Library

Li Dongyuan said: The Yellow Emperor asked, "What is the reversal and順 (shun) relationship between xingqi (form-qi) and bingqi (disease-qi)?" Qibo replied, "When xingqi (form-qi, referring to the body's constitutional strength) is insufficient and bingqi (disease-qi, referring to the pathogenic factor's strength) is sufficient, this indicates that the evil pathogen is prevailing; one should urgently apply the draining method. When xingqi is sufficient and bingqi is insufficient, one should urgently apply the tonifying method. If both xingqi and bingqi are insufficient, this signifies a deficiency of both Yin and Yang; acupuncture should not be used, as it would exacerbate the deficiency. Repeatedly exacerbating the deficiency leads to the exhaustion of both Yin and Yang, depletion of blood and qi, emptiness of the five Zang organs, withering of sinews, bones, and marrow; the elderly will perish, and even the robust will not recover. If both xingqi and bingqi are sufficient, this is termed 'excess in both Yin and Yang'; one should urgently drain the pathogen and regulate the excess and deficiency. Thus it is said: 'Excess is drained, deficiency is tonified.' This is what is meant."

The explanation states: The Sage has shown benevolent care in great detail. However, fearing that commoners, farmers, and people in remote areas might not understand literary language, vulgar terms are used for clarification: Only when the disease surges and the patient's spirit and symptoms increase, this is called 'bingqi excess,' indicating rampant pathogenic factors; one should urgently use cold, sour, and bitter agents to drain. If during the surge of the disease, the spirit is fatigued and weak, this is called 'bingqi deficiency,' indicating insufficiency of true Qi; one should urgently use pungent, sweet, and warm agents to tonify. Regardless of whether xingqi is excess or deficiency, one only considers whether bingqi is excess or deficiency. Deficiency is tonified, excess is drained.

'Xingqi' refers to: 'Qi' denotes respiration through the mouth and nose; 'Xing' denotes skin, flesh, sinews, bones, and blood vessels. A robust physique indicates excess, while emaciation indicates deficiency. Regarding 'Qi', one must examine respiration: if labor is performed without panting as usual, it is Qi excess; if panting is rapid, breathing is short, or breath is insufficient, it is Qi deficiency. Thus, 'xingqi' refers to the blood and qi within the physical body. Whether to tonify or drain does not depend solely on this, but on the state of bingqi during the disease's surge. If bingqi increases during the surge, it is pathogenic excess, requiring urgent drainage. If during the surge, the spirit is weak, speech is powerless, and there is reluctance to speak, it is true Qi deficiency, requiring urgent tonification. If the patient has deficient xingqi and also deficient bingqi during the surge, this is a dual deficiency of Yin and Yang; acupuncture is contraindicated. One should tonify with sweet medicines. If the condition persists after medication, one may moxa the Qihai acupoint (Sea of Qi), located 1.5 cun below the umbilicus.

Zihe Zheng said: People who love tonification include those who tonify without illness and those who tonify with illness. Some consult quack doctors, others ask wandering physicians. Quacks, seeking to please those demanding tonics, discuss only mild substances, such as herbs like Congrong (Cistanche Herba), Niuxi (Achyranthis Bidentatae Radix), Bajiji (Morindae Officinalis Radix), and Tusizi (Cuscutae Semen). Wandering physicians, seeking fame and self-aggrandizement, discuss only heavy/mineral substances, such as Danzha (Cinnabar), Qishi (Quartz), and Liuhuang (Sulfur). I do not know if this constitutes tonification, nor which Zang organ is being tonified. If one claims to tonify the Heart, the Heart belongs to Ding Fire, its meridian is the Hand-Shaoyin Heart Meridian; using hot tonics would generate sores and ulcers. If one claims to tonify the Liver, the Liver belongs to Yi Wood, its meridian is the Foot-Jueyin Liver Meridian; using hot tonics would generate tremors and vertigo. The Spleen is Ji Earth, its meridian is the Foot-Taiyin Spleen Meridian; using hot tonics would cause swelling and fullness. The Lung is Xin Metal, its meridian is the Hand-Taiyin Lung Meridian; using hot tonics would cause irritability and depression. The Heart cannot be tonified, the Liver cannot be tonified, the Spleen cannot be tonified, the Lung cannot be tonified; could it be that one is tonifying the Kidney? Everyone knows the Kidney belongs to Gui Water, but ignores that its meridian connects to the Zi-Wu Ministerial Fire. Tonifying the fire in the Kidney makes the fire blaze hotter; tonifying the water in the Kidney dries up the water further. With the fire blazing and the water dried, connecting upwards to the Heart's Ding Fire, Fire acts alone without restraint; Liver Wood fails to control Spleen Earth, and Lung Metal fails to control Liver Wood. The extremity of the Five Zang diseases transmits to the Six Fu organs; the extremity of the Six Fu diseases spreads to the Triple Burner. Thus, myriad diseases arise together. Minor issues are negligible, but major ones are terrifying. Improper tonification can lead to middle-jiao damage or sudden aphonia and death. As for the results of tonifying without illness, or mis-tonifying with illness: vomiting treated with tonics, post-vomiting tonics, diarrhea treated with tonics, dysentery treated with tonics, malaria treated with tonics, cough treated with tonics, consumptive disease treated with tonics, postpartum treated with tonics. For vomiting, Hewei Wan (Stomach Harmonizing Pill) or Dingchen Jian (Cloves and Aquilaria Decoction); for diarrhea/dysentery, Doukou Wan (Cardamom Pill) or Yumike San (Poppy Shell Powder); for cough, Ningshen San (Spirit-Calming Powder); for consumptive disease, Guifu (Cinnamon Twig and Aconite); for postpartum, Wuji Wan (Black Phoenix Pill) or Heishen San (Black Spirit Powder). I do not know what these are called tonification, nor what their intent is. Unknowingly, vomiting worsens with heat, becoming more violent; diarrhea with heat leads to confusion of clear and turbid; dysentery with heat becomes chronic/intermittent; malaria with heat causes fever to advance rather than recede; cough with heat prevents dampness from clearing; consumptive disease with heat aggravates ministerial fire; postpartum with heat exacerbates uterine bleeding. Eight or nine out of ten die due to such errors; only one or two survive. The dead die unjustly; the survivors survive by luck, yet remain emaciated and wretched, unbearable to behold. Generally speaking, excess should be reduced, deficiency should be tonified; this is the true meaning of tonification. If Yang is excess and Yin is deficiency, one should reduce Yang and tonify Yin; if Yin is excess and Yang is deficiency, one should reduce Yin and tonify Yang. For heat patterns, Mangxiao (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma) reduce Yang and tonify Yin; for cold patterns, Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Preparata) reduce Yin and tonify Yang. How can one rely solely on hot medicines? In fact, cold medicines also have tonifying properties. The Classic says: "Reduce what is excessive, manifest what is deficient." This is the principle.

I respectfully note: Zhang Zhongjing, discussing Taiyang disease with knotted and intermittent pulses, attributed it to the deficiency and decline of blood and qi failing to connect continuously, thus prescribing Zhigancao Tang (Honey-Panax Decoction). This is indeed a method of tonifying deficiency, but there is no precedent for routine tonification. Later generations often mistakenly applied it as a routine tonic. Therefore, Zihe Zheng vigorously criticized this abuse, which was highly beneficial. However, his statement that Mangxiao and Dahuang "reduce Yang and tonify Yin" referred to Zhang Zhongjing's concept of Yin-Yang excess and deficiency, not a method for tonifying absolute deficiency. Students should study the theories of Li Dongyuan and Zhu Danxi to expand their understanding.

Furthermore, people know the benefits of tonification but not its harms. There are six methods of tonification discussed: Pingbu (Mild Tonification), Junbu (Strong Tonification), Wenbu (Warm Tonification), Hanbu (Cold Tonification), Jinli zhi bu (Tonification for Sinews and Strength), and Fangshi zhi bu (Tonification for Sexual Vitality). Ren Shen (Ginseng Radix) and Huang Qi (Astragali Radix) represent Mild Tonification; Fuzi (Prepared Aconite Root) and Liuhuang (Sulfur) represent Strong Tonification; Doukou (Cardamomi Fructus) and Guirui (Cinnamomi Cortex) represent Warm Tonification; Tianmendong (Asparagi Radix) and Wujia Pi (Acanthopanacis Cortex) represent Cold Tonification; Bajiji (Morindae Officinalis Radix) and Congrong (Cistanche Herba) represent Tonification for Sinews and Strength; Shiyan (Swallow Stone), Haima (Seahorse), Qishi (Quartz), and Danzha (Cinnabar) represent Tonification for Sexual Vitality. These six constitute the modern notion of tonification. If applied to treat disease, not only are the effects sparse, but the harms are incalculable. The Nan Jing (Classic of Difficult Issues) states: "East is excess, West is deficiency; drain South, tonify North." This means Liver Wood is excess and Lung Metal is deficient; drain Heart Fire and tonify Kidney Water. By this theory, the aforementioned six types of tonification are irrelevant. Let us cite examples of harm caused by tonification, primarily the fault of Warm Tonification. Although the Nei Jing states, "For deficiency of form, warm with Qi; for deficiency of essence, tonify with flavor," Qi belongs to Yang (Heaven's nourishment), and Blood belongs to Yin (Earth's nourishment). One must beware of imbalance; 'warm' does not mean 'hot'. Moreover, the Classic says, "Deficient conditions are tonified, exhausted conditions are warmed." Here, 'warm' implies gentle warming, not heating. Again, "Tonify the mother in deficiency, drain the son in excess" aims at balancing; it does not require cauterization, intense fire, smelting stones, burning arsenic, sulfur, ginger, or aconite to be considered tonification. True 'Pingbu' (Mild Tonification) maintains Yin-Yang equilibrium. Yet, contemporary people hate cold and love warmth, willingly enduring toxic harshness, dying without regret. This is truly lamentable!

Luo Tianyi (author of Baojian) said: The proverb goes, "Taking medicine without illness is like installing pillars inside a wall." This is baseless and harmful. Physicians believe Heaven provides five flavors to harmonize the five Zang organs; food regulates them, but excess causes disease. Grains nourish, fruits assist, meats benefit, vegetables fill; combined, they tonify essence and Qi. If taken improperly or without dietary moderation, illness may still arise. How much more so for medicines, which attack pathogens? They should not be taken without illness. The Shengji Jing states: Cultivators err by over-tonifying, lightly ingesting mineral/Yang agents. When illness strikes, Tian Gui (menstrual essence/reproductive essence) exhausts, and Ying Blood dries. Conversely, soft/Yin agents weaken the illness, causing True Fire to diminish and Wei Qi to scatter. One-sided excess injures one Zang organ; how can one avoid illness? Sun Simiao of the Tang Dynasty stated: Medicinal properties are biased, disrupting Zang organ harmony. Pei Jian advised Emperor Xianzong: Medicine attacks disease; it is not for daily use. Minerals are harsh, toxic, and fire-refined; human Zang organs cannot withstand them. Zhang Gao advised Emperor Muzong: Clear mind leads to harmonious blood and Qi; excessive desires lead to disease. Medicine attacks disease; it should not be taken without illness. Thus, Han Yu inscribed on Li Zi's tomb: I do not know when the practice of taking elixirs began. It kills countless people, yet society admires it. How confused we are! I present six officials I personally knew who perished due to medicine, as a warning to the world. I also cite three or four recent cases where people sought longevity without cause, only to fall ill or die. Is 'installing pillars in a wall' not an apt metaphor? High buildings have solid foundations; inserting pillars into walls is irrational. Jiegu Laoren said: "Taking medicine without illness is making trouble out of nothing." This is an unchangeable truth. To preserve health, one relies on healthy Zang and Fu organs, careful regimen, seasonal adaptation (nourishing in Spring/Summer, storing in Autumn/Winter), regulated diet and sleep, minimal desire, tranquility, and internal preservation of Spirit. This is the 'medicine of non-medication'. Alas, the past is gone and cannot be blamed; let future generations take heed.

I respectfully note: Modern secular interpretation mistakes 'pillar' for 'rat'. Installing rats inevitably damages walls. This metaphorically describes how taking medicine without illness creates problems where none existed, which is closer to reason. However, this serves as a deep warning from the ancients. Later generations distorted the term 'pillar', likely due to phonetic evolution or misunderstanding.