By Liu Feng-wu translated by Shuai Xue-Zhong & Bob Flaws
This essay is the opening chapter in a book titled,
"The Essence of Liu Feng-wu's Gynecology," which was published in January. Liu Feng-wu was a famous Chinese doctor specializing in gynecology and living in the Beijing area in the middle of this century. The Chinese source text from which this translation was done was originally compiled in 1976 but not published till 1982. Typically, books such as this are compiled in China by a master's students after the master has retired or when he has been accorded the title of lao yi sheng, Old Chinese Doctor. The book is divided into three sections: Book One is a selection of medical essays describing key insights of this senior practitioner into various aspects of clinical practice. The essay below is the first essay in Book One. Book Two is a compilation of Old Doctor Liu illustrative case histories. For instance, there are 12 cases histories on amenorrhea, seven on dysmenorrhea, four on nausea during pregnancy, etc. Book Three is divided into two parts. The first part is a collection of Dr. Liu's personally created, "eperiential" formulas with their ingredients, indications, and rationales. The second part is a mini-ben cao or materia medica of the medicinals Dr. Liu thought especially important in his practice of Chinese gynecology. Many of these formulas are unique, and Dr. Liu has some very interesting insights on certain, less frequently used medicinals which he liked to use all the time.
In particular, this essay discusses Li Dong-yuan's theories concerning the importance of regulating the qi mechanism's upbearing and downbearing vis " vis gynecology. These theories are often only glossed over at most Western undergraduate acupuncture and Chinese medical schools. However, they are some of the most important theories Chinese medicine has to offer when it comes to treating typical Western patients. The translation below was done by Shuai Xue-zhong of Changsha, PRC and Bob Flaws.
The spleen and stomach are connected to each other by a membrane and are located in the abdomen. One is a viscus, while the other is a bowel. They have an exterior-interior relationship and are the pivots of the qi transformation's upbearing and downbearing. The spleen governs movement and tranformation, while the stomach rules reception and absorption. The spleen moves fluids and humors for the stomach, upbears the clear, downbears the turbid, and transports the finest essence of water and grains. It is the origin of the engenderment and transformation of qi and blood. If the stomach is strong and the spleen is fortified, water and grain qi is exuberant, essence is sufficient, and the spirit is effulgent. The qi mechanism flows smoothly and is harmonious. Thus the former heaven obtains nourishment, while the latter heaven obtains assistance. In addition, the spleen also has the important actions of boosting the qi, containing the blood, governing the muscles and flesh, and governing the four limbs. The spleen and stomach are also capable of conducting and abducting, transporting and transforming the dregs and the bowel qi via the large intestine, thus transforming the turbidity within the bowels and discharging toxic heat. Therefore, they are called "the latter heaven root."
I. The close functional relationship of the spleen & stomach's upbearing & downbearing
The spleen and stomach exist in a functional interrelationship vis a vis the dispersion and transformation [i.e., digestion] of water and grains and the assimilation and transporation of fluids and humors. The spleen resides in the central islet [i.e., the middle burner] in the interior which is categorized as yin. It stores and does not discharge. Therefore, the spleen is a yin viscus. However, its nature is to govern upbearing, and upbearing is yang. In order to upbear, it necessarily depends on yang qi. This is what transports fluids and humors upward. If the spleen does not upbear, it is of no use [i.e., it does not function], while if there is no yang, it cannot upbear. The spleen governs movement and transformation and produces stirring [i.e., activity]. Stirring is yang. Therefore,the spleen is yin in substance but yang in function. The stomach is categorized as a yang bowel. It discharges and does not store. Its nature is mainly downbearing. Downbearing is yin. Water and grains enter the stomach and obtain movement downward. All this depends on the stomach bowel's function of descending and downbearing. If there is no yin, there is no downbearing. If there is no downbearing, the bowel qi does not flow freely and the dregs are not descended. Hence, toxic, turbid substances are not transformed. Therefore, the stomach is yang in form but yin in function.
The spleen likes dryness and is averse to dampness, while the stomach likes moisture but is averse to dryness. Dampness is a yin evil. If damp evils are excessive, spleen yang suffers encumberance and is not able to upbear. This then leads to the spleen's movement losing its command. If the stomach obtains dampness and moistening, it is able to descend and downbear. Dryness is a yang evil. If dry qi is excessively exuberant, this necessarily leads to yin qi being damaged. If yin qi is damaged, then it will lose its function of moistening and descending [or precipitating]. Therefore, in the Ye Tian Shi Yi An (Ye Tian-shi's Medical Records) it says:
If the spleen appropriately upbears, this leads to fortification, while if the stomach appropriately downbears, this leads to harmonization. When tai yin damp earth obtains yang , it can move. When yang ming dry earth obtains yin, it is quiet.
The spleen likes dryness, and the stomach likes moisture. However, this cannot be too excessive. If dry qi is excessive, this results in damaging the spleen's yang qi and consumes fluids and humors. If damp evils are excessive, this results in damaging the stomach's yang qi. Dryness and dampness are mutually antagonisitic yet mutually co-productive, while functions of upbearing and downbearing are necessarily interdependent.
II. The relationship between the spleen & stomach's upbearing & downbearing and the other viscera
A. The liver & spleen
In the "The Pulse Signs of the Viscera & Bowels, Channels & Network Vessels, and Former & Latter [Heaven] Diseases" in the Jin Gui Yao Lue (Essentials of the Golden Cabinet), it says:
When liver disease appears, know that the liver will conduct [the disease] to the spleen. Therefore, first replete [i.e., supplement or fortify] the spleen.
This is what is meant by reinstating the function of the spleen and stomach and secondarily treating liver disease. In order to treat the spleen, one should upbear. In order to treat the stomach, one should downbear. If the liver qi is depressed and bound, it may counterflow horizontally and first damage the spleen. Liver effulgence leads to gallbladder fire depression and binding. If this combines with the stomach qi, it leads to upward counterflow. Counterflow produces disease. It leads to the appearance of nausea, vomiting, a bitter [taste] in the mouth, and other such conditions. At the time of treatment, one should course the liver and resolve depression, orderly reach [i.e., free the flow of] the qi mechanism, and clear liver-gallbladder fire while also descending and downbearing the stomach qi and upbearing the spleen qi. Thus all such conditions can be eliminated. This is what is meant by treating the liver and secondarily treating the spleen.
Another example is liver effulgence and spleen vacuity. This results in the spleen qi not upbearing. [In that case,] necessarily there must be painful diarrhea. At the time of treatment, one should restrain the liver and fortify the spleen. The formula to use is Tong Xie Yao Fang (Painful Diarrhea Essential Formula). Within this, Radix Albus Paeoniae Lactiflorae (Bai Shao) harmonizes and restrains the liver. Radix Ledebouriellae Divaricatae (Fang Feng) courses the liver and upbears spleen yang. Rhizoma Atractylodis Macrocephalae (Bai Zhu) fortifies the spleen and supplements the qi. And Pericarpium Citri Reticulatae (Chen Pi) harmonizes the stomach. Thus liver depression is coursed and resolved, spleen qi obtains upbearing, and painful diarrhea is stopped automatically.
B. The heart & spleen
The heart stores the spirit, while the spleen governs thinking. Excessive thinking and worrying damage both the heart and spleen. If spleen qi depression endures, it leads to qi binding and non-obtaint of upbearing. If the heart qi becomes debilitated, the spleen qi easily suffers detriment and the muscles and flesh become emaciated. In gynecology, one commonly uses Gui Pi Tang (Restore the Spleen Decoction) in order to nourish the blood and supplement the heart, upbear the spleen and boost the qi. When the heart qi is nourished, it is able to resolve depression and binding. When depression and binding are resolved, spleen yang is upborne and flows smoothly. The qi is effulgent and blood is automatically engendered.
C. The lungs & spleen
The spleen governs the scattering [i.e., distribution] of essence which is upwardly transported to the lungs. If the spleen qi is effulgent and exuberant, the lung qi is full and sufficient. If the spleen qi is insufficient, the lung qi must be vacuous. Therefore, in order to treat the lungs, it is necessary to treat the spleen. The lungs govern the management and regulation and diffusion of fluids and humors. If the lung qi does not diffuse, it will be difficult for the spleen qi to upbear smoothly. Hence, within Si Jun Zi Tang (Four Gentlemen Decoction), Radix Panacis Ginseng (Ren Shen) supplements the lung qi, Rhizoma Atractylodis Mcrocephalae (Bai Zu) supplements the spleen qi, and Sclerotium Poriae Cocos (Fu Ling) assists Atractylodes by fortifying the spleen and percolating dampness, while Radix Glycyrrhizae (Gan Cao) boosts the qi and supplements the center. Thus the spleen is fortified, the stomach is nourished, yang is upborne, and the qi is supplemented. If the lung qi is vacuous or there is lung consumption, vacuity detriment, or other such conditions, yin fluids may be insufficient and eating and drinking may be reduced and scanty. Then essence blood will be insufficient, and, in women, there will be blocked menstruation [i.e., amenorrhea]. Typically, this can be rapidly treated by supplementing both the lungs and spleen.
D. The spleen & kidneys
The kidneys are the viscera which store essence and are "the former heaven root." They are located in the lower burner. Therefore they are ultimate yin within yin. They store not only true yin but also true yang. The spleen [on the other hand] is the source of qi and blood and fluid and humor transformation and engenderment. It supplies the material basis for the continuous enrichment and engenderment of kidney yin and kidney yang. If kidney yang is insufficient, it may not be able to stir spleen yang. Hence spleen qi is not easily and smoothly upborne. If the spleen qi is weak, movement and transformation loose their duty and are not able to transport essence to the kidneys. This then results in kidney qi insufficiency. Thus the spleen and kidneys mutually enrich and assist one another. For example, Si Shen Wan (Four Spirits Pills) are said to mainly treat kidney diarrhea. However, within them, Fructus Psoraleae Corylifoliae (Bu Gu Zhi) supplements the fire of the gate of life; Fructus Evodiae Rutecarpae (Wu Zhu Yu) warms the center and dispels cold; Fructus Myristicae Fragrantis (Rou Dou Kou) moves the qi and disperses food, warms the center and rectifies the intestines; Fructus Schisandrae Chinensis (Wu Wei Zi) astringes yin and boosts the qi, secures and astringes and stops diarrhea; uncooked Rhizoma Zingiberis (Sheng Jiang) warms the center; and Fructus Zizyphi Jujubae (Da Zao) fortifies the spleen. Therefore, this formula warms the kidneys and warms the spleen, secures the intestines and stops diarrhea. The spleen and kidneys are both treated even though the treatment of the kidneys is the main.
III. The clinical signifcance of the spleen & stomach's upbearing & downbearing
A. The internal link between the treatment of the spleen & the treatment of the stomach
The spleen and stomach have an exterior-interior relationship. If the spleen is diseased, the stomach is not able by itself to move fluids and humors. If the stomach is diseased, the spleen loses the place from which it receives its endowment. Therefore, diseases of the spleen and stomach are mutually interrelated. In clinic, one may see stomach disease accompanied by symptoms and signs of spleen disease. While if the spleen is diseased, one will see simultaneous signs of stomach disease. If [disease] manifests simply as spleen vacuity, the spleen can be heavily [i.e., greatly] supplemented. The formulas used are: Sheng Ling Bai Zhu San (Ginseng, Poria & Atractylodes Powder), Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction), etc. [However,] sometimes, the external manifestations seem to be due to spleen vacuity, yet their source is stomach disease. For instance, what looks like spleen vacuity diarrhea may be due to stomach stagnation downwardly disinhibiting the spleen qi. [In such cases,], heavy emphasis [on supplementation alone] is not able to treat the spleen. Instead, one should disperse food and abduct stagnation. When stagnation is removed, disinhibition will be stopped and the spleen qi will be able to obtain recovery. On the contrary, if scanty intake of food, dry mouth, heart fluster [i.e., palpitations], and shortness of breath are due to stomach stagnation torpid intake, then only using dispersing and abducting formulas will not be able to achieve the [desired therapeutic] effect. [In this case,] one should use Xiang Sha Liu Jun Zi Tang (Auklandia & Amomum Six Gentlemen Decoction), Wu Wei Yi Gong San (Five Flavors Special Effect Powder), etc. to mainly supplement the spleen. Then one will be able to affect a cure. Hence, it is very hard to separate fortifying the spleen from harmonizing of the stomach. What is necessary is to clearly divide the main from the secondary. Then stress should be laid accordingly so that one treats the root.
B. The dialectical relationship between upbearing yang & enriching yin
The relationship between upbearing yang and enriching yin is nothing other than the concrete measures adopted in clinic based on the inherent characteristics of the spleen's liking dryness and the stomach's liking moisture. It is also an apposite and united principle that suits the upbearing of spleen qi and downbearing of stomach qi. If the spleen is vacuous and the spleen qi does not upbear, then movement and transformation have no authority [i.e., power]. This then reuslts in the appearance of venter chill and abdominal distention. Food enters but moves slowly and there is a preference for warm drinks. The stools are loose and the urination is clear and uninhibited. Women's menstruation is irregular or there may be flooding and leaking and abnormal vaginal discharge. If severe, qi vacuity may fall downward and the four limbs may lack strength. [There may be] shortness of breath, disinclination to speak, prolpase of the anus, etc. In that case, Wan Dai Tang (End Vaginal Discharge Decoction) is often used for treating women's spleen vacuity and damp stagnation, lassitude of the spirit, poor appetite, loose stools, swollen feet, and ceaseless vaginal discharge. Within this formula, Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Rhizoma Atractylodis (Cang Zhu), Pericarpium Citri Reticulatae (Chen Pi), and Radix Glycyrrhizae (Gan Cao) supplement the spleen and boost the qi, upbear yang and dry dampness, with upbearing of yang being the aspect that is stressed. At the same time, Radix Bupleuri (Chai Hu) and Herba Seu Flos Schizonepetae Tenuifoliae (Jing Jie Sui) are used to strengthen the action of upbearing yang and scattering dampness. Radix Albus Paeoniae Lactiflorae (Bai Shao) and Radix Dioscoreae Oppositae (Shan Yao) are used to enrich yin, harmonize the liver, and supplement the spleen. Semen Plantaginis (Che Qian Zi) disinhibits water and eliminates dampness. Thus, as a whole, this formula supplements and scatters (upbears), disperses (dries dampness) and upbears (yang), and supplements vacuity without stagnating evils. The dialectic relationship between upbearing yang and enriching yin should be dealt with correctly so as to make yang upbear and yin grow, yin engender and yang grow, and balance yin and yang.
As another example, for spleen vacuity accompanied by dampness and flooding and leaking downward bleeding [i.e., uterine bleeding], Sheng Yang Yi Wei Tang (UpbearYang& Boost the Stomach Decoction) with additions and subtractions is often used. This boosts the stomach. When it is replete, it fortifies the spleen. Within this formula, Liu Jun Zi (Six Gentlemen [Decoction]) strengthens yang and boosts the stomach. To this is added uncooked Radix Astragali Membranacei (Huang Qi) in order to increase and strengthen the function of supplementing the qi and upbearing yang. Radix Bupleuri (Chai Hu) and Radix Et Rhizoma Notopterygii (Qiang Huo) upbear yanhg and scatter dampness. ([Dr. Liu] never gave up using them because they emit sweat and resolve the exterior.) These stress the aspect of upbearing yang. Radix Albus Paeoniae Lactilforae (Bai Shao) restrains yin in order to harmonize the constructive. While Sclerotium Poriae Cocos (Fu Ling) and Rhizoma Alismatis (Ze Xie) disinhibit dampness and downbear turbidiy. A small amount of Rhizoma Coptidis Chinensis (Huang Lian) is added to discharge and downbear vacuity fire. The above-mentioned formula and medicinals are the best examples of correctly dealing with the relationship between upbearing yang and enriching yin in association with the characteristics of upbearing the spleen and downbearing the stomach.
The stomach likes moisture but is averse to dryness and its nature is mainly downbearing. If there is dry heat in the stomach and yin fluids are insufficient, the throat will be dry and the mouth will be thristy. Stomach grasping [i.e., the intake of food] will be devitalized. [In that case,] treatment should mainly clear (stomach) heat and nourish yin. For instance, in Sha Shen Mai Dong Tang (Glehnia & Ophiopogon Decoction), Radix Glehniae Littoralis (Sha Shen), Tuber Ophiopogonis Japonici (Mai Dong), Rhizoma Polygonati Odoarti (Yu Zhu), and Radix Trichosanthis Kirlowii (Tian Hua Fen) are ingredients which clear heat and moisten dryness, engender fluids and nourish yin, heavily moistening and downbearing. These are combined with Semen Dolichoris Lablab (Bian Dou) and Radix Glycyrrhizae (Gan Cao), which boost the qi and harmonize the center, and Folium Mori Albi (Sang Ye), which lightly diffuses, upbears, and scatters, in order to upbear, diffuse, and strengthen the spleen.
As another example, due to dry evils damaging yin, a woman' s menstruation may becomme blocked because her blood is vacuous and her fluids are debilitated. [In that case,] it is ok to use San He Tang (Triple Combination Decoction, i.e.,the combination of Tiao Wei Cheng Qi Tang , Regulate the Stomach & Order the Qi Decoction, Liang Ge San, Cool the Diaphragm Powder, and Si Wu Tang, Four Materials Decoction). When dry heat obtains clearing, yin fluids will recover. When the stomach obtains downbearing, spleen qi obtains upbearing. The chong [penetrating] and ren [conception or controlling] vessels and pathways become freely flowing and uninhibited, and the menstrual water becomes self-regulated.
Yet another example from gynecology is that, during a warm heat disease, there may sometimes appear a bowel repletion condition. Internally, heat accumulates and is exuberant. [In that case,] one should use Da Cheng Qi Tang (Major Order the Qi Decoction) with additions and subtractions to urgenty precipitate. This will free the flow and downbear dryness and heat. The result will be the engenderment of fluids and the preservation of yin. Sometimes there may be blood vacuity blocked menstruation. [In that case,] one should use Gui Pi Tang (Restore the Spleen Decoction) to treat it. Wishing to downbear, first upbear. Wishing to free the flow, first supplement. When yang is upborne and the blood is sufficient, the chong and ren will be full and exuberant, and hence the menstrual blood will automatically be free-flowing. Thus, the aim lies in correctly dealing with the dialectic relationship between upbearing yang and enriching yin no matter whether urgently precipitating to preserve yin, using sweet, moistening [medicinals] to increase fluids or upbearing yang and boosting rhe qi. When yang is upborne, yin grows.
Therefore, the medical experts who have discussed [and based treatment on] the spleen and stomach are very many. Their experiential knowledge based on clinical practice can be summarized thus: The spleen and stomach have an exterior-interior relationship. One is yin and one is yang; one upbears and one downbears; and they function interdependently. The spleen is a yin viscus but its function is yang. Without upbearing, yang cannot function. [Therefore,] for yang to function, one must upbear. The stomach is a yang bowel but its function is yin. Yin governs downbearing. If there is no downbearing, yin cannot function. Thus, in treating the spleen, one must know how to promote upbearing, while in treating the stomach, one must know how to promote downbearing. Only if one observes yin and yang, knows upbearing and downbearing, and is clear about supplementing and discharging is one able to grasp the key point of spleen and stomach function.
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