Differentiating Deficiencies

Qi and Yang

Qi and Yang are two enigmas that can be viewed as both entities and functions in the body.  They both have a substantial nature, as they are created from substance and in turn create substance, but these two fundaments can be seen to have primarily functional natures as well.  Indeed they exist as permutations of function itself.  The creation of Yang flows in balance with Yin.  These two opposing yet complementary forces cascade into their extreme states only to finally morph into each other, as illustrated in the I-Ching.   The generation of Qi involves an intermixing cascade that includes fundamental Original Qi,  Grain Qi created from food, Pectoral Qi made from air and Grain Qi, and True Qi that courses the channels, nourishes the organs, and exists as both defensive Wei Qi and nourishing Ying Qi.

Both Qi and Yang may be best understood as belonging to the “functional family” of the body.  In the spectrum between structure and function that permeates the cosmos, these two phenomena fall on the side of function. While Yin and Blood find themselves closer to the structural end of this spectrum, all four of the fundamental substance are indeed both structural and functional in their nature and the effects they have in the body.

Qi is function itself.  The function of an organ in the body is that organ’s Qi.  Therefore, the vitality of that function is an expression of that organ’s Qi.  Qi is also the energy that motivates all function in the body.  Viewed in this way Qi is both qualitative, as seen in an organ’s expression of vitality, and quantitative, as seen when a lack of Qi influences the expression of that organ’s vitality.  In this way when we see the outward expression of an organ, or indeed a whole person, we are glimpsing the very vital energy that generates that expression.

Yang can also be understood in similar terms.  Yang is both a product and producer of function.  Yang is the warmth of the body, but Yang also generates the warmth of the body. The expressions of Yang in the body are seen in all things that have Yang qualities; lightness, brightness, outwardness, dryness, loudness, warmth…  Indeed expression itself in Yang in nature and Yang’s most fundamental articulation in the body is in the presence of warmth that showcases its vitality.

Both Qi and Yang, being of the “functional family”, then express deficiency as a loss of function.  If Restoration or Supplementing therapy involves replenishing the absence of some essential substance or function, then Qi and Yang tonics supplement function, while Blood and Yin tonics supplement substance.  As all Yang possesses and changes into Yin, and all Yin possesses and changes to Yang, so are structure and function both influenced by all four types of tonics.

Qi is mostly Yang in nature, yet it possesses Yin character as well.  Though Qi does tend to express itself in Yang ways, it does not encompass all of the things that Yang does in the body. As a result, while a deficiency in either will likely exhibit as a hypofunctioning of an organ or tissue, Qi and Yang deficiency both have unique symptom pictures.

The Qi Deficient Person

A deficiency of Qi can occur locally or systemically.  When occurring locally the symptom picture will involve a hypofunctioning of a specific organ, shortness of breath in Lung Qi deficiency for example, with signs of systemic Qi deficiency also simultaneously occurring. Systemically, Qi deficiency or vacuity involves weakness, collapse, loosening, depression, fatigue, mental dullness, poor memory, poor focus, low appetite, and low immunity. These symptoms can all be seen as the result of an insufficient amount of energy to perform certain functions.  The functions (Qi) are deficient because the energy that supplies those functions (Qi) is deficient.

A Qi deficient person may have a pale complexion and talk at a low volume, mumble, or lack the strength to speak.  They may dress lazily or carelessly (though one must have an acute fashion sense to utilize this symptom correctly in diagnosis).  They may move slowly, with lack of verve, and show physical tiredness in their movements.  Their attitude might be apathetic and they may have trouble gathering motivation to perform certain tasks.  They might show lassitude and laziness, and exhibit a careless (though not necessarily carefree) attitude.  A Qi deficient person might break into sweat spontaneously or with strange ease. They might show signs of fatigue, both mental and physical, and exhibit a pale complexion, poor digestion, loose stools, or dribbling urine.  Their pulse may feel feeble and weak because there is an insufficient amount of Qi to propel the Blood through the vessels. The tongue can show as pale or perhaps even puffy and scalloped at the edges.

Systemic Qi deficiency is most often found in those with immune deficiency, chronic viral and bacterial infections, convalescence, and postpartum and post surgical weakness.

Treatment: Supplement Qi, taking care to encourage Qi dispersal to avoid creating stagnation, adding Qi regulating herbs as necessary, Mandarin Peel being commonly used for this purpose. Most Qi tonics posses an energetic/flavor profile that is sweet, slightly bitter, and cool.  Qi Tonics include: Gotu Kola Leaf (Kidney Essence), Stinging Nettle Seed (Kidney Qi and Essence), Licorice Fern Root (Lung Qi), Elecampane Root (Lung Qi, Spleen Qi – honey mix fried), Hawthorn Leaf, Flower, and Berry (Heart Qi), Milk Thistle (Spleen Qi), Milky Oat Seed, Codonopsis (Spleen Qi), Asian Ginseng (Spleen Qi, Lung Qi ), Astragalus (Spleen Qi, Lung Qi, Wei Qi), Eleuthero Root, Spikenard Root (Lung QI), Gravel Root (Kidney Qi), Licorice Root (Spleen Qi), Ashwagandha, Tribulus terrestris  (Kidney Qi)

The Yang Deficient Person

Yang and Qi, both being part of the “functional family”, will express similar symptoms when deficient. Yang deficiency often presents locally, as in seen in the low sex drive of a Kidney Yang deficient person, but can present systemically as well.  The Yang deficient person may show a pale complexion, fatigue, depression, weak digestion like the Qi deficient person, but the symptoms that allow us to differentiate Yang deficiency from Qi deficiency are those that are specifically indicate that there is a lack of Yang in the body.  Thus we will also see a lack of heat, dryness, lightness, and expression, along with the potential presence of excessive Yin.  Thus, in addition to those symptoms shared with a Qi deficient person, a Yang deficient person may also show an aversion to cold, cold hands and feet, frequent urination, loose stools with undigested food, a dark colored tongue, and a slow pulse.

In systemic Yang deficiency, the “fire in the vital gate” – the source of Yang Qi of the whole body – shows vacuity.  This syndrome usually stems from an innate deficiency, improper nutrition (often excessive intake of cold, heavy, dampening foods), insufficient activity, or from the damaging of Yang due to long term illness.  A deficiency of fire in the vital gate leads to a failure of Yang to check and balance Yin and leads to an excessive expression of Yin that manifests as coldness and fluid retention.  In this syndrome, responsiveness and metabolism decline.  Like Qi deficiency, physiological activities are weak in general, resistance and immunity are low, but adequate heat is uniquely absent   Thus a Yang deficient person produces a symptom complex of coldness, pallor, aversion to cold, retention of fluid, disturbances of water metabolism, dampness, and fluid stagnation.  Because Yang is rooted in the Kidney, Yang deficiency can often manifest Kidney Yang deficiency symptoms such as frequent urination, infertility, low libido, lower back, knee, and leg pains.  Eventually this syndrome can lead to inhibition of Yin, a deficiency of vital essence, and the degeneration and atrophy of the endocrine glands.

Treatment:  Yang supplementing medicinals increase function and warmth by stimulating the arterial circulation that brings glucose and oxygen, the fundamental requirements for cellular metabolism and respiration, to the cells.  Beyond circulation stimulation, some of these medicinals seem to have endocrine effects as well, which accounts for their use in augmenting the fire in the vital gate – the vital warmth body that originates in the Kidney/adrenal complex – instead of as mere exterior relieving medicinals. They can be seen as energizing the sympathetic nervous system. Likewise,  because Yang is rooted in the Kidney, many Yang tonics have actions on Kidney Yang.  Yang Tonics include: Damiana, Epimedium, Fenugreek Seed, Walnut, Teasel Root, Dodder Seed, Yohimbe, Muira Puama, Celery Seed/Ajwan, Saw Palmetto Berry, Ashwagandha, Cordyceps, Cayenne.

Blood and Yin

Blood and Yin are as closely related to each other as Qi and Yang are, respectively.  If Qi and Yang are fundamental energies and substance belonging  to the “functional family”  then Blood and Yin belong to the “structural family”.  Both Blood and Yin are foremost viewed as substances, but as Yang exists in Yin, so do these substances possess very important functions. Blood nourishes the body, bringing nutrients to the interior and exterior, and, being Yin in quality, Blood also moistens the skin, hair, eyes, sinews, and tongue.  Blood acts as a foundation for the Mind and nourishes Essence as well.

Yin in the body includes the presence of Yin, the functions it serves, and the substances that can be qualitatively described as Yin.  Blood is considered part of Yin, both substantially and functionally, as is Ying-Qi or Nutrittive Qi, the Yin aspect of True Qi that exists in opposite balance with the defensive Wei Qi.  Fluids are a Yin element as well.

Fluids, or Jinye, encompasses all the liquids of the body other than Blood.  They are formed from what we eat and drink in a series of successive stages of refinement that separate Jin, the clear, light, watery, pure aspects from Ye, the heavy, thick, dense and turbid aspects. Jin manifests as sweat, tears, saliva, and mucus.  Wei Qi flows quickly in Jin and this aspect of Fluids moistens and nourishes the skin, muscles, and tendons.  Jin becomes a part of Blood, helping to thin it and prevent stagnation.

Ying-Qi flows slowly in Ye, which nourishes and moistens the interior – the viscera, joints, bowels, brain, and marrow.  The formation of Jin and Ye occurs primarily through the Spleen’s powers of transformation and transportation, though the Lungs and Upper Warmer are involved in Jin refinement and movement and the Kidney, Middle, and Lower Warmers are involved in Ye transformation, dissemination, and excretion. As a whole, Jinye nourish and moisten the body and, encompassing both interstitial fluid and aspects of venous blood, are involved in the removal of metabolic waste products from the cells.  These functions clearly put the lymph in the realm of Jinye.

The Blood Deficient Person

Blood deficiency can be seen as a deficiency in the quantity or quality of Blood.  Whether qualitative and/or quantitative, this kind of deficiency results in a loss of the functions that Blood serves in the body.  Therefor a Blood deficient person will show symptoms associated with a lack of nourishment and moistening of the organs and tissues. Chinese Medicine scholar Giovanni Maciocia notes that Blood deficiency is “in the middle of a pathological continuum between Qi and Yin deficiency”, and as such a Blood deficient person may show signs associated with Yin deficiency (dryness and potentially even the false fire associated with Yin deficiency) yet they will also show signs associated with the absence of nourishment and the vitality that nourishment brings to the body, notably in the form of a vibrant complexion and a calm, focused, and vigorous mind.

The Blood deficient person may experience lassitude, insomnia, poor memory, blurred vision or spots in the vision, dry eyes, dry hair, tingling or numbness of the limbs, hands, and feet, dizziness, or heart palpitations.  They may present as emaciated, with pale lips and a sallow complexion.  The tongue can be pale and dry and the pulse empty, fine, or choppy. Blood deficiency  often presents gynecologically in menstruating female-bodied people and can include infertility, scanty periods, delayed menses, and amenorrhoea.

Treatment: Because Blood is considered a condensed form of Qi, supplementing Blood often involves combining Qi and Blood tonics. Likewise, because Blood is also considered part of Yin, many Blood tonics are also Yin tonics.   Blood Tonics include: Baneberry Root, Blueberry, White Peony, Dong Quai, Milk Thistle, Molasses, Lycium Berry, Prepared Rhemania, Prepared He Shou Wu, Mulberry, Blackberry, Raspberry, Huckleberry/Bilberry, Dark Grape, Black Sesame Seed.

The Yin Deficient Person

Yin deficiency is characterized by dryness, as the moistening functions of Yin in the body are insufficient due to a lack of actual Yin substance.  In this way both the quality and quantity of vital essence (comprised of the Yin substances –  Fluid, Essence, and Blood) are diminished.  When there is not enough Yin in the body to keep Yang in balance, Yang can end up over expressing itself in relation to its Yin counterpart.  Thus in Yin deficiency a person exhibits dryness with heat and weakness.  Even though there is an over expression of Yang, this does not indicate that there is an overabundance of Yang.  Rather, in cases of Yin deficiency, it is the lack of Yin that is ultimately responsible for symptomatic expressions of Heat.

A Yin deficient person will show signs of dryness of the mucous membranes, especially the mouth and throat, but will also manifest signs of a specific kind of Heat, known as False Fire or Deficient Heat.  These Heat symptoms are not of the vigorous nature found in cases of Yang excess, but are deficient and weak in nature, and this syndrome at it’s core is a deficient one.  Signs of Deficient Heat include a low erratic fever, heat in the 5 spaces (palms, soles of feet, and chest), night sweats, mental restlessness, excitability followed by faintness, dark or bloody urine, dry stools, a dry red tongue with no coat, and a feeble but rapid pulse.

In comparison Yang excess is very much an excess condition.  Here Heat is vigorous and there is strength in the individual.  Yang excess results in a true hyper functioning of organs, tissues, and body systems.  This individual may be overly excited or reactive and possess a vigorous metabolism. The tongue may be red, but not necessarily dry, and the pulse is full and rapid.  Yang excess can result from pathogenic heat that invades the body, from persistent emotion, a long standing obstruction of Qi, or from Blood stasis.  While excess Yang can consume Fluids, this consumption is a result of the excess Yang or Heat, as opposed to cases of Yin deficiency where preexisting Fluid consumption or deficiency is the cause of False Fire.

Treatment: Treatment of Yin deficiency involves clearing Deficient Heat and supplementing the body’s innate Yin with Yin tonics.  Like Blood tonics, these Yin tonics are often cloying or mucilaginous in nature.  When taken internally, mucogenic Yin tonics have local effects associated with the topical application of mucilage to the mucous membranes of the digestive system, but also have a yet to be scientifically identified reflexive action that encourages mucosal moistening throughout the body. Care should be taken to strengthen the Spleen or use Disperse Food medicinals as indicated in order to avoid stagnation and dampness. Some of these remedies can be seen as nourishing the parasympathetic nervous system, the Yin aspect of the autonomics.  Yin Tonics include: Mallow family herbs, Licorice Fern, Pine Lousewort, Fremontia californica (Fremontodenron californium), Chia Seed, Flax Seed, Milky Oat Seed, Milk Thistle, Solomon’s Seal, False Solomon’s Seal, Dark Grape, Mulberry, Huckleberry/Bilberry, Saw Palmetto Berry, Cordyceps, Asparagus Root, American Ginseng, Eclipta, Amla, Comfrey root, Wild Yam, Licorice Root, Black Sesame Seed, Chickweed Herbs that Clear False Heat include: Bugleweed, Meadowsweet, California Figwort, Burdock Root, Eclipta

Sources:

The Healing Power of Ginseng, Paul Bergner

The Yoga of Herbs, Dr. David Frawley and Dr. Vasant Lad

Chinese Traditional Herbal Medicine, Leslie and Michael Tierra

Western Herbs According to Traditional Chinese Medicine, Thomas Avery Garran

Western Herbs in Chinese Medicine, Thomas Avery Garran

The Essential Book of Traditional Chinese Medicine, Liu Yanchi

The Energetics of Western Herbs, Peter Holmes

Medicinal Plants of the Mountain West, Michael Moore

Medicinal Plants of the Desert and Canyon West, Michael Moore

Chinese Herbal Medicine Materia Medica 3rd Edition, Bensky, et al. 

Herbal Energetics in Clinical Practice, Michael Moore

East West Herb Course Book, vol. 3, Michael and Leslie Tierra

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