Wáng Wéi 王维 (693 or 694 or 701 – 761), courtesy name Mójí 摩诘, also known as Mójí Jūshì 摩诘居士, was originally from Hédōng Púzhōu 河东蒲州 (modern Yongji, Shanxi). He later moved to Jīngzhào Lántián 京兆蓝田 (modern Lantian, Shaanxi), and his ancestral home was Qíxiàn 祁县 in Shanxi. He was a poet and painter of the Tang dynasty.
He came from the Hedong branch of the Tàiyuán Wángshì 太原王氏, known specifically as the Hédōng Wángshì 河东王氏. At nineteen, he traveled to Jingzhao prefecture to sit for the examinations and won first place. At twenty-one, he passed the jìnshì 进士 examination. Over the years, he served as Yòu Shíyí 右拾遗 (Right Remonstrator), Jiǎnchá Yùshǐ 监察御史 (Censor), and Héxī Jiédùshǐ Pànguān 河西节度使判官 (Assistant to the Military Commissioner of Héxī).
During Emperor Xuánzōng’s Tiānbǎo era, he was appointed Lìbù Lángzhōng 吏部郎中 (Director in the Ministry of Personnel) and Gěishìzhōng 给事中 (Palace Aide). When Ān Lùshān 安禄山 captured Cháng’ān 长安, Wáng Wéi was forced to accept an official position under the rebel regime. After Cháng’ān was retaken, he was demoted to Tàizǐ Zhōngyǔn 太子中允 (Assistant to the Heir Apparent), but later rose to Shàngshū Yòuchéng 尚书右丞 (Vice Minister of the Ministry of Works). He died in the second year of the Shàngyuán 上元 era (761), in the seventh month, at the age of sixty-one.
Wáng Wéi not only practiced Chán 禅 Buddhism and studied Daoist teachings (Zhuāngxué 庄学, Xìndào 信道), but also excelled in poetry, calligraphy, painting, and music. His poetic fame was especially prominent during the Kāiyuán 开元 and Tiānbǎo 天宝 eras, and he was particularly skilled in five-character verse (wǔyán 五言).
Many of his poems describe landscapes and pastoral life; together with Mèng Hàorán 孟浩然, he was known as “Wáng–Mèng 王孟” and was honored with the title “Poet-Buddha” (Shīfó 诗佛). His painting, especially his landscape style, reached great heights, and later generations regarded him as the founder of the Southern School of landscape painting (Nánzōng shānshuǐhuà zhī zǔ 南宗山水画之祖).
Sū Shì 苏轼 said of him: “Taste Mojie’s poems and there are paintings within them; view Mojie’s paintings and there is poetry within them.”
More than 400 of his poems survive today. Representative works include “Xiāngsī 相思” (Longing) and “Shānjū Qiūmíng 山居秋暝” (Autumn Evening in the Mountains). His extant writings include Wáng Yòuchéng Jí 《王右丞集》 and Huàxué Mìjué 《画学秘诀》.
1.《鸟鸣涧》 鸟鸣涧 人闲桂花落， 夜静青山空。 月出惊山鸟， 时鸣春涧中。
Birds Calling in the Ravine With people at leisure, osmanthus blossoms fall; In the still night, green mountains lie empty. When the moon rises, it startles the mountain birds, Who now and then cry out in the spring ravine.
Commentary In the first two lines, the poem’s focus settles on the words “fall” and “empty.” “Fall” portrays the poet’s unhurried, leisurely state of mind—only then can one sense the tiny osmanthus blossoms drifting down without a sound. “Empty” depicts the vast, far-reaching atmosphere created by the stillness of night. The next two lines shift from silence to sound: “startled” and “crying” further express the tranquility of the moonlit night and the emptiness of the valleys. The most interesting point is that through the birds’ cry, the desolate quiet of the first lines suddenly gives rise to a pulse of life, filling the poem with vitality amidst its serenity. This is precisely the elegant, leisurely attitude toward life that Wáng Wéi pursued.
2.《杂诗》 君自故乡来，应知故乡事。 来日绮窗前，寒梅着花未？
Miscellaneous Poem You come from my old hometown— You must know the affairs of home. Tell me, before the embroidered window, Has the winter plum begun to bloom?
Commentary This is a uniquely conceived poem of homesickness. The poet expresses intense longing for home through concern for the plum blossoms there. All four lines are the traveler’s questions—implying deep care for his homeland. He could ask about many things, yet he chooses the plum outside the window. This seemingly small and casual question contains boundless longing and affection. The “winter plum” is no longer just a plant before the window, but a symbol of all that is worth remembering at home—an embodiment of homesickness that feels intimate, natural, and full of meaning.
3.《相思》 红豆生南国，春来发几枝。 愿君多采撷，此物最相思。
Longing Red berries grow in the southern land— In spring, how many new branches appear? I hope you gather them in plenty, For this is the seed of deepest longing.
Commentary This poem was written for the famous singer Li Guinian. In only twenty characters, it expresses the poet’s heartfelt affection. After the An Lushan Rebellion, Li Guinian wandered in the south, and it is said he often sang this poem, deeply moving all who heard it. The first two lines naturally and sincerely introduce the red berries. The last two lines convey feeling through metaphor—intimate and touching. Centered entirely on the symbol of the red berry, the poem expresses longing with simplicity and warmth, creating a lasting emotional resonance.
4.《九月九日忆山东兄弟》 独在异乡为异客，每逢佳节倍思亲。 遥知兄弟登高处，遍插茱萸少一人。
Thinking of My Brothers on the Double Ninth Alone in a strange land as a lonely guest, Every festive day my thoughts of home double. From afar I know my brothers have climbed the heights; Among the dogwood sprigs they wear, one person is missing—me.
Commentary This is a festival poem expressing longing for family. The first two lines describe the poet’s inner feelings during the festival. In the first line, one “alone” and two uses of “foreign/strange” portray a deep sense of isolation and unfamiliarity, making the second line’s “doubled homesickness” especially affecting. It resonates with anyone who has spent a holiday far from home, touching the heart and becoming a timeless line. The last two lines use the custom of climbing heights and wearing dogwood on the Double Ninth Festival to imagine the poet’s brothers back home. This not only shows his longing for family but also emphasizes his own disappointment and loneliness—deepening the poem’s theme.
Song of Weicheng (also Seeing Yuan Er Off to Anxi) Morning rain at Weicheng dampens the light dust; At the travelers’ lodge, the willows look freshly green. I urge you—drink one more cup of wine, For once you pass west of Yang Gate, there will be no old friends.
Commentary The poem depicts the emotional scene of parting with a close friend. The first two lines describe the beauty of the homeland after rain; the last two express the affection and reluctance at parting. Artistically, the opening lines serve as a gentle prelude, while the final lines reveal the true theme. The poet skillfully conveys sorrow and tenderness with restraint, making the emotions sincere and warm. Thus this poem has been passed down through the ages and is loved by generations.
With my upcoming Liú Dùzhōu book release, I felt it would be apt to share a couple random cases from this brilliant physician. These cases do not appear in my book, but were ones I found during my many deep dives and Liú Dùzhōu rabbit holes. Enjoy!
Case of Dysmenorrhea Patient: Li, female, 45 years old. Initial consultation on May 5, 1993.
History: The patient developed dysmenorrhea one year prior after undergoing an induced abortion. During each menstrual period, she experienced severe, cold pain in the lower abdomen that was unrelieved by analgesics. Her menstrual cycle was delayed, with scanty, dark-colored blood containing clots. This menstrual period began yesterday. She also presented with dry mouth, chapped lips, dizziness, soreness in the waist, weakness in the legs, and fatigue when lifting. The tongue was dark, and the pulse was deep.
Diagnosis: This was diagnosed as a condition of deficiency and cold in the Chong and Ren channels, with blood stasis obstruction.
Treatment: The treatment principle was to warm the channels, dispel cold, eliminate blood stasis, and nourish the blood. The prescription was derived from the Jīnguì yàolüè formula Wēn Jīng Tāng:
wüzhūyú 8g
guìzhī 10g
shēngjiāng 10g
dāngguī 12g
báisháo 12g
chuānxiōng 12g
dǎngshēn 10g
zhìgāncǎo 10g
mǔdānpí 10g
ējiāo (dissolved separately) 10g
bànxià 15g
màidōng 30g
Outcome: After taking five doses, the cold pain in the lower abdomen was significantly relieved. The same prescription was continued for five more doses. By the next menstrual period, the abdominal pain did not recur. From that point forward, her menstruation became regular and without discomfort. (Selected Clinical Case Studies of Liú Dùzhōu)
Commentary: Wēn Jīng Tāng is effective for treating dysmenorrhea. Renowned Hangzhou physician Qiu Xiaomei once recalled: “I was fortunate to work alongside the famous Zhejiang physician Ye Xichun. Ye’s profound and unique medical skills provided me with many valuable insights. For example, when treating cold-induced dysmenorrhea, the routine application of Wēn Jīng Tāng often proved effective. However, there were cases where it was ineffective.” (The Path of Renowned TCM Physicians)
This highlights that even when using Wēn Jīng Tāng, it is crucial to match the formula to the correct pattern. In this case, Dr. Liú Dùzhōu documented not only the patient’s localized symptoms (such as delayed menstruation, severe cold pain in the lower abdomen, and scanty dark menses) but also systemic characteristics such as dry lips, a dark tongue, and a deep pulse, along with the abortion as the inducing factor.
Case of Neurotic Disorder and Irritability
Patient: Cao, a 72-year-old female, who first consulted on October 26, 1995. The patient had been experiencing persistent irritability for two years, with a recent worsening trend. Western medicine diagnosed it as a neurotic disorder, and she was given sedatives and anxiolytics, but there was no improvement. She then sought traditional Chinese medicine treatment.
Presenting Symptoms: The patient complained of intense irritability, which was unbearable. Her family members were sympathetic and cautious, but she could not express herself or felt misunderstood. She became agitated and, during severe episodes, felt relief only after hitting her chest and abdomen with a stick. She felt a rising sensation from the navel to the chest, which worsened the irritability. She also experienced abdominal bloating with a feeling of obstruction. Additional symptoms included insomnia, restlessness, nausea, poor appetite, irregular bowel movements, and yellow urine. Her tongue was red at the tip, with a greasy coating, and the pulse was wiry and slippery.
Diagnosis: A pattern of fire stagnation in the chest and abdomen, with downward pressure on the stomach and intestines.
Follow-up: After 7 doses, the patient reported a 50% reduction in irritability. Her chest and abdomen felt clearer, and her mood stabilized. She was able to sleep at night, and her appetite improved. The treatment was highly effective, and the patient continued with 7 more doses. Upon follow-up, she still had symptoms of sleep disturbances, dry mouth, a bitter taste, and yellow urine, indicating that heat had not fully resolved. The prescription was then changed to Chái Qín Wēn Dǎn Tāng [Wēn Dǎn Tāng plus cháihú & huángqín) combined with Zhīzǐ Hòupò Tāng to clear phlegm-heat and treat the remaining symptoms. After one month, the patient fully recovered. (From Liú Dùzhōu Lin Zhen Yan An Xuan (Selected Clinical Cases of Liú Dùzhōu))
Note: The difference between Zhīzǐ Hòupò Tāng and Zhīzǐ Shí Tāng lies in the abdominal symptoms. The former is indicated when abdominal symptoms like bloating and constipation are present, while the latter is primarily used for chest-related symptoms like chest oppression and cough. Zhīzǐ Hòupò Tāng and Xiǎo Chéng Qì Tāng both contain zhǐshí and hòupò, which treat abdominal fullness and pain. The key difference is that zhīzǐ and dàhuáng have distinct effects: Zhīzǐ clears irritability, while dàhuáng is used to purge and clear heat. Therefore, Zhīzǐ Hòupò Tāng is more suitable for chest obstruction and irritability, while Xiǎo Chéng Qì Tāng is better for constipation and abdominal pain. The patient’s detailed symptoms of irritability and abdominal fullness illustrate the application of Zhīzǐ Hòupò Tāng for heat-related disturbances and its ability to address both physical and emotional symptoms.
The patient is a 50-year-old male farmer from Yongqiang. He has always been healthy and has never been ill until the last 5 years. Recently, he frequently experiences coldness in his toes, especially in the summer. Whenever his toes feel cold, he also feels discomfort in his abdomen, which is followed by diarrhea. This year, the symptoms have become more frequent, and his hands and feet have started to experience spasms, which he never had before. This has caused him some anxiety. He has visited many doctors who all diagnosed him with intestinal dysfunction, but the treatments did not bring noticeable results. The patient is also a distant relative of mine, so he came to seek my help.
First Consultation (July 10, 2005): Upon examination, the patient reported the symptoms mentioned above, along with night sweats in winter, spontaneous sweating in summer, and a lack of thirst. However, there were no significant abnormalities found in his pulse or tongue. Abdominal examination revealed thin, weak abdominal muscles. Based on this, I suspected a Guìzhī Tāng pattern. The patient’s symptoms of cold feet in summer leading to abdominal discomfort reminded me of a Japanese Kampo [physicians] experience, where he said: “Cold feet in summer causing abdominal pain should be treated with Guìzhī Jiā Fùzǐ Tāng.” Therefore, I prescribed 7 doses of Guìzhī Jiā Fùzǐ Tāng, replacing shēngjiāng with gānjiāng, essentially combining Guìzhī Tāng and Sì Nì Tāng.
Follow-up Consultation (July 17, 2005): After taking the medicine for one week, the patient reported feeling very comfortable and as if he had met a long-lost friend. The coldness in his toes, abdominal discomfort, and diarrhea had also improved. Since the prescription had been effective, I continued with Guìzhī Jiā Fùzǐ Tāng for another 7 doses.
Follow-up Consultation (July 24, 2005): After another week of medication, the patient’s condition continued to improve. The spasms in his hands and feet had disappeared, and the symptoms of cold toes, abdominal discomfort, and diarrhea had significantly improved. However, spontaneous sweating continued. Based on the symptoms, I added Yù Píng Fēng Sǎn to the original formula and instructed the patient to take it for two weeks before stopping the medication to observe the results.
After a month of continuous treatment with the combined formula of Guìzhī Jiā Fùzǐ Tāng and Yù Píng Fēng Sǎn, the patient’s symptoms disappeared, and he stopped the medication. A year later, when I met his family, I learned that his condition had been completely cured.
Note: In classical Chinese medicine, it’s important to pay attention to experience-based maxims. As Gě Hóng from the Jin Dynasty mentioned in Bàopǔzǐ: “In the transmission of medical secrets, words are not written down, only passed down through oral formulas.” In traditional herbal medicine, treatment is based on patterns and symptom differentiation. The treatment in this case is simple and effective when considering the pattern and maxim: “Cold feet in summer causing abdominal pain should be treated with Guìzhī Jiā Fùzǐ Tāng.”
In this case, the “coldness in the toes” symptom might suggest the use of xìxīn, which treats retained fluids and dampness. However, the patient’s coldness, spontaneous sweating, and diarrhea were more in line with the Sì Nì Tāng pattern, so I added fùzǐ and replaced shēngjiāng with gānjiāng to match the correct pattern.
Case of Blood Amassment Induced Madness by Cao Yingfu 曹颖甫
Shen Shiwan’s younger sister, a frail young woman under the age of twenty, suddenly suffered a fright while out shopping. Upon returning home, she descended into madness—attacking anyone she encountered with seemingly boundless strength.
Several days passed without improvement, and I was called to examine her. By then, her condition had persisted for seven or eight days, with no signs of relief. Upon inquiry, I learned that she had not had her menstrual period for two months. Seizing an opportunity while she slept, I entered her room to examine her. Her pulse was deep and tight, and her lower abdomen appeared distended.
I stepped outside and told Shen Shiwan, “This is a case of blood amassment. A strong purgative will cure it.” I prescribed Táohé Chéng Qì Tāng as follows:
Táorén 1 liang
Dàhuáng 5 qian
Mángxiāo 2 qian
Zhìgāncǎo 2 qian
Guìzhī 2 qian
Zhǐshí 3 qian
The next day, I returned to check on her. She had passed a large amount of dark blood, her madness had completely subsided, she showed no signs of exhaustion, and she could even drink porridge. She was now ashamed to face others and refused to come out. (From Jingfang Shiyan Lu – Empirical Records of Classical Formulas)
Commentary:
The key diagnostic markers for Táohé Chéng Qì Tāng include “[patient] appears as if mad” and a “tense bound lower abdomen,” which strongly indicate its use in psychiatric disorders related to blood stagnation. The case aligns closely with classical descriptions—particularly the immediate menstrual discharge of dark purple blood after treatment, a vivid demonstration of the classical principle: “when blood is discharged, the illness will resolve.”
Hormonal changes can often lead to premenstrual symptoms such as irritability, insomnia, headaches, and cognitive issues, which frequently improve after menstruation. This phenomenon, referred to as blood amassment (xu xue 蓄血), remains a fascinating area for further study.
The prescription is quite potent and purgative. If hòupò were added, it would become a combination of Táohé Chéng Qì Tāng and Dà Chéng Qì Tāng. Interestingly, Dà Chéng Qì Tāng is also used in neurological conditions, including delirium, incoherent speech, hallucinations, clouded vision, and severe restlessness, often with more pronounced abdominal fullness and distension.
Case of Shock-Induced Immobility and Chest Oppression by Yè Júquán 叶橘泉
A businessman, known for his cautious and timid nature, had a habitual fondness for alcohol. At the time, Suzhou was under Japanese occupation. One midnight, Japanese military police, accompanied by local collaborators, conducted a household inspection. Terrified, the man was left speechless, eyes wide in shock, unable to respond. He was suddenly slapped across the face by the military police and collapsed to the ground, lying rigid and unconscious, appearing as if he had suffered a stroke.
I was invited to examine him. His pulse was thin and wiry, with a slippery sensation upon deep palpation. His face was flushed, tears welled up in his eyes, and though he appeared to have sensation when touched, he remained speechless and motionless in a rigid supine posture. His pupillary reflexes were normal, and no signs of hemiplegia were present, but his feet were icy cold, his rectus abdominis was tense, and there was a palpable mass in the lower abdomen. He had not had a bowel movement for several days.
I prescribed Táohé Chéng Qì Tāng with the addition of niúxī and chuānxiōng. After taking the formula, he had a bowel movement, his feet became warm, and he soon let out a deep sigh, moaning as if relieved of an immense weight. He then spoke for the first time, saying that he had felt a crushing pressure on his chest.
A second dose was given, after which his stool contained traces of blood. Upon examination, it was found that he had preexisting hemorrhoids, which had started bleeding. I then reduced the dosage and continued treatment for several more doses, leading to a full recovery. (From Zhongguo Bainian Bainming Zhongyi Linchuangjia Congshu – Yè Júquán – A Century of Renowned Chinese Physicians: Yè Júquán)
Commentary:
This case illustrates a shock-induced immobility with clear signs of blood stasis and psychological disturbance. Although the patient did not exhibit violent mania, his mental dysfunction was undeniable. The physician skillfully identified abdominal tension, a palpable lower abdominal mass, and prolonged constipation as key indications for Táohé Chéng Qì Tāng, demonstrating a flexible application of classical formulas.
Two key diagnostic markers stand out in this case:
Flushed face with cold lower limbs – a hallmark external manifestation of blood stasis, which can serve as a visual clue for selecting Táohé Chéng Qì Tāng.
Post-treatment rectal bleeding – This reinforces the classical principle that “blood will discharge after taking the formula”, not only in the form of menstrual bleeding in women but also through lower gastrointestinal or even urinary tract bleeding in certain cases. However, this effect is not universally observed in all patients.
Hanshan 寒山 (dates of birth and death unknown), courtesy name and sobriquet also unknown, was a native of Chang’an (modern-day Xi’an, Shaanxi) and lived in seclusion in the Tiantai Mountains of eastern Zhejiang for over 70 years, passing away at the age of over 100. According to modern day poet Red Pine, Han Shan was born in the ancient town of Hantan at the western edge of the Yellow River floodplain, about 300 kilometres east of Chang’an, and his family only moved to Chang’an when he was little.1 Scholars generally place his life during the Tang Dynasty (618–907 CE), though specific details about his life are elusive due to his reclusive lifestyle and the mythical aura surrounding him.
A renowned poet-monk of the Tang Dynasty, Hanshan hailed from an aristocratic family but failed multiple attempts at the imperial examinations. Eventually, he renounced worldly pursuits, became a monk, and after the age of 30, withdrew to the Tiantai Mountains, living in seclusion and adopting the name “Hanshan” (Cold Mountain).
According to Yan Zhenfei’s Examination of Hanshan’s Life Story, supported by historical texts such as Northern History and Book of Sui, Hanshan was the son of Yang Wen, a descendant of the Sui royal family. Due to jealousy and ostracism within the imperial court, combined with the influence of Buddhist thought, he retreated to the Cold Cliffs of the Tiantai Mountains. He was known for his eccentric lifestyle, wearing a birch-bark hat, tattered clothing, and wooden clogs. He enjoyed playing with children, spoke freely and unpredictably, and was difficult for others to understand. He often visited the Guoqing Temple in Tiantai, where he befriended two monks, Fenggan and Shide. Hanshan would collect leftover temple food in bamboo tubes to sustain himself in his mountain home.
Hanshan frequently wrote poems and gathas (short Buddhist verses) on the rocks and trees of the wilderness. His poetry was straightforward, capturing the joys of mountain life and expressing Buddhist ideals of detachment, life’s wisdom, and compassion for the poor. He also criticized social norms and injustice. Han Shan’s poems focus on Buddhist and Daoist themes, with self-reflections and commentary on Tang society. These stylistic and thematic elements align with the intellectual and spiritual currents of the Tang era. His works were later compiled into the Collected Poems of Hanshan in three volumes, with 312 poems preserved in the Complete Tang Poems. In the Yuan Dynasty, his works were introduced to Korea and Japan and later translated into languages like Japanese, English, and French.
Legend has it that the Taoist that first collected Han Shan’s poetry, was a man named Xu Lingfu, who had moved to the Tiantai mountains in 815 to practice and live in seclusion as well and stayed for his remaining days. Based on several writings, we can ascertain that the two met sometime after 825 and before Xu’s death in 841.
This legendary poet, initially overlooked by society, gained increasing recognition and global dissemination in the 20th century. As one of his poems proudly declares:
“Some laugh at my poetry, [yet] my poems unite with the classical odes. No need for Zheng’s commentary, Nor Mao’s annotations to shine.”2
Han Shan is more often regarded as a spiritual figure than a historical one. He is depicted as a “laughing hermit” embodying Zen wisdom, with his poetry serving as a timeless bridge to his thought rather than a concrete record of his life. The following are a few personal favourites that I feel capture the essence of Han Shan’s style and voice. All translations are my own.
我居山，勿人識。白雲中，常寂寂。
I reside in the mountains unaware of anyone, among the white clouds, always in solitude.
寒山深，我稱心。 純白石，勿黃金。 泉聲響，撫伯琴。 有子期，辨此音。
Deep in cold mountain, I am content. Pure white stones are not gold. The springs sound, and I gently pluck a qin. If Ziqi3 were here, he’d recognize these sounds.
寒山子，長如是； 獨自居，不生死．
Master cold mountain, is always like this, residing alone, free from birth or death.4
In the layered cliffs, I chose my dwelling, Where bird paths are cut from human presence. What is at my courtyard edge? White clouds embrace the shrouded stones. I have lived here many years, observing the changes of the seasons.5 I send word to households with bells and tripods,6 Empty titles are of no benefit.
If you desire a place to calm your body, cold mountain can keep you protected. A gentle breeze blows hidden pines, the closer you come, the more exceptional it sounds. Below a grey haired man mutters [the words] he has read of Huang-Lao.7 For ten years he has not returned home, forgotten the path from which he came.
Alone I lie beneath the layered cliffs, Steaming clouds, fail to disperse throughout the day. Though the room is dim and misty, My heart-mind is free from all clamor. In dreams, I float within the imperial palace, My ethereal soul returns, crossing the stone bridge. I cast away things that disturb me, Especially the gourd among the trees.
All who read my poems, Must protect and purify their heart-mind. Let grudging and greed be purified daily, And flattery and fawning be corrected at once. Drive away and eliminate evil conduct, Take refuge and receive your true nature. Attain the Buddha’s body today— Swiftly, swiftly, as the law commands.
家有寒山詩， 勝汝看經卷。 書放屏風上， 時時看一遍。
Having Hanshan’s poems at home Surpasses your reading of scrolls. Write them down upon a screen, And read it through from time to time.
吾心似秋月， 碧潭清皎潔。 無物堪比倫， 教我如何說。
My mind is like the autumn moon, A clear pond, pure and bright. Nothing in the world compares— How can I find the words to describe it?
Red Pine, The Collected Songs of Cold Mountain (Port Townsend: Copper Canyon Press, 2000), 13. ↩︎
Han Shan is referring to the Shijing (Classic of Poetry) here and is insinuating that his poetry is easier to read, hence commentaries are unnecessary. Zheng and Mao were the standard commentaries on the Shijing. ↩︎
This is a reference to Zhong Ziqi (钟子期), a renowned Guqin (ancient Chinese seven-string plucked instrument) musician from the State of Chu during the Spring and Autumn Warring periods. Zhong Ziqi was known for his acute listening skills and deep sensitivity to music, capturing the emotions and psychological depth behind melodies. The Ziqi-style Guqin is said to have been designed in his honor, characterized by a straight and deep neck with a half-moon shape. ↩︎
A reference to Samsāra, the cycle of birth and death or re-birth and re-death. ↩︎
While the text literally says spring and winter, this can be translated simply as seasons. ↩︎
This is an ancient reference to wealthy families and households. ↩︎
Huang-Lao is an early school of Daoist thought and an important branch of Daoism that advocates active engagement with the world. It applies the philosophy of traditional reclusive Daoism to governance, aiming to achieve national prosperity and military strength. The school is named after its association with the Yellow Emperor (Huangdi) and the veneration of Laozi. Huang-Lao Daoism later became the foundation of Daoism as a religious tradition. Followers of Laozi claimed to represent the teachings of the Yellow Emperor and also revered Yi Yin and Jiang Taigong. They promoted the principles of tranquility and non-action (wu wei), avoiding interference with the people and allowing the populace to “self-transform,” thereby bringing peace and stability to the world. ↩︎
The following translation is taken from Ouyang Weiquan’s ‘Exploration of Cold Damage Six-Conformation Pattern Differentiation and Formula Presentations – Jingfang Approach to the Identification and Treatment of Skin Diseases.’
Approach to Identifying and Treating Skin Diseases
Regardless of the type of skin disease or lesion, if there is a presentation of interior cold deficiency in the Taiyin channel along with symptoms of heat in the upper body, this formula can be considered.
This formula is frequently used for young women with facial acne or seborrheic dermatitis and is often combined with Dang Gui Shao Yao San.
Patients with systemic lupus erythematosus (SLE) who have undergone long-term corticosteroid treatment often present symptoms corresponding to this formula. Clinically, using this formula based on the diagnosis can quickly reduce skin lesions, alleviate symptoms, and, with consistent use, normalize various lupus-related indicators.
Other conditions such as urticaria, chronic eczema, and psoriasis may also benefit from this formula.
Systemic Lupus Erythematosus (SLE) Treated with Chai Hu Gui Zhi Gan Jiang Tang Combined with Dang Gui Shao Yao San
Yang, female, 51 years old. Initial consultation: May 13, 2005. History of systemic lupus erythematosus (SLE) for 13 years. Previously treated with both Western medicine and Traditional Chinese Medicine in the rheumatology and internal medicine departments, with relatively stable disease progression. Currently taking 10 mg/day of prednisone. However, the patient had been experiencing unrelieved joint pain in the limbs, neck, and back for over two years. Symptoms included pain in the elbows, wrists, finger joints, knees, and ankles, along with neck and back pain. She reported slight sensitivity to cold, normal appetite, slight dry mouth with no desire to drink, preference for warm drinks, and reduced urination. Tongue was dark red with a white coating, and the pulse was deep and thin.
Prescription:
Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San with modifications:
After taking the formula, the patient reported significant improvement. She obtained an additional 12 doses on her own. After taking the formula her joint pain in the limbs and neck/back had almost completely disappeared. Cold sensitivity was no longer noticeable, her energy levels had improved, and her dry mouth had markedly lessened. Her tongue was dark red with a yellowish coating, and her pulse was thin. 20g ofShi Gao was added to the previous formula.
The patient continued this treatment until July 15, 2005. By then, joint pain was completely resolved, and no other discomfort was reported. Her energy levels remained good. The dosage of prednisone was reduced to 5 mg/day. The prescription was adjusted by removing Shi Gao and continued as a consolidation treatment.
The formula Chai Hu Gui Zhi Gan Jiang Tang originates from the Shang Han Lun, Clause 147, where is says:
“In cold damage that has lasted five or six days, sweating has already been promoted followed by purgation, and there is fullness and mild congestion in chest and ribs, with inhibited urination, thirst but no vomiting, and only the head is sweating, with alternating cold and heat, and heart vexation, this means that [the pattern] has not yet resolved, and Chaihu Guizhi Ganjiang Tang governs.”
This formula addresses Shaoyang depressed heat with inhibition of the pivot mechanism combined with Taiyin spleen cold and internal deep-lying water-rheum. Hu Xishu frequently combined this formula with Dang Gui Shao Yao San to treat SLE presenting with blood deficiency, exuberant water, and Shaoyang depressed heat, with notable efficacy.
The authors own clinical observations suggest that after systemic lupus erythematosus (SLE) is stabilized with corticosteroid treatment, symptoms often align with the pattern corresponding to this formula presentation. Using the formula according to the pattern has proven to be effective.
Original Work by Keisetsu Ōtsuka, with translation [from Japanese to Chinese] and commentary by Wang Ningyuan: Kampo and Abdominal Diagnosis
Primary Gangrene of the Left Big Toe
The patient is a 52-year-old male with a good complexion and obesity.
Two years prior, he began experiencing pain in the left big toe, which was diagnosed as primary gangrene. At the same time, there was swelling and hardness near the left lower abdomen close to the iliac fossa, accompanied by tenderness. After being examined by a renowned surgeon, exploratory laparotomy was performed but no abnormal lesions were found.
Initial Consultation: November 7, 1925
Pulse: Left side was deep and choppy; right side was deep and small.
Blood Pressure: 112/70 mmHg.
Symptoms: The left dorsal artery of the foot was undetectable. The left big toe appeared purplish, with blackened toenails. The degree of pain fluctuated and worsened after exertion, significantly impacting sleep due to the pain.
Abdominal Diagnosis
On the right side, there was fullness and discomfort in the chest and hypochondrium. In the lower left abdomen, at the site of the previous surgery, there was resistance and tenderness.
The patient had bowel movements once a day, but they were not smooth.
I considered the resistance and tenderness in the left lower abdomen to be an abdominal sign of blood stasis. The resistance and tenderness, which were previously suspected by the surgeon to indicate a tumor, may also have been due to blood stasis.
Based on the signs of right-sided chest and hypochondriac fullness and the abdominal sign of blood stasis, I prescribed a combination of Da Chai Hu Tang and Tao He Cheng Qi Tang.
Course of Treatment
One week later: No significant changes.
Ten days later: The affected foot felt lighter, and the pain lessened.
After about two months: The color of the toenails improved, and the patient reported almost no pain. However, the dorsal artery of the foot remained undetectable.
After about ten months: The affected toe started showing a reddish color, the toenails turned pink, and although weak, the pulse of the dorsal artery became palpable.
Later, the patient developed swelling in the right knee joint and was treated with Yue Bi Jia Zhu Tang for about three weeks, which resolved the condition.
It has now been eight years, and the gangrene has not recurred.
— From Thirty Years of Kampo Clinical Practice, authored by Keisetsu Ōtsuka, translated by Wang Ningyuan
To learn Chinese medicine, one must first understand the terminology of the twelve channels. To understand these terms, one must first grasp the principles behind yin and yang, the five phases, and the six qi [atmospheric influences]. To understand these, one must first become familiar with the circular movement of the heat that reaches the earth’s surface from the sun during the twenty-four solar terms. This movement encompasses the directions of right, bottom, left, top, and center; descending, sinking, ascending, and floating; autumn, winter, spring, and summer; and northwest, southeast, and other compass points. In the diagram [shown below], the dashed line represents the earth’s surface; below it is below ground, and above it is above ground.
The upper part of the circle in the diagram represents the clouds, while the center represents the center of the circular atmospheric movement of a living environment. By observing from this center, one can see the universal scope of a living being’s habitat. The “center” character in the diagram signifies the reader. “Descending” refers to the heat that the sun emits to the ground during summer, which sinks into the earth. “Sinking” means this heat descends into the water beneath the earth. “Ascending” refers to the heat rising from below the earth to above the surface. “Floating” refers to this heat, which rises above the ground and coexists with the summer sun’s heat. “Center” represents the middle position among descending, sinking, ascending, and floating.
The point of descent begins at the start of autumn, the point of sinking begins at the start of winter, the point of ascent begins at the start of spring, and the point of floating begins at the start of summer. Before the autumn equinox, there is more heat above the ground than below. At the autumn equinox, the heat is balanced between above and below the ground. Before the spring equinox, there is more heat below the ground than above. At the spring equinox, the heat is again balanced between above and below. The winter solstice marks the peak of heat that has descended beneath the earth from the start of autumn. The summer solstice marks the peak of heat that has risen above the ground from the start of spring. When descending reaches its peak, ascending begins, and vice versa. This continuous rise and fall generate life force and are natural phenomena of the atmospheric circular movement.
In plants, leaves fall in autumn, indicating the descent of heat within the plant. Roots grow in winter, indicating the sinking of heat within the plant. Budding in spring shows the rising of heat, while thriving growth in summer shows the floating of heat. Observing the descending, sinking, ascending, and floating of heat in plants makes this concept easy to understand.
Discussing the descending, sinking, ascending, and floating of heat in plants is akin to discussing the heat’s behaviour in the atmosphere and, ultimately, within the human body. The dashed line in the diagram represents the ground in the universe and corresponds to the space between the chest and navel in the human body, specifically two inches above the navel. Heat naturally ascends and floats and does not descend or sink by itself. The force of autumn’s energy gathering leads to the descent and sinking of heat. Heat descending marks the beginning of life for living beings; if heat does not descend, it can lead to death. More details on the autumn energy gathering will be elaborated on in subsequent sections.
In the place where a living being resides, the sunlight that reaches and warms the ground represents yang. The period when this light and heat have passed and the new light has not yet arrived is called yin (as depicted by Fuxi in the trigrams: “—” for the yang trigram and “– –“ for the yin trigram, symbolizing this very principle). Yang naturally rises and expands, while yin naturally descends and compresses. The movement of yang is upward, while the movement of yin is downward. When yin and yang interact, they create a force of attraction, following one another and forming a circular movement.
The nature of Yang is movement, while the nature of yin is stillness. Stillness leads to sinking, while movement leads to floating.
The transition from stillness to movement results in rising, and the transition from movement to stillness results in descending. The cycle of ascending, floating, descending, and sinking completes a round of movement, which generates centre qi. This centre qi is [the essence] of life in living beings. This is the origin of the circular movement of the atmosphere and the fundamental process through which individual beings are formed. Humans are endowed with life through the circular movement of yin and yang in the atmosphere. The human body is an inheritance of this cosmic individual creation.
By first understanding the yin and yang of the cosmic atmosphere, one can naturally understand yin and yang within the human body. The Five phases (Wood, Fire, Earth, Metal, Water) represent the five types of material present within the entire cycle of ascending, floating, descending, and sinking of yin and yang energies. [The Chinese term] xing (行) [translated as phases] implies movement.
All living beings possess both yin and yang natures because the atmosphere contains these forces. This explains the origin of the terms yin and yang in Chinese medicine. The concept of creation (造化) refers to the universal atmospheric movement that nurtures living beings and can also be seen as another name for the cosmos itself.
The atmospheric conditions throughout the year align with the Five Phases. During summer, the atmosphere corresponds to fire, as the heat from the sun reaching the ground is at its peak. This heat is associated with fire. Since heat rises, the summer atmosphere is characterized by heat that floats upward, thus being classified as fire qi. In summer, the sun is at its strongest in the south, which is why the south is associated with fire qi. The noontime of a day is also linked to fire qi because the sun’s heat is most intense at this time.
The period from the spring equinox to the start of summer is called Sovereign [or Imperial] Fire (君火), while the period from Lesser Fullness of Grain (小满) to Lesser Summer-Heat (小暑) is called Ministerial Fire (相火). The meanings of Sovereign Fire and Ministerial Fire will be explained in more detail later.
Metal is associated with autumn. During this time, the sun shifts southward, increasing pressure on the earth’s surface, and metal qi permeates the sky, signifying the descent of atmospheric pressure. The presence of metal qi in the sky becomes evident in autumn, leading to a cool and descending atmosphere that characterizes autumn as metal qi. The qi of creation (造化之气) rises in the east and descends in the west, with descending energy being most potent in the west, which is why the west is linked to metal qi. The hour of Yǒu (酉时, around 5-7 p.m.) is also associated with metal qi, as its cooling and descending force is most significant at this time.
[The term] “between the sky” refers to the space above the earth’s surface. The nature and behaviour of metal qi will be detailed further in the meteorological proofs found in the section on cosmology.
Winter qi corresponds to water. The life of living beings is entirely dependent on the heat from the sun reaching the earth. The heat from the sun in the summer becomes the root of life for the following year. However, this fiery heat must descend into the earth during autumn and be stored in the water beneath the earth during winter before it can nourish life. In winter, the atmosphere sinks and has the ability to preserve; this ability to sink and preserve is characteristic of water. Warm air rises, while cold air sinks, so in winter, the atmosphere sinks due to coldness and is associated with water qi. The south is considered above the ground, while the north is considered below the ground; thus, the north is associated with water qi. The hour of Zǐ (子时, around 11 p.m. to 1 a.m.) is also linked to water qi as it marks the peak of atmospheric sinking. In the cosmic framework of life, the south is above and the north is below, with the direction of atmospheric ascent being southward and descent being northward.
Spring qi corresponds to wood. The annual circular movement of the atmosphere ends in winter and begins anew in spring, with the end serving as the root of the beginning. The heat absorbed by the ground during the previous summer is collected by metal qi in autumn and descends into the earth, where it is stored within the water during winter. The fusion of fire and water produces warm water qi, which rises. This warmth rises during spring, breaking through the soil and initiating the growth of vegetation, thus corresponding to wood qi. Wood represents the ascending release of fiery energy from water, emerging from dormancy into activity.
Center qi corresponds to earth. Throughout the year, the atmosphere follows the cycle of rising in spring, floating in summer, descending in autumn, and sinking in winter. Therefore, spring qi corresponds to wood, summer qi to fire, autumn qi to metal, and winter qi to water. The complete cycle of rising, floating, descending, and sinking forms a full year. Between summer and autumn lies the central qi, which is associated with the earth. The earth qi of the ground mediates the interactions of rising, floating, descending, and sinking in the atmosphere, making it the center of these transitions. Thus, central qi belongs to the earth phase. The five phases—metal, water, wood, fire, and earth—are materials within the circular movement of the atmosphere. [The Chinese term] xing (行) implies movement.
This is the origin of the term Five phases in Chinese medicine. Correspondingly, the human body experiences its own version of spring, summer, autumn, and winter, as well as its own directions of east, south, west, and north.
Each of the five phase substances possesses its own unique ability. Wood qi has the ability to course and discharge, fire qi perfuses, metal qi constrains, water qi stores and conceals, and earth qi transports and transforms. These abilities are also referred to as forces as well as functions.
The movement of spring qi comes from winter, hence it is said, “Water generates wood.” Summer qi follows spring, so “Wood generates fire.” The qi of late [or long] summer follows summer, so “Fire generates earth.” Autumn qi comes from the energy of late summer, hence “Earth generates metal.” Finally, winter qi comes from autumn, so “Metal generates water.” The transitional period between summer and autumn is called late summer.
The collecting function of metal restricts the coursing and discharging function of wood, therefore it is said that “Metal controls wood.” The perfusing function of fire restricts the constraining function of metal, so “Fire controls metal.” The storing function of water restricts the perfusing function of fire, so “Water controls fire.” The transporting and transforming function of earth restricts the storing function of water, so “Earth controls water.” The coursing and discharging function of wood restricts the transporting and transforming function of earth, so “Wood controls earth.” [The term] yunhua 运化 refers to transportation and transformation, involving movement and integration. [The term] xuantong 宣通refers to the perfusion of heat, enabling its circulation and dispersal. Earth controlling water refers to its ability to reduce [or contain] water.
Mutual generation represents the sequential order of the circular movement of atmospheric energy, while mutual control represents the balancing mechanism within this movement. Mutual generation supplements what is lacking, while mutual control prevents excess. Both mutual generation and control are ways in which the circular movement maintains its continuity and balance. When the qi of heaven and humanity are in harmony, there is no disease. Balanced circular movement brings peace, and peace maintains circular movement. Mutual generation promotes life, while mutual control ensures balance. These concepts form the basis of physiology, pathology, and treatment in Chinese medicine.
The annual cycle of the five-phase circular movement can be reflected in a single day, and the daily cycle can be further simplified to one breath. Each breath, encompassing one inhalation and exhalation, mirrors the rising and descending of atmospheric energy within the human body, forming a complete cycle. The term “heaven” in “heaven and humanity” refers to the entirety of nature’s creation.
The circular movement of atmospheric energy over a year follows a pattern where spring is governed by wood, signifying growth; summer by fire, signifying development; autumn by metal, signifying collection; winter by water, signifying storage; and centre earth signifying transformation. These five phases—growth, development, collection, storage, and transformation—represent the successful completion of the five-phase cycle.
The six qi are wind, heat, summer heat, dampness, dryness, and cold. They arise when the five-phase cycle is disrupted, reflecting an imbalance in the natural influences. While each phase corresponds to one of the five qi, fire has two variations, resulting in six distinct forms of qi.
Sovereign fire operates with an emphasis on upward movement, while ministerial fire focuses on downward movement. Ministerial fire descends into the water during autumn and rises again during spring to become sovereign fire. Meanwhile, sovereign fire follows the ministerial fire downward. This is termed the five phases, but in fact, it is a system of six phases. Since each of the six qi has its own functional role and observable phenomena, the concept is also known as the six phases and six qi.
In the Inner Classic (Huangdi Neijing), it is said: “On Earth, there are the Five Phases; in Heaven, there are the Six Qi.” However, this explanation alone is insufficient. The addition of ministerial fire (相火) to the Five Phases, referred to as the Five Phases and Six Qi, in fact [should be] the Six Phases and Six Qi.
The natural pattern involves the ascending of yang and the descending of yin. The intrinsic nature of yin is to descend, but the ascending of the three yin indicates the presence of yang within yin.
The intrinsic nature of yang is to ascend, yet the descent of the three yang indicates the presence of yin within yang.
The phases—metal, wood, water, and fire—preside over the four cardinal directions, while ministerial fire and earth qi co-govern the central palace. The central palace corresponds to the surface of the Earth, while the four cardinal directions are more distant from the Earth. The circular motion of the Six Movements and Six Qi follows the sequence of four nodes for each qi phase:
These [divisions of the qi periods] mark the root and source of seasonal illnesses. The circular movement of qi that unifies heaven and humanity is most apparent in these seasonal diseases. While internal damage and complex diseases also relate to the Six Qi, they do not generally lead to the same rapid consequences as seasonal diseases. Seasonal illnesses are caused by the disruption of the six qi, which easily leads to the depletion of central qi, resulting in rapid fatality, due to the easy dissipation of qi balance when influenced by the changing seasons.
The surface of the Earth is associated with yang, while below the surface is associated with yin. During the initial qi period, the overall climate transitions from cold to warm. The yang heat stored in underground water during autumn begins to rise in early spring, combining with water to generate wood qi. This wood qi represents the source of yang for the entire year. The solar term Major Cold (大寒) marks the extreme of yin, hence it is referred to as Jueyin (厥阴), with “jue” meaning “extreme.” Wood qi governs movement, and if is impeded, it will generate wind. As such, this is referred to as Jueyin Wind-Wood (厥阴风木).
The second qi [period] arises from the underground yin position and manifests as the upward rising of wood qi. At this time, the atmosphere is relatively warm, not reaching the extreme of yin as seen in Jueyin, thus it is referred to as Shao [lesser] yin (少阴). The upward rising of wood qi represents the yang qi stored in water, which descended during the autumn of the previous year. This yang qi rises from the ground to the surface, illuminating the vast universe and spreading its brightness, which resembles the behavior of the sovereign; therefore, it is called Sovereign fire (君火). At this point, the atmosphere transitions from warm to hot, also referred to as heat-fire (热火).
During the third qi period of Shaoyang (少阳) and Ministerial Fire (相火), the surface of the Earth is filled with abundant yang heat. As the coolness of night descends, this cool air moves down into the underground water. However, when the summer heat rises, it alternates between descending and ascending. The water underground serves as the foundation for life. This yang heat is fundamentally the source of life; with the surface having an abundance of yang heat and the underground having less, it is termed Shao [lesser] yang. This yang heat descends into the underground water in order to generate central qi. When the central qi rotates, it creates a harmonious balance between the upper and lower realms, much like the role of a minister, hence it is called Ministerial Fire. This fire does not descend, and when the summer heat lingers, it is also referred to as Summer-Heat Fire.
During the fourth qi period of Taiyin damp earth, the surface of the ground is filled with abundant yang heat. The previously stored yang energy from below the surface also rises up. The surface experiences extreme heat, while underground, it remains extremely cold. Heat is associated with yang, and cold is associated with yin. Since there is an excess of yin in the atmosphere, it is referred to as Tai [greater] yin. In water, there is qi; when fire is above water, it generates dampness. At this time, the surface is filled with yang heat that has yet to descend into the earth. The clash of heat and cold leads to the drenching and proliferation of dampness. The earth’s qi is at the point of rising and falling, thus it is termed damp earth.
Yangming dry metal occupies the yang position on the surface. During the fifth qi period, the yang heat that fills the surface, influenced by the autumn’s collection, begins to descend. Below centre earth, yang qi is abundant. Dampness has receded, the great universe is bright, and yang is flourishing and luminous; hence it is called Yangming [Yang brightness]. [When] metal qi is vigorous and dampness has also receded, dryness and heat qi bind. At this time, the atmospheric metal qi is under great pressure, hence it is called dry metal.
During the sixth qi period of Taiyang cold water, the yang heat from the surface, having been gathered by autumn, completely descends into the water underground. The qi of creation has its roots in the lower regions. [Since] yang is copious below the centre, it is thus referred to as Tai [greater] yang. This yang heat descends into the water, where it is stored and not discharged. At this time, the atmospheric pressure drops, and the external water becomes cold. When it is cold outside, it means the yang is stored within the water, hence it is called cold water.
The circular movement of the five phases forms a single qi. Wood ascends [while] metal descends; [when] wood does not [suffer from] wind disease, metal [will not suffer] from dryness disease. Water ascends [while] fire descends; [when] fire does not [suffer from] heat or summer-heat disease; water [will not suffer] from cold disease. [When the] earth moves in the center; the earth [will not suffer] from dampness disease. If the movement is not circular and ascending and descending do not interact, each [phase] manifests its own qi, leading to diseases such as wind, heat, summer heat, dampness, dryness, and cold—these are diseases of the atmosphere. The qi of the human body is also like this.
In the period of initial qi, it is suitable to nourish wood qi. During the second qi period, it is suitable to nourish fire qi. In the third qi, it is suitable to supplement ministerial fire qi. During the fourth qi, it is suitable to nourish earth qi. In the fifth qi, [one should] nourish metal qi. In the sixth qi, it is suitable to supplement water qi. The ministerial fire descending into the water marks the beginning of the sovereign fire.The sovereign fire is the culmination of the ministerial fire’s qi, and it descends together with the ministerial fire.
Peng Chengzu (1871-1949), courtesy name Ziyi, was a member of the Bai ethnic group from Heqing, Yunnan. His father served as an official in Guizhou, where Peng Ziyi was born and raised in a family with a strict academic environment. As he grew older, he pursued studies with renowned scholars in Guizhou, developing a wide range of knowledge. Peng had a natural passion for medicine and delved deeply into medical studies. Later, he traveled to Beijing, where he served as a physician at the Imperial Medical Institute during the late Qing Dynasty. This position allowed him access to extensive medical archives and renowned medical texts in the capital.
Peng Ziyi’s book, Circular Movements in Ancient Chinese Medicine, builds upon the ideas from The ‘Sisheng Xinyuan’ text by Huang Yuanyu, an imperial physician of the Qianlong era in the Qing Dynasty. Huang’s work focused on the concept of the circulation and rotation of central qi, rising and descending in cycles. Peng Ziyi extended this concept by introducing the idea of “circular movements of rotating axles” as a view of Qi transformation. His book explains the principles of life movement within the human body and the foundational concepts of disease treatment in Chinese medicine through clear and straightforward reasoning.
Case taken from “Selected Readings on the Efficacy of Kampo Formulas”, by Yang Dahua
Chronic Hepatitis (A Case by Dōmei Yakazu)
A 48-year-old woman developed symptoms five years ago. She experienced chest discomfort, right shoulder pain, swelling in the right side of her neck, numbness in her right hand, and persistent mild fever. After being examined at a university-affiliated hospital, she was diagnosed with acute tuberculous lymphadenitis and treated with streptomycin and para-aminosalicylic acid. However, this led to severe stomach problems and the onset of serious jaundice. Alarmed, she was admitted to another hospital and diagnosed with acute hepatitis. After two months, she was discharged.
Over the following five years, her right shoulder pain, hand numbness, and swelling remained untreated. Her lymph nodes would swell with overwork, and she suffered from a persistent feeling of distention and fullness in her chest, with nausea when tightening her belt. Her physical condition and nutrition were average, her complexion was decent, and her pulse was weak but her blood pressure normal. She had tightness below her chest like a hard plate with intense tenderness on palpation, as well as quite noticeable pain below her right ribs. When the shoulder pain was severe, she would experience shortness of breath.
The symptoms observed closely align with the [Original] line of Dà Chái Hú Tāng [from the Shang Han Lun]: “Distress below the heart, a feeling of depression and slight vexation, fullness in the chest and rib-sides, hard glomus below the heart, vomiting, and abdominal fullness and pain.” Because of the connection between the right shoulder pain, hand numbness, and the tightness with tenderness below the right ribs, the fullness in the chest and rib-sides would fluctuate, sometimes improving and other times remaining unchanged. Although her pulse was relatively weak, Dà Chái Hú Tāng was prescribed with the addition of 5g of gé gēn (Pueraria root).
After taking this prescription for 10 days, the shoulder pain, hand numbness, and chest discomfort she had suffered with for five years was almost completely resolved. A month later, her motion sickness while traveling in cars and trains also resolved, and her hard glomus below the heart and fullness improved. After three months, her long-standing issues were completely resolved, so she discontinued the herbs. (Explanation of the Clinical Applications of Kampo Formulas by Dōmei Yakazu).
The severe stomach disturbance and jaundice should be considered an adverse reaction to para-aminosalicylic acid. Diagnosing it as acute hepatitis was inappropriate, [whereas] drug-induced liver damage would have been more accurate. After stopping the medication and undergoing treatment, her condition returned to normal, and her discomfort over the next five years had nothing to do with liver damage. The phrase “tightness below the chest like a hard plate, with intense pain on palpation, as well as quite noticeable pain below her right ribs” does not indicate symptoms of liver disease.
The patient’s case was a typical presentation of Dà Chái Hú Tāng, so it was appropriate to prioritize the abdominal symptoms without giving much attention to the limb symptoms. The addition of gé gēn was likely to address the limb symptoms of right shoulder pain and hand numbness. However, would the formula have been equally effective without adding gé gēn? Since the formula aligned with the Dà Chái Hú Tāng pattern, adding gé gēn might not have been necessary. It is also not common to add gé gēn to Dà Chái Hú Tāng, whereas herbs such as máng xiāo or hòu pò are more common.
The decision to use Dà Chái Hú Tāng despite the weak pulse reflects a preference for focusing on the abdominal signs as opposed to the pulse. In chronic conditions, the pulse may not react as strongly as in acute illnesses. In other words, when the pulse and abdominal signs do not align, it is necessary to prioritize the abdominal signs. The Essential Guide to Key Kampo Formulas: A Collection of Mnemonics (translated by Qiu Nianyong) states, “The pulse for the Dà Chái Hú Tāng pattern is usually deep and excess, or deep, slow and strong, yet [one] need not rigidly adhere to this pulse manifestation.” [The text] also gives examples of variances in the pulse when Dà Chái Hú Tāng is indicated in cases of abscesses, diarrhea, warm diseases, etc. This suggests that the abdominal signs associated with Dà Chái Hú Tāng are relatively stable, while the pulse can vary according to the disease.
Was the patient’s abdominal pattern caused by tuberculous lymphadenitis? It is unclear. Her limb symptoms were all on the right side—was the pain below the right ribs related? Perhaps from the perspective of a Kampo physician, the limb and abdominal symptoms could be manifestations of the same pathological change, like leaves and flowers on the same tree. Once Dà Chái Hú Tāng was administered, all these symptoms resolved, suggesting that the formula uprooted the tree, causing both the flowers and leaves to wither. In this case, the limb symptoms disappeared first, while the abdominal symptoms resolved more slowly, akin to the different timing of the leaves and flowers falling. The development of abdominal signs and limb symptoms is not necessarily the same, and their underlying causes are likely more complex.
Dōmei Yakazu (1905-2002), was a Japanese physician born in Tokyo. Dōmei graduated from the Tokyo Medical College in 1930 and later studied Chinese medicine. In 1954, he conducted pharmacological research at Tokyo Medical University, obtaining his doctorate in 1959.
For over 50 years, Dōmei Yakazu, together with Keisetsu Ōtsuka, dedicated himself to the revival of Kampo (traditional Japanese medicine) in Japan, making significant contributions to the promotion and development of Eastern medicine. His notable works include; Explanation of Key Kampo Formulas from Later Generations, Explanation of the Clinical Applications of Kampo Formulas, Practical Kampo Diagnosis and Treatment, The Great Encyclopedia of Kampo Medicine, The Medical Encyclopedia of Kampo Diagnosis and Treatment, A Brief History of Kampo over the Past Century of the Meiji Era, and A Hundred Stories of Kampo Therapy.
1. Concept of Water Qi (here, water qi does not refer to edema). In ancient times, there were various concepts regarding water qi. Some believed that water qi was the cold qi of water, such as in the saying by Cheng Wuji in relation to the upward surging of water qi “when water and cold clash, cold in the lung [will result in] counterflow qi.” Others believed that water qi was simply water-rheum, as mentioned by Qian Tianlai: “Water qi belongs to water-rheum.” I believe they each seem to be partially correct because water and cold often jointly cause illnesses. Water represents its form, while cold indicates its qi, like a shadow following its form, inseparable. Therefore, the concept of water qi includes both water-rheum and cold qi.
2. Patterns and Mechanisms of the Upward Surging of Water Qi
The upward surging of water qi is a common and frequently occurring clinical condition. Physicians of various generations have attached great importance to it and have also made developments in its treatment. This condition originated from the “Shang Han Lun” and the “Jin Gui Yao Lue Fang Lun.” Zhongjing proposed the corresponding treatment mainly using the formula Linggui [Zhugan Tang], establishing the basis for the treatment of the upward surging of water qi in later generations. However, the original Linggui formula and its patterns, modifications, and variations are scattered throughout different chapters, making it difficult for people to grasp comprehensively and impossible to reference. To this end, a comprehensive summary is conducted, highlighting the essential points and incorporating personal insights, with the aim of making the characteristics of the upward surging of water qi and the related formula presentations clear to the medical community.
Line 67 of the Shang Han Lun discusses the treatment of the upward surging of water qi. I believe this section represents the concept of “water heart disease.”
The term “water heart disease” influenced the name “rheumatic heart disease” in Western medicine. The name highlights the focus of the disease, reflecting its essential problem, which is more direct than the name “water qi encroaching on the heart.”
The line in the original text says:
“In cold damage [disease] following vomiting or purgation, [if there is] counterflow fullness below the heart, qi surging upward into the chest, dizziness upon rising, and a deep and tight pulse; If sweating is promoted this will stir the channels and there will be quivering and trembling, and Fuling Guizhi Baizhu Gancao Tang governs.”
The phrase “[following] vomiting or purgation” indicates that the mechanism of the condition is related to deficiency rather than excess. It is precisely the deficiency of heart yang that leads to the occurrence of “water heart disease.”
The heart belongs to fire and is the Taiyang within the Yang. It resides in the chest, holding the authority of fire Yang, intimidating the evil of water cold in the lower jiao, not daring to step beyond the threshold of the Lei Chi [or beyond its limits]. Now, due to “the deficiency of Qi after vomiting or diarrhea,” when the heart Yang is deficient, the authority of restraining water cold in the lower jiao is lost. Therefore, there is an opportunity for the cold and Yin Qi in the lower jiao to take advantage, leading to the occurrence of “water heart disease.”
In modern times, influenced by Western medicine, many physicians only recognize that “the heart governs the blood vessels” and the occurrence of angina pectoris and coronary heart disease due to blood stasis in the heart where “all vessels converge.” However, they fail to recognize the physiological characteristics of the heart lying in its Yang Qi. The Suwen • Discussion on the Six Sections on the Organs” states: “The heart is the root of life, [it is responsible] for the changes of the spirit… It is the Taiyang within the Yang, connected with the Qi of summer.” This passage means that the heart is the foundation of life, governing the changes of the spirit. The heart’s extraordinary function is determined by its Yang Qi function. As the heart belongs to the fire organ and resides in the chest, both the chest and fire belong to Yang. Therefore, the heart is referred to as the “Taiyang within Yang.” The heart primarily governs Yang Qi, followed by governing the blood vessels. Both governing the blood vessels and the spirit are related to the dominant role of heart Yang. If heart Yang is lost, pulsation stops, blood circulation ceases, and consciousness disappears.
“Water heart disease” primarily manifests as deficiency of heart Yang, which triggers the invasion of water-cold pathogens from below, attacking the circulation of heart-chest Yang Qi and the blood vessels. At the same time, it should be noted that in ‘water heart disease,’ the spleen’s earth element, which acts as a dam against water in the middle burner, and kidney yang, which governs the water Qi in the lower burner, also show signs of laxity, failing to contain the upward movement of pathogenic cold-water. The term “逆” (nì), meaning “reversal” or “counterflow,” in “counterflow fullness below the heart” carries a dual implication. It not only indicates the pathological mechanism of water Qi rising in reverse but also conveys corresponding symptoms. “Fullness” refers to distension or fullness, also known as “glomus fullness,” caused by the blockage of the Qi mechanism and lack of free flow in the upper abdomen, resulting in distension and fullness.
“Counterflow fullness below the heart,” traditionally interpreted as a symptom between the epigastrium and the stomach, is actually one of the manifestations of heart Yang deficiency. It occurs because of the deficiency of Yang Qi ascending, resulting in fullness in the middle. It’s common in clinical practice to mistake heart-related pain and fullness below the heart as gastric epigastric disorders, which physicians must be vigilant about.
Now, considering the deficiency of heart Yang above and the movement of water-cold Qi in the middle, hence the manifestation of “qi rushing upwards to the chest,” directly affecting the palace of separation. Zhang Zhongjing did not specifically mention the manifestations of Qi rushing to the chest, so I’ll elaborate: the chest is where the heart’s Qi congregates, a place of harmony. As Gao Xueshan said, “Rays of light radiate from the center, sensing only a gathering of the great harmonizing source qi.” If heart Yang is invaded by water-cold, the patient may feel fullness and stuffiness in the chest, accompanied by breathlessness and pain. As the lungs reside in the chest, governing the command of cold, when water-cold intrudes upon the lungs, causing the condensation of cold fluids, symptoms such as coughing, wheezing, thick phlegm, facial edema, and so on may appear.
“Dizziness upon rising” refers to severe dizziness upon standing, leading the patient to remain lying down out of fear of exacerbating the dizziness. There are two causes of dizziness: first, heart-spleen Yang deficiency, where insufficient clear Yang Qi ascends to nourish the head; second, the upward rush of water Qi, Yin battling against Yang, resulting in both deficiency and suppression of clear Yang, thus causing dizziness.
我们结合临床观察，水气上冲头目尚不止此，每见视力下降，目见黑花，耳聋、鼻塞与不闻香臭等五官科疾患。
Based on clinical observations, the manifestations of water Qi rushing upward are not limited to those mentioned above. It is often associated with disorders of the five sensory organs, including decreased vision, seeing black spots, hearing loss, nasal congestion, and loss of sense of smell.
Mr. Li, a 56-year-old farmer from Xushui County, suffered from nasal congestion, particularly severe at night, forcing him to breathe through his mouth, resulting in severe dryness of the mouth. Occasionally experiencing palpitations, he sought treatment. Diagnosed with the syndrome of water Qi encroaching on the heart, he was treated with the formula Linggui Zhugan Tang. After taking [the formula], his nasal congestion completely recovered.
Mr. Li, a senior student at Changli High School, in his fourties, suffered from retinitis, with a dark object obstructing his upper right field of vision. He had previously tried various prescriptions such as Yiqi Congming Tang and Qiju Dihuang Tang, with little effect. Upon examination, his complexion was sallow, tongue was pale and swollen, and his pulse was wiry and irregular, [and he also experienced] palpitations and dizziness. Diagnosed with the pattern of water Qi rushing upward and obstructing clear Yang, he was prescribed Linggui Zhugan Tang with added Ze Xie. After approximately thirty doses, the dark spots in his vision disappeared.
Based on clinical observations, water Qi rushing upward often manifests as discomfort in the throat, resembling the pattern of “plum pit qi,” where there is a sensation of obstruction in the throat, as if something is stuck and cannot be swallowed or expelled.
Before the Cultural Revolution, I took students to intern at the Chengzi Mine. One student treated a woman surnamed Bai who had plum pit qi. She had undergone three courses of treatment with Banxia Houpo Tang from the “Jingui Yaolue” but showed no improvement, so she was referred to me for diagnosis. Upon palpating her pulse, it was wiry, and upon observing her tongue coating, it appeared moist and slippery. I diagnosed her with water Qi rushing upward, causing obstruction in the throat due to water-cold, rather than phlegm obstruction. I prescribed Guizhi 12g, Fuling 30g, Baizhu 10g, and Zhi Gancao 6g to be taken continuously for five doses. Afterward, her throat was clear and the condition was resolved. The student was amazed and asked, “Why was Banxia Houpo Tang ineffective?” I explained, “Banxia Houpo Tang is used for phlegm accumulation causing throat obstruction, while Linggui Zhugan Tang is for throat obstruction due to water Qi rushing upward. The characteristics of the wiry pulse and moist tongue coating were indicative of the latter, and mistaking it for phlegm led to the saying ‘a difference of a hair leads to a difference of a thousand miles.’ The student nodded in agreement.
[In regards to] “a deep and tight pulse.” The depth signifies the interior, also representing water diseases, while the tightness indicates cold. Deep tightness precisely reflects the condition of a water-cold pathology.
Eran Even, Ph.D., Dr. TCM. 