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A033 Review of a Prescription Formula

Recently, as the new semester started, I have been busy with outpatient visits, emergency visits, and elective courses. I also wanted to find time to study in the night shift emergency department. The pressure has been increasing, so the frequency of updates on this account will significantly decrease.

However, there is another public account called "LowHair" that specifically writes fairy tales (or at least they can be considered as such). It serves as a channel to relieve stress. If you are interested, you can take a look.

Recently, while preparing for the formula examination, I came across a topic: Zuogui Pill and Yougui Pill.

I didn't study formulaology well back then, but I vaguely remember that one of these pills is for nourishing yang, and the other is for nourishing yin.

If I can't remember clearly, I'll check my notes. Zuogui Pill nourishes the yin of the kidney, while Yougui Pill nourishes the yang of the kidney. Wait, isn't it supposed to be left ascending and right descending? Doesn't the left represent yang and yin?

When encountering a Chinese medicine question that I don't understand, I always ask a senior brother first.

👨‍🎓: Senior brother, I have a question. Why is Zuogui Pill for nourishing yin and Yougui Pill for nourishing yang when left represents yang and right represents yin?
👨‍🏫: The concept of left representing yang and right representing yin comes from left ascending and right descending, which means the liver ascends and the lungs descend. Zuogui Pill is described as replenishing the yin of the left kidney, which corresponds to the yin of the kidney pulse on the left wrist.

Oh, I see. So left ascending and right descending is not the same as left returning and right returning. I understand now (or at least I think I do)!

After a few days, I remembered this question again. Wait, why is the left pulse related to yin and the right pulse related to yang? I don't want to bother my senior brother again, so I'll check the book. The original text can be found in "Jing Yue Quan Shu". I directly searched for the original text of Zuogui Pill and Yougui Pill, and here are the excerpts:

"Jing Yue Quan Shu, Volume 51, De Ji, New Formula Eight Formations, Bu Zhen"
Zuogui Pill No. 4: It treats true yin deficiency of the kidney water, which cannot nourish the camp and defense, leading to gradual weakness. Symptoms may include alternating deficiency and heat, spontaneous sweating, or night sweats, loss of consciousness, blood not returning to its source, deficiency damaging yin, inability to control urination, deficient qi causing dizziness, blurred vision, deafness, dry mouth, dry tongue, sore lower back, weak legs, and various signs of deficiency of essence and fluid. This formula should be used to strengthen the main water and nourish the original yin of the left kidney, thus replenishing essence and blood. It is suitable for this purpose.
Yougui Pill No. 5: It treats deficiency of original yang, whether congenital or due to excessive labor, resulting in weakened life gate fire, inability to generate earth, and spleen and stomach deficiency and cold. Symptoms may include nausea, bloating, stomach upset, aversion to cold, abdominal pain, loose stools, frequent diarrhea, involuntary urination, cold and painful hernia, or cold invading the lower abdomen causing edema. In summary, those with deficiency of true yang will experience fatigue, weakness, palpitations, lack of coordination, seeing evil spirits, or inability to produce offspring. This formula should be used to supplement the original fire and nourish the right kidney, thus strengthening the spirit and qi. It is suitable for this purpose.

This passage only confirms that Zuogui Pill nourishes the yin of the left kidney and Yougui Pill nourishes the yang of the right kidney. But it's not enough, so I continue to search.

"Jing Yue Quan Shu, Volume 5, Dao Ji, Pulse and Spirit Chapter, Positional Interpretation 2"
Left Cun: It represents the heart, and its pulse is located in the heart and pericardium. It receives the qi of the southern ruler fire, and the spleen earth is generated. The lung metal is controlled, and it governs the clarity and turbidity of the spirit. Right Cun: It represents the lungs, and its pulse is located in the lungs and middle burner. It receives the dryness of the western ruler metal, and the kidney water is generated. The liver wood is controlled, and it governs the good and evil of emotions. These two positions are called the upper positions, so any diseases related to the head, throat, teeth, neck, shoulders, and back are observed here.
Left Guan: It represents the liver, and its pulse is located in the liver and gallbladder. It receives the wind of the eastern ruler wood, and the heart fire is generated. The spleen earth is controlled, and it governs the rank and status of officials. Right Guan: It represents the spleen, and its pulse is located in the spleen and stomach. It receives the dampness of the central ruler earth, and the lung metal is generated. The kidney water is controlled, and it governs the abundance or scarcity of wealth. These two positions are located in the middle, so any diseases related to the sides, ribs, abdomen, and back are observed here.
Left Chi: It represents the kidneys, and its pulse is located in the kidneys, bladder, and large intestine. It receives the cold water of the northern ruler, and the liver wood is generated. The heart fire is controlled, and it governs the longevity of yin qi. Right Chi: It represents the triple burner, and its pulse is located in the kidneys, triple burner, life gate, and small intestine. It receives the qi of the northern ruler's heavenly fire, and the spleen earth is generated. The lung metal is controlled, and it governs the longevity of yang qi. These two positions are called the lower positions, so any diseases related to the waist, abdomen, vagina, and knees are observed here.

This passage confirms that pulse diagnosis is indeed related to the left representing yin and the right representing yang. But it's not enough, so I continue to search. Fortunately, the next passage mentions it.

"Jing Yue Quan Shu, Volume 5, Dao Ji, Pulse and Spirit Chapter, Positional Interpretation 2"
Someone asked: Why is the right Chi considered yang and related to fire? It is because Chi is the place of the snake's martial arts, and it is located in the northwest, which is the region of firmness. Therefore, the right hand and right foot are stronger than the left. This is the meaning of left representing yin and right representing yang. This article has a detailed discussion, which can be found in "Lei Jing, Qiu Zheng Lu".

I move on to "Lei Jing Tu Yi, Qiu Zheng Lu":

"Lei Jing Tu Yi, Qiu Zheng Lu"
Among the five organs, each has one, but the kidneys have two, which makes them unique. For example, the ears and eyes are paired, but the left eye is more dominant than the right eye. The hands and feet are paired, but the right side is stronger than the left side. Therefore, the god of the north is the snake, with the snake representing yang and martial arts representing yin. The pulses of the two wrists are divided into left and right, with the left representing water and the right representing fire. Left yang and right yin are the common principles, but why is it said that the left represents water and the right represents fire? It is because the kidneys belong to the center of the zodiac, and their qi corresponds to the division of yin and yang in the winter solstice. After the winter solstice, the sky rotates to the left, which means it is spring. The Big Dipper is located in the wood of the Xing constellation, and the sun and moon move to the right and meet in the Hai constellation. The Chen constellation is next to Zi, which means that when yang advances one month, it retreats one palace, and the Great Yang gradually moves to the right. People also follow this pattern, so the right side of the water position represents fire. Moreover, the human body is originally connected to the earth, and the firmness of the earth is in the northwest, so the right Chi should represent yang according to the logical reasoning.

Hmm, the reason I can understand and accept is that humans are right-handed, with the right side being stronger and the left side being weaker, so the right represents yang and the left represents yin. I can't understand or accept the other reasons.

Senior brother: If the liver wants to ascend, it needs a source, which is the yin of the liver and kidney. The yin of the body is used for yang. If the lungs want to descend, they need to contract and be serene, which is consistent with the function of the kidney to store and secure. When the kidney fails to receive qi and becomes deficient, it will lead to shortness of breath. Therefore, the right side represents kidney yang.

I find my senior brother's explanation more convincing. At this point, I have spent a whole hour (I won't mention the unrelated literature I came across in between). I feel like I'm getting too caught up in this question. I'll understand as much as I can and stop here. I can revisit this question later.

Recently, my senior brother wrote an article further discussing the logic behind left ascending and right descending ➡️ "The Underlying Logic of Left Ascending and Right Descending"

We discussed this question again.

👨‍🎓: I understand left ascending now. The heart and liver ascend, which means energy disperses. But I still don't understand why the lungs descend.
👨‍🏫: I think it has to do with the negative pressure in the chest during exhalation, which helps the right heart receive blood. However, the synchronization of heartbeat and breathing is different, so we can only say that exhalation is like this. During inhalation, it helps the heart pump blood by increasing pressure. But the strength of the heart is also overlooked.
👨‍🎓: What about the kidneys' function of storing and securing?
👨‍🏫: 😂 You really want to thoroughly understand the physiology of Chinese medicine. Let me think. It should be related to the kidneys' reabsorption function.
👨‍🎓: Based on your theory, can we understand the lungs and kidneys as maintaining the contraction force of blood vessels? We discussed before that when the kidney qi and kidney yang are deficient, the pulse feels dispersed.
👨‍🏫: That is caused by angiotensin in the blood vessels. The adrenal glands control kidney yang.

Hmm, as you can see, we still haven't fully understood it.

But sometimes, it's difficult to fully understand certain questions in a short period of time. Our abilities are limited, and our thinking may be biased (perhaps the path of integrating Chinese and Western medicine has deviated? The path of focusing on internal evidence may be more appropriate?). Regardless, the process of thinking is the most important. Continuously asking questions and thinking about them can exercise our brains, just like sharpening a knife.

When it comes to making immediate decisions, a sharp knife will always cut more neatly and efficiently than a dull one!

I shared this experience to also share a concept: there is always something to learn in Chinese medicine. Don't consider reviewing as a waste of time. If it weren't for this opportunity, I might not have systematically reviewed the content of "Jing Yue Quan Shu" related to this question.

However, while delving into research, we must also focus on exam preparation. We don't want to fail the exam ⚠️.

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