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Essence Theory of Folk Traditional Chinese Medicine by Chengkong

Liu Wencheng
Reprinted from Folk TCM Network

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Author Biography: Liu Wencheng, male, a folk Traditional Chinese Medicine (TCM) practitioner, pseudonym Chengkong. Influenced by his father since childhood, he studied Confucian, Buddhist, and Daoist theories. Later, he specialized in family-inherited TCM. Clinically, he bases his theory on "Qi" (vital energy) in the universe. He posits that when Yin and Yang combine, Qi transformation occurs; when they separate, Qi transformation stops. When Yin and Yang are harmonious, the body is healthy; when they sever, myriad diseases arise. Following the *Huangdi Neijing* (Yellow Emperor's Inner Canon), diagnosis involves observing complexion, palpating pulses, examining physical forms, and listening to voices, prioritizing the differentiation of Yin and Yang. Treatment for Cold patterns uses Heat herbs, and treatment for Heat patterns uses Cold herbs. For deficiency of form, tonify with flavor-rich substances; for deficiency of essence, tonify with Qi-thin substances. Medication is guided by Six Meridian differentiation based on Yin-Yang syndromes: if a specific syndrome exists, use the corresponding medicine.

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Chapter 1 Introduction

I am an authentic folk TCM practitioner. My father only transmitted the core principles (Xinfa), requiring me to comprehend them myself. For instance: "The human body's water and fire constitute a single mass of Qi." This refers to the theory of Qi transformation. He stated that once you understand the true meaning of this sentence, you have grasped more than half of TCM. He could cure gastric ulcers with just three doses of medicine, telling me only: "Indulging in cold foods and drinks while hungry injures the stomach fu organs; damage to the mucosa leads to ulceration." This is merely a principle, but it led me to realize that the pathogenesis of gastric ulcers involves mixed Cold and Heat damaging righteous Qi. It reminded me why freshly cooked hot rice does not spoil, but spoils after cooling down. Cold and damp bacterial toxins cluster together, causing the rice to sour and rot. In the *I Ching* (Book of Changes), this water and fire are called Kan and Li. They are the root of human life. The Kan hexagram symbolizes two Yin lines embracing one Yang line; in the human body, this corresponds to the Kidney. This Yang line is also called Kan Yang, which is Hot, while the two Yin lines represent Yin Essence, which is Cold and Moistening. The Li hexagram symbolizes two Yang lines embracing one Yin line; in the human body, this corresponds to the Heart. This Yin line represents Yin Blood, which is Warm and Moistening. Daoism has a concept called "Drawing from Kan to Fill Li," meaning transferring the True Yang from Kan to the True Yin in Li, forming a warm, cohesive mass of Qi, resulting in the Pure Qian hexagram. Qian represents strength; thus, the person has no disease, with a light body, robust health, abundant spirit, and bright eyes. The human body is formed by the transformation of Yin and Yang into Qi; Yin and Yang cannot be separated for even a moment. When Yin and Yang combine, life thrives; when they sever, life ends, vitality diminishes, or death occurs. The concept of Yin and Yang is a primary concept in TCM. Yin-Yang differentiation is essentially the differentiation of true and false Cold and Heat. Clarifying the truth of Cold and Heat makes treatment much easier. Cold patterns (Yin syndromes) use Warm-Hot (Yang) herbs, while Heat patterns (Yang syndromes) use Bitter-Sweet-Cold herbs. Here lies the issue of using Bitter-Cold herbs for Excess Heat patterns versus Sweet-Cold herbs for Yin Deficiency fever. Distinguishing Yin and Yang syndromes is key to TCM treatment. The *Neijing* proposes Six Meridian differentiation, and the *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases) explains it in greater detail. In reality, regardless of whether it is a Three Yin or Three Yang meridian syndrome, if a Yin syndrome appears, use Warm-Hot herbs; if a Yang syndrome appears, use Bitter-Sweet-Cold herbs. The Six Meridian differentiation in the *Shanghan Zabing Lun* is essentially identifying the location of the disease, its association with meridians and Zang-Fu organs. Yin-Yang differentiation is not always explicit, but my late master was very clear about it. Many clinicians and Jingfang (classical formula) practitioners today are conservative and do not seek understanding from the *I Ching*, lacking flexibility. The reason for poor efficacy is that they only identify the disease location without clarifying the essence of the disease. The essence of the disease belongs to either a Yin or Yang syndrome.

The key to Yin-Yang differentiation is to clarify the patient's Yin-Yang constitution, i.e., Yin or Yang syndromes. This is the most critical aspect of disease identification. This is the Root (Ben), while clinical symptoms are the Branch (Biao). The Branch can be true or false. One must not invert Root and Branch; doing so leads to endless disaster, violating the prohibition against treating deficiency as excess and excess as deficiency.

Chapter 2 General Discussion (Monism)

Section 1 The Essence of TCM (Monism)

TCM originally aims to regulate balance. Yang transforms Yin essence into Qi and Form. The unity of Yin and Yang constitutes Qi; when Qi transforms, myriad diseases cannot arise. The essence of TCM is Qi. For Cold, apply Heat to facilitate Qi transformation; for Heat, apply Cold to generate Qi transformation; for dryness, apply Warm-Moistening to create cohesive Qi. There is no need to seek remedies elsewhere; remember the clear instructions of ancestors in your heart. All diseases stem from stopped Qi transformation; after Qi transformation resumes, all diseases depart. The human body's water and fire form a single mass of Qi. If there is too much Water, the Taiyang becomes a frozen land. Restoring Yang and transforming Qi thaws the ice; when spring warmth arrives, myriad diseases dissipate. When Yin and Yang unite, Qi transforms; when they separate, life ends. Kan holds one Yang embraced by two Yins; Li holds two Yans embracing one Yin. When Kan and Li interact and achieve Ji Ji (Completion/Intersection), the Eight Pure Hexagrams become Qian, and Qi is cohesive. With cohesive Qi, myriad diseases do not arise. With Qi, spiritual brilliance is contained within; vigorous spirit makes illness difficult. Urine is pale yellow, stools are formed. If diseased, it is still a True Yang syndrome: short urine, constipation, preference for cold drinks; Bitter-Cold herbs draining Heat can cure it. Without Qi, there is fatigue and pale complexion; clear copious urine, loose stools; thirst with preference for hot drinks; aversion to cold, curled posture, and reluctance to speak; Lizhong Tang and Sini Tang are applicable. For Excess Cold causing constipation, Warm-Moistening is needed; Dahuang Fuzi Decoction is applicable. For Yang Deficiency with fluid depletion causing bowel movement, short urine, dry stools, and bluish complexion, add Maimendong, Wuweizi, Lizhong Tang, Fuzi, and Xixin; after Warm-Moistening, bowels unblock. Extreme Yang Deficiency presents as Daiyang (Floating Yang): upper excess, lower deficiency, clear copious urine, red face, cold feet, restlessness bordering on death; large doses of Sini Tang can restore Yang. To deeply understand medical principles, integrate Medicine and I Ching, and principles will become clear.

Section 2 Mantra of Qi Transformation

When Yin and Yang unite, Qi transforms; when they separate, life ends. Kan holds one Yang embraced by two Yins; Li holds two Yins embracing one Yang. Kan and Li interact to form Qian; with cohesive Qi, myriad diseases do not arise. To deeply understand medical principles, integrate Medicine and I Ching, and all principles become clear. People do not know the logic of Yin and Yang, deviating from the source in diagnosis and differentiation. Not knowing that Yuan Yang resides within Yin, they fail to use Fuzi and Ganjiang to assist its generation. Blindly adding Yin-nourishing herbs to seek Yang, unaware that Yin Excess causes deficient Yang to rise, yet using Damp-Heat clearing Bitter-Cold herbs exacerbates pharyngitis. A fishy mouth odor indicates Yang Deficiency; mixed Cold and Heat with Middle Jiao Deficiency. True Cold smells fishy; True Heat smells foul. Mixed Cold and Heat presents with both odors. Fishy and foul breath indicates mixed Cold and Heat; if Cold exceeds Heat, use Lizhong Tang below, heavily adding Jiang and Fu to regulate the Middle. Once Cold departs, the fishy odor naturally disappears. Women with a fishy odor in the Lower Jiao, preferring warmth in the lower abdomen, with sore back pain, indicate weak Kan Yang. Restoring Yang and reversing counterflow allows Hot Qi to flow; adding Wuzhuyu, Rougui, Huajiao, and Xixin expels Cold further.

Chapter 3 Essence Theory of Yin-Yang Six Meridian Differentiation for Myriad Diseases

Section 1 Yin and Yang

Yin-Yang differentiation is distinguishing the quantity of Yin and Yang. Yin refers to subtle substances; Yang refers to Yang Qi. True Cold, or Yin Cold (Yin syndrome), means little Yang Qi; True Heat (Yang syndrome) means consumption of essence and fluids. True Cold belongs to Yang Deficiency; True Heat belongs to Yang Excess (or Yin Deficiency). Deficient Heat includes Yin Deficiency fever (few subtle substances) and Yang Deficiency fever (Yin syndrome) where deficient Yang floats outward. Pathologically, Yin is Cold, and Yang is Heat. For True Heat, use Warm-Hot herbs (Pungent-Sweet-Bland dispersing category); for True Heat [Note: Text error, likely meant True Cold], use Bitter-Cold herbs. For Yin Deficiency fever, use Sweet-Bland-Cold herbs. For Yang Deficiency fever, use herbs to restore Yang and transform Qi (e.g., Dan Fuzi, Ganjiang, Sheng Gancao).

Section 2 Theory of Six Meridian Syndromes for Myriad Diseases

Six Meridian differentiation encompasses Eight Principles differentiation (Yin-Yang, Interior-Exterior, Cold-Heat, Deficiency-Excess) and includes differentiation of Qi, Blood, Essence, Fluids, Zang-Fu organs, and meridians. It is erroneous for modern people to understand Six Meridian syndromes only as manifestations of external febrile diseases; it also includes Warm diseases and miscellaneous diseases.

First, understand the concept of Six Meridians: Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, Jueyin.

Taiyang, Yangming, and Shaoyang are the Three Yang (meridians). Taiyin, Shaoyin, and Jueyin are the Three Yin meridians.

The concept of Six Meridians was proposed in the *Huangdi Neijing* and later enriched by Zhang Zhongjing. These six meridians are distinguished by the degree of Yin and Yang. Before Chinese ancients had writing, they used knotted cords for record-keeping. One knot represented Yang (—), and two knots represented Yin (- -). More complex matters were represented by arranging and combining these knots, categorizing similar properties, extending to Yin-Yang Bagua. The Eight Trigrams (Qian, Kan, Gen, Zhen, Xun, Li, Kun, Dui) consist of three Yao (lines). Each hexagram consists of three Yao, which can be Yin Yao, Yang Yao, all Yin, all Yang, or mixed. The Bagua is vast without outside and small without inside, containing all things in the universe. No matter how large or small, everything is included.

Below is a detailed explanation:

I. Taiyang Syndrome

Taiyang syndrome results from the three Yang Yao of Taiyang being injured by Cold and Dampness.

Taiyang consists of three Yang Yao; having many Yang Yao, it is called Taiyang. Its hexagram image is Qian, representing strength. Taiyang represents the Hand and Foot Taiyang meridians and serves as the barrier for the whole body. The Hand Taiyang Small Intestine has the function of separating the clear from the turbid. The Foot Taiyang Bladder stores and excretes urine. Due to factors such as pathogen nature, severity of infection, and constitutional strength, Taiyang Exterior Syndromes can be divided into Wind Strike and Cold Damage.

Taiyang Exterior Syndromes

1. Taiyang Cold Damage: Injury to one Yang is Cold Damage (pathological hexagram Dui with top broken). Wei Yang is invaded by Cold, injuring the upper Yang Yao first. If Righteous Qi is sufficient (the other two Yao are not diseased), Cold stagnates and transforms into Heat, causing fever. Cold is a Yin pathogen with a contracting nature, causing stiffness and pain in the head and neck, body pain, and lower back pain. Cold closes the Xu Fu (pores), causing anhidrosis. The Lung and skin/hair are exterior-interior related; blocked Xu Fu causes panting. Since the pathogen is at the Exterior and has not entered the Interior, the pulse is Floating-Tight. Dispersing Wind-Cold can use Mahuang Tang class formulas.

2. Taiyang Wind Strike Syndrome: Meaning external injury by Wind pathogen.

Two Yang Cold Damage leading to Wind Strike (pathological hexagram Zhen). Constitutionally Yang Deficient (Middle Yang weak), after Cold pathogen invasion, Ying Yin is injured, and Wei Qi is insufficient. Wei Qi protects the exterior and warms the limbs; therefore, fever, aversion to wind, spontaneous sweating, headache, and Floating-Loose pulse appear. Nasal congestion and dry retching may even occur.

The main pathogenesis is disharmony of Ying and Wei. Harmonizing Ying and Wei can use Guizhi Tang class formulas to supplement Middle Yang; when Ying and Wei are harmonized, pathogens are expelled.

(II) Taiyang Fu Organ Syndromes

Taiyang Cold pathogen transmits directly to the Foot Taiyang Bladder. Bladder Qi transformation dysfunction produces Water Accumulation Syndrome. Prescription: Wuling San.

Taiyang Cold pathogen injures Yang; insufficient Yang leads to failed Qi transformation, causing water accumulation in the bladder, treatable with Wuling San. If Taiyang Cold pathogen remains unresolved, stagnates, and transforms into Heat, entering the Bladder via the meridian, Heat knots in the Bladder, damaging collaterals and causing Blood Accumulation. Prescription: Taohao Chengqi Tang. Prolonged injury to the Three Yang leads to Qi failing to control fluids and blood, causing persistent hematuria (Yin syndrome); use herbs to restore Yang and transform Qi, prescription Sini Tang.

Summary as follows:

1. Water Accumulation Syndrome: Cold pathogen injures Yang, pathogen enters Bladder, Bladder Qi transformation fails, fluids do not move, leading to water accumulation.

Manifestations: Dysuria, slight fever, thirst desire to drink, vomiting immediately after drinking, Floating pulse.

2. Blood Accumulation Syndrome: Cold pathogen enters Interior and transforms into Heat; Heat and Blood struggle and accumulate in the Bladder and lower abdomen.

Manifestations: Hardness, fullness, and pain in the lower abdomen, free urination, delirium like madness.

3. Hematuria: Cold limbs, loose stools, hematuria. Prescription: Sini Tang.

(III) Taiyang Warm Disease

Actually, Taiyang Warm Disease is caused by indulgence in lust, failing to store Essence in winter. Yang leaks with Essence, leading to Shaoyin Deficiency-Cold. Cold pathogen enters Shaoyin, does not cause immediate onset but becomes latent Qi. When Spring Qi of Shaoyang arises in spring, Yang Qi stirs the latent pathogen, causing disease. Because it results from Essence injury, there is thirst, fever, but no aversion to cold. The *Neijing* calls this: Winter injury by Cold generates Warm Disease in Spring. Latent pathogen disease should be distinguished from epidemics entering via mouth and nose. Epidemics enter via mouth and nose, onset is rapid, with high fever, thirst, splitting headache, irritability, desire for cold drinks, yellow-red urine, constipation or diarrhea.

II. Yangming Syndrome

Two Yangs combined illuminate Yangming. Two Yang Yao outside, one Yin Yao inside, hexagram image is Li, hollow in the middle, storing but not filling. Normally, the stomach cavity is warm. Yangming includes the Hand Yangming Large Intestine meridian and Foot Yangming Stomach meridian. The Stomach ripens food and drink to transform Qi and Blood; the Large Intestine conducts waste to transform fluids.

(I) Yangming Exterior Syndrome: Untreated Taiyang disease, pathogenic Heat transmits via meridian to Yangming. The hollow Yao is filled by pathogenic Heat. Two Yangs intertwine with pathogenic Heat to form a pathological Qian hexagram. Qian is great red, so there is fever (high fever), red face, thirst, irritability, desire for cold drinks, yellow-dry tongue coating, and Surging-Large pulse. There is only formless pathogenic Heat, no有形 (formed) dry stool. Textbooks stating severe fever and profuse sweating are incorrect; after profuse sweating, Heat escapes with sweat, where does Heat come from?

Prescription: Baihu Tang class.

(II) Yangming Interior Syndrome: Pathogenic Heat sinks into Yangming for a long time, fluids are scorched, feces do not pass (pathological hexagram Qian). Qian represents hardness. Pathogenic Heat coexists with dry stool, known as "Stomach House Excess," concise and comprehensive.

Clinical manifestations: Tidal fever in the afternoon, sweating on hands and feet, abdominal hardness, fullness, distension, pain, refusal to press, constipation, passing gas in abdomen, irritability, even coma, delirium, mania, insomnia, thick-yellow-dry or scorched-black-cracked tongue coating, prickles on tongue edges and tip, Deep-Slow-Real or Slippery-Rapid pulse. Prescription: Chengqi Tang class.

III. Shaoyang Syndrome

One Yang and two Yins constitute Shaoyang. Yang hides in muscle interstices, warming the interior and solidifying the interstices. Hexagram image is Kan, Outer Yin, Inner Yang, storing essence juice (bile). Untreated Taiyang disease: First, pathogenic Heat transmits internally to Shaoyang (pathological Dui hexagram, solid bottom, empty top). Essence juice is scorched, cannot descend to Small Intestine, and floats up to the mouth, causing bitter taste, chest and hypochondriac fullness. Bile (essence juice) cannot smoothly descend to Small Intestine, impairing Small Intestine's function of separating clear from turbid. Formula: Xiaochaihu Tang. Second, Taiyin Dampness encumbrance (pathological Kun hexagram) can also cause essence juice not to descend but float up to the mouth, causing chest/hypochondriac fullness, silence, loss of appetite, alternating chills and fever, bitter taste, dry throat, dizziness, irritability, preference for vomiting, white or thin-yellow coating, Wiry pulse. Prescription: Dahuang Fuzi Tang, Cangzhu, Yiyiren, Banxia, etc., drying Dampness herbs.

IV. Taiyin Syndrome

Taiyin has many Yins, three Yin Yao (physiological hexagram Kun). Within Yin, Essence, Qi, and Spirit are stored. Taiyin includes Hand Taiyin Lung meridian and Foot Taiyin Spleen meridian. Spleen is the official of transportation and transformation, preferring Dryness and disliking Dampness. Quintessential essences of grains rely on its transport. Excess Dampness traps Spleen, causing Taiyin disease. Lung is a delicate organ, preferring Moisture and disliking Dryness and Dampness. Taiyin is a Yin Zang, substantive Yin but functional Yang. Cold-Dampness encumbers Taiyin Spleen, causing abdominal fullness and heavy body. Prescription: Dahuang Fuzi Tang. Damp and Cold pathogens attack the delicate Lung upward, causing cough. Cold pathogen injuring Lung causes continuous cough; prescription: Mahuang Fuzi Xixin Tang or add Gancao and Shengjiang. Damp pathogen injuring Lung causes dull cough; prescription: Mahuang Fuzi Xixin Tang plus Cangzhu, Yiren, and Banxia. Damp-Heat intertwining leads to Jaundice. Yang Jaundice with Heavy Heat, yellow urine, use Yinchen Tang. Yin Jaundice with Heavy Dampness and Cold, clear urine, loose stools, add Zhu and Fu.

Characteristics of Taiyin disease: Abdominal fullness, inability to eat, preference for vomiting, preference for warmth and pressure.

Manifests as Interior Deficiency-Cold syndrome: Abdominal fullness, distension, pain, loss of appetite, diarrhea, occasional abdominal pain, preference for warmth and pressure, pale tongue with white-greasy coating, Deep-Slow-Weak pulse.

V. Shaoyin Syndrome

Shaoyin has one Yin Yao; few Yins make it Shaoyin (hexagram image Li). Many Yang Yao themselves are not diseased. Two Yangs embracing Yin constitute Heart (Li). Shaoyin stores Essence and Fluids within Yin. Shaoyin disease means Yang cannot extend (Yang Qi decreases), causing aversion to cold, curled posture, desire to sleep. Deficient Yang floats outward to the tongue root; enlarged tonsils cause fever; dizziness, head distension, hypertension; cold limbs are the cause. Kan Yang injured becomes Kun; who knows the reason for lifelessness? Taiyang pathogenic Heat transmits to Shaoyin (pathological Qian hexagram, Yin Yao in Li filled by pathogenic Heat). After Yin injury, Essence and Fluids are damaged, causing irritability, thirst, desire for cold drinks. Shaoyin includes Hand Shaoyin Heart meridian and Foot Shaoyin Kidney meridian. Foot Shaoyin Kidney hexagram is Kan, two Yins embracing one Yang. Normally, Heart Fire descends and Kidney Water ascends, forming a Ji Ji hexagram, transforming into a warm mass of Qi. This warm mass is the root of life. Modern people do not cherish it, indulging in cold foods/drinks, daily consuming Yang. Long-term Yin Excess and Yang Deficiency cause deficient Yang to be forced outward by Excess Yin. Limbs become irritable; hypertension, cerebral hemorrhage, cerebral infarction, etc., erupt. Thirst without desire for cold drinks, or rinsing mouth without swallowing, pharyngitis, etc., erupt.

In summary, Shaoyin disease is mainly Deficiency-Cold, mostly showing Shaoyin Cold Transformation Syndrome, rarely Shaoyin Heat Transformation Syndrome.

(I) Shaoyin Cold Transformation Syndrome: Refers to systemic Deficiency-Cold manifestations due to insufficient Heart-Kidney Yang Qi, pathogen entering internally, transforming into Cold from Yin.

Manifestations: Aversion to cold, cold extremities, vomiting unable to eat or vomiting immediately after eating, clear copious urine, diarrhea with undigested food, curled posture desiring sleep, Deep-Thin pulse; body contrary not averse to cold, red face, minute pulse nearing extinction.

Prescription: Sini Tang class to restore Yang and rescue from counterflow.

(II) Shaoyin Heat Transformation Syndrome: Refers to Interior Deficiency-Heat manifestations due to Shaoyin Yin Deficiency and Yang Hyperactivity, transforming into Heat from Yang.

Manifestations: Dry mouth and throat or pain, irritability and insomnia, diarrhea or spontaneous passage of undigested food, yellow-red short urine, or abdominal distension with constipation, red tongue tip, Thin-Rapid pulse.

Prescription: Huanglian Ejiao Tang class to nourish Yin and clear Heat.

Characteristics of Shaoyin disease: Shaoyin Cold Transformation, minute-thin pulse, desire to sleep. Shaoyin Heat Transformation, minute-thin-rapid pulse, irritability desiring sleep.

VI. Jueyin Syndrome

Jueyin has one Yang supporting two Yins (physiological hexagram Zhen), including Hand Jueyin Pericardium meridian and Foot Jueyin Liver meridian. Cold entering Jueyin injures one Yang; Zhen changes to Kun, becoming Taiyin village. Jueyin and Taiyin are neighbors; Yang injury causes Spleen function to lose healthy transport; Dampness traps Taiyin, Spleen Yang sinks, polydipsia with long clear urine. Heat entering Jueyin injures one Yin (pathological hexagram Li, top Yao of Zhen filled by pathogenic Heat), causing thirst, irritability, and delirium. Disease (Cold or Heat) entering Jueyin mixes Cold and Heat; Jiang, Fu, Jiao, Bo, Wumei descend.