such as fullness in the heart area, Qi rising to the chest, dizziness, palpitations, and difficulty urinating are not merely due to deficiency of Yang Qi in the lower jiao causing internal water accumulation. Additionally, if the heart Yang is insufficient and cannot control the kidney water, or if the spleen is weak and cannot transport water, then water will overflow. Cold water rising to the heart can cause palpitations, affecting the lungs can lead to wheezing, attacking the stomach can cause vomiting, and if it obstructs the clear orifices, it can cause dizziness; if it overflows externally, it can cause swelling.The heart Yang resides above, like the sun shining brightly, warming the middle and lower jiao, as the saying goes, “When the sun shines in the sky, the Yin mist disperses.” The kidney Yang resides below, supported by the kidney Yin, serving as the root of Yang Qi in the body. Both work together to warm and nourish the internal organs and limbs, maintaining normal physiological functions. If the heart Yang is insufficient and cannot warm the middle and lower jiao, then “Yin mist” will arise; if the kidney Yang is insufficient, it cannot control Yin, leading to cold water overflowing, affecting the heart and lung, damaging heart Yang. In summary, deficiency of heart Yang can lead to deficiency of kidney Yang, and deficiency of kidney Yang can further exacerbate heart Yang deficiency. This mutual influence results in increased cold and weakened Yang.In the “Shang Han Lun,” it states: “Excessive sweating can cause the person to clasp their hands over their heart, experiencing palpitations and desiring pressure; Gui Zhi Gan Cao Tang (Cinnamon Twig and Licorice Decoction) is indicated for this.” It also states: “In Shaoyin disease, if symptoms persist for two to three days, and then four to five days, with abdominal pain, difficulty urinating, heaviness and pain in the limbs, and diarrhea, this indicates water Qi. The person may cough, have difficulty urinating, have diarrhea, or vomit; Zhen Wu Tang (True Warrior Decoction) is indicated for this.” Patients with heart and kidney Yang deficiency often present with cold signs in the pulse, such as deep, weak (reduced) string-like pulses. Clinically, one may observe weak (reduced) Yang with string-like Yin, or string-like Yang with weak (reduced) Yin. From the accompanying symptoms, if the upper heart Yang is damaged, the heart loses its Yang Qi protection, leading to palpitations and a desire for pressure. Additionally, insufficient heart Yang can lead to cold stagnation in the chest, resulting in discomfort in the heart and chest. Kidney Yang deficiency can present with signs of cold in the lower jiao, such as difficulty urinating and coldness in the lower back and legs. At the same time, if cold water overflows from the lower jiao, affecting the heart and lung, one may also see cough, palpitations, and vomiting.In clinical practice, for heart and kidney Yang deficiency, Li Lao often uses Zhen Wu Tang combined with Gui Zhi Gan Cao Tang for treatment. Gui Zhi Gan Cao Tang consists of Gui Zhi (Cinnamon Twig) and Gan Cao (Licorice), where Gui Zhi is acrid and sweet to tonify heart Yang, and Gan Cao is sweet and warm to nourish heart fluids. The combination of these two herbs, with their acrid and sweet properties, transforms Yang, allowing heart Yang to be replenished, thus calming palpitations; when “the sun shines in the sky,” the Yin turbidity in the heart dissipates, and chest fullness and discomfort decrease. Furthermore, Gui Zhi Gan Cao warms and assists heart Yang, ensuring sufficient heart Yang, which can then warm kidney Yang. Zhen Wu Tang primarily treats the lower jiao. In this formula, Fu Zi (Aconite) tonifies kidney Yang, paired with Sheng Jiang (Fresh Ginger) to disperse Yin cold; Fu Ling (Poria) promotes urination; Bai Zhu (White Atractylodes) strengthens the spleen to manage water. However, Li Lao believes the key role of Shao Yao (Peony) is to nourish Yin, as “for every part of evil water that is excessive, there is a corresponding reduction in true water.” If body fluids do not transform and become damp phlegm, then true water decreases; “when dampness is excessive, dryness ensues,” thus when transforming dampness, it is essential to assist with Yin-protecting herbs to solidify true water. The cold water Qi can remain in the kidneys and also overflow to the heart, presenting different manifestations, but the pathogenesis is consistent, and Zhen Wu Tang can be used for treatment. Using Fu Zi and Sheng Jiang to treat cold, Fu Ling and Bai Zhu to strengthen the earth to control water. When kidney Yang is replenished and cold water is treated, it will not overflow to the heart. At the same time, kidney Yang and heart Yang support each other. In summary, warming heart Yang above and warming kidney Yang below, with mutual assistance between heart and kidney, will disperse Yin cold.For those with kidney Yang deficiency and fatigue, the essence and Qi of the kidneys are also weak. Therefore, for those with prolonged illness and both Yin and Yang deficiency, when warming Yang, one can add Ba Jiao Tian (Morinda Root), Rou Cong Rong (Cistanche), and Xian Ling Pi (Epimedium) to warm the kidneys and benefit essence. Observing the Yang pulse, if heart Yang is deficient and water is severely reversed, one often adds Gui Zhi to warm and regulate heart Yang, balancing the counterflow. For those with spleen and kidney Yang deficiency, one often adds Fu Zi, Gan Jiang (Dried Ginger), and Rou Gui (Cinnamon) to warm and tonify kidney Yang. If Qi deficiency is severe, one can combine with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If there is cold binding the muscle surface, one can combine with Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) to disperse it. If there is unresolved lung water, one can use Xi Xin (Asarum) to warm the lungs and resolve water, treating according to the symptoms for effectiveness.2. Warming Yang and Dispelling ColdIn the “Jin Kui Yao Lue – Chest Bi, Heart Pain, and Shortness of Breath” chapter, it states: “The pulse should be taken as neither too excessive nor too deficient; Yang is weak and Yin is string-like, which leads to chest bi and pain. This is because of extreme deficiency.” It is known that if Yang Qi is insufficient, the body loses its ability to warm and promote, leading to Yin cold stagnation, resulting in various pains and bi syndromes. Clinically, one often observes weak Yang with string-like Yin pulses or string-like Yang with weak Yin pulses, both indicating Yang Qi deficiency and the emergence of Yin cold. If cold stagnation or binding is evident, the string pulse may show signs of tightness. Li Lao effectively treats this clinically with warming Yang and dispelling cold methods. However, warming Yang and dispelling cold should not be generalized, as they specifically target Yang deficiency and cold stagnation.The main method is to warm Yang, where the pulse is often string-like and may also be deep, slow, and weak. Weakness indicates Yang deficiency; if Yang is deficient, it cannot warm and promote, leading to a string-like and deep, slow pulse. Kidney deficiency with cold syndrome indicates insufficient kidney Yang, with the fire of the Ming Men (Gate of Life) declining, presenting symptoms such as soreness and weakness in the lower back and knees, aversion to cold, and cold limbs. This is often treated with Shen Qi Wan (Kidney Qi Pill) or You Gui Wan (Restore the Right Kidney Pill) to warm and tonify kidney Yang. The kidneys govern the body’s Yang Qi; if kidney Yang is deficient, it manifests as overall Yang Qi deficiency, with symptoms such as cold limbs, profuse sweating, aversion to cold, and a desire to sleep. In such cases, one often uses Rou Gui, Fu Zi, and Gan Jiang, along with Ren Shen (Ginseng) and Fu Zi to strongly warm and tonify Yang Qi. For extreme Yang deficiency, Li Lao often says, “It is better to be strong than soft,” using Ren Shen and Fu Zi to strongly tonify Yang Qi; at this time, one should not use soft tonification methods like “fire from water.”
The main method for dispelling cold often shows signs of tightness in the pulse. Tightness is caused by the cold nature of contraction and binding, thus cold can be divided into guest cold due to weak Yang, or internal cold due to weak Yang producing Yin. Weak Yang producing Yin is primarily indicated by Yang deficiency, with the pulse being string-like and tight, and pressing it shows weakness; thus, the main method is to warm Yang as mentioned above. However, if cold stagnation is evident, the pulse shows signs of stagnation, and simply warming Yang may not sufficiently dispel the stagnation, so one can slightly add warming and dispersing herbs. If Yang is weak and Yin is producing guest cold, it can transform into cold binding or cold stagnation, presenting as body pain, aversion to cold without sweating, abdominal cold, and muscle cramps. At this time, Yang deficiency is accompanied by cold evil, and the pulse may be string-like but strong upon pressing, indicating the presence of cold. If one solely treats the root by warming Yang, it may either insufficiently dispel the stagnation or risk cold closing in on Yang, leading to Yang stagnation, restlessness, and a pulse that is deep, string-like, tight, and rapid, where improper tonification can be harmful. Conversely, if one solely dispels cold, the cold may resolve but Yang will become more deficient, potentially leading to Yang collapse. Therefore, when the pulse shows signs of tightness or weakness with cold stagnation, one should use warming and dispersing herbs to resolve the cold, and tonifying herbs to invigorate Yang, allowing Yang to recover and cold to retreat, leading to improvement in the condition. The main method is: Ma Huang Fu Zi Xi Xin Tang. Li Lao believes this formula has three uses: first, for those with Yang deficiency and cold binding at the muscle surface; second, for those with Yang deficiency and cold evil directly affecting the Shaoyin, presenting with internal cold symptoms; these two categories indicate a combination of Yang deficiency and cold evil. Fu Zi warms Yang, Ma Huang disperses cold binding, and Xi Xin opens kidney Yang, while also guiding Ma Huang into the Shaoyin to disperse cold stagnation. Depending on the severity of the Zheng (correct) and Xie (evil) conditions, the dosages and roles of each herb may vary, and one can also assist with the three sweating methods. Third, for pure Yang deficiency with Yin cold stagnation. The use of Ma Huang is not to disperse guest cold but to invigorate and promote Yang Qi, resolving cold stagnation, and then adding Xi Xin to open kidney Yang. However, at this time, the focus should be on tonifying deficiency, thus Fu Zi is the monarch herb to greatly tonify kidney Yang, while the amounts of Ma Huang and Xi Xin should be small, and one should not recklessly add sweating methods.If cold bi obstructs the meridians, leading to stagnation and blockage, such as headaches, limb numbness, palpitations, and urgency, one can add Quan Xie (Scorpion), Wu Gong (Centipede), Jiang Can (Silkworm), and Chan Tui (Cicada Slough) to this formula to relieve spasms. This can also be used for hypertension caused by cold evil obstructing the blood vessels. For severe Yang deficiency, one can increase the dosage of Fu Zi, Gan Jiang, and Rou Gui; if there is concurrent kidney deficiency and essence depletion with symptoms such as soreness in the lower back and knees, tinnitus, premature ejaculation, or scanty menstruation, one can use Ba Jiao Tian, Suo Yang (Cynomorium), Rou Cong Rong, Xian Mao (Curculigo), Xian Ling Pi, or You Gui Wan to warm Yang and benefit essence. If there is concurrent liver and stomach cold, one can add Wu Zhu Yu (Evodia) and Gan Jiang to warm the liver and warm the earth. If there is concurrent spleen Yang deficiency, one can use Gui Gan Jiang Zao Ma Xin Fu Tang (Cinnamon, Ginger, Jujube, Asarum, and Aconite Decoction) with modifications. If there is cold binding in the lower abdomen with blood stasis, one can use Shao Fu Zhu Yu Tang (Lower Abdomen Invigorating Blood Decoction) with modifications. If there is severe cold pain, one can add Zhi Chuan Wu (Processed Aconite).
