10 Kesalahan Diagnosa Yang Sering Terjadi Pada Anak

Menegakkan diagnosis suatu penyakit oleh seorang dokter seringkali tidak semudah yang dibayangkan. Beberapa kelainan atau penyakit yang berbeda sering menampakkan tanda dan gejala klinis yang sama. Sehingga dalam beberapa kasus acapkali terjadi “wrong diagnosis” atau kesalahan diagnosis atau overdiagnosis suatu penyakit padahal seseorang tidak menderitanya.

image

Kesalahan diagnosis atau wrong diagnosis artinya seseorang diberikan diagnosis penyakit tertentu tetapi sebenarnya belum tentu mengalami gangguan tersebut. Bukan hanya di Indonesia, hal ini juga sering terjadi di luar negeri. Istilah dan kondisi yang hampir serupa diistilahkan pit fall diagnosis, overdiagnosis atau misdiagnosis.

Banyak faktor yang terjadi mengapa hal itu sering terjadi. Faktor utama adalah dalam beberapa penyakit yang dalam menentukan gold standar atau untuk memastikan suatu penyakit dengan diagnosis klinis atau hanya dengan mengamati riwayat penyakit dan manifestasi penyakit. Sedangkan alat bantu diagnosis seperti pemeriksaan laboratorium atau pemeriksaan penunjang lainnya tidak banyak diharapkan karena sering spesifitas dan sensitifitas tidak terlalu bagus sehingga sering mengakibatkan false positif atau false negatif.

Artinya, dalam pemeriksaan laboratorium terjadi kesalahan yang seharusnya negatif tetapi saat diperiksa hasilnya positif dan sebaliknya. Selain akurasi alat tidak baik sering terjadi kesalahan interpretasi penilaian hasil laboratorium.

Berikut 10 overdiagnosis yang paling sering terjadi, khususnya pada anak-anak:

Continue reading

Obat Itu Racun…

Yakin seyakin-yakinnya saya pada saat ini tidak ada seorang pun yang tidak pernah merasakan yang namanya obat, bahkan dari bayi yang baru lahir ceprot juga sudah kena imunisasi. Pada post sebelumnya Pengobatan Versi Saat Ini saya sudah bercerita, begitu sudah terbentuknya dalam benak setiap orang bila obat merupakan salah satu bahan pokok dalam hidup. Bahkan ketika ke dokter dan pulang tanpa membawa resep atau obat seperti belum merasa yakin akan bisa sembuh. Fenomena yang saya temui dalam masyarakat juga saat mereka menebus obat dengan harga yang sangat-sangat mahal, mereka akan berusaha mencari uang, ngutang sana-sini dengan satu harapan bila mereka akan lebih baik dengan mengkonsumsi obat tersebut. Continue reading

Pengobatan Versi Saat Ini

Post ini saya tujukan bagi para pembaca yang gemar minum obat atau punya hobi berobat…

Malik tergolek lemas. Matanya sayu. Bibirnya pecah-pecah. Wajahnya kian tirus. Di mataku ia berubah seperti anak dua tahun kurang gizi. Biasanya aku selalu mendengar celoteh dan tawanya di pagi hari. Kini tersenyum pun ia tak mau. Sesekali ia muntah. Dan setiap melihatnya muntah, hatiku tergores-gores rasanya. Lambungnya diperas habis-habisan seumpama ampas kelapa yang tak lagi bisa mengeluarkan santan. Pedih sekali melihatnya terkaing-kaing seperti itu.

Continue reading

Itu Salah!

Kemaren tambah lagi 1 kejadian yang membuat aku apriori, antipati dan males ke tempat yang namanya dokter, rumah sakit atau instalasi medis lainnya. Ceritanya beberapa waktu lalu, aku beserta istri dan anakku pergi ke dokter anak di bilangan Renon sana, just say his name is dr. M. Anakku sudah hampir seminggu muntah-muntah, apapun yang dimakannya dimuntahkan kembali tapi dia tetap keliatan energik tidak terlihat lemas seperti anak kurang makan. Continue reading

Limpa

From Wang Kentang and Wu Mianxue, The Compendium of Traditional Diagnosis (Gu Jin Yitong Zhengmai Quanshu), 1601:

spleenThe stomach is called the sea of grain and water; everything is assimilated here. The spleen is in charge of transportation; everything is moved by its workings. Absorbing and moving: these are the essential actions which define the spleen/stomach network as the main source of the life-sustaining postnatal energy.

From Li Zhongzi, A Primer of Medical Objectives (Yizong Bidu), 1637:

What makes the spleen the source of postnatal energy? Once a child has been born, it will feel hungry after one day without food, and it will die after seven days without food. Once we have entered the realm of the physical body, therefore, we have to be nourished by qi that is derived from food (gu qi). Once the food enters the stomach, it is transported to the six fu organs, and thus there will be qi. It will be appropriately dispensed to the five zang organs, and thus there will be blood. Human beings must rely on this type of nourishment in order to stay alive. It is for this reason that the spleen is called the source of postnatal energy.

From Cheng Wenyou, Quotes from Medicine (Yishu), 1826:

Be aware that the spleen network cannot be compared to a system of mills or mortars that grind or pound away on the incoming food. Rather, the spleen’s ability to transform food and drink primarily depends on its suctioning affect: preventing the food from falling down! Every food item entering the stomach consists of both a qi component and a material component. The material component of the food naturally sinks downwards, while its qi component naturally rises upwards. Once in the stomach, the food gets “steamed” under the influence of stomach qi. Then, in the process of being separated into its material and its light parts, it is being suctioned by the qi of the neighboring spleen. In this fashion, the stomach qi is being assisted in its vital work and all of the food essence remains where it needs to be for processing-all the way until every bit of food qi has been extracted and only the material shell remains, at which time the lower gate of the stomach opens and the dregs are being discarded downwards.

From Li Dongyuan, A Treatise on the Spleen and Stomach (Piwei Lun), 1249:

The stomach is called the sea of grain and water. Once food enters the stomach, its essential energy is moved upwards to infuse first the spleen and then the lung. In this fashion, the command of spring and summer is being carried out, and the entire body receives nourishment. This is due to the influence of clear heavenly qi.

Once the ascending motion has reached its climax, this current shifts directions and flows downwards toward the bladder. In this fashion, the command of autumn and winter is being carried out, and the waste becomes processed and the flavors will manifest. This is due to the influence of turbid earth qi.

If we then regulate our daily lives by adjusting them to the prevailing energy of the seasons, if we avoid exposure to extreme cold and extreme heat, if we eat and drink in regular intervals, if we protect our shen by avoiding states of extreme anger or extreme ecstasy, and if we strive for balance by living in moderation during all four seasons, there will be peace. Otherwise, the spleen and stomach will suffer harm, and our true qi will leak downward in trickles or currents [i.e., diarrhea], with the possibility of failing to rise again. This, then, would be like having autumn and winter but no spring and summer, and a situation would arise in which the functions of birth and growth are muffled by the qi of death and extinction. Naturally, all kinds of diseases would arise from such a situation. At the same time it is without question that if there was only rising and no descending momentum within the body there would be disease.

From Yu Chang, The Statutes of Medicine (Yimen Falü), 1658:

Both the zang and the fu organ networks depend primarily on the spleen and the stomach. All food we eat enters the stomach and is then transported by the spleen, just like the dirt on earth [is distributed by wind and water to nourish all life forms]. It should be pointed out, however, that the spleen/stomach’s capability of transforming the food is actually dependent on the two essential qualities of fire and water. The spleen and stomach cannot do this by themselves. When fire is in a state of excess, the spleen and stomach will be dry; when water is in a state of excess, the spleen and stomach will be damp. Either situation will cause the hundred diseases to arise.

From Yang Jizhou, The Great Compendium of Acupuncture and Moxibustion (Zhenjiu Dacheng), ca. 1590; listed in the spleen channel section as a quote from an older Daoist source, The Original Classic of Guiding the Breath (Daoyin Benjing) :

The spleen is situated at the center of the five organ networks. Therefore, it is assigned to no particular season but flourishes during all four seasons. It contains and fosters the five flavors, it brings about the five mental faculties, and it moves the four extremities and the one hundred marrows.

As soon as there is irregular intake of food and drink or overexertion of any kind, the spleen qi will be harmed. As soon as the spleen and stomach suffer damage, food and drink stagnate and do not transform: the mouth loses its ability to distinguish flavors, the extremities feel limp and tired, discomfort and distention is felt in the stomach and abdominal regions, symptoms of vomiting and diarrhea appear, and there may be dysentery or a host of other symptoms which have been specified in the Neijing and other books, and which can be looked up there.

If we therefore force ourselves to eat when we are not hungry, the spleen will suffer. If we force ourselves to drink when we are not thirsty, the stomach will bloat. If we eat beyond capacity, the vessels in which the qi circulates will become obstructed, and the body’s center (stomach region) will become jammed and shut off. If we eat too little, on the other hand, the body will become emaciated, the stomach will grow anxious, and our thoughts will become unsteady. If we eat contaminated food, the heart’s ability to differentiate will become blurred, and we will grow more and more restless. If we eat things that we should not eat, the four great upheavals will occur and bring along disease. None of these types of behavior represents the way of good health.

Therefore, it is most important to consume our food at the appropriate time, to drink our fluids in regular intervals, and to avoid both overeating and hunger pains. If we eat and drink according to these simple guidelines, then not only the spleen/stomach network itself will remain unspoiled and function perfectly, but also the five zang and the six fu organ networks will all be in a harmonious state of health.

After food and drink enter the mouth, they pass through the epigastric region into the stomach. From the stomach, the immaterial flavors contained in the food penetrate the five organs, whereas the material components enter the small intestine where they are further transformed. When they reach the lower opening of the small intestine, the first stage of the process of separating clear and murky materials occurs. Murky materials are the waste, to be passed on to the large intestine. The clear materials are the source of all bodily fluids; they enter the bladder which is called the store house of fluids. In the bladder, once again a separation of pure and murky materials takes place. The murky debris goes into the urine to be excreted, while the clear material enters the gallbladder. The gallbladder, finally, guides this purified fluid essence to the spleen which dispenses it to the five organ networks; they, in turn, utilize it to produce digestive saliva, nourishing saliva, nasal discharge, tears, and sweat. The flavors, meanwhile, penetrate the five organs and transform into the five types of essential dew, which return to the spleen where they are transformed into blood. In the form of nourishing blood, finally, they are returned to the organs.

The Classic states: “When the spleen is healthy it can generate all living things. If it becomes depleted, it can bring about the hundred diseases.” The ancient poet, politician, and medical scholar Su Dongpo (1037-1101) used to harmonize the spleen by moderating food intake, even when there was enough money to eat lots. Therefore, I wish to extend the following advice to people who are in the habit of throwing lavish banquets: derive happiness from internal peace; always leave room in your stomach, so you can nourish your qi; and spend less if you wish to increase your material wealth.

The healthy person maintains the inside, while the unhealthy person maintains the outside. The person who maintains the inside pacifies his/her zang and fu organ networks, and thus causes the blood in the vessels to flow smoothly and uninhibited. The person who maintains the outside indulges in dazzling flavors and luxuriant culinary delights; albeit at first glance the body of such a person may appear strong and sturdy, a fierce verminous qi is corroding the zang and fu organs inside.


The stomach is in charge of receiving food and drink via the mouth and esophagus, containing them, and finally fermenting them. The stomach is therefore called the “sea of grain and water.” After “grinding and fermenting” the incoming materials part of the essence distilled from food is passed on to the spleen, while the rest is passed on downwards to the small intestine. If the stomach fails to receive and ferment properly, the supply of postnatal qi to the other organ networks will be disturbed. Master Hua’s Classic of the Central Viscera states: “If the stomach qi is strong, all of the five zang and the six fu networks will be strong.”

The spleen is in charge of the transformation and distribution of food essence and fluids, as well as the transformation of pathological dampness. A healthy spleen will facilitate the optimal absorption and distribution of essence. Consequently, the entire body will be provided with the nutrients that are essential for survival. It is for this reason that the spleen has been labeled the postnatal root of life. If there is proper absorption and transformation of food essence, the food will turn into refined essence rather than into “damp” slush stagnating in the digestive tract. Conversely, the presence of dampness in the system will severely hamper the transformative actions of the spleen.

Part of the spleen’s transporting function, moreover, is to move fluids upwards to the lung, from where they are “sprinkled” over the entire body to ensure proper moisturization. If this basic metabolism of fluids can function undisturbed, no buildup of pathological dampness will occur within the system.

The crucial transporting function of the spleen is entirely based on its action of “raising the pure (essence).” This means that in its physiological state the spleen qi exhibits a rising momentum. If the spleen qi rises, a “transporting” affect will ensue.

On the other hand, the equally important action of passing on of the dregs-and the continued differentiation of pure and turbid fluids-are a result of the stomach’s downward momentum, generally referred to as “descending the turbid.” Fluid differentiation and absorption is achieved cooperatively by the small intestine, the triple warmer, and the bladder, but these aspects of fluid metabolism are often attributed, simply, to the descending function of the stomach.

The influential Treatise on the Spleen and Stomach (Pi Wei Lun), written by the Yuan Dynasty medical authority Li Dongyuan, strongly underscores the rising function of the spleen. To clarify his point, Li refers to the workings of nature. He reminds his readers that the human body is a miniature replica of the surrounding macrocosm. All phenomena on earth, the Treatise points out, are produced by the intercourse of ascending earthly and descending heavenly qi. The upward momentum of the essence qi, propelled by the spleen, can be compared to the clear yang of nature which ascends toward heaven until it congeals into clouds in the sky. The ethereal part of this essence (the yang within yang) purifies and nourishes lung qi, thus maintaining an atmosphere of moistness, freshness, and clarity in the upper burner (which affects the sensory orifices of the ears, eyes, mouth, and nose). The denser portion of this ascending yang substance (the yin within yang) moistens the skin, strengthens the pores, and gives firmness to the limbs. And just as the turbid yin in nature condenses below to form earth, the Treatise goes on to explain, the clear essence of the turbid yin derived from food (the yang within yin) “turns red” and transforms into blood, thus nourishing the body, while the dregs and superfluous fluids are excreted. The turbid part of the turbid (the yin within yin), finally, forms the material basis for the bone marrow.

The Qing Dynasty essay collection, Spontaneous Thoughts Inspired by Reading the Medical Classics (Duyi Suibi), summarizes this pivotal role of the spleen/stomach by drawing a Taiji (yin-yang symbol) of bodily waxing and waning: “The heart and the lung are yang; as they follow the downward impulse of stomach qi and descend on the right, they transform into yin. The liver and the kidney are yin; as they follow the upward impulse of spleen qi and ascend on the left, they transform into yang.”

The hollow stomach is in charge of “fermenting and ripening” incoming food. The character wei (stomach) reflects the stomach’s likeness to a high altitude field. Since fields in higher locations are closer to the sun and their moisture can easily drain downwards, their earth has a tendency to get dry, earning it the designation “yang earth.” As the yang earth of the body, the stomach is known to easily become dry.

The spleen, among other things, is in charge of transforming dampness. The character pi (spleen) reflects the spleen’s likeness to a low-altitude field. Like the earth at the bottom of a valley, the spleen has a tendency to become damp, and is thus known as “yin earth.”

The ideal milieu for their functioning is slight moistness for the stomach and near dryness for the spleen; that is the exact opposite of their natural tendencies, so the spleen and stomach must rely on each other to achieve a state of balance. Otherwise, the drying action of the stomach may fail to control spleen damp, and signs of stagnant water accumulation in the system will arise. Or the moistening quality of the spleen may fail to nourish the dry stomach, and symptoms of thirst, voracious appetite, or other signs of stomach heat will appear.

Although it is primarily the lung which governs bodily qi, and primarily the heart which governs blood, the spleen is the physical earth center which is the source of both the body’s qi and blood. Both of these vital substances are considered to be transformations of food essence.

Qi does not only move body essences, but it also holds them in place. The fact that the blood circulates in the vessels without leaving its proper path is particularly attributed to the restraining function of spleen qi. The Classic of Difficulties (Nanjing) simply states: “The spleen contains the blood [pi tong xue]” This function of the spleen [associated with the earth element or phase] is evocative of the characteristics of earth: just as the rivers and streams are contained by an earthen bed, the body’s blood is contained in the channels.

The absorbing and transporting function of the spleen/stomach is directly reflected in the development of a person’s flesh and muscles. Strong and well developed arms and legs are therefore considered to be an important indicator for good spleen function. Weak, cold, painful, obese, or malformed arms and legs are a primary sign of spleen weakness.

The condition of the spleen manifests in the flesh of the mouth-the lips. Bright red lips, for instance, may indicate damp heat in the stomach. Chronic gum bleeding or structural changes of the gums may arise from spleen deficiency, while symptoms of severe dryness in the mouth, gum swelling, tooth aches, or severe hemorrhaging may be the result of a stomach excess (heat, dryness) condition. Structural pathologies in the oral cavity (including tongue shape and tongue coating) and unusual taste sensations in the mouth (or lack thereof) are almost always indicative of spleen/stomach disturbances.

The mental processes of thinking and remembering are considered to be part of the physiological activity of the spleen. A person with a poor digestive system usually cannot think clearly. This is because clear yang energy fails to rise up to the heart and brain, or because of accumulating dampness clouding the orifices. As always, this relationship also works the other way around: if a person thinks or worries too much, this can easily lead to digestive symptoms such as poor appetite, diarrhea, or constipation.

The Spleen/Stomach Is Unable to Absorb, Transform, and Transport: If stomach qi becomes injured, the stomach loses its ability to contain food, and the person will exhibit symptoms of aversion to food or drink, nausea and vomiting, hiccuping, or frequent belching. If the spleen loses its ability to transform and transport the essence of food, abdominal distention, loose stools or diarrhea, fatigue, or emaciation may occur. Also, if the spleen loses its ability to transport fluids and transform dampness, internal dampness and phlegm will accumulate, potentially manifesting in a variety of phlegm disorders, diarrhea, or edema.

The Balance Between Raising the Clear and Descending the Turbid is Disturbed: If the stomach’s turbid substances do not descend, but push upwards instead, there will be symptoms of distention, vomiting, hiccuping, or belching of foul gases or sour liquids. If “the clear” cannot be properly raised upwards by the spleen, typical symptoms that may result are diarrhea, prolapse of the stomach, prolapse of the anus, or prolapse of the uterus/vagina. Collected Sayings by Dr. Wu (Wu Yi Hui Jiang) pointed out: “Among the many therapeutic approaches to spleen and stomach disorders, none is superior to harmonizing the dynamics of raising and descending.”

Imbalance of Dryness and Dampness: If dampness hampers the free unfolding of spleen yang and thus the spleen’s transporting ability, the stomach function will immediately be affected and symptoms of poor appetite or nausea will result. On the other hand, if there is excessive heat and dryness present in the stomach, this condition will in turn influence the function of the spleen: fluids will be scorched, resulting in constipation; or the spleen yang may collapse downward, causing symptoms of fatigue, constant sleepiness, frail extremities, diarrhea, and a slow pulse.

Stomach Disorder Influencing the Six Fu Organs: If there is dry heat in the stomach, it scorches the body’s fluids; as a result, there will be constipation, and the transporting function of the large intestine will become severely inhibited. Damp heat in the spleen/stomach “steaming” the neighboring gallbladder can cause the bile to overflow and produce jaundice. Downpouring of damp heat from the spleen/stomach can have a detrimental effect on the triple warmer, the small intestine, and the bladder, and thus cause symptoms of dark and burning urination or dribbling urinary block. In the stomach itself, dry heat or food stagnation usually cause a loss of descending action, manifesting as epigastric stuffiness, vomiting, belching, acid regurgitation, abdominal distention, or constipation.

The Spleen Cannot Contain the Blood within the Vessels: If spleen qi decreases in strength, a loss of the spleen’s function of containing the blood within the vessels may result. Various types of bleeding are thus sometimes associated with a deficiency of spleen qi, particularly recurrent hematomas, certain types of purpura, and prolonged menstrual bleeding. Since spleen-related hemorrhaging is always caused by a deficiency syndrome and usually involves slow leakage of pale blood, it should not be confused with the acute loss of profuse amounts of dark red blood caused by blood heat.

Unbalanced Mental Activity Harming the Spleen: If a person is involved in excessive worrying, thinking in pensive circles that lead nowhere, or simply has a mental focus that is too narrow or too intense, spleen symptoms such as loss of appetite, general exhaustion, or inhibited qi flow (causing insomnia, sleepiness, or lack of vision and mental clarity) may gradually manifest.

Mental and Physical Exhaustion Taking Their Toll on the Spleen: Ancient Chinese texts place particular emphasis on the fact that any exertion beyond one’s individual limits will result in injury to the qi of the spleen/stomach. If a person is not allowed to recover from extreme exhaustion, there may be permanent weakness and fatigue, shallow breathing and a decreased desire to talk, heat sensations and spontaneous sweating, or asthmatic breathing that comes on with even slight physical exertion. In Neijing terms: “Exertion fritters away the qi.”

The Spleen Is Unable to Govern the Flesh and the Muscles: Prolonged sitting or lying down is said to harm the spleen, and thus cause atrophy of the muscles. Since the spleen governs the flesh layer, all disorders such as a heavy and sore body, slow healing wounds, bed sores, emaciated arms and legs, the weak extremities of the chronically bed-ridden patient, and certain types of paralysis are results of spleen injury.

Spleen Disorder Affecting Changes in Appetite and Taste Sensation: A poor appetite, the feeling that “everything tastes like nothing,” a voracious appetite, sugar cravings, or other pathological changes in appetite or taste sensation usually involve the spleen/stomach network. As the respective chapter in the historic reference work, An Illustrated Encyclopedia (Tushu Bian), explains: “Poor appetite is a sign of acute food stagnation or injury to the spleen/stomach. If the patient is hungry, but cannot get much of the food down, this is a sign of cold pathogens in the spleen. If a person craves sweets, this is a sign of spleen deficiency.”

Tonify the spleen (with bland/sweet flavors) (bu pi; gan dan shi pi): dioscorea (shanyao), hoelen (fuling), lotus seed (lianzi), euryale (qianshi), coix (yiyiren), dolichos (biandou).

Build the center and uplift qi (jian zhong yi qi): codonopsis (dangshen), atractylodes (baizhu), astragalus (huangqi), jujube (dazao).

Warm the spleen (wen pi): dry ginger (ganjiang), evodia (wuzhuyu), black pepper (hujiao), zanthoxylum (shujiao).

Move the spleen (yun pi): red atractylodes (cangzhu), magnolia bark (houpo), cardamon (sharen), amomum (baidoukou).

Harmonize the center and regulate qi (li qi): citrus (chenpi), saussurea (muxiang), agastache (huoxiang), perilla stalk (sugeng), clove (dingxiang), galanga (gaoliangjiang).

Emolliate acute central distress (huan ji): licorice (gancao), jujube (dazao), honey (fengmi).

Raise central yang and lift collapse (sheng yang ju xian): cimicifuga (shengma), pueraria (gegen), astragalus (huangqi).

Dry damp (zao shi): red atractylodes (cangzhu), tsao-kuo (caoguo), cardamon (sharen), pinellia (banxia).

Transform phlegm (hua tan): citrus (chenpi), pinellia (banxia), bamboo skin (zhuru), bamboo resin (tianzhuhuang), bamboo sap (zhuli), sinapis (baijiezi), arisaema (tiannanxing).

Percolate damp (shen shi): hoelen (fuling), coix (yiyiren).

Disinhibit damp (li shi): polyporus (zhuling), alisma (zexie), akebia (mutong), capillaris (yinchen), polygonum (bianxu).

Drive out water rheum (zhu yin): zanthoxylum seed (jiaomu), atractylodes (baizhu), euphorbia (daji), daphne (yuanhua), kan-sui (gansui), phytolacca (shanglu).

Nourish stomach yin (yang wei yin): ophiopogon (maimendong), yu-chu (yuzhu), trichosanthes root (tianhuafen), dendrobium (shihu).

Clear stomach heat (qing wei re): gypsum (shigao), coptis (huanglian).

Purge stomach fire (xie wei huo): rhubarb (dahuang), mirabilitum (mangxiao).

Dissolve food accumulation (xiao dao): crataegus (shanzha), shen-chu (shenqu), malt (maiya), gallus (jineijin), chih-ko (zhike), raphanus (laifuzi).

Harmonize the stomach and descend rebellious qi (he wei jiang ni): fresh ginger (shengjiang), pinellia (banxia), clove (dingxiang), agastache (huoxiang), hematite (daizheshi).

Control acid (zhi suan): evodia (wuzhuyu), coptis (huanglian), cardamon (sharen), fritillaria (zhe beimu), cuttlefish bone (wuzegu), calcined oyster shell (duan muli).

Just as the earth assumes the position of centeredness, balance, and harmony in nature, the spleen/stomach network is the body’s center of balance. All up and down movements pivot around it, and both damp and dry qualities come together here to form a physiologically beneficial alliance. As the main text of the fever school, Wenbing Tiaobian, points out: “The spleen should be treated like the beam of a scale: if it is not in horizontal balance, it will not be at peace.” Treating the spleen/stomach also requires the use of substances that are harmoniously balanced. Foods and herbs that are overly hot or cold or dry or moistening should be avoided.

As a general rule, spleen disorders are usually of a deficient nature, requiring the tonification of central qi and the stimulation of the ascending movement of clear yang qi. Stomach disorders, though they may be based on deficient functions, usually involve excess or accumulation problems; accumulation needs to be dissolved and guided out.

Since the functioning of both the spleen and the stomach are closely tied to their respective directional momentum, proper qi movement needs to be restored in case of erratic movement. If the upwardly mobile spleen yang collapses downward (diarrhea, organ prolapse, etc.), it should be lifted by employing measures that tonify the spleen and boost central qi. If the stomach’s descending motion is upset, as is the case with rebellious stomach qi (nausea, vomiting, etc.), the situation should be rectified by harmonizing the stomach and descending the rebellious qi.

Herbs that eliminate pathological dampness are common spleen therapies, including bitter herbs that dry damp, bland herbs that percolate damp, and spicy herbs that break down and eliminate phlegm and other types of pathological liquid. The stomach is often treated with substances that nourish and protect its physiological fluids: sweet and cold herbs that moisten dryness; salty and cold herbs that clear stomach heat; and herbs that protect its yin by clearing stomach heat, cleansing stomach fire, or in severe cases, effecting emetic or purgative action.

As the principal flavor of harmony, sweet has a primary affinity to the earth network. Therefore, if the spleen is in acute distress, sweet flavors can harmonize the spleen and be beneficial to the production of central qi. As the Neijing points out: “Sweet generates the spleen.” If sweet foods are used excessively, however, they will produce phlegm, obstruct transformation, and harm the flesh layer that is associated with the spleen. Swelling, bloating, and obesity will result. Again, this fundamental principle has been recorded by the Neijing, stating that “sweet harms the flesh,” and “if the disease is in the flesh layer, the patient should abstain from the excessive consumption of sweet flavors.”

When treating spleen/stomach disorders, the system’s relationship to other organ networks needs to be taken into consideration. Particularly the liver’s overbearing influence needs to be corrected if it is the original cause for the spleen’s distress. Spleen tonics are therefore often accompanied by herbs that smooth and emolliate the liver.

SPLEEN QI DEFICIENCY (pi qi xu): primary symptoms include decreased appetite; sallow complexion; fatigue; shallow breathing or shortness of breath; little desire to talk; epigastric and/or abdominal bloating (especially after eating); loose or unformed bowel movements. Secondary symptoms may include weak or emaciated extremities; edematous extremities; inhibited urination; decreased amount of (pale colored) menstrual flow. The tongue typically manifests with a pale body, toothmarks, and a thin white coating; the pulse tends to be weak and slow.

Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), hoelen (fuling), dioscorea (shanyao), lotus seed (lianzi), coix (yiyiren), dolichos (biandou), jujube (dazao); citrus (chenpi), shen-chu (shenqu).

Representative Formulas: Four Major Herbs Combination (Si Junzi Tang); Six Major Herbs Combination (Liu Junzi Tang).

DOWNWARD COLLAPSE OF SPLEEN QI (pi qi xia xian): primary symptoms include weak voice; shortness of breath; fatigue; bloating sensation right after eating; prolapsing sensation in stomach and abdomen (wan fu zhong duo); (bianyi pinshuo); or possibly prolapse of anus due to chronic diarrhea; or prolapse of stomach or uterus. Secondary symptoms may include dizziness; unclear sensory perception (especially blurry vision); poor appetite; spontaneous sweating; mental and physical fatigue; diarrhea. The tongue typically presents with a pale body and a thin white coating; the pulse tends to be weak and empty.

Representative Herbs: astragalus (huangqi), codonopsis (dangshen), atractylodes (baizhu), dioscorea (shanyao), dolichos (biandou), cimicifuga (shengma), pueraria (gegen); bupleurum (chaihu), citrus (chenpi).

Representative Formula: Ginseng and Astragalus Combination (Buzhong Yiqi Tang).

STOMACH YIN DEFICIENCY (wei yin xu): primary symptoms include dry lips; frequent thirst sensation; dry throat; sticky sensation in the mouth; poor appetite; sensation of emptiness, stuckness, or pain in epigastric region. Secondary symptoms may include hunger sensation without desire for food; constipation; restlessness; sensations of surging heat. The tongue typically presents with a red body and a mirror surface without coating, or with a red body and little coating, or with a dry tongue and little moisture; the pulse tends to be fine and rapid.

Representative Herbs: glehnia (bei shashen), ophiopogon (maimendong), yu-chu (yuzhu), dendrobium (shihu), raw rehmannia (sheng dihuang), trichosanthes root (tianhuafen), Asian pear juice (li zhi), sugar cane juice (ganzhe zhi); bamboo skin (zhuru).

Representative Formulas: Glehnia and Ophiopogon Formula (Shashen Maidong Yin), Boost the Stomach Decoction (Yiwei Tang).

SPLEEN YANG DEFICIENCY (pi yang xu): primary symptoms are spleen qi deficiency symptoms with an emphasis on cold signs, such as abdominal pain that improves with the application of heat and pressure; cold extremities; poor appetite; abdominal bloating; loose or unformed stools. Secondary symptoms include decreased taste sensation; little desire to drink; edematous extremities; inhibited urination; increased amounts of clear vaginal discharge. The tongue typically presents with a pale and tender body and a white and slippery coating; the pulse tends to be deep and fine, or deep and slow.

Representative Herbs: dry ginger (ganjiang), aconite (fuzi), evodia (wuzhuyu), zanthoxylum (chuanjiao), clove (dingxiang), atractylodes (baizhu), codonopsis (dangshen).

Representative Formulas: Ginseng and Ginger Combination (Lizhong Tang), Fill the Spleen Formula; Magnolia and Atractylodes Combination (Shipi Yin).

COLD DAMP OBSTRUCTING THE SPLEEN (han shi kun pi): primary symptoms are a general sense of heaviness in the body and/or the head; discomfort or bloating in the abdomen or epigastric region; reduced taste sensation; little or no thirst; abdominal pain; unformed stools or diarrhea. Secondary symptoms include no appetite; nausea and vomiting; sticky sensation in mouth; puffy face; edematous extremities; bags under the eyes; increased vaginal discharge. The tongue is typically fat and has a greasy white coating; the pulse tends to be soft and moderate.

Representative Herbs: red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), magnolia bark (houpo), citrus (chenpi), pinellia (banxia), tsao-kuo (caoguo), agastache (huoxiang), (peilan), perilla stalk ( zi sugeng).

Representative Formulas: Magnolia and Citrus Combination (Pingwei San); Magnolia and Hoelen Combination (Wei Ling Tang).

DAMP HEAT IMPLICATING THE SPLEEN (shi re yun pi): primary symptoms are stuffy sensation in the subcostal and epigastric regions; abdominal bloating; poor appetite; dry and sticky sensation in mouth; aversion to greasy foods; nausea and vomiting; general sensation of heaviness; jaundiced eyes and face. Secondary symptoms may be body itch; fever; dark and scanty urination; obstructed bowel movements. The tongue typically presents with a greasy and yellow coating; the pulse tends to be soft and rapid.

Representative Herbs: capillaris (yinchen), bamboo skin (zhuru), red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), polyporus (zhuling), alisma (zexie), chih-shih (zhishi).

Representative Formulas: Capillaris and Hoelen Five Formula (Yinchen Wuling San); Capillaris and Hoelen Four Formula (Yinchen Siling San).

THE SPLEEN CANNOT CONTAIN THE BLOOD WITHIN THE VESSELS (pi bu tong xue): primary symptoms are general signs of spleen qi deficiency, such as pale face and tendency towards diarrhea, accompanied by signs of bleeding, such as blood in the stool, nose bleed, gum bleeding, subcutaneous bleeding (purpura), increased amounts of menstrual bleeding or continuous spotting. Secondary symptoms may include other spleen deficiency symptoms, such as decreased appetite; fatigue, bloating after eating; shallow breathing or shortness of breath; cold extremities; skinny constitution. The tongue typically presents with a pale body and a white coating; the pulse tends to be soft, fine, and weak.

Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), tang-kuei (danggui), dioscorea (shanyao), lotus seed (lianzi), roasted ginger (paojiang), longan (longyanrou), baked licorice (zhi gancao).

Representative Formula: Ginseng and Longan Combination (Guipi Tang).

taken from: http://www.itmonline.org/5organs/spleen.htm

Hati

From Zhou Xuehai, Reflections Upon Reading the Medical Classics (Du Yi Suibi), ca. 1895:

The physician who knows how to harmonize the liver knows how to treat the hundred diseases.

From Tang Rongchuan, A Treatise on Blood Disorders (Xuezheng Lun), 1884:liver

Spreading is the nature of wood. The transformation of food qi relies entirely on the spreading and dredging function of liver wood once the food enters the stomach. If the liver’s pure yang does not rise, it cannot spread and dredge the grain and fluids, and distention and discomfort in the middle region will inevitably result.

The liver is associated with wood. Wood qi is characterized by its upward momentum and its innate desire to be straight. As long as the flow of liver qi is not impeded, the blood vessels will remain open and unobstructed.

The liver is the organ that is in charge of storing blood. It also commands the ministerial fire (xiang huo). If there is sufficient blood, this fire will be warm but not fierce. As a result, the blood can circulate smoothly through the body’s three burning spaces; it will reach the pores, and every single place in the body will benefit from its warming and nourishing function.

From Zhang Xichun, Chinese at Heart But Western Where Appropriate: Essays Investigating an Integrated Form of Medicine (Yixue Zhong Zhong Can Xi Lu), 1933:

Liver and spleen function together by assisting each other. However, people are always quick to point out that an excess of liver wood can injure the spleen earth, and thus have a detrimental affect on the proper digestion of food. But nobody seems to pay attention to the fact that a weak liver cannot circulate the spleen qi and thereby also cause maldigestion. Below, the liver connects to the Sea of Qi [lower dantian, associated with the kidney], which means that the liver is closely associated with the body’s ministerial fire. It can utilize the power of this fire to produce earth. The food which enters the spleen and stomach relies on this power to be ‘cooked.’ This is what is meant by saying that the liver and the spleen function by assisting each other.

From Ye Tianshi, A Handbook of Clinical Case Histories (Linzheng Zhinan Yian), 1746:

The liver is known as both the wood organ and the wind organ. Because it houses the ministerial fire within, we can say that the structure of the liver is yin while its function is yang. Its nature is firm and resolute, and it is in charge of moving and ascending. The liver relies entirely on kidney water to sustain it, on blood to moisten it, on lung metal’s clear nature and descending function to keep it in check, and on the generosity of the middle palace’s earth qi to nourish it. In this way, a firm and unrelenting character is being fitted with a soft and harmonious body, resulting in the liver’s balancing and free flowing nature.

From Zhang Huang, A Compendium of Illustrated Texts (Tushu Bian), Ming Dynasty:

The liver is associated with wood. It stores the blood and is the home of the hun spirits. Among the seven human emotions, only anger is of an intense nature. It dries up the blood and dissipates the hun spirits. The person who understands the way of nourishing the liver, therefore, never throws fits of anger.

From Yu Bian, Medical Teachings Continued (Xu Yishuo), 1522:

The Classic of Sagely Benefits states: ‘The seasonal cycle of transformation begins with the wood phase. In the body, therefore, the process of germinating and nurturing the twelve channel systems is initiated by the liver. During the first month of pregnancy, for instance, a woman’s fetus is nourished by her jueyin liver network.’ The liver, therefore, marks the beginning of cyclical action, the stirring of spring yang which all living things rely upon as a catalyst for their growth. By avoiding outbursts of anger and by fostering this particular type of yang energy, your prenatal qi will keep generating forever. The liver is also in charge of color; if its qi is in harmony, the body will exhibit a healthy luster. If its qi is injured, the body will appear dry and brittle. Nourishing the liver, therefore, first of all means to refrain from anger. This is the key for the maintenance of good health.

From Yang Jizhou, The Great Compendium of Acupuncture and Moxibustion (Zhenjiu Dacheng), ca. 1590:

The eyes represent the orifices of the liver. When a person closes his/her eyes and falls asleep, the blood returns to the liver. From there it is transmitted to the eyes, and the ability to see results from this. When a person sleeps, now, the nameless fire within grows dim in order to revitalize. Although it may be impossible to refrain from sleeping altogether, it is advisable not to just let this energy dissipate for the mere sake of falling into a slumber.

Insomnia caused by a cold deficiency pattern of the gallbladder is accompanied by symptoms of restless thought and a sensation of extreme mental weariness. Excess heat in the liver will typically cause a person to sleep too much, resulting in the mirror of intelligence gathering dust and a deterioration of the root of good health. None of these conditions, obviously, are the result of proper nourishing of the liver and gallbladder nor an appropriate way of subduing the sleep demons.

This is what you should do: do not get angry, do not lay down during the day, and always retire your body but not your shen. The essence of sleep, after all, is the soul of the body. If you can manage to sleep little, then the master mind will be bright and alert. Not only will your shen qi be flowing freely and purely, but you will also not be disturbed by dreams. Every time you are overcome by a craving for sleep, blood rushes to the heart and the original shen is forced to leave its abode. The clouds then cast a gloomy shadow over the heavenly realm of spirit, and the shen itself will grow dim and unconscious just like its domicile.

The Daoist master Zhang Sanfeng once said: ‘Grasp the dream in the dream; behold the darkness within the darkness. Since I saw the face of the girl, I can happily view the paradise, Penglai, right in front of my eyes. This is precisely what I mean! The Neijing , furthermore, states: ‘The three months of spring are the period of commencement; heaven and earth are born, and all living things are flourishing. Get up early in the morning, walk around in the courtyard, loosen your hair and relax your body. By doing so you will generate mental strength and act in harmony with the qi of spring, thus following the way of nourishing life. If you live contrary to this principle, you will harm your liver.’ Everybody should be aware of this basic principle.

From Cai Luxian, Chinese Medicine and Pharmacology: A Collection (Zhongguo Yiyao Huihai), 1936:

The gallbladder stores the essential fluids. It is thus called the ‘chief of staff’ and the ‘store house of essence.’ All the organs are of a murky nature, only the gallbladder is clear. All the other fu organs are called “bowels in charge of transporting” or something like this; only the gallbladder is not labeled as a transporter, but stands out as a ‘store house.’ It is a fu (transport) network, but has the characteristics of a zang (storage) network.


Blood flow varies according to the time of day, the season of the year, a person’s constitution, and the state of physical and mental quietude or agitation. The blood flows at a reduced rate when sleeping, and at an increased rate when physically working. Thirteen centuries ago, the influential Tang dynasty scholar Wang Bing described this function of the liver in the following manner: “The liver stores the blood, and the heart moves it. If a person moves about in a waking state, then the blood is distributed throughout all channels; if a person rests, the blood returns to the liver.”

Emotions such as anger, embarrassment, or unexpected joy can also increase blood flow, causing the ears and face to turn red. In situations when less blood is needed, it is “stored in the liver,” which thus assumes a warehouse-like function. The actual storage of blood is done in the penetrating vessel, one of the eight extraordinary vessels that extends from the lower dantian to the head; this vessel is often considered to be part of the liver network. The liver is best compared to a managing clerk, who moves goods in and out of the warehouse as they are needed.

Just as important is the liver’s function of maintaining a smooth and uninterrupted flow of virtually all body substances (including qi, blood, jing, and liquids and humors). The term shu (sometimes translated as coursing or smoothing) is used to refer to the action of maintaining a mode of operation in the body that is not stagnating, not overly agitated, and continuously flowing. The term xie (sometimes translated as draining) is used to refer to the liver’s action of purging stagnation in the spleen/stomach. Proper coursing and draining, or lack thereof, is mostly reflected in the relation of emotions to qi and blood circulation and to the influence of the liver on digestive system functions:

Emotional aspect: the ancient Chinese observed that human emotions are largely governed by the heart network. However, they also concluded that mental well-being or various shades of depression have an association with the coursing and draining function of the liver. Only if the liver carries this task out properly can the body’s qi and blood flow unobstructed, and thus facilitate a feeling of ease, harmony, and peace. If for some reason the liver fails to maintain this state, depression (of liver qi) or pathological rising (of liver yang) may result. As the Qing Dynasty classic, A Treatise on Blood Disorders (Xue Zheng Lun), states: “The liver is classified as wood; wood qi is characterized by its determination to go straight to where it wants to go to; if it is not blocked or suppressed, the movement in the vessels will be smooth.”

Digestive aspect: since this moving function of the liver regulates the qi flow in the entire body, it influences the dynamics of the other organ networks, particularly the neighboring digestive systems. It assists the upward and downward flows of the spleen/stomach system (the stomach is to move the food mass downward, the spleen is to move the extracted qi upward), passes bile into the intestines, helps to transport food essence, and aids the unobstructed movement and metabolism of water. The Treatise on Blood Disorders says “Coursing and draining is an integral part of liver nature. Once food qi enters the stomach, it is entirely up to the liver wood to course and drain it. Only if this process is intact will grain and water transform properly.”

Hun is originally an ancient astronomical term, describing the light of the moon (as opposed to its material body). Just like moonlight is a reflection of sunlight, hun stands for a particular type of consciousness that is reflecting waking consciousness (shen) on another plane. The Neijing comments in its typical terse code: “Hun is that what follows shen going in and out.”

Hun can be interpreted as the realm of the subconscious that is particularly active during sleep time. Therefore, all Chinese words that include the character hun describe states of dreaming or trance. As Zhang Jingyue, master physician of the Ming dynasty, put it: “This dim state of consciousness during dreaming, or the elusive visions we see meandering during nocturnal sleep, all fall under the category of hun.” Hun, in other words, can be understood as an ethereal type of consciousness which can separate from the body during sleep and interact with other “souls” (as hun is often translated) during this time.

Different from po (see the chapter on lung for more information), the vital instinctive spirit that is tied closely to the material body, hun is what is believed to leave the body after death and what can be called upon in prayers. The wandering ghosts (that usually cause trouble) described in Chinese stories are actually hun that roam about aimlessly, because they have nobody to perform the pacifying sacrificial rites for them.

According to traditional concepts, male physiology is mostly based on qi (yang), while female physiology is primarily based on blood (yin). Males tend to have an abundance of qi that they can afford to spend freely, while females have an abundance of blood that they can give away freely (as becomes evident from the menstrual bleeding). Liver function, therefore, has great influence over an important part of female physiology-menstruation.

The penetrating vessel and the conception vessel, are two pathways linked to the liver that are intimately involved with the transportation of blood. The penetrating vessel, above compared to a warehouse, is also called the Sea of Blood; and the conception vessel, as the name indicates, is credited with the function of nourishing the uterus and the fetus. Both the conception vessel and the penetrating vessel belong to the category of the eight extraordinary vessels. Both these vessels are involved in the liver’s ability to store blood; they set out from the uterus, and are also closely linked with the kidney channel.

The Neijing says: “In females, the tiangui (ability to conceive) arrives at the age of two times seven; at this point, the conception vessel will be open, the penetrating vessel will be exuberant, and therefore menstruation arrives in regular intervals and pregnancy becomes possible….At the age of seven times seven, the conception vessel becomes deficient, the penetrating vessel is exhausted, the tiangui dries up, and menstruation stops; aging is taking place and there will be no more pregnancies.”

The tendons connect the muscles to the bones. In accordance with the characteristics of the liver, they facilitate smooth and continuous movement. Because of this basic concept, some scholars have recently included the nerves (which do not have a separate designation in classical Chinese theory) under the category “tendons” (jin). The proper functioning of the tendons relies entirely on their nourishment by liver blood.

The nails are considered the surplus of the tendons: as such, they are an exterior manifestation of the general quality of the tendons, and thus, liver blood within. Dry and brittle or extremely pale nail beds always indicate a poor quality of liver blood, while pink nailbeds and firm nails indicate a healthy state of liver blood.

Hair is also associated with the liver blood: it is called the “surplus of the blood” (xue yu). The rich liver blood of females is expressed in lush, long, and fast growing hair on the head; males have more facial and body hair, which is governed by the qi organ, lung. Dry and brittle hair can be an indication of liver blood deficiency, while hair that suddenly falls out (alopecia) is usually because of both deficiency of blood and impeded flow of liver blood to the head, usually due to sudden emotional trauma.

The eyes are nourished by the essence of all five organ networks, and thus differentiated into five organ specific zones which may reveal important diagnostic information. The eyes as a whole, however, represent the opening of the liver, and are thus considered to be more closely linked to the liver than to any of the other organ networks. “Liver qi communicates with the eyes,” states the Neijing, “and if the liver functions harmoniously, the eyes can differentiate the five essential colors….If the liver receives blood, we can see. The liver channel branches out to the eyes. Both liver qi and liver blood flood the eyes to maintain proper eyesight. A person’s eyesight may therefore also serve as an indicator for liver function.

Just as trees (wood) tend to unrelentingly pursue their upward quest for the light, the liver represents the innate will of the body/mind to spread outward. Just like qi and blood have to spread within the body to ensure physical survival, human shen needs to spread freely through the social environment to guarantee an uninhibited passage through life. Individuals with strong liver qi and blood are usually excellent strategic planners and decision makers: they know how to spread themselves into the world. Due to these qualities, they often make outstanding business managers. If, however, this tough and determined spreading nature of the liver is not in a state of harmonious balance with the softer side of liver wood-ease, smoothness, flexibility-the wood-endangering state of rigidity arises.

The Liver Is Unable to Store the Blood: if the liver fails to be properly nourished by the qi derived from food via the spleen/stomach, or if for some reason the function of storing and regulating the blood becomes affected, symptoms of blurred vision, cramping, inhibited joint movement, dry eyes, night blindness, trembling hands and feet, numb extremities, dry, brittle, malformed, or grey nails, dry and split hair, scanty menstruation, or amenorrhea may occur.

The Liver Loses Its Ability to Course and Drain: if qi gets stuck, the inhibited coursing action of liver qi immediately manifests in the form of mental and emotional symptoms; depression, sensation of emotional pain, or crying are typical examples. If liver qi flares up and upsets the harmonious interplay between body and mind, outbursts of anger, or pain and distention in the sides of the chest may result.

This condition has also immediate consequences to the functioning of the spleen/stomach, specifically the actions of absorbing, transforming, and transporting grain qi (postnatal essence). Typical signs of a liver qi disorder implicating the neighboring spleen/stomach system are belching, regurgitation of stomach acid, vomiting, and diarrhea.

If the liver is not coursing the qi, body fluids (which also rely on liver qi to be moved) may stagnate, with a potential development of edema or ascites. And very importantly, if liver qi stagnates for a long time the proper circulation of blood will be impaired. Therefore, people with chronic diseases that involve liver qi stagnation often present with symptoms of both qi and blood stagnation, such as piercing pain in the chest, tumors and growths, and irregular menstruation.

Liver Disharmony Reflecting on the Emotions and Mental Activities: a deficiency of liver qi typically causes a person to be indecisive and adrift, with a marked inability to plan ahead effectively. If gallbladder qi is deficient, the person will be fearful, have a panicky disposition, and have difficulty making decisions.

Certain emotional states can result from, or cause, liver qi disorders. For example, a state of depression brought on by an unexpected event can eventually cause physical symptoms attributed to liver qi stagnation; liver qi stagnation, in turn, can cause mental depression. An intense outbreak of anger can induce sudden headaches, dizziness, chest pain, and other signs of liver-qi flare up (as the Neijing points out: “When a person is angry, the qi moves up); liver qi flaring up can cause one to feel anger. Sometimes a person will suffer a stroke (“qi and blood rushing to the brain”) during or shortly after an outburst of anger. Anger is a physiologically normal emotion and will usually not cause disease. The constant suppression of anger or putting oneself always in a situation that generates anger, on the other hand, can be the cause of long ranging problems, since it promotes a chronic state of internal qi stagnation.

Excess Pathogens in the Liver Channel: wind-heat (external heat) entering the liver channel causes red, swollen, or painful eyes. Upflaring liver fire from internal causes may also produce red eyes, or a white film on the eye. Hyperactivity of liver yang manifests in upwardly mobile symptoms, especially hypertension and dizziness. Liver-wind (internal wind) may produce seizures, uncontrollable eye movements, lock jaw, or tetanic cramping. The Neijing points out that: “All wind and dizziness disorders belong to the liver.”

Cold pathogens have a coagulating affect on the liver channel causing abdominal pain radiating to the genitals, testicular pain, or vaginal atrophy.

Course the liver and regulate qi (shu gan li qi): cyperus (xiangfuzi), bupleurum (chaihu), blue citrus (qingpi), curcuma (yujin), melia (chuanlianzi).

Move blood and expel stasis (huo xue xing yu): persica (taoren), carthamus (honghua), tang-kuei (danggui), red peony (chishao), leech (shuizhi), tabanus (mengchong), corydalis (yanhusuo), notoginseng (sanqi), achyranthes (niuxi), leonurus fruit (chongweizi).

Smooth the liver and nourish blood (rou gan): tang-kuei (danggui), peony (baishao), lycium fruit (gouqizi), gelatin (ejiao), zizyphus (suanzaoren).

Moisten the liver and tonify yin (zi yin): rehmannia (dihuang), ho-shou-wu (heshouwu), ligustrum (nuzhenzi), astragalus seed (shawanjili).

Astringe the liver (lian gan): chaenomeles (mugua), mume (wumei), schizandra (wuweizi), peony (baishao).

Clear liver heat (qing gan): scute (huangqin), gardenia (zhizi), prunella (xiakucao), celosia (qingshuangzi).

Purge liver heat (xie gan): gentiana (longdancao), indigo (qingdai), isatis (daqingye), aloe (luhui).

Cool liver blood (liang gan): moutan (mudanpi), lithospermum (zicao), sanguisorba (diyu), biota tops (cebaiye).

Course wind heat in the liver channel (shu feng): chrysanthemum (juhua), mentha (bohe), tribulus (baijili), vitex (manjingzi), siler (fangfeng).

Open the collaterals and sweep out the wind (huo luo sou feng): silkworm (jiangchan), typhonium (baifuzi), scorpion (quanxie), tribulus (baijili), equisetum (muze), agkistrodon (baihuashe), zaocys (wuxiaoshe).

Warm the liver (wen gan): evodia (wuzhuyu), artemisia (aiye), fennel (huixiang), zanthoxylum (chuanjiao), cinnamon twig (guizhi), tang-kuei (danggui).

Calm the liver (ping gan): peony (baishao), uncaria (gouteng).

Sedate the liver (zhen gan): oyster shell (muli), haliotis (shijueming), tortoise shell (guiban), turtle shell (biejia).

Extinguish internal wind (xi feng): gastrodia (tianma), antelope horn (lingyangjiao), centipede (wugong), scorpion (quanxie), silkworm (jiangchan).

If the liver fails to store the blood, it needs to be nourished and smoothed with blood tonic substances such as tang-kuei (danggui) and peony (baishao). If liver yin-the liver’s basic physiological substance that gets refined into liver blood-has already been damaged, the liver needs to be moistened with yin tonic substances such as rehmannia (dihuang) or ho-shou-wu (heshouwu).

If liver qi is depressed, the liver needs to be treated with substances that restore its coursing function, such as bupleurum (chaihu) or cyperus (xiangfuzi). If prolonged qi stagnation has affected the blood by causing blood stasis, the liver blood needs to moved and the stasis expelled by using substances like persica (taoren) and carthamus (honghua).

In a situation where an outbreak of rage has triggered a rampant and, usually, upwardly mobile qi flow, the liver needs to be calmed with gently descending substances such as peony (baishao) or uncaria (gouteng). If liver qi surges upwards and draws blood along with it, calming and descending substances need to be combined with herbs that cool liver blood, such as moutan (mudanpi); achyranthes (niuxi) will also guide blood downward. If a fit of anger sets liver fire ablaze, liver heat needs to be cleared with herbs like scute (huangqin), or in more serious situations also be addressed with materials that strongly purge liver heat such as gentiana (longdancao).

If wood fails to course and drain earth, the symptoms of stuckness, fullness, and distress in the middle burner need to be alleviated by coursing the liver (e.g., with bupleurum; chaihu) and harmonizing the spleen/stomach (e.g., with white atractylodes; baizhu).

In the case that wind-heat pathogens have invaded the liver channel network, the wind has to be expelled by using substances that course liver wind, such as mentha (bohe) or chrysanthemum (juhua). If the coagulating influence of cold pathogens are obstructing the proper flow of blood in the liver channels, the liver needs to be warmed and the cold dissipated with herbs like artemisia (aiye) or evodia (wuzhuyu).

If upflaring liver fire causes symptoms of heat in the upper burner, liver heat has to be cleared. If a constitutional yin deficiency causes fire and develops into the serious condition of rebelliously upflaring liver yang, the rampant liver yang needs to be subdued by employing a combination of calming (gently descending) and purging (strongly descending) medicinals. The physician Zhang Xichun, however, has cautioned against pushing down and thereby humiliating the liver-the “proud general” of the organ systems-too intensely; small amounts of substances that promote its physiologically upward qi flow, such as germinated barley (maiya) and melia (chuanlianzi), should be included in formulas that sedate the liver.

If there is liver wind stirring internally, the liver should be calmed and the wind extinguished. If wind-phlegm pathogens block the collaterals causing surface numbness and pain, then substances that can both sweep the wind from the collaterals and clear phlegm obstruction of the collaterals, such as silkworm (jiangchan) or typhonium (baifuzi), should be used.

As an upwardly mobile yang organ, the liver easily suffers from symptoms of hyperactivity. As an emergency measure, the Neijing suggests the ingestion of sweet flavors to moderate symptoms of pain, cramping, and other signs of acute liver aggravation.

Furthermore, as with the wood network that is energetically akin to proliferating spring foliage, the liver has the innate desire to spread and disperse. If this spreading aspect of liver physiology is disturbed, various levels of stagnation manifest and dispersing measures need to be employed. Since pungent flavors can directly disperse stagnation, they can generally be recommended for a condition characterized by stagnant qi. Pungent flavors, however, are generally warming in nature and the liver, particularly when its flow is suppressed, tends to heat up easily. Different from the often exclusive use of pungent substances in lung treatment, it is thus important in liver therapy to include along with the pungent herbs bitter, cold materials. Bitter materials such as scute (huangqin) or gentiana (longdancao) are usually classified as having a heat clearing or heat purging affect. Sour, moreover, is the flavor with a direct affinity to the liver network. If used appropriately, sour foods or herbs can be of benefit to the liver. As the Neijing points out: “Sour generates the liver,” but also warns against the excessive use of sour flavors, since this would actually cause damage to the liver system: “If the disease is in the tendon layer, do not eat sour flavors.”

Damp heat in the gallbladder needs to be addressed not only by clearing liver heat, but also by disinhibiting gallbladder damp (e.g., with capillaris; yinchen). In situations where gallbladder qi deficiency impacts the smooth circulation of liver qi, general qi tonification needs to be supported by herbs that pacify the shen and nourish kidney yin.

The liver’s mother organ and lower burner neighbor, the kidney, when weakened, can have a detrimental affect on the liver’s qi, yin, and blood. Thus, liver tonification often indicates the use of herbs like rehmannia (dihuang) and lycium fruit (gouqizi) that also have a tonic affect on the kidney.

LIVER QI STAGNATION (gan qi yu jue): primary symptoms are tendency to get depressed; frequent sighing; impatient disposition and temper outbreaks; sensations of stuffiness; fullness or congestion in the chest, intercostal, or subcostal regions. Secondary symptoms include obstructed bowel movements; dry and distended eyes; feeling of something being stuck in the throat; self-doubts and crying; pain (especially intercostal and abdominal) that is characterized by moving, pulling, or penetrating sensations; in females; premenstrual breast distention; menstrual cramping and irregular menstruation. The tongue typically presents with a reddish body (especially at the sides) and a thin coating; the pulse tends to be wiry.

Representative Herbs: bupleurum (chaihu) with peony (baishao), cyperus (xiangfuzi), curcuma (yujin), cnidium (chuanxiong), blue citrus (qingpi), chih-shih (zhishi), corydalis (yanhusuo), melia (chuanlianzi).

Representative Formulas: Bupleurum and Chih-shih Formula (Sini San); Bupleurum and Cyperus Formula (Chaihu Shugan San).

LIVER BLOOD DEFICIENCY (gan xue xu): primary symptoms are pale face color; dizziness; dry eyes or, at a more advanced stage, blurry vision (especially at night); numbness in the extremities (including arms easily “falling asleep” while sleeping); limited flexibility of tendons and muscles. Secondary symptoms include pale lips and nails; dry, split, atrophied, or malformed nails; muscle twitching; spasms or cramping in the extremities; trembling hands or feet; occasional intercostal pain; ringing in the ears; in females: decreased and pale menstrual flow. The tongue is typically pale or pink; the pulse tends to be fine, or wiry and forceless.

Representative Herbs: tang-kuei (danggui), peony (baishao), gelatin (ejiao), ligustrum (nuzhenzi), cornus (shanzhuyu), cnidium (chuanxiong), zizyphus (suanzaoren), millettia (jixueteng).

Representative Formulas: Tang-kuei Four Combination (Siwu Tang); Tonify the Liver Decoction (Bugan Tang); Linking Decoction (Yiguan Jian) minus melia (chuanlianzi) plus peony (baishao).

LIVER YIN DEFICIENCY (gan yin xu): primary symptoms are dizziness; blurry vision; dry eyes; dull intercostal pain; dry mouth and throat; heat sensations in palms and soles. Secondary symptoms include numbness in extremities; limited tendon flexibility; lusterless nails; impatient disposition and temper outbreaks; flushed cheeks; dark urination; constipation; low grade fever; restlessness and insomnia; tidal heat sensations; night sweats. The tongue typically presents with redness and little or no coating; the pulse tends to be wiry and fine, or wiry, fine, and rapid.

Representative Herbs: peony (baishao), lycium fruit (gouqizi), ligustrum (nuzhenzi), gelatin (ejiao), tang-kuei (danggui), rehmannia (dihuang), cornus (shanzhuyu), ho-shou-wu (heshouwu), turtle shell (biejia), zizyphus (suanzaoren), biota (baiziren).

Representative Formulas: Linking Decoction (Yiguan Jian); Ligustrum and Eclipta Formula (Erzhi Wan).

LIVER FIRE BLAZING (gan huo shang yan): primary symptoms are pain and distention in the head; dizziness; ringing in the ears or sudden deafness; red face; red, swollen, or painful eyes; dry and bitter sensation in the mouth; marked impatience and tendency to throw fits of anger. Secondary symptoms include insomnia; vivid dreaming; throbbing or burning pain along sides of chest; dark urination; constipation. The tongue typically presents with a red body and a yellow coating; the pulse tends to be wiry and rapid.

Representative Herbs: gentiana (longdancao), prunella (xiakucao), gardenia (zhizi), chrysanthemum (juhua), aloe (luhui), antelope horn (lingyangjiao), bupleurum (chaihu), ch’ing-hao (qinghao), moutan (mudanpi), eriocaulum (gujingcao), celosia (qingxiangzi).

Representative Formulas: Gentiana Combination (Longdan Xiegan Tang); Tang-kuei and Aloe Pill (Danggui Luhui Wan); Purge the Green Pill (Xieqing Wan).

REBELLIOUS UPFLARING OF LIVER YANG (gan yang shang kang): primary symptoms are dizziness; distention and pain in the head; ringing in the ears; redness and heat sensation in the face and upper part of the body. Secondary symptoms include insomnia; vivid dreaming; impatience; angry disposition; heavy head and “light feet” (easily stumbles); weak and sore lower back and knees; dry mouth and throat. The tongue is typically red; the pulse tends to be wiry and forceful, or wiry, fine, and rapid.

Representative Herbs: uncaria (gouteng), haliotis (shijueming), dragon bone (longgu), oyster shell (muli), gastrodia (tianma), tribulus (baijili), silkworm (jiangchan), peony (baishao), tortoise shell (guiban), turtle shell (biejia), rehmannia (dihuang).

Representative Formula: Gastrodia and Uncaria Combination (Tianma Gouteng Yin).

LIVER WIND STIRRING INTERNALLY (gan feng nei dong): primary symptoms are cramping; seizures; trembling; shaking; dizziness; and numbness. This category is usually divided into three subcategories:

  1. Extreme Heat Generating Wind (re ji sheng feng): primary symptoms are high fever, restlessness, thirst, flushed face, red eyes, seizures or cramping. Secondary symptoms include dark urination; constipation; upwardly turned eyes; unconsciousness; delirious talk. The tongue typically presents with a red body and a yellow coating; the pulse tends to be wiry and rapid.
    Representative Herbs: rhino horn (xijiao), antelope horn (lingyangjiao), ox gallstone (niuhuang), uncaria (gouteng), gastrodia (tianma), anemarrhena (zhimu), raw rehmannia (sheng dihuang), chrysanthemum (juhua), scute (huangqin).
    Representative Formulas: Antelope and Uncaria Decoction (Lingyang Gouteng Tang ); Ox Gallstone Pacify the Palace Pill; Bezoar and Curcuma Formula (Angong Niuhuang Wan).
  2. Hyperactive Liver Yang Producing Wind (gan yang hua feng): primary symptoms are cramping; seizures; numbness in the extremities; paralysis (especially of the hemiplegic type); slurred speech; mouth and eyes going off to one side. Secondary symptoms include sudden loss of consciousness or severely impacted mental faculties; splitting headache; severe dizziness; weakness or soreness in lower back and knees; dry mouth; flushed face. The tongue is typically bright red; the pulse tends to be wiry.
    Representative Herbs: uncaria (gouteng), gastrodia (tianma), achyranthes (niuxi), hematite (daizheshi), silkworm (jiangchan), cicada (chantui), centipede (wugong), peony (baishao), rhino horn (xijiao), ox gallstone (niuhuang), antelope horn (lingyangjiao).
    Representative Formulas: Sedate the Liver and Extinguish the Wind Decoction (Zhengan Xifeng Tang); Downward Momentum Decoction (Jianling Tang).
  3. Blood Deficiency Generating Wind (xue xu sheng feng): primary symptoms are dizziness; headache; blurry vision; numbness in the extremities or, in more severe cases, symptoms of cramping, trembling, or twitching. Secondary symptoms include dry and itching skin; fainting spells; and general blood deficiency symptoms such as pale complexion, pale lips and nails, brittle or malformed nails, and dull intercostal pain. The tongue typically presents with a pale body and little coating; the pulse tends to be fine and wiry.
    Representative Herbs: cooked rehmannia (shu dihuang), peony (baishao), tang-kuei (danggui), millettia (jixueteng), earthworm (dilong), uncaria (gouteng).
    Representative Formulas: Tang-kuei Four Combination (Siwu Tang); Settle Tremor Pill (Dingzhen Wan).

COLD PATHOGENS HAVING A COAGULATING AFFECT ON THE PROPER FLOW IN THE LIVER CHANNELS (han chi gan mai): primary symptoms are lower abdominal distention and pain. In females, these may include symptoms of menstrual cramping or pain due to abdominal masses; in males, radiating pain to or from the testicles, or general aversion to cold and preference for warm temperatures are indications. Secondary symptoms include testicular cold sensation or undescended testicle; atrophy of scrotum; cold extremities; little desire to drink fluids; clear and profuse amounts of urination. The tongue is typically moist and presents with a slippery white coating; the pulse tends to be deep and slow, or deep and wiry.

Representative Herbs: tang-kuei (danggui), cinnamon twig (guizhi), evodia (wuzhuyu), artemisia (aiye), lindera (wuyao), fennel (huixiang).

Representative Formulas: Tang-kuei, Evodia, and Ginger Combination (Danggui Sini Jia Wuzhuyu Shengjiang Tang); Warm the Liver Decoction (Nuangan Jian); Tiantai Mountain Lindera Powder (Tiantai Wuyao San); Fennel and Citrus Seed Pill (Huixiang Juhe Wan).

DAMP HEAT IN THE LIVER/GALLBLADDER (gan dan shi re): primary symptoms are discomfort, stuffiness, or pain in chest, epigastric, or subcostal region; abdominal distention; nausea; bitter or unpleasant taste in mouth; no appetite; restlessness; easily angered; dark urination. Secondary symptoms include alternating heat/cold sensations; thick and colored vaginal discharge; itching or swollen genitalia; obstructed bowel movements; jaundice and yellow eyes. The tongue typically presents with a reddish body and a greasy yellow coating; the pulse tends to be wiry and rapid.

Representative Herbs: gentiana (longdancao), capillaris (yinchen), gardenia (zhizi), scute (huangqin), rhubarb (dahuang), indigo (qingdai), akebia (mutong), alisma (zexie), plantago leaves (cheqiancao), hoelen (fuling), coix (yiyiren), talc (huashi), bupleurum (chaihu), curcuma (yujin).

Representative Formulas: Bupleurum and Chih-shih Formula (Sini San) plus capillaris (yinchenhao); Gentiana Combination (Longdan Xiegan Tang); Capillaris Combination (Yinchenhao Tang).

taken from: http://www.itmonline.org/5organs/liver.htm

Paru – paru

From Shen Jin’ao, Doctor Shen’s Compendium of Honoring Life (Shen Shi Zunsheng Shu), 1773:

lungThe lung is the master of qi. Above, it connects to the throat; below, it connects to the orifices of the heart and the liver. It is in charge of inhalation and exhalation, and, in more general terms, the flux of coming in and going out.

It is situated atop the other organs, so that it can keep them in check and push the body’s waste materials downward, all the way into the large intestine. In other words, it takes in clear qi and gives off murky refuse; it absorbs the yin within taiyang to sustain the body’s yang qi [it absorbs the material essence of universal qi to sustain the body’s functions], and it commands the yang within taiyin to propel the body’s yin substances [it commands the descending force to move out the waste]. In cooperation with the foot taiyin spleen network, it transports qi and provides it to all the other organs; it is for this reason that both the lung and the spleen are both called taiyin.

The lung is associated with the phase element metal, the direction west, and the season of autumn. In autumn, the seasonal qi turns crisp and clear, and all living things rely on its force to become ripe and complete. Metal is the mother of water. Lung qi, therefore, generally moves downwards. When our bodies rest, it descends into the kidney palace and combines with water, a process the Neijing refers to as ‘the mother concealing herself inside the newly conceived offspring.’

Only the kidney is ‘true water,’ conceived in the heavenly spheres where the state of oneness prevails. It is thus only appropriate that the kidney’s mother, the lung, resides at the very top of the dome that is formed by the body’s main cavity. In a cosmic context, this would be like being situated at the upper source of the stream of heavenly energy, flowing downwards through the head, and finally entering the [kidney’s] Dragon Gate below to combine [with true water] to form the ocean [of bodily qi]. Since the lung thus functions by transporting essence to the other organs, its main action could also be compared to the climatic process of sprinkling morning dew, a heavenly substance which is dispensed generously every morning to nourish all living creatures [below] on earth.

Typically, the lung is sensitive to dryness as well as to cold and heat. This means that the lung’s function of lubricating the other organs with essence has a tendency to deviate from its mode of smooth operation by providing either not enough or too much lubrication. Or, if invaded by evil qi, it will be unable to assume its commanding role among the organ networks, and will instead produce diseases of a dry or a hot or a cold nature. This is the reason why the ancient books all refer to the lung as ‘the delicate organ.’

From Ye Tianshi, A Handbook of Clinical Case Histories (Linzheng Zhinan Yian) , 1746:

The lung is the main pump behind the action of inhalation and exhalation. It is located at the highest point of the body, and thus is in a position to receive the clear qi that ascends from the other organ networks. Its nature is to be clear and aloft, and its functional quality is to expand downwards-be in charge of all descending movement within the body. Also, the lung is known as the delicate organ, which is extremely sensitive to the influence of evil qi. Each of the six influences [liuyin], therefore, can easily cause a state of imbalance in the lung. The lung has an innate aversion to cold, to heat, to dryness, to dampness, and most of all, to fire and wind. In the presence of these kinds of pernicious influences the lung easily loses its clear and crisp equilibrium; it will be inhibited in its function to descend and command, and as a result of this, normally free flowing qi will become obstructed and stagnate.

From Yu Chang, The Statutes of Medicine (Yimen Falü) , 1658:

All bodily qi has its physical origin in the lung. If the lung’s qi is clear and straightforward, then there is not a single type of qi in the body that will not obey and flow along smoothly. However, if the lung qi becomes obstructed and turns murky, then the qi dynamics of the entire body will start to go against their natural flow and start to move upwards instead of downwards.

From Yang Jizhou, The Great Compendium of Acupuncture and Moxibustion (Zhenjiu Dacheng) , ca. 1590. This paragraph appears in the chapter on the lung channel, and is marked as a quote from an older Daoist source, The Original Classic of Guiding the Breath (Daoyin Benjing) :

The lung is the lid of the five organ networks. It produces the voice, and it provides proper moisturization to the skin. As soon as there is either internal damage due to the seven harmful emotions, or external injury due to the six climatic influences, the rhythmical process of inhaling and exhaling and the general qi flow between the body’s inside and outside are disturbed; the lung metal then loses its clear quality. If we want to restore purity in the metal, we must first strive to regulate the breath. Once the breath is regulated, erratic movement will not occur and the heart fire will calm down all by itself. The process is as follows: first, we must concentrate on the dantian, this will quiet the heart; then, we must relax and broaden the center of our torso; and finally, we must visualize that the qi comes and goes freely through every single pore of our body. Soon, there will be no obstruction, and if we focus diligently enough our actual breath will become very fine and subtle. This, then, can be called the true breath [as achieved during meditation]. The breath, therefore, has its origin in the heart. When the heart is at peace, the qi is in a state of harmony and can return to its root in the lower abdomen with every breath we take. In this fashion, the lung and its breath can truly fulfill their assigned role as the mother of the [lower] dantian.

From The Hidden Tao: A Collection (Daozang) ; Ming Dynasty compilation of esoteric Taoist texts (ca. 1600), some of them dating back to 600 B.C.:

Qi disorders of the lung manifest as coughing. The secretion [ye] associated with the lung is nasal discharge. The lung qi connects with the brain above and the spleen below. In general, all types of bodily qi are governed by the lung. Laying down for too long harms the lung. The lung is the source of inhaling and exhaling. It is the officer in charge of qi. If noxious kidney qi enters the lung, there will be lots of nasal discharge.

The large intestine is the bowel associated with the lung. If it is in harmony with the lung, the hair of the body and head will be lustrous. If the hair becomes dry and falls off, the lung is exhausted.

The Central Juncture Classic (Huangting Jing) states: ‘The lung palace can be compared to a lid. In its innermost part reside the seven lads in charge of regulating the qi. In the outside world, it corresponds to Mt. Song [the highest of China’s Five Holy Mountains]. The nose is its surface site. ‘Shang’ is its sound, pungent is its flavor, tart is its smell. If noxious heart qi enters the lung, the person will experience an aversion to tart, putrid smells. Its disposition is righteousness, its humor is anger, its fluid [jin] is saliva. If a patient suffers from lung consumption, there will be lots of saliva. During the three months of autumn, the Metal King carries out his chore of termination, and everything withers. The wise person who wants to put his po spirits to rest and thus preserve his material body, must restrain his seed [avoid ejaculation of sperm], nourish things, be merciful, and not be too exuberant in his expressions.’

The lung makes a pair with the large intestine. On the body surface, it assumes form in the nose. If lung wind is present, the nose will be congested. If the face appears withered, the lung is dry. If the nose itches, there is a worm in the lung. If a person is panicky and constantly frightened, the po spirits are leaving the lung. If white and black spots appear all over the body, the lung is weak. If somebody has a powerful voice, the lung is strong. If somebody cannot bear exposure to cold, the lung is in shambles. If somebody craves pungent food, the lung is deficient. If somebody experiences constipation, the lung is obstructed. If somebody has a glossy white face color, the lungs are healthy.

If the lung is diseased, there will be frequent coughing, symptoms of upward qi movement, a puffy face, an excessive desire to lay down, blemishes in the face, a yellow-white face color, a cold nose, a headache, pain and distention in chest and back, restless extremities, itching of the skin, obstruction in the throat, dreams of beautiful ladies clad in silken fabrics and fancy jewelry-oneself wearing scaled armor-or of speckled banners and lofty heroes. We can remove these conditions by working with the mantra “ssssssssssssssssssss” and by clicking our teeth at sunrise nine times: first, pull in fresh air through your nostrils, then gently “sssssssssss” thirty-six times to expel lung heat and all other kinds of noxious qi which may lodge there.


According to the traditional Chinese world view, every process and every thing represents a transformation of one and the same qi. Yin (matter) and yang (function) are the two most basic differentiations of this-ONE-universal Qi.

According to various references in the Neijing, the term qi, when used in the context of the human body, has essentially two meanings:

  1. material building blocks that are essential for the maintenance of physical life, as in yuan qi (original qi), da qi (breath), or gu qi (food qi);
  2. functional aspects of specific organ networks, such as stomach qi, liver qi, taiyang channel qi, etc.

Qi in the body is produced and maintained by two basic sources: prenatal jing qi (essence) of the kidney and postnatal air and food qi that is processed in the lung and spleen/stomach systems.

Qi, by definition, moves. It is the uninhibited movement of bodily qi which facilitates health. The basic movements of qi are ascending (sheng), descending (jiang), going out (chu), and coming in (ru).

The basic functions of bodily qi are:

  1. Moving and circulating structural body substances (blood circulation, distribution of fluids, growth process, function of organ/channel networks).
  2. Warming the various layers of the body (if skin and muscles are not warmed due to qi deficiency, there will be aversion to cold, cold hands and feet, etc.).
  3. Creating a protective shield effect against external pathogens such as wind or cold as well as, in modern terms, viruses and bacteria.
  4. Stabilizing and holding the structural parts of the body in place (otherwise bleeding, sweating, enuresis, prolapse of organs may occur).
  5. Driving metabolism (e.g., in the process of blood production, or in the functioning of certain organs, such as qi transformation facilitating water metabolism in the bladder).

There are many different layers of bodily qi which are referred to by the following terms:

Yuan Qi (original qi), also called jing qi (essence qi) or shenjian dong qi (qi that spirals out from between the kidneys). It is created by the interaction of the body’s yuan yang (original yang) and yuan yin (original yin). It is considered to be the most fundamental qi of the human body, the root source of metabolism. The Qing dynasty medical scholar Xu Lingtai states in his influential treatise, Discussing the Origins and the Development of Medicine (Yixue Yuanliu Lun, 1757): “And where, then, is this so called original qi located? All five organ networks possess their own true jing which is their piece of the original qi. However, the true home of this substance is what the Daoist classics call the dantian, or what the Nanjing (Classic of Difficulties) calls mingmen (gate of life), and what the Neijing calls ‘the little heart next to the seventh vertebrae.'”

Da Qi (great qi), also called tian qi (heavenly qi): the breath.

Gu Qi (grain qi), also called di qi (earthly qi): qi distilled from food.

Zhen Qi (true qi): the body’s total energy, being the combination of prenatal original qi and postnatal air/food qi.

Zong Qi (ancestral qi): combination of the two aspects of postnatal qi, the breath, and distilled food essence. It gathers in the middle dantian that is located between the nipples, and surfaces in the throat to support the breath and the voice. It also enters the heart channel to promote circulation of qi and blood.

Ying Qi (nutritive qi): manufactured from the denser portion of food essence; circulates inside the blood vessels; can combine with fluids to produce blood; helps blood to circulate. Ying (nutritive qi) and xue (blood) can therefore be differentiated only theoretically-in physical form they are always one.

Wei Qi (protective qi): made from the more ethereal portion of food essence; circulates outside the vessels; warms the muscles, moistens the skin, is in charge of opening and closing the pores. This is why it can protect the body against the invasion of pernicious qi invading from the outside.

Zheng Qi (righteous qi), Xie Qi (pernicious qi): righteous qi can be understood as the traditional equivalent to the immune system, responding to the invasion of external pathogens. The scholar Xie Liheng once made the following remark about the origins of righteous qi: “zheng qi (righteous qi) is actually a manifestation of the power of yuan qi (original qi).” His colleague Li Zhongzhai elaborated on the meaning of its antagonist, pernicious qi: “xie qi (pernicious qi, evil qi) is nothing else but the six pathogenic influences of wind, cold, summer heat, dampness, dryness, and fire.”

Zangfu Jingluo Zhi Qi (organ and channel network qi): organ qi (liver qi, spleen qi, etc.) refers to the respective functions of different organ networks. Channel network qi refers to the qi flowing through the meridians that produces the feeling of local distention during needling or acupressure.

Zhong Qi (central qi): qi of spleen and stomach. Mostly refers to the transporting function of the spleen, specifically referring to its rising action. When the central qi collapses, there will be signs of downward leakage such as diarrhea, profuse urination, prolapse of anus, etc.

It is important to note that all of these different types or layers of qi are governed by the lung, and can be coordinated in a fruitful way only by the lung. In other words, all four of the basic qi movements of ascending, descending, going out, and coming in are influenced by the lung. This governing of the qi includes influence on the spleen qi raising food essence to the lung, from where it is distributed over the entire body; stomach qi descending, passing waste to the intestines to be discarded; kidney yang “steaming” vital fluids (jing) upwards; liver qi rising; lung qi descending. etc.

Po is an ancient astronomical term designating the material body of the moon, while its counterpart, hun, is used to specify the light of the moon. In nature, the term po is thus used to represent the visceral life force that lies latent in the earth, and in medicine it is used to describe both measurable physiological functions and development. The scholar Kong Yingda explains: “The spirit of form is called po. When human beings are first born, they can see and hear, their hands and feet can move; these actions are due to the workings of po.” Zhang Jingyue, the master physician of the Ming Dynasty, further elaborated: “The effect of po is that we can move and do things, that there is itching and pain.” In sum, po entails the basic instincts that we possess from birth, enabling us to see and hear and eat and cry, even with the early state of awareness and activity of a baby. Since breathing is the most fundamental of all instincts, the lung is the residence of the po spirits.

According to the classic definition in the Neijing, “Po follows jing.” In Chinese colloquial language, people with a voluminous voice, intense eyes, or reflexes suited to the performance of martial arts are said “to have a lot of qi po.”

The lung is closely associated with the heart, just as the qi is closely associated with the blood. The administrating aspect of the lung mostly refers to its controlling and harmonizing function in regard to the flow of blood. As the Neijing definition reads: “The lung opens the one hundred vessels.” Concerning the intimate relationship of qi and blood, the classic further states: “Qi is the commander of blood; if qi moves, blood moves.”

Just like a metal object absorbs the temperature of its environment in an instant, the metal organ (lung) is most easily influenced by external influences of pernicious heat or cold.

Lung qi constantly descends, moving water downwards: it thus provides the rest of the organ networks with fluids, and even regulates urination. The defining Neijing line reads: “The lung is the upper source of water.” If it loses its crucial descending function, there may be symptoms of stuffy chest, cough, asthma, or signs of water stagnation such as phlegm, urinary problems, edema, etc.

The lung qi is in charge of propelling the protective qi (wei qi), the fluids, and the food essence over the entire body. It thus warms the muscles and the surface, harmonizes the opening and closing action of the surface pores, and moistens the body hair and the skin. If lung qi is weak, the protective qi (wei qi) cannot nourish the body hair properly, causing it to become brittle. Similar to the pores on the surface of the lung, moreover, the pores on the surface of the skin are qi gates in charge of “body breathing.” If the protective qi is too weak to properly close the pores, sweat pours out. If there is an excess of pernicious qi in the lung, on the other hand, the opening mechanism of the pores easily gets jammed; then the ventilating function of the pores gets disturbed, and there may be symptoms of inhibited sweating, such as no sweating during a fever.

A branch of the lung channel connects with the large intestine below, thus forming a pair. The lung is known as yin (structural, essence storing) metal, the large intestine as yang (hollow, transmitting) metal. Lung qi is the pushing power behind the large intestine’s action of transporting and discarding waste materials. From a more general perspective, it could be said that the large intestine acts in accordance with the qi from the five organ networks which reaches it via the lung. Constipation may be due to a deficiency or stagnation of propelling power, or a fluid problem (dryness) related to the lung. The anus, because of the large intestine’s intimate relationship with the lung, is called the po gate.

The nose is in charge of breathing and smelling; functions that depend entirely on a healthy lung. Also, the nose is one possible gateway through which external pernicious qi can invade the lung. If the lung is invaded by pernicious qi, there may be nasal symptoms such as stuffy nose, nasal discharge, or loss of smell. If there is an acute obstruction of qi due to lung heat, there will be asthmatic breathing, in which case the nose may quiver.

The throat is in charge of the voice, which can be compared to the sound emanating from a metal bell. When the metal organ (lung) is afflicted by disease, the voice may appear changed, muffled, or even lost as in the case of sore or hoarse throat.

Abnormal Upbearing and Downbearing of Lung Qi: If the body surface is invaded by cold, or if there is internal heat obstructing the lung, the smooth process of dissipating qi, as governed by the lung, will be disturbed. This disturbance of outwardly flowing qi typically results in sensations of chills, drafts, fever, spontaneous sweating, or inhibited sweating-a symptom complex that is generally labeled as a “disharmony between the body’s ying (nutritive) and wei (protective) layers.”

If lung qi is deficient, and thus falls short in fulfilling its physiological duties of “misting” postnatal essence over the organ networks or disseminating wei qi and essence to the skin and body hair, then dry skin, spontaneous sweating, or a propensity to catch frequent colds may result. Every disturbance of outward qi flow, moreover, will necessarily involve disruption of the downward distribution of qi. Coughing, asthmatic breathing, and a stuffy sensation in the chest are typical indications for a reversal of the lung’s downward qi flow.

Lung Imbalance Affecting Its Opening and Regulating Affect on the Water Pathways: The lung is situated in the upper burner and referred to as the upper source of water. If lung qi fails to descend, it cannot open and regulate the water pathways and ensure the unobstructed transportation of fluids to the bladder. Signs of water stagnation will inevitably ensue, such as phlegm buildup, a puffy face, edema, or inhibited urination. As the Neijing points out: “Lung qi disperses jing; in the upper part of the body, it is rooted in the lung; below, it feeds into the bladder.” The lung disseminates essential fluids: physiological jing (essence), jin (body fluids), and ye (body humors). At the same time, it feeds into and excretes superfluous fluids from the body via the bladder. Lung malfunction therefore can easily cause pathological changes in water metabolism, particularly bladder function.

Dryness Affecting the Lung Causing a Depletion of Liquids and Humors: External conditions like environmental cold, heat, and dryness, or internal dryness of the lung or large intestine all have the potential to injure the fluid supply of the body and cause dryness symptoms in the nose, throat, lungs, skin, body hair, or intestines. The Neijing comments: “The lung has a natural aversion to dryness.” In addition to being easily harmed by dryness, it passes on the condition as symptoms of dryness elsewhere.

Grief and Sadness Harming the Lung: Grief, sadness, and melancholy are associated with the lung. If one indulges in these emotional states, harm to the lung network will result and symptoms of emaciation, lack of energy, or dry skin may occur. The other way around, a low supply of lung qi can cause a gloomy state of mind. A particularly sad experience, moreover, may cause a person to adopt a pessimistic attitude toward life (which is really a state of dampened qi). “If a person is sad,” it is said in the Neijing, “his qi will dissipate.”

Lung Disease Influencing the Nose, Throat, and Large Intestine: If external pathogens invade the lung, its orifice, the nose, will manifest symptoms of stuffiness, nasal discharge, inability to distinguish smell, or quivering nostrils (in asthma patients). Since the throat is governed by lung qi, an invasion of external pathogens can easily cause a loss of voice. Both external (excess) and internal (deficiency) conditions, moreover, can be the cause of swelling and pain in the throat, including enlargement and suppuration of the tonsils. If the lung is unable to disseminate enough fluids to its associated fu organ below, the large intestine, or if the fluids are scorched by lung heat, there will be constipation. As the primary text of the fever school, Systematic Differentiation of Warm Diseases (Wenbing Tiaobian), describes: “If somebody suffers from invasion of pernicious dry metal qi that is prominent during the fall, it will gradually lead to intestinal coagulation that will become harder and harder, and that must be purged.” Heat accumulation in the large intestine, in turn, can interrupt the proper up/down dynamics of lung qi, and become a potential cause of coughing or asthmatic breathing.

Dissipate lung qi (xuan fei): platycodon (jiegeng), scallions (congbai), fermented soy (dan douchi), lotus leaf (heye).

Open up the surface (fa biao): ma-huang (mahuang), perilla leaf (zisuye), schizonepeta (jingjie), mentha (bohe), angelica (baizhi).

Clear lung heat (qing fei): scute (huangqin), morus leaf (sangye), phragmites (lugen), anemarrhena (zhimu), gypsum (shigao).

Moisten lung yin (run fei): lily (baihe), ophiopogon (maimendong), scrophularia (xuanshen), polygonatum (yuzhu), trichosanthes root (tianhuafen).

Astringe the lung (lian fei): schizandra (wuweizi), mume (wumei), (yingsuke), terminalia (hezi).

Stop coughing (zhi ke): stemona (baibu), aster (ziwan), (madouling), tussilago (kuandonghua).

Calm asthmatic breathing (ping chuan): ma-huang (mahuang), apricot seed (xingren), perilla seed (zisuzi), honey baked eriobotrya (zhi pipaye).

Disinhibit phlegm (li tan): pinellia (banxia), peucedanum (qianhu), fritillaria (beimu), bamboo skin (zhuru), bile treated arisaema (dan nanxing).

Purge lung qi (xie fei): lepidium (tinglizi), morus bark (sangbaipi), water melon rind (xiguapi), (baiqiangen)

Raise lung qi (sheng fei qi) :platycodon (jiegeng), cimicifuga (shengma).

Tonify lung qi (bu fei qi): ginseng (renshen), astragalus (huangqi), gecko (gejie).

Clear heat in the large intestine (qing chang): phellodendron (huangbai), coptis (huanglian), rhubarb (dahuang), sterculia (pangdahai).

Moisten the large intestine (run chang): linum (huoma ren), trichosanthes seeds (gualou ren), apricot seed (xingren), cistanche (roucongrong), tang-kuei (danggui).

Since the lung is primarily in charge of qi, lung therapy should mostly utilize medicinal substances that affect the qi, not the blood. It is the particular function of lung qi to dissipate outwards, and to descend and dispense downwards. If these functions are compromised, they need to be rectified by restoring the outwardly dissipating function of the lung (primarily by opening up the surface with diaphoretics), and/or restoring the downward flow of lung qi (by calming coughing and asthmatic breathing, or opening up the water passages, or purging lung qi).

Since the lung is located in the highest position of the organ networks, it is accustomed to a clear and pure environment comparable to the crisp and fresh air on a mountain top. It is most appropriate, therefore, to treat lung disorders with light and purifying herbs (consisting mostly of the leaf and blossom parts of plants). The lung, moreover, is known as the “fragile organ,” and thus should not be treated with methods that are extreme. Ideal herbs are pungent (but not too hot or too cold), and sweet and moistening.

If phlegm or heat accumulation obstructs the downward flow of lung qi (primarily manifesting in coughing or asthmatic breathing), the lung should be purged by the application of bitter herbs that initiate downward movement, such as apricot seeds (xingren), scute (huangqin), or lepidium (tinglizi).

Lung tonification, in addition to using qi tonics with a specific affinity to the metal system (like ginseng or astragalus), entails astringing the patient’s surface energy. In order to achieve this astringing affect, sour and moisturizing herbs (particularly schizandra) are often included in therapeutic approaches to chronic lung disorders.

Pungent flavors have a particular affinity for the lung network. It is a characteristic of spicy substances that they generally have a dispersing effect. In a healthy individual, pungent food assists the lung’s outwardly dissipating function which is involved in nourishing and regulating the pores on the body surface. In a person suffering from a common cold, pungent substances can help to relieve the blocked surface by inducing diaphoresis. Chinese peasants often take a pungent decoction of ginger, garlic, and scallions to fight off wind cold disorders. Horseradish, garlic, onions, ginger, mustard, and other pungent foods and spices are deemed beneficial to the lung if used in moderation. “Pungent flavors generate the lung,” states the Neijing. The Classic warns immediately, however, that if used inappropriately or excessively, they will cause harm to the lung, the skin, and the body hair. Eating too much pungent food disperses the lung’s physiological qi and dries its yin.

If there is excess heat in the lung network, the large intestine can be purged to relieve lung heat and restore the descending dynamic of the lung system. If there is constipation due to lack of fluids in the large intestine, consider possible causes in its zang organ pair: nourish lung yin to moisturize the zang and fu metal organs (e.g., use trichosanthes root), and/or fortify lung qi (e.g., use astragalus) so that physiological fluids can be properly distributed to the large intestine.

LUNG QI DEFICIENCY (fei qi xu): primary symptoms include a pale face; shortness of breath during physical activity; a low voice; a general aversion to cold temperatures; cough/asthma without force; and spontaneous or inhibited sweating. Lung qi deficiency usually entails surface deficiency, manifesting either in a proneness to colds and flus; or a general sense of “being invaded” or overwhelmed by people or events. Secondary symptoms may be fatigue; disinclination to talk; chronic presence of clear and watery phlegm. The tongue typically presents with a pale body and a thin white coating; the pulse tends to be weak.

Representative Herbs: astragalus (huangqi), ginseng (renshen), atractylodes (baizhu), dioscorea (shanyao), schizandra (wuweizi), jujube (dazao), licorice (gancao), siler (fangfeng).

Representative Formulas: Ginseng and Astragalus Combination (Buzhong Yiqi Tang); Jade Screen Formula (Yuping Feng San); Decoction for Replenishing Original Qi (Baoyuan Tang) minus cinnamon bark (rougui) plus schizandra (wuweizi).

LUNG YIN DEFICIENCY (fei yin xu): primary symptoms include a dry cough with no phlegm or small amounts of sticky phlegm (possibly with traces of impacted blood); dry nose and throat; and hoarseness or loss of voice. Secondary symptoms include a skinny constitution; chronic sore throat; hot flashes; flushed cheeks in the afternoon; a burning sensation in the palms or soles of the feet; and night sweats. The tongue typically presents with a dry body and little or no coating; the pulse tends to be fine and rapid.

Representative Herbs: lily (baihe), ophiopogon (maimendong), glehnia (bei shashen), scrophularia (xuanshen), polygonatum (yuzhu), white tree fungus (yin’er), cordyceps (dongchong xiacao), raw rehmannia (sheng dihuang), asparagus (tianmendong), fritillaria (beimu), platycodon (jiegeng).

Representative Formulas: Lily Combination (Baihe Gujin Tang); Nourish the Yin and Clear Heat in the Lung Decoction (Yangyin Qingfei Tang).

LUNG YANG DEFICIENCY (fei yang xu): symptoms similar to lung qi deficiency, with emphasis on cold symptoms that require warming.

Representative Herbs: dry ginger (ganjiang), asarum (xixin).

Representative Formulas: Licorice and Ginger Decoction (Gancao Ganjiang Tang); Hoelen, Licorice, Schizandra, and Asarum Decoction (Ling Gan Wuwei Jiang Xin Tang).

LUNG QI AND YIN DEFICIENCY (fei qi yin liang xu zheng): primary symptoms are chronic cough without force; shortness of breath when physically active; spontaneous sweating and/or night sweats; dry mouth and throat. Secondary symptoms may include mental and physical fatigue; low voice; pale face; flushed cheeks; little but sticky phlegm; traces of blood in the phlegm; low grade afternoon fevers; and skinny constitution. The tongue is typically pale with a gloss of tender redness; and the pulse tends to be fine and weak.

Representative Herbs: ginseng (renshen), ophiopogon (maimendong), astragalus (huangqi), schizandra (wuweizi), dioscorea (shanyao), raw rehmannia (sheng dihuang), lily (baihe), anemarrhena (zhimu), fritillaria (beimu), peony (baishao), licorice (gancao).

Representative Formulas: Generate the Pulse Powder; Ginseng and Ophiopogon Formula (Shengmai San); Lily Combination (Baihe Gujin Tang).

WIND COLD INVADING THE LUNG (feng han fan fei): primary symptoms are chills; stuffy nose; clear and copious discharge, and/or cough. Secondary symptoms may include headache; sneezing; obstructed voice; fever; and body pain. The tongue is typically covered with a thin white coating; the pulse is floating.

Representative Herbs: ephedra (mahuang), apricot seeds (xingren), cinnamon twig (guizhi), asarum (xixin), fresh ginger (shengjiang), citrus (chenpi), pinellia (banxia), platycodon (jiegeng), aster (ziwan).

Representative Formulas: Ma-huang Combination (Mahuang Tang); Apricot Seed and Perilla Formula (Xing Su San).

WIND HEAT INVADING THE LUNG: primary symptoms are fever with slight aversion to wind and cold, and sore throat or cough with possibly some sticky or yellow phlegm. Secondary symptoms may include nasal discharge; thirst; asthma; red and itchy skin rashes; and restlessness. The tongue typically presents with a red tip, is covered with a thin white or yellow coating; the pulse is floating and rapid.

Representative Herbs: morus leaves (sangye), platycodon (jiegeng), forsythia (lianqiao), lonicera (yinhua), ma-huang in combination with gypsum (shigao), apricot seeds (xingren), phragmites (lugen), houttuynia (yuxingcao).

Representative Formulas: Morus and Chrysanthemum Combination (Sang Ju Yin); Lonicera and Forsythia Formula (Yin Qiao San).

DRYNESS INVADING THE LUNG (zao xie fan fei): primary symptoms are dry cough without phlegm; dry nose and throat. Possibly small amounts of sticky phlegm that is hard to expectorate or causes pain when coughing; traces of blood in the phlegm; headache. The tongue is typically red and covered with a thin; dry yellow coating; and the pulse is floating; fine; and rapid.

Representative Herbs: glehnia (bei shashen), eriobotrya (pipaye), fritillaria (beimu), trichosanthes root (gualou), phragmites (lugen).

Representative Formulas: Eriobotrya and Ophiopogon Combination (Qingzao Jiufei Tang); Morus Leaf and Apricot Seed Decoction (Sang Xing Tang).

COLD PHLEGM OBSTRUCTING THE LUNG (han tan zu fei): primary symptoms are expectoration of runny white phlegm, or asthmatic breathing accompanied by an inability to lay down on the back. Secondary symptoms include profuse amounts of phlegm that is easy to cough up; rattling phlegm sound in throat; aversion to cold; stuffy sensation in chest; white and greasy tongue coating; and a deep and slow pulse that is often slippery in the first pulse positions.

Representative Herbs: perilla seed (zi suzi), sinapis (baijiezi), raphanus (laifuzi), asarum (xixin), citrus (chenpi), pinellia (banxia), hoelen (fuling); ma-huang (mahuang), apricot seed (xingren), belamcanda (shegan).

Representative Formulas: Belamcanda and Ma-huang Combination (Shegan Mahuang Tang); Atractylodes and Hoelen Combination (Ling Gui Zhu Gan Tang).

HEAT PHLEGM OBSTRUCTING THE LUNG (tan re yong fei): primary symptoms are coughing or asthmatic breathing accompanied by phlegm sounds in the chest or throat; and expectoration of thick, yellow phlegm. Secondary symptoms include fever and choppy breathing; coagulation of phlegm into rubbery clots that are difficult to expectorate; traces of blood in phlegm; stuffiness and distention in the chest. Patient typically presents with red tongue with yellow and greasy coating, and a slippery and possibly rapid pulse.

Representative Herbs: trichosanthes fruit (gualou), fritillaria (beimu), bamboo skin (zhuru), scute (huangqin), houttuynia (yuxingcao), morus bark (digupi), peucedanum (qianhu), eriobotrya (pipaye), apricot seed (xingren), lepidium (tinglizi).

Representative Formulas: Minor Trichosanthes Combination (Xiao Xianxiong Tang); Phragmites Combination (Weijing Tang).

WATER AND COLD AFFLICTING THE LUNG (shui han she fei): primary symptoms are coughing; asthmatic breathing accompanied by an inability to lay down on one’s back; and edema or swelling in the lower extremities. Secondary symptoms include copious amounts of phlegm; stuffiness and fullness in sides of chest; distention and fullness in the lower abdomen; cold pain in the lower back; cold knees; inhibited urination; or chills and fever with body pain and no sweat. Patient typically presents with a thin white and moist (or greasy) tongue coating; and a floating and tight pulse.

Representative Herbs: ma-huang (mahuang), cinnamon twig (guizhi), asarum (xixin), dry ginger (ganjiang), aster (ziwan), apricot seed (xingren), perilla seed (zi suzi), aconite (fuzi), hoelen (fuling), alisma (zexie), atractylodes (baizhu).

Representative Formula: Minor Blue Dragon Combination (Xiao Qinglong Tang).

taken from: http://www.itmonline.org/5organs/lung.htm