II. Clinical Applications of the Spleen-and-Kidney-Tonifying Method

The Spleen governs the transportation and transformation of food and water, nourishing all the five zang organs, six fu organs, limbs, and bones; ancient sages referred to it as the "root of postnatal life." The Kidney is the source of essence and blood, the abode of primordial yin and yang, and was called the "root of prenatal life" by the ancients. The postnatal function of the Spleen depends on the warming influence of the Kidney's primordial fire, while the ascending function of the primordial yang relies on the moistening effect of the postnatal Spleen. Thus, it can be said: "Strengthening the Spleen is not as effective as strengthening the Kidney." Li Dongyuan also stated: "Strengthening the Kidney is not as effective as strengthening the Spleen." Although these two statements appear contradictory, they precisely reveal the extremely close intrinsic relationship between tonifying the Spleen and tonifying the Kidney. Zhang Jingyue elaborated on this relationship in even greater detail, saying: "At birth, a person's foundation lies in the source of essence and blood; after birth, nourishment comes from food and water. Without essence and blood, there would be no basis for the body; without food and water, the body could not grow strong. Essence and blood are governed by the Mingmen, while food and water are governed by the Spleen and Stomach. Therefore, the Mingmen receives primordial qi, whereas the Spleen and Stomach receive postnatal qi. Consequently, the sea of food and water primarily depends on the primordial, while the sea of essence and blood must rely on the postnatal for sustenance. Thus, from birth to old age, if one's primordial foundation is insufficient, as long as one receives postnatal nurturing, the effort to strengthen the primordial can achieve half of its intended effect." The Spleen and Kidney 36 complement each other, maintaining the growth and development of bodily functions; tonifying the Spleen and strengthening the Kidney can mutually reinforce each other, jointly promoting the abundance of righteous qi. In the struggle between pathogenic factors and righteous qi, this enhances the body's ability to expel pathogens, facilitating recovery from illness and restoring health. Based on this understanding, in many cases people have often combined "tonifying the Spleen" and "tonifying the Kidney" in clinical practice, a treatment known as the Spleen-and-Kidney-tonifying method. II. Clinical Applications of the Spleen-and-Kidney-Tonifying Method Disease is the product of the struggle between righteous qi and pathogenic factors, and the ebb and flow of the condition reflects the waxing and waning of these forces. Among the two pathogenic factors—deficiency of righteous qi and excess of pathogenic qi—TCM has always emphasized the primary role of righteous qi deficiency in causing disease, which has opened up broad avenues for the clinical application of the Spleen-and-Kidney-tonifying method. (1) Chronic Nephritis TCM does not have a specific term for nephritis, but based on syndrome analysis, it falls under the category of "edema." Zhang Jingyue said: "All conditions such as edema are diseases involving the Spleen, Lung, and Kidney. Water is the ultimate yin, so its root lies in the Kidney; water transforms into qi, so its manifestation lies in the Lung; water fears earth, so its control lies in the Spleen. When the Lung is deficient, water fails to transform into essence and instead becomes water; when the Spleen is deficient, earth fails to control water and instead overcomes it; when the Kidney is deficient, water has no master and runs wild." This illustrates that the manifestation of edema lies in the Lung, its root lies in the Kidney, and its control lies in the Spleen. Edema is further divided into yin water and yang water: the former is more related to the Spleen and Kidney, characterized by deficiency and cold; the latter is more related to the Lung, characterized by excess and heat. Clinically, the former is similar to chronic nephritis. It is evident that the focus of treating chronic nephritis should be on the Spleen and Kidney, with the main clinical approach being the Spleen-and-Kidney-tonifying method. Liaoning College of Traditional Chinese Medicine treated 100 cases of chronic nephritis using this method, achieving complete remission in 33 cases, near-complete remission in 13 cases, partial remission in 39 cases, for an overall effectiveness rate of 85%. The 281st Hospital of the People's Liberation Army reported on integrated TCM and Western medicine treatment of 110 cases of chronic nephritis, using the Spleen-and-Kidney-tonifying method for herbal medicine, resulting in 67 clinically cured cases, accounting for 60.9%, 15 near-cured cases, and 17 improved cases, for a total effectiveness rate of 90%. The author has also used the Spleen-and-Kidney-tonifying method in clinical practice to treat this disease, with consistently remarkable results. Patient Wu, male, 29 years old, developed acute nephritis four years ago, which progressed to chronic due to improper treatment. Over the past four years, he has experienced recurrent edema, with urinary protein consistently ranging from +~++++, and microscopic examination revealing red blood cells, white blood cells, and casts. In recent months, the edema has worsened, accompanied by fatigue, dizziness, lower back pain, aversion to cold, abdominal distension, nausea, and vomiting. Serum non-protein nitrogen is 115 mg, the tongue is swollen, pale, and has tooth marks, the coating is slightly yellow and greasy, and the pulse is deep, fine, and string-like. Based on the diagnosis of Spleen and Kidney yang deficiency, the Spleen-and-Kidney-tonifying method was applied, using ingredients such as Rehmannia, Cornus fruit, Chinese yam, Moutan bark, Poria, Alisma, Plantago seeds, Codonopsis, Atractylodes, Astragalus, Achyranthes, Cinnamon, Prepared Aconite, Imperata rhizome, Cicada slough, Motherwort, and Perilla stem, adjusted according to the patient’s condition. After taking more than 100 doses, all symptoms disappeared, serum non-protein nitrogen returned to normal, and routine urine tests showed only a small number of red blood cells under microscopy, with all other parameters normal. (2) Chronic Bronchitis TCM refers to this disease as "long-term cough" or "asthmatic cough," classifying it as internal injury cough; improper treatment of external invasion can lead to internal injury cough. This disease is triggered by external factors, causing repeated exacerbations. TCM has long recognized that "the manifestation lies in the Lung, while the root lies in the Spleen and Kidney." The "manifestation" refers to the symptoms, while the "root" refers to the underlying cause, indicating that treating the Spleen and Kidney is fundamental to curing this disease. Using the Spleen-treating method to treat chronic bronchitis is the traditional "nourishing earth to generate metal" approach; using the Kidney-treating method is the traditional "warming the Kidney to collect qi" approach; applying both methods simultaneously constitutes the Spleen-and-Kidney-tonifying method. For a long time, following this principle of syndrome differentiation and treatment, good therapeutic effects have been achieved in the prevention and treatment of chronic bronchitis. The Xiyuan Hospital of the Beijing Institute of Traditional Chinese Medicine achieved an efficacy rate of 95.5% using the Guben pill to treat this disease, a formula combining Six Gentlemen Decoction, Yupingfeng Powder, Psoralea corylifolia, and Purple River Horse, aimed at tonifying the Spleen and Kidney. The Shaanxi Provincial Institute of Traditional Chinese Medicine used Cinnamon, Prepared Aconite, Atractylodes, and Dried Ginger to formulate the Sanzi Yangqin Pill, also achieving good results in treating this disease. Judging from the composition of this formula, it still falls under the Spleen-and-Kidney-tonifying method. In the summer of 1978, the author encountered a silicosis patient, male, 60 years old, with facial edema, cyanotic lips, severe coughing and shortness of breath, thin and clear sputum, difficulty breathing (requiring intermittent oxygen), sensitivity to cold, intestinal rumbling and loose stools, abdominal distension and poor appetite, chest X-ray showing severe emphysema and right heart enlargement, indicating advanced silicosis. The pulse was deep and slippery, both尺 pulses were weak, the tongue was dark purple, and the coating was slightly yellow and greasy. Based on Spleen and Kidney yang deficiency and the Kidney's inability to collect qi, the Spleen-and-Kidney-tonifying method was applied, using Gui Fu Ba Wei Wan combined with Jinshui Liu Jun Jian, adjusted according to the patient’s condition. After taking more than 40 doses, most symptoms significantly subsided, and breathing became smoother. 38 (3) Tumors TCM believes that the key to the occurrence of this disease is "deficiency of righteous qi." The "Medical Essentials Read" states: "The formation of accumulations arises from insufficient righteous qi, allowing pathogenic qi to take hold." During the Song and Yuan dynasties, Zhang Yuanshi, Li Dongyuan, Luo Tianyi, and others all made similar arguments about "nourishing righteous qi to naturally eliminate accumulations." In recent years, reports of successful tumor treatment through righteous qi enhancement have been increasing. Longhua Hospital affiliated with Shanghai University of Traditional Chinese Medicine treated a case of advanced liver cancer using the Spleen-and-Kidney-tonifying method; after two months of ineffective Western chemotherapy, they switched to Chinese medicine, and the patient gradually improved, regaining spirit and having ascites resolved within three months before discharge. They also used this method to treat a case of advanced breast cancer, with the tumor completely disappearing after four months. In 1978, the author treated a case of mediastinal tumor: Mr. Ju, male, 48 years old, with chest pain and shortness of breath, inner restlessness, dry cough without phlegm, and occasional difficulty swallowing. X-ray confirmed a mediastinal tumor, approximately 10 cm × 9 cm in size. Given the large size of the tumor, surgery recommended conservative TCM treatment for a period, so the Spleen-and-Kidney-tonifying method was applied, using Liu Wei Di Huang Tang combined with Er Chen Tang, adjusted according to the patient’s condition. After taking more than 100 doses, the patient’s subjective symptoms completely disappeared, and X-ray confirmed that the tumor had shrunk to 4 cm × 5 cm. Subsequently, surgery removed an elliptical tumor measuring 3 cm × 4 cm × 6 cm, with a smooth surface and no adhesions. Pathology report: nerve fiber tumor. (4) Leukemia Qin Bowei said: "In general, leukemia is a deficiency syndrome. Although it may sometimes be infected by external pathogens, it cannot be regarded as a typical excess or external invasion syndrome." Yan Dexin also believed that "this disease is fundamentally a deficiency, though it may sometimes present with phlegm-heat, damp-heat, or blood stasis, but the condition changes very rapidly. In fact, it is caused by deficiency, making it a syndrome of deficiency at the root and excess at the manifestation." According to the theory that "the Kidney governs bone marrow production," this disease should be related to Kidney deficiency; and according to the theory that "the middle jiao receives qi and extracts juice to form blood," it should also be related to Spleen deficiency. In recent years, more and more places have been treating this disease using the Spleen-and-Kidney-tonifying method. Gu et al. used the Bu Zhong Yi Qi Tang for tonifying the Spleen combined with the Jian Bu Hu Qian Wan for tonifying the Kidney to treat a case of subacute myeloid leukemia, achieving good results. In 1967, the author admitted a case of acute monocytic leukemia, treating it with the Spleen-and-Kidney-tonifying method, heavily relying on Tai Zi Shen, Lu Dang Shen, Ginseng roots, and Bei Sha Shen to tonify the Spleen, and Liu Wei Di Huang Tang to tonify the Kidney, taking more than 400 doses, 39 achieving complete remission, and the patient has remained healthy for 15 years to date. (5) Aplastic Anemia In recent years, TCM’s understanding of this disease has increasingly leaned toward "deficiency at the root, excess at the manifestation." Since the disease is caused by impaired hematopoietic function of the red bone marrow, and given that "the Kidney governs bone marrow production," Kidney deficiency should be related to this disease. TCM also has the theory that "the middle jiao receives qi and extracts juice to form blood," linking this disease to Spleen deficiency as well. Shanghai University of Traditional Chinese Medicine’s Shuguang Hospital treated 82 cases of chronic aplastic anemia using the Spleen-and-Kidney-tonifying method, achieving an efficacy rate of 91.46%, significantly higher than the control group treated with other Chinese medicines or combined TCM and Western medicine. Pei Shen believes that "the Kidney governs bone marrow, while the Spleen governs the extremities," emphasizing that tonifying the Kidney can improve bone marrow hematopoiesis, and tonifying the Spleen can enhance peripheral blood counts. Therefore, he proposed that tonifying the Kidney and Spleen is the main principle for treating aplastic anemia, and the author also follows the Spleen-and-Kidney-tonifying method when treating aplastic anemia. In June 1975, the author treated a patient named Sun, male, 20 years old, with pale complexion, extreme fatigue, loss of appetite, five-heart restlessness, bone-steaming heat, night sweats, dizziness, palpitations, poor sleep, frequent dreams, and scattered bleeding points on gums and skin throughout the body. Hemoglobin was 5 g, red blood cells 1.7 million/mm³, platelets 29,000, white blood cells 1,700/mm³. Bone marrow examination showed a significant reduction in all three cell lines, with a relative increase in lymphocytes. Using the Spleen-and-Kidney-tonifying method, with Codonopsis, Atractylodes, Astragalus, Poria, Rehmannia, Cornus fruit, Moutan bark, Cinnamon, Polygonatum, Anemarrhena, Phellodendron, Prepared Aconite, and Chicken Blood Vine, adjusted according to the patient’s condition, a total of more than 100 doses were taken, all symptoms subsided, hemoglobin rose to 10 g, white blood cells reached 4,100/mm³, platelets 68,000/mm³, and bone marrow examination showed significant improvement, allowing the patient to return to work. III. Discussion Through long-term clinical practice, traditional Chinese medicine has come to understand that "the Kidney governs the prenatal, while the Spleen governs the postnatal," and has adopted "tonifying the Spleen and Kidney" as a fundamental method for strengthening the body in clinical applications, enabling numerous diseases to heal. This is by no means accidental. Recent experimental studies have proven that the TCM concepts of "Spleen" and "Kidney" have the following significances: ① immune system; ② endocrine system; ③ metabolic system; ④ autonomic nervous system; ⑤ gastrointestinal and pancreatic digestive system. "Tonifying the Spleen and Kidney" indeed has the effect of improving the functions of these systems. In addition to primary diseases affecting these systems, all chronic illnesses can, to varying degrees, cause disturbances in these areas. Therefore, the scope of application for the "Spleen-and-Kidney-tonifying method" is extremely broad. Beyond the chronic bronchitis, chronic nephritis, tumors, leukemia, and aplastic anemia mentioned in this article, the "Spleen-and-Kidney-tonifying method" can treat chronic hepatitis, chronic prostatitis, chronic arthritis, various collagen diseases, diabetes, diabetes insipidus, chronic colitis, and many other conditions. The widespread use of this treatment fully demonstrates the superiority of TCM’s “treating different diseases with the same method,” and experimental research on this therapy eloquently reveals the scientific basis of TCM’s “treating different diseases with the same method,” thereby presenting the “Spleen-and-Kidney-tonifying method” to the public in a new light. Part I Academic Thoughts 41 A Critical Examination of Gui Zhi Shaoyao Zhimu Tang Pei Zhengxue Gui Zhi Shaoyao Zhimu Tang appears in the "Stroke and Arthralgia" chapter of the "Jin Kui Yao Lue," where it is written: "For pain in all joints, a frail body, feet swollen as if detached, dizziness and shortness of breath, and a feeling of warmth and nausea, Gui Zhi Shaoyao Zhimu Tang is the principal prescription." Throughout history, physicians have used this formula, with modifications, to treat various joint diseases with remarkable success. The formula aims to dispel wind and dampness, disperse cold, and relieve pain; it has proven effective in treating rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and other conditions. In my experience, replacing the Prepared Aconite with 15 g each of Sichuan Aconite and Wild Aconite dramatically increases the efficacy. Sichuan Aconite is a local specialty of Sichuan Province, while Wild Aconite is cultivated elsewhere; both have the same taste and properties, and their combination enhances each other’s effects, making the formula even more potent. The active ingredient in both is aconitine, including major aconitine and minor aconitine, which are highly toxic. However, heating to above 90°C for one hour completely destroys the toxic components while preserving the active ingredients. Therefore, when using 15 g each of Sichuan Aconite and Wild Aconite, they must first be decocted for one hour. Adding 20 g of Asarum to Gui Zhi Shaoyao Zhimu Tang echoes the formula of Ma Huang Fu Zi Asarum Tang, significantly enhancing the effect of Sichuan Aconite and Wild Aconite. However, since Asarum contains a large amount of safrole, which is toxic, it must also be decocted for one hour before use. Besides treating the aforementioned joint diseases, given that the "Jin Kui Yao Lue" mentions "dizziness, shortness of breath, and swelling of the feet" among the main symptoms, I have also used this formula to treat systemic lupus erythematosus with good results. Especially for patients who have been taking hormones for a long time and are heavily dependent on them, unable to stop abruptly, using Gui Zhi Shaoyao Zhimu Tang allows for a gradual withdrawal of hormones, further alleviating their suffering. 42 I believe that rheumatoid arthritis is a connective tissue disease, now classified as an autoimmune disorder. Specifically, it seems to belong to Type III hypersensitivity reactions, namely the binding and deposition of antigen-antibody complexes, triggering a series of pathological responses. Therefore, I expanded the application of this formula to scleroderma, Sjögren’s syndrome, Raynaud’s disease, subacute lupus, nephrotic syndrome, dermatomyositis, and other conditions, with most patients showing some therapeutic effect. In practice, I found that this formula has a clear immunomodulatory effect. Some patients had their immune indicators closely monitored before and after using the formula, such as IgM, IgG, IgA, CD3, CD4, and CD8, and all showed significant improvements, demonstrating the formula’s immunomodulatory effect. The composition of Gui Zhi Shaoyao Zhimu Tang is remarkably rigorous. Although the name includes Gui Zhi, Shaoyao, and Zhimu, Prepared Aconite is actually the main ingredient. Prepared Aconite (Aconite) is described as "the source of fire to dispel darkness," akin to "clearing the sky of ten thousand miles of dust." Type III hypersensitivity reactions involve repeated battles between antigens and antibodies, ultimately leading to mutual destruction and the formation of "darkness" and "dust." Gui Zhi promotes yang energy, ensuring it flows freely inside and out; Bai Shao restrains yin energy, preventing the subtle qi from dissipating along with the yang energy; Zhimu prevents the pungent heat of Aconite from damaging yang energy. These three ingredients work together around Aconite, each fulfilling its own role, ensuring that Aconite effectively sweeps away darkness and dust. By including them in the formula’s name, they serve as a guard for the commander-in-chief, keeping him safe in the command center while securing victory from afar. Ma Huang opens the pancreas to welcome sunlight; Atractylodes strengthens the middle jiao, Dried Ginger warms the middle jiao, and Licorice harmonizes the whole system. All three aim to strengthen the spleen and stomach, ensuring that Aconite’s army can march forward unimpeded. 43 Chinese Medicines and Plant Classification Pei Zhengxue There is a clear correlation between the taste and properties of Chinese medicines and plant classification. The taste and properties are also related to the medicinal effects of the herbs, so plant classification is closely linked to the clinical efficacy of Chinese medicines. To understand the clinical application of each herb, one must start with its plant classification. Commonly used Chinese medicines fall into the following families: ① Umbelliferae: Qianghuo, Duhuo, Fangfeng, Baizhi, Chaihu, Qianhu, Coriander, Gaoben, Danggui, Chuanxiong, etc.; ② Asteraceae: Dandelion, Bajiangcao, Ziwang, Donghua, Wild Chrysanthemum, Chrysanthemum, Qinghao, Niubangzi, Cang’erzi, Xiqiancao, Loulu, Yinchen, Peilan, Cangshu, Baishu, Da Xiao Ji, etc.; ③ Liliaceae: Yuzhu, Huangjing, Zhimu, Beimu, Shancigu, Tiandong, Maidong, Weirui, Lily, Tufuling, etc.; ④ Labiatae: Huangqin, Xia Kucao, Zisu, Bohe, Huoxiang, Motherwort, Danshen, Zelan, etc.; ⑤ Polygonaceae: Dahuang, Tudahuang, Heshouwu, Pianxu, etc.; ⑥ Ranunculaceae: Huanglian, Fupian, Aconite, Danpi, Bai Shao, Chi Shao, Weilingxian, etc.; ⑦ Fabaceae: Huangqi, Shandougen, Chixiaodou, Bailian, Gancao, Kushen, Geben, Buguzhi, Lubazi, etc.; ⑧ Rosaceae: Taoren, Xingren, ShanZha, Rose, Papaya, Citrus, Buddha’s Hand, Xianhecao, etc. The above lists eight families of commonly used Chinese medicines, which will now be analyzed as follows. Among the Umbelliferae herbs, Chaihu, Qianhu, Qianghuo, Duhuo, Baizhi, Fangfeng, Coriander, and Gaoben are all traditional wind-dispelling and dampness-eliminating medicines, with obvious exterior-releasing and pain-relieving effects. Only Danggui and Chuanxiong are traditional blood-tonifying and circulation-promoting herbs. Upon closer examination, these two herbs are often added to traditional headache remedies, because only the top of the head can be reached by wind, and these two herbs are both good at treating headaches and dispelling wind. There is an old saying: "Treat wind first, then activate blood; once blood is activated, wind will naturally disappear." This shows that since both herbs belong to the Umbelliferae family, they should share certain commonalities with other members of the family. 44 Among the Asteraceae herbs, Dandelion, Bajiangcao, Wild Chrysanthemum, Chrysanthemum, Qinghao, Niubangzi, Loulu, Yinchen, Da Xiao Ji, and Xiqiancao all have heat-clearing and detoxifying effects, indicating that the primary function of Asteraceae herbs is heat-clearing and detoxification. Although Cangshu, Baishu, Cang’erzi, and Peilan are not traditionally considered heat-clearing and detoxifying herbs, modern pharmacological research shows that Cang’erzi has a powerful inhibitory effect on Staphylococcus aureus; Cangshu extracts contain lactones I, II, and III, all of which have strong antibacterial and anti-inflammatory effects; Baishu essential oil has a noticeable inhibitory effect on esophageal cancer and ascitic cancer; Peilan has obvious clinical efficacy against intestinal infections, and experiments have proven that it also strongly inhibits intestinal viruses. These studies show that although Cangshu, Baishu, Cang’erzi, and Peilan are not traditionally considered heat-clearing and detoxifying herbs, their pharmacological actions do include heat-clearing and detoxification. Among the Liliaceae herbs, Yuzhu, Huangjing, Zhimu, Weirui, Lily, Tiandong, and Maidong are all traditional yin-tonifying herbs. Although Beimu, Shancigu, and Tufuling are not traditionally considered yin-tonifying herbs, Beimu has heat-clearing, lung-moisturizing, and phlegm-dissolving effects; Tufuling is a major heat-clearing and detoxifying agent; Shancigu clears heat and softens hard masses. All these herbs have heat-clearing effects, and since heat easily harms yin, clearing heat helps restore yin, thus also having yin-nourishing and yin-tonifying effects! Among the Labiatae herbs, Huangqin, Bohe, and Xia Kucao all have heat-clearing and fire-draining effects, serving as traditional heat-clearing and fire-draining or heat-clearing and detoxifying agents. Although Huoxiang and Zisu are not traditionally considered heat-clearing herbs, Huoxiang, in addition to regulating the gastrointestinal tract, has been shown by modern experiments to have a significant inhibitory effect on gastrointestinal fungi, as well as on leptospira and rhinovirus; Zisu, besides relieving cough and dissolving phlegm and clearing heat, has also been proven by modern experiments to have a strong inhibitory effect on Staphylococcus aureus and Shigella dysenteriae; Motherwort, Danshen, and Zelan all have blood-activating and stasis-resolving effects. Danshen clears heat, Motherwort cools blood and reduces swelling, and Zelan detoxifies—all of which also have fire-draining effects. According to recent experiments, all three herbs have varying degrees of antibacterial effects, indicating that Labiatae herbs all have direct or indirect heat-clearing and fire-draining effects. Among the Polygonaceae plants, Dahuang, Tudahuang, Heshouwu, and Pianxu all have fire-draining and dampness-eliminating effects, with Heshouwu additionally having blood-tonifying and marrow-filling effects. 45 Among the Fabaceae plants, Huangqi, Buguzhi, Geben, Lubazi, and Bailian either tonify qi, or tonify yang, or nourish essence, or elevate yang; Kushen, although a heat-clearing and dampness-drying agent, has been shown by modern pharmacological research to have a significant effect on raising white blood cells, thus also having qi-tonifying effects. Among the Rosaceae plants, Taoren, Xingren, ShanZha, Rose, Papaya, Citrus, Buddha’s Hand, and Xianhecao all have qi-moving and blood-activating effects, with Xingren relieving cough, ShanZha aiding digestion, Papaya eliminating dampness, and Xianhecao stopping bleeding and boosting qi—each has its own unique characteristics within the same category. Overall, herbs from the same family generally follow the principle of shared usage within the family, with differences arising from variations in genus and species. This is why there are similarities and differences within the same family. However, the effects of various herbs in the Ranunculaceae family differ greatly: Prepared Aconite and Aconite are intensely hot and yang-enhancing; Huanglian is extremely cold and fire-draining; Danpi and Chi Shao activate blood and clear虚热; Weilingxian, on the other hand, is a traditional wind-dispelling herb, with modern research showing it has a tremendous inhibitory effect on viruses. Herbs in this family have yet to be fully explored.