TO TONIFY OR TO EXPEL: THAT IS THE QUESTION

Since the beginning of the history of Chinese herbal medicine, there has been an ongoing debate between different schools of thought as to whether one should tonify or expel. Lui Wan Su (1110-1200), a chief exponent of the School of Cooling, emphasized the necessity of clearing Heat and Fire. Zhu Dan Xi (1281-1358) said that nourishing Yin is the most crucial treatment principle because Yin is depleted by overwork. The School of Eliminating Pathogenic Factors, led by Chang Cong Cheng (1156-1228) advocated vomiting, sweating, purgation and even inducing salivation, sneezing and lachrymation as a way of expelling pathogenic factors, in his view the cause of most pathologies. Li Dong Yuan, the author of the celebrated “Discussion on Stomach and Spleen” (Pi Wei Lun) said that most diseases are caused by a deficiency of Stomach and Spleen induced by overwork and irregular diet and therefore advocated tonifying the Stomach and Spleen as the most important treatment method.
Therefore, it is important to be aware that there is no “set answer” as to when to tonify and when to expel and that one must examine each individual case and come to a decision based on the symptoms and signs of that patient using our own knowledge and judgement.

EMPTY CONDITIONS

Tonics are obviously applicable when a patient suffers from a predominantly Empty condition, manifesting with a deficiency of either Qi, Blood, Yin or Yang, or a combination of any of these. It is important always to bear in mind that we must diagnose whether a condition is Full or Empty mainly from taking the pulse and observing the tongue. For example, a 50-year-old man may complain of tiredness, depression and exhaustion but, on taking his pulse, we find it is Full and Wiry. Therefore we can deduce that his symptoms derive from a Full rather than an Empty condition and it would not be applicable to tonify either with acupuncture or herbs.

CAUSES OF DISEASE IN EMPTY CONDITIONS

As mentioned above, some schools of thought believe that, theoretically, we should never need to prescribe herbal tonics if we ate a proper diet and balanced work and rest in a good way. So this implies that, even eight or nine hundred years ago, humans had a tendency to work too hard, not rest and not eat a good diet, rather than this being a purely 21st century phenomenon! Today, of course, few people live in a way which is health-enhancing and therefore it is often necessary to tonify with herbal medicine. The following are the most commonly seen factors which deplete a patient's energy

THE TONGUE AND PULSE IN EMPTY CONDITIONS

Obviously the state of the tongue and pulse will depend on which vital substance is lacking. The table below summarizes how they may appear:

These are, however, general guidelines and it should be remembered that, in practice, the clinical picture is usually more complicated than this.

TONIFYING WITH HERBS AND WITH ACUPUNCTURE

When prescribing herbs, it is absolutely paramount to be accurate in one’s diagnosis (although it goes without saying that whatever treatment methods we are using the more accurate the diagnosis, the more effective the treatment will be). For example, you see a patient who has some Spleen-Qi deficiency and also Dampness. If treating just with acupuncture, it would be possible to do Tonic prescriptions should be prescribed only if we are absolutely sure that the condition is predominantly an Empty one, otherwise they may “stir up” the pathogenic factor and cause the patient’s symptoms to be worse. Any underlying deficiency will obviously need to be addressed, but this may be done either with acupuncture or by prescribing two herbal remedies at the same time, i.e. a tonic and a remedy to clear the pathogenic factor.

In my experience, if we are not absolutely sure whether to prescribe a remedy which primarily tonifies or expels a pathogenic factor, it is safer to prescribe the former and tonify with acupuncture. I have seen patients’ conditions get worse when they are given a tonic too soon but I have never seen a patient deteriorate when given a remedy that clears a pathogenic factor.

YANG TONICS

Strengthen the Root
Pattern: Kidney-Yang deficiency, Fire of the Gate of Vitality declining, slight Blood deficiency
Action: Tonify and warm Kidney-Yang, stoke up the Fire of the Gate of Vitality, fill the Essence, nourish Blood, strengthen the Will-Power
Indications: Chilliness, cold feet, cold limbs, lower backache, weak knees, dizziness, tinnitus, depression, exhaustion, impotence, lack of libido, loose stools, pale urination, oedema, lack of drive
Tongue: Pale, Wet
Pulse: Deep-Weak

Unicorn Pearl
Pattern: Kidney-Yang deficiency, Essence deficiency
Action: Tonify and warm Kidney-Yang, nourish the Essence, strengthen the Governing, Directing and Penetrating vessels
Indications: Infertility, backache, dizziness, tinnitus, feeling cold, a history of amenorrhoea, or scanty periods, irregular periods, frequent pale urination, tiredness, depression, a history of miscarriages, pale complexion.
Tongue: Pale, wet
Pulse: Deep, weak

Calm the Spirit
Pattern: Spleen-Qi and Spleen-Blood deficiency, Heart-Qi and Heart-Blood deficiency
Action: Tonify Spleen-Qi and Spleen-Blood, tonify Heart-Qi and Heart-Blood, calm the Mind, open the Mind=s orifices, stimulate the Spleen=s holding of Blood.
Indications: Palpitations, insomnia, anxiety, poor memory, depression, dull-pale face which may also have a slight malar flush, a slight feeling of heat in the evening, poor appetite, loose stools, tiredness, weariness, constipation, despondency, weak limbs, scanty periods or very heavy periods.
Tongue: Pale, thin or swollen, depending on whether Blood or Qi deficiency predominates.
Pulse: Weak, choppy

Brighten the Eyes
Pattern: Deficient Liver-Blood and Kidneys not nourishing the eyes
Action: Nourish Liver-Blood and the Kidneys, brighten the eyes
Indications: Dull headaches around the eyes and eyebrows, blurred vision, floaters, gritty eyes, tired eyes, dry eyes, dizziness, tiredness, dull-pale complexion, scanty periods, depression, insomnia, tingling limbs, poor memory, dry hair.
Tongue: Pale, especially on the sides, thin
Pulse: Choppy or fine.

Growing Jade
Pattern: Kidney-Yin and Essence deficiency
Action: Nourish Kidney-Yin, nourish the Essence, strengthen the Directing and Penetrating vessels.
Indications: Infertility, a history of amenorrhoea or miscarriages, scanty periods, irregular periods, dizziness, tinnitus, a dry throat, a feeling of heat in the evening, backache, depression, slight anxiety, dry stools, dry hair, scanty-dark urine, night-sweating, malar flush.
Tongue: Red without coating
Pulse: Floating-Empty

Jade Spring
Pattern: Stomach-Yin deficiency, Spleen-Yin deficiency, Lung-Yin deficiency, Stomach-Empty Heat
Action: Nourish Stomach-, Spleen- and Lung-Yin, clear Stomach Empty Heat
Indications: Excessive hunger, dry mouth, desire to drink in small sips, dry lips, tiredness, mental restlessness, poor digestion, slight burning epigastric pain, mouth ulcers, dry stools.

QI TONICS

Prosperous Earth
Pattern: Spleen-Qi and Lung-Qi deficiency, Dampness
Action: tonify Spleen-Qi and Lung-Qi, resolve Dampness
Indications: poor digestion, tiredness, slight abdominal distension and fullness, poor appetite, craving for sweets, loose stools, desire to lie down, weak voice, propensity to catching colds, mild depression
Tongue: Pale
Pulse: Weak or Empty

Central Mansion
Pattern: Spleen- and Stomach-Qi deficiency, Stomach- and Spleen-Yin deficiency, Dampness in the Middle Burner, Lung-Qi deficiency
Action: Tonify Stomach- and Spleen-Qi, nourish Stomach- and Spleen-Yin, resolve Dampness, stop diarrhoea, tonify Lung-Qi.
Indications: Loose stools, diarrhoea, poor appetite, poor digestion, a slight feeling of fullness and heaviness of the epigastrium, nausea, weakness of the limbs, epigastric pain, tiredness, late onset diabetes.
Tongue: Pale, slightly Swollen, sticky but thin coating which may be rootless, Stomach crack or cracks.
Pulse: Weak in general, slightly slippery

Brocade Sinews
Pattern: Chronic Wind-Damp Painful Obstruction (Bi) Syndrome with Liver-Blood and/or Liver-Yin deficiency
Action: Nourish Liver-Blood and Liver-Yin, benefit sinews, expel Wind-Dampness from the joints.
Indications: chronic soreness and slight swelling of the joints, dizziness, numbness or tingling of limbs, poor memory, insomnia, dry skin and hair, dry eyes, blurred vision.
Tongue: Pale and thin or Red and thin without coating
Pulse: Choppy or fine, possibly only on the left side.

Researched and edited by Rebecca Avern Lic.Ac, M.B.Ac.C

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