Herbs that tonify

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Chapter Fourteen. Herbs that tonify
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1. What are the functions of tonifying herbs and their indications? What precautions should be observed in their usage?

Tonifying herbs possess tonifying, nourishing, supplementing and strengthening abilities. They are used to treat Deficiency syndromes. As the main substances of the body are the Qi and Essence, which further generate the Blood, Body Fluids, Yin and Yang, the Deficiency syndromes can be generally divided into four types: deficiency of the Qi, deficiency of the Blood, deficiency of the Yin and deficiency of the Yang. They can be further subdivided into the deficiency of specific organs, such as Kidney-Yin deficiency, Spleen-Qi deficiency or Heart-Blood deficiency. Deficiency syndromes may also exist in patients with a weak constitution, in those in the recovery period of diseases, as well as in elderly people and children; in these patients, it is hard to determine which organ is weak and which part should be tonified, as the condition of the patient is generally weak.
The tonifying herbs can be divided into four categories: tonifying the Qi, tonifying the Blood, tonifying the Yin and tonifying the Yang. As the Essence is the basic material of the Qi, Blood, Yin and Yang, tonifying the Essence is included within these four categories. In order for the practitioner to master the functions and applications of tonifying herbs, it is important to compare the characteristics of herbs in different categories as well as those within a single category. Although they all possess tonifying ability, the strength, speed, temperature and nature of each is quite different. For instance, Ren Shen ( Ginseng radix) can tonify the Qi, and its action is quick and strong, therefore it is suitable for treating severe Qi deficiency and is used in the critical condition of Qi collapse. Dang Shen ( Codonopsis radix) and Fu Ling ( Poria) can also tonify the Qi but their action is much gentler and slower than that of Ren Shen. They are especially useful for treating chronic deficiency of the Qi, or conditions in which the patient is unable to bear the strong tonifying herbs. Some herbs such as Shu Di Huang ( Rehmanniae radix praeparata) and Huang Qi ( Astragali radix) are very effective for tonifying Qi deficiency, but their rich and cloying nature places a burden on the Stomach and Spleen; therefore herbs that regulate the Qi to promote digestion should be used in the meantime. In patients who suffer from chronic disease, elderly people or patients with a generally weak constitution, herbs that are neutral and light without a cloying nature should be used—for example, Bai Bian Dou ( Dolichoris lablab semen), Yu Zhu ( Polygonati odorati rhizoma) and Bai He ( Lilii bulbus); they can be used for a longer period of time. There are herbs that tonify certain organs and are particularly suitable for weakness of that organ—for instance, Huang Qi tonifies the Spleen-Qi and Lung-Qi, whereas Bai Zhu ( Atractylodis macrocephalae rhizoma) tonifies only the Spleen-Qi.
The tonifying herbs are used for treating Deficiency syndrome; they are not suitable for use in conditions where substantial excessive pathological products are present, such as Phlegm, food and water accumulation, or stagnation of Qi and Blood. Because of their rich and cloying nature, the tonifying herbs may retain these pathological products in the body. For the same reason, they are not suitable for use in conditions where there are exogenous pathogenic factors. However, in many cases, Deficiency syndromes are complicated with Excess pathological factors, or internal disorders are complicated with external factors, and the factor of Deficiency often plays a causative role in the pathological process, so in these circumstances tonifying herbs can be used in combination with herbs that eliminate Excess pathological factors and exogenous pathogenic factors.
Many tonifying herbs have a sweet and cloying nature, and are therefore not easily digested. As they may cause distension of the abdomen and reduced appetite, they should be combined with herbs that promote Qi movement in the Stomach, Spleen and Large Intestine, especially in patients with deficiency of the Middle Jiao, elderly people and children.
In addition, for treating chronic Deficiency syndromes, the treatment should take place in courses. Generally speaking, winter is a better season to start tonifying treatment than summer because winter is the time of storing and the digestive capability is stronger than in summer. Another way of starting the treatment is following the changes of Yin and Yang in nature: to treat Yin deficiency the treatment should be given in spring and summer; to treat Yang deficiency the treatment should be given in autumn and winter.

2. What are the methods of ‘direct tonifying’ and ‘indirect tonifying’

Direct tonifying and indirect tonifying are commonly used strategies in Chinese herbal medicine. Both are used for treating Deficiency syndromes. ‘Direct tonifying’ means to tonify the weak part of the body directly. For example, Shu Di Huang ( Rehmanniae radix praeparata) can tonify the Kidney-Essence if there is Kidney-Essence deficiency; Huang Qi ( Astragali radix) can tonify the Spleen-Qi and Dang Gui ( Angelicae sinensis radix) can tonify the Liver-Blood directly if there is Spleen-Qi and Liver-Blood deficiency.
‘Indirect tonifying’ means to tonify the body according to the relationship of the Zang Fu organs as well as the relationship of the Qi and Blood. According to the Five Elements theory, the five Zang organs are related by physiology and pathology. By following the cycle of generation, a basic treatment principle for Deficiency syndrome is developed. This principle is: ‘if there is deficiency in one organ, tonify the mother organ’. That is one strategy of indirect tonifying.
Although the five organs can be tonified according to this principle, in clinical practice, some methods are more often used and are more effective than others. For instance, suppose that a patient complains that he often catches cold, his nose is blocked and he also sweats easily. Meanwhile, he has a pale face, his tongue body is pale and flabby with a white coating and his pulse is soft and weak. According to the symptoms and the examinations, the diagnosis is weakness of the Lung-Qi. Therefore, according to this principle, the treatment starts with tonifying the Spleen-Qi, the mother organ of the Lung. When the Spleen-Qi is sufficient, it lifts the Qi to the Lung, thereby strengthening the Exterior. Huang Qi and Bai Zhu ( Atractylodis macrocephalae rhizoma) are often used in this condition. This is called ‘ fertilizing the Earth in order to generate the Metal’. There is another reason why this method is frequently used in clinical practice. It is believed that the Spleen is the source of the Qi and the Lung is the container of the Qi; therefore, to tonify the Lung-Qi, one should start with tonifying the Spleen-Qi. This is why all the herbs that tonify the Lung-Qi and strengthen the Exterior enter both the Lung and Spleen meridians; examples include Huang Qi and Ren Shen ( Ginseng radix). Another commonly used indirect tonifying pattern is called ‘ nourishing the Water to receive the Wood’. It is used in conditions where the Liver-Yin and Blood are so weak that the Liver-Yang escapes the control of the Yin and so it rises up. The treatment method here is to tonify strongly the Kidney-Yin, the mother organ of the Liver, in order to tonify the Liver-Yin and control the Liver-Yang. Because the Kidney and Liver are both located in the Lower Jiao, the Kidney contains the Essence and the Liver contains the Blood; the Kidney-Essence can turn into Blood so as to supplement the Liver-Yin and Blood, and to control the Liver-Yang. This method is very often used for hypertension, glaucoma, menopausal syndrome and diabetes, with symptoms such as headache, dizziness, tinnitus, dry and painful eyes, blurred vision, hot flushes, tingling or numbness of the extremities, a deep red or purple tongue body with or without a thin coating and a thready and wiry pulse. Indirect tonifying can also be used in other conditions—for example, tonifying the Liver-Blood so as to treat Heart-Blood deficiency in the treatment of mental disorders. For instance, one can use Dang Gui, Shu Di Huang, Bai Shao Yao ( Paeoniae radix lactiflora) and Suan Zao Ren ( Ziziphi spinosae semen), which tonify the Blood and enter the Liver meridian, to treat palpitations, restlessness and insomnia.
The indirect tonifying strategy also follows the relationship between Qi and Blood, Yin and Yang of the body or in one organ. According to the concepts that ‘the Qi is the commander of the Blood, the Blood is the mother of the Qi’ and ‘the Yin exists on the Yang and the Yang exists on the Yin’, methods are used to tonify the Qi in order to generate the Blood in the condition of Blood deficiency, and to tonify the Yin in order to generate the Yang in the condition of Yang deficiency. The former is often used in critical situations where the patient has lost a large amount of blood in a short time and it is impossible to supply the blood in a very short period of time. Here Ren Shen and Huang Qi should be used first to strengthen the Qi in order to control and generate the Blood. The latter is often used in situations where the Kidney-Yang is weak—for instance, in elderly people, patients suffering from cold in the back, knees and extremities, clear urine and loose stools. Treatment can be given to tonify the Kidney-Yin strongly, whilst simultaneously using smaller amounts of gentle, sweet and warm herbs to warm the Kidney-Yang, instead of just using hot and pungent herbs to activate the Kidney-Yang, which may consume the Kidney-Yin and, furthermore, also injure the Kidney-Yang.
Comparing the strategy of direct tonifying with that of indirect tonifying, the direct tonifying method can be used alone, whereas the indirect tonifying method is often used with the first method, especially in chronic cases. In the herbal literature, there can be found herbs which have the functions of tonifying both the mother organ and the child organ, the Yin and the Yang, although they have a particular emphasis—for example, Huang Qi primarily tonifies the Spleen-Qi and secondly the Lung-Qi; Dang Gui primarily tonifies the Liver-Blood and secondly the Heart-Blood; Shu Di Huang mainly tonifies the Kidney-Essence and the Kidney-Yin, but gently tonifies Kidney-Yang as well.

3. What is the opinion of the ‘school of tonifying the Spleen’ in the herbal literature?

The concept of the earth being the center can be found in Chinese classics of philosophy and agriculture. In TCM, the idea that the Spleen and Stomach are the principal organs in tonification has a very long history too. In the Jin dynasty, a famous physician Li Dong Yuan wrote a book named Discussion on the Spleen and Stomach ( ad 1249), which completed the theory and treatment based on this concept, and tonifying the Spleen has become a real school of thought since that time.
The ‘school of tonifying the Spleen’ is also called ‘the school of fertilizing the Earth’. People in this school hold the opinion that the Spleen (together with the Stomach) is the foundation of life. After a person is born, the growth and development depend on the condition of the Spleen and Stomach. The Spleen and Stomach are in the Middle Jiao and are responsible for receiving, digesting and transforming food and drink into Essence, Qi, Blood and Body Fluids. Afterwards, the Spleen transports them into the Lung and spreads them throughout the whole body. The unused part of the food and drink is eliminated from the Large Intestine. Although this transportation is partially carried out by the dispersing function of the Lung and the transporting function of the intestines, the Qi of the Lung and intestines also comes from the Spleen.
Furthermore, as the Spleen and Stomach are in the Middle Jiao, which connects the Upper Jiao and Lower Jiao though lifting and descending the water and the Qi, it is a key control system of the body in both physiology and pathology.
Moreover, in practice, tonifying the body through the Spleen is easier and quicker than doing this through other organs. The therapeutic effects show strong support for this school. The Post-Heaven Essence and Qi generated from the Spleen are relatively easier to restore and strengthen compared with the Pre-Heaven Essence and Qi, which are stored in the Kidney. As the Kidney-Essence does not increase much after a person is born, the whole development of the person requires the supplementation of the Spleen-Essence and the Blood. This is a very positive viewpoint in terms of life and health because it implies that one can improve one’s well-being by strengthening the Spleen, no matter how weak a constitution one is born with and how weak the Kidney-Essence and the Kidney-Qi are. Therefore, although the constitution is determined by the Kidney-Essence and Qi, the condition of health can be changed and improved by developing and strengthening the function of the Spleen and Stomach. For instance, one person may be born with a very good constitution, and so has the capability to have a healthy and a long life, but that certainly will not happen if the Kidney-Essence has been consumed quickly and the Spleen is impaired badly by not taking good care of them—for instance, living in a very busy, stressful or unrestrained way for many years, or suffering from fear, anxiety, stress or starvation, such as lived in war or natural disasters. Conversely, a premature baby, although originally having a weaker Pre-Heaven Qi and Essence, may be taken good care of so that the function of the Spleen is supported and developed, and live in a healthy way both physically and mentally, so that overall the person’s health is better, and the life is longer, than in the former case.
For these reasons, the concept and the treatment of protecting and strengthening the Spleen are very widely used in clinical practice. This idea also influences the nursing and dietary ideas and methods of TCM.

4. What is the opinion of the ‘school of tonifying the Kidney’ in the herbal literature?

The ‘school of tonifying the Kidney’ holds the opinion that the Kidney is the most important organ in the body because the Yin, Yang, Qi and Essence of the Kidney are the principal substances of life and the Kidney determines the constitution and vitality of each individual. Moreover, the Yin, Yang, Qi and Essence of the Kidney are the origin of the Yin, Yang, Qi and Essence of the other organs, so the condition of the Kidney determines the condition of the whole body. This school therefore believes that the tonifying process should be started from the Kidney.
From study and practice, this school developed many very effective methods to treat Kidney deficiency based on the understanding of the relationship between Yin, Yang, Qi and Essence of the Kidney. A series of strategies was created. For instance, when treating Kidney-Yin deficiency, the practitioner will add in a small amount of herbs that tonify the Yang to a larger amount of herbs that tonify the Yin; the aim of this is to warm and activate the Yin in order to generate it sufficiently. Conversely, when treating Kidney-Yang deficiency, the practitioner adds some herbs that tonify the Yin with the herbs that tonify the Yang; this is because the Yin is regarded as the root of the Yang. When tonifying either the Yin or the Yang, the practitioner also uses a large amount of herbs that tonify the Kidney-Essence; this is because the Kidney-Essence is the fuel for the Yang and the substantial source of the Yin. When the Kidney-Essence is sufficient, the Yang acts on the Yin, and then generates the Kidney-Qi. This concept can be clearly seen in the formulas Zuo Gui Wan ( Restore the Left Kidney Pill) and You Gui Wan ( Restore the Right Kidney Pill), which were designed by the Taoist physician Zhang Jie Bin in the Ming dynasty.
As the Kidney is regarded as the root of life, this school has also invented many indirect methods of strengthening the other organs through tonifying the Kidney. For instance, when treating Spleen-Yang and Qi deficiency, the practitioner will use herbs that tonify the Kidney-Yang and Qi in order to warm and generate the Spleen-Yang and Qi. When treating a cough, shortness of breath and asthma, which are caused by Lung-Qi deficiency, the practitioner uses herbs that tonify the Kidney in order to grasp the Qi and regulate the breath. To treat chronic cough, thirst, a tendency to be hungry, dry eyes and blurred vision, caused by deficiency of the Lung-Yin, Stomach-Yin and Liver-Yin, the practitioner uses herbs that primarily tonify the Kidney-Yin in order to generate the Yin of these organs. To treat many emotional disorders, such as fear, anxiety or restlessness, or poor memory and inability to concentrate, the method of tonifying the Kidney is also often used.
Since the Kidney-Qi and Kidney-Essence determine the development of the body, the method of tonifying the Kidney plays an important role in the treatment of retardation in children, disorders of menstruation and learning difficulties in young people, infertility, menopausal syndrome in adults and degenerative disease in elderly people.
Since the Kidney-Qi and Kidney-Essence are inherited from the parents and do not increase after birth, some people have a passive attitude about the method of tonifying the Kidney; they think the Kidney-Qi and Kidney-Essence can only be consumed and the constitution cannot be changed as it depends on the Kidney condition. However, the school of tonifying the Kidney believes that, although the Kidney-Essence cannot easily be increased, it can be strong and sufficient if protected and used in the right way. Tonifying the Kidney is impossible to achieve in a short time, but people can use this idea to protect the Kidney in many ways over the whole lifetime. There are many ways to tonify and protect the Kidney, such as Chinese herbal therapy, Qi Gong exercise, Chinese dietary therapy and maintaining a healthy lifestyle. All of these can prevent disease, maintain health and lead to longevity. In this way, a person born with a poor constitution can live a happy and healthy life, and a person born with a robust constitution may live even longer than the average age at that time.

5. What are the differences between strong tonification and gentle tonification?

In strong tonification, either herbs that have a strong tonifying ability, or herbs that are gentle in action but in large dosage, are used to tonify severe weakness of the Qi, Blood, Yin or Yang of the body. This method can be generally divided into strong tonification of the Yang and Qi, and strong tonification of the Yin and Blood. Strong tonification of the Yang and Qi is especially used in critical conditions—for instance, in conditions where there is loss of a large amount of blood in a short time, or in myocardial infarction, when the blood pressure drops or is unstable. Because the substantial parts of the body, such as the Yin, Body Fluids, Blood and Essence, cannot be tonified in a very short time, first the herbs that can strongly and quickly strengthen the Qi and rescue the Yang are used; in order to hold the Blood, the Yin and the Body Fluids, the herbs that tonify the Qi and Yang are administrated immediately by transfusion.
Strong tonification of the Yin and Blood is often used for severe weakness of the Blood and Essence, such as in conditions of advanced wasting in diabetes or starvation, and dyscrasia in advanced cancer. Strong tonification has a particular therapeutic value for treating young patients and patients whose Spleen and Stomach are not impaired as these herbs are rich, sweet and cloying, and they are not easily digested. The commonly used herbs for strong tonification are Ren Shen ( Ginseng radix), Huang Qi ( Astragali radix), Shu Di Huang ( Rehmanniae radix praeparata), Huang Jing ( Polygonati rhizoma) and E Jiao ( Asini corii colla).
In gentle tonification, either herbs that have a gentle tonifying nature, or a small dosage of herbs that have a strong tonifying ability, are used to tonify the Qi, Blood, Yin and Yang gradually in order to treat Deficiency syndromes. This method is used much more often than strong tonification, as the Deficiency syndrome has a chronic process and chronic Deficiency syndromes are seen more often than acute cases in clinical practice.
Also, in chronic cases, all the organs and their functions are impaired, so the body cannot bear the strong tonifying herbs, which are sweet, rich and cloying and often bring about digestive disorders, or are harsh in action and may lead to new disturbances of the Yin and Yang, Qi and Blood. For example, patients who suffer from Qi deficiency will feel dryness in the nose, eyes and throat, and fullness in the chest and Stomach after using a large dosage of Ren Shen or Huang Qi because the herbs are heavy and generate Heat in the body. Patients who suffer from Blood deficiency may have ulcers in the mouth and get heavy menstruation or bleeding after using large amounts of Dang Gui ( Angelicae sinensis radix) or Ren Shen because these herbs are warm and can activate the movement of the weakened Blood and Qi. Patients with dyscrasia can lose their appetite instead of putting on weight because the rich and sweet herbs are too heavy to be digested by a weak Spleen. A gentle method is thus more suitable for different chronic Deficiency syndromes. The commonly used herbs are Dang Shen ( Codonopsis radix), Bai Zhu ( Atractylodis macrocephalae rhizoma), Fu Ling ( Poria), Dang Gui and Bai Shao Yao ( Paeoniae radix lactiflora).

6. What are the indications for herbs that tonify the Qi?

The herbs that tonify the Qi are used for conditions of Qi deficiency. Qi is a type of refined Essence produced by the internal organs. It also promotes the functions of these internal organs. According to its source, the place where it belongs and its function, Qi can be divided into different types, such as Original Qi, Nutritive Qi, Defensive Qi, gathering Qi, Qi of the Zang Fu organs or Qi of the meridians. Qi is able to warm and nourish the body, promote the physiological function of all organs of the body, and protect against the invasion of exogenous pathogenic factors. In a normal condition, Qi circulates smoothly and constantly in the body.
If the Qi is insufficient, it may manifest as either general weakness or specific weakness in a certain organ. The former shows in weakness of the constitution, an inability to endure intensive mental stress and physical exertion, a tendency to tire easily, and to fall ill often and then the disease develops quickly. It is often seen in children, elderly people, patients who are suffering from mild chronic disease or neurosis, and patients recovering from an operation or from disease. Qi deficiency may alternatively manifest in certain organs. For instance, Spleen-Qi deficiency manifests as a poor appetite, abdominal distension, loose stools or diarrhea, a feeling of heaviness in the limbs and fatigue; Lung-Qi deficiency manifests as shortness of breath, a low and weak voice, pallor and a tendency to sweat easily; Heart-Qi deficiency brings about palpitations, restlessness, tightness in the chest, perspiration, and a faint and irregular pulse; Kidney-Qi deficiency may cause retardation of development, a poor constitution, spermatorrhea, premature ejaculation, edema, enuresis, urinary incontinence, and weakness in the back and legs. In Qi deficiency conditions, the tongue is pale or slightly pale, the body of the tongue is flabby, with teeth marks in a severe case, and the coating is white, or white and sticky. The pulse is weak and soft, or deep and thready, especially at the region of the corresponding organ.
The herbs that tonify the Qi are very effective for improving the general condition and treating general weakness of the Qi. They can also tonify the Qi of a specific organ as the herbs enter different meridians and have specific functions for that organ. However, there are some exceptions. For instance, herbs that tonify the Kidney-Qi are just the herbs that tonify the Kidney-Essence, Yin and Yang because the Kidney-Qi is developed directly from these. Another example is the tonification of the Liver-Qi; since the Liver-Qi is directly generated by the Liver-Blood, the herbs that treat Liver-Qi deficiency are just the herbs that treat Liver-Blood deficiency.

7. What are the characteristics of the herbs that tonify the Qi?

The herbs that are able to tonify the Qi of the body have the following characteristic properties.

Sweet in taste

Most of herbs that tonify the Qi have a sweet taste. Sweetness has a nourishing, moistening and harmonizing nature, so is able to tonify the Qi, especially the substantial aspect of the Qi, in order to treat disorders caused by Qi deficiency. The therapeutic result of tonifying by sweet herbs is achieved from three approaches. First of all, sweetness is a suitable taste for Qi deficiency as, in the case of Qi deficiency, both the Qi and Yang are impaired. The syndrome shows as general weakness and coldness. If warm and pungent herbs are used to warm and activate the Qi and Yang, the condition of the patient can be improved in a short period of time. After a while, however, the symptoms reappear. Meanwhile, patients may complain of dryness in the nose, throat and mouth, constipation and even bleeding. This is because warmth and pungency can activate the function of the body, but do not tonify the substantial parts of it. Without supplementation of the substantial parts, such as the Yin, Body Fluids and Essence, the functional improvement does not last long. Warmth and pungency may consume the Yin and the Blood of the body, and bring about a side-effect of Dryness. In contrast, sweet herbs are neutral with respect to the Yin, Yang, Qi and Blood; they can tonify one party without injuring the others. Thus they are able not only to tonify the Qi, but also to nourish the Blood and Yin as well. As they do not give rise to a side-effect of Dryness, they are suitable for Qi deficiency and disharmony of the Qi and Blood, Yin and Yang. Secondly, sweetness enters the Spleen, the most important organ for Qi generation. The Spleen is located in the Middle Jiao, and connects with the Upper Jiao and Lower Jiao, so is very important for Qi transportation. Sweetness especially benefits the Spleen-Qi and strengthens its function, therefore spreading the Qi within the entire body. Thirdly, because sweetness remains working in one place and has no moving tendency, it may reduce the speed of an aggressive pathogenic process, moderate the harsh properties of herbs in a tonifying formula and slow the haste of other herbs so as to prevent the side-effects of these herbs.

Slightly warm in temperature

Most of the herbs that tonify the Qi are slightly warm in temperature. As Qi must constantly move, it needs not only the substantial part, which can be obtained from the sweet taste of the herbs, but also a moving capability, which can be increased by the warm nature of the herbs. When gentle warmth and sweetness coexist in one herb, the tonifying action shows clearly. This action is described as: ‘t he gentle Fire steams the sweet, and then the Qi is generated gradually’. However, the herbs should be warm rather than hot because hot herbs consume the Yin and Qi. So there is also a saying: ‘t he gentle Fire generates the Qi and the strong Fire destroys the Qi’.

Entering the Spleen and Lung meridians

Most of the herbs that tonify the Qi mainly enter the Spleen and Lung meridians. As the Spleen is the most important organ for producing the Qi, the herbs that enter the Spleen may effectively tonify the Qi of the whole body. Since the Lung can disperse and descend the Qi, it is an important organ for transporting and regulating the Qi. The herbs that enter the Lung meridian are effective for strengthening the function of the Lung and accelerating the Qi movement.

Bitter in taste

Some of the herbs that tonify the Qi have a bitter taste, which possesses a drying ability. When the Qi is deficient in the body, and especially when the Spleen-Qi is deficient, the Qi may fail to transport Dampness and cause water or Dampness accumulation. Herbs that have bitter or bitter-warm properties may dry Dampness and strengthen the function of the Spleen as well as the other internal organs so as to treat Qi deficiency. Bai Zhu ( Atractylodis macrocephalae rhizoma) is a good example.

Bland and neutral

Some of the herbs that tonify the Qi are bland and neutral. Blandness is able to leach out Dampness and promote urination. It is suitable for treating accumulation of Dampness that is caused by the Qi deficiency. Neutrality is an ideal temperature to treat disorders where Heat and Cold are complicated. Neutrality is easily combined with other tastes and temperature to treat Qi deficiency with the disharmony of the Blood, Yin and Yang. The commonly used herb is Fu Ling ( Poria).
In addition, herbs that tonify the Qi may have some side-effects. These are mainly caused by their rich nature and the sweet taste, which place an extra burden on the Spleen and lead to Qi stagnation and Dampness accumulation. The manifestations of this are fullness of the epigastrium, distension of the abdomen and difficulty of bowel movement. To avoid this, in clinical practice, these tonifying herbs are often used with a small amount of herbs that promote Qi movement, such as Chen Pi ( Citri reticulatae pericarpium) and Mu Xiang ( Aucklandiae radix)**.

8. Ren Shen ( Ginseng radix) and Huang Qi ( Astragali radix) are the most important herbs for tonifying the Qi. What are their characteristics?

Ren Shen and Huang Qi are two strong herbs for tonifying the Qi. Both are sweet and slightly warm, and enter the Spleen and Lung meridians. Sweetness possesses a tonifying ability and the gentle warmth may gently strengthen the Yang, which further generates the Qi. They strongly tonify the Spleen-Qi, strengthen the Middle Jiao and promote the function of the Spleen to generate the Blood, Essence and Body Fluids. They can treat Spleen-Qi deficiency, which manifests as poor appetite, distension of the abdomen, loose stools, diarrhea and fatigue.
The Spleen, together with the Stomach, is regarded as the foundation of the life after birth. When the Spleen-Qi is strong enough, it can transport the Qi to the Lung so as to strengthen the Lung-Qi and the Defensive Qi. Both herbs are very effective for treating Lung-Qi deficiency, which manifests as shortness of breath, a weak voice, a tendency to catch cold and spontaneous sweating.
Ren Shen is particularly able to tonify the Original Qi and rescue the Yang and so is used for critical conditions where the Qi is severely injured and the Yang has collapsed. The patient may have shallow respiration, cold limbs, a pale face, profuse sweating and a very weak pulse. These conditions can be seen after severe vomiting or diarrhea, shock, fainting or losing a large amount of Blood. Because Ren Shen can strongly tonify the Original Qi, the principal Qi of the body, it can also tonify the Qi of all the internal organs—for instance, it tonifies the Heart-Qi, calms the Mind and therefore treats palpitations and restlessness. It can tonify the Spleen-Qi and promote the function of the Spleen. Moreover, it promotes the generation of the Blood and treats fatigue, insomnia and dizziness caused by Qi and Blood deficiency. It also promotes the generation of the Body Fluids and therefore treats profuse sweating and thirst caused by Qi and Yin deficiency.
Huang Qi is warmer than Ren Shen in temperature. As it does not tonify the Original Qi, it is not used in critical conditions or in Qi deficiency of all the internal organs. Huang Qi enters the Spleen and Lung meridians and its function focuses on the Spleen and the Lung. It can strongly tonify the Spleen-Qi and promote its function, strengthening the foundation of life so as to improve the patient’s condition and strengthen the Qi in general. It is able to lift the Spleen-Qi and increase the strength of the muscles, which are controlled by the Spleen, and so it treats a prolapsed uterus, Stomach and rectum, as well as tiredness and heavy sensations in the body and limbs. Because it can tonify the Spleen-Qi and strengthen the muscles, it can promote the healing process in chronic ulceration, sores or wounding. It also strengthens the Spleen-Qi and controls the Blood, which must circulate in the blood vessels, and therefore can be used in bleeding conditions.
Huang Qi has another very important function—to tonify the Lung-Qi and stabilize the Exterior. Huang Qi can strongly tonify the Spleen-Qi, which can then further transport the Qi to the Lung; therefore it treats shortness of breath, and a low and weak voice, caused by the Lung-Qi deficiency. Furthermore, when the Spleen-Qi and the Lung-Qi are sufficient, the Defensive Qi is also strong; thus it can control the pores better and promote the Qi and Blood circulation on the surface of the body so as to strengthen the Exterior. This is why Huang Qi is often used to treat recurrent colds, spontaneous sweating and chronic sinusitis.
Ren Shen and Huang Qi have their own characteristic actions in tonifying the Qi. They are also characterized by their quick actions. In clinical practice, they can be used together to treat severe Qi deficiency. However, they can bring about some side-effects because of their rich and warm nature, especially in patients with deficiency of the Spleen and Stomach. If the patient complains of fullness in the Stomach or distension in the abdomen, herbs that promote the digestion should be used, such as Chen Pi ( Citri reticulatae pericarpium) and Sha Ren ( Amomi xanthioidis fructus).

9. What are the differences between the different products of Ren Shen ( Ginseng radix)?

Ren Shen and its products are classified into many types according to the habitat, climate, the conditions of cultivation and the processing procedure. The properties and the functions of Ren Shen therefore vary vastly.
The type called ‘Ye Shan Shen’, or the ‘wild mountain root’, grows in the Chang Bai Mountain between China and Korea, and is regarded as the best quality of Ren Shen. Its function of tonifying the Qi is the strongest. Since the herb grows in the mountains for many years and is not easy to find, the price is very high and it is used only for very severe cases.
Most of the Ren Shen used today is cultivated. Its effect in tonifying the Qi is not as strong as that of the wild root. After it is collected, washed and then dried by wind or the sun, the product is called ‘Sheng Shai Shen’, or ‘raw dried root’. It is sweet and neutral, and is effective for tonifying the Qi as well as nourishing the Yin. Its function is relatively strong for cultivated Ren Shen.
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