I. "Righteous Qi" and the Theory of "Qi Deficiency Causing Disease"

I. "Righteous Qi" and the Theory of "Qi Deficiency Causing Disease" The body's "righteous qi," also known as "true qi," is described in the "Spiritual Pivot · On True Qi and False Qi" as: "True qi is what we inherit from heaven and is supplemented by the qi of food, filling the body." Thus, true qi comprises both innate and acquired components. Over the centuries, physicians have attributed the innate component to the kidneys, calling it "original qi" (yuan qi); the acquired component to the spleen and stomach, calling it "middle qi" (gu qi). Part of the middle qi combines with respiratory qi, accumulating in the chest's qi sea, called "ancestral qi." The "Spiritual Pivot · On Invading Pathogens" states: "Ancestral qi accumulates in the chest, rises through the throat, runs through the heart and veins, and facilitates respiration." Thus, ancestral qi embodies both respiratory movement and circulatory power. Another part of the middle qi originates in the middle jiao, traveling within the vessels; its nature is gentle and smooth, called "nutrient qi." Yet another part of the middle qi comes from the upper jiao, traveling outside the vessels; its nature is swift and slippery, called "defensive qi." Therefore, the body's "righteous qi" consists of yuan qi, gu qi, ancestral qi, nutrient qi, and defensive qi, with nutrient qi, defensive qi, and ancestral qi being aspects of the middle qi. Building on the "qi deficiency causes disease" concept emphasized in the "Inner Canon," physicians over the centuries have gradually enriched this idea through long-term clinical practice, ultimately forming the TCM theory of "qi deficiency causing disease." Jiang Hanzheng said: "Wherever evil qi gathers, qi must be deficient; evil qi takes advantage of the deficiency to invade, making deficiency the root and evil the symptom." Zhu Danxi said: "Whenever evil qi invades, it must be due to the deficiency of righteous qi, otherwise evil qi cannot take hold. If righteous qi is strong, evil qi has no chance to invade." Zhang Jingyue said: "There has never been a case where righteous qi recovers but evil qi does not retreat, nor has there ever been a case where righteous qi is exhausted but life does not end." These statements clarify TCM's view that "righteous qi" is the root of disease, thus forming the TCM theory of "qi deficiency causing disease." II. "Righteous Qi" and "Immunity" In general, the "righteous qi" referred to in TCM represents the body's intrinsic disease-resistant capacity, equivalent to the physiological functions of the immune system. The immune system comprises non-specific immunity and specific immunity. Non-specific immunity is innate, with a non-selective defense mechanism that acts against various pathogenic factors to varying degrees, including normal physiological functions such as the skin-mucosal barrier, blood-brain barrier, blood-fetal barrier, reticular endothelial cells, phagocytic action of neutrophils, as well as lysozyme, complement, and interferon present in bodily fluids. Specific immunity is acquired, targeted, and only effective against certain pathogenic factors, including the immune-active T cells and their associated lymphokines that eliminate corresponding antigens, as well as antibodies present in bodily fluids that correspond to different antigens (immune-active globulins). Shan

In TCM's "righteous qi," "defensive qi" is similar to non-specific immunity. The "Spiritual Pivot · On the Storage of Qi" states: "Defensive qi warms the muscles, nourishes the skin, enriches the pores, and controls opening and closing." It also says: "When defensive qi is balanced, the muscles become relaxed, the skin soft, and the pores tight." This shows that defensive qi is an important factor in eliminating external pathogenic factors in peripheral tissues such as muscles, skin, and mucous membranes, acting as a skin-mucosal barrier. Defensive qi can vigorously resist invading pathogens, and the intense struggle between the two gives rise to disease. The "Plain Questions · On Symptoms" says: "Where defensive qi is present, it combines with evil qi to cause disease." This phenomenon is similar to the immune response triggered when phagocytes engulf pathogenic microorganisms. Sometimes defensive qi can even surround invading "evil qi," forming local abscesses, just as the "Plain Questions · On Wind" says: "Wind enters the meridians along with the sun, spreads between the muscles, interacts with defensive qi, but the flow is obstructed, causing muscle inflammation and ulcers." The "Plain Questions · On Abscesses" also says: "When cold pathogens invade the meridians, blood stagnates... Stagnant blood cannot flow, and when defensive qi follows, it cannot pass through, leading to blockage and overheating. Excessive heat causes tissue decay, and decaying tissue turns into pus." This once again illustrates how similar defensive qi is to the phagocytic action of neutrophils and reticular endothelial cells in immunology. Defensive qi's role is not limited to skin, muscles, and pores; it also protects internal organs. The "Spiritual Pivot · On the Flow of Defensive Qi" states: "It starts in the yin, often flows from the foot's Shaoyin meridian to the kidney, from the kidney to the heart, from the heart to the lungs, from the lungs to the spleen, and back to the kidney, completing a cycle." This shows that defensive qi can travel through all the organs and meridians, similar to the dispersed reticular endothelial system and the systemic immune system circulating throughout the body. The "Plain Questions · On Arthritis" says: "Defensive qi is the vigorous qi of water and grain... It permeates the peritoneum,

spreads through the chest and abdomen, and if it encounters resistance, it causes disease; if it finds support, it heals." This shows that wherever defensive qi travels, it fights against evil qi—if it cannot win, disease occurs, which is what we call "resistance"; if it defeats evil qi, disease is cured, which is what we call "support." This is similar to the outcome of immune responses triggered when pathogenic factors enter the body. The above discussion shows that defensive qi in righteous qi has a function similar to non-specific immunity in modern immunology.

In "righteous qi," "original qi" is similar to specific immunity. Original qi is kidney qi, encompassing both kidney yin and kidney yang, and is the decisive factor in maintaining the body's internal yin-yang balance. The "Plain Questions · On the Harmony of Vital Energy and Heavenly Qi" states: "When yin is balanced and yang is concealed, spirit is maintained; when yin and yang are separated, vital energy ceases." This indicates that yin-yang balance is a prerequisite for maintaining the body's normal physiological state. Once yin-yang balance is disrupted, the body falls ill and may even die. Modern immunology holds that the functions of T cells dependent on the thymus and B cells independent of the thymus are the main factors constituting specific immunity, or adaptive immunity, and that the precursors of these two types of cells are stem cells located in the bone marrow. The "Plain Questions · On the Great Principle of Yin and Yang" says: "Kidneys generate bone marrow," from which it can be inferred that stem cells in the bone marrow differentiate into T cells and B cells, and that the functional states of these two cell types are closely related to the "kidneys." Therefore, it is conceivable that by regulating kidney yin and kidney yang, one can improve the body's specific immune response. Modern TCM experimental research proves that what we call kidney yin and kidney yang are actually functions of the hypothalamus-pituitary-adrenal cortex system. Modern immunology believes that the pituitary-adrenal cortex system promotes adrenal cortical secretion through ACTH, thereby reducing and suppressing immune responses; it also uses growth hormone secreted by the pituitary to increase and promote immune responses②. This system is further maintained by antigens, antibodies, lymphokines, and the nervous system, ensuring hormonal balance and stable immune function. In summary, TCM's "righteous qi" carries the meaning of immune function in modern immunology. "Defensive qi" in "righteous qi" is equivalent to non-specific immunity; "original qi" is equivalent to specific immunity. The body's immune process has three functions: 1) physiological defense, 2) self-stabilization, 3) immune surveillance. These three functions are jointly undertaken by non-specific immunity and specific immunity, which coordinate with each other and work together. For the same body and the same organ tissues, the immune function produced is the result of the combination of non-specific and specific immunity—just like defensive qi and original qi coexist to form the body's righteous qi. III. Strengthening the Body and Nurturing the Root: Immunotherapy

Since the body's "righteous qi" is equivalent to the immune system, strengthening the body and nurturing the root undoubtedly has the significance of immunotherapy. Defensive qi is born from water and grain, originating from the spleen and stomach; judging from its origin, it can be considered another aspect of middle qi. Based on this, using the "tonify middle qi and benefit qi" method can strengthen defensive qi's ability to expel evil qi. The traditional TCM practice of using Bu Zhong Yi Qi Tang to treat and prevent colds in weak individuals is a clinical application of this idea. In recent years, domestic experimental research has shown that Bu Zhong Yi Qi Tang can indeed improve protein metabolism in tumor-bearing bodies and enhance the body's resistance⑧. The Isotope Laboratory of the Beijing Tuberculosis Research Institute injected animals intravenously with iodine-131 labeled plasma protein colloidal solution, measuring the clearance rate in the blood as an indicator of the reticular endothelial system's phagocytic function, discovering

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Input: Currently, qi-tonifying herbs such as Codonopsis pilosula, Atractylodes macrocephala, and Astragalus membranaceus (the basic ingredients of Buzhong Yiqi Tang) have been shown to enhance the phagocytic function of the reticuloendothelial system; in contrast, the control group consisting of herbs that nourish yin and clear heat, such as Glehnia littoralis, Lilium brownii, Fritillaria thunbergii, and Scutellaria baicalensis, did not exhibit this effect④. Furthermore, experiments have demonstrated that Codonopsis pilosula can increase the number of white blood cells in peripheral blood⑤; additionally, another experiment showed that injecting Codonopsis pilosula extract into rabbits can elevate the proportion of neutrophils in peripheral blood⑥. These two studies suggest that Codonopsis pilosula, by tonifying middle qi, can strengthen the defensive function of white blood cells. The Guang’anmen Hospital of the China Academy of Traditional Chinese Medicine measured the phagocytic activity of macrophages in 89 patients with malignant tumors, finding that their phagocytic rates were significantly lower than those of healthy individuals, indicating that the non-specific immune function of diseased organisms is weaker than normal. Among them, five cervical cancer patients who received Fu Zheng therapy with spleen-strengthening and qi-tonifying effects all showed a significant increase in macrophage phagocytic function⑦, suggesting that the Buzhong Yiqi method can enhance the body’s non-specific immune function. The Shanghai Acupuncture Treatment Mechanism Research Group reported that after acupuncture at Zusanli for 2–4 hours in rabbits, the white blood cell count increased markedly; however, no changes in white blood cells were observed when stimulating Shangjuxu or Chengshan points, or when applying skin stimulation, nerve stimulation, or non-acupoint needling⑧. This indicates that only Zusanli (located on the Foot Yangming Stomach Meridian), which can regulate spleen and stomach functions (middle qi and defensive qi), can improve the body’s non-specific immune function, whereas other meridian points do not have this effect. From the above data, it can be seen that using TCM methods to tonify middle qi and regulate defensive qi can enhance the phagocytic functions of macrophages, neutrophils, and the reticuloendothelial system, suggesting that this therapeutic approach has the effect of promoting non-specific immune function. As for improving specific immune function, numerous experiments have shown that TCM kidney-tonifying therapies often achieve this goal. The Shanghai Cancer Research Institute used crude fetal alpha-fetoprotein as an antigen to immunize rabbits, inducing an immune response, then divided the animals into groups receiving kidney-yin-tonifying drugs and kidney-yang-tonifying drugs for antibody measurement. The results showed that yang-tonifying drugs could accelerate antibody formation, while yin-tonifying drugs could prolong antibody survival◎, indicating that kidney-tonifying therapies can improve specific humoral immune function. Some researchers conducted rose flower test on patients with chronic bronchitis due to kidney deficiency to measure their specific cellular immunity, finding that the ratio of T cells in these patients was generally low; after administering kidney-tonifying traditional Chinese medicines, the T cell ratio gradually increased, and clinical symptoms also improved accordingly. Others, from the perspective of specific humoral immunity, measured the IgA content in sputum from patients with chronic bronchitis, finding that after treatment with kidney-tonifying drugs such as rabbit placenta, the IgA content in patients’ sputum tended to increase①. The First Outpatient Department of the Chengdu Military Region conducted serum IgA and IgG measurements on more than 50 patients with chronic bronchitis due to kidney deficiency, finding that both values were below normal: IgA averaged 71.62 mg%, while IgG averaged 596.30 mg% (normal range: 1000–2000 mg%). After applying warming and tonifying kidney-yang drugs via navel patches, the above indicators all increased to varying degrees②, further demonstrating the regulatory effect of warming and tonifying kidney-yang on specific humoral immunity. In clinical trials, some researchers used in vitro lymphocyte transformation tests to study chronic bronchitis, finding that yang-tonifying drugs could increase the lymphocyte transformation rate in patients with chronic bronchitis③; others used compound yang-tonifying drugs to treat nasopharyngeal carcinoma patients, also observing an increase in lymphocyte transformation rate①. These two experimental results indicate that yang-tonifying drugs can promote and regulate the transformation of lymphoblasts within T cells and the release of lymphokines, thereby enhancing the body’s cellular immunity. In summary, among the medicinal formulas used to adjust immune function, qi-tonifying and spleen-strengthening formulas can enhance the body’s defensive qi, essentially focusing on regulating and promoting non-specific immunity; kidney-tonifying drugs can regulate the body’s original yin and original yang, essentially focusing on promoting specific immunity. According to TCM theory, defensive qi belongs to postnatal qi, while kidney qi belongs to prenatal qi. Modern medicine views non-specific immunity as being determined by innate factors, while specific immunity is acquired later; although the terminology does not fully match, both perspectives acknowledge the roles of innate and acquired factors, which is no coincidence. TCM believes that although prenatal qi and postnatal qi are fundamentally different, they are physiologically complementary and mutually reinforcing—Li Dongyuan pointed out in “On the Spleen and Stomach” that “original qi cannot be nourished without stomach qi.” Later developments have suggested that if prenatal qi lacks the support of postnatal qi, it will inevitably become depleted; similarly, if postnatal qi lacks the guidance of prenatal qi, it will stagnate and fail to function properly. Modern medicine also views non-specific immunity and specific immunity as mutually reinforcing. It can be said that specific immunity is built upon non-specific immunity, but it can also strengthen or weaken non-specific immunity; in fact, the two work together within the body—for example, complement, as a factor of non-specific humoral immunity, can broadly enhance and promote the bactericidal action of immunoglobulins in specific humoral immune components; meanwhile, various lymphokines released by T cells, as factors of specific cellular immunity, can widely promote the phagocytic functions of macrophages and the reticuloendothelial system. Based on these views, it can be considered that tonifying middle qi can enhance the body’s non-specific immunity, which is its primary aspect, but it is also beneficial for promoting specific immunity; similarly, tonifying kidney qi can enhance the body’s specific immunity, which is its primary aspect, but it is also beneficial for promoting non-specific immunity.

IV. Fu Zheng Pei Ben Therapy for Immune Diseases