1. Why is it called Supporting Yang?
First, let us understand the importance of Yang Qi to the human body. The “Huangdi Neijing” states, “Yang Qi is like the sky and the sun; if it loses its place, it will shorten life and not shine.” Mr. Zheng Qinan believes that “a thread of true Yang in the kidney is the foundation of human life”; and Dr. Li Ke emphasizes this point, stating that humans exist between heaven and earth, obtaining Yang from heaven and Yin from earth, and the combination of heaven and earth Qi is called humanity. Zheng Qinan explains that if a person practices and abandons Yin to strive for Yang, pure Yang becomes an immortal, while pure Yin becomes a ghost. If there is only Yin Qi and no Yang Qi, one becomes a ghost. Therefore, to be a normal person, one should not harm Yang Qi. “Wherever Yang Qi does not reach in the skin, organs, and orifices, there is disease. Yang deficiency accounts for 80-90% of cases, while Yin deficiency is rarely seen.” Cold and dampness are harmful, accounting for 80-90% of cases.” This is the experience of my master, Dr. Li Ke, which is worth learning and understanding. The cool tea in Guangdong is very harmful, and Dr. Li does not agree with drinking cool tea; drinking it depletes and attacks Yang Qi. Many children, when they catch a cold and have a fever, use antibiotics, which depletes Yang Qi each time. After a few days, when Yang Qi rises to fight back, they have a fever again and use antibiotics, leading to a victory of evil Qi over Yang, further depleting Yang Qi, and eventually, they stop having a fever, allowing evil Qi to enter the three Yin. Therefore, protecting Yang Qi is very important. When catching a cold, one should naturally expel the cold evil rather than blindly use cool medicines or anti-inflammatory injections to bind the evil Qi inside. When Yang Qi is strong, a person is strong; when Yang Qi is weak, a person is weak; when Yang Qi is lost, a person dies. With Yang Qi, there is life; without Yang Qi, there is death. To promote the protection of Yang Qi, Dr. Li Ke specifically published a book titled “Human Yang Qi and Disease,” which shows his emphasis on Yang Qi. He believes that all diseases arise from cold; when Yang Qi is deficient, numerous diseases arise. Nowadays, not only tumors but most diseases are related to damage to Yang Qi. The modern lifestyle often leads to an excess of Yin and a deficiency of Yang, such as going to KTV at night, staying up late, drinking cold beverages, and the extensive use of antibiotics and hormones in hospitals, which can also lead to the depletion of Yang Qi. I have a friend who works at a radio station; he finishes his program around 11 or 12 at night, and after a late-night snack, he goes to exercise. I told him that this violates the principles of Yin and Yang. The “Huangdi Neijing” states: “Therefore, Yang Qi governs the exterior during the day; at dawn, human Qi is born; at noon, Yang Qi is abundant; in the evening, Yang Qi is already weak, and the Qi gates close. Therefore, in the evening, one should gather and not disturb the muscles and bones, nor expose oneself to mist and dew. If one goes against these three times, the body will become weak.” Therefore, we should follow the natural order; in the evening, Yang Qi should be collected and restrained. If one does not rest and instead depletes it, is this not harming Yang? Additionally, excessive desires, irregular living habits, and other bad lifestyle choices can lead to Yang Qi deficiency and internal excess of Yin and cold. This is why the Fire God School of TCM has emerged in recent years. If everyone is Yin deficient and Yang excessive, how can there be a fire? Therefore, the recent popularity of the Supporting Yang School and Fire God School is due to their effectiveness. In fact, the meaning of Supporting Yang has both broad and narrow definitions. Supporting Yang means assisting and supporting Yang Qi; as long as one does not harm Yang Qi, it is Supporting Yang. Regardless of the method or approach, as long as it allows a person to return to their natural circular movement, the six Qi are one Qi, and when the six Qi can each return to their place, that is Supporting Yang. Dr. Li Ke said: Supporting Yang is the truth; the eight methods cannot be abandoned. The eight methods are sweating, vomiting, purging, harmonizing, warming, clearing, resolving, and tonifying. The eight methods cannot be abandoned; this is to protect Yang Qi and true Qi. What needs to be cleared should be cleared, and what needs to be purged should be purged. The narrow definition of Supporting Yang is to use warming and hot medicines or foods to support Yang Qi, expelling cold evil from the body and warming the body’s original Yang. Currently, we use this approach more often because most patients have an excess of Yin and a deficiency of Yang, with cold Yin in the lower body obstructing the rise of Yang Qi, so our methods primarily focus on promoting the rise of Yang. Next, let’s discuss circular movement; Dr. Li Ke highly praises circular movement. Yang Qi must move and restore itself so that life can continue, and Yang Qi can naturally transform. One must not harm it. Warm water allows wood to grow; most modern people are in a state of cold water, which leads to stagnant wood and prevents growth. Therefore, in clinical practice, we observe where the problem lies and treat it, allowing the six Qi to return to their places; this is the broad definition of Supporting Yang.
2. The fundamental cause and mechanism of tumor formation is the excess of Yin and deficiency of Yang. Tumors are tangible entities, falling under the categories of “accumulation” and “tumor” in TCM classics. The “Shuowen Jiezi” states: “Tumor means swelling, derived from disease, and leaves a sound.” The “Shengji Zonglu” states: “The position of the tumor means stagnation that does not leave.” What does stagnation that does not leave mean? It means that tangible phlegm, blood stasis, dampness, and toxins remain in a localized area, forming a “tumor.” The “Huangdi Neijing” states: “Yang transforms Qi, and Yin forms shape.” Zhang Jingyue states, “Yang moves and disperses, thus transforming Qi,” while “Yin is still and condenses, thus forming shape.” Yang transforms Qi, and Yin forms shape; this point should be well understood. The characteristics of Yang Qi are active; Yang has the function of Qi transformation, which can promote the normal function of the organs. Yang is hot, so it can transform Yin into Qi. The characteristics of Yin are stillness; Yin is solid, so it can condense and take shape. The “Lingshu: The Beginning of All Diseases” states: “When accumulation begins to form, how can it be resolved once it has formed?” “Accumulation begins to form due to cold, and it becomes an accumulation of Qi.” The understanding of the etiology and pathogenesis of tumor diseases in the “Huangdi Neijing” is that cold phlegm accumulates, phlegm and blood stasis accumulate, and cold stagnation accumulates. Whether it is cold phlegm accumulation, phlegm and blood stasis accumulation, or cold stagnation accumulation, “it arises from cold” is the initiating cause and fundamental etiology of accumulation. Cold is contractive, while heat is expansive. Tumor patients often have a three Yin constitution, characterized by insufficient Yang Qi, making it difficult to resist the invasion of cold evil. Therefore, evil Qi enters from the exterior to the interior, from the meridians into the organs, gradually entering the three Yin, forming lumps in the areas where Yang Qi is weakest. According to Dr. Li Ke, the earliest tumors are formed due to the decline of Yang and the condensation of cold and dampness into accumulation. Tumors are often the result of three Yin hiding cold, deep cold, and even ice-like conditions, with the original Qi being ill and evil Qi invading. Tumors are “garbage Yin essence”; the formation of tumors is due to the excessive power of “Yin forming shape,” causing tangible and intangible garbage to accumulate to the point where the body cannot transport it. The fundamental reason is the deficiency of pre- and post-natal original Qi, with cold evil as the main factor, leading to a chaotic state of cold and heat, deficiency and excess, ultimately forming various fortresses of different sizes, shapes, locations, and densities. Thus, we believe that the fundamental pathogenesis of tumors is “excess of Yin and deficiency of Yang, Yang deficiency and cold condensation, phlegm, dampness, blood stasis, and toxins”; therefore, Supporting Yang and inhibiting Yin is the fundamental method of treatment. In the summer, when I see patients in the clinic, the air conditioning is on, and the patient feels very cold. I turn off the air conditioning, but even after turning it off, the patient still feels cold. Not only that, but I also feel that their entire energy field is cold. These patients often have coldness below their knees, with severe Yin cold, which not only affects themselves but also others. Dr. Li Ke believes that the failure of Yang Qi to transform is the source of all diseases; all tangible evils arise from the failure of Yang Qi to transform, and all deficiencies of essence and blood are due to the failure of Yang to transform Yin. Some Yin-deficient patients also need to support Yang to achieve the transformation of Yin into Yang. Supporting Yang is a major treatment method; Yang deficiency can be assisted, and Yin deficiency can also be assisted. Yang Qi can assist all Qi transformations in the body, and supporting Yang can treat all diseases in the body. Dr. Li Ke believes that the major methods for treating tumors are to tonify the deficient, unblock the obstructed, warm, transform, reduce, grind, lift, and resolve; when there is excessive fullness, it should be broken. In treating tumors, one should not harbor thoughts of cancer but rather focus on “protecting original Qi; if one can preserve a portion of original Yang, there is a glimmer of hope. If original Yang is strengthened by one part, the tumor will diminish by one part.” In treatment, we often use Sheng Fuzi (Raw Aconite), Sheng Nansheng (Raw Rhizoma Arisaematis), and Sheng Caowu (Raw Aconite) to break Yin and return to Yang, supporting Yang and transforming Yin. This is some of Dr. Li Ke’s recent experiences in treating tumors; he is always learning and thinking. Below are some of my own clinical experiences in treating tumors for your reference. Treatment of tumors should be staged, and staging should be based on syndrome differentiation. Treatment misconceptions include: treating the disease when it appears, treating the tumor when it appears. The treatment strategy should combine staging and differentiate between deficiency and excess. The treatment principle is to protect the two fundamentals and support the body while inhibiting the tumor. The theory, method, and prescription: differentiation of the six meridians, with Qi circulating. For early-stage tumors, if the evil is prominent, treatment can first attack the evil. For those with deficient original Qi but also mixed with evil excess, if the stomach Qi is strong enough, we often use Yang He Tang (Yang Harmony Decoction). For cases of Yang decline and cold dampness condensing into accumulation, breaking the ice and returning to Yang is key. San Sheng Yin (Three Life Decoction) and Wu Sheng Yin (Five Life Decoction) can be used; when sunlight shines, the Yin mist disperses, and the ice and snow melt, allowing the hundred vessels to flow freely. First, use this powerful medicine to blast open the fortress of the tumor, and then guide the six Qi. For cases of intense cancer toxicity, such as significantly enlarged lymph nodes and severe heat toxicity, the main treatment can be based on the Kan Gan Du Ming Tang (Attack Cancer and Seize Life Decoction), but attacking cancer should not be excessive; protecting the spleen and stomach is key to success. Many mid-stage patients undergo aggressive treatments, such as radiotherapy, chemotherapy, and the use of bitter cold TCM, leading to deficiency of Zheng Qi. At this time, there is often significant deficiency of Middle Qi, such as diarrhea, abdominal distension, and abdominal pain, which indicates a state of Yang deficiency and internal cold. The appetite is poor, with nausea and vomiting, pale and swollen tongue, white greasy coating, and weak pulse. At this time, one should support the Zheng Qi and support the stomach Qi; preserving a portion of stomach Qi allows for a glimmer of hope. If the spleen and stomach fail, life will be extinguished, and danger will be imminent. In clinical practice, I often use Li Zhong Tang (Regulate the Middle Decoction) or Fu Gui Li Zhong Tang (Aconite and Cinnamon Regulate the Middle Decoction) as the main prescription for treatment. If it reaches the late stage, when the patient is gasping for breath and on the verge of death, the specific disease is no longer important; what matters is saving life and transforming this pattern. Ultimately, whether they can live depends on their fate. In critical moments, saving Yang is urgent; one should abandon cancer treatment but preserve original Yang. Dr. Li Ke emphasizes this point. Late-stage tumors often have Yin without Yang; at this stage, patients often exhibit dual deficiencies, showing signs of Yang deficiency and internal cold, such as aversion to cold, fatigue, cold hands and feet, and some may have Shaoyin or Jueyin patterns. There may also be diarrhea, inability to eat, or vomiting immediately after eating, or body heat without aversion to cold, which is a manifestation of virtual Yang escaping or Yang being constrained. At this time, the method should be to break Yin and return to Yang, using Si Ni Tang (Four Reversal Decoction), Bai Tong Tang (White Communication Decoction), and Po Ge Jiu Xin Tang (Break Constraint and Rescue the Heart Decoction). When Dr. Li Ke treats heart failure and critical heart failure at the life-and-death juncture, he often uses large doses of Po Ge Jiu Xin Tang, more than three doses daily, with no upper limit on the amount of Aconite. 3. Complications of tumors: 80% of patients with malignant tumors (at the time of discovery) are already in mid to late stages. Tumor complications are significant factors affecting the quality of life of patients. Once tumors are mentioned, there are two key points that lead to patient death: on one hand, the tumor itself leads to death, and on the other hand, complications from the tumor lead to death. Among tumor complications, cancer pain is the most common, along with various accumulations, such as large pleural effusion and ascites; various blood disorders, such as hemoptysis, hematemesis, melena, and vaginal bleeding; various obstructions, such as gastrointestinal obstruction and venous embolism; as well as tumor fever, etc. Regardless of how many manifestations there are, how complex they are, the fundamental issue remains the same: excess of Yin and deficiency of Yang. Tumor patients exhibit many symptoms, but the root cause is the disturbance of a thread of true Yang in the kidney, the foundation of innate essence, leading to these complications. The fundamental pathogenesis lies here; one should not treat the disease as it appears, as this can easily lead to misconceptions and poor outcomes. Cold evil stagnation is a key factor in pain. 70% to 90% of late-stage cancer patients experience varying degrees of pain, with 70% having pain as the primary symptom, and cancer pain is often a reason for suicide. Cancer patients may commit suicide for two reasons: one is financial difficulties, not wanting to burden their families, and the other is the inability to endure cancer pain. I once treated an elderly revolutionary in his eighties who developed a tumor. He said, “Dr. Deng, I was captured by the Kuomintang and endured severe torture, but I could withstand it. Now, when the cancer pain strikes, I really can’t take it; sometimes I think about jumping off this building to end it all.” Why? Because cancer pain is a physiological response that is difficult to resist with willpower. He also said, “I didn’t surrender even under severe torture from the Kuomintang, so why do I lose my dignity when the pain strikes? That pain is unbearable.” Cancer pain often presents as severe pain, worsening with cold and alleviating with warmth, pale complexion, cold body, and other symptoms of cold stagnation and Qi stagnation, with insufficient Qi and blood. The pathogenesis is that Yang Qi does not reach, and Qi movement is obstructed. So, what is Zhang Zhongjing’s approach to treating pain? Through literature review, we find that Zhang Zhongjing’s approach to treating pain mainly focuses on warming, unblocking, and tonifying. Dr. Li Ke’s experience emphasizes warming Yang, transforming phlegm, and unblocking channels, with commonly used prescriptions being Danggui Si Ni Jia Wuyou Shengjiang Tang (Angelica Four Reversal Decoction with Prepared Aconite and Ginger), Da Wutou Tang (Major Aconite Decoction), and Wu Sheng Yin (Five Life Decoction). Recently, we have been observing the use of Wu Sheng Ding (Five Life Essence) externally for treating cancer pain, which has shown relatively quick effects and is effective for patients with mild to moderate pain; it is both convenient and safe.
As for accumulations, the pathogenesis of their formation is mainly Yang deficiency and inability to transform. Clinically, we often encounter patients with large pleural effusions and ascites. Limb edema is somewhat easier to manage; at worst, it just makes movement inconvenient. However, large pleural effusion and ascites can compress the heart and lungs, causing palpitations, shortness of breath, and cough. Ascites can cause abdominal distension, making it impossible to eat, severely affecting quality of life. Everyone knows that “for phlegm and fluid diseases, one should use warming medicines to harmonize them”; we believe that the fundamental pathogenesis is also Yang deficiency and Yin excess. The treatment should warm Yang, transform Qi, and promote water metabolism. For lung-related issues, Xiao Qinglong Tang (Minor Blue Dragon Decoction) combined with Tingli Dazao Xiaofei Tang (Tingli and Jujube Decoction) can be used with modifications. For ascites, Zhenwu Tang (True Warrior Decoction), Ling Gui Zhu Gan Tang (Poria, Cinnamon, and Atractylodes Decoction), Wuling San (Five Ingredient Powder), and Xiao Banxia Jia Fuling Tang (Minor Pinellia Decoction with Poria) can be used. For pleural effusion, in addition to Gualou and Xiebai formulas, Dr. Li Ke also mentioned Weijing Tang (Reed Stem Decoction), using 120g of reed root to treat large pleural effusions. However, if there is no basis for damp-heat, bitter cold medicines should be used sparingly; otherwise, Qi transformation will be hindered, and water Qi will stagnate, worsening the condition.
Blood disorders are acute conditions in tumors, often threatening life. Dr. Li Ke’s approach to treating acute conditions is based on Yang deficiency. He said, “Severe blood loss leads to coldness in the limbs; this is Qi following blood loss, and the spleen and stomach Yang are deficient.” In clinical practice, large doses of Po Ge Jiu Xin Tang and Danggui Bu Xue Tang (Angelica Blood-Tonifying Decoction) are often used. Dr. Li Ke often uses four types of charcoal, including roasted ginger charcoal combined with hawthorn, malt, and shenqu (fermented wheat) to achieve immediate effects. He believes that these four charcoals are very effective for bleeding due to spleen Qi deficiency, while Po Ge is aimed at Shaoyin Yang deficiency and internal excess of Yin cold.
The meaning of cold damage
The application of Chaihu and Muli drug group—clearing heat and dispelling evil