2. Endocrine Aspects

In recent years, materials combining organ differentiation with endocrinology are still mostly focused on the spleen and kidney.

The kidney is the foundation of innate vitality and the source of life, making it an extremely important organ for the human body. The “Su Wen·Shanggu Tianzhen Lun” says: “At seven years old, a girl’s kidney qi is strong, her teeth change, and her hair grows; at fourteen, she reaches puberty, the Ren channel opens, the Tai Chong channel becomes robust, and her menstruation occurs regularly, allowing her to bear children; at forty-nine, the Ren channel becomes weak, the Tai Chong channel declines, and the ‘puberty’ ends, the earth channel closes, and she loses her ability to bear children.” Shen Kuo also said: “Women without strong kidney qi have no power.” He even extracted sex hormone crystals of a certain purity from human urine, calling them “autumn stones,” used to treat diseases related to growth, development, and sexual characteristics (endocrine disorders). Clearly, traditional Chinese medicine has long attributed endocrine dysfunction to the kidney. After the Ming Dynasty, the Wen Nei school emerged, with more discussions about the kidney and Mingmen. Zhang Jingyue said: “Mingmen is the root of original qi, the abode of water and fire, and the yin qi of the five organs cannot be nourished without it, nor can the yang qi of the five organs be activated without it. Mingmen has a ‘fire state,’ which is precisely original yang, the fire of life itself.” These statements all indicate that the kidney and Mingmen are closely linked to the body’s energy metabolism. In the early 1960s, Shen Zi Yin and others at the First Medical College of Shanghai began experimental research aimed at clarifying the relationship between the kidney and adrenal gland endocrine systems. They first noticed that six different diseases—functional uterine bleeding, bronchial asthma, pregnancy toxemia, systemic lupus erythematosus, coronary heart disease, and neurasthenia—each exhibited clinical manifestations of kidney Yang deficiency at a certain stage of their development. At this point, if the same general kidney-tonifying therapy was administered, all six diseases would improve to some extent. From this, they inferred that there might be a common metabolic dysfunction in the pathological processes of these six diseases, and that this metabolic dysfunction was the internal factor, while the external manifestation was the kidney Yang deficiency syndrome. Kidney-tonifying therapy could alleviate and eliminate the kidney Yang deficiency syndrome, thereby undoubtedly regulating the internal metabolic dysfunction. Later, through a series of experiments, they finally discovered that patients with kidney Yang deficiency had significantly lower 24-hour urinary excretion of 17-hydroxycorticosteroids than normal; after kidney-tonifying treatment, the level returned to normal, and the kidney Yang deficiency syndrome also improved accordingly. The amount of 17-hydroxycorticosteroids in urine reflects the synthesis, secretion, and catabolism of adrenal cortical hormones in the body; any disruption in one of these three processes will lead to changes in the urinary 17-hydroxycorticosteroid levels. Such disruptions are usually closely related to the hypothalamus-pituitary-adrenal cortex system, leading to the conclusion that the TCM kidney, to some extent, has the functions of the hypothalamus-pituitary-adrenal cortex system; the TCM kidney deficiency syndrome, to some extent, is the external manifestation of insufficient hypothalamus-pituitary-adrenal cortex function; and kidney-tonifying therapy, to some extent, can improve the functions of the hypothalamus-pituitary-adrenal cortex system. Based on this conclusion, it becomes obvious why TCM kidney-tonifying therapy can treat many different diseases. Besides the aforementioned six diseases, the author frequently uses kidney-tonifying therapy to treat aplastic anemia, leukemia, tumors, hypertension, chronic nephritis, prostatitis, lumbar muscle strain, rheumatoid arthritis, and other conditions, all achieving varying degrees of clinical efficacy. With a clear understanding of the above mechanism, this provides an important avenue for exploring the reasons behind these therapeutic effects.

The spleen is the foundation of acquired vitality and, like the kidney, is another extremely important organ for the human body. Based on the principles that “the spleen governs transportation” and “it transforms waste into the five flavors,” people generally believe that the TCM spleen has the absorption and digestion functions of the modern medical small intestine. In recent years, the similarities between the spleen and the modern medical pancreas have gradually attracted attention, leading to a preliminary exploration of the relationship between the spleen and the endocrine system. The “Su Wen·Tai Yin Ming Lun Pian” says: “The spleen and stomach are connected by a membrane, yet they can transport their bodily fluids.” This shows that the anatomical location of the spleen is similar to that of the pancreas. The “Su Wen” also says: “Patients with spleen disease experience heaviness, hunger, and muscle wasting.” This is very similar to the symptoms of diabetes. Ming Dynasty scholar Zhang Jingyue once wrote:

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The above views were further developed, stating: "Zhongxiao refers to diseases of the middle burner; excessive eating leads to constant hunger, yet the body becomes increasingly emaciated. The root cause lies in the spleen and stomach, which is also known as 'xiaozhong' (《景岳全书》)." This clearly indicates that diabetes, a condition caused by endocrine dysfunction of the pancreatic islets, is one of the diseases of the spleen. In the past decade, modern medicine has discovered the gastrointestinal and pancreatic endocrine system. It began in 1964 when foreign researchers found that after infusing glucose solution into the duodenum, the blood insulin concentration rose rapidly, far exceeding the level achieved through intravenous glucose injection in the same organism. Subsequently, APVD cells with special endocrine functions were discovered in the mucosa of the upper small intestine. These cells secrete several peptide hormones (such as gastrin, glucagon, secretin, cholecystokinin, and enterogastrone), which enter the bloodstream to regulate digestion, absorption, storage, and breakdown. This regulatory function often operates under the participation of the vagus nerve. Together with the vagus nerve, this endocrine system is called the "gastrointestinal and pancreatic endocrine system." The spleen in traditional Chinese medicine performs functions very similar to this endocrine system. Hou Can from Sun Yat-sen Medical College, starting from analyzing symptoms of spleen deficiency such as excessive salivation, dampness, abdominal distension, loose stools, acid regurgitation, and nausea, believed that when spleen yang is deficient, vagal tone increases. Some studies measured the activity of true cholinesterase in patients with spleen yang deficiency and found it higher than in the normal control group, supporting this view. Hou Can also participated in measuring autonomic nervous function in 53 patients with chronic dysentery due to spleen deficiency and found that 53% had parasympathetic dominance, while only 5% had sympathetic dominance. Jiangsu New Medical College used isolated rabbit intestinal tube experiments to show that tonifying spleen formulas such as Buzhong Yiqi Tang could inhibit excessive intestinal peristalsis, further supporting the above viewpoint. In the aforementioned gastrointestinal and pancreatic endocrine system, the parasympathetic nervous system only serves to transmit information and regulate the secretion levels of its products. For example, hypoglycemic drugs promote increased insulin secretion, leading to hypoglycemia. When insulin secretion increases, this situation simultaneously triggers reflexive responses: ① increased gastrin secretion (promoting gastric acid and pepsin secretion), ② increased secretin secretion (promoting pancreatic enzyme release), ③ increased cholecystokinin secretion (promoting bile secretion). As a result, the activity of the "gastrointestinal and pancreatic secretion system" is fully mobilized, preparing for upcoming digestive and absorptive activities. This demonstrates that the spleen in traditional Chinese medicine, in terms of its digestive, absorptive, and metabolic functions, essentially plays a role similar to the modern medical "gastrointestinal and pancreatic endocrine system," with the pancreatic islet endocrine system being the main driver. The traditional Chinese medicine belief that diabetes is caused by spleen deficiency and the effectiveness of treating this disease with spleen-tonifying methods thus find their preliminary explanation.

Traditional Chinese medicine has always attached great importance to the relationship between the spleen and the kidneys. Zhang Jingyue said: "At the beginning of human life, the 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's formation; 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 innate qi, whereas the spleen and stomach receive acquired qi. Thus, the sea of food and water relies primarily on innate qi, while the sea of essence and blood must depend on acquired qi for sustenance. Consequently, from birth to old age, if one's innate foundation is insufficient, as long as one receives sufficient acquired nourishment, it can compensate for half of the innate deficiency." After clarifying the endocrine relationship between the spleen and the kidneys, understanding Zhang Jingyue's view becomes more precise. The kidneys have the hypothalamus–pituitary–adrenal cortex system, while the spleen has the gastrointestinal and pancreatic endocrine system. The former uses energy substances to sustain life activities, whereas the latter absorbs and produces energy substances to supply the former. The two systems mutually promote and restrain each other, maintaining a dynamic balance of unity in opposition.

Note: ① Shen Ziyin et al. Preliminary exploration of the rules of combined TCM and Western medicine diagnosis and treatment based on kidney yin and kidney yang. Shanghai Journal of Traditional Chinese Medicine, 1962, 1:19

② Gu Tianjue et al. Observation on changes in urinary 17-hydroxysteroid excretion in patients with kidney deficiency. Chinese Journal of Internal Medicine, 1964, 1:307

③ Zhang Zehao. Exploration of the principles of reinforcing vital energy and nurturing the root in traditional Chinese medicine. Chongqing Medical Journal, 1977, 3:67

④ Li En. The relationship between biochemistry and traditional Chinese medicine. New Pharmaceutical Research, 1977, 1:42

⑤ Hou Can. Preliminary exploration of the nature of the spleen in traditional Chinese medicine. New Pharmaceutical Journal, 1977, 10:5

⑥ Pei Zhengxue. Reinforcing vital energy and nurturing the root and immunity. Compilation of materials on the integration of TCM and Western medicine, 1978, 2:15

(New Pharmaceutical Journal, 1977, 3)

Application of Tongfu Therapy in Internal Medicine Emergencies

Pei Zhengxue

Tongfu therapy, specifically Tongfu Xie Re therapy, is a method of promoting bowel movements to clear internal heat. The author has used this method to rescue patients with internal medicine emergencies, achieving good therapeutic effects.

I. Case Examples

[Case 1] Wang ××, male, 51 years old, worker, emergency admission on August 6, 1982. Three days prior, the patient experienced severe upper abdominal pain, like a knife cut, radiating to the left chest, waist, shoulder, and back, accompanied by nausea and vomiting, along with pallor, cold extremities, and decreased blood pressure. A consultation with a traditional Chinese medicine physician was requested. Physical examination: body temperature 37.8°C, pulse 102 beats/min, respiration 28 breaths/min, blood pressure 8.0/5.3 kPa (60/40 mmHg), pale complexion, painful expression, confused mental state, soft neck, no abnormalities on lung auscultation, normal heart size, grade II systolic blowing murmur heard at the apex. Abdomen slightly distended, with obvious tenderness and mild rebound tenderness in the left upper quadrant; liver and spleen not palpable, cold extremities, no pathological reflexes elicited. Laboratory tests: white blood cell count 18,000/mm³, neutrophils 84%, lymphocytes 16%, amylase 1260 U (Somogyi method), urinary amylase 445 U (Winslow method). Diagnosis: acute pancreatitis with shock. Traditional Chinese medicine differentiation: red tongue with thick yellow greasy coating, deep fine rapid pulse, dry hard stools, combined with severe chest and abdominal pain, pallor, cold extremities, indicating excess yang internally and obstruction externally—internal yangming organ fullness, external yin obstruction and limb coldness; the more heat, the deeper the obstruction. Treatment should focus on clearing fire and attacking fullness to address the root cause, using Dachengqi Tang with modifications: 10 g each of rhubarb, mirabilite, fructus aurantii immaturus, bupleurum, and white peony; 6 g each of corydalis, chuanchongzi, magnolia bark, and scutellaria; 3 g each of coptis, agastache, and cardamom; decocted in water and taken twice daily for two consecutive days. Concurrently, fluid replacement and intramuscular injections of penicillin and streptomycin were administered. Next day’s follow-up: significant reduction in abdominal pain, clearer mental state, large amounts of dark black turbid watery stool passed, blood pressure 13.3/10.7 kPa (100/80 mmHg). Patient still experiences intermittent worsening pain in the left upper abdomen, radiating to the left chest, waist, and shoulder, accompanied by bitter taste and dry throat, abdominal distension and bowel sounds. Pulse is wiry and rapid, tongue is red with thick yellow greasy coating. Syndrome indicates residual internal heat and pathogenic factors residing in the Shaoyang channel; treatment should address both exterior and interior, using Dachaihu Tang with modifications: 10 g each of bupleurum, scutellaria, fructus aurantii immaturus, and rhubarb; 15 g white peony; 6 g each of chuanxiong, xiangfu, corydalis, and chuanchongzi; 3 g coptis; 20 g each of yiyiren and hongteng; decocted in water and taken once daily for a total of six doses. Follow-up: patient’s condition improved, blood pressure stable, tongue coating thinner, pulse wiry, only occasional dull pain in the left upper abdomen. Amylase dropped from 1260 U to 60 U, urinary amylase from 224 U to 120 U; continued taking Shugan Wan (produced by Yu County Pharmaceutical Factory in Henan Province), one pill morning and night to maintain recovery.

[Case 2] Chen ××, male, 68 years old, retired worker, first visit on April 7, 1983. One day prior, the patient experienced chest tightness and coughing, suddenly followed by hemoptysis—bright red blood mixed with foam. Over the past day, bleeding did not stop, totaling about half a bottle; the hospital diagnosed “bronchiectasis with massive hemorrhage.” Past history includes chronic bronchitis, no tuberculosis, no heart disease, nor liver or stomach ailments. Physical examination: body temperature 38°C, respiration 20 breaths/min, pulse 102 beats/min, blood pressure 13.3/8.7 kPa (100/65 mmHg). Patient appears weak but alert, chest symmetrical, slightly barrel-shaped; intercostal spaces deformed, percussion reveals hyperresonance, bilateral respiratory movement deep and uniform; coarse breath sounds with scattered dry rales in both lungs; heart size normal, mitral area slightly enlarged with obvious murmurs, A2>P2, A slightly elevated. Abdomen flat and soft, no tenderness in the epigastric region, no palpable masses, ascites sign negative. Chest X-ray: obvious thickening of lung markings, increased translucency, expanded lung fields, suggesting chronic bronchitis combined with emphysema and bronchiectasis. Laboratory tests: white blood cell count 18,600/mm³, neutrophils 82%, lymphocytes 18%, erythrocyte sedimentation rate 2 mm/hour. Diagnosis: bronchiectasis, emphysema, and massive hemoptysis. Traditional Chinese medicine differentiation: red tongue with thick yellow greasy coating, large and rapid pulse, dry hard stools, chest and diaphragm fullness, coughing and shortness of breath, phlegm obstructing airways, foamy bloody sputum. Syndrome indicates lung fire rising to the top, forcing blood out—treatment should clear lung and stomach, cool blood to stop bleeding, using Liangge San with modifications: 10 g each of rhubarb, mirabilite, forsythia, scutellaria, gardenia, bletilla, trichosanthes, citrus peel; 6 g each of coptis, fritillaria, licorice; 3 g lotus seedpod; decocted in water and taken once daily (along with 800,000 units of penicillin intramuscularly every 8 hours and 0.5 g of streptomycin intramuscularly every 12 hours), for a total of four doses. Follow-up: hemoptysis stopped, coating became thinner, still yellow greasy coating, chest fullness and shortness of breath lessened compared to before, phlegm still abundant, yellow thick pus-like discharge, bowel movements 2–3 times daily, stool brown-black, smelly, turbid, watery. Pulse wiry and rapid. Removed mirabilite and bletilla, continued for five more doses. Follow-up: except for chest fullness and shortness of breath, all symptoms resolved, pulse wiry and weak, tongue pale with slight yellow greasy coating. Advised to take Maiwei Dihuang Wan twice daily, one pill each time, to maintain recovery.

II. Reflections

In the above cases, although Western medicines were used in conjunction during treatment, the application of Tongfu therapy undoubtedly played an important role in controlling the condition. In Case 1, Tongfu therapy promoted emptying of pancreatic juice and enhanced pancreatic drainage, potentially facilitating resolution of congestion and edema. In Case 2, Tongfu therapy seemed to alleviate pulmonary edema and congestion, thereby aiding in the relief of pulmonary hemorrhage. Furthermore, Sanhuang Xiexin Tang is a well-known fire-clearing and hemostatic agent, highly effective in treating pulmonary hemorrhage. Traditional Chinese medicine holds that "the lungs and large intestine are related as exterior and interior," so clearing the gastrointestinal tract is akin to "removing the fuel from under the pot"—a fundamental approach. Adding coptis further embodies the idea that "clearing the heart means clearing fire, and clearing fire means stopping bleeding." Tongfu therapy is indeed effective in treating various emergencies, but its primary indication for emergency treatment should be "internal accumulation of real heat," which is entirely consistent with traditional concepts. The author believes that "internal accumulation of real heat" can lead to conditions such as excess yang obstructing yin (shock), heat stirring up wind (convulsions), forced blood to run amok (bleeding), and heat invading the pericardium (coma). All these dangerous conditions are rooted in heat accumulation, providing ample scope for Tongfu therapy in emergency treatment. The application of Tongfu therapy should be tailored to the specific condition to prevent excessive diarrhea and subsequent complications; once the syndrome of "internal accumulation of real heat" changes, new diagnostic criteria should be applied to tailor treatment accordingly, ensuring complete recovery.

(Chinese Journal of Integrated Traditional and Western Medicine, 1986.6)

Combining Macroscopic and Microscopic Differentiation

Enhancing the Level of TCM Diagnosis and Treatment

Pei Zhengxue

Over the past century, modern science and technology have advanced at an astonishing pace, shifting humanity's understanding of disease from the macroscopic to the microscopic. Traditional Chinese medicine, as a natural science in humanity's fight against disease, should naturally become part of the modern scientific network and advance in tandem with modern science and technology. However, due to historical constraints, previous generations were unable to make greater strides in this regard. This historic mission now falls squarely on the shoulders of us TCM practitioners. To achieve this goal, the author proposes combining macroscopic and microscopic differentiation for discussion with colleagues; any shortcomings are welcome to be criticized and corrected.

I. Traditional TCM Differentiation is Macroscopic

"Differentiation and treatment based on syndrome" is a hallmark of TCM clinical practice. The foundation of differentiation and treatment is observation, auscultation, inquiry, and palpation; the method is logical reasoning. During the process of differentiation and treatment, doctors rely solely on their sensory organs and the analytical capabilities of the cerebral cortex. Looking back at the history of TCM development, from Bian Que in the 4th century BC to modern physicians like Xiao Longyou and Pu Fuzhou, their practical experience and academic thought have always been rooted in agriculture and handicrafts as the social foundation. Throughout history, TCM practitioners never had the opportunity to use the sophisticated tools provided by large-scale industry to study traditional Chinese medicine, so the traditional achievements in TCM could only come from macroscopic observation and judgment of the external manifestations of disease. In this process, tongue color, pulse condition, patients' subjective symptoms, and certain external physical signs became the main basis for diagnosing disease. Previous generations summarized four diagnostic methods, eight categories, qi, blood, phlegm, fire, five movements and six energies... Thus, a distinctive TCM differentiation system was formed. This system has indeed played a tremendous role in humanity's understanding and treatment of disease and continues to do so today. However, human senses can only observe the external manifestations of disease, lacking direct insight into its internal qualitative changes. Throughout their rich clinical practice, physicians also employed reasoning methods such as analogy and similarity, striving to form an accurate understanding of the essence of disease. Although these imaginings lacked a solid experimental research foundation, they originated from clinical practice and therefore held universal guiding significance for TCM clinical practice.

II. Modern Medical Data is Microscopic

In recent times, the development of large-scale industry and natural sciences have complemented and promoted each other. With the help of theories provided by natural sciences and advanced tools produced by large-scale industry, humanity's understanding of disease has gradually become more microscopic. At the end of the 17th century, following the Industrial Revolution in Britain, Western medicine took off, with experimental research replacing traditional logical reasoning. Microscopic understanding supplemented medieval macroscopic reasoning, and Western medicine emerged with a brand-new look, forming a microscopic system based on physiological and pathological changes in organs, tissues, cells, body fluids, and nerves. Every link in this system, as well as the corresponding clinical treatments and prescriptions, are closely tied to the progress of modern natural sciences. It permeates and interacts with other branches of modern natural sciences, such as physics, chemistry, microbiology, meteorology, geology, etc., advancing in sync. For example, liver function tests, protein electrophoresis, alpha-fetoprotein testing for liver disease; fiber gastroscopy, tissue biopsy for stomach disease—these diagnostic methods and microscopic data are all products of experimental research and results of mutual penetration among various fields of modern natural sciences.

III. Only by Combining Macro and Micro Can We Fully Understand Disease

Macroscopic differentiation is an important aspect of understanding disease, while microscopic differentiation is another crucial aspect. To achieve comprehensive and precise differentiation, both must be combined. Taking liver disease as an example, based on macroscopic patterns such as liver qi stagnation, liver wood overcoming earth, liver-gallbladder damp-heat, and liver-kidney yin deficiency, if we can comprehensively consider microscopic changes in liver function, plasma proteins, alpha-fetoprotein, etc., from the perspective of TCM differentiation and treatment, we will surely deepen our understanding and improve therapeutic efficacy. The author has discovered some patterns through long-term clinical practice that may serve as references for colleagues. For instance, to lower SGPT, one should mainly use herbs that clear heat and detoxify, such as honeysuckle, forsythia, dandelion, houttuynia, prunella, polygonatum, gentian, sedum; to turn turbidity test negative, one should mainly use herbs that tonify and consolidate, such as astragalus, codonopsis, polygonum multiflorum, angelica sinensis. By correlating medication with syndrome, we can conclude that the former is due to heat toxicity, while the latter is due to deficiency—SGPT rise indicates elevated transaminases, which is "excess"; increased turbidity indicates decreased albumin, which is "deficiency." The "Inner Canon" says, "eliminate excess, replenish deficiency," so the former uses heat-clearing and detoxifying methods, while the latter uses tonifying and consolidating methods. The author often uses heat-clearing and detoxifying methods to lower surface antigen ratios and tonifying and consolidating methods to turn core antibody negative. Modern immunology, however, views the relationship between antigens and antibodies as complementary. Chronic nephritis's macroscopic differentiation often reflects yang deficiency with water overflowing, spleen-stomach qi deficiency, lung failing to descend, liver-gallbladder real fire, bladder damp-heat, etc.; microscopic differentiation should pay attention to tubules, red blood cells, white blood cells, urinary protein, non-protein nitrogen in serum, carbon dioxide binding capacity, etc. in routine urine tests. When treating this disease, the author first determines a basic formula based on macroscopic differentiation, such as Zhenwu, Jisheng, Liu Jun, Longdan Xiegan, etc., then prescribes tonifying and consolidating agents for proteinuria, fire-clearing and hemostatic agents for hematuria, and heat-clearing and detoxifying agents for white blood cells in urine; if non-protein nitrogen rises or carbon dioxide binding capacity decreases, one should adopt methods to clear the upper and lower parts. For stomach pain, macroscopic differentiation includes spleen-stomach qi deficiency, liver-stomach disharmony, stomach fire raging, spleen-stomach damp-heat, lung-stomach yin deficiency, etc.; microscopic differentiation involves fiber gastroscopy, pathological biopsy changes, gastric juice analysis, etc. The author usually determines a basic formula based on macroscopic differentiation, such as Liu Jun, Xiaoyao, Qingwei, Xie Xin, Yiguan Jian, etc.; if microscopic findings reveal superficial gastritis, add coptis and scutellaria; if atrophic gastritis, add danshen, xuanhu, coptis, scutellaria; if gastric or duodenal ulcer, add white peony, raw oyster shell, cuttlefish bone; if gastric prolapse, add astragalus, fructus aurantii immaturus, white atractylodes; if gastric mucosal prolapse, add sandalwood, agarwood, cardamom, grass seeds, etc.

IV. Conclusion

Combining macroscopic and microscopic differentiation is an important trend in the current development of TCM diagnosis and treatment. It not only improves the therapeutic efficacy of TCM but also represents a characteristic of TCM's development in the 1980s. Only by boldly extending TCM scholarship into the microscopic world can TCM both preserve its unique characteristics and integrate into the interconnected, mutually penetrating network of modern science and technology. Only in this way can TCM advance in step with modern science and technology.

(Chinese Journal of Traditional Chinese Medicine, 1986.7)

On Spleen-Tonifying and Kidney-Nourishing Methods

Pei Zhengxue

The spleen governs central qi, while the kidneys govern primordial qi; central qi is also called spleen qi, and primordial qi is also called kidney qi. Together, they are referred to as "zheng qi." The "Plain Questions·On the Art of Acupuncture in the Lost Chapters" states: "When zheng qi resides within, evil cannot invade." The "Plain Questions·On the Discussion of Fever" further says: "Wherever evil gathers, qi must be deficient." Clearly, the presence of zheng qi in the human body is of paramount importance for preventing illness. Based on this, TCM regards "deficiency of zheng qi" as the root cause of disease and proposes the major method of reinforcing and consolidating zheng qi. Since zheng qi is composed of central qi and kidney qi, in the method of reinforcing and consolidating zheng qi, spleen-tonifying and kidney-nourishing are undoubtedly the two most important aspects.

I. The Interrelationship Between Spleen-Tonifying and Kidney-Nourishing

The spleen is responsible for the transformation and transportation of food and water, nourishing all five zang organs, six fu organs, and the entire body—ancient people called it the "foundation of postnatal life." The kidneys are the source of essence and blood, where original yin and original yang reside—ancient people called them the "foundation of prenatal life." The postnatal spleen's transformation and transportation depend on the warming influence of the prenatal kidney fire; the prenatal true yang's ascent depends on the moistening effect of the postnatal spleen soil. Xu Zhike once said: "It's better to nourish the kidneys than to nourish the spleen." Li Dongyuan also said: "It's better to nourish the spleen than to nourish the kidneys." Although these two statements seem contradictory, they precisely reveal the extremely close relationship between spleen-tonifying and kidney-nourishing.

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Intrinsic relationships. Zhang Jingyue's exposition on this relationship is even more detailed, as he said: "At the beginning of human life, it originates from the source of essence and blood; after birth, it is nourished by food and water. Without essence and blood, there would be no foundation for the body; without food and water, the body could not grow strong. The regulation of essence and blood resides in the Mingmen, while the regulation of food and water resides in the Spleen and Stomach. Therefore, the Mingmen receives innate qi, and the Spleen and Stomach receive acquired qi. Thus, the sea of food and water primarily relies on innate qi, whereas the sea of essence and blood must rely on acquired qi for sustenance. Consequently, from birth to old age, if one's innate foundation is insufficient, as long as one receives the nurturing power of acquired qi, it can compensate for the deficiency of innate qi to a considerable extent."^①^ The Spleen and Kidney complement each other and maintain the growth and development of human bodily functions; strengthening the Spleen and tonifying the Kidney can mutually reinforce each other to promote the abundance of vital energy, enhancing its ability to expel pathogenic factors during the struggle between righteous qi and pathogenic factors, thereby facilitating recovery from illness and restoring health. Based on this, in many cases, previous practitioners often combined "strengthening the Spleen" with "tonifying the Kidney" in clinical practice, a treatment known as the method of strengthening the Spleen and tonifying the Kidney.

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

Disease is the product of the struggle between righteous qi and pathogenic factors, and the progression or regression of the condition reflects the ebb and flow of these two forces. Among the two pathogenic factors—deficiency of righteous qi and excess of pathogenic qi—Traditional Chinese Medicine has always emphasized the primary pathogenic role of righteous qi deficiency, which has opened up broad avenues for the clinical application of the method of strengthening the Spleen and tonifying the Kidney.