Huáng Yuán-Yù (黄元御) on the importance of center earth in physiological regulation

The following is a collection of notes gathered for research on a course I am developing on center earth physiology and pathology. This is a large subject, and therefore the following information is far from complete, but is merely presented here to provide a glimpse into this important concept of proper physiological movement and dynamics. 

In the majority of Huáng’s books, great importance is laid on proper physiological movement throughout the body. Huáng’s interpretations of formulas and disease mechanisms are usually described through the lens of the proper or faulty movement and breakdown of this dynamic. The basic tenet of this medicine is based on proper movement and interaction of yin and yang, and when describing physiology or pathology, the terms Shùn (顺) translated as ‘normal’, ‘favourable’ or ‘to follow the course of’, and Nì (逆), typically translated as ‘counterflow’ are used. In very simple terms, when the body is running in ‘Shùn’, all physical processes are in harmony, running along their proper course, resulting in a state of health. When ‘Nì’ occurs and the natural movement or order of things are running against their proper course, physiological processes start to break down, resulting in dis-ease. 

As can be seen from the image below, proper healthy movement in the entire human organism is dependant on this specific circular dynamic. Elucidation on this concept is not mentioned in many literary works, with the exception of Qing Dynasty scholar/physician Péng Zǐ-Yì’s (彭子益), Circular Movements in Ancient Chinese Medicine (圆运动的古中医学), a text primarily focused on these circular movements. 

Physiological Implications

The following commentary is essentially a translation of Huáng’s original chart, with a few extra tidbits added from some of his other works. 

“When ascending and descending are balanced, and yin and yang interact, this is referred to as center qi.”

Center Qi debilitation results in an obstruction to ascent and descent. 

Foot Taiyin Spleen governs ascent on the left – Foot Yangming Stomach governs descent on the right. 

When Kidney water is too cold, this results in diseases of the Essence. 

When the stomach fails to descend, the heart is unable to descend as well leading to excessive cold of kidney water due to lack of fire. 

Heart fire flaring results in diseases of the Shen. 

When the spleen fails to ascend, both the liver and kidneys are unable to ascend. When water fails to ascend, fire flares. 

** Proper movement of center qi ensures a good balance between water and fire. 

When liver wood is depressed, this results in blood diseases. 

When the spleen fails to ascend, wood is depressed. Because the liver stores blood, when wood is depressed, this results in blood disease. 

When the lungs are obstructed on the right, this results in qi diseases. 

When the stomach fails to descend, the lungs are also unable to descend. Because the lungs store the qi, obstructed metal leads to qi disease. 

Spleen dampness is the result of center qi non-transformation resulting in a failure to ascend or descend. This leads to the improper movement of both the clear yang and turbid yin. Another possibility is a yang deficiency in the body which leads to the earth being unable to descend. As a result dampness forms.

[Upper] – Lung-Metal and Heart-Fire —> descend through stomach-earth —> When stomach earth fails to descend, this leads to counterflow ascent of both metal and fire. 

[Lower] – Liver-Wood and Kidney-Water —> ascend through spleen-earth —> When the earth is weak or center earth yang is deficient this leads to earth dampness with a failure to ascend, and thus both wood and water sink. 

Musings on Bēn Tún Tāng

A formula I’ve been quite intrigued with for many years, and use quite often in clinic, is Bēn Tún Tāng from the Jīn Guì Yào Lüè. The following is a short translation from one of my favourite Qīng dynasty scholar/physicians Huáng Yuán-Yù, followed by some brief clinical musings written by myself. 

Huáng Yuán-Yù on Bēn Tún Tāng

Translated from the Cháng Shā Yào Jiě (长沙药解)

The Golden Cabinet’s Bēn Tún Tāng

Gān Cǎo  2 liǎng

Bàn Xià 4 liǎng

Shēng Jiāng 4 liǎng

Shēng Gé (Gēn) 5 liǎng

Huáng Qín 2 liǎng

Xiōng Qióng 2 liǎng

Dāng Guī 2 liǎng

Sháo Yào 2 liǎng

Gān Lǐ Gēn Bái Pí 1 jīn 

This formula treats Bēn Tún qi, with surging into the chest, abdominal pain, and alternating heat and cold. When yang collapses, and the spleen is vanquished, (this causes) sinking and obstruction in Liver-wood, wood qi depressed effusion, and surging from the umbilicus, abdomen, chest and diaphragm, (resulting in) pain and concurrent heat and cold. Because Liver-wood surges upwards, both the stomach and gall-bladder run counterflow, and the Shaoyang is depressed and distressed, this results in a struggle between the interior and the yin, and this ongoing battle manifests with alternating cold and heat. The qi of Jué Yīn is wind-wood. When wind stirs it consumes the blood, and when warmth is depressed, it results in heat. Gān Cǎo supplements the earth and moderates the center; Shēng Jiāng and Bàn Xià descend stomach and gall-bladder counterflow; Huáng Qín and Shēng Gé (Gēn) clear depressed heat in the stomach and gall-bladder; Xiōng Qióng and Sháo Yào course wood and moisten wood dryness; Gān Lǐ Gēn Bái Pí clears the liver and descends surging qi. 

Gān Lǐ Gēn Bái Pí is sweet, cold, collecting and astringent. It is excellent at descending the surging qi of Jué Yīn, which can therefore treat bēn tùn. It is mainly indicated for alleviating thirst, eliminating vexing counterflow, arresting dysentery, and stopping vaginal discharge. 

Notes:

In my experience, Bēn Tùn (running piglet) can be both objective and subjective. Subjective in that the patient will feel some sort of rush that starts in the lower body, and rises either to the chest, throat, or face. It’s pretty hard to get a patient to tell you that they feel a surging sensation from their lower abdomen to their chest. Some do, but it’s not something I hear very often. Anxiety can manifest this way for some people, while some will tell you that they get facial redness, slightly dizzy or a bit of a rush when they are nervous. Another possibility for some is that this sensation, or ‘rush’ can cause patients to become anxious. I would interpret these manifestations as a form of running piglet. 

However, running piglet is also objective, manifesting in several ways such as; sudden sweating, facial redness, epigastric pain, chest tightness, shortness of breath, dizziness, headaches/migraines, premenstrual acne, etc.

This is due to a wood-earth pathology, where wood is abundant, which damages the earth, hence we see the abdominal pain. Since we have a Shào Yáng element here, there is alternating heat and cold (往来寒热), which can be interpreted the way Huáng Huáng (黄煌) does in that this alternating heat and cold can refer to anything that alternates, or occurs cyclically. This is a major feature of the Shào Yáng, and so having someone that breaks out into sweats, gets cyclical acne, cyclical migraines, anxiety attacks, etc., that is due to a wood-earth pathology, Bēn Tùn Tāng is a great choice. 

In addition, we have an element of a Jué Yīn pathology as well just to complicate things. Here, blood was affected which left a slight blood deficiency and when there is not enough blood and wood-qi tries to move, this can get stuck and lead to heat (which is the flaring of ministerial fire). 

Sāng Bái Pí is the most common substitute for the Gān Lǐ Gēn Bái Pí. Some doctors like Hu Xi-Shu used Chái Hú as they saw this pattern as a Shào Yáng-Tài Yīn concurrent pattern, and added Chái Hú to clear Shào Yáng heat from the chest. I personally use Sāng Bái Pí, as I feel that due to the flaring of ministerial fire, there is a bit of heat in the lungs and adding Sāng Bái Pí ensures that it gets cleared but also that metal descends. With the Spleen-earth affected, ascent and descent in the entire body is affected and we always need to make sure that the proper physiological wheel keeps turning. 

Huáng Yuán-Yù on Wú Zhū Yú Tāng

Wú Zhū Yú (吳茱萸): Acrid and bitter flavor, warm nature; enters the foot Yángmíng stomach, foot Tàiyīn spleen, and foot Juéyīn liver channels. Warms the centre, drains dampness, opens depression, breaks congealment, descends turbid yin to stop vomiting, and ascends clear yang to stop diarrhea. 

Cold Damage’s Wú Zhū Yú Tāng

Wú Zhū Yú (吳茱萸) 1 shēng

Rén Shēn (人蔘) 3 liǎng

Shēng Jiāng (生薑) 6 liǎng

Dà Zǎo (大棗) 12 pieces

Treats Yángmíng cold damage with a desire to vomit after eating. Normally, stomach qi descends, [which results] in the absence of vomiting on the intake [of food]. [When] stomach qi adversely ascends, this results in vomiting and reduced [food] intake. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng warm the stomach and descend counterflow. [This] treats Juéyīn disease with dry retching, vomiting of foamy drool, and headaches. 

Due to deficiency of the earth, wood becomes stagnant, centre qi is harmed, the stomach ascends as opposed to descending, and turbid qi is upthrusted, resulting in headaches and dry retching. 

When damp qi is congealed and stagnant, this results in vomiting of foamy drool. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng descend counterflow and course wood. [This] treats Shàoyīn disease with vomiting, diarrhea, reversal cold of the extremities, vexation, agitation and a desire to die. 

When cold water rebels against the earth, the spleen sinks and the stomach [runs] counterflow, which leads to both vomiting and diarrhea. [When] center qi is depleted, the four limbs lack warmth, resulting in reversal cold of the extremities. [When] yang departs from its root, it disperses and strays without returning, resulting in vexation, agitation and a desire to die. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng descend counterflow and ascend that which is sinking. 

In the Jīn Guì [this formula] treats vomiting and chest fullness. [When] the center is deficient and the stomach runs counterflow, turbid qi becomes congested in the chōng vessel, resulting in vomiting and chest fullness. Rén Shēn and Dà Zǎo bank the earth and supplement the center; Wú Zhū Yú and Shēng Jiāng descend counterflow and drain fullness. 

Huáng Yuán-Yù on line 80 of the Shāng Hán Lùn

“伤寒,医以丸药下之,身热不去,微烦者, 栀子干姜汤主之。”

“In cold damage, (which was) treated with a great purging pill; (if) the fever has not abated (and there is) slight vexation, Zhī Zǐ Gān Jiāng Tāng governs”.

This formula treats cold damage following major purgation (manifesting with) body heat and slight vexation.
(Here) major purging has injured center qì, with turbid yīn ascending counterflow, and the generation of stasis, (which) injures the bowels (fǔ organs); this results in obstruction to imperial fire, which is unable to descend, therefore there is body heat and heart vexation. Zhī Zǐ Gān Jiāng Tāng is used, as gān jiāng descends counterflow and warms the center, while zhī zǐ ejects stasis and eliminates vexation.

Zhī Zǐ

Bitter flavor, cold nature; enters the hand shào yīn heart, foot tài yīn spleen, foot jué yīn liver, and foot tài yáng bladder channels.
Clears heart fire and eliminates vexation depression, drains spleen earth and eliminates damp heat. (It) ejects turbid stasis from the chest and diaphragm and cools smokey-yellowing from the skin.

Gān Jiāng

Acrid flavor, warm nature; enters the foot yáng míng stomach, foot tài yīn spleen, foot jué yīn liver, and hand tài yīn lung channels. (Gān Jiāng) dries dampness, warms the center, moves depression, downbears turbidity, supplements and boosts fire (of the) earth, breaks up the absorption of water and grains, warms the spleen, stomach and extremities; regulates yīn and yáng and settles nausea and vomiting; downbears turbid counterflow, calms coughing, lifts desertion and sinking and stops efflux diarrhea.

**Above medicinal info translated from ‘Huáng Yuán-Yù’s Interpretation of Medicinals’ (黄元御药解)

Huáng Yuán-Yù on line 100 of the Shāng Hán Lùn

“伤寒,阳脉涩,阴脉弦,法当腹中急痛,先与小建中汤,不差者,小柴胡汤主之。”

“In cold damage (where) the yáng pulse is choppy, and the yīn pulse is wiry, as a rule there should be urgent abdominal pain; first give Xiǎo Jiàn Zhōng Tāng. If it is not reduced, Xiǎo Chái Hú Tāng governs.”

The liver and gall-bladder are from the same qì. If the gall-bladder fails to descend the cùn pulse will be choppy; if the liver fails to ascend, then the chǐ pulse will be wiry. (When) gall-bladder qì ascends counterflow, and restrains stomach-earth, abdominal pain will be seen in the chest and diaphragm. (If) the liver descends and restrains spleen-earth, abdominal pain will be seen in the abdomen and rib-sides. When wood qì is desiccated and dry, then pain will be urgent. When pathogenic factors are in both the liver and gall-bladder, wind-fire will be depressed, injuring central qì. Xiǎo Jiàn Zhōng Tāng is first used; Yí Táng, Gān Cǎo, and Dà Zǎo supplement spleen essence and moderate urgent pain. Shēng Jiāng, Guì Zhī and Sháo Yào outthrust wood depression and clear wind-fire. If it is not reduced and remains, give (Xiǎo) Chái Hú (Tāng) in order to drain ministerial fire.