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Tian Shi (Heavenly Master) said: The treatment of Qi disorders aims to balance excess and deficiency of Qi. What is termed "Qi excess" is not an abundance of healthy Qi, but rather a state where healthy Qi is deficient while pathogenic Qi is excessive. If one mistakenly treats it as an excess of healthy Qi and uses drugs that dissipate Qi, healthy Qi will become further depleted and pathogenic Qi more entrenched, leading to incurable harm. The correct prescription should employ herbs that tonify healthy Qi, assisted by agents that dispel pathogens. In this way, healthy Qi will naturally flourish, and pathogenic Qi will gradually diminish. The formula consists of Ren Shen (Ginseng Radix) 1 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 qian, Gan Cao (Licorice Root) 1 qian, Chai Hu (Bupleuri Radix) 3 qian, Bai Shao (Paeoniae Radix Alba) 3 qian, Ma Huang (Ephedrae Herba) 1 qian, and Ban Xia (Pinelliae Rhizoma) 1 qian, decocted in water and taken orally. The brilliance of this formula lies in combining dispersing agents within the framework of tonifying healthy Qi, ensuring that healthy Qi surpasses pathogenic Qi. Consequently, the two will contend, and the pathogen will flee; otherwise, defeat is inevitable. This illustrates the principle of treating Qi disorders.

Zhang Gong stated: There are many methods for treating Qi disorders. Tian Shi mentioned only one, which seems incomplete. I shall expand upon it. For Qi sinking (prolapse due to Qi deficiency), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) can be used; for Qi decline (deficiency of primal Qi), Liu Jun Zi Tang (Six Gentlemen Decoction) may be adopted; for Cold Qi (Yang deficiency), Ren Shen Bai Zhu Fu Zi Tang (Ginseng, Atractylodes, and Aconite Decoction) can be applied; for Qi deficiency, Si Jun Zi Tang (Four Gentlemen Decoction) is used; for Qi stagnation (stagnation of Qi mechanism), Gui Pi Tang (Restore the Spleen Decoction) is indicated; for Heat Qi, Sheng Mai San (Generate the Pulse Powder) is employed; for wheezing, Du Shen Tang (Single Ginseng Decoction) is used; for agitated Qi (disordered Qi movement), Er Chen Tang (Two Aged Ingredients Decoction) with added Ren Shen is prescribed; for Qi obstruction (blockage of Qi flow), She Ye Tang (Belamcanda Decoction) is utilized; for rebellious Qi (ascending Qi), Xiao Yao San (Free and Easy Wanderer Powder) is applied. With these additions, the methods for treating Qi disorders are nearly complete, allowing practitioners to treat based on symptoms.

Hua Jun agreed and added: There is indeed a distinction between Qi deficiency and Qi excess. Qi deficiency manifests as emaciation and weakness, making treatment difficult; Qi excess presents as robustness and strength, making it easier to identify. For deficiency, Tian Shi’s formula is used; for excess, there is another formula. It consists of Zhi Ke (Immature Bitter Orange) 5 fen, Bai Zhu 1 qian, Chen Pi (Citrus Reticulatae Pericarpium) 5 fen, Fu Ling (Poria) 3 qian, Gan Cao 1 qian, Shan Zha (Crataegi Fructus) 10 seeds, Chai Hu 1 qian, Bai Shao 3 qian, and Chao Zhi Zi (Fried Gardenia Fruit) 1 qian, decocted in water and taken orally. (Annotation: Xiao Shi Tang (Eliminate Excess Decoction).) This also supplements the limitations of Tian Shi’s approach.

Lei Gong remarked: Hua Jun’s supplementation is excellent.

On Treating Blood Disorders by Following Their Nature

Tian Shi said: Treating blood disorders refers to conditions where blood fails to return to its vessels, bleeding either upwards or downwards, or from the limbs, skin, and hair follicles. Blood circulates through the meridians, moving externally through the skin and hair, centrally through the zang-fu organs, internally through the sinews and bones, upwards to the head, eyes, and hands, and downwards to the urination/defecation orifices, feet, and umbilicus. The entire body is traversed by blood pathways. Once blood fails to remain within its vessels, it wanders recklessly, penetrating any opening and leaking through any gap. Severe cases involve vomiting, bleeding from pores, oozing from the gums, persistent leakage from the abdomen and umbilicus, and even continuous bleeding from stool or urine. Therefore, blood should be guided according to its nature rather than opposed. The formula uses Dang Gui (Angelica Sinensis Radix) 3 qian, Bai Shao 3 qian, Shu Di Huang (Rehmanniae Radix Preparata) 5 qian, Chuan Xiong (Ligusticum Chuanxiong Rhizoma) 1 qian, Jing Jie Mo (Schizonepetae Spica Powder) 1 qian, Sheng Di Huang (Rehmanniae Radix) 5 qian, Mai Dong (Ophiopogonis Radix) 3 qian, Qian Cao Gen (Rubiae Cordifoliae Radix et Rhizoma) 1 qian, and Gan Cao 1 qian, decocted in water. This formula is a modification of Si Wu Tang (Four Substances Decoction). Its brilliance lies in using Qian Cao Gen and Jing Jie to guide blood back into the vessels without disrupting its nature, allowing blood to return naturally without conflict. While hemostatic agents may temporarily stop bleeding, they act like pressing grass with a stone: although effective initially, the nature of the blood seeks to break free and will eventually surge violently when given space. In contrast, this formula guides the blood by following its nature. It is akin to traveling with a domineering person; slight opposition provokes anger and potentially violent conflict. However, if one praises and accommodates them, providing sustenance, harmony is achieved, and their strength aids one’s own deficiencies. Like sharing a boat without enemies, or coexisting peacefully in one room, over time, the blood becomes cooperative, nourishing the sinews and complexion, permanently preventing recurrence. Why oppose it so severely as to invite conflict? Thus, the method of treating blood requires careful attention.

Zhang Gong commented: This reasoning is sound and humane. Treating blood disorders primarily with Si Wu Tang, supplemented by Jing Jie and Qian Cao, effectively follows the nature of blood to guide it back to the vessels. However, using Liu Wei Wan Tang (Six-Ingredient Pill Decoction) for blood disorders is also ingenious. Blood disorders most strictly contraindicate cold and cooling substances, as cold causes stagnation and impedes the return of blood to the vessels. Liu Wei Wan Tang is brilliant because it is neither cold nor hot; it tonifies Kidney Water to nourish Liver Wood. When Liver Wood is nourished, blood has a vessel in which to reside and naturally does not leak outward, let alone vomit upwards. The formula contains Shu Di Huang 5 qian, Shan Zhu Yu (Corni Fructus) 3 qian, Shan Yao (Dioscoreae Rhizoma) 2 qian, Dan Pi (Moutan Cortex) 2 qian, Ze Xie (Alismatis Rhizoma) 2 qian, and Fu Ling 2 qian. This is the formula for Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction). Adding Mai Dong 3 qian and Bei Wu Wei Zi (Schisandrae Chinensis Fructus) 1 qian allows for clearing and tonifying Lung Metal, nourishing the skin and hair, and strengthening the pores, thereby preventing blood from escaping outward. With Lung Metal undisturbed, it can adequately control Liver Wood. Since Liver Wood fears Metal’s control, it will not attack the Lungs upward. Therefore, this formula is highly suitable for blood disorders. Long-term use for three years without hematemesis signifies rebirth; otherwise, the patient remains on the brink of life and death.

Hua Jun agreed and added: I have another formula: Sheng Di Huang 1 liang, Jing Jie 1 qian, Mai Dong 3 qian, and Yuan Shen (Scrophulariae Radix) 3 qian, decocted in water. (Annotation: Zhi Xue Gui Jing Fang (Stop Bleeding and Return Blood to Vessels Formula).) One dose stops the bleeding, followed by Liu Wei Tang for complete recovery.

Lei Gong stated: I also have a unique formula for blood disorders. Use Sheng Di Huang 1 liang, San Qi Gen Mo (Notoginseng Root Powder) 3 qian, Jing Jie Mo 1 qian, and Ren Shen 3 qian. Decoct in water and take with the powder. One dose stops the bleeding.
Subsequently, Liu Wei Tang must be used for regulation.