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TCM Tonifying Methods (bu fa)
 
What is tonification (bu fa) and why is it used?

Under functioning of the body's structure, organs, or entirety is an important feature of disease development. Traditional Chinese Medicine (TCM) regards these pathological states as a deficiency of vital energy (qi) or asthenia syndrome. This deficiency can result from congenital and acquired factors; congenital factors indicate abnormal conditions present at birth, while acquired factors indicate things like improper diet, emotional disturbance, indulgence, chronic and major illness, childbirth, environmental influences, and aging.

A busy herbal pharmacy in one of Beijing's TCM hosptials showing different herbs used in tonic preparations.
Tonification is a therapeutic treatment that nourishes and replenishes the qi, blood, yin and yang of the human body when they are deficient or weak. It is applicable to one or several of the organs, or one of the qi, blood, yin and yang, or the weakness of all of them as a whole. This is a method, unique to TCM, to sustain and restore the harmony of the body. Although Chinese medicine has a rich philosophical and theoretical background, it has also spawned many practical treatments that can relieve human suffering from a minor irritation to a potentially life-threatening situation. Methods of tonification may include the use of diet, herbal preparations, acupuncture, massage and sexual activities.
Four basic kinds of deficiencies can affect health and require tonification.


What does tonification treat?


Tonification is mainly used to treat a particular deficiency in the body. Symptoms of an asthenia syndrome vary according to the cause, degree of deficiency, and organs involved. It is important to first address the underlying deficiency before applying the appropriate tonification method in order to obtain the maximum benefit for the patient. Deficiency falls into the following classifications:

1. Qi-deficiency
Qi can be interpreted as the "life energy" or "life force," which flows within us. It can also sometimes refer to the physiological functions of organs and meridians. Qi-deficiency manifests as under-functioning of the entire body or certain organs, especially in the respiratory and digestive systems. It usually occurs in cases of chronic illness, improper diet, weakness of old age, overstrain and injury. Clinical symptoms include dizziness, shortness of breath, reluctance to speak, fatigue, and spontaneous sweating. The tongue is pink and pulse is weak. TCM physicians usually focus on boosting the lung and spleen in these situations.

2. Blood-deficiency
Blood is viewed simply as the red fluid inside the blood vessels that provides nutrition for the body. The nutrients transported by the blood are not restricted to physical materials only. Its meaning can be extended to anything that provides nourishment to the body, thus blood deficiency leads to inadequate nourishment of the body. In TCM, asthenia syndrome is closely related to problems of the heart, liver, and spleen; common symptoms include pale complexion, dry skin, dizziness, palpitations, insomnia, numbness in limbs, and in women there may be an abnormal menstrual period. On examination, the tongue is pale and the pulse fine. This kind of deficiency is usually due to major blood loss, spleen weakness, or chronic illness.

3. Yin-deficiency
Yin and yang are relative terms used to describe how the body works and how disease occurs. Yin and yang are two opposite aspects of the body's organs and functions. Yang usually refers to the organ's functions whereas yin is commonly used to refer to an organ's structure. Disharmony in the two aspects is the cause of disease or physiological disorders. When yin-deficiency occurs, the organs will become hyper-functioning due to relative hyperactivity of yang which leads to exuberance and congestion of heat, and is manifested by dizziness, flushing, dryness in the mouth and throat, a fever occurring at the same time of day, spontaneous sweating, constipation, tinnitus (ringing of the ears), discomfort in the eyes, red tongue (with or without fur), and the pulse is fine and rapid. Causes and specific symptoms vary with different organ systems.

4. Yang-deficiency
Yang-deficiency reflects an insufficiency in the body's functionality resulting in a slower metabolism, and is manifested by an internal exuberance of yin-cold. Symptoms include pale and somber complexion, cold body and limbs, an aversion to cold, a desire for warmth, a withered spirit, drowsiness and lethargy, a pale tongue, and a deep, weak pulse. The causes and symptoms vary with different organs.

Yin and Yang signs in the body

Body signs

Yang signs present with yin deficiency Yin signs present with yang deficiency
Face/Body Red face, fever, hot feeling, agitated and active manner Pale face, low spirit, feels cold, cold limbs, tired and weak
Voice/Breathing Coarse and strong voice, coarse breathing, dry mouth, thirsty Low voice, reduced appetite, flat taste in mouth, lack of thirst, shortness of breath
Urine/Stool Dark urine, foul smelling stool, constipation Copious and clear urine, loose stools
Tongue Red and scarlet tongue or yellow and black moss present on tongue Pale and swollen tongue with white fur
Pulse Rapid and floating, flooded and strong, slippery and full pulse Slow and sinking, weak, frail pulse
Adapted from Chinese Herbal Medicine, Daniel P. Reid. Shambhala 1993.


How is tonification applied to humans?


"Deficiency should be treated by tonifying therapy" is the basic principle of tonification. Suwen (The book of Plain Questions), written during Zhou Dynasty, has defined deficiency as being caused by a "depletion of essential-qi," which can be interpreted as weakness caused by insufficiency of vital energy, making it appropriate for tonifying therapy.

Choosing an appropriate tonification therapy will depend on several factors. It is important to note that traditional Chinese thinking sees an individual as part of nature with which he or she interacts. Climatic and environmental influences cannot be overlooked in treatment. For example, a special tonification therapy may be used to prevent a deficiency that commonly occurs in a particular season. Tonification can, therefore, be used as an illness or disease preventing measure. According to the differential diagnosis and holistic concept of TCM, the following treatments should be noted:

1. Tonification in accordance with seasons
The therapeutic method should be chosen according to climatic changes; Huang Di Nei Jing (The Yellow Emperor's Medicine Classic) has a famous phrase: "nourishing yang in spring and summertime, nourishing yin in autumn and wintertime." TCM believes changes in environmental qi are closely related to movement of qi inside the body, so it is important to take account of climatic changes during treatment. Modern TCM physicians usually apply the following rules:

E.g. Ephedra can be used with this method.
Spring is suitable for the "sheng bu" method: using herbs with a lifting effect results in lifting the yang, inducing sweating and expelling cold-evils.
E.g. Lotus can be used with this method.
Summer is suitable for the "qing bu" method: using herbs with a cold or cool character results in clearing away the heat-evils and promoting fluid metabolism.
E.g. Ginseng can be used with this method.
Autumn is suitable for the "ping bu" method: using herbs with a neutral and mild character results in recovery from general weakness.
E.g. Deer horn can be used with this method.
Winter is suitable for the "zi bu" method: using herbs with a moist and nourishing character results in clearing away dry-evils and keeping in warmth.

2. Tonification in accordance with locality
The therapeutic method should be chosen according to geographical region as claimed by the Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic): "treatment in accordance with local conditions." Nowadays when applying tonification, physicians focus on using cooling tonification in the southern regions of China, and warming tonification in the northern regions of China. This is due to the difference in physical constitutions of the people. Chinese medicine dosages and types of herbs selected to treat deficiencies may also vary depending on the availability of the medial substances in a given region.

Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic)

3. Tonification in accordance with individuality
The therapeutic method should be chosen according to the physique of the individual; as claimed by the Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic): "There are 25 types of yin yang people." Modern physicians have classified people into groups according to different constitutions, such as normal, red-heat, sluggish-cold, fatigue-pale and so on. These also should be considered clinically. For example, the therapeutic aim for the red-heat type is nourishing yin and expelling heat, for the sluggish-cold type invigorating yang and expelling cold, and for the fatigue-pale type replenishing qi and promoting blood production; mild approaches to reinforce the overall qi, blood, yin and yang are used for those with a normal constitution.

4. Tonification in accordance with disease or syndrome
The therapeutic method used should be based on TCM differential diagnosis. The deficiency is identified, and then drugs are applied that replenishes qi, promotes blood production, invigorates yin or nourishes yang. For example, in emergencies or severe cases, rigorous tonifying in which a larger and stronger quantity of tonic is prescribed is used to quickly overcome the serious condition. However, TCM believes this approach damages the spleen and stomach in the long term, leading to problems in digestion and absorption. Therefore gentle tonifying is more commonly employed. Lower dosages used over a long period gradually leads to the desired effect.


What are the methods of tonification?


Extensive medical experience has shown that various approaches can be utilized to reach the goal of tonification:

1.
Special soups are commonly used as tonics.
Tonifying by diet: Food and drink are necessities for maintaining functioning and vitality. TCM believes that "inadequate qi will result if dieting for half day, qi depletion will occur if dieting for a whole day." Qi can be interpreted as the life energy of body. Ancient physicians emphasized the tonifying effect of diet, which, similar to herbal applications, is based on TCM principles.
   
2.
Herbal decoctions sold in restaurants are often kept in big containers.
Tonifying by herbs: A proper combination of tonics in prescription can result in effective recovery from a deficiency. This is one of most important and common treatments used in TCM. Sun Simiao (581-682 A.D.), one of the most influential physicians in the history of Chinese medicine, in his best known work Qianjin Yaofang (Precious worth a Thousand Gold for Emergencies) stated: "If you are in your fifties, keep taking a tonic in all seasons, then you will remain healthy and prolong your lifespan." The book also listed some tonic prescriptions.
   
3.
moxibustion
Tonifying by acupuncture and moxibustion: Moxibustion replenishes the yang-qi and expels the yin-cold, invigorates the inborn effectively, warming the spleen and kidney, thereby reviving yang for resuscitation. On the other hand, while some physicians doubt the tonic effect of acupuncture, others have created special acupunctural manipulations for the purposes of tonification.
   
4. Tonifying by massage: This is achieved by massaging the relevant acupuncture points through the application of hand technique to vary the effect. The usual points selected are those that possess tonic properties such as the guan-yuan and san-li.
 
Sample of acu-pressure points that possess tonic properties.
   
5. Tonifying by sexual activities: according to TCM, a healthy and moderate sexual life maintains smooth circulation of qi and blood, improves resistance, and prolongs life.


How does tonification work?


From the viewpoint of TCM tonification works to improve health in three ways:

 
Organs represented from a TCM perspective.

1.Regulating the balance of yin yang: yin yang disharmony is the cause of disease and physiological disorders. Disharmony means the proportion of yin and yang is unequal and unbalanced. When one aspect is deficient, the other is in excess, thus the therapeutic strategy is to replenish the deficiency and remove the excess, restoring the body to its natural balance.

2.Promoting the function of organs: when the organs work actively, the transformation and transportation of substances are effective; essence stored in the kidney is abundant and full of vitality. In the opposite case, deficiency will develop. Tonification helps to promote organ functioning and recovery from deficiency.

3.Stimulating the circulation of blood and qi: blood and qi should be kept in motion for proper circulation. When deficiency occurs leading to a state of stagnation, they can no longer flow smoothly and nourish the body. Tonification invigorates the source of the qi and blood, stimulates their production, and improves the overall condition of the body.

   

People first began researching the mechanism by which tonification works at the beginning of the 20th century. From the viewpoint of modern medicine, preliminary scientific research has shown that herb, food, acupuncture, or moxibustion tonification therapies help to:

  Regulate the function of the adrenal cortex
  Enhance the immune system
  Promote the function of the sex organs
  Improve the renal system
  Improve the respiratory system
  Improve the digestive system
  Regulate the nervous system
  Improve the blood circulatory system
  Improve the metabolism

Please note that these are general conclusions only, and that no single herb or food can possess all the above benefits. Different approaches are used to deal with specific problems.


References

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党毅,中醫營養食療學,北京:科學出版社,1995
   
2. Dang Yi, Peng Yong & Li Wenkui, Chinese Functional Food, New World Press, 1999.
   
3. Dang Yi, Wang Huizhu & Peng Yong, Chinese Health Tea, New World Press, 1999.
   
4. Luo Yuankai, ed. TCM Gynecology, Shanghai Science and Technology Publishing House, 1986.
羅元愷主編,中醫婦科學,上海:上海科學技術出版社,1986
   
5. Shi Yuguang & Shan Shujian, ed. Diarrhea in Children, Beijing TCM Ancient Books Publishing House, 1988.
史宇廣,單書健主編,小兒腹瀉專集,北京:中醫古籍出版社,1988
   
6. Tang, Sun Simiao's Qianjin Yifang (A Supplement to the Essential Prescriptions Worth a Thousand Gold or Supplement to Precious Prescriptions). Beijing People's Medical Publishing House Copying, 1955.
唐.孫思邈撰,備急千金要方,北京:人民衛生出版社影印,1955
   
7. Yuan, Hu Sihui's Yinshan Zhengyao (Important Principles of Food and Drink), 1st edition collated by Liu Yushu. Beijing People's Medical Publishing House, 1986.
元.忽思慧撰,劉玉書點校,飲膳正要,第一版,北京:人民衛生出版社,
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8. Gao Xuemin, ed. Chinese Medicine 1st edition. Beijing TCM Science & Technology Publishing House, 1990.
高學敏,中藥學,第一版,北京:中國醫藥科技出版社,1990
   
9. Leng Fangnan, ed. Clinical Study on Chinese Medicinal Diet and Food Therapy 1st edition. Beijing People's Medical Publishing House, 1993.
冷方南等主編,中華臨床藥膳食療學,第一版,北京人民衛生出版社,1993
   
10. Dang Yi, Eat Grains for Better Health 1st edition, Taiwan Yuan-qi-zhai Publishing House,1994.
党毅,吃五穀更健康,第一版,臺灣:元氣齋出版社,1994
   
11. Gu Chunhau, ed. A Complete Book for Tonification, People's Medical Publishing House, 1996.
賈春華等編著, 補益全書, 人民衛生出版社,1996
   
12. Huang Mukun, ed. An Essential Book for Tonification, SCMP Book Publishing Ltd., 1993
黃木坤編著, 補身必讀, 博益出版集團有限公司,1993
   
13. Ou Ming, ed. Chinese-English Dictionary of Traditional Chinese Medicine. Guangdong Science and Technology Publishing House, 1999.
歐明主編,漢英中醫辭典,廣東科技出版社,1999。
   
Written By:
Dang Yi (黨毅) MD PhD
Professor, Beijing University of Chinese Medicine; Visiting Professor, Middlesex
University, London, UK; Vice Director, Gourmet Food Institute of Health Care and Nutrition of Beijing, PRC.
 
Editors:
Angela Collingwood MSN, Integrated Chinese Medicine Holdings Ltd.
Rose Tse, Integrated Chinese Medicine Holdings Ltd.
Jennifer Eagleton, BA & MA (Asian Studies)
Raka Dewan, Integrated Chinese Medicine Holdings Ltd.