How to understand the efficacy of Guizhi in “harmonizing, regulating qi, and descending rebellious qi”?
Original text: In Taiyang disease, after purging, if the qi rushes upward, Gui Zhi Tang can be used, following the original method. If the qi does not rush upward, it should not be used.
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Taiyang disease affects the exterior (表). When a person suffers from Taiyang disease, the ying and wei qi naturally shifts toward the muscle surface to release the exterior. If purging is mistakenly used at this time, the medicine will cause the qi to descend. This situation is like when you insist on going outward, but someone pulls you downward from behind. What would your reaction be? If you want to continue going outward, you must struggle upward forcefully. “After purging, if the qi rushes upward” is the body’s reactive struggle against the qi sinking caused by the mistaken purging. This indicates that the body still has the ability to continue releasing the exterior. Therefore, the overall qi mechanism, after being constrained by purging, reactively struggles upward and outward to expel the pathogenic factors from the exterior.
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Because this upward qi rush occurs due to the exterior syndrome—ying and wei qi trending upward to the exterior—using Gui Zhi Tang to resolve the exterior syndrome will stop the qi from rushing upward. The original text says “Gui Zhi Tang can be used” rather than a phrase like “Gui Zhi Tang treats it,” which indicates that the text is describing a treatment method, not necessarily only using the original formula of Gui Zhi Tang. Clinically, modifications can be made. For vomiting, appropriate additions of Sheng Jiang (fresh ginger) and Ban Xia (Pinellia) can be made; for wheezing, apricot kernel (Xing Ren) can be added. These are specific symptoms of the qi rushing upward.
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“After sweating, if a person feels palpitations below the navel and desires to make a running piglet (ben tun), the decoction of Poria, Cinnamon Twig, Licorice, and Jujube (Fuling Guizhi Gancao Dazao Tang) is indicated.” The textbook explains this as qi rushing upward, referring to the running piglet, and our teacher said that this treatment works through the combined effects of the ingredients. The use of Poria here indicates that the pathogenesis is related to the accumulation of body fluids. The defensive qi moves toward the exterior, so there is abnormal accumulation of untransformed water vapor in the lower burner. While sweating, the person’s qi mechanism ascends, and these abnormally accumulated water vapors also rush upward, which is the running piglet.
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“In typhoid, after vomiting or diarrhea, if there is fullness and reversal under the heart, qi rushing up to the chest, dizziness on standing, a deep and tight pulse, and sweating causes agitation along the meridians, with the body trembling violently, the decoction of Poria, Cinnamon Twig, White Atractylodes, and Licorice (Fuling Guizhi Baizhu Gancao Tang) is indicated.” This describes water retention in the middle burner, where sweating leads to water retention impacting the meridians, causing violent trembling. In fact, the qi rushing upward here includes panting, vomiting, and running piglet. When I studied Chinese medicine, our teacher said the qi rushing upward mentioned here refers to running piglet (though I might have misheard).
“117. Applying a moxibustion needle to induce sweating; if the needle site is affected by cold, causing a nodule to form and turn red, it will inevitably trigger ben tun (a sensation of urgent upward rushing qi). When qi rushes from the lower abdomen up toward the heart, moxibustion should be applied to one moxa cone on each nodule, along with Guizhi Jia Gui Tang (Cinnamon Twig Decoction plus Additional Cinnamon Bark), with two additional liang of cinnamon bark added.” This passage describes the excessive dispersion of qi outside the body, which causes the yang qi of the lower burner to rush upward, leading to ben tun. It refers to the needle site being affected by cold, meaning the patient is in a cold environment. At this time, using a burning needle generates insufficient heat, causing the body’s defensive qi to mobilize extensively to rush to the area invaded by cold; hence the nodule forms and turns red. The most direct manifestation is chilblains, which itch when indoors, and soaking in hot water often causes palpitations. At this point, warming the body surface with moxibustion is used, followed by taking Guizhi Jia Gui Tang to quickly deliver yang qi of the decoction to the body surface, meeting the body’s needs and thus eliminating the symptoms of ben tun.