- Brief Introduction of Professor Yuan-Sheng TAN’s Theory of “Deficiency, Stasis and Wind” in Treating Hypertension
Brief Introduction of Professor Yuan-Sheng TAN’s Theory of “Deficiency, Stasis and Wind” in Treating Hypertension
Shun-Min WANG a, b Lu-Jun TANG a Qian ZHOU a Duo-Mei LU a Wu-Lei DUAN a Cheng CHEN a Lu HUANGb Yuan-Sheng TAN a, b＊
a.Hunan University of Chinese Medicine, Changsha City, Hunan Province, 410208
b.The First Hospital of Hunan University of Chinese Medicine, Changsha City, Hunan Province, 410007
Yuan-Sheng TAN (1962- ), Doctor of Medicine, chief physician, professor, doctoral and graduate tutor. Research direction: research on the prevention and treatment of traditional Chinese medicine for cardiovascular diseases.
This paper introduces Professor Yuan-Sheng TAN’s view to treat hypertension symptoms of “deficiency, stasis and wind” from the aspects of theory, therapy, prescription and herbs. Before introducing the sub-theses of “deficiency, stasis and wind”, it briefly sorts out the discourses of physicians through the ages. protocol.
Since the second half of 20th century, great changes have taken place in human disease spectrum. Nowadays, the most serious diseases threatening to the human health mainly are cardiovascular disease (CVD), cerebrovascular disease and malignant tumor. The incidence of hypertension reaches around 20%. In the CVD spectrum, hypertension is an upstream disease, so the poorly controlled hypertension may cause a series of complications, such as left ventricle hypertrophy, hypertensive heart disease, coronary arteriosclerotic heart disease, or even heart failure. Moreover, it also may cause cerebrovascular disease, such as stroke, hypertensive encephalopathy; other organ injuries, such as renal arteriosclerosis and kidney failure. In short, hypertension is a high-incidence disease that is greatly threatening human health. The hypertension prevention and treatment can postpone or avoid many serious complications, so it is of great social significance to prevent and treat hypertension. Adhering to the benefiting mankind feeling of “good physician is like good prime minister”, Professor Yuan-Sheng TAN has been intended to make contributions to the important social demand aspect, namely, prevention and treatment of hypertension. After 15 years of exploration and accumulation, he proposes the view to treat hypertension from the “deficiency, stasis and wind”. The brief introduction is as follows:
Professor Yuan-Sheng TAN holds the view that hypertension symptoms are not in complete conformity with “dizziness” and “headache” in traditional Chinese medicine (TCM) , but generally belong to the category of “dizziness” and “headache” in TCM. According to many discourses of physicians through the ages, generally, the hypertension belongs to syndrome of asthenia in origin and sthenia in superficiality. The asthenia in origin refers to deficiency of liver-yin and kidney-yin and the sthenia in superficiality refers to hyperactivity of liver-yang and stasis blocking channels. At the early state, the symptoms mainly are deficiency of liver-yin and kidney-yin, yin deficiency and yang hyperactivity and liver yang causing wind; at the middle and advanced stage, the symptoms mainly are yin deficiency with blood stasis and blood stasis causing wind, specifically:
Soul Box for Acupuncture–Hailun1: “The deficiency of brain may cause dizziness, tinnitus, legs weakness, eyes dimness, tiredness, fatigue and drowsiness.” Soul Box for Acupuncture–Kouwen2: “Therefore, where pathogenic factors exist, there has the problem of deficiency. When qi fails to transport upward, brain deficiency, tinnitus, headache, dizziness…may be caused”
Yuan-Fang CHAO, a physician of the Sui Dynasty, thought that the deficiency of viscera and pathogenic factors in brain could cause dizziness. In General Treatise on the Cause and Symptoms of Diseases2, he pointed out that: “The assembled channels gather in the essences of the five zang-organs and six fu-organs. The essences of the muscles, bones and blood, together with the meridians, belong to eye connector that is connected with brain at the upstream. The pathogenic factors enter in the brain through the eye connector by taking advantage of the deficiency, which causes the headache and eye connector disease, leading to dizzy eyes.”
Jie-Bin ZHANG, a physician of the Ming Dynasty, stressed that “no deficiency, no dizziness”. As for the therapy, he thought the “the treatment of deficiency” should be taken as the principal thing. In Complete Works of Jingyue – Dizziness3, he said that “80%-90% patients with dizziness have the problem of deficiency, while only 10%-20% of them have the problem of fire and phlegm.” “No deficiency, no dizziness, so the treatment of deficiency shall be taken as the principal thing.”
Yan-Chun XU, a physician of the Ming Dynasty, pointed out that deficiency refers to qi and blood, while the excess refers to phlegm, wind and fire. The deficiency was the root cause, while the excess was the incidental symptom. In Yuji Weiyi4, he said that “people all say that dizziness is caused by upper excess and lower deficiency, but don’t know the real cause was the deficiency of qi and blood and the excess of phlegm, wind and fire.”
Wen-Qi WANG, a physician of the Qing Dynasty, thought the deficiency was the root cause of dizziness and attached much importance to the deficiency of liver and kidney. In Zazheng Huixin Lu5, he said “generally, 60%-70% are of deficiency and 20%-30% are of phlegm and fire. That is to say, the cold and dizziness are often caused by the deficiency of upper-warmer primordial qi after sweating and vomiting and excretion whose treatments are superficial.”
Xiang-Ao BAO, a physician of the Qing Dynasty, made beneficial explorations in aspects of prevention and treatment of dizziness and decrease of poor prognosis. In New Compilation of Proved Recipes6, he said that “if the qi and blood are sufficient, the yin and yang are in balance, the pathogenic fire is removed. As a result, dizziness disappears.”
1.1 Qi deficiency
The primordial qi may be consumed and damaged by aeipathia, serious disease and defatigation, or naturally declines due to the internal organs hypofunction of the old and infirm, or become deficient in production congenitally due to inherent shortage and postnatal loss of nourishment. In a word, the deficiency of primordial qi will result in the weakened function of driving, inducing astringency, defense and transformation of qi and internal organs hypofunction, causing symptoms such as short of breath, spiritual fatigue, weakness, spontaneous perspiration, feeble pulse and aggravated symptoms after activity. “Qi is the commander of blood and promotes the blood circulation”. When the qi is deficient, the blood circulation is slow, namely the stasis. Therefore, the qi deficiency can cause the stasis.
1.2 Blood deficiency
The decreased transportation and transformation functions of spleen and stomach and the deficiency of source of engendering transformation will cause the formation deficiency of new blood. The excess consumption of blood after various hemorrhages, aeipathia, serious disease and defatigation will lead to the internal organs and meridians lacking of moistening, causing symptoms such as pale complexion, dizziness, numbness in the hands and feet, thin and weak pulse, even tendon and vessel spasm and wind formation from blood deficiency.
1.3 Yin deficiency
The yin fluid can be consumed by prolonged heat disease or miscellaneous diseases or sexual strain and impaired by emotional stress, endogenous fire and over dosage of warm dry things, so that the deficiency of yin fluid in body fails restraining yang, resulting in the decreased nourishing effect which may cause deficiency heat symptoms such as tidal fever, night sweating, dry throat, red cheeks, red tongue with little coating, thin and rapid pulse. For a long course, it may cause stasis due to the stagnation of dry and unsmooth body fluid and blood, or even cause wind formation due to yin deficiency and yang excess.
1.4 Yang deficiency
The consumption of yang may be caused by life-gate fire deficiency of the old, living in cold and cool place for a long time, or over dosage of cold and cool things, aeipathia or further aggravated qi deficiency. The body lacks of warm nourishing, resulting in the weakened function of driving and transformation of qi, causing symptoms such as cold body and limbs, tastelessness in mouth without thirst, clear urine, loose stool, pale tongue and weak pulse. The qi-blood circulation is slow due to the cold body, forming stasis over time.
Ren-Zhai YANG, a physician of the Song Dynasty, was the first to know about dizziness from the perspective of blood stasis. In Renzhai Zhizhi Fanglun7, he said “the blocked circulation, stasis and stagnation can cause dizziness”.
Wan-Su LIU of the Jin and Yuan periods thought that the disease was caused by the endogenous wind and fire. In Suwen Xuanji Yuanbingshi - Disease Reflected by Five Elements8, he said: “the dizziness is caused by flourishing wood due to wind… The fighting of movements causes the dizziness.”
Ken-Tang WANG, a physician of the Ming Dynasty, clearly pointed out the pathogenesis of the headache is caused by stasis, namely “stagnation of meridians and collaterals”. In Criteria of Miscellaneous Diseases Diagnosis – Headache9, he said: “the reversed flow of qi of internal organs and channels up to the clear channel of brain leads to the blocked circulation. When the channels are blocked, pains are caused. The head is like the sky, the clear yang of three yang and six fu organs gathers here and the blood of the essence of three yin and five zang organs also flows into the brain. Therefore, the pathogenic factors of six climatic conditions and the reversed qi of five elements of body can impair each other, which may cover the clear mind, block the channels or be in conflict with the qi. The pulse is full due to the stagnated heat, resulting in pain.”
There were many discourses in this aspect provided by physicians of the Ming and Qing Dynasties. For instance, Zhong-Zi LI’s Essential Readings for Medical Professionals10: “The upward reversed flow of blood stasis will also cause dizziness.” Tuan YU’s Standard Medical Book11: “The blood stasis causes dizziness.” Ji PAN’s Continuation of Medical Guide12: “The dizziness may be caused by blood stasis… The yang all goes upward to the brain and all channels go upward to eyes. When the channels are blocked due to blood stasis, the transportation of blood becomes deficient. Then the deficiency in blood transportation causes the dizziness.” Qian WU’s Golden Mirror of Medicine13: “The blood stasis causes the dizziness.” Rong-Chuan TANG’s A Treatise on Blood Troubles – Blood Stasis14: “The blood stasis in heat can cause cardiodynia, dizziness, faint mind and unconsciousness.” Tain-Shi YE: “The prolonged and frequent diseases must impair the collaterals, where blood gathers, so the prolonged diseases surely cause stasis and blockade.” Namely, so-called “protracted disease intruding into collaterals” and “protracted disease intruding into blood”. Many physicians at that time advocated the theory of “stasis causing dizziness”, which had far-reaching influence on the later generations to understand the hypertension from the stasis. Among them, the most influential one is Qing-Ren WANG’s Correction on the Errors of Medical Works15. Qing-Qen WANG had extremely profound research on the blood stasis syndrome, especially the qi deficiency and blood stasis syndrome. He stressed that “the key to treatment is to understand the qi and blood.” “The primordial qi is deficient so that it can’t reach into the blood vessels. As a result, the blood vessels stagnate, stasis appears.” “The exogenous headache must have the exterior symptoms of fever and aversion to cold, which can be cured by diaphoresis; the heat accumulation must have the symptoms of dry tongue and thirsty, which can be cured by activating qi; the qi deficiency must have the symptoms of faint pain, which can be cured by Ren Shen(Ginseng Radix) and Huang Qi(Radix Astragali). The headache without exterior symptoms, interior symptoms, qi deficiency, phlegm or retained fluid, but attack or cured at times and can’t be effectively cured by various prescriptions, can be cured by only one dose of this prescription.” It can be said that Qing-Ren WANG is the first one to cure headache by promoting blood circulation and removing blood stasis. A series of his prescriptions are still widely used in clinical.
It is also mentioned in one of Professor Yuan-Sheng TAN’s articles16: “The blood stasis exists in the whole course of the pathogenesis of hypertension and its status in the pathogenesis of hypertension has changed significantly.”
As what mentioned above, qi deficiency, blood deficiency, yin deficiency and yang deficiency can cause stasis, which is not explained repeatedly here.
Si-Mao SUN, a famous medical scientist of the Tang Dynasty, attached much importance to wind disease. He thought that the pathogenic factor easily causes the deficiency of the viscera and the wind pathogen was the commonest. In Valuable Prescriptions for Emergency – Preface Cases17, “the disharmony of wind and qi will cause general tetanus and closure of pores… When the wind stops, the qi is blocked…” He was good at treating various diseases including dizziness and headache from the wind. It should be said that he mainly understood dizziness and headache from the “exogenous wind”, but there are also theories related to endogenous wind in the books, such as the Valuable Prescriptions for Emergency – Wind Dizziness18: “Si-Bo XU says: the disease of wind dizziness is caused by unsteady heart qi and excess of heart, so the high wind and facial heat appear. The intermingled phlegm and heat stir the wind. The disturbed wind heart leads to blurred vision with restlessness, so it is called wind dizziness.”
Zi-Ming CHEN, a physician of the Song Dynasty said in Complete Collection of Prescriptions for Women – Volume III Eighth Discourse on Prescription for Harmful Wind Hemiplegia18: “Zi-Heng WANG says: “The wind to human is like the water to a boat. The water can bear and overturn the boat; the wind can nourish and harm the body. Generally, the water enters into the leaking boat is like wind harms the deficient body.” The ancients also said “the treatment of blood is the first to treat wind. The wind will be removed naturally when the blood circulates. It is better to nourish blood and then remove the wind for the treatment, which is always effective.”
Zhong-Zi LI, a physician of the Ming Dynasty, said in Essential Readings for Medical Professionals – Volume 10 – Paralysis 10: “The treatment of blood is the first to treat wind. The wind will be removed naturally due to the smooth circulation of blood.”
The opinions on the etiology and pathogenesis of liver wind were put forward to in the A Guide to Clinical Practice with Medical Records19, collated by Xiu-Yun HUA, who was one of the disciples of the famous physician of the Qing Dynasty Tian-Shi YE, which thought that liver wind was the “stirring of yang-qi.” It is also explicitly pointed out that such endogenous stirring of liver wind is “not exogenous pathogenic factor”. It is endogenous or caused by extreme changes of emotions; or deficiency of kidney water, so that water fails to moisten wood; or deficiency of middle-warmer yang, so that the endogenous wind stirs secretly, etc. In short, it is related to the Jueyin wind and wood, namely the theory of “yang causing endogenous wind”. In the book, “the dizziness is not caused by exogenous pathogenic factors, but the upward stirring of wind yang of liver and gallbladder. It even may cause the faint and tumble. The symptoms include phlegm, heat, deficiency in the middle and lower. It is divided into the treatment of gallbladder, stomach and liver. For the excess of fire, the Linɡ Yanɡ Jiao(Saiga tatarica Linnaeus), Zhi Zi(Gardeniae Fructus)、Lian Qiao(Forsythiae Suspensae Fructus)、Tian Hua Fen(Trichosanthis Radix)、Xuan Shen(Scrophulariae Radix)、Sheng Di(Rehmanniae Radix)、Dan Pi(Moutan Radicis Cortex)、Sang Ye(Mori Folium) are used to clear the heat in orifices and collaterals of the upper warmer, which is the treatment from the gallbladder; the Yangming must be treated with herbs such as Zhu Li(Phyllostachys nigra(Lodd.))、Jiang Zhi(ginger juice)、Shi Chang Pu(Acori Tatarinowii Rhizoma)、Hua Ju Hong(Citri Grandis Exocarpium) and Erchen decoction; the deficiency in the middle shall be combined with Ren Shen(Ginseng Radix), or Poria Cocos Decoction according to Waitai Miyao; the deficiency in the lower must be treated from the liver. It is a suppressing treatment that to improve liver and kidney function by nourishing yin and suppressing the excessive yang. The herbs with the efficacy to extinct wind, such as Tian Ma(Gastrodia elata), Gou Teng (Uncariae Ramulus cum Uncis), Ju Hua(Chrysanthemi Flos), can be added according to the symptoms. The root cause of the disease is the liver wind. The liver wind, wind in the middle and head wind shall be considered at the same time.”
Jin-Ao SHEN, a physician of the Qing Dynasty, held the view that dizziness was the disease of liver wind and the headache was the disease of kidney deficiency. In his Highlights of Source of Miscellaneous Diseases20, the “source of headache” was included, in which the symptoms such as headache, dizziness and head wind dizziness were expounded respectively.
Pei-Qin LIN, a physician of the Qing Dynasty, held the view that the ministerial fire was in liver and gall, while liver and gall were organs of wind and wood, governing moving and ascending, thus the dizziness was caused by the stirring wind to the head due to yang ascending. In Different Kinds of Diseases21, it is said that: “the blurred vision, tinnitus, dizziness and restlessness may be caused by mental or physical hyperactivity, extreme emotions, earth qi ascending, loose storing in winter, decreased kidney fluid of the old causing water failing to nourish wood, or unrecovered spirit after disease causing yin failing to absorb yang.” Besides, he explicitly pointed out the opinion of endogenous wind as the principal thing.
Zong-Hai TANG, a physician of the late Qing Dynasty, listed the “dizziness and headache” syndrome in A Treatise on Blood Disorders22. He combined the dizziness and headache and expounded that “dizziness and headache are two diseases, but the two diseases always occur in patients with hemorrhage.” “The dizziness and headache are caused by coldness; dizziness and headache of women are mainly caused by phlegm-fire and the ascending of phlegm and qi… The above mentioned are all sthenia syndromes of dizziness and headache, and also the deficiency syndromes. It shall be divided into dizziness and headache and different treatments shall be used. The liver deficiency can cause dizziness… The deficiency of liver blood can cause wind. As wind governing moving, the trembling and dizziness are caused. The blood deficiency of the patients due to hemorrhage can cause wind, which can be cured by Xiaoyao Powder add Chuan Xion(Chuanxiong Rhizoma), Qing Xiang Zi(Celosiae Argenteae Semen) and Xia Ku Cao(Prunella vulgaris). Or it is essential for calming wind to nourish liver, using Zuogui Decoction add Niu Xi(Cyathulae Radix),Ba Ji Tian(morinda officinalis), Ju Hua(Chrysanthemi Flos), Xi Xin(Herba Asari), Gou Qi(Lycii Fructus)… Because of blood deficiency, the stirring wind and fire can cause the dizziness. I don’t divide it into dizziness and headache, or the treatment of liver and kidney but treat it all with Decoction of Four Drugs, combined with Xuan Shen(Scrophulariae Radix) and Gou Qi(Lycii Fructus)…”
3.1 Blood stasis forming wind
The protracted disease intrudes into collaterals, causing the stagnation of channels and collaterals and blocked circulation of blood. The symptoms of stirring wind appear due to the lacking of moistening and nourishing of organs, meridians and limbs, with specific symptoms of limb convulsion, dizziness, tremor, etc.
There is no relevant reference that clearly expounds this opinion, but it can be derived from some references. For instance, the old saying goes “the treatment of blood is the first to treat wind. The wind will be removed naturally when blood circulates.” But “If Does it mean when the blood cannot circulate, it is the wind to be treated?” However, the blocked blood circulation” which means stasis shows that stasis can stir wind.
3.2 Liver-yang forming wind
The consumption of yin fluid can be caused by long hyperactivity of liver-yang, or the yin fails to suppress yang due to the deficiency of liver-yin and kidney-yin. The long yang-hyperactivity and yin-deficiency can cause the symptoms of wind, such as, dizziness, paralysis, convulsion, tremor, or even sudden faint and tumbling, facial paralysis, hemiplegia, etc.
3.3 Yin deficiency stirring wind
The consumption of yin fluid, tendon and vessel malnutrition and fascia contracture can be caused by protracted disease, internal damage, or at the later stage of heat disease. As a result, the dizziness, limb tremor and seizures may appear due to the consumption and deficiency of liver-yin and endogenous wind stirring in deficiency condition.
3.4 Blood deficiency causing wind
The protracted miscellaneous internal damage diseases, deficiency of blood formation due to deficiency of source of engendering transformation, blood deficiency due to protracted diseases, or chronic and acute hemorrhage can cause the deficiency of liver-blood and endogenous wind stirring in deficiency condition, resulting in deficiency of ying blood, malnutrition of tendon, vessel and skin, dizziness, limb tremor, paralysis, contracture and pruritus.
In addition, as for the zang-fu viscera, Professor Yuan-Sheng TAN attaches more importance to liver and kidney.
On the principles of searching for the root cause of disease in treatment and simultaneous treatment of root cause and symptoms, Professor Yuan-Sheng TAN founds the therapy of nourishing yin to soften liver and removing the stasis to calm endogenous wind by sticking to the pathogenesis from “deficiency, stasis and wind”. Nourishing yin to soften liver can treat yin deficiency and yang hyperactivity, disperse and treat blood stasis, calm and treat wind. It can be said to be a precise and appropriate therapy hitting the pathogenesis.
Prescription and Herbs
Based on the therapy of “nourishing yin to soften liver and removing the stasis to calm endogenous wind”, after more than 10 years of exploration, Professor Yuan-Sheng TAN has developed the Compound Qishaojiangya Tablet (CQT), with the prescription consisting of San Qi(Panax Notoginseng), Bai Shao(Paeoniae Alba Radix), Sang Ji Sheng(Parasitic Loranthus), Du Zhong (Eucommia), Dan Sheng(Savia Miltiorrhiza), Tian Ma(Gastrodia Elata), Luo Fu Mu(Rauvolfia Verticillata(Lour.) Baill), Di Long(Lumbricus), Ge Gen (Puerariae Lobatae Radix), Chao Xiang Fu(Fried Rhizoma Cyperi) and Gan Cao(Glycyrrhiizae Radix). In the prescription, San Qi(Panax Notoginseng) can promote blood circulation to dispel blood stasis and Bai Shao(Paeoniae Alba Radix) can nourish yin to soften liver and calm wind. Both of the two are the main drugs. The Sang Ji Sheng(Parasitic Loranthus) and Du Zhong (Eucommia) can tonify the liver and kidney; Dan Sheng(Savia Miltiorrhiza) can promote blood circulation to dispel blood stasis and Tian Ma(Gastrodia Elata) can suppress hyperactive liver for calming endogenous wind. All of the three are ministerial herbs. The Luo Fu Mu(Rauvolfia Verticillata(Lour.) Baill) can repress liver and clear heat; the Di Long(Lumbricus) can calm wind and dredge collaterals; the Ge Gen (Puerariae Lobatae Radix) can engender liquid and promote blood circulation; the Chao Xiang Fu(Fried Rhizoma Cyperi) can regulate qi and soothe the liver. All of these herbs are the adjuvant herbs. The Gan Cao(Glycyrrhiizae Radix) is the conductant herb to coordinate the drug actions of the prescription. The use of the above mentioned 11 herbs can tonify yin, calm yang hyperactivity, dredge collaterals, moisten brain and nourish clear orifices to stop dizziness.
The preliminary animal experiments and clinical application has proved that it is of good efficacy in prevention and treatment of hypertension!
The modern pharmacological study: San Qi(Panax Notoginseng), Bai Shao(Paeoniae Alba Radix), Sang Ji Sheng(Parasitic Loranthus), Di Long(Lumbricus), Dan Sheng(Savia Miltiorrhiza), Ge Gen (Puerariae Lobatae Radix), Gan Cao(Glycyrrhiizae Radix) can inhibit the platelet aggregation. The Bai Shao(Paeoniae Alba Radix) can also relieve the smooth muscle spasm; the Tian Ma(Gastrodia Elata) can increase the arterial vascular compliance and reduce peripheral resistance; the Ge Gen (Puerariae Lobatae Radix) has the function of β-acceptor inhibition, and the Du Zhong (Eucommia), Di Long(Lumbricus), Luo Fu Mu(Rauvolfia Verticillata(Lour.) Baill), Chao Xiang Fu(Fried Rhizoma Cyperi), etc. all have the antihypertensive effects.
The authors declare that they have no competing interests.
The authors thank for the fund support from National Natural Science Foundation of China（No. 81473616）， science and technology program major project of China Hunan Provincial Science & Technology Department (2016DK2002).
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