By Professor Xue Yi Ming
Treatment of Gastro-Intestinal Disorders Based on Li Dong Yuan’s Theory of the Spleen and Stomach
Li Gao (1180-1251), also known as Ming Zhi, was born in Zhen Ding, now known as Bao Ding, in the province of Hebei. In later years became known by the name Dong Yuan Lao Ren (东垣老人) or Master Dong Yuan, and now, in academic circles, he is most commonly referred to as Li Dong Yuan. Li was not only a giant in the realm of theory but was an accomplished practitioner of internal medicine. He was the author of many books: most famously, Pi Wei Lun (Treatise on the Spleen and Stomach),Nei Wai Shang Bian Huo Lun (Clarification of Confusions in Internal and External Injury) and Lan Shi Mi Cang (Secrets from the Orchid Chamber). Amongst his many books, the most outstanding contribution was his theory on the physiological functions of the spleen and stomach and the aetiology and pathogenesis of internal injury. His theory on the differential diagnosis and treatment strategy relating to the theory of the spleen and stomach was entirely based on his practical applications and experience.
Academic Background
History
The theory of the spleen and stomach is an important component of Chinese medicine theory and has its origins in Huang Di Nei Jing (Yellow Emperor’s Internal Classic). It forms the core of Li Dong Yuan’s hypothesis which, although based on fundamental theory found in the Nei Jing, in fact goes much further. By integrating his own clinical experience with basic theory, Li Dong Yuan is credited with implementing and perfecting a systematic and comprehensive theory with clinical relevance.
Theory on the Spleen and Stomach and Source Qi
Li’s core premise of his theory on the spleen, stomach and source qi, may be defined as being a form of primal qi inherited from pre-heaven, which constitutes the root of vital qi which supplements the five viscera. Li Dong Yuan said: “True qi is also known as source qi, emanating from pre-heaven but dependent on the supplementation of the stomach qi.” [Reference: Pi Wei Lun: Pei Wei Xu Shi Quan Bian Lun (Treatise on the Spleen and Stomach: Complete Chapter on the Excess and Deficiency of the Spleen and Stomach)]. The vitality and strength of the source qi is dependent on the healthy function of the spleen and stomach to supplement it and provide it with nourishment. Our pre-natal essence qi is reliant on the continual nourishing of stomach qi because the stomach is the source of the twelve channels and the sea of grain and water. Thus, the spleen and stomach and source qi are one; hence it is often referred to as “Spleen stomach source qi”.
Theory on the Ascent and Descent of Spleen and Stomach
The movement of qi such as ascending, descending, floating and sinking is a natural phenomenon related to the basic movement of all matters in the universe. Under normal circumstances, ascent and descent is a movement of inter-substitution, whereas the movement of floating and sinking constitutes changes which from a cycle of infinity. This theory can apply equally to seasonal qi and qi movement within the human body. The spring and summer qi are characterised by ascending and floating, reflecting growth and flourishing. Conversely the autumn and winter qi are characterised by descending and sinking, reflecting conservation and storage. The seasonal qi of spring, summer, autumn and winter all follow a pattern, with the exception of long summer located in the centre and acting as a pivot for qi movement. Similarly, the movement of human yin, yang and essence qi is reliant on the spleen and stomach performing the role of a pivot.
If the spleen and stomach are damaged, impaired ascent and descent will result in two scenarios. The first is excessive descent with insufficient ascent. This is tantamount to prolonged autumn and winter without spring and summer, whence hundreds of diseases emanate. The second is prolonged ascent without descent which is also a cause of disease.
In summary, Li placed great emphasis on the uplifting of spleen yang qi. Hence, in treatment, he liked to use Sheng Ma and Chai Hu to raise the spleen yang. He pointed out the importance of draining the yin fire; clinically, however, there should be more emphasis on the raising of spleen yang, while the draining of yin fire is secondary.
Theory on Internal Damage to the Spleen and Stomach
The spleen and stomach are the root of source qi, and are therefore the root of health. Any sustained damage to the spleen and stomach will result in the exhaustion of source qi, resulting in illness. Li emphasized that stomach qi is the root of health and damage to the spleen and stomach can be the root cause of all disease. Factors leading to deficiency of the spleen and stomach can be summed up as improper diet, over-exhaustion and emotional stress.
Clinical Strategies of Li Dong Yuan
1. Sweet and warm medicinals to alleviate heat
The representative formula is Bu Zhong Yi Qi Tang or ‘Supplement the Middle and Benefit Qi Decoction’. Li identified that excessive heat effusion due to internal injury can often be mistaken for heat effusion due to external contraction, with the consequent inappropriate use of a purging strategy. This is a scenario described in Nan Jing (Classic of Difficulties) as “damaging the deficiency and tonifying the excess”, a situation known as xu xu shi shi虚虚实实. The indicated strategy should be the adoption of sweet and warm herbs to tonify the middle and lift the yang combined with sweet and cold herbs to purge the yin fire. This is Li’s basic strategy to treat heat effusion attributed to internal injury with yin fire harassment. It must be remembered that the usage of bitter, cold herbs must not be excessive. This is because the root cause of yin fire stems from the deficiency of spleen and stomach with the sinking or collapse of the middle qi. Thus the usage of Huang Bai and Di Huang according to Li should be prescribed with caution as the excessive use of bitter, cold herbs may cause complications.
Bu Zhong Yi Qi Tang: Huang Qi, Ren Shen, Zhi Gan Cao, Bai Zhu, Sheng Ma, Chai Hu, Chen Pi, Dang Gui.
2. Raising the yang and dispersing the fire
When the spleen and stomach qi is deficient with subsequent sinking of the middle qi, this leads to a pathological condition of upsurging and harassment of yin fire with obstruction at thesurface of the muscle layer, affecting the heart, lung and skin. Li advocated a strategy of “dispersing and out-thrusting the constrained fire” by incorporating acrid and dispersing herbs to out-thrust the constrained fire, combined with the basic strategy of using sweet warm herbs to augment qi. This is a complex strategy of supporting the root and addressing the tip. In addition to the sweet, warm, qi-augmenting herbs, a large dosage of wind herbs is incorporated to address the symptoms caused by the yin fire. The representative formula is Sheng Yang San Huo Tang or ‘Raise the Yang and Disperse the Fire Decoction’, thus responding to the requirements of the treatment principle.
Sheng Yang San Huo Tang: Ren Shen, Zhi Gan Cao, Sheng Ma, Chai Hu, Ge Gen, Qiang Huo, Du Huo, Fang Feng, Sheng Gan Cao, Bai Shao.
3. Raising the yang and eliminating damp
Li initially used Tiao Zhong Yi Qi Tang or ‘Regulate the Middle and Benefit Qi Decoction’ (Huang Qi, Ren Shen, Zhi Gan Cao, Sheng Ma, Chai Hu, Ju Pi, Huang Bai, Cang Zhu) to treat internal injury characterised by heat and damp. The rationale was that owing to weakness of the spleen and stomach, there is an accumulation of damp turbidity. The damp accumulation can, over time, generate heat, resulting in a pattern of both damp and heat. Once the damp heat receded, Li used Sheng Yang Yi Wei Tang or ‘Raise the Yang and Benefit the Stomach Decoction’ (Ren Shen, Huang Qi, Bai Zhu, Gan Cao, Chai Hu, Fang Feng, Qiang Huo, Du Huo, Ban Xia, Bai Shao, Jie Pi, Fu Ling, Ze Xie, Huang Lian).
Sheng Yang Yi Wei Tang is a derivative of Bu Zhong Yi Qi Tang for disorders characterised by heaviness and generalised ache, parched throat and tongue, poor appetite, sloppy stools, frequent urination, indigestion, aversion to wind, abnormal complexion. The incorporation of wind herbs is based on the philosophy that wind can overcome dampness.
Modern Applications
1. Stomach pain
Dr. Zhou Xiao Hong’s case study (Jiangsu Provincial Chinese Medicine Hospital)
Liu x Male 37 years old
First consultation: 17th November 2003
Chief complaint: The patient suffered from recurring stomach pain and distension over the past three months.
Current signs and symptoms: Distending pain in the stomach cavity with pain affecting the left side of the ribs. The condition worsened after the consumption of food with pain being accompanied by acid reflux. Other symptoms included a bitter taste in the mouth, intestinal rumbling, sloppy stool and frequent bowel movement, spontaneous sweating, difficulty sleeping. His tongue was red with thin, yellow, greasy tongue coat and her pulse was moderate. He also had a history of smoking and drinking and was diagnosed as suffering from chronic, superficial gastritis, duodenal bulbar ulcer, cholecystitis and fatty liver. He had been treated with herbs to disperse constrained liver qi, supplemented by herbs to clear heat but there was no improvement.
Diagnosis: Spleen deficiency with excess constrained damp heat in the stomach and liver and stomach qi stagnation
The previous treatment failed to identify the spleen deficiency hence the result was not satisfactory.
Treatment principle: Disperse constrained liver qi and augment spleen qi.
Formula: Chai Hu 10g, Huang Qin 10g, Chao Shan Zhi Zi 10g, Dan Dou Chi 10g, Jin Qian Cao 30g, Shi Chang Pu 10g, Hou Po 10g, Zhi Shi 10g, Jiao Zha Qu 15g each, Fang Feng 10g, Chao Bai Zhu 10g, Zhi Huang Qi 10g, Fu Ling 10g, Yi Yi Ren 30g. Seven doses.
After the above course of medication, her condition improved but her tongue coat was still greasy. The same formula was prescribed for another week.
This article is an extract from the Pearls of Wisdom Seminar in 2006. You can purchase the entire article as a downloadable pdf. Alternatively you can download the Pearls Souvenir Book which contains a total of 14 seminar and workshop lectures from Pearls of Wisdom Seminars 2002-12.
Pearls of Wisdom Chinese Medicine Ten Year Souvenir Book
Pearls of Wisdom Souvenir 10th anniversary edition collecting 14 seminars and workshops from 2002 to 2012.
About Professor Xue Yi Ming
Professor Xue Yi Ming is one of China’s foremost experts in the Schools of Thought of Chinese Medicine. He specialises in the study of a number of early Chinese Medicine practitioners and the individual philosophy of each towards disease and its treatm…Read more