Chapter 5

Acupuncture Treatment Protocols

Acupuncture Protocols for Shen Disorders

The effective points described in Chapter 4 are combined in various patterns to yield treatments for
particular shen disorders and to meet the requirements of individual patients. In the majority of cases, it
can be said that shen disorders are treated by a combination of local points (that is, points of the head
and neck, especially GV-20 and sishencong at the top of the head, GV-14 and GV-15 at the neck- where
the meridian enters the brain; and GV-23 and GV-26 at the face) plus distal points, with a focus on
points of the wrist/hand and ankle/feet. Presented here are some point groups from published reports of
treatments proclaimed effective.

Protocols: Treating Children

Disorders of the mind and spirit frequently appear early in life. Today, it is suggested that these are
caused by genetic defects, by early trauma to the head or nervous system, or exposure during the
neonatal months or early infancy to chemical or other influences that may cause changes in brain
function. According to traditional Chinese medicine, the inborn problems are said to be due to essence
deficiency, while the other potential causes are basically the same as described in modern medicine,
even though they may be visualized differently.
The modern Chinese medical literature includes a number of reports of treating children with
acupuncture. This approach may not be easily applied in the West, because both children and their
parents are less likely to be willing to participate in pediatric needling as a therapeutic method.
However, the point selection should be informative in guiding practitioners seeking to treat disorders
either in children, young adults, or adults. Thus, the following presentation is especially focused on the
point selections.
Patients with childhood epilepsy (ages 5-16 years) were treated to control symptoms immediately
(effects of acupuncture reported to occur within 10 minutes) at the Hospital for Mental Diseases in
Anhui Province (1). Treatment involved the following collection of points as the main ones from which
selection was made: renzhong (GV-26), baihui (GV-20), yintang (M-HN-3), fengchi (GB-20), jianshi
(PC-5), daling (PC-7), shenmen (HT-7), hegu (LI-4), guanyuan (CV-4), fenglong (ST-40), sanyinjiao
(SP-6), yongquan (KI-1), and taichong (LV-3). Treatment surrounding baihui was done by threading
the needles, somewhat like the method of scalp acupuncture. The author reported: "We found the
method very effective in treatment of neural and psychic diseases." The physicians also used blood
letting at the fingertip points (shixuan, M-UE-1).
A study of acupuncture for pediatric cerebral palsy was reported by the Children's Hospital at Shanghai
Medical University (2). The 117 children treated were 10 years and under, mostly in the range of 3-7
years. The main points selected were yamen (GV-15), dazhui (GV-14), fengchi (GB-20), shenshu (BL-
23), neiguan (PC-6) and zusanli (ST-36). Auxiliary points could also be added. Injection of fluids
(glutamine solution or a combination of blood vitalizing herbs) into the head points was used.
Significant improvement was claimed for just over half of the patients. The authors pointed out that the
points shenshu and zusanli were selected to tonify the kidneys and benefit the marrow (brain).
Several of the points were treated by acupuncture through to a nearby point, such as neiguan through to
waiguan, or hegu through to houxi. The authors claimed that all patients were cured by the treatment,
though the condition recurred in 11 cases of 53, which could then be controlled by 1-2 courses of
treatment (a course lasted one week to one month, depending on the patient, with daily acupuncture).
Tourette's syndrome in children aged 6-15 was treated at the affiliated hospital of the Tianjin College of
Traditional Chinese Medicine (3). The patients were divided into two groups depending on whether
they were classified as having yangming stagnant heat (66 of the patients), in which case the main
points used were neiting (ST-44), quchi (LI-11), pianli (LI-6), and sibai (ST-2), or if they had
deficiency of kidney and heart (90 of the patients), in which case the main points used were yamen
(GV-15), lianquan (CV-23), shenmen (HT-7), and fuliu (KI-7). According to the report, 73% of the 156
patients were relieved of the syndrome with ability to terminate previous medication.
Mental retardation in children aged 8-14 was reported by the Institute of Acupuncture at the Academy
of Traditional Chinese Medicine (4). Three groups of acupuncture points were selected and each group
was applied once every other day during the course of a month, followed by the second group the
second month and the third group during the third month:
baihui (GV-20), sishencong (M-HN-1), shenmen (HT-7), and taichong (LV-3);
fengfu (GV-16), shangxing (GV-23), tongtian (BL-7), daling (PC-7), and kunlun (BL-60);
scalp points in the scalp acupuncture zones, neiguan (PC-6), and zhaohai (KI-6).
The effects of treatment were relatively modest, with 9 of 128 cases showing marked effect, but any
improvement that was noted (about 2/3 of cases had some improvement) appeared to be retained over
the follow-up period of one year. Regarding the selection of points, the authors stated:
Since the lesion of mental retardation is in the brain, the acupoints in the head and neck regions are
selected for its treatment. The governing channel goes into the medulla and brain as the sea of yang
channels, and the bladder channel goes into the brain from the top. Besides the mental and physical
development of children are also related to the heart, kidney, and liver, so effective acupoints on the
governing, bladder, heart, liver, and kidney channels are selected for regulating the visceral functions to
promote the brain functions.

Protocols: Depression, Neurosis, Schizophrenia,

and Other Disorders in Adults
The use of the group of points surrounding baihui (GV-20), called sishencong (M-HN-1), was the
subject of a report from the Hospital of Scalp Acupuncture in Anhui Province (5). Six cases were cited
as examples of successful protocols, including headache and Meniere's syndrome, and the following
that fit the subject of the current article:

 Schizophrenia: sishencong (M-HN-1), sanyinjiao (SP-6), and taichong (LV-3);

 Neurosis: sishencong (M-HN-1), renzhong (GV-26), anmian (N-HN-54), neiguan (PC-6),
sanyinjiao (SP-6), and taichong (LV-3).
The points baihui plus sishencong were recommended by Ding Dezheng, at the Department of
Psychiatry at the Zhuji Health Centre, in Henan, who reported on his experience treating various
mental diseases (6). He noted that these points "raise the lucid yang and tranquilize the mind." He
indicates them especially for depressive psychosis manifested by sadness, worry, grief, sorrow, and
disinclination to life due to extreme sorrow.
Other acupuncture treatment strategies were also reported as useful. For example, a study on treatment
of schizophrenia, involving acupuncture and herbs, was conducted at a hospital in Mongolia (7).
Acupuncture was performed with three groups of points, with one group treated each day
consecutively, then repeated. The point groups were:
renzhong (GV-26), shangxing (GV-23), neiguan (PC-6), and xuanzhong (GB-39);
yintang (M-HN-3), hegu (LI-4), yanglingquan (GB-34), and taichong (LV-3);
baihui (GV-20), shanzhong (CV-17), quchi (LI-11), and yongquan (KI-1).
Anxiety neurosis was treated at the Qindao Medical University using acupuncture in 80 patients, some
of which were young students (aged 18 or over), but most were older workers, up to age 72 (8). The
main points used were zusanli (ST-36), neiguan (ST-25), taichong (LV-3), shenshu (BL-23), mingmen
(GV-4), and quchi (LI-11). Treatment was every other day for 10 treatments, with a break of 3-7 days
before beginning another course of treatment, up to 40 treatments. The therapy was reported to be
highly effective, with 55 of the patients showing obvious alleviation of symptoms.
Dementia due to traumatic injury to the head was treated at the General Hospital of Chengdu (9). 32
patients were treated by acupuncture, which was initiated one to three months after the traumatic event.
Two main points were used: shenmen (HT-7) and houxi (SI-3). It was reported that 15 of the patients
showed marked improvements after 20 daily acupuncture treatments.

Protocols: Senile Dementia and Depressive

Psychosis in the Elderly
Senile dementia, the term often found in Chinese medical publications, has been largely disposed of in
modern medical practice, with the ability to distinguish different causes, including Alzheimer's Disease,
atherosclerosis (formerly: vascular dementia), and stroke. Recent evaluations have indicated that some
degree of mental impairment is present in virtually all persons who pass the age of 90. A summary of
published acupuncture protocols is presented in the table below.
Table 1: Summary of treatment methods and results for senile dementia from translated Chinese
medical journal reports published 1996-1998. Various adjunct points were used for some patients.

Study Group and Outcome Measures

Main Points Used
Treatment Duration Claimed Results
shenting (GV-24), shenmen Improved symptoms, mainly
40 patients aged 60-88; treated (HT-7), jianshi (PC-5), hegu vertigo, dizziness, headache,
every other day for 30 (LI-4), zusanli (ST-36), palpitation, fidgets, and
treatments (10). sanyinjiao (SP-6), taichong numbness of limbs. Improved
(LV-3) score on mental health exam.
26 patients aged 61-87; 10 shigou (GV-26), baihui (GV-
Mental state recovered in 9
consecutive days treatment; 2 20), dazhui (GV-14), fengchi
cases, improved markedly in 11
day break; total of 32-40 (GB-20), neiguan (PC-6), taixi
cases.
treatments (11). (KI-3), xuanzhong (GB-39).
46 patients with history of Mental function assessments
cerebrovascular disease aged improved significantly;
sishensong (M-HN-1), fengchi
53-80; 5 consecutive days reduction of blood free-
(GB-20), neiguan (PC-6)
treatment; 2 days break; total of radicals. Short term marked
35 treatments (12). improvement in only 2 cases.
fengfu (GV-15), dazhui (GV-
14), neiguan (PC-6), shenmen
29 patients, aged 55-83; 28 (HT-7); hegu (LI-4), adjunct Marked improvement in mental
consecutive days treatment; points: zusanli (ST-36), jiexi functions in 5 patients. Some
break of 3-5 days, then repeat (ST-41), taichong (LV-3), changes in CT scan and blood
up to 5 times (13). fenglong (ST-40), xinshu (BL- lipids (improvements).
14), ganshu (BL-18), and
baihui (GV-20)
The data in the table illustrates that the number of acupuncture treatments is at least 30, and the
frequency of treatments is daily or every other day, with short breaks of 2 or more days between groups
of daily treatments. Improvements were noted in several measures for the patient groups overall;
marked effectiveness (substantial and obvious improvement) from the treatment, usually did not
involve more than one-third of patients.
Acupuncture was applied in the treatment of depression and psychosis in older patients at the Institute
of Mental Hygiene in Beijing (14). The patients were aged 50-74 and suffered from conditions such as
manic-depressive psychosis, reactive psychosis, and neurosis. The treatment focused on baihui (GV-20)
and yintang (M-HN-3), using electroacupuncture stimulation. Of 30 patients treated, it was claimed that
marked effects were observed in 19 (about 2/3). The claimed improvements were in depressed mood,
suicidal intention, anxiety, insomnia, and irritability, as well as alleviation of some accompanying
physical symptoms.
Post-stroke depression was treated at the Qiaoli Hospital of Traditional Chinese Medicine in Zhuhai
(15). A group of three needles was inserted along the hair line, with one in the center at shenting (GV-
24) and the others on either side by about 10 cm, at benshen (GB-13). Additionally, three needles were
applied to wrist/hand on each side: neiguan (PC-6), shenmen (HT-7), and laogong (PC-8). Adjunct
points were used according to syndrome such as qihai (CV-6), zusanli (ST-36), and sanyinjiao (SP-6)
for qi and yin deficiency, or the combination of fengchi (GB-20), taichong (LV-3), and baihui (GV-20)
for wind-phlegm disorder. The authors commented that:
The influence of depression on patients after stroke is sometimes more serious than the functional
disturbance of the limbs and can impact the progression and prognosis of stroke. Many antidepressant
drugs produce several severe side effects and the patients had difficulty tolerating those therapies. The
'three intelligence needles' [scalp points] and hand intelligence needles [forearm/hand points] are
frequently used for the treatment of post stroke disorders and also for weak mental function in children
by professor Jin Rui at Guangzhou University of Traditional Chinese Medicine. The intelligence
needles at the head directly impact the functional activity of the cerebral frontal lobe and the mind and
check the liver and calm wind. The hand points are the important ones for treatment of mental diseases:
they can regulate the mental state, open orifices, tranquilize the mind, clear the pericardium, and help
sleep. Acupuncture can improve the blood flowing in the brain or can promote absorption of hematoma
in the brain, leading cerebral cells to be awakened and to gain recovery of functions, speeding up the
repair of the injured brain tissues. Acupuncture can also promote release of a large quantity of serotonin
in the brain and noradrenalin in the spinal cord.

Protocols: Use of Renzhong with Neiguan

In recent reports on treatment of depression, anxiety neurosis, and other mental disorders, emphasis has
been placed on using the combination of renzhong (GV-26) and neiguan (PC-6) with a small number of
other points to attain a positive response. Some treatments involving these two points were already
mentioned above.
An example is a protocol for depression after stroke, reported by Wang Hairong at the Tianjin College
of Traditional Chinese Medicine (16). There were 140 patients treated, with 86 cases of infarction and
54 cases of hemorrhage. Patients received acupuncture treatment every day for 2-3 courses of treatment
lasting 10 days per course. The main points treated were renzhong (GV-26), neiguan (PC-6), shenmen
(HT-7), and taichong (LV-3). Secondary points were treated according to the basis of depression, such
as liver qi stagnation; qi stagnation transformed to fire syndrome; deficiency of heart and spleen; or for
accompanying mental disturbance. The authors concluded that:
The present study has proved that acupuncture is very effective for treating the depressive syndromes
after cardiovascular accident, with a total effective rate of 87%. Renzhong (GV-26) when punctured
with the reducing technique may bring back the consciousness, strengthen the brain functions, and
tranquilize the mind. Neiguan (PC-6) and shenmen (HT-7), when used in combination, can nourish the
heart, tranquilize the mind, improve the qi and blood circulation, and remove the obstruction form the
channels. taichong (LV-3) is very important for promoting qi activities. In summary, the present
acupuncture treatment can regulate the functions of the nervous system, and make a balance between
the excitement and inhibition process of the cerebral cortex.
A somewhat similar protocol was developed by a team from the Tianjin College of Traditional Chinese
Medicine that was invited to Germany to treat patients with depression (17). The main points included
renzhong (GV-26) and neiguan (PC-6), with the additional head points shangxing (GV-23), yintang (M-
HN-3), and baihui (GV-20). Supplemental body points might be selected according to particular
syndromes defined by the traditional system; thus for liver fire syndrome, taichong (LV-3), xingjiao
(LV-2), and fengchi (GB-20) would be added.
In a report on treatment of anxiety neurosis (18), the primary therapy involved needling renzhong (GV-
26), neiguan (PC-6), baihui (GV-20), and sanyinjiao (SP-6). Additional points were used for specific
symptoms; for example, for those who had excessive display of emotionalism, several points named for
treatment of shen disorders were used: shishencong (M-HN-1), benshen (GB-13), shenting (GV-24),
shentang (BL-44), and shenzhu (GV-12).

Supplementing Acupuncture Therapy

In China, needling is performed daily or every other day, and at least 30 treatments within a period of
about two months is typical for a course of therapy that leads to notable improvements in many, but
certainly not all, of the patients. The authors of some studies pointed out that acupuncture was not
considered sufficient by itself. In the above-mentioned report on anxiety-neurosis, the authors pointed
out that:
In the clinical treatment of melancholia, psychological treatment can never be ignored. After listening
attentively to the patient and making analysis of the external and internal causes, the doctor should try
to help the patient find out the psychological factor and tell the patient that this disease is a functional
disease and curable, in order to encourage the patient to overcome psychological obstacles and thus to
raise the therapeutic effects.
In addition, herb therapies are often used for the patients, not only as an adjunct to acupuncture, but as
a follow-up after an intensive course of acupuncture therapy has been completed. The use of herbs is
complicated by their apparent similarity to drugs. The next four chapters explore the concepts that
herbalists utilize in analyzing shen disorders and the commonly used herbs and formulas.

References
1. Yang Jinan, Treatment of status epilepticus with acupuncture, Journal of Traditional Chinese
Medicine 1990; 10(2): 101-102.
2. Shi Bingpei, Bu Huaidi, and Lin Liyu, A clinical study on acupuncture treatment of pediatric
cerebral palsy, Journal of Traditional Chinese Medicine 1992; 12(1): 45-51.
3. Wu Lianzhong, Li Huimin, and Kang Ling, 156 cases of Gilles De La Tourette's Syndrome
treated by acupuncture, Journal of Traditional Chinese Medicine 1996; 16(3): 211-213.
4. Tian Lingdi, et al., Composite acupuncture treatment of mental retardation in children, Journal
 of Traditional Chinese Medicine 1995; 11(1): 34-37.
5. Liu Hechun, Illustrative cases treated by the application of the extra point sishencong, Journal
of Traditional Chinese Medicine 1998; 18(2): 111-114.
6. Ding Dezheng, Personal experience in acupuncture treatment of mental disorders, Journal of
Traditional Chinese Medicine 2001; 21(4): 277-281.
7. Wu Fengqi, Treatment of schizophrenia with acu-moxibustion and Chinese medicine, Journal of
Traditional Chinese Medicine 1995; 15(2): 106-109.
8. Liu Guizhen, et al., Observation on the curative effect of acu-moxibustion plus systemic
desensitization on anxiety neurosis, Shanghai Journal of Acupuncture and Moxibustion 1998;
17(4): 17-18.
9. Zhang Anren, et al., Effect of acupuncturing houxi and shenmen in treating cerebral traumatic
dementia, Chinese Journal of Integrated Traditional and Western Medicine 1995; 15(9): 519-
521.
10. Shen Weidong and Li Ding, A preliminary clinical study on senile dementia treated by
acupuncture and moxibustion, Shanghai Journal of Acupuncture and Moxibustion 1996; 15(5):
5-6.
11. Yang Xiangtan, 26 cases of senile dementia treated with acupuncture by resuscitation
method, Chinese Acupuncture and Moxibustion 1996; 11: 3.
12. Lai Xinsheng, et al., Analysis of near-term effect of electroacupuncture in treating
vascular dementia, Journal of Traditional Chinese Medicine (Chinese) 1997; 38(6): 340-343.
13. Liang Zhong, et al., 115 cases of senile dementia treated by a combination of
acupuncture and Chinese herb therapies, Chinese Acupuncture and Moxibustion 1998; 12: 712-
714.
14. Liu Guangzhi, et al., Electroacupuncture treatment of presenile and senile depressive
state, Journal of Traditional Chinese Medicine 1992; 12(2): 91-94.
15. Liang Yue, Intelligence three needles and hand intelligence needle applied to treat
depression after cerebral apoplexy, Shanghai Journal of Acupuncture and Moxibustion 1998;
17(2): 27.
16. Wang Hairong, Acupuncture treatment of depressive syndrome after cerebral vascular
accidents, Journal of Traditional Chinese Medicine 2002; 22 (4): 274-275.
17. Zhang Chuanhong, Li Jinbo, and Wang Shu, Treatment of melancholia in Germany by
acupuncture method of resuscitation, Journal of Traditional Chinese Medicine 2004; 24 (1): 22-
23.
Chapter 1
What Is Shen (Spirit)?
The Chinese character for shen, usually translated as "spirit," has two components. To the right is the
character which gives both the basic meaning and pronunciation, shen. In the book Tracing the Roots
of Chinese Characters by Li Leyi (1), the following explanation of the earliest known form of the
character is given: "Graphically, it is the curved lightening flashes appearing in the clouds. The ancient
people believed lightning was the manifestation of god." To the left is the modified form of the
character shi (as used to form a radical, which is the category designator), which Li explains:
"Originally, it was the stone table for offering ceremonial sacrifices to the gods…characters with the
radical shi always pertain to ritual ceremonies, worship, or prayer." Today, this character (shi) more
generally means to make known, to manifest, to show; this is because the ritual ceremonies display the
inner prayer and worship of people. We can say that the Chinese writing character which has been
formed into shen to refer to the spirit implies the manifestations of a person's relationship to god [the
small letter 'g' is used here because the Chinese reference does not specify the personal God, as in the
Western Judea-Christian-Islamic tradition; still there are obvious similarities of ancient ceremonial
sacrifices on stone alters]. Historically, Chinese culture recognizes a creator god, Pan Gu, a trinity of
divine Emperors (Tian Huang, Di Huang and Ren Huang, the emperors of heaven, earth, and man,
respectively) and of divine helpers who come in human form, You Cao, Fu Xi, Shen Nong (2).
The earliest known discourse on shen in the medical context is found in the Huangdi Neijing Lingshu,
in Scroll Two. The document that comes down to us today is believed to have originated during the
Han Dynasty, perhaps around 100 B.C. In a translation by Wu Jingnuan (3), the relevant section on
spirit is titled "The Roots of the Spirit." The section, like others, begins with a question from Huang Di
(the Yellow Emperor) which is answered by Qi Bo (the chief physician), who begins his explanation
this way:
"Heaven abides so that we have virtue. Earth abides so that we have qi. When virtue flows and qi is
blended there is life."
The starting point for an understanding of shen is the meeting place of heaven and earth, which is man.
Heaven is the origin of the spiritual aspect of man and provides ongoing spiritual influences; earth is
the origin of the physical aspect of man and it continues to affect his body; the interaction of heaven
and earth, the spiritual and physical, provides life; the ongoing harmonious interaction of heaven and
earth in man is essential to maintaining life. The physical aspect is described here as qi. There is a
frequent misconception in the West that qi is ethereal or "energetic," and this is a misinterpretation (4);
in the traditional system of thought, qi is substantive but also dynamic, likened to steam and mist.
In the discussion presented in the scroll, there is reference to not only the spirit (shen) , but to two other
entities which should be discussed before proceeding (see chapter appendix for more details). One is
hun, which is translated often (and in this specific text) as the human soul; in fact, it is depicted as a
collection of 3 entities working together. Hun is manifested in dreams, and it is the aspect of the human
that persists after death of the body; thus, hun has a meaning that correlates to some extent with the
idea of the soul in Western thought. When Chinese texts talk about the ghosts of ancestors, they are
referring to hun. The other entity is po (actually represented as 7 entities), sometimes described as the
"animal spirit" but perhaps more accurately portrayed as the physical vitality. Its action keeps the body
alive; it is still active when a person is in a coma or is "brain dead;" it is gone when a person dies.
Neither hun nor po are the same as shen, and po is not the same as qi. We can say that in describing
these three entities, the shen is differentiated from the other two: it is not the human soul nor the vitality
of the human body. From the ancient Chinese view of embryology, the hun and po combine together
with the seminal essence (jing) and give rise to the spirit (shen) .
Shen, hun, and po each have a "seat" in the body, a place where they are said to rest and take residence.
Thus, even though each of them can influence all aspects of the human person, they rely on certain
parts of the person as a base. This situation might be likened to our own experience of working in the
community and interacting with our neighbors, then returning home as a place for recuperation, rest,
family interactions, and maintaining personal identity. Shen rests in the heart and vessels; hun rests in
the liver; and po rests in the lungs. Although these three entities are the dominant concern in the ancient
texts, in keeping with the influential system of five elements, two other organ systems are identified as
having their own spiritual characteristics which are not the same as, but might be likened to, the other
three: yi (intention, planning, thought, wisdom) is associated with the spleen and zhi (will; the strength
to carry out yi) is associated with the kidney.
Though we have all these terms depicting components of the person, it is shen that is the focus of most
discussion in the field of Chinese medicine, because that is the entity that is under the greatest control
via our behavior and it is the entity that displays the greatest influence over body functions. We can
attempt to learn more about the spirit by examining what is thought to harm it and what can be done to
avoid harm or to repair harm, which is a subject of the Lingshu scroll.
There are two types of harm that can come to the spirit, one is external, the other is internal: This
division is also used in the discussion of other physical disorders (another category of causation, one
that is deemed neither strictly external nor internal, is based on activities, such as eating, exercising,
etc.). External harm was viewed as the effect of "dissolute evil," which is often referred to as an
influence of "demons" (5) and, later in Chinese medical history, was shifted into the general category of
"wind" (6). The concept of demons causing disorders in people permeated virtually the entire world in
these ancient times, and demons were most often the causative factor suggested in cases of mental
disorders (particularly outlandish, obviously strange behavior) and neuromuscular disorders
(particularly ones that were sudden and dramatic, such as epileptic seizures). Today, we might convert
this ancient concept to one with more modern characterization, in which something (which we would
not call a demon, but would involve, for example, neurotransmitters and other neural regulators) causes
a dramatic alteration in neurological functions.
According to the Lingshu scroll, such external adverse influences could be avoided by maintaining
strength and balance:
The wise nourish life by flowing with the four seasons and adapting to cold or heat, by harmonizing joy
and anger in a tranquil dwelling, by balancing yin and yang, and what is hard and soft. So it is that
dissolute evil cannot reach the man of wisdom, and he will be witness to a long life.
These few words may seem to be simple instructions, but they are only the outline of what could
constitute entire books of instructions. I would like to offer a brief elaboration to assist with the
discussion of the nature of spirit.
"Flowing with the four seasons" has the meaning of staying in communion with nature. This concern,
expressed already more than 2,000 years ago when cities were simple compared to those we have
today, is not merely about dressing for the weather (which is implied as part of the next statement of
adapting to cold or heat), but it refers to giving attention to many different aspects of nature: the rising
and setting of the sun, the varying weather patterns, the changing plant and animal life, the different
sensations of the body as the day progresses, and so on. Today, we isolate ourselves from nature:
missing the sunrise in favor of an alarm clock; eating according to what is in processed food packages
rather than what has just been grown and harvested around us; dressing independent of the weather and
then relying on artificial heat and cooling; cutting away the forests to live among concrete, asphalt, and
mechanized vehicles. Though there can be no turning back of the clock of progress, there are choices to
be made in living in the modern world, such as the extent to which we relate to the natural setting. This
issue of communion with nature is not about going to the store to purchase organic produce and
encapsulated herb extracts; rather, this is about turning attention to natural cycles, to natural settings,
and to relationships with plants, animals, mountains, valleys, water, sky, sun and moon.
"Harmonizing joy and anger" refers to not allowing any emotion to become dominant or extreme, but it
also refers to the opposite problem of unnaturally avoiding experience of emotions by setting up
barriers. The person who is calm as a result of pursuing wise and healthful practices that lead to a
tranquil and easy nature can enjoy inner strength and healthy life. An important aspect of this is one's
own dwelling place, which should be nurturing, tranquil, and restful. Too often today, much of life
seems a battleground, whether it is at home, at work, or on the road traveling between the two. People
who engage in extreme behavior are a centerpiece of the world of television, which has become an
unintended learning resource for many children as they grow up and develop their attitudes.
Balancing yin and yang (and hard and soft) refers to development of a sense of appropriate response.
Yin is a more withdrawn receptive state of being, while yang is a more outgoing and active state of
being; both have their times for being appropriate. Remaining in a "yin" condition when yang is
needed, or vice versa, results in disorganization of life and harm to the body and spirit.
What the text is calling upon people to do is to adapt a lifestyle that is, at this time in history,
substantially different than the ordinary. It requires turning to the health of the spirit, calmness of the
emotions, and to worship and prayer directed at the heavenly influences and away from the
unconscious pursuit of earthly things that lead toward extremes, while remaining intimately in touch
with nature.
At the heart of the matter is the calmness which comes from an understanding of the relations between
heaven, earth, and man. As the scroll describes, emotions in the extreme, which disrupt calmness, harm
the person's spirit (I have inserted explanatory comments):
Too much joy and happiness can cause the spirit to shrink and scatter and not stay stored [that is, not
return to resting in the heart]. Sorrow and grief can cause qi to be blocked in the foundations so it does
not move [these emotions especially affect the lung, the seat of po, the vitality does not spread through
the body and the person has difficulty with getting around]. Great anger causes confusion and doubt
and a lack of control [anger is associated with the liver, the seat of hun, the soul is no longer able to
command the person, and seemingly random forces take control]. Fear and fearing cause the spirit to be
unsettled, to shrink away and to be nonreceptive [fear is the emotion that, more than any of them,
adversely affects the spirit and the body-one's planning, and will to carry out plans, shrink away and
one is even afraid to be helped].
It may seem odd to worry about experiencing too much joy and happiness. People can place excessive
emphasis on the frequent experience of these emotions; so much so that one ignores other important
aspects of life. As a result, the emotion and its context become false indicators of reality and lead one
astray. This is not to argue against joy and happiness that are a natural outcome of enlightened spiritual
living when harmony has already been attained; rather, it is about a focus on these emotions apart from
such harmonious living. The emotions that have the greatest potential for harm when excessive, in
addition to the dramatic impact of anger, are fear, fright, worry, and anxiety. As the text goes on to
specify: "The heart and mind with frightened and distressed thoughts and anxiety can result in injury to
the spirit."
The prolonged experience of living a fearful life leads to dysfunction, weakness, and premature death.
The Lingshu scroll continues:
Fear and fearing without release can result in injury to the seminal essence [jing]. The injured seminal
essence can cause the bones to be diseased and deficient. At the time of reproduction, the seminal
essence will not descend [this refers to the interchange between essential fluids in the brain and in the
kidney as described in the ancient literature]. Thus, the five viscera, which are the controls and
storehouses of the seminal essence, should not be harmed [by excesses in the emotions; the text
includes a description of visceral harm from each type of emotional excess]. If they are injured it will
result in loss of protection, and the yin [the substance of the body] will become hollow. The yin being
hollow will result in lack of qi [which is important for replenishing the jing]. A lack of qi will cause
death.
The deficiency of bones has many implications. At one level, this applies to the problem of
osteoporosis, where the bones become fragile and readily break (often contributing to health decline
and premature death). It also applies to the bone marrow, the source of blood cells; the spinal cord and
brain are also considered a type of marrow of the spinal column. Further, this deficiency refers to the
movements of the bones; hence, difficulty in walking is considered one of the outcomes of bone
disease, as are severe pains that afflict the bones and joints, such as occurs with osteoarthritis. The loss
of protection means not only susceptibility to external influences, such as cold and heat and infectious
agents, but also loss of protection from internal disruptions that may yield growth of tumors, water
swelling, and failure of the organs to carry out their critical functions.
In sum, shen refers to that aspect of our being that is spiritual and looks to the universe around, and is
not focused on emotions. Shen draws our attention to the divine, contributes to wisdom, virtue, and
calmness, and maintains our whole being in order. The spirit can be harmed by external factors if we
fail to maintain vitality through good habits, physical strength, and adequate nourishment. The spirit
can also be harmed by internal factors, mainly excessive emotions.
These are things that are, to a certain extent, under our control. While many external factors are beyond
our control, our protection from them through lifestyle choices is not. While emotional reactions to
various situations are spontaneous and beyond our control, the ability to return to equanimity is a skill
that can be mastered. To investigate further the critical issues, it will be worthwhile to examine in some
detail the matter of flowing with nature, a basic Taoist concept, so that a path to communion with
nature and inner strength can be identified (Chapter 2), and to look at some of the Chinese ways for
controlling the emotions (Chapter 3). These approaches are said to be related to benefiting the hun
(ordering relations with the outer world) and po (stabilizing the inner world), respectively. After
contemplating these means of staying healthy, it will then be worthwhile to consider Chinese medical
treatments (mainly acupuncture and herb therapies) that can assist those who have been adversely
affected by shen disorders.

References
1. Li Leyi, Tracing The Roots of Chinese Characters: 500 Cases, 1993 Beijing Language and
Culture University Press, Beijing.
2. Wei Tsuei, Roots of Chinese Culture and Medicine, 1989 Chinese Culture Books Company,
Oakland, CA.
3. Wu Jingnuan (translator), Ling Shu, 1993 Taoist Center, Washington, D.C.
4. Dharmananda S, Qi: Drawing a concept, 1997 START Manuscripts, ITM, Portland, OR.
5. Dharmananda S, Disorders caused by demons, 1997 START Manuscripts, ITM, Portland, OR.
6. Dharmananda S, Feng: Drawing a concept; the meaning of wind in Chinese medicine, 1999
START Manuscripts, ITM, Portland, OR.
7. Needham J, Science and Civilisation in China, vol. 2, 1974 Cambridge University Press,
London.

Appendix: Hun and Po

The following introduction to the hun and po was derived primarily from Joseph Needham's
exploration of the subject (7) with supplemental information from a few other sources.

More than 2,500 years ago in China, the idea developed,

or solidified, that the human body encompassed two
types of entities, usually described in English as "souls,"
which are called the hun and po. These two types of
entities represent the yang and yin, respectively. The po,
of which there are said to be seven, are of earthly
nature, being most closely allied with the body
substance, flesh. The hun, of which there are said to be
three, are of heavenly nature. The hun and po are
depicted in the painting below as two groups of wise
men in a calm setting and in friendly discussion.

The hun originates in the heavens (as if from the air)

and enters and exits the body through the hun gate
(hunmen, acupuncture point BL-47); upon death, it
 departs to heaven. The Chinese practice of ancestor
worship encompasses taking care of the departed hun,
which, because of their residence in heaven, are thought
to be able to help mediate the earthly human wishes
with the gods. Further, it was thought that dissatisfied
ancestral spirits (those who were not cared for by their
offspring in succeeding generations) could cause
illnesses or misfortunes. During life, the resting place of
the hun is in the liver (the hun gate is at the back, near
the liver).

The po is derived from the earth (as if from the soil) and enters and exits the body through the po door
(pohu, acupuncture point BL-42); upon death it returns to the earth. The Chinese practices of burial of
the dead encompass taking care of the po, which eventually blends into the earth and does not retain
separate identity (as an exception, emperors were embalmed so that both po and hun could remain
viable entities, retaining their original form). During life, the resting place of the po is in the lungs (the
po door is at the back, by the lungs). If the qi and yin of the lungs is adequate, the po can remain
vigorous.
One of the earliest discussions involving the hun and po was recorded in the 6th Century B.C., in which
the following was said: "When a fetus begins to develop [into a human form and personality], it is due
to the po. Then comes the yang part, hun. The jing [essences] of many things then give strength to
these, and so they acquire the vitality, animation, and good cheer of these essences. Thus, eventually
there arises spirituality and intelligence [shenming]."
There has been some disagreement in the Chinese literature as to when the po and hun actually arrive.
For example, in the Du Shu Bian (16th century A.D.), it is said that the hun arrives during the seventh
month of pregnancy (signaled by the ability to move the left hand) and the po arrives during the eighth
month of pregnancy (signaled by the ability to move the right hand), rather than the other way around,
with the po being first, which was the more prevalent view; in fact, it was often suggested that the hun
entered the body after birth.
Around 80 A.D., a brief discussion of hun and po was presented in Paihu Tangte Lun (Discussions in
the White Tiger Hall): "Hun expresses the idea of continuous propagation, unresting flight; it is the qi
of the Lesser Yang [associated with liver/gallbladder], working in man in an external direction, and it
governs the instincts (xing)....Hun is connected with the idea of weeding, for with the instincts, evil
weeds [in man's nature or in his spiritual path] are removed. po expresses the idea of continuous
pressing urge on man; it is the qi of the Lesser Yin [kidney/heart], and works in him, governing the
emotions....Po is connected with the idea of brightening, for with the emotions the interior [personality]
is governed."
Here, hun is expressed in terms of outer-directed activity: using the instincts to select a course of action
and to avoid the pitfalls (evil weeds); po is expressed in terms of inner dynamics, adjusting one's
emotional reactions and personality. This reflects the basic yin/yang dichotomy, with yin representing
the internal and yang the external.
In an ancient book describing meditation practice, it was said that one should "be still, as if one had no
hun;" that is, the drive to act, to do things, should be abandoned during meditation, leaving one able to
remain motionless and focused on the inner condition. In a book on Taoism, it is said that one should
"keep your hun from confusion, and it [the Tao] will come of itself, unify the qi and control the
shen....All categories of things are brought into being by this; this is the door of power." Thus, the
practice of meditation, avoiding the stimuli offered by civilization, and calming or regulating the
ambition for outward change (while maintaining the drive for inner transformation, which will then
affect the outer conditions) are activities associated with predominance of the po; searching the outer
world for opportunities, applying thought and personal energy towards significant changes in the
world, and relying on pleasurable stimuli that the world has to offer are associated with predominance
of the hun.
The seven po may have originally been thought to be linked with the seven emotions. The seven
emotions are described variously in English, but one such list is joy, anger, grief, fear, love, hate, and
desire. For each of the emotions, there is an impact on the qi, so that if the emotion is quite intense, the
qi may become significantly disturbed, leading to physical and mental disorders. In the Sanyin Ji Yi
Bingzheng Fang Lun (Treatise on Three Categories of Pathogenic Factors), it is said that "In the
interior of the body reside the jing and shen, the hun and po, the mind and sentiments, mourning and
thoughts. They tend to be harmed by the seven emotions."
It is possible that the three hun were originally thought to be linked to the three major objectives of
human action: relationship to societal authorities (in China, the Emperor and his representatives; in the
modern world, it would include employers, law officers, governors, etc.), relationship to one's spouse
(this would apply also to other relatives of the same generation and to neighbors), and relationship to
one's children (this might also apply to others who are dependent upon your time and resources). It is a
key tenet of Chinese philosophy, most clearly depicted by Confucianism, that relationships with others
are important to both social harmony and to one's own physical and mental health.
It was thought that the hun and po could leave the body, even before death, though only a few of the 10
entities would be involved. Ge Hong, a famous Taoist, wrote during the 3rd century A.D. that: "All
men, wise or foolish, know that their bodies contain hun and po. When some of them quit the body,
illness ensues; when they all leave him, a man dies. In the former case, the shamans have formulas for
restraining them; in the latter, the Book of Rites provide ceremonials for summoning them back. These
po and hun are of all things the most intimately bound up with us, but throughout our lives probably no
one ever actually hears or sees them."
In fact, it has been suggested that the hun, being of yang nature, may often depart the body during life
and travel about, then return. Such adventures include certain dreams, the quasi-dream state that occurs
at the border of sleep and which sometimes involves the sense of floating or sudden movement, and
what we today call "out of body experiences." It is thought, at least in some Chinese communities, that
insomnia, anxiety, fright and other states of mental agitation might arise if one of the hun stayed away
too long. As a matter of diagnosis, patients reporting repeated nightmares are thought to be
experiencing a disorder of the liver; the distressed hun give rise to the nightmare.
It was also believed that one or more of the hun could be virtually forced from the body of a child (less
likely, but still possible in an adult) by a frightful experience; for example, being startled by a stranger.
In such case, the child would become susceptible to disorders such as abdominal distress or epilepsy
that were induced by demons. Other indicators of hun departure include listlessness, fretfulness, and
simple continual sickliness. No doubt, conditions defined in modern times such as autism, attention
deficit disorder, and other mental dysfunctions and psychological conditions have the potential of being
classified, from the Chinese traditional perspective, as due to soul-loss or soul-disturbance. In China,
that was a widespread scare in 1768, in which it was thought that sorcerers were stealing the hun of
numerous people (and using the power of the dissociated hun for their own purposes).
The po could depart, or fail to be given sufficient rest and comfort, because of fright, deficiency of the
jing, or constraint of the lung qi (perhaps due to excessive grief or sadness). In such a case, a person
might suffer from weakened sensory ability, distress of the limbs (such as numbness), or might lose
control of the feces (as the rectum was thought to be regulated by the po; the anus was known in earlier
times as pomen: po gate). In the book Classic of Categories (1624), it is said that "Po moves and
accomplishes things and pain and itching can be felt." Thus, from a diagnostic point of view, pain,
numbness, and itching (as well as other sensory disturbances) and/or experience of serious elimination
disorders (debilitated intestinal function) might indicate a distress of the po.
At death, the hun, being of yang nature, departs immediately, but the po, being of yin nature, departs
more slowly. For some time, there were Chinese rituals, practiced at the time a person lost
consciousness or died, attempting to call back the hun, so that it might reunite with the po, thereby
restoring life and consciousness. It was also thought that if a person experienced a sudden and violent
death, the po and hun might not be satisfied in simply dissolving into earth and heaven, but rather
remain close by, as malevolent ghosts (gui). Such ghosts were thought to be able to cause accidents to
happen and illnesses to arise seemingly out of nowhere.
Detail section of the painting "The Five Hundred Arhats," by Wu Pin (1601) from the book Eight
Dynasties of Chinese Paintings (1980 Cleveland Museum of Art). As explained in Chapter 2, the
Arhats, commonly called Luohan in China, are Buddhist sages who share many ideals with the Taoists.
One of the ideals is the natural state of mind, in which thoughts and ideas flow like water around
obstacles, represented by the stones in the stream of this painting. The Arhats are crossing a turbulent
section of the stream by making good use of those same obstacles, turning them to their advantage. The
characters on either side have a calm and relaxed demeanor; those who are crossing the river are
concentrating on the task at hand, which will soon be gone, just like the water rushing down the stream,
and they will continue on with their journey. Two of the Arhats are crossing right, two are crossing left,
and two are enjoying the experience as they pause on stones in the middle of the stream.
Chapter 2
A Mind that is Free

Going with the Flow of Nature

In order to better understand the Chinese therapeutic approach to disorders of the shen, we have to first
examine in greater detail the Chinese concept of healthy spirit. This concern falls into the realm of
philosophy and religion, because it involves the correct ordering of one's thoughts, desires, goals, and
methods. Who is to determine what is correct? The answer is in the messages attributed to god or to
sages. In this chapter the Taoist (pinyin: Daoist) approach to spiritual health is the focal point, but it is
necessary also to mention Buddhism, which (in China only) is closely related, and also to briefly
mention Confucianism; these also have had an influence on traditional Chinese medicine. Most patients
visiting Western practitioners of Chinese medicine are not familiar with these Asian religions, at least,
not in detail. The medical doctor, acupuncturist, or other practitioner trained in the West is rarely in a
position to relay the basic concepts of Asian spirituality except to the extent that they might be
integrated into his or her therapeutic style (choices of questions to ask the patient; ways of answering
patient questions; medical interventions and life style changes to recommend). Rather, most patients
(and physicians) will have come from a Judeo-Christian background or a non-religious secular
humanist background, which was derived from it. Many of the Taoist, Buddhist, and Confucian ideas,
particularly those about recommendations for living properly in society, are consistent with the Western
ideas, though the points of emphasis differ.
To help draw attention to the fact that these philosophical-religious concepts influence Chinese medical
therapeutics, we can consider the name given to a popular herb formula that is used for, among other
things, mental distress, depression, and anxiety: Xiao Yao San. The title given to the herb prescription
makes reference to the unfettered wandering of the Taoists who prided themselves in being in tune with
the movements of nature, living in harmony with the seasons, and in balance with the qi of the earth.
The corresponding acupuncture point is taichong (LV-3), which is widely used today for depression,
frustration, pent-up feelings, irritability, and mood swings; to match the herbal formula Xiao Yao San,
that point would be combined with sanyinjiao (SP-6) to strengthen the center while freeing up the
circulation of qi. There will be more about the herbs and acupuncture points in later chapters. First, it is
necessary to consider the underlying concepts.

Taoist Wandering: A Mind that Is Free

The fundamentals of Taoism are described in the book Tao Te Ching (pinyin: Dao De Jing), attributed
to the legendary Lao-tzu (pinyin: Laozi). It is the most widely translated book from Asia. To study this
work involves considerable time and effort; the following discourse is aimed at helping the reader
understand some of the main points that are relevant to the issues of spiritual health.
In chapter 8 of the 81-chapter work (a chapter being only a few sentences long), the Tao is likened to
water. The translations vary among the popular English language versions (1-4), but a rendering that
captures the essence of all of them is this one (5):
The highest good is like water; water is good at benefiting the ten thousand things and yet it has
tranquility [does not compete with them]. It dwells in places the masses of people detest, therefore it is
close to the Way [Tao].
There are three key elements of this saying about water as a depiction of the Tao: water is positive
(good, beneficial); it can flow without striving or competing, remaining tranquil; and it enters places
that people would usually avoid. The way water flows around obstacles, as observed when watching a
mountain stream, has been taken by many readers of this ancient book as an emblem of the proper way
the mind should deal with the difficulties it encounters. Joining the flow of Tao, where ever it may go,
leads one to unusual places, but places meant to be visited by those who have devoted themselves to
the Tao. People detest the places not because they are bad but because they are not familiar; they are
held back by fear of the unknown, not trusting in the Tao. Fear is the emotion that ultimately causes the
most difficulties. Going into nature and observing the flow of streams is, in itself, one of the natural
remedies for a troubled mind. Learning to move gracefully around obstacles is one of the aims of
practicing Tai Qi Chuan (pinyin: Tai Ji Quan).
The philosophy of Taoism was elucidated further by Chuang-tzu (pinyin: Zhuangzi), who is believed to
have lived around 365-290 B.C. (Taoism is sometimes referred to as the Lao-Chuang philosophy).
While Lao-tzu focused a large part of his description on the way in which rulers should properly rule
their people, Chuang-tzu gave a more personalized account of Taoism suited to the individual. A record
of Chuang-tzu's teachings, simply called the Chuang-tzu, was recorded around 310 A.D. by Guo Xiang
in a form similar to that which exists now. By that time, Taoism had become a major force in Chinese
society. It had influenced Chinese herbalists, many of whom were Taoist alchemists seeking
immortality. They used a variety of means to attain their goal, including meditation, special exercises
that were later to become the familiar chi-kung (pinyin: qigong), and ingestion of various alchemical
substances, some of which became important in herbal remedies (and, unfortunately, often included
poisonous components).
The first chapter of the book of Chuang-tzu's teachings (6) is titled Xiao Yao; this has been translated as
"Wandering Boundless and Free." Xiao has the meaning of free and unrestrained; yao has the meaning
of distant; thus, the term implies going a long distance without restraint. The chapter is comprised of
short sayings or stories (in English translation, each is about 50-100 words) that encourage the reader to
be free of rigid concepts. These sayings, steeped in Chinese mythology and culture, are often difficult
for Westerners to interpret; one that is relatively easy to understand is about Lieh-tzu (pinyin: Liezi), a
third author associated with books of Taoist sayings:
Lieh-tzu rode the wind and set out, boundless and clear, returning after only 15 days. To be so blessed
is rare-and, yet, however free that wind made him, he still depended on something. But, if you mount
the source of heaven and earth and the ten thousand changes, if you ride the six seasons of qi in their
endless dispute-then you travel the inexhaustible, depending on nothing at all. Hence the saying: 'The
realized remain selfless; the sacred remain meritless; the enlightened remain nameless.'
The key is to depend on nothing at all, that is, to be free of all rigid concepts, attachments to material
goods, positions of recognition, and all obstructions to movement through life, to have one's mind and
body move according to the Tao, often translated as the "Way." The realized Taoist becomes selfless
(helpful to others but not concerned about receiving rewards and praise, hence meritless and nameless).
In this description, it is said that to set out boundless and clear (free) is a rare and blessed thing. This
roaming is not referring to actually traveling about the countryside (which is an external practice that
mimics what happens inside); it refers to what goes on within the mind, either during meditation or in
daily life. This story by Chuang-tzu reflects the words found in Chapter 25 of the Tao Te Ching, where
the Tao is depicted this way (3):
I do not know its name, call it Tao. For lack of a better word, I call it great. Being great, it flows. It
flows far away. Having gone far, it returns....Man follows the earth; earth follows heaven; heaven
follows the Tao; the Tao follows what is natural.
As in the Chuang-tzu story, there is movement going away and coming back, and it is a long distance
(in the story, 15 days in roundtrip being a short journey); the ultimate leader in the journay is that which
is natural. Another telling passage in Chuang-tzu's chapter titled Xiao Yao is this small debate between
Chuang-tzu and Hui-tzu (pinyin: Huizi). Hui-tzu was a contemporary of Chuang-tzu who held a
contrary and competing philosophical view based on rationalism:
'I have a big tree,' said Hui-tzu to Chuang-tzu. 'Its huge trunk is so gnarled and knotted that no
measuring string can gauge it, and its branches are so bent and twisted they defy compass and square. It
stands right beside the road, and still carpenters never notice it. These words of yours [referring to the
stories of Chuang-tzu recorded in this chapter], so vast and useless, everyone ignores them the same
way.'
Chuang-tzu replied [after giving examples of his point]: 'Now, you've got this huge tree, and you
agonize over how useless it is. Why not plant it in a village where there's nothing at all, in a land where
emptiness stretches away forever? Then you could be no one drifting lazily beside it, roam boundless
and free as you doze in its shade. It won't die young from the axe. Nothing will harm it. If you have no
use, you have no grief.
The tree that is logically useful (its wood is desirable) will be cut down; the tree that is logically useless
(its wood too gnarled to be of value) is spared. So, which is better? To be useful or useless? And who is
to decide whether something is useful: the gnarled tree serves just fine for shade and is not in danger of
being cut down for its wood. In Chapter 22 of the Tao Te Ching, Lao-tzu says (3):
Wise men embrace the one, and set an example to all. Not putting on a display, they shine forth; not
justifying themselves, they are distinguished. Not boasting, they receive recognition, not bragging, they
never falter. They do not quarrel, so no one quarrels with them.
The tree, in the story above, may be huge, but carpenters never notice it. The Taoist is likewise
unnoticed because he does not try to call attention to himself; not calling attention to himself, no one
quarrels with him. But, this does not mean that he is without value. Like the Tao, he is "great," like the
tree, he can provide welcome relief (shade) and a break from desolation (absence of wisdom and
virtue). He is not so useless after all. How many people fret over not being as "great" as another or as
they dream to be, feeling depressed about it, yet can do things that are truly important for another
person, and so they are doing their part?
Zhi Dun (314-366 A.D.) introduced Buddhism, a philosophy based on the avoidance of rigid, limiting
concepts, to Taoist China. In his commentary about the book of Chuang-tzu, one passage survives to
the present; it is about Xiao Yao (7):
Free and easy wandering refers to the mind of the perfected. When Chuang-tzu talks about the Great
Tao, he uses the analogy of the Peng bird and the quail. Because the Peng's life is without obstruction,
the bird is free from all limitation in the realm beyond the body. The quail, on the other hand, because it
lives in the near and scorns the far, it is limited and obstructed in its mind. The perfected one rides the
truth of heaven, soars aloft, and wanders boundlessly in unfettered freedom. He treats beings as beings-
without being treated as a mere being himself. He is not self-satisfied in his wandering. Mystically one
with the universe, he does not act purposefully. He is not hurried, yet moves swiftly. He goes
everywhere in his freedom. He is truly a free and easy wanderer.
In the book Road To Heaven: Encounters with Chinese Hermits (8), Bill Porter relays this poem by
Wang Wei (699-761 A.D.; see inside cover), a Taoist who lived in Chungnan:
In my prime, I loved the Way;
a Chungnan cottage in old age.
When I want to roam alone,
wonders are wasted all on me.
Hiking to the river's source,
sitting, watching clouds arise.
Sometimes with an old recluse,
talking, laughing, free from time.
The "Way" or Tao is freedom from worries about time (meaning worries about accomplishments that
will be recognized by others), with a life that appears leisurely, like that of a butterfly fluttering here
and there. However, to attain the state of true freedom, each individual must cultivate the proper
attitude: to overcome the tendencies of striving for reward and resisting obstacles that seem to stand in
the way. In the Tao Te Ching (chapter 48) it is said: "The world is ruled by letting things take their
course, it cannot be ruled by interfering." Letting things take their course is often described as "being in
harmony with nature." Harmony with nature requires yielding, but it results in great things. If this were
the totality of the teaching, the Taoist would seem rather irresponsible. However, this is one part of the
teaching; the other part provides for a certain grounding.
The study of this first aspect of Taoism is supposed to help one overcome the ingrained personal
approach of clashing with-rather than flowing around-a difficulty that is encountered, typically a
difficulty that is placed by one's own mind. The lack of freedom of the mind influences the person's
flow of qi and blood, causing it to flow erratically and bind up; the bodily condition, in return,
contributes to stagnant or erratic mental function, with the potential for continued worsening of the
total condition. In the Chinese model of health and disease, the free flow of qi and blood is the
requirement for health and the obstructed flow of qi and blood is a cause of disease (there are other
causes, such as deficiencies and excesses). The obstruction of circulation corresponds to both a
physical stagnation (repression of natural movement) and the psychological condition we call
depression, the sense of inability to move and change to overcome obstacles. The great herbal teacher
Zhu Danxi said (10): "So long as the qi and blood enjoy harmonious flow, none of the hundreds of
diseases can arise. Once they are depressed and suppressed, various diseases are produced."

Basics of Taoist Action: Doing while not Doing

Another aspect of the Taoist teaching, ultimately related to the freedom described above, but having a
different starting point, may prove more practical: it answers a question about how humans live
together, not just with nature, but with each other. Further, in addressing this issue, Taoism teaches how
to manage one's own mental proclivities.
The underlying principle regarding actions presented in the Tao Te Ching is that one should take care
of things that are in need of doing, and then move on to the next thing that needs to be done, without
any attachment to the accomplishment of the first or the potential outcome of the next. By avoiding any
"attachment to the accomplishment" it is meant that one should not dwell upon such things as taking
credit for it, accumulating rewards (including material things and power), or spending time with
retelling it in order to get recognition.
Along these lines also, with regard to one's work, do not bother doing things other than what needs to
be done. For example, one should not spend time at efforts that are aimed specifically at collecting
wealth, accumulating power, or gaining praise, or even bothering others by taking up their time with
unnecessary things. Moving from one moment to the next, taking care of what is necessary, and not
straying from that, is the Way. So long as one follows this teaching, things will progress smoothly; but
as one deviates from this pattern, obstacles and heartaches arise. Because one does not dwell upon
accomplishments nor make efforts to gain things, it is said that "nothing is done." It should be
understood, however, that this does not mean simply sitting lazily, avoiding doing anything or skirting
obvious responsibilities; something is done, just not specially recognized as such. Also, in the absence
of striving after wealth, power, or praise, one may come by it naturally, which brings its own
requirements for action; these outcomes aren't necessarily bad, just not suitable as a goal in themselves.
These spiritual messages may be particularly relevant to the ordinary conditions that affect people
today. The Taoist belief is that one will suffer from not following this teaching; since this is about a
way of being, not just a response to any individual event or undertaking, a person who fails to follow
the Tao may continually behave in a way that causes distress; a potential source of a serious mental
disorder.
Here are some sample quotations about the proper way of living (3).
"Creating, yet not possessing. Working, yet not taking credit. Work is done, then forgotten. Therefore, it
lasts forever." (chapter 2).
"If nothing is done, then all will be well." (chapter 3)
"The sage stays behind, thus he is ahead. He is detached, thus at one with all. Through selfless action,
he attains fulfillment." (chapter 7)
"Amass a store of gold and jade, and no one can protect it. Claim wealth and titles, and disaster will
follow. Retire when the work is done. This is the way of heaven." ["Retire when the work is done" here
means that one should not try to make anything further of the accomplishment.] (chapter 9)
"Giving birth and nourishing, bearing yet not possessing, working yet not taking credit, leading yet not
dominating, this is the primal virtue." (chapter 10)
"Surrender yourself humbly; then you can be trusted to care for things. Love the world as your own
self; then you can truly care for all things." (chapter 13)
"Who can remain still until the moment of action? Observers of the Tao do not seek fulfillment, not
seeking fulfillment, they are not swayed by desire for change." ["Remain still" here means that one is
not constantly pursuing selfish fulfillment between the actions that are essential.] (chapter 15)
"Wise men embrace the one and set an example to all. Not putting on a display, they shine forth; not
justifying themselves, they are distinguished; not boasting, they receive recognition; not bragging, they
never falter." (chapter 22)
"He who stands on tiptoe is not steady; he who strides cannot maintain the pace; he who makes a show
is not enlightened; he who is self-righteous is not respected; he who boasts achieves nothing; he who
brags will not endure. According to followers of the Tao, 'these are extra food and unnecessary
luggage.' They do not bring happiness, therefore followers of the Tao avoid them." (chapter 24)
"Achieve results, but never glory in them. Achieve results, but never boast. Achieve results, but never
be proud. Achieve results, because this is the natural way." (chapter 30)
"A truly good man does nothing, yet leaves nothing undone. A foolish man is always doing yet much
remains to be done." ["Always doing" here means that he is wasting time doing unnecessary things.]
(chapter 38)
"The sage works without recognition. He achieves what has to be done without dwelling on it. He does
not try to show his knowledge." (chapter 77)

The Things to Be Done and the Way to Do Them

The above teachings tell about one's attitude in work. What is the nature of the actions, the things to be
taken care of? How is one to know what is needed and what ought not to be done? What is one to be
like in day-to-day affairs? As the following quotes display, one can know what to do by focusing
attention on such virtuous things as gentleness, kindness, truthfulness, competence, alertness,
simplicity, yielding (rather than obstructing), constancy, openheartedness, caring, perseverance,
willingness to take on difficult tasks, mercy, economy, generosity, humility, gentleness, meditation, etc.,
and avoids such things as extremes, excesses, complacency, abandoning those in need, trying to do too
much at once rather than take the small steps that are necessary, ignoring what is known, having desires
for unnecessary things, and rigidity in ideas, as well as avoiding those concerns described earlier, such
as boasting, accumulating wealth and power, and seeking rewards.
Here are some sample quotations (3). One of the great teachings is the last one listed here, from chapter
81, about giving of oneself for others.
"In dwelling, be close to the land, in meditation, go deep in the heart, in dealing with others, be gentle
and kind, in speech, be true, in ruling, be just, in business, be competent, in action, watch the timing."
(chapter 8)
"Alert, like men aware of danger, courteous, like visiting guests, yielding, like ice about to melt,
simple, like uncarved blocks of wood...." (chapter 9)
"Knowing constancy is insight, not knowing constancy leads to disaster. Knowing constancy, the mind
is open; with an open mind, you will be openhearted. Being openhearted, you will act royally. Being
royal, you will attain the divine. Being divine, you will be at one with the Tao." (chapter 16)
"The sage takes care of all men and abandons no one. He takes care of all things and abandons
nothing." (chapter 27)
"The sage avoids extremes, excesses, and complacency." (chapter 29)
"Perseverance is a sign of will power. He who stays where he is endures." (chapter 33)
"The truly great man dwells on what is real and not what is on the surface." (chapter 38)
"There is no greater sin than desire, no greater curse than discontent, no greater misfortune than
wanting something for oneself. Therefore, he who knows that enough is enough will always have
enough." (chapter 46)
"All things arise from Tao. By virtue they are nourished, developed, cared for, sheltered, comforted,
grown, and protected." (chapter 51)
"Keep your mouth shut, guard the senses, and life is ever full. Open your mouth, always be busy, and
life is beyond hope."(chapter 52)
"Cultivate virtue in yourself and virtue will be real; cultivate virtue in the family, and virtue will
abound; cultivate virtue in the village, and virtue will grow...." (chapter 54)
"Knowing harmony is constancy, knowing constancy is enlightenment." (chapter 55)
"In caring for others and serving heaven, there is nothing like restraint. Restraint begins with giving up
one's own ideas. This depends on virtue gathered in the past. If there is a good store of virtue, then
nothing is impossible." (chapter 59)
"Reward bitterness with care. See simplicity in the complicated. Achieve greatness in little things. In
the universe the difficult things are done as if they are easy. In the universe, great acts are made up of
small deeds. The sage does not attempt anything very big, and thus achieves greatness. Easy promises
make for little trust. Taking things lightly results in great difficulty. Because the sage always confronts
difficulties, he never experiences them." (chapter 63)
"The sage seeks freedom from desire. He does not collect precious things. He learns not to hold on to
ideas. He brings men back to what they have lost." (chapter 64)
"From mercy comes courage; from economy comes generosity; from humility comes leadership."
(chapter 67)
"Knowing ignorance [knowing that you are ignorant] is strength; ignoring knowledge is sickness."
(chapter 71)
"A man is born gentle and weak; at his death he is hard and stiff. Green plants are tender and filled with
sap; at their death they are withered and dry. Therefore, the stiff and unbending is a disciple of death;
the gentle and yielding is a disciple of life." (chapter 76)
"The sage never tries to store things up; the more he does for others, the more he has; the more he gives
to others, the greater his abundance." (chapter 81)
Many of the recommendations of the Tao Te Ching may seem obvious. Yet, even those who have
achieved great equanimity know that one can again and again experience failings, and thus, must be
reminded and brought back to what has been lost. As it is said in the Tao Te Ching (chapter 78):
"Under heaven everyone knows this; yet no one puts it into practice."

Linking Taoism and Buddhism

Taoists, when confronted with a rise in devotion to Buddhism in China, eventually adopted it as part of
their own philosophical base. As Taoist Master Yang at the Baxianggong (Eight Immortals Temple,
Beijing) said recently (8):
Buddhists and Taoists walk the same path. They just dream different dreams. Essentially, Buddhism
and Taoism are the same. Their sacred texts talk about the same things. It's just that Taoism emphasizes
life, and Buddhism emphasizes nature. But people who truly cultivate, cultivate both. In terms of actual
practice, Buddhism is somewhat better than Taoism. Even though Taoists talk about cultivating their
mind, they often have a harder time controlling their emotions. They have a harder time suppressing
feelings of pride. But to cultivate either of them successfully is very hard."
To say that "Buddhism emphasizes nature" and that "Buddhism is somewhat better" are remarkable
statements from a Taoist. Yet, he has hit upon one potential pitfall: feelings of pride. Because the
Taoists have invested heavily on developing certain talents (e.g., physical disciplines, some aimed at
longevity), they may forget the basic teaching and take pride in their accomplishments.
The Tao Te Ching is thought to have originated from teachings given sometime around the 4th century
B.C. According to legend, during his travels to the west, Lao-tzu gave the written teachings to Yin Xi,
the guardian of the Hangu Pass, who preserved them. The origins of Buddhism are usually traced to
Shakyamuni (Siddharta, Gautama), an Indian prince who renounced his royal inheritance and pursued a
path of asceticism (which nearly killed him) and then found a path of balance (the middle way). This
led, ultimately, to full enlightenment that was attained during prolonged meditation, throughout which
he faced the demons of mundane consciousness. His enlightenment consists of an egoless state, where
calm prevails. The philosophy of Buddhism was presented in the form of discussions between Buddha
(as the enlightened former prince became known) and his disciples in documents called sutras
(teachings, discourses, sermons). The earliest of these are traced back to around the 4th century B.C.
Among the most important of ancient texts are the Lotus Sutra, Heart Sutra, Avatamsaka Sutra, and
Diamond Sutra (the latter considered especially important in bringing Buddhism to China).
Although Buddhist scholars don't agree, and certainly people of India won't agree, many Taoists believe
that Lao-tzu was, in fact, one and the same man as Buddha, or, at the very least, was the actual
originator of Buddhism. There is a story that Lao-tzu traveled west, following the Changnan Mountain
range, and reached India where his teachings were received as Buddhism. It is also told that Lao-tzu,
not as a man, but as a holy immortal, was able to make Yin Xi (recipient of the Tao Te Ching
manuscript) appear as the Buddha to the "barbarians" in India, where the teachings were transmitted. In
this way, Buddhism is seen in China as nothing more than a foreign sect of Taoism.
The close connection between Taoism and Buddhism is still perceived by some Taoists. In 1995,
Shambhala Publications produced a book called Huahu Ching: The Later Teachings of Lao Tzu (9).
This version of the Huahu Ching is nothing other than The Diamond Sutra even though there is no
mention of that title, followed up with several pages of unique Taoist writings. Hua-ching Ni, its
translator, who claims to be part of a 2,000 year old lineage of Taoist masters, says that the original text
of the Huahu Ching was lost and has been passed on by oral tradition, a tradition of which he is a
recipient. In the book, the transformation of Siddhartha to the Buddha is described thus: "Rejecting his
position as crown prince, he went into the mountains and cultivated the Tao. He realized the highest
Tao and duly was called the Buddha."
Bill Porter, in his talks with mountain-dwelling hermits, found plenty of Ch'an practitioners (as Chinese
Buddhists are called) living alongside the Taoists hermits. One of the Taoists he interviewed, Jen
Fajung, abbot of Loukuantai, said this (8):
Taoists and Buddhists seek that which doesn't change. This is why they don't seek fame or fortune.
They seek only the Tao, which is the nothingness of which we are all created and to which we all
return. Our goal is to be one with this natural process.
For several centuries, China grappled with the question of whether Taoism or Buddhism should be
officially sanctioned: which one was the best? This question also raised the concern of how
Confucianism, which was deemed clearly different than the closely related pair of Taoism and
Buddhism, would fit in. As Livia Kohn relays in her book Early Chinese Mysticism (10):
In the fourth century, Chinese literati integrated Buddhism in an encompassing "harmony among three
teachings." The chief exponent of this integrationist view was Sun Chuo (ca. 310-390 A.D.), who
combined Confucian social responsibility, the Lao-Zhuang [Taoist Canon] ideal of contemplation, and
Buddhist enlightenment. In the fifth century, the first wave of court debates took place in south
China....Following Sun Chuo's line of reasoning, Zhang Rong contended that both teachings [Taoism
and Buddhism] were fundamentally identical. Both court factions should therefore have equal say in
matters of state. The Buddhist Zhou Yong countered this argument by referring to the association of
Taoism with the Great Peace of 184 A.D. [Great Peace refers to a Taoist movement: using predictions
based in Taoists texts, the followers staged a rebellion that lasted over a decade; this rebellion was the
"beginning of the end" of the Han Dynasty, which collapsed in 220 A.D.]. Contrary to this lowly
heritage, he claimed Buddhism was lofty and of high quality.
Gu Huan, in his Yixia Lun (On Barbarians and Chinese) of the year 467 A.D., argued that Buddhism
was quite suitable for barbarians, while Taoism was the proper teaching for the Chinese. [He argued
also that:] Buddhism was concerned with salvation of the spirit, was second hand, did not involve filial
piety [a key aspect of Confucianism], and contains complex and abstruse ideas; by contrast Taoism was
concerned with longevity of the body, original, very filial, and straightforward, concrete, and
practical....In the sixth century, a second round of debates-now growing increasingly polemical-was
staged at the Northern Wei court. In 520 A.D., the Taoist Jiang Bin and the Buddhist Tan Muzui argued
the seniority of their teachings in the presence of the emperor. They concentrated on the problem of
dating. If Laozi went west to convert the barbarians and become the Buddha, he must have left China
earlier than the recorded birth of Buddha in India [which doesn't agree with the reported dates]…..the
Buddhists emerged victorious from this phase of the debate and thereby gained influence at the court....
The debates went on for centuries more. Taoism and Buddhism have remained intertwined in China
ever since.
Buddhism has had some influence on herbal use in China. For example, the development of the popular
herb heshouwu (Polygonum multiflorum) is attributed to a Buddhist priest who knew Mr. He, the man
who first took the herb and found its miraculous properties. Its pair of intertwined vines were thought
by some to represent the close linkage between Buddhism and Taoism. The fruit luohanguo was
developed into a medicinal agent by Buddhist monks. During the Tang Dynasty, Guilin (where this fruit
originated) was a major Buddhist retreat area with many temples. The fruit was then named after the
Luohan, which are advanced Buddhist practitioners (in India, they are called Arhats; see illustration).
Buddhism is an approach to life that posits the primacy of mind. Its doctrine considers the disturbance
of mind by attraction, revulsion, and confusion, to be the primary spiritual disorder which leads one to
suffering. Therefore, calming the mind, particularly by meditating, is the most important means of
gaining health of the spirit. Living a moral life is understood to be a means of not only helping others,
but also preventing situations that disturb the mind. Because Buddhist belief depicts a long cycle of
birth, death, and rebirth, it does not emphasize earthly immortality, and also places less emphasis on
maintaining bodily health than do the Taoists. Buddhism puts greater emphasis on calming the
emotions and stabilizing the body so that prolonged meditation is possible.

Confucianism
Confucianism predated both Taoism and Buddhism and is attributed to Kung-fu-tze (pinyin: Kong
Fuzi) whose name was Latinized to Confucius. Confucianism is a complex system of moral, social,
political, and religious teaching aimed at making men worthy of respect. Confucius' ideal person, the
junzi, is not simply the man of virtue, but the man of learning and of good manners. The perfect man
must combine the qualities of saint, scholar, and gentleman. The key element, though, is his moral
force.
There is a well-known Chinese herb formula named for the gentleman described by Confucius, called
Si Junzi Tang; the "Four Gentleman Decoction." This name was given because of the great respect held
for the four major ingredients, as well as for the valuable action of this formula in rectifying the
person's "center" to aid restoration of health. In the book, Confucius Lives Next Door (11), T.R. Reid
describes the term junzi this way:
It is written with two characters that mean royal [jun] and person [zi]. This tells us that traditionally
junzi referred to a prince, an aristocrat, someone who obtained a position of stature and power through
birth. Confucius accepted the basic principle that certain people have the right to hold elite positions,
but then he completely changed the rules for joining the ranks of the elite. To Confucius, the junzi-the
term has been variously translated as "the noble man," "the superior man," the "gentleman"-was a
person who had earned elite status. To be a gentleman, a person had to spend a lifetime studying and
following the rules of virtuous conduct. Just being born right was not enough.
Confucianism laid the way for the development of Taoism by emphasizing the character of the ideal
man. However, Confucianism had the tendency to fall into the nature of a legalistic approach, where
one followed certain rules of behavior, but did not necessarily have the inner nature that would lead to
good results, so the Taoists countered by proclaiming freedom from such rules, emphasizing the
cultivation of the ideal inner condition in harmony with nature. Confucianism itself appears to have
arisen as a move away from an earlier belief system in which a heavenly god ruled over humans. Thus
Confucius shifted the burden of moral behavior to the set of rules, particularly about social and family
relationships. In recent times, the influence of Confucianism on society was best seen in Japan, where it
had been introduced from China around the 12th Century.

References
1. Wu JCH (translator), Tao Teh Ching, 1961 St. John's University Press, New York, NY.
2. Kwok, MH, Palmer M, and Ramsay J, The Illustrated Tao Te Ching, 1994 Barnes and Noble
Books, New York, NY.
3. Feng GF and English J, Tao Te Ching, 1972 Vintage Books, New York, NY.
4. Porter B (aka Red Pine), Lao-tzu's Taoteching, 1996 Mercury House, San Francisco, CA.
5. Henricks RG, Lao-Tzu Te-Tao Ching: A New Translation Based on the Recently Discovered
Ma-Wang-Tui Texts, 1989 Ballantine Books, New York, NY.
6. Hinton D, Chuang Tzu: The Inner Chapters, 1997, Counterpoint, Washington D.C.
7. Kohn L, Early Chinese Mysticism: Philosophy and Soteriology in the Taoist Tradition, 1992
Princeton University Press, Princeton, NJ.
8. Porter B, Road to Heaven: Encounters with Chinese Hermits, 1993 Mercury House, San
Francisco, CA.
9. Hua-Ching Ni, Hua Hu Ching: The Later Teachings of Lao Tzu, 1995 Shambhala
Publications, Inc., Boston, MA.
10. Kohn L, Early Chinese Mysticism, 1992 Princeton University Press, Princeton, NJ.
11. Reid TR, Confucius Lives Next Door, 1999 Random House, New York, NY.
Chapter 3
Emotional Equilibrium
Relax, Be Healthy, Have a Long Life
Emotions often seem to behave like the weather: somewhat unpredictable and beyond control. In the
West, there has been considerable concern about the social and relationship problems associated with
pent-up emotions (particularly in women) and with habitual non-expression of emotions (particularly in
men), so that the very concept of "controlling" emotions is looked upon with suspicion. By contrast,
keeping emotions within certain reasonable bounds is an issue at the forefront of Asian religions and
healing arts; the primary concern there is adopting habits that help one to remain relatively calm. When
tranquility of mind is attained, emotions do not vanish: they are still experienced and expressed, and
emotions remain unpredictable, but their intensity is usually lessened and their potential impact on both
physical and mental health is curtailed. The emotional equilibrium that is desired by the Asian
philosophy translates to spiritual freedom and the ability to flow with nature, as described in the
previous chapter. Many people today have looked to Asia for help in this area, though too frequently
the simple methods advocated there are ignored, with more interest shown in those methods surrounded
by mysticism.
This subject of emotional calm has been an important topic in the field of Chinese medicine. Based on
a long history of seeking good health and longevity, there are specific means of attaining balance and
harmony for emotions that have become incorporated into the Chinese culture, at least for those who
show interest in it. An example of the Chinese approach to having a healthy emotional life is presented
in The Mystery of Longevity by Liu Zheng Cai (1):
The Canon of Medicine (Nei Jing) advises, in summing the experiences of centenarians in remote
times: 'Do not be weighed down by perplexing thoughts; strive to be calm and optimistic; be
complacent [calm in the face of situations that can cause anger]; keep sound in body and mind. This
way, one can live to the age of 100.' The Canon of Medicine recognizes that emotional and
psychological factors are important causes for illness. It indicates that excessive emotion impairs the
internal organs of the human body. 'Anger hurts the liver, joy hurts the heart, brooding hurts the spleen,
and melancholy hurts the lungs.' Hence, it proposes regulating the emotions by 'keeping the heart calm
and cheerful and the mind free of worries.' 'Where can disease come from when the emotional state
maintains inner composure?' Scholars on the art of healthy living in subsequent generations set forth
many specific methods of maintaining optimism in accordance with this principle.
A project of The All-China Association of Traditional Chinese Medicine in the 1980s led to publication
of the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine, published as a 20
volume set. Volume 9 is dedicated to "Maintaining Your Health;" the first chapter begins with mental
health care, and the first section deals with "being open minded and optimistic." The section is
presented here; it represents an overview of the traditional literature on the subject (2):
As the proverb goes, 'Optimism will help you forget sorrow.' An optimistic stable mood and good
mental balance will calm the vital energy and spirit, aid the circulation of blood and qi, and improve
health. The ancient book Guan Zi states, 'The quality of one's life depends on maintaining a positive
happy state of mind. Anxiety and anger lead to confusion of the mind. There can be no mental balance
when anxiety, grief, joy, and anger exist. Thus, desire should be subdued, and disorder be checked.
Happiness and luck will arrive on their own if there is no disturbance of mind.' The book Nei Jing also
points out that one should strive for tranquility and happiness, remaining free from anger, resentment,
and troubled thoughts. It indicates that by avoiding angry moods and a troubled state of mind and by
cultivating tranquility, optimism, and happiness, one will obtain longevity with a sound body which
will not be easily degenerated and with a sound mind which will not be easily distracted. The book
Huai Nan Zi advocates 'happiness and cheerfulness,' which is said to be part of human nature. The
book Zun Sheng Ba Jian also maintains that to tranquilize the mind one should have a happy mood.
These statements indicate that good health is always based on happy and tranquil moods. To keep a
happy mood, one must have a noble spirit, high ideals, an expanded outlook, a sanguine and lively
disposition, and an open and broad mind. While dealing with daily affairs and people, one must not be
disposed to feeling extremely depressed from personal losses. As is said in the book Ji Zhong San Ji,
'Cultivate a good temperament for the sake of mind; tranquilize the mind for the sake of life; avoid
emotional extremes and adopt a care-free attitude.' If one can achieve such equanimity, he will be safe
from unnecessary worries and enjoy an undisturbed mind and a sound body.
Also, to keep a happy state of mind, one should be able to tackle a problem in a composed manner. As
the book Sou Shi Qing Bian says, 'Don't worry about a problem before it has actually manifested don't
worry too much after it has existed, and don't cling to what has already passed; instead; one should
adopt a detached attitude towards coming or going, leaving it alone and checking all emotions such as
anger, fear, desire, joy, and anxiety. That is the way to health and longevity.'
Happiness lies in contentment, which is important not only for physical and mental health, but also in
keeping a happy mood. The book Dao De Jing says, 'There is no sin greater than discontent, and no
error greater than covetousness.' Therefore, knowing what contentment is means constant satisfaction.
The book Zun Sheng Ba Jian maintains, 'Contentment will bring neither abuse nor danger.' Both
statements express the ideal that lasting happiness can be achieved only through contentment. In our
actual life, most anxieties and worries result from going after and coveting fame, a higher status, and
material comfort. In face of such desires, one should always keep in mind: 'There are many others who
have less than I' In so doing, it will be easier for one to refrain from excessive desire and competition,
to remain content with what one has, and to be cheerful and open-minded, so that anxiety will be
expelled, tranquility of soul obtained, and the mind maintained in an optimistic and stable state.
The self-cultivation of one's sense of morality is another important method to maintain optimism, to
which the ancients paid great attention. They professed, 'The kind will enjoy longevity.' The kind here
mean all those who have a well-developed sense of morality. The cultivation of morality involves
devoted attention. The methods discoursed upon by the ancients, such as moderating desires, remaining
content, and being tolerant, kind and courteous are all essential for that purpose. They also believed: 'A
person of great morality is sure to obtain longevity.' The reason why such a person lives a long life lies
in the fact that he is 'apt to cultivate the great-qi', being broad-minded and strong willed as well as
having great ideals and aims; meanwhile, those who respect others will receive respect from others, and
those who are content will enjoy lasting happiness…all of these factors, together with tolerance and
avoidance of anxiety, contribute to a balanced mind and a cheerful mood.
One guarantee of maintaining an optimistic frame of mind is to continuously enrich one's life by
cultivating a great variety of interests and hobbies, such as reading, meeting friends, traveling, fishing,
playing chess, practicing calligraphy, painting, reciting poetry, singing, playing musical instruments,
watering flowers, growing bamboo, etc. There are many discussions handed down from the ancients,
maintaining that such activities can bring on cheerful mood and refine one's sensibility. The book Yi
Qing Xiao Lu says, 'One should always enjoy simple pleasures such as sunshine in winter or shade in
summer, beautiful scenes on a bright day, walking cheerfully with a stick, watching fish in a pond,
listening to birds singing in the woods, drinking a cup of wine or playing a stringed musical
instrument.' What is meant by this quotation is that one should relax the mind, choose and cultivate
one's own hobbies, and increase continually one's interest in life so that comfortable feelings, a stability
of mind and cheerfulness will result, all of which contribute to good health and longevity.
In short, open-mindedness and optimism are important principles in regulating the mind and in health
care. As it has been explained in the book Nei Jing: 'That is why the sages did not concern themselves
with purposeful actions. They cultivated tranquility and developed emptiness of mind. Their way of
health care brought about a substantial longevity.' This points out that those competent at health care
will not do anything they feel reluctant to do, remaining free from whimsical and improper thoughts,
keeping a cheerful and happy mood, cherishing a rich variety of interest, leading a tranquil and
undisturbed life, maintaining a mind which is relaxed, happy, open, and optimistic, this contributes to
longevity.
The book continues with some additional description and advice, with a focus on being careful about
desires, which cause disorder of the body and mind, both in distracting one from essential tasks by
trying to fulfill them and causing one anguish if they are not fulfilled. Although not mentioned in the
text, Buddhism has been one of the dominant sources of the philosophy of maintaining equanimity by
controlling desires through practicing moderation in living and meditation; Buddhism arose in response
to Indian practices that emphasized asceticism as an extreme method of overcoming desires.
The advice about controlling emotions by calming the mind presented in the Encyclopedia was further
developed and described by Yuan Liren and Liu Xiaoming of the Beijing College of Traditional
Chinese Medicine as part of their series of articles on health preservation published in the Journal of
Traditional Chinese Medicine (3). They refer to the "seven emotions" (qiqing) which are first outlined
here:

Chinese Term Typical Translation Terms

joy; also: happiness, excitement, pleasure,
Xi
elation
Nu anger; also: irritation
anxiety; also: over-thinking, pensiveness,
Si
brooding
You melancholy; also: sorrow, grief, worry, anxiety
Bei grief; also: sorrow, sadness
 Kong fear
Jing fright; also: terror
Their description of the nature of emotions and their depiction of traditional methods for dealing with
the emotions is quoted here at length. It will be noted that they have simplified and reduced the
meaning of shen to mind, in keeping with the modern Chinese avoidance of reference to spiritual
matters:
In traditional Chinese medicine, all such concepts as consciousness, feeling, and thought are referred to
as shen, meaning mind, which is considered to be stored in the heart and to govern all the activities of
the organism. Regulation by the mind is necessary in all physiological functions. In fact, the so-called
three treasures [shen, jing, qi] are: mind, essence (which constitutes the material basis of the human
body), and qi (which is the motive force of all life activities). A sound mind is considered the basis of
health and longevity; similarly, scarcity of essence, deficiency of qi, and weakness of mind are the
main causes of illness and aging. Since mind plays the role of governing life and commanding all the
physiological functions of the primary internal organs and those of the rest of the body as well, it is
easily depleted or impaired. Hence, taking good care of the mind is particularly important.
The activities of the mind can be classified into two kinds: emotional and mental. The former refers to
changes of mood, known in traditional Chinese medicine as the seven emotions, i.e., joy, anger,
melancholy, anxiety, grief, fear, and terror; while mental activities refers to consciousness and thinking.
Since the activities of the mind are the general responses of the organs in conforming with the outside
environment under the guidance of the heart, maintenance of the mind is bound to involve many
aspects, which include roughly the following: preserving the tranquil mind, easing the mind, and
regulating emotions. A brief account of these methods is given below.
Preserving a tranquil mind. Tranquil here refers to the state of mind being peaceful, tranquil, free
from excessive desires and distracting thoughts, unaffected by outside changes. Such a state of mind
will harmonize the organs and maintain a smooth circulation of qi and blood, benefiting the health.
This consists of the following aspects:
1. Minimize egoism and personal desires: Excessive egoism and unbounded desires tend to deplete
one's mentality, causing disharmony between qi and blood, and with the organs as well, inviting
disease, whereas, less egoism and desires helps remove unnecessary mental burdens, enabling
one to take a calm and nonchalant attitude toward fame, wealth, and other desires, hence, the
mental qi will be preserved and health protected. Here are two points that are essential. First,
one should be aware of the harmful effect of excessive egoism and desires so that the mind may
be rationally controlled in a tranquil state; second, one should take a correct attitude toward
personal gains and losses. An ancient book entitled Health-Preservation Skills Developed by
Taishang Laojun points out: 'Those who are expert at health preservation will always first try
to eliminate the six harmful elements, namely: fame and profit, the desire for which should be
suppressed; the desire for sex, to which one should not abandon oneself; wealth, for which one
should not be greedy; rich food, which one should not eat with abandon; unrealistic fantasies,
which should be got rid of, for they distract one's thoughts from reality and are harmful to one's
 mind; and jealousy, which should also be eliminated.' Eradication of the above-mentioned six
harmful factors has since ancient times been considered essential for health preservation and is
therefore worthy of our attention.
2. Be broadminded in conducting oneself in society: When faced with undesirable things and
situations, one should be broadminded and try to look on the bright side. In handling various
kinds of complicated problems and abrupt changes in one's daily life, a stable state of mind and
an optimistic attitude toward one's life is very good for preserving a sound mind. This includes
the following aspects: first, set a lofty goal in life-health preservation requires first and foremost
that one should cherish hopes, love life, and keep a lofty goal, a noble ideal, and sound morality,
all of which guarantees for a sound mind; second, be content and be happy, for it keeps one
satisfied with what one has, caring little about temporary setbacks and failures, and this, in turn,
will bring about both physical and mental health.
Easing the mind. Moods are the responses of people to their surroundings, and everyone experiences
the seven emotions and six desires [six harmful elements, described above]. If not properly regulated,
the emotions will cause stagnation of qi and blood, and disharmony between the organs, leading to
illness, even early death. Those who lived a long life, according to historical records, are almost all
people apt to regulate their moods, the essence of which is to cultivate the mind with virtuous and
elevated ideas and mold the temperament. Various methods have been developed and described by
people in the past, which can be boiled down to the following: creating a happy mood by engaging in a
great variety of carefree, light, and lively activities in which spirit is heightened, intelligence is
increased, muscles and tendons are exercised, and circulation of qi and blood is activated so that health
preservation is achieved in the midst of amusement and sports, achieving the aim of nurturing the mind,
strengthening the body, and prolonging life. Some traditional methods employed for this purpose
include taking up hobbies, such as playing the piano and chess; raising flowers, plants, birds, or fish;
sightseeing; and chatting with friends.
Adjusting emotions. In one's daily life, the complicated situation is bound to influence one's moods
such as from joy to anger, grief, etc. When one is in a bad or abnormal mood, one should try to adjust
and control it lest it go to an extreme. As a mental means of health care, the following methods are
used:
1. Exercising self-control: Traditional Chinese medicine holds that the seven emotions, i.e., joy,
anger, melancholy, anxiety, grief, fear, and terror, are, in the extreme, one of the main causes of
illness. Therefore, timely adjustment of one's emotions with a view to preventing them from
going to the extreme is an effective method of health preservation. Ever since ancient times,
experts in health preservation have believed that anger is the chief pathogenic factor, for great
anger may impair the liver and also affect the heart, stomach, and brain. Hence, control of anger
is an important method of adjusting the emotions. The essence is to control emotions by rational
reasoning, that is, to cultivate one's morality, train one's will, consciously control one's mood,
and overcome emotional impulses with reason. As the ancients put it: 'When faced with
something exasperating, one should calmly consider which is more important-anger or health?'
 This comparison will enable one to gradually eliminate anger.
2. Providing outlets for anger. This is to help regain one's psychological balance by finding proper
outlets for detrimental emotions accumulated in one's mind. This method can be explained in
three parts. First, direct release: When one is in great sorrow, he should have a good cry so that
he may feel comfortable after his sorrow has been fully given vent to. This is a measure
beneficial to health care; it helps regulate the circulation of qi and blood and, consequently,
prevents depression. Other measures are: a loud cry when in great pain; a thorough pouring out
of one's heart when in great anger; a deep sigh or moan when worried; or hearty singing when
in great joy. Different forms of expression are used for different emotions, all to restore the
mind to a peaceful and tranquil state. Second, there is controlled release: in contrast to direct
release, this measure stresses a controlled and gradual release of pent-up emotion in one's mind
when in bad moods. For instance, one may confide in relatives or good friends the bitterness or
grievance, or express feeling by saying poems or writing articles. The advice and consolation of
one's relatives and friends and the release of emotion will enable one to acquire psychological
comfort and support, broaden the mind, and finally become happy and at peace. This is a good
method for eliminating detrimental emotions. Third, there is the method of diverting one's
attention. This is also known as diverting one's emotion, that is, changing the focus of
excitation, the principle of which is to free a person from entangling emotions by taking certain
measures to separate oneself from harmful stimulating factors....For instance, when in great
distress or depression, one may listen to a favorite piece of music or when one is in great sorrow
following some misfortune, one may stay with relatives or good friends for a period of time; the
change of surroundings and atmosphere may divert bitter emotions, allowing one to restore
normal life after calming the mind. Or when one is afflicted by troubling thoughts, one may take
a walk so that the surroundings of nature may relax and refresh the mind, and thinking ability
will be restored.
This summation by Yuan and Liu shows that one should respond promptly and effectively to emotional
distress rather than allowing the emotions to manifest over a period of time and thus damage the whole
person, and should cultivate habits and thought patterns that help one avoid frequent experience of
emotional excess.
Shi Tianji, a scholar on the art of healthy living in the Ming Dynasty, proposed 'Six Always' for
maintaining a calm and cheerful state of mind, relayed in the book The Mystery of Longevity (1):
1. Always be peaceful in mind. Remain peaceful in mind without vain hopes. Do not covet, do not
indulge in vain wishes, do not worry about personal gains and losses. Hence, Shi Tianji said, 'If
one has few desires, his mind will naturally be peaceful. Just look at secluded hills and remote
valleys! Most people there enjoy long life spans because they have few desires and always
remain peaceful in mind.'
2. Always be kind-hearted. A kind-hearted person often takes pleasure in helping others and has no
desire to harm others. Whenever he conceives an idea, makes a remark, or does a deed, he
always ponders whether it is beneficial or harmful to others. 'When others are evil, I remain
 upright; when others are vicious, I remain kind-hearted; when others stir up troubles, I strive to
alleviate troubles; when others harm people, I serve people. If I act in this way, I shall have a
clear conscience and naturally feel calm and tranquil in mind.'
3. Always uphold justice. Distinguish between evil and virtue and between right and wrong. Virtue
and evil are antagonistic, and right and wrong are not to be confused. If one maintains his
awareness, upholds integrity, and remains clear-headed and sharp-eyed, he will naturally be free
from worries and troubles. Hence, Shi Tianji said, 'When the sun shines in the sky, obscurity is
naturally cleared away. When one grasps this miraculous concept, he will be cured of disease
and attain longevity as well.'
4. Always be cheerful. Adapt to different circumstances; feel complacent at all times; avoid
overdoing anything and do not hurt anyone's feelings. As Bai Juyi says in a poem: 'Be cheerful,
whether rich or poor; he who does not laugh can only be a fool.' One should often have hearty
laughs. A folk saying goes, 'A good laugh makes one ten years younger; worry turns the hair
gray.'
5. Always be pleasant. Harmony is paramount in human relations. Be amiable, modest and
prudent, broad-minded and magnanimous; do not be calculating and do not worry about trifles.
To be amiable in dealing with others will bring happiness to both the others and oneself.
6. Always be contented: it is a rare person who avoids all adversity. One should remain cheerful
despite adversities. Yan Feitai had a wise epigram on caring for life. 'Just step back to think
everything will naturally be all right.' 'Contentment is happiness.' Whenever this is adversity,
compare it with a worse circumstance and one will feel calm and cheerful.
Thanks to the availability of translated books, and to documents such as those quoted here, Westerners
have relatively easy access to these Oriental traditional systems of dealing with emotions; additionally,
they have other means of dealing with emotions, including their own religious heritage and established
psychological aids.
In modern Chinese work, doctors specializing in cancer therapies often comment about their sense that
emotion contributes to the health status of the patients, affecting the outcome of treatment, which is life
or death. For example, Sun Binyan writes in his book Cancer Treatment and Prevention (4):
According to our understanding of the tumor patient, most have suppression of the emotions. They tend
to hold in their anger. Although some patients have good results after treatment, emotional stimulation
may cause them to decline again and then the previous treatment would have been in vain. Some
people have a severe phobia about cancer. Before they know the real disease, they have a lot of
suspicion. Once they know they have the cancer, their whole spirit breaks down. This kind of spiritual
state is very bad for the treatment.
Pan Mingji, in his book Cancer Treatment with Fu Zheng Pei Ben Principle (5), presents a section
on etiology of cancer; he notes that (5):
A lot of evidence proves that those who are optimistic and undertake exercises [in China, this refers
mainly to taiji and qigong, along with similar types of practices, as well as hiking in the woods] tend to
have healthy and sound function of the nervous system, strong physiques, and naturally great
anticancer ability and immunity. Even if those people come into contact with outside carcinogens, they
will not develop cancer. On the contrary, those who have mental injury, who are disheartened, or often
have a fear of cancer, and who do not undertake exercises at all or are overtired, whose daily life is
irregular and unsanitary, whose spirit and nerve function is disorganized, tend to reduce their defensive
ability. As a result, the rate of cancer occurrence among those people is higher.

References
1. Liu Zheng Cai, The Mystery of Longevity, 1990 Foreign Language Press, Beijing.
2. Xu Xiangcai (chief ed.), The English-Chinese Encyclopedia of Practical Traditional
Chinese Medicine, (Vol. 9) 1989 Higher Education Press, Beijing.
3. Yuan Liren and Liu Xiaoming, Health preservation by mental means, Journal of Traditional
Chinese Medicine 1993; 13(2): 144-147.
4. Sun Binyan, Cancer Treatment and Prevention, 1991 Offete Enterprises, San Mateo, CA.
5. Pan Mingji, Cancer Treatment with Fu Zheng Pei Ben Principle, 1992 Fujian Science and
Technology Publishing House, Fujian.
Chapter 4
Acupuncture Points

Acupuncture Points for Treatment of Shen

Disorders
Practitioners of acupuncture are already familiar with the principle points indicated for shen disorders
as a result of their basic training in the field as well as information gleaned from a variety of published
reports. In addition, within a short time of developing a practice, acupuncturists may come to prefer
using certain points based on both theoretical considerations (the meridian affected, the indications for
the point, etc.) and prior experience. There are quite a few such points, so the purpose of this chapter
will be to examine some aspects of their utilization in China in order to give further insights to
practitioners. In modern Chinese reports, treatment of shen is frequently described as treatment of the
mind, or even of the brain, but this should not distract from the meaning of shen as spirit, described in
Chapter One. Points used for one condition, which might be deemed a spirit disorder, might also be
used for another condition, one attributed to a physical brain disorder. Even though the treatments
might be the same, it is not necessarily the case that the two disorders have the same underlying basis.
Some acupuncture points were named for their effect on shen disorders, such as shenmen (HT-7),
shenting (GV-24), shentang (BL-24), shendao (GV-11), shenzhu (GV-12), benshen (GB-13), and
sishensong (M-HN-1). So, these are often included today as part of a treatment based on traditional
indications for the points.
In this chapter, following a description of methodology for the source documents (which are Chinese
medical journals except one Japanese medical journal reporting on a Chinese source), the acupuncture
points of primary interest are laid out in tables. Because of the large number of points mentioned, the
reader might easily be overwhelmed by this presentation. Therefore, as a summary to this chapter, 34
key points are laid out in Table 5, grouped according to the meridians.
Researchers at the Zhejiang Academy of Traditional Chinese Medicine undertook an extensive review
of traditional medical literature and determined the acupuncture points most consistently relied on to
treat disorders of the mind and brain (1). That is, they searched for points (called, in their English
translation, "intelligence points") that were repeatedly mentioned in the traditional literature for certain
disorders, such as dementia, poor memory, and loss of consciousness.
The authors said that they "read up all the literature on acupuncture before the Ming Dynasty and most
of the relevant literature of the Ming and Qing Dynasties, and collected together 29 intelligence
points." For each of the major medical texts consulted, the authors present a listing of the points
mentioned that are relevant to treating mental conditions. For example, in the Huang Di Ming Tang
Jing, the points listed are tianfu (LU-3), lieque (LU-7), neiguan (PC-6), ximen (PC-4), yongquan (KI-
1), and youmen (KI-21). They then determined the frequency of mention of the points among all the
texts in relation to treating certain conditions (see Table 1), yielding a total of 17 points mentioned in
more than one text.
In addition to individual point recommendations, a few acupuncture formulas listed in texts were
examined. Frequency of reliance on individual points within the numerous formulas yields a somewhat
different result than examining points specifically indicated for mind-brain disorders, since formulas
are constructed with main and secondary points as well as adjunctive points. In the prescriptions, the
main points mentioned (5 times or more) were shenmen (HT-7), xinshu (BL-15), baihui (GV-20), and
lieque (LU-7). Two adjunctive points were mentioned at least 3 times: zusanli (ST-36) and houxi (SI-3).
The International Acupuncture Training Centers and other organizations in China, such as the Academy
of Traditional Chinese Medicine, compiled an acupuncture text: Chinese Acupuncture and
Moxibustion (2), published in 1987. In the section on zangfu syndromes, there is a series of
descriptions for symptoms that are often associated with shen disorders, such as insomnia, poor
memory, heart palpitations, manic-depressive disorders, epilepsy, and melancholia. The acupuncture
points, which were presented in groups as main points to be selected from, are presented in Table 2.
Shogo Ishino, at the Oriental Medicine Research Center of the Kitasato Institute in Japan, reported on
acupuncture treatment for senile psychic disorders (3). As a main source text, he relied on the book
Highly Valuable Commentaries on Acupuncture and Moxibustion: Grand System of Medical
Classics on Acupuncture and Moxibustion, an encyclopedic collection published in China in 1978.
The points mentioned in that text are listed in Table 3.
A Western textbook, A Manual of Acupuncture (4), presents summations of uses of the acupuncture
points. It includes an index of symptoms and diseases with the list of indicated points. Table 4 presents
the points mentioned in this index for mind-brain disorders (some indications were combined in
preparing the table). In a few cases, particularly epilepsy and mania, there were so many points listed in
the index that there would be no benefit derived from examining the collection, so a subdivision (e.g.,
childhood epilepsy from fright) is presented when available.
The commonly mentioned points in the first four tables yields Table 5, which presents the main
acupuncture points utilized in treatment of mind-brain disorders. Two "extra points," sishencong (M-
HN-1) and yintang (M-HN-3), have become popularized in recent years for treatment of mental
disorders though these points received relatively little mention in the literature reviews; they are
included in the table to more completely reflect current practice.
While there are only a few points for each of the channels represented, it is evident that there is much
emphasis on treating the back (along the spinal column) and head to address mind and brain disorders.
A large number of points along the bladder channel and the governing vessel are mentioned in the
literature, even if most of those points are suggested only once or twice. The governing vessel
continues along the spine over the top of the head, where baihui (GV-20) and sishencong (four points
surrounding GV-20) are utilized. This vessel continues over to the face where the extra point yintang is
located (between the eye brows) to the end of the channel at renzhong (GV-26). Needling points along
the spinal column and on the head, including fengchi (GB-20), may provide a relatively direct means
(proximate treatment) of stimulating the central nervous system and affecting the brain.
Points on the arms and legs may well function via different mechanisms than those associated with the
spine and head, though it has been suggested that the effects may still be mediated by stimulating
regions of the brain, such as affecting the amygdaloid nucleus when neiguan (PC-6) is needled (5, 6).
There is a collection of points listed in Table 5 that are located in the interval from the wrist to the
elbow, including three pericardium points, two heart points, two large-intestine points, and the main
lung point, lieque (LU-7); this grouping extends to the hand with two more pericardium points. Another
hand point, hegu (LI-4) is frequently used as an adjunctive point in many modern treatment protocols
for these mind-brain disorders. Similarly, there is a group of points on the lower leg, including two
kidney points, three stomach points, and two spleen points, and continuing to the foot with the liver
points and one more kidney point, yongquan (KI-1). These groupings of points may reflect an ability to
stimulate release of certain neural transmitter substances by applying needles or moxibustion to
specific peripheral regions of the body. The wrists, hands, ankles, and feet are richly endowed with
nerves that transmit fine details as required for hand utilization and mobility (especially over uneven
terrain). Of the points listed in Table 5, very few points (e.g., two conception-vessel points on the
abdomen and tianfu (LU-3) on the upper arm) seem to diverge from the pattern of treating the spinal
column and head or treating the distal portions of the limbs.
Table 1: Frequency of mention of an acupuncture point for the listed condition in the comprehensive
collection of traditional texts examined by the researchers in Zhejiang (1). The points are listed
according to total number of references, in descending order (23 references for baihui for two disorders
to only 2 references for dazhong for one disorder).

Poor Loss of Deficiency of Deficiency of

Point Dementia
Memory Consciousness Spiritual Qi Heart Qi
 Baihui (GV-20) 13 10
Xinshu (BL-15) 4 14
Zhongchong (PC-9) 7 7
Ximen (PC-4) 13
Lieque (LU-7) 12
Gaohuangshu (BL-
11
43)
Youmen (KI-21) 11
Neiguan (PC-6) 9 1
Tianfu (LU-3) 10
Shendao (GV-11) 9
Yongquan (KI-1) 8
Shenmen (HT-7) 4 2 2
Jiuwei (CV-15) 6
Juque (CV-14) 5
Quchi (LI-11) 4
Dacheng (SP-15) 3
Dazhong (KI-4) 2

Table 2: Main points listed for treatment of specified disorders in Chinese Acupuncture and
Moxibustion.

Insomnia shenmen (HT-7), sanyinjiao (SP-6), anmian (M-HN-54)

sishencong (M-HN-1), xinshu (BL-15), pishu (BL-20), zusanli (ST-36),
Poor memory
shenshu (BL-23), zhaohai (KI-6)
Palpitation xinshu (BL-15), juque (CV-14), shenmen (HT-7), neiguan (PC-6)
xinshu (BL-15), ganshu (BL-18), pishu (BL-20), shenmen (HT-7),
Depression
fenglong (ST-40)
dazhui (GV-14), fengfu (GV-16), shuigou (GV-26), neiguan (PC-6),
Manic disorder
fenglong (ST-40)
Epilepsy (during shuigou (GV-26), jiuwei (CV-15), jianshi (PC-5), taichong (LV-3),
seizure) fenglong (ST-40)
xinshu (BL-15), yintang (M-HN-3), shenmen (HT-7), sanyinjiao (SP-6),
Epilepsy (after seizure)
taixi (KI-3), yaoqi (extra)
Differentiated into four categories (liver qi stagnation, transformation of
Melancholia stagnant qi into fire, stagnation of phlegm, and insufficiency of blood).
Main point: taichong (LV-3), included in three of four syndromes.

Table 3: Points listed in Highly Valuable Commentaries on Acupuncture and Moxibustion for
selected disorders. The points in the text were differentiated according to whether the treatment should
be acupuncture or moxibustion or both, but this distinction is not presented here.

tianjing (TB-10), shaoshang (LU-11), shenmai (BL-62), renzhong (GV-

Apoplexy 26), baihui (GV-20), fengshi (GB-31), dazhui (GV-14), jianjing (GB-21),
jianshi (PC-5), quchi (LI-11), zusanli (ST-36)
Unconsciousness zhongchong (PC-9), dadun (LV-1), baihui (GV-20)
gaohuang (BL-43), shendao (GV-11), ganshu (BL-18), burong (ST-19),
Melancholia
liangmen (CV-21)
Amnesia, shenmen (HT-7), saling (PC-7), juque (CV-14), shangwan (CV-13),
absentmindedness, zusanli (ST-36), jianyu (LI-15), feishu (BL-13), shenshu (BL-23), pishu
palpitations (BL-20)
renzhong (GV-26), baihui (GV-20), shenmen (HT-7), jinmen (BL-63),
Epilepsy juque (CV-14), kunlun (BL-60), jinsuo (GV-8), yongquan (KI-1),
shangwan (CV-13), yanggang (BL-48), yintang (M-HN-3)
chize (LU-5), shenmen (HT-7), jianshi (PC-5), tiangjing (TB-10), baihui
Insanity (GV-20), zhongwan (CV-12), chengshan (BL-57), fengchi (GB-20),
quchi (LI-11), shangwan (CV-13)

Table 4: Points listed for each of the specified disorders in the index to A Manual of Acupuncture.
Chinese point names (pinyin) are not included due to large number of points listed.

LU-4, ST-23, ST-41, SP-1, SP-2, KI-1, KI-4, PC-4, PC-7, CV-19, plus
Agitation
other points for combined syndromes (e.g., with heat in the chest)
CV-14, ST-36, LU-10, KI-9, CV-8, GB-39, BL-18, KI-4, PC-8, LV-2,
Anger
LV-13, KI-7, KI-1, GV-12, CV-14, HT-5
Anxiety and worry BL-15, GB-39, KI-12, CV-12, LV-1, LV-5
Apprehension PC-5, PC-6, PC-8
Aversion to people
ST-37, ST-44, GB-17, CV-15
talking
Coma PC-8, GV-26, CV-1
Dementia HT-7, BL-15, KI-4
Depression HT-5, LV-5
Epilepsy, childhood
LU-7, SP-5, GB-13, GV-8, GV-12, GV-21
fright
LI-13, HT-7, HT-8, ST-7, PC-6, LV-5, GV-4, CV-4, plus other points for
Fear and fright
specific types (e.g., sudden fright)
Hallucination LI-5, LI-7, ST-40, ST-41, BL-10, BL-61, GV-12
Laughter, abnormal PC-7, PC-8, LI-7, GV-26, ST-40, HT-7, ST-36, LU-7, LI-5, SP-5, KI-7
Loss of consciousness,
LU-11, LI-1, HT-9, SI-1, KI-1, LV-1, GV-15, GV-26, CV-6, CV-8
stroke
 Mad walking ST-23, SI-5, SI-8, BL-8, BL-9, LV-13, GV-19, BL-13
Madness BL-5, BL-9, BL-60, KI-1, KI-9, TB-10, TB-12, TB-13, GB-9 LV-2
Melancholy PC-4, LU-3, SP-5
LU-7, LI-11, HT-3, HT-7, BL-15, BL-43, KI-1, KI-21, KI-3, PC-5, PC-
Memory loss
6, GB-20, GV-11, GV-20, CV-14, M-HN-1, PC-6
Mental retardation KI-4
Ranting and raving KI-14, LI-7, ST-36, KI-9, TB-2, GV-12, LI-6
LU-3, ST-36, SP-1, SP-15, HT-7, KI-6, PC-6, PC-7, PC-8, TB-10, LV-2,
Sadness and weeping LU-10, HT-1, SI-7, GV-11, GV-20, HT-4, GV-16, HT-5, ST-41, HT-8,
SP-7, GV-13, LU-5, BL-15, PC-9
LI-10, LI-15, ST-36, BL-15, BL-23, BL-40, PC-6, PC-8, PC-9, GB-2,
Stroke GB-13, GB-15, GB-21, GB-40, LV-2, GV-16, GV-20, CV-4, M-UE-1,
M-HN-1

Table 5: Summary of 34 main points relied on for mind and brain disorders. The indications presented
here are from A Manual of Acupuncture, selecting only those conditions associated with mind and
brain disorders. To be listed in the table, the point had to be mentioned frequently in the literature cited
above (1-4) and/or in the medical reports (described in Chapter 5), and indicated for several types of
mind and brain disorder. taichong (LV-3) was added to reflect modern applications of the point now
often used in place of xingjian (LV-2); similarly fengchi (GB-20) was added to this table because of the
high frequency of its use in modern practice. Some of the points, such as sanyinjiao (SP-9) and zusanli
(ST-36) are mainly added for tonification therapy, rather than being chosen for specific effects on mind
and brain disorders. Other adjunctive points sometimes employed in formulas, such as the hand points
hegu (LI-4) and houxi (SI-3), are not included in the table because they have few indications for mind
and brain disorders and are not mentioned in the traditional literature in that context, though they are
used in modern practice.

Relation to Channels/Indications Related to Mind/Brain

Point
Disorders
GOVERNING VESSEL (GV)
Meeting point of the GV, LI, and ST channels. Sudden loss of
Renzhong (GV-26) consciousness, coma, childhood fright, stroke, mania-depression,
epilepsy, inappropriate laughter, unexpected laughter and crying.
Meeting point of the GV, BL, GB, TB, and LV channels.
Dizziness, blindness, stroke, loss of consciousness, epilepsy,
Baihui (GV-20) fright palpitations, poor memory, lack of mental vigor,
disorientation, much crying, sanity, and crying with desire to die,
mania.
Mad walking, delirious raving, seeing ghosts, rage with desire to
Shenzhu (GV-12)
kill people.
Shendao (GV-11) Sadness and anxiety, poor memory, fright palpitations, timidity,
 epilepsy.
HEART (HT)
Luo point of the Heart channel. Frequent yawning and groaning
Tongli (HT-5) with sadness, vexation and anger, sadness and fright, depressive
disorder, fright palpitations.
Shu, yuan, and earth point of the Heart channel. Insomnia,
frequent talking during sleep, poor memory, mania-depression,
Shenmen (HT-7)
epilepsy, dementia, mad laughter, insulting people, sadness, fear
and fright, disorientation, fright palpitations.
BLADDER (BL)
Shu point of the heart. Fright palpitations, poor memory, anxiety,
weeping with grief, frightened and cautious, insomnia, excessive
Xinshu (BL-15)
dreaming, disorientation, delayed speech development, mania-
depression, epilepsy, dementia, mad walking, stroke.
Gaohuangshu (BL- Shu point of the vital region. Poor memory, insomnia, phlegm-
43) fire mania, dizziness.
KIDNEY (KI)
Jing and wood point of the KI channel. Epilepsy, childhood
fright, dizziness, cloudy vision, agitation, insomnia, poor
Yongquan (KI-1)
memory, propensity to fear, rage with desire to kill people,
madness.
Luo point of the KI channel. Agitation, dementia, mental
Dazhong (KI-4) retardation, somnolence, propensity to anger, fright, fear, and
unhappiness, desire to close the door and remain at home.
Xi point of the yin linking vessel. Madness, mania, mania
Zhubin (KI-9)
depression disorder, raving, fury and cursing, tongue thrusting.
CONCEPTION VESSEL (CV)
Front mu point of the heart. Mania disorder, mania-depression,
tendency to curse and scold others, ranting and raving, anger,
Juque (CV-14)
disorientation, loss of consciousness, epilepsy, fright palpitation,
poor memory, agitation.
Luo point of the conception vessel. Epilepsy, mania, mad
Jiuwei (CV-15) walking, mad singing, aversion to the sound of people talking,
fright palpitations.
PERICARDIUM CHANNEL (PC)
Xi point of the PC channel. Agitation, insomnia, melancholy, fear
Ximen (PC-4)
and fright of people, insufficiency of spirit qi, epilepsy.
Luo point of the PC channel. Fright palpitations, insomnia,
Neiguan (PC-6) epilepsy, mania, poor memory, apprehension, fear and fright,
sadness, loss of memory following stroke.
Shu, yuan, and earth point of the PC channel. Insomnia, epilepsy,
Daling (PC-7) mania, manic raving, propensity to laugh (without ceasing),
agitation, weeping with grief, sadness, fright, and fear.
 Ying and fire point of the PC channel. Loss of consciousness,
Laogong (PC-8) epilepsy, mania-depression, fright, sadness, propensity to anger,
apprehension, ceaseless laughter.
Jing and wood point of the PC channel. Stroke, loss of
Zhongchong (PC-9)
consciousness, night crying in children.
LUNG CHANNEL (LU)
Window of heaven point. Somnolence, insomnia, sadness,
Tianfu (LU-3) weeping, disorientation and forgetfulness, ghost-talk,
melancholy, crying.
Luo point of the LU channel. Stroke, epilepsy, fright, loss of
Lieque (LU-7) consciousness, poor memory, palpitations, propensity to laughter,
frequent yawning and stretching.
STOMACH CHANNEL (ST)
He and earth point of the ST channel. Mania-depression, manic
Zusanli (ST-36) singing, raving, abusive talk, anger, fright, tendency to sadness,
outrageous laughter.
Luo point of the ST channel. Dizziness, plumpit qi, mania-
depression, mad laughter, great happiness, desires to ascend to
Fenglong (ST-40)
high places and sing, discards clothing and runs around,
restlessness, seeing ghosts, indolence, epilepsy.
Jing and fire point of the ST channel. Epilepsy, mania, agitation,
Jiexie (ST-41)
sadness and weeping, fright palpitations, raving, seeing ghosts.
SPLEEN CHANNEL (SP)
Jing and metal point of SP channel. Mania-depression, agitation,
Shangqui (SP-5) excessive thinking, propensity to laughter, nightmares,
melancholy, fright, stroke.
Meeting point of SP, LV, and KI channels. Heart palpitations,
sanyinjiao (SP-6)
insomnia, fright, dizziness.
GALLBLADDER CHANNEL (GB)
Meeting point of the GB and TB channels. Dizziness, stroke,
Fengchi (GB-20)
insomnia, loss of memory, epilepsy.
LIVER CHANNEL (LV)
Ying and fire point of the LV channel. Propensity to anger,
sadness, propensity to fright, closes eyes and has no desire to
Xingjian (LV-2)
look, excessive fright, propensity to fear as if seeing ghosts,
madness, insomnia, epilepsy, loss of consciousness, stroke.
Shu, yuan, and earth point of the LV channel. Dizziness,
taichong (LV-3)
childhood fright, sighing, insomnia, easily fearful.
Luo point of the LV channel. Plumpit qi, depression, fright
Ligou (LV-5)
palpitations, fear and fright, worry and oppression.
LARGE INTESTINE CHANNEL (LI)
Wenliu (LI-7) Xi point of the LI channel. Tongue thrusting, frequent laughter,
 raving, seeing ghosts.
He and earth point of the LI channel. Manic disorders, poor
Quchi (LI-11)
memory, tongue-thrusting, dizziness.
EXTRA POINTS
Sishencong (M-HN-
Stroke, epilepsy, manic-depression, insomnia, poor memory.
1)
Yintang (M-HN-3) Fright, insomnia, agitation, restlessness.

References
1. Chen Yongcan and Yang Meiling, Literature research on screening of the nucleus acupoints for
treating of intellectual disturbances, Journal of Traditional Chinese Medicine 1999; 19(2): 83-
88.
2. Cheng Xinnong (chief editor), Chinese Acupuncture and Moxibustion, 1987 Foreign
Languages Press, Beijing.
3. Shogo Ishino, Treatment of senile psychic disorders with acupuncture and moxibustion,
International Journal of Oriental Medicine, 1999; 24(3): 149-154.
4. Deadman P and Mazin AK, A Manual of Acupuncture, 1998 Journal of Chinese Medicine
Publications, East Sussex, England.
5. Lai Zhongfang, Effect of electro-acupuncture of neiguan on spontaneous discharges of single
unit in amygdaloid nucleus in rabbits, Journal of Traditional Chinese Medicine 1989; 9(2): 144-
150.
6. Lai Zhongfang, Role of amygdaloid nucleus in the correlation between the heart and acupoint
neiguan in rabbits, Journal of Traditional Chinese Medicine 1991; 11 (2): 128-138.
7. Gu Shizhe, et al., Four acupuncture methods for treating mental disorders, Journal of
Traditional Chinese Medicine 2001; 21(3): 207-210.

APPENDIX: General Methods of Acupuncture

Treatment for Mental Disorders
At the Beijing University of Traditional Chinese Medicine, a group of acupuncturists described the
basic approach to mental disorders by dividing the treatment strategies into four categories (7). One of
these is psychological intervention, mainly talking over an appropriate view of life situations; this can
be accompanied by acupuncture points used to calm the mind. Another method was treating the root
and manifestation (ben and biao) aspects of internal disharmonies relying on body points, particularly
those meeting points as the shu, yuan, luo, he, and xi points. A third type involved enhancement of the
zangfu functions, and regulating the ascending and descending qi; among the recommended points
were taichong (LV-3) and neiguan (PC-6) that are commonly selected for mental disorders. The most
specific therapy, though, was use of points mainly on the head, with particular attention to the
Governing Vessel points (from GV-14 through GV-24), sishenshong (M-HN-1), and the Gallbladder
Vessel points shuaigu (GB-8) and tianchong (GB-9). These methods, and some of the sample points
suggested for treatment, are outlined in the table below.
Table 6: Four Acupuncture Methods for Mental Disorders.

sishensong (M-HN-1), benshen (GB-13), shenting (GV-24), dazhui (GV-

Points of the head area
14), baihui (GV-20), fengfu (GV-16), shuaigu (GB-8), tianchong (GB-9)
spleen: gongsun (SP-4), neiguan (PC-6), zhongwan (CV-12), fenglong
Regulating zangfu (ST-40), tianshu (ST-25); liver: shanzhong (CV-17), zhangmen (LV-13),
organs taichong (LV-3), zulingqi (GB-41); liver/kidney: taichong (LV-3),
xingjian (LV-2), zhaohai (KI-6), ganshu (BL-18), shenshu (BL-23).
Treating root and
rely on shu, yuan, luo, he, and xi points
branch
shenmen (HT-7), saling (PC-7), juque (CV-14), shangwan (CV-13),
Psychotherapy with
zusanli (ST-36), jianyu (LI-15), feishu (BL-13), shenshu (BL-23), pishu
acupuncture
(BL-20)
Chapter 6
Xuedao Zheng, Baihe Bing, Meihe Qi
[blood course syndrome, lily disease, plum-pit qi]

Background
Before embarking on a description of herbs used in treating shen-disorders, it may be helpful to
examine some categories of illness that have been described particularly in relation to herb prescribing.
Although these have their origins in ancient Chinese medicine, Japanese doctors have given more
attention to them in recent decades than the Chinese, so Japanese sources are frequently relied upon for
the descriptions. The disorders presented here are consistent with various neurotic syndromes.
Practitioners offering natural health care services often encounter patients who have, as part of their
syndrome, a neurotic condition, characterized by worry, lack of clarity, and inability to control their
emotions sufficiently to aid their health. They may present symptoms that are difficult to describe
clearly, with some symptoms that vary or that appear to present conflicting characteristics (especially in
terms of traditional Chinese categories such as hot/cold, dry/damp, etc.), and they may have unusual
responses to therapies that have already been tried. Such patients are likely to have visited many
practitioners in the past and felt unsatisfied with both the diagnosis given and the outcome of treatment.
They usually display, upon further questioning, a close linkage between emotional, behavioral, and
health problems.
Such patients have been given (or are able to find on their own) non-standard disease classifications,
namely those that are not widely accepted in the practice of modern medicine. These diagnoses include
candidiasis, multiple allergies, parasites, heavy metal or other toxicity, chronic fatigue syndrome, leaky
gut, and others for which standard testing procedures do not confirm the disorder (though various
alternative medicine methods may seem supportive). Finding a culprit to blame the condition on,
something separate from the individual's emotions and behavior, is often deemed important. Thus, the
diagnosis may include reference to a toxin or parasite or rare infection, or an impact from modern
society, such as food additives, drugs, or environmental pollutants. Yet, these attributions can be very
misleading because, whether or not they are present, they may have little to do with the symptoms.
A diagnosis for these patients such as "liver qi stagnation," "spleen weakness," or "heart fire," may be
given by practitioners of Chinese medicine. These exotic terms do not carry the risk of labeling the
condition with a term that merely stimulates the emotional reactions to it (e.g., neurosis, hysteria, or
hypochondria). While the Chinese medical terms don't automatically convey such concepts as neurotic
hypersensitivity or chronic anxiety, Chinese writers often translate the traditional terms in that way
when producing translated text books. There is no question among medical doctors in the West-and
those in the East-that physical problems exist in these patients; indeed, such patients may have one or
more standard medical diagnoses along with the unexplained disorders. However, the patient also is
recognized as having functional disorders associated with psychological problems and with behavior
patterns that impair both physical and mental health. Doctors often find that sedative and anti-
depressant drugs provide a certain degree of relief for the patients, though compliance with using the
drugs is often poor because the patients worry about taking them or fear the side effects.
It is not always possible to separate organic diseases from others that might be termed psychosomatic,
neurotic, or related to behavior and thought patterns. As an example, the condition known as chronic
fatigue syndrome has been very difficult for medical researchers to study because there is such a
diverse range of physical and mental conditions that are presented by those who claim to be suffering
from it. Among them are persons who are simply depressed or living an erratic lifestyle that brings
about fatigue, and there are others who have some kind of viral infection (or group of viruses) that may
be identified as the culprit. The infectious agents can wreak havoc on the immune system and cause
fatigue as a side effect, but so can emotional disturbances and the adverse effects of certain activities
and difficult experiences.
Chinese physicians have dealt with complex patients and difficult to diagnose diseases, such as those
depicted above, for many centuries. Examples of relevant disease categories to be presented here
include xue dao zheng (blood course syndrome), baihe bing (lily disease), and meihe qi (plum pit qi).
These syndromes have an interesting underlying unity, which is the accumulation of damp or phlegm-
damp.
It is hoped that by presenting an overview of the way the Chinese have interpreted such patterns and
treated them, practitioners who prescribe Chinese herbs as a part of their practice will be aided in both
understanding and developing therapeutic plans for the unusual syndromes. Specifically, instead of
veering off into a variety of alternative medicine explanations and techniques, practitioners will find
that such problems are amenable to the traditional Chinese medical approach with a focus on herbs.
Acupuncture therapies that address these patterns are also potentially helpful.
Causes of Neurotic Complaints
Although there are many possible causes of complex disorders characterized by neurosis, two appear
especially common from the Oriental view, as presented in the classical and modern literature:
1. Long-term irregularities in diet yield many systemic disorders, starting with a disruption of the
stomach/spleen system and then affecting each of the other organs to some extent, partly
because of primary deficiencies in their nourishment and secondary accumulations of excess
materials (e.g., stagnant blood or fluids). Ultimately, the kidney essence fails to be nourished
and the individual becomes critically weakened and subject to a variety of serious diseases,
including erratic activity of the immune system. A primary outcome is that of the deficiencies of
qi and blood is to allow pathological influences from the outside to penetrate the "empty"
vessels; the deficiency of qi and kidney essence allows internal organs to malfunction and body
tissues to alter into an unhealthy condition. As part of this pattern, the person may become
neurotic about eating and may suffer several functional disorders that cause discomfort. The
origins of this problem might be traced to lack of appropriate parental guidance or influences of
people who have unhealthy habits.
2. Emotional distress causes a variety of dysfunctions and contributes to a person's life being in a
constant state of upheaval and uncertainty. The emotional agitation adversely affects the heart
system, a key regulator for all the other organ systems; it disturbs the sleep and causes one to
use poor judgment in regulating work and rest, and virtually all other activities as well. The
emotional disorders are sometimes the result of frightful or other disturbing events during
childhood.
The two causative factors-habits and emotions-often appear together, as poor dietary habits can lead
one to be emotionally unstable (by failing to nourish the viscera, for example, therefore not allowing
the inner "spirits" to rest), while emotional distress inhibits the functions of the spleen/stomach system
(for example, excessive worry and anxiety impair the "transforming and transporting" functions).
Thus, in many situations a reasonable starting point for making improvements in a complex patient is
by addressing the weakness of the stomach/spleen. Food therapy can have a big impact on healing, with
its main effect being on the stomach/spleen. If a person cannot tolerate ingestion of healing foods and
herbs, then it will be difficult to apply the desired kidney tonics, blood-vitalizing herbs, or other healing
agents without getting adverse reactions. Certainly, the gentle damp-dispersing agents, such as hoelen
(fuling) and atractylodes (baizhu) and the herbs that help moderate the severity of potentially irritating
herbs on the stomach, such as jujube (dazao) and licorice (gancao), can usually be tolerated. Thus, the
formula Si Junzi Tang is often suggested (which has these herbs plus ginseng or codonopsis)
Acupuncture may be essential to reinvigorate the digestive system first, relying on points such as
zusanli (ST-36) and sanyinjiao (SP-6). If a person does not change from an imbalanced diet towards a
more balanced one (in relation to the disorder), it is difficult to heal the body even when the proper
herbal therapies are administered and tolerated. Chinese dietary therapy for those with weak spleen and
stomach often incorporates rice with a small amount of cooked vegetables and meat (it is only slightly
more complex than that). A common error among Western practitioners of Chinese medicine is to focus
on elimination diets (avoiding, for example, dairy, wheat, meat, etc.) rather than to focus on nutritious
diets.
The other starting point for complex problems is the heart system, to be addressed by calming the
spirit. This therapy is usually accomplished by sedating hyperactivity associated with both the liver and
heart systems (liver disorders, particularly those involving liver fire, agitate the heart) and nourishing
deficiencies. When the spirit is calm, the emotions are not so extreme, and the internal cause of disease,
the unbalanced emotional responses, is removed or reduced in its influence. Acupuncture is one of the
important therapies to address these concerns. Of special importance is neiguan (PC-6), which helps
calm the emotions and settle the stomach qi. Mild sedative herbs, such as zizyphus (suanzaoren), biota
(boziren), and albizzia (hehuanpi) can be given to most patients.
There are some herbal formulas that address both the distress of the digestive system and the lack of
control of the emotions, which will be described in the following chapters. But, it should be mentioned
here that the famous Licorice and Jujube Combination (Gancao Xiaomai Dazao Tang), comprised of
the two named herbs plus a type of whole wheat (xiaomai), is a tonic for the stomach/spleen system
and a sedative for the heart system. The use of wheat as a remedy in China may well reflect its natural
content of B-vitamins that were lacking in some diets. In the book 100 Famous and Effective
Prescription (1), the traditional indications for this simple formula are reported to include "frequent
sad feelings, irritability, restless sleep, abnormal speech and behavior in severe cases....," while its
modern applications (in which the formula is usually prepared with some added ingredients) include
"neurasthenia, hysteria, schizophrenia, menopausal syndrome, etc." Here, as in many of the Chinese
texts, menopausal syndrome refers mainly to the mental distress experienced during menopause, more
so than hot flashes, dryness, or other physical symptoms. In the Shanghan Lun (2) and Jingui Yaolue
(3) a combination of ginger, licorice, and jujube was included in many of the prescriptions to help
enhance the effects of the key herbs of the formula. These three herbs benefit the stomach and spleen
system; jujube and licorice, two of three herbs in the above-mentioned formula, also provide calming
effects. Licorice has the traditional indications of calming the spirit and treating palpitation and
melancholy (4).
One of the most popular formulas for tonifying the stomach/spleen and calming the emotions is
Ginseng and Longan Combination (Guipi Tang); it contains the ingredients of Si Junzi Tang. Guipi
Tang will be discussed at some length in the following two chapters. A variety of other methods, aside
from tonifying the stomach/spleen and calming the heart, have been applied in the treatment of these
complex disorders. One can attempt, for example, to harmonize the circulation of qi and blood, get rid
of obstructing accumulated fluids, or clear agitational heat. Several such methods are to be described
here.

Introducing Xue Dao Zheng

The term xue dao zheng means "blood course syndrome" (xue = blood; dao = way, movement; zheng =
pattern, syndrome; xue zhi dao is the general term for blood course). The syndrome encompasses
something different than what is now termed blood stasis, and might best be described as the
combination of qi and blood stagnation combined with fluid accumulation.
The term xue dao first appears in the Chinese literature in chapter 75 of the Lingshu (5), compiled over
2,000 years ago. There, it is said:
When food and drink cannot be regulated, and joy and anger are not timely, this condition causes the
ferrying of liquids to overflow to the insides. These liquids then descend and detain in the marshes
[lower burner; affecting the reproductive organs] making the blood paths to be obstructed. Day by day
this condition enlarges without rest.
When a person's dietary behavior is regular and the emotions stable, then the blood will naturally flow
freely, otherwise, the blood paths will become obstructed. The condition can then continually worsen as
the unhealthy daily patterns persist. The disorder begins with the overflow of liquids (from their normal
path of movement through the triple burner system); as the description continues, it is noted that: "This
disease prospers with the accumulation of water." Excess water is seen as a means of worsening
obstruction (of qi and blood circulation). The excess water is sometimes called shuidu, or water toxin.
Here, toxin implies a harmful condition (not necessarily something chemically toxic); most often, water
toxin manifests as edema, but the water can also be hidden (lishui), obstructing without being seen.
Xue dao zheng mainly signifies obstructed or limited blood circulation that occurs in the "blood
chamber" (liver, uterus, and chongmai channel). Chen Wuji stated that (6): "The blood chamber is
called a chamber because, like a room in a house, it is a place to linger. The body's blood chamber is
the place where the blood gathers and where all the channels and vessels convene, and that is why it is
referred to as the sea of blood." The sea of blood (xuehai) is a term familiar to acupuncturists (the point
xuehai, SP-10, is commonly used in the treatment of uterine blood flow disorders, such as menstrual
bleeding or amenorrhea or postpartum blood stasis). It is also a designation for one of the eight
extraordinary channels, which is alternatively called the chongmai (penetrating channel or thrusting
channel). The sea of blood is part of the liver network, involved with the storing of blood, affecting
menstruation and female sex hormones. The channel connects the lower abdomen with the head. When
there is emptiness or fullness or stagnation in the lower warmer, the qi has a tendency to thrust
upwards, or, as sometimes translated to English, to "flush up." The result is symptoms in the head, such
as mental irritability, sweating of the forehead, tinnitus, or difficulty swallowing (with nausea). As
explained by Wang Bing (6):
The chongmai is the sea of blood: that is the place where all of the channels convene. In males, the
blood moves from here, whereas in females it stays here, and this is why this area is also called the
blood chamber (xueshi).
The fact that the blood lingers in the blood chamber for women, but not men, is one of the reasons why
xue dao zheng mainly affects women. The blood chamber can be afflicted by internal forces (the seven
emotions) or by external forces (e.g., wind and cold), or other conditions (neither solely internal nor
external, including infections, surgical interventions, and other damages, leading to alteration in the
circulation of qi and blood). In turn, blood course syndrome can generate unfavorable mental
symptoms that further complicate the physical condition of stagnation.
Xue dao zheng is a syndrome that is now mentioned mainly in the modern Japanese literature, rather
than the Chinese literature. One of the primary commentators on xue dao zheng and its treatment is the
famous Japanese herb doctor, Yakazu Domei. He first published an analysis of the syndrome in 1939.
In 1982, he published a revised article on this subject (7). Selected aspects of that review will be
discussed in this section, along with commentaries from other sources.
Japanese doctors have speculated that, in modern terms, the hormonal changes that occur with
menstruation, pregnancy, and menopause, as well as the effects of administered hormones and of
induced abortion, can exacerbate autonomic nervous system disorders, leading to the syndrome. Yakazu
Domei has suggested that there is a restored concern for the classically defined xue dao syndrome:
Due to changing social conditions, there has been a marked rise in disorders of this type. In fact,
according to Dr. Kuhuto's statistics xue dao zheng places second among problems of out-patients. Its
etiology is varied: genital [uterine] abnormalities caused by artificial abortion, fear of pregnancy,
misuse of hormonal preparations, all of which cause an imbalance of the autonomic nervous system.
The concerns raised here can explain why there would be a new interest in this syndrome: modern
circumstances have replaced earlier causes of the syndrome, which had previously been attributed to
"wind" or "fever" or "cold" entering the uterus, or to complications associated with childbirth.
When consulting the body of reports on this syndrome, one can detect a certain level of annoyance that
the physicians experience when trying to deal with the patients. The patients themselves appear
chronically dissatisfied and, as in one description, are peevish (other characterizations: angry, jealous,
anxious, nervous). Further, they may be unresponsive to the medical questioning or go on and on about
their symptoms; even when they get better, they may not recognize it and admit it. No doubt, the
physicians would consider that not only the disorder, but the patients themselves are "difficult" or
"complex."

Xue Dao Zheng As Neurosis

The modern description of xue dao zheng is often presented by the Japanese as "erratic complaints
syndrome," based on its manifestation rather than its cause. Erratic complaints refers both to a
multiplicity of problems and to the complaints coming and going, with the patient being very sensitive
to environmental, dietary, and emotional influences.
In the article Clinical experience with women's erratic complaints syndrome (8), it is reported that
"most patients with this syndrome have a nervous temperament...in some cases the symptoms go away,
but the patient is unaware of the improvement." In a list of 49 symptoms characteristic of women's
erratic complaints syndrome, the most common were: distention and pain in the diaphragm region and
hypochondrial region; nausea; blurring eyesight; fatigue; itching; and late rising. In presenting three
case histories of women treated for the syndrome, the authors point out that "all three patients in this
study had had induced abortions....Many patients with this syndrome have had induced abortions
and/or gynecological surgery." Gynecological surgeries affect abdominal blood flow and are performed
frequently in modern times, including Cesarean section for childbirth and hysterectomy for several
disorders (e.g., fibroids, unexplained uterine bleeding, and tumors). In a book by Mizuno Takusai (1841
A.D.) it was mentioned that xue dao zheng includes ailments preceding and following childbirth, as
well as a variety of menstrual irregularities.
Shyoshi Kuhuto, a modern practitioner in Japan quoted by Yakazu Domei, has characterized the erratic
complaints syndrome as follows (7):
1. In the same patient, many symptoms coexist; about 90% have more than five symptoms.
2. The symptoms are changeable and have nothing to do with neurological structures.
3. The manifestation of symptoms is apt to be influenced by environmental factors. For example,
the symptoms frequently appear on rainy or cloudy days or when living with an unfriendly
relative. They appear one day and disappear the next or occur in the morning and disappear in
the afternoon.
4. The symptoms reflect the emotional state or other mental factors.
5. The patient can become angry easily, and yawns and stretches a lot. They have a tendency to
become upset even over trivial things and cannot control their anger.
This description appears to fit neurosis. In the book Clinic of Traditional Chinese Medicine (9),
neurosis is described as follows: "The patients get excited or fatigued easily, and are frequently
accompanied with various forms of somatic discomfort. It is more common in middle-aged females."
Major clinical manifestations are "insomnia, waking up easily, distractibility, poor memory, emotion is
easy to be changed, hypersensitivity, abdominal distention, frequent urination, constipation, and
belching." Of importance, the lack of emotional control is evident; the person is hypersensitive and
complains of what would otherwise be considered trivial things or ordinary discomforts, such as occur
with weather changes or when consuming foods and meals that lead to some uneasiness. Men can also
suffer these conditions, but the incidence is higher for women.
Neurosis associated with blood stagnation, as occurs with xue dao zheng is described this way by
Yamada Terutane (10):
An experienced physician can easily detect neurotic or blood-stagnated women by virtue of their
external signs, such as a worried look, anxiety, suspiciousness, and slurred speech. These patients
generally do not feel like talking, but when asked, they either enumerate all their complaints (which
may last for hours) or quietly submit their subjective symptoms in writing, often having prepared them
in advance.
The reference to "slurred speech" is a poor translation. It means incoherent or illogical statements,
rather than inability to control the muscles associated with speech; for example, the conclusion drawn
by the patient seems unrelated to the prior description of events, so that it seems that the person is
linking words together that don't connect. Terutane notes further that xue dao zheng especially affects
middle-aged women with any of the following medical history, symptoms, and signs:
 1. Those who have had abortions or undergone surgical operations causing worsening of the
problems.
2. Those who have changing and inconsistent nature of their subjective symptoms, such as
headache, heaviness of the head, stiff shoulders, and dizziness.
3. Those who worry excessively about their health but in reality are healthy or have a minor
gastroptosis [technically, distention of the stomach due to weak musculature, but referring to
weak digestion or poor tolerance to foods]. This type of patient generally has a thin physique
and a pale complexion.
4. Those who are judged, upon clinical examination, to be normal but claim to have palpitations
and cardiac hyperfunction. Some who experience intensified heartbeat, especially while in bed,
probably suffer from a nervous disorder.
5. Women who submit their own symptoms and signs in written form during clinical visits. Such
women usually suffer from a nervous disorder [the patients often explain that they were worried
that they might leave something out, so they carefully wrote down everything].
6. Those suffering from acute, whole, or localized body fever [this means a hot sensation, but not
an actual elevation of body temperature] due to blood stasis. For an excess conformation,
Cinnamon and Hoelen Formula (Guizhi Fuling Wan) is prescribed; for a deficiency
conformation, Bupleurum and Peony Formula (Jiawei Xiaoyao San) is preferable.
7. Those who frequently feel tired, who have difficulty recovering from fatigue, or who have a
weak physique.
8. Those afflicted with insomnia, inability to sleep well, morning fatigue, drowsiness in the
daytime and particularly after lunch.
9. Those suffering from dysmenorrhea, amenorrhea, or other menstrual complaints.

Xue Dao Zheng and Menopausal Syndrome

Several Japanese physicians link xue dao zheng to menopausal symptoms. According to Yakazu Domei
(7), the way that xue dao syndrome became closely associated with menopause in the Japanese
literature is as follows:
For years, when confronted with the term xue dao, many physicians trained in modern medicine just
smiled. As a result, the term was replaced by the words climacteric disturbance or disturbance of the
autonomic nervous system. However, these two terms describe only a part of the xue dao zheng.
In other words, because the traditional Chinese medical term was not acceptable by the modern-trained
physicians (who just smiled in embarrassment when the discussion turned to such an archaic concept),
it was replaced with another that was considered acceptable: climacteric disturbance.
Hosono Shiro touched on the subject of blood stasis and menopause in the first of his ten lectures on
Chinese herbal medicine presented in English by the Oriental Healing Arts Institute (11):
The stagnant blood conformation results from abnormalities in the central nervous, endocrine, and
circulatory systems caused by changes in metabolism....The stagnant blood conformation also
resembles menopausal disorders caused by hormonal and central nervous system abnormalities.
He also considered that post-partum illnesses and infertility were related to this type of problem. Poor
memory, mental anomalies, and poor emotional control are among the symptoms he considers as
primary indicators of the stagnated blood circulation.
The Kojien Encyclopedia quoted by Yakazu Domei (7) describes chi no michi, which is a common
Japanese designation for xue dao zheng, as having the meaning of a syndrome of the path of blood
circulation, and also referring to "uterus-related diseases." These latter problems are said to usually
manifest in relation to the menstrual cycle, with symptoms such as headaches, nausea, hot flashes,
sweating, etc., which might include premenstrual syndrome, menopausal distress, and post-partum
disorders. Of course, some of these conditions are not uterine problems but, rather, ovarian problems;
in the traditional Chinese literature, there is no division between the uterus and ovaries, so the
translation is often haphazard.
In his book Aging and Blood Stasis (12), Yan Dexin describes three categories of menopausal
syndrome, emphasizing the emotional factors:
1. Heart spirit bewildered and chaotic: the mental state is not calm. The heart spirit is abstracted.
Sadness is so damaging one feels like weeping. The body and spirit are tired and fatigued. There
is scant qi, disinclination to speak, frequent yawning....
2. Heart blood deficiency: heart palpitations, restlessness, heart vexation, scant sleep, excessive
suspicion, easy anger, nervous tension, apprehension, anxiety....
3. Liver qi stagnation: essence-spirit worry and depression, nervous tension, apprehension, chest
oppression, heaving sighs, sometimes cold, sometimes hot, dizziness, vexation and agitation....
Many of these symptoms are the same as those described above for the middle-aged women who suffer
from xue dao zheng. It should be emphasized that some of the symptom reports are difficult to interpret
directly; for example, a woman might sleep normally or even excessively, but complain about insomnia
because she did not feel that the sleep gave her the sense of feeling rested; heart palpitations may be
reported when the heart rate is normal but the sense that the heart is 'not right' is experienced.
The basic therapeutic approach to xue dao zheng is to both nourish blood and vitalize blood circulation,
to strengthen the spleen and aid qi circulation, and to alleviate fluid accumulation associated with
deficiency and stagnation. The herbs tang-kuei (danggui), peony (baishao), and hoelen (fuling) are
frequently included in the prescriptions; all three benefit the spleen; tang-kuei and peony nourish and
vitalize blood; hoelen dispels accumulated moisture and calms the spirit.

Biehe Bing: Lily Disease

A complex and irregular disease described in the Jingui Yaolue (3) is "lily disease" (baihe bing). Lily
disease is named after the main ingredient in formulas designed for its treatment, the herb lily-baihe.
When used for treating this condition, lily is usually prescribed in small formulas with just one or two
other herbs. According to this ancient text:
Baihe bing is a disease characterized by general malaise-a desire but inability to eat, talk, lie down, or
walk. The patient often appears quiescent. Sometimes he has an appetite, sometimes not. He feels cold,
but has no chills or else feels hot, but has no fever. A bitter taste invades his mouth and his urine flows
red. No herbs can cure him because severe vomiting and diarrhea occur upon ingestion of herbs. It
seems as though a certain spirit has possessed him though he appears to be normal except for a minute
and quick pulse.
The conflicting and complicated pattern of symptoms gives the impression that there is a foreign
influence (spirit; ghost) that has taken some control. The malaise characterized by "desire but inability"
is typical of depression. The description of red urine in this context is consistent with the concept of
heat centered in the heart that flows downward to the small intestine (the fu organ associated with the
heart), and from there to the urinary bladder. This downward flow is due to the presence of damp
(moisture accumulation) that carries the heat downward; the dampness also impairs the movement and
expression of the individual. The vomiting and diarrhea mentioned here can come about because of
damp accumulation affecting the spleen and from heat affecting the stomach, making it react to many
herb remedies.
According to the Shennong Bencao Jing (13): "Lily is sweet and balanced. It mainly treats evil qi,
abdominal distention, and heart pain. It disinhibits urination and defecation, supplements the center,
and boosts the qi." One of the important actions is to "disinhibit" urination, which is a method for
conducting out excess fluid and heat. Today, lily is often described simply as a yin nourishing herb,
especially used for dry cough. The Chinese English Manual of Common-Used Herbs of Traditional
Chinese Medicine (14) provides these indications for lily aside from moisturizing the lungs and
relieving cough: "Clear away heart-fire and tranquilize the mind: for the convalescence of febrile
diseases or yin deficiency with heat manifested as irritability, insomnia, dreaminess, palpitation, and
absent-mindedness."

Modern Interpretations of Lily Disease

Lily disease has been associated in modern times with various psychological illnesses. In Chinese
English Manual of Common-Used Prescriptions of Traditional Chinese Medicine (15), the
indications for Lily and Talc Formula (Baihe Huashi San), includes this description:
Mainly for lily syndrome (depressive state of psychic disease), manifested as mental disorder,
irritability, insomnia, anorexia....
Modern Clinical Necessities for Acupuncture and Moxibustion (16) mentions the syndrome:
Hysteria, mostly seen in the female, is a paroxysmal disease with complex and variable symptoms. In
traditional Chinese medicine, it belongs to the category of Bai He Bing.
The main points recommended in this text are ximen (PC-4), which has an action similar to neiguan
(PC-6), and yongquan (KI-1), which is used to drain the excess from above. More broadly, hysteria
belongs to the larger class of disorders known as neurosis. In the companion text Modern Clinical
Necessities for Traditional Chinese Medicine (17), it is said that:
Neurosis is a collective term for neurasthenia, hysteria, and obsession, which are diseases of
disturbance of higher nervous functions commonly found in the clinic. They are classified in traditional
Chinese medicine into yuzheng (depression), meihe qi (plum pit qi; globus hystericus), zangzao
(hysteria), and baihe bing (lily disease).
According to the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine (18),
hysteria is the term used to refer to "a condition characterized by a series of mental symptoms and
signs, such as emotional depression or unrest, abnormal crying or laughing. The causative factor of the
condition is related to emotional disturbances such as depression, excessive joy, anger, or
grief....Excessive anger can impair the function of liver in maintaining free flow of qi, causing
derangement of qi mechanism and emotional unrest. Habitual depression with over-thinking and
sorrow cause the liver to overact on the spleen...." The condition is listed in the section on gynecology.
Among the formulas recommended in this text for neurosis are Licorice and Jujube Combination
(Gancao Xiaomai Dazao Tang), Lily and Rehmannia Combination (Baihe Dihuang Tang, a simple
heat-clearing formula based on use of lily), and Bupleurum and Dragon Bone Combination (Chaihu
Jia Longgu Muli Tang), which is an ancient remedy for mental agitation described in the Shanghan
Lun (2). Formulas such as these are recommended in the treatment of chronic fatigue syndrome in
China. In one medical journal article (19), the Chinese physician Yin Hengze designed a formula for
chronic fatigue based on blending Four Major Herbs Combination (Si Junzi Tang), Lily and Rehmannia
Combination (Baihe Dihuang Tang), and Tang-kuei and Bupleurum Formula (Xiao Yao San). The
patients, suffering from a variety of symptoms including constant fatigue after any activity, difficulty
concentrating, depression, sleep disorder, aches and pains, sore throats, etc., were treated with both the
herb formula and psychotherapy. It was reported that two weeks of such treatment would produce some
symptom resolution in about 2/3 of the patients.

Meihe Qi: Plum Pit Qi (Globus Hystericus)

The Western term globus hystericus implies a lump (actually, the sensation of a lump) that is the result
of hysteria. The Chinese term for the condition, meihe qi (plum pit qi), indicates that the sensation is
the result of qi stagnation and accumulation. There is no physical lump present; the feeling of its
presence may come and go and it is highly irritating.
The Jingui Yaolue (3) presents a treatment for this disorder, namely Pinellia and Magnolia
Combination (Banxia Houpu Tang), a formula that disperses stagnant qi, stagnant fluid, and
accumulated phlegm-fluid. The text mentions that the condition happens in women, and prior to
introducing the formula, it is mentioned that "sometimes a woman contracts evil wind with fever and
chillphobia at the onset of menses...." The implication is that this disorder is in some way related to the
uterus (or, more generally, the xuehai). The text continues with the introduction of Licorice and Jujube
Combination (Gancao Xiaomai Dazao Tang) for "a woman with visceral irritation [hysteria] who tends
to grieve and cry as though possessed by a spirit." In Commonly Used Chinese Herb Formulas with
Illustrations (20), the indications for Pinellia and Magnolia Combination are:
Neurosis, nervous exhaustion, hysteria, nervousness, insomnia, fearfulness, neurotic esophageal
constriction [globus hystericus], recurrent palpitations....
The formula is a simple one, comprised of magnolia bark, pinellia, fresh ginger, hoelen, and perilla
leaf. In Chinese-English Manual of Common-Used Prescriptions in Traditional Chinese Medicine
(15), it is said that the formula is "mainly for cases of globus hystericus due to the disorder of the seven
emotions and the stagnation of phlegm." The sensation of a lump in the throat (rather than elsewhere) is
attributed to "abnormal rising qi." One of the herbs used for such conditions is perilla leaf, which is a
major component of Lindera and Cyperus Formula (Zhengqi Tianxiang San), indicated for "climacteric
neurosis in females, diseases caused by occlusion and stagnation of qi, hysteria, neurasthenia, pre-
partum and post-partum neuroses, amenorrhea, melena, neuroses of widows, nuns, and monks (20)."
The last reference to widows, nuns, and monks suggests the psychological impact of being unmarried
and not having a normal sexual and social life and does not necessarily mean that this syndrome was
observed in such individuals.
Hong-yen Hsu provided a review of treatments for abnormal sensations in the throat (21). He
considered that aside from local disturbances, such as inflammatory disease, the causes included mental
factors, stating: "Fear and tension, as well as other strong emotions, often induce physiological
problems in the autonomic nervous system." He reports that the condition is due to "mental depression,
malfunction of the liver and spleen, accumulation of sputum, alternate flushing up of sputum and qi; it
is caused by anger while eating and an imbalance between the liver and the stomach." Recommended
formulas include Pinellia and Magnolia Combination (Banxia Houpu Tang) and several other
prescriptions relying on pinellia (banxia) as a key component; this herb has long been used for its
combined effect of resolving phlegm accumulation and lowering stomach qi. Hsu relayed the
experience of physicians at the Tokyo University Medical School who treated plum pit qi syndromes.
According to the report, 21 patients received Pinellia and Magnolia Combination (mostly for female
patients with nervousness) and 13 patients received Bupleurum and Dragon Bone Combination (mostly
for male patients with strong physique; see pages 74-75 for more details about this important formula).

Fluid Connection
The three syndromes described here involve different pathologies in the TCM system: stagnant blood
in xue dao zheng, heart fire in baihe zheng, and stagnant qi in meihe qi. All three syndromes also tend
to involve fluid accumulation; unfortunately, this aspect is not emphasized in the modern literature. As
will be seen in the chapter on herb formulas, many of the treatments for these syndromes incorporate
herbs for draining damp. Japanese physicians refer to shuidu (water toxin) and lishui (hidden water),
the concept that accumulated fluids can have a corrupt nature when they accumulate, leading to
production of bizarre symptoms. In the Chinese literature, there is reference to "turbidity" which
implies corrupted fluids, and is especially applied to phlegm (phlegm-turbidity). Both moisture and
phlegm can remain "hidden," particular concern is expressed for hidden phlegm, called "phlegm-mist."
References
1. Dong Zhi Lin and Jiang Jing Xian, 100 Famous and Effective Prescriptions of Ancient and
Modern Times, 1990 China Ocean Press, Beijing.
2. Hsu HY and Peacher WG (editors), Shang Han Lun: The Great Classic of Chinese Medicine,
1981 Oriental Healing Arts Institute, Long Beach, CA.
3. Hsu HY and Wang SY, Chin Kuei Yao Lue, 1983 Oriental Healing Arts Institute, Long Beach,
CA.
4. Hsu CS and Chen MF, Treatment of depression and other emotional disorders with Licorice and
Jujube Combination, International Journal of Oriental Medicine, 1992; 17(4): 187-189.
5. Wu Jingnuan, Ling Shu, 1993 The Taoist Center, Washington, D.C.
6. Unschuld PU, Introductory Readings in Classical Chinese Medicine, 1988 Kluwer Academic
Publishers, Dordrecht.
7. Yakazu Domei, The meaning of Hsieh Tao Cheng [xue dao zheng] and its treatment with
Chinese formulas, Bulletin of the Oriental Healing Arts Institute, 1982; 7(7): 1-10.
8. Shigeru Arichi, Yu KK, and Machiko Sakaguchi, Clinical experience with women's erratic
complaints syndrome, Bulletin of the Oriental Healing Arts Institute, 1981; 6(5): 34-37.
9. Zhang Enqin (chief ed.), Clinic of Traditional Chinese Medicine, 1989 Publishing House of
Shanghai College of Traditional Chinese Medicine, Shanghai.
10. Yamada Terutane, Some personal experiences with the application of Chinese herbal
medicine (VII), Oriental Healing Arts International Bulletin 1986; 11(7): 547-555.
11. Hosono Shiro, Ten lectures on Chinese herbal medicine: I., Bulletin of the Oriental
Healing Arts Institute, 1984; 9(2): 67-83.
12. Yan Dexin, Aging and Blood Stasis, 1995 Blue Poppy Press, Boulder, CO.
13. Yang Shouzhong (translator), The Divine Farmer's Materia Medica, 1998 Blue Poppy
Press, Boulder, CO.
14. Ou Ming, ed., Chinese-English Manual of Common-Used Herbs in Traditional Chinese
Medicine, 1989 Joint Publishing Co., Hong Kong.
15. Ou Ming, ed., Chinese-English Manual of Common-Used Prescriptions in Traditional
Chinese Medicine, 1989 Joint Publishing Co., Hong Kong.
16. Zhang Ru and Dong Zhilin, Modern Clinical Necessities for Acupuncture and
Moxibustion, 1990 China Ocean Press, Beijing.
17. Wang Qi and Dong Zhilin, Modern Clinical Necessities for Traditional Chinese
Medicine, 1990 China Ocean Press, Beijing.
18. Xu Xiangcai, et al., The English-Chinese Encyclopedia of Practical Traditional Chinese
Medicine, 1990 Higher Education Press, Beijing.
19. Yin Hengze, Clinical observation on the therapeutic effect of three formula decoction in
treating 32 cases of chronic fatigue syndrome, Shanghai Journal of Traditional Chinese
Medicine 1999; 3: 19-20.
20. Hsu HY and Hsu CS, Commonly Used Chinese Herb Formulas with Illustrations, 1980
rev. ed., Oriental Healing Arts Institute, Long Beach, CA.
 21. Hsu HY, Chinese herb therapy for abnormal sensations in the throat, Bulletin of the
Oriental Healing Arts Institute 1984; 9(2): 63-66.

Painting by Chen Hung-shou (1598-1652). For a time, he lived as a Buddhist monk at a monastery. He
painted numerous nature scenes; in this one, a scholar is enjoying nature under a pine tree emerging
from a towering rock. In his right hand he holds a brush, as he is inspired by the beauty of the scene to
write poetry. From Eight Dynasties of Chinese Painting (1980 Cleveland Museum of Art).
Chapter 7
Herbs

Herbs for Treatment of Shen Disorders

The earliest texts describing Chinese herbs include numerous ingredients that are said to affect the
spiritual life of man. The first formal book of medicinal substances that survived to the present is the
Shennong Bencao Jing (Shennong's Herbal Classic, attributed to one of the three divine helpers that
came in human form, Shennong, and written around 100 A.D.), used as a source of the quotes in this
section (1).
The way Chinese herbs are used for shen disorders has changed over time and is affected by cultural
differences among the countries utilizing Chinese medicine. For example, the three syndromes describe
in the previous chapter (and the contribution of "hidden water" or "water toxin") have been of interest
in ancient times in China and in Japan today, but herb formulas presented in modern Chinese texts
often have yet a different focal point, which will be described in this chapter.
Further, the selection of ingredients to use in treatments has changed, especially in recent years, and
particularly as one takes the formulas from Asia and tries to utilize them in Western countries, where
there are different concepts of what serves as an acceptable ingredient. For example, the most revered
of the ingredients for shen disorders (and for several other conditions) in China throughout the past
2,000 years is one which we no longer would even consider using, but its ancient description is worth
relaying:
Dansha is sweet and slightly cold. It treats hundreds of diseases of the five viscera and the body. It
nurtures the essence spirit (jingshen), quiets the hun and po, boosts the qi brightens the eyes, and kills
spirit demons and evil ghosts. Protracted taking may enable one to communicate with the spirit light
and prevent senility….
This compound, cinnabar, was one of many mineral agents that were relied upon for such spiritual
aims. It is a mercury compound that the Chinese believed was safe to use, and which had been used
routinely until just a few years ago. The stories about "contaminated" Chinese herb products that are
relayed in Western countries often reflected detection of mercury from cinnabar, as well as arsenic from
realgar, two items that had been trusted by the physicians in China. This was not contamination, but
intentional inclusion of the ingredients.
Animal parts were also used for the spirit remedies, including this one that we also don't use today:
Shexiang is acrid and warm. It mainly keeps off malignant qi, kills ghosts and [adverse] spiritual
matters, [cures] malaria, gu toxins [certain types of parasites], epilepsy, and tetany, and removes the
three worms. Protracted taking may eliminate evils to prevent depressive ghost dreams in sleep.
This substance, musk, is from an endangered deer species mainly found in the mountainous area of
Tibet and adjacent mountainous Chinese provinces, and was commonly employed in remedies for
reviving consciousness because of its potent fragrance. Endangered species concerns have eliminated
from use numerous animal substances that were considered of great value. Further, European
governments have somewhat arbitrarily restricted virtually all animal ingredients from use in "herbal"
formulas.
A mineralized animal substance, dragon bone (fossilized bones of large mammals, so no animal
material remains), was long employed as a spirit medicine:
Longgu is sweet and balanced. It mainly treats heart and abdominal demonic influx, [adverse] spiritual
matters, old ghosts, cough, and counterflow [of qi], diarrhea and dysentery of pus and blood….
Dragon bone is still in use; dragon teeth is collected from similar source materials and used similarly
(though especially for treatment of disorders associated with fright). Fossilized tree resins, in the form
of amber (also called succinum; the Chinese name is hupo, referring to the po soul of the tiger, which it
is said to represent), are included in traditional and modern formulas for spirit disorders.
Ordinary plant materials are the main ingredients in spirit formulations, and the best known of these is
ginseng. Due to attempts to vigorously promote its sale in the West, the applications of this herb have
been altered to serving primarily as an energy tonic, a use quite different than in traditional Chinese
medicine:
Renshen is sweet and a little cold. It mainly supplements the five viscera. It quiets the essence spirit
[jingshen], settles the hun and po, checks fright palpitations, eliminates evil qi, brightens the eyes,
opens the heart, and sharpens the wits….
The case of ginseng is an example of how information about herb use can become distorted. As a result,
many people worry that ginseng will have an agitating quality when, in fact, it is used in the Chinese
formulas as a calming substance.
There are some principles of therapy that have changed due to the developments of modern medicine.
For example, throughout the history of Chinese medicine several shen disturbances, including loss of
consciousness, mania, and emotional agitation, were understood to occur as the direct result of feverish
diseases. Thus, herbs that purge fire, including rhino horn (no longer used), raw rehmannia (sheng
dihuang), coptis (huanglian), gardenia (shanzhizi), moutan (mudanpi), and scute (huangqin), were
sometimes key ingredients in the prescriptions. In modern times, most of these feverish conditions can
be controlled with antibiotics, antipyretic drugs, and other modern therapies (or can be prevented
outright by vaccination) so that the mind and brain disorders that are the subject of potential Chinese-
herbal treatment today are rarely associated with febrile disease. While these same fire-purging herbs
have some sedative effects, it is clear from the ancient formula descriptions that they were included
mainly for their role in treating a febrile condition.

As a result of research done during the 20th Century, modern Chinese practitioners have turned much of
their attention to the principle of treating blood stasis, which was less frequently described in ancient
times. While xue dao zheng usually involved the problem of abdominal stagnation of blood flow,
today's efforts are usually directed at blood stasis affecting the heart and brain, looking particularly at
the problem of strokes and other diseases of aging associated with vascular blockage. Ingredients such
as red peony (chishao), cnidium (chuanxiong), persica (taoren), carthamus (honghua), and salvia
(danshen) are the most frequently relied upon for these purposes.
Thus, one can say that some principles of therapy now have less emphasis than before (i.e., clearing
heat) and others have more emphasis than before (i.e., vitalizing blood), and this is important to
recognize when analyzing formulas described in modern clinical reports from China. Similarly, some
ingredients are less often used, such as animal substances, while others are more frequently used,
especially those plant materials that have escaped worries about toxicity and endangered species status.

Basic Therapeutic Approaches

There are four main therapeutic approaches using herbs in traditional Chinese medicine to address the
problems classified as spirit disorders:
1. Tonification therapy. The brain is described as an extension of the marrow which belongs to the
kidney system, so herbs that nourish the kidney are understood to nourish the brain (and spinal
cord). Lack of nourishment (particularly of the fluid component, that is, yin and blood) of any
organ can lead to mental distress, due to the fact that the internal spirits cannot rest if their
associated internal organs are "empty," that is, deficient in essential fluids. In particular,
deficiency of liver and heart can easily cause disturbance of the mind (due to hyperactivity of
the hun and shen). Weakness of spleen qi is often ultimately responsible for lack of nourishment
of all the organs and the body; the spleen also promotes upward circulation of qi to reach the
brain.
2. Regulating qi. The free flow of visceral qi, regulated by the liver, is understood to correspond to
the mental condition, particularly the thought processes and the reactions to experiences. For
example, stagnated (depressed) liver qi circulation corresponds to mental depression, repetitive
thoughts, limited outlook, and other mental conditions that, in turn, cause problems in social
situations, furthering the liver qi stagnation. Although anger is the emotion frequently cited as
associated with the liver and its circulation of qi, in fact, other emotions also have various
effects on the qi, and the consequence may be stagnation of liver qi circulation.
3. Calming agitation. Aside from the problem of deficiency that leads to unsettling of the spirit, the
mind can be agitated as a result of heat, wind, or uprushing qi and yang, disorders that may be
 secondary to deficiency (e.g., yin deficiency of the liver yields liver fire and internal wind) or
may be an excess pattern (from a pathogenic influence or from diet, excess emotions, etc.).
Herbs are used to clear the heat (purge fire), sedate the wind, and settle the upward rising of qi
and yang.
4. Clearing orifices of phlegm-mist. The connection between the heart and mind (or brain) is made
by channels (orifices) that can become obstructed; the ultimate source of the obstruction may be
weak stomach/spleen function leading to accumulation of phlegm, or fire syndrome damaging
fluids and transforming them to pathological phlegm. Aromatic and penetrating herbs can clear
the obstruction and phlegm-resolving herbs can help prevent the orifices from becoming
obstructed again.
In designing a formulation, it is common to rely primarily on one or more of the first three methods
listed here to treat shen disorders. In fact, tonification therapy is a part of nearly all the treatments used
in modern practice. The fourth method (which will be analyzed more fully in the appendix to this
chapter), is especially used in cases of severe disturbance, for ailments associated with the phlegm
syndrome, and for treatment of elderly patients.
Tables 1-4 list some sample herbs in each of the four therapeutic areas of primary concern. The herbs
were selected for inclusion in these tables on the basis of high frequency of use in treating mind and
brain disorders as described in both the traditional and modern literature (the formulas for treating the
disorders will be described in the next two chapters). Some items frequently mentioned in traditional
literature (e.g., musk, rhino horn, cinnabar) and used until recently in China have been retained here to
assist in the study of that literature.
Within each category, the herbs are listed alphabetically by common name (followed by pinyin and
typical botanical source for clear identification). In the section of "main actions," the information is
derived primarily from Oriental Materia Medica (2), with only those actions that are relevant to
treatment of mental disorders included in the table. Since the concept of phlegm-mist is not often
elucidated, an extensive explanation is presented in the appendix.
Table 1: Tonic Therapies Frequently Used for Shen Disorders.

Herb Main Actions Comments

The Chinese name means to enhance the
supplements spleen,
Alpinia disposition of the individual (increase wisdom,
warms the kidney,
yizhiren is one translation). It is thought to improve the
astringes essence,
Alpinia oxyphylla thinking function associated with the spleen and
fortifies qi
the will associated with the kidney.
Asparagus
Asparagus is considered similar in nature, taste,
tianmendong nourishes yin, moistens
and function to ophiopogon and is commonly
Asparagus dryness
used in combination with it to nourish the yin.
cochinchinensis
Astragalus supplements qi, Astragalus helps the spleen generate a pure and
huangqi increases yang clear qi that rises upward to nourish the heart
Astragalus
and brain
membranaceous
Atractylodes
This aromatic tonic for the spleen disperses
baizhu supplements spleen,
stagnated fluids that can obscure the heart
Atractylodes tonifies qi
orifices.
macrocephalla
Cistanche nourishes kidney The soft, black, salty herb is thought to quickly
roucongrong essence, supplements nourish the deficient kidney essence,
Cistanche salsa yang invigorating yang without harming the yin.
In China, codonopsis is almost always used as a
Codonopsis invigorates the spleen
substitute for ginseng as a stomach/spleen tonic,
dangshen and stomach,
but it lacks the spirit-calming qualities of
Codonopsis pilosula replenishes qi
ginseng.
Cornus supplements liver and The sour fruit is frequently used to astringe and
wuzhuyu kidney, astringes nourish the essence and help prevent
Cornus officinalis essence deterioration of health.
The seed is thought to help prevent leakage of
Cuscuta
supplements kidney essence (as an astringent), therefore it is used to
tusizi
essence, clears vision prevent deterioration. It gently tonifies yang,
Cuscuta chinensis
without harming yin.
Dioscorea is used in many treatments for
Dioscorea supplements spleen,
weakening of the kidney essence; its ability to
shanyao stomach and kidneys,
benefit the spleen at the same time is unusual
Dioscorea batatas astringes essence
among the Chinese herbs for that purpose.
Ginseng is one of the original remedies for
replenishes and
spirit disorders used in Chinese medicine; it has
supplements original
Ginseng a calming nature and replenishes all
qi, benefits the five
renshen deficiencies. In the West, ginseng has taken on
viscera, pacifies the
Panax ginseng the connotation of an energy stimulant;
spirit, soothes the soul,
practitioners and patients often worry about the
increases wisdom
proclaimed stimulant action of this herb.
Ho-shou-wu nourishes yin, Ho-shou-wu is a famous "anti-aging" herb that
heshouwu replenishes essence is reputed to keep the body and mind young and
Polygonum and blood, tonifies active. By nourishing the kidney and liver, it
multiflorum liver and kidneys nourishes the brain.
strengthens spleen,
harmonizes middle Hoelen is used to soak up excess moisture and
Hoelen
warmer, tranquilizes improve spleen function; it is also favored as a
fuling
the heart, pacifies the sedative. It has a mild action. The sedative fu-
Poria cocos
spirit, resolves shen (see Table 3) is from the same source.
moisture
supplements the heart, This sedative tonic has properties that imitate
Longan
stabilizes the spirit, the actions of ginseng plus tang-kuei. It is
longyanroux
tonifies spleen, primarily used in Ginseng and Longan
Euphoria longana
nourishes blood Combination (Guipi Tang).
 supplements liver and Lycium is commonly used in cases of essence
Lycium
kidneys, promotes deficiency and is considered especially useful
gouqizi
production of essence because of its mild nature, not producing any
Lycium barbarum
and blood adverse digestive effects even in large dosage.
nourishes yin, moistens This yin-nourishing herb is especially relied
Ophiopogon
dryness, removes heat, upon when there is phlegm accumulation and
maimendong
resolves phlegm, calms heart agitation; sometimes asparagus is added to
Ophiopogon japonicus
spirit enhance the heat clearing action.
Peony is the most commonly used blood
supplements blood,
Peony nourishing herb because its other properties
vitalizes blood, cools
baishao (vitalizing and cooling blood, astringing liver
blood, astringes liver
Paeonia alba yin) take care of several requirements of the
yin, strengthens spleen
formulations.
nourishes blood, yin, This rich, black processed root is considered
Rehmannia
and essence, one of the most important herbs to nourish the
shudihuang
supplements kidney liver and kidney. It is used to prevent and even
Rehmannia glutinosa
and liver reverse the deterioration associated with aging.
This herb is used for nourishing the blood of the
Tang-kuei
supplements and liver and heart, which has the effects of
danggui
moves blood controlling emotional distress and relieving
Angelica sinensis
spasms.
Table 2: Qi-regulating Herbs. Bupleurum is included in this table as an important qi regulating herb,
particularly for shen disorders, but in the Materia Medica it is placed in the surface relieving category,
which reflected one of its most frequent uses at the time the herb categories were established; magnolia
bark is categorized with aromatic moisture resolving herbs, but it has an important role in regulating qi
circulation and so is included here.

Herb Main Actions Comments

Bupleurum strongly dredges liver qi; this action
Bupleurum may be uncomfortable in those with blood
regulates liver qi,
chaihu deficiency (it is often administered with blood
raises yang qi
Bupleurum chinense tonics); it also aids rising of qi, so that herbs to
lower qi may be needed in the formula.
disperses central qi, Used for food stagnancy, epigastric aching, and
Chih-ko
regulates horizontal qi lung congestion; it is often used to aid
zhiqiao
circulation; resolves bupleurum in dispersing qi and to aid pinellia in
Citrus aurantium
phlegm resolving phlegm.
disperses central qi, Used for abdominal stagnation with
Chih-shih
regulates vertical qi constipation; helps direct qi flow downward.
zhishi
circulation; purges Chih-shih is helpful in reducing damp-heat and
Citrus aurantium
gallbladder, clears heat phlegm accumulation especially that associated
(unripe fruit)
and phlegm with gallbladder stagnation or heat.
Citrus disperses qi, The most widely used qi-regulating herb; it is
chenpi strengthens spleen, also used in treatment of most phlegm
Citrus reticulata dries moisture and disorders, combined with pinellia. Citrus aids
 phlegm the spleen in dispersing moisture.
strongly disperses
Cyperus Analgesic for headaches and abdominal pains
central qi, alleviates
xiangfu, xiangfuzi and alleviates qi stagnation; this is considered
pain, regulates
Cyperus rotundus an important herb for treating depression.
menstruation
Lindera This herb is used like bupleurum to disperse
disperses qi alleviates
wuyao stagnant qi, but is especially used in cold
pain, warms the kidney
Lindera strychnifolia syndromes and for weak kidney qi.
Magnolia bark Mainly used for abdominal distention,
dries dampness, moves
houpu uprushing of qi, food stagnation, obstruction of
qi
Magnolia obovata phlegm, and tightness of the diaphragm.
Saussurea
disperses qi, alleviates
muxiang Used for mainly for abdominal disorders that
pain, controls diarrhea,
Saussurea lappa or include diarrhea.
sedative
Jurinea soulei
Table 3: Sedative Herbs. Polygala, listed in the Materia Medica among the heart-nourishing herbs, has
been listed both here and in the category of herbs to help resolve phlegm mist (Table 4).

Herb Main Actions Comments

This seed is very oily, so it is used only in
Biota
nourishes heart and moderate dosage if there is a spleen-damp
baiziren
calms mind syndrome, but is favored for constipation and
Biota orientalis
dryness.
This is the premier sedative of the Chinese
Cinnabar tradition and mentioned in numerous ancient
sedates the heart and
zhusha and modern formulas; however, it is avoided in
calms the mind
mercuric sulfide the West due to its content of mercury, the
active constituent.
These are fossilized bones of ice age animals,
pacifies the liver,
Dragon bone comprised mainly of soluble minerals, such as
restrains floating yang,
longgu calcium carbonate. It has a nutritive and
sedates and calms the
fossil bones calming action. It is also an astringent for
mind
kidney essence.
Dragon teeth Like dragon bones, dragon teeth are fossilized;
sedates and calms the
longchi Chinese doctors regard them as especially
spirit
fossil teeth useful for fright-induced mental disorders.
Fu-shen Fu-shen is mostly the same material as hoelen
sedative, moisture-
fushen (see Tonics) with similar properties, but
resolving, strengthens
Poria cocos + includes portions of pine root; the pine confers a
spleen
Pinus sp. sedative effect.
Oyster shell is used to calm agitation; it has
Oyster shell pacifies the liver and
astringent properties and also reduces excess
muli restrains the floating
stomach acid. It mainly contains calcium
Ostrea gigas yang
carbonate.
 Polygala is a nourishing sedative, often
Polygala stabilizes the heart,
combined with zizyphus; it is commonly used
yuanzhi calms the mind,
with acorus to disperse phlegm-mist and enliven
Polygala tenuifolia disperses phlegm
the mental functions.
Like cornus, it is relied upon to astringe essence
and prevent deterioration of health; modern
Schizandra
astringes essence, research has shown that it normalizes cerebral
wuweizi
calms agitation electrical discharges and is thus used in
Schizandra chinensis
treatments for brain disorders, especially for
insomnia and poor memory.
This is the aged resin mostly from various pine
Succinum sedates and calms trees; the ancient Chinese said that this material
hupo spirit, vitalizes blood is actually the soul of tigers that have died, and
fossilized resin circulation it has a sedating quality that still imparts the
tiger's power.
Zizyphus nourishes heart and The most commonly-used sedative especially
suanzaoren calms spirit, nourishes treats mental disorders characterized by
Zizyphus spinosa liver insomnia and agitation.

What is Phlegm-Mist Affecting the Orifices of

the Heart?
Before presenting the herbs for phlegm-mist, the nature of this condition is first described. Although
phlegm-mist can affect different parts of the body, the terminology of "phlegm misting the orifices of
the heart" (tanmi xinqiao) is frequently used for the concept as it refers to function of the brain and the
syndrome that produces or worsens shen disorders.
The condition is sometimes described as phlegm entering the heart, or as phlegm entering the heart
meridian (or "channel"). The original description of meridians in the Chinese medical system is related
to blood vessels. We know this, in part, because virtually all mentions of the flow of qi in the ancient
texts are actually about the combined flow of "qi and blood." It is easy to become confused about the
Chinese view of human physiology when modern writers describe meridians as pathways existing
solely for the flow of qi, to be distinguished from blood vessels for the flow of blood, which is not
consistent with the prior 2,000 years of Chinese literature. The fact that the meridian maps (for
acupuncture) do not correspond with blood vessels merely indicates that what was eventually mapped
for purposes of describing acupuncture therapies failed to follow precisely the underlying traditional
conceptual framework. When describing long-held ideas about human physiology such as this, it is
important to consider the context, and in this case, the flow of qi and blood were considered to be
unified and involved the same "vessels."
Phlegm mist is a concept that can be traced back at least to the Song Dynasty. By that time, Chinese
doctors were distinguishing "substantial" phlegm (such as sputum, which is described as "condensed
pathological fluid") and "insubstantial phlegm" or "hidden phlegm" (such as the mist of the heart
orifices; a "thin pathological fluid"). The substantial phlegm would mainly accumulate in the lungs and
stomach and could be noted in the sinuses and throat, while the insubstantial phlegm would accumulate
in the meridians, distributing to various parts of the body, such as the heart orifices and the brain (e.g.,
causing dizziness or loss of consciousness in severe cases), the lymph nodes (causing nodules and
swellings), and the limbs (e.g., causing numbness). The two types of phlegm were thought to have the
same origin and the same fundamental nature, but would permeate different parts of the body (the thick
sputum could not penetrate the meridians, but the insubstantial phlegm could).
Further, insubstantial phlegm can combine with other pathological influences to yield phlegm-fire,
wind-phlegm, and phlegm-turbidity. According to the doctrine that evolved, the phlegm mist when
combined with the other pathological factors-such as fire, wind, or damp-could produce more severe
symptoms. Its material nature would capture the more ethereal forces of fire or wind to make the
disease persist; similarly, the phlegm mist could blend with damp to yield turbidity that obscures the
clear flow of qi and yang to the brain, interfering with normal mental and sensory functions, though not
completely blocking the circulation to the brain except in the worst cases, in which case one might
suffer what we understand today to be a stroke.
Diseases and symptoms attributed to phlegm mist affecting the heart orifices in addition to stroke
paralysis affecting the major muscles (hemiplegia), include dizziness, loss of consciousness (coma),
mania (emotional outbursts, disturbed speech), convulsions (especially epilepsy), sudden sensory loss
(deafness, blurred vision, loss of taste and smell, inability to speak), lockjaw, and stiff tongue. Several
of these symptoms may be the result of strokes. Diseases currently treated in China by herbs that
resolve phlegm-mist affecting the heart orifices also include manic-depressive disorder and senile
dementia (Alzheimer's disease).
Table 4: Herbs that Clear Phlegm Mist and Open the Orifices. In addition to herbs in the Materia
Medica categories of opening orifices and resolving phlegm, this table includes curcuma, a blood
vitalizing herb with phlegm-resolving action. Silkworm, a wind-calming herb, and polygala, a heart-
nourishing sedative, both also help resolve phlegm mist, so are included here.

Herb Main Actions Comments

This is the most commonly-used Chinese herb
Acorus opens orifices, expels
(of plant origin) for treatment of mental
changpu phlegm and turbidity,
disorders. It is often used with polygala to open
Acorus gramineus replenishes intelligence
the orifices.
Arisaema is described as having the power to
Arisaema resolves phlegm mist, vaporize phlegm accumulations; it is mainly
tiannanxing, disperses used when treating phlegm obstruction of the
Arisaema accumulations, relieves orifices. Bile processed arisaema (dannanxing)
consanguineum convulsions is used for phlegm-mist associated with a fire
syndrome.
Bamboo removes heat, Bamboo shaving, leaves, juice, or dried
zhuru, zhuli, transforms phlegm, secretion are all used to treat irritability, fidgets,
tianzhuhuang calms fright and convulsions. They are particularly favored
 Phyllostachys nigra in treatment of children's disorders.
Borneol is a potent herb for invigorating
Borneol
opens orifices, moves circulation and opening orifices; it is often
longnao
qi, vitalizes blood combined with musk and/or acorus to open
purified compound
orifices.
Curcuma is best known for its ability to vitalize
Curcuma regulates flow of qi
circulation of qi and blood, but it is useful in
yujin and blood, resolves
treating phlegm accumulation disorders,
Curcuma aromatica phlegm
especially when there is qi stagnation.
Musk, with its penetrating aroma and
opens orifices,
Musk stimulating quality, is mostly used for severe
invigorates blood
shexiang cases of brain disorder, especially when the
circulation, resolves
Moschus moschiferus person is losing consciousness or suffering from
turbidity
delirium.
Ox gallstone is utilized to correct gallbladder
opens orifices,
Ox gallstone disorders that result in hot phlegm moving
transforms phlegm,
niuhuang upward to cloud the consciousness. Bile acids
clears heat, removes
Bos taurus and minerals are combined to make synthetic
toxin, calms fright
oxstone.
harmonizes stomach, Pinellia is the most commonly-used phlegm-
Pinellia
dries dampness, resolving herb in Chinese medicine; it is used to
banxia
removes phlegm, help prevent development of phlegm-mist and it
Pinellia ternata
disperses accumulation settles uprising stomach qi.
Platycodon
Platycodon is thought to direct the action of
jiegeng
resolves phlegm other herbs to the upper body; in addition, it
Platycodon
helps to resolve phlegm-mist accumulation
grandiflorum
Polygala stabilizes the heart,
Polygala is often used with acorus for resolving
yuanzhi calms the mind,
phlegm that obstructs the orifices of the heart.
Polygala tenuifolia disperses phlegm
It is tempting to try and correlate the traditional Chinese concept of phlegm-mist with a substance or
condition defined by modern medicine so that the Chinese diagnostic category could be explained in
terms of our current knowledge of physiology. Thus, for example, the condition of atherosclerosis,
where plaques that include fatty materials (e.g., cholesterol and lipoproteins) coat the arteries, might be
one case of phlegm-mist affecting the orifices; certainly, stroke is frequently associated with this type
of blockage of the carotid arteries. The accumulation of amyloid plaques in the brain of persons with
Alzheimer's disease might also correspond, to some extent, to phlegm mist. Disorders of the thick fluid
in the ear drum, which might be depicted as a phlegm-type disorder (e.g., phlegm-turbidity), can yield
dizziness. The formation of blood clots in the arteries or veins, while seeming to fit the category of
blood stasis, may be an example of phlegm accumulation, in the sense that phlegm is a sticky substance
and the clot forms by the coagulation of various blood components (such as fibrin and platelets) into a
spongy mass. By contrast, extensive bruising, where clotted blood resides outside the vessels and forms
a firm mass, more clearly fits the blood stasis description.
The ancient doctors saw phlegm-mist primarily involved with sudden and dramatic change: the person
would faint, go into a convulsion, or suddenly erupt with crazy behavior. For example, as described in
the Advanced Textbook on Traditional Chinese Medicine and Pharmacology (3): "voracious
eating, overdrinking alcohol, and emotional irritation combine to cause food retention in the stomach,
which causes stomach qi to disturb upward, blocking the clear cavity and thus resulting in loss of
consciousness." The idea was that a substantial amount of phlegm would suddenly rush to the heart.
Then, when the phlegm blockage cleared, the person would return to normal, though in some cases,
there could be persisting symptoms (e.g., hemiplegia). The condition being described parallels what
happens when a blood clot forms in the arteries supplying the heart or brain, causing the person to
collapse. If the clot clears out quickly enough, the person recovers; if not, there may be persisting
symptoms or the person may die.
This connection between the traditional concept of phlegm blockage and the modern understanding of
formation of obstructive blood clots in the vessels was illustrated in a presentation at the 1987 TCM
conference in Shanghai (4). The researchers differentiated the disease conditions of 158 patients who
suffered from "upward disturbances of wind-phlegm and accumulation of phlegm-heat." Using the
TCM criteria, they divided these cases as follows: 120 of "channel stroke" (phlegm blocking the heart
orifices); 32 cases of fu-organ stroke (e.g., phlegm originating from the stomach or gallbladder); and 6
cases of zang-organ stroke (e.g., phlegm blocking the heart). Turning to Western medical diagnosis for
these same patients yielded: 145 cases of thrombosis of the carotid artery system; 8 cases of thrombosis
of the vertebro-basilar system; and 5 cases of embolism. The treatment administered to the patients was
based on expelling phlegm and purging the intestines. After a few days of this purging therapy
(generally less than two weeks), the focus of treatment shifted to "clearing heat, expelling phlegm,
vitalizing blood, and invigorating the channels." Liquid bamboo sap (zhuli) was used as an essential
ingredient in most of the cases.
As to the origins of the phlegm mist, the starting point is understood to be the generation of
pathological phlegm (excess phlegm-fluid) which can be the result of external influences (six
exogenous pathogenic factors), internal influences (abnormal emotional activities), and/or behavior
(especially irregular diet, but also overeating rich foods and/or drinking excess alcohol). For phlegm
mist to affect the heart orifices, which are at the top of the internal organs, it must rise upward, and that
occurs through certain mechanisms such as uprising qi from the stomach; uprising damp-heat from the
gallbladder (often due to persistent qi stagnation of the liver and rising liver yang); excessive
"steaming" of water by kidney yang (due to kidney yin deficiency); and heart fire. Perhaps the most
serious of the phlegm-mist syndromes is from a fire disorder (tanhuo raoxin). It is described in
Chinese Herbal Medicine: Formulas and Strategies (5) this way: "The vigorous blazing heat
scorches the fluids and causes them to congeal into phlegm. Heat and phlegm accentuate each other
and completely veil the orifices of the heart, further disturbing the spirit and impairing the
consciousness."
Persons with phlegm-mist syndrome need not have obvious phlegm excess (substantial phlegm), such
as coughing up sputum, runny nose, obesity (the excess fatty tissue is now considered a type of phlegm
mass), or phlegm-nodules (e.g., lipomas), but the problems of substantial phlegm and insubstantial
phlegm often go together because of common underlying causes. Usually, the patient suffering from
phlegm-mist will display at least some subtle signs of phlegm, such as slippery and smooth tongue
coating or slippery pulse. In the ancient Chinese texts, there are stories about treating patients with
phlegm-mist disorder using herbs that induce vomiting: discharge of copious amounts of mucous fluid
from the stomach occurs, followed by alleviation of the symptoms.
Several ingredients used in the traditional formulas for phlegm-mist disorders are problematic for
Western practitioners. For example, neither ox gallstone nor musk are readily available, and sometimes
the dosage of borneol used in Chinese formulas can be risky (it acts as a heart stimulant in high doses).
But, other ingredients are considered acceptable and the most commonly used ones are the pair of
acorus and polygala, usually combined with herbs that are considered heart sedatives (e.g., zizyphus
and biota seed); additionally, the pair of bamboo with arisaema, often with herbs that resolve phlegm-
damp (e.g., pinellia, citrus, and hoelen) is a common treatment approach. It is worth illustrating here
how some of the ingredients described above are utilized for the phlegm-mist conditions. A good
example is Anshen Dingzhi Wan, which is comprised of acorus, polygala, dragon teeth, fu-shen,
ginseng, hoelen; another is Ditan Tang, which is comprised of bamboo, arisaema, pinellia, citrus, chih-
shih, hoelen, ginseng, acorus, and licorice. Both formulas include ginseng, hoelen, and acorus, where
ginseng and hoelen tonify the spleen (to help prevent phlegm-fluid accumulation) and calm the heart
(fu-shen is a type of hoelen with greater calming qualities), and acorus is used to clear phlegm mist
from the orifices. Acorus is indicated for phlegm-damp obstructing the heart and for cases due to
dampness retained in the center (i.e., stomach/spleen).
The idea of phlegm-mist has evolved over time, and this entity is now included as a diagnostic category
for certain chronic ailments that do not necessarily have sudden onset, as occurs with some cases of
depression, deterioration of memory, or gradual onset of a seizure disorder, as well as for the prolonged
period of post-stroke syndrome. In such cases, milder agents (other than the highly aromatic musk and
borneol) are relied upon. As an example, Clinic of Traditional Chinese Medicine (6) recommends a
formula for treating a syndrome of "depressive psychosis" marked by conditions such as emotional
depression, apathy, dementia, muttering to oneself, frequent outbursts of crying or laughing for no
apparent reason, and low desire for food; the formula is comprised of acorus, polygala, arisaema,
curcuma, pinellia, citrus, chih-shih, cyperus, hoelen, licorice. In the book Traditional Chinese
Treatment for Senile Diseases (7), a similar formula is suggested for cases of senile dementia with
depression and other symptoms such as those just mentioned, with the herbs chih-shih and licorice
removed and replaced by gardenia. These formulas are modifications of the traditional Shunqi Daotan
Tang (Smooth the Qi and Purge the Phlegm Decoction).
For the long-term therapy of patients suffering from phlegm-mist disorder, dietary adjustments are
considered very important. Fried foods, heavily salted foods, and foods that are difficult to digest are
eliminated to avoid the problem of producing pathological phlegm from undigested food. Herbs that
promote digestion are also potentially of value. If constipation is present, this disorder is to be
addressed because it contributes to abdominal stagnation and the increased possibility of upward flow
of qi and fluid to affect the heart and its orifices.

Resolving Fluid Accumulation

As noted at the end of Chapter 6, one of the potential contributors to shen disorders is accumulation of
fluids. Herbs that resolve fluid accumulation are included in three of the tables presented in the current
chapter. For example, in the group of tonic herbs, atractylodes and hoelen are used for getting rid of
stagnated fluids; herbs that tonify the spleen, such as astragalus, ginseng, codonopsis, alpinia, and
dioscorea assist its function in distributing fluids. In the group of qi resolving herbs, most of the herbs
also disperse stagnant fluids, and all of the citrus-based materials (citrus, blue citrus, chih-shih, and
chih-ko) have a drying effect; magnolia bark is especially valued for dispersing accumulated fluid. In
the group of herbs for phlegm mist, all the herbs resolve fluid accumulation, particularly the thickened
fluids categorized as phlegm. Only the sedative herbs (Table 3) have limited capability to resolve fluids
(fu-shen functions like hoelen to resolve moisture; polygala helps get rid of phlegm-mist), and these are
almost always used with fluid-resolving herbs from the other categories. Hence, as an underlying
therapeutic principle, getting rid of accumulated fluids that may be causing physical and mental
disorders is almost always a part of treating shen disorders.

References
1. Yang Shou-zhong (translator), The Divine Farmer's Materia Medica, 1998 Blue Poppy Press,
Boulder, CO.
2. Hsu HY, et al., Oriental Materia Medica: A Concise Guide, 1986 Oriental Healing Arts
Institute, Long Beach, CA.
3. State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional
Chinese Medicine and Pharmacology, (Vol. 2) 1995-6 New World Press, Beijing.
4. Editorial Committee, International Conference on Traditional Chinese Medicine and
Pharmacology Proceedings, 1987 China Academic Publishers, Beijing.
5. Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990 rev. ed.,
Eastland Press, Seattle, WA.
6. Zhang Enqin (chief editors), Clinic of Traditional Chinese Medicine, 1989 Publishing House
of Shanghai College of Traditional Chinese Medicine, Shanghai.
7. Hou Jinglun Geng Xiu'e (chief editors), Traditional Chinese Treatment for Senile Diseases,
1997 Academy Press, Beijing.
Chapter 8
Traditional Herb Formulas
Herbs Formulas for Treatment of Shen
Disorders
There are hundreds of herbal formulas useful for shen disorders among the vast collection of Chinese
medical literature. However, a relatively small number of prescriptions have been handed down over
time and collected into texts that are used for the study of Chinese medicine today. These formulas are
the ones most likely to be used by physicians in China and the West, at least as a reference point for
preparing an individualized prescription, but often as a prepared formula ready to administer.
The well-established formulas for treatment of shen disorders may be subdivided into three groups for
purposes of analysis and discussion: those that focus on tonification therapy; those that combine qi
regulating and tonification; and those that combine tonification, sedating, and orifice opening. By
presenting these three groups, it is not intended to suggest that other combinations of therapeutic
principles are to be avoided, but that these three reveal the characteristics of most traditional formulas
used today for shen disorders. Four sample formulas have been selected for each category of
prescription.

Tonification Formulas
Deficiency of qi and blood are considered underlying syndromes that make a person susceptible to a
wide variety of disorders and diseases. Qi and blood fill the vessels to block entry of pathological
influences and they nourish the organs to protect them from deterioration or harmful changes in
structure and function. In addition, qi deficiency leads to insufficient raising of clear yang to the brain,
reducing mental and sensory acuity, while blood deficiency leads to insufficient moistening of the
internal organs, making them less receptive as a resting place for the associated spirit.
The concept of raising clear yang is important to mental function; it was described by Li Dongyuan in
his famous text Pi Wei Lun (1). He noted that:
After water and grain enter the stomach, yang qi ascends. Fluids and qi enter the heart and penetrate the
lungs to replenish the skin and hair and to disperse throughout the hundreds of vessels. The spleen
receives qi from the stomach to irrigate the four limbs and nourish the qi and blood. If, on the other
hand, the stomach is injured by improper food and drink and the spleen is damaged by being
overwhelmed [taxation fatigue], they become deficient….Generally speaking, if the spleen and
stomach are deficient and weak, yang qi is unable to grow and rise up….When the spleen is diseased,
yang qi flows down to overwhelm the kidneys.
In particular, the yang qi ascends to the top of the head, converging at the point GV-20 (baihui; hundred
convergences; and the meeting point for the six yang channels). Since the kidneys nourish the marrow
and brain, the problem of failure of yang qi to flow upward and invigorate the brain is compounded by
downward flow of yang qi inhibiting the kidney (thus weakening the kidney's nourishment of the
brain). Tonifying the spleen qi and raising qi become important, particularly where the brain function
appears impeded (slow thought, reduced sensory function, cloudiness, confusion, poor memory, etc.).
The herbs ginseng and astragalus (usually with licorice) are used for this purpose. Other ingredients
may be added to assist in raising yang qi, such as cimicifuga ( shengma ), which is not one of the tonic
herbs.
In the following list of sample formulas, all have astragalus, ginseng, and licorice for tonifying qi,
benefiting the spleen and heart, and raising clear yang. The formulas all contain constituents of the
main qi tonic formula, Si Junzi Tang (Four Major Herbs Combination) and the main blood nourishing
formula, Si Wu Tang (Tang-kuei Four Combination). Schizandra, an astringent herb, is listed among the
nourishing sedatives, which is how it is often used today. Yiqi Congming Tang is a formula primarily
used for sensory weakness (poor vision or hearing), but it also improves brain function more generally,
so is included here.
Table 1: Tonification Formulas for Shen Disorders.

Yiqi Congming Renshen

Ingredient type Guipi Tang Yangxin Tang
Tang Yangying Tang
Tonify/Raise Qi Astragalus Astragalus Astragalus Astragalus
Ginseng Ginseng Ginseng Ginseng
Atractylodes Atractylodes
Si Junzi Tang
Ingredients Hoelen Hoelen Hoelen
Licorice Licorice Licorice Licorice
Tang-kuei Tang-kuei Tang-kuei
Peony Peony
Si Wu Tang
Ingredients Rehmannia
Cnidium
Polygala Polygala Polygala
Nourishing Zizyphus Zizyphus
Sedatives Schizandra Schizandra
vitex, cimicifuga, fu-shen, biota,
jujube, longan, citrus, cinnamon
pueraria, pinellia,
Other Herbs saussurea, ginger twig
phellodendron cinnamon bark
Of these formulas, Guipi Tang is the best known and most widely used. Domei Yakazu (2) relays a
summary of applications of this formula as described in Japanese literature:
1. It is a wonderful prescription used mainly to treat a spleen and heart that are exhausted and
injured by excessive thinking and worrying, resulting in amnesia and reckless acts or destructive
behavior.
2. For those with insufficient blood in the heart, or for intestinal wind and bloody stools;
hematemesis, epistaxis, spermatorrhea, white turbid urine, or dripping and painful urination, or
for the strong-willed deep thinkers who have withered, yellow complexions, the prescription has
a miraculous effect.
 3. It is used for women who are peevish and irritable, can't be satisfied by any man, and can't get
what they want. This mental condition leads to jealousy and hostility, resulting in weak and
depressed spleen and heart with the accompanying symptoms of reckless acts, palpitation, flare-
up of weak fire, white dandruff, paralysis in the feet and hands, fondness of lying in bed, poor
appetite, thirst, itching and feverish skin heat, body odor, and pain and swelling or leukorrhea in
the genital area.
4. It has an excellent effect in treating all diseases of the female genitalia. For bleeding during
coitus, add cimicifuga [ shengma ] and peony [baishao] to the formula [note: shengma raises qi
and peony astringes blood, so this combination is intended to prevent the falling of blood].
5. It has a marvelous effect in curing the weakness in widows and virgins who are sexually
frustrated and, as a consequence, suffer depression and anxiety.
In addition to these common concerns, Guipi Tang may be of interest for a modern application of
aiding persons withdrawing from certain antidepressant drugs (SSRIs), as described in the Appendix.

Qi-Regulating Formulas
Bupleurum is one of the most important of the herbs for alleviating stagnation of liver qi associated
with depression of the mind. All the formulas listed in the table below include this herb; other qi
regulating ingredients are cyperus, citrus, and either chih-shih (immature fruit) or chih-ko (mature
fruit), which are types of citrus fruits. As with the above mentioned tonic formulations, ingredients of
Si Junzi Tang and of Si Wu Tang are included, because deficiency of qi and blood contributes to the
stagnation syndrome affecting the liver.
Table 2: Qi-Regulating Formulas for Treating Shen Disorders.

Zhuru Wendan Chaihu Shugan

Ingredient type Xiao Yao San Yi Gan San
Tang San
Bupleurum Bupleurum Bupleurum Bupleurum
Regulate flow of Cyperus Cyperus
Qi Citrus Citrus
Chih-shih Chih-ko
Ginseng
Atractylodes Atractylodes
Si Junzi Tang
Ingredients Hoelen Hoelen Hoelen
Licorice Licorice Licorice
Tang-kuei Tang-kuei
Peony Peony Peony
Si Wu Tang
Ingredients
Cnidium Cnidium
ginger, mentha pinellia, ginger, Uncaria
 [add gardenia
and moutan to platycodon,
Other Herbs
form Jiawei Xiao bamboo, coptis,
Yao San]
Of these formulas, by far the most widely used is Xiao Yao San (Tang-kuei and Bupleurum Formula)
and its modification Jiawei Xiao Yao San (Bupleurum and Peony Formula), made from the former by
adding the heat clearing herbs gardenia and moutan. The central herb of Xiao Yao San is bupleurum
(chaihu), used to release the liver qi that is stagnated by emotion. According to the Bencao Jiuzhen of
1773 A.D. (3):
Bupleurum is used for the condition of heat entering the women's blood chamber....In some cases, one
may use it during pregnancy or after delivery...bupleurum has a lubricating nature; it is an excellent
herb to stimulate the passage of qi...in cases of heat accumulation and blocked passage, it should be
assisted by tang-kuei and scute (huangqin).
Based on such descriptions, bupleurum has been especially used in treatments for women, mainly in
the context of Xiao Yao San and its derivative prescriptions. Souhaku Asada, a famous Japanese
physician quoted in an article on bupleurum prescriptions, indicates that bupleurum has "calming
characteristics," removing irritation, arresting panic, and treating vertigo, dizziness, tinnitus, and
hearing difficulties (4).
As C.S. Cheung describes bupleurum's function (5), "it dredges the liver and relieves congestion." The
term "dredges" is particularly appropriate, because the Chinese concept is that the liver, especially
when it has been disturbed by frustration (inexpressible anger), can tenaciously hold on to the qi that it
is supposed to help circulate, and the qi needs to be released by some means. An important herb for
treating stagnation with emotional depression is cyperus (xiangfuzi), which is notable for its pleasant
and penetrating fragrance. However, during the past century, bupleurum has gradually taken on greater
importance for this role. It is especially relied upon when there is a stagnation of circulation associated
with both the liver and spleen. The spleen is said to distribute the qi and moisture from food, a function
that is disturbed by anxiety and worry.
The liver is associated with the wood element, which corresponds with growing plants. It is said that
young plants that are full of sap grow vigorously during the spring (the season associated with wood)
and bend easily under the pressure of wind (the climatic condition associated with wood), bouncing
back readily (bending and bouncing back mimics the xiao yao ideal of journeying and returning). On
the other hand, when wood has become aged and dried, its growth is slowed and it is no longer able to
bend in the wind; rather, it can easily break; it can also easily be burned by fire. To assure that the liver,
as representative of the wood element, remains healthy and able to easily respond to stresses (such as
emotional reactions), it needs to be moistened. Hence, in the formula Xiao Yao San , bupleurum is
joined by tang-kuei and peony, two herbs that nourish the liver blood. These herbs prevent and even
reverse a condition of liver dryness.
The spleen is associated with the earth element, corresponding to the soil in which plants grow. When
the soil is well drained, it supports the health of plants. When the earth becomes too moist, it is no
longer a healthy medium; instead, plants growing in such conditions yellow and wilt, and their roots
may rot. The soil that is saturated with moisture can no longer drain additional moisture that falls as
rain, so there are floods and damage. Therefore, by this analogy, to keep the spleen and liver healthy,
the excess moisture must be drained, and this is accomplished in the formula Xiao Yao San with the
moisture resolving herbs hoelen and atractylodes. In addition, the function of the spleen is invigorated
by baked licorice, a sweet, tonifying herb.
The complete Xiao Yao San formulation is filled out with two other herbs as adjuncts: mentha, to aid in
the dredging of the liver; and fresh ginger, to aid the function of the spleen. These two herbs are also
used to resolve congestion at the body surface, a function to which bupleurum also contributes.
The most widely used modification of Xiao Yao San is Bupleurum and Peony Formula (Jiawei Xiao
Yao San ; jiawei means added ingredients; literally, added flavors). The additions, gardenia (shanjizi)
and moutan (mudanpi), both clear heat; gardenia is said to purge fire from the liver and drain damp-
heat from the gallbladder, while moutan is said to clear heat from the blood. The accumulation of qi in
the liver is a type of fire syndrome (excess of qi) and the dryness of liver wood that arises further fuels
the development of fire. This modified version is one of the most frequently prescribed formulas in
Japan, particularly for emotional disorders and "erratic complaints" experienced by women (one of the
xue dao zheng conditions described in Chapter 6); it is commonly given for perimenopause and early
stage of menopause. Dr. Wago Mitani presents Bupleurum and Peony Formula as the central treatment
for climacteric syndrome (6), which he says is comprised of symptoms such as "lack of physical
strength, anxiety, poor concentration, insomnia, lethargy, somatic instability, tendency toward fatigue,
and mild fever." The formula is also frequently prescribed for treatment of viral hepatitis because of its
beneficial effects on the liver. In several modern books about Kampo medicine, Jiawei Xiao Yao San is
mentioned but the original Xiao Yao San is not.
The primary reason for selecting Jiawei Xiao Yao San is the finding of evident symptoms of heat and
agitation that would call for the inclusion of moutan and gardenia. Such heat symptoms are mentioned
in the traditional indications for Xiao Yao San , but the added herbs improve the treatment when those
symptoms are more evident. This formulation addresses the condition of "conflict between heat and the
blood," in which the well-nourished blood can restrain heat. In return, the well-directed heat circulates
the blood and prevents it from stagnating. Jiawei Xiao Yao San is indicated when the blood is
insufficiently nourished and the heat is agitated (alternately constrained or rushing out without
direction); the blood and heat are in conflict rather than harmony.
In a review of uses of Bupleurum and Peony Formula (7), Yakazu Domei indicated that of 65 patients
treated by this prescription in his clinic, 43 of them were cases of xue dao zheng. In his analysis, he
mentioned that the formula is effective for "treating various female diseases and general nervousness
and anxiety." He states that:
This formula is regarded as having the ability to adjust the irregularity of the autonomic nerves caused
by the stagnation of liver qi and the ability to act as a tranquilizer. In addition to treating menopausal
disturbances of weak conformations, the formula is widely used for treating irregular menses, the side
effects of abortions and miscarriages, emotional distress caused by any salpingoplasty [gynecological
surgery] or uterine disturbance, infertility, etc.
Another formula listed in Table 2 is Yigan San (Bupleurum Formula), which is indicated for fire in the
liver meridian, producing symptoms such as tic, teeth-grinding, or neurotic behavior. In a review of this
formula by Dr. Hong-yen Hsu (8) it is said that the formula "decreases tendency toward anger and
irritability, and treats insomnia due to excitement and neurotic hypersensitivity...also indicated for those
with poor nutritional habits, decreased tolerance to stressful situations, heightened sensitivity to mild
mental and physical excitement, and lack of autonomic nerve coordination." The formula is given to
adults as well as children (for whom it was originally designed) and said to treat, among other things,
menopausal disturbance and xue dao zheng. According to Dr. Hsu, in Commonly Used Chinese Herb
Formulas with Illustrations (13) if pinellia and citrus are added to Bupleurum Formula, that formula
"is indicated for adults (especially those past middle age, either perimenopause or postmenopause) with
obvious neuropathy [neurotic conditions]." Pinellia and citrus promote the function of the stomach and
gallbladder and help to remove dampness and phlegm-mist that may lead to mental dysfunction.

Sedative Formulations
The formulas described below incorporate three treatment methods: tonification, sedating the spirit, and
opening the orifices. Three of the formulas are modern patents (that have been available for several
decades). Ingredients lists provided for patent remedies such as these should be interpreted with some
reservations, as the manufacturers often do not disclose all ingredients. The other formula, Tianwang
Buxin Dan, is a traditional prescription as well as a patent, so the ingredients of the former version are
widely publicized, though they vary considerably among the texts. The first three formulas listed had
included cinnabar until recently. Polygala, which serves both as a sedative and orifice-opening herb, is
classified here with the orifice-opening group; each formula includes at least one other herb aimed at
resolving phlegm mist (e.g., acorus, bamboo, platycodon). Hoelen and alpinia, which each appear in
two of the formulas, aid in dispersing fluids and thus contribute to preventing development of phlegm-
mist, but are listed separately.
Table 3: Sedative Brain-Nourishing Formulas

Tianwang Buxin Baizi Yangxin

Ingredient type Bunao Wan Jiannao Wan
Dan Wan
Biota Biota Biota Biota
Zizyphus Zizyphus Zizyphus
Spirit-Sedating Schizandra Schizandra Schizandra
Ingredients Dragon Teeth Dragon Teeth
Succinum Succinum
Orifice Opening Polygala Polygala Polygala
and Phlegm Acorus Acorus Acorus
Clearing
Bamboo Bamboo
 Platycodon
Ingredients
Tang-kuei Tang-kuei Tang-kuei Tang-kuei
Lycium fruit Lycium fruit Lycium fruit
Blood and Yin
Ophiopogon Ophiopogon
Nourishing
Ingredients Rehmannia Rehmannia
Cistanche Cistanche
walnut, ginseng, alpinia, hoelen,
asparagus,
gastrodia, salvia, gastrodia, scrophularia,
Other Herbs ginseng, hoelen
alpinia, arisaema dioscorea licorice
Tianwang Buxin Dan (Ginseng and Zizyphus Formula) is the best known of the prescriptions in this
group. It is considered suitable for long-term therapy in treating chronic brain disorders, such as those
that occur with aging. Bunao Wan (Cerebral Tonic Pills) is a modern patent remedy indicated mainly
for poor memory and insomnia, and also used for anxiety, heart palpitations, and being easily
frightened. Healthy Brain Pills (Jianao Wan) is a modern patent designed along the same lines as
Cerebral Tonic Pills, and for the same indications. Baizi Yanxin Wan (Biota Heart Nourishing Pills) is a
patent remedy that represents a variation of the traditional Tianwang Buxin Dan; numerous other
factories produce their own sedative formulas in which they attempt to improve on this widely-used
prescription.
The name Tianwang Buxin Dan makes reference to the "King of Heaven" (tian = heaven; wang = king,
ruler) and to the action of supplementing the heart (buxin), being prepared in the form of a large pill
rolled in cinnabar (dan; without cinnabar, the preparation should be called simply a pill: wan). The
formula was first recorded in the Shesheng Mipou (Secret Investigations into Obtaining Health)
written by Hong Ji in 1638 A.D. There is a story explaining the formula's unusual name-that Hong Ji
had a dream in which the Heavenly King visited him and gave him the formula. However, Tianwang
Buxin Dan is actually a relatively simple modification of a much earlier prescription known to Hong Ji,
Pingbu Zhenxin Dan, from the famous book of the Song Dynasty, Taiping Huimin Hejiju Fang.
The recipe for Tianwang Buxin Dan is reported in differing texts with markedly different proportions of
ingredients. The herb described as the key herb of the formula, rehmannia, is present in proportions
ranging from 8% to 32% of the total weight. Following is the recipe presented in Chinese Herbal
Medicine: Formulas and Strategies (9), in which rehmannia makes up 31% of the formula:

Tianwang Buxin Dan

120
shengdi Rehmannia, raw
grams
wuweizi Schizandra 30 grams
danggui Tang-kuei 30 grams
tianmendong Asparagus 30 grams
maimendong Ophiopogon 30 grams
boziren Biota 30 grams
suanzaoren Zizyphus 30 grams
 renshen Ginseng 15 grams
danshen Salvia 15 grams
xuanshen Scrophularia 15 grams
fuling Hoelen 15 grams
yuanzhi Polygala 15 grams
jiegeng Platycodon 15 grams
The herbs are powdered and then made into honey pills, typically yielding a bolus of about 9 grams
(about 2/3 herbs, 1/3 honey); this batch is enough for a two month supply at one pill twice per day.
Until recently, these pills were rolled in cinnabar, which was one of the examples of why remedies
from China were said to be contaminated with heavy metals (in this case, mercury). Now, the pills are
made without it.
The formula has the primary function of nourishing yin and blood and clearing heat. Several herbs of
the formula have mild sedative effects, including ginseng, salvia, schizandra, polygala, biota, hoelen,
and zizyphus. The formula is indicated for those showing deficiency syndrome with dryness, such as
dry stool, dry mouth, and little tongue coating, and with heat (tongue body is red, pulse is rapid),
though it can be used more generally. It is probably best used in cases of insomnia with constipation
and for those who feel warm at night (there may be night sweating); it is avoided in cases of diarrhea
and for persons who tend to be cold. The effect of the herbs in Tianwang Buxin Dan have been
described by C.S. Cheung as follows (10):
The principle of treatment is to moisten the yin, clear the heat, nurture the blood and calm the spirit.
Raw rehmannia as the chief herb in the prescription, moistens the yin, clears heat, and prevents any
disturbances of spirit by deficiency. Scrophularia, ophiopogon, and asparagus assist rehmannia in
moistening the yin and clearing heat. Salvia and tang-kuei nourish the blood and nurture the heart. The
heart spirit becomes calm when the blood of the heart is repleted. Ginseng and hoelen benefit the heart
qi and calm the heart spirit; biota and polygala calm the heart and pacify the spirit. Platycodon
functions to carry the other herbs upwards; cinnabar is used to coat the pills: both of them act as
messengers to enter the heart.

APPENDIX 1: Guipi Tang and SSRI

Withdrawal Syndrome
The problem of adverse reactions to withdrawing from the antidepressants known as selective serotonin
reuptake inhibitors (SSRIs) is important to patients, especially since they already may suffer from
problems of anxiety and fear which can exacerbate their concerns about symptoms that arise. A Chinese
herbal therapy for this condition has not been established, but can be suggested from the typical
symptoms of withdrawal. A listing of symptoms that have been repeatedly observed in patients
withdrawing from SSRIs is arranged in the left column of the following table by general type, and
paired with a potential TCM interpretation of the symptoms in the right column.
Table 4: SSRI Withdrawal Symptoms and their TCM Interpretations.
 Symptoms Potential TCM Interpretation
Deficiency of blood affecting the liver and heart,
with instability of shen and hun (spirit associated
Psychiatric with the liver; especially affects dreaming). These
anxiety, crying spells, insomnia, symptoms may additionally correspond to qi
irritability, agitation, mood lability, vivid deficiency and stagnation (liver/spleen
or bizarre dreams, difficulty with disharmony or simple spleen weakness), so the
concentration and memory total syndrome would involve qi and blood
deficiency and qi stagnation, destabilizing the
mind.
Neurologic
Damp accumulation may produce all of these
dizziness, lightheadedness, headache,
symptoms; insufficient rise of clear yang qi may
paresthesia (electric shock-like tingling),
also produce these symptoms.
vertigo
These symptoms may correspond to generation of
Motor
internal wind, a condition which results from
dystonia (gait instability), tremor
deficiency of liver blood.
Accumulation of dampness is a possible cause;
Gastrointestinal
adverse flow of qi may occur (upward or
nausea, vomiting, diarrhea
downward flow contrary to normal flow).
Somatic Qi deficiency, along with impaired circulation of
chills, fatigue, lethargy, myalgias, qi may cause these symptoms; dampness can
rhinorrhea, sweating contribute to all these symptoms.
Summing up the notes about TCM interpretation, the withdrawal syndrome may revolve around the
problems of qi and blood deficiency, which may be accompanied by qi stagnation and dampness
accumulation (and, in rare cases, also by internal wind). These deficiency syndromes of Chinese
medicine are attributed primarily to the spleen (for qi) and liver (for blood); a Western interpretation of
the same pattern might be a relative deficiency in serotonin availability or an imbalance of
neurotransmitters that occurs when the drugs are removed.
Key herbs that might be considered for SSRI withdrawal syndrome based on the symptom analysis
include:
Atractylodes (white atractylodes): tonifies qi, resolves damp
Peony (white peony): nourishes blood, vitalizes blood circulation
Tang-kuei: nourishes blood, vitalizes blood circulation
Zizyphus: nourishes liver and heart blood and clams shen
Saussurea: circulates qi, calms shen
Ginseng: tonifies qi, calms shen
Astragalus: tonifies qi, raises yang qi
Polygala: resolves phlegm, calms shen
Fu-shen or Hoelen: resolves damp, calms shen
Pinellia: resolves damp, lowers stomach qi
Citrus: resolves damp, circulates qi
A formula with these ingredients can be constructed from the traditional formula Gupi Tang, which
includes most of the herbs. According to Giovanni Maciocia, who is widely respected for his
knowledge of TCM, this formula is itself used for treating depression (11). He noted that: "The formula
Guipi Tang tonifies spleen-qi and heart-blood and calms the mind: it is ideally suited to treat post-natal
depression and insomnia. This formula is also recommended by Wu Qian in his Golden Mirror of
Medicine for post-natal depression from worry, pensiveness, and sadness." The ingredients may be
provided as a decoction ( Guipi Tang ), dried decoction, or in tablet form (Guipi Wan). A typical
powder preparation is (12):

Guipi San
(Ginseng and Longan Combination)
renshen Ginseng 15 g
huangqi Astragalus 15 g
longyanrou Longan 12 g
fuling Hoelen 10 g
baizhu Atractylodes 10 g
danggui Tang-kuei 10 g
suanzaoren Zizyphus 10 g
yuanzhi Polygala 10 g
muxiang Saussurea 5g
zhigancao Licorice 5g
dazao Jujube 5g
shengjiang Ginger 5g
In China, codonopsis has been used in place of ginseng for several decades, but the original formula is
with ginseng for rapidly restoring the spleen qi and calming the spirit. For those with a more significant
level of "damp" syndrome (especially with digestive disturbance), one might add to Gui Pi Tang one of
the following:
Er Chen Wan aka Citrus and Pinellia Combination (has citrus, pinellia, hoelen)
Si Jun Zi Tang aka Major Four Herbs Formula (has ginseng, atractylodes, hoelen)
Wu Ling San aka Hoelen Five Herb Formula (has atractylodes and hoelen)
Xiang Sha Liu Jun Zi Tang aka Saussurea and Cardamom Combination (has ginseng, saussurea, hoelen,
atractylodes, citrus, and pinellia)
Xiao Yao San aka Tang-kuei and Bupleurum Formula (has hoelen, atractylodes, tang-kuei, and peony)
While there have not been studies providing clinical evidence for efficacy of Gui Pi Tang, or any of the
herbs mentioned, to alleviate SSRI discontinuation symptoms, it is a characteristic of modern Chinese
medicine practices to select herbs on the basis of symptom patterns, with the expectation of attaining
some level of effect. The symptoms are understood to be a manifestation of an underlying imbalance,
whether described in ancient terms (e.g., qi and blood deficiency) or modern terms (e.g.,
neurotransmitter release and reuptake). That imbalance generates symptoms via common mechanisms
that can be affected by the herbs. Starting an herbal formula along with gradual drug dose reductions
may prevent or minimize the withdrawal symptoms.
APPENDIX 2: Bupleurum and Dragon Bone
Combination for Xue Dao Zheng
Two bupleurum-based prescriptions stand out in the literature related to xue dao zheng: Bupleurum and
Peony Formula, which has already been discussed, and Bupleurum and Dragon Bone Combination
(Chaihu Jia Longgu Muli Tang). Another formula mentioned less frequently is Bupleurum and
Cinnamon Combination (Chaihu Guizhi Tang), which has several herbs in common with Bupleurum
and Dragon Bone Combination. In the book Commonly Used Chinese Herb Formulas with
Illustrations (13) this latter formula is said to treat numerous symptoms, including a variety of
emotional and neurological disorders-nervous exhaustion, neurotic behavior, irritability, and hysteria.
The ingredients for Bupleurum and Dragon Bone Combination are:

Bupleurum and Dragon Bone

Combination
chaihu Bupleurum 20%
banxia Pinellia 12%
fuling Hoelen 12%
guizhi Cinnamon 8%
huangqin Scute 8%
renshen Ginseng 8%
muli Oyster shell 8%
longgu Dragon bone 8%
shengjiang Ginger 8%
dahuang Rhubarb 8%
This formula calms the spirit with ginseng, dragon bone, and oyster shell, resolves phlegm-dampness
with pinellia, ginger, and hoelen, and purges fire with scute and rhubarb. In Commonly Used Chinese
Herb Formulas with Illustrations, the formula is said to be useful for neurosis, hysteria, neurotic
insomnia, climacteric disorders, neurotic palpitation, and neurotic impotence. Combining this with a
formula for stagnant blood or for qi stagnation and phlegm accumulation is thought to help resolve xue
dao disorders even more effectively. Bupleurum and Cinnamon Combination is produced by deleting
hoelen, rhubarb, dragon bone, and oyster shell (all of which have sedative effects) and replacing them
with peony, licorice, and jujube (which contribute an antispasmodic and analgesic action).
Yakazu Domei (14), described use of Bupleurum and Dragon Bone Combination for 65 of his patients.
Many of these patients were being treated for neurosis (heart palpitations, neurasthenia, hysteria, and
neurotic chest pains). He classified the applications of the formula as treating three conditions: flushing
up of qi, stagnant water, and lower torso weakness. As to the first, he listed symptoms of chest distress,
discomfort, palpitations, strange moods, irritability, insomnia, stiff shoulders, heavy headedness,
headaches, vertigo, frequent napping, spasms, delirium, and mania. For stagnant water syndrome, he
included the symptoms of generalized lassitude and body heaviness along with water retention, and for
lower torso weakness, he referred to weak legs, low back pain, impotence, and cold feet. He further
mentions that the formula is frequently used to treat "the complications of mental, emotional, and
nervous distress."
According to Takahide Kuwaki (15), the xue dao syndrome (which he calls "nervous diseases and
autonomic nervous disorders") is usually treated with:
...formulas containing descending herbs, which in this case could be called sedatives. Of these
descending drugs, dragon bone and oyster shell containing formulas are most often used. The two
major formulas containing dragon bone and oyster shell are Bupleurum and Dragon Bone Combination
(Chaihu Longgu Muli Tang) and Cinnamon and Dragon Bone Combination (Guizhi Jia Longgu Muli
Tang).
He suggests that the first formula is given to more robust types and the second to obviously weakened
patients. Bupleurum and Dragon Bone Combination was not included in Table 2 with the qi regulating
bupleurum-base formulas nor with the sedative formulas that have ingredients like dragon bone and
oyster shell because this formula does not quite fit the patterns described for those approaches. While it
includes qi tonics (ginseng, jujube), the qi regulating herb bupleurum (but not others for that purpose),
and the sedatives dragon bone and oyster shell, it lacks blood nourishing herbs (that would make it
more suited to long-term use) and only has a small contribution towards the problem of phlegm mist
(hoelen and pinellia, but no acorus or polygala, for example). It is most suited, in its standard form, for
short term use.

APPENDIX 3: Formula for Plum Pit Qi

Syndrome
Pinellia and Magnolia Combination (Banxia Houpu Tang) was presented in the Jingui Laoyue (16), a
treatise composed at the end of the Han Dynasty (ca. 220 A.D.). The text includes this brief statement:
"A woman who feels as if a piece of broiled meat is stuck in her throat should take Banxia Houpu
Tang." This statement has been interpreted to mean that the woman is suffering from globus hystericus,
the feeling of a lump (globus) resulting from hysteria (an emotional state of mind originally thought to
be associated with the uterus). The Chinese later described the sensation as that of a plum pit caught in
the throat. Its cause is attributed to the emotions coupled with stagnation of phlegm. In a Japanese
report on treatment of 45 patients with abnormal sensations in the throat (sense of pressure, swelling,
or, in most cases, something stuck in the throat), relayed by Dr. Hong-yen Hsu (17), 21 of the patients
of "weak" constitution were given Pinellia and Magnolia Combination, while 13 patients of "firm"
constitution were given Bupleurum and Dragon Bone Combination.
The applications of Pinellia and Magnolia Combination have been expanded to include both the
sensation of a lump that is without obvious physical cause and also now for several physical disorders,
such as esophageal spasms, hoarseness, or difficulty swallowing. In two recent studies conducted in
Japan, the formula was proclaimed beneficial in treating swallowing difficulty in the elderly. It was
used to improve the swallowing reflex in those who suffered from stroke (18) and difficulty swallowing
as a result of progression of Parkinson's disease (19). The mechanism of its action in these cases
remains to be established.
In modern Chinese texts, Pinellia and Magnolia Combination is classified with the qi regulating
formulas, even though none of the herb ingredients are classified in the Materia Medica as having the
primary property of being qi regulators. Rather, these ingredients help circulate both qi and moisture. A
typical presentation of its ingredients and quantities is (20):

Pinellia and Magnolia Combination

banxia Pinellia 12 g
fuling Hoelen 12 g
houpo Magnolia 9g
Shengjiang Fresh ginger 9g
zisuye Perilla 6g
From the traditional Chinese point of view, both magnolia bark and perilla leaf regulate the flow of qi
moisture and these actions are attributed to their fragrant components that have a dispersing effect.
These herbs alleviate the neurotic and depressive syndromes that lead to plum pit qi. The qi regulating
formulas in general, and the ingredient perilla leaf in particular, are recommended in China for
treatment of depression and anxiety. In a recent laboratory evaluation, Pinellia and Magnolia
Combination was reported to have antidepressant activities (21), confirming this application. In fact,
magnolia bark extract has been promoted as an anti-depressant and anti-anxiety agent without the side
effects of tricyclic antidepressants (22).

APPENDIX 4. Modern Use of Salvia as a

Sedative
Salvia, danshen (the Chinese name implies a cinnabar-colored ginseng-like herb) has long been known
as a sedative, but is not often used as such. It is an ingredient in the traditional Tianwang Buxin Dan
and the 20th Century brain-nourishing and sedative patent Bunao Wan. Modern research has
demonstrated the sedative quality of an active component of salvia, miltirone, in animal models that
predict clinical tranquilizing effects. Salvia has been incorporated into TCM treatments for insomnia,
dementia, and other effects of brain dysfunction. Salvia is thought to have blood nourishing and blood
vitalizing effects similar to that of Si Wu Tang , to have cooling effects like that of red peony (chishao),
and to have calming effects similar to that of ginseng.
A formula developed by the current author, called Salvia/Amber Tablets, illustrates its use in the
context of treating shen disorders. The formula is:

danshen Salvia 30%

hupo Succinum 18%
suanzaoren Zizyphus 16%
longchi Dragon tooth 13%
 zhuli Bamboo sap 13%
renshen Ginseng 10%
The formula is intended to infuse courage to the heart to overcome fright. Ginseng and amber
(succinum; spirit of the tiger) may confer the will or courage that has retreated under the pressure of
traumatic external events. The key herb salvia calms the agitated spirit. Salvia and amber are both
recognized as blood-vitalizers; when used with the qi tonic ginseng, they can restore the circulation that
has been impaired by fear. To these herbs is added the dragon's tooth, which is a sedative for fright, and
it represents the crystallization of the dragon in the earth (dragon and tiger, in Taoist literature,
represent the yang and yin, respectively). There is also bamboo sap, the crystallization of the essence of
bamboo that is found at the joints of the bamboo stem. Like dragon's tooth, it is used for calming fright,
but it also dissipates the phlegm-mist that obstructs the orifices. Zizyphus nourishes the heart to aid the
spirit in gaining rest. The entire formula enhances the basic heart functions; the formula clears heat,
nourishes the yin essences, vitalizes blood circulation, and calms the spirit. In the book Mental
Dysfunction as Treated by Traditional Chinese Medicine (23) there is a section on the syndrome of
"deficiency of heart and lack of courage," with the following comments:
1. When the heart is in a deficient state, the soul [shen; spirit] is rolling and restless.
2. Lack of courage results in fright and timidity.
3. Therapeutic principle: benefit the qi and subdue the fright; calm the soul and steady the will.
The author, C.S. Cheung, mentions in this context "the pill to calm the soul and steady the will"
(Anshen Dingzhi Wan also called Anshen Yuanzhi Wan; mentioned in the previous chapter), which has
the chief ingredients ginseng and dragon teeth (others: hoelen, fu-shen, polygala, acorus). He
recommends using this together with Zizyphus Combination (which has a large dose of zizyphus) for
"serious cases."

References
1. Yang Shouzhong and Li Jianyong (translators), Li Dongyuan's Treatise on the Spleen and
Stomach, 1993 Blue Poppy Press, Boulder, CO.
2. Domei Yakazu, The application of Gui Pi Tang, Bulletin of the Oriental Healing Arts Institute of
U.S.A., 1980; 5(3): 21-28.
3. Unschuld PU, Introductory Readings in Classical Chinese Medicine, 1988 Kluwer Academic
Publishers, Dordrecht.
4. Kunio Matsuda, Bupleurum prescriptions in Chinese herbal medicine, Bulletin of the Oriental
Healing Arts Institute, 1983; 8(1): 21-28.
5. Cheung CS and Belluomini J, Traditional and new interpretation of prescriptions: the
harmonizing group, Journal of the American College of Traditional Chinese Medicine, 1984;
(1): 3-15.
6. Wago Mitani, Kanpo treatment of climacteric disorder, International Journal of Oriental
Medicine 1992; 17(1): 27-32.
7. Yakazu Domei, Clinical experience with Bupleurum and Peony Formula, Bulletin of the
 Oriental Healing Arts Institute, 1980; 5(3): 11-20.
8. Hsu HY, Application of Chinese herbal formulas and scientific research: Bupleurum Formula
and Bupleurum and Chih-shih Formula, International Journal of Oriental Medicine 1992; 17(2):
114-120.
9. Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990 rev. ed.,
Eastland Press, Seattle, WA.
10. Cheung CS and Belluomini J, Heart, Journal of the American College of Traditional
Chinese Medicine 1984; (4): 40-58.
11. Maciocia G, The Foundations of Chinese Medicine, 1989, Churchill Livingstone,
London.
12. Ou Ming, Chinese-English Manual of Common-Used Prescriptions in Traditional
Chinese Medicine, 1989 Joint Publishing Co., Hong Kong.
13. Hong-Yen Hsu and Chau-Shin Hsu, Commonly Used Chinese Herb Formulas with
Illustrations, 1980 rev. ed., Oriental Healing Arts Institute, Long Beach, CA.
14. Yakazu Domei, Bupleurum and Dragon Bone Combination, Bulletin of the Oriental
Healing Arts Institute, 1983; 8(7): 42-44.
15. Takahide Kuwaki, Chinese Herbal Therapy, 1990 Oriental Healing Arts Institute, Long
Beach, CA.
16. Hsu HY and Wang SY (translators), Chin Kuei Yao Lueh, 1983 Oriental Healing Arts
Institute, Long Beach, CA.
17. Hsu HY, Chinese herb therapy for abnormal sensations of the throat, Bulletin of the
Oriental Healing Arts Institute 1984; 9(2): 63-66.
18. Iwasaki K, et al., Traditional Chinese medicine Banxia Houpu Tang improves
swallowing reflex, Phytomedicine 6(2): 102-106.
19. Iwasaki K, et al., The effects of the traditional Chinese medicine banxia houpo tang on
the swallowing reflex in Parkinson's disease, Phytomedicine 2000; 7(4): 259-263.
20. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of
Traditional Chinese Medicine, vol. 2, 1993 Heilongjiang Education Press, Harbin.
21. Luo L, et al., Antidepressent effects of banxia houpo tang, a traditional Chinese
medicinal empirical formula, Journal of Ethnopharmacology 2000; 73(1-2): 277-281.
22. Kuribara H, Stavinoha WB, and Maruyama Y, Honokial, a putative anxiolytic agent
extracted from magnolia bark, has no diazepam-like side-effects in mice, Journal of Pharmacy
and Pharmacology 1999; 51(1): 97-103.
23. Cheung CS, Lai YK, and Kaw UA, Mental Dysfunction as Treated by Traditional
Chinese Medicine, 1981 Traditional Chinese Medicine Publisher, San Francisco, CA.
Chapter 9
Sample Herbal Treatment Strategies
Subjects of Study
Chinese medical reports on herbal therapies for shen disorders are spread somewhat randomly
throughout the Chinese medical literature, most being in obscure journals. One of the areas that has
gotten considerable attention is "senile dementia," which involves deterioration of brain function, with
symptoms such as depression, confusion, poor memory, and slow responses. The treatment of this
problem with Chinese herbs is not substantially different than the treatment of other disorders that
affect mental status, particularly in adults. This is because traditional Chinese medicine is based on
general principles of treatment rather than unique ways to combat specific diseases. The therapeutic
approaches described in chapters 7 and 8 are applicable to this condition. For purposes of contrast, the
treatment of attention deficit disorder (ADD) in children will be presented afterward. In both cases, the
therapies described were actually used in clinical practice for dozens or even hundreds of patients, not
merely recommended on the basis of indications for a traditional formula. Claims for success were
presented in the literature, but the frequency of improvement (i.e. "success rate," which was often high)
is not conveyed here because the standards of reporting and analysis in the reports differ significantly
from what is utilized in Western medical studies. Instead, the main focus here is on the selection of
herbs.

Herbal Therapies for Senile Dementia

Selected information from two large review articles published in the Journal of Traditional Chinese
Medicine is presented below in order to summarize a broad range of Chinese medical literature.
In a 1996 review of Chinese herbal therapies for senile dementia (1), doctors at the Chengdu University
of Traditional Chinese Medicine and Pharmacy presented the diagnosed syndromes and key herbs used
to treat the patients, and these are relayed in Table 1.
Table 1: Modern Differential Diagnosis and Treatment for Senile Dementia.

Syndrome/Ther
Main Symptoms Key Herbs
apeutic Method
Deficiency of progressive dementia, dizziness,
rehmannia, cornus, dioscorea, ho-
kidney essence tinnitus, insomnia, poor memory,
shou-wu, lycium, eucommia, tang-
[tonification difficulties in speech, dull eyes, and
kuei, zizyphus, polygala
therapy] slow responses
dull expressions, vague mind,
Stagnation of
depression, poor memory, abnormal pinellia, hoelen, acorus, polygala,
phlegm
behavior, involuntary crying or curcuma, chih-ko, citrus, bamboo,
[resolving
laughing, dizziness, heavy head or bamboo sap
phlegm-mist]
limbs, sleepiness
Deficiency of qi dizziness, poor memory, indifferent ginseng*, astragalus, tang-kuei,
and blood expression, dreaminess and light atractylodes, fu-shen, rehmannia,
[tonification sleep, susceptible to fright, pale ho-shou-wu, polygala, peony,
therapy] complexion and listlessness, unable zizyphus
 to participate in normal daily * codonopsis or pseudostellaria
activities could be substitutes for ginseng
dizziness, headache, poor memory,
Cerebral blood salvia, carthamus, persica, cnidium,
dementia, stiff tongue and
stasis astragalus, angelica, musk, tang-
incapability of uttering a sound,
[vitalize blood] kuei, red peony
history of apoplexy
The authors suggested that there are two main actions of the herbs in the formulas: to replenish the
kidney so as to nourish the brain and to supplement and invigorate both qi and blood to provide
adequate circulation in the brain. They translated the means by which these actions affect dementia to a
Western idiom as follows:
1. To supply substances needed by the brain and nerve cells to carry out normal metabolism and
regulate cerebral activities; and
2. To invigorate the following activities: blood supply to the heart, immunologic functions,
detoxification of the liver, nutrient absorption of the alimentary system, and utilization of
energy by the body to improve the nutritional and metabolic state, or, in other words, to regulate
the vitality of the whole body to improve mental function and combat senility.
The authors also suggested that if blood-vitalizing herbs are included with the tonic therapies that the
results will be even better than using tonics alone, mainly because of the improved microcirculation.
In a 1999 review from the Ningjin County Hospital of Traditional Chinese Medicine (2), journal reports
were divided into four groups: general differentiation using traditional formulas; treatment based on
differentiation of regulating and nourishing the kidney and heart; treatment based on differentiation of
blood stasis and phlegm obstruction; and treatments based on modern prescriptions. In this
presentation, a number of the prescriptions are designated by their traditional names, but many were
said to be "modified" without specifying the alterations made.

1. Treatment Based on General Differentiation

Using Traditional Formulas
Several examples of this approach were offered. Following is one giving the diagnostic category and
recommended formula for treatment relying on well-known traditional formulations that had been
slightly modified:

 Deficiency of brain and spinal cord: Modified Bushen Yisui Tang (Decoction for Tonifying the
Kidney and Rectifying the Marrow);
 Deficiency of heart and spleen: Guipi Tang (Ginseng and Longan Combination);
 Hyperactivity of heart fire and liver fire: Modified Tianma Gouteng Yin (Gastrodia and Uncaria
Formula) plus Huanglian Xiexin Tang (Coptis Combination);
 Yin deficiency of liver and kidney: Modified Qi Ju Dihuang Tang (Lycium, Chrysanthemum,
and Rehmannia Formula) plus Dingzhi Tang (Emotion-calming Decoction);
  Stagnation and obstruction by phlegm and blood stasis: Modified Banxia Baizhu Tianma Tang
(Pinellia and Gastrodia Combination); and
 Stagnation of qi and blood: Modified Xiaoyao San (Bupleurum and Tang-kuei Formula) plus
Tongqiao Huoxue Tang (Decoction for Activating Blood Circulation).
Here are two other sets of recommendations, the first attributed to Xu Shizhen, the second attributed to
the work of Zhao Xiangjun:

Category Xu Shizhen's Recommendations

Liver/Kidney Yin Deficiency Modified Bushen Yinao Tang
Spleen/Kidney Yang Deficiency Modified Yougui Wan
Accumulation/Obstruction by
Modified Erchen Tang
Phlegm
Interior Obstruction by Blood
Modified Fuyuan Huoxue Tang
Stasis
Zhao Xiangjun's
Category
Recommendations
Failure of Kidney Essence Modified Yougui Wan
Liver/Kidney Yin Deficiency Modified Zuogui Wan
Heart/Spleen Deficiency Modified Guipi Tang
Obstruction by Phlegm and Blood Mengshi Guntan Wan plus Xuefu
Stasis Zhuyu Tang
This information can be summarized as follows: the primary formulas for deficiency syndromes are
modifications of Guipi Tang and the pills for tonifying the left and right kidneys (Zuogui Wan and
Yougui Wan; or the related formula for nourishing kidney and marrow Bushen Yisui Tang). For phlegm
obstruction, Erchen Tang and related formulas, such as Banxia Baizhu Tianma Tang are used. For blood
stasis, formulas comprised of several blood vitalizing (huoxue) herbs were used. Obstruction by
phlegm accumulation and blood stasis might be treated together.

2. Treatment by Regulating and Nourishing

Heart and Kidney
Two examples of self-designed base formulas were offered for this category:

 Insufficiency of heart qi: codonopsis, hoelen, licorice, acorus, polygala;

 Deficiency of kidney yin: asparagus, ophiopogon, rehmannia (cooked and raw), cornus.
Those formulations were derived from Guipi Tang and Tianwang Buxin Dan, respectively. A more
extensive differentiation involved these therapeutic categories and formulas:

 Reinforcing kidney and replenishing essence: rehmannia, lycium, ho-shou-wu, curculigo,

epimedium, acorus, polygala;
  Nourishing kidney and eliminating phlegm: Modified Dingzhi Wan and Yougui Wan;
 Nourishing the kidney, removing blood stasis: rehmannia, ho-shou-wu, lycium, cyathula,
persica, carthamus, cnidium, earthworm, cyperus, acorus, polygala; and
 Nourishing yin and eliminating phlegm: rehmannia, ho-shou-wu, ophiopogon, forsythia,
coptis, pinellia, bamboo, curcuma, acorus, polygala, salvia.
In these formulations, the most consistent aspect of treatment is use of acorus and polygala to open the
orifices and invigorate the brain and use of rehmannia to nourish the kidney.

3. Treatment Based on Differentiationof Blood

Stasis and Phlegm Accumulation
Two articles were described in this section of the review, one focused on blood stasis and the other
focused on phlegm obstruction. The blood stasis formulas are not well known, so they will not be
relayed here except for one of the suggestions which was based on standard prescriptions: for qi
deficiency and blood stasis the recommendation was to use modified Yiqi Congming Tang (mentioned
in Chapter 8 in the tonic section) plus Tao Hong Siwu Tang (this is Si Wu Tang , the most frequently
used blood nourishing herbs, with persica and carthamus). For the phlegm accumulation disorders, the
basic formula recommended was Banxia Baizhu Tianma Tang (Pinellia and Gastrodia Combination)
with acorus added (additional herbs might also be added).

4. Treatment by Modern Prescriptions

The following information is based on reports in which a single base formula was utilized for numerous
cases of senile dementia, rather than relying on differential diagnosis with several corresponding
formulas. So, each of these formulas appeared in a separate clinical report. The formulas are presented
here according to the therapeutic approach that was utilized. In many cases, the formula was then
modified slightly to address the unique symptoms of the patients:

Therapeutic Category Formula Ingredients

Supplementing qi and activating
blood circulation to remove stasis
Nourishing the kidney and brain
Tonifying the kidney,
supplementing qi, and activating
blood circulation
Tonifying the kidney,
supplementing qi, and activating
blood circulation
astragalus, codonopsis, cnidium, red peony,
peony, persica, pueraria, millettia, alpinia,
curcuma, acorus, polygala
ho-shou-wu, cornus, dioscorea, lycium,
cuscuta, red peony, salvia, curcuma
astragalus, codonopsis, pueraria, salvia,
crataegus, lycium, polygonatum, cornus,
tang-kuei, gastrodia, acorus
astragalus, codonopsis, alpinia, lycium, ho-
shou-wu, salvia, red peony, cnidium, acorus,
polygala
 cornus, cuscuta, alpinia, placenta, leech,
Tonifying the kidney and activating
crataegus, curcuma, arisaema, acorus,
blood circulation to remove stasis
polygala
rehmannia, cistanche, tortoise shell, cornus,
Tonifying the kidney and activating polygonatum, tribulus, silkworm, gastrodia,
blood circulation to remove stasis astragalus, curcuma, acorus, arisaema,
carthamus
pinellia, hoelen, citrus, ginger, bamboo,
Dispelling phlegm and removing
chih-shih, coptis, zizyphus, silkworm,
blood stasis
arisaema, gastrodia, salvia, curcuma, acorus
astragalus, red peony, cnidium, persica,
Dispelling phlegm and removing earthworm, bamboo, aurantium, pinellia,
blood stasis carthamus, gastrodia, silkworm, scorpion,
leech, centipede, curcuma, acorus, polygala
The authors of the review commented:
TCM holds that while the location of the disease is in the brain, its root cause is insufficiency of vital
essence and energy of various zangfu organs in addition to obstruction by stagnation of phlegm and
blood stasis. The weak constitution due to old age often leads to weakness and failure of the zangfu
organs and deficiency of qi and blood and deficiency of yin and yang. This weakness and failure may
give rise to stagnation of qi, causing blood stasis, which, in turn, leads to accumulation of qi to form
phlegm that may retain in the five zang organs and obstruct collaterals of the brain to confuse the mind,
hence the occurrence of dementia. Its pathogenesis is deficiency in origin and excess in superficiality.
An examination of the formulas presented in these two review articles illustrates the basic approach
that has been used and high reliance on a relatively small number of herbs.

 Treat the organ-system deficiencies, primarily spleen qi deficiency (astragalus, codonopsis,

alpinia) and kidney/liver deficiencies (rehmannia, cornus, ho-shou-wu, lycium)
 Add herbs for resolving phlegm-mist, primarily acorus, polygala, curcuma, pinellia, arisaema;
 Alleviate blood-stasis, relying primarily on salvia, red peony, pueraria, persica, carthamus, and
cnidium; and
 When present as a secondary manifestation, alleviate wind (silkworm, gastrodia).

Treatment of Attention Deficit Disorder

Attention Deficit Disorder (ADD) involves difficulty with concentrating on a single task for a sufficient
period of time to accomplish the goal at hand. Although excessive movement is commonly observed
with this condition, it is not necessarily a component of ADD (when present, the disorder may be
termed ADHD, to include the "hyperkinetic" aspect). In some instances, ADD might be a misdiagnosis
for behavioral problems that are related to home and social situations without an underlying brain
dysfunction.
ADD is usually not diagnosed until lack of concentration at school is deemed a problem, typically in
the first or second grades (ages 7 to 8). Males are at least four or five times as likely as females to have
this diagnosis. While for many children affected by ADD there is some reduction in the symptoms as
the child enters puberty, the disorder will often continue for the rest of the individual's life.
Manifestations such as impulsiveness, recklessness, irritability, aggression, and poor emotional
development can have a lasting impact. Sometimes, puberty brings about a switch from hyperactivity to
persistent sluggishness, depression, and moodiness, which is liable to be equally disruptive. The ADD
syndrome has been identified in adults as well.
The primary treatment for ADD is the administration of stimulant drugs. It is postulated that the
controlling action of certain mid-brain activities may be deficient in these individuals and therefore a
stimulant is able to bring about the desired control. The stimulation of brain function may also enhance
alertness and concentration. The primary drug used for this disorder is methylphenidate (Ritalin), a
relatively mild derivative of amphetamine. Ritalin is also used in the treatment of depression, emotional
withdrawal in the elderly, and narcolepsy. This drug can have side effects, mainly nervousness and
insomnia. Ritalin is ineffective in about 30% of cases diagnosed as ADD.
In China, the same attention deficit problem has been noted, and Ritalin has been used as a therapy, but
herb formulas may be utilized instead (3). From the traditional Chinese medical viewpoint, ADD is
caused by a kidney essence deficiency that affects brain development. Further, the yin aspect of the
kidney is most deficient, leading to excessive expression of yang: this is manifest as the hyperactivity
and wandering of the mind. The orifices are not clear, and that leads to erratic behavior of the spirit.
Accordingly, this syndrome is to be treated by nourishing the kidney yin, opening the heart orifices,
and settling the agitated yang. The main herbs used for nourishing the kidney in children with this
syndrome are rehmannia, lycium, cornus, deer antler (especially the gelatin, which is more yin
nourishing) and tortoise shell; these are the same ingredients used in treating adults with senile
dementia. For example, these ingredients are included traditional Zuogui Wan (Left Restoring Pill) used
to treat kidney yin deficiency when there are deficiencies of "marrow and essence." Zuogui Wan, which
adds some tonification for the kidney yang, was mentioned in the suggested treatments for senile
dementia as well.
Phlegm obstruction of the heart orifices usually leads to confusion, inability to concentrate, and poor
memory. It occurs for a variety of reasons, but often because of weak digestion and/or poor diet.
Among the main herbs for clearing the heart orifices and enhancing the mental function are acorus,
polygala, curcuma, and alpinia. To settle the agitated the yang (which may manifest as hyperactivity
and insomnia) the so-called "heavy sedating agents" are used. The traditional concept is that these
substances bear down on the rising and disordered yang. The main substances given for ADD by
Chinese doctors are dragon bone or dragon teeth, oyster shell (or mother of pearl), and succinum. In
some cases, herbs to purge deficiency fire that accompanies yin deficiency syndrome might be
employed. Phellodendron and anemarrhena are the most commonly used items for this purpose.
The dosages of herbs used in treating the children were often rather high, and so the details will be
relayed here when available. The dosage for adults is proportionately higher.
As an example of applying these methods, children with ADD were treated with a syrup made from
alpinia, ho-shou-wu, lycium, dragon bone, oyster shell, acorus, curcuma, and salvia for two to four
months. Three times per day, the children would take 25 ml of the liquid plus 2 grams of deer antler
powder. A similar method was used in a study of children with ADD who were given a decoction of
acorus, polygala, dragon bone, and oyster shell, modified by adding 3-6 herbs according to symptoms,
and a powder of succinum.
Excellent results were claimed in a small study of children treated with a decoction of ligustrum, peony,
lycium, mother-of-pearl, and polygonum stem (each ingredient 10-15 grams), modified with addition
of some herbs for specific symptoms, such as blood deficiency (add rehmannia and gelatin), spleen
deficiency (add hoelen and atractylodes), or restless sleep (add zizyphus). The total daily dose was
about 60 grams of herbs, the decoction taken in three divided doses. Treatment times of 15 to 60 days
were used, and no recurrence was noted within six months of follow-up. Another high dosage
decoction was made with raw rehmannia, ophiopogon, tortoise shell, peony, pseudostellaria, gelatin,
baked licorice, curcuma, cnidium, acorus, polygala, oyster shell, and dragon bone; each ingredient 6-12
grams (except 20 grams oyster shell). This combination, with over 120 grams of crude herbs, was
administered as a single dose per day. In a large scale study ADD, three different formulas were used;
two were decoctions and the third a large honey bolus (six grams per pill). The pill, as an example, was
a kidney tonic, with rehmannia, tortoise shell, dioscorea, cornus, hoelen, phellodendron, anemarrhena,
polygala, acorus, and dragon teeth.
Two formulas described in the literature were made in the form of a sugar paste; one comprised mainly
of acorus and polygala, and the other contains those two herbs plus tortoise shell, hoelen, dragon bone,
alpinia, dioscorea, and lotus seeds. The dose of these pastes was 10-15 ml each time, and they were
taken two to three times per day. Treatment time was about one month. It was pointed out that the paste
could be encapsulated for purposes of easier administration.
Early in 1993, based on the literature reviewed here, ITM prepared an experimental formulation
(Acorus Tablets). The formula contains acorus, polygala, fu-shen, alpinia, curcuma, raw rehmannia,
dragon bone, dragon teeth, oyster shell, bamboo sap, tortoise shell, and succinum. It contains no
stimulants. The formula has been used by both children and adults since then.

References
1. Wang Xiaoping and Zhai Mudong, Experience in TCM treatment of senile dementia, Journal of
Traditional Chinese Medicine 1996; 16(4): 299-303.
2. Sun Guanlan, Ren Jianlin, and Sun Qingjun, Advances in TCM treatment of senile dementia,
Journal of Traditional Chinese Medicine 1999; 19(4): 304-312.
3. Fruehauf H, Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs, 1997
Institute for Traditional Medicine, Portland, OR.
Appendix: Frequently-mentioned formulas
In the section of this chapter devoted to treatments for senile dementia, certain formulas were
mentioned repeatedly. Their ingredients are briefly mentioned here for easy reference.
Zuogui Wan: rehmannia, dioscorea, cornus, lycium, achyranthes (or cyathula), cuscuta, deer antler
gelatin, tortoise shell gelatin.
Yougui Wan: rehmannia, dioscorea, cornus, lycium, cuscuta, deer antler gelatin, eucommia, tang-kuei,
cinnamon bark, aconite.
Erchen Tang: pinellia, citrus, hoelen, fresh ginger, jujube, mume.
Banxia Baizhu Tianma Tang (Pinellia and Gastrodia Combination): pinellia, citrus, hoelen, fresh ginger,
jujube, gastrodia, atractylodes.

A traditional acupuncture chart from the Wellcome Trust in London. This chart directs attention to
some of the key zones for treatment to be described in Chapter 10, where the methods outlined in this
booklet are summarized. At the top of the head and coming down the center of the face is the
Governing Vessel, with its important points such as baihui (GV-20) at the top of the head, shenting
(GV-24) at the hairline, and renzhong (GV-26) just below the nose. At each wrist, the chart indicates a
multiplicity of points (along with the pulse taking positions); especially valuable are the Pericardium
points, such as neiguan (PC-6), and the Heart point shenmen (HT-7). At the feet, several valuable
points are shown, especially along the liver and kidney channels, of which yingquan (KI-1), taixi (KI-
3) and taichong (LV-3) are frequently used for shen disorders
. Chapter 10
Summary, Speculation, Suggestions

Acupuncture
The best speculations available to us about the origins of acupuncture point to the likelihood that
needles were used to lance boils and to let out blood from areas where veins looked distended and/or
darkened. The technique was broadened to let out various "evils" including evil spirits, thus allowing
the internal resources to rebuild. Such treatments were thought of as one time interventions. Dou
Hanqing (ca. 1230 A.D.), in his discussion of acupuncture techniques, quoted the famous phrase (1):
"Take a piercing stone-needle and apply it outside to remove the evil and support the true." Referring to
the stone needles, he noted that they could "expel disease and cure evil-there is nothing it can not heal."
As the concepts of disease causation developed, needles were also used to let out wind, cold, heat,
damp, or other pathological factors that had invaded from the environment into the body, often thought
to gain access through the pores. The treatments were still intended to be short and quick, but there
were added considerations about how, when, and where to needle. Dou Hanqing wrote:
The Way of the Doctor-if he can clearly understand the principle of using the needle-is to swiftly
eliminate pain as if it were plucked out by the hand. And to shatter blockages releasing them far and
wide, as dissolving ice. As soon as the mystery of this is accomplished, you eliminate the problems of
early deaths and mistaken treatments.
This medical art developed considerably into what comes down to us as modern acupuncture based on
the concept that one can regulate the body functions through insertion of the needles, not just let things
out and immediately get rid of a disease. The Lingshu (2) is the text that points to the situation that was
evolving from the original concept. In the third scroll, it says:
The unskilled physician grasps only the form when he uses the techniques of acupuncture. The superior
physician understands the spirit: his understanding of man includes both the blood and qi, whether
there is excess or deficiency, whether he should tonify or disperse. The spirit and the guest, the primary
and the evil, meet. The spirit is the primary qi, the guest is the evil qi. "Located at the door" means that
the evil qi pursues the primary qi at those places where it comes out and enters. Don't just stare at
disease! Begin by knowing the evil and the primary qi, and which channels are diseased….The
unskilled physician only guards the gates….The superior physician knows the subtleties; he
understands how to handle qi….
The "form" that the unskilled physician grasps is the inserting of needles into points on the body,
relying only on places of obvious obstruction or the doorways where pathogens can exit. The superior
physician first diagnoses the various conditions of qi, such as deficiency and excess, and adjusts his
needling accordingly. The "evil" is like a guest or invader in the body; the unskilled physician only
stands at the doorway trying to block the entrance of an evil qi or open the door to let it out. The
superior physician tracks down the location of the evil qi in the channels and escorts it to the door. The
spirit or "primary qi" is the normal qi of the body, which the superior physician can coax into action to
help get rid of the pathogenic guest. The disease is not just something stared at, looked at in a cursory
manner; rather, it is to be understood and properly handled.
Over the centuries, considerable effort was applied to determining what points could alleviate spirit
disorders, not solely by serving as a door (spirit gate), but also by adjusting the healthy qi to overcome
the perverse qi. The result of these efforts is a focus on points at the head, on the wrists, and on the feet
and lower part of the legs. I would like to propose that treating this set of points (to be detailed later)
corresponds with the Daoist (Taoist) wandering in the wooded mountain trails. That is, acupuncture
partly serves the role as an in-office version of a trek through the woods.
In walking along these trails, especially with the limited quality of shoes available to them, the Daoists
had their feet and ankles and calves thoroughly and vigorously massaged by the irregular surfaces. At
the same time, their eyes, ears, and nostrils were filled with the sensory stimuli of nature: sky, trees,
mountains, waters, animals, and so on. While enjoying the beauty, fragrance, and sound of their
surroundings, these wanderers also had to stay attentive-whether for dangerous terrain or dangerous
animals. Thus, their nervous systems were entirely alert. In climbing they would sometimes grasp at
branches and stones; for their meals they would be plucking various fruits and making food out of the
natural materials they encountered, thus working their hands and wrists. Today, many people turn
instead to half hour sessions of foot reflexology or rotating specially designed Chinese balls in the
hands for a few minutes, or getting acupuncture for 20-40 minutes to stimulate the qi flow; but then
they do not at the same time encounter nature by sensation, so it is a lesser benefit, it is less holistic.
When the practitioner decorates his office with Chinese nature paintings and even with the charts
showing the flow patterns of the meridians, the patient gets a small glimpse of the desirable encounter;
with the fragrance of moxa and the sounds of a small fountain or gentle traditional Chinese music, the
patient has a sensory experience completely different from what is typically found in a modern medical
office.
Thus, it is proposed, at one level, that the Chinese medicine practitioner is standing in for a nature hike!
In saying this, I am not proposing that people who follow the Daoist path regularly (being out in nature
for hours rather than 30 minutes, and doing so daily rather than once a week) don't sometimes suffer
from shen disorders. Nor do I suggest that all shen disorders might be resolved by Daoist wandering on
rocky paths through forested mountains. However, when practitioners of Chinese medicine refer to the
concept of the body as a microcosm for the universe (as the macrocosm), they are agreeing to the idea
that what goes on within the body needs to be attuned to the world outside, and that is the natural
world. Such correspondence between the inner and outer worlds comes about by interacting with
nature. The acupuncturist directs the patient's attention to the "Tao which is great."
Continuing the quotation from Dou Hanqing, with some slight editing of the translation to make the
point more evident:
What was hidden from your view, can now be distinguished-you are able to understand secrets from the
ancient books of the past. What was hidden was the underlying pattern-to perceive it is to begin to
explain it. Understanding the patterns means enlightenment. The pattern, illuminated and revealed by
those who came before, easily throws its light upon you later scholars.
What are these patterns? He described the flow of qi and blood in the body this way: "Traveling in
ditches or collecting pools, or else running like a stream in a valley, along different pathways. The
pathways here are the tracks. Among the points on the vessels some are called, ditches, pools, streams,
valleys-just as each is in a different position along the track or pathway." That is, the interior of the
body is like nature, and when examining the body, one is looking for how its natural function has been
disturbed-hoping to restore it. The Daoists provided a model for healthy function, which is contained in
the concept of Xiao Yao. A hidden secret is that the needling of patients can mimic the Xiao Yao. This is
not the only way to practice acupuncture, but it is one of the ways.

Herbs
There can be little doubt that the earliest determination of medicinal properties of herbs had to do with
immediate effects of consuming them. In most cases, these were things to be avoided, such as herbs
causing vomiting or diarrhea. However, the effects were utilized for healing-much as ancient
acupuncture was-to let out evils from the body. In such cases, they would typically be taken once or
twice, with the expectation that the disease would change markedly, preferably in the direction of
resolution. The standard methods of therapy mentioned in the Shanghan Lun (3) were types of
purging: vomiting, laxation, and perspiration. They were frequently mentioned in the context of being
used wrongly (like the acupuncturists who only relied on opening the door to let out evil). What was
then introduced in that text was a more sophisticated analysis of disorders and more complex therapies
that involved locating the problem within certain part of the body and addressing it with methods of
tonifying or dispersing or even harmonizing, usually with only a few days of treatment.
There also developed a different concept that some medicinal substances could be taken routinely over
a long period to protect health and gain long life or immortality. Unfortunately, many of these remedies
were not really based on experience of positive outcomes, but on theories that had been worked out by
a few individuals. Some of the substances they advocated did not stand the test of time. Alchemists,
believing in the ability to transform the body in a way that would correspond to chemical
transformations, became involved in using a number of toxic substances. One of the results of the
toxicity was loss of body weight, a change that may today seem beneficial in terms of the problem of
obesity, but was actually part of the harm done to a person through such things as heavy metal
poisoning. To this day, we read of Chinese herbs that had this effect (causing the body weight to
decline), often without realizing that this attribution is not necessarily a positive one. Sometimes this
weight loss effect was attributed to herbs that are non-toxic (such as ginseng), but the herb didn't have
that effect; instead, it was simply included as a listed property because that herb was considered to be
one that could contribute to gaining immortality.
Over time, herb therapies have gone through a variety of changes, especially as they have come to us in
the West. Some herbs that are especially potent in effect, but also potentially causing serious side
effects, have been dropped from the treatments in recent times. These are replaced, in actual practice,
by drugs that also have potent effects and potential for side-effects, but are better studied and better
controlled than the natural substances. For the non-toxic agents, there is a tendency to use very high
doses in China (e.g., 120 grams or more in decoction for a one day dose), and these high doses may
contribute common nutrients, such as vitamins and minerals, as well as any chemical constituents that
are active. In that sense, they serve a function similar to eating nutritious foods or consuming dietary
supplements made with components such as vitamins, minerals, and amino acids. Numerous Chinese
investigations into the herbal remedies have been based on determining the quantity of such things as
trace minerals and amino acids to help explain their effects. Some of the substances used for treating
shen disorders, such as oyster shell and dragon bone and wheat, may have part of their value explained
by the presence of calcium compounds and B-vitamins, things that are as easily attained by consuming
certain foods or supplements (the Chinese diet lacked calcium rich dairy products and relied on milled
rice which lacked vitamin B). It is understood that such minerals and vitamins can have a positive
influence on the function of the brain and nervous system for persons who suffer deficiencies.
In addition to providing what we might consider ordinary nutritional benefits, many of the herbs may
have indirect therapeutic effects on shen disorders. For example, a person who has poor blood sugar
regulation may experience difficulty with mental concentration when blood sugar is either high or low;
herbs that regulate blood sugar may stabilize the mental condition without having a direct impact on the
brain.
At this time, it is difficult to know what ingredients are truly effective in treating shen disorders. Some
herbs have been shown, through laboratory testing, to affect neurotransmitters, such as acetylcholine or
serotonin, and some clinical trials have demonstrated improvements in patient conditions (e.g.,
depression, insomnia, memory, response time). The herbs that are most frequently employed have a
variety of different active components, though there may be a prevalence of steroidal glycosides among
several of the commonly used herbs. The question of which ingredients are active and their mechanism
for various effects on the brain and mind is an area that requires further investigation. China has had a
limited investment in researching herbal effects on shen disorders, partly for political reasons and partly
because of the great difficulty involved in assessing the effects.

Suggested Protocols
I would like to present a protocol of acupuncture and herbs corresponding to the analysis presented in
this booklet that would lead directly to rapid improvement in most patients. This might be considered a
system of treatment that involves some relatively simple choices. By contrast, according to a large
component of the Chinese medical literature, one should undertake an extensive diagnostic overview,
determine a pattern of dysfunction, and treat accordingly, utilizing therapies that are both traditionally
recognized and also influenced by personal training and clinical experience. Is there a way to offer
something that is true to both these intentions? I believe there may be. On the one hand, we have the
complete Chinese medical system, with hundreds of acupuncture points and hundreds of herbs, which
provides for meeting the demands of the methodology called differential diagnosis and treatment. One
can hardly dispense with all of that. On the other hand, numerous practitioners, some of them revered
for their competency, have observed that there are certain acupuncture point sets that can be used
reliably for many patients, or have utilized a small number of herbal prescriptions to help patients with
diverse conditions. The potential value of such an approach based on trustworthy regimens is that it
allows many people to benefit even when the practitioner is not in a position to provide full differential
diagnosis and treatment.. Even in modern medicine, where we have very detailed analyses that lead to
much finer differentiation of diseases than in Chinese medicine, we still sometimes find some central
therapeutic approaches that are relied upon over and over. As a prime example, a relatively safe anti-
inflammatory can have the potential to alleviate a wide range of conditions, both acute and chronic. In
fact, aspirin is one such compound, and this substance is now produced at an estimated rate of 24
million pounds per year. One can similarly think of treatments for mental disorders, such as Prozac
(fluoxetine), for which the U.S. alone used 1.2 billion dosages in one year.

The 20th century acupuncturist Wang Leting (4) had described an acupuncture protocol, called "Old Ten
Needles" for gastrointestinal diseases which can also be chosen and used for other diseases. It was
pointed out that "Generally speaking, the Old Ten Needles can be selected for all kinds of
gastrointestinal diseases regardless of whether they are vacuous [deficient] or replete [excess], cold or
hot." In a similar manner, certain herbal formulas are very broadly used, often for gastrointestinal
disorders and then additionally for other conditions, of which Guipi Tang is a good example mentioned
in Chapter 8.
For shen disorders, I propose the following structures for basic treatment using acupuncture and herbs,
which can be further modified according to the practitioner's decisions

Acupuncture Basics for Shen Disorder

At least two points are selected along the centerline of the head to the neck, thus on the GV vessel
(including extra point yintang). These points run from GV-14 through GV-26. Starting at GV-14, the
back of the head points are selected for strengthening yang and for treating disorders that physically
affect the brain. Reaching the top of the head, one regulates the yang and treats disorders that are
primarily affecting the function of the brain, such as with insomnia and memory. Moving to the front of
the head, one treats points to remove excess and to calm agitation. Points along either side of the center
line may be used additionally, such as sishencong or fengqi (GB-20).
Two or more points are selected on the forearm or hand, the most common choices are PC-6 (or
adjacent points PC-5 or PC-7) and HT-7. These points can be treated to enhance the function and
nourishment of the heart while draining excess from the head; LI-4, at the hand, is an example of a
point that is especially used for draining.
One or two points are selected on the lower leg or foot. The points may be used for draining excess
(e.g., LV-2 or LV-3) or for tonifying (e.g., KI-3 and SP-6); sometimes points slightly higher on the calf
are used, such as ST-40 (for draining) or ST-36 (for tonifying) For tonification therapy, one may also
include the use of points in the waist area, such as CV-4 or CV-6, GV-4, or BL-23. If such tonification
is not required, then the points at the head, hand/wrist, and foot/lower leg are sufficient.
The combination of head points and points at all the extremities (bilateral upper and lower limbs)
produces a pattern of effects that is notable; it may be described as a stabilizing pattern. This protocol
can be seen to be contained within the treatments of most of the clinical reports listed in Chapter 5, but
the authors do not describe their treatments as following this general pattern, rather, the set of points is
simply laid out and some comments may be provided about the value of individual points or,
occasionally, the value of a certain combination of two points.
There is a traditional concept of treating "one point above, with two points below," but, in this case, the
recommendation is to treat points above as specifically referring to the head (and neck) and points at
the extremities (with emphasis on the distal areas) are the ones below. It is also possible to recommend
an order to applying the needles. This begins with needling the top of the head (such as GV-20), which
is often less painful than other points and has a calming effect; then any additional points in the
head/neck area are treated. After that, the hands/wrists are needled, and this will have the effect of
giving a greater stimulus to the brain. Finally the feet are needled in order to complete the circuit of
circulation from the extremities to the head.
A purpose of this needling order is to clear the movement of qi in the head region first, removing any
blockages and calming agitation. Next, the flow of qi and blood to the head region from the arms
allows for a stronger sensation. Finally, the distal points at the lower body help regulate the gross
circulation of qi throughout the body. This approach is particularly relevant to disorders that are
considered to affect the brain, mind, and spirit. The exception is where the patient experiences an
obvious nervousness that would be attributed to liver qi excess, in which case the use of the lower body
points (e.g., LV-3, LV-2) might be the starting point; then the head and finally the arms might be
treated.
Except when using the bladder meridian or governing vessel points at the back, this treatment can be
applied with the patient lying in the comfortable face-up position. If needling the back of the head
points such as GV-14, 15, or 16, or GB-20, the patient may be seated so long as attention is paid to the
rare possibility of fainting.

Herbal Basics for Shen Disorder

Herbal therapeutics for shen disorders often present a certain limited set of herbs repeatedly. These
basic herbs are summarized in the following table:

Category Main herbs Others

Licorice is often included; mild tonics, such
as longan or jujube might be added.
Qi tonics to raise the
ginseng, astragalus Codonopsis can be used in place of ginseng
clear yang
as a spleen tonic, but it lacks the shen
calming effects.
Pinellia and citrus added for greater fluid
accumulation or obvious phlegm; alpinia may
Damp-clearing herbs hoelen, atractylodes
be used to invigorate stomach/spleen
function.
Blood nourishing Rehmannia is also used, especially for older
tang-kuei, peony
herbs patients.
Albizzia bark or flower used for depression;
Spirit calming herbs zizyphus, biota oyster shell and dragon bone or dragon teeth
used for fright and agitation.
Arisaema, curcuma, and bamboo are used
Phlegm-mist clearing additionally for severe cases; platycodon may
acorus, polygala
herbs be included, especially where there is
obvious sputum accumulation.
bupleurum, plus one
or more of: citrus, Cyperus is sometimes used for depression;
Qi regulating herbs chih-shih, chih-ko, lindera might be used in place of bupleurum
saussurea, magnolia for weak constitution patients.
bark
 Moutan is sometimes used for heat in the
Heat clearing herbs coptis, gardenia
blood.
Scrophularia and/or lily might be used
additionally; these herbs are for yin
ophiopogon,
Yin nourishing herbs deficiency agitation with insomnia and night
rehmannia, cornus
sweating; lily helps drain damp and treats
neurosis.
Kidney essence ho-shou-wu, tortoise These herbs are particularly used with older
replenishing herbs shell, lycium, cuscuta patients.
salvia, red peony,
Blood stasis syndromes tend to occur in cases
Blood vitalizing herbs cnidium, persica,
with long duration and in elderly patients.
carthamus
Key formulations mentioned in the previous chapters are Guipi Tang, Tianwang Buxin Dan, and Jiawei
Xiaoyao San. A practitioner using these formulations, or others relying primarily on the herbs listed in
the above table, will be working in a manner consistent with most Chinese medicine experts in China.
The herbs for resolving phlegm or phlegm-mist and for vitalizing blood may need to be added to these
basic combinations.
In the modern circumstances, it is common for people to approach practitioners involved with Chinese
medicine only after a disorder has been present for some time and has not resolved either on its own or
with standard medical approaches. In Western society in particular, many people suffer from certain
disorders of excess (due, largely, to dietary excess) and stagnation (due, largely, to sedentary life style).
Because of the chronic nature of the problems, the excess and stagnation cause or occur simultaneously
with certain deficiencies, particularly in the function and proper nourishment of the viscera. Therefore,
it is almost always the case that patients will benefit from the therapeutic principles including clearing
excess (e.g., getting rid of damp and phlegm and heat), dispersing stagnation (vitalizing circulation of
qi, blood, and fluids), and tonification (e.g., nourishing qi and yin).
For the herbs to be effective, it is important to avoid using too many ingredients at once. Many patients
prefer taking a small quantity of herb materials (today, many people consume herbal tablets, capsules,
or pills, rather than heavy decoctions), so in order to get a large enough dosage of the key ingredients,
only a few items ought to be used. As examples, Guipi Tang has 12 ingredients and Tianwang Buxin
Dan has 13; and most of the treatments described have no more than 16 ingredients. Sometimes, two
formulas are combined to produce a therapy, such as using a kidney nourishing prescription (e.g.,
Zuogui Wan) and a formula for resolving phlegm accumulation (e.g., Banxia Baizhu Tianma Tang);
each of these formulas had 8 ingredients, for a total of 16. Although most of the treatment strategies
outlined in the table above may appear attractive for addressing a patient's needs, the therapy should
usually focus on only a few of them. As necessary, the therapy can be changed over time as some
conditions improve and others then become the target of concern.
An important part of the protocol, as revealed in the previous chapters, is to drain fluids. In cases with
obvious moisture accumulation, the herbs hoelen and atractylodes are especially desired, possibly in
the context of using spleen qi tonics to enhance the moisture dispersing action attributed to the spleen
organ system. As the fluid is transformed to phlegm-fluid due to stagnation, herbs such as pinellia and
citrus, magnolia bark, or alpinia may be added. If the disorder displays signs of phlegm-mist, then
acorus and polygala become important (for severe cases, arisaema and bamboo are added) and one
should consider the possibility of blood stasis occurring at the same time (salvia is a favored herb). In
the case where yin deficiency is present, lily may be used to drain fluid without damaging yin.

Final Thoughts
To sum up, ancient Chinese therapeutics were originally quite coarse in nature (big needles and lances,
herbs with strong, even toxic, action) and used briefly to affect a change. Later, the system was refined
so that more subtle adjustments could be made. These subtle effects may be seen, in some sense, as a
replacement for components of lifestyle-such as walking through mountain paths and eating a
nutritious diet-that were recommended by Chinese philosophers who thought along the same lines as
the early medical scholars.
In addition to any specific action that might be attained via acupuncture and herbs, it is the interaction
of the physician with the patient that is critical. Chinese medicine offers what for many appears to be a
positive intervention, which contrasts with what is seen as a negative intervention of modern medicine.
The impression about the positive or negative impact of a style of treatment (i.e., Western or Eastern) is
often a matter of interpretation, but the contrasting views provide for an opening in the relationship.
The doctor who offers Chinese medical therapy has at his disposal the Chinese conceptual framework
about health. That acupuncture and herbs tie into a larger picture, namely the interaction of the patient
with the world outside them and, in particular, the spiritual part of their being, may be important for
many people, a key to changing their health.
This is not to say that the Western world can't offer essentially the same thing as does the Asian culture
in terms of this holistic view. It is only that doctors and patients in the Western world have fallen into a
pattern of thinking and acting that some find unsatisfactory. The patient presents a disorder and the
doctor presents a treatment-typically drugs and/or surgery-but there isn't much time to go into other
aspects of a person's health or the concerns have become sufficiently routine ("lose weight, stop
smoking") that they are quickly passed over. In fact, the Western doctor must reserve his or her time for
the technical aspects of diagnosis and medical intervention.
Theoretically, the Western doctor ought to be able to rely on the person's church (or other religious
organization) to take care of the spiritual matters that are important to healing. The person's family
ought to help with maintenance of a healthy pattern of behavior, including diet and exercise. The
culture that a person lives within is supposed to help provide healthy mental and physical activities; and
the medical literature put into layman's terms (popular format) is supposed to tell people what are
generally understood to be healthy or unhealthy practices. But, we find today in our society many
people isolated from their spiritual tradition, from their family, from the better side of their culture, and
skeptical of the general health care teachings (searching instead through various alternatives), so that
they are left without good health and have limited hope. They are looking for something else to fill the
gaps.
Chinese medicine offers an alternative that seems attractive to some. It has the spirituality of Daoism,
for example, that actually fits well with the uncertainties of the modern times, and offers the natural
concepts of yin and yang and five elements that fill a void left by too much technological information
about the chemical make-up of the body and the environment. China has a unique dietary approach
(such as attributing cold and hot or yin and yang properties to foods and herbs) and the physical culture
of taiji quan and qi gong (that strikes many far more harmonious than running and weight lifting). The
Far East has the therapeutics of acupuncture which seems both mysterious and effective, and it has
what is perceived as a more potent form of herbalism than is available in the West (and this perception
may be justified because of the greater reliance on herb therapy).
In order to tap into and gain the most from the Chinese system, its components should not be taken in
isolation. There are cases where acupuncture and/or herbs are simply provided as the sole remedies,
without going into a broader context, and this can be appropriate for injuries or infections. However,
for those with shen disorders, where the mental function, the emotions, and the spirit are all involved, a
focus on techniques of needling and herb prescribing herbs may be too narrow. For that reason, this
booklet begins with an introduction to the underlying concept of the shen and its disorders in relation to
how a person lives.

References
1. Bertschinger R, The Golden Needle and Other Odes of Traditional Acupuncture, 1991
Churchill-Livingstone, London.
2. Wu Jingnuan (translator), Ling Shu, or The Spiritual Pivot, 1993 Taoist Center, Washington,
D.C.
3. Hsu HY and Peacher WG (editors), Shang Han Lun: The Great Classic of Chinese Medicine,
1981 Oriental Healing Arts Institute, Long Beach, CA.
4. Yu Huichan and Han Furu, Golden Needle Wang Leting, 1996 Blue Poppy Press, Boulder,
CO.
Appendix
Quick Reference to Herb Names
This table helps to better identify the Chinese herbal materials mentioned in the text. The common
names that are used throughout the text are those that have been utilized by ITM and the Oriental
Healing Arts Institute for the past thirty years, with a few minor changes. The pinyin terms will help
those who are not familiar with the common names to refer to most Chinese literature. It is a frequent
practice in China to use many different herbs as a source of the same basic item; these herbs have the
same therapeutic action, from the traditional viewpoint. This cross-reference index lists a single,
representative botanical source for the item. The plant part used has been indicated. There is some
confusion in the literature about the designation of fruits and seeds, especially since some plants
produce a structure that is essentially both. There is also some confusion about whether just the tops or
the whole plant is used for some weedy herbs. It may depend on the collection techniques and post-
collection cleaning as to what is actually obtained. Not all the materials listed here are derived from
plants. For animals, the scientific name is given and has the same structure as the botanical names; for
minerals, a common name or a chemical description may be given. The category listing refers to the
Materia Medica section, and is mainly that used in Oriental Materia Medica. The Materia Medica
category does not necessarily define the primary current use of the herb; it does, however, indicate a
major application of the herb.

Herb Name Pinyin Scientific Name Part Category

Achyranthes niuxi Achyranthes bidentata root vitalize blood
Aconite fuzi Aconitum charmichaeli root dispel chill
Acorus shichangpu Acorus gramineus rhizome open orifices
nourishing
Albizzia hehuanpi Albizzia julibrissin bark
sedative
nourishing
Albizzia flower hehuanhua Albizzia julibrissin flower
sedative
Alisma aquatica- remove
Alisma zexie rhizome
plantago moisture
Alpinia yizhiren Alpinia oxyphylla fruit tonify yang
Altaica jiujiechangpu Anemone altaica rhizome open orifices
Anemarrhena
Anemarrhena zhimu rhizome purge fire
aspholoides
dispel wind-
Angelica baizhi Angelica dahurica root
chill
Antler gelatin lujiaojiao Cervus nippon gelatin nourish blood
Apricot seed xingren Prunus armeniaca kernel relieve cough
Areca peel dafupi Areca catechu peel regulate qi
Arisaema resolve cold
Arisaema tiannanxing rhizome
consanguineum phlegm
Arisaema resolve cold
Arisaema, bile dannanxing rhizome
consanguineum phlegm
Asparagus
Asparagus tianmendong root nourish yin
cochinchinensis
Astragalus
Astragalus huangqi root tonify qi
membranaceous
Atractylodes
Atractylodes baizhu rhizome tonify qi
macrocephalla
fragrant,
Atractylodes, red cangzhu Atractylodes lancea rhizome
resolve damp
Aurantium juhong Citrus reticulata peel regulate qi
 resolve hot
Bamboo sap tianzhuhuang Phyllostachys nigra sap
phlegm
nourishing
Biota baiziren Biota orientalis seed
sedative
Blue citrus qingpi Citrus nobilis fruit regulate qi
Dryobalanops
Borneol longnao; bingpian resin open orifices
aromatica
dispel wind-
Bupleurum chaihu Bupleurum chinense root
heat
fragrant
Cardamon Sharen Amomum villosum seeds
resolve damp
Carthamus Honghua Carthamus tinctorius flower vitalize blood
clear heat,
Cassia seed juemingzi Cassia obtusifolia seed
clarify vision
Chih-ko zhike, zhiqiao Citrus aurantium fruit regulate qi
Chih-shih zhishi Citrus aurantium unripe fruit regulate qi
dispel wind-
Chin-chiu qinjiao Gentiana macrophylla root
damp
clear summer
Ching-hao qinghao Aremisia apiacea tops
heat
Chrysanthemum dispel wind-
Chrysanthemum juhua flower
morifolium heat
dispel wind-
Cimicifuga shengma Cimicifuga heracleifolia rhizome
heat
Cinnamon bark rougui Cinnamomum cassia bark dispel chill
dispel wind-
Cinnamon twig guizhi Cinnamomum cassia twig
chill
Cistanche roucongrong Cistanche salsa top tonify yang
Citrus chenpi Citrus reticulata rind regulate qi
Cnidium chuanxiong Ligusticum walichii rhizome vitalize blood
Codonopsis dangshen Codonopsis pilosula root tonify qi
remove
Coix yiyiren Coix lachryma-jobi seed
moisture
clear heat, dry
Coptis huanglian Coptis chinensis rhizome
damp
Cordyceps dongchongxiacao Cordyceps sinensis mycelium tonify yang
Cornus shanzhuyu Cornus officinalis fruit astringent
Corydalis yanhusuo Corydalis bulbosa tuber vitalize blood
Crataegus shanzha Crataegus cuneata fruit digestant
Curculigo xianmao Curculigo orchiodes rhizome tonify yang
Curcuma yujin Curcuma aromatica tuber vitalize blood
Cuscuta tusizi Cuscuta chinensis seed tonify yang
Cyathula chuanniuxi Cyathula capitata root vitalize blood
Cyperus xiangfuzi Cyperus rotundus rhizome regulate qi
Deer antler lurong Cervus Nippon antler tonify yang
Dioscorea shanyao Dioscorea batatas rhizome tonify qi
Dipsacus xuduan Dipsacus asper root tonify yang
Dragon bone longgu Fossil bone whole sedative
Dragon tooth longchi Fossil bone whole sedative
Drynaria gusuibu Drynaria fortunei rhizome tonify yang
extinguish
Earthworm dilong Pheretima asiatica whole
wind
Eclipta hanliancao Eclipta prostrata top nourish yin
Epimedium yinyanghuo Epimedium sagittatum leaf tonify yang
Eucommia duzhong Eucommia ulmoides bark tonify yang
Eupolyphaga zhechong Eupolyphaga sinensis whole vitalize blood
Euryale qianshi Euryale ferox seed astringent
Evodia wuzhuyu Evodia rutaecarpa fruit dispel chill
Forsythia lianqiao Forsythia suspensa fruit clean toxin
Frankincense ruxiang Boswellia carterii gum vitalize blood
resolve hot
Fritillaria zhebeimu Fritillaria thunbergii bulb
phlegm
Fu-shen fushen Poria cocos/Pinus sp. root/fungus sedative
Gardenia zhizi or shanzhizi Gardenia jasminoides fruit purge fire
extinguish
Gastrodia tianma Gastrodia elata tuber
wind
Gastrodia extinguish
mihuanjun Armillaria mellea whole
mushroom wind
Gelatin ejiao Equus asinus skin extract tonify blood
clear heat, dry
Gentiana longdancao Gentiana scabra root
damp
Ginger (dry) ganjiang Zingiberis officinale rhizome dispel chill
dispel wind-
Ginger (fresh) shengjiang Zingiberis officinale rhizome
chill
Ginseng renshen Panax ginseng root tonify qi
resolve cold
Gleditsia (spine) zaojiaoci Gleditsia officinalis spine
phlegm
Haematite daizheshi Haematite mineral sedative
 extinguish
Haliotis shijueming Haliotis diversicolor shell
wind
Ho-shou-wu heshouwu Polygonum multiflorum root tonify blood
remove
Hoelen fuling Poria cocos whole
moisture
Jujube dazao or hongzao Zizyphus jujuba fruit tonify qi
resolve hot
Lapis Mengshi Lapis mineral
phlegm
Licorice Gancao Glycyrrhiza uralensis root tonify qi
Ligustrum Nüzhenzi Ligustrum lucidum fruit nourish yin
Lily baihe Lily brownii bulb nourish yin
Lindera wuyao Lindera strychnifolia root regulate qi
Longan longyanrou Euphoria longana aril (fruit) tonify blood
Lonicera jinyinhua Lonicera japonica flower clean toxin
Lotus seed lianzi Nelumbo nucifera seed astringent
Lotus stamen lianxu Nelumbo nucifera stamen astringent
purge
Lycium bark digupi Lycium barbarum root bark
deficiency fire
Lycium (fruit) gouqizi Lycium barbarum fruit tonify blood
Magnetite cishi Magnetite mineral sedative
fragrant,
Magnolia bark houpo Magnolia obovata bark
resolve damp
Malt maiya Hordeum vulgare sprout digestant
Melia chuanlianzi Melia toosendan fruit regulate qi
dispel wind-
Mentha bohe Mentha arvensis tops
heat
Millettia jixueteng Spatholobus suberectus stem vitalize blood
Morinda bajitian Morinda officinalis root tonify yang
Morus (bark) sangbaipi Morus alba root bark relieve cough
Mother of pearl zhenzhumu Pinctada margaritifera shell sedative
clear heat,
Moutan mudanpi Paeonia moutan root bark
cool blood
Mume wumei Prunus mume fruit astringent
Myrrh moyao Commiphora sp. resin vitalize blood
Ophiopogon maimendong Ophiopogon japonicus tuber tonify yin
Oyster shell muli Ostrea gigas shell sedative
Peony (white) baishao Paeonia lactiflora root nourish blood
Perilla leaf zisuye Perilla frutescens leaf dispel wind-
 chill
Persica taoren Prunus persica kernel vitalize blood
Phellodendron clear heat, dry
Phellodendron huangbai bark
amurense damp
Typhonium resolve cold
Pinellia banxia tuber
flagelliforme phlegm
remove
Plantago seed cheqianzi Plantago asiatica seed
moisture
Platycodon resolve cold
Platycodon jiegeng root
grandiflorum phlegm
nourishing
Polygala yuanzhi Polygala tenuifolia root
sedative
Polygonatum huangjing Polygonatum sibericum rhizome tonify qi
nourishing
Polygonum stem yejiaoteng Polygonum multiflorum stem
sedative
Prunella xiakucao Prunella vulgaris top purge fire
Psoralea buguzhi Psoralea corylifolia seed tonify yang
Pseudostellaria
Pseudostellaria taizishen root tonify qi
heterophylla
Pteropus wulingzhi Pteropus pselaphon excretion vitalize blood
dispel wind-
Pueraria gegen Pueraria lobata root
heat
Red peony chishao Paeonia lactiflora root vitalize blood
Rehmannia shu dihuang Rehmannia glutinosa root tonify blood
clear heat,
Rehmannia (raw) sheng dihuang Rehmannia glutinosa root
cool blood
Rhubarb dahuang Rheum palmatum rhizome purgative
Salvia danshen Salvia miltiorrhiza root vitalize blood
San-chi sanqi Panax notoginseng root regulate blood
resolve hot
Sargassum haizao Sargassum fuisforme whole
phlegm
Saussurea muxiang Jurinea souliei root regulate qi
Schizandra wuweizi Schizandra chinensis fruit astringent
clear heat, dry
Scute huangqin Scutellaria baicalensis root
damp
Scrophularia clear heat,
Scrophularia xuanshen root
ningpoensis cool blood
Artemisia annua and
Shen-chu shenqu whole digestant
others
Siler fangfeng Ledebouriella root dispel wind-
 seseloides chill
Bombyx mori/Batrytis extinguish
Silkworm jiangcan whole
sp. wind
resolve cold
Sinapis baijiezi Brassica hirta seed
phlegm
clear heat, dry
Sophora kushen Sophora angustifolia root
damp
Sparganium
Sparganium sanleng rhizome vitalize blood
stoloniferum
Succinum hupo Succinum (fossil resin) whole sedative
remove
Talc huashi Talcum whole
moisture
Tang-kuei danggui Angelica sinensis root nourish blood
Tortoise shell guiban Chinemys reevesii shell nourish yin
extinguish
Tribulus baijili Tribulus terrestris baijili
wind
resolve hot
Trichosanthes fruit gualou Trichosanthes kirilowii fruit
phlegm
Turmeric jianghuang Curcuma longa rhizome vitalize blood
Turtle shell biejia Amyda sinensis shell nourish yin
Typha (bulrush) puhuang Typha latifolia pollen hemostatic
extinguish
Uncaria gouteng Uncaria rynchophylla stem
wind
dispel wind-
Vitex manjingzi Vitex rotundifolia fruit
heat
Zedoaria ezhu Curcuma zedoaria rhizome vitalize blood
nourishing
Zizyphus suanzaoren Zizyphus spinosa seed
sedative
return to itm online

Abdominal Adhesions: Prevention and Treatment

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
Adhesions are strands or of scar tissue (fibrin bands; see illustration, below) that form in response to
abdominal surgery and extend beyond the specific site of incision, sometimes forming separately from
the incision site within the peritoneum. Scar tissue that mends the incision is normal, but the adhesions
form additionally under some circumstances that are not fully understood. There are specific features of
a surgical procedure that help induce the formation of adhesions. For example, drying of the tissues
during surgery increases adhesion formation, a situation remedied by paying attention to the arid
conditions and correcting them during then procedures. Intentional drying of the tissues, by applying
gauze, is an otherwise desirable procedure to aid the surgeon's view of the area, but because of
increased adhesions, it must be minimized. Tissues that become dry should be quickly moistened and
air (carbon dioxide) that is passed over the surgery site to maintain cleanliness also must contain
adequate moisture to prevent rapid drying of the exposed fluids. Laparotomy (open abdominal surgery)
is more likely to produce adhesions than surgery performed via laparoscopy in which a small scope
with attached microsurgical instruments is inserted through a slit in the abdomen (1-3).

Left: a representation of a normal peritoneum, the transparent membrane that wraps the pelvic and
abdominal organs. Right: after surgical trauma, fibrous bands of collagen grow as part of the normal
healing process and form adhesions. Adhesions connect tissues or structures that are normally
separate. Adhesions in the abdomen or pelvic area can lead to infertility, pelvic pain, small bowel
obstruction, or the need for repeat surgery (1).
The incidence of adhesions following abdominal surgery is cumulative with multiple surgeries and
female gynecological surgeries give a particularly high rate of adhesions. In one study, autopsy
investigations indicated a 90% incidence of adhesions in patients with multiple surgeries, 70%
incidence of adhesions in patients with a gynecologic surgery, a 50% incidence of adhesions with
appendectomy, and a greater than 20% incidence of adhesions in patients with no surgical history.
Adhesions may occur as the result of tissue damage to the abdomen besides surgery, including
traumatic injury, inflammatory disease, intraperitoneal chemotherapy, and radiation therapy (1).
The most frequent problem with adhesions is a constriction of the small intestine, producing
constipation (sometimes complete bowel blockage, requiring emergency treatments). Abdominal pain
is another common symptom, caused when the bands of scar tissue bind up the internal organs so that
movements pull on them. Linkage of menstruation to changes in bowel function (e.g., inducing
diarrhea) may occur as the result of scar tissue attaching the uterus to the intestine. Adhesions may also
impair fertility in women by causing blockage of the fallopian tubes. It has been estimated that:

 At least one-third of women who suffer from pelvic pain have adhesions as a cause of or
contributor to the pain.
 Adhesions involving the ovaries or fallopian tubes are responsible for 15-20 percent of female
infertility cases.
 Small bowel obstruction is often a surgical emergency and is particularly common after
gynecological surgery.
To prevent adhesion formation, surgeons may now apply a fine fabric barrier to surround the organs,
thus isolating them from the scar tissue strands (the barrier dissolves after the surgery). Although
adhesions can be removed by surgical intervention (adhesiolysis) using a laparoscopic technique (4),
recent studies suggested that such surgery produces limited benefits that are often short-term. Many
patients are treated with multiple adhesiolysis procedures in an attempt to improve the symptoms of
adhesions. Each year, 400,000 adhesiolysis procedures are performed in the U.S., costing the health
care system about $2 billion in hospitalization and surgeon expenses.
Most times, adhesions cause few, if any, notable effects. But, for those who do suffer from their adverse
effects, the question arises as to whether the adhesions can be reduced or eliminated by methods other
than further surgery.

CHINESE HERB MEDICINE FOR

ADHESIONS
The problem of developing abdominal adhesions is noted in the Chinese medical literature. Dr. Fu
Kezhi, at the Harbin office of ITM, carried out a literature search, yielding several studies summarized
here.
Chinese medicine has been applied both to prevention of adhesions and to their treatment when they
cause bowel blockage. The preventive measure involves relatively immediate post-surgical
intervention. The basis of the preventive therapy is to treat the abdominal stasis that occurs following
surgery. Normally, after an abdominal surgery, the bowels are virtually paralyzed for many hours, up to
two days in older patients and complicated surgeries. Doctors and nurses check for the return of bowel
sounds (indicating movements) after the surgery, to make sure recovery is proceeding. Since
obstructive constipation is one of the primary responses to developing adhesions, concern about bowel
stasis is a clear concern. In China, an herbal formula used for treating constipation is administered
about 6 hours after surgery, to assure the action of the bowels in a relatively short time with continued
bowel responsiveness, indicating lack of adhesion formation.
The formulas are usually a derivative of the ancient prescription Da Chengqi Tang (Major Rhubarb
Combination). The traditional formula has four ingredients: rhubarb and mirabilitum as purgatives and
chih-shih and magnolia as qi regulating herbs. The modifications of the formula usually involve adding
additional qi regulating herbs (notably saussurea) and blood vitalizing herbs (especially persica, red
peony, and salvia) to promote the circulation of qi and blood in the abdomen and prevent formation of
adhesions, which are seen as the result of prolonged stasis. An example is the administration of a
formula called Tao Zhi Zhi Po Fang, comprised of rhubarb, magnolia, chih-ko (in place of chih-shih),
saussurea, persica, carthamus, leech, and salvia, provided 6 hours after abdominal surgery (5).
Compared to a control group not treated with these herbs, bowel sounds and bowel functions resumed
many hours earlier and the incidence of adhesions (determined by typical symptoms of adhesions
appearing within the next three years) was significantly lowered.
In another report (6), a modified Major Rhubarb Combination was administered after surgery while
during surgery a protective barrier fluid was used to isolate the organs and prevent adhesions. The
authors noted:
Treatment by integrating traditional Chinese medicine and western medicine has been adopted in many
surgical departments, especially the application of Modified Major Rhubarb Combination. The formula
has the properties of inducing purgation, promoting qi circulation, resolving blood stagnation, and
assuring that the hollow viscera remain unimpeded; specifically, stomach-qi can move downward
freely to eliminate fullness and distention, the qi in the abdomen can circulate freely, and the bowels
remain open; it can stimulate early peristalsis of the bowels after surgery. When using the Modified
Major Rhubarb Combination soon after surgery for adhesive bowel obstruction, it can markedly
shorten the time period of intestine paralysis.
Because the herbal treatment within hours after surgery is impractical for Western patients (and the use
of purgatives would be objected to by the medical profession on grounds of it possibly causing
damage), the question about treating existing adhesions arises. In Chinese investigations of this matter,
the patients are usually those who have come to the hospital with a severe disorder, usually bowel
blockage, for which surgery would be utilized. Patients may first be treated with herbs to see if this is
successful in relieving the blockage, while surgery can be used as a back-up.
The non-surgical treatment of adhesion-induced medical crisis is similar to that used for the preventive
measure after surgery, at least in cases involving bowel blockage. For example, in one evaluation (7),
patients were treated with a derivative of Major Rhubarb Combination made with: rhubarb (15 g),
magnolia (10 g), chih-shih (10 g), mirabilitum (20 g), persica (10g), red peony (15 g), and stir-fried
raphanus (45 g). Raphanus (radish seed) is used to aid the downward flow of qi, normalize digestion,
and alleviate abdominal pain. The herbs were administered in 1-2 batches a day, orally or through a
stomach tube. Of 250 patients treated this way, 88% were able to avoid surgery. As with the method for
preventing adhesions in the first place, there is some doubt that this approach would be used in the
West, as there is concern about using strong purgative treatments when bowel blockage exists. In
China, the patients are carefully monitored while pursuing this treatment as an inpatient and are
referred to surgery if the problem is not promptly resolved.
Another report of this type of treatment approach involved use of two slightly different decoctions,
depending on the differential diagnosis (8); these were:

 Modified Major Rhubarb Combination: rhubarb (10-30 g), mirabilitum (6-15 g), magnolia (20
g), chih-shih (10 g), persica (10 g), red peony (10 g), and stir-fried raphanus seed (30g)
 Adhesion Lysis Decoction: cassia leaf (10g), mirabilitum (6-10 g), magnolia (10 g), lindera (10
g), persica (10 g), red peony (10 g), and stir-fried raphanus seed (10 g).
These formulations could be modified: for severe pain, add 10 grams each of corydalis, frankincense,
and myrrh; for a case with vomiting, add 10 grams pinellia and 30 grams raw hematite.
As in the previous study, these formulas prevented the need for surgery in about 86% of cases.
Presumably, these therapies could be applied to Western patients suffering from constipation that has
not developed into full obstruction requiring hospitalization; the formulas are not inherently different
from traditional herb prescriptions now administered for acute constipation. For example, Major
Rhubarb Combination is routinely sold as a dried extract granule by several Chinese herb suppliers
worldwide.
A limitation of the purgative herb therapy is that while it relieves the immediate crisis, the problem can
return, because the adhesions are not gone. An attempt to resolve this dilemma was designed on the
basis of using Chinese herb therapy to treat the obstructive crisis and then using laparoscopic surgery to
remove the adhesions to prevent further occurrences. By so doing, one can usually avoid emergency
surgery as a result of intestinal obstruction; instead, the surgery can proceed at a time when the
intestinal functions have normalized and a less invasive surgical technique (laparoscopic surgery) can
be utilized. In one study using this two-stage method (9), patients received one of three basic herb
therapies for the intestinal obstruction:

 Modified Major Rhubarb Combination: rhubarb, mirabilitum, chih-shih, magnolia, persica, red
peony, and stir-fried raphanus seed;
 Euphorbia Obstruction-relieving Decoction: euphorbia (gansui), rhubarb, magnolia, saussurea,
persica, achyranthes, and red peony; or
 Entero-adhesion Lysis Decoction: cassia leaf, mirabilitum, magnolia, saussurea, lindera, persica,
red peony, and stir-fried raphanus
In these formulations, rhubarb, euphorbia, and cassia leaf all serve the same function of inducing
peristalsis. The purgative herb is the central ingredient in treatment, while the others are supportive; in
one study (10), euphorbia was used as a single herb to treat intestinal obstruction due to adhesions in
order to prevent the need for surgery.
The desire of most patients would be to alleviate the problem of adhesions before a crisis of bowel
obstruction occurs, and to treat other manifestations of adhesions, such as abdominal pain and reduced
fertility. The Chinese literature appears silent on this issue, but there are some possibilities to be
considered.

CAN ADHESIONS BE MODIFIED OR

REMOVED WITHOUT SURGERY?
Doctors and researchers are aware that scar tissue is difficult to remove or alter. One method of
degrading undesirable scar tissue that has shown promise is to apply hyaluronidase, a mucolytic
enzyme. Hyaluronidase breaks down hyaluronic acid, an ingredient of connective tissue. It is injected
into the scar and may work best if the scar if physically degraded by surgical means and then treated by
the enzyme to prevent reformation of the original scar mass. A new application of hyaluronidase is to
provide it during surgery: protective barriers infused with hyaluronidase are being tried in an effort to
further reduce the formation of the adhesions.

Hyaluronidase is a body component that is normally present but may be

produced in large quantities in response to some stimuli. It primarily acts on
hyaluron, the structural component of the extracellular matrix, comprised of
hyaluronic acid (pictured left; these units repeat in long chains), one of
several glucosaminoglycans (GAGs) that comprise connective tissues.
Hyaluronidase is an important component in natural repair processes of
tissues, where hyaluron is broken down and reformed.

Hyaluronidase can be viewed as a softening and flow-promoting enzyme. Hyaluronidase is excreted by

bacteria as a means of helping breakdown and penetrate cellular barriers so that infection can proceed.
Tumor cells may take advantage of hyaluronidase, secreting it as a means of penetrating into the
surrounding tissues and aiding metastasis. The enzyme is used pharmaceutically in administering
certain drug therapies to help the drugs penetrate cells more easily.
The fact that existing scars may be degraded somewhat by the enzyme action suggests the possibility
that herbal therapies could contribute to alleviating adhesion symptoms by stimulating the body's
production of hyaluronidase (or other enzymes of similar function) to perform this task. Even if scar
tissue is not removed, if it can be softened (made more elastic), there may be relief from its physical
manifestations such as bowel blockage, pain, and some cases of infertility. Herbs that are reputed to aid
healing of injuries, soften abdominal masses, and alleviate abdominal pain of various origins may act,
in part, by breaking down undesirable collagens to alleviate the symptoms. Antifibrotic and mass
reducing herbs are used to treat abdominal disorders such as uterine fibroids and liver fibrosis, and are
also used to treat skin masses in scleroderma; it is possible that they function by increasing the
degradation of fibrous tissue via hyaluronidase. Key herbs for reducing fibrosis and masses are listed in
Table 1 (11).
TABLE 1. Key Herbs for Reducing Fibrosis and Masses.

Herb Common Name (Pinyin) TCM Functions Uses and Potential Applications
Achyranthes vitalize blood circulation, blood stasis mass in the
(niuxi/chuanniuxi) disperse swelling abdomen, abdominal pain
Arca shell vitalize blood circulation, blood stasis and phlegm mass in
(walengzi) disperse masses, control pain abdomen
blood stasis mass in the
Carthamus vitalize blood, disperse stagnant abdomen, traumatic injury,
(honghua) blood abdominal pain due to stagnated
blood
Cnidium vitalize blood, promote qi
abdominal pain, fibrosis
(chuanxiong) circulation, control pain
Frankincense
vitalize blood, control pain traumatic injury, abdominal pain
(ruxiang)
Myrrh vitalize blood, remove stagnant blood stasis mass in the
(moyao) blood, control pain abdomen, abdominal pain
Persica blood stasis mass in the
vitalize blood
(taoren) abdomen, traumatic injury
Red peony vitalize blood, disperse stagnant abdominal pain, accumulation in
(chishao) blood, control pain abdomen
Salvia inhibit fibrin deposition, promote
vitalize blood
(danshen) fibrinolysis
vitalize blood, promote qi
Sparganium blood stasis mass in the
circulation, disperse mass,
(sanleng) abdomen, abdominal pain
control pain
Succinum vitalizes blood, disperses abdominal pain due to
(hupo) stagnant blood obstruction
Tang-kuei abdominal pain, promotes
vitalizes blood
(danggui) fibrinolysis
Turtle shell disperse stagnant blood, soften
blood stasis mass in the abdomen
(biejia) hardness, disperse accumulations
Zedoaria vitalize blood, promote qi blood stasis mass in the
(ezhu) circulation, control pain abdomen, abdominal pain

SAMPLE FORMULATIONS AND

TREATMENT STRATEGY
The herbs from the table above are ingredients in traditional and modern formulas used in resolving
problems that are relevant to fibrous masses and adhesions. For example, a traditional formula for
treating pain due to old trauma, which may reflect existence of adhesions, is Sanleng Heshang Tang
(12). It is comprised of 12 herbs for regulating circulation of qi and blood and alleviating pain; the
formula includes sparganium, zedoaria, myrrh, frankincense, and tang-kuei. A formula for "movable or
immovable mass in the abdomen," Huoluo Xiaoling Dan, is made with just four herbs: salvia, myrrh,
frankincense, and tang-kuei. A modern formula developed for treating uterine fibroids, Gong Zheng
Tang, includes sparganium, zedoaria, achyranthes, tang-kuei, and persica (13). A modern treatment for
endometrial cysts is Nei Yi Wan (14), which includes succinum and turtle shell. Herbs used to relieve
skin hardening in scleroderma include tang-kuei, red peony, and salvia (15). These same herbs were
commonly applied to treatment of liver fibrosis secondary to hepatitis (see: Treatment and prevention
of liver fibrosis).
A treatment for existing adhesions would follow the pattern of treating any other abdominal mass or
fibrotic condition, namely a high dose therapy administered for a period of 3-6 months. During this
treatment, an effort to stretch the scar fibers, possibly stimulating the local response to softening the
fibers, might be pursued via exercises and massage therapy. Care must be taken not to induce any
damage during such efforts.

REFERENCES
1. Women's Surgery Group, Adhesions,
http://www.womenssurgerygroup.com/conditions/Adhesions/overview.asp
2. Khaitan E, Scholz S, Richards WO, Laparoscopic adhesiolysis and placement of Seprafilm: a
new technique and novel approach to patients with intractable abdominal pain, Journal of
Laparoendoscopy and Advanced Surgical Techniques 2002; 12(4): 241-247.
3. Kavic SM, Adhesions and adhesiolysis: the role of laparoscopy, Journal of the Society of
Laparoendoscopic Surgeons 2002; 6(2): 99-109.
4. Shayani V, Siegert C, and Favia P, The role of laparoscopic adhesiolysis in the treatment of
patients with chronic abdominal pain or recurrent bowel obstruction, Journal of the Society of
 Laparoendoscopic Surgeons 2002; 6(2): 111-114.
5. Su Fachun, et al., Clinical observation on Tao Zhi Zhi Po Fang used for preventing intestinal
adhesion after surgical operation, Chinese Journal of Surgery by Integrating Traditional
Chinese Medicine and Western Medicine; 2000; 6(6): 404-405
6. Sun Dechun, et al., A report on 6 cases of adhesive bowel obstruction treated with Major
Rhubarb Combination and sodium hyaluronate, Chinese Journal of Surgery with Integrated
Traditional and Western Medicine, 2001; 7(1): 32-33.
7. Chen Guifeng, 250 cases of adhesive intestinal obstruction treated by integrating Traditional
Chinese Medicine and Western Medicine, Chinese Journal of Surgery with Integrated
Traditional and Western Medicine, 2000; 6 (5): 325.
8. Zhang Jinfang and Wang Zhiqiang, Analysis on 102 cases of adhesive bowel obstruction treated
by integrating Traditional Chinese Medicine and Western Medicine, Chinese Journal of Surgery
with Integrated Traditional and Western Medicine 2001; 7(3): 160.
9. Wang Zhenyu, et al., Laparoscopy and combination of traditional Chinese medicine and
Western medicine in adhesive intestinal obstruction, Chinese Journal of Surgery with Integrated
Traditional and Western Medicine 2002; 8(1): 3-5.
10. Liang Desen, et al., Curative effect of Gansui (Euphorbia kansui root) in treating
adhesive bowel obstruction, Chinese Journal of Surgery with Integrated Traditional and Western
Medicine 2001; 7(1): 33-34.
11. Hsu HY, et al., Oriental Materia Medica, 1986 Oriental Healing Arts Institute, Long
Beach, CA.
12. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of
Traditional Chinese Medicine, vol. 2, 1993 Heilongjiang Education Press, Harbin
13. Wu Dingyuan, Preliminary report of 136 cases of uterine myoma treated by traditional
Chinese medicine, Journal of the American College of Traditional Chinese Medicine 1982 (1):
64-70.
14. Wang DZ, Wang ZQ and Zhang ZF, Study on the treatment of endometriosis with
removing blood-stasis and purgation method, Chinese Journal of Integrated Traditional and
Western Medicine 1991; 11(9): 524-526.
15. Fruehauf H, Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs,
Institute for Traditional Medicine 1997, Portland, OR.
Disorder Articles
Abdominal Adhesions Abdominal Adhesions: Prevention and Treatment
Alopecia Treatment of Alopecia with Chinese Herbs
Alzheimer's Disease: Treatment with Chinese
Alzheimer's Disease
Herbs
Amyotrophic Lateral Sclerosis
Treatment of ALS with Chinese Medicine
(ALS)
Anemia Iron Deficiency Anemia
An Analysis of Chinese Herbal Prescriptions for
Arthritis
Rheumatoid Arthritis
Treating Advanced Arthritis With Chinese Herbs
Asthma Acupuncture Treatment of Asthma
Chinese Herbal Treatments for Attention Deficit
Attention Deficit Disorder
Disorder
Autism Autism
Autoimmune Diseases and the Potential Role of
Autoimmune Disease
Chinese Herbal Medicine
Treatment of Avascular Femoral Necrosis with
Avascular Femoral Necrosis
Chinese Herbs
β-Thalassemia Treatment of β-Thalassemia with Chinese Herbs
Benign Prostatic Hyperplasia
Herbal Therapy for BPH
(BPH)
Yunnan Paiyao: Uses for injury and surgery; gastro-
Bleeding
intestinal, respiratory, and urogenital disorders
Perimenopausal Brain Fog: Acupuncture and Herbs
Brain Fog
to Stimulate Brain Activity
Countering the Adverse Effects of Cancer
Cancer
Chemotherapy
Adjunct Cancer Therapies at IEP Clinic
Prognosis After Diagnosis of Liver Cancer
How Emotions May Contribute to Cancer
Estrogen Dependent Tumors & Herbs: How
Modern Conditions Change Traditional Practices
Countering the Side Effects of Modern Medical
Therapies with Chinese Herbs
Questionable Cancer Therapies I: PC-Spes
Do Herbs, Vitamins, and Antioxidants Adversely
Affect Cancer Therapies?
Cancer Treatment Strategies at IEP
The Treatment of Gastro-Intestinal Cancers with
Chinese Medicine
 An Epidemic of Sinus Disorders: Natural
Sinus Health
Treatments with Ayurvedic Methods
Sjögren’s Syndrome Triple Burner (Sanjiao) with reference to treatment
of Sjögren’s Syndrome
Treatment of Throat and Voice Disorders with
Throat Disorders
Chinese Medicine
Treatments for Thyroid Diseases with Chinese
Thyroid Diseases
Herbal Medicine
Treatment of Tinnitus, Vertigo, and Meniere's
Tinnitus
Disease with Chinese Herbs
Acupuncture Assistance for Withdrawal from
Tobacco Addiction
Tobacco Smoking
Tourette's Syndrome: Potential Treatments with
Tourette's Syndrome
Chinese Medicine
Ulcerative Colitis The Use of Jianpiling in Treating Ulcerative Colitis
Uterine Bleeding Chinese Herbal Therapy for Uterine Fibroids
Excessive Uterine Bleeding Treated with Saraca...
The Qi Keeps The Blood Within the Vessels: The
Story of Gui Pi Tang
Uterine Fibroids Chinese Herbal Therapy for Uterine Fibroids
Viral Myocarditis Viral Myocarditis: Coxsackie Virus Infections
Treatment of Tinnitus, Vertigo, and Meniere's
Vertigo
Disease with Chinese Herbs
Vitiligo Treatment of Vitiligo with Chinese Herbs
West Nile Virus West Nile Virus

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Five Zone Acupuncture and Six Actions Herb Prescribing:

Countering the Adverse Effects of Cancer Chemotherapy
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine (ITM), Portland,
Oregon

Offering traditional Chinese medicine (TCM) as an adjunct to modern cancer therapies, with the
primary aim of countering the adverse effects of those modern therapies and secondarily to improve
long-term outcomes, represents a relatively new application of TCM. Experience with this medical
specialty at one of the Institute for Traditional Medicine facilities was outlined in my 2013 report
Adjunct Cancer Therapy at the Immune Enhancement Project (IEP) Clinic (1). In that document,
which focused attention on the acupuncture aspect of the therapeutic program, I referred to the five
zones method and here elaborate that approach to acupuncture point selection (part I). The main focus
of the remainder of the current paper is introducing what I refer to as Six Actions Herb Prescribing,
relaying experience gained in China and at the IEP Clinic in relation to design of herb formulations for
cancer patients (part II)+.

I. Wǔqū Fāngfǎ (五区方法): Five Zones Method

The five zones method reflects a practice of many acupuncturists that had not been formally
described by acupuncturists. I presented this method, without giving it a name, in an article on
mind/brain disorders produced in 2000 (2), saying: “In this article, the use of standard body
acupuncture for mind and brain disorders is discussed. It will be seen that only a limited number of
points, on just a few of the acupuncture channels, are repeatedly relied upon to treat a variety of these
disorders. This may reflect the unique effectiveness of at least some of these acupuncture points which
appear to be grouped around the head, forearms, and lower legs.” I then expanded upon these
acupuncture treatment strategies in my book on treating shen [spirit] disorders (3), for which I
mentioned this grouping of acupuncture points in both the acupuncture section and concluding
remarks. I further pointed to this method in a brief update for the acupuncture section of that book
published the following year (4), providing a more recent example of its use for treating depression in
post-stroke patients. It was not until 2012 that I designated this point selection approach as the five
zones method, having previously referred only to needling the “three parts of the body,” for which two
parts have bilateral needling, hence, a total of five zones. The name for the method was publicly
revealed in 2013 at the 25th Anniversary Pacific College Symposium. In giving this brief overview of
the developments, I want to make clear that I did not devise the method I am describing, but reported
on acupuncture point selections that were being widely used in modern TCM, and then gave a
definition to the acupuncture formulations by noting the range of points utilized, and, finally, provided
this designation. While the method has its greatest number of applications in treating mind/brain
disorders, it is by no means limited to that area of therapy as will be described below.
The five zones include the bilateral “transportation districts,” from elbow to hand and from knee to
foot, that incorporate the five types of peripheral transportation (shu) points: jing, ying, shu, jing he,
translated as: well, spring, stream, river, sea, representing the gradually enlarging flow through the
channels. With Wuqu Fangfa, the points to be needled within these zones need not be only the
transportation points, but should normally include at least one bilateral pair of the transportation points
 for arms and one pair for legs in the total point set, examples being forearm points shenmen (HT-7),
waiguan (TB-5), hegu (LI-4), quchi (LI-11), and lower leg points yinlingquan (SP-9), taichong (LV-3),
taixi (KI-3), zusanli (ST-36). The combination of hegu (LI-4) and taichong (LV-3), known as siguan
(four gates), is commonly selected to calm psychological and physical distress; as another example,
shenmen (HT-7), taixi (KI-3) and zusanli (ST-36) are often chosen in the treatment of organic brain
disorders.
With this method, points are also selected in the zone of head and back of the neck—the fifth zone
—primarily along the centerline, the GV vessel ranging from dazhui (GV-14) through renzhong (GV-
26; also called shuigou) and including the extra point yintang between GV-24 and GV-25. Starting at
dazhui (GV-14), the back of the head points are selected for strengthening yang and for treating
disorders that physically affect the brain. Reaching the top of the head, needling regulates the yang and
alleviates disorders that affect the function of the brain, such as insomnia. Moving to the front of the
head, treated points drain excess and calm agitation. Points along either side of the center line may be
used additionally, such as sishencong (EX-HN-1), fengqi (GB-20), or anmian.
The inclusion of centerline head points with the more commonly selected points at all the
extremities (bilateral upper and lower limbs) produces effects that are notable; I have described the
effects as a “stabilizing pattern.” In essence, the four peripheral transportation zones help the clear
yang to ascend to the head and the head points of the fifth zone help the yang to return to the lower
body, so that the mind is calm and focused and the body has a more firm and controlled foundation.
Wuqu Fangfa does not preclude use of points at other locations of the body, but does require these
five zones to be needled as a substantial portion of the treatment strategy. The most common additions
for general use are the waist area points: at the front of the body from guanyuang (CV-4) to zhongwan
(CV-12) and alongside this channel, such as tianshu (ST-25); and at the back from yaoyangguan (GV-3)
to jizhong (GV-6), mainly relying on shu points of the adjacent bladder channel from dachangshu (BL-
25) to pishu (BL-20), as well as points on the outer bladder channel of that region, such as zhishi (BL-
52). When specific symptoms suggest use of points elsewhere, they are selected accordingly as
secondary points. Ashi points and modern ear acupuncture points (which are not head points of Wuqu)
might make another addition, but attention to the five zones should not be lost.
Because needling of these zones is often recommended by acupuncturists without making
reference to the presence of a particular methodology as I am defining here, practitioners reading about
the treatment of symptoms and diseases may not gain a valuable insight into this five zone strategy that
can be purposefully employed. For example Dr. Li Zhang, trained at Beijing University of Chinese
Medicine, described treatments for anxiety (5) with four syndrome categories using points that fit the
Wuqu method. This table displays the recommended points, with head/neck, arm, and leg points
separated into columns for easy visualization of the five zones.

Pattern Head/Neck Arms Legs Others

Heart/Spleen sishencong shaohai, shenmen, yinlingquan, fenglong, danzhong, zhongwan, qihai
Deficiency daling sanyinjiao
Liver Qi Stagnation sishencong, yintang, waiguan, yemen yinlingquan, zusanli, ligou, qimen, xuehai, daimai
Affecting Spleen taiyang taichong
Kidney Qi Deficiency sishencong, yintang, chize, neiguan jiaoxin, taixi, shenmai, guanyuan, zhongli
shengting kunlun
Lung Qi Deficiency sishencong, yintang quchi, kongzui, zusanli, xiajuxu, fenglong, yutang
lieque neiting
The most frequent references to point selection consistent with the five zone method of therapy is
to be found in the book Case Studies from the Medical Records of Leading Chinese Acupuncture
Experts (6). Though the book was compiled in 2009 and published in 2011, it predominantly presents
case reports from before the year 2000, some going back to the 1960s.
The advisor for this book and the largest contributor of case studies to its collection is a leading
acupuncture professor, one of China’s designated “great masters of TCM,” Cheng Xinnong (1921-
present). Even more so than the others whose cases were offered, he used the five zones treatment
pattern frequently and for a diverse array of disorders.
Cheng is best known internationally for his book Chinese Acupuncture
and Moxibustion (7) chosen in China and the west as a college text for
acupuncture studies. He noted that for the use of distal points (emphasis
added): “Among the points of the fourteen meridians, those located on the
limbs, especially below the elbow and knee joints, are effective not only
for local disorders but also for disorders of the remote zang-fu organs and
tissues on the course of their pertaining meridians.” In the collection of
case studies, it is noted that: “The head is the place where all the yang
channels meet, and clean yang qi of the six fu organs and the essence of
the five zang organs all flow upward to it.” The conceptual framework
for the five zone method is essentially laid out in these two statements, but the parts needed to be joined
together: peripheral points from elbow to fingers and from knees to toes, and the points in the region of
the head and neck.
From an examination of published acupuncture strategies that do not incorporate the five zones,
such as those that dominate the extensive list of recommendations in Therapeutics of Acupuncture
and Moxibustion (8), it is evident that the forearm and lower leg points are often selected, but head
points not included. The deficiency in choosing head points was a concern expressed by the developers
of scalp acupuncture (9), who focused on what were designated as shu points on the scalp, placing
particular reliance on the “zone” of central line of the governing vessel and adjacent to it. Scalp
acupuncture was often accompanied by needling shu points on the extremities, such as quchi (LI-11),
hegu (LI-4), waiguan (TB-5), neiguan (PC-6), sanyinjiao (SP-6), and taichong (LV-3) for stroke
patients.
Needling the points of the governing channel removes obstruction in the flow of the yang qi and
essence and thereby aids the return of these pure essences to the rest of the body, so that the head points
will be important for treating symptoms that arise locally, such as headache, dizziness, facial paralysis,
 sinus congestion, and eye disorders, as well as for treating syndromes affecting the rest of the body,
which may be due to dysfunctions of the brain (e.g., epilepsy, post-stroke, and restlessness) or because
of disrupted circulation of qi, blood, and yang downward, as in acute lumbar pain due to invasion of
wind.
The situations that may call for use of Wuqu Fangfa can be contrasted to those where other methods
would be more appropriate. Although the outline presented here represents broad generalizations, the
division illustrates that Wuqu Fangfa has many applications but is not a likely first choice for other
medical concerns:

Indications for Five Zone Method Other Methods Usually More Appropriate
Disorders affecting the head Localized disorders, but not the head or along GV vessel
Dysfunctions, injuries, diseases of the brain Disorders affecting primarily the fu organs
Emotional distress and mental imbalances Disorders that do not disturb the mental activities
Peripheral nervous system dysfunction Endocrine dysfunction
Disorders affecting several parts of the body Disorders primarily affecting a single zang organ
Imbalances in yang qi circulation Imbalances of yin essence
The “other methods” include simple needling with two or three points locally or, for more
complex patterns, leaving out one area of the five defined zones: for example, no points of the
head/neck zone, or no forearm points, or no lower leg points; there will usually be more attention
to torso points. In the case of adverse effects of chemotherapy and radiation, because these
medical interventions affect several parts of the body, cause an imbalance of yang qi circulation
(often affecting appetite and sleep as a result), are accompanied by emotional distress, adversely
alter brain activity (the condition sometimes referred to as “chemo brain”) and sometimes the
peripheral nervous system (neuropathy), the five zone method fits well for this application.
For easy reference, I present here a summary of the five zones method as applies to the treatment
of cancer patients at the IEP Clinic, relying on our foundational group of points, the new twenty
needles and their associated points (1):
New Twenty Needles Points:
zusanli (ST-36)
sanyinjiao (SP-6)
taixi (KI-3) Lower Limbs
taichong (LV-3)
hegu (LI-4) Upper Limbs
quchi (LI-11)
neiguan (PC-6)
baihui (GV-20) Head
yintang (Ex-HN-3)
qihai (CV-6) Torso
zhongwan (CV-12)
tianshu (ST-25)

Example of Five Zones Method

Common additions to the above set were the lower limb points yinlingquan (SP-9; substituted for
SP-6 or added to it), zhaohai (KI-6; substituted for KI-3), qiuxu (GB-40); upper limb points shousanli
(LI-10, frequent substitute for LI-11); shenmen (HT-7; substitute for PC-6 or added to it), lieque (LU-
7), waiguan (TB-5); torso points jianjing (GB-21), danzhong (CV-17; also called shanzhong); and
head/neck points shenting (GV-24; added to GV-20), fengchi (GB-20), and extra point anmian (near
GB-20). In a few instances, two adjacent points on a meridian were needled at the same time, such as
LI-10 and LI-11 or GB-20 and GB-21. For calming the disturbed spirit, some practitioners at IEP also
add ear points.

II. Six Actions Herb Therapy

Introduction to the Reasons for Changing Herbal Strategies

The subject of counteracting adverse effects of cancer therapies with herbs has been approached by
many Chinese physicians. The reason for offering this particular presentation about six actions is to
raise the concern that the initial focal point for thinking about and addressing this problem may be
inadequate, while remaining largely unchallenged. I am willing to make this suggestion because I have
experienced other areas of Chinese medicine applied to modern medical concerns where the original
way of analyzing the disorder relied too heavily on ancient concepts that were more suited to the
experience with notably different disease conditions, even though symptoms were similar. There are
instances where Chinese physicians have come to this same conclusion, so I am not treading upon
entirely new territory.

As an example, multiple sclerosis is a disease that was relatively rare in earlier centuries
(appearing in the late 19th century) and virtually non-existent in China until quite recently. One of its
common manifestations is a progressive difficulty with moving the legs and feet, which then causes
withering of the leg muscles because they are less used. These signs of the disease turned attention of
modern TCM doctors to the ancient literature, as is the common method of determining how to proceed
from the traditional-style pathology and therapeutics to the modern case. They sought formerly
encountered diseases that caused weakening of the muscles, particularly of the legs, with withering of
the muscle mass, a condition known as weizheng (flaccidity syndrome). The texts, starting with the
preferred reference point, the Neijing Suwen, depicted a heat syndrome that caused damage through one
or more of a number of possible mechanisms. The dominant thought was that heat so damaged the yin
that it could no longer sustain the flesh, and the muscles would wither. Treatment strategies for such
conditions—restoring yin and cleansing deficiency heat that remained after the initiating disorder—had
been developed in ancient times and were then suggested by modern practitioners of TCM for patients
with MS (10)

However, upon seeing numerous American MS patients at the IEP clinic, it became evident that
neither a feverish disease nor other fire syndrome was associated with onset of MS, that yin deficiency
was rarely seen as a predominant disease manifestation, and that yin nourishing herbs were of value but
had only limited effect on the current status of the disability or its progression. By contrast, it was
observed that stagnation syndromes were more prevalent.

Along similar lines, a Chinese physician, Cheng Yongde, who saw many patients with ALS,
considered that the application of ancient doctrines was steering treatment in the wrong direction,
working with one of the traditional views of weizheng. I wrote about his considerations in an article on
ALS (11):

Cheng Yongde noted that in the past Chinese physicians mainly relied on the ancient doctrine of the
Niejing Suwen (ca. 100 A.D.) in treating diseases where the muscles atrophy. The basic approach they
take when encountering a disease that causes the muscles to weaken and atrophy is to direct treatment
at enhancing the function of the stomach/spleen system, rooted in the concept that the spleen governs
the muscles. By treating the associated meridians (e.g., yangming meridian), the muscles would be
nourished and invigorated. Cheng believes, instead, that ALS is due to a blockage of the governing
vessel, leaving it unable to regulate the qi and blood flowing to the viscera; then, the limbs are not
adequately nourished by the flow of qi and blood. Therefore, using acupuncture to unblock the
governing vessel is the key to therapy.
The lesson to be gained from these and other such examples is that when we encounter new
disease conditions, the first analysis made through the process of applying standard TCM principles
may need revision as experience and understanding of the new disorder grows; the determination
serving as a starting point may represent only one aspect of the disease process, possibly not the central
one Even if some success is attained initially, it may be only a partial result compared to what is
potentially to be achieved. I chose these two examples because they represent cases where tonification
therapies—to replenish damaged yin on the one hand, and to restore function of the spleen and its
generation of qi and blood to nourish the muscles on the other—did not quite fit the patient
presentations.

In the case of countering the side-effects of chemotherapy and radiation, the early clinical work on
this subject was done in China at a time when there were only a few chemotherapy drugs and when
radiation beams were quite crudely applied (the beam was relatively wide and could only be
approximately aimed at the internal mass). The effects of treatment were drastic and were also largely
uncontrolled by any of the palliative medications that were available. Of particular note was the
frequent occurrence of oral ulcerations and skin irritation from chemotherapy and substantial burning
of the skin (and everything in the path) of the radiation beam. It is not surprising, then, that in an
English language publication based on this early work (12) it was reported that “According to
Traditional Chinese Medicine, radiation and chemotherapy are regarded as an extrinsic external
stimulus which manifest in the form of heated toxin. It invades the body as an external evil damaging
and destroying the normal physiology….”

At the outset, each particular manifestation of this destructive effect was treated by modifications
of well-known traditional formulas, thus, for example: a modified Xuanfuhua Daizheshi Tang (Inula
and Hematite Combination) for treating nausea and vomiting; a modified Guipi Tang (Ginseng and
Longan Combination) for low blood counts; or modified Baitouweng Tang (Pulsatilla Combination) for
burning and inflammation affecting the bowels. However, not long afterward it was realized that one
could address the fundamental impact of the medical treatments by relying on a basic formula suited to
most patients that might then be modified if necessary to address the most severe manifestations in the
individual. Such modification would either be attained by adding herbs for the specific concern or by
providing a second formulation to address the condition.

The dominant treatment method for countering side effects of cancer chemotherapy has been
tonification, and this comes in response to the evident debility caused by the interventions and the
apparent inability of some organs to function, such as the spleen (in relation to the digestive system
disturbances) and the kidney (in relation to the blood system deficiencies). Defensive activity would be
impaired (as revealed by serious infections) and the hair would fall out (indicating blood deficiency).
Because of the interpretation that “heat toxin” damaged the yin and substantially weakened the spleen,
nourishing yin (with moistening herbs like maimendong and herbs that benefit the hair, like nüzhenzi)
and tonifying qi (with herbs that bolster weiqi, such as huangqi, and that protect spleen functions, with
soothing herbs like qianshi and shanyao) became the prominent methods.

By examining formulas that the modern TCM doctors were prescribing for their patients, certain
herbs drew the attention of laboratory researchers. For example huangqi (astragalus) and nüzhenzi
(ligustrum) were announced as being beneficial for cancer patients at a 1983 Chinese conference (MD
Anderson Cancer Center in Houston cosponsored the Chinese conference and provide the site for
research on these two herbs). A pair of related publications suggested that each of these herbs could
have the effect of restoring immune functions in the patients, as illustrated by study of blood drawn
from them and compared to that from a control group of non-cancer patients.

While there is no doubt that cancer patients undergoing modern medical therapies suffer from
deficiency syndromes, some of the modern drugs give less evidence of heat toxin and yin deficiency
than was seen in the past. The circumstances surrounding cancer diagnosis and treatment as well as
physiological effects of cancer treatment also point to the presence of stagnation syndromes, not just
deficiency. The presence of stagnation was originally observed only in passing, for example that
radiation and chemotherapy causes (12, emphasis added): “imbalance of yin and yang, obstruction of
the circulation of qi and blood, disturbance of the function of the organs…” In one of the most
extensive texts about providing herbal support for cancer patients undergoing chemotherapy (13), a
section was devoted to the problem of blood stasis, indicating its importance. Nonetheless, little further
commentary was provided throughout the rest of the book and the formulas routinely incorporated only
one herb, jixueteng (millettia) that might have been classified as being used for this purpose.
Therefore, the emphasis and aim of this article will be to make a broader analysis of the situation and
suggest a more comprehensive way of treatment.

Why Six Actions?

Since ancient times, scholars of Chinese medicine have frequently presented their medical concepts,
diagnostics, and therapeutics by enumeration of a small number of divisions: three essences, four
diagnostic methods, five elements, six climatic factors, seven emotional factors, eight types of herbal
therapy. When establishing these defined categories in order to concisely sum up the complexities of
nature and of human health and disease and to provide an easy reference for memorization and
description, subtle gradations—complex and intermediate conditions—could become lost. Such losses
are particularly acute during a student’s study of these classifications, because a novice can easily
accept the simplicity they convey as being not so much a useful tool for interchange of information and
ideas, but a profound key to an absolute reality of nature. The important subtleties that are not
immediately obvious from the classification systems can be brought back into the discussion, and
especially so when describing multiple therapeutic actions of an individual herbs or particular
circumstances that affect a patient. Still, it is necessary to intentionally and sometimes laboriously
pursue the actual complexities rather than taking the easier path of turning to the few restrictive
categories. Otherwise the fallback route of black and white divisions will overshadow reality, clouding
observations and limiting effective actions.

When it comes to herbal therapies, the most fundamental influence driving the original
development of its categories was—and remains—the concept of yin and yang. In the Advanced
Textbook on Traditional Chinese Medicine and Pharmacology (14), where the early history of
Chinese medicine theories is being reviewed and brought forward to the modern times, it is noted that:

In the final analysis, a disease is the result of a breakdown in the equilibrium of the body’s yin and
yang….Thus, a cardinal principle of treatment is to reconcile the two aspects….just as Basic Questions
says, “The yin and yang should be carefully observed and adjusted.” ….Since the theory of yin/yang
underlies the differentiation of syndromes, all pathological changes may be summarized as disturbances
of yin and yang. Any disorders of the exterior and interior, of descending and ascending of qi, all
syndromes of heat and cold, excess and deficiency, any disharmony between the ying and wei systems,
and all disturbances of the qi and blood, are expressions of the disharmony between yin and yang.
Broadly speaking, the following treatment methods are used to balance yin and yang: relieving exterior
syndromes and eliminating interior syndromes; sending up the lucid yang and bringing down wastes;
clearing away the heat and warming the cold; reinforcing the deficient in deficiency syndromes and
reducing the excess is excess syndromes; harmonizing the nutrient and defensive systems; and
adjusting the qi and blood.
This last listing of methods provides subdivisions of yin and yang that depict paired opposites of
bodily conditions, such as deficiency and excess; cold and heat; internal causation and external
causation of disorders; internal manifestation and external manifestation of symptoms and signs. This
set of four pairs gave rise to the standard “eight methods [strategies] of therapy” used in herbalism.
The eight features of an ailment to be addressed by herbs were elucidated by Gou Congshi in the
Bencao Yanyi, published around 1119 A.D. He provided some fairly limiting category descriptions,
which point to the general principles involved allowing for broader applications, writing that (15):

There are eight important points in the treatment of illness...The first is deficiency, signified by the five
signs: fine pulse, cold skin, shortness of breath, polyuria and diarrhea, low appetite for food and drink.
The second is excess, this is signified by the five signs: full pulse, hot skin, bloated abdomen, urinary
retention and constipation, depression. The third is cold, that is, cold in the internal organs [zangfu].
The fourth is heat, that is, heat in the internal organs. The fifth is superficial evil, signifying that the
disease did not originate with a disturbance of the normal qi in the organs. The sixth is internal evil,
that is, the illness did not arise from external causes. The seventh is interior; this signifies that the
disease is not located in the body surface [skin and muscles]. The eighth is the exterior; this signifies
that the illness is not located in the interior portion of the body [internal organs, bones].
And, the basic yin/yang division later yielded the three other pairs: “sending up the lucid yang and
bringing down wastes; harmonizing the nutrient and defensive systems; and adjusting the qi and
blood.”

As the systematic application of herbology grew more complex over the subsequent centuries, the
number of categories of treatment also grew so that in most modern listings of herbs the various
medicinal materials are divided into about two dozen standard categories. In addition to the above
mentioned categories there are such groupings as herbs to: resolve phlegm, sedate internal wind, open
the orifices, sedate the spirit, and astringe discharge.

The number six frequently has been used in Chinese medicine categorization, such as the six
environmental influences, the six disease stages (of the Shanghan Lun), and the six pairs of zang and fu
(with five sets corresponding to the five elements, and the fire element divided into two). It is not a
matter of six being a magical number to which the medical scholars tried to fit many of their concepts,
rather, it is a number of categories that is sufficiently large to account for many phenomena, yet small
enough that the divisions can be remembered and worked with. As will become evident, the six actions
herb therapy comprise about the largest number of therapeutic effects that can be utilized at once
without formulations becoming diffuse and cumbersome.

The “Six Actions Herb Prescribing” that is described here does not represent a proposal for a new
categorization of the herb actions; rather, these are strategies selected as a particular subset of the
roughly two dozen groupings routinely used in modern TCM. To incorporate the important herbs into
these groups, some adjustments are made as to how a few of the herbs might be best categorized for the
current purpose. As an example, chaihu (bupleurum) is categorized in modern Materia Medica with
the herbs for resolving the surface (the cooling subgroup), but this herb is probably more often used in
regulating the flow of qi—influencing the liver’s controlling mechanism and helping to raise clear qi—
so it is placed in what follows with qi regulating herbs. The six actions chosen for inclusion here are
contained within the yin/yang summary that was given in the Advanced Textbook (14) as quoted
above, with a focus on “adjusting qi and blood.” The six actions come from expansion of the pairing of
qi and blood, namely: qi and blood to be nourished; qi and blood to be circulated; clear qi to be raised
up to the brain; and blood to be generated from marrow (the brain and marrow being two extensions of
the kidney organ system).

My selection of these therapeutic approaches was arrived at through recognition that the actions
are both theoretically of benefit in countering the side effects of chemotherapy for cancer and they are
being utilized frequently at the IEP Clinic because practitioners are seeing these as appropriate to the
cancer patients. Experience at IEP is of potential value because the circumstances in China differed
from those encountered here and the changes in modern medical treatment are progressing rapidly with
new drugs, new drug delivery methods, and improved palliative care. In contrast to the continued
reliance on tonification therapy relayed in modern literature, it is proposed here that all six action of
herbs are likely of value in treating cancer patients and that most of them should be combined into a
single treatment, either within a single formulation, or through the combining of two or more base
formulas. This article will focus attention on chemotherapy, but the principles of treatment for
countering adverse effects of radiation therapy are quite similar.

An Orientation to Chemotherapy
The term chemotherapy could be applied to any drug; the term was originally utilized by the German
chemist Paul Ehrlich when he was working on drugs to treat infections: he coined it for any use of
chemicals (chemo-) given to treat disease (therapy). In the realm of cancer treatment, chemotherapy is
most often used to describe drugs that directly inhibit the reproduction of cancer cells (e.g., 5-FU,
taxol, platinum drugs), but it can also be used to depict other strategies, such as drugs that block
estrogens from stimulating cancer cells (e.g. Tamoxifen, Aromatase Inhibitors), which typically involve
a notably different (and often milder) set of adverse reactions. The subject of concern in this article is
the former group of drugs that powerfully inhibit the metabolism and reproduction of cancer cells,
often leading to cell death (apoptosis). A characteristic of their common side effect profiles is that they
tend to also inhibit the metabolic activity and reproduction of other non-cancer cells, having
particularly strong impact on rapidly reproducing cells. Chemotherapy drugs are selected, developed,
and approved for use by virtue of their specificity for inhibiting cancer cells, yet none of the current
widely used agents are sufficiently specific that they don’t produce to a lesser extent the same type of
inhibitory impact on non-cancer cells. Inhibitory effects include bone marrow suppression, impaired
turn-over of gastro-intestinal cells, and reduced mitochondrial activity. While active cancer cells
(those that are reproducing) will die as a result of the treatment, with shrinking of tumor masses, non-
cancer cells are more likely to be functionally inhibited but with relatively limited die-off, so that
recovery of their functions can take place during the days after treatment is withdrawn. Sometimes
adverse effects will persist, especially in the case of neurological damage to peripheral nerves, but for
most patients the production of blood cells and intestinal cells returns to normal or near normal.

TCM Interpretation of Chemotherapy Adverse Effects

In the early development of Chinese medicine some herbs were suggested to have the capability to
counteract toxicity of plant drugs, and I reviewed these in the introduction to the subject of countering
side effects of modern drug therapies (16). The best known of the group is licorice, and there are two
 prominent sets of herb materials that are related to it: 1) those from the same family as licorice
(Leguminosae) also used for this purpose, including shandougen (Sophora subprostrata), baibiandou
(dolichos), dandouchi (soja; processed soybeans), and chixiaodou (phaseolus); and 2) very sweet
tasting items, such as dazao (jujube) and fengmi (honey). Eating legumes (beans, Chinese: dou) as part
of the diet for cancer patients is best for getting an adequate dose of these food-herbs for this counter-
toxicity approach, rather than adding ingredients to already complex herb formulas, but shandougen,
though attributed some sweet taste, is predominantly very bitter, so this ingredient or its concentrated
extract, would be used in formulations that could be swallowed directly without tasting (e.g., tablet).

The primary approach to chemotherapy adverse effects requires an analysis of the bodily
imbalances that are to be rectified. From the TCM perspective, the ability of the body to regenerate
day to day is primarily a function of the qi and blood and so the inhibition of cellular reproduction by
chemotherapy points to imposed deficiencies of qi and blood. The Advanced Textbook (14) lists five
functions of qi, designated as: promoting, warming, defensive, controlling, and activity. Qi and blood
function as a pair, and in virtually all the ancient medical literature of China, the phrase “qi and blood”
was the basis for what we today often simply depict as qi. The nature and role of blood in TCM is
somewhat less clearly defined than qi, but one of the Neijing Suwen quotations is often utilized to give
a sense of the function of blood: “When the liver receives blood, the vision is normal; when the feet
receive blood, they are able to walk; when the palms receive blood, they are able to hold things; and
when the fingers receive blood, they are able to grasp.”

Once the first dose or two of chemotherapy works its way through the populations of existing cells
to impact their activity and reproduction (about ten days), the physical changes come on very rapidly.
From the first day of obvious symptoms, their severity increase day by day, either until a plateau is
reached or some corrective measures are put in place, with palliative drugs, for example. This rapid
change in the body’s ability to promote its replenishment, control its functions, and be active in
transformation of food essences, with lethargy as one of the signs of the drug actions illustrates the
impairment of qi and blood. The defensive action of qi is today interpreted in terms of immune
responses, so herbs that tonify qi and herbs that are said to enhance immune responses may be gathered
together under the same grouping.

Below is presented a table of herbs that tonify qi, adding to the standard list eleuthero and
gynostemma and medicinal mushrooms (a few of which are described in a separate table); additionally,
two antitoxin herbs that were used in China as anticancer medicinals but are now often designated as
functioning through immune enhancing activity are included in a separate table in this section.

Herbs that Tonify Qi

Common Name, Additional Properties Comments

Pinyin, Sources
Astragalus increases and raises clear qi Frequently used for persons debilitated by disease with
huangqi and yang, controls sweating weakened immune functions, poor digestion, and
spontaneous sweating.
Astragalus
membranaceus
Atractylodes dries dampness, harmonizes Especially used in cases of weakened digestion and
baizhu stomach and spleen diarrhea and for those who easily get infections.
Atractylodes
macrocephala
Codonopsis increases fluids Frequently used as a substitute for ginseng; it lacks the
dangshen yang invigorating action.
Codonopsis
pilosula
Eleuthero benefits kidney; warm Developed as health product in Russia during 1970s,
ciwujia adopted by China for same use, as a ginseng-substitute.
Eleutherococcus
senticosus
Medicinal benefits lungs, sweet In modern times, these herbs are increasingly used for
Mushroom* immune-enhancing properties.

Ginseng tonifies kidney and lung, Useful in virtually all deficiency syndromes; especially
renshen pacifies spirit, invigorates, used with spirit agitation.
raises yang
Panax ginseng
Gynostemma benefits lung; cool A Chinese folk remedy for lung diseases, popularized in
jiaogulan the 1990s, after it was found to contain some active
ingredients of ginseng.
Gynostemma
pentaphyllum
Jujube pacifies spirit, harmonizes Used as an aid to reduce harshness, protect the stomach,
dazao (or hongzao) actions of herbs, protects and harmonize the action of ingredients.
stomach
Zizyphus jujuba
Licorice moistens lungs, harmonizes Often prepared by honey-frying to enhance tonic effects;
gancao actions of herbs, counters used in small amounts in numerous formulas to
toxicity harmonize ingredients.
Glycyrrhiza
uralensis

*Examples of Mushrooms used to Boost Immune Functions

Cordyceps controls cough and dyspnea Mainly used for chronic asthma associated with kidney
dongchongxiacao deficiency; recently adopted as immune enhancing agent.
Cordyceps
sinensis
Coriolus dispels moisture; warm Developed as a source of immune-enhancing polysaccharides
yunzhi in Japan during 1970s, adopted by China for same purpose.
Coriolus
versicolor
Ganoderma* nourishes all internal organs, Designated as a sedative, this herb is mainly used now for
lingzhi removes toxin, vitalizes blood immune-enhancing and blood-circulating properties.
Ganoderma
lucidum

Anti-Toxin Herbs that Enhance Immune Functions

Common Name, Additional or Comments

Dominant Properties
Pinyin, Sources

Oldenlandia antitumor effects Modern applications are mainly for cancer patients; it is an herb
of low toxicity with reputation for inhibiting tumor growth.
baihuasheshecao
Oldenlandia
diffusa
Scutellaria antitumor effects Modern applications of this herb are as an addition to oldenlandia
banzhilian in the treatment of tumors.
Scutellaria
barbata
Herbs that Nourish Blood

Tang-kuei vitalizes blood, moves qi, This is the most widely used blood nourishing herb.
danggui moistens intestines, regulates
menstruation
Angelica sinensis

Lycium nourishes yin, aids vision, Especially used for the combination of kidney- and
gouqizi benefits marrow liver-deficiency syndrome and for eye disorders.
Lycium barbarum

Peony (white cools blood, vitalizes blood, Peony is extensively used for a variety of applications;
peony) baishao astringes liver yin, alleviates red peony (chishao) is used when blood vitalizing is
spasms and pain the main concern.
Paeonia alba

Ho-shou-wu nourishes yin Ho-shou-wu is mostly used when there is kidney and
heshouwu liver deficiency; it is almost always used in formulas
for the hair.
Polygonum multiflorum

Rehmannia nourishes yin, benefits marrow Extensively used in cases of kidney deficiency, and
almost always used when for kidney/liver deficiency.
shou dihuang

Rehmannia glutinosa

Smoothing the Flow of Qi, Enlivening the Circulation of Blood

Deficiency of qi will itself cause some disturbance in the flow of qi through the body. However, a
substantial impact on the quality of qi circulation comes from emotional distress that is in this case
associated with cancer diagnosis and response to the difficult experience of medical treatments that
often become increasingly traumatic. In the book Prevention and Treatment of Carcinoma with
Traditional Chinese Medicine (17), it is noted that:

The mental state of the patient plays an important role in the course of treatment….Generally speaking,
cancer patients are in low spirits and full of worries….Vexation, hesitation, grief, fear, nervousness,
depression and low spirit should be relieved so as to prevent poor appetite.
While the author believed that the mental state of the patient would be addressed primarily by the
actions and words of family, friends, and medical staff, these conditions persist to a certain extent and
influence the body. As one major consequence, qi circulation can stagnate, thus worsening drug-
induced fatigue, lowering appetite, and altering ability to make decisions.

Further, while qi deficiency is a reasonable means of representing what happens to the person as a
result of the chemotherapy impact on cellular activities, the transporting action of the spleen and the qi
smoothing action of the liver are also inhibited by chemotherapy, so that there is a direct effect on qi
circulation that requires attention.

Both qi deficiency and disturbances in qi circulation impair the free flowing of blood, as does the
decline in physical activity that results from fatigue. In the book Cancer Treatment with Fu Zheng
Pei Ben Principle by Pan Mingji (13), Pan indicates that blood stasis is a problem even before cancer
is diagnosed, before any treatment with surgery, chemotherapy, or radiation. He says:

TCM believes the mechanism of cancer is related to blood stasis….The fact that cancer patients reveal
a state of hyper-coagulation has been gradually accepted….90% of cancer cases reveal, by fingertip
volume pulse wave and microcirculation of the nail fold, that arterial capillaries are spasmodic and
narrow, with decreased or even missing capillary loops. Some may reveal blood corpuscle congestion
and blood flow is intermittently interrupted.
Tissue damage due to surgery or radiation therapy will cause more severe blood stasis in the
affected area. With regard to chemotherapy, Pan notes that blood vitalizing herbs are important to the
comprehensive treatment, including the long-term success of the medical therapies:
Usually, the side effects of chemotherapy can be greatly ameliorated when coordinated with Fu Zheng
Pei Ben prescriptions and [herbs] which activate blood circulation and relieve blood stasis, thereby also
increasing the blood flowing in cancer tissue. It is very helpful when the concentration of chemicals,
immune remedies, and immune lymphocytes increase in the cancer tissues, as the therapeutic effect is
then also greatly increased.
Along similar lines, it is thought that the impact of radiation therapy is improved by vitalizing
blood circulation, because one of the mechanisms of radiation is to introduce high concentrations of
reactive (ionized) oxygen to kill the cancer cells, such that if the cells are at the same time better able to
get oxygen from the blood the effect will be enhanced. Additionally, quick access of immune
substances from the blood will help kill the damaged cells and break them down. Pan referred to this in
a later text (18), saying:

The main function of this medicine [herbs for removing blood stasis] is to ameliorate damage to
microcirculation and add to the flow of blood and oxygen in tumor tissue. It is desirable to bring the
anticarcinogen [drug] into the tumor to help the chemotherapy drugs. One of the reasons why
radiotherapy fails is the lack of oxygen in cancer cells. The medicine for removing blood stasis can
increase the quantity of oxygen in cancer cell and heighten their sensitivity to radiation.
Limited circulation reduces the ability of the severely damaged cancer cells to die, while good
circulation may help the less damaged normal cells recover more quickly. The concern for improving
circulation to tumor cells differs from efforts to halt tumor-stimulated growth of a circulatory system
for a tumor mass, for which the drugs that inhibit the generation of new vessels (angiogenesis
inhibitors) are directed. The tumor needs a blood supply to survive at all, but it is able to utilize a
restricted one quite effectively and especially the restrictions prevent cancer treatments from having
their full effects.

Western practitioners of Chinese medicine raised the concern that activating blood circulation
might promote metastasis of cancer cells. However, metastasis in many cancers is a normal process
that is very difficult to alter, and the Chinese concept is that the primary cause for concern is not the
temporary circulation of the cells, but the adherence of them to other tissues, an adherence that is
needed to allow for new tumor growth. The herbs used for promoting blood circulation are understood
to reduce this adherence and thus inhibit metastatic growths from occurring.

While the formerly mentioned methods of tonify qi and nourishing blood are a good means of
improving qi circulation, additional efforts may be needed. Below are some of the herbs classified as
regulating qi, with a separated section to display the large number of ingredients that are various types
of citrus fruits. It is important to note, however, that herbs in other categories may also regulate qi as a
secondary property, such as chuanxiong (cnidium), so that one can formulate concisely by relying on
those ingredients.

Herbs that Regulate Qi

Common Name, Additional or Dominant Comments

 Pinyin, Sources Properties

Areca seed dispels moisture Primarily used for abdominal swelling associated
binglangzi accumulation, breaks up with water accumulation. Areca peel (dafupi) is
Areca catechu accumulations sometimes used instead.

Bupleurum raises yang qi, resolves Used for dredging qi from liver constraint;
chaihu surface, cooling especially valued for disorders that combine
internal syndromes with external syndromes.
Bupleurum chinense
Citrus Group resolves phlegm-damp Several members of the citrus family are used to
regulate qi; they are grouped together in a table
(see separate table) displaying some of their slight differences.

Cyperus xiangfuzi alleviates pain, regulates Analgesic for headaches and abdominal pains and
Cyperus rotundus menstruation alleviates stagnation-caused menstrual
irregularities; overcomes mild depression.

Lindera wuyao alleviates pain, warms the Mainly used for lower abdominal pain associated
Lindera strychnifolia kidney with cold kidney; has properties similar to
cinnamon twig (guizhi).

Melia alleviates pain Mainly used for pain in the chest and upper
abdomen (liver area).
chuanlianzi

Melia toosendan

Saussurea alleviates pain, controls Used for mainly for abdominal disorders that
muxiang diarrhea, sedative include diarrhea.
Saussurea lappa or Jurinea
souliei

CITRUS GROUP OF QI REGULATING HERBS

Common Name, Additional or Dominant Comments
Properties
Pinyin, Sources

Chih-ko zhiqiao resolves phlegm, disperses Used for food stagnancy, epigastric aching,
Citrus aurantium accumulations and lung congestion.

Chih-shih zhishi purges gallbladder to produce Used for abdominal stagnation with
mild laxative effect, clears heat
Citrus aurantium and phlegm constipation and for lung congestion.

Blue citrus qingpi resolves phlegm Mainly used for lung disorders with phlegm
Citrus reticulata accumulation and for dispersing soft
swellings.

Citrus strengthens spleen, dries The most widely used qi-regulating herb; it is
moisture and phlegm also used in treatment of most phlegm
chenpi disorders, combined with pinellia.

Citrus noblis

Aurantium lowers up-rushing qi, relieves Used for nausea, vomiting, hiccough, and
jupi stagnation in the chest coughing.
Citrus reticulata

Fu-shou alleviates pain, controls Used for digestive distress with abdominal
vomiting pain and distention.
fushougan

Citrus medica

The herbs that vitalize blood circulation are emphasized as important

by TCM cancer specialists but often do not appear in the formulations, with
the primary exception of jixueteng (millettia or spatholobus, see illustration
below, the stem is used). This herb is chosen because of its dual use for
nourishing and vitalizing blood circulation; it came into the cancer adjunct
formulas early on and has been retained.
 HERBS
Common Name,
Pinyin, Sources
Carthamus honghua
Carthamus tinctorius
Cnidium chuanxiong
Ligusticum chuanxiong
Corydalis yanhusuo
Corydalis ambigua
Curcuma
yujin
Curcuma aromatica
Millettia jixueteng
Spatholobus suberectus
Myrrh moyao
Commiphora sp.
Frankincense (or mastic) ruxiang controls pain, relaxes
Boswellia carterii
Red peony chishao
Paeonia obovata
Persica taoren
Prunus persica
Salvia danshen
Salvia miltiorrhiza
Sparganium (or Scirpus) sanleng regulates qi, disperses mass
THAT VITALIZE BLOOD
Additional or Dominant
Properties
regulates menstruation,
alleviates pain of injuries
dispels wind, regulates qi,
controls pain, nourishes blood most formulas for qi and blood staganation and in
controls pain, regulates qi
regulates qi, disperses
accumulations
nourishes blood, alleviates
numbness, relaxes tendons
controls pain, disperses
swellings, promotes tissue
regeneration
muscles, reduces bleeding
clears heat, cools blood
moistens the intestines
cools blood, nourishes blood, Primarily used for cardiovascular disorders and for
sedative
Comments
Combined with persica in treatments of blood stasis
causing pain.
It is the main herb used for headache pain; used in
many formulas for nourishing blood.
Mainly used for abdominal pain syndromes, including
menstrual pain.
Mainly used in cases of qi and blood stagnation with
accumulation, including treatment of phlegm masses
and other lumps.
Modern applications are mainly for anemia and
promoting microcirculation; traditionally used for
numbness of the legs in the elderly.
Used mainly for injuries (along with frankincense,
ruxiang) and for swellings, such as abscesses.
Mainly used in treatment of injuries, usually
combined with myrrh (moyao), considered useful for
peripheral neuropathy.
Especially used for blood stasis syndrome with blood
heat.
Often used for abdominal blood stasis accompanied
by constipation; combined with carthamus (honghua)
for blood stasis disorders.
liver fibrosis; also useful as a sedative.
Mainly used for hard masses (blood stasis type),
especially those in the abdomen; usually combined
Sparganium stoloniferum with Zedoaria (ezhu).

Vaccaria wangbuliuxing regulates menstruation, Primarily used for swelling in the lower abdomen,
Vaccaria pramidata disperses swelling particularly for women’s disorders.

Zedoaria ezhu regulates qi, disperses mass, Mainly used for hard masses, in combination with
Curcuma zedoaria benefits stomach functions Sparganium (sanleng); also for digestive disturbance
with distention.

Raising Clear Qi and Yang

Raising of clear qi primarily refers to extracting the nutritive essences from food and raising them to
the upper body so that they can then be distributed (by lung and heart) to all the organs. Raising of the
clear yang refers mainly to bringing both nutrients and yang qi to the head so that the brain and mind
can function properly; the yang will then be distributed downward from the top of the body. However,
the references to raising clear (“lucid”) qi and yang are not firmly distinguished and depending on the
author and the emphasis placed on the different functions, these terms may be used interchangeably and
so it is perhaps best to refer to them together as an entity.

In the book Essentials of Chinese Medicine (19), there is this explanation of raising of the clear:

This is a characteristic function of the spleen, and refers to both raising clear qi upward and stabilizing
the internal organs in their original locations [i.e., counteracting prolapse].
Controlling the raising up of the Clear: Here, the “clear” means the nutrients that are extracted from
drink and food, and raising the clear means propelling them upward and distributing them. After food
and drink have been digested by the stomach, the spleen extracts the nutrients and, though its function
of raising the clear, delivers them upward to the heart and lung, and thence to the entire body.
If this function of the spleen is normal, all the internal viscera and tissues will obtain enough nutrients
and function well. If it is abnormal, there may appear such symptoms as dizziness, blurred vision, and
fatigue. If clear yang fails to ascend, the clear and the turbid may remain intermixed and sink
downward. This may be manifested by such symptoms as spermatorrhea, vaginal discharge, abdominal
distention, and diarrhea.
The separation of clear and turbid is an important subdivision of the raising of the clear;
“intermixing” of clear and turbid, when their separation is incomplete, can lead to a variety of
abdominal problems and discharges from the lower body. In his essay, Heaven Above, Earth Below,
Cheng Lok-Kwan provides this elucidation (20):

The distinction between clear yang and turbid yin is very important in Chinese medicine. Turbid means
thick, or dense. Turbid does not mean dirty or bad. The head is heaven: it is the highest part of the body.
It is the most yang part of the body, hence, it should be filled with clear yang. If it is, the brain and
senses will function well. The person will be able to perceive the world and communicate clearly, and
respond appropriately. If it is not, then we think either a blockage prevented the clear yang from rising,
or that the body is unable to descend the turbid yin. Either way, the head is now filled with turbid yin.
The senses will be clouded, the head will feel heavy, and the person will not be able to think or speak
clearly.
Here, the concept of raising clear yang is associated with bringing nourishment (which is as aspect
of the qi) to the brain. For raising clear qi and yang, the primary principle is to strengthen the spleen,
particularly with herbs that contribute an upward movement, so that huangqi (astragalus) and renshen
(ginseng) are key items. However, to assure separation of clear and turbid, herbs that promote the
digestive functions of the stomach are utilized: they help to generate a clear qi and to aid the downward
movement to the “thick” digestive materials. Of greatest importance are shenqu (shen-chu), maiya
(malt), and jineijin (gallus) and the aromatic herbs sharen (cardamom), muxiang (saussurea), and
yizhiren (alpinia). To help make sure the channels of flow are clear and open, orifice opening herbs are
used, such as shichangpu (acorus) and yuanzhi (polygala). As an adjunct to these different types of
herbs, those that help filter excess dampness are utilized: they improve spleen function, aid the
separation of clear and turbid, and promote fluid movement to the kidney system. The primary
ingredients relied upon are baizhu (atractylodes) and fuling (hoelen). Some herbs were already
described in the tables above.

ADDITIONAL HERBS TO HELP RAISING CLEAR QI AND

YANG
Common Name, Additional or Dominant Comments
Pinyin, Sources Properties
Acorus sedative, warms meridians, This is the most widely used herb for orifice
shichangpu invigorates digestion opening; it is included in many sedative
formulas and has a mild action.
Acorus gramineus
Alpinia supplements spleen, Mainly used for abdominal pain due to cold;
yizhiren strengthens stomach also for poor appetite; action is similar to
cardamom (sharen).
Alpinia oxyphylla
Cardamom alleviates stagnation of food Alleviates stomach pain, loss of appetite,
sharen nausea, diarrhea, and fullness after eating.
Amomum villosum
Crataegus helps digestion of meat and This herb has modern uses of promoting blood
shanzha fats, resolves phlegm circulation; traditionally used to promote
digestion of thick foods.
Crataegus pinnatifida
Gallus controls diarrhea This material is thought to help break down
jineijin masses and is used in treatment of concretions
Chicken gizzard lining (stones) and tumors.
Hoelen (or Poria) strengthens spleen, calms The most widely used herb for filtering fluids,
fuling spirit it is very mild yet highly effective, especially in
decoction form.
Poria cocos
Malt regulates qi Used as a mild agent to harmonize liver and
maiya spleen, regulating the flow of qi while
promoting the stomach’s digestive function.
Hordeum vulgare
Shen-chu strengthens spleen, controls This is the most widely used digestive aid; it is
shenqu diarrhea, resolves surface also suited to treatment of acute ailments, such
congestion as summer heat syndrome.
Medicated wheat
Oryza harmonizes stomach and Sprouted rice is used as a tonic and also a
guya spleen, strengthens spleen stomach protectant when administering fire-
purging herbs, such as gypsum (shigao).
Oryza sativa
Polygala resolves phlegm Often selected for insomnia, poor memory, and
confusion associated with “phlegm mist
yuanzhi
affecting the heart orifices.”
Polygala tenuifolia

Benefitting the Marrow

One of the cell lines highly sensitive to the effects of chemotherapy and radiation are the stem cells that
produce red and white blood cells and platelets (thrombocytes) located in the marrow. The decline in
production of new blood cells is one of the major reasons for halting a chemotherapy sequence,
because of increased susceptibility to infection (as a result of low WBC) and debilitating fatigue (result
of low RBC). Some protection of the marrow function is attained by utilizing hormones that stimulate
the production of blood cells (e.g., Epogen and Neupogen); it is anticipated that some protective action
can be attained with herbs such as lurong (deer antler), shudi (rehmannia), and gouqizi) lycium fruit.

While the marrow of Chinese medicine has this overlapping connection to the marrow we
understand by modern medicine that produces these blood cell lines, the marrow of Chinese medicine
also extends to the brain. Therefore, nourishing the marrow along with raising the pure qi and yang, is
important in maintaining good cognitive function, memory, and mental focus, according to the Chinese
medicine system. Some of the herbs for benefiting marrow were already included in descriptions of
blood nourishing herbs.

ADDITIONAL HERBS FOR BENEFITING MARROW

Common Name, Additional or Dominant Comments
Pinyin, Sources Properties
Deer antler nourishes blood, invigorates Frequently used in cases of weakness with a
lurong yang combination of yin, yang, and blood deficiency;
the gelatin nourishes blood.
Cervus nippon
Cistanche moistens intestines Mostly used for impotence and infertility;
roucongrong useful in cases of constipation due to abdominal
Cistanche salsa cold and blood deficiency.
Cuscuta astringent, clears vision Widely used in kidney-tonic formulas due to its
tusizi mild nature. Used in eye formulas based on
Cuscuta chinensis treating kidney/liver deficiency.
Dipsacus vitalizes blood Mainly used in cases of wounds and bone
xuduan fractures; also for female reproductive
Dipsacus asper disorders.
Morinda dispels chill, invigorates yang Mainly used when yang deficiency manifests in
bajitian chilliness and cold-caused pain.
Morinda officinalis
Psoralea dispels chill, nourishes blood Used in cases of coldness due to yang
buguzhi deficiency; also used in treating bone marrow
Psoralea corylifolia deficiency.
Tortoise shell lowers yang, cools blood, Frequently used for deficiency of yin and blood
guiban nourishes blood, stops with yang agitation or bleeding, with modern
Chinemys reevesii bleeding use for aplastic anemia.
Turtle Shell softens lumps, disperses Used for abdominal masses; combined with
biejia accumulations tortoise shell (guiban) in treatment of yin and
Trionychidae species blood deficiency with sweating.

Providing the Herbal Formulations

In China, the majority of the reported work done with cancer patients has been through administration
of high dose decoctions. The decoction form allows for adjustment of ingredients according to patient
presentation. This form also allows for a high level of active constituents, since a quantity of one to
two cups of tea can maintain in soluble form the extractable content of about 100-200 grams of dried
crude herbs. The decoctions are prepared for the patients when they are in hospital, and that service is
often continued by the hospital pharmacy for out-patients.

Many western patients (though certainly not all) reject the decoction form due to the lengthy
cooking procedure, the smell of the herbs while being prepared, and the taste of the decoction when
consumed. The use of dried decoctions to make “instant” teas removes these first two barriers, but
usually imposes a significant cost, and few practitioners or patients realize that the conversion from
100-200 grams of dried herbs in decoctions corresponds to about 20-40 grams of dried decoctions
(made as 5:1 extracts).

By switching to culturally acceptable forms, such as pills, capsules, and tablets, the quantity of
herb materials that can reasonably be ingested is greatly reduced, while the cost may remain relatively
high. Some herbs are successfully used in their powdered form in somewhat modest quantity, and
some extracts that can be put into pill form are more concentrated than the dried decoctions used to
make tea. Therefore, with some careful design, herbal materials in these more acceptable forms may be
utilized, but with the understanding that a significant number of “units” must be consumed to have the
desired impact, that is, to have more than a placebo effect or greater than a barely perceptible outcome.

Transitioning from Tonic Formulation

The attempt to counteract the adverse effects of chemotherapy came to be known as Fu Zheng
treatment, meaning to “support normality.” The concept was that adverse influences, whether those
described in ancient times (often as evil qi, xieqi) or of modern times (such as side effects of powerful
drugs) were resisted by the person’s normal qi, which could be strengthened by tonic herbs. Later, this
basic concept was broadened to what Pan Mingji had described as Fu Zheng Pei Ben, where the latter
term means to strengthen the root, referring to supplementing the depleted foundation of qi, blood, and
essence (jing). In his 1988 book describing that approach (13), Pan presented a generalized
prescription based on his clinical work with cancer patients undergoing chemotherapy which he dubbed
Yiqi Buxue Jianpi Tang (yiqi is a term used to indicate strengthening the qi and raising the clear qi;
buxue is to nourish the blood; and jianpi is to strengthen the spleen). His formula was a very high dose
decoction as follows:

Yiqi Buxue Jianpi Tang

Chinese Name Common Name Dosage Relevant Action
huangqi astragalus 15-30 tonify qi, strengthen spleen
dangshen codonopsis 15-18 tonify qi, strengthen spleen
baizhu atractylodes 12 tonify qi; strengthen spleen
fuling hoelen 12 improve spleen function
gancao licorice 4.5 tonify qi; strengthen spleen
shudi rehmannia 15 nourish blood
gouqizi lycium 12 nourish blood
heshouwu ho-shou-wu 12 nourish blood
huangjing polygonatum 10 tonify qi
nüzhenzi ligustrum 15 nourish yin
beishashen glehnia 10 nourish yin
maimendong ophiopogon 10 nourish yin
jixueteng millettia 24 nourish blood
qianshi euryale 12 strengthen spleen
shanyao dioscorea 12 strengthen spleen
 The decoction of about 200 grams of herbs could be further modified to address specific
symptoms, mainly by adding more herbs, though some of the standard ingredients might be removed as
well (he did not indicate which might be removed, but gave lists of potential additions). Dangshen
(codonopsis) was being used as a substitute for renshen (ginseng). Although renshen was the preferred
ingredient, this prescription was written at the time when the herb was mainly reserved for
manufactured products and for export, not allowed for most hospital prescriptions.

The effects of tonifying qi and strengthening the spleen, and of nourishing blood and yin are each
supported by several herbs of Pan’s basic formula, but in light of the six herb actions, it is weak in the
areas of circulating qi and blood, and only slightly directed at benefitting marrow.

Use of this particular formulation in the west turned out to be problematic for a number of reasons,
most of them described above in terms of the decoction form of the herbs. The instant tea (dried
decoctions) that were available for use appeared more attractive, and formula selection came from
Japan.

In Japan, the practice of Chinese herbal medicine called Kampo, has been based on selecting
formulas from a group of prescriptions that had been selected by experts in the early 1950s and then
relied upon continuously since then. The problem of countering side effects of chemotherapy was
raised in the 1980s, and the primary formula selected for that purpose was Shiquan Dabu Tang
(Ginseng and Tang-kuei Ten Combination). At that time, and until recently, the Kampo formulas were
provided to the west mainly through Taiwan rather than Japan, and this particular formula was well-
known. It tonifies qi and strengthens the spleen with the ingredients of Si Junzi Tang (Major Four
Herbs Combination) and nourishes and vitalizes blood with the ingredients of Si Wu Tang (Tang-kuei
Four Combination), and also aids the uplifting of clear qi with huangqi (astragalus). A number of its
ingredients are considered important for enhancing immune functions, including renshen, huangqi,
baizhu, and gancao. The formula is relatively weak in the areas of promoting circulation of qi
(danggui and chuanxiong have some effect), and it is also deficient in nourishing the marrow.

Chinese doctors also considered this formula for the same applications, but made various
modifications to better suit their understanding of the needs. As an example (21), the base formula was
modified by adding jixueteng (millettia), huangjing (polygonatum), gouqizi (lycium fruit), heshouwu
(ho-shou-wu), shanzhuyu (cornus), lianzi (lotus seed), and shanyao (dioscorea), which primarily
increased the tonification effects and more closely approximated Pan’s recommended formula; it was
stronger in benefiting marrow than Shiquan Dabu Tang alone.

Early Efforts at ITM

At the end of the 1980s, as Pan’s Fu Zheng Pei Ben book became available, concerns regarding cancer
therapies remained strongly focused on immunosuppression. This was a decade before approval of the
drug neuopogen for helping stimulate production of white blood cells (WBC), when a break in the
chemotherapy regimen was common; allowing for growth and metastasis of cancer cells, making them
resistant to further treatment. An early effort at countering the immunosuppression was an ITM
formula in tablet form designated Astragalus 10+ (Huang Qi Da Bu Pian). The name reflects a key
ingredient for enhancing immune functions, and portrays the development of the formulation, which
began in 1986 as “Astragalus Eight Herb Formula” was then expanded to Astragalus Ten Herb
Formula, and finally to the twelve herb version (hence the “+”) first described in 1988. It includes the
eight herbs that were subject of considerable research efforts following up on the “adaptogen” model,
as mentioned above, and eventually adding others which were consistent with the concept of Fu Zheng
Pei Ben therapy. Using renshen (ginseng) rather than dangshen (codonopsis), Astragalus 10+ includes
ingredients of Pan Mingji’s prescription: (maimendong) ophiopogon, nüzhenzi (ligustrum), heshouwu
(ho-shou-wu), baizhu (atractylodes), and huangqi (astragalus). It additionally provides the adaptogens
ciwujia (eleuthero) and wuweizi (schizandra), and these other ingredients: lingzhi (ganoderma;
reflecting the growing interest in medicinal mushrooms for cancer patients), roucongrong (cistanche;
pursuing the idea of nourishing kidney yin and yang to enhance marrow function), and shangshen
(morus fruit, which nourishes yin and blood while improving marrow, having a function similar to
gouqizi). The formula can be properly described as a combination of tonic herbs, with principles of
action being to tonify qi, raise clear qi and yang, nourish blood, and benefit marrow. In relation to six
herb actions, the formulation is weak in the areas of regulating qi circulation and vitalizing blood
(lingzhi was considered a blood vitalizing herb). The number of tablets to take was rather large to help
approach a useful dosage, though one could not come close to the massive dosage of Pan’s decoctions.

An effort to get a decoction format was also made. The concept behind it was to suggest turning to
this form of administration for patients recently diagnosed and about to start or just starting
chemotherapy, before the most severe symptoms had set in. The patient would have a chance to get
used to making and drinking decoctions without the presence of nausea, and the result of using the
formula would hopefully reduce the severity of the reactions, permitting continued use of the decoction
for some time. The usual recommendation, provided in advance of offering the first batch of crude
herbs, was to plan on using the decoctions for about three weeks then follow-up with tablets if desired.

The crude herbs were provided in packets that were ready to cook as a tea, and labeled
Astragalus/Oldenlandia Mixture. The intent of the formula was illustrated in the name, with astragalus
already well-known for qi tonifying and immune enhancing effects and with baihuasheshecao
(oldenlandia) being one of China’s “anticancer” herbs. This herb is almost always used in combination
with banzhilian (scutellaria) for cancer patients, and its activity was increasingly attributed to immune-
related functions rather than any direct inhibition of cancer cell growth. Given the concerns about
development of chemotherapy induced nausea that could inhibit use of this form of the herbs,
digestion-promoting, stomach-calming ingredients were included: yizhiren (alpinia), sharen
(cardamom), and shenqu (shen-chu). To help assure the continued distribution of “clear qi,” jiegeng
(platycodon) was included to resolve phlegm and stagnation in the chest. The choice of yizhiren and
sharen was made to also aid the circulation of qi, as these spicy agents would disperse stagnation.
Further, based on the concept that qi and blood deficiency were early adverse effects of chemotherapy,
huangqi in this formula was paired with the blood nourishing agents shudi (rehmannia) and biejia
(turtle shell). Since qi and blood deficiency engendered impairment of blood circulation, jixueteng
(millettia) and danshen (salvia) were also used. The combination of shudi and biejia for nourishing
kidney yin with danshen and jiexueteng for microcirculation were expected to help protect bone
marrow. This formulation was thus an early representation of the six actions approach that this article
has described.

A new tablet formula was then composed, to be one of the potential alternatives to Astragalus 10+,
which made use of an herb gaining interest by Chinese physicians working with cancer patients:
jiaogulan (gynostemma). This herb was not one of the mainline TCM ingredients, but was known
from folk medicine. Researchers discovered that its active components were similar to, and in some
cases the same as, those of ginseng. Based on traditional uses, it also has some of the properties
attributed to jiegeng (platycodon). The following formula, called Gynostemma Tablets (Fu Zheng
Kang Ai Pian), was made for patients with concern about low bone marrow function (22):

jiaogulan Gynostemma
huangqi Astragalus
baizhu Atractylodes
baihuasheshecao Oldenlandia
gouqizi Lycium
heshouwu Ho-shou-wu
danggui Tang-kuei
buguzhi Psoralea
tusizi Cuscuta

The emphasis is on tonifying qi and raising clear qi (huangqi, jiaogulan, baizhu) and nourishing
blood and yin (danggui, heshouwu, gouqizi), but two herbs are included for benefiting marrow, buguzhi
(psoralea) and tusizi (cuscuta), and these two were selected because they were being used in China for
conditions of low production of blood cells, such as in cases of aplastic anemia as well as for
leukopenia secondary to cancer chemotherapy.

This formula returns to the focus on tonification therapy, but was intended to be combined with
another formula, such as one for regulating qi and vitalizing blood, and this is because it lacks the other
methods of therapy that have been identified as of importance for these cases.

Further investigation of Chinese prescriptions for bone marrow deficiencies led to design of a
second formula, called Millettia 9 (Ji Xue Teng Pian) that could be combined with one of the above
combinations (Astragalus 10+ or Gynostemma Tablets or the Astragalus/Oldenlandia Decoction)
providing an emphasis on blood vitalizing to restore microcirculation to the marrow (22):

jixueteng Millettia
danshen Salvia
sangshen Morus fruit
yejiaoteng Polygonum stem
huangqi Astragalus
chuanxiong Cnidium
shudi Rehmannia
xuduan Dipsacus
muxiang Saussurea

This formula is derived from blood-nourishing prescriptions described in Chinese medicine

publications for bone marrow depression. As an example, if one combined Gynostemma Tablets with
Millettia 9, the formula closely approximates Jixueteng Yijing Tang (23; Millettia Raise the Marrow
Decoction), which likewise includes jixueteng, danshen, huangqi, and shudi from Millettia 9 and
gouqizi, huangqi, heshouwu, buguzhi, tusizi, and danggui from Gynostemma Tablets, the only other
ingredients in Jixueteng Yijing base formula are ejiao (gelatin), nüzhenzi (ligustrum), and hanliancao
(eclipta).

In these formulas, jixueteng (millettia) and danshen (salvia) are of particular interest because
Chinese doctors consider these to have both vitalizing and nourishing properties, which is also true of
chuanxiong (cnidium). Yejiaoteng (polygonum stem) is the stem of heshouwu, sharing in its blood
nourishing properties. Muxiang regulates qi circulation, but also helps raise clear qi. Xuduan with
shudi benefit both the yang and yin of the kidney to nourish marrow; xuduan (dipsacus) has the
secondary effect of vitalizing blood circulation. A combination of Gynostemma Tablets and Millettia 9
will contribute to all six methods of therapy, with perhaps a weakness in the area of raising clear qi,
though that is addressed with huangqi (astragalus) and baizhu (atractylodes); regulating qi circulation is
also somewhat limited, accomplished in part with chuanxiong (cnidium) and primarily with muxiang
(saussurea). Still, the Chinese concept that nourishing the blood of the liver allows it to better circulate
qi definitely applies here, and there is considerable focus of these formulas in nourishing blood. This
pair of formulas used together is one which practitioners at IEP have considered especially effective.

The difficulty encountered is delivering these six therapeutic methods with a relatively small
number of herbs, so additional formulation work is underway. Normally, two to three herbs are to be
employed for each therapeutic action, relying especially on herbs that provide more than one of those
actions. Each of these two formulas has 9 herbs, and there are 17 different herbs (though heshouwu
and yejiaoteng could be deemed a single herbal material, so 16); this is comparable to Pan’s base
formula of 15 herbs.

To consolidate multiple formulas into one concise prescription that incorporates all six herb
actions is accomplished by selecting only those herbs that are most critical to the desired effects. A
previous presentation of six actions herb prescribing came about by combining three TCM formulas for
helping patients with multiple sclerosis and other autoimmune disorders. After successful treatment, or
as a result of natural disease variations, when the patient is in a relatively stable condition, a formula
can be utilized to help maintain that condition. In 1998, the formula called Remission Pills (San Fang
Ding Ji Pian; San Fang refers to three formulas) was introduced by ITM for these cases. It involved
the combination of Xiao Chaihu Tang (Minor Bupleurum Combination) to tonify qi, raise clear qi, and
regulate qi circulation, Tao Hong Siwu Tang (Tang-kuei Four Combination with taoren and honghua) to
nourish blood and vitalize blood, and Liuwei Dihuang Wan (Rehmannia Six Formula) to benefit
kidney. Because of the different application, the sixth action did not focus as much on the marrow
aspect of the kidney as would formulas for cancer patients. The formula has 18 ingredients.

An investigation of herb prescribing at the IEP Clinic shows that certain formulations aside from
the usual ones for counteracting adverse chemotherapy effects are used with some frequency. Some are
given only once or intermittently for particular situations that arise, such as using a prescription for
common cold or influenza or a combination suited for an acute injury. The most commonly used
prescription for general use, often given for an extended time, is a tablet called Bupleurum 12 (Tiao He
Pian; the name refers to its harmonizing intent). This is a “constitutional” formula that addresses
general imbalances rather than a specific symptom or disease. Bupleurum 12 is especially useful for
regulating qi and raising qi and yang, the two areas where a combination such as Gynostemma Tablets
and Millettia 9 are somewhat weak. Although I do not advise combining three formulas at once to get
the desired actions (but prefer to design alternative formulas that provide the desired therapeutic actions
with fewer herbs), it is worthwhile to see how the herbs in these three frequently used formulas at IEP
Clinic serve to address the six herb actions:

Action Herbs with Primary Use in the Category Herbs with Secondary Use
Tonify qi huangqi, renshen, jiaogulan, gancao baizhu
Regulate qi chaihu, zhishi, muxiang danggui, chuanxiong
Raise clear qi fuling, banxia, ganjiang huangqi, baizhu, renshen, chaihu
Nourish blood danggui, baishao, shudi, heshouwu, gouqizi, jixueteng, danshen, chuanxiong
sangshen, yejiaoteng
Vitalize blood jixueteng, danshen, chuanxiong, xuduan, baishao, danggui
Benefit marrow buguzhi, tusizi, xuduan shudi, goujizi

In working toward developing more concise formulations, a starting point is the key herbs that
generate the desired actions. Some of the herbs described in this article are clearly central to the
treatment strategy for aiding cancer patients suffering from side effects of their medical therapies,
including huangqi (astragalus), jixueteng (millettia), shudi (rehmannia), baizhu (atractylodes), and
danggui (tang-kuei). The other formula ingredients are best chosen to extend the properties of those
herbs, and in this case, attention to marrow benefiting herbs is distinctly needed. Of the six herb
actions, the regulation of qi has been the weakest aspect of this area of formula development and it is
my hope that this deficiency will be recognized by the explanations provided here and rectified in the
future. While some specific herbal combinations that are used at the IEP Clinic have been described
here, the same approach can be utilized with other formulations, so these serve only as examples for
explanation. Most importantly, the six herb action prescribing method provides a foundation for
designing an effective treatment.
References
1. Dharmananda S, Adjunct Cancer Therapy at the Immune Enhancement Project (IEP) Clinic.
2013 Institute for Traditional Medicine, Portland, OR.
2. Dharmananda S, Acupuncture and Herbs for Mind/Brain Disorders (part I: Acupuncture). 2000
Institute for Traditional Medicine, Portland, OR.
3. Dharmananda S, Towards a Spirit at Peace. 2005 Institute for Traditional Medicine, Portland,
OR.
4. Dharmananda S, Acupuncture for Shen Disorders Update, 2006 Institute for Traditional
Medicine, Portland, OR.
5. Zhang L, Generalized Anxiety Disorder and Acupuncture Treatment. Acupuncture.com 2010: 8
(7).
6. Zhu B, Wang HC, Case Studies from the Medical Records of Leading Chinese Acupuncture
Experts, 2010 Singing Dragon, Philadelphia, PA.
7. Cheng XN (chief editor), Chinese Acupuncture and Moxibustion. 1987 (revised 1999; third
edition 2010) Foreign Languages Press, Beijing.
8. Xu XG (chief editor), Therapeutics of Acupuncture and Moxibustion (vol 6. of The English-
Chinese Encyclopedia of Practical Traditional Chinese Medicine). 1989 Higher Education
Press, Beijing.
9. Dharmananda S and Vickers E, Synopsis of Scalp Acupuncture. 2000 Institute for Traditional
Medicine, Portland, OR.
10. Dharmananda S, Chinese Herbal Treatment for Multiple Sclerosis and Other Flaccidity
Syndromes, Including Myasthenia Gravis and Amyotrophic Lateral Sclerosis. 1996 Institute for
Traditional Medicine, Portland, OR.
11. Dharmananda S, Treatment of ALS with Chinese Medicine. 2003 Institute for Traditional
Medicine, Portland, OR.
12. Cheung CS, Kaw UA, Treatment of Toxic Effects Resulting from Radiation and
Chemotherapy by Traditional Chinese Medicine. 1980 Traditional Chinese Medicine
Publisher, San Francisco, CA.
13. Pan Mingji (compiler). Cancer Treatment with Fu Zheng Pei Ben Principle.
1987/1988 Fujian Science and Technology Publishing House, Fuzhou
14. State Administration of TCM and Pharmacy, Advanced Textbook of Traditional
Chinese Medicine and Pharmacology (v. 1). 1991 New World Press. Beijing.
15. Dharmananda S, Enumerating the Methods of Therapy. 1997 Institute for Traditional
Medicine, Portland, OR.
16. Dharmananda S, Counteracting the Side Effects of Modern Medical Therapies with
Chinese Herbs. 1998 Institute for Traditional Medicine, Portland, OR.
17. Kun J. Prevention and Treatment of Carcinoma with Traditional Chinese Medicine.
1983/1985 Commercial Press, Hong Kong.
18. Pan Mingji (compiler). How to Discover Cancer through Self Examination. 1990
Fujian Science and Technology Publishing House, Fuzhou.
 19. Liu L and Liu ZW, Essentials of Chinese Medicine (v 2). 2010 Springe-Verlag, London
20. Cheng LK, Heaven Above, Earth Below. 2011 http://lok-kwan.com/2011/08/21/heaven-
above-earth-below/
21. Wang YR, Influence of Shiquan Dabu Tang (Ginseng and Tang-kuei Ten Combination)
on immune functions after radio- and chemotherapies in tumor patients. Hubei Journal of
Traditional Chinese Medicine 1997; 19(5): 21–22.
22. Dharmananda S. A Bag of Pearls. 2004 Institute for Traditional Medicine, Portland, OR
23. Dharmananda S, Millettia (jixeuteng). 1999 Institute for Traditional Medicine, Portland,
OR.
February 2014

ADJUNCT CANCER THERAPY AT THE

IMMUNE ENHANCEMENT PROJECT (IEP) CLINIC
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine (ITM), Portland, Oregon
The TCM Interpretation
People who receive a diagnosis of cancer cannot help but feel that they have been struck by a powerful
force; the test results conveyed by a medical expert produce a sense of being injured and weakened; life
pathways are suddenly obstructed, and, in some cases, the recipient of such news may become
apprehensive of defeat even before embarking on the long journey through cancer therapy. Being
informed of having cancer disturbs the spirit, an impact that fits the traditional Chinese medicine
(TCM) classification of emotion as pathogenic factor, with anxiety and fear as an initial response.
After that, it is not uncommon for anger to arise over inadequacies of diagnosis and prognosis, as well
as from learning the limited treatment options; emotional distress may lead to depression. All this
distress has a substantial effect on qi, causing it to weaken, stagnate, and to circulate unevenly. The
particular manifestation of changes to the body will vary among individuals, but the disruption of
circulatory patterns yields common syndromes.

In the Advanced Textbook of Traditional Chinese Medicine and Pharmacology (1) the harmful
impacts of strong emotions on health, as manifest via the internal organ functions, are summarized:
Although emotional factors may impair all five zang organs, they mostly affect the heart, liver, and
spleen. Because the heart controls the mind, heart malfunction may cause palpitations, insomnia,
dream-disturbed sleep, mental restlessness, laughing and weeping without apparent cause, mania,
hysteria, etc. Liver trouble often leads to depression, irascibility, hypochondria pain, sighing, a feeling
of obstruction in the throat, menstrual irregularities, and pain due to distention or a lump in the breast;
these occur because the liver is responsible for the free flow of qi. The spleen controls the
transportation and transformation of nutrients. So, spleen dysfunction gives rise to a poor appetite,
distending pain in the stomach, and diarrhea. Emotional activities may both disturb the function of a
single organ and that of several organs simultaneously. Pensiveness, for instance, injures both the heart
and spleen and leads to the expenditure of heart blood and the impeded transport of nutrients. When
anger injures the liver, the spleen is often involved as well, resulting in the disharmony of both.
The emotional influences on the organ functions are compounded by physical damage to the body;
in the early stages of cancer, the disease itself has not caused much direct physical harm. Yet, the
process of arriving at the diagnosis may have already involved various kinds of invasive tests (e.g.,
biopsy), and if there is a particular tumor site (as opposed to a disseminated disease), initial treatment
will often include surgical removal of a mass. Modern surgical techniques are designed to minimize
damage, but there is always some level of circulatory disruption at the surgical site; sometimes portions
of the body are removed along with the tumor (e.g., mastectomy, colectomy, oophorectomy).
Therefore, accompanying the physical injury, the procedure might leave the patient with the feeling of
never again fully possessing what was there before, as it is either damaged or missing; the traumatic
emotional consequences may be somewhat lessened by knowledge that these surgeries save function
and life or, at the least, that they provide hope for such a result. Still the thoughts associated with loss
of wholeness are not easily overcome and may lead to melancholy and sleep disturbance.

Chemotherapy is the component of cancer treatment that most frequently leads people to seek help
from Chinese medicine; unlike the local damage caused by surgery, chemotherapy has broad influences
on body functions and overall sense of well-being. There has been good reason to pursue this kind of
natural health care assistance. During China’s immediate post-revolutionary period, it was realized that
the attempt to use TCM alone as a treatment for cancer was not yielding significant long-term results.
Therefore, considerable laboratory and clinical research was undertaken with the aim of utilizing the
medical tradition for a different objective: to help people better cope with the adverse effects of
chemotherapy and to improve overall outcomes (e.g., increasing the degree of tumor response, survival
rate, and total longevity). This work, dominated by herbal medicine, generated promising results by
the early 1960s, and the information about this methodology was eventually brought to the Western
world, which was just beginning to adopt Chinese medicine by the mid-1970s. The primary uses of
Chinese medicine in the West were initially directed to other applications, such as treatment of pain
(e.g., arthritis, sciatica, injuries), but by the mid-1990s acupuncture and Chinese herbs became known
as resources for cancer patients. In an evaluation of dozens of surveys conducted with cancer patients
to determine how many were turning to “alternative and complementary medicine” and from which
methods they sought help (2), 81 such surveys from several countries were considered to have useful
data related to Chinese medicine. All but three of the surveys were published during 2000-2010 (the
last year checked); the other 3 were published in the earlier interval 1995-1999. Chinese medicine was
a common means of therapy that the patients utilized, for which acupuncture was by far the most
commonly-tried technique.

The chemicals utilized for cancer treatment are feared for their toxicity and the resulting damaging
effects, which often include fatigue, reduced production of blood cells, irritation of the gastro-intestinal
tract, and loss of hair. The plan to begin chemotherapy heightens the already existing anxiety and fear
arising from the initial diagnosis and any surgical treatment, and the chemicals impair the organs that
have been distressed by emotions. Additionally, the impact of the cancer-inhibiting treatments on bone
marrow (blood-cell-producing stem cells), which is considered an extension of the kidney system as
described by traditional Chinese anatomy and physiology, begins undermining the foundations of the
body, namely, the essence stored in the kidney.

While cancer that is detected early (stages 1 or 2) may require but one course of chemotherapy
lasting a few months, that same undertaking is only the first of many such protocols when the condition
being treated is diagnosed at an advanced stage (stages 3 or 4). In such cases, there will typically be a
series of weekly treatments using one or two powerful drugs followed by a change to another series if
the first was too difficult to tolerate or if it failed to have the desired effect (either immediately or after
a period of temporary success); this process of shifting drugs, each with its unique side effect profile,
might continue for years. As a complicating factor, patients who have treatment-resistant tumors are
increasingly enrolled in trials of new drugs or new combination therapies which provide hope for a
good outcome that was elusive before but also adds the additional worry of being given a placebo
treatment at a critical time. Thus, for those with metastatic cancer or suspected metastasis, there is the
distress of entering a very uncertain future, with the roller coaster of newly offered hope and dashed
hopes. The flow of qi becomes erratic and there is difficulty finding rest day or night; a struggle ensues
in the usually simple task of taking in adequate food and then being able to distribute its nutrients.

In addition to impairing the functions of the internal organs, chemotherapy may cause lasting
damage to peripheral nerves (neuropathy) and brain cells (cognitive impairment); when treating older
patients, there is also potential permanent inhibition of the bone marrow, where the temporary drug-
induced suppression transforms into a progressive collapse.

Radiation is used for some patients to eliminate the last remaining cancer cells at the original cancer
site from which the bulk of the tumor was surgically removed; other times radiation serves as an
alternative to surgery; and this method is often selected for reducing metastatic growths when they are
producing severe symptoms, such as spinal metastases that cause pain. Though the techniques of
radiation have improved dramatically in recent years, reducing damage to surrounding tissue with more
accurate visualization of the tumor location and with far greater focus of the tumor-killing rays, there
are still adverse effects of burning some tissues in the radiation pathway and impairing marrow stem
cells and body energy. Both chemotherapy and radiation typically lead to lowered blood status and
depletion of qi after any prolonged treatment.

Many patients come to the IEP Clinic very soon after receiving their cancer diagnosis (most often,
after surgery, and either just before or just after beginning chemotherapy), though others don’t learn
about what is offered at the clinic until a later phase in their process of responding to the diagnosis.
Indeed, a number of people arrive when last ditch therapies are being pursued, and the patients might
not have become aware that they were reaching the end of their journey with a disease resistant to
known treatments. In advanced cases, the qi is weakened and the functions of the five zang organs are
compromised.

Patients present to the IEP practitioners physical and emotional conditions affected by the stage of
cancer at time of diagnosis and phase of medical intervention they are in, while being confronted with
personal circumstances that affect how they will proceed with treatment. In keeping with the basic
principles of traditional Chinese medicine, each patient is treated according to their unique needs,
which differ not only between patients but also, for any given person, from one visit to another. Yet,
there are aspects of the IEP clinical work that are relatively uniform; the common methods are outlined
briefly here because they may help inform and guide other practitioners less familiar with treating
cancer patients. Based on the description given above, a basic treatment needs to be supportive,
strengthening, and stabilizing for body and mind; such treatment may be categorized as tonifying.
There is also need to release stagnation related to emotional impact on qi circulation, to help resolve the
accumulations associated with cancer growth (qi entanglement, phlegm-dampness, and blood stasis),
and to alleviate the obstructing effects of cancer therapies on qi and blood circulation.

Three Therapeutic Modes

At the IEP Clinic, there are three basic modes of treatment; the primary one is acupuncture.
Acupuncture is expected to produce quick and obvious results that are often felt at the time of treatment
and persist to some extent for hours or days thereafter. This treatment method is most easily adjusted
in response to patient reports of symptoms of concern. Acupuncture point selection will be a major
focus of the following section.

Acupuncture is complemented by a form of massage therapy referred to as “Zen Shiatsu.” This is a

modern variant of the traditional Japanese pressure massage; it was developed by Shizuto Masunaga
(1925-1981) and it is of particular interest in relation to an acupuncture program because the treatment
strategy is largely based on meridian therapy (3). The meridian pathways used by the shiatsu
practitioners are similar to the Chinese ones, the main difference being an extension of each meridian to
range from legs to arms, passing through the associated diagnostic region of the abdomen. The theory
of acupuncture treatment holds that needling has, as one of its major functions, the alleviation of
obstruction of qi circulation and consequent normalization of qi and blood flow for the treated
meridian. The impact of acupuncture at points on one or, as more common, a few meridians treated in
a single session is not limited to the freeing up of circulation in those particular meridians; it has a
beneficial impact on the entire system. Acupuncture points are frequently selected because of their
individual indications rather than strictly on the basis of a meridian diagnosis, yet, in the overall
analysis, meridians are a central feature of treatment strategies. Zen Shiatsu reinforces this meridian-
opening effect; it is not necessary for the meridians treated by this application of pressure to be the
same meridians as those treated by the acupuncturist: the mutual benefits of opening and stabilizing
circulation in one meridian upon the functional capabilities of others allows these two similar but
distinctive systems of diagnosis and therapy—acupuncture and Zen Shiatsu—to reinforce one another.

The third mode is Chinese herbs plus nutritional supplements and diet counseling; these sometimes
diverse considerations—involving both Chinese and Western approaches to the analysis and selection
of ingredients—are bound together as one modality for purposes of this discussion based on the
Chinese concept of the close relationship between administering herbs, especially the mild herbs we are
able to use in modern practice, and dietetic treatments. A group of practitioners who have training in
both Chinese medicine and naturopathic medicine are available during one portion of the clinic
schedule to assist IEP patients in the area of diet and nutrition (as well as related concepts of
naturopathic therapies), while Chinese herbs are recommended throughout the program.

These three modes of therapy, covering many aspects of adjunctive care, are not comprehensive.
One could add, for example, qigong exercises and other natural health care approaches from the
Chinese tradition as well as incorporate health care practices from other cultures (e.g., yoga). The three
modes that are provided at IEP fit within the limited availability of physical space, the constraints of
practitioner and patient time for participation, and the primary range of expertise at the Institute for
Traditional Medicine.

The plan described to patients interested in utilizing IEP services is that they will come to the clinic
for acupuncture twice per week during the first several weeks of treatment and at those times when
chemotherapy or radiation is in progress; the frequency may decline to once per week after sessions of
the medical therapy are completed, that is, during periods when there is less physical and emotional
distress. Shiatsu services are made available to an extent that allows for treatment every other week,
which is almost always provided immediately before or immediately after acupuncture. Typical of
supportive shiatsu therapy is pressing along the stomach and spleen meridians, especially the portions
at the legs, and along the triple heater (sanjiao) and heart protector (pericardium) meridians that
traverse the arms. Acupuncture and shiatsu sessions are just a half hour each; in other settings, the
practitioners might spend 45 minutes for an acupuncture visit and an hour for a shiatsu visit, but the
shorter treatment duration fits with the concept of offering more frequent and lower cost treatment.

Herbal and nutritional supplements are often provided in accordance with a basic model of
“supporting normality,” that is, following the “fuzheng” concept developed in China for this purpose,
which would typically incorporate huangqi (astragalus) and baizhu (atractylodes) as spleen qi tonics
and danggui (tang-kuei) and gouqizi (lycium fruit) as liver blood nourishing agents. If the qi and blood
are full, the Chinese doctrine says, then pathological influences will not be able to disrupt normal
functions. One of the common concerns is the bone marrow inhibiting effect of chemotherapy and
radiation, for which various forms of Shengxue Tang (Decoction for Generating Blood) are utilized.
The formulations used in China vary considerably, but two common ingredients are jixueteng (millettia;
spatholobus) and huangqi (astragalus); most other components of such formulas are additional blood-
vitalizing agents and tonics (for qi, blood, and essence). I reviewed several such blood generating
formulas in my 1998 article Countering the Side Effects of Modern Medical Therapies (4) and in my
1999 article Millettia (jixueteng) (5). The clinicians at IEP have reported that this treatment approach
seems to be one of the most effective of the commonly prescribed herbal therapies. The primary
formula used at IEP when patients convey concerns over blood tests showing marked inhibition of
marrow is a tablet comprised of jixueteng, danshen, sangshen, yejiaoteng, huangqi, chuanxiong, shudi,
xuduan, and muxiang.

Standard nutritional supplements recommended to patients include a broad mixture of minerals and
vitamins and a mixture of antioxidants intended to replace the multiplicity of products that are
recommended in the literature. These provide a substantial quantity of the substances that are
purported to be of low quantity in the blood stream (due to reduced food consumption and/or poor
absorption) and in particularly high need in light of the effects of the anti-cancer medical therapies.

A naturopathic consultation is offered close to the beginning of the acupuncture series and may be
followed up from time to time, with average duration between consultations of about three to four
months. At each visit, the patient’s current symptoms, lab test results, drugs, Chinese herbs, nutritional
supplements, and daily activities are reviewed. There may be suggestions made for some additional
laboratory testing, for undertaking certain diet and exercise strategies, and for supplements not
routinely included in the IEP model. Among common recommendations associated with these
consultations are eating multiple small meals to manage the problem of reduced appetite, utilizing
various protein sources (whether isolates or high-protein foods), taking supplemental fish oil and
vitamin D3, using probiotics, taking melatonin for sleep (also used for symptom relief at higher than
usual dosage, such as 20 mg/day), and getting basic exercise (even if limited to 20 to 30 minute walks,
though more is encouraged when possible). Such direct suggestions are supplemented by referral to
specialists who might assist with other methods of addressing unique symptoms or by providing
additional treatment programs.

To encourage the greatest level of participation in the IEP program components, the cost of
treatment is set by a monthly fee that is established on a sliding scale basis, often allowing free
treatment, and currently not exceeding $150/month. The cost to the patient is not influenced by
frequency of acupuncture, shiatsu, or naturopathic consultation, or by the selection or quantity of
prescribed supplements within our basic list. There will be an extra cost for any of the naturopathic
recommendations that are outside the standard supplement regimens and patients will have to incur the
costs or submit to their insurance the expenses associated with any additional laboratory testing that
they pursue in response to suggestions at IEP.

Foundational Acupuncture
During most visits to the clinic by cancer patients, a model point formulation is utilized, which is
modified as appropriate. The acupuncturists at IEP refer to the most commonly selected acupuncture
point set with terms such as “cancer support,” “chemo support,” or “immune support,” and the
variations in designation are not intended to indicate different concepts. The primary strategy begins
with an adaptation of an approach that was utilized by Wang Leting, a TCM practitioner whose work
spanned the pre-revolutionary and post-revolutionary period in China; he practiced for 50 years from
1929-1979. An English translation from the 1984 Chinese book that describes his work is Golden
Needle Wang Leting, which was published in 1997 (6).

Much of Wang’s therapeutic efforts revolved around one particular acupuncture point on the stomach
meridian: zusanli (ST-36). He is reported to have said: “For hundreds of diseases, don’t forget
zusanli,” and “in treating the root, first treat the stomach” and “if a person is diseased and one does not
treat the stomach, on what can they rely for life?” In 1998, I produced an extensive review of zusanli
and its uses to encourage better understanding of the factors that lead to its selection as a key part of the
treatment (7).

Two of Wang’s point formulations serve as inspiration for the foundational acupuncture at IEP. Of
particular interest as an adjunct therapy for cancer patients, there was one which Wang Leting described
as having an effect like that of the herbal formula Shiquan Dabu Tang (Ginseng and Tang-kuei Ten
Combination). This well-known tonic prescription combines the spleen/stomach formula Sijunzi Tang
(Major Four Herbs Combination) with the liver blood formula Siwu Tang (Tang-kuei Four
Combination) plus huangqi (astraglus) and rougui (cinnamon bark). It has been the traditional formula
most frequently recommended for support of cancer patients in recent decades, especially utilized for
this purpose by Japanese and Taiwanese doctors who select from a set of about two hundred traditional
formulations that are covered by national health insurance. In composing the acupuncture point
formula, Wang contemplated the actions of the herbs and compared those with the functions of
acupuncture points; thus, for example, he drew a parallel between needling of hegu (LI-4) and the role
of astragalus because, among other similarities, they both address insufficiency of defensive qi.

Wang’s Shiquan Dabu acupuncture formula:

zusanli (ST-36)
sanyinjiao (SP-6)
neiguan (PC-6)
guanyuan (CV-4)
zhongwan (CV-12)
hegu (LI-4)
quchi (LI-11)
yanglingquan (GB-34)
taichong (LV-3)
zhangmen (LV-13)

Wang also frequently used a formulation which he called Old Ten Needles, the term “old”
referring to a traditional style of acupuncture point selection. He worked with certain key points for
years and then finalized this particular group around 1966. Wang’s primary application for Old Ten
Needles was gastrointestinal weakness and distress, a common concern for the patients at IEP.

Wang’s Old Ten Needles:

zusanli (ST-36)
tianshu (ST-25)
neiguan (PC-6)
qihai (CV-6)
xiawan (CV-10)
zhongwan (CV-12)
shangwan (CV-13)

The first three points of this small formula are treated bilaterally, making 6 of the 10 points, and the
next four are along the front centerline, so each has one needle, making four more.

By the time this information was relayed in the English language text, many acupuncturists in the
U.S. were already familiar with a slightly different set of ten needles that was relayed by Miriam Lee in
her 1992 book (8).

Lee’s Ten Great Needles:

zusanli (ST-36)
sanyinjiao (SP-6)
hegu (LI-4)
quchi (LI -11)
lieque (LU-7)

All five of these points are treated bilaterally. Like Wang, Lee considered zusanli as a key point and
devoted a chapter of her book to using that point alone. Lee had utilized this set of ten needles for a
wide variety of disorders, but especially for disorders causing weakness, fatigue, and depression. Other
variants of this approach, in which a small group of needles comprise a foundational treatment, have
been reported. One of the IEP practitioners had developed his own variant of Lee’s ten needles by
replacing quchi (LI-11) with shousanli (LI-10) and replacing lieque (LU-7) with shenmen (HT-7).

Through adding and subtracting from these insightful formulations, we have the group of points used at
the IEP Clinic for adjunctive cancer therapy, which I now refer to as “New Twenty Needles” (NTN).
These points are still “old” in the sense of common traditional points and combinations, but they are
here used for a new application—in support of patient’s undergoing medical treatments for cancer—
which postdates Wang and Lee’s primary work. Not all these points would be used at one treatment
session, but a total of ten to twenty body points (this count including the bilateral needling, but not
including any added ear needles) would form the basis of one session.

New Twenty Needles (NTN):

zusanli (ST-36)
tianshu (ST-25)
neiguan (PC-6)
taichong (LV-3)
hegu (LI-4)
quchi (LI-11)
sanyinjiao (SP-6)
taixi (KI-3)
qihai (CV-6)
zhongwan (CV-12)
baihui (GV-20)
yintang (Ex-HN-3)

The points that differ from those listed by Wang and Lee are baihui (GV-20) and yintang (Ex-HN-3),
which are especially used in stabilizing the emotional distress common to our patients, and taixi (KI-3),
for tonification therapy to resist the impairing effect of chemotherapy and radiation on the kidney yin
and yang. To better display how these are used, the NTN points can be described in terms of being
“primary” or “secondary”, not to distinguish their relative values, but to draw attention to the fact that
the primary points are being used two to three times as often as the secondary ones.

NTN Primary Points:

zusanli (ST-36)
sanyinjiao (SP-6) Lower Limbs
taichong (LV-3)
hegu (LI-4) Upper Limbs
quchi (LI-11)
baihui (GV-20) Head

NTN Secondary Points:

taixi (KI-3) Lower Limbs
neiguan (PC-6) Upper Limbs
qihai (CV-6)
zhongwan (CV-12) Torso
tianshu (ST-25)
yintang (Ex-HN-3) Head
Common additions to the above set were the lower limb points yinlingquan (SP-9; substituted for SP-6
or added to it), zhaohai (KI-6; substituted for KI-3), qiuxu (GB-40); upper limb points shousanli (LI-
10, frequent substitute for LI-11); shenmen (HT-7; substitute for PC-6 or added to it), lieque (LU-7),
waiguan (TB-5); torso points jianjing (GB-21), danzhong (CV-17; also called shanzhong); and
head/neck points shenting (GV-24; added to GV-20), fengchi (GB-20), and extra point anmian (near
GB-20). In a few instances, two adjacent points on a meridian were needled at the same time, such as
LI-10 and LI-11 or GB-20 and GB-21. The additional points mentioned here, though beyond the
NTN, belong to the foundational acupuncture treatment group.
The acupuncture set selected during a patient visit may involve some alterations to address symptoms
that have become severe. Thus, for example, a complaint of women undergoing treatment for
hormone-dependent cancers is hot flashes, and if they become more frequent or intense fuliu (KI-7) in
conjunction with yinxi (HT-6) would be used; these are points routinely combined with several others
that belong to NTN for this symptom in non-cancer patients. In efforts to alleviate foot neuropathy,
extra point bafeng (four points on an affected foot) might be used, sometimes adding yongquan (KI-1)
or rangu (KI-2). Nonetheless, when these same symptoms are relatively stable—not especially
disruptive or not worsening—the foundational acupuncture with NTN is usually sufficient to provide
relief without the necessity of needling points deemed specific to those symptoms.

Due to the relatively short duration of an acupuncture session, 30 minutes, patients are usually treated
on one side of the body, laying face up, without needling of back points (GB-20 is the main exception,
but can be treated because of the curvature of the neck). The usual set of foundational points also
minimizes the need to remove clothing so long as the patient wears loose clothing that allows exposure
below the knee and from the elbow down. For points that are ordinarily needled bilaterally, a patient
might instead receive left-sided and right-sided points that differ; this method would most often occur
if there were unique symptoms on one side; for example, one arm might have swelling from
lymphedema while the other arm remains unaffected.

In my article on zusanli, I relayed an immune enhancing protocol that was being evaluated in patients
whose primary complaint was pain, based on the pair of zusanli and hegu (LI-4); other pairings I
relayed from the Chinese medical literature were zusanli and neiguan (PC-6), reported to be useful for
side effects of chemotherapy and radiation such as poor appetite, nausea, vomiting, diarrhea, dizziness,
insomnia, and fatigue), and zusanli with sanyinjiao (SP-6) that had been provided to patients
undergoing radiation therapy to prevent impairment of white blood cell counts. I pointed out that this
set of four points (zusanli, hegu, neiguan, sanyinjiao) were the main ones employed in a study of
treating pain due to stomach cancer and the side effects of stomach cancer treatment by chemotherapy.
In a more recent study describing treatment of liver cancer patients having postoperative gastroparesis
(9), a set of four primary acupuncture points were: zhongwan (CV-12), zusanli (ST-36), neiguan (PC-
6), and sanyinjiao (SP-6), which is the same set, except hegu is replaced by zhongwan. As can be
seen, this fundamental pattern of treatment applies to chemotherapy and to surgery as well as to
different cancer types.

The general stabilizing effect of the point sets used at IEP is illustrated by similar acupuncture formulas
for treating tremor. In the book Case Studies from the Medical Records of Leading Chinese
Acupuncture Experts (10), a suggested treatment was: zusanli (ST-36), sanyinjiao (SP-6), hegu (LI-
4), taixi (KI-3), taichong (LV-3), shousanli (LI-10), shenmen (HT-7), and fengchi (GB-20), with
xuanzhong (GB-39) and yanglingquan (GB-34) included for specific treatment of tremor. Wang
Leting had compared the acupuncture point yuanglingquan with rougui (cinnamon bark) in Shiquan
Dabu Tang because they both treat upwardly counterflowing qi and both eliminate wind, cold, and
damp.

The foundational acupuncture set also follows a description I provided in a booklet on treating
disturbed spirit (11), which indicated the tendency of Chinese doctors to utilize “five zones” of
acupuncture for spirit disorders, typically treating one to four points in each zone: in the area of the
head (e.g., GV-20, GV-24, yintang); at the forearm-hand area bilaterally (e.g., LI-10, PC-6, LI-4, HT-7),
and on the lower limbs bilaterally beneath the knee (e.g., ST-36, SP-6, KI-3, LV-3). The five zones are
treated together to yield a therapy for anxiety, depression, insomnia, easy crying, and other
characteristic symptoms of shen disorders. The points zusanli (ST-36), tianshu (ST-25), sanyinjiao
(SP-6), taichong (LV-3), quchi (LI-11), neiguan (PC-6), and baihui (GV-20) of NTN are examples of
those commonly used in modern Chinese treatments for persistent anxiety and distress. Renzhong (GV-
26; also called shuigou) is often chosen in China for these psychological conditions—in addition to, or
rather than, shenting (GV-24) or yintang—though this point is not as acceptable for use in the West.
Examples of Chinese medical literature reports on this five zone pattern of treatment include a study of
patients with mental depression (12) that relied on needling the main points baihui (GV-20), shenting
(GV-24), yintang (Ex-HN-3), renzhong (GV-26), anmian (extra point near GB-20), danzhong (CV-17),
neiguan (PC-6), daling (PC-7), shenmen (HT-7), and taichong (LV-3) and treatment of “depressive
neurosis” with herbs and acupuncture (13) using taiyang (Ex-HN-5), shenting (GV-24), qucha (BL-4),
baihui (GV-20), neiguan (PC-6), shenmen (HT-7), sanyinjiao (SP-6), and taichong (LV-3).

For the purpose of calming the disturbed spirit, some practitioners at IEP also add ear points, most
often turning to variants of the “5NP,” referring to Nogier’s Points (NP) that have since been adopted
into the Chinese system. These particular points were initially recommended by Dr. Michael Smith for
the National Acupuncture Detoxification Association (NADA) protocol, namely 5NP = sympathetic,
shenmen, lung, liver and kidney. A simplified version is more commonly applied at IEP, called “3NP”
= shenmen, liver, and kidney. Sometimes, ear point selection varies from these standardized protocols,
simplifying to shenmen alone or by substituting a point in the basic set (e.g., heart replacing lung) or
adding one or two other points to 3NP.

In a recent study of using acupuncture for patients with lung cancer (14), points selected for treatment
were: hegu (LI-4), taichong (LV-3), zusanli (ST-36), sanyinjiao (SP-6), lieque (LU-7), and 3NP. This
pattern is consistent with that used at IEP. As another example, a protocol for cancer patients
monitored for effects on depression and sleep disturbance (15) utilized the points fenglong (ST-40),
yinlingquan (SP-9), xuehai (SP-10), sanyinjiao (SP-6), neiguan (PC-6), yintang (Ex-HN-3), baihui
(GV-20), sishencong (Ex-HN-1; these are four points surrounding GV-20), and ear point shenmen.
Except for the shift of zusanli to fenglong and addition of xuehai, this pattern fits reasonably well with
what is being done at IEP. Sishencong can serve an alternative to using shenting (GV-24) in treating
distress symptoms, and is also sometimes the choice for this purpose at IEP.

The New Twenty Needles and commonly used added points serve multiple functions but especially
help with the emotional distress associated with cancer diagnosis and treatment, supporting immune
functions, alleviating pain, and normalizing the gastrointestinal system. Standard herbal formulas
prescribed to the patients will further support one or more functions of the acupuncture treatment.

Extraordinary Results: Examples of Treatment Effects

The ideal cases where success can be declared are those where the IEP methods of therapy assist
patients recently diagnosed with stage 1 or stage 2 cancer get through the course of medical treatment,
such as surgery and chemotherapy, with relative ease. Thanks to the three modes of therapy described
above, particularly the dramatic effect often experienced from receiving acupuncture, there is an
amelioration of anxiety and other emotional distress, they find that the medical and adjunctive
interventions—though taking a lot of time—produce a minimum of disruption to capabilities, and they
arrive in just a few months to the end result of being evaluated by their oncologist as cancer free or, at
least, there is not a recurrence due to undetectable metastatic cells for some years after the initial course
of treatment. Quite a few patients have this situation and for them the stabilizing effect of acupuncture
and other adjunctive therapies is greatly appreciated. The course of their participation at IEP might
involve about 60 acupuncture treatments and about 15 shiatsu sessions, a commitment that could be
afforded by some patients attending clinics charging standard rates.

However, a sense of success is sometimes more evident in those situations where the patient has
advanced cancer and is not expected to be cured of the disease; the patient may not be able to work or
can only do so to a limited extent: these are difficult situations where a person suffers greatly in a state
of little hope in the absence of such a program of adjunct therapy. For these situations, being able to
tolerate the ongoing chemotherapy attempts is a great achievement and maintaining reasonable pain
control is welcomed; the ability to function, make difficult medical decisions, and be present to family
members accomplishes much in transforming a terrible situation into one which can have many bright
moments.

Below, ten examples of patients with advanced cancer treated at IEP are described. They came to
the program at ages 48-75, which is a typical range for patients at IEP. Most of these patients came to
the clinic with stage 3 or stage 4 cancer (one had indeterminate staging with signs of metastatic
disease); in all but two of the cases conveyed here the patient died, usually shortly after their last visit
to IEP, indicating that they retained activity and mobility until their last few days. Practitioners at the
clinic selected these cases as examples of extraordinary results because of the very favorable feedback
from the patients and their families (sometimes also their doctors) as well as their impression that
individual treatments yielded especially good responses. The patients are not presented here in any
particular order; there were seven women and three men in the collection of cases, and this represents
the roughly 2:1 ratio of female to male cancer patients treated at the clinic. IEP chart notes present any
noteworthy comments made by the patient at each visit as well as the basic details of the treatment
administered (e.g., acupuncture points). The records can be used to determine compliance with
recommended frequency for acupuncture and shiatsu, the dates when chemotherapy or other medical
treatment is initiated or terminated, what symptoms are of primary concern, any reported significant
changes in symptoms, the total duration of participation at the clinic, and, in most instances, the cause
for completion of the treatment program.

1. Patient TV, a 75-year-old man with terminal cancer. He had gone to the hospital in very serious
condition and was diagnosed with stage 4 lung adenocarcinoma (patient was non-smoker) and came to
our clinic about seven months later. Chemotherapy caused notable tiredness, weakness, and fatigue.
However, his primary complaint was severe chest pain, particularly at the primary tumor site; he also
suffered some abdominal pain, and from time to time, felt pain all over his body. He continued to
receive chemotherapy during the first several months of his IEP clinic visits.

He responded very well to acupuncture, with notable pain reduction. Pain would return, but
acupuncture would help control it each time and his appetite improved as well. He received 38
acupuncture treatments, often with electro-acupuncture incorporated for pain control, and 18 shiatsu
treatments over the period of six months before he was no longer able to attend the clinic; he lost
ability to walk and sit-up and then went into a coma and died one month after his last visit to IEP.

It was found that electro-acupuncture (EA) was especially effective for his pain. An example of EA
was hegu (LI-4) to taichong (LV-3) on the left, lingxu (KI-24) to qimen (LV-14) on the right, but the
specific point selection for EA varied. Aside from the usual points selected for cancer support, points
for chest pain such as lingxu (KI-24) and wuyi (ST-15) were commonly used.

The success in this case was the marked pain relief that allowed him a quality of life he would not
otherwise have had during his final months. Pain in late stage 4 cancer is often intractable; patients do
not like taking high doses of morphine or other powerful pain drugs (this patient had been using
oxycodone), as they feel they cannot mentally function at an adequate level. In this case, the
impairment of breathing that occurs with any high dose of such pain drugs would compromise
breathing capabilities that had already been reduced by the lung tumor and would therefore risk
bringing on coma and early death. Despite coming to our clinic with a far advanced cancer condition,
he remained stable during the months of his visits. He most likely succumbed to a circulatory shut
down because of the widespread cancer, lack of physical activity, and reduced nutritional status
associated with low appetite.

2. Patient VI, a 57-year-old woman with terminal liver cancer affecting the bile duct (stage 4), came to
the clinic just after diagnosis; he had undergone exploratory surgery and not had yet started
chemotherapy. She received treatments at our clinic for 15 months, and then planned on moving into
hospice, but died promptly before she could make that transition. Except for the first three months at
IEP, she did not get frequent acupuncture as usual for our protocol; in total she received 88 acupuncture
treatments and 29 shiatsu treatments.

She did well with her chemo treatments, with a relatively low level of side-effects; nonetheless, her hair
fell out, she had fatigue and hot flashes and she did miss one scheduled chemo due to low blood
counts. Practitioner notes after six months of chemo indicated: “generally tolerating chemo well,” and
her tumor responded to the treatment, shrinking by 40%, but radiation was added in an effort to get the
tumor under greater control. After nearly a year of chemo, and then with added radiation, the
practitioner report indicated that she was “feeling well.” A change in the chemo regimen at that point
had obvious deleterious effects, with her reporting notable depletion of energy and developing
neuropathy. The most serious development, however, was shoulder pain attributed to a tumor pressing
upon a nerve. The pain worsened, extending from shoulder to chest, and she was put on morphine.
This last phase of her life included a period between when she was reported as “feeling well” to a
couple of months later when she was reported as “doing o.k. and “pretty good;” but, she ceased coming
to the clinic at that point and died two months later.

This patient was diagnosed at a time when the cancer was advanced and beyond effective treatment.
Nonetheless, combining Chinese medicine, chemotherapy, and radiation, she did well with her
treatments for over a year, and then suffered a rapid decline due to the fact that the tumor remained and
was causing obstruction (pain due to nerve impingement; death likely due to blockage of the liver).
Her acupuncture treatment was mainly categorized as “immune support” utilizing the NTN needle set
and 3NP as described above.

3. Patient JM, a 48-year-old woman, arrived at our clinic with stage 4 colon cancer. She had already
had three surgeries, and several courses of chemotherapy during the year and a half between diagnosis
and coming to our clinic for the first time. Surgery included removal of parts of her colon, ovaries, and
parts of her liver (this last, just three weeks prior to attending our clinic), and she was pursuing
chemotherapy while participating in the IEP Clinic. She had 64 acupuncture treatments, and 16 shiatsu
treatments over a period of 10 months. During most of the time at our clinic the practitioners relayed
that she was feeling well, and on days when chemo side effects were more prominent (with heartburn,
reduced appetite, and nausea), she felt better after getting acupuncture, which was described as “very
helpful” for acid reflux and for nausea. A practitioner noted “acupuncture seems to eliminate post-
chemo GERD.” She did experience hair loss and fatigue as part of the chemo side effects over time.

After completing her course of chemotherapy, she continued to come to the clinic for about 10 weeks;
her hair began growing back (the hair loss had disturbed her), and she was gaining strength, but with
some fatigue. After completing our program, she came in to report that she was “doing really well.”
She continued taking herbal and nutritional formulations that had been previously prescribed. Her
tolerance of the chemotherapy-induced symptoms and her quick recovery from its effects (especially
given the immediately prior history of surgery and chemotherapy) were remarkable. During much of
her time at the clinic she received acupuncture with the basic chemo support concepts. She remains
alive today.

4. Patient CR, a 65-year-old woman, had a diagnosis of ovarian cancer the year before coming to the
IEP Clinic. She had undergone surgery and was treated with chemotherapy for nearly 11 months; her
cancer was at stage 4. She attended the clinic over a period of more than 8 years. After a total of nine
years of chemotherapy, her cancer was deemed untreatable, and she was taken off the last regimen; she
continued to come to the clinic for a few more treatments and then ceased coming because of sudden
deteriorated health. We learned that she passed away two months after her last visit to our clinic; for
the prior two months she had been coming only twice per month for acupuncture.

During her last years at the clinic, the acupuncture frequency was routinely once per week. She
was given general cancer support protocols and was also treated for individual symptoms as they arose;
for example, when she tried her last chemotherapy drug she had a reaction of severely reduced appetite
and that was the focus of therapies with acupuncture and her medications. Throughout much of her
time at the clinic, she did report fatigue or low energy, but on many visits she felt well otherwise, and
she was given the general acupuncture treatment described as “maintenance” or “tune up” or “cancer
support.”

What was remarkable about her case was not only her longevity, but how well she was managing
with ongoing chemotherapy for years. For example, 10 months before she died, it was noted in her
chart that “her CA-125 was going up, but she doesn’t have any symptoms.” Five months before her
death, she was reported to be “eating well, no pain issues,” and she had no insomnia, normal bowel
conditions, but low energy. And in the next month, the practitioner wrote “no complaints today.” One
of our practitioners considered that “part of the reason she did well for years was her personality (not
easily rattled) and that her daughter and family (2 granddaughters) lived across the street…She often
talked about them in treatments.” What eventually caused her death, most likely, were metastatic
tumors in the lungs, which impaired her breathing, along with the final chemo attempt, which appeared
to contribute to a downturn without providing any cancer inhibition; those impairments caused her to
come to the clinic less frequently the last two months and then cease getting acupuncture for about 6
weeks before she died.

5. Patient OA, a 75-year-old man, had breast cancer diagnosed 8 years earlier, followed by liver cancer,
which had been successfully treated 5 years earlier, but then recurred a year before coming to IEP.
There were two tumor-removing surgeries (breast and liver) and a later abdominal surgery for bowel
blockages. He came to the clinic at a time when his cancer was not showing up on scans (the cancer
appeared to be in remission according to his oncologist, and the apparent remission was reported again
a few months later), but he was utilizing doxorubicin-eluting beads, a new type of long-term liver
cancer therapy and he eventually received other chemotherapy treatments because his oncologist was
sure that the tumor growth would resume if not more aggressively pursued. He had considerable
abdominal pain, being treated with morphine. He received 67 acupuncture treatments and 38 shiatsu
treatments over 10 months (this is an unusually high number of shiatsu for this period of time, utilized
to help address pain symptoms). Acupuncture point selection for this patient was somewhat more
varied than for many patients because of the efforts to alleviate certain specific symptoms that arose,
but he did frequently receive general “cancer support” treatment as described above.

He had a number of symptoms, many of them involving pain and/or spasms at several sites,
which would easily vary from one week to the next. Still, this patient reported “feeling well” and
“feeling much better with shiatsu and acupuncture” during the first three months; there were
intermittent reports of him feeling well two months before his death. Fatigue remained a persistent
complaint, but treatment was helping with pains of the middle back, stomach, and head. Chemotherapy
was then discontinued, but a tumor was eventually visualized affecting the bile duct, and he had to have
a drain put in for the bile to bypass the obstruction. Chemotherapy was not resumed, and it appears the
oncologist did not believe further chemotherapy would be of help. The patient, who had been doing
reasonably well at his last visit to our clinic, died within four weeks of that visit.

Despite his advanced age and years of dealing with cancer, the surgeries, and the chemotherapy,
he remained in fairly good health during his time with us; he was known locally as a master musician
and he continued performing for six months after his first visit to IEP. He likely succumbed as the
result of a blood infection associated with the port that had been used for bile duct drainage.

6. Patient LZ, a 51-year-old woman, was diagnosed with stage 3 ovarian cancer a few weeks before
coming to the IEP clinic, having had a debulking surgery for the tumor, and starting chemo just the
week before her first acupuncture treatment. She originally received twice per week acupuncture, but
later took breaks and would come back for a series of acupuncture sessions over a period of about three
years. She then took off about one year and came back toward the end of her life for two treatments;
she died two months after the last treatment.

She managed remarkably well through a long course of various chemotherapy attempts. She was
able to return to work, at least part time and, for a short while, full time, and resumed her active
lifestyle (e.g., going skiing). Her utilization of acupuncture was much less than we advised. During
her first year, she received 49 acupuncture treatments, a rate of just under once per week (she had
started at twice per week, but soon reduced the frequency to once per week), and the second year she
had 30 treatments over a period of 9 months, then was absent for about five months following a skiing
accident (broke both legs), and then another 32 treatments over a year. Because of the lower
acupuncture frequency and taking time off, she probably got much less effect than was possible. It
appears she initially was quite drawn to acupuncture therapy and then was less interested in that
approach: the first year, she did not receive any shiatsu massage, but for the following years, she
arranged to have shiatsu without acupuncture for every other visit. This patient preferred lying in the
prone position, so the standard needling received by most patients was usually not administered in her
case, and her protocol included several points of the Bladder Meridian and Hua Tuo points and
tianzong (SI-11); she might also receive treatment at points of the foundational protocol easily
accessible in that position and compatible with the others chosen.

She often reported fatigue and low energy from chemotherapy, but the focus of treatment would
typically be for pains that arose in different parts of her body. Sometimes, this was from her physical
activities; for example, she reported one day that everything was sore from physical activity
(swimming, hiking, and golfing)

What finally depleted her system, it appears, was non-cancer related surgeries: she had chipped
talus bones which were treated by surgery (two separate surgeries, one ankle at a time), and then rectal
surgery for hemorrhoids. It was right around the time of these surgeries that she ceased getting
acupuncture, retired from her teaching career, and, though we don’t know what happened during this
time, she developed leg lymphedema, probably from the series of lower body surgeries, and was not
able to continue her passion for physical activity. She lived about half hour drive from the clinic and
this lengthy transit, which was time consuming for her, yet something she could do regularly while she
was relatively healthy. With her skiing accident (broken legs) and later surgeries she wasn’t able to
travel to our clinic. So, her location explained why she didn’t get regular acupuncture when it might
have helped for recovery from injury and surgery as well as manage the effects of cancer treatments.

7. Patient LC, a 48-year-old woman, had been diagnosed ovarian cancer just two months before starting
treatment at IEP; she already had surgery and had undergone the first two chemotherapy sessions. The
surgery revealed extensive cancer in her abdomen (categorized as stage 3c, grade 3), and she had a
hysterectomy as well as oophorectomy. She came for acupuncture twice per week initially, but soon
transitioned to once per week and occasionally missed a week. She received a total of 68 acupuncture
treatments and 48 shiatsu over a period of about 19 months.

Her health during the chemotherapy was remarkably stable; she had persistent complaints of
constipation, and did develop some hand neuropathy, but did not experience fatigue and low energy.
After completing her first course of chemotherapy, which was just over three months long, she
rebounded well and her constipation resolved (it would come back as a symptom later). Despite her
basic good health, she developed persistent anxiety and feeling “emotional” overall. Her anxiety was
primarily over the cancer diagnosis, and, in fact, about nine months after starting at IEP she received
the news that the cancer had returned and that the prognosis was poor. A new chemotherapy was
begun, and this produced fatigue and some neuropathy (fingers and toes); she otherwise tolerated it
well. After a CAT scan, she was put on another chemo drug, and this was less well tolerated;
unfortunately, at this time she came in for acupuncture infrequently, and she died four months after
starting that new treatment. Her death did not appear to be due to the new chemotherapy effects, as
after the first treatment or two that “hit her hard” she was tolerating it well; for example, she reported
no neuropathy at her last visit. Her acupuncture treatments were consistent with others for general
support, but because of the substantial abdominal symptoms, she would tend to get needled along
Conception Vessel points that were in addition to those used for most other patients.

In my interpretation, the turning point for her was a loss of will to live when the cancer tests
showed that the disease was progressing. The anxiety that she reported a year and a half earlier—after
her first chemotherapy series which resulted in cancer being undetectable—stuck with her and could
turn to depression. For one of her chemotherapy series, she was in a research protocol and was
convinced she was receiving the placebo. During a later chemotherapy protocol, a practitioner
recorded that her mood was low and that she was “scared”; despite this, the same chart record indicates
“good quality of life,” and there were other reports of her “doing well.” A later note indicated that she
was sad and emotional after having had a liver ultrasound in the morning before her visit to our clinic.
At her last visit to the clinic, about 6 weeks before she died, she reported that a recent MRI showed a
lesion on the pancreas.

While acupuncture helped with emotional distress, she was not getting treatment with sufficient
frequency after the first three months. During her last year at the IEP Clinic, she had taken a
substantial break for nearly four months, and then returned for treatments only once per week during
the final six months. Her tolerance of several courses of chemotherapy was remarkable, and though
she seemed increasingly emotionally defeated, she maintained a relatively good health status through
her time at IEP, with many chart notes indicating that symptoms had improved.

8. Patient CB, a 58-year-old man, was diagnosed with stage 4 bilateral lung adenocarcinoma two
months prior and had his first chemotherapy just before coming to the clinic; he was also scheduled for
a series of radiation treatments for tumors on the spine. He received 250 acupuncture treatments at our
clinic over a period of 32 months and did not receive shiatsu other than three treatments during the last
weeks of his time at IEP. His final visit to us was followed by his transfer to hospice, and then he died
a week after entering hospice.

He was put on a series of different chemotherapy treatments; one of them, which unfortunately caused
apparent allergy reaction with significant itching, did result in shrinkage of the lung tumors (this was
about 9 months into the treatments). He also developed persistent shortness of breath and coughing
that may have been from the presence of the tumors despite their shrinking, or as a reaction to
chemotherapy; this symptom was alleviated to some extent by acupuncture. Unlike most of the other
patients described here, because of the focus on the lung symptoms, he less frequently received the
foundational acupuncture protocol that was given when lying face up, and tended to receive more
points aimed at alleviating breathing problems, with several back points, such as the extra point
dingchuan and Bladder Meridian points (e.g., BL-7, BL-12, BL-13, along with frequent use of KI-3).
For several session, he would sit up for treatment to make it easier to access all the points at once. He
sometimes received needles at the standard points, with frequent addition of chize (LU-5). Overall, he
suffered from fatigue, nausea, and shortness of breath, and then with pain. Though he struggled with
various side effects of the chemotherapy regimens and radiation treatments, he responded well to
acupuncture to keep the symptoms under some control.

After about two years, one of the chemotherapies he tried was an experimental one and he was
convinced that he received the placebo; regardless, his study participation was suspended because his
tumors were growing. Switching then to another chemotherapy, his symptoms stabilized, and his
shortness of breath was better. This stability remained for several months, and his CAT scan showed
the cancer to be stable as well; his blood lab results also looked good. Unfortunately the tumor at his
spine then began growing, so radiation was resumed for that and a tumor in his fibula was also found,
which was likewise treated with radiation. A new drug regimen was also tried, since the former drug
seemed to be losing its beneficial effects, as demonstrated by the growth of these bone metastases. It
was at the time of this transition in medical treatments, with failure of the newly introduced drug to
have substantial tumor-shrinking effects, that he began showing deterioration, with worsening lung
condition, pleural effusion, loss of muscle mass, and increased pain due to bone cancer; he died a few
weeks later, just ten days after his last visit to IEP.

The situation that overwhelmed him was the failure to control the tumor growth more so than the
cumulative impact of multiple drastic cancer drugs and radiation. Most likely, his lungs became unable
to provide sufficient oxygen and even though he was put on oxygen at the hospital, this did not suffice
because of his deteriorated physical condition associated with low appetite and insufficient nutrition.

9. Patient LS, a 57-year-old woman, was diagnosed with stage 4 ovarian cancer three months before
coming to the clinic; she had surgery and started chemotherapy during the month prior to her first
acupuncture session, and was suffering from significant side effects; she was also losing weight. The
cancer had spread over several areas, so that even though she had hoped to discontinue chemotherapy,
it was deemed a necessary treatment; at one point she underwent chemotherapy for a tumor at her left
shoulder. She had 125 acupuncture treatments and 41 shiatsu sessions over a period of 13 months.
She was highly symptomatic at every visit: fatigue, nausea, loss of appetite, constipation, poor sleep,
heartburn, lung congestion, cough, costal pain, and low back pain. Acupuncture and other therapies
helped her manage these symptoms, but could not overcome them; they kept her functioning and there
were occasional reports of her “doing good” or “feeling better emotionally” or that her “back is better.”
Specific benefits were suggested: “ear points helping nausea” as well as general ones, such as this
comment relayed by a shiatsu practitioner nearly four months into the IEP clinical program: “feels like
she is doing well, shiatsu and acupuncture helping a lot.” About two months before her last visit, she
seemed to recognize that she had lost the battle with cancer and practitioners frequently charted her as
being “teary” and “crying” and having experience of panic and anxiety, being overwhelmed; sadness,
and depression. Nonetheless, she kept coming to the clinic regularly until just a few weeks before she
died.

She came on average twice per week for acupuncture as we had recommended, and though she suffered
many symptoms, she had functioned quite well until about three months before her death. In this case,
the turning point appeared to be a dramatic loss of control over her situation, where she became highly
emotional and somewhat disoriented. The chemotherapy, and, perhaps the cancer itself, may have
affected her brain functions, and her situation was not helped by the fact that she developed oral thrush
and then needed considerable dental work, including a root canal. This patient had not been healthy
prior to her cancer diagnosis, having suffered long-term asthma, sinus allergies, and GERD. She had
not given up hope on cancer treatment; even two months before her death, she had been given the
option of palliative care (end of life care) or another try at chemotherapy, and she chose the latter.

10. Patient CM had come to our clinic many years ago, following a 1999 diagnosis of breast cancer
detected during a routine mammogram at age 62. She had a modified mastectomy at that time. Her
cancer was in remission and she came back to the clinic for treatment of other non-cancer related
conditions and health maintenance. Then, more than ten years after her first cancer diagnosis, she came
to the clinic for adjunctive cancer treatment when she was diagnosed with a recurrence of breast cancer
(age 73): she was scheduled at that time for a full mastectomy and then chemotherapy. There were
findings of cancer cells in the lymph nodes an partial evidence of metastatic sites. For the next 27
months, she came for acupuncture 95 times, but especially tried to arrange to have shiatsu, which she
had 65 times. She completed the program in good health; after that, she left on a trip overseas for five
weeks and on her return dropped into IEP for just a couple of follow-up treatments. She is alive today
at age 76.

Her chemotherapy resulted in fatigue and neuropathy, but these had largely resolved once those
treatments ended (some permanent peripheral neuropathy as evident), with her main complaints being
various aches and pains, many of them from physical activities she undertook rather than the
consequences of cancer treatment. Typical of her favorable reports was a practitioner note indicating:
“Doing well, energy better, and walking 2 miles consistently.” This report was six weeks after a course
of side effect laden chemotherapy had been completed. While recovery from its side effects is to be
expected even without intervention, her recovery was remarkably fast: she was beginning to feel
notably better just two weeks after the last chemo treatment. Notes reporting her doing very well are
found intermittently throughout the years of treatment.

The basis for her good outcomes include limited aggressiveness of the cancer she had, with a long
period of remission after the first treatment, and the fact that she was able to remain physically active.
She followed the treatment schedule suggested at our clinic, and pursued several naturopathic
recommendations, and she underwent regular testing by her oncologist, taking the medications and
supplements prescribed by her doctors. These factors likely contributed to her remaining in overall
good health despite suffering somewhat from the immediate reactions to chemotherapy.

References
1. Huang Yarong, compiler, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, volume 2,
1996 New World Press, Beijing.
2. Carmady B and Smith CA, Use of Chinese medicine by cancer patients: a review of surveys. Chinese Medicine
2011; 6:22.
3. Dharmananda S, Zen Shiatsu: The Legacy of Shizuto Masunaga, ITM online articles, 2002:
http://www.itmonline.org/arts/shiatsu.htm
4. Dharmananda S, Countering the Side-effects of Modern Medical Therapies with Chinese Herbs, ITM online
articles, 1998: http://www.itmonline.org/arts/sidefx.htm
5. Dharmananda S. Millettia (jixueteng), ITM online articles, 1999: http://www.itmonline.org/arts/millettia.htm.
6. Yu Huichan and Han Furu, Golden Needle Wang Leting, 1997 Blue Poppy Press, Boulder, CO
7. Dharmananda S. Zusanli: Stomach-36, 1998 ITM online articles: http://www.itmonline.org/arts/zusanli.htm
8. Lee M, Insights of a Senior Acupuncturist, 1992 Blue Poppy Press, Boulder, CO.
9. Sun BM, et.al., Acupuncture versus metoclopramide in treatment of postoperative gastroparesis syndrome in
abdominal surgical patients: a randomized controlled trial, Journal of Chinese Integrative Medicine. 2010;
8(7):641-644.
10. Zhu B, Wang HC, Case Studies from the Medical Records of Leading Chinese Acupuncture Experts, 2010
Singing Dragon, Philadelphia, PA.
11. Dharmananda S, Towards a Spirit at Peace, 2005 ITM Publications, Portland, OR; also available at ITM online
articles: http://www.itmonline.org/shen/index.htm
12. He, QY et.al. A controlled study on treatment of mental depression by acupuncture plus TCM medication, Journal
of Traditional Chinese Medicine 2007; 27(3): 166-169.
13. Zhao JH and Sang P, Clinical observation on acupuncture treatment of depressive neurosis in 30 cases, Journal of
Traditional Chinese Medicine 2006; 26(3): 191-192.
14. Kasymjanova G, et.al. The potential role for acupuncture in treating symptoms in patients with lung cancer: an
observational longitudinal study, Current Oncology 2013; 20(3):152-157
15. Feng Yu, et.al. Clinical research of acupuncture on malignant tumor patients for improving depression and sleep
quality, Journal of Traditional Chinese Medicine 2011; 31(3): 199-202.

September 2013

Five Zone Acupuncture

Adjunct Cancer Therapies at IEP Clinic
Feng: The Meaning of Wind in Chinese Medicine
Triple Burner (Sanjiao)
Restructuring American Acupuncture Practices
An Introduction to Acupuncture and How it Works
Ma Danyang's 12 Acupoints: Valuable Points for Acupuncturists...
Synopsis of Scalp Acupuncture
Electro-Acupuncture
Moxibustion: Practical Considerations for Modern Use of an Ancient Technique
Bleeding Peripheral Points: An Acupuncture Technique
Acupuncture and Herbs for Mind/Brain Disorders I: Acupuncture
The Significance of Pulse Diagnosis in the Modern Practice of Traditional Chinese Medicine
Acupuncture Treatment of Asthma
Fengchi (Gallbladder-20)
Neiguan (Pericardium-6)
Zusanli (Stomach-36)
Cupping