Heiner Fruehauf

Heiner Fruehauf

With Heiner Fruehauf
National University of Natural Medicine, College of Classical Chinese Medicine

Interview by Bob Quinn, DAOM

New imageHeiner Fruehauf sat down recently with his long-time student and colleague at National University of Natural Medicine, Bob Quinn, to discuss ascending and descending functions in the body. While on the surface a seemingly simple topic, it is in reality crucial to understand the up-down movement dynamic if one is to practice herbal medicine effectively.

Note: This interview is published in three parts due to its length.

Part 1

QUINN: Heiner, I want to thank you for making the time to chat about this topic. It has been a few years, I think, since we have done one of these interviews and then published an edited version. As with the other interviews my hope is that as you help me to look at this topic more closely, others who read this will also be helped, and that their patients will then benefit. The feedback I have received about the other interviews has been very positive and I am grateful for that.

I have wanted to talk about qi circulation with you for some time. I think it is especially due to my continued work with chronic Lyme patients in my private practice and on my shifts here at NUNM. At first I thought we could provocatively call this interview “Up and Down,” but then settled on the more standard phrasing of “ascending and descending.” In short, I have never treated a single chronic Lyme patient where this issue does not play a key role. Every single one of them has tragically tight necks and upper backs, and I really mean 100% of them. But they also have a deficient lower jiao. The lower abdomen might at first report as tight and congested, but once that congestion is cleared, the deficiency shows through. Many of these patients also have terrible headaches. Virtually all of them have anxiety to one degree or another, often quite debilitating. These three symptoms, it appears to me, share the common thread of being ascending phenomena—that is, qi moving up that cannot then cycle back down. It gets trapped above, either in the chest in the case of anxiety, at the neck in cases of neck pain and tension, and in the head in the case of headaches. I could list more symptoms, but I think you get the picture. We say in English: What goes up, must come down, but for these patients the qi seems to not come back down without our help.

In our interview on the Fire Spirit (huoshen pai) approach, I think we touched on an idea that can explain this: As mingmen weakens, the lower “root” can no longer anchor the body’s healthy heat below, and it then follows the nature of heat and rises in the body. Perhaps first it causes digestive complaints when it reaches the middle jiao, and then as it rises further it harasses the Heart spirit, bringing anxiety, and then it can rise further still resulting in headaches, stiff neck and shoulders. I know in recent years you have brought into your herb thinking teachings from Wu Sheng’an, a master practitioner from Xi’an, China. As I understand his approach, it focuses largely on reasserting a healthy up-down dynamic in the patient through innovative herb combinations, many of which are not at all familiar to TCM practitioners (Dr. Wu did not come up through the standardized TCM college system, but apprenticed with classically trained 19th century masters).

Where I hope we go in this discussion is to tease out what we might call different types of ascending and descending. I think in your Classical Pearls line, for instance, one can find different formulas to deal with up and down movement, and these various formulas are often radically different one from another. So obviously it is not as simple a topic as one might think by looking at the phrase “up and down”.

HEINER: Good introduction to an interesting topic, Quinn! One could say that all disease in Chinese medicine comes down to an imbalance between yin and yang. There is a quote from the Ming dynasty scholar-physician Zhang Jingyue (1583-1640) I translated before that captures this principle:

When diagnosing and treating disease, we must first of all differentiate between yin and yang. This is simply the most important principle of medicine. If the physician correctly differentiates yin and yang, the treatment will never be accompanied by side effects.

So, when focusing on pathologies related to ascending and descending qi dynamics, we are really talking about yin and yang imbalances. As a young herbal practitioner, I thought that balancing yin and yang primarily meant to pay attention to the hot and cold nature of the herbs in a formula. For somebody trained in the classical Shanghan lun style of herbalism, my focus thus was to always safeguard the yang by including warming medicinals. In the words of Chen Xiuyuan (1753-1823), one of the most accomplished authors on that particular lineage in the Qing Dynasty: “If in doubt, always tonify the yang, and thereby make sure that the patient does not get harmed.” In contrast, much of modern TCM herbalism seems to have internalized the nature-phobic body image of Western medicine and imitated the methodology of antibiotics by favoring heat-clearing herbs such as Huanglian, Huangqin, Huangbai, Zhizi, and Dahuang. In China, you can buy these over-the-counter in extracted form, including pharmacologically refined Huangliansu (berberine sulfate), and use it instead of antibiotics when anything red or itchy appears. In Western herbalism, we see an equivalent to this sort of knee-jerk reaction in the prominent use of the cooling herbs goldenseal or Oregon grape. They are just like antibiotics when considering their heat-clearing effect. Then there is the prominent use of yin tonics in modern Chinese herbalism, especially Dihuang (rehmannia)—another common violation of the classical mandate to safeguard the balance of yin and yang. I find that yin tonic herbs—which I use all the time, I want to be clear on that—have the capacity to act like steroids. Since autoimmune diseases are extremely common nowadays, we need to utilize these herbs, but most often as modifications to a base formula that first and foremost supports the yang qi. You will see this principle manifested in every formula of the Classical Pearl line of herbal products, which best reflects my own style of clinical practice. The yin tonic materials are added to control the drying effect of the yang tonic herbs. In addition, they help to “shut down” the body’s over-reactions that we generally refer to as autoimmune complications.

QUINN: And to this mix, where I have to say from having worked in your clinic you were already having notable success with tough cases, you added the teachings of Dr. Wu Sheng’an. Can you talk about him and this way of thinking?

HEINER: About five or six years ago I met Wu Sheng’an in Xi’an. He traces his herbal lineage back to the famous Spleen/Stomach expert Huang Yuanyu (1704-1758), better known under the pen name Huang Kunzai (Huang Who Stabilizes Like the Earth), a scholar-physician who lived during the Qing dynasty. He wrote 8-9 books about the importance of the earth element in the practice of Chinese medicine. Huang’s work, however, is not so much about the principle that everything comes from the earth and the consequential need to tonify the Spleen in the way of Li Dongguan (1180-1251). Huang primarily stressed the importance of the middle burner as the central pivot around which all up and down movement in the body revolves. He reminded his contemporaries that all up and down imbalances in the body can be harmonized by restoring the upward momentum of the Spleen and the downward momentum of the Stomach. In other words, Dr. Wu learned to look at the concept of yin and yang in Chinese herbalism primarily from the perspective of the body’s up and down dynamics. From a temperature perspective, he prefers to use herbs that are neutral as well as bland, rather than spicy or pungent. Bland is the flavor that is most friendly to the Spleen. When our digestive system is acutely sick, we tend to crave bland foods. Shanyao is an example of a bland food grade herb that benefits the digestion. Dr. Wu is very specific—more than any other herbalist I have seen—when it comes to looking at his prescriptions from an up-down perspective; just like a poet looks at the words in his creation to see what realm the words transport you into. Dr. Wu, like a poet who chooses and reexamines every word for its exact role and place in a stanza, always double-checks his formulas to make sure there aren’t any superfluous ingredients. It is as if he sees arrows next to each herb in a prescription—this one pointing up and that one pointing down. I found this approach extremely interesting and clinically very useful. I should add that another pertinent feature of Dr. Wu’s up and down approach is his therapeutic focus on the Lung as the “prime minister” of the organ networks, which commands all qi movement in the body. I had expected his primary focus to be on the Spleen and Stomach, but although he acknowledges the middle jiao as the pivot of all energetic momentum in the body, Dr. Wu tends to often start treatment with the Lung in order to drive this central pivot the way he wants.

QUINN: And qi stagnation figures in this?

HEINER: Yes. Our colleague Volker Scheid, an anthropologist by training, recently wrote an excellent article on the oversimplification of Liver qi stagnation in modern TCM diagnostics. Too many patients get diagnosed with Liver qi stagnation and are prescribed Xiaoyao San. From Dr. Wu’s perspective, he looks at the Lung (rather than the Liver) as the primary driver of qi in the body. As a metal organ, the Lung is of course in charge of driving the qi down. Energy movement in his formulas, therefore, is not so much initiated by Liver herbs such as Xiangfuzi or Chaihu. In contrast, he prefers herbs like Zisuzi or Shegan or Xingren or Houpo or Banxia to help the qi of Lung and Stomach move down. As a result, all the qi in the body starts to move. I found this approach helpful, not just for situations that involve the Lungs in an obvious way, but in an extended sense.

Classical Chinese Medicine

QUINN: Can you give more details, for instance with Xingren, on how Dr. Wu might use it?

HEINER: Yes. Dr. Wu might use Xingren, not just for cough or sore throat as we see in many TCM formulas nowadays, but in a way that most of us are accustomed to using Xiangfuzi or Yanhusuo for qi stagnation. Xingren is bland and temperature neutral, and therefore friendly to the Spleen; practically a food-grade herb that is often used for making pudding in China, similar to almond meal in Western cooking. Dr. Wu thus frequently prescribes this herb for conditions involving qi stagnation, i.e. depression, lymphatic congestion, cancer, heart disease, menstrual pain, etc.

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Part 2

QUINN: Can you contrast the effectiveness of this approach with what we might call the “Liver qi approach” you mentioned earlier.

HEINER: I have found that approaching qi stagnation via the Lung works faster. While the Lung is classified as a metal organ due to its primarily descending momentum, the Liver is a wood organ: its job is to move blood and fluids upwards against gravity.

QUINN: An ascending force.

HEINER: Yes, ascending from earth to Heaven; into the opposite direction, really. In modern urban industrialized settings, we primarily see conditions that require a rebalancing of the descending functions in the body, since most patients suffer from counterflow issues: acid reflux, high blood pressure, insomnia…

QUINN: Anxiety.

HEINER: Anxiety, absolutely; and dizziness, a symptom that seems to have become more prevalent in recent years. In addition, many skin diseases can also be interpreted as a kind of counterflow—toxins welling up to the surface instead of being discharged below. Constipation, naturally, is also a type of counterflow—something that is supposed to go down and out is stuck and stays up instead. Lots of conditions can benefit from this approach.

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QUINN: This use of Xingren is found in the four-herb formula I learned that was created by Dr. Wu and transmitted to me through you. I think this very unique remedy features in the Metal Pearls formula in the Classical Pearls line. Can you discuss this formula?

HEINER: Sure. The name of this remedy, which sprang directly from the “pivot” teachings of Huang Kunzai, is She Jie Xing Chong Tang: She for Shegan (belamcanda); Jie for Jiegeng (platycodon); Xing for Xingren (apricot seed); Chong means “worm” and here refers to Jiangcan (silk worm).

QUINN: Are these herbs set in stone, or is there room to substitute as needed?

HEINER: According to my own experience, changes can be made, such as exchanging Dilong—another “worm”—for Jiangcan. Overall, the design of the formula aims at motivating the movement of all bodily qi via the Lung: Shegan, Xingren, and Jiangcan strongly descend the qi, especially when combined, and thus foster the Lung’s primary (“metal”) function of distributing qi in downward motion. Jiegeng, on the other hand, supports the aspect of the Lung that is supposed to move up and out; the aspect that opens into the nose and governs weiqi circulation in the skin layer. Together, they support all aspects of Lung function and associated qi movement in the body, with a primary focus on the Lung’s downward “metal” momentum. While this remedy does not contain any laxatives, I have found that it works great for most cases of habitual constipation. And perhaps most importantly, this approach is most effective for Western patients who tend to depression, most often a manifestation of what we call bei—sadness, grief or loss—in the terminology of Chinese medicine. A diagnosis of “depression” is most often accompanied by a feeling of sadness and stuckness and the sensation of a weight on the chest—if this condition is mild, it will cause depression; if chronic and severe, it will lead to heart disease. When this kind of patient takes this remedy, the weight tends to lift, and rather quickly a sense of breath and freedom and openness returns. The diaphragm opens, and communication between the upper and lower burner commences—just as depicted by Hexagram 11 (Tai), perhaps the most graphic picture of Lung function in Chinese medicine, transmitted to us by the Han dynasty creators of a science that associated all bodily functions (“the microcosm”) with cosmic energy movements (“the macrocosm”). From a Western medicine perspective, moreover, this remedy can be regarded as a great flusher of the lymph. Cancer is always the result of longstanding lymphatic congestion. Shegan, especially, is regarded as an anti-toxin and anti-cancer herb in the Chinese materia medica. I even use it for patients suffering from HIV/AIDS and Lyme disease. But the temperature of Shegan is cool, so it often needs to be modified for longer-term use.

QUINN: What would you add or replace it with?

HEINER: I often alternate or replace Shegan with Zisuzi, an herb that also stimulates downward momentum but is warm in temperature. Altogether it can be said that this four-herb formula demonstrates how yin and yang can be regulated from the primary perspective of the body’s up and down movements. In the urban pressure cooker of modern times, we tend to drive ourselves to “do more, more, more, faster, faster, faster.” If you think of yin and yang as two phases of the cycle of movement—expand (yang) and contract (yin), and up (yang) and down (yin)—it becomes clear right away where the primary imbalance of modern life is. As creatures who tend to live in constantly buzzing and illuminated cityscapes, we know how to go up, how to expand, but we do not know how to reign in all of the energy we have drummed up, by directing it downward and inward again. Most of our patients have developed an aversion to going to sleep early, and no one is exactly elated at the suggestion of rest. We don’t know how to rest, to contemplate and just be anymore, originally one of our most natural instincts. Instead, everyone feels compelled to be active all the time. Even when we are exhausted, we find ourselves watching TV or doing email. In contrast, the station of rest and being is the strength of the Eastern approach.

Classical Chinese Medicine

QUINN: Earlier you made brief mention of Li Dongyuan, who also had a focus on the Spleen/Stomach, not as a pivot in the sense you are describing here with Dr. Wu, but in a different way. Li favored Huangqi and Renshen, and I do not hear you mentioning those herbs. Can you contrast these two approaches a bit more?

HEINER: Li Dongyuan lived about 1,000 years ago, during an era punctuated by war, starvation and rampant epidemics—a chaotic historic environment that is portrayed, among other places, in the contemporary Netflix series Marco Polo. The sick people he encountered tended to show signs of depletion and prolapse of Spleen qi. In the tumultuous years following the breakup of the Song dynasty, ginseng and astragalus could give people the energy needed to carry on in times of privation. Astragalus, with its lifting action, was a fundamental ingredient used to remedy this situation. Most modern patients, in contrast, exhibit a combination of excess and deficiency, some qi stagnation and definitely symptoms of counterflow. In the Classical Pearl line, the most widely used products are formulas that in one way or another address symptoms of anxiety and insomnia. This fact alone can serve as an indicator for currently relevant up-down imbalances in the body: our primary focus needs to be on supporting the descending rather than the ascending momentum of the body. Peace Pearls, for instance, a remedy based on the traditional Kidney yang tonic Qianyang Dan (Submerge the Yang Pellet), is a frequently used remedy; it also treats counterflow, but from another perspective than Metal Pearls or Counterflow Pearls, via a mechanism that we can discuss later on. But before we go there, I want to summarize Dr. Wu’s unique approach in the following way: If in doubt, treat the Lung; use She Jie Xing Chong Tang to regulate stagnating qi anywhere in the body. And note that this principle is carried out by stimulating downward movement (rather than the dispersal) of Lung qi. Dr. Wu teaches us that pathologically upwelling qi ought to be directed downward rather than be diagnosed as a type of “wind,” which would invariably lead to a frittering away of already deficient Lung qi.

Classical Chinese Medicine

QUINN: Talk about Banxia, if you would. It has to be part of any discussion, it seems to me, about descending qi dynamics.

HEINER: If you look at most Banxia containing remedies, such as Xiao Chaihu Tang or Banxia Xiexin Tang, you see that the lead symptom tends to be nausea and vomiting, essentially Stomach pathology. Banxia is indeed an herb that primarily reverses counterflow in the Stomach network. Because of the prominent use of the anti-phlegm remedy Erchen Tang in TCM herbalism, many of us have been tempted to think of Banxia first as a Lung herb. In addition, I should mention that the ancient Chinese associated the Banxia (“midsummer”) plant with the summer solstice and the 5th lunar month of the year. This is the central time when the current of universal qi movement in nature reverses course, switching gears from an outwardly expanding movement to a downward and inward course. In this most traditional way of thinking, Banxia is actually associated with the Heart, since Han dynasty cosmology associates the Heart with the climactic position of the 5th month during the year and the time period of 11 am – 1 pm during the day. Banxia, which is maturing around the solstice, absorbs this energetic shift in nature by embodying the descending quality that emerges at this time. The Huangdi neijing contains only 13 herbal remedies, and one of them is Banxia Shumi Tang—a remedy for treating insomnia, essentially a Heart disorder that also involves the Stomach in the relevant passage. The tidal hexagrams associated with the Stomach and the Heart are hexagram 43 and 44, respectively—a hexagram pair that signifies a patho-physiological relationship between Heart and Stomach, very much in the way that metal organs or yangming organs make a pair. What the herb Banxia treats is counterflow in both of these organs. Only secondarily does it affect the Lung.

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Part 3

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.

Classical Chinese Medicine

Moxa Addendum

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.
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© 2016 Heiner Fruehauf and Bob Quinn


There’s a video lecture with Heiner Fruehauf and Dr. Wu Sheng’an, The Essence of Chinese Medicine, available to the public.


Learn more about Dr. Wu’s extraordinary educational background.

About Dr. Wu