The Doctrine of "Vital Energy" and "Pathogenic Qi Deficiency"

The Doctrine of "Vital Energy" and "Pathogenic Qi Deficiency"

The human body's "vital energy," also known as "true qi," is described in the "Spiritual Pivot·On the Puncture of True Evil" as follows: "True qi is what one receives from heaven, combined with the qi of food and drink, filling the body." True qi encompasses both innate and acquired aspects. Throughout history, physicians have attributed the innate aspect to the two kidneys, calling it "original qi" (primordial qi); they have attributed the acquired aspect to the spleen and stomach, calling it "middle qi" (food qi). Part of the middle qi combines with respiratory qi, accumulating in the sea of qi in the chest, called "ancestral qi." The "Spiritual Pivot·On the Guest of Evil" states: "Ancestral qi accumulates in the chest, emerges from the throat, runs through the heart vessels, and facilitates respiration." Thus, ancestral qi has the meaning of both respiratory movement and blood circulation power. Another part of the middle qi originates in the middle jiao, flows within the meridians, and is gentle and smooth, called "nutritive qi"; another part originates in the upper jiao, flows outside the meridians, and is brisk and slippery, called "defensive qi." Therefore, the human body's "vital energy" consists of original qi, middle qi, ancestral qi, nutritive qi, and defensive qi, with nutritive qi, defensive qi, and ancestral qi all being aspects of middle qi.

Building upon the "Inner Canon's" emphasis on the pathogenic role of vital energy deficiency, physicians throughout history have gradually enriched this view through long-term clinical application, thus forming the TCM doctrine of "pathogenic qi deficiency." Jiang Hanzheng said: "Wherever evil gathers, the qi must be deficient; evil takes advantage of the deficiency to enter—deficiency is the root, evil is the symptom." Zhu Danxi said: "Whenever evil invades, it must first exploit the deficiency of vital energy before it can take hold; if vital energy is strong, evil has no way to enter on its own." Zhang Jingyue said: "There has never been a case where vital energy recovers but evil does not retreat, nor has there ever been a case where vital energy is exhausted but life remains unshaken." These statements clarify TCM's diagnostic viewpoint that "vital energy is the root," thereby establishing the TCM doctrine of "pathogenic qi deficiency."

80 Pei Zhengxue's Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

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Part One: Academic Thought

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Dead. 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 Theory of Yin-Yang Correspondence" states: "The kidneys generate bone marrow," from which it can be inferred that the transformation of stem cells in the bone marrow into T cells and B cells, as well as the functional state of these two types of cells, are closely related to the "kidneys."

Therefore, by regulating kidney yin and kidney yang, one can improve the body's specific immune response. Modern TCM experimental research proves that what is referred to as kidney yin and kidney yang is, in essence, the function of the hypothalamus–pituitary–adrenal cortex system. Modern immunology believes that the pituitary–adrenal cortex system promotes adrenal cortical secretion through the action of ACTH, thereby reducing and suppressing immune responses; at the same time, it increases and promotes immune responses through growth hormone secreted by the pituitary. Moreover, this system is influenced by antigens, antibodies, lymphokines, and the nervous system, maintaining its own endocrine characteristics and ensuring the stability of immune function. In summary, TCM's "vital energy" carries the meaning of immune function in modern immunology. "Defensive qi" within "vital energy" corresponds to non-specific immune function; "original qi" corresponds to specific immune function.

The body's immune process has three aspects of function: ① physiological defense; ② self-stabilization; ③ immune surveillance. The completion of these three functions is jointly undertaken by non-specific immunity and specific immunity, which coordinate with each other and work together. For the same organism and the same organ group, the resulting immune function is the product of the combination of non-specific immunity and specific immunity, just like how defensive qi and original qi coexist to form the body's vital energy.

Strengthening Vital Energy and Immunotherapy

Since the human body's "vital energy" is equivalent to the body's immune function, strengthening vital energy 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 method of tonifying the middle qi and benefiting qi can strengthen the defensive function of defensive qi. The traditional TCM use of Bu Zhong Yi Qi Tang to treat and prevent colds in weak individuals is precisely a clinical application of this view. In recent years, domestic experimental research has shown that Bu Zhong Yi Qi Tang can indeed improve protein metabolism in tumor-bearing organisms and enhance the body's resistance.

The Isotope Laboratory of the Beijing Tuberculosis Research Institute injected animals intravenously with a colloidal solution of ³I-labeled plasma proteins, measuring the clearance rate in the blood as an indicator of the phagocytic function of the reticuloendothelial system. They found that qi-tonifying herbs such as codonopsis, atractylodes, and astragalus (the basic ingredients of Bu Zhong Yi Qi Tang) have the effect of enhancing the phagocytic function of the reticuloendothelial system; in contrast, the control group consisting of ginseng, lily, fritillaria, and scutellaria, which nourish yin and clear heat, did not have this effect. There were also experiments showing that codonopsis can increase the number of white blood cells in peripheral blood; furthermore, experiments proved that injecting rabbit with codonopsis extract can increase the proportion of neutrophils in peripheral blood. Both experiments demonstrate that codonopsis, which tonifies middle qi, can strengthen the defensive function of white blood cells.

The Guang'anmen Hospital of the Chinese Academy of Traditional Chinese Medicine measured the phagocytic function of macrophages in 89 patients with malignant tumors, and found that their phagocytic rates were significantly lower than those of normal people, indicating that the non-specific immune function of diseased organisms was lower than normal. Among them, five cervical cancer patients who received Fu Zheng therapy with spleen-strengthening and qi-benefiting effects saw a significant increase in the phagocytic function of their macrophages, demonstrating that Bu Zhong Yi Qi therapy can enhance the non-specific immune function of the body.

The Shanghai Acupuncture Treatment Group for Appendicitis reported that after needling the Zusanli point on rabbits for 2–4 hours, the number of white blood cells increased significantly; however, no change in white blood cell count was observed after needling Shangjuxu or Chengshan points, or after skin stimulation, nerve stimulation, or needling at non-acupoint locations. This indicates that only the Zusanli point (the Foot Yangming Stomach Meridian), which can regulate the functions of the spleen and stomach (middle qi and defensive qi), can improve the body's non-specific immune function; other meridian acupoints do not have this effect.

The above data show that using TCM methods to tonify middle qi and regulate defensive qi can strengthen the phagocytic functions of macrophages, neutrophils, and the reticuloendothelial system, revealing that this therapy 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 protein as an antigen to immunize rabbits, inducing an immune response, then divided them into groups to administer kidney-yin-tonifying drugs and kidney-yang-tonifying drugs for antibody testing. The results showed that yang-tonifying drugs could accelerate the formation of antibodies, while yin-tonifying drugs could prolong the survival time of antibodies, demonstrating that kidney-tonifying therapies can improve specific humoral immune function. Some researchers conducted rose bud tests 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-related herbal medicines, the ratio of T cells gradually increased, and the clinical symptoms improved accordingly. Others studied specific humoral immunity by measuring the IgA content in the sputum of chronic bronchitis patients, finding that it tended to increase.

The First Outpatient Department of the Chengdu Military Region administered serum IgA and IgG tests to over 50 patients with chronic bronchitis due to kidney deficiency, and found that their values were all below normal: IgA averaged 71.62 mg/dL (normal range 96–440 mg/dL), and IgG averaged 596.30 mg/dL (normal range 1000–2000 mg/dL). After applying warming and tonifying kidney-yang medicines, these indicators all increased to varying degrees. This demonstrates the regulatory effect of warming and tonifying kidney-yang on specific humoral immunity.

In clinical experiments, some researchers used in vitro lymphocyte transformation tests to study chronic bronchitis, finding that aphrodisiac drugs could increase the lymphocyte transformation rate of chronic bronchitis patients; others used compound aphrodisiac medications to treat nasopharyngeal cancer patients, also finding that they could increase the lymphocyte transformation rate. These two experimental results show that aphrodisiac 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 prescriptions for adjusting immune function, qi-tonifying and spleen-strengthening prescriptions can strengthen the body's defensive qi, essentially focusing on regulating and promoting the body's non-specific immunity; kidney-tonifying drugs can regulate the body's original yin and original yang, essentially focusing on promoting the body's specific immunity.

TCM believes that defensive qi belongs to postnatal qi, while kidney qi belongs to prenatal qi. Modern medicine believes that non-specific immunity is inherited from birth, while specific immunity is acquired later. Although the naming is not entirely consistent, both recognize the two factors of prenatal and postnatal origins, which is by no means accidental. TCM believes that although prenatal qi and postnatal qi are fundamentally different, they complement each other physiologically and are mutually interdependent. Li Dongyuan pointed out in his "Discourse on the Spleen and Stomach": "Original qi cannot be nourished without stomach qi." Later developments have shown that if prenatal qi lacks the enrichment of postnatal qi, it will inevitably lead to depletion and exhaustion;

Part One: Academic Thought

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If postnatal qi lacks the support of prenatal qi, it will become stagnant and unable to flow. Modern medicine also believes that non-specific immunity and specific immunity complement each other.

It can be said that specific immunity is built on the foundation of non-specific immunity, but it can also strengthen and weaken non-specific immunity; in fact, the two work together inside the body. For example, complement, as a factor of non-specific humoral immunity, can broadly strengthen and promote the bactericidal effect of immunoglobulins in specific humoral immune components; as a factor of specific cellular immunity, various lymphokines released by T cells can broadly promote the phagocytic function of macrophages and the reticuloendothelial system. Based on the above view, it can be considered that tonifying middle qi can enhance the body's non-specific immunity, which is its main aspect; however, it is also beneficial for promoting specific immunity. Tonifying kidney qi can enhance the body's specific immunity, which is its main aspect; however, it is also beneficial for promoting non-specific immunity.

Pei Zhengxue's Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

Published by Hefei Guoxue Publishing House

For treating this disease, the effective rate reaches as high as 95.5%. The formula is a combination of Liu Jun Zi Tang, Yu Ping Feng San, Psoralea corylifolia, and Zihéche, aimed at strengthening the spleen and benefiting qi, warming yang and tonifying kidney.

To observe the effect of this formula on the immune response in chronic bronchitis, sputum lysozyme levels were measured in some cases before and after a course of treatment. The results showed that after treatment, the patients' sputum lysozyme levels increased (P<0.001), indicating that Guben Wan has the effect of enhancing the body's non-specific humoral immunity.

The Shaanxi Provincial Institute of Traditional Chinese Medicine used cinnamon and processed Aconite to tonify the kidney, atractylodes and dried ginger to strengthen the spleen, along with white mustard seed, radish seed, and perilla seed to descend qi and eliminate phlegm, composing Tan Yin Wan to treat chronic bronchitis. The efficacy was very good. This formula was proven by animal experiments conducted by the provincial chronic bronchitis basic research collaboration group: the agglutination titer of rabbits given Tan Yin Wan was significantly higher than that of the control group, demonstrating that Tan Yin Wan can enhance the body's specific humoral immunity. The First Medical College of Shanghai and other institutions used raw rehmannia, cooked rehmannia, polygonatum, golden cherry, epimedium, and cornelian cherry to tonify the kidney, supplemented by atractylodes, yam, and tangerine peel to strengthen the spleen, producing Wen Yang Pian to treat this disease, achieving an effective rate of over 95%. Immunological experiments proved that patients treated with Wen Yang Pian had significantly higher serum immunoglobulin IgG and IgA levels compared with before treatment, and some patients' skin sensitivity tests turned from negative to positive. This shows that Wen Yang Pian, which strengthens the spleen and tonifies the kidney, has an improving effect on both specific and non-specific immunity.

2. Chronic Nephritis

The onset of this disease is often related to dysfunction of the body's immune stabilization function. Due to this dysfunction, the body loses the ability to distinguish between "self" and "non-self," mistaking its own tissues for foreign substances and producing corresponding antibodies, leading to abnormal immune reactions. Specifically, the body treats the glomerular basement membrane tissue as an antigen, producing corresponding antibodies that bind to the basement membrane, forming antigen–antibody complexes. Under the promotion of complement activation, inflammatory reactions occur, causing tissue damage in the renal parenchyma. This is an abnormal immune reaction dominated by specific immunity, but still involving non-specific immunity. TCM does not have a specific name for nephritis, but based on syndrome analysis, it falls under the category of "edema." Ming Dynasty scholar Zhang Jingyue said: "All cases of edema and similar syndromes are diseases related to the spleen, lungs, and kidneys. Since water is the ultimate yin, its root lies in the kidneys; when water turns into qi, its manifestation lies in the lungs; and since water fears earth, its control lies in the spleen. Now, when the lungs are weak, water fails to transform into essence and instead becomes water; when the spleen is weak, earth fails to control water and instead oppresses it; and when the kidneys are weak, water has no master and wanders aimlessly." ① This shows that the manifestation of this disease lies in the lungs, its root lies in the kidneys, 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 kidneys, characterized by deficiency and cold; the latter is more related to the lungs, characterized by excess and heat. Its clinical presentation is similar to acute nephritis in the former case and similar to chronic nephritis in the latter case. It can be seen that the key pathological signs of chronic nephritis still lie in the spleen and kidneys.

TCM treats this disease by strengthening the spleen with Bu Zhong Yi Qi Tang adjusted as needed; and by tonifying the kidney with Jisheng Shenqi Wan adjusted as needed, which happens to be an effective measure for regulating both non-specific and specific immunity. In 1965, at the National Chronic Nephritis Symposium held by the Chinese Academy of Traditional Chinese Medicine, it was proposed to focus on the classification of chronic nephritis based on spleen-kidney pathology, dividing it into kidney-yang-deficiency type and kidney-yin-deficiency type. ② Liaoning College of Traditional Chinese Medicine followed this classification and treated 100 cases of chronic nephritis with both spleen and kidney tonification, achieving complete remission in 33 cases, basic remission in 13 cases, and partial remission in 39 cases, with an overall effective rate of 85%. ② The 281st Hospital of the Chinese People's Liberation Army reported on the integrated Chinese-Western medicine treatment of 110 cases of chronic nephritis, with traditional Chinese medicine mainly focusing on tonifying the kidney and strengthening the spleen. Clinically, 67 cases were cured, accounting for 60.9%, 15 cases were basically cured, and 17 cases improved, resulting in an overall effective rate of 90%. The 51st Hospital of the PLA used Yan

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Pei Zhengxue's Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases

Published by Hefei Guoxue Publishing House

From a medical perspective, discussions similar to leukemia are often scattered across syndromes such as deficiency fatigue, consumption, blood disorders, and warm diseases. The "Spiritual Pivot·On the Sea" states: "When the marrow sea is insufficient, the brain spins, ears ring, legs ache, dizziness occurs, eyes cannot see, and one feels sluggish and wants to lie down." The "Essentials of the Golden Cabinet·On Deficiency Fatigue" says: "Men with pale complexions suffer from thirst and blood loss, sudden shortness of breath and palpitations, and floating pulses indicate internal deficiency." The "Miscellaneous Writings of Famous Doctors" states: "Men around twenty years old, once they damage their essence and blood, will inevitably develop symptoms of yin deficiency and fire stirring. Night sweats during sleep, afternoon fever, sticky phlegm and cough, fatigue and weakness, reduced appetite—even phlegm mixed with blood, hemoptysis, vomiting blood, or nosebleeds, sinking and rapid pulse, muscle wasting—this is called consumption, the most severe and difficult to treat." From these leukemia-like syndromes, it can be seen that this disease is primarily characterized by "deficiency." Qin Bowei believes: "Overall, leukemia is a deficiency syndrome. Although it sometimes involves external pathogens, it cannot be regarded as a typical real syndrome or exogenous syndrome." Yan Dexin also believes that "this disease is a deficiency syndrome; although it sometimes presents with phlegm-heat, warm heat, or blood stasis, it changes extremely rapidly. In fact, it is caused by deficiency, so it is a syndrome of deficiency as the root and excess as the manifestation." ⑨ This understanding is consistent with the Western medical view that immune function decline leads to disease. According to the doctrines of "the kidneys govern bones" and "the kidneys generate bone marrow," this disease should be related to kidney deficiency; according to the doctrine of "the middle jiao transforms qi into juice, which is called blood," this disease should be related to the spleen.

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Death of Yin is the extreme stage of Yin deficiency syndrome. According to the principle that "Yin deficiency generates internal heat," patients with death of Yin still exhibit symptoms similar to "internal heat," such as warm hands and feet and hot skin. However, as death of Yin progresses further, these internal heat symptoms may disappear due to the principles of "isolated Yin cannot generate life" and "isolated Yang cannot grow." Death of Yang can quickly lead to death of Yin, followed by death. Death of Yang is the extreme stage of Yang deficiency syndrome. According to the principle that "Yang deficiency generates external cold," patients with death of Yang still retain symptoms similar to "external cold," such as pale complexion, cold limbs, and feeling cold all over. However, as death of Yang advances, these external cold symptoms will worsen until life ends. All fatal cases ultimately end in death of Yang, meaning that death of Yin precedes death of Yang, but death of Yang follows rapidly. The Suwen's "On the Vital Energy and Heavenly Principles" states: "Yang energy is like the sky and the sun; if it loses its proper place, lifespan will be shortened and vitality will not be evident." Therefore, among death of Yin and death of Yang, death of Yin is a sign of critical condition, and the progression of death of Yin inevitably leads to death of Yang; of course, there are also cases where death of Yang appears first and then death of Yin follows quickly, as well as cases where both death of Yang and death of Yin occur simultaneously.

2. Exterior and Interior

Exterior and interior are two categories used to distinguish the depth of a disease. Generally speaking, diseases located in the exterior are superficial and mild, making them easier to treat; diseases located in the interior are deep and severe, making them harder to treat. Progression from exterior to interior indicates disease development and aggravation; progression from interior to exterior indicates disease alleviation and recovery. The former is considered "reverse," while the latter is considered "natural." In addition, there is also a semi-exterior, semi-interior syndrome, which refers to conditions where the disease location lies between the exterior and interior. Most syndromes related to the Shaoyang Gallbladder Meridian fall into this category.