Supplementing therapy is somewhat unique to herbal and nutritional medicine. While physiotherapies like acupuncture and tuina focus on altering the movement of Qi and Blood, herbal therapy has the ability to directly supplement these through the administration of Qi and Blood Tonics. Qi and Blood are closely tied and the failure of one often causes disturbances in the other. Blood is the material basis for Qi and relies on Qi for formation and circulation. The flow of Blood follows the flow of Qi and restriction of Qi movement can lead to stagnation of Blood. Just as Blood and Qi are related so are Qi and Yang and Blood and Yin. Because of their similarities Qi and Yang deficiency often share common symptoms as do Blood and Yin. Giovanni Maciocia notes that though Blood and Qi are so closely tied, Blood is also part of Yin and thus Blood is “in the middle of a pathological continuum between Qi and Yin deficiency” (and thus many Blood tonics are also Yin tonics). This becomes relevant when considering that some people with both Yin and Blood Deficiency may show signs of anxiety and manic behavior while others with Qi and Blood deficiency will suffer from depression.
Chinese medical theory creates four categories of herbs that supplement vacuity or deficiency: Qi tonics, Blood tonics, Yin tonics, and Yang tonics and the terminology around this kind of supplementation can be a bit murky. In Western herbalism the term tonic can refer to a substance that increases tissue tone, tissue strength, general or specific vitality, or any combination of the above. The relationship between tissue tone and strength seems to be at the root of this nomenclature and while this similarity is appropriate in describing certain kinds of tonification, it also seems inappropriate when attempting to describe other types, namely Yin and Blood supplementation. So it seems that the Western medical ideas of tone, strength, and vitality are not completely in line with the Chinese medical ideas of supplementing deficiency of Qi, Blood, Yang, and Yin, (which can be seen as an augmenting of the quality and/or quantity of these substances). For this reason it seems more accurate to talk about these remedies as supplementing herbs rather than tonics. The wording is a bit more awkward, lacking a good single english noun that accurately describes their role, and maybe this is just an exercise in semantics, but for myself it ultimately allows a deeper understanding of the nature of these remedies and the circumstances in which they can be accurately prescribed. That being said, in this and the following essays I will use the terms “tonic” and “supplementing herb” interchangeably, for the purposes of attempted eloquence.
According to Liu Yuanchi, Qi is a “rarefied substance that is constantly in motion. The movement of Qi is literally the activity of life. …because it is a substance, Qi is also viewed as none other than the fundamental material for the construction of the body”. Qi activates the body, and is activity in the body. Seen in this way any given organ’s Qi is the activity of that organ in the body. So, to say Kidney Qi is deficient is to say that the functions the Kidneys serve in the body (storing vital essence and vital function, producing marrow, regulating water, coordinating respiration, storing willpower, and governing the head, hair, ears, genitals, and anus) are deficient. Qi is the source of all movement in the body, moving in four possible directions: ascending, descending, entering, and leaving. Qi defends against pathogens, holds blood and body fluid in their proper vessels, and transforms food into the basic life perpetuating materials. Qi does all of these separate things and changes character as it slips between these functions.
Original Qi or Yuan Qi comes from the inherited essence and is nourished by the acquired essence that is derived from food, water, and air. It exists everywhere in the body, in the interstitial spaces between the skin and muscles, around the organs and tissues, and courses through the body through the Triple Burner. Original Qi can be seen as the fundamental Qi of the body as it is the foundation for Yin and Yang and the motivating power of all vitality in the body.
Grain Qi or Gu Qi is the Qi created from food after it is “rotted and ripened” in the stomach and transformed and refined by the Spleen. Grain Qi is not yet a usable form of Qi, but rather a type of Qi precursor that must mix with Original Qi and rise to merge with Natural Air Qi to become the True Qi used by the body. It is Grain Qi that is the foundation of Blood as well.
Natural Air Qi, Pectoral Qi, or Zong Qi is combined from air inhaled into the Lungs and Grain Qi transformed by the Stomach and Spleen. It is stored in the chest and propels respiration, the beating of the heart, and the circulation of the Blood. This Qi gathers in the throat and aids speech and a strong voice. (One symptoms of Qi deficiency is trouble speaking and/or a soft voice). Pectoral Qi flows downward to the aid the Kidneys while Original Qi flows upward to aid respiration.
True or Zhen Qi is Qi in its final state of transformation and refinement, distilled from Grain Qi and Pectoral Qi. This is the Qi used by the body that courses the channels and nourishes the organs. True Qi takes two forms: Wei Qi and Ying Qi.
Wei Qi is the anti pathogenic Qi of the surface of the body. It comes from transformed food essence and is part of Yang Qi, sometimes being called Defensive Yang. (Yang Qi is the Qi that warms the body, in effect regulating body temperature.) It doesn’t travel through the vessels but rather through the skin and flesh. Wei Qi controls the opening and closing of the pores, helping regulate body temperature like Yang Qi, and it moistens the skin and defends against external pathogenic factors. (One symptom of Qi deficiency is spontaneous sweating associated with an impairment in Wei Qi’s regulating of the pores.)
Ying Qi is the nourishing Qi made from food essence created by the Stomach and Spleen. As True Qi flows from the Lungs into the Heart (now considered Ying Qi) it merges with and transforms into Blood, flowing into the vessels circulating the Blood and supplying it with nutrients. Ying Qi nourishes the entire body and is the form of Qi manipulated by acupuncture.
When so much of what Qi does is dependent on the transformation of food by the Spleen and Stomach, which itself is dependent on Qi, it becomes apparent not only how important the healthy functioning of these organs is but how a destabilizing feedback cycle can arise when these organs are in deficiency.
Qi Deficiency or Vacuity
From a Western biomedical perspective Qi deficiency can be seen as a preclinical state of hypotonia and hypofunctioning of tissues that is associated with deficient neuroendocrine function and low immunity. Qi vacuity involves systemic deficiencies that can appear as general weakness and lassitude as well as specific localized deficiencies with typical symptoms that are associated with deficient organ systems. Qi deficiency is common in chronic conditions, during recovery from acute disease, and in general recovery by old and weak patients. It is seen in prolonged illness, hypofunctioning, or weakness of organs and tissues that leads to the consumption of vital energy beyond the capacity of the body’s native ability to replenish it.
General Qi vacuity symptoms can appear as general lowered body resistance to internal and external stressors, a tendency to perspire, susceptibility to exogenous pathogens, lassitude, cold limbs due to lack of nourishment or deficient Yang Qi, apathy, and lack of strength to speak or breathe. When Qi is deficient it cannot motivate the Blood circulation well and vessels can wither, creating a feeble pulse. Water retention and disturbances in fluid distribution can arise leading to the formation of Dampness, Phlegm, sometimes in the form of edema. If Qi fails to ascend properly the sense organs in the head are not nourished and dizziness and ringing in the ears can result. Likewise, if Qi fails to ascend when there is Spleen Qi weakness, the downward bearing action of the organs can overwhelm Qi’s role in “lifting” organs to hold them in place, resulting in abdominal distention, a down bearing heaviness in the abdomen and lumbar region, prolapse of organs – especially the uterus and rectum. These are signs that differentiate this syndrome from the shared symptoms seen in typical Qi deficiency, namely lassitude, feeble voice, lack of strength to speak or breath, and a thready and forceless pulse.
Organ Specific Symptoms
Heart Qi Deficiency – general symptoms – palpitations, dyspnea (difficult or labored breathing), spontaneous sweating – Differentiating symptoms from Heart Yang Deficiency – pallor, lassitude, pale tongue with thin coat, fine weak or irregular intermittent pulse. Treatment – supplement Heart Qi.
Lung Qi Deficiency – general symptoms – cough – Differentiating symptoms from Lung Yin Deficiency – asthma, lassitude, shortness of breath, feeble voice, intolerance of cold, spontaneous sweating, pallor, expectoration of copious thin sputum, pale tongue with white coating, empty and weak pulse – Treatment – supplement Lung Qi
Spleen Qi Deficiency – general symptoms – poor appetite, fullness and distention in abdomen, loose stools, pallor or sallow complexion – Differentiating symptoms from other types of Spleen Deficiency – feeble breath, apathy, gaunt form, lassitude, fullness in abdomen after meals, pale tongue with white cost, slow and weak pulse – Treatment – Supplement Spleen Qi
Spleen Sinking or Collapsing in Middle Burner – general symptoms – poor appetite, fullness and distention in abdomen, loose stools, pallor or sallow complexion – Differentiating symptoms from other types of Spleen Deficiency – down bearing sensation in abdomen and lumbar, dyspnea, tenesmus (continuous urge to vacate the bowels), gastropsis (downward displacement of stomach), pale tongue, weak pulse – Treatment – reinforce Qi to restore ability to uplift
Failure of Spleen to Control Blood – general symptoms – poor appetite, fullness and distention in abdomen, loose stools, pallor or sallow complexion – Differentiating symptoms from other types of Spleen Deficiency – bloody stools, blood in urine, excessive menstrual flow, uterine bleeding, purple pale tongue, weak pulse – Treatment – supplement Qi and control Blood.
Kidney Qi Deficiency – while I was able to come across some references to Kidney Qi deficiency many sources address Kidney Yin and Yang disorders when dealing with Deficiency and Im wondering if because the Kidney is the seat of Yin and Yang in the body then Qi deficiencies of this organ are understood more as Yin and Yang deficiencies.
Supplement Qi Deficiency Medicinals
Gotu Kola Leaf (Kidney Essence), Stinging Nettle Seed (Kidney Qi and Essence), Licorice Fern Root (Lung Qi), Elecampane Root (Spleen Qi – honey mix fried), Hawthorn Leaf, Flower, and Berry (Heart Qi), Milk Thistle (Spleen Qi), Milky Oat Seed, Codonopsis, Ginseng, Astragalus (Wei Qi), Eleuthero Root, Spikenard Root (Lung QI), Gravel Root (Kidney Qi), – sweet, slightly bitter, and cool being the most common energetic/flavor profile of Qi tonics.
Blood transports nutrients to the organs, flesh, and bones and is the material basis for mental activities, therefore an abundance of Qi and Blood is said to lead to clear and vigorous thought. Blood is made from primarily from Grain Qi with Original Qi aiding in this transformation. Blood is also made in the Marrow, which is in turn produced by the Jing stored in the Kidneys. Blood is therefore said to be generated by the post-heaven Qi of the Spleen and Stomach, which creates Grain Qi, and the pre-heaven Qi of the Kidneys. The Kidneys then can be seen as important to the formation of Blood as they store Jing and are also the source of Original Qi. In this way nourishing the Blood involves supplementing the Spleen and Kidneys as the health of these organs can directly affect the formation of Blood.
The Liver regulates the storage of Blood, controlling the amount of Blood circulating at any given time in response to the demands of the body. Because of this, most cases diagnosed as Blood Deficiency are in fact considered Liver-Blood Deficiency, which can be seen as a lowering of the quality of the Blood so that it fails to nourish the Zang-Fu organs, the vessels, and other parts of the body. This syndrome is very common in adult females and is often at the core of other associated conditions. In addition, because the Heart governs the Blood and Blood originates in Grain Qi produced by the Spleen, the syndromes Heart-Blood deficiency and Spleen Blood Deficiency are also seen.
Giovanni Maciocia notes that there are two kinds of “Blood”: one that originates from the Spleen and is called Blood; and another form called Tian Gui that is not considered Blood at all but rather a “heavenly water” derived from the Kidneys that is the source of menstrual blood. Maciocia defines Tian Gui as not just menstrual blood but also includes the ova from the ovaries. He quotes Fu Qing Zhu who states that “the generation of “kidney water” (and therefore menstrual blood) has nothing to do with Heart, Liver, and Spleen, but the transformation of “kidney water” (into menstrual blood) is helped by Heart, Liver, or Spleen”. In this way females are seen to posses two kinds of blood: the Blood that is stored by the Liver, houses the Hun, nourishes the tendons, nails, eyes, and hair and flows when the skin is cut; and the menstrual blood or Tian Gui. How academic these differences are or how important this differentiation is for clinical work I am completely unaware, but Maciocia does note that these two kinds of blood form a connection in the Liver and that a deficiency of Tian Gui can also present symptoms of regular Blood deficiency.
The Liver provides Blood to the uterus and thus females are prone to Blood Deficiency, both from the monthly flow of Blood and from diet and stress. Gynaecological symptoms of Blood deficiency can involve infertility, scanty periods, delayed cycle, and amenorrhoea. Non-gynaecological symptoms include insomnia, poor memory, blurred vision, dry eyes, dry hair, tingling of limbs, a dry pale tongue and a fine or choppy pulse. General Blood Deficiency symptoms, as listed by Liu Yuanchi, include pallor or sallow complexion, pale lips, dizziness, palpitations, insomnia, numbness of hands and feet, pale tongue, and empty pulse.
Maciocia notes that because Liver Blood Deficiency is so common it is often at the center of other patterns, including Liver Qi Stagnation, Liver Yang Rising, Wind Heat in the Skin, Empty Heat, Heart Blood Deficiency, Kidney Yin Deficiency, Kidney Yang Deficiency, Cold in the Uterus, Qi Deficiency, and Liver Blood Stasis. In addition to these Liu Yuanchi includes the symptom complexes of Qi Deficiency with Blood Stasis, Qi Deficiency with loss of Blood, Prostration of Qi after great loss of Blood, and Blood Deficiency with Blood Stasis. Below some of these are elaborated.
Liver Qi Stagnation and Liver Blood Deficiency
Liver Qi Stagnation manifests differently whether it occurs with Blood Deficiency, showing amongst a background of Blood Deficient symptoms, or without it, deriving solely from emotional or physiological stress. Maciocia says that the former is more common in females who have classic signs of pre-menstrual tension. Liver Qi Stagnation with Liver Blood Deficiency manifests as mild irritability, depression, sobbing or crying, and slight breast distention. In this syndrome complex the tongue is normal, entirely pale, or pale in the liver area (on the sides) and the pulse is wiry on the left side and weak on the right. In pure Liver Qi Stagnation the irritability is more pronounced, depression in absent, but outbursts of anger are present, and breast distention is more pronounced with possible pain. The tongue here is either normal or red on the sides and the pulse is full and wiry on both sides.
Wind Heat in the Skin and Liver Blood Deficiency
Because Liver Blood moistens and nourishes the skin, a deficiency can be at the root of skin diseases. The Wind arising from Liver Blood Deficiency is not external Wind, nor is it internal Wind, but rather a unique form that lodges in the skin causing dryness, itching, scaling, and lesions that move from place to place or appear and disappear suddenly.
Empty Heat and Liver Blood Deficiency
Blood and Yin are closely related and empty heat can arise from Liver Blood Deficiency though it normally is a result of Yin Deficiency. Here we see the relationship between Blood and Yin. Treatment – clear Empty Heat, nourish Blood.
Qi Deficiency and Blood Deficiency
Maciocia notes that because Blood is the mother of Qi, Blood Deficiency will almost always lead to Qi deficiency. Symptoms include lack of strength to breath and speak, lassitude, spontaneous sweating, pallor, palpitations, insomnia, pale flabby tongue, thready and weak pulse. Treatment – Supplement Qi and Blood.
Qi Deficiency with Blood Stasis
Symptoms include general lassitude, feeble breathing, spontaneous sweating, pain aggravated by pressure, dark tongue with red spots. Treatment – Supplement Qi to promote Blood circulation, possibly invigorate Blood.
Qi Deficiency with loss of Blood
Hemorrhaging (subcutaneous or uterine), shortness of breath, general lassitude, pallor, pale tongue, fine and weak pulse. Treatment – Supplement Qi to keep Blood inside the vessels.
Prostration of Qi after great loss of Blood
Symptoms include massive hemorrhaging, pallor, cold limbs, profuse sweating, fainting, feeble and thready or hollow pulse. Treatment – Supplement Qi to prevent collapse
Blood Deficiency with Blood Stasis
Symptoms include dizziness, palpitations, insomnia, pale tongue with red spots, fine and choppy pulse, painful fixed masses aggravated by pressure. Treatment – invigorate Blood and nourish Blood.
Supplement Blood Deficiency Medicinals
Baneberry Root, Blueberry, White Peony, Dong Quai, Milk Thistle, Molasses, Lycium Berry, Prepared Rhemania, Prepared He Shou Wu (both stewed or steamed with the left over water from cooking black soybeans – 1g of soybeans to 10g of He Shou Wu),
On Blood Deficiency, Giovanni Maciocia
Chinese Traditional Herbal Medicine Vol. 1, Michael and Lesley Tierra
The Essential Book of Traditional Chinese Medicine Vol. 1, Liu Yuanchi
Western Herbs in Chinese Medicine, Thomas Avery Garran
Western Herbs According to Chinese Medicine, Thomans Avery Garran
Ho-Shou-Wu – What’s in a Name?, Subhuti Dharmananda
The Energetic of Western Herbs Vol. 1, Peter Holmes
Healing Power of Ginseng, Paul Bergner
Medicinal Plants of the Desert and Canyon West, Michael Moore