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Constitutional Treatment "Fortify the Righteous, Secure the Root"

by Nigel Dawes

"The superior physician treats those who are not yet sick; the ordinary physician treats those who are already sick".

-Nei Jing Su Wen

Introduction

In Chinese medicine the term: "Fu Zheng Gu Ben" is used to identify a specific therapeutic principle: "Fortify the Righteous, Secure the Root." It is applied in practices including herbal medicine in particular, but also in acupuncture, dietetics, Qi Gong and other therapies which have the potential of restoring and regulating normal body metabolism, leading to enhanced resistance to disease and optimizing health.1 This notion of attending to the body's natural homeostatic potential and attempting to gently support the normal functioning of the individual on all levels lies at the heart of healing and accounts for the early emphasis on prophylactic practices in medical traditions of all cultures.

In Oriental Medicine ( OM ), disease is seen as the result of a distorted relationship between excessive pathogenic influences on the one hand and compromised defense mechanisms on the other. In the practice of OM , depending on the particular discipline involved, there may be more or less emphasis on interventive techniques designed to address pathogenic influences directly. We associate terms such as "treatment" and "medicine" with such approaches, which have come to dominate the practice of OM these days, especially in the hospital-based environment.

From the earliest times however, emphasis was also placed on identifying distortions in the normal flow of the body's life force, or Qi, and correcting them, thereby allowing the natural, health- promoting energy to flow of its own volition, bringing the organism gently back into harmony. Diagnosis within this framework relied less on the exclusive isolation and identification of pathogenic entities and more on an inclusive web of relationships that were established by careful analysis; not of the micro but of the macrobiotic elements of the case at hand. These could include assessment of a person's body type, build, skin and muscle quality, behavior, attitude and affect (including "spirit"), voice tone and quality as well as their digestive strength and body temperature. Basic OM theoretical paradigms including Yin and Yang and the 5-Phases provided a framework of interpretation for these findings and resulted in an assessment that could be termed a "constitutional analysis". In many of the classics of acupuncture such as the Nei Jing and Nan Jing and of Herbology such as the Shang Han Lun, constitutional analysis is frequently referred to in diagnosis (we talk of Yin, Yang, Qi, Blood, Fluid, Fire, Earth, Metal, Water and Wood "Types" for example) and the selection of appropriate treatment strategies (Bu - meaning "Tonify"; Jian - meaning "Build" or Tiao meaning "Regulate"). Fu Zheng therapy in fact is an expression of the original art of analyzing and treating the person rather than the disease; of strengthening that which is proper and correct in terms of the energy system and of promoting the integrity of all the regulatory mechanisms of the body.

Fortify the Righteous (Fu Zheng)

"Between Heaven and Earth there seems to be a bellows.

When emptied, it is still inexhaustible. When activated, it wants only to continue." -Lao Zi.

The term Zheng here refers to the Zheng Qi or "Upright," "Correct" Qi of the body whose job it is to ensure proper physiological functioning and maintain homeostasis. In OM theory these days, it is generally interpreted that this form of Qi results from the combination of the two most basic survival functions of the organism: breathing (Da Qi) and eating (Gu Qi). The resulting Qi collects in the chest before entering the channel system (beginning with the Lung) in its more rarified form, called "True Qi" (Zhen Qi), and entering the vascular system (beginning with the heart) in its more material form, Blood (Xue). Already we are thrown into one of the many seemingly paradoxical statements of fact in Chinese medicine (the reference to Bob Flaws' concise text of the same name is not unintentional). Namely, a phenomenon, here the example being a physiological "substance", Qi, and a specific manifestation of it, namely Zheng Qi, can apparently exist in different forms varying from the manifest to the non-manifest. It can flow with the unseen movement of the channels and also as part of the tangible life force of the blood itself. Whatever was conceived of as being the function of this Zheng Qi therefore, it apparently operates on different, discreet dimensions simultaneously, somehow contributing in a comprehensive manner to the overall optimum functioning of the organism. We shall call it the "Righteous Qi".

The Chinese character for Zheng includes a horizontal stroke at the top symbolizing heaven and another at the bottom earth with a vertical connecting stroke symbolizing the interaction between the two. The imagery is highly reminiscent of one of the most fundamental of the Taoist cosmological principles that came so heavily to influence early Chinese medical thinking: the Three Treasures (San Bao) - namely Shen (Heaven), Jing (Earth) and Qi (Life). The simplest interpretation of the notion of Zheng Qi therefore suggests, as the Nei Jing Su Wen does repeatedly, that the "correct" way of living is to follow the design laid down by heaven and earth. To live one's life according to the natural rhythms of which we are a part: environmental (climate, seasons etc.) and personal (emotions, relationships and so on). To go against the natural flow of these phenomena would be to invite discord, unrest and ultimately, disease. The Taoist creed was of course to identify and advocate specific practices by which a person could maintain such spiritual, emotional and physical harmony and not stray from the "righteous" path.

Those familiar with the fundamental Taoist dialectic will find nothing new so far in this discussion. Yet an aspect often underemphasized is that nothing in the Taoist writings suggests an interpretation of the notion of "Zheng" as being related to a moral sense of what is right. Rather it is a very personal, and therefore totally individual definition. What is right for you may not be right for me. Contained within the now populist Taoist symbol of the Taiji is this very image of relative truth. Yin/Yang theory can speak to us across the millennia as an infinitely useful clinical tool precisely because of its relativism. So when we attempt to define the significance of what this Zheng Qi is in physiological terms inside the human body, we are faced immediately with the fact that we can glimpse its function and define it accordingly, yet if we pursue an active material definition we will inevitably be frustrated. So what of its functions?

The Heaven, Earth, Man theory discussed earlier, derived from Taoist cosmology, developed in the I Ching (Book of Changes) and later incorporated in the theory of the Three Treasures (San Bao), proposes a universal symbolism useful in explaining relationships and interactions between phenomena. In considering this symbolic model in relation say, to the vital organs of the body, it is not difficult to identify the Lung, Spleen and Kidney as representative respectively of the Shen, Qi, Jing aspects of the three treasures. In fact, when considering Fu Zheng Gu Ben therapy it is precisely the function of these three organs which is so significant.

The Lung (Fei Zang) and Zheng Qi

"To eat Qi means breathing deeply and strongly to release the old and receive the new"

-Wang Chong from the "Discussions of Judgements", E. Han Dynasty (25-220 CE)

For example, in terms of Zheng Qi, we can understand the Lung, located in the upper jiao, whose job it is to capture the Cosmic (Da) Qi and draw it downward into the body, as being symbolically related to Heaven (Yang). By extension, the skin and the defensive (Wei) Qi that floats above and beneath it symbolize the Yang-related (exterior) elements of our self-protective ability. The Lung, the Prime Minister in the language of the classical "12 officials", acts as a liaison between the forces of Heaven, symbolized not merely by the oxygen/carbon dioxide exchange cycle, but by all the unseen "cosmic" influences on our being (from spirits to neutrinos, from emotions to x-rays). The "mist" of the upper jiao is a perfect symbol for the subtle particles that constantly bombard our being from without - those that sustain us (both chemical and psychic), and those of course that would harm us (bacteria, viruses, allergens, Constitutional Treatment continued from page 30 negative emotions for example). One of the Lung's primary roles is to constantly be vigilant in filtering all this "information" and demonstrate the discriminative ability to selectively absorb that which will nourish yet repel that which would harm, maintaining an harmonious exchange with the environment.

The Po , the Shen of the Lung, is the great gatherer, constantly igniting the primitive survival instincts within us, the will to acquire, to own, to inhabit, to define and make ones' own. The Po identifies who we are, our boundaries, our limits and this instinct is a source of comfort to us materially (a roof over our heads, food to eat, companionship - the fundamentals of sustaining life) and spiritually (safety, security, a sense of self, who we are in the world). It allows us to feel literally "at home in our skin". So on a biochemical and psychic level, the Lung has a function closely related to that of what we can call the Yang aspect of the Zheng Qi, acquiring from the less material environment all those influences that have the potential for strengthening us physically and emotionally.

The virtue of the Lung ( Ping ) is related to beauty in the esthetic sense involving appreciation for perspective, contrast and, ultimately, perfect harmony and balance. As the image of the great "bellows" reminds us, the canopy of the Lung both literally and symbolically contracts and expands constantly to maintain harmony in the system (a perfect metaphor for homeostasis). The job of the Lung is to literally "do what is right" in terms of the intrinsic integrity of the organism as well as its relationship to the environment. No single bodily function symbolizes this more powerfully than the breath itself, which of course is one of the many literal translations of the character for Qi itself.

In terms of the five movements (Wu Xing), Lung-metal is the only one to express multi-directional energy (in and out, up and down). The other 4 are all uni-directional in their movement tendencies: Heart (flaring up) and Liver (reaching out) are the more Yang movement expressions; Earth (gathering in the middle) and Water (condensing downwards) the more Yin. The metal harmonizes the opposing tendencies of Yin and Yang in Qi movement terms and here we notice again the Lung's intrinsic and important link with the whole notion of Zheng Qi, of what is upright and righteous in terms of attitude and behavior and in terms of the quality and function of Qi that reflects such correctness of mind and body. Ultimately it is the Lung that has the closest link to the concept of Zheng and therefore it is to the Lung and its function that the early philosophers, sages, priests, martial and healing artists looked when devising practices that were aimed at supporting the body's natural resistance to invasion by demons, enemies, wind, cold, bad food, excessive emotion or any other potential interpretation of the cause of disease. Breathing exercises of all kinds formed the backbone of the earliest preventive health practices and the resurgence of Qi Gong in Fu Zheng therapy today (especially in cancer therapy) is testimony to its continued relevance. On the more esoteric level, practicing respect (one of the virtues of the metal element) for the environment and all life forms within it by what the Taoists called "right action" or virtuous behavior, was believed to emanate directly from a healthy Lung function and in turn to support it.

Follow up

This article has focused on ways in which the human body attempts to strengthen and defend itself against "marauding invaders" (to use the language of Sun Su's "The Art of War")and has attempted to explain one aspect of Fu Zheng therapy by focusing on the role of the Lungs in relationship to some of the body's natural defenses. In the next article, I will examine the Gu Ben (Secure the Root) aspect of Fu Zheng Gu Ben therapy with particular emphasis on the roles of the Spleen and Kidney respectively in relationship to the Essence (Jing). A third article will deal with treatment strategies with particular reference to the practice of Kanpo (Sino-Japanese Herbal Medicine) and its focus on constitutional treatment approaches.

Nigel Dawes will be presenting a morning lecture and afternoon workshop on Constitutional Treatment at the 2004 Pacific Symposium in San Diego on Friday, Nov. 5, 2004.

• In the literature, studies on the immune, endocrene, nervous, blood and cardio-vascular systems involving acupuncture, Qi Gong and herbs have shown promising results and Fu Zheng therapy has been described as being adaptogenic, modifying biological responses and enhancing various immune functions.