QUINN: This word “counterflow” is out there now in our conversation, and your Classical Pearls line has an actual Counterflow Pearls formula. Can you discuss the thinking behind that formula?
HEINER: Counterflow Pearls is based on the Shanghan lun remedy Xuanfu Daizhe Tang, which unfortunately is rarely prescribed anymore today. According to my own clinical experience, this remedy is most suitable to treat syndromes involving GERD, high cholesterol, high blood pressure, and/or diabetes. From the perspective of ancient cosmology, this remedy focuses on reversing counterflow symptoms originating from the Heart and Stomach, akin to the single herb Banxia. This formula, of course, contains Banxia as one of its major ingredients.
QUINN: And you also talk at times about counterflow in the jueyin. Can you expand on that?
HEINER: Jueyin counterflow is a bit more complex, in my opinion. At least it took me a while to fully understand the important clinical points involved here. “Wood,” naturally, describes the main ascending aspect of the life force. The standardized TCM diagnostic system appears to be particularly afraid of a sudden explosive rise of this force, an excess condition generally referred to as Liver yang rising (ganyang shangkang); hence the prevalence of formulas that strongly descend the Liver yang with cooling materials in the modern practice of TCM, such as Longdan Xiegan Tang, Zhengan Xifeng Tang and Tianma Gouteng Yin. However, what tends to happen most often with chronic patients suffering from wood pathology, especially the elderly, is that this aspect of the vital force lacks sufficient oomph to ascend properly, invariably resulting in a situation where yin pathogens take its place. This, essentially, is the core issue of jueyin disease: the warming and expansive powers of spring have become cold and deficient, producing circulation issues as well as an accumulation of stagnating blood or dampness or phlegm, especially in the upper parts of the body. The jueyin chapter of the Shanghan lun features two major remedies to address this situation: Danggui Sini Tang and Wuzhuyu Tang. Danggui Sini Tang is clearly the master circulator, intended to enervate the extremities and the head by moving Liver yang up and out. Danggui Sini Tang plus gingko leaf, for instance, comprises the basis for Evergreen Pearls, a remedy designed for degenerative brain disorders like cognitive decline or even Parkinsons disease. It promotes the wood force to unfold its natural momentum, by going up. Wuzhuyu Tang, on the other hand, is designed to address the other aspect of jueyin syndrome, by descending and transforming yin pathogens like cold and phlegm. So, in cases where conventional approaches with Banxia fail to solve problems of nausea or dizziness or headache, Wuzhuyu Tang is generally called for—it tends to make an immediate difference. The remedy Ginkgo Pearls, by the way, is based on Wuzhuyu Tang, and can be used to address this kind of situation.
QUINN: I know you have a pulse pattern you use to identify when to give evodia (Wuzhuyu).
HEINER: In my experience, the pulse associated with Wuzhuyu manifests as a weak yet distinct slippery point at the right guan position. In contrast, conditions that call for Banxia tend to exhibit a more long and wiry quality on the right side. In addition, people who need Wuzhuyu generally have an ashen face color. Wuzhuyu Tang is really for treating the aftermath of jueyin syndrome: since the yang has not properly ascended to the head for a long time, we now need to help the body to descend the yin pathogens that have made itself at home here instead. Temperature neutral herbs will not work for this condition; pungent and warming materials with a descending effect are needed to transform the yin accumulation above that was originally caused by cold. These two jueyin formulas can of course be combined, in the form of the Shanghan lun modification Dangui Sini Jia Wuzhuyu Shengjiang Tang. I often use this approach for pituitary tumors, for instance.
QUINN: And for the Lyme patients with terrible co-infection headaches?
HEINER: Yes, for them the Wuzhuyu approach is very important. Often, nothing else will touch those. Banxia Baizhu Tianma Tang, the foundation of Balance Pearls, or Chai Ge Jieji Tang, soon to be produced in the form of Release Pearls, are other remedies that can be considered for acute headaches in Lyme patients. Banxia Baizhu Tianma Tang should be thought of when the predominant symptom is dizziness, while Chai Ge Jieji Tang is best for acute headaches accompanied by neck pain and pain behind the eyes. Last but not least we need to pay attention to the role of the Kidney in counterflow situations, something that we already touched upon at the beginning of our conversation. One image associated with “metal” is that of a mountain or a glacier that sits atop the organ systems like a protective lid. The Lung is called “the umbrella” (huagai) of the organ networks in Chinese medicine, as well as “the upper source of water.” The Heart, moreover, is located in the position of the 5th month or high noon on the holomap that linked macrocosm and microcosm in Han dynasty cosmology. The same goes for the Stomach, which is also sitting near the top, in the position of the 3rd month and described by hexagram 43, which features five yang lines driving to the top. All three of these networks easily suffer from counterflow issues when their built in downward momentum fails to function properly. But there is also a “lower source of water,” namely the Kidney. Just like in nature some of the downward momentum of fresh water flow is motivated by the mountains’ “metal” push from above and the ocean’s “water” pull from below, the Kidney plays an important role in anchoring the body’s qi flow. “Water” primarily signifies storage, so the Kidney acts like the system’s battery source that constantly seeks to recharge by drawing energy down and into itself; just like the ocean is the earth’s ultimate water reservoir, sitting at the bottom like a giant storage tank that constantly gets replenished by mountain streams. When this lower burner battery function weakens, we typically find a slippery quality in the Kidney pulse on the left hand that is much more obvious than the other pulses. Kidney means water, means winter, means storage, means below ground. Healthy Kidney function, therefore, should be reflected by a chi pulse that is low and subtle upon palpation in comparison to the other pulse positions. In this situation, however, it is the opposite—loud, obvious, and at the surface, while all the other pulses appear weak and submerged. This situation signals failure of the Kidney battery to do its job of wintry storage below.
QUINN: So, you are saying you work from the top, the Lung, the upper source of water, as well as from the bottom, the Kidney, the lower source of water?
HEINER: Yes, particularly with elderly and chronic patients, people who are very sick and burnt out. The Kidney aspect of a prescription for this kind of patient could be a rehmannia (Dihuang) formula like Shenqi Wan. In the Tangye jing (Decoction Classic), rehmannia is classified as “water within water”—winter upon winter, storage plus storage, the ultimate downward pulling material. Since Dihuang, however, is a rather sticky substance that is often hard to digest, the Fire Spirit School suggests a viable alternative on the yang tonic side: aconite (Fuzi), especially in the context of Zheng Qin’an’s formula Qianyang Dan that I already mentioned above, and that we dedicated an entire interview to before. In my experience, this approach is equally if not more important in clinical practice. It greatly increases the lower burner’s ability to draw down and store yang qi. Qianyang Dan is one of the most important expressions of the Fire Spirit School’s sini fa (herbal approaches featuring aconite as the lead herb). We owe to this method the understanding that Fuzi, especially in amounts over 15 grams and in combination with Sharen or Baidoukou, can strongly pull yang qi back into the lower burner—echoing the assessment of this herb in the Tangye jing, where it was first classified as “water within wood,” something that has the capacity of not only stimulating but also storing the life force.
QUINN: And you are comfortable using Dr. Wu’s Lung centered approach together with the Kidney method of the Fire Spirit School, by using, for instance, the four herbs we mentioned earlier—She Jie Xing Chong Tang—in combination with Qianyang Dan or other aconite based remedies? Fusing both approaches?
HEINER: Good question! I consider myself very fortunate to have been exposed to the informational stream of both of these unique and clinically valuable lineages—with Shanghan lun-based classical herbalism on one side, particularly as interpreted by the 19th and 20th century masters of the Fire Spirit School and their focus on the downward drawing effect of aconite, and the approach of Dr. Wu on the other, who was deeply influenced by the scholar physicians of the Fever School. Even though Dr. Wu can be considered a Shanghan scholar and author in his own right, the formulas he uses in clinical practice tend to be bland and temperature neutral rather than pungent and hot. He rarely prescribes cinnamon, and I have never seen him use aconite. But in my own clinical practice I combine the two formulas you mentioned, Qianyang Dan and She Jie Xing Chong Tang all the time.
QUINN: I do it myself and that was why I am asking. (laughter)
HEINER: In fact, if I had to use only one base formula for the treatment of chronic diseases I would most likely choose this combination. I would probably add some moistening herbs like Baihe or Maimendong and Wuweizi to be certain that there is sufficient moistening action, as well. Two seemingly unrelated herbal lineages are brought together in this way, but their striving for yin-yang balance, especially when it comes to the up and down dynamics of the body, is one and the same. One mini-formula focuses on restoring the pushing function of the upper source of water, while the other works on the pulling effect of the lower source of water. I have found that it is clinically extremely effective to combine the strong points of these two styles of herbal practice.
QUINN: We have run out of time. I have to get over to my shift at our clinic. I want to thank you for making the time available for this chat. It has, as it always does, stimulated my thinking and clarified some questions I was holding.
HEINER: I’m always happy to discuss some of the unique questions of Chinese medicine with you—I always learn something myself in the process. In addition, I hope, along with the intention you stated at the beginning of our talk, that our readers might also benefit.
Bob Quinn is also a dedicated moxa student of Junji Mizutani. Junji, like Heiner, as was made clear in this interview, finds a talent in combining the styles of past masters. In his case he has combined the Sawada and Fukaya moxa styles in an artful way. Moxa, surprisingly to many, can be employed in the service of descending the qi, the topic of this interview; the trick is to use high-grade, super pure gold moxa, and not too much of it. This more expensive moxa actually burns significantly cooler than the crude, green, unrefined mugwort. A few simple ways this qi-descending can be encouraged with direct moxa are as follows (all utilize gold super pure moxa):
- Direct half-rice sized pieces of moxa on LI-11 have a strongly descending effect. This point is the earth point on a metal channel, so bearing in mind what Heiner explained in this interview, it should come as no surprise that this has a descending action.
- The same kind of moxa on ST-36. Of course this is an earth point on an earth channel.
- Moxa can be utilized to treat the chongmai, which we all learn is an effective treatment for counterflowing qi. We treat the master point SP-4 first, and then the couple point, PC-6. The master point will receive more pieces of moxa than the couple point. Typically ratios of 3 to 2 or 5 to 3 are used. This can be done bilaterally.
- Small amounts of moxa in the lower jiao are also of help in drawing draw the qi. The same small pieces of moxa can be done on CV-6 or 4 or both.