Chapter 1

What Is Shen (Spirit)?

The Chinese character for shen, usually translated as "spirit," has two
components. To the right is the character which gives both the basic meaning
and pronunciation, shen. In the book Tracing the Roots of Chinese
Characters by Li Leyi (1), the following explanation of the earliest known
form of the character is given: "Graphically, it is the curved lightening flashes
appearing in the clouds. The ancient people believed lightning was the
manifestation of god." To the left is the modified form of the character shi (as
used to form a radical, which is the category designator), which Li explains:
"Originally, it was the stone table for offering ceremonial sacrifices to the
gods…characters with the radical shi always pertain to ritual ceremonies,
worship, or prayer." Today, this character (shi) more generally means to make
known, to manifest, to show; this is because the ritual ceremonies display the
inner prayer and worship of people. We can say that the Chinese writing
character which has been formed into shen to refer to the spirit implies the
manifestations of a person's relationship to god [the small letter 'g' is used here
because the Chinese reference does not specify the personal God, as in the
Western Judea-Christian-Islamic tradition; still there are obvious similarities of
ancient ceremonial sacrifices on stone alters]. Historically, Chinese culture
recognizes a creator god, Pan Gu, a trinity of divine Emperors (Tian Huang, Di
Huang and Ren Huang, the emperors of heaven, earth, and man, respectively)
and of divine helpers who come in human form, You Cao, Fu Xi, Shen Nong
(2).

The earliest known discourse on shen in the medical context is found in

the Huangdi Neijing Lingshu, in Scroll Two. The document that comes down
to us today is believed to have originated during the Han Dynasty, perhaps
around 100 B.C. In a translation by Wu Jingnuan (3), the relevant section on
spirit is titled "The Roots of the Spirit." The section, like others, begins with a
question from Huang Di (the Yellow Emperor) which is answered by Qi Bo
(the chief physician), who begins his explanation this way:
"Heaven abides so that we have virtue. Earth abides so that
we have qi. When virtue flows and qi is blended there is
life."

The starting point for an understanding of shen is the meeting place of

heaven and earth, which is man. Heaven is the origin of the spiritual aspect of
man and provides ongoing spiritual influences; earth is the origin of the physical
aspect of man and it continues to affect his body; the interaction of heaven and
earth, the spiritual and physical, provides life; the ongoing harmonious
interaction of heaven and earth in man is essential to maintaining life. The
physical aspect is described here as qi. There is a frequent misconception in the
West that qi is ethereal or "energetic," and this is a misinterpretation (4); in the
traditional system of thought, qi is substantive but also dynamic, likened to
steam and mist.

In the discussion presented in the scroll, there is reference to not only the
spirit (shen) , but to two other entities which should be discussed before
proceeding (see chapter appendix for more details). One is hun, which is
translated often (and in this specific text) as the human soul; in fact, it is
depicted as a collection of 3 entities working together. Hun is manifested in
dreams, and it is the aspect of the human that persists after death of the body;
thus, hun has a meaning that correlates to some extent with the idea of the soul
in Western thought. When Chinese texts talk about the ghosts of ancestors, they
are referring to hun. The other entity is po (actually represented as 7 entities),
sometimes described as the "animal spirit" but perhaps more accurately
portrayed as the physical vitality. Its action keeps the body alive; it is still active
when a person is in a coma or is "brain dead;" it is gone when a person dies.
Neither hun nor po are the same as shen, and po is not the same as qi. We can
say that in describing these three entities, the shen is differentiated from the
other two: it is not the human soul nor the vitality of the human body. From the
ancient Chinese view of embryology, the hun and po combine together with the
seminal essence (jing) and give rise to the spirit (shen) .

Shen, hun, and po each have a "seat" in the body, a place where they are
said to rest and take residence. Thus, even though each of them can influence
all aspects of the human person, they rely on certain parts of the person as a
base. This situation might be likened to our own experience of working in the
community and interacting with our neighbors, then returning home as a place
for recuperation, rest, family interactions, and maintaining personal
identity. Shen rests in the heart and vessels; hun rests in the liver; and po rests
in the lungs. Although these three entities are the dominant concern in the
ancient texts, in keeping with the influential system of five elements, two other
organ systems are identified as having their own spiritual characteristics which
are not the same as, but might be likened to, the other three: yi (intention,
planning, thought, wisdom) is associated with the spleen and zhi (will; the
strength to carry out yi) is associated with the kidney.

Though we have all these terms depicting components of the person, it

is shen that is the focus of most discussion in the field of Chinese medicine,
because that is the entity that is under the greatest control via our behavior and
it is the entity that displays the greatest influence over body functions. We can
attempt to learn more about the spirit by examining what is thought to harm it
and what can be done to avoid harm or to repair harm, which is a subject of
the Lingshu scroll.
 There are two types of harm that can come to the spirit, one is external, the
other is internal: This division is also used in the discussion of other physical
disorders (another category of causation, one that is deemed neither strictly
external nor internal, is based on activities, such as eating, exercising, etc.).
External harm was viewed as the effect of "dissolute evil," which is often
referred to as an influence of "demons" (5) and, later in Chinese medical history,
was shifted into the general category of "wind" (6). The concept of demons
causing disorders in people permeated virtually the entire world in these ancient
times, and demons were most often the causative factor suggested in cases of
mental disorders (particularly outlandish, obviously strange behavior) and
neuromuscular disorders (particularly ones that were sudden and dramatic, such
as epileptic seizures). Today, we might convert this ancient concept to one with
more modern characterization, in which something (which we would not call a
demon, but would involve, for example, neurotransmitters and other neural
regulators) causes a dramatic alteration in neurological functions.

According to the Lingshu scroll, such external adverse influences could be

avoided by maintaining strength and balance:
The wise nourish life by flowing with the four seasons and
adapting to cold or heat, by harmonizing joy and anger in a
tranquil dwelling, by balancing yin and yang, and what is
hard and soft. So it is that dissolute evil cannot reach the
man of wisdom, and he will be witness to a long life.

These few words may seem to be simple instructions, but they are only the
outline of what could constitute entire books of instructions. I would like to
offer a brief elaboration to assist with the discussion of the nature of spirit.

"Flowing with the four seasons" has the meaning of staying in communion
with nature. This concern, expressed already more than 2,000 years ago when
cities were simple compared to those we have today, is not merely about
dressing for the weather (which is implied as part of the next statement of
adapting to cold or heat), but it refers to giving attention to many different
aspects of nature: the rising and setting of the sun, the varying weather patterns,
the changing plant and animal life, the different sensations of the body as the
day progresses, and so on. Today, we isolate ourselves from nature: missing the
sunrise in favor of an alarm clock; eating according to what is in processed food
packages rather than what has just been grown and harvested around us;
dressing independent of the weather and then relying on artificial heat and
cooling; cutting away the forests to live among concrete, asphalt, and
mechanized vehicles. Though there can be no turning back of the clock of
progress, there are choices to be made in living in the modern world, such as
the extent to which we relate to the natural setting. This issue of communion
with nature is not about going to the store to purchase organic produce and
encapsulated herb extracts; rather, this is about turning attention to natural
cycles, to natural settings, and to relationships with plants, animals, mountains,
valleys, water, sky, sun and moon.

"Harmonizing joy and anger" refers to not allowing any emotion to become
dominant or extreme, but it also refers to the opposite problem of unnaturally
avoiding experience of emotions by setting up barriers. The person who is calm
as a result of pursuing wise and healthful practices that lead to a tranquil and
easy nature can enjoy inner strength and healthy life. An important aspect of
this is one's own dwelling place, which should be nurturing, tranquil, and
restful. Too often today, much of life seems a battleground, whether it is at
home, at work, or on the road traveling between the two. People who engage in
extreme behavior are a centerpiece of the world of television, which has become
an unintended learning resource for many children as they grow up and develop
their attitudes.

Balancing yin and yang (and hard and soft) refers to development of a sense
of appropriate response. Yin is a more withdrawn receptive state of being, while
yang is a more outgoing and active state of being; both have their times for
being appropriate. Remaining in a "yin" condition when yang is needed, or vice
versa, results in disorganization of life and harm to the body and spirit.

What the text is calling upon people to do is to adapt a lifestyle that is, at
this time in history, substantially different than the ordinary. It requires turning
to the health of the spirit, calmness of the emotions, and to worship and prayer
directed at the heavenly influences and away from the unconscious pursuit of
earthly things that lead toward extremes, while remaining intimately in touch
with nature.

At the heart of the matter is the calmness which comes from an

understanding of the relations between heaven, earth, and man. As the scroll
describes, emotions in the extreme, which disrupt calmness, harm the person's
spirit (I have inserted explanatory comments):
Too much joy and happiness can cause the spirit to shrink
and scatter and not stay stored [that is, not return to resting
in the heart]. Sorrow and grief can cause qi to be blocked
in the foundations so it does not move [these emotions
especially affect the lung, the seat of po, the vitality does
not spread through the body and the person has difficulty
with getting around]. Great anger causes confusion and
doubt and a lack of control [anger is associated with the
liver, the seat of hun, the soul is no longer able to command
the person, and seemingly random forces take control].
Fear and fearing cause the spirit to be unsettled, to shrink
away and to be nonreceptive [fear is the emotion that, more
than any of them, adversely affects the spirit and the body-
 one's planning, and will to carry out plans, shrink away and
one is even afraid to be helped].

It may seem odd to worry about experiencing too much joy and happiness.
People can place excessive emphasis on the frequent experience of these
emotions; so much so that one ignores other important aspects of life. As a
result, the emotion and its context become false indicators of reality and lead
one astray. This is not to argue against joy and happiness that are a natural
outcome of enlightened spiritual living when harmony has already been
attained; rather, it is about a focus on these emotions apart from such
harmonious living. The emotions that have the greatest potential for harm when
excessive, in addition to the dramatic impact of anger, are fear, fright, worry,
and anxiety. As the text goes on to specify: "The heart and mind with frightened
and distressed thoughts and anxiety can result in injury to the spirit."

The prolonged experience of living a fearful life leads to dysfunction,

weakness, and premature death. The Lingshu scroll continues:
Fear and fearing without release can result in injury to the
seminal essence [jing]. The injured seminal essence can
cause the bones to be diseased and deficient. At the time of
reproduction, the seminal essence will not descend [this
refers to the interchange between essential fluids in the
brain and in the kidney as described in the ancient
literature]. Thus, the five viscera, which are the controls
and storehouses of the seminal essence, should not be
harmed [by excesses in the emotions; the text includes a
description of visceral harm from each type of emotional
excess]. If they are injured it will result in loss of
protection, and the yin [the substance of the body] will
become hollow. The yin being hollow will result in lack of
qi [which is important for replenishing the jing]. A lack of
qi will cause death.

The deficiency of bones has many implications. At one level, this applies
to the problem of osteoporosis, where the bones become fragile and readily
break (often contributing to health decline and premature death). It also applies
to the bone marrow, the source of blood cells; the spinal cord and brain are also
considered a type of marrow of the spinal column. Further, this deficiency refers
to the movements of the bones; hence, difficulty in walking is considered one
of the outcomes of bone disease, as are severe pains that afflict the bones and
joints, such as occurs with osteoarthritis. The loss of protection means not only
susceptibility to external influences, such as cold and heat and infectious agents,
but also loss of protection from internal disruptions that may yield growth of
tumors, water swelling, and failure of the organs to carry out their critical
functions.
 In sum, shen refers to that aspect of our being that is spiritual and looks to
the universe around, and is not focused on emotions. Shen draws our attention
to the divine, contributes to wisdom, virtue, and calmness, and maintains our
whole being in order. The spirit can be harmed by external factors if we fail to
maintain vitality through good habits, physical strength, and adequate
nourishment. The spirit can also be harmed by internal factors, mainly
excessive emotions.

These are things that are, to a certain extent, under our control. While many
external factors are beyond our control, our protection from them through
lifestyle choices is not. While emotional reactions to various situations are
spontaneous and beyond our control, the ability to return to equanimity is a skill
that can be mastered. To investigate further the critical issues, it will be
worthwhile to examine in some detail the matter of flowing with nature, a basic
Taoist concept, so that a path to communion with nature and inner strength can
be identified (Chapter 2), and to look at some of the Chinese ways for
controlling the emotions (Chapter 3). These approaches are said to be related to
benefiting the hun (ordering relations with the outer world) and po (stabilizing
the inner world), respectively. After contemplating these means of staying
healthy, it will then be worthwhile to consider Chinese medical treatments
(mainly acupuncture and herb therapies) that can assist those who have been
adversely affected by shen disorders.

References

1. Li Leyi, Tracing The Roots of Chinese Characters: 500

Cases, 1993 Beijing Language and Culture University Press,
Beijing.
2. Wei Tsuei, Roots of Chinese Culture and Medicine, 1989
Chinese Culture Books Company, Oakland, CA.
3. Wu Jingnuan (translator), Ling Shu, 1993 Taoist Center,
Washington, D.C.
4. Dharmananda S, Qi: Drawing a concept, 1997 START
Manuscripts, ITM, Portland, OR.
5. Dharmananda S, Disorders caused by demons, 1997 START
Manuscripts, ITM, Portland, OR.
6. Dharmananda S, Feng: Drawing a concept; the meaning of
wind in Chinese medicine, 1999 START Manuscripts, ITM,
Portland, OR.
7. Needham J, Science and Civilisation in China, vol. 2, 1974
Cambridge University Press, London.
Appendix: Hun and Po
The following introduction to the hun and po was derived primarily from
Joseph Needham's exploration of the subject (7) with supplemental information
from a few other sources.

More than 2,500 years ago in China, the idea developed, or solidified, that
the human body encompassed two types of entities, usually described in English
as "souls," which are called the hun and po. These two types of entities
represent the yang and yin, respectively. The po, of which there are said to be
seven, are of earthly nature, being most closely allied with the body substance,
flesh. The hun, of which there are said to be three, are of heavenly nature.
The hun and po are depicted in the painting below as two groups of wise men
in a calm setting and in friendly discussion.

The hun originates in the heavens (as if from the air) and enters and exits
the body through the hun gate (hunmen, acupuncture point BL-47); upon death,
it departs to heaven. The Chinese practice of ancestor worship encompasses
taking care of the departed hun, which, because of their residence in heaven,
are thought to be able to help mediate the earthly human wishes with the gods.
Further, it was thought that dissatisfied ancestral spirits (those who were not
cared for by their offspring in succeeding generations) could cause illnesses or
misfortunes. During life, the resting place of the hun is in the liver (the hun gate
is at the back, near the liver).

The po is derived from the earth (as if from the soil) and enters and exits
the body through the po door (pohu, acupuncture point BL-42); upon death it
returns to the earth. The Chinese practices of burial of the dead encompass
taking care of the po, which eventually blends into the earth and does not retain
separate identity (as an exception, emperors were embalmed so that
both po and hun could remain viable entities, retaining their original form).
During life, the resting place of the po is in the lungs (the po door is at the back,
by the lungs). If the qi and yin of the lungs is adequate, the po can remain
vigorous.

One of the earliest discussions involving the hun and po was recorded in
the 6th Century B.C., in which the following was said: "When a fetus begins to
develop [into a human form and personality], it is due to the po. Then comes
the yang part, hun. The jing [essences] of many things then give strength to
these, and so they acquire the vitality, animation, and good cheer of these
essences. Thus, eventually there arises spirituality and intelligence [shenming]."

There has been some disagreement in the Chinese literature as to when

the po and hun actually arrive. For example, in the Du Shu Bian (16th century
A.D.), it is said that the hun arrives during the seventh month of pregnancy
(signaled by the ability to move the left hand) and the po arrives during the
eighth month of pregnancy (signaled by the ability to move the right hand),
rather than the other way around, with the po being first, which was the more
prevalent view; in fact, it was often suggested that the hun entered the body
after birth.

Around 80 A.D., a brief discussion of hun and po was presented in Paihu

Tangte Lun (Discussions in the White Tiger Hall): "Hun expresses the idea
of continuous propagation, unresting flight; it is the qi of the Lesser Yang
[associated with liver/gallbladder], working in man in an external direction, and
it governs the instincts (xing)....Hun is connected with the idea of weeding, for
with the instincts, evil weeds [in man's nature or in his spiritual path] are
removed. po expresses the idea of continuous pressing urge on man; it is the qi
of the Lesser Yin [kidney/heart], and works in him, governing the
emotions....Po is connected with the idea of brightening, for with the emotions
the interior [personality] is governed."
 Here, hun is expressed in terms of outer-directed activity: using the
instincts to select a course of action and to avoid the pitfalls (evil weeds); po is
expressed in terms of inner dynamics, adjusting one's emotional reactions and
personality. This reflects the basic yin/yang dichotomy, with yin representing
the internal and yang the external.

In an ancient book describing meditation practice, it was said that one

should "be still, as if one had no hun;" that is, the drive to act, to do things,
should be abandoned during meditation, leaving one able to remain motionless
and focused on the inner condition. In a book on Taoism, it is said that one
should "keep your hun from confusion, and it [the Tao] will come of itself,
unify the qi and control the shen....All categories of things are brought into
being by this; this is the door of power." Thus, the practice of meditation,
avoiding the stimuli offered by civilization, and calming or regulating the
ambition for outward change (while maintaining the drive for inner
transformation, which will then affect the outer conditions) are activities
associated with predominance of the po; searching the outer world for
opportunities, applying thought and personal energy towards significant
changes in the world, and relying on pleasurable stimuli that the world has to
offer are associated with predominance of the hun.

The seven po may have originally been thought to be linked with the seven
emotions. The seven emotions are described variously in English, but one such
list is joy, anger, grief, fear, love, hate, and desire. For each of the emotions,
there is an impact on the qi, so that if the emotion is quite intense, the qi may
become significantly disturbed, leading to physical and mental disorders. In
the Sanyin Ji Yi Bingzheng Fang Lun (Treatise on Three Categories of
Pathogenic Factors), it is said that "In the interior of the body reside
the jing and shen, the hun and po, the mind and sentiments, mourning and
thoughts. They tend to be harmed by the seven emotions."

It is possible that the three hun were originally thought to be linked to the
three major objectives of human action: relationship to societal authorities (in
China, the Emperor and his representatives; in the modern world, it would
include employers, law officers, governors, etc.), relationship to one's spouse
(this would apply also to other relatives of the same generation and to
neighbors), and relationship to one's children (this might also apply to others
who are dependent upon your time and resources). It is a key tenet of Chinese
philosophy, most clearly depicted by Confucianism, that relationships with
others are important to both social harmony and to one's own physical and
mental health.

It was thought that the hun and po could leave the body, even before death,
though only a few of the 10 entities would be involved. Ge Hong, a famous
Taoist, wrote during the 3rd century A.D. that: "All men, wise or foolish, know
that their bodies contain hun and po. When some of them quit the body, illness
ensues; when they all leave him, a man dies. In the former case, the shamans
have formulas for restraining them; in the latter, the Book of Rites provide
ceremonials for summoning them back. These po and hun are of all things the
most intimately bound up with us, but throughout our lives probably no one
ever actually hears or sees them."

In fact, it has been suggested that the hun, being of yang nature, may often
depart the body during life and travel about, then return. Such adventures
include certain dreams, the quasi-dream state that occurs at the border of sleep
and which sometimes involves the sense of floating or sudden movement, and
what we today call "out of body experiences." It is thought, at least in some
Chinese communities, that insomnia, anxiety, fright and other states of mental
agitation might arise if one of the hun stayed away too long. As a matter of
diagnosis, patients reporting repeated nightmares are thought to be experiencing
a disorder of the liver; the distressed hun give rise to the nightmare.

It was also believed that one or more of the hun could be virtually forced
from the body of a child (less likely, but still possible in an adult) by a frightful
experience; for example, being startled by a stranger. In such case, the child
would become susceptible to disorders such as abdominal distress or epilepsy
that were induced by demons. Other indicators of hun departure include
listlessness, fretfulness, and simple continual sickliness. No doubt, conditions
defined in modern times such as autism, attention deficit disorder, and other
mental dysfunctions and psychological conditions have the potential of being
classified, from the Chinese traditional perspective, as due to soul-loss or soul-
disturbance. In China, that was a widespread scare in 1768, in which it was
thought that sorcerers were stealing the hun of numerous people (and using the
power of the dissociated hun for their own purposes).

The po could depart, or fail to be given sufficient rest and comfort, because
of fright, deficiency of the jing, or constraint of the lung qi (perhaps due to
excessive grief or sadness). In such a case, a person might suffer from weakened
sensory ability, distress of the limbs (such as numbness), or might lose control
of the feces (as the rectum was thought to be regulated by the po; the anus was
known in earlier times as pomen: po gate). In the book Classic of
Categories (1624), it is said that "Po moves and accomplishes things and pain
and itching can be felt." Thus, from a diagnostic point of view, pain, numbness,
and itching (as well as other sensory disturbances) and/or experience of serious
elimination disorders (debilitated intestinal function) might indicate a distress
of the po.

At death, the hun, being of yang nature, departs immediately, but the po,
being of yin nature, departs more slowly. For some time, there were Chinese
rituals, practiced at the time a person lost consciousness or died, attempting to
call back the hun, so that it might reunite with the po, thereby restoring life and
consciousness. It was also thought that if a person experienced a sudden and
violent death, the po and hun might not be satisfied in simply dissolving into
earth and heaven, but rather remain close by, as malevolent ghosts (gui). Such
ghosts were thought to be able to cause accidents to happen and illnesses to
arise seemingly out of nowhere.

Detail section of the painting "The Five Hundred Arhats," by Wu Pin (1601)
from the book Eight Dynasties of Chinese Paintings (1980 Cleveland
Museum of Art). As explained in Chapter 2, the Arhats, commonly called
Luohan in China, are Buddhist sages who share many ideals with the Taoists.
One of the ideals is the natural state of mind, in which thoughts and ideas flow
like water around obstacles, represented by the stones in the stream of this
painting. The Arhats are crossing a turbulent section of the stream by making
good use of those same obstacles, turning them to their advantage. The
characters on either side have a calm and relaxed demeanor; those who are
crossing the river are concentrating on the task at hand, which will soon be
gone, just like the water rushing down the stream, and they will continue on
with their journey. Two of the Arhats are crossing right, two are crossing left,
and two are enjoying the experience as they pause on stones in the middle of
the stream.
 Chapter 2
A Mind that is Free
Going with the Flow of Nature
In order to better understand the Chinese therapeutic approach to disorders of
the shen, we have to first examine in greater detail the Chinese concept of
healthy spirit. This concern falls into the realm of philosophy and religion,
because it involves the correct ordering of one's thoughts, desires, goals, and
methods. Who is to determine what is correct? The answer is in the messages
attributed to god or to sages. In this chapter the Taoist (pinyin: Daoist) approach
to spiritual health is the focal point, but it is necessary also to mention
Buddhism, which (in China only) is closely related, and also to briefly mention
Confucianism; these also have had an influence on traditional Chinese
medicine. Most patients visiting Western practitioners of Chinese medicine are
not familiar with these Asian religions, at least, not in detail. The medical
doctor, acupuncturist, or other practitioner trained in the West is rarely in a
position to relay the basic concepts of Asian spirituality except to the extent that
they might be integrated into his or her therapeutic style (choices of questions
to ask the patient; ways of answering patient questions; medical interventions
and life style changes to recommend). Rather, most patients (and physicians)
will have come from a Judeo-Christian background or a non-religious secular
humanist background, which was derived from it. Many of the Taoist, Buddhist,
and Confucian ideas, particularly those about recommendations for living
properly in society, are consistent with the Western ideas, though the points of
emphasis differ.

To help draw attention to the fact that these philosophical-religious

concepts influence Chinese medical therapeutics, we can consider the name
given to a popular herb formula that is used for, among other things, mental
distress, depression, and anxiety: Xiao Yao San. The title given to the herb
prescription makes reference to the unfettered wandering of the Taoists who
prided themselves in being in tune with the movements of nature, living in
harmony with the seasons, and in balance with the qi of the earth. The
corresponding acupuncture point is taichong (LV-3), which is widely used
today for depression, frustration, pent-up feelings, irritability, and mood
swings; to match the herbal formula Xiao Yao San, that point would be
combined with sanyinjiao (SP-6) to strengthen the center while freeing up the
circulation of qi. There will be more about the herbs and acupuncture points in
later chapters. First, it is necessary to consider the underlying concepts.

Taoist Wandering: A Mind that Is Free

The fundamentals of Taoism are described in the book Tao Te
Ching (pinyin: Dao De Jing), attributed to the legendary Lao-tzu (pinyin:
Laozi). It is the most widely translated book from Asia. To study this work
involves considerable time and effort; the following discourse is aimed at
helping the reader understand some of the main points that are relevant to the
issues of spiritual health.

In chapter 8 of the 81-chapter work (a chapter being only a few sentences

long), the Tao is likened to water. The translations vary among the popular
English language versions (1-4), but a rendering that captures the essence of all
of them is this one (5):
The highest good is like water; water is good at benefiting
the ten thousand things and yet it has tranquility [does not
compete with them]. It dwells in places the masses of
people detest, therefore it is close to the Way [Tao].

There are three key elements of this saying about water as a depiction of
the Tao: water is positive (good, beneficial); it can flow without striving or
competing, remaining tranquil; and it enters places that people would usually
avoid. The way water flows around obstacles, as observed when watching a
mountain stream, has been taken by many readers of this ancient book as an
emblem of the proper way the mind should deal with the difficulties it
encounters. Joining the flow of Tao, where ever it may go, leads one to unusual
places, but places meant to be visited by those who have devoted themselves to
the Tao. People detest the places not because they are bad but because they are
not familiar; they are held back by fear of the unknown, not trusting in the Tao.
Fear is the emotion that ultimately causes the most difficulties. Going into
nature and observing the flow of streams is, in itself, one of the natural remedies
for a troubled mind. Learning to move gracefully around obstacles is one of the
aims of practicing Tai Qi Chuan (pinyin: Tai Ji Quan).

The philosophy of Taoism was elucidated further by Chuang-tzu (pinyin:

Zhuangzi), who is believed to have lived around 365-290 B.C. (Taoism is
sometimes referred to as the Lao-Chuang philosophy). While Lao-tzu focused
a large part of his description on the way in which rulers should properly rule
their people, Chuang-tzu gave a more personalized account of Taoism suited to
the individual. A record of Chuang-tzu's teachings, simply called the Chuang-
tzu, was recorded around 310 A.D. by Guo Xiang in a form similar to that which
exists now. By that time, Taoism had become a major force in Chinese society.
It had influenced Chinese herbalists, many of whom were Taoist alchemists
seeking immortality. They used a variety of means to attain their goal, including
meditation, special exercises that were later to become the familiar chi-kung
(pinyin: qigong), and ingestion of various alchemical substances, some of
which became important in herbal remedies (and, unfortunately, often included
poisonous components).

The first chapter of the book of Chuang-tzu's teachings (6) is titled Xiao
Yao; this has been translated as "Wandering Boundless and Free." Xiao has the
meaning of free and unrestrained; yao has the meaning of distant; thus, the term
implies going a long distance without restraint. The chapter is comprised of
short sayings or stories (in English translation, each is about 50-100 words) that
encourage the reader to be free of rigid concepts. These sayings, steeped in
Chinese mythology and culture, are often difficult for Westerners to interpret;
one that is relatively easy to understand is about Lieh-tzu (pinyin: Liezi), a third
author associated with books of Taoist sayings:
Lieh-tzu rode the wind and set out, boundless and clear,
returning after only 15 days. To be so blessed is rare-and,
yet, however free that wind made him, he still depended on
something. But, if you mount the source of heaven and
earth and the ten thousand changes, if you ride the six
seasons of qi in their endless dispute-then you travel the
inexhaustible, depending on nothing at all. Hence the
saying: 'The realized remain selfless; the sacred remain
meritless; the enlightened remain nameless.'

The key is to depend on nothing at all, that is, to be free of all rigid concepts,
attachments to material goods, positions of recognition, and all obstructions to
movement through life, to have one's mind and body move according to the
Tao, often translated as the "Way." The realized Taoist becomes selfless
(helpful to others but not concerned about receiving rewards and praise, hence
meritless and nameless). In this description, it is said that to set out boundless
and clear (free) is a rare and blessed thing. This roaming is not referring to
actually traveling about the countryside (which is an external practice that
mimics what happens inside); it refers to what goes on within the mind, either
during meditation or in daily life. This story by Chuang-tzu reflects the words
found in Chapter 25 of the Tao Te Ching, where the Tao is depicted this way
(3):
I do not know its name, call it Tao. For lack of a better
word, I call it great. Being great, it flows. It flows far away.
Having gone far, it returns....Man follows the earth; earth
follows heaven; heaven follows the Tao; the Tao follows
what is natural.

As in the Chuang-tzu story, there is movement going away and coming

back, and it is a long distance (in the story, 15 days in roundtrip being a short
journey); the ultimate leader in the journay is that which is natural. Another
telling passage in Chuang-tzu's chapter titled Xiao Yao is this small debate
between Chuang-tzu and Hui-tzu (pinyin: Huizi). Hui-tzu was a contemporary
of Chuang-tzu who held a contrary and competing philosophical view based on
rationalism:
'I have a big tree,' said Hui-tzu to Chuang-tzu. 'Its huge
trunk is so gnarled and knotted that no measuring string can
 gauge it, and its branches are so bent and twisted they defy
compass and square. It stands right beside the road, and still
carpenters never notice it. These words of yours [referring
to the stories of Chuang-tzu recorded in this chapter], so
vast and useless, everyone ignores them the same way.'
Chuang-tzu replied [after giving examples of his point]:
'Now, you've got this huge tree, and you agonize over how
useless it is. Why not plant it in a village where there's
nothing at all, in a land where emptiness stretches away
forever? Then you could be no one drifting lazily beside it,
roam boundless and free as you doze in its shade. It won't
die young from the axe. Nothing will harm it. If you have
no use, you have no grief.

The tree that is logically useful (its wood is desirable) will be cut down; the
tree that is logically useless (its wood too gnarled to be of value) is spared. So,
which is better? To be useful or useless? And who is to decide whether
something is useful: the gnarled tree serves just fine for shade and is not in
danger of being cut down for its wood. In Chapter 22 of the Tao Te Ching,
Lao-tzu says (3):
Wise men embrace the one, and set an example to all. Not
putting on a display, they shine forth; not justifying
themselves, they are distinguished. Not boasting, they
receive recognition, not bragging, they never falter. They
do not quarrel, so no one quarrels with them.

The tree, in the story above, may be huge, but carpenters never notice it.
The Taoist is likewise unnoticed because he does not try to call attention to
himself; not calling attention to himself, no one quarrels with him. But, this
does not mean that he is without value. Like the Tao, he is "great," like the tree,
he can provide welcome relief (shade) and a break from desolation (absence of
wisdom and virtue). He is not so useless after all. How many people fret over
not being as "great" as another or as they dream to be, feeling depressed about
it, yet can do things that are truly important for another person, and so they are
doing their part?

Zhi Dun (314-366 A.D.) introduced Buddhism, a philosophy based on the

avoidance of rigid, limiting concepts, to Taoist China. In his commentary about
the book of Chuang-tzu, one passage survives to the present; it is about Xiao
Yao (7):
Free and easy wandering refers to the mind of the perfected.
When Chuang-tzu talks about the Great Tao, he uses the
analogy of the Peng bird and the quail. Because the Peng's
life is without obstruction, the bird is free from all
 limitation in the realm beyond the body. The quail, on the
other hand, because it lives in the near and scorns the far, it
is limited and obstructed in its mind. The perfected one
rides the truth of heaven, soars aloft, and wanders
boundlessly in unfettered freedom. He treats beings as
beings-without being treated as a mere being himself. He is
not self-satisfied in his wandering. Mystically one with the
universe, he does not act purposefully. He is not hurried,
yet moves swiftly. He goes everywhere in his freedom. He
is truly a free and easy wanderer.

In the book Road To Heaven: Encounters with Chinese Hermits (8),

Bill Porter relays this poem by Wang Wei (699-761 A.D.; see inside cover), a
Taoist who lived in Chungnan:
In my prime, I loved the Way;
a Chungnan cottage in old age.
When I want to roam alone,
wonders are wasted all on me.
Hiking to the river's source,
sitting, watching clouds arise.
Sometimes with an old recluse,
talking, laughing, free from time.

The "Way" or Tao is freedom from worries about time (meaning worries
about accomplishments that will be recognized by others), with a life that
appears leisurely, like that of a butterfly fluttering here and there. However, to
attain the state of true freedom, each individual must cultivate the proper
attitude: to overcome the tendencies of striving for reward and resisting
obstacles that seem to stand in the way. In the Tao Te Ching (chapter 48) it is
said: "The world is ruled by letting things take their course, it cannot be ruled
by interfering." Letting things take their course is often described as "being in
harmony with nature." Harmony with nature requires yielding, but it results in
great things. If this were the totality of the teaching, the Taoist would seem
rather irresponsible. However, this is one part of the teaching; the other part
provides for a certain grounding.

The study of this first aspect of Taoism is supposed to help one overcome
the ingrained personal approach of clashing with-rather than flowing around-a
difficulty that is encountered, typically a difficulty that is placed by one's own
mind. The lack of freedom of the mind influences the person's flow of qi and
blood, causing it to flow erratically and bind up; the bodily condition, in return,
contributes to stagnant or erratic mental function, with the potential for
continued worsening of the total condition. In the Chinese model of health and
disease, the free flow of qi and blood is the requirement for health and the
obstructed flow of qi and blood is a cause of disease (there are other causes,
such as deficiencies and excesses). The obstruction of circulation corresponds
to both a physical stagnation (repression of natural movement) and the
psychological condition we call depression, the sense of inability to move and
change to overcome obstacles. The great herbal teacher Zhu Danxi said (10):
"So long as the qi and blood enjoy harmonious flow, none of the hundreds of
diseases can arise. Once they are depressed and suppressed, various diseases
are produced."

Basics of Taoist Action: Doing while not Doing

Another aspect of the Taoist teaching, ultimately related to the freedom
described above, but having a different starting point, may prove more practical:
it answers a question about how humans live together, not just with nature, but
with each other. Further, in addressing this issue, Taoism teaches how to
manage one's own mental proclivities.

The underlying principle regarding actions presented in the Tao Te

Ching is that one should take care of things that are in need of doing, and then
move on to the next thing that needs to be done, without any attachment to the
accomplishment of the first or the potential outcome of the next. By avoiding
any "attachment to the accomplishment" it is meant that one should not dwell
upon such things as taking credit for it, accumulating rewards (including
material things and power), or spending time with retelling it in order to get
recognition.

Along these lines also, with regard to one's work, do not bother doing
things other than what needs to be done. For example, one should not spend
time at efforts that are aimed specifically at collecting wealth, accumulating
power, or gaining praise, or even bothering others by taking up their time with
unnecessary things. Moving from one moment to the next, taking care of what
is necessary, and not straying from that, is the Way. So long as one follows this
teaching, things will progress smoothly; but as one deviates from this pattern,
obstacles and heartaches arise. Because one does not dwell upon
accomplishments nor make efforts to gain things, it is said that "nothing is
done." It should be understood, however, that this does not mean simply sitting
lazily, avoiding doing anything or skirting obvious responsibilities; something
is done, just not specially recognized as such. Also, in the absence of striving
after wealth, power, or praise, one may come by it naturally, which brings its
own requirements for action; these outcomes aren't necessarily bad, just not
suitable as a goal in themselves.

These spiritual messages may be particularly relevant to the ordinary

conditions that affect people today. The Taoist belief is that one will suffer from
not following this teaching; since this is about a way of being, not just a
response to any individual event or undertaking, a person who fails to follow
the Tao may continually behave in a way that causes distress; a potential source
of a serious mental disorder.
 Here are some sample quotations about the proper way of living (3).
"Creating, yet not possessing. Working, yet not taking credit. Work is done,
then forgotten. Therefore, it lasts forever." (chapter 2).
"If nothing is done, then all will be well." (chapter 3)
"The sage stays behind, thus he is ahead. He is detached, thus at one with all.
Through selfless action, he attains fulfillment." (chapter 7)
"Amass a store of gold and jade, and no one can protect it. Claim wealth and
titles, and disaster will follow. Retire when the work is done. This is the way of
heaven." ["Retire when the work is done" here means that one should not try to
make anything further of the accomplishment.] (chapter 9)
"Giving birth and nourishing, bearing yet not possessing, working yet not taking
credit, leading yet not dominating, this is the primal virtue." (chapter 10)
"Surrender yourself humbly; then you can be trusted to care for things. Love
the world as your own self; then you can truly care for all things." (chapter 13)
"Who can remain still until the moment of action? Observers of the Tao do not
seek fulfillment, not seeking fulfillment, they are not swayed by desire for
change." ["Remain still" here means that one is not constantly pursuing selfish
fulfillment between the actions that are essential.] (chapter 15)
"Wise men embrace the one and set an example to all. Not putting on a display,
they shine forth; not justifying themselves, they are distinguished; not boasting,
they receive recognition; not bragging, they never falter." (chapter 22)
"He who stands on tiptoe is not steady; he who strides cannot maintain the pace;
he who makes a show is not enlightened; he who is self-righteous is not
respected; he who boasts achieves nothing; he who brags will not endure.
According to followers of the Tao, 'these are extra food and unnecessary
luggage.' They do not bring happiness, therefore followers of the Tao avoid
them." (chapter 24)
"Achieve results, but never glory in them. Achieve results, but never boast.
Achieve results, but never be proud. Achieve results, because this is the natural
way." (chapter 30)
"A truly good man does nothing, yet leaves nothing undone. A foolish man is
always doing yet much remains to be done." ["Always doing" here means that
he is wasting time doing unnecessary things.] (chapter 38)
"The sage works without recognition. He achieves what has to be done without
dwelling on it. He does not try to show his knowledge." (chapter 77)

The Things to Be Done and the Way to Do Them

The above teachings tell about one's attitude in work. What is the nature of the
actions, the things to be taken care of? How is one to know what is needed and
what ought not to be done? What is one to be like in day-to-day affairs? As the
following quotes display, one can know what to do by focusing attention on
such virtuous things as gentleness, kindness, truthfulness, competence,
alertness, simplicity, yielding (rather than obstructing), constancy,
openheartedness, caring, perseverance, willingness to take on difficult tasks,
mercy, economy, generosity, humility, gentleness, meditation, etc., and avoids
such things as extremes, excesses, complacency, abandoning those in need,
trying to do too much at once rather than take the small steps that are necessary,
ignoring what is known, having desires for unnecessary things, and rigidity in
ideas, as well as avoiding those concerns described earlier, such as boasting,
accumulating wealth and power, and seeking rewards.

Here are some sample quotations (3). One of the great teachings is the last
one listed here, from chapter 81, about giving of oneself for others.
"In dwelling, be close to the land, in meditation, go deep in the heart, in dealing
with others, be gentle and kind, in speech, be true, in ruling, be just, in business,
be competent, in action, watch the timing." (chapter 8)
"Alert, like men aware of danger, courteous, like visiting guests, yielding, like
ice about to melt, simple, like uncarved blocks of wood...." (chapter 9)
"Knowing constancy is insight, not knowing constancy leads to disaster.
Knowing constancy, the mind is open; with an open mind, you will be
openhearted. Being openhearted, you will act royally. Being royal, you will
attain the divine. Being divine, you will be at one with the Tao." (chapter 16)
"The sage takes care of all men and abandons no one. He takes care of all things
and abandons nothing." (chapter 27)
"The sage avoids extremes, excesses, and complacency." (chapter 29)
"Perseverance is a sign of will power. He who stays where he is endures."
(chapter 33)
"The truly great man dwells on what is real and not what is on the surface."
(chapter 38)
"There is no greater sin than desire, no greater curse than discontent, no greater
misfortune than wanting something for oneself. Therefore, he who knows that
enough is enough will always have enough." (chapter 46)
"All things arise from Tao. By virtue they are nourished, developed, cared for,
sheltered, comforted, grown, and protected." (chapter 51)
"Keep your mouth shut, guard the senses, and life is ever full. Open your mouth,
always be busy, and life is beyond hope."(chapter 52)
"Cultivate virtue in yourself and virtue will be real; cultivate virtue in the
family, and virtue will abound; cultivate virtue in the village, and virtue will
grow...." (chapter 54)
"Knowing harmony is constancy, knowing constancy is enlightenment."
(chapter 55)
"In caring for others and serving heaven, there is nothing like restraint. Restraint
begins with giving up one's own ideas. This depends on virtue gathered in the
past. If there is a good store of virtue, then nothing is impossible." (chapter 59)
"Reward bitterness with care. See simplicity in the complicated. Achieve
greatness in little things. In the universe the difficult things are done as if they
are easy. In the universe, great acts are made up of small deeds. The sage does
not attempt anything very big, and thus achieves greatness. Easy promises make
for little trust. Taking things lightly results in great difficulty. Because the sage
always confronts difficulties, he never experiences them." (chapter 63)
"The sage seeks freedom from desire. He does not collect precious things. He
learns not to hold on to ideas. He brings men back to what they have lost."
(chapter 64)
"From mercy comes courage; from economy comes generosity; from humility
comes leadership." (chapter 67)
"Knowing ignorance [knowing that you are ignorant] is strength; ignoring
knowledge is sickness." (chapter 71)
"A man is born gentle and weak; at his death he is hard and stiff. Green plants
are tender and filled with sap; at their death they are withered and dry.
Therefore, the stiff and unbending is a disciple of death; the gentle and yielding
is a disciple of life." (chapter 76)
"The sage never tries to store things up; the more he does for others, the more
he has; the more he gives to others, the greater his abundance." (chapter 81)

Many of the recommendations of the Tao Te Ching may seem obvious.

Yet, even those who have achieved great equanimity know that one can again
and again experience failings, and thus, must be reminded and brought back to
what has been lost. As it is said in the Tao Te Ching (chapter 78): "Under
heaven everyone knows this; yet no one puts it into practice."

Linking Taoism and Buddhism

Taoists, when confronted with a rise in devotion to Buddhism in China,
eventually adopted it as part of their own philosophical base. As Taoist Master
Yang at the Baxianggong (Eight Immortals Temple, Beijing) said recently (8):
Buddhists and Taoists walk the same path. They just dream
different dreams. Essentially, Buddhism and Taoism are
the same. Their sacred texts talk about the same things. It's
just that Taoism emphasizes life, and Buddhism
emphasizes nature. But people who truly cultivate,
cultivate both. In terms of actual practice, Buddhism is
somewhat better than Taoism. Even though Taoists talk
 about cultivating their mind, they often have a harder time
controlling their emotions. They have a harder time
suppressing feelings of pride. But to cultivate either of
them successfully is very hard."

To say that "Buddhism emphasizes nature" and that "Buddhism is

somewhat better" are remarkable statements from a Taoist. Yet, he has hit upon
one potential pitfall: feelings of pride. Because the Taoists have invested
heavily on developing certain talents (e.g., physical disciplines, some aimed at
longevity), they may forget the basic teaching and take pride in their
accomplishments.

The Tao Te Ching is thought to have originated from teachings given

sometime around the 4th century B.C. According to legend, during his travels
to the west, Lao-tzu gave the written teachings to Yin Xi, the guardian of the
Hangu Pass, who preserved them. The origins of Buddhism are usually traced
to Shakyamuni (Siddharta, Gautama), an Indian prince who renounced his royal
inheritance and pursued a path of asceticism (which nearly killed him) and then
found a path of balance (the middle way). This led, ultimately, to full
enlightenment that was attained during prolonged meditation, throughout which
he faced the demons of mundane consciousness. His enlightenment consists of
an egoless state, where calm prevails. The philosophy of Buddhism was
presented in the form of discussions between Buddha (as the enlightened former
prince became known) and his disciples in documents called sutras (teachings,
discourses, sermons). The earliest of these are traced back to around the 4th
century B.C. Among the most important of ancient texts are the Lotus Sutra,
Heart Sutra, Avatamsaka Sutra, and Diamond Sutra (the latter considered
especially important in bringing Buddhism to China).

Although Buddhist scholars don't agree, and certainly people of India won't
agree, many Taoists believe that Lao-tzu was, in fact, one and the same man as
Buddha, or, at the very least, was the actual originator of Buddhism. There is a
story that Lao-tzu traveled west, following the Changnan Mountain range, and
reached India where his teachings were received as Buddhism. It is also told
that Lao-tzu, not as a man, but as a holy immortal, was able to make Yin Xi
(recipient of the Tao Te Ching manuscript) appear as the Buddha to the
"barbarians" in India, where the teachings were transmitted. In this way,
Buddhism is seen in China as nothing more than a foreign sect of Taoism.

The close connection between Taoism and Buddhism is still perceived by

some Taoists. In 1995, Shambhala Publications produced a book called Huahu
Ching: The Later Teachings of Lao Tzu (9). This version of the Huahu
Ching is nothing other than The Diamond Sutra even though there is no
mention of that title, followed up with several pages of unique Taoist writings.
Hua-ching Ni, its translator, who claims to be part of a 2,000 year old lineage
of Taoist masters, says that the original text of the Huahu Ching was lost and
has been passed on by oral tradition, a tradition of which he is a recipient. In
the book, the transformation of Siddhartha to the Buddha is described thus:
"Rejecting his position as crown prince, he went into the mountains and
cultivated the Tao. He realized the highest Tao and duly was called the
Buddha."

Bill Porter, in his talks with mountain-dwelling hermits, found plenty of

Ch'an practitioners (as Chinese Buddhists are called) living alongside the
Taoists hermits. One of the Taoists he interviewed, Jen Fajung, abbot of
Loukuantai, said this (8):
Taoists and Buddhists seek that which doesn't change. This
is why they don't seek fame or fortune. They seek only the
Tao, which is the nothingness of which we are all created
and to which we all return. Our goal is to be one with this
natural process.

For several centuries, China grappled with the question of whether Taoism
or Buddhism should be officially sanctioned: which one was the best? This
question also raised the concern of how Confucianism, which was deemed
clearly different than the closely related pair of Taoism and Buddhism, would
fit in. As Livia Kohn relays in her book Early Chinese Mysticism (10):
In the fourth century, Chinese literati integrated Buddhism
in an encompassing "harmony among three teachings." The
chief exponent of this integrationist view was Sun Chuo
(ca. 310-390 A.D.), who combined Confucian social
responsibility, the Lao-Zhuang [Taoist Canon] ideal of
contemplation, and Buddhist enlightenment. In the fifth
century, the first wave of court debates took place in south
China....Following Sun Chuo's line of reasoning, Zhang
Rong contended that both teachings [Taoism and
Buddhism] were fundamentally identical. Both court
factions should therefore have equal say in matters of state.
The Buddhist Zhou Yong countered this argument by
referring to the association of Taoism with the Great Peace
of 184 A.D. [Great Peace refers to a Taoist movement:
using predictions based in Taoists texts, the followers
staged a rebellion that lasted over a decade; this rebellion
was the "beginning of the end" of the Han Dynasty, which
collapsed in 220 A.D.]. Contrary to this lowly heritage, he
claimed Buddhism was lofty and of high quality.
Gu Huan, in his Yixia Lun (On Barbarians and Chinese) of
the year 467 A.D., argued that Buddhism was quite suitable
for barbarians, while Taoism was the proper teaching for
the Chinese. [He argued also that:] Buddhism was
 concerned with salvation of the spirit, was second hand, did
not involve filial piety [a key aspect of Confucianism], and
contains complex and abstruse ideas; by contrast Taoism
was concerned with longevity of the body, original, very
filial, and straightforward, concrete, and practical....In the
sixth century, a second round of debates-now growing
increasingly polemical-was staged at the Northern Wei
court. In 520 A.D., the Taoist Jiang Bin and the Buddhist
Tan Muzui argued the seniority of their teachings in the
presence of the emperor. They concentrated on the problem
of dating. If Laozi went west to convert the barbarians and
become the Buddha, he must have left China earlier than
the recorded birth of Buddha in India [which doesn't agree
with the reported dates]…..the Buddhists emerged
victorious from this phase of the debate and thereby gained
influence at the court....

The debates went on for centuries more. Taoism and Buddhism have
remained intertwined in China ever since.

Buddhism has had some influence on herbal use in China. For example, the
development of the popular herb heshouwu (Polygonum multiflorum) is
attributed to a Buddhist priest who knew Mr. He, the man who first took the
herb and found its miraculous properties. Its pair of intertwined vines were
thought by some to represent the close linkage between Buddhism and Taoism.
The fruit luohanguo was developed into a medicinal agent by Buddhist monks.
During the Tang Dynasty, Guilin (where this fruit originated) was a major
Buddhist retreat area with many temples. The fruit was then named after
the Luohan, which are advanced Buddhist practitioners (in India, they are called
Arhats; see illustration).

Buddhism is an approach to life that posits the primacy of mind. Its doctrine
considers the disturbance of mind by attraction, revulsion, and confusion, to be
the primary spiritual disorder which leads one to suffering. Therefore, calming
the mind, particularly by meditating, is the most important means of gaining
health of the spirit. Living a moral life is understood to be a means of not only
helping others, but also preventing situations that disturb the mind. Because
Buddhist belief depicts a long cycle of birth, death, and rebirth, it does not
emphasize earthly immortality, and also places less emphasis on maintaining
bodily health than do the Taoists. Buddhism puts greater emphasis on calming
the emotions and stabilizing the body so that prolonged meditation is possible.

Confucianism
Confucianism predated both Taoism and Buddhism and is attributed to Kung-
fu-tze (pinyin: Kong Fuzi) whose name was Latinized to Confucius.
Confucianism is a complex system of moral, social, political, and religious
teaching aimed at making men worthy of respect. Confucius' ideal person,
the junzi, is not simply the man of virtue, but the man of learning and of good
manners. The perfect man must combine the qualities of saint, scholar, and
gentleman. The key element, though, is his moral force.

There is a well-known Chinese herb formula named for the gentleman

described by Confucius, called Si Junzi Tang; the "Four Gentleman Decoction."
This name was given because of the great respect held for the four major
ingredients, as well as for the valuable action of this formula in rectifying the
person's "center" to aid restoration of health. In the book, Confucius Lives
Next Door (11), T.R. Reid describes the term junzi this way:
It is written with two characters that mean royal [jun] and
person [zi]. This tells us that traditionally junzi referred to
a prince, an aristocrat, someone who obtained a position of
stature and power through birth. Confucius accepted the
basic principle that certain people have the right to hold
elite positions, but then he completely changed the rules for
joining the ranks of the elite. To Confucius, the junzi-the
term has been variously translated as "the noble man," "the
superior man," the "gentleman"-was a person who had
earned elite status. To be a gentleman, a person had to
spend a lifetime studying and following the rules of
virtuous conduct. Just being born right was not enough.

Confucianism laid the way for the development of Taoism by emphasizing

the character of the ideal man. However, Confucianism had the tendency to fall
into the nature of a legalistic approach, where one followed certain rules of
behavior, but did not necessarily have the inner nature that would lead to good
results, so the Taoists countered by proclaiming freedom from such rules,
emphasizing the cultivation of the ideal inner condition in harmony with nature.
Confucianism itself appears to have arisen as a move away from an earlier belief
system in which a heavenly god ruled over humans. Thus Confucius shifted the
burden of moral behavior to the set of rules, particularly about social and family
relationships. In recent times, the influence of Confucianism on society was
best seen in Japan, where it had been introduced from China around the
12th Century.

References

1. Wu JCH (translator), Tao Teh Ching, 1961 St. John's

University Press, New York, NY.
2. Kwok, MH, Palmer M, and Ramsay J, The Illustrated Tao
Te Ching, 1994 Barnes and Noble Books, New York, NY.
3. Feng GF and English J, Tao Te Ching, 1972 Vintage Books,
New York, NY.
4. Porter B (aka Red Pine), Lao-tzu's Taoteching, 1996
Mercury House, San Francisco, CA.
5. Henricks RG, Lao-Tzu Te-Tao Ching: A New Translation
Based on the Recently Discovered Ma-Wang-Tui Texts,
1989 Ballantine Books, New York, NY.
6. Hinton D, Chuang Tzu: The Inner Chapters, 1997,
Counterpoint, Washington D.C.
7. Kohn L, Early Chinese Mysticism: Philosophy and
Soteriology in the Taoist Tradition, 1992 Princeton
University Press, Princeton, NJ.
8. Porter B, Road to Heaven: Encounters with Chinese
Hermits, 1993 Mercury House, San Francisco, CA.
9. Hua-Ching Ni, Hua Hu Ching: The Later Teachings of
Lao Tzu, 1995 Shambhala Publications, Inc., Boston, MA.
10. Kohn L, Early Chinese Mysticism, 1992 Princeton
University Press, Princeton, NJ.
11. Reid TR, Confucius Lives Next Door, 1999 Random House,
New York, NY.
 Chapter 3
Emotional Equilibrium
Relax, Be Healthy, Have a Long Life
Emotions often seem to behave like the weather: somewhat unpredictable and
beyond control. In the West, there has been considerable concern about the
social and relationship problems associated with pent-up emotions (particularly
in women) and with habitual non-expression of emotions (particularly in men),
so that the very concept of "controlling" emotions is looked upon with
suspicion. By contrast, keeping emotions within certain reasonable bounds is
an issue at the forefront of Asian religions and healing arts; the primary concern
there is adopting habits that help one to remain relatively calm. When
tranquility of mind is attained, emotions do not vanish: they are still experienced
and expressed, and emotions remain unpredictable, but their intensity is usually
lessened and their potential impact on both physical and mental health is
curtailed. The emotional equilibrium that is desired by the Asian philosophy
translates to spiritual freedom and the ability to flow with nature, as described
in the previous chapter. Many people today have looked to Asia for help in this
area, though too frequently the simple methods advocated there are ignored,
with more interest shown in those methods surrounded by mysticism.

This subject of emotional calm has been an important topic in the field of
Chinese medicine. Based on a long history of seeking good health and
longevity, there are specific means of attaining balance and harmony for
emotions that have become incorporated into the Chinese culture, at least for
those who show interest in it. An example of the Chinese approach to having a
healthy emotional life is presented in The Mystery of Longevity by Liu Zheng
Cai (1):
The Canon of Medicine (Nei Jing) advises, in summing
the experiences of centenarians in remote times: 'Do not be
weighed down by perplexing thoughts; strive to be calm
and optimistic; be complacent [calm in the face of
situations that can cause anger]; keep sound in body and
mind. This way, one can live to the age of 100.' The Canon
of Medicine recognizes that emotional and psychological
factors are important causes for illness. It indicates that
excessive emotion impairs the internal organs of the human
body. 'Anger hurts the liver, joy hurts the heart, brooding
hurts the spleen, and melancholy hurts the lungs.' Hence, it
proposes regulating the emotions by 'keeping the heart
calm and cheerful and the mind free of worries.' 'Where can
disease come from when the emotional state maintains
inner composure?' Scholars on the art of healthy living in
 subsequent generations set forth many specific methods of
maintaining optimism in accordance with this principle.

A project of The All-China Association of Traditional Chinese Medicine

in the 1980s led to publication of the English-Chinese Encyclopedia of
Practical Traditional Chinese Medicine, published as a 20 volume set.
Volume 9 is dedicated to "Maintaining Your Health;" the first chapter begins
with mental health care, and the first section deals with "being open minded and
optimistic." The section is presented here; it represents an overview of the
traditional literature on the subject (2):
As the proverb goes, 'Optimism will help you forget
sorrow.' An optimistic stable mood and good mental
balance will calm the vital energy and spirit, aid the
circulation of blood and qi, and improve health. The ancient
book Guan Zi states, 'The quality of one's life depends on
maintaining a positive happy state of mind. Anxiety and
anger lead to confusion of the mind. There can be no mental
balance when anxiety, grief, joy, and anger exist. Thus,
desire should be subdued, and disorder be checked.
Happiness and luck will arrive on their own if there is no
disturbance of mind.' The book Nei Jing also points out
that one should strive for tranquility and happiness,
remaining free from anger, resentment, and troubled
thoughts. It indicates that by avoiding angry moods and a
troubled state of mind and by cultivating tranquility,
optimism, and happiness, one will obtain longevity with a
sound body which will not be easily degenerated and with
a sound mind which will not be easily distracted. The
book Huai Nan Zi advocates 'happiness and cheerfulness,'
which is said to be part of human nature. The book Zun
Sheng Ba Jian also maintains that to tranquilize the mind
one should have a happy mood. These statements indicate
that good health is always based on happy and tranquil
moods. To keep a happy mood, one must have a noble
spirit, high ideals, an expanded outlook, a sanguine and
lively disposition, and an open and broad mind. While
dealing with daily affairs and people, one must not be
disposed to feeling extremely depressed from personal
losses. As is said in the book Ji Zhong San Ji, 'Cultivate a
good temperament for the sake of mind; tranquilize the
mind for the sake of life; avoid emotional extremes and
adopt a care-free attitude.' If one can achieve such
equanimity, he will be safe from unnecessary worries and
enjoy an undisturbed mind and a sound body.
Also, to keep a happy state of mind, one should be able to
tackle a problem in a composed manner. As the book Sou
Shi Qing Bian says, 'Don't worry about a problem before
it has actually manifested don't worry too much after it has
existed, and don't cling to what has already passed; instead;
one should adopt a detached attitude towards coming or
going, leaving it alone and checking all emotions such as
anger, fear, desire, joy, and anxiety. That is the way to
health and longevity.'
Happiness lies in contentment, which is important not only
for physical and mental health, but also in keeping a happy
mood. The book Dao De Jing says, 'There is no sin greater
than discontent, and no error greater than covetousness.'
Therefore, knowing what contentment is means constant
satisfaction. The book Zun Sheng Ba Jian maintains,
'Contentment will bring neither abuse nor danger.' Both
statements express the ideal that lasting happiness can be
achieved only through contentment. In our actual life, most
anxieties and worries result from going after and coveting
fame, a higher status, and material comfort. In face of such
desires, one should always keep in mind: 'There are many
others who have less than I' In so doing, it will be easier for
one to refrain from excessive desire and competition, to
remain content with what one has, and to be cheerful and
open-minded, so that anxiety will be expelled, tranquility
of soul obtained, and the mind maintained in an optimistic
and stable state.
The self-cultivation of one's sense of morality is another
important method to maintain optimism, to which the
ancients paid great attention. They professed, 'The kind will
enjoy longevity.' The kind here mean all those who have a
well-developed sense of morality. The cultivation of
morality involves devoted attention. The methods
discoursed upon by the ancients, such as moderating
desires, remaining content, and being tolerant, kind and
courteous are all essential for that purpose. They also
believed: 'A person of great morality is sure to obtain
longevity.' The reason why such a person lives a long life
lies in the fact that he is 'apt to cultivate the great-qi', being
broad-minded and strong willed as well as having great
ideals and aims; meanwhile, those who respect others will
receive respect from others, and those who are content will
enjoy lasting happiness…all of these factors, together with
 tolerance and avoidance of anxiety, contribute to a
balanced mind and a cheerful mood.
One guarantee of maintaining an optimistic frame of mind
is to continuously enrich one's life by cultivating a great
variety of interests and hobbies, such as reading, meeting
friends, traveling, fishing, playing chess, practicing
calligraphy, painting, reciting poetry, singing, playing
musical instruments, watering flowers, growing bamboo,
etc. There are many discussions handed down from the
ancients, maintaining that such activities can bring on
cheerful mood and refine one's sensibility. The book Yi
Qing Xiao Lu says, 'One should always enjoy simple
pleasures such as sunshine in winter or shade in summer,
beautiful scenes on a bright day, walking cheerfully with a
stick, watching fish in a pond, listening to birds singing in
the woods, drinking a cup of wine or playing a stringed
musical instrument.' What is meant by this quotation is that
one should relax the mind, choose and cultivate one's own
hobbies, and increase continually one's interest in life so
that comfortable feelings, a stability of mind and
cheerfulness will result, all of which contribute to good
health and longevity.
In short, open-mindedness and optimism are important
principles in regulating the mind and in health care. As it
has been explained in the book Nei Jing: 'That is why the
sages did not concern themselves with purposeful actions.
They cultivated tranquility and developed emptiness of
mind. Their way of health care brought about a substantial
longevity.' This points out that those competent at health
care will not do anything they feel reluctant to do,
remaining free from whimsical and improper thoughts,
keeping a cheerful and happy mood, cherishing a rich
variety of interest, leading a tranquil and undisturbed life,
maintaining a mind which is relaxed, happy, open, and
optimistic, this contributes to longevity.

The book continues with some additional description and advice, with a
focus on being careful about desires, which cause disorder of the body and
mind, both in distracting one from essential tasks by trying to fulfill them and
causing one anguish if they are not fulfilled. Although not mentioned in the text,
Buddhism has been one of the dominant sources of the philosophy of
maintaining equanimity by controlling desires through practicing moderation
in living and meditation; Buddhism arose in response to Indian practices that
emphasized asceticism as an extreme method of overcoming desires.
 The advice about controlling emotions by calming the mind presented in
the Encyclopedia was further developed and described by Yuan Liren and Liu
Xiaoming of the Beijing College of Traditional Chinese Medicine as part of
their series of articles on health preservation published in the Journal of
Traditional Chinese Medicine (3). They refer to the "seven emotions" (qiqing)
which are first outlined here:
Chinese Term Typical Translation Terms
joy; also: happiness, excitement, pleasure,
Xi
elation
Nu anger; also: irritation
anxiety; also: over-thinking, pensiveness,
Si
brooding
You melancholy; also: sorrow, grief, worry, anxiety
Bei grief; also: sorrow, sadness
Kong fear
Jing fright; also: terror

Their description of the nature of emotions and their depiction of traditional

methods for dealing with the emotions is quoted here at length. It will be noted
that they have simplified and reduced the meaning of shen to mind, in keeping
with the modern Chinese avoidance of reference to spiritual matters:
In traditional Chinese medicine, all such concepts as
consciousness, feeling, and thought are referred to as shen,
meaning mind, which is considered to be stored in the heart
and to govern all the activities of the organism. Regulation
by the mind is necessary in all physiological functions. In
fact, the so-called three treasures [shen, jing, qi] are: mind,
essence (which constitutes the material basis of the human
body), and qi (which is the motive force of all life
activities). A sound mind is considered the basis of health
and longevity; similarly, scarcity of essence, deficiency of
qi, and weakness of mind are the main causes of illness and
aging. Since mind plays the role of governing life and
commanding all the physiological functions of the primary
internal organs and those of the rest of the body as well, it
is easily depleted or impaired. Hence, taking good care of
the mind is particularly important.
The activities of the mind can be classified into two kinds:
emotional and mental. The former refers to changes of
mood, known in traditional Chinese medicine as the seven
emotions, i.e., joy, anger, melancholy, anxiety, grief, fear,
and terror; while mental activities refers to consciousness
and thinking. Since the activities of the mind are the general
 responses of the organs in conforming with the outside
environment under the guidance of the heart, maintenance
of the mind is bound to involve many aspects, which
include roughly the following: preserving the tranquil
mind, easing the mind, and regulating emotions. A brief
account of these methods is given below.
Preserving a tranquil mind. Tranquil here refers to the
state of mind being peaceful, tranquil, free from excessive
desires and distracting thoughts, unaffected by outside
changes. Such a state of mind will harmonize the organs
and maintain a smooth circulation of qi and blood,
benefiting the health. This consists of the following
aspects:

1. Minimize egoism and personal desires: Excessive egoism and

unbounded desires tend to deplete one's mentality, causing
disharmony between qi and blood, and with the organs as
well, inviting disease, whereas, less egoism and desires helps
remove unnecessary mental burdens, enabling one to take a
calm and nonchalant attitude toward fame, wealth, and other
desires, hence, the mental qi will be preserved and health
protected. Here are two points that are essential. First, one
should be aware of the harmful effect of excessive egoism
and desires so that the mind may be rationally controlled in a
tranquil state; second, one should take a correct attitude
toward personal gains and losses. An ancient book
entitled Health-Preservation Skills Developed by Taishang
Laojun points out: 'Those who are expert at health
preservation will always first try to eliminate the six harmful
elements, namely: fame and profit, the desire for which
should be suppressed; the desire for sex, to which one should
not abandon oneself; wealth, for which one should not be
greedy; rich food, which one should not eat with abandon;
unrealistic fantasies, which should be got rid of, for they
distract one's thoughts from reality and are harmful to one's
mind; and jealousy, which should also be eliminated.'
Eradication of the above-mentioned six harmful factors has
since ancient times been considered essential for health
preservation and is therefore worthy of our attention.
2. Be broadminded in conducting oneself in society: When
faced with undesirable things and situations, one should be
broadminded and try to look on the bright side. In handling
various kinds of complicated problems and abrupt changes in
one's daily life, a stable state of mind and an optimistic
 attitude toward one's life is very good for preserving a sound
mind. This includes the following aspects: first, set a lofty
goal in life-health preservation requires first and foremost that
one should cherish hopes, love life, and keep a lofty goal, a
noble ideal, and sound morality, all of which guarantees for a
sound mind; second, be content and be happy, for it keeps one
satisfied with what one has, caring little about temporary
setbacks and failures, and this, in turn, will bring about both
physical and mental health.
Easing the mind. Moods are the responses of people to
their surroundings, and everyone experiences the seven
emotions and six desires [six harmful elements, described
above]. If not properly regulated, the emotions will cause
stagnation of qi and blood, and disharmony between the
organs, leading to illness, even early death. Those who
lived a long life, according to historical records, are almost
all people apt to regulate their moods, the essence of which
is to cultivate the mind with virtuous and elevated ideas and
mold the temperament. Various methods have been
developed and described by people in the past, which can
be boiled down to the following: creating a happy mood by
engaging in a great variety of carefree, light, and lively
activities in which spirit is heightened, intelligence is
increased, muscles and tendons are exercised, and
circulation of qi and blood is activated so that health
preservation is achieved in the midst of amusement and
sports, achieving the aim of nurturing the mind,
strengthening the body, and prolonging life. Some
traditional methods employed for this purpose include
taking up hobbies, such as playing the piano and chess;
raising flowers, plants, birds, or fish; sightseeing; and
chatting with friends.
Adjusting emotions. In one's daily life, the complicated
situation is bound to influence one's moods such as from
joy to anger, grief, etc. When one is in a bad or abnormal
mood, one should try to adjust and control it lest it go to an
extreme. As a mental means of health care, the following
methods are used:

1. Exercising self-control: Traditional Chinese medicine holds

that the seven emotions, i.e., joy, anger, melancholy, anxiety,
grief, fear, and terror, are, in the extreme, one of the main
causes of illness. Therefore, timely adjustment of one's
emotions with a view to preventing them from going to the
 extreme is an effective method of health preservation. Ever
since ancient times, experts in health preservation have
believed that anger is the chief pathogenic factor, for great
anger may impair the liver and also affect the heart, stomach,
and brain. Hence, control of anger is an important method of
adjusting the emotions. The essence is to control emotions by
rational reasoning, that is, to cultivate one's morality, train
one's will, consciously control one's mood, and overcome
emotional impulses with reason. As the ancients put it: 'When
faced with something exasperating, one should calmly
consider which is more important-anger or health?' This
comparison will enable one to gradually eliminate anger.
2. Providing outlets for anger. This is to help regain one's
psychological balance by finding proper outlets for
detrimental emotions accumulated in one's mind. This method
can be explained in three parts. First, direct release: When
one is in great sorrow, he should have a good cry so that he
may feel comfortable after his sorrow has been fully given
vent to. This is a measure beneficial to health care; it helps
regulate the circulation of qi and blood and, consequently,
prevents depression. Other measures are: a loud cry when in
great pain; a thorough pouring out of one's heart when in
great anger; a deep sigh or moan when worried; or hearty
singing when in great joy. Different forms of expression are
used for different emotions, all to restore the mind to a
peaceful and tranquil state. Second, there is controlled
release: in contrast to direct release, this measure stresses a
controlled and gradual release of pent-up emotion in one's
mind when in bad moods. For instance, one may confide in
relatives or good friends the bitterness or grievance, or
express feeling by saying poems or writing articles. The
advice and consolation of one's relatives and friends and the
release of emotion will enable one to acquire psychological
comfort and support, broaden the mind, and finally become
happy and at peace. This is a good method for eliminating
detrimental emotions. Third, there is the method of diverting
one's attention. This is also known as diverting one's emotion,
that is, changing the focus of excitation, the principle of
which is to free a person from entangling emotions by taking
certain measures to separate oneself from harmful stimulating
factors....For instance, when in great distress or depression,
one may listen to a favorite piece of music or when one is in
great sorrow following some misfortune, one may stay with
relatives or good friends for a period of time; the change of
 surroundings and atmosphere may divert bitter emotions,
allowing one to restore normal life after calming the mind. Or
when one is afflicted by troubling thoughts, one may take a
walk so that the surroundings of nature may relax and refresh
the mind, and thinking ability will be restored.

This summation by Yuan and Liu shows that one should respond promptly
and effectively to emotional distress rather than allowing the emotions to
manifest over a period of time and thus damage the whole person, and should
cultivate habits and thought patterns that help one avoid frequent experience of
emotional excess.

Shi Tianji, a scholar on the art of healthy living in the Ming Dynasty,
proposed 'Six Always' for maintaining a calm and cheerful state of mind,
relayed in the book The Mystery of Longevity (1):

1. Always be peaceful in mind. Remain peaceful in mind

without vain hopes. Do not covet, do not indulge in vain
wishes, do not worry about personal gains and losses. Hence,
Shi Tianji said, 'If one has few desires, his mind will naturally
be peaceful. Just look at secluded hills and remote valleys!
Most people there enjoy long life spans because they have
few desires and always remain peaceful in mind.'
2. Always be kind-hearted. A kind-hearted person often takes
pleasure in helping others and has no desire to harm others.
Whenever he conceives an idea, makes a remark, or does a
deed, he always ponders whether it is beneficial or harmful to
others. 'When others are evil, I remain upright; when others
are vicious, I remain kind-hearted; when others stir up
troubles, I strive to alleviate troubles; when others harm
people, I serve people. If I act in this way, I shall have a clear
conscience and naturally feel calm and tranquil in mind.'
3. Always uphold justice. Distinguish between evil and virtue
and between right and wrong. Virtue and evil are
antagonistic, and right and wrong are not to be confused. If
one maintains his awareness, upholds integrity, and remains
clear-headed and sharp-eyed, he will naturally be free from
worries and troubles. Hence, Shi Tianji said, 'When the sun
shines in the sky, obscurity is naturally cleared away. When
one grasps this miraculous concept, he will be cured of
disease and attain longevity as well.'
4. Always be cheerful. Adapt to different circumstances; feel
complacent at all times; avoid overdoing anything and do not
 hurt anyone's feelings. As Bai Juyi says in a poem: 'Be
cheerful, whether rich or poor; he who does not laugh can
only be a fool.' One should often have hearty laughs. A folk
saying goes, 'A good laugh makes one ten years younger;
worry turns the hair gray.'
5. Always be pleasant. Harmony is paramount in human
relations. Be amiable, modest and prudent, broad-minded and
magnanimous; do not be calculating and do not worry about
trifles. To be amiable in dealing with others will bring
happiness to both the others and oneself.
6. Always be contented: it is a rare person who avoids all
adversity. One should remain cheerful despite adversities.
Yan Feitai had a wise epigram on caring for life. 'Just step
back to think everything will naturally be all right.'
'Contentment is happiness.' Whenever this is adversity,
compare it with a worse circumstance and one will feel calm
and cheerful.

Thanks to the availability of translated books, and to documents such as

those quoted here, Westerners have relatively easy access to these Oriental
traditional systems of dealing with emotions; additionally, they have other
means of dealing with emotions, including their own religious heritage and
established psychological aids.

In modern Chinese work, doctors specializing in cancer therapies often

comment about their sense that emotion contributes to the health status of the
patients, affecting the outcome of treatment, which is life or death. For example,
Sun Binyan writes in his book Cancer Treatment and Prevention (4):
According to our understanding of the tumor patient, most
have suppression of the emotions. They tend to hold in their
anger. Although some patients have good results after
treatment, emotional stimulation may cause them to decline
again and then the previous treatment would have been in
vain. Some people have a severe phobia about cancer.
Before they know the real disease, they have a lot of
suspicion. Once they know they have the cancer, their
whole spirit breaks down. This kind of spiritual state is very
bad for the treatment.

Pan Mingji, in his book Cancer Treatment with Fu Zheng Pei Ben
Principle (5), presents a section on etiology of cancer; he notes that (5):
A lot of evidence proves that those who are optimistic and
undertake exercises [in China, this refers mainly
 to taiji and qigong, along with similar types of practices, as
well as hiking in the woods] tend to have healthy and sound
function of the nervous system, strong physiques, and
naturally great anticancer ability and immunity. Even if
those people come into contact with outside carcinogens,
they will not develop cancer. On the contrary, those who
have mental injury, who are disheartened, or often have a
fear of cancer, and who do not undertake exercises at all or
are overtired, whose daily life is irregular and unsanitary,
whose spirit and nerve function is disorganized, tend to
reduce their defensive ability. As a result, the rate of cancer
occurrence among those people is higher.

References

1. Liu Zheng Cai, The Mystery of Longevity, 1990 Foreign

Language Press, Beijing.
2. Xu Xiangcai (chief ed.), The English-Chinese Encyclopedia
of Practical Traditional Chinese Medicine, (Vol. 9) 1989
Higher Education Press, Beijing.
3. Yuan Liren and Liu Xiaoming, Health preservation by mental
means, Journal of Traditional Chinese Medicine 1993; 13(2):
144-147.
4. Sun Binyan, Cancer Treatment and Prevention, 1991
Offete Enterprises, San Mateo, CA.
5. Pan Mingji, Cancer Treatment with Fu Zheng Pei Ben
Principle, 1992 Fujian Science and Technology Publishing
House, Fujian.
 Chapter 4
Acupuncture Points
Acupuncture Points for Treatment of Shen Disorders
Practitioners of acupuncture are already familiar with the principle points
indicated for shen disorders as a result of their basic training in the field as well
as information gleaned from a variety of published reports. In addition, within
a short time of developing a practice, acupuncturists may come to prefer using
certain points based on both theoretical considerations (the meridian affected,
the indications for the point, etc.) and prior experience. There are quite a few
such points, so the purpose of this chapter will be to examine some aspects of
their utilization in China in order to give further insights to practitioners. In
modern Chinese reports, treatment of shen is frequently described as treatment
of the mind, or even of the brain, but this should not distract from the meaning
of shen as spirit, described in Chapter One. Points used for one condition, which
might be deemed a spirit disorder, might also be used for another condition, one
attributed to a physical brain disorder. Even though the treatments might be the
same, it is not necessarily the case that the two disorders have the same
underlying basis.

Some acupuncture points were named for their effect on shen disorders,
such as shenmen (HT-7), shenting (GV-24), shentang (BL-24), shendao (GV-
11), shenzhu (GV-12), benshen (GB-13), and sishensong (M-HN-1). So, these
are often included today as part of a treatment based on traditional indications
for the points.

In this chapter, following a description of methodology for the source

documents (which are Chinese medical journals except one Japanese medical
journal reporting on a Chinese source), the acupuncture points of primary
interest are laid out in tables. Because of the large number of points mentioned,
the reader might easily be overwhelmed by this presentation. Therefore, as a
summary to this chapter, 34 key points are laid out in Table 5, grouped
according to the meridians.

Researchers at the Zhejiang Academy of Traditional Chinese Medicine

undertook an extensive review of traditional medical literature and determined
the acupuncture points most consistently relied on to treat disorders of the mind
and brain (1). That is, they searched for points (called, in their English
translation, "intelligence points") that were repeatedly mentioned in the
traditional literature for certain disorders, such as dementia, poor memory, and
loss of consciousness.

The authors said that they "read up all the literature on acupuncture before
the Ming Dynasty and most of the relevant literature of the Ming and Qing
Dynasties, and collected together 29 intelligence points." For each of the major
medical texts consulted, the authors present a listing of the points mentioned
that are relevant to treating mental conditions. For example, in the Huang Di
Ming Tang Jing, the points listed are tianfu (LU-3), lieque(LU-
7), neiguan (PC-6), ximen (PC-4), yongquan (KI-1), and youmen (KI-21).
They then determined the frequency of mention of the points among all the texts
in relation to treating certain conditions (see Table 1), yielding a total of 17
points mentioned in more than one text.

In addition to individual point recommendations, a few acupuncture

formulas listed in texts were examined. Frequency of reliance on individual
points within the numerous formulas yields a somewhat different result than
examining points specifically indicated for mind-brain disorders, since
formulas are constructed with main and secondary points as well as adjunctive
points. In the prescriptions, the main points mentioned (5 times or more)
were shenmen (HT-7), xinshu (BL-15), baihui (GV-20), and lieque (LU-7).
Two adjunctive points were mentioned at least 3 times: zusanli (ST-36)
and houxi (SI-3).

The International Acupuncture Training Centers and other organizations in

China, such as the Academy of Traditional Chinese Medicine, compiled an
acupuncture text: Chinese Acupuncture and Moxibustion (2), published in
1987. In the section on zangfu syndromes, there is a series of descriptions for
symptoms that are often associated with shen disorders, such as insomnia, poor
memory, heart palpitations, manic-depressive disorders, epilepsy, and
melancholia. The acupuncture points, which were presented in groups as main
points to be selected from, are presented in Table 2.

Shogo Ishino, at the Oriental Medicine Research Center of the Kitasato

Institute in Japan, reported on acupuncture treatment for senile psychic
disorders (3). As a main source text, he relied on the book Highly Valuable
Commentaries on Acupuncture and Moxibustion: Grand System of
Medical Classics on Acupuncture and Moxibustion, an encyclopedic
collection published in China in 1978. The points mentioned in that text are
listed in Table 3.

A Western textbook, A Manual of Acupuncture (4), presents summations

of uses of the acupuncture points. It includes an index of symptoms and diseases
with the list of indicated points. Table 4 presents the points mentioned in this
index for mind-brain disorders (some indications were combined in preparing
the table). In a few cases, particularly epilepsy and mania, there were so many
points listed in the index that there would be no benefit derived from examining
the collection, so a subdivision (e.g., childhood epilepsy from fright) is
presented when available.

The commonly mentioned points in the first four tables yields Table 5,
which presents the main acupuncture points utilized in treatment of mind-brain
disorders. Two "extra points," sishencong (M-HN-1) and yintang (M-HN-3),
have become popularized in recent years for treatment of mental disorders
though these points received relatively little mention in the literature reviews;
they are included in the table to more completely reflect current practice.

While there are only a few points for each of the channels represented, it is
evident that there is much emphasis on treating the back (along the spinal
column) and head to address mind and brain disorders. A large number of points
along the bladder channel and the governing vessel are mentioned in the
literature, even if most of those points are suggested only once or twice. The
governing vessel continues along the spine over the top of the head,
where baihui (GV-20) and sishencong (four points surrounding GV-20) are
utilized. This vessel continues over to the face where the extra point yintang is
located (between the eye brows) to the end of the channel at renzhong (GV-26).
Needling points along the spinal column and on the head,
including fengchi (GB-20), may provide a relatively direct means (proximate
treatment) of stimulating the central nervous system and affecting the brain.

Points on the arms and legs may well function via different mechanisms
than those associated with the spine and head, though it has been suggested that
the effects may still be mediated by stimulating regions of the brain, such as
affecting the amygdaloid nucleus when neiguan (PC-6) is needled (5, 6). There
is a collection of points listed in Table 5 that are located in the interval from the
wrist to the elbow, including three pericardium points, two heart points, two
large-intestine points, and the main lung point, lieque (LU-7); this grouping
extends to the hand with two more pericardium points. Another hand
point, hegu (LI-4) is frequently used as an adjunctive point in many modern
treatment protocols for these mind-brain disorders. Similarly, there is a group
of points on the lower leg, including two kidney points, three stomach points,
and two spleen points, and continuing to the foot with the liver points and one
more kidney point, yongquan (KI-1). These groupings of points may reflect an
ability to stimulate release of certain neural transmitter substances by applying
needles or moxibustion to specific peripheral regions of the body. The wrists,
hands, ankles, and feet are richly endowed with nerves that transmit fine details
as required for hand utilization and mobility (especially over uneven terrain).
Of the points listed in Table 5, very few points (e.g., two conception-vessel
points on the abdomen and tianfu (LU-3) on the upper arm) seem to diverge
from the pattern of treating the spinal column and head or treating the distal
portions of the limbs.

Table 1: Frequency of mention of an acupuncture point for the listed condition

in the comprehensive collection of traditional texts examined by the researchers
in Zhejiang (1). The points are listed according to total number of references,
in descending order (23 references for baihui for two disorders to only 2
references for dazhong for one disorder).
 Poor Loss of Deficiency of Deficiency of
Point Dementia
Memory Consciousness Spiritual Qi Heart Qi
Baihui (GV-20) 13 10
Xinshu (BL-15) 4 14
Zhongchong (PC-9) 7 7
Ximen (PC-4) 13
Lieque (LU-7) 12
Gaohuangshu (BL-
11
43)
Youmen (KI-21) 11
Neiguan (PC-6) 9 1
Tianfu (LU-3) 10
Shendao (GV-11) 9
Yongquan (KI-1) 8
Shenmen (HT-7) 4 2 2
Jiuwei (CV-15) 6
Juque (CV-14) 5
Quchi (LI-11) 4
Dacheng (SP-15) 3
Dazhong (KI-4) 2

Table 2: Main points listed for treatment of specified disorders in Chinese

Acupuncture and Moxibustion.

Insomnia shenmen (HT-7), sanyinjiao (SP-6), anmian (M-HN-54)

sishencong (M-HN-1), xinshu (BL-15), pishu (BL-20), zusanli (ST-36), shenshu (BL-
Poor memory
23), zhaohai (KI-6)
Palpitation xinshu (BL-15), juque (CV-14), shenmen (HT-7), neiguan (PC-6)
Depression xinshu (BL-15), ganshu (BL-18), pishu (BL-20), shenmen (HT-7), fenglong (ST-40)
Manic disorder dazhui (GV-14), fengfu (GV-16), shuigou (GV-26), neiguan (PC-6), fenglong (ST-40)
Epilepsy (during
shuigou (GV-26), jiuwei (CV-15), jianshi (PC-5), taichong (LV-3), fenglong (ST-40)
seizure)
Epilepsy (after xinshu (BL-15), yintang (M-HN-3), shenmen (HT-7), sanyinjiao (SP-6), taixi (KI-
seizure) 3), yaoqi (extra)
Differentiated into four categories (liver qi stagnation, transformation of stagnant qi into fire,
Melancholia stagnation of phlegm, and insufficiency of blood). Main point: taichong (LV-3), included in
three of four syndromes.

Table 3: Points listed in Highly Valuable Commentaries on Acupuncture

and Moxibustion for selected disorders. The points in the text were
differentiated according to whether the treatment should be acupuncture or
moxibustion or both, but this distinction is not presented here.
 tianjing (TB-10), shaoshang (LU-11), shenmai (BL-62), renzhong (GV-
Apoplexy 26), baihui (GV-20), fengshi (GB-31), dazhui (GV-14), jianjing (GB-21), jianshi (PC-
5), quchi (LI-11), zusanli (ST-36)
Unconsciousness zhongchong (PC-9), dadun (LV-1), baihui (GV-20)
gaohuang (BL-43), shendao (GV-11), ganshu (BL-18), burong (ST-
Melancholia
19), liangmen (CV-21)
Amnesia,
shenmen (HT-7), saling (PC-7), juque (CV-14), shangwan (CV-13), zusanli (ST-
absentmindedness,
36), jianyu (LI-15), feishu (BL-13), shenshu (BL-23), pishu (BL-20)
palpitations
renzhong (GV-26), baihui (GV-20), shenmen (HT-7), jinmen (BL-63), juque (CV-
Epilepsy 14), kunlun (BL-60), jinsuo (GV-8), yongquan (KI-1), shangwan (CV-
13), yanggang (BL-48), yintang (M-HN-3)
chize (LU-5), shenmen (HT-7), jianshi (PC-5), tiangjing (TB-10), baihui (GV-
Insanity 20), zhongwan (CV-12), chengshan (BL-57), fengchi (GB-20), quchi (LI-
11), shangwan (CV-13)

Table 4: Points listed for each of the specified disorders in the index to A
Manual of Acupuncture. Chinese point names (pinyin) are not included due
to large number of points listed.

LU-4, ST-23, ST-41, SP-1, SP-2, KI-1, KI-4, PC-4, PC-7, CV-19, plus other points for
Agitation
combined syndromes (e.g., with heat in the chest)
CV-14, ST-36, LU-10, KI-9, CV-8, GB-39, BL-18, KI-4, PC-8, LV-2, LV-13, KI-7, KI-1,
Anger
GV-12, CV-14, HT-5
Anxiety and worry BL-15, GB-39, KI-12, CV-12, LV-1, LV-5
Apprehension PC-5, PC-6, PC-8
Aversion to people
ST-37, ST-44, GB-17, CV-15
talking
Coma PC-8, GV-26, CV-1
Dementia HT-7, BL-15, KI-4
Depression HT-5, LV-5
Epilepsy, childhood
LU-7, SP-5, GB-13, GV-8, GV-12, GV-21
fright
LI-13, HT-7, HT-8, ST-7, PC-6, LV-5, GV-4, CV-4, plus other points for specific types
Fear and fright
(e.g., sudden fright)
Hallucination LI-5, LI-7, ST-40, ST-41, BL-10, BL-61, GV-12
Laughter, abnormal PC-7, PC-8, LI-7, GV-26, ST-40, HT-7, ST-36, LU-7, LI-5, SP-5, KI-7
Loss of
LU-11, LI-1, HT-9, SI-1, KI-1, LV-1, GV-15, GV-26, CV-6, CV-8
consciousness, stroke
Mad walking ST-23, SI-5, SI-8, BL-8, BL-9, LV-13, GV-19, BL-13
Madness BL-5, BL-9, BL-60, KI-1, KI-9, TB-10, TB-12, TB-13, GB-9 LV-2
Melancholy PC-4, LU-3, SP-5
LU-7, LI-11, HT-3, HT-7, BL-15, BL-43, KI-1, KI-21, KI-3, PC-5, PC-6, GB-20, GV-11,
Memory loss
GV-20, CV-14, M-HN-1, PC-6
Mental retardation KI-4
Ranting and raving KI-14, LI-7, ST-36, KI-9, TB-2, GV-12, LI-6
 LU-3, ST-36, SP-1, SP-15, HT-7, KI-6, PC-6, PC-7, PC-8, TB-10, LV-2, LU-10, HT-1, SI-
Sadness and weeping
7, GV-11, GV-20, HT-4, GV-16, HT-5, ST-41, HT-8, SP-7, GV-13, LU-5, BL-15, PC-9
LI-10, LI-15, ST-36, BL-15, BL-23, BL-40, PC-6, PC-8, PC-9, GB-2, GB-13, GB-15, GB-
Stroke
21, GB-40, LV-2, GV-16, GV-20, CV-4, M-UE-1, M-HN-1

Table 5: Summary of 34 main points relied on for mind and brain disorders.
The indications presented here are from A Manual of Acupuncture, selecting
only those conditions associated with mind and brain disorders. To be listed in
the table, the point had to be mentioned frequently in the literature cited above
(1-4) and/or in the medical reports (described in Chapter 5), and indicated for
several types of mind and brain disorder. taichong (LV-3) was added to reflect
modern applications of the point now often used in place of xingjian (LV-2);
similarly fengchi (GB-20) was added to this table because of the high frequency
of its use in modern practice. Some of the points, such as sanyinjiao (SP-9)
and zusanli (ST-36) are mainly added for tonification therapy, rather than being
chosen for specific effects on mind and brain disorders. Other adjunctive points
sometimes employed in formulas, such as the hand points hegu (LI-4)
and houxi (SI-3), are not included in the table because they have few indications
for mind and brain disorders and are not mentioned in the traditional literature
in that context, though they are used in modern practice.

Point Relation to Channels/Indications Related to Mind/Brain Disorders

GOVERNING VESSEL (GV)
Meeting point of the GV, LI, and ST channels. Sudden loss of consciousness, coma,
Renzhong (GV-26) childhood fright, stroke, mania-depression, epilepsy, inappropriate laughter, unexpected
laughter and crying.
Meeting point of the GV, BL, GB, TB, and LV channels. Dizziness, blindness, stroke, loss of
Baihui (GV-20) consciousness, epilepsy, fright palpitations, poor memory, lack of mental vigor,
disorientation, much crying, sanity, and crying with desire to die, mania.
Shenzhu (GV-12) Mad walking, delirious raving, seeing ghosts, rage with desire to kill people.
Shendao (GV-11) Sadness and anxiety, poor memory, fright palpitations, timidity, epilepsy.
HEART (HT)
Luo point of the Heart channel. Frequent yawning and groaning with sadness, vexation and
Tongli (HT-5)
anger, sadness and fright, depressive disorder, fright palpitations.
Shu, yuan, and earth point of the Heart channel. Insomnia, frequent talking during sleep, poor
Shenmen (HT-7) memory, mania-depression, epilepsy, dementia, mad laughter, insulting people, sadness, fear
and fright, disorientation, fright palpitations.
BLADDER (BL)
Shu point of the heart. Fright palpitations, poor memory, anxiety, weeping with grief,
Xinshu (BL-15) frightened and cautious, insomnia, excessive dreaming, disorientation, delayed speech
development, mania-depression, epilepsy, dementia, mad walking, stroke.
Gaohuangshu (BL-
Shu point of the vital region. Poor memory, insomnia, phlegm-fire mania, dizziness.
43)
KIDNEY (KI)
Jing and wood point of the KI channel. Epilepsy, childhood fright, dizziness, cloudy vision,
Yongquan (KI-1) agitation, insomnia, poor memory, propensity to fear, rage with desire to kill people,
madness.
 Luo point of the KI channel. Agitation, dementia, mental retardation, somnolence, propensity
Dazhong (KI-4)
to anger, fright, fear, and unhappiness, desire to close the door and remain at home.
Xi point of the yin linking vessel. Madness, mania, mania depression disorder, raving, fury
Zhubin (KI-9)
and cursing, tongue thrusting.
CONCEPTION VESSEL (CV)
Front mu point of the heart. Mania disorder, mania-depression, tendency to curse and scold
Juque (CV-14) others, ranting and raving, anger, disorientation, loss of consciousness, epilepsy, fright
palpitation, poor memory, agitation.
Luo point of the conception vessel. Epilepsy, mania, mad walking, mad singing, aversion to
Jiuwei (CV-15)
the sound of people talking, fright palpitations.
PERICARDIUM CHANNEL (PC)
Xi point of the PC channel. Agitation, insomnia, melancholy, fear and fright of people,
Ximen (PC-4)
insufficiency of spirit qi, epilepsy.
Luo point of the PC channel. Fright palpitations, insomnia, epilepsy, mania, poor memory,
Neiguan (PC-6)
apprehension, fear and fright, sadness, loss of memory following stroke.
Shu, yuan, and earth point of the PC channel. Insomnia, epilepsy, mania, manic raving,
Daling (PC-7)
propensity to laugh (without ceasing), agitation, weeping with grief, sadness, fright, and fear.
Ying and fire point of the PC channel. Loss of consciousness, epilepsy, mania-depression,
Laogong (PC-8)
fright, sadness, propensity to anger, apprehension, ceaseless laughter.
Jing and wood point of the PC channel. Stroke, loss of consciousness, night crying in
Zhongchong (PC-9)
children.
LUNG CHANNEL (LU)
Window of heaven point. Somnolence, insomnia, sadness, weeping, disorientation and
Tianfu (LU-3)
forgetfulness, ghost-talk, melancholy, crying.
Luo point of the LU channel. Stroke, epilepsy, fright, loss of consciousness, poor memory,
Lieque (LU-7)
palpitations, propensity to laughter, frequent yawning and stretching.
STOMACH CHANNEL (ST)
He and earth point of the ST channel. Mania-depression, manic singing, raving, abusive talk,
Zusanli (ST-36)
anger, fright, tendency to sadness, outrageous laughter.
Luo point of the ST channel. Dizziness, plumpit qi, mania-depression, mad laughter, great
Fenglong (ST-40) happiness, desires to ascend to high places and sing, discards clothing and runs around,
restlessness, seeing ghosts, indolence, epilepsy.
Jing and fire point of the ST channel. Epilepsy, mania, agitation, sadness and weeping, fright
Jiexie (ST-41)
palpitations, raving, seeing ghosts.
SPLEEN CHANNEL (SP)
Jing and metal point of SP channel. Mania-depression, agitation, excessive thinking,
Shangqui (SP-5)
propensity to laughter, nightmares, melancholy, fright, stroke.
sanyinjiao (SP-6) Meeting point of SP, LV, and KI channels. Heart palpitations, insomnia, fright, dizziness.
GALLBLADDER CHANNEL (GB)
Meeting point of the GB and TB channels. Dizziness, stroke, insomnia, loss of memory,
Fengchi (GB-20)
epilepsy.
LIVER CHANNEL (LV)
Ying and fire point of the LV channel. Propensity to anger, sadness, propensity to fright,
Xingjian (LV-2) closes eyes and has no desire to look, excessive fright, propensity to fear as if seeing ghosts,
madness, insomnia, epilepsy, loss of consciousness, stroke.
Shu, yuan, and earth point of the LV channel. Dizziness, childhood fright, sighing, insomnia,
taichong (LV-3)
easily fearful.
Luo point of the LV channel. Plumpit qi, depression, fright palpitations, fear and fright, worry
Ligou (LV-5)
and oppression.
LARGE INTESTINE CHANNEL (LI)
Wenliu (LI-7) Xi point of the LI channel. Tongue thrusting, frequent laughter, raving, seeing ghosts.
He and earth point of the LI channel. Manic disorders, poor memory, tongue-thrusting,
Quchi (LI-11)
dizziness.
EXTRA POINTS
Sishencong (M-HN-
Stroke, epilepsy, manic-depression, insomnia, poor memory.
1)
Yintang (M-HN-3) Fright, insomnia, agitation, restlessness.

References

1. Chen Yongcan and Yang Meiling, Literature research on

screening of the nucleus acupoints for treating of intellectual
disturbances, Journal of Traditional Chinese Medicine 1999;
19(2): 83-88.
2. Cheng Xinnong (chief editor), Chinese Acupuncture and
Moxibustion, 1987 Foreign Languages Press, Beijing.
3. Shogo Ishino, Treatment of senile psychic disorders with
acupuncture and moxibustion, International Journal of
Oriental Medicine, 1999; 24(3): 149-154.
4. Deadman P and Mazin AK, A Manual of Acupuncture,
1998 Journal of Chinese Medicine Publications, East Sussex,
England.
5. Lai Zhongfang, Effect of electro-acupuncture of neiguan on
spontaneous discharges of single unit in amygdaloid nucleus
in rabbits, Journal of Traditional Chinese Medicine 1989;
9(2): 144-150.
6. Lai Zhongfang, Role of amygdaloid nucleus in the correlation
between the heart and acupoint neiguan in rabbits, Journal of
Traditional Chinese Medicine 1991; 11 (2): 128-138.
7. Gu Shizhe, et al., Four acupuncture methods for treating
mental disorders, Journal of Traditional Chinese Medicine
2001; 21(3): 207-210.

APPENDIX: General Methods of Acupuncture Treatment for Mental

Disorders
At the Beijing University of Traditional Chinese Medicine, a group of
acupuncturists described the basic approach to mental disorders by dividing the
treatment strategies into four categories (7). One of these is psychological
intervention, mainly talking over an appropriate view of life situations; this can
be accompanied by acupuncture points used to calm the mind. Another method
was treating the root and manifestation (ben and biao) aspects of internal
disharmonies relying on body points, particularly those meeting points as
the shu, yuan, luo, he, and xi points. A third type involved enhancement of the
zangfu functions, and regulating the ascending and descending qi; among the
recommended points were taichong (LV-3) and neiguan (PC-6) that are
commonly selected for mental disorders. The most specific therapy, though,
was use of points mainly on the head, with particular attention to the Governing
Vessel points (from GV-14 through GV-24), sishenshong (M-HN-1), and the
Gallbladder Vessel points shuaigu (GB-8) and tianchong (GB-9). These
methods, and some of the sample points suggested for treatment, are outlined
in the table below.

Table 6: Four Acupuncture Methods for Mental Disorders.

sishensong (M-HN-1), benshen (GB-13), shenting (GV-24), dazhui (GV-

Points of the head area
14), baihui (GV-20), fengfu (GV-16), shuaigu (GB-8), tianchong (GB-9)
spleen: gongsun (SP-4), neiguan (PC-6), zhongwan (CV-12), fenglong (ST-
40), tianshu (ST-25); liver: shanzhong (CV-17), zhangmen (LV-13), taichong (LV-3),
Regulating zangfu organs
zulingqi (GB-41); liver/kidney: taichong (LV-3), xingjian (LV-2), zhaohai (KI-
6), ganshu (BL-18), shenshu (BL-23).
Treating root and branch rely on shu, yuan, luo, he, and xi points
Psychotherapy with shenmen (HT-7), saling (PC-7), juque (CV-14), shangwan (CV-13), zusanli (ST-
acupuncture 36), jianyu (LI-15), feishu (BL-13), shenshu (BL-23), pishu (BL-20)
 Chapter 5
Acupuncture Treatment Protocols
Acupuncture Protocols for Shen Disorders
The effective points described in Chapter 4 are combined in various patterns to
yield treatments for particular shen disorders and to meet the requirements of
individual patients. In the majority of cases, it can be said that shendisorders
are treated by a combination of local points (that is, points of the head and neck,
especially GV-20 and sishencong at the top of the head, GV-14 and GV-15 at
the neck- where the meridian enters the brain; and GV-23 and GV-26 at the
face) plus distal points, with a focus on points of the wrist/hand and ankle/feet.
Presented here are some point groups from published reports of treatments
proclaimed effective.

Protocols: Treating Children

Disorders of the mind and spirit frequently appear early in life. Today, it is
suggested that these are caused by genetic defects, by early trauma to the head
or nervous system, or exposure during the neonatal months or early infancy to
chemical or other influences that may cause changes in brain function.
According to traditional Chinese medicine, the inborn problems are said to be
due to essence deficiency, while the other potential causes are basically the
same as described in modern medicine, even though they may be visualized
differently.

The modern Chinese medical literature includes a number of reports of

treating children with acupuncture. This approach may not be easily applied in
the West, because both children and their parents are less likely to be willing to
participate in pediatric needling as a therapeutic method. However, the point
selection should be informative in guiding practitioners seeking to treat
disorders either in children, young adults, or adults. Thus, the following
presentation is especially focused on the point selections.

Patients with childhood epilepsy (ages 5-16 years) were treated to control
symptoms immediately (effects of acupuncture reported to occur within 10
minutes) at the Hospital for Mental Diseases in Anhui Province (1). Treatment
involved the following collection of points as the main ones from which
selection was made: renzhong (GV-26), baihui (GV-20), yintang (M-HN-
3), fengchi (GB-20), jianshi (PC-5), daling (PC-7), shenmen (HT-7), hegu (LI-
4), guanyuan (CV-4), fenglong (ST-40), sanyinjiao (SP-6), yongquan (KI-1),
and taichong (LV-3). Treatment surrounding baihui was done by threading the
needles, somewhat like the method of scalp acupuncture. The author reported:
"We found the method very effective in treatment of neural and psychic
diseases." The physicians also used blood letting at the fingertip points
(shixuan, M-UE-1).
 A study of acupuncture for pediatric cerebral palsy was reported by the
Children's Hospital at Shanghai Medical University (2). The 117 children
treated were 10 years and under, mostly in the range of 3-7 years. The main
points selected were yamen (GV-15), dazhui (GV-14), fengchi (GB-
20), shenshu (BL-23), neiguan (PC-6) and zusanli (ST-36). Auxiliary points
could also be added. Injection of fluids (glutamine solution or a combination of
blood vitalizing herbs) into the head points was used. Significant improvement
was claimed for just over half of the patients. The authors pointed out that the
points shenshu and zusanli were selected to tonify the kidneys and benefit the
marrow (brain).

Several of the points were treated by acupuncture through to a nearby point,

such as neiguan through to waiguan, or hegu through to houxi. The authors
claimed that all patients were cured by the treatment, though the condition
recurred in 11 cases of 53, which could then be controlled by 1-2 courses of
treatment (a course lasted one week to one month, depending on the patient,
with daily acupuncture).

Tourette's syndrome in children aged 6-15 was treated at the affiliated

hospital of the Tianjin College of Traditional Chinese Medicine (3). The
patients were divided into two groups depending on whether they were
classified as having yangming stagnant heat (66 of the patients), in which case
the main points used were neiting (ST-44), quchi (LI-11), pianli (LI-6),
and sibai (ST-2), or if they had deficiency of kidney and heart (90 of the
patients), in which case the main points used were yamen (GV-
15), lianquan (CV-23), shenmen (HT-7), and fuliu (KI-7). According to the
report, 73% of the 156 patients were relieved of the syndrome with ability to
terminate previous medication.

Mental retardation in children aged 8-14 was reported by the Institute of

Acupuncture at the Academy of Traditional Chinese Medicine (4). Three
groups of acupuncture points were selected and each group was applied once
every other day during the course of a month, followed by the second group the
second month and the third group during the third month:
baihui (GV-20), sishencong (M-HN-1), shenmen (HT-7), and taichong (LV-
3);
fengfu (GV-16), shangxing (GV-23), tongtian (BL-7), daling (PC-7),
and kunlun (BL-60);
scalp points in the scalp acupuncture zones, neiguan (PC-6), and zhaohai (KI-
6).

The effects of treatment were relatively modest, with 9 of 128 cases

showing marked effect, but any improvement that was noted (about 2/3 of cases
had some improvement) appeared to be retained over the follow-up period of
one year. Regarding the selection of points, the authors stated:
Since the lesion of mental retardation is in the brain, the
acupoints in the head and neck regions are selected for its
treatment. The governing channel goes into the medulla
and brain as the sea of yang channels, and the bladder
channel goes into the brain from the top. Besides the mental
and physical development of children are also related to the
heart, kidney, and liver, so effective acupoints on the
governing, bladder, heart, liver, and kidney channels are
selected for regulating the visceral functions to promote the
brain functions.

Protocols: Depression, Neurosis, Schizophrenia, and Other

Disorders in Adults
The use of the group of points surrounding baihui (GV-20),
called sishencong (M-HN-1), was the subject of a report from the Hospital of
Scalp Acupuncture in Anhui Province (5). Six cases were cited as examples of
successful protocols, including headache and Meniere's syndrome, and the
following that fit the subject of the current article:

 Schizophrenia: sishencong (M-HN-1), sanyinjiao (SP-6),

and taichong (LV-3);
 Neurosis: sishencong (M-HN-1), renzhong (GV-
26), anmian (N-HN-54), neiguan (PC-6), sanyinjiao (SP-6),
and taichong (LV-3).

The points baihui plus sishencong were recommended by Ding Dezheng,

at the Department of Psychiatry at the Zhuji Health Centre, in Henan, who
reported on his experience treating various mental diseases (6). He noted that
these points "raise the lucid yang and tranquilize the mind." He indicates them
especially for depressive psychosis manifested by sadness, worry, grief, sorrow,
and disinclination to life due to extreme sorrow.

Other acupuncture treatment strategies were also reported as useful. For

example, a study on treatment of schizophrenia, involving acupuncture and
herbs, was conducted at a hospital in Mongolia (7). Acupuncture was performed
with three groups of points, with one group treated each day consecutively, then
repeated. The point groups were:
renzhong (GV-26), shangxing (GV-23), neiguan (PC-6), and xuanzhong (GB-
39);
yintang (M-HN-3), hegu (LI-4), yanglingquan (GB-34), and taichong (LV-3);
baihui (GV-20), shanzhong (CV-17), quchi (LI-11), and yongquan (KI-1).
 Anxiety neurosis was treated at the Qindao Medical University using
acupuncture in 80 patients, some of which were young students (aged 18 or
over), but most were older workers, up to age 72 (8). The main points used
were zusanli (ST-36), neiguan (ST-25), taichong (LV-3), shenshu (BL-
23), mingmen (GV-4), and quchi (LI-11). Treatment was every other day for 10
treatments, with a break of 3-7 days before beginning another course of
treatment, up to 40 treatments. The therapy was reported to be highly effective,
with 55 of the patients showing obvious alleviation of symptoms.

Dementia due to traumatic injury to the head was treated at the General
Hospital of Chengdu (9). 32 patients were treated by acupuncture, which was
initiated one to three months after the traumatic event. Two main points were
used: shenmen (HT-7) and houxi (SI-3). It was reported that 15 of the patients
showed marked improvements after 20 daily acupuncture treatments.

Protocols: Senile Dementia and Depressive Psychosis in the Elderly

Senile dementia, the term often found in Chinese medical publications, has been
largely disposed of in modern medical practice, with the ability to distinguish
different causes, including Alzheimer's Disease, atherosclerosis (formerly:
vascular dementia), and stroke. Recent evaluations have indicated that some
degree of mental impairment is present in virtually all persons who pass the age
of 90. A summary of published acupuncture protocols is presented in the table
below.

Table 1: Summary of treatment methods and results for senile dementia from
translated Chinese medical journal reports published 1996-1998. Various
adjunct points were used for some patients.

Study Group and Outcome Measures

Main Points Used
Treatment Duration Claimed Results
Improved symptoms, mainly
40 patients aged 60-88; treated shenting (GV-24), shenmen (HT- vertigo, dizziness, headache,
every other day for 30 7), jianshi (PC-5), hegu (LI-4), zusanli (ST- palpitation, fidgets, and
treatments (10). 36), sanyinjiao (SP-6), taichong (LV-3) numbness of limbs. Improved
score on mental health exam.
26 patients aged 61-87; 10
shigou (GV-26), baihui (GV-20), dazhui (GV-
consecutive days treatment; 2 Mental state recovered in 9 cases,
14), fengchi (GB-20), neiguan (PC-
day break; total of 32-40 improved markedly in 11 cases.
6), taixi (KI-3), xuanzhong (GB-39).
treatments (11).
46 patients with history of Mental function assessments
cerebrovascular disease aged improved significantly; reduction
sishensong (M-HN-1), fengchi (GB-
53-80; 5 consecutive days of blood free-radicals. Short term
20), neiguan (PC-6)
treatment; 2 days break; total of marked improvement in only 2
35 treatments (12). cases.
fengfu (GV-15), dazhui (GV-
29 patients, aged 55-83; 28 14), neiguan (PC-6), shenmen (HT- Marked improvement in mental
consecutive days treatment; 7); hegu (LI-4), adjunct points: zusanli (ST- functions in 5 patients. Some
break of 3-5 days, then repeat 36), jiexi (ST-41), taichong(LV- changes in CT scan and blood
up to 5 times (13). 3), fenglong (ST-40), xinshu (BL- lipids (improvements).
14), ganshu (BL-18), and baihui (GV-20)
 The data in the table illustrates that the number of acupuncture treatments
is at least 30, and the frequency of treatments is daily or every other day, with
short breaks of 2 or more days between groups of daily treatments.
Improvements were noted in several measures for the patient groups overall;
marked effectiveness (substantial and obvious improvement) from the
treatment, usually did not involve more than one-third of patients.

Acupuncture was applied in the treatment of depression and psychosis in

older patients at the Institute of Mental Hygiene in Beijing (14). The patients
were aged 50-74 and suffered from conditions such as manic-depressive
psychosis, reactive psychosis, and neurosis. The treatment focused
on baihui (GV-20) and yintang (M-HN-3), using electroacupuncture
stimulation. Of 30 patients treated, it was claimed that marked effects were
observed in 19 (about 2/3). The claimed improvements were in depressed
mood, suicidal intention, anxiety, insomnia, and irritability, as well as
alleviation of some accompanying physical symptoms.

Post-stroke depression was treated at the Qiaoli Hospital of Traditional

Chinese Medicine in Zhuhai (15). A group of three needles was inserted along
the hair line, with one in the center at shenting (GV-24) and the others on either
side by about 10 cm, at benshen (GB-13). Additionally, three needles were
applied to wrist/hand on each side: neiguan (PC-6), shenmen (HT-7), and
laogong (PC-8). Adjunct points were used according to syndrome such
as qihai (CV-6), zusanli (ST-36), and sanyinjiao (SP-6) for qi and yin
deficiency, or the combination of fengchi (GB-20), taichong (LV-3),
and baihui (GV-20) for wind-phlegm disorder. The authors commented that:
The influence of depression on patients after stroke is
sometimes more serious than the functional disturbance of
the limbs and can impact the progression and prognosis of
stroke. Many antidepressant drugs produce several severe
side effects and the patients had difficulty tolerating those
therapies. The 'three intelligence needles' [scalp points] and
hand intelligence needles [forearm/hand points] are
frequently used for the treatment of post stroke disorders
and also for weak mental function in children by professor
Jin Rui at Guangzhou University of Traditional Chinese
Medicine. The intelligence needles at the head directly
impact the functional activity of the cerebral frontal lobe
and the mind and check the liver and calm wind. The hand
points are the important ones for treatment of mental
diseases: they can regulate the mental state, open orifices,
tranquilize the mind, clear the pericardium, and help sleep.
Acupuncture can improve the blood flowing in the brain or
can promote absorption of hematoma in the brain, leading
cerebral cells to be awakened and to gain recovery of
 functions, speeding up the repair of the injured brain
tissues. Acupuncture can also promote release of a large
quantity of serotonin in the brain and noradrenalin in the
spinal cord.

Protocols: Use of Renzhong with Neiguan

In recent reports on treatment of depression, anxiety neurosis, and other mental
disorders, emphasis has been placed on using the combination
of renzhong (GV-26) and neiguan (PC-6) with a small number of other points
to attain a positive response. Some treatments involving these two points were
already mentioned above.

An example is a protocol for depression after stroke, reported by Wang

Hairong at the Tianjin College of Traditional Chinese Medicine (16). There
were 140 patients treated, with 86 cases of infarction and 54 cases of
hemorrhage. Patients received acupuncture treatment every day for 2-3 courses
of treatment lasting 10 days per course. The main points treated
were renzhong (GV-26), neiguan (PC-6), shenmen (HT-7), and taichong (LV-
3). Secondary points were treated according to the basis of depression, such as
liver qi stagnation; qi stagnation transformed to fire syndrome; deficiency of
heart and spleen; or for accompanying mental disturbance. The authors
concluded that:

The present study has proved that acupuncture is very effective for treating the
depressive syndromes after cardiovascular accident, with a total effective rate
of 87%. Renzhong (GV-26) when punctured with the reducing technique may
bring back the consciousness, strengthen the brain functions, and tranquilize
the mind. Neiguan (PC-6) and shenmen (HT-7), when used in combination,
can nourish the heart, tranquilize the mind, improve the qi and blood
circulation, and remove the obstruction form the channels. taichong (LV-3) is
very important for promoting qi activities. In summary, the present
acupuncture treatment can regulate the functions of the nervous system, and
make a balance between the excitement and inhibition process of the cerebral
cortex.

A somewhat similar protocol was developed by a team from the Tianjin

College of Traditional Chinese Medicine that was invited to Germany to treat
patients with depression (17). The main points included renzhong (GV-26)
and neiguan (PC-6), with the additional head points shangxing (GV-
23), yintang (M-HN-3), and baihui (GV-20). Supplemental body points might
be selected according to particular syndromes defined by the traditional system;
thus for liver fire syndrome, taichong (LV-3), xingjiao (LV-2),
and fengchi (GB-20) would be added.

In a report on treatment of anxiety neurosis (18), the primary therapy

involved needling renzhong (GV-26), neiguan (PC-6), baihui (GV-20),
and sanyinjiao (SP-6). Additional points were used for specific symptoms; for
example, for those who had excessive display of emotionalism, several points
named for treatment of shen disorders were used: shishencong (M-HN-
1), benshen (GB-13), shenting (GV-24), shentang (BL-44), and shenzhu(GV-
12).

Supplementing Acupuncture Therapy

In China, needling is performed daily or every other day, and at least 30
treatments within a period of about two months is typical for a course of therapy
that leads to notable improvements in many, but certainly not all, of the patients.
The authors of some studies pointed out that acupuncture was not considered
sufficient by itself. In the above-mentioned report on anxiety-neurosis, the
authors pointed out that:
In the clinical treatment of melancholia, psychological
treatment can never be ignored. After listening attentively
to the patient and making analysis of the external and
internal causes, the doctor should try to help the patient find
out the psychological factor and tell the patient that this
disease is a functional disease and curable, in order to
encourage the patient to overcome psychological obstacles
and thus to raise the therapeutic effects.

In addition, herb therapies are often used for the patients, not only as an
adjunct to acupuncture, but as a follow-up after an intensive course of
acupuncture therapy has been completed. The use of herbs is complicated by
their apparent similarity to drugs. The next four chapters explore the concepts
that herbalists utilize in analyzing shen disorders and the commonly used herbs
and formulas.

References

1. Yang Jinan, Treatment of status epilepticus with acupuncture,

Journal of Traditional Chinese Medicine 1990; 10(2): 101-
102.
2. Shi Bingpei, Bu Huaidi, and Lin Liyu, A clinical study on
acupuncture treatment of pediatric cerebral palsy, Journal of
Traditional Chinese Medicine 1992; 12(1): 45-51.
3. Wu Lianzhong, Li Huimin, and Kang Ling, 156 cases of
Gilles De La Tourette's Syndrome treated by acupuncture,
Journal of Traditional Chinese Medicine 1996; 16(3): 211-
213.
4. Tian Lingdi, et al., Composite acupuncture treatment of
mental retardation in children, Journal of Traditional Chinese
Medicine 1995; 11(1): 34-37.
5. Liu Hechun, Illustrative cases treated by the application of
the extra point sishencong, Journal of Traditional Chinese
Medicine 1998; 18(2): 111-114.
6. Ding Dezheng, Personal experience in acupuncture treatment
of mental disorders, Journal of Traditional Chinese Medicine
2001; 21(4): 277-281.
7. Wu Fengqi, Treatment of schizophrenia with acu-moxibustion
and Chinese medicine, Journal of Traditional Chinese
Medicine 1995; 15(2): 106-109.
8. Liu Guizhen, et al., Observation on the curative effect of acu-
moxibustion plus systemic desensitization on anxiety neurosis,
Shanghai Journal of Acupuncture and Moxibustion 1998;
17(4): 17-18.
9. Zhang Anren, et al., Effect of
acupuncturing houxi and shenmen in treating cerebral
traumatic dementia, Chinese Journal of Integrated Traditional
and Western Medicine 1995; 15(9): 519-521.
10. Shen Weidong and Li Ding, A preliminary clinical study on
senile dementia treated by acupuncture and moxibustion,
Shanghai Journal of Acupuncture and Moxibustion 1996;
15(5): 5-6.
11. Yang Xiangtan, 26 cases of senile dementia treated with
acupuncture by resuscitation method, Chinese Acupuncture
and Moxibustion 1996; 11: 3.
12. Lai Xinsheng, et al., Analysis of near-term effect of
electroacupuncture in treating vascular dementia, Journal of
Traditional Chinese Medicine (Chinese) 1997; 38(6): 340-
343.
13. Liang Zhong, et al., 115 cases of senile dementia treated by a
combination of acupuncture and Chinese herb therapies,
Chinese Acupuncture and Moxibustion 1998; 12: 712-714.
14. Liu Guangzhi, et al., Electroacupuncture treatment of
presenile and senile depressive state, Journal of Traditional
Chinese Medicine 1992; 12(2): 91-94.
15. Liang Yue, Intelligence three needles and hand intelligence
needle applied to treat depression after cerebral apoplexy,
Shanghai Journal of Acupuncture and Moxibustion 1998;
17(2): 27.
16. Wang Hairong, Acupuncture treatment of depressive
syndrome after cerebral vascular accidents, Journal of
Traditional Chinese Medicine 2002; 22 (4): 274-275.
17. Zhang Chuanhong, Li Jinbo, and Wang Shu, Treatment of
melancholia in Germany by acupuncture method of
resuscitation, Journal of Traditional Chinese Medicine 2004;
24 (1): 22-23.
18. Zhang Hong, Zeng Zheng, and Deng Hong, Acupuncture
treatment of 157 cases of anxiety neurosis, Journal of
Traditional Chinese Medicine 2003; 23 (1): 55-56.
 Chapter 6
Xuedao Zheng, Baihe Bing, Meihe Qi
[blood course syndrome, lily disease, plum-pit qi]
Background
Before embarking on a description of herbs used in treating shen-disorders, it
may be helpful to examine some categories of illness that have been described
particularly in relation to herb prescribing. Although these have their origins in
ancient Chinese medicine, Japanese doctors have given more attention to them
in recent decades than the Chinese, so Japanese sources are frequently relied
upon for the descriptions. The disorders presented here are consistent with
various neurotic syndromes.

Practitioners offering natural health care services often encounter patients

who have, as part of their syndrome, a neurotic condition, characterized by
worry, lack of clarity, and inability to control their emotions sufficiently to aid
their health. They may present symptoms that are difficult to describe clearly,
with some symptoms that vary or that appear to present conflicting
characteristics (especially in terms of traditional Chinese categories such as
hot/cold, dry/damp, etc.), and they may have unusual responses to therapies that
have already been tried. Such patients are likely to have visited many
practitioners in the past and felt unsatisfied with both the diagnosis given and
the outcome of treatment. They usually display, upon further questioning, a
close linkage between emotional, behavioral, and health problems.

Such patients have been given (or are able to find on their own) non-
standard disease classifications, namely those that are not widely accepted in
the practice of modern medicine. These diagnoses include candidiasis, multiple
allergies, parasites, heavy metal or other toxicity, chronic fatigue syndrome,
leaky gut, and others for which standard testing procedures do not confirm the
disorder (though various alternative medicine methods may seem supportive).
Finding a culprit to blame the condition on, something separate from the
individual's emotions and behavior, is often deemed important. Thus, the
diagnosis may include reference to a toxin or parasite or rare infection, or an
impact from modern society, such as food additives, drugs, or environmental
pollutants. Yet, these attributions can be very misleading because, whether or
not they are present, they may have little to do with the symptoms.

A diagnosis for these patients such as "liver qi stagnation," "spleen

weakness," or "heart fire," may be given by practitioners of Chinese medicine.
These exotic terms do not carry the risk of labeling the condition with a term
that merely stimulates the emotional reactions to it (e.g., neurosis, hysteria, or
hypochondria). While the Chinese medical terms don't automatically convey
such concepts as neurotic hypersensitivity or chronic anxiety, Chinese writers
often translate the traditional terms in that way when producing translated text
books. There is no question among medical doctors in the West-and those in
the East-that physical problems exist in these patients; indeed, such patients
may have one or more standard medical diagnoses along with the unexplained
disorders. However, the patient also is recognized as having functional
disorders associated with psychological problems and with behavior patterns
that impair both physical and mental health. Doctors often find that sedative
and anti-depressant drugs provide a certain degree of relief for the patients,
though compliance with using the drugs is often poor because the patients worry
about taking them or fear the side effects.

It is not always possible to separate organic diseases from others that might
be termed psychosomatic, neurotic, or related to behavior and thought patterns.
As an example, the condition known as chronic fatigue syndrome has been very
difficult for medical researchers to study because there is such a diverse range
of physical and mental conditions that are presented by those who claim to be
suffering from it. Among them are persons who are simply depressed or living
an erratic lifestyle that brings about fatigue, and there are others who have some
kind of viral infection (or group of viruses) that may be identified as the culprit.
The infectious agents can wreak havoc on the immune system and cause fatigue
as a side effect, but so can emotional disturbances and the adverse effects of
certain activities and difficult experiences.

Chinese physicians have dealt with complex patients and difficult to

diagnose diseases, such as those depicted above, for many centuries. Examples
of relevant disease categories to be presented here include xue dao zheng (blood
course syndrome), baihe bing (lily disease), and meihe qi (plum pit qi). These
syndromes have an interesting underlying unity, which is the accumulation of
damp or phlegm-damp.

It is hoped that by presenting an overview of the way the Chinese have

interpreted such patterns and treated them, practitioners who prescribe Chinese
herbs as a part of their practice will be aided in both understanding and
developing therapeutic plans for the unusual syndromes. Specifically, instead
of veering off into a variety of alternative medicine explanations and
techniques, practitioners will find that such problems are amenable to the
traditional Chinese medical approach with a focus on herbs. Acupuncture
therapies that address these patterns are also potentially helpful.

Causes of Neurotic Complaints

Although there are many possible causes of complex disorders characterized by
neurosis, two appear especially common from the Oriental view, as presented
in the classical and modern literature:

1. Long-term irregularities in diet yield many systemic

disorders, starting with a disruption of the stomach/spleen
 system and then affecting each of the other organs to some
extent, partly because of primary deficiencies in their
nourishment and secondary accumulations of excess materials
(e.g., stagnant blood or fluids). Ultimately, the kidney essence
fails to be nourished and the individual becomes critically
weakened and subject to a variety of serious diseases,
including erratic activity of the immune system. A primary
outcome is that of the deficiencies of qi and blood is to allow
pathological influences from the outside to penetrate the
"empty" vessels; the deficiency of qi and kidney essence
allows internal organs to malfunction and body tissues to alter
into an unhealthy condition. As part of this pattern, the person
may become neurotic about eating and may suffer several
functional disorders that cause discomfort. The origins of this
problem might be traced to lack of appropriate parental
guidance or influences of people who have unhealthy habits.
2. Emotional distress causes a variety of dysfunctions and
contributes to a person's life being in a constant state of
upheaval and uncertainty. The emotional agitation adversely
affects the heart system, a key regulator for all the other organ
systems; it disturbs the sleep and causes one to use poor
judgment in regulating work and rest, and virtually all other
activities as well. The emotional disorders are sometimes the
result of frightful or other disturbing events during childhood.

The two causative factors-habits and emotions-often appear together, as

poor dietary habits can lead one to be emotionally unstable (by failing to nourish
the viscera, for example, therefore not allowing the inner "spirits" to rest), while
emotional distress inhibits the functions of the spleen/stomach system (for
example, excessive worry and anxiety impair the "transforming and
transporting" functions).

Thus, in many situations a reasonable starting point for making

improvements in a complex patient is by addressing the weakness of the
stomach/spleen. Food therapy can have a big impact on healing, with its main
effect being on the stomach/spleen. If a person cannot tolerate ingestion of
healing foods and herbs, then it will be difficult to apply the desired kidney
tonics, blood-vitalizing herbs, or other healing agents without getting adverse
reactions. Certainly, the gentle damp-dispersing agents, such as hoelen (fuling)
and atractylodes (baizhu) and the herbs that help moderate the severity of
potentially irritating herbs on the stomach, such as jujube (dazao) and licorice
(gancao), can usually be tolerated. Thus, the formula Si Junzi Tang is often
suggested (which has these herbs plus ginseng or codonopsis) Acupuncture may
be essential to reinvigorate the digestive system first, relying on points such
as zusanli (ST-36) and sanyinjiao (SP-6). If a person does not change from an
imbalanced diet towards a more balanced one (in relation to the disorder), it is
difficult to heal the body even when the proper herbal therapies are
administered and tolerated. Chinese dietary therapy for those with weak spleen
and stomach often incorporates rice with a small amount of cooked vegetables
and meat (it is only slightly more complex than that). A common error among
Western practitioners of Chinese medicine is to focus on elimination diets
(avoiding, for example, dairy, wheat, meat, etc.) rather than to focus on
nutritious diets.

The other starting point for complex problems is the heart system, to be
addressed by calming the spirit. This therapy is usually accomplished by
sedating hyperactivity associated with both the liver and heart systems (liver
disorders, particularly those involving liver fire, agitate the heart) and
nourishing deficiencies. When the spirit is calm, the emotions are not so
extreme, and the internal cause of disease, the unbalanced emotional responses,
is removed or reduced in its influence. Acupuncture is one of the important
therapies to address these concerns. Of special importance is neiguan (PC-6),
which helps calm the emotions and settle the stomach qi. Mild sedative herbs,
such as zizyphus (suanzaoren), biota (boziren), and albizzia (hehuanpi) can be
given to most patients.

There are some herbal formulas that address both the distress of the
digestive system and the lack of control of the emotions, which will be
described in the following chapters. But, it should be mentioned here that the
famous Licorice and Jujube Combination (Gancao Xiaomai Dazao Tang),
comprised of the two named herbs plus a type of whole wheat (xiaomai), is a
tonic for the stomach/spleen system and a sedative for the heart system. The use
of wheat as a remedy in China may well reflect its natural content of B-vitamins
that were lacking in some diets. In the book 100 Famous and Effective
Prescription (1), the traditional indications for this simple formula are reported
to include "frequent sad feelings, irritability, restless sleep, abnormal speech
and behavior in severe cases....," while its modern applications (in which the
formula is usually prepared with some added ingredients) include
"neurasthenia, hysteria, schizophrenia, menopausal syndrome, etc." Here, as in
many of the Chinese texts, menopausal syndrome refers mainly to the mental
distress experienced during menopause, more so than hot flashes, dryness, or
other physical symptoms. In the Shanghan Lun (2) and Jingui Yaolue (3) a
combination of ginger, licorice, and jujube was included in many of the
prescriptions to help enhance the effects of the key herbs of the formula. These
three herbs benefit the stomach and spleen system; jujube and licorice, two of
three herbs in the above-mentioned formula, also provide calming effects.
Licorice has the traditional indications of calming the spirit and treating
palpitation and melancholy (4).
 One of the most popular formulas for tonifying the stomach/spleen and
calming the emotions is Ginseng and Longan Combination (Guipi Tang); it
contains the ingredients of Si Junzi Tang. Guipi Tang will be discussed at some
length in the following two chapters. A variety of other methods, aside from
tonifying the stomach/spleen and calming the heart, have been applied in the
treatment of these complex disorders. One can attempt, for example, to
harmonize the circulation of qi and blood, get rid of obstructing accumulated
fluids, or clear agitational heat. Several such methods are to be described here.

Introducing Xue Dao Zheng

The term xue dao zheng means "blood course syndrome" (xue = blood; dao =
way, movement; zheng = pattern, syndrome; xue zhi dao is the general term for
blood course). The syndrome encompasses something different than what is
now termed blood stasis, and might best be described as the combination of qi
and blood stagnation combined with fluid accumulation.

The term xue dao first appears in the Chinese literature in chapter 75 of
the Lingshu (5), compiled over 2,000 years ago. There, it is said:
When food and drink cannot be regulated, and joy and
anger are not timely, this condition causes the ferrying of
liquids to overflow to the insides. These liquids then
descend and detain in the marshes [lower burner; affecting
the reproductive organs] making the blood paths to be
obstructed. Day by day this condition enlarges without rest.

When a person's dietary behavior is regular and the emotions stable, then
the blood will naturally flow freely, otherwise, the blood paths will become
obstructed. The condition can then continually worsen as the unhealthy daily
patterns persist. The disorder begins with the overflow of liquids (from their
normal path of movement through the triple burner system); as the description
continues, it is noted that: "This disease prospers with the accumulation of
water." Excess water is seen as a means of worsening obstruction (of qi and
blood circulation). The excess water is sometimes called shuidu, or water toxin.
Here, toxin implies a harmful condition (not necessarily something chemically
toxic); most often, water toxin manifests as edema, but the water can also be
hidden (lishui), obstructing without being seen.

Xue dao zheng mainly signifies obstructed or limited blood circulation that
occurs in the "blood chamber" (liver, uterus, and chongmai channel). Chen
Wuji stated that (6): "The blood chamber is called a chamber because, like a
room in a house, it is a place to linger. The body's blood chamber is the place
where the blood gathers and where all the channels and vessels convene, and
that is why it is referred to as the sea of blood." The sea of blood (xuehai) is a
term familiar to acupuncturists (the point xuehai, SP-10, is commonly used in
the treatment of uterine blood flow disorders, such as menstrual bleeding or
amenorrhea or postpartum blood stasis). It is also a designation for one of the
eight extraordinary channels, which is alternatively called
the chongmai (penetrating channel or thrusting channel). The sea of blood is
part of the liver network, involved with the storing of blood, affecting
menstruation and female sex hormones. The channel connects the lower
abdomen with the head. When there is emptiness or fullness or stagnation in the
lower warmer, the qi has a tendency to thrust upwards, or, as sometimes
translated to English, to "flush up." The result is symptoms in the head, such as
mental irritability, sweating of the forehead, tinnitus, or difficulty swallowing
(with nausea). As explained by Wang Bing (6):
The chongmai is the sea of blood: that is the place where
all of the channels convene. In males, the blood moves
from here, whereas in females it stays here, and this is why
this area is also called the blood chamber (xueshi).

The fact that the blood lingers in the blood chamber for women, but not
men, is one of the reasons why xue dao zheng mainly affects women. The blood
chamber can be afflicted by internal forces (the seven emotions) or by external
forces (e.g., wind and cold), or other conditions (neither solely internal nor
external, including infections, surgical interventions, and other damages,
leading to alteration in the circulation of qi and blood). In turn, blood course
syndrome can generate unfavorable mental symptoms that further complicate
the physical condition of stagnation.

Xue dao zheng is a syndrome that is now mentioned mainly in the modern
Japanese literature, rather than the Chinese literature. One of the primary
commentators on xue dao zheng and its treatment is the famous Japanese herb
doctor, Yakazu Domei. He first published an analysis of the syndrome in 1939.
In 1982, he published a revised article on this subject (7). Selected aspects of
that review will be discussed in this section, along with commentaries from
other sources.

Japanese doctors have speculated that, in modern terms, the hormonal

changes that occur with menstruation, pregnancy, and menopause, as well as
the effects of administered hormones and of induced abortion, can exacerbate
autonomic nervous system disorders, leading to the syndrome. Yakazu Domei
has suggested that there is a restored concern for the classically defined xue
dao syndrome:
Due to changing social conditions, there has been a marked
rise in disorders of this type. In fact, according to Dr.
Kuhuto's statistics xue dao zheng places second among
problems of out-patients. Its etiology is varied: genital
[uterine] abnormalities caused by artificial abortion, fear of
pregnancy, misuse of hormonal preparations, all of which
cause an imbalance of the autonomic nervous system.
 The concerns raised here can explain why there would be a new interest in
this syndrome: modern circumstances have replaced earlier causes of the
syndrome, which had previously been attributed to "wind" or "fever" or "cold"
entering the uterus, or to complications associated with childbirth.

When consulting the body of reports on this syndrome, one can detect a
certain level of annoyance that the physicians experience when trying to deal
with the patients. The patients themselves appear chronically dissatisfied and,
as in one description, are peevish (other characterizations: angry, jealous,
anxious, nervous). Further, they may be unresponsive to the medical
questioning or go on and on about their symptoms; even when they get better,
they may not recognize it and admit it. No doubt, the physicians would consider
that not only the disorder, but the patients themselves are "difficult" or
"complex."

Xue Dao Zheng As Neurosis

The modern description of xue dao zheng is often presented by the Japanese as
"erratic complaints syndrome," based on its manifestation rather than its cause.
Erratic complaints refers both to a multiplicity of problems and to the
complaints coming and going, with the patient being very sensitive to
environmental, dietary, and emotional influences.

In the article Clinical experience with women's erratic complaints

syndrome (8), it is reported that "most patients with this syndrome have a
nervous temperament...in some cases the symptoms go away, but the patient is
unaware of the improvement." In a list of 49 symptoms characteristic of
women's erratic complaints syndrome, the most common were: distention and
pain in the diaphragm region and hypochondrial region; nausea; blurring
eyesight; fatigue; itching; and late rising. In presenting three case histories of
women treated for the syndrome, the authors point out that "all three patients in
this study had had induced abortions....Many patients with this syndrome have
had induced abortions and/or gynecological surgery." Gynecological surgeries
affect abdominal blood flow and are performed frequently in modern times,
including Cesarean section for childbirth and hysterectomy for several
disorders (e.g., fibroids, unexplained uterine bleeding, and tumors). In a book
by Mizuno Takusai (1841 A.D.) it was mentioned that xue dao zheng includes
ailments preceding and following childbirth, as well as a variety of menstrual
irregularities.

Shyoshi Kuhuto, a modern practitioner in Japan quoted by Yakazu Domei,

has characterized the erratic complaints syndrome as follows (7):

1. In the same patient, many symptoms coexist; about 90% have

more than five symptoms.
 2. The symptoms are changeable and have nothing to do with
neurological structures.
3. The manifestation of symptoms is apt to be influenced by
environmental factors. For example, the symptoms frequently
appear on rainy or cloudy days or when living with an
unfriendly relative. They appear one day and disappear the
next or occur in the morning and disappear in the afternoon.
4. The symptoms reflect the emotional state or other mental
factors.
5. The patient can become angry easily, and yawns and stretches
a lot. They have a tendency to become upset even over trivial
things and cannot control their anger.

This description appears to fit neurosis. In the book Clinic of Traditional

Chinese Medicine (9), neurosis is described as follows: "The patients get
excited or fatigued easily, and are frequently accompanied with various forms
of somatic discomfort. It is more common in middle-aged females." Major
clinical manifestations are "insomnia, waking up easily, distractibility, poor
memory, emotion is easy to be changed, hypersensitivity, abdominal distention,
frequent urination, constipation, and belching." Of importance, the lack of
emotional control is evident; the person is hypersensitive and complains of what
would otherwise be considered trivial things or ordinary discomforts, such as
occur with weather changes or when consuming foods and meals that lead to
some uneasiness. Men can also suffer these conditions, but the incidence is
higher for women.

Neurosis associated with blood stagnation, as occurs with xue dao zheng is
described this way by Yamada Terutane (10):
An experienced physician can easily detect neurotic or
blood-stagnated women by virtue of their external signs,
such as a worried look, anxiety, suspiciousness, and slurred
speech. These patients generally do not feel like talking,
but when asked, they either enumerate all their complaints
(which may last for hours) or quietly submit their
subjective symptoms in writing, often having prepared
them in advance.

The reference to "slurred speech" is a poor translation. It means incoherent

or illogical statements, rather than inability to control the muscles associated
with speech; for example, the conclusion drawn by the patient seems unrelated
to the prior description of events, so that it seems that the person is linking
words together that don't connect. Terutane notes further that xue dao
zheng especially affects middle-aged women with any of the following medical
history, symptoms, and signs:

1. Those who have had abortions or undergone surgical

operations causing worsening of the problems.
2. Those who have changing and inconsistent nature of their
subjective symptoms, such as headache, heaviness of the
head, stiff shoulders, and dizziness.
3. Those who worry excessively about their health but in reality
are healthy or have a minor gastroptosis [technically,
distention of the stomach due to weak musculature, but
referring to weak digestion or poor tolerance to foods]. This
type of patient generally has a thin physique and a pale
complexion.
4. Those who are judged, upon clinical examination, to be
normal but claim to have palpitations and cardiac
hyperfunction. Some who experience intensified heartbeat,
especially while in bed, probably suffer from a nervous
disorder.
5. Women who submit their own symptoms and signs in written
form during clinical visits. Such women usually suffer from a
nervous disorder [the patients often explain that they were
worried that they might leave something out, so they carefully
wrote down everything].
6. Those suffering from acute, whole, or localized body fever
[this means a hot sensation, but not an actual elevation of
body temperature] due to blood stasis. For an excess
conformation, Cinnamon and Hoelen Formula (Guizhi Fuling
Wan) is prescribed; for a deficiency conformation,
Bupleurum and Peony Formula (Jiawei Xiaoyao San) is
preferable.
7. Those who frequently feel tired, who have difficulty
recovering from fatigue, or who have a weak physique.
8. Those afflicted with insomnia, inability to sleep well,
morning fatigue, drowsiness in the daytime and particularly
after lunch.
9. Those suffering from dysmenorrhea, amenorrhea, or other
menstrual complaints.

Xue Dao Zheng and Menopausal Syndrome

Several Japanese physicians link xue dao zheng to menopausal symptoms.
According to Yakazu Domei (7), the way that xue dao syndrome became
closely associated with menopause in the Japanese literature is as follows:
For years, when confronted with the term xue dao, many
physicians trained in modern medicine just smiled. As a
result, the term was replaced by the words climacteric
disturbance or disturbance of the autonomic nervous
system. However, these two terms describe only a part of
the xue dao zheng.

In other words, because the traditional Chinese medical term was not
acceptable by the modern-trained physicians (who just smiled in
embarrassment when the discussion turned to such an archaic concept), it was
replaced with another that was considered acceptable: climacteric disturbance.

Hosono Shiro touched on the subject of blood stasis and menopause in the
first of his ten lectures on Chinese herbal medicine presented in English by the
Oriental Healing Arts Institute (11):
The stagnant blood conformation results from
abnormalities in the central nervous, endocrine, and
circulatory systems caused by changes in
metabolism....The stagnant blood conformation also
resembles menopausal disorders caused by hormonal and
central nervous system abnormalities.

He also considered that post-partum illnesses and infertility were related to

this type of problem. Poor memory, mental anomalies, and poor emotional
control are among the symptoms he considers as primary indicators of the
stagnated blood circulation.

The Kojien Encyclopedia quoted by Yakazu Domei (7) describes chi no

michi, which is a common Japanese designation for xue dao zheng, as having
the meaning of a syndrome of the path of blood circulation, and also referring
to "uterus-related diseases." These latter problems are said to usually manifest
in relation to the menstrual cycle, with symptoms such as headaches, nausea,
hot flashes, sweating, etc., which might include premenstrual syndrome,
menopausal distress, and post-partum disorders. Of course, some of these
conditions are not uterine problems but, rather, ovarian problems; in the
traditional Chinese literature, there is no division between the uterus and
ovaries, so the translation is often haphazard.

In his book Aging and Blood Stasis (12), Yan Dexin describes three
categories of menopausal syndrome, emphasizing the emotional factors:
 1. Heart spirit bewildered and chaotic: the mental state is not
calm. The heart spirit is abstracted. Sadness is so damaging
one feels like weeping. The body and spirit are tired and
fatigued. There is scant qi, disinclination to speak, frequent
yawning....
2. Heart blood deficiency: heart palpitations, restlessness, heart
vexation, scant sleep, excessive suspicion, easy anger,
nervous tension, apprehension, anxiety....
3. Liver qi stagnation: essence-spirit worry and depression,
nervous tension, apprehension, chest oppression, heaving
sighs, sometimes cold, sometimes hot, dizziness, vexation and
agitation....

Many of these symptoms are the same as those described above for the
middle-aged women who suffer from xue dao zheng. It should be emphasized
that some of the symptom reports are difficult to interpret directly; for example,
a woman might sleep normally or even excessively, but complain about
insomnia because she did not feel that the sleep gave her the sense of feeling
rested; heart palpitations may be reported when the heart rate is normal but the
sense that the heart is 'not right' is experienced.

The basic therapeutic approach to xue dao zheng is to both nourish blood
and vitalize blood circulation, to strengthen the spleen and aid qi circulation,
and to alleviate fluid accumulation associated with deficiency and stagnation.
The herbs tang-kuei (danggui), peony (baishao), and hoelen (fuling) are
frequently included in the prescriptions; all three benefit the spleen; tang-kuei
and peony nourish and vitalize blood; hoelen dispels accumulated moisture and
calms the spirit.

Biehe Bing: Lily Disease

A complex and irregular disease described in the Jingui Yaolue (3) is "lily
disease" (baihe bing). Lily disease is named after the main ingredient in
formulas designed for its treatment, the herb lily-baihe. When used for treating
this condition, lily is usually prescribed in small formulas with just one or two
other herbs. According to this ancient text:
Baihe bing is a disease characterized by general malaise-a
desire but inability to eat, talk, lie down, or walk. The
patient often appears quiescent. Sometimes he has an
appetite, sometimes not. He feels cold, but has no chills or
else feels hot, but has no fever. A bitter taste invades his
mouth and his urine flows red. No herbs can cure him
because severe vomiting and diarrhea occur upon ingestion
of herbs. It seems as though a certain spirit has possessed
 him though he appears to be normal except for a minute
and quick pulse.

The conflicting and complicated pattern of symptoms gives the impression

that there is a foreign influence (spirit; ghost) that has taken some control. The
malaise characterized by "desire but inability" is typical of depression. The
description of red urine in this context is consistent with the concept of heat
centered in the heart that flows downward to the small intestine (the fu organ
associated with the heart), and from there to the urinary bladder. This downward
flow is due to the presence of damp (moisture accumulation) that carries the
heat downward; the dampness also impairs the movement and expression of the
individual. The vomiting and diarrhea mentioned here can come about because
of damp accumulation affecting the spleen and from heat affecting the stomach,
making it react to many herb remedies.

According to the Shennong Bencao Jing (13): "Lily is sweet and

balanced. It mainly treats evil qi, abdominal distention, and heart pain. It
disinhibits urination and defecation, supplements the center, and boosts the qi."
One of the important actions is to "disinhibit" urination, which is a method for
conducting out excess fluid and heat. Today, lily is often described simply as a
yin nourishing herb, especially used for dry cough. The Chinese English
Manual of Common-Used Herbs of Traditional Chinese Medicine (14)
provides these indications for lily aside from moisturizing the lungs and
relieving cough: "Clear away heart-fire and tranquilize the mind: for the
convalescence of febrile diseases or yin deficiency with heat manifested as
irritability, insomnia, dreaminess, palpitation, and absent-mindedness."

Modern Interpretations of Lily Disease

Lily disease has been associated in modern times with various psychological
illnesses. In Chinese English Manual of Common-Used Prescriptions of
Traditional Chinese Medicine (15), the indications for Lily and Talc Formula
(Baihe Huashi San), includes this description:
Mainly for lily syndrome (depressive state of psychic
disease), manifested as mental disorder, irritability,
insomnia, anorexia....

Modern Clinical Necessities for Acupuncture and Moxibustion (16)

mentions the syndrome:
Hysteria, mostly seen in the female, is a paroxysmal disease
with complex and variable symptoms. In traditional
Chinese medicine, it belongs to the category of Bai He
Bing.

The main points recommended in this text are ximen (PC-4), which has an
action similar to neiguan (PC-6), and yongquan (KI-1), which is used to drain
the excess from above. More broadly, hysteria belongs to the larger class of
disorders known as neurosis. In the companion text Modern Clinical
Necessities for Traditional Chinese Medicine (17), it is said that:
Neurosis is a collective term for neurasthenia, hysteria, and
obsession, which are diseases of disturbance of higher
nervous functions commonly found in the clinic. They are
classified in traditional Chinese medicine
into yuzheng (depression), meihe qi (plum pit qi; globus
hystericus), zangzao (hysteria), and baihe bing (lily
disease).

According to the English-Chinese Encyclopedia of Practical

Traditional Chinese Medicine (18), hysteria is the term used to refer to "a
condition characterized by a series of mental symptoms and signs, such as
emotional depression or unrest, abnormal crying or laughing. The causative
factor of the condition is related to emotional disturbances such as depression,
excessive joy, anger, or grief....Excessive anger can impair the function of liver
in maintaining free flow of qi, causing derangement of qi mechanism and
emotional unrest. Habitual depression with over-thinking and sorrow cause the
liver to overact on the spleen...." The condition is listed in the section on
gynecology.

Among the formulas recommended in this text for neurosis are Licorice
and Jujube Combination (Gancao Xiaomai Dazao Tang), Lily and Rehmannia
Combination (Baihe Dihuang Tang, a simple heat-clearing formula based on
use of lily), and Bupleurum and Dragon Bone Combination (Chaihu Jia Longgu
Muli Tang), which is an ancient remedy for mental agitation described in
the Shanghan Lun (2). Formulas such as these are recommended in the
treatment of chronic fatigue syndrome in China. In one medical journal article
(19), the Chinese physician Yin Hengze designed a formula for chronic fatigue
based on blending Four Major Herbs Combination (Si Junzi Tang), Lily and
Rehmannia Combination (Baihe Dihuang Tang), and Tang-kuei and
Bupleurum Formula (Xiao Yao San). The patients, suffering from a variety of
symptoms including constant fatigue after any activity, difficulty concentrating,
depression, sleep disorder, aches and pains, sore throats, etc., were treated with
both the herb formula and psychotherapy. It was reported that two weeks of
such treatment would produce some symptom resolution in about 2/3 of the
patients.

Meihe Qi: Plum Pit Qi (Globus Hystericus)

The Western term globus hystericus implies a lump (actually, the sensation of
a lump) that is the result of hysteria. The Chinese term for the condition, meihe
qi (plum pit qi), indicates that the sensation is the result of qi stagnation and
accumulation. There is no physical lump present; the feeling of its presence may
come and go and it is highly irritating.
 The Jingui Yaolue (3) presents a treatment for this disorder, namely
Pinellia and Magnolia Combination (Banxia Houpu Tang), a formula that
disperses stagnant qi, stagnant fluid, and accumulated phlegm-fluid. The text
mentions that the condition happens in women, and prior to introducing the
formula, it is mentioned that "sometimes a woman contracts evil wind with
fever and chillphobia at the onset of menses...." The implication is that this
disorder is in some way related to the uterus (or, more generally, the xuehai).
The text continues with the introduction of Licorice and Jujube Combination
(Gancao Xiaomai Dazao Tang) for "a woman with visceral irritation [hysteria]
who tends to grieve and cry as though possessed by a spirit." In Commonly
Used Chinese Herb Formulas with Illustrations (20), the indications for
Pinellia and Magnolia Combination are:
Neurosis, nervous exhaustion, hysteria, nervousness,
insomnia, fearfulness, neurotic esophageal constriction
[globus hystericus], recurrent palpitations....

The formula is a simple one, comprised of magnolia bark, pinellia, fresh

ginger, hoelen, and perilla leaf. In Chinese-English Manual of Common-
Used Prescriptions in Traditional Chinese Medicine (15), it is said that the
formula is "mainly for cases of globus hystericus due to the disorder of the
seven emotions and the stagnation of phlegm." The sensation of a lump in the
throat (rather than elsewhere) is attributed to "abnormal rising qi." One of the
herbs used for such conditions is perilla leaf, which is a major component of
Lindera and Cyperus Formula (Zhengqi Tianxiang San), indicated for
"climacteric neurosis in females, diseases caused by occlusion and stagnation
of qi, hysteria, neurasthenia, pre-partum and post-partum neuroses,
amenorrhea, melena, neuroses of widows, nuns, and monks (20)." The last
reference to widows, nuns, and monks suggests the psychological impact of
being unmarried and not having a normal sexual and social life and does not
necessarily mean that this syndrome was observed in such individuals.

Hong-yen Hsu provided a review of treatments for abnormal sensations in

the throat (21). He considered that aside from local disturbances, such as
inflammatory disease, the causes included mental factors, stating: "Fear and
tension, as well as other strong emotions, often induce physiological problems
in the autonomic nervous system." He reports that the condition is due to
"mental depression, malfunction of the liver and spleen, accumulation of
sputum, alternate flushing up of sputum and qi; it is caused by anger while
eating and an imbalance between the liver and the stomach." Recommended
formulas include Pinellia and Magnolia Combination (Banxia Houpu Tang) and
several other prescriptions relying on pinellia (banxia) as a key component; this
herb has long been used for its combined effect of resolving phlegm
accumulation and lowering stomach qi. Hsu relayed the experience of
physicians at the Tokyo University Medical School who treated plum pit qi
syndromes. According to the report, 21 patients received Pinellia and Magnolia
Combination (mostly for female patients with nervousness) and 13 patients
received Bupleurum and Dragon Bone Combination (mostly for male patients
with strong physique; see pages 74-75 for more details about this important
formula).

Fluid Connection
The three syndromes described here involve different pathologies in the TCM
system: stagnant blood in xue dao zheng, heart fire in baihe zheng, and stagnant
qi in meihe qi. All three syndromes also tend to involve fluid accumulation;
unfortunately, this aspect is not emphasized in the modern literature. As will be
seen in the chapter on herb formulas, many of the treatments for these
syndromes incorporate herbs for draining damp. Japanese physicians refer
to shuidu (water toxin) and lishui (hidden water), the concept that accumulated
fluids can have a corrupt nature when they accumulate, leading to production
of bizarre symptoms. In the Chinese literature, there is reference to "turbidity"
which implies corrupted fluids, and is especially applied to phlegm (phlegm-
turbidity). Both moisture and phlegm can remain "hidden," particular concern
is expressed for hidden phlegm, called "phlegm-mist."

References

1. Dong Zhi Lin and Jiang Jing Xian, 100 Famous and Effective
Prescriptions of Ancient and Modern Times, 1990 China
Ocean Press, Beijing.
2. Hsu HY and Peacher WG (editors), Shang Han Lun: The
Great Classic of Chinese Medicine, 1981 Oriental Healing
Arts Institute, Long Beach, CA.
3. Hsu HY and Wang SY, Chin Kuei Yao Lue, 1983 Oriental
Healing Arts Institute, Long Beach, CA.
4. Hsu CS and Chen MF, Treatment of depression and other
emotional disorders with Licorice and Jujube Combination,
International Journal of Oriental Medicine, 1992; 17(4): 187-
189.
5. Wu Jingnuan, Ling Shu, 1993 The Taoist Center,
Washington, D.C.
6. Unschuld PU, Introductory Readings in Classical Chinese
Medicine, 1988 Kluwer Academic Publishers, Dordrecht.
7. Yakazu Domei, The meaning of Hsieh Tao Cheng [xue dao
zheng] and its treatment with Chinese formulas, Bulletin of
the Oriental Healing Arts Institute, 1982; 7(7): 1-10.
8. Shigeru Arichi, Yu KK, and Machiko Sakaguchi, Clinical
experience with women's erratic complaints syndrome,
 Bulletin of the Oriental Healing Arts Institute, 1981; 6(5): 34-
37.
9. Zhang Enqin (chief ed.), Clinic of Traditional Chinese
Medicine, 1989 Publishing House of Shanghai College of
Traditional Chinese Medicine, Shanghai.
10. Yamada Terutane, Some personal experiences with the
application of Chinese herbal medicine (VII), Oriental
Healing Arts International Bulletin 1986; 11(7): 547-555.
11. Hosono Shiro, Ten lectures on Chinese herbal medicine: I.,
Bulletin of the Oriental Healing Arts Institute, 1984; 9(2): 67-
83.
12. Yan Dexin, Aging and Blood Stasis, 1995 Blue Poppy Press,
Boulder, CO.
13. Yang Shouzhong (translator), The Divine Farmer's Materia
Medica, 1998 Blue Poppy Press, Boulder, CO.
14. Ou Ming, ed., Chinese-English Manual of Common-Used
Herbs in Traditional Chinese Medicine, 1989 Joint Publishing
Co., Hong Kong.
15. Ou Ming, ed., Chinese-English Manual of Common-Used
Prescriptions in Traditional Chinese Medicine, 1989 Joint
Publishing Co., Hong Kong.
16. Zhang Ru and Dong Zhilin, Modern Clinical Necessities for
Acupuncture and Moxibustion, 1990 China Ocean Press,
Beijing.
17. Wang Qi and Dong Zhilin, Modern Clinical Necessities for
Traditional Chinese Medicine, 1990 China Ocean Press,
Beijing.
18. Xu Xiangcai, et al., The English-Chinese Encyclopedia of
Practical Traditional Chinese Medicine, 1990 Higher
Education Press, Beijing.
19. Yin Hengze, Clinical observation on the therapeutic effect of
three formula decoction in treating 32 cases of chronic fatigue
syndrome, Shanghai Journal of Traditional Chinese Medicine
1999; 3: 19-20.
20. Hsu HY and Hsu CS, Commonly Used Chinese Herb
Formulas with Illustrations, 1980 rev. ed., Oriental Healing
Arts Institute, Long Beach, CA.
21. Hsu HY, Chinese herb therapy for abnormal sensations in the
throat, Bulletin of the Oriental Healing Arts Institute 1984;
9(2): 63-66.
Painting by Chen Hung-shou (1598-1652). For a time, he
lived as a Buddhist monk at a monastery. He painted
numerous nature scenes; in this one, a scholar is enjoying
nature under a pine tree emerging from a towering rock. In
his right hand he holds a brush, as he is inspired by the
beauty of the scene to write poetry. From Eight Dynasties
of Chinese Painting (1980 Cleveland Museum of Art).
 Chapter 7
Herbs
Herbs for Treatment of Shen Disorders
The earliest texts describing Chinese herbs include numerous ingredients that
are said to affect the spiritual life of man. The first formal book of medicinal
substances that survived to the present is the Shennong Bencao
Jing (Shennong's Herbal Classic, attributed to one of the three divine helpers
that came in human form, Shennong, and written around 100 A.D.), used as a
source of the quotes in this section (1).

The way Chinese herbs are used for shen disorders has changed over time
and is affected by cultural differences among the countries utilizing Chinese
medicine. For example, the three syndromes describe in the previous chapter
(and the contribution of "hidden water" or "water toxin") have been of interest
in ancient times in China and in Japan today, but herb formulas presented in
modern Chinese texts often have yet a different focal point, which will be
described in this chapter.

Further, the selection of ingredients to use in treatments has changed,

especially in recent years, and particularly as one takes the formulas from Asia
and tries to utilize them in Western countries, where there are different concepts
of what serves as an acceptable ingredient. For example, the most revered of
the ingredients for shen disorders (and for several other conditions) in China
throughout the past 2,000 years is one which we no longer would even consider
using, but its ancient description is worth relaying:
Dansha is sweet and slightly cold. It treats hundreds of
diseases of the five viscera and the body. It nurtures the
essence spirit (jingshen), quiets the hun and po, boosts the
qi brightens the eyes, and kills spirit demons and evil
ghosts. Protracted taking may enable one to communicate
with the spirit light and prevent senility….

This compound, cinnabar, was one of many mineral agents that were relied
upon for such spiritual aims. It is a mercury compound that the Chinese believed
was safe to use, and which had been used routinely until just a few years ago.
The stories about "contaminated" Chinese herb products that are relayed in
Western countries often reflected detection of mercury from cinnabar, as well
as arsenic from realgar, two items that had been trusted by the physicians in
China. This was not contamination, but intentional inclusion of the ingredients.

Animal parts were also used for the spirit remedies, including this one that
we also don't use today:
 Shexiang is acrid and warm. It mainly keeps off malignant
qi, kills ghosts and [adverse] spiritual matters, [cures]
malaria, gu toxins [certain types of parasites], epilepsy, and
tetany, and removes the three worms. Protracted taking
may eliminate evils to prevent depressive ghost dreams in
sleep.

This substance, musk, is from an endangered deer species mainly found in

the mountainous area of Tibet and adjacent mountainous Chinese provinces,
and was commonly employed in remedies for reviving consciousness because
of its potent fragrance. Endangered species concerns have eliminated from use
numerous animal substances that were considered of great value. Further,
European governments have somewhat arbitrarily restricted virtually all animal
ingredients from use in "herbal" formulas.

A mineralized animal substance, dragon bone (fossilized bones of large

mammals, so no animal material remains), was long employed as a spirit
medicine:
Longgu is sweet and balanced. It mainly treats heart and
abdominal demonic influx, [adverse] spiritual matters, old
ghosts, cough, and counterflow [of qi], diarrhea and
dysentery of pus and blood….

Dragon bone is still in use; dragon teeth is collected from similar source
materials and used similarly (though especially for treatment of disorders
associated with fright). Fossilized tree resins, in the form of amber (also called
succinum; the Chinese name is hupo, referring to the po soul of the tiger, which
it is said to represent), are included in traditional and modern formulas for spirit
disorders.

Ordinary plant materials are the main ingredients in spirit formulations, and
the best known of these is ginseng. Due to attempts to vigorously promote its
sale in the West, the applications of this herb have been altered to serving
primarily as an energy tonic, a use quite different than in traditional Chinese
medicine:
Renshen is sweet and a little cold. It mainly supplements
the five viscera. It quiets the essence spirit [jingshen],
settles the hun and po, checks fright palpitations,
eliminates evil qi, brightens the eyes, opens the heart, and
sharpens the wits….

The case of ginseng is an example of how information about herb use can
become distorted. As a result, many people worry that ginseng will have an
agitating quality when, in fact, it is used in the Chinese formulas as a calming
substance.
 There are some principles of therapy that have changed due to the
developments of modern medicine. For example, throughout the history of
Chinese medicine several shen disturbances, including loss of consciousness,
mania, and emotional agitation, were understood to occur as the direct result of
feverish diseases. Thus, herbs that purge fire, including rhino horn (no longer
used), raw rehmannia (sheng dihuang), coptis (huanglian), gardenia
(shanzhizi), moutan (mudanpi), and scute (huangqin), were sometimes key
ingredients in the prescriptions. In modern times, most of these feverish
conditions can be controlled with antibiotics, antipyretic drugs, and other
modern therapies (or can be prevented outright by vaccination) so that the mind
and brain disorders that are the subject of potential Chinese-herbal treatment
today are rarely associated with febrile disease. While these same fire-purging
herbs have some sedative effects, it is clear from the ancient formula
descriptions that they were included mainly for their role in treating a febrile
condition.

As a result of research done during the 20th Century, modern Chinese

practitioners have turned much of their attention to the principle of treating
blood stasis, which was less frequently described in ancient times. While xue
dao zheng usually involved the problem of abdominal stagnation of blood flow,
today's efforts are usually directed at blood stasis affecting the heart and brain,
looking particularly at the problem of strokes and other diseases of aging
associated with vascular blockage. Ingredients such as red peony (chishao),
cnidium (chuanxiong), persica (taoren), carthamus (honghua), and salvia
(danshen) are the most frequently relied upon for these purposes.

Thus, one can say that some principles of therapy now have less emphasis
than before (i.e., clearing heat) and others have more emphasis than before (i.e.,
vitalizing blood), and this is important to recognize when analyzing formulas
described in modern clinical reports from China. Similarly, some ingredients
are less often used, such as animal substances, while others are more frequently
used, especially those plant materials that have escaped worries about toxicity
and endangered species status.

Basic Therapeutic Approaches

There are four main therapeutic approaches using herbs in traditional Chinese
medicine to address the problems classified as spirit disorders:

1. Tonification therapy. The brain is described as an extension

of the marrow which belongs to the kidney system, so herbs
that nourish the kidney are understood to nourish the brain
(and spinal cord). Lack of nourishment (particularly of the
fluid component, that is, yin and blood) of any organ can lead
to mental distress, due to the fact that the internal spirits
cannot rest if their associated internal organs are "empty," that
 is, deficient in essential fluids. In particular, deficiency of
liver and heart can easily cause disturbance of the mind (due
to hyperactivity of the hun and shen). Weakness of spleen qi
is often ultimately responsible for lack of nourishment of all
the organs and the body; the spleen also promotes upward
circulation of qi to reach the brain.
2. Regulating qi. The free flow of visceral qi, regulated by the
liver, is understood to correspond to the mental condition,
particularly the thought processes and the reactions to
experiences. For example, stagnated (depressed) liver qi
circulation corresponds to mental depression, repetitive
thoughts, limited outlook, and other mental conditions that, in
turn, cause problems in social situations, furthering the liver
qi stagnation. Although anger is the emotion frequently cited
as associated with the liver and its circulation of qi, in fact,
other emotions also have various effects on the qi, and the
consequence may be stagnation of liver qi circulation.
3. Calming agitation. Aside from the problem of deficiency that
leads to unsettling of the spirit, the mind can be agitated as a
result of heat, wind, or uprushing qi and yang, disorders that
may be secondary to deficiency (e.g., yin deficiency of the
liver yields liver fire and internal wind) or may be an excess
pattern (from a pathogenic influence or from diet, excess
emotions, etc.). Herbs are used to clear the heat (purge fire),
sedate the wind, and settle the upward rising of qi and yang.
4. Clearing orifices of phlegm-mist. The connection between the
heart and mind (or brain) is made by channels (orifices) that
can become obstructed; the ultimate source of the obstruction
may be weak stomach/spleen function leading to
accumulation of phlegm, or fire syndrome damaging fluids
and transforming them to pathological phlegm. Aromatic and
penetrating herbs can clear the obstruction and phlegm-
resolving herbs can help prevent the orifices from becoming
obstructed again.

In designing a formulation, it is common to rely primarily on one or more

of the first three methods listed here to treat shen disorders. In fact, tonification
therapy is a part of nearly all the treatments used in modern practice. The fourth
method (which will be analyzed more fully in the appendix to this chapter), is
especially used in cases of severe disturbance, for ailments associated with the
phlegm syndrome, and for treatment of elderly patients.

Tables 1-4 list some sample herbs in each of the four therapeutic areas of
primary concern. The herbs were selected for inclusion in these tables on the
basis of high frequency of use in treating mind and brain disorders as
described in both the traditional and modern literature (the formulas for
treating the disorders will be described in the next two chapters). Some items
frequently mentioned in traditional literature (e.g., musk, rhino horn, cinnabar)
and used until recently in China have been retained here to assist in the study
of that literature.

Within each category, the herbs are listed alphabetically by common name
(followed by pinyin and typical botanical source for clear identification). In the
section of "main actions," the information is derived primarily from Oriental
Materia Medica (2), with only those actions that are relevant to treatment of
mental disorders included in the table. Since the concept of phlegm-mist is not
often elucidated, an extensive explanation is presented in the appendix.

Table 1: Tonic Therapies Frequently Used for Shen Disorders.

Herb Main Actions Comments
The Chinese name means to enhance the disposition of the
Alpinia supplements spleen, warms
individual (increase wisdom, is one translation). It is thought to
yizhiren the kidney, astringes essence,
improve the thinking function associated with the spleen and
Alpinia oxyphylla fortifies qi
the will associated with the kidney.
Asparagus
Asparagus is considered similar in nature, taste, and function to
tianmendong nourishes yin, moistens
ophiopogon and is commonly used in combination with it to
Asparagus dryness
nourish the yin.
cochinchinensis
Astragalus
huangqi supplements qi, increases Astragalus helps the spleen generate a pure and clear qi that
Astragalus yang rises upward to nourish the heart and brain
membranaceous
Atractylodes
baizhu supplements spleen, tonifies This aromatic tonic for the spleen disperses stagnated fluids
Atractylodes qi that can obscure the heart orifices.
macrocephalla
Cistanche The soft, black, salty herb is thought to quickly nourish the
nourishes kidney essence,
roucongrong deficient kidney essence, invigorating yang without harming
supplements yang
Cistanche salsa the yin.
Codonopsis
In China, codonopsis is almost always used as a substitute for
dangshen invigorates the spleen and
ginseng as a stomach/spleen tonic, but it lacks the spirit-
Codonopsis stomach, replenishes qi
calming qualities of ginseng.
pilosula
Cornus
supplements liver and kidney, The sour fruit is frequently used to astringe and nourish the
wuzhuyu
astringes essence essence and help prevent deterioration of health.
Cornus officinalis
Cuscuta The seed is thought to help prevent leakage of essence (as an
supplements kidney essence,
tusizi astringent), therefore it is used to prevent deterioration. It
clears vision
Cuscuta chinensis gently tonifies yang, without harming yin.
Dioscorea
Dioscorea is used in many treatments for weakening of the
shanyao supplements spleen, stomach
kidney essence; its ability to benefit the spleen at the same time
Dioscorea and kidneys, astringes essence
is unusual among the Chinese herbs for that purpose.
batatas
Ginseng replenishes and supplements Ginseng is one of the original remedies for spirit disorders used
renshen original qi, benefits the five in Chinese medicine; it has a calming nature and replenishes all
Panax ginseng viscera, pacifies the spirit, deficiencies. In the West, ginseng has taken on the connotation
 soothes the soul, increases of an energy stimulant; practitioners and patients often worry
wisdom about the proclaimed stimulant action of this herb.
Ho-shou-wu
nourishes yin, replenishes Ho-shou-wu is a famous "anti-aging" herb that is reputed to
heshouwu
essence and blood, tonifies keep the body and mind young and active. By nourishing the
Polygonum
liver and kidneys kidney and liver, it nourishes the brain.
multiflorum
strengthens spleen,
Hoelen Hoelen is used to soak up excess moisture and improve spleen
harmonizes middle warmer,
fuling function; it is also favored as a sedative. It has a mild action.
tranquilizes the heart, pacifies
Poria cocos The sedative fu-shen (see Table 3) is from the same source.
the spirit, resolves moisture
Longan supplements the heart, This sedative tonic has properties that imitate the actions of
longyanroux stabilizes the spirit, tonifies ginseng plus tang-kuei. It is primarily used in Ginseng and
Euphoria longana spleen, nourishes blood Longan Combination (Guipi Tang).
Lycium supplements liver and Lycium is commonly used in cases of essence deficiency and is
gouqizi kidneys, promotes production considered especially useful because of its mild nature, not
Lycium barbarum of essence and blood producing any adverse digestive effects even in large dosage.
Ophiopogon
nourishes yin, moistens This yin-nourishing herb is especially relied upon when there is
maimendong
dryness, removes heat, phlegm accumulation and heart agitation; sometimes asparagus
Ophiopogon
resolves phlegm, calms spirit is added to enhance the heat clearing action.
japonicus
Peony is the most commonly used blood nourishing herb
Peony supplements blood, vitalizes
because its other properties (vitalizing and cooling blood,
baishao blood, cools blood, astringes
astringing liver yin) take care of several requirements of the
Paeonia alba liver yin, strengthens spleen
formulations.
Rehmannia This rich, black processed root is considered one of the most
nourishes blood, yin, and
shudihuang important herbs to nourish the liver and kidney. It is used to
essence, supplements kidney
Rehmannia prevent and even reverse the deterioration associated with
and liver
glutinosa aging.
Tang-kuei This herb is used for nourishing the blood of the liver and heart,
danggui supplements and moves blood which has the effects of controlling emotional distress and
Angelica sinensis relieving spasms.

Table 2: Qi-regulating Herbs. Bupleurum is included in this table as an

important qi regulating herb, particularly for shen disorders, but in the Materia
Medica it is placed in the surface relieving category, which reflected one of its
most frequent uses at the time the herb categories were established; magnolia
bark is categorized with aromatic moisture resolving herbs, but it has an
important role in regulating qi circulation and so is included here.

Herb Main Actions Comments

Bupleurum strongly dredges liver qi; this action may be
Bupleurum
regulates liver qi, raises yang uncomfortable in those with blood deficiency (it is often
chaihu
qi administered with blood tonics); it also aids rising of qi, so
Bupleurum chinense
that herbs to lower qi may be needed in the formula.
Chih-ko disperses central qi, regulates Used for food stagnancy, epigastric aching, and lung
zhiqiao horizontal qi circulation; congestion; it is often used to aid bupleurum in dispersing
Citrus aurantium resolves phlegm qi and to aid pinellia in resolving phlegm.
Chih-shih
disperses central qi, regulates Used for abdominal stagnation with constipation; helps
zhishi
vertical qi circulation; purges direct qi flow downward. Chih-shih is helpful in reducing
Citrus
gallbladder, clears heat and damp-heat and phlegm accumulation especially that
aurantium (unripe
phlegm associated with gallbladder stagnation or heat.
fruit)
Citrus disperses qi, strengthens The most widely used qi-regulating herb; it is also used in
chenpi spleen, dries moisture and treatment of most phlegm disorders, combined with
Citrus reticulata phlegm pinellia. Citrus aids the spleen in dispersing moisture.
Cyperus strongly disperses central qi, Analgesic for headaches and abdominal pains and alleviates
xiangfu, xiangfuzi alleviates pain, regulates qi stagnation; this is considered an important herb for
Cyperus rotundus menstruation treating depression.
Lindera This herb is used like bupleurum to disperse stagnant qi, but
disperses qi alleviates pain,
wuyao is especially used in cold syndromes and for weak kidney
warms the kidney
Lindera strychnifolia qi.
Magnolia bark Mainly used for abdominal distention, uprushing of qi, food
houpu dries dampness, moves qi stagnation, obstruction of phlegm, and tightness of the
Magnolia obovata diaphragm.
Saussurea
muxiang
disperses qi, alleviates pain, Used for mainly for abdominal disorders that include
Saussurea
controls diarrhea, sedative diarrhea.
lappa or Jurinea
soulei

Table 3: Sedative Herbs. Polygala, listed in the Materia Medica among the
heart-nourishing herbs, has been listed both here and in the category of herbs
to help resolve phlegm mist (Table 4).

Herb Main Actions Comments

Biota
baiziren nourishes heart and This seed is very oily, so it is used only in moderate dosage if there is a
Biota calms mind spleen-damp syndrome, but is favored for constipation and dryness.
orientalis
Cinnabar
This is the premier sedative of the Chinese tradition and mentioned in
zhusha sedates the heart and
numerous ancient and modern formulas; however, it is avoided in the
mercuric calms the mind
West due to its content of mercury, the active constituent.
sulfide
pacifies the liver,
Dragon bone These are fossilized bones of ice age animals, comprised mainly of
restrains floating yang,
longgu soluble minerals, such as calcium carbonate. It has a nutritive and
sedates and calms the
fossil bones calming action. It is also an astringent for kidney essence.
mind
Dragon teeth
sedates and calms the Like dragon bones, dragon teeth are fossilized; Chinese doctors regard
longchi
spirit them as especially useful for fright-induced mental disorders.
fossil teeth
Fu-shen
fushen sedative, moisture- Fu-shen is mostly the same material as hoelen (see Tonics) with similar
Poria resolving, strengthens properties, but includes portions of pine root; the pine confers a sedative
cocos + spleen effect.
Pinus sp.
Oyster shell pacifies the liver and
Oyster shell is used to calm agitation; it has astringent properties and
muli restrains the floating
also reduces excess stomach acid. It mainly contains calcium carbonate.
Ostrea gigas yang
Polygala
stabilizes the heart, calms Polygala is a nourishing sedative, often combined with zizyphus; it is
yuanzhi
the mind, disperses commonly used with acorus to disperse phlegm-mist and enliven the
Polygala
phlegm mental functions.
tenuifolia
Schizandra Like cornus, it is relied upon to astringe essence and prevent
wuweizi astringes essence, calms deterioration of health; modern research has shown that it normalizes
Schizandra agitation cerebral electrical discharges and is thus used in treatments for brain
chinensis disorders, especially for insomnia and poor memory.
Succinum
sedates and calms spirit, This is the aged resin mostly from various pine trees; the ancient
hupo
vitalizes blood Chinese said that this material is actually the soul of tigers that have
fossilized
circulation died, and it has a sedating quality that still imparts the tiger's power.
resin
Zizyphus
nourishes heart and
suanzaoren The most commonly-used sedative especially treats mental disorders
calms spirit, nourishes
Zizyphus characterized by insomnia and agitation.
liver
spinosa

What is Phlegm-Mist Affecting the Orifices of the Heart?

Before presenting the herbs for phlegm-mist, the nature of this condition is first
described. Although phlegm-mist can affect different parts of the body, the
terminology of "phlegm misting the orifices of the heart" (tanmi xinqiao) is
frequently used for the concept as it refers to function of the brain and the
syndrome that produces or worsens shen disorders.

The condition is sometimes described as phlegm entering the heart, or as

phlegm entering the heart meridian (or "channel"). The original description of
meridians in the Chinese medical system is related to blood vessels. We know
this, in part, because virtually all mentions of the flow of qi in the ancient texts
are actually about the combined flow of "qi and blood." It is easy to become
confused about the Chinese view of human physiology when modern writers
describe meridians as pathways existing solely for the flow of qi, to be
distinguished from blood vessels for the flow of blood, which is not consistent
with the prior 2,000 years of Chinese literature. The fact that the meridian maps
(for acupuncture) do not correspond with blood vessels merely indicates that
what was eventually mapped for purposes of describing acupuncture therapies
failed to follow precisely the underlying traditional conceptual framework.
When describing long-held ideas about human physiology such as this, it is
important to consider the context, and in this case, the flow of qi and blood were
considered to be unified and involved the same "vessels."

Phlegm mist is a concept that can be traced back at least to the Song
Dynasty. By that time, Chinese doctors were distinguishing "substantial"
phlegm (such as sputum, which is described as "condensed pathological fluid")
and "insubstantial phlegm" or "hidden phlegm" (such as the mist of the heart
orifices; a "thin pathological fluid"). The substantial phlegm would mainly
accumulate in the lungs and stomach and could be noted in the sinuses and
throat, while the insubstantial phlegm would accumulate in the meridians,
distributing to various parts of the body, such as the heart orifices and the brain
(e.g., causing dizziness or loss of consciousness in severe cases), the lymph
nodes (causing nodules and swellings), and the limbs (e.g., causing numbness).
The two types of phlegm were thought to have the same origin and the same
fundamental nature, but would permeate different parts of the body (the thick
sputum could not penetrate the meridians, but the insubstantial phlegm could).

Further, insubstantial phlegm can combine with other pathological

influences to yield phlegm-fire, wind-phlegm, and phlegm-turbidity. According
to the doctrine that evolved, the phlegm mist when combined with the other
pathological factors-such as fire, wind, or damp-could produce more severe
symptoms. Its material nature would capture the more ethereal forces of fire or
wind to make the disease persist; similarly, the phlegm mist could blend with
damp to yield turbidity that obscures the clear flow of qi and yang to the brain,
interfering with normal mental and sensory functions, though not completely
blocking the circulation to the brain except in the worst cases, in which case
one might suffer what we understand today to be a stroke.

Diseases and symptoms attributed to phlegm mist affecting the heart

orifices in addition to stroke paralysis affecting the major muscles (hemiplegia),
include dizziness, loss of consciousness (coma), mania (emotional outbursts,
disturbed speech), convulsions (especially epilepsy), sudden sensory loss
(deafness, blurred vision, loss of taste and smell, inability to speak), lockjaw,
and stiff tongue. Several of these symptoms may be the result of strokes.
Diseases currently treated in China by herbs that resolve phlegm-mist affecting
the heart orifices also include manic-depressive disorder and senile dementia
(Alzheimer's disease).

Table 4: Herbs that Clear Phlegm Mist and Open the Orifices. In addition to
herbs in the Materia Medica categories of opening orifices and resolving
phlegm, this table includes curcuma, a blood vitalizing herb with phlegm-
resolving action. Silkworm, a wind-calming herb, and polygala, a heart-
nourishing sedative, both also help resolve phlegm mist, so are included here.

Herb Main Actions Comments

Acorus
opens orifices, expels This is the most commonly-used Chinese herb (of plant origin)
changpu
phlegm and turbidity, for treatment of mental disorders. It is often used with polygala
Acorus
replenishes intelligence to open the orifices.
gramineus
Arisaema Arisaema is described as having the power to vaporize phlegm
resolves phlegm mist,
tiannanxing, accumulations; it is mainly used when treating phlegm
disperses accumulations,
Arisaema obstruction of the orifices. Bile processed arisaema (dannanxing)
relieves convulsions
consanguineum is used for phlegm-mist associated with a fire syndrome.
Bamboo
zhuru, zhuli, Bamboo shaving, leaves, juice, or dried secretion are all used to
removes heat, transforms
tianzhuhuang treat irritability, fidgets, and convulsions. They are particularly
phlegm, calms fright
Phyllostachys favored in treatment of children's disorders.
nigra
Borneol
Borneol is a potent herb for invigorating circulation and opening
longnao opens orifices, moves qi,
orifices; it is often combined with musk and/or acorus to open
purified vitalizes blood
orifices.
compound
Curcuma
Curcuma is best known for its ability to vitalize circulation of qi
yujin regulates flow of qi and
and blood, but it is useful in treating phlegm accumulation
Curcuma blood, resolves phlegm
disorders, especially when there is qi stagnation.
aromatica
Musk
opens orifices, invigorates Musk, with its penetrating aroma and stimulating quality, is
shexiang
blood circulation, resolves mostly used for severe cases of brain disorder, especially when
Moschus
turbidity the person is losing consciousness or suffering from delirium.
moschiferus
Ox gallstone opens orifices, transforms Ox gallstone is utilized to correct gallbladder disorders that
niuhuang phlegm, clears heat, removes result in hot phlegm moving upward to cloud the consciousness.
Bos taurus toxin, calms fright Bile acids and minerals are combined to make synthetic oxstone.
Pinellia harmonizes stomach, dries Pinellia is the most commonly-used phlegm-resolving herb in
banxia dampness, removes phlegm, Chinese medicine; it is used to help prevent development of
Pinellia ternata disperses accumulation phlegm-mist and it settles uprising stomach qi.
Platycodon
Platycodon is thought to direct the action of other herbs to the
jiegeng
resolves phlegm upper body; in addition, it helps to resolve phlegm-mist
Platycodon
accumulation
grandiflorum
Polygala
yuanzhi stabilizes the heart, calms the Polygala is often used with acorus for resolving phlegm that
Polygala mind, disperses phlegm obstructs the orifices of the heart.
tenuifolia

It is tempting to try and correlate the traditional Chinese concept of

phlegm-mist with a substance or condition defined by modern medicine so that
the Chinese diagnostic category could be explained in terms of our current
knowledge of physiology. Thus, for example, the condition of atherosclerosis,
where plaques that include fatty materials (e.g., cholesterol and lipoproteins)
coat the arteries, might be one case of phlegm-mist affecting the orifices;
certainly, stroke is frequently associated with this type of blockage of the
carotid arteries. The accumulation of amyloid plaques in the brain of persons
with Alzheimer's disease might also correspond, to some extent, to phlegm mist.
Disorders of the thick fluid in the ear drum, which might be depicted as a
phlegm-type disorder (e.g., phlegm-turbidity), can yield dizziness. The
formation of blood clots in the arteries or veins, while seeming to fit the
category of blood stasis, may be an example of phlegm accumulation, in the
sense that phlegm is a sticky substance and the clot forms by the coagulation of
various blood components (such as fibrin and platelets) into a spongy mass. By
contrast, extensive bruising, where clotted blood resides outside the vessels and
forms a firm mass, more clearly fits the blood stasis description.

The ancient doctors saw phlegm-mist primarily involved with sudden and
dramatic change: the person would faint, go into a convulsion, or suddenly erupt
with crazy behavior. For example, as described in the Advanced Textbook on
Traditional Chinese Medicine and Pharmacology (3): "voracious eating,
overdrinking alcohol, and emotional irritation combine to cause food retention
in the stomach, which causes stomach qi to disturb upward, blocking the clear
cavity and thus resulting in loss of consciousness." The idea was that a
substantial amount of phlegm would suddenly rush to the heart. Then, when the
phlegm blockage cleared, the person would return to normal, though in some
cases, there could be persisting symptoms (e.g., hemiplegia). The condition
being described parallels what happens when a blood clot forms in the arteries
supplying the heart or brain, causing the person to collapse. If the clot clears
out quickly enough, the person recovers; if not, there may be persisting
symptoms or the person may die.

This connection between the traditional concept of phlegm blockage and

the modern understanding of formation of obstructive blood clots in the vessels
was illustrated in a presentation at the 1987 TCM conference in Shanghai (4).
The researchers differentiated the disease conditions of 158 patients who
suffered from "upward disturbances of wind-phlegm and accumulation of
phlegm-heat." Using the TCM criteria, they divided these cases as follows: 120
of "channel stroke" (phlegm blocking the heart orifices); 32 cases of fu-organ
stroke (e.g., phlegm originating from the stomach or gallbladder); and 6 cases
of zang-organ stroke (e.g., phlegm blocking the heart). Turning to Western
medical diagnosis for these same patients yielded: 145 cases of thrombosis of
the carotid artery system; 8 cases of thrombosis of the vertebro-basilar system;
and 5 cases of embolism. The treatment administered to the patients was based
on expelling phlegm and purging the intestines. After a few days of this purging
therapy (generally less than two weeks), the focus of treatment shifted to
"clearing heat, expelling phlegm, vitalizing blood, and invigorating the
channels." Liquid bamboo sap (zhuli) was used as an essential ingredient in
most of the cases.

As to the origins of the phlegm mist, the starting point is understood to be

the generation of pathological phlegm (excess phlegm-fluid) which can be the
result of external influences (six exogenous pathogenic factors), internal
influences (abnormal emotional activities), and/or behavior (especially
irregular diet, but also overeating rich foods and/or drinking excess alcohol).
For phlegm mist to affect the heart orifices, which are at the top of the internal
organs, it must rise upward, and that occurs through certain mechanisms such
as uprising qi from the stomach; uprising damp-heat from the gallbladder (often
due to persistent qi stagnation of the liver and rising liver yang); excessive
"steaming" of water by kidney yang (due to kidney yin deficiency); and heart
fire. Perhaps the most serious of the phlegm-mist syndromes is from a fire
disorder (tanhuo raoxin). It is described in Chinese Herbal Medicine:
Formulas and Strategies (5) this way: "The vigorous blazing heat scorches the
fluids and causes them to congeal into phlegm. Heat and phlegm accentuate
each other and completely veil the orifices of the heart, further disturbing the
spirit and impairing the consciousness."

Persons with phlegm-mist syndrome need not have obvious phlegm excess
(substantial phlegm), such as coughing up sputum, runny nose, obesity (the
excess fatty tissue is now considered a type of phlegm mass), or phlegm-
nodules (e.g., lipomas), but the problems of substantial phlegm and
insubstantial phlegm often go together because of common underlying causes.
Usually, the patient suffering from phlegm-mist will display at least some subtle
signs of phlegm, such as slippery and smooth tongue coating or slippery pulse.
In the ancient Chinese texts, there are stories about treating patients with
phlegm-mist disorder using herbs that induce vomiting: discharge of copious
amounts of mucous fluid from the stomach occurs, followed by alleviation of
the symptoms.

Several ingredients used in the traditional formulas for phlegm-mist

disorders are problematic for Western practitioners. For example, neither ox
gallstone nor musk are readily available, and sometimes the dosage of borneol
used in Chinese formulas can be risky (it acts as a heart stimulant in high doses).
But, other ingredients are considered acceptable and the most commonly used
ones are the pair of acorus and polygala, usually combined with herbs that are
considered heart sedatives (e.g., zizyphus and biota seed); additionally, the pair
of bamboo with arisaema, often with herbs that resolve phlegm-damp (e.g.,
pinellia, citrus, and hoelen) is a common treatment approach. It is worth
illustrating here how some of the ingredients described above are utilized for
the phlegm-mist conditions. A good example is Anshen Dingzhi Wan, which is
comprised of acorus, polygala, dragon teeth, fu-shen, ginseng, hoelen; another
is Ditan Tang, which is comprised of bamboo, arisaema, pinellia, citrus, chih-
shih, hoelen, ginseng, acorus, and licorice. Both formulas include ginseng,
hoelen, and acorus, where ginseng and hoelen tonify the spleen (to help prevent
phlegm-fluid accumulation) and calm the heart (fu-shen is a type of hoelen with
greater calming qualities), and acorus is used to clear phlegm mist from the
orifices. Acorus is indicated for phlegm-damp obstructing the heart and for
cases due to dampness retained in the center (i.e., stomach/spleen).

The idea of phlegm-mist has evolved over time, and this entity is now
included as a diagnostic category for certain chronic ailments that do not
necessarily have sudden onset, as occurs with some cases of depression,
deterioration of memory, or gradual onset of a seizure disorder, as well as for
the prolonged period of post-stroke syndrome. In such cases, milder agents
(other than the highly aromatic musk and borneol) are relied upon. As an
example, Clinic of Traditional Chinese Medicine (6) recommends a formula
for treating a syndrome of "depressive psychosis" marked by conditions such
as emotional depression, apathy, dementia, muttering to oneself, frequent
outbursts of crying or laughing for no apparent reason, and low desire for food;
the formula is comprised of acorus, polygala, arisaema, curcuma, pinellia,
citrus, chih-shih, cyperus, hoelen, licorice. In the book Traditional Chinese
Treatment for Senile Diseases (7), a similar formula is suggested for cases of
senile dementia with depression and other symptoms such as those just
mentioned, with the herbs chih-shih and licorice removed and replaced by
gardenia. These formulas are modifications of the traditional Shunqi Daotan
Tang (Smooth the Qi and Purge the Phlegm Decoction).

For the long-term therapy of patients suffering from phlegm-mist disorder,

dietary adjustments are considered very important. Fried foods, heavily salted
foods, and foods that are difficult to digest are eliminated to avoid the problem
of producing pathological phlegm from undigested food. Herbs that promote
digestion are also potentially of value. If constipation is present, this disorder is
to be addressed because it contributes to abdominal stagnation and the increased
possibility of upward flow of qi and fluid to affect the heart and its orifices.

Resolving Fluid Accumulation

As noted at the end of Chapter 6, one of the potential contributors to shen
disorders is accumulation of fluids. Herbs that resolve fluid accumulation are
included in three of the tables presented in the current chapter. For example, in
the group of tonic herbs, atractylodes and hoelen are used for getting rid of
stagnated fluids; herbs that tonify the spleen, such as astragalus, ginseng,
codonopsis, alpinia, and dioscorea assist its function in distributing fluids. In
the group of qi resolving herbs, most of the herbs also disperse stagnant fluids,
and all of the citrus-based materials (citrus, blue citrus, chih-shih, and chih-ko)
have a drying effect; magnolia bark is especially valued for dispersing
accumulated fluid. In the group of herbs for phlegm mist, all the herbs resolve
fluid accumulation, particularly the thickened fluids categorized as phlegm.
Only the sedative herbs (Table 3) have limited capability to resolve fluids (fu-
shen functions like hoelen to resolve moisture; polygala helps get rid of phlegm-
mist), and these are almost always used with fluid-resolving herbs from the
other categories. Hence, as an underlying therapeutic principle, getting rid of
accumulated fluids that may be causing physical and mental disorders is almost
always a part of treating shen disorders.

References

1. Yang Shou-zhong (translator), The Divine Farmer's

Materia Medica, 1998 Blue Poppy Press, Boulder, CO.
2. Hsu HY, et al., Oriental Materia Medica: A Concise
Guide, 1986 Oriental Healing Arts Institute, Long Beach,
CA.
3. State Administration of Traditional Chinese
Medicine, Advanced Textbook on Traditional Chinese
Medicine and Pharmacology, (Vol. 2) 1995-6 New World
Press, Beijing.
4. Editorial Committee, International Conference on
Traditional Chinese Medicine and Pharmacology
Proceedings, 1987 China Academic Publishers, Beijing.
5. Bensky D and Barolet R, Chinese Herbal Medicine:
Formulas and Strategies, 1990 rev. ed., Eastland Press,
Seattle, WA.
6. Zhang Enqin (chief editors), Clinic of Traditional Chinese
Medicine, 1989 Publishing House of Shanghai College of
Traditional Chinese Medicine, Shanghai.
7. Hou Jinglun Geng Xiu'e (chief editors), Traditional Chinese
Treatment for Senile Diseases, 1997 Academy Press,
Beijing.
 Chapter 8
Traditional Herb Formulas
Herbs Formulas for Treatment of Shen Disorders
There are hundreds of herbal formulas useful for shen disorders among the vast
collection of Chinese medical literature. However, a relatively small number of
prescriptions have been handed down over time and collected into texts that are
used for the study of Chinese medicine today. These formulas are the ones most
likely to be used by physicians in China and the West, at least as a reference
point for preparing an individualized prescription, but often as a prepared
formula ready to administer.

The well-established formulas for treatment of shen disorders may be

subdivided into three groups for purposes of analysis and discussion: those that
focus on tonification therapy; those that combine qi regulating and tonification;
and those that combine tonification, sedating, and orifice opening. By
presenting these three groups, it is not intended to suggest that other
combinations of therapeutic principles are to be avoided, but that these three
reveal the characteristics of most traditional formulas used today
for shen disorders. Four sample formulas have been selected for each category
of prescription.

Tonification Formulas
Deficiency of qi and blood are considered underlying syndromes that make a
person susceptible to a wide variety of disorders and diseases. Qi and blood fill
the vessels to block entry of pathological influences and they nourish the organs
to protect them from deterioration or harmful changes in structure and function.
In addition, qi deficiency leads to insufficient raising of clear yang to the brain,
reducing mental and sensory acuity, while blood deficiency leads to insufficient
moistening of the internal organs, making them less receptive as a resting place
for the associated spirit.

The concept of raising clear yang is important to mental function; it was

described by Li Dongyuan in his famous text Pi Wei Lun (1). He noted that:
After water and grain enter the stomach, yang qi ascends.
Fluids and qi enter the heart and penetrate the lungs to
replenish the skin and hair and to disperse throughout the
hundreds of vessels. The spleen receives qi from the
stomach to irrigate the four limbs and nourish the qi and
blood. If, on the other hand, the stomach is injured by
improper food and drink and the spleen is damaged by
being overwhelmed [taxation fatigue], they become
deficient….Generally speaking, if the spleen and stomach
are deficient and weak, yang qi is unable to grow and rise
 up….When the spleen is diseased, yang qi flows down to
overwhelm the kidneys.

In particular, the yang qi ascends to the top of the head, converging at the
point GV-20 (baihui; hundred convergences; and the meeting point for the six
yang channels). Since the kidneys nourish the marrow and brain, the problem
of failure of yang qi to flow upward and invigorate the brain is compounded by
downward flow of yang qi inhibiting the kidney (thus weakening the kidney's
nourishment of the brain). Tonifying the spleen qi and raising qi become
important, particularly where the brain function appears impeded (slow
thought, reduced sensory function, cloudiness, confusion, poor memory, etc.).
The herbs ginseng and astragalus (usually with licorice) are used for this
purpose. Other ingredients may be added to assist in raising yang qi, such as
cimicifuga ( shengma ), which is not one of the tonic herbs.

In the following list of sample formulas, all have astragalus, ginseng, and
licorice for tonifying qi, benefiting the spleen and heart, and raising clear yang.
The formulas all contain constituents of the main qi tonic formula, Si Junzi
Tang (Four Major Herbs Combination) and the main blood nourishing formula,
Si Wu Tang (Tang-kuei Four Combination). Schizandra, an astringent herb, is
listed among the nourishing sedatives, which is how it is often used today. Yiqi
Congming Tang is a formula primarily used for sensory weakness (poor vision
or hearing), but it also improves brain function more generally, so is included
here.

Table 1: Tonification Formulas for Shen Disorders.

Renshen
Ingredient type Guipi Tang Yiqi Congming Tang Yangxin Tang
Yangying Tang
Tonify/Raise Qi Astragalus Astragalus Astragalus Astragalus
Ginseng Ginseng Ginseng Ginseng
Atractylodes Atractylodes
Si Junzi Tang
Ingredients Hoelen Hoelen Hoelen
Licorice Licorice Licorice Licorice
Tang-kuei Tang-kuei Tang-kuei
Peony Peony
Si Wu Tang
Ingredients Rehmannia
Cnidium
Polygala Polygala Polygala
Nourishing Zizyphus Zizyphus
Sedatives
Schizandra Schizandra
jujube, longan, vitex, cimicifuga, pueraria, citrus, cinnamon fu-shen, biota, pinellia,
Other Herbs saussurea, ginger phellodendron twig cinnamon bark
 Of these formulas, Guipi Tang is the best known and most widely used.
Domei Yakazu (2) relays a summary of applications of this formula as
described in Japanese literature:

1. It is a wonderful prescription used mainly to treat a spleen

and heart that are exhausted and injured by excessive thinking
and worrying, resulting in amnesia and reckless acts or
destructive behavior.
2. For those with insufficient blood in the heart, or for intestinal
wind and bloody stools; hematemesis, epistaxis,
spermatorrhea, white turbid urine, or dripping and painful
urination, or for the strong-willed deep thinkers who have
withered, yellow complexions, the prescription has a
miraculous effect.
3. It is used for women who are peevish and irritable, can't be
satisfied by any man, and can't get what they want. This
mental condition leads to jealousy and hostility, resulting in
weak and depressed spleen and heart with the accompanying
symptoms of reckless acts, palpitation, flare-up of weak fire,
white dandruff, paralysis in the feet and hands, fondness of
lying in bed, poor appetite, thirst, itching and feverish skin
heat, body odor, and pain and swelling or leukorrhea in the
genital area.
4. It has an excellent effect in treating all diseases of the female
genitalia. For bleeding during coitus, add cimicifuga
[ shengma ] and peony [baishao] to the formula
[note: shengma raises qi and peony astringes blood, so this
combination is intended to prevent the falling of blood].
5. It has a marvelous effect in curing the weakness in widows
and virgins who are sexually frustrated and, as a consequence,
suffer depression and anxiety.

In addition to these common concerns, Guipi Tang may be of interest for a

modern application of aiding persons withdrawing from certain antidepressant
drugs (SSRIs), as described in the Appendix.

Qi-Regulating Formulas
Bupleurum is one of the most important of the herbs for alleviating stagnation
of liver qi associated with depression of the mind. All the formulas listed in the
table below include this herb; other qi regulating ingredients are cyperus, citrus,
and either chih-shih (immature fruit) or chih-ko (mature fruit), which are types
of citrus fruits. As with the above mentioned tonic formulations, ingredients
of Si Junzi Tang and of Si Wu Tang are included, because deficiency of qi and
blood contributes to the stagnation syndrome affecting the liver.

Table 2: Qi-Regulating Formulas for Treating Shen Disorders.

Ingredient Chaihu
Xiao Yao San Zhuru Wendan Tang Yi Gan San
type Shugan San
Bupleurum Bupleurum Bupleurum Bupleurum

Regulate flow Cyperus Cyperus

of Qi Citrus Citrus
Chih-shih Chih-ko
Ginseng
Atractylodes Atractylodes
Si Junzi Tang
Ingredients Hoelen Hoelen Hoelen
Licorice Licorice Licorice
Tang-kuei Tang-kuei
Peony Peony Peony
Si Wu Tang
Ingredients
Cnidium Cnidium
pinellia, ginger,
ginger, mentha [add gardenia and
platycodon, bamboo, Uncaria
Other Herbs moutan to form Jiawei Xiao Yao San]
coptis,

Of these formulas, by far the most widely used is Xiao Yao San (Tang-kuei
and Bupleurum Formula) and its modification Jiawei Xiao Yao
San (Bupleurum and Peony Formula), made from the former by adding the heat
clearing herbs gardenia and moutan. The central herb of Xiao Yao San is
bupleurum (chaihu), used to release the liver qi that is stagnated by emotion.
According to the Bencao Jiuzhen of 1773 A.D. (3):
Bupleurum is used for the condition of heat entering the
women's blood chamber....In some cases, one may use it
during pregnancy or after delivery...bupleurum has a
lubricating nature; it is an excellent herb to stimulate the
passage of qi...in cases of heat accumulation and blocked
passage, it should be assisted by tang-kuei and scute
(huangqin).

Based on such descriptions, bupleurum has been especially used in

treatments for women, mainly in the context of Xiao Yao San and its derivative
prescriptions. Souhaku Asada, a famous Japanese physician quoted in an article
on bupleurum prescriptions, indicates that bupleurum has "calming
characteristics," removing irritation, arresting panic, and treating vertigo,
dizziness, tinnitus, and hearing difficulties (4).
 As C.S. Cheung describes bupleurum's function (5), "it dredges the liver
and relieves congestion." The term "dredges" is particularly appropriate,
because the Chinese concept is that the liver, especially when it has been
disturbed by frustration (inexpressible anger), can tenaciously hold on to the qi
that it is supposed to help circulate, and the qi needs to be released by some
means. An important herb for treating stagnation with emotional depression is
cyperus (xiangfuzi), which is notable for its pleasant and penetrating fragrance.
However, during the past century, bupleurum has gradually taken on greater
importance for this role. It is especially relied upon when there is a stagnation
of circulation associated with both the liver and spleen. The spleen is said to
distribute the qi and moisture from food, a function that is disturbed by anxiety
and worry.

The liver is associated with the wood element, which corresponds with
growing plants. It is said that young plants that are full of sap grow vigorously
during the spring (the season associated with wood) and bend easily under the
pressure of wind (the climatic condition associated with wood), bouncing back
readily (bending and bouncing back mimics the xiao yao ideal of journeying
and returning). On the other hand, when wood has become aged and dried, its
growth is slowed and it is no longer able to bend in the wind; rather, it can easily
break; it can also easily be burned by fire. To assure that the liver, as
representative of the wood element, remains healthy and able to easily respond
to stresses (such as emotional reactions), it needs to be moistened. Hence, in the
formula Xiao Yao San , bupleurum is joined by tang-kuei and peony, two herbs
that nourish the liver blood. These herbs prevent and even reverse a condition
of liver dryness.

The spleen is associated with the earth element, corresponding to the soil
in which plants grow. When the soil is well drained, it supports the health of
plants. When the earth becomes too moist, it is no longer a healthy medium;
instead, plants growing in such conditions yellow and wilt, and their roots may
rot. The soil that is saturated with moisture can no longer drain additional
moisture that falls as rain, so there are floods and damage. Therefore, by this
analogy, to keep the spleen and liver healthy, the excess moisture must be
drained, and this is accomplished in the formula Xiao Yao San with the moisture
resolving herbs hoelen and atractylodes. In addition, the function of the spleen
is invigorated by baked licorice, a sweet, tonifying herb.

The complete Xiao Yao San formulation is filled out with two other herbs
as adjuncts: mentha, to aid in the dredging of the liver; and fresh ginger, to aid
the function of the spleen. These two herbs are also used to resolve congestion
at the body surface, a function to which bupleurum also contributes.

The most widely used modification of Xiao Yao San is Bupleurum and
Peony Formula (Jiawei Xiao Yao San ; jiawei means added ingredients;
literally, added flavors). The additions, gardenia (shanjizi) and moutan
(mudanpi), both clear heat; gardenia is said to purge fire from the liver and drain
damp-heat from the gallbladder, while moutan is said to clear heat from the
blood. The accumulation of qi in the liver is a type of fire syndrome (excess of
qi) and the dryness of liver wood that arises further fuels the development of
fire. This modified version is one of the most frequently prescribed formulas in
Japan, particularly for emotional disorders and "erratic complaints"
experienced by women (one of the xue dao zheng conditions described in
Chapter 6); it is commonly given for perimenopause and early stage of
menopause. Dr. Wago Mitani presents Bupleurum and Peony Formula as the
central treatment for climacteric syndrome (6), which he says is comprised of
symptoms such as "lack of physical strength, anxiety, poor concentration,
insomnia, lethargy, somatic instability, tendency toward fatigue, and mild
fever." The formula is also frequently prescribed for treatment of viral hepatitis
because of its beneficial effects on the liver. In several modern books about
Kampo medicine, Jiawei Xiao Yao San is mentioned but the original Xiao Yao
San is not.

The primary reason for selecting Jiawei Xiao Yao San is the finding of
evident symptoms of heat and agitation that would call for the inclusion of
moutan and gardenia. Such heat symptoms are mentioned in the traditional
indications for Xiao Yao San , but the added herbs improve the treatment when
those symptoms are more evident. This formulation addresses the condition of
"conflict between heat and the blood," in which the well-nourished blood can
restrain heat. In return, the well-directed heat circulates the blood and prevents
it from stagnating. Jiawei Xiao Yao San is indicated when the blood is
insufficiently nourished and the heat is agitated (alternately constrained or
rushing out without direction); the blood and heat are in conflict rather than
harmony.

In a review of uses of Bupleurum and Peony Formula (7), Yakazu Domei

indicated that of 65 patients treated by this prescription in his clinic, 43 of them
were cases of xue dao zheng. In his analysis, he mentioned that the formula is
effective for "treating various female diseases and general nervousness and
anxiety." He states that:
This formula is regarded as having the ability to adjust the
irregularity of the autonomic nerves caused by the
stagnation of liver qi and the ability to act as a tranquilizer.
In addition to treating menopausal disturbances of weak
conformations, the formula is widely used for treating
irregular menses, the side effects of abortions and
miscarriages, emotional distress caused by any
salpingoplasty [gynecological surgery] or uterine
disturbance, infertility, etc.
 Another formula listed in Table 2 is Yigan San (Bupleurum Formula),
which is indicated for fire in the liver meridian, producing symptoms such as
tic, teeth-grinding, or neurotic behavior. In a review of this formula by Dr.
Hong-yen Hsu (8) it is said that the formula "decreases tendency toward anger
and irritability, and treats insomnia due to excitement and neurotic
hypersensitivity...also indicated for those with poor nutritional habits,
decreased tolerance to stressful situations, heightened sensitivity to mild mental
and physical excitement, and lack of autonomic nerve coordination." The
formula is given to adults as well as children (for whom it was originally
designed) and said to treat, among other things, menopausal disturbance
and xue dao zheng. According to Dr. Hsu, in Commonly Used Chinese Herb
Formulas with Illustrations (13) if pinellia and citrus are added to Bupleurum
Formula, that formula "is indicated for adults (especially those past middle age,
either perimenopause or postmenopause) with obvious neuropathy [neurotic
conditions]." Pinellia and citrus promote the function of the stomach and
gallbladder and help to remove dampness and phlegm-mist that may lead to
mental dysfunction.

Sedative Formulations
The formulas described below incorporate three treatment methods:
tonification, sedating the spirit, and opening the orifices. Three of the formulas
are modern patents (that have been available for several decades). Ingredients
lists provided for patent remedies such as these should be interpreted with some
reservations, as the manufacturers often do not disclose all ingredients. The
other formula, Tianwang Buxin Dan, is a traditional prescription as well as a
patent, so the ingredients of the former version are widely publicized, though
they vary considerably among the texts. The first three formulas listed had
included cinnabar until recently. Polygala, which serves both as a sedative and
orifice-opening herb, is classified here with the orifice-opening group; each
formula includes at least one other herb aimed at resolving phlegm mist (e.g.,
acorus, bamboo, platycodon). Hoelen and alpinia, which each appear in two of
the formulas, aid in dispersing fluids and thus contribute to preventing
development of phlegm-mist, but are listed separately.

Table 3: Sedative Brain-Nourishing Formulas

Tianwang Buxin Baizi Yangxin
Ingredient type Bunao Wan Jiannao Wan
Dan Wan
Biota Biota Biota Biota
Zizyphus Zizyphus Zizyphus
Spirit-Sedating Schizandra Schizandra Schizandra
Ingredients
Dragon Teeth Dragon Teeth
Succinum Succinum
Polygala Polygala Polygala
Acorus Acorus Acorus
Orifice Opening and Bamboo Bamboo
Phlegm Clearing
Ingredients Platycodon

Tang-kuei Tang-kuei Tang-kuei Tang-kuei

Lycium fruit Lycium fruit Lycium fruit
Blood and Yin Nourishing Ophiopogon Ophiopogon
Ingredients
Rehmannia Rehmannia
Cistanche Cistanche
hoelen,
asparagus, walnut, gastrodia, ginseng, alpinia, salvia,
scrophularia,
Other Herbs ginseng, hoelen alpinia, arisaema gastrodia, dioscorea
licorice

Tianwang Buxin Dan (Ginseng and Zizyphus Formula) is the best known
of the prescriptions in this group. It is considered suitable for long-term therapy
in treating chronic brain disorders, such as those that occur with aging. Bunao
Wan (Cerebral Tonic Pills) is a modern patent remedy indicated mainly for poor
memory and insomnia, and also used for anxiety, heart palpitations, and being
easily frightened. Healthy Brain Pills (Jianao Wan) is a modern patent designed
along the same lines as Cerebral Tonic Pills, and for the same indications. Baizi
Yanxin Wan (Biota Heart Nourishing Pills) is a patent remedy that represents a
variation of the traditional Tianwang Buxin Dan; numerous other factories
produce their own sedative formulas in which they attempt to improve on this
widely-used prescription.

The name Tianwang Buxin Dan makes reference to the "King of Heaven"
(tian = heaven; wang = king, ruler) and to the action of supplementing the heart
(buxin), being prepared in the form of a large pill rolled in cinnabar (dan;
without cinnabar, the preparation should be called simply a pill: wan). The
formula was first recorded in the Shesheng Mipou (Secret Investigations into
Obtaining Health) written by Hong Ji in 1638 A.D. There is a story explaining
the formula's unusual name-that Hong Ji had a dream in which the Heavenly
King visited him and gave him the formula. However, Tianwang Buxin Dan is
actually a relatively simple modification of a much earlier prescription known
to Hong Ji, Pingbu Zhenxin Dan, from the famous book of the Song
Dynasty, Taiping Huimin Hejiju Fang.

The recipe for Tianwang Buxin Dan is reported in differing texts with
markedly different proportions of ingredients. The herb described as the key
herb of the formula, rehmannia, is present in proportions ranging from 8% to
32% of the total weight. Following is the recipe presented in Chinese Herbal
Medicine: Formulas and Strategies (9), in which rehmannia makes up 31%
of the formula:
 Tianwang Buxin Dan
shengdi Rehmannia, raw 120 grams
wuweizi Schizandra 30 grams
danggui Tang-kuei 30 grams
tianmendong Asparagus 30 grams
maimendong Ophiopogon 30 grams
boziren Biota 30 grams
suanzaoren Zizyphus 30 grams
renshen Ginseng 15 grams
danshen Salvia 15 grams
xuanshen Scrophularia 15 grams
fuling Hoelen 15 grams
yuanzhi Polygala 15 grams
jiegeng Platycodon 15 grams

The herbs are powdered and then made into honey pills, typically yielding
a bolus of about 9 grams (about 2/3 herbs, 1/3 honey); this batch is enough for
a two month supply at one pill twice per day. Until recently, these pills were
rolled in cinnabar, which was one of the examples of why remedies from China
were said to be contaminated with heavy metals (in this case, mercury). Now,
the pills are made without it.

The formula has the primary function of nourishing yin and blood and
clearing heat. Several herbs of the formula have mild sedative effects, including
ginseng, salvia, schizandra, polygala, biota, hoelen, and zizyphus. The formula
is indicated for those showing deficiency syndrome with dryness, such as dry
stool, dry mouth, and little tongue coating, and with heat (tongue body is red,
pulse is rapid), though it can be used more generally. It is probably best used in
cases of insomnia with constipation and for those who feel warm at night (there
may be night sweating); it is avoided in cases of diarrhea and for persons who
tend to be cold. The effect of the herbs in Tianwang Buxin Dan have been
described by C.S. Cheung as follows (10):
The principle of treatment is to moisten the yin, clear the
heat, nurture the blood and calm the spirit. Raw rehmannia
as the chief herb in the prescription, moistens the yin, clears
heat, and prevents any disturbances of spirit by deficiency.
Scrophularia, ophiopogon, and asparagus assist rehmannia
in moistening the yin and clearing heat. Salvia and tang-
kuei nourish the blood and nurture the heart. The heart
spirit becomes calm when the blood of the heart is repleted.
Ginseng and hoelen benefit the heart qi and calm the heart
spirit; biota and polygala calm the heart and pacify the
spirit. Platycodon functions to carry the other herbs
upwards; cinnabar is used to coat the pills: both of them act
as messengers to enter the heart.
APPENDIX 1: Guipi Tang and SSRI Withdrawal Syndrome
The problem of adverse reactions to withdrawing from the antidepressants
known as selective serotonin reuptake inhibitors (SSRIs) is important to
patients, especially since they already may suffer from problems of anxiety and
fear which can exacerbate their concerns about symptoms that arise. A Chinese
herbal therapy for this condition has not been established, but can be suggested
from the typical symptoms of withdrawal. A listing of symptoms that have been
repeatedly observed in patients withdrawing from SSRIs is arranged in the left
column of the following table by general type, and paired with a potential TCM
interpretation of the symptoms in the right column.

Table 4: SSRI Withdrawal Symptoms and their TCM Interpretations.

Symptoms Potential TCM Interpretation

Deficiency of blood affecting the liver and heart, with instability
Psychiatric
of shen and hun (spirit associated with the liver; especially affects dreaming).
anxiety, crying spells, insomnia,
These symptoms may additionally correspond to qi deficiency and stagnation
irritability, agitation, mood lability,
(liver/spleen disharmony or simple spleen weakness), so the total syndrome
vivid or bizarre dreams, difficulty
would involve qi and blood deficiency and qi stagnation, destabilizing the
with concentration and memory
mind.
Neurologic
dizziness, lightheadedness, Damp accumulation may produce all of these symptoms; insufficient rise of
headache, paresthesia (electric clear yang qi may also produce these symptoms.
shock-like tingling), vertigo
Motor These symptoms may correspond to generation of internal wind, a condition
dystonia (gait instability), tremor which results from deficiency of liver blood.
Gastrointestinal Accumulation of dampness is a possible cause; adverse flow of qi may occur
nausea, vomiting, diarrhea (upward or downward flow contrary to normal flow).
Somatic
Qi deficiency, along with impaired circulation of qi may cause these
chills, fatigue, lethargy, myalgias,
symptoms; dampness can contribute to all these symptoms.
rhinorrhea, sweating

Summing up the notes about TCM interpretation, the withdrawal syndrome

may revolve around the problems of qi and blood deficiency, which may be
accompanied by qi stagnation and dampness accumulation (and, in rare cases,
also by internal wind). These deficiency syndromes of Chinese medicine are
attributed primarily to the spleen (for qi) and liver (for blood); a Western
interpretation of the same pattern might be a relative deficiency in serotonin
availability or an imbalance of neurotransmitters that occurs when the drugs are
removed.

Key herbs that might be considered for SSRI withdrawal syndrome based
on the symptom analysis include:
Atractylodes (white atractylodes): tonifies qi, resolves
damp
Peony (white peony): nourishes blood, vitalizes blood
circulation
 Tang-kuei: nourishes blood, vitalizes blood circulation
Zizyphus: nourishes liver and heart blood and clams shen
Saussurea: circulates qi, calms shen
Ginseng: tonifies qi, calms shen
Astragalus: tonifies qi, raises yang qi
Polygala: resolves phlegm, calms shen
Fu-shen or Hoelen: resolves damp, calms shen
Pinellia: resolves damp, lowers stomach qi
Citrus: resolves damp, circulates qi

A formula with these ingredients can be constructed from the traditional

formula Gupi Tang, which includes most of the herbs. According to Giovanni
Maciocia, who is widely respected for his knowledge of TCM, this formula is
itself used for treating depression (11). He noted that: "The formula Guipi
Tang tonifies spleen-qi and heart-blood and calms the mind: it is ideally suited
to treat post-natal depression and insomnia. This formula is also recommended
by Wu Qian in his Golden Mirror of Medicine for post-natal depression from
worry, pensiveness, and sadness." The ingredients may be provided as a
decoction ( Guipi Tang ), dried decoction, or in tablet form (Guipi Wan). A
typical powder preparation is (12):

Guipi San
(Ginseng and Longan Combination)
renshen Ginseng 15 g
huangqi Astragalus 15 g
longyanrou Longan 12 g
fuling Hoelen 10 g
baizhu Atractylodes 10 g
danggui Tang-kuei 10 g
suanzaoren Zizyphus 10 g
yuanzhi Polygala 10 g
muxiang Saussurea 5g
zhigancao Licorice 5g
dazao Jujube 5g
shengjiang Ginger 5g

In China, codonopsis has been used in place of ginseng for several decades,
but the original formula is with ginseng for rapidly restoring the spleen qi and
calming the spirit. For those with a more significant level of "damp" syndrome
(especially with digestive disturbance), one might add to Gui Pi Tang one of
the following:
Er Chen Wan aka Citrus and Pinellia Combination (has
citrus, pinellia, hoelen)
Si Jun Zi Tang aka Major Four Herbs Formula (has
 ginseng, atractylodes, hoelen)
Wu Ling San aka Hoelen Five Herb Formula (has
atractylodes and hoelen)
Xiang Sha Liu Jun Zi Tang aka Saussurea and Cardamom
Combination (has ginseng, saussurea, hoelen, atractylodes,
citrus, and pinellia)
Xiao Yao San aka Tang-kuei and Bupleurum Formula (has
hoelen, atractylodes, tang-kuei, and peony)

While there have not been studies providing clinical evidence for efficacy
of Gui Pi Tang, or any of the herbs mentioned, to alleviate SSRI discontinuation
symptoms, it is a characteristic of modern Chinese medicine practices to select
herbs on the basis of symptom patterns, with the expectation of attaining some
level of effect. The symptoms are understood to be a manifestation of an
underlying imbalance, whether described in ancient terms (e.g., qi and blood
deficiency) or modern terms (e.g., neurotransmitter release and reuptake). That
imbalance generates symptoms via common mechanisms that can be affected
by the herbs. Starting an herbal formula along with gradual drug dose reductions
may prevent or minimize the withdrawal symptoms.

APPENDIX 2: Bupleurum and Dragon Bone Combination for Xue

Dao Zheng
Two bupleurum-based prescriptions stand out in the literature related to xue dao
zheng: Bupleurum and Peony Formula, which has already been discussed, and
Bupleurum and Dragon Bone Combination (Chaihu Jia Longgu Muli Tang).
Another formula mentioned less frequently is Bupleurum and Cinnamon
Combination (Chaihu Guizhi Tang), which has several herbs in common with
Bupleurum and Dragon Bone Combination. In the book Commonly Used
Chinese Herb Formulas with Illustrations (13) this latter formula is said to
treat numerous symptoms, including a variety of emotional and neurological
disorders-nervous exhaustion, neurotic behavior, irritability, and hysteria. The
ingredients for Bupleurum and Dragon Bone Combination are:
Bupleurum and Dragon Bone Combination
chaihu Bupleurum 20%
banxia Pinellia 12%
fuling Hoelen 12%
guizhi Cinnamon 8%
huangqin Scute 8%
renshen Ginseng 8%
muli Oyster shell 8%
longgu Dragon bone 8%
shengjiang Ginger 8%
dahuang Rhubarb 8%
 This formula calms the spirit with ginseng, dragon bone, and oyster shell,
resolves phlegm-dampness with pinellia, ginger, and hoelen, and purges fire
with scute and rhubarb. In Commonly Used Chinese Herb Formulas with
Illustrations, the formula is said to be useful for neurosis, hysteria, neurotic
insomnia, climacteric disorders, neurotic palpitation, and neurotic impotence.
Combining this with a formula for stagnant blood or for qi stagnation and
phlegm accumulation is thought to help resolve xue dao disorders even more
effectively. Bupleurum and Cinnamon Combination is produced by deleting
hoelen, rhubarb, dragon bone, and oyster shell (all of which have sedative
effects) and replacing them with peony, licorice, and jujube (which contribute
an antispasmodic and analgesic action).

Yakazu Domei (14), described use of Bupleurum and Dragon Bone

Combination for 65 of his patients. Many of these patients were being treated
for neurosis (heart palpitations, neurasthenia, hysteria, and neurotic chest
pains). He classified the applications of the formula as treating three conditions:
flushing up of qi, stagnant water, and lower torso weakness. As to the first, he
listed symptoms of chest distress, discomfort, palpitations, strange moods,
irritability, insomnia, stiff shoulders, heavy headedness, headaches, vertigo,
frequent napping, spasms, delirium, and mania. For stagnant water syndrome,
he included the symptoms of generalized lassitude and body heaviness along
with water retention, and for lower torso weakness, he referred to weak legs,
low back pain, impotence, and cold feet. He further mentions that the formula
is frequently used to treat "the complications of mental, emotional, and nervous
distress."

According to Takahide Kuwaki (15), the xue dao syndrome (which he calls
"nervous diseases and autonomic nervous disorders") is usually treated with:
...formulas containing descending herbs, which in this case
could be called sedatives. Of these descending drugs,
dragon bone and oyster shell containing formulas are most
often used. The two major formulas containing dragon
bone and oyster shell are Bupleurum and Dragon Bone
Combination (Chaihu Longgu Muli Tang) and Cinnamon
and Dragon Bone Combination (Guizhi Jia Longgu Muli
Tang).

He suggests that the first formula is given to more robust types and the
second to obviously weakened patients. Bupleurum and Dragon Bone
Combination was not included in Table 2 with the qi regulating bupleurum-base
formulas nor with the sedative formulas that have ingredients like dragon bone
and oyster shell because this formula does not quite fit the patterns described
for those approaches. While it includes qi tonics (ginseng, jujube), the qi
regulating herb bupleurum (but not others for that purpose), and the sedatives
dragon bone and oyster shell, it lacks blood nourishing herbs (that would make
it more suited to long-term use) and only has a small contribution towards the
problem of phlegm mist (hoelen and pinellia, but no acorus or polygala, for
example). It is most suited, in its standard form, for short term use.

APPENDIX 3: Formula for Plum Pit Qi Syndrome

Pinellia and Magnolia Combination (Banxia Houpu Tang) was presented in
the Jingui Laoyue (16), a treatise composed at the end of the Han Dynasty (ca.
220 A.D.). The text includes this brief statement: "A woman who feels as if a
piece of broiled meat is stuck in her throat should take Banxia Houpu Tang."
This statement has been interpreted to mean that the woman is suffering
from globus hystericus, the feeling of a lump (globus) resulting from hysteria
(an emotional state of mind originally thought to be associated with the uterus).
The Chinese later described the sensation as that of a plum pit caught in the
throat. Its cause is attributed to the emotions coupled with stagnation of phlegm.
In a Japanese report on treatment of 45 patients with abnormal sensations in the
throat (sense of pressure, swelling, or, in most cases, something stuck in the
throat), relayed by Dr. Hong-yen Hsu (17), 21 of the patients of "weak"
constitution were given Pinellia and Magnolia Combination, while 13 patients
of "firm" constitution were given Bupleurum and Dragon Bone Combination.

The applications of Pinellia and Magnolia Combination have been

expanded to include both the sensation of a lump that is without obvious
physical cause and also now for several physical disorders, such as esophageal
spasms, hoarseness, or difficulty swallowing. In two recent studies conducted
in Japan, the formula was proclaimed beneficial in treating swallowing
difficulty in the elderly. It was used to improve the swallowing reflex in those
who suffered from stroke (18) and difficulty swallowing as a result of
progression of Parkinson's disease (19). The mechanism of its action in these
cases remains to be established.

In modern Chinese texts, Pinellia and Magnolia Combination is classified

with the qi regulating formulas, even though none of the herb ingredients are
classified in the Materia Medica as having the primary property of being qi
regulators. Rather, these ingredients help circulate both qi and moisture. A
typical presentation of its ingredients and quantities is (20):
Pinellia and Magnolia Combination
banxia Pinellia 12 g
fuling Hoelen 12 g
houpo Magnolia 9g
Shengjiang Fresh ginger 9g
zisuye Perilla 6g

From the traditional Chinese point of view, both magnolia bark and perilla
leaf regulate the flow of qi moisture and these actions are attributed to their
fragrant components that have a dispersing effect. These herbs alleviate the
neurotic and depressive syndromes that lead to plum pit qi. The qi regulating
formulas in general, and the ingredient perilla leaf in particular, are
recommended in China for treatment of depression and anxiety. In a recent
laboratory evaluation, Pinellia and Magnolia Combination was reported to have
antidepressant activities (21), confirming this application. In fact, magnolia
bark extract has been promoted as an anti-depressant and anti-anxiety agent
without the side effects of tricyclic antidepressants (22).

APPENDIX 4. Modern Use of Salvia as a Sedative

Salvia, danshen (the Chinese name implies a cinnabar-colored ginseng-like
herb) has long been known as a sedative, but is not often used as such. It is an
ingredient in the traditional Tianwang Buxin Dan and the 20th Century brain-
nourishing and sedative patent Bunao Wan. Modern research has demonstrated
the sedative quality of an active component of salvia, miltirone, in animal
models that predict clinical tranquilizing effects. Salvia has been incorporated
into TCM treatments for insomnia, dementia, and other effects of brain
dysfunction. Salvia is thought to have blood nourishing and blood vitalizing
effects similar to that of Si Wu Tang , to have cooling effects like that of red
peony (chishao), and to have calming effects similar to that of ginseng.

A formula developed by the current author, called Salvia/Amber Tablets,

illustrates its use in the context of treating shen disorders. The formula is:
danshen Salvia 30%
hupo Succinum 18%
suanzaoren Zizyphus 16%
longchi Dragon tooth 13%
zhuli Bamboo sap 13%
renshen Ginseng 10%

The formula is intended to infuse courage to the heart to overcome fright.

Ginseng and amber (succinum; spirit of the tiger) may confer the will or courage
that has retreated under the pressure of traumatic external events. The key herb
salvia calms the agitated spirit. Salvia and amber are both recognized as blood-
vitalizers; when used with the qi tonic ginseng, they can restore the circulation
that has been impaired by fear. To these herbs is added the dragon's tooth, which
is a sedative for fright, and it represents the crystallization of the dragon in the
earth (dragon and tiger, in Taoist literature, represent the yang and yin,
respectively). There is also bamboo sap, the crystallization of the essence of
bamboo that is found at the joints of the bamboo stem. Like dragon's tooth, it is
used for calming fright, but it also dissipates the phlegm-mist that obstructs the
orifices. Zizyphus nourishes the heart to aid the spirit in gaining rest. The entire
formula enhances the basic heart functions; the formula clears heat, nourishes
the yin essences, vitalizes blood circulation, and calms the spirit. In the
book Mental Dysfunction as Treated by Traditional Chinese Medicine (23)
there is a section on the syndrome of "deficiency of heart and lack of courage,"
with the following comments:

1. When the heart is in a deficient state, the soul [shen; spirit] is

rolling and restless.
2. Lack of courage results in fright and timidity.
3. Therapeutic principle: benefit the qi and subdue the fright;
calm the soul and steady the will.

The author, C.S. Cheung, mentions in this context "the pill to calm the soul
and steady the will" (Anshen Dingzhi Wan also called Anshen Yuanzhi Wan;
mentioned in the previous chapter), which has the chief ingredients ginseng and
dragon teeth (others: hoelen, fu-shen, polygala, acorus). He recommends using
this together with Zizyphus Combination (which has a large dose of zizyphus)
for "serious cases."

References

1. Yang Shouzhong and Li Jianyong (translators), Li

Dongyuan's Treatise on the Spleen and Stomach, 1993
Blue Poppy Press, Boulder, CO.
2. Domei Yakazu, The application of Gui Pi Tang, Bulletin of
the Oriental Healing Arts Institute of U.S.A., 1980; 5(3): 21-
28.
3. Unschuld PU, Introductory Readings in Classical Chinese
Medicine, 1988 Kluwer Academic Publishers, Dordrecht.
4. Kunio Matsuda, Bupleurum prescriptions in Chinese herbal
medicine, Bulletin of the Oriental Healing Arts Institute,
1983; 8(1): 21-28.
5. Cheung CS and Belluomini J, Traditional and new
interpretation of prescriptions: the harmonizing group,
Journal of the American College of Traditional Chinese
Medicine, 1984; (1): 3-15.
6. Wago Mitani, Kanpo treatment of climacteric disorder,
International Journal of Oriental Medicine 1992; 17(1): 27-
32.
7. Yakazu Domei, Clinical experience with Bupleurum and
Peony Formula, Bulletin of the Oriental Healing Arts
Institute, 1980; 5(3): 11-20.
8. Hsu HY, Application of Chinese herbal formulas and
scientific research: Bupleurum Formula and Bupleurum and
 Chih-shih Formula, International Journal of Oriental
Medicine 1992; 17(2): 114-120.
9. Bensky D and Barolet R, Chinese Herbal Medicine:
Formulas and Strategies, 1990 rev. ed., Eastland Press,
Seattle, WA.
10. Cheung CS and Belluomini J, Heart, Journal of the American
College of Traditional Chinese Medicine 1984; (4): 40-58.
11. Maciocia G, The Foundations of Chinese Medicine, 1989,
Churchill Livingstone, London.
12. Ou Ming, Chinese-English Manual of Common-Used
Prescriptions in Traditional Chinese Medicine, 1989 Joint
Publishing Co., Hong Kong.
13. Hong-Yen Hsu and Chau-Shin Hsu, Commonly Used
Chinese Herb Formulas with Illustrations, 1980 rev. ed.,
Oriental Healing Arts Institute, Long Beach, CA.
14. Yakazu Domei, Bupleurum and Dragon Bone Combination,
Bulletin of the Oriental Healing Arts Institute, 1983; 8(7): 42-
44.
15. Takahide Kuwaki, Chinese Herbal Therapy, 1990 Oriental
Healing Arts Institute, Long Beach, CA.
16. Hsu HY and Wang SY (translators), Chin Kuei Yao Lueh,
1983 Oriental Healing Arts Institute, Long Beach, CA.
17. Hsu HY, Chinese herb therapy for abnormal sensations of the
throat, Bulletin of the Oriental Healing Arts Institute 1984;
9(2): 63-66.
18. Iwasaki K, et al., Traditional Chinese medicine Banxia
Houpu Tang improves swallowing reflex, Phytomedicine
6(2): 102-106.
19. Iwasaki K, et al., The effects of the traditional Chinese
medicine banxia houpo tang on the swallowing reflex in
Parkinson's disease, Phytomedicine 2000; 7(4): 259-263.
20. Huang Bingshan and Wang Yuxia, Thousand Formulas and
Thousand Herbs of Traditional Chinese Medicine, vol. 2,
1993 Heilongjiang Education Press, Harbin.
21. Luo L, et al., Antidepressent effects of banxia houpo tang, a
traditional Chinese medicinal empirical formula, Journal of
Ethnopharmacology 2000; 73(1-2): 277-281.
22. Kuribara H, Stavinoha WB, and Maruyama Y, Honokial, a
putative anxiolytic agent extracted from magnolia bark, has
 no diazepam-like side-effects in mice, Journal of Pharmacy
and Pharmacology 1999; 51(1): 97-103.
23. Cheung CS, Lai YK, and Kaw UA, Mental Dysfunction as
Treated by Traditional Chinese Medicine, 1981 Traditional
Chinese Medicine Publisher, San Francisco, CA.
 Chapter 9
Sample Herbal Treatment Strategies
Subjects of Study
Chinese medical reports on herbal therapies for shen disorders are spread
somewhat randomly throughout the Chinese medical literature, most being in
obscure journals. One of the areas that has gotten considerable attention is
"senile dementia," which involves deterioration of brain function, with
symptoms such as depression, confusion, poor memory, and slow responses.
The treatment of this problem with Chinese herbs is not substantially different
than the treatment of other disorders that affect mental status, particularly in
adults. This is because traditional Chinese medicine is based on general
principles of treatment rather than unique ways to combat specific diseases. The
therapeutic approaches described in chapters 7 and 8 are applicable to this
condition. For purposes of contrast, the treatment of attention deficit disorder
(ADD) in children will be presented afterward. In both cases, the therapies
described were actually used in clinical practice for dozens or even hundreds of
patients, not merely recommended on the basis of indications for a traditional
formula. Claims for success were presented in the literature, but the frequency
of improvement (i.e. "success rate," which was often high) is not conveyed here
because the standards of reporting and analysis in the reports differ significantly
from what is utilized in Western medical studies. Instead, the main focus here
is on the selection of herbs.

Herbal Therapies for Senile Dementia

Selected information from two large review articles published in the Journal of
Traditional Chinese Medicine is presented below in order to summarize a broad
range of Chinese medical literature.

In a 1996 review of Chinese herbal therapies for senile dementia (1),

doctors at the Chengdu University of Traditional Chinese Medicine and
Pharmacy presented the diagnosed syndromes and key herbs used to treat the
patients, and these are relayed in Table 1.

Table 1: Modern Differential Diagnosis and Treatment for Senile

Dementia.

Syndrome/Therapeutic
Main Symptoms Key Herbs
Method
Deficiency of kidney progressive dementia, dizziness, tinnitus, insomnia, rehmannia, cornus, dioscorea, ho-
essence poor memory, difficulties in speech, dull eyes, and shou-wu, lycium, eucommia, tang-
[tonification therapy] slow responses kuei, zizyphus, polygala
dull expressions, vague mind, depression, poor
pinellia, hoelen, acorus, polygala,
Stagnation of phlegm memory, abnormal behavior, involuntary crying or
curcuma, chih-ko, citrus, bamboo,
[resolving phlegm-mist] laughing, dizziness, heavy head or limbs,
bamboo sap
sleepiness
 ginseng*, astragalus, tang-kuei,
dizziness, poor memory, indifferent expression, atractylodes, fu-shen, rehmannia,
Deficiency of qi and blood dreaminess and light sleep, susceptible to fright, ho-shou-wu, polygala, peony,
[tonification therapy] pale complexion and listlessness, unable to zizyphus
participate in normal daily activities * codonopsis or pseudostellaria
could be substitutes for ginseng
dizziness, headache, poor memory, dementia, stiff salvia, carthamus, persica, cnidium,
Cerebral blood stasis
tongue and incapability of uttering a sound, history astragalus, angelica, musk, tang-
[vitalize blood]
of apoplexy kuei, red peony

The authors suggested that there are two main actions of the herbs in the
formulas: to replenish the kidney so as to nourish the brain and to supplement
and invigorate both qi and blood to provide adequate circulation in the brain.
They translated the means by which these actions affect dementia to a Western
idiom as follows:

1. To supply substances needed by the brain and nerve cells to

carry out normal metabolism and regulate cerebral activities;
and
2. To invigorate the following activities: blood supply to the
heart, immunologic functions, detoxification of the liver,
nutrient absorption of the alimentary system, and utilization
of energy by the body to improve the nutritional and
metabolic state, or, in other words, to regulate the vitality of
the whole body to improve mental function and combat
senility.

The authors also suggested that if blood-vitalizing herbs are included with
the tonic therapies that the results will be even better than using tonics alone,
mainly because of the improved microcirculation.

In a 1999 review from the Ningjin County Hospital of Traditional Chinese

Medicine (2), journal reports were divided into four groups: general
differentiation using traditional formulas; treatment based on differentiation of
regulating and nourishing the kidney and heart; treatment based on
differentiation of blood stasis and phlegm obstruction; and treatments based on
modern prescriptions. In this presentation, a number of the prescriptions are
designated by their traditional names, but many were said to be "modified"
without specifying the alterations made.

1. Treatment Based on General Differentiation Using Traditional

Formulas
Several examples of this approach were offered. Following is one giving the
diagnostic category and recommended formula for treatment relying on well-
known traditional formulations that had been slightly modified:
  Deficiency of brain and spinal cord: Modified Bushen Yisui
Tang (Decoction for Tonifying the Kidney and Rectifying the
Marrow);
 Deficiency of heart and spleen: Guipi Tang (Ginseng and
Longan Combination);
 Hyperactivity of heart fire and liver fire: Modified Tianma
Gouteng Yin (Gastrodia and Uncaria Formula) plus Huanglian
Xiexin Tang (Coptis Combination);
 Yin deficiency of liver and kidney: Modified Qi Ju Dihuang
Tang (Lycium, Chrysanthemum, and Rehmannia Formula)
plus Dingzhi Tang (Emotion-calming Decoction);
 Stagnation and obstruction by phlegm and blood stasis:
Modified Banxia Baizhu Tianma Tang (Pinellia and Gastrodia
Combination); and
 Stagnation of qi and blood: Modified Xiaoyao
San (Bupleurum and Tang-kuei Formula) plus Tongqiao
Huoxue Tang (Decoction for Activating Blood Circulation).

Here are two other sets of recommendations, the first attributed to Xu

Shizhen, the second attributed to the work of Zhao Xiangjun:

Category Xu Shizhen's Recommendations

Liver/Kidney Yin Deficiency Modified Bushen Yinao Tang
Spleen/Kidney Yang Deficiency Modified Yougui Wan
Accumulation/Obstruction by Phlegm Modified Erchen Tang
Interior Obstruction by Blood Stasis Modified Fuyuan Huoxue Tang
Category Zhao Xiangjun's Recommendations
Failure of Kidney Essence Modified Yougui Wan
Liver/Kidney Yin Deficiency Modified Zuogui Wan
Heart/Spleen Deficiency Modified Guipi Tang
Obstruction by Phlegm and Blood Stasis Mengshi Guntan Wan plus Xuefu Zhuyu Tang

This information can be summarized as follows: the primary formulas for

deficiency syndromes are modifications of Guipi Tang and the pills for
tonifying the left and right kidneys (Zuogui Wan and Yougui Wan; or the related
formula for nourishing kidney and marrow Bushen Yisui Tang). For phlegm
obstruction, Erchen Tang and related formulas, such as Banxia Baizhu Tianma
Tang are used. For blood stasis, formulas comprised of several blood vitalizing
(huoxue) herbs were used. Obstruction by phlegm accumulation and blood
stasis might be treated together.
2. Treatment by Regulating and Nourishing Heart and Kidney
Two examples of self-designed base formulas were offered for this category:

 Insufficiency of heart qi: codonopsis, hoelen, licorice,

acorus, polygala;
 Deficiency of kidney yin: asparagus, ophiopogon, rehmannia
(cooked and raw), cornus.

Those formulations were derived from Guipi Tang and Tianwang Buxin
Dan, respectively. A more extensive differentiation involved these therapeutic
categories and formulas:

 Reinforcing kidney and replenishing essence: rehmannia,

lycium, ho-shou-wu, curculigo, epimedium, acorus, polygala;
 Nourishing kidney and eliminating
phlegm: Modified Dingzhi Wan and Yougui Wan;
 Nourishing the kidney, removing blood stasis: rehmannia,
ho-shou-wu, lycium, cyathula, persica, carthamus, cnidium,
earthworm, cyperus, acorus, polygala; and
 Nourishing yin and eliminating phlegm: rehmannia, ho-
shou-wu, ophiopogon, forsythia, coptis, pinellia, bamboo,
curcuma, acorus, polygala, salvia.

In these formulations, the most consistent aspect of treatment is use of

acorus and polygala to open the orifices and invigorate the brain and use of
rehmannia to nourish the kidney.

3. Treatment Based on Differentiationof Blood Stasis and Phlegm

Accumulation
Two articles were described in this section of the review, one focused on blood
stasis and the other focused on phlegm obstruction. The blood stasis formulas
are not well known, so they will not be relayed here except for one of the
suggestions which was based on standard prescriptions: for qi deficiency and
blood stasis the recommendation was to use modified Yiqi Congming
Tang (mentioned in Chapter 8 in the tonic section) plus Tao Hong Siwu
Tang (this is Si Wu Tang , the most frequently used blood nourishing herbs,
with persica and carthamus). For the phlegm accumulation disorders, the basic
formula recommended was Banxia Baizhu Tianma Tang (Pinellia and
Gastrodia Combination) with acorus added (additional herbs might also be
added).

4. Treatment by Modern Prescriptions

The following information is based on reports in which a single base formula
was utilized for numerous cases of senile dementia, rather than relying on
differential diagnosis with several corresponding formulas. So, each of these
formulas appeared in a separate clinical report. The formulas are presented here
according to the therapeutic approach that was utilized. In many cases, the
formula was then modified slightly to address the unique symptoms of the
patients:

Therapeutic Category Formula Ingredients

Supplementing qi and activating astragalus, codonopsis, cnidium, red peony, peony, persica, pueraria,
blood circulation to remove stasis millettia, alpinia, curcuma, acorus, polygala
Nourishing the kidney and brain ho-shou-wu, cornus, dioscorea, lycium, cuscuta, red peony, salvia, curcuma
Tonifying the kidney, supplementing astragalus, codonopsis, pueraria, salvia, crataegus, lycium, polygonatum,
qi, and activating blood circulation cornus, tang-kuei, gastrodia, acorus
Tonifying the kidney, supplementing astragalus, codonopsis, alpinia, lycium, ho-shou-wu, salvia, red peony,
qi, and activating blood circulation cnidium, acorus, polygala
Tonifying the kidney and activating cornus, cuscuta, alpinia, placenta, leech, crataegus, curcuma, arisaema,
blood circulation to remove stasis acorus, polygala
Tonifying the kidney and activating rehmannia, cistanche, tortoise shell, cornus, polygonatum, tribulus,
blood circulation to remove stasis silkworm, gastrodia, astragalus, curcuma, acorus, arisaema, carthamus
Dispelling phlegm and removing pinellia, hoelen, citrus, ginger, bamboo, chih-shih, coptis, zizyphus,
blood stasis silkworm, arisaema, gastrodia, salvia, curcuma, acorus
astragalus, red peony, cnidium, persica, earthworm, bamboo, aurantium,
Dispelling phlegm and removing
pinellia, carthamus, gastrodia, silkworm, scorpion, leech, centipede,
blood stasis
curcuma, acorus, polygala

The authors of the review commented:

TCM holds that while the location of the disease is in the
brain, its root cause is insufficiency of vital essence and
energy of various zangfu organs in addition to obstruction
by stagnation of phlegm and blood stasis. The weak
constitution due to old age often leads to weakness and
failure of the zangfu organs and deficiency of qi and blood
and deficiency of yin and yang. This weakness and failure
may give rise to stagnation of qi, causing blood stasis,
which, in turn, leads to accumulation of qi to form phlegm
that may retain in the five zang organs and obstruct
collaterals of the brain to confuse the mind, hence the
occurrence of dementia. Its pathogenesis is deficiency in
origin and excess in superficiality.

An examination of the formulas presented in these two review articles

illustrates the basic approach that has been used and high reliance on a relatively
small number of herbs.

 Treat the organ-system deficiencies, primarily spleen qi

deficiency (astragalus, codonopsis, alpinia) and kidney/liver
deficiencies (rehmannia, cornus, ho-shou-wu, lycium)
  Add herbs for resolving phlegm-mist, primarily acorus,
polygala, curcuma, pinellia, arisaema;
 Alleviate blood-stasis, relying primarily on salvia, red peony,
pueraria, persica, carthamus, and cnidium; and
 When present as a secondary manifestation, alleviate wind
(silkworm, gastrodia).

Treatment of Attention Deficit Disorder

Attention Deficit Disorder (ADD) involves difficulty with concentrating on a
single task for a sufficient period of time to accomplish the goal at hand.
Although excessive movement is commonly observed with this condition, it is
not necessarily a component of ADD (when present, the disorder may be termed
ADHD, to include the "hyperkinetic" aspect). In some instances, ADD might
be a misdiagnosis for behavioral problems that are related to home and social
situations without an underlying brain dysfunction.

ADD is usually not diagnosed until lack of concentration at school is

deemed a problem, typically in the first or second grades (ages 7 to 8). Males
are at least four or five times as likely as females to have this diagnosis. While
for many children affected by ADD there is some reduction in the symptoms as
the child enters puberty, the disorder will often continue for the rest of the
individual's life. Manifestations such as impulsiveness, recklessness,
irritability, aggression, and poor emotional development can have a lasting
impact. Sometimes, puberty brings about a switch from hyperactivity to
persistent sluggishness, depression, and moodiness, which is liable to be
equally disruptive. The ADD syndrome has been identified in adults as well.

The primary treatment for ADD is the administration of stimulant drugs. It

is postulated that the controlling action of certain mid-brain activities may be
deficient in these individuals and therefore a stimulant is able to bring about the
desired control. The stimulation of brain function may also enhance alertness
and concentration. The primary drug used for this disorder is methylphenidate
(Ritalin), a relatively mild derivative of amphetamine. Ritalin is also used in the
treatment of depression, emotional withdrawal in the elderly, and narcolepsy.
This drug can have side effects, mainly nervousness and insomnia. Ritalin is
ineffective in about 30% of cases diagnosed as ADD.

In China, the same attention deficit problem has been noted, and Ritalin
has been used as a therapy, but herb formulas may be utilized instead (3). From
the traditional Chinese medical viewpoint, ADD is caused by a kidney essence
deficiency that affects brain development. Further, the yin aspect of the kidney
is most deficient, leading to excessive expression of yang: this is manifest as
the hyperactivity and wandering of the mind. The orifices are not clear, and that
leads to erratic behavior of the spirit. Accordingly, this syndrome is to be treated
by nourishing the kidney yin, opening the heart orifices, and settling the agitated
yang. The main herbs used for nourishing the kidney in children with this
syndrome are rehmannia, lycium, cornus, deer antler (especially the gelatin,
which is more yin nourishing) and tortoise shell; these are the same ingredients
used in treating adults with senile dementia. For example, these ingredients are
included traditional Zuogui Wan (Left Restoring Pill) used to treat kidney yin
deficiency when there are deficiencies of "marrow and essence." Zuogui Wan,
which adds some tonification for the kidney yang, was mentioned in the
suggested treatments for senile dementia as well.

Phlegm obstruction of the heart orifices usually leads to confusion,

inability to concentrate, and poor memory. It occurs for a variety of reasons,
but often because of weak digestion and/or poor diet. Among the main herbs
for clearing the heart orifices and enhancing the mental function are acorus,
polygala, curcuma, and alpinia. To settle the agitated the yang (which may
manifest as hyperactivity and insomnia) the so-called "heavy sedating agents"
are used. The traditional concept is that these substances bear down on the rising
and disordered yang. The main substances given for ADD by Chinese doctors
are dragon bone or dragon teeth, oyster shell (or mother of pearl), and succinum.
In some cases, herbs to purge deficiency fire that accompanies yin deficiency
syndrome might be employed. Phellodendron and anemarrhena are the most
commonly used items for this purpose.

The dosages of herbs used in treating the children were often rather high,
and so the details will be relayed here when available. The dosage for adults is
proportionately higher.

As an example of applying these methods, children with ADD were treated

with a syrup made from alpinia, ho-shou-wu, lycium, dragon bone, oyster shell,
acorus, curcuma, and salvia for two to four months. Three times per day, the
children would take 25 ml of the liquid plus 2 grams of deer antler powder. A
similar method was used in a study of children with ADD who were given a
decoction of acorus, polygala, dragon bone, and oyster shell, modified by
adding 3-6 herbs according to symptoms, and a powder of succinum.

Excellent results were claimed in a small study of children treated with a

decoction of ligustrum, peony, lycium, mother-of-pearl, and polygonum stem
(each ingredient 10-15 grams), modified with addition of some herbs for
specific symptoms, such as blood deficiency (add rehmannia and gelatin),
spleen deficiency (add hoelen and atractylodes), or restless sleep (add
zizyphus). The total daily dose was about 60 grams of herbs, the decoction taken
in three divided doses. Treatment times of 15 to 60 days were used, and no
recurrence was noted within six months of follow-up. Another high dosage
decoction was made with raw rehmannia, ophiopogon, tortoise shell, peony,
pseudostellaria, gelatin, baked licorice, curcuma, cnidium, acorus, polygala,
oyster shell, and dragon bone; each ingredient 6-12 grams (except 20 grams
oyster shell). This combination, with over 120 grams of crude herbs, was
administered as a single dose per day. In a large scale study ADD, three
different formulas were used; two were decoctions and the third a large honey
bolus (six grams per pill). The pill, as an example, was a kidney tonic, with
rehmannia, tortoise shell, dioscorea, cornus, hoelen, phellodendron,
anemarrhena, polygala, acorus, and dragon teeth.

Two formulas described in the literature were made in the form of a sugar
paste; one comprised mainly of acorus and polygala, and the other contains
those two herbs plus tortoise shell, hoelen, dragon bone, alpinia, dioscorea, and
lotus seeds. The dose of these pastes was 10-15 ml each time, and they were
taken two to three times per day. Treatment time was about one month. It was
pointed out that the paste could be encapsulated for purposes of easier
administration.

Early in 1993, based on the literature reviewed here, ITM prepared an

experimental formulation (Acorus Tablets). The formula contains acorus,
polygala, fu-shen, alpinia, curcuma, raw rehmannia, dragon bone, dragon teeth,
oyster shell, bamboo sap, tortoise shell, and succinum. It contains no stimulants.
The formula has been used by both children and adults since then.

References

1. Wang Xiaoping and Zhai Mudong, Experience in TCM

treatment of senile dementia, Journal of Traditional Chinese
Medicine 1996; 16(4): 299-303.
2. Sun Guanlan, Ren Jianlin, and Sun Qingjun, Advances in
TCM treatment of senile dementia, Journal of Traditional
Chinese Medicine 1999; 19(4): 304-312.
3. Fruehauf H, Treatment of Difficult and Recalcitrant
Diseases with Chinese Herbs, 1997 Institute for Traditional
Medicine, Portland, OR.

Appendix: Frequently-mentioned formulas

In the section of this chapter devoted to treatments for senile dementia, certain
formulas were mentioned repeatedly. Their ingredients are briefly mentioned
here for easy reference.
Zuogui Wan: rehmannia, dioscorea, cornus, lycium, achyranthes (or cyathula),
cuscuta, deer antler gelatin, tortoise shell gelatin.
Yougui Wan: rehmannia, dioscorea, cornus, lycium, cuscuta, deer antler gelatin,
eucommia, tang-kuei, cinnamon bark, aconite.
Erchen Tang: pinellia, citrus, hoelen, fresh ginger, jujube, mume.
Banxia Baizhu Tianma Tang (Pinellia and Gastrodia Combination): pinellia,
citrus, hoelen, fresh ginger, jujube, gastrodia, atractylodes.
A traditional acupuncture chart from the Wellcome Trust
in London. This chart directs attention to some of the key
zones for treatment to be described in Chapter 10, where
the methods outlined in this booklet are summarized. At the
top of the head and coming down the center of the face is
the Governing Vessel, with its important points such
as baihui (GV-20) at the top of the head, shenting (GV-24)
at the hairline, and renzhong (GV-26) just below the nose.
At each wrist, the chart indicates a multiplicity of points
(along with the pulse taking positions); especially valuable
are the Pericardium points, such as neiguan (PC-6), and the
Heart point shenmen (HT-7). At the feet, several valuable
points are shown, especially along the liver and kidney
channels, of which yingquan (KI-1), taixi (KI-3)
and taichong (LV-3) are frequently used for shen disorders
 Chapter 10
Summary, Speculation, Suggestions
Acupuncture
The best speculations available to us about the origins of acupuncture point to
the likelihood that needles were used to lance boils and to let out blood from
areas where veins looked distended and/or darkened. The technique was
broadened to let out various "evils" including evil spirits, thus allowing the
internal resources to rebuild. Such treatments were thought of as one time
interventions. Dou Hanqing (ca. 1230 A.D.), in his discussion of acupuncture
techniques, quoted the famous phrase (1): "Take a piercing stone-needle and
apply it outside to remove the evil and support the true." Referring to the stone
needles, he noted that they could "expel disease and cure evil-there is nothing
it can not heal."

As the concepts of disease causation developed, needles were also used to

let out wind, cold, heat, damp, or other pathological factors that had invaded
from the environment into the body, often thought to gain access through the
pores. The treatments were still intended to be short and quick, but there were
added considerations about how, when, and where to needle. Dou Hanqing
wrote:
The Way of the Doctor-if he can clearly understand the
principle of using the needle-is to swiftly eliminate pain as
if it were plucked out by the hand. And to shatter blockages
releasing them far and wide, as dissolving ice. As soon as
the mystery of this is accomplished, you eliminate the
problems of early deaths and mistaken treatments.

This medical art developed considerably into what comes down to us as

modern acupuncture based on the concept that one can regulate the body
functions through insertion of the needles, not just let things out and
immediately get rid of a disease. The Lingshu (2) is the text that points to the
situation that was evolving from the original concept. In the third scroll, it says:
The unskilled physician grasps only the form when he uses
the techniques of acupuncture. The superior physician
understands the spirit: his understanding of man includes
both the blood and qi, whether there is excess or deficiency,
whether he should tonify or disperse. The spirit and the
guest, the primary and the evil, meet. The spirit is the
primary qi, the guest is the evil qi. "Located at the door"
means that the evil qi pursues the primary qi at those places
where it comes out and enters. Don't just stare at disease!
Begin by knowing the evil and the primary qi, and which
channels are diseased….The unskilled physician only
 guards the gates….The superior physician knows the
subtleties; he understands how to handle qi….

The "form" that the unskilled physician grasps is the inserting of needles
into points on the body, relying only on places of obvious obstruction or the
doorways where pathogens can exit. The superior physician first diagnoses the
various conditions of qi, such as deficiency and excess, and adjusts his needling
accordingly. The "evil" is like a guest or invader in the body; the unskilled
physician only stands at the doorway trying to block the entrance of an evil qi
or open the door to let it out. The superior physician tracks down the location
of the evil qi in the channels and escorts it to the door. The spirit or "primary
qi" is the normal qi of the body, which the superior physician can coax into
action to help get rid of the pathogenic guest. The disease is not just something
stared at, looked at in a cursory manner; rather, it is to be understood and
properly handled.

Over the centuries, considerable effort was applied to determining what

points could alleviate spirit disorders, not solely by serving as a door (spirit
gate), but also by adjusting the healthy qi to overcome the perverse qi. The
result of these efforts is a focus on points at the head, on the wrists, and on the
feet and lower part of the legs. I would like to propose that treating this set of
points (to be detailed later) corresponds with the Daoist (Taoist) wandering in
the wooded mountain trails. That is, acupuncture partly serves the role as an in-
office version of a trek through the woods.

In walking along these trails, especially with the limited quality of shoes
available to them, the Daoists had their feet and ankles and calves thoroughly
and vigorously massaged by the irregular surfaces. At the same time, their eyes,
ears, and nostrils were filled with the sensory stimuli of nature: sky, trees,
mountains, waters, animals, and so on. While enjoying the beauty, fragrance,
and sound of their surroundings, these wanderers also had to stay attentive-
whether for dangerous terrain or dangerous animals. Thus, their nervous
systems were entirely alert. In climbing they would sometimes grasp at
branches and stones; for their meals they would be plucking various fruits and
making food out of the natural materials they encountered, thus working their
hands and wrists. Today, many people turn instead to half hour sessions of foot
reflexology or rotating specially designed Chinese balls in the hands for a few
minutes, or getting acupuncture for 20-40 minutes to stimulate the qi flow; but
then they do not at the same time encounter nature by sensation, so it is a lesser
benefit, it is less holistic. When the practitioner decorates his office with
Chinese nature paintings and even with the charts showing the flow patterns of
the meridians, the patient gets a small glimpse of the desirable encounter; with
the fragrance of moxa and the sounds of a small fountain or gentle traditional
Chinese music, the patient has a sensory experience completely different from
what is typically found in a modern medical office.
 Thus, it is proposed, at one level, that the Chinese medicine practitioner is
standing in for a nature hike! In saying this, I am not proposing that people who
follow the Daoist path regularly (being out in nature for hours rather than 30
minutes, and doing so daily rather than once a week) don't sometimes suffer
from shen disorders. Nor do I suggest that all shen disorders might be resolved
by Daoist wandering on rocky paths through forested mountains. However,
when practitioners of Chinese medicine refer to the concept of the body as a
microcosm for the universe (as the macrocosm), they are agreeing to the idea
that what goes on within the body needs to be attuned to the world outside, and
that is the natural world. Such correspondence between the inner and outer
worlds comes about by interacting with nature. The acupuncturist directs the
patient's attention to the "Tao which is great."

Continuing the quotation from Dou Hanqing, with some slight editing of
the translation to make the point more evident:
What was hidden from your view, can now be
distinguished-you are able to understand secrets from the
ancient books of the past. What was hidden was the
underlying pattern-to perceive it is to begin to explain it.
Understanding the patterns means enlightenment. The
pattern, illuminated and revealed by those who came
before, easily throws its light upon you later scholars.

What are these patterns? He described the flow of qi and blood in the body
this way: "Traveling in ditches or collecting pools, or else running like a stream
in a valley, along different pathways. The pathways here are the tracks. Among
the points on the vessels some are called, ditches, pools, streams, valleys-just
as each is in a different position along the track or pathway." That is, the interior
of the body is like nature, and when examining the body, one is looking for how
its natural function has been disturbed-hoping to restore it. The Daoists
provided a model for healthy function, which is contained in the concept
of Xiao Yao. A hidden secret is that the needling of patients can mimic the Xiao
Yao. This is not the only way to practice acupuncture, but it is one of the ways.

Herbs
There can be little doubt that the earliest determination of medicinal properties
of herbs had to do with immediate effects of consuming them. In most cases,
these were things to be avoided, such as herbs causing vomiting or diarrhea.
However, the effects were utilized for healing-much as ancient acupuncture
was-to let out evils from the body. In such cases, they would typically be taken
once or twice, with the expectation that the disease would change markedly,
preferably in the direction of resolution. The standard methods of therapy
mentioned in the Shanghan Lun (3) were types of purging: vomiting, laxation,
and perspiration. They were frequently mentioned in the context of being used
wrongly (like the acupuncturists who only relied on opening the door to let out
evil). What was then introduced in that text was a more sophisticated analysis
of disorders and more complex therapies that involved locating the problem
within certain part of the body and addressing it with methods of tonifying or
dispersing or even harmonizing, usually with only a few days of treatment.

There also developed a different concept that some medicinal substances

could be taken routinely over a long period to protect health and gain long life
or immortality. Unfortunately, many of these remedies were not really based on
experience of positive outcomes, but on theories that had been worked out by a
few individuals. Some of the substances they advocated did not stand the test
of time. Alchemists, believing in the ability to transform the body in a way that
would correspond to chemical transformations, became involved in using a
number of toxic substances. One of the results of the toxicity was loss of body
weight, a change that may today seem beneficial in terms of the problem of
obesity, but was actually part of the harm done to a person through such things
as heavy metal poisoning. To this day, we read of Chinese herbs that had this
effect (causing the body weight to decline), often without realizing that this
attribution is not necessarily a positive one. Sometimes this weight loss effect
was attributed to herbs that are non-toxic (such as ginseng), but the herb didn't
have that effect; instead, it was simply included as a listed property because that
herb was considered to be one that could contribute to gaining immortality.

Over time, herb therapies have gone through a variety of changes,

especially as they have come to us in the West. Some herbs that are especially
potent in effect, but also potentially causing serious side effects, have been
dropped from the treatments in recent times. These are replaced, in actual
practice, by drugs that also have potent effects and potential for side-effects,
but are better studied and better controlled than the natural substances. For the
non-toxic agents, there is a tendency to use very high doses in China (e.g., 120
grams or more in decoction for a one day dose), and these high doses may
contribute common nutrients, such as vitamins and minerals, as well as any
chemical constituents that are active. In that sense, they serve a function similar
to eating nutritious foods or consuming dietary supplements made with
components such as vitamins, minerals, and amino acids. Numerous Chinese
investigations into the herbal remedies have been based on determining the
quantity of such things as trace minerals and amino acids to help explain their
effects. Some of the substances used for treating shen disorders, such as oyster
shell and dragon bone and wheat, may have part of their value explained by the
presence of calcium compounds and B-vitamins, things that are as easily
attained by consuming certain foods or supplements (the Chinese diet lacked
calcium rich dairy products and relied on milled rice which lacked vitamin B).
It is understood that such minerals and vitamins can have a positive influence
on the function of the brain and nervous system for persons who suffer
deficiencies.
 In addition to providing what we might consider ordinary nutritional
benefits, many of the herbs may have indirect therapeutic effects
on shen disorders. For example, a person who has poor blood sugar regulation
may experience difficulty with mental concentration when blood sugar is either
high or low; herbs that regulate blood sugar may stabilize the mental condition
without having a direct impact on the brain.

At this time, it is difficult to know what ingredients are truly effective in

treating shen disorders. Some herbs have been shown, through laboratory
testing, to affect neurotransmitters, such as acetylcholine or serotonin, and some
clinical trials have demonstrated improvements in patient conditions (e.g.,
depression, insomnia, memory, response time). The herbs that are most
frequently employed have a variety of different active components, though
there may be a prevalence of steroidal glycosides among several of the
commonly used herbs. The question of which ingredients are active and their
mechanism for various effects on the brain and mind is an area that requires
further investigation. China has had a limited investment in researching herbal
effects on shen disorders, partly for political reasons and partly because of the
great difficulty involved in assessing the effects.

Suggested Protocols
I would like to present a protocol of acupuncture and herbs corresponding to
the analysis presented in this booklet that would lead directly to rapid
improvement in most patients. This might be considered a system of treatment
that involves some relatively simple choices. By contrast, according to a large
component of the Chinese medical literature, one should undertake an extensive
diagnostic overview, determine a pattern of dysfunction, and treat accordingly,
utilizing therapies that are both traditionally recognized and also influenced by
personal training and clinical experience. Is there a way to offer something that
is true to both these intentions? I believe there may be. On the one hand, we
have the complete Chinese medical system, with hundreds of acupuncture
points and hundreds of herbs, which provides for meeting the demands of the
methodology called differential diagnosis and treatment. One can hardly
dispense with all of that. On the other hand, numerous practitioners, some of
them revered for their competency, have observed that there are certain
acupuncture point sets that can be used reliably for many patients, or have
utilized a small number of herbal prescriptions to help patients with diverse
conditions. The potential value of such an approach based on trustworthy
regimens is that it allows many people to benefit even when the practitioner is
not in a position to provide full differential diagnosis and treatment.. Even in
modern medicine, where we have very detailed analyses that lead to much finer
differentiation of diseases than in Chinese medicine, we still sometimes find
some central therapeutic approaches that are relied upon over and over. As a
prime example, a relatively safe anti-inflammatory can have the potential to
alleviate a wide range of conditions, both acute and chronic. In fact, aspirin is
one such compound, and this substance is now produced at an estimated rate of
24 million pounds per year. One can similarly think of treatments for mental
disorders, such as Prozac (fluoxetine), for which the U.S. alone used 1.2 billion
dosages in one year.

The 20th century acupuncturist Wang Leting (4) had described an

acupuncture protocol, called "Old Ten Needles" for gastrointestinal diseases
which can also be chosen and used for other diseases. It was pointed out that
"Generally speaking, the Old Ten Needles can be selected for all kinds of
gastrointestinal diseases regardless of whether they are vacuous [deficient] or
replete [excess], cold or hot." In a similar manner, certain herbal formulas are
very broadly used, often for gastrointestinal disorders and then additionally for
other conditions, of which Guipi Tang is a good example mentioned in Chapter
8.

For shen disorders, I propose the following structures for basic treatment
using acupuncture and herbs, which can be further modified according to the
practitioner's decisions

Acupuncture Basics for Shen Disorder

At least two points are selected along the centerline of the head to the neck, thus
on the GV vessel (including extra point yintang). These points run from GV-14
through GV-26. Starting at GV-14, the back of the head points are selected for
strengthening yang and for treating disorders that physically affect the brain.
Reaching the top of the head, one regulates the yang and treats disorders that
are primarily affecting the function of the brain, such as with insomnia and
memory. Moving to the front of the head, one treats points to remove excess
and to calm agitation. Points along either side of the center line may be used
additionally, such as sishencong or fengqi (GB-20).

Two or more points are selected on the forearm or hand, the most common
choices are PC-6 (or adjacent points PC-5 or PC-7) and HT-7. These points can
be treated to enhance the function and nourishment of the heart while draining
excess from the head; LI-4, at the hand, is an example of a point that is
especially used for draining.

One or two points are selected on the lower leg or foot. The points may be
used for draining excess (e.g., LV-2 or LV-3) or for tonifying (e.g., KI-3 and
SP-6); sometimes points slightly higher on the calf are used, such as ST-40 (for
draining) or ST-36 (for tonifying) For tonification therapy, one may also
include the use of points in the waist area, such as CV-4 or CV-6, GV-4, or BL-
23. If such tonification is not required, then the points at the head, hand/wrist,
and foot/lower leg are sufficient.

The combination of head points and points at all the extremities (bilateral
upper and lower limbs) produces a pattern of effects that is notable; it may be
described as a stabilizing pattern. This protocol can be seen to be contained
within the treatments of most of the clinical reports listed in Chapter 5, but the
authors do not describe their treatments as following this general pattern, rather,
the set of points is simply laid out and some comments may be provided about
the value of individual points or, occasionally, the value of a certain
combination of two points.

There is a traditional concept of treating "one point above, with two points
below," but, in this case, the recommendation is to treat points above as
specifically referring to the head (and neck) and points at the extremities (with
emphasis on the distal areas) are the ones below. It is also possible to
recommend an order to applying the needles. This begins with needling the top
of the head (such as GV-20), which is often less painful than other points and
has a calming effect; then any additional points in the head/neck area are
treated. After that, the hands/wrists are needled, and this will have the effect of
giving a greater stimulus to the brain. Finally the feet are needled in order to
complete the circuit of circulation from the extremities to the head.

A purpose of this needling order is to clear the movement of qi in the head

region first, removing any blockages and calming agitation. Next, the flow of
qi and blood to the head region from the arms allows for a stronger sensation.
Finally, the distal points at the lower body help regulate the gross circulation of
qi throughout the body. This approach is particularly relevant to disorders that
are considered to affect the brain, mind, and spirit. The exception is where the
patient experiences an obvious nervousness that would be attributed to liver qi
excess, in which case the use of the lower body points (e.g., LV-3, LV-2) might
be the starting point; then the head and finally the arms might be treated.

Except when using the bladder meridian or governing vessel points at the
back, this treatment can be applied with the patient lying in the comfortable
face-up position. If needling the back of the head points such as GV-14, 15, or
16, or GB-20, the patient may be seated so long as attention is paid to the rare
possibility of fainting.

Herbal Basics for Shen Disorder

Herbal therapeutics for shen disorders often present a certain limited set of
herbs repeatedly. These basic herbs are summarized in the following table:

Category Main herbs Others

Licorice is often included; mild tonics, such as longan or
Qi tonics to raise jujube might be added. Codonopsis can be used in place of
ginseng, astragalus
the clear yang ginseng as a spleen tonic, but it lacks the shen calming
effects.
 Pinellia and citrus added for greater fluid accumulation or
Damp-clearing
hoelen, atractylodes obvious phlegm; alpinia may be used to invigorate
herbs
stomach/spleen function.
Blood nourishing
tang-kuei, peony Rehmannia is also used, especially for older patients.
herbs
Spirit calming Albizzia bark or flower used for depression; oyster shell and
zizyphus, biota
herbs dragon bone or dragon teeth used for fright and agitation.
Arisaema, curcuma, and bamboo are used additionally for
Phlegm-mist
acorus, polygala severe cases; platycodon may be included, especially where
clearing herbs
there is obvious sputum accumulation.
bupleurum, plus one or more of:
Qi regulating Cyperus is sometimes used for depression; lindera might be
citrus, chih-shih, chih-ko,
herbs used in place of bupleurum for weak constitution patients.
saussurea, magnolia bark
Heat clearing
coptis, gardenia Moutan is sometimes used for heat in the blood.
herbs
Scrophularia and/or lily might be used additionally; these
Yin nourishing
ophiopogon, rehmannia, cornus herbs are for yin deficiency agitation with insomnia and night
herbs
sweating; lily helps drain damp and treats neurosis.
Kidney essence ho-shou-wu, tortoise shell,
These herbs are particularly used with older patients.
replenishing herbs lycium, cuscuta
Blood vitalizing salvia, red peony, cnidium, Blood stasis syndromes tend to occur in cases with long
herbs persica, carthamus duration and in elderly patients.

Key formulations mentioned in the previous chapters are Guipi

Tang, Tianwang Buxin Dan, and Jiawei Xiaoyao San. A practitioner using these
formulations, or others relying primarily on the herbs listed in the above table,
will be working in a manner consistent with most Chinese medicine experts in
China. The herbs for resolving phlegm or phlegm-mist and for vitalizing blood
may need to be added to these basic combinations.

In the modern circumstances, it is common for people to approach

practitioners involved with Chinese medicine only after a disorder has been
present for some time and has not resolved either on its own or with standard
medical approaches. In Western society in particular, many people suffer from
certain disorders of excess (due, largely, to dietary excess) and stagnation (due,
largely, to sedentary life style). Because of the chronic nature of the problems,
the excess and stagnation cause or occur simultaneously with certain
deficiencies, particularly in the function and proper nourishment of the viscera.
Therefore, it is almost always the case that patients will benefit from the
therapeutic principles including clearing excess (e.g., getting rid of damp and
phlegm and heat), dispersing stagnation (vitalizing circulation of qi, blood, and
fluids), and tonification (e.g., nourishing qi and yin).

For the herbs to be effective, it is important to avoid using too many

ingredients at once. Many patients prefer taking a small quantity of herb
materials (today, many people consume herbal tablets, capsules, or pills, rather
than heavy decoctions), so in order to get a large enough dosage of the key
ingredients, only a few items ought to be used. As examples, Guipi Tang has
12 ingredients and Tianwang Buxin Dan has 13; and most of the treatments
described have no more than 16 ingredients. Sometimes, two formulas are
combined to produce a therapy, such as using a kidney nourishing prescription
(e.g., Zuogui Wan) and a formula for resolving phlegm accumulation
(e.g., Banxia Baizhu Tianma Tang); each of these formulas had 8 ingredients,
for a total of 16. Although most of the treatment strategies outlined in the table
above may appear attractive for addressing a patient's needs, the therapy should
usually focus on only a few of them. As necessary, the therapy can be changed
over time as some conditions improve and others then become the target of
concern.

An important part of the protocol, as revealed in the previous chapters, is

to drain fluids. In cases with obvious moisture accumulation, the herbs hoelen
and atractylodes are especially desired, possibly in the context of using spleen
qi tonics to enhance the moisture dispersing action attributed to the spleen organ
system. As the fluid is transformed to phlegm-fluid due to stagnation, herbs
such as pinellia and citrus, magnolia bark, or alpinia may be added. If the
disorder displays signs of phlegm-mist, then acorus and polygala become
important (for severe cases, arisaema and bamboo are added) and one should
consider the possibility of blood stasis occurring at the same time (salvia is a
favored herb). In the case where yin deficiency is present, lily may be used to
drain fluid without damaging yin.

Final Thoughts
To sum up, ancient Chinese therapeutics were originally quite coarse in nature
(big needles and lances, herbs with strong, even toxic, action) and used briefly
to affect a change. Later, the system was refined so that more subtle adjustments
could be made. These subtle effects may be seen, in some sense, as a
replacement for components of lifestyle-such as walking through mountain
paths and eating a nutritious diet-that were recommended by Chinese
philosophers who thought along the same lines as the early medical scholars.

In addition to any specific action that might be attained via acupuncture

and herbs, it is the interaction of the physician with the patient that is critical.
Chinese medicine offers what for many appears to be a positive intervention,
which contrasts with what is seen as a negative intervention of modern
medicine. The impression about the positive or negative impact of a style of
treatment (i.e., Western or Eastern) is often a matter of interpretation, but the
contrasting views provide for an opening in the relationship. The doctor who
offers Chinese medical therapy has at his disposal the Chinese conceptual
framework about health. That acupuncture and herbs tie into a larger picture,
namely the interaction of the patient with the world outside them and, in
particular, the spiritual part of their being, may be important for many people,
a key to changing their health.
 This is not to say that the Western world can't offer essentially the same
thing as does the Asian culture in terms of this holistic view. It is only that
doctors and patients in the Western world have fallen into a pattern of thinking
and acting that some find unsatisfactory. The patient presents a disorder and the
doctor presents a treatment-typically drugs and/or surgery-but there isn't much
time to go into other aspects of a person's health or the concerns have become
sufficiently routine ("lose weight, stop smoking") that they are quickly passed
over. In fact, the Western doctor must reserve his or her time for the technical
aspects of diagnosis and medical intervention.

Theoretically, the Western doctor ought to be able to rely on the person's

church (or other religious organization) to take care of the spiritual matters that
are important to healing. The person's family ought to help with maintenance
of a healthy pattern of behavior, including diet and exercise. The culture that a
person lives within is supposed to help provide healthy mental and physical
activities; and the medical literature put into layman's terms (popular format) is
supposed to tell people what are generally understood to be healthy or unhealthy
practices. But, we find today in our society many people isolated from their
spiritual tradition, from their family, from the better side of their culture, and
skeptical of the general health care teachings (searching instead through various
alternatives), so that they are left without good health and have limited hope.
They are looking for something else to fill the gaps.

Chinese medicine offers an alternative that seems attractive to some. It has

the spirituality of Daoism, for example, that actually fits well with the
uncertainties of the modern times, and offers the natural concepts of yin and
yang and five elements that fill a void left by too much technological
information about the chemical make-up of the body and the environment.
China has a unique dietary approach (such as attributing cold and hot or yin and
yang properties to foods and herbs) and the physical culture of taiji quan and qi
gong (that strikes many far more harmonious than running and weight lifting).
The Far East has the therapeutics of acupuncture which seems both mysterious
and effective, and it has what is perceived as a more potent form of herbalism
than is available in the West (and this perception may be justified because of
the greater reliance on herb therapy).

In order to tap into and gain the most from the Chinese system, its
components should not be taken in isolation. There are cases where acupuncture
and/or herbs are simply provided as the sole remedies, without going into a
broader context, and this can be appropriate for injuries or infections. However,
for those with shen disorders, where the mental function, the emotions, and the
spirit are all involved, a focus on techniques of needling and herb prescribing
herbs may be too narrow. For that reason, this booklet begins with an
introduction to the underlying concept of the shen and its disorders in relation
to how a person lives.
References

1. Bertschinger R, The Golden Needle and Other Odes of

Traditional Acupuncture, 1991 Churchill-Livingstone,
London.
2. Wu Jingnuan (translator), Ling Shu, or The Spiritual Pivot,
1993 Taoist Center, Washington, D.C.
3. Hsu HY and Peacher WG (editors), Shang Han Lun: The
Great Classic of Chinese Medicine, 1981 Oriental Healing
Arts Institute, Long Beach, CA.
4. Yu Huichan and Han Furu, Golden Needle Wang Leting,
1996 Blue Poppy Press, Boulder, CO.
 Appendix
Quick Reference to Herb Names
This table helps to better identify the Chinese herbal materials mentioned
in the text. The common names that are used throughout the text are those that
have been utilized by ITM and the Oriental Healing Arts Institute for the past
thirty years, with a few minor changes. The pinyin terms will help those who
are not familiar with the common names to refer to most Chinese literature. It
is a frequent practice in China to use many different herbs as a source of the
same basic item; these herbs have the same therapeutic action, from the
traditional viewpoint. This cross-reference index lists a single, representative
botanical source for the item. The plant part used has been indicated. There is
some confusion in the literature about the designation of fruits and seeds,
especially since some plants produce a structure that is essentially both. There
is also some confusion about whether just the tops or the whole plant is used
for some weedy herbs. It may depend on the collection techniques and post-
collection cleaning as to what is actually obtained. Not all the materials listed
here are derived from plants. For animals, the scientific name is given and has
the same structure as the botanical names; for minerals, a common name or a
chemical description may be given. The category listing refers to the Materia
Medica section, and is mainly that used in Oriental Materia Medica. The
Materia Medica category does not necessarily define the primary current use of
the herb; it does, however, indicate a major application of the herb.

Herb Name Pinyin Scientific Name Part Category

Achyranthes niuxi Achyranthes bidentata root vitalize blood
Aconite fuzi Aconitum charmichaeli root dispel chill
Acorus shichangpu Acorus gramineus rhizome open orifices
Albizzia hehuanpi Albizzia julibrissin bark nourishing sedative
Albizzia flower hehuanhua Albizzia julibrissin flower nourishing sedative
Alisma zexie Alisma aquatica- plantago rhizome remove moisture
Alpinia yizhiren Alpinia oxyphylla fruit tonify yang
Altaica jiujiechangpu Anemone altaica rhizome open orifices
Anemarrhena zhimu Anemarrhena aspholoides rhizome purge fire
Angelica baizhi Angelica dahurica root dispel wind-chill
Antler gelatin lujiaojiao Cervus nippon gelatin nourish blood
Apricot seed xingren Prunus armeniaca kernel relieve cough
Areca peel dafupi Areca catechu peel regulate qi
Arisaema tiannanxing Arisaema consanguineum rhizome resolve cold phlegm
Arisaema, bile dannanxing Arisaema consanguineum rhizome resolve cold phlegm
Asparagus tianmendong Asparagus cochinchinensis root nourish yin
Astragalus huangqi Astragalus membranaceous root tonify qi
Atractylodes baizhu Atractylodes macrocephalla rhizome tonify qi
Atractylodes, red cangzhu Atractylodes lancea rhizome fragrant, resolve damp
Aurantium juhong Citrus reticulata peel regulate qi
Bamboo sap tianzhuhuang Phyllostachys nigra sap resolve hot phlegm
Biota baiziren Biota orientalis seed nourishing sedative
Blue citrus qingpi Citrus nobilis fruit regulate qi
Borneol longnao; bingpian Dryobalanops aromatica resin open orifices
Bupleurum chaihu Bupleurum chinense root dispel wind-heat
Cardamon Sharen Amomum villosum seeds fragrant resolve damp
Carthamus Honghua Carthamus tinctorius flower vitalize blood
Cassia seed juemingzi Cassia obtusifolia seed clear heat, clarify vision
Chih-ko zhike, zhiqiao Citrus aurantium fruit regulate qi
Chih-shih zhishi Citrus aurantium unripe fruit regulate qi
Chin-chiu qinjiao Gentiana macrophylla root dispel wind-damp
Ching-hao qinghao Aremisia apiacea tops clear summer heat
Chrysanthemum juhua Chrysanthemum morifolium flower dispel wind-heat
Cimicifuga shengma Cimicifuga heracleifolia rhizome dispel wind-heat
Cinnamon bark rougui Cinnamomum cassia bark dispel chill
Cinnamon twig guizhi Cinnamomum cassia twig dispel wind-chill
Cistanche roucongrong Cistanche salsa top tonify yang
Citrus chenpi Citrus reticulata rind regulate qi
Cnidium chuanxiong Ligusticum walichii rhizome vitalize blood
Codonopsis dangshen Codonopsis pilosula root tonify qi
Coix yiyiren Coix lachryma-jobi seed remove moisture
Coptis huanglian Coptis chinensis rhizome clear heat, dry damp
Cordyceps dongchongxiacao Cordyceps sinensis mycelium tonify yang
Cornus shanzhuyu Cornus officinalis fruit astringent
Corydalis yanhusuo Corydalis bulbosa tuber vitalize blood
Crataegus shanzha Crataegus cuneata fruit digestant
Curculigo xianmao Curculigo orchiodes rhizome tonify yang
Curcuma yujin Curcuma aromatica tuber vitalize blood
Cuscuta tusizi Cuscuta chinensis seed tonify yang
Cyathula chuanniuxi Cyathula capitata root vitalize blood
Cyperus xiangfuzi Cyperus rotundus rhizome regulate qi
Deer antler lurong Cervus Nippon antler tonify yang
Dioscorea shanyao Dioscorea batatas rhizome tonify qi
Dipsacus xuduan Dipsacus asper root tonify yang
Dragon bone longgu Fossil bone whole sedative
Dragon tooth longchi Fossil bone whole sedative
Drynaria gusuibu Drynaria fortunei rhizome tonify yang
Earthworm dilong Pheretima asiatica whole extinguish wind
Eclipta hanliancao Eclipta prostrata top nourish yin
Epimedium yinyanghuo Epimedium sagittatum leaf tonify yang
Eucommia duzhong Eucommia ulmoides bark tonify yang
Eupolyphaga zhechong Eupolyphaga sinensis whole vitalize blood
Euryale qianshi Euryale ferox seed astringent
Evodia wuzhuyu Evodia rutaecarpa fruit dispel chill
Forsythia lianqiao Forsythia suspensa fruit clean toxin
Frankincense ruxiang Boswellia carterii gum vitalize blood
Fritillaria zhebeimu Fritillaria thunbergii bulb resolve hot phlegm
Fu-shen fushen Poria cocos/Pinus sp. root/fungus sedative
Gardenia zhizi or shanzhizi Gardenia jasminoides fruit purge fire
Gastrodia tianma Gastrodia elata tuber extinguish wind
Gastrodia mushroom mihuanjun Armillaria mellea whole extinguish wind
Gelatin ejiao Equus asinus skin extract tonify blood
Gentiana longdancao Gentiana scabra root clear heat, dry damp
Ginger (dry) ganjiang Zingiberis officinale rhizome dispel chill
Ginger (fresh) shengjiang Zingiberis officinale rhizome dispel wind-chill
Ginseng renshen Panax ginseng root tonify qi
Gleditsia (spine) zaojiaoci Gleditsia officinalis spine resolve cold phlegm
Haematite daizheshi Haematite mineral sedative
Haliotis shijueming Haliotis diversicolor shell extinguish wind
Ho-shou-wu heshouwu Polygonum multiflorum root tonify blood
Hoelen fuling Poria cocos whole remove moisture
Jujube dazao or hongzao Zizyphus jujuba fruit tonify qi
Lapis Mengshi Lapis mineral resolve hot phlegm
Licorice Gancao Glycyrrhiza uralensis root tonify qi
Ligustrum Nüzhenzi Ligustrum lucidum fruit nourish yin
Lily baihe Lily brownii bulb nourish yin
Lindera wuyao Lindera strychnifolia root regulate qi
Longan longyanrou Euphoria longana aril (fruit) tonify blood
Lonicera jinyinhua Lonicera japonica flower clean toxin
Lotus seed lianzi Nelumbo nucifera seed astringent
Lotus stamen lianxu Nelumbo nucifera stamen astringent
Lycium bark digupi Lycium barbarum root bark purge deficiency fire
Lycium (fruit) gouqizi Lycium barbarum fruit tonify blood
Magnetite cishi Magnetite mineral sedative
Magnolia bark houpo Magnolia obovata bark fragrant, resolve damp
Malt maiya Hordeum vulgare sprout digestant
Melia chuanlianzi Melia toosendan fruit regulate qi
Mentha bohe Mentha arvensis tops dispel wind-heat
Millettia jixueteng Spatholobus suberectus stem vitalize blood
Morinda bajitian Morinda officinalis root tonify yang
Morus (bark) sangbaipi Morus alba root bark relieve cough
Mother of pearl zhenzhumu Pinctada margaritifera shell sedative
Moutan mudanpi Paeonia moutan root bark clear heat, cool blood
Mume wumei Prunus mume fruit astringent
Myrrh moyao Commiphora sp. resin vitalize blood
Ophiopogon maimendong Ophiopogon japonicus tuber tonify yin
Oyster shell muli Ostrea gigas shell sedative
Peony (white) baishao Paeonia lactiflora root nourish blood
Perilla leaf zisuye Perilla frutescens leaf dispel wind-chill
Persica taoren Prunus persica kernel vitalize blood
Phellodendron huangbai Phellodendron amurense bark clear heat, dry damp
Pinellia banxia Typhonium flagelliforme tuber resolve cold phlegm
Plantago seed cheqianzi Plantago asiatica seed remove moisture
Platycodon jiegeng Platycodon grandiflorum root resolve cold phlegm
Polygala yuanzhi Polygala tenuifolia root nourishing sedative
Polygonatum huangjing Polygonatum sibericum rhizome tonify qi
Polygonum stem yejiaoteng Polygonum multiflorum stem nourishing sedative
Prunella xiakucao Prunella vulgaris top purge fire
Psoralea buguzhi Psoralea corylifolia seed tonify yang
Pseudostellaria taizishen Pseudostellaria heterophylla root tonify qi
Pteropus wulingzhi Pteropus pselaphon excretion vitalize blood
Pueraria gegen Pueraria lobata root dispel wind-heat
Red peony chishao Paeonia lactiflora root vitalize blood
Rehmannia shu dihuang Rehmannia glutinosa root tonify blood
Rehmannia (raw) sheng dihuang Rehmannia glutinosa root clear heat, cool blood
Rhubarb dahuang Rheum palmatum rhizome purgative
Salvia danshen Salvia miltiorrhiza root vitalize blood
San-chi sanqi Panax notoginseng root regulate blood
Sargassum haizao Sargassum fuisforme whole resolve hot phlegm
Saussurea muxiang Jurinea souliei root regulate qi
Schizandra wuweizi Schizandra chinensis fruit astringent
Scute huangqin Scutellaria baicalensis root clear heat, dry damp
Scrophularia xuanshen Scrophularia ningpoensis root clear heat, cool blood
Shen-chu shenqu Artemisia annua and others whole digestant
Siler fangfeng Ledebouriella seseloides root dispel wind-chill
Silkworm jiangcan Bombyx mori/Batrytis sp. whole extinguish wind
Sinapis baijiezi Brassica hirta seed resolve cold phlegm
Sophora kushen Sophora angustifolia root clear heat, dry damp
Sparganium sanleng Sparganium stoloniferum rhizome vitalize blood
Succinum hupo Succinum (fossil resin) whole sedative
Talc huashi Talcum whole remove moisture
Tang-kuei danggui Angelica sinensis root nourish blood
Tortoise shell guiban Chinemys reevesii shell nourish yin
Tribulus baijili Tribulus terrestris baijili extinguish wind
Trichosanthes fruit gualou Trichosanthes kirilowii fruit resolve hot phlegm
Turmeric jianghuang Curcuma longa rhizome vitalize blood
Turtle shell biejia Amyda sinensis shell nourish yin
Typha (bulrush) puhuang Typha latifolia pollen hemostatic
Uncaria gouteng Uncaria rynchophylla stem extinguish wind
Vitex manjingzi Vitex rotundifolia fruit dispel wind-heat
Zedoaria ezhu Curcuma zedoaria rhizome vitalize blood
Zizyphus suanzaoren Zizyphus spinosa seed nourishing sedative