“The three months of Autumn are the time of harvest. The energy of Heaven begins to blow swiftly and the energy of Earth begins to change colour. One should go to bed early and rise early: maintain a peaceful mind in order to mitigate the decaying effects of Autumn; and restrain one’s desires outwardly in order to preserve the energy of the Lungs. The Qi of Autumn controls nourishing and receiving. If one does not follow these rules in the Autumn, one will fall ill in Winter.”
Autumn is here: a time of decrease and withdrawal. Few people in developed societies today change their behaviour or routine when the seasons change: most of us continue working the long hours and getting the same amount of sleep that we do in spring and summer at this time of the year. But the wise Chinese knew that autumn is a time when we should begin to conserve our Qi and Yang energy in order to get us through the coming winter months.
When we do not live according to the seasons, tiredness, fatigue, weakness and exhaustion may result, especially at this time of the year. As acupuncturists and herbalists, we may therefore find ourselves prescribing more tonic herbal remedies.
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 patterns and signs of that patient using our own knowledge and judgement.
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.
1. Poor diet: our post-natal Qi is mostly affected by what we eat. Eating on the go and eating the wrong foods weaken our Qi. A striving to be “fashionably thin”, causing patient’s to eat too little or follow fad diets generally leads to a deficiency of Qi and Blood. Patients who have been vegetarian for a long time and have not included good quality protein in their diet often present with severe Blood or Yin deficiency.
2. Overwork: working long hours and always being on the go depletes our Yin energy. This view was proposed by Zhu Dan Xi (a chief exponent of the School of Yin- Nourishing) in the 14th century and still very much applies to our society today. Many patients leave home at 6am and return at 10pm and expect not to be physically affected by this. Excessive mental work depletes Spleen-Qi and eventually Spleen-Blood. This is commonly seen in practice in students who are studying long hours or those in professions where a lot of mental work is needed.
3. Emotions: over-thinking and worry deplete Spleen-Qi and Blood. Fear depletes Kidney- Yin and/or -Yang. Grief and sadness deplete Lung-Qi. All these emotions, as well as many others, are widespread in today’s society.
4. Excessive sexual activity: injures the Kidneys, especially Kidney-Yin (more in men than in women)…Read more.