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Rebellious Lung Qi
Rebellion of Lung Qi is movement of Qi in any direction other than dispersing/descending. This causes Cough, asthma, etc. Know the herbs which restore normal function of Qi. Then you choose the herbs based on the differentiation – wind cold, phlegm, heat, etc. This is the basic principle.
Su Zi Jiang Qi Tang
Upper excess and lower deficiency. Memorize this! This is the formula for this problem. The upper excess is cold phlegm retention and the lower xu is Kidney yang xu.
Upper excess of cold phlegm retention:
Cough
Shortness of breath
Ashtma
Phlegm production (white phlegm)
Fullness of chest
White watery or white greasy coating
Ban xia clears the cold phlegm.
Kidney Yang Qi xu:
Cold feelings
Edema of extremities
Shortness of breath
Lower back weakness, possibly knees too
Zi su zi guides down for the lower
Ding Chuan Tang
Ma huang is in this formula. Beware for the hypertension patients. Easily induces sweating, regulates theblood vessels. Lots of high bp pressure patients in the US. Gotta watch this. Also good for excess causing asthma.
For exterior W/C + Phlegm (heat) in the interior
Ma huang is for the external wind cold; ban xia, sang bai pi for the phlegm; xing ren to descend lung qi; huang qi and sang bai pi for the heat in the Lung.
You can use this until the phlegm is gone. You don’t use it for x number of days, but until the sx resolve.
Again, forbidden in cases of hypertension.
Remember: inside, have phlegm heat in addition to the external wind/cold.
Xiao Qing Long Tang
External wind cold invasion + interior phlegm fluid retention.
If catch wind/cold inside with the phlegm inside the main sx will be lots of nasal discharge. Think about the chinese dragon – the green dragon always has water coming out of it’s mouth water.
Pay attention to the Ma huang and ban xia, much like the previous formula.
Gui zhi warms the cold and warms the middle jiao to help resolve phlegm/damp. Damp tends to be cold. This helps resolve. Gan jiang is warm and the taste is pungent so it assists with resolving cough.
Why the bai shao and wu wei zi? Dosage is low. Bai shao is about liver yin/blood – nourishes the blood and nutritive qi.
Ma Xing Shi Gan Tang
This is for Wind-Heat invasion + Phlegm retention + Lung Heat
Shi gao is specifically for Lung/Stomach. Could be a high fever. Look at the dosages to the right. Shi Gao has a very high dose. This recovers the lung’s function and clears pathogenic heat.
Ma huang is balanced by shi gao.
Notice that the past 2 formulas also have ma huang.
Rebellious Stomach Qi
Stagnation of food, stomach heat, liver overacting on stomach, stomach qi xu, lots of damp/fluid in the stomach, bad food will all cause the stomach Qi to rebel. Stomach Qi is supposed to descend. If it rebels there is belching, vomiting/nausea, etc.
You must nourish and descend the stomach qi. Sheng jiang, gan cao and da zao are the main herbs to assist/protect Spleen/Stomach qi. Zhang Zhongjing’s formulas always protect the stomach and always have at least one of these herbs. This area of the body is extremely important because this is where most of your post heaven qi comes from.
Look at doses in the formulas below. Pay attention to them.
Fresh ginger + ban xia is for damp/phlegm. This kind of n/v has mucous. If no mucus, don’t use ban xia. You can always add a little ginger to your food to assist the stomach, but not too much – it’s warm and you don’t want to add too much. You can also add daikon radish which helps descend and helps you lose weight too. Cleans the digestive tract.
Xuan Fu Dai Zhe Tang
Qi Xu.
This is for Stomach Qi xu with pretty bad Qi rebellion + Phlegm retention.
Ren shen, sheng jiang, da zao and gan cao are for the stomach. Ren shen is further for the qi xu. dai zhe shi (mineral) is to descend as is xuan fu hua (the only flower that descends – it also helps w/ LU phl). Could also have n/v.
Sx for stomach are fullness in ST area and belching which doesn’t help with the full feeling. Phlegm retention sx are white and greasy tongue coating and a moderate of slippery pulse.
Ju Pi Zhu Ru Tang
Stomach Heat.
Note the lower ginseng dose. Zhu ru is for phlegm heat causing the stomach heat, also good for vomiting/nausea due to phlegm heat. Ju pi is part of the chen pi family.
Definitely has some heat sx. Stomach will be sensitive – it’s already thrown up so you can’t give it a bunch of bitter herbs for the heat – that will make you throw up more. You have to balance the bitterness even if it’s a little bit warm.
Ding Xiang Shi Di Tang
Stomach Cold.
Stomach xu not too bad, more cold accumulation. Ding xiang for vomiting and hiccup. It’s a rather warm herb. You are still treating the Qi. Ren Shen is low – 3g. Too much qi tonifying herbs here will cause stagnation and bloating. You need to soothe the stomach’s movement path more than stuff it full of more Qi.
For Qi disorders, know and be abel to fill in the chart below.
Qi Deficiency
Qi xu diagnosis for a client is indicated by pulse, tongue, fatigue/lassitude. What if the pulse is weak but the patient feels fine? American patients take a lot of vitamins which will somewhat artificially boost energy. Or maybe they drink Red Bull! But you can see the deficiency regardless. Look at the overall condition of the person. Conversely, fatigue/tired is not a positive indicator of deficiency – could be circumstantial like they drove all day within the last couple of days. Look at the face and use facial diagnosis – look at the body condition and such. Add up all of the sx to get your final dx.
There is general qi xu which can progress to qi descending, a more severe qi xu problem. If Qi descending progresses and does not improve it will move to Qi prolapse, quite severe.
That said, the basic sx of qi xu are both mental and physical fatigue/weakness, lassitude and tiredness. Other sx can be dizziness, spontaneous sweating. All sx become worse after exertion. Look for a weak pulse in one or more positions and a tongue with teethmarks that may/may not be pale. Depending on what organs are affected other sx will appear. Qi cannot control what it is supposed to when it is weak. As an example, bleeding sx can occur when the Qi is not sufficent to hold the blood in the vessel.
Organs most often involved:
Lung Qi – wei qi
Aversion to cold, spontaneous sweating, easily get sick/catch cold.
Stomach/Spleen
Digestive sx:
- Stomach: distention right after eating
- Spleen: n/v, gas/bloat a few hours after eating, loose stool possibly.
Heart
Kidney
Weak low back/knees, incontinence
Other kinds of Qi xu:
Zong Qi or Pectoral Qi, related to Lung and Heart.
Low voice – hard to speak, might sound like words die out at the end.
Wei Qi xu, related to Lung
Aversion to cold, spontaneous sweating, easily get sick/catch cold.
Ying Qi, related to Blood
Etiology
Not eating breakfast? Coffin nails for Qi xu! Don’t just drink coffee for breakfast. Note below that Qi xu can develop to other badness. You need to know the key signs for each of these for clinic purposes
Examples:
Blood xu = pale, now figure out which organ – heart or liver
Yang xu = cold
Leakage of body fluids can = menstrual spotting, incontinence, sweating, night sweats…
You also need to know the single herbs that tonify Qi
Ginseng covers all of them.
Also know what else these tonify. I.e., shan yao is for spleen/ki qi, also nourishes yin. Fresh better than dry. Bai zhu is for sp/st and assists with damp. Zhi Gan cao for lu, sp/st, ht qi. Fresh gan cao is to clear heat for external purposes.
Warm and Sweet tastes generate Qi. This creates a small fire which builds Qi – a large fire will burn it up. If a patient is really craving sugar, tell them to do it in the morning. Body assimilates it better then.
When you are tonifying Qi, be aware that it very easy to cause Qi stagnation and/or poor appetite. Best way to tonify the body is through eating! Always a small amount of move Qi herbs: chen pi, mu xiang. If heart area, move/regulate the blood. If lung qi, add regulate lung qi herbs. If kidney, add regulate ki qi herbs. And so forth.
Another caution: don’t give Qi tonifying herbs for external syndromes! That’s like handing a crow bar to a burglar who is trying to break in to your house. (Caveat: You only add ginseng in small doses to some formulas for patients that are really weak – but the primary herbs are to fight the external invader.)
Si Jun Zi Tang
This is the representative/basic formula for Qi xu. This is a very gentle formula – that’s why it’s the Four Gentlemen! This can also boost the immune system because of it’s strengthening of the Sp/St.
Why is this the representative formula? Spleen/stomach is the ‘2nd heaven’ or source of post heaven qi. If the spleen/stomach is weak, you are not going to be able to tonify qi. Stomach qi, spirit and root are the 3 things you should check in the pulse. (These are the 3 levels of depth in the 2nd/right position.)
Note the same doses for each herb. Ren shen and zhi gan cao are for all organs, bai zhu for stomach, fu ling for spleen. Damp weakens the spleen function and fu ling drains the damp out.
Take prior to meals.
Know the modifications!
Yi gong san.
- Si jun zi tang + chen pi
For qi xu with qi yu. Stronger to tonify the qi than to move the stagnation. Moving the qi will assist with tonification and makes the movement of it smoother.
Liu jun zi tang
- Si jun zi tang + ban xia and chen pi
Qi deficiency with Phlegm damp retention. You could also say er chen tang (phlegm/damp is the main focus) + ban xia, fu ling, chen pi. Same herbs, different focus. If mucus is more + qi xu, do it this way.
Xiang sha liu jun zi tang
- Liu jun zi tang + mu xiang and sha ren.
You need this with Qi xu + d/ph and Qi yu in the middle jiao. Mu xiang moves the qi, sha ren warms and such. This helps with pain in the mj.
SpleenQi xu
This is Sp xu + qi xu. Look for general poor appetite, abdominal bloating a few hours after eating, loose soft watery stool (without strong smell) most of the time, sometimes abdominal pain – which is likely to be moving pain and relieved by release of gas, etc. Might also have other basic Qi xu signs. Since this is a xu sign, touch will feel good.
The formula you use is Si Jun Zi Tang with/without modifications above.
Spleen Qi Xu Not Controlling the Blood
Look for bruising, early periods with excess pale blood, spotting, blood in the stool, metrostaxis and metrorrhagia. This all means that the blood can’t be held in the vessels.
Dang gui assists the blood. Huang qi is a highish dosage and will assist the Qi. If the Qi is moving at the right speed the blood will not leak! Suan zao ren and yuan zhi are for heart/shen issues – heart Blood/yin xu issues. Sheng jiang and da zao aid the MJ. Mu xiang, like chen pi, will move the Qi also.
Sinking of MJ Qi
In addition to fatigue, tired, SOB, weak limbs, look for:
Prolapse
Mostly of organs, characteristic of MJ Qi. Primarily rectum, uterus, KI, St, etc. The Qi is dropping – can’t maintain momentum so other stuff that depends upon the Qi will drop as well.
- Chronic diarrhea, dysentery, watery/soft/loose stools
- Absence of taste
- Dizziness, headache
Fever due to Qi xu
Be sure this isn’t due to external! This is a fever that is caused by an inability of the qi to circulate so there is some stagnation which causes heat. Strangely, there are also cold signs – preference for warm drinks, dislike of cold, etc.
- This is fever worse with exertion, which further taxes the qi and makes it even less able to move.
- Spontaneous sweating
- Thirst with pref for warm drink
- SOB, fatigue, weakness of 4 limbs, pale limbs
- Dislike of cold
Pulse: flooding (big), but empty, weak
Tongue: pale with tm’s and a thin white coat
Representative formula:
Very similar to Si Jun Zi Tang, but note no fu ling which drops stuff downward. Shen ma and chai hu helps lift the Yang qi. Note both have 3 grams. Look at the tonifying herbs (huang qi, ren shen): much larger. Dang gui is a blood herb.
You can modify this formula to target the organ that is prolapsed also. This happens in pregnancy so you may add herbs that benefit the fetus. You may also see this during women’s menses.
Stomach Qi xu
This is Qi xu plus Stomach sx. Look for focal distention (immediately after eating and no matter how much you eat), dull pain, pressure feels a lot better. (Compare this with food stagnation with similar signs, but “don’t touch me!”). Belching also.
Lung Qi xu
Wu wei zi (Kidney herb) are added to hold the breath down. Lung has a lot to do with circulation of blood – hence the shu di huang. This tonifies the Lung organ plus the base of breath. Doesn’t really focus on dispersal. Lung qi xu is about SOB primarily.
Wei Qi xu
This is tied to Lung. The representative formula is Yu Ping Feng San. Gotta know the ingredients for this one. Note that Huang qi is used, not ren shen. Huang qi consolidates the surface, “closes the door.” Addresses both lung and sp/st also.
Sx include easily catching colds, spontaneous sweating, aversion to wind and a weak pulse.
Yu Ping Feng san builds a strong defense by using Huang qi to consolidate the surface qi to defend against external as well as bai zhu which tonifies spleen and therefore makes the body stronger. Fang feng expels/repels external wind but also internal wind. Fang feng seems contradictory because it can open the surface, but this is necessary for metabolic functions to communicate with the outside. Basically, you are 70% closed, but 30% open.
This formulas is both nutritive and defensive. Taken long term in small dosages and can combine with bu zhong yi qi tang. Note that it is a powder – “san.” This means you take a bit each time.
NOTE: When there is an external pathogen you can still use this formula! Because of that 30% open bit.
Test Review:
Review formula list – know the ingredients for the bold ones.
Know the singles that are for the different Qi xu’s – lung, heart, etc.
Syndromes – Winter 2010
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