By Monica Otto
Qin Bowei was one of the most respected physicians in China in the twentieth
century. He was not only a clinician, but a writer and teacher as well. He wrote
extensively about Chinese medicine and founded a number of TCM schools
throughout China. He was a political activist when it came to the perpetuation
of TCM during the Guomintang regime, a time when TCM was under scrutiny and
repression. His teaching style was to conduct large-scale classes in which he
would present case studies and then moderate discussions about them. His only
apparent vice was that of smoking and even then, he used cigarette wrappers to
write down his ideas. One of his masterpieces, Qian Zhai Yi Xue Jian Gao, was
actually composed on hundreds of small pieces of cigarette wrappers!
Qin Bowei was fluent in articulating how to merge old world TCM into the
framework of modern TCM.
A Qin Bowei Anthology is a prime example of this style of writing. He takes
the traditional view of liver disease and translates it into a way in which it
can be directly applied to modern standards. This particular essay focuses on
the differentiation between liver qi and liver depression, two of the most
common disorders of not only TCM, but current times as well.
In the Anthology, Qin Bowei is especially concerned with making a precise
distinction between the terminologies of these two disorders. Although these
liver qi and liver depression were mentioned in English treatment manuals, the
line that divides them is indistinguishable. He moves through a discussion of
liver patterns with the expertise of someone who has devoted his life to
understanding and teaching each pattern and disease. He defines it in such a way
that you are left with a much broader range of treatment options and strategies,
thereby increasing your opportunity for success. For example, intrinsic to liver
qi is the presence of horizontal counter flow and hyperactivity of the liverís
capacity for coursing and draining. Liver depression, on the other hand, is the
failure of the liverís capacity to course and drain. Presenting symptoms may be
similar; however, the pathodynamics are exactly opposite. If one fails to define
the specific treatment method for each pattern and one lacks the terminology
refinement required to make those distinctions, then the clinical outcome will
most likely be less than favorable. Qin Bowei gives us the opportunity to make
these distinctions and greatly improve our chances of success with our patients.
And since "liver qi stagnation" is the most commonly diagnosed disease in
today's world, it becomes a very important distinction for us as practitioners
The concept of liver depression is characterized by a general
inhibition of liver qi with symptoms of hypochondriac fullness and impaired
digestion. There is too much liver qi congested in the liver and it
produces a malfunctioning of the liver qi. Depression describes flow stoppage
associated with congestion or impairment of flow. There are six types of
depressions: 1) Qi; 2) Damp; 3) Fire; 4) Phlegm; 5) Blood and 6) Food. Of these
six, qi depression is the most relevant, as it underlies all others. When it is
eliminated, all other forms will naturally disappear.
The concept of liver qi
is characterized by horizontal counterflow with symptoms of hypochondriac pain
and distention, including breast tenderness and swelling. Liver qi has counter
flowed out of normal bounds and exudes undue influence on other organ symptoms.
Liver depression can produce liver qi but not vice versa. This is because a lack
of circulation is inherent in liver depression. Liver depression may also
produce heat while liver qi cannot. Liver qi and liver depression are related
patterns yet definitely distinct. While both patterns may negatively effect
digestion, liver qi is defined as the restraining of earth by an effulgence of
wood; that is, excessive coursing and draining. Liver depression, on the other
hand, is characterized by a failure of wood to restrain earth; that is an
inability to course and drain. This has essential bearing on the diagnosis and
therapy treatment. Both patterns require methods of coursing, draining and
rectifying. Qin Bowei says liver depression typically requires more coursing and
draining, while liver qi requires more emphasis on rectification.
depression or wood not restraining earth is characterized by a depression of
liver qi that is then incapable of coursing the spleen and stomach.
Therapeutically, earth is often harmonized with damp transforming, stomach and
spleen regulating herbs. When this is accomplished, the liver becomes regulated
without further intervention. Chai Hu is the main herb used to course the liver,
according to Qin Bowei.
Liver qi or wood over restraining earth is
characterized by a depression of qi that has counter flowed horizontally,
impairing the spleen and stomach. Treatment will focus on rectifying the liver
but also coursing and draining while regulating the spleen and stomach. Bai Shao,
Qing Pi and Xiang Fu are all indicated as important herbs to include in this
type of disorder.
Today's society is overflowing with a number of different
stressors, from to school to family to trauma. Stress plays an enormous role in
liver functioning. The liver's normal function is impaired when this stress is
made upon the body. More than ever, people allow stress to affect them in
negative ways. That is precisely why Qin Bowei's ideas are imperative to
treatment today. No other author prior to him has made the distinction between
different liver disorders, yet each one deserves due respect. Treatment is not
going to be as successful if we just treat everyone with typical liver qi
stagnation. A differentiation must be made to treat our patients successfully.
Monica Otto is an intern at the Yo San University Clinic. (310)