One major aspect of Chinese Medicine that sets it apart from many of the other established health systems of the world is the importance of ‘Syndrome Differentiation’. For an accurate syndrome differentiation to be derived, the TCM practitioner must carry out a very detailed diagnostic process, collecting signs and symptoms of disease from the patient. This data must then be differentiated into a precise syndrome. Only then can the practitioner formulate an effective treatment strategy either treating the root cause, the presenting symptoms or both.

 

There is a saying in Chinese Medicine that states “Treating the same disease with different methods and treating different diseases with the same method”. Gui Pi Tang is a perfect example of the later part of this saying, as it is a treatment that can be applied to a huge range of different health problems, which from the surface have no apparent links. The way in which this one formula can be used for such a wide range of syndromes is that their root problem remains the same. The manifestations simply appear as different diseases depending on the health and constitution of the patient. Remembering this principal, combined with accurate diagnosis and syndrome differentiation, this one formula can be used to treat a wide range of disorders. The following article will look at what conditions Gui Pi Tang can treat and how it achieves it.

 

Gui Pi Tang,meaning ‘Restore The Spleen Decoction’, is a formula that tonifies both the qi and the blood. It first appeared back in the Song Dynasty but was modified during the Ming dynasty in the text <<Revised Fine Formulas for Women>>. Its name refers to the main action of the formula; which is to strengthen the spleen. It also replenishes the qi, tonifies the blood, and nourishes the heart.

 

Below is a list of the herbs making up the formula and the dosages that are used in modern day practice.

 

Dang Shen       党 參               12-18g

Huang Qi         黄  芪              9-12g

Bai Zhu            白  术              9-12g

Fu Shen           茯   神             9-12g

Suan Zao Ren 酸 枣 仁          9-12g

Long Yan Rou 龙 眼 肉          6-9g

Mu Xiang        木 香               3-6g

Zhi Gan Cao   炙甘 草           3-6g

Dang Gui        当 归               6-9g

Zhi Yuan Zhi    炙 远 志          3-6g

Sheng Jiang     生 姜               5 pieces

Da Zao            大 枣              1 piece

(Bensky and Barlot 1990, p255)

 

The king herbs of Dang Shen, Huang Qi, Bai Zhu and Zhi Gan Cao focus their action on the spleen, with the combined action of tonifying the spleen qi, drying dampness and augmenting qi.  The assistant herbs Long Yan Rou, Dang Gui, Suan Zao Ren, Fu Shen and Zhi Yuan Zhi concentrate on ‘tonifying the blood and calming the spirit’. The adjuvant, Mu Xiang, regulates qi helping to counteract the cloying nature of the tonic herbs. The envoys Sheng Jiang and Da Zao facilitate the action of the other herbs and also help to strengthen the spleen.

Before the uses of the formula are explained, the organs which the formula directly influences shall be explored. The formula’s name and the chief ingredients show that its main function is tonifying and nourishing the spleen. Also a large proportion of the herbs concentrate on nourishing the heart and tonifying the blood.

If we look at the generation cycle in the Five Element Theory, it can be seen that Fire generates Earth. In this theory it is understood that fire relates to the heart and earth relates to the spleen, making the heart the mother of the spleen.

It is the heart’s duty to supply the body with blood. To achieve this, it must propel the blood and also maintain the condition of the vessels. Its second responsibility is to control the mental activity, as the shen (spirit) is housed within the heart. The spleen’s duties include transforming food into essence & blood then transporting it to the whole body, regulating the water metabolism and sending up the pure qi .

 

‘Heart fire warming the spleen earth’ is used to describe the working relationship between the spleen and the heart. This refers to the fact that the spleen can only perform its duties fully when it is supplied adequately with blood from the heart. To reciprocate the spleen generates blood which it sends up to nourish the heart.

 

Using this understanding, pathology can occur in two ways. ‘The mothers disorder affecting the child’ refers to the deficient function of the heart unable to support the spleen by supplying adequate amounts of blood. This can be caused by factors such as over pensiveness, which wears out the heart blood and qi. ‘The child stealing the mothers qi’ refers to deficiency of the heart blood caused by the inability of the spleen qi to produce and control blood. Factors such as chronic disease and improper diet will lead to deficiency of spleen qi.

 

When reduced functioning of the spleen leads to a deficiency of blood, the heart will receive insufficient blood. This under nourishment affects the shen housed within the heart causing it to become disturbed and malnourished. This can lead to palpitations, arrhythmia, insomnia, poor memory and dizziness; these shall be looked at first. Depending of the constitution of the patient, any of these syndromes can become the main complaint and the others will often appear as accompanying symptoms. Gui Pi Tang is able to reinforce the function of the spleen and promote the production of blood, so that the heart can be nourished. It is also able to calm the spirit easing the symptoms. The formula is often modified by the addition of herbs with a stronger action to calm the spirit if the symptoms are severe.

 

Arrhythmia is caused by the heart muscle being under nourished leading to irregular beating of the heart. It will be accompanied by palpitation, dizziness, shortness of breath, pale complexion, insomnia and a thready and weak pulse. Here Gui Pi Tang is used to replenish blood, nourish the heart, tranquillise the shen and supplement qi. Wang suggests (2002, p85) modifying the formula slightly, increasing the dosage of Huang Qi (黃 芪) to 30g, this will greatly tonify the spleen functioning restoring the balance between the spleen and heart.

 

When a dreamful and restless sleep, palpitations, amnesia, poor appetite, dizziness and a weak pulse accompany insomnia; deficiency of the heart and spleen is again the cause. Gui Pi Tang is able to nourish the heart, invigorate the spleen and tranquillise the shen to restore normal sleep. If the blood deficiency is extensive, herbs such as Shu Di Huang (熟 地 黃) and Er Jiao (阿 胶) can be added to nourish the blood. If the insomnia is severe then Wu Wei Zi (五 味 子) can be added to help calm the shen.

 

When the shen is malnourished, poor memory and memory loss are encountered. It is often the result of anxiety, worry and pensiveness which impair the heart and spleen. It is accompanied by insomnia, palpitation, poor appetite and a lack of vitality. Gui Pi Tang can tonify and nourish the heart and spleen and calm the spirit.

 

Vertigo is the simultaneous occurrence of dizziness and blurred vision while experiencing a spinning sensation. Accompanying symptoms of pale complexion, palpitation, poor appetite and lassitude are often triggered by exertion or over-strain. Deficiency of the spleen means food that is ingested cannot be transformed into qi and blood, neither will it be transported about the body. This means that the brain will go unnourished and vertigo occurs. Gui Pi Tang is able to replenish qi, nourish blood and invigorate the spleen.

 

Sweating is closely associated to the heart as the sweat is seen to be the fluid of the heart. If the blood from the spleen does not enrich the heart, the ensuing heart blood deficiency will generate empty fire. This fire combined with the hearts weakened function to control the sweat leads to spontaneous sweating or perspiration while sleeping. It will be accompanied by palpitation, insomnia, breathlessness, pale complexion and a weak pulse. Gui Pi Tang is able to nourish the heart and tonify the blood to stop the perspiration. It can be modified by the addition of Long Gu (龙 骨) and Mu Li (牡 蛎) which are able to astringe the loss of fluid due to deficiency. Zhi Mu (知 母) and Qing Hao (青 蒿) will help to reduce the fire from the deficiency, while Shu Di Huang (熟 地 黃) will tonify the blood.

 

This describes a range of conditions that are caused by abnormal emotions leading to qi stagnation. It can manifest as emotional depression, irrational mood changes or restlessness and irritability. Strong emotions can affect the spleen directly or by disrupting the liver, which in turn disturbs the spleens normal function. The spleens production of blood and qi is inadequate to support the heart and mental upset occurs. The qi and blood insufficiency also cause symptoms of palpitation, insomnia, amnesia, pale complexion, poor appetite and a thready and weak pulse. Gui Pi Tang can be utilised due to its action of invigorating the spleen, nourishing the heart, replenishing the qi and calming the mind. Peng suggests (2000, p353) modification by the addition of He Huan Hua (合 欢 花) to relieve the stagnation of qi and calm the spirit. Wang proposes (2002, p391) adding Yu Jin (郁 金) and Fo Shou (佛 手) for patients who become easily upset.

 

Blood deficiency due to long term illness, excessive bleeding or failure of the spleen in the production of blood can cause a type of deficient fever. The yang of the body is no longer anchored by the yin / blood and it floats upward causing fever. It manifests as a low-grade fever with dizziness, blurred vision, pale complexion and a weak thready pulse. This type of fever is often seen in patients with rheumatic or neurotic fever or suffering from malignant tumours. Gui Pi Tangs action of replenishing qi and blood will help regain control of the yang and bring the fever under control.

 

We have seen above how Gui Pi Tang is able to nourish the spleen so that it may produce more blood in cases of blood deficiency. However another function of the spleen is to command the blood. This means that the spleen qi is responsible for keeping the blood flowing within the vessels. If the spleen qi is insufficient the blood will escape from the blood vessels leading to haemorrhagic syndromes. These syndromes cover discharge of blood from any of the nine orifices or blood diffusing under the skin. Bleeding can occur anywhere in the body, depending upon the constitution of the patient. It can be due to weakness in the respiratory, digestive or urinary systems.

 

 As long as this bleeding is due to the inability of the spleen to control the blood then Gui Pi Tang can be modified to be effective. In the haemorrhagic syndromes Gui Pi Tang is often modified by removing many of the herbs responsible for calming the spirit and nourishing the heart and replaced with herbs that stop bleeding directly. It is also very important that herbs to tonify the blood are included as blood is being lost and must be replenished quickly.

 

Nose bleeding accompanied by pale complexion, dizziness and palpitation will often been seen in diseases such as aplastic anaemia and leukaemia. Gui Pi Tang invigorates the qi to stop the bleeding.

 

Continual spitting or vomiting of dull pink blood originating from the upper digestive tract is often a symptom of gastroduodenal ulcer. Symptoms of palpitation, shortness of breath and listlessness will also appear. Gui Pi Tang with the addition of Bai Ji (白 及) and Wu Zei Gu (乌 贼 骨) is able to invigorate the spleen, nourish the heart, and strengthen the qi to keep the blood within the vessels. Wang identifies (2002, p404) that deficiency of qi in the middle jiao can damage the yang leading to cold in the spleen and stomach. If this occurs then Ai Ye (艾 叶) and Pao Jiang (炮 姜) are to be added.

 

Red blood in the stool indicates bleeding from the lower digestive tract while dark purplish blood indicates bleeding in the stomach or small intestine. Any number of gastrointestinal diseases can cause this bleeding from ulcers to chrones disease. Again symptoms of poor appetite, lassitude, palpitation and sleeplessness will accompany the bleeding. Gui Pi Tang can strengthen the qi to stop the bleeding and can be modified by the addition of Bai Ji (白 及) and Hai Piao Xiao (海 螵 蛸) to strengthen this action. If the bleeding is heavy then Huai Hua (槐 花) and Di Yu (地 榆) can also be added.

 

Urhematin caused by haematopathy sees blood appearing in the urine for a prolonged period accompanied by a dim complexion, shortness of breath and lethargy. Gui Pi Tang invigorates the spleen to control the blood.

This syndrome sees the appearance of recurrent and persistent, bluish purple patches in the skin. They may be accompanied by dizziness, pale or sallow complexion, poor appetite and lassitude. Gui Pi Tang will help to replenish qi to stop the bleeding. This action can be strengthen by the addition of Shu Di Huang (熟 地 黃) and Xian He Cao (仙 鹤 草) which will help to nourish the blood and stop bleeding respectively.

These dull purple spots under the skin develop after prolonged disease which has damaged the spleen qi. Western science sees it as blood leaking out of the vessels due to decreased levels of platelets in the blood. Wang suggests (2002, p423) modifying Gui Pi Tang by including Xian He Cao (仙 鹤 草) and Qian Cao (茜 草) to help stop bleeding and Ji Xue Teng (鸡 血 藤) to tonify the blood.

Leukopenia is a disease where the level of white blood cells drops to below 4.0x10⁹/L. When it appears with sallow complexion, lassitude, poor appetite, palpitation, insomnia and a thready weak pulse; it is understood to be due to deficiency of both spleen and heart. In this case it is suitable to use Gui Pi Tang.

 

 

It can be seen that Gui Pi Tang really embodies the saying “Treating different diseases with the same treatment.” It can be used to treat a vast number of different diseases by slight modification of its components. This is achievable because the root of all of the diseases remains the same, an inability of the spleen to perform its normal duties. Whether this poor function is caused by direct attack of the organ from external or emotional factors or if it is due to attack from its parent organ the heart, the formula is still of benefit. It is especially effective in syndromes where both the spleen and the heart suffer deficiency, but with some modification it is able to treat a broad range of bleeding disorders with great efficacy.

 

However, the key to the successful use of this formula is not only knowing how to modify it to increase its effectiveness. Emphasis must be placed on accurate syndrome differentiation. As without correctly identifying the syndrome, the formula cannot be used successfully no matter how it is modified. This is why syndrome differentiation lies at the very heart of Traditional Chinese Medicine practice.

 

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