The Mysterious House 2
Medicinals to Unblock the Xuánfǔ
In the previous post, I began a discussion of the xuánfǔ, or Mysterious House, a network of micro-structures that reaches and links everything from the surface of the body to the deepest tissues, including the viscera, bones, sensory organs, and so forth. The theory around these ubiquitous edifices was proposed in the Jīn dynasty by Líu Wánsù, expanding upon a reference in the Huángdì Nèijīng Sùwèn. The xuánfǔ are said to be the portals through which the vital substances of the body – qì, blood, fluids, essence, even spirit – are freely distributed, forming connections with other body systems such as the network vessels (luòmài). Proponents of xuánfǔ theory say that blockage of the xuánfǔ is a primary etiological factor as well as a consequence of other pathological processes in the body.
In this edition of Clinical mulch, I am going to give some examples of treating chronic diseases with Chinese herbal medicine based on xuánfǔ theory. As noted in the previous article, xuánfǔ were originally described as sweat pores, which are typically discussed in relation to acute exterior patterns such as wind-cold fettering the lung. But proponents of xuánfǔ theory include addressing xuánfǔ pathology in interior and miscellaneous diseases as well.
Wind Medicinals
Given the original description in the Sùwèn as sweat pores, it is not surprising that the first recommendation to open the xuánfǔ are herbs that are diaphoretic [sweat-promoting] in nature. The term that is often used is “wind medicinals [fēngyào風藥]”.
According to Liú et al. (2024), the classification of wind medicinals arose from Zhāng Yuánsù [张元素] in the Jīn dynasty. Its foundation came from Sùwèn chapter 5 (Treatise on Phenomena Applied to Yīnyáng/ Yīnyáng yīng xiàng dà lùn/ 陰陽應象大論) discussing the aroma of herbs and their relationship to ascending and descending. Zhāng Yuánsù used the idea of “thin flavors are yáng within yīn, and thin flavors unblock,” [味之薄者，陰中之陽，味薄則通] and classified medicinals with this taste and function as “wind upbearing and engendering [風升生],” later shortened in common parlance to “wind medicinals”. The classification was further developed by Zhāng’s pupil, Lǐ Dōngyuán, and later by others. The medicinals found in this category are upbearing, scattering, outthrusting/venting, scurrying/mobile, unblocking, drying, and stirring, [升, 散, 透, 窜, 通, 燥, 动] and include mostly the modern category of warm-acrid and cool-acrid exterior-resolving herbs. They have the ability to raise, move, scatter, dry dampness, guide herbs upward or to particular channels, and to open the mysterious [开玄]. Wind medicinals resonate with the spring seasonal qì of growth and effusion, which means they are not only able to resolve the exterior but also unblock the interior; they can treat the six evils but are also useful for internal damage and miscellaneous diseases (Zēng et al., 2023).
As wind medicinals are acrid and mobile, and have an opening, penetrating, scattering, diffusing and freeing nature, they are useful not only for the skin and fleshy exterior, to effuse the striations on the surface and promote sweating, but also have the capability to diffuse the zàngfǔ and free the tissues [宣脏腑, 通组织] , open the xuán and unblock the fǔ [开玄通府], regulate and reach the channels and tissues [调达经络组织], course and disinhibit the liquids, humors, qì and blood aspects [在调达经络组织, 疏利津液气血] (Zēng et al., 2023).
The general effects of wind medicinals can be summarized as three: coursing and effusing; outthrusting (venting) and scattering; and lifting and raising [疏发、透散、升举].
The coursing and effusing function includes resolving depression and coursing the liver, regulating and facilitating the qì mechanism, dispersing binds and transforming stasis, distributing water and scattering damp, and so on.
The category of venting and scattering covers exterior resolving and sweat effusing, wind diffusing and scattering evils, effusing depressed fire outward as well as venting rashes and resolving toxins, etc.
Lifting and raising encompasses lifting yáng and raising the sunken, lifting the clear to distribute qì as well as carrying medicinals upward, and so forth (Zēng et al., 2023).
Professor Wáng’s Use of Wind Medicinals
One of the principal proponents of xuánfǔ theory in our time is Professor Wáng Míngjié [王明杰], of southern Sìchuān province (Yè, 2024). Professor Wáng has investigated xuánfǔ theory for decades, as well as Lǐ Dōngyuán’s theories of wind medicine. He believes wind medicinals are ideal for opening xuánfǔ. Due to their light and mobile nature which can penetrate both interior and exterior, they are essential for opening the xuán and resolving depression. They can open the orifices, stimulate the transformation of qì, are effective at opening and closing, facilitate the spirit mechanism, and are key medicinals to stop pain (Zēng et al., 2023).
“论病首重郁闭，临证善用开通，百病疏风为先，顽症从风论治”
"Of chief importance when considering disease is depression and blockage; in clinical practice [one should] make good use of opening and unblocking; for the hundred diseases, first course wind; stubborn diseases are treated through wind theory."
Wáng Míngjié [王明杰], (Liú et al., 2024)
Wind medicinals are like the growing and effusing qì of spring, inspiring the human body with burgeoning vitality; they stimulate qì transformation in the body, promote the zàngfǔ’s qì and blood, and facilitate the unimpeded flow of fluids through the tissues. Thus in appropriate formulas they can have an activating function, generating a kind of synergy. One can look at guìzhī’s [Ramulus Cinnamomi] function of freeing yáng and transforming qì; or cháihú [Radix Bupleuri] coursing the liver and resolving depression, as well as raising clear yáng; or jiégěng [Radix Platycodi] carrying other medicinals upwards, to find some examples of this activating feature of wind medicinals (Zēng et al., 2023).
The properties among wind medicinals differ somewhat, as does their ability to open xuánfǔ. In general, the warm, acrid, aromatic, and scurrying substances are stronger and acrid, cool, balanced, and bland substances are relatively weaker. Their tropisms also differ; gǎoběn [Radix Ligustici] and mànjīngzĭ [Fructus Viticis] are good at unblocking the brain xuánfǔ; xīnyíhuā [Flos Magnoliae] and cāng’ěrzĭ [Fructus Xanthii] are good at unblocking the nasal xuánfǔ; cháihú and xìxīn [Herba Asari] are good at unblocking the eye xuánfǔ, and so on.
Insect Medicinals
In many clinical situations, Professor Wáng not only employs exterior wind herbs to open the xuánfǔ, but combines them with interior wind medicinals, primarily those derived from insects. (Zēng et al., 2023).
Many wind-related diseases are not just a simple matter of exterior vs interior wind but may have both: exterior wind triggers interior wind, and vice versa. As to the xuánfǔ, both exterior pathogens (wind, and what wind carries with it – damp, cold, heat) can block the xuánfǔ as well as cause qì and blood stasis, phlegm turbidity, and so forth. Interior vacuity can lead to malnourishment of the tissues, causing the xuánfǔ to wither, unable to properly open and close. In this way, mutually engendering pathomechanisms of vacuity and stagnation can combine in chronic diseases. In yīn vacuity, if the xuánfǔ are withered and unable to open, heat can build up and stir interior wind. Interior stasis of blood can arise from blockage of xuánfǔ, which can restrict the circulation of blood to the sinews, causing tremor and spasm; an example of wind-induced blood stasis. (Li et al., 2024)
Insect-type medicinals have mobile, scurrying, drilling, and outthrusting [走窜钻透] properties. They are strong-acting, and have the effects of opening the heart [心窍], opening the brain [脑窍], unblocking the nine orifices and five senses [五官九窍开通], and facilitating the spirit mechanism [畅达神机] (Zēng et al., 2023). In addition, they have the ability to track down and remove [搜剔] obstructions from the channel system (Li et al., 2024).
Combining Exterior and Interior Approaches
An example of this combination approach is Professor Wáng’s Qīwèi Zhuī Fēng Sǎn [Seven Flavors Chasing-the-Wind Powder,七味追风散]. This formula includes qiānghuó [Radix Notopterygii], báizhǐ [Radix Angelicae Dahuricae], chuānxiōng [Rx Chuanxiong] and tiānmá [Rhizoma Gastrodiae], and the insect medicinals quánxiē [Buthus Martensi], jiāngcán [Bombyx Batryticatus] and dìlóng [Pheretima]. In general, the formula can dispel wind, extinguish wind, open the mysterious and reach the spirit [祛风息风, 开玄达神]. The prescription is primarily used for vertigo, headache, stroke, dementia, and epilepsy. For headache, Professor Wáng adds báisháo [Radix Paeoniae Alba] and yánhúsuǒ [Rhizoma Corydalis] for severe pain; for epilepsy, he adds wúgōng [Scolopendra], dǎnnánxīng [Pulvis Arisaemae cum Felle Bovis] and zhèbèimǔ [Bulbus Fritillariae Thunbergi]. (Li et al., 2024)
Supplementing and Unblocking
Once the xuánfǔ are unblocked, the qì, blood, and fluids will flow freely and the body will eliminate the evil by itself. But long-term blockage of xuánfǔ can lead to vacuity situations, and long-term vacuity can lead to blockage of xuánfǔ, which further depletes vital substances. In these cases, supplementation is appropriate along with the opening and unblocking medicinals. An ideal herb for this is huángqí [Radix Astragali], which supplements qì but also lifts and raises the clear yáng, and which Professor Wáng will prescribe along with the wind medicinals and insect products (Zēng et al., 2023).
In treating chronic fatigue, Professor Wáng will often use simultaneous unblocking and supplementing to unblock the xuánfǔ and aid the spirit mechanism. Supplementing in this case is the basis but the wind medicinals are necessary to open the xuánfǔ and enhance the effects of the supplementing herbs. Typically this can involve the liver and kidneys, as well as spleen and stomach. In the case of liver and kidneys, the supplementing medicinals are often greasy and hard to digest; the wind medicinals are light and mobile and can promote qì transformation, unblock depressed liver qì, and open the distribution routes for qì and blood to reach the organs. In the case of the spleen, the wind herbs can raise clear yáng and course the liver qì, in addition to opening the orifices and xuánfǔ. (Hú et al., 2024)
Some useful combinations include:
Professor Wáng will sometimes give small doses of máhuáng [Herba Ephedrae] along with large doses of huángqí in cases of severe fatigue. (Hú et al., 2024)
In cases of body pain, qiānghuó and fángfēng [Radix Saposhnikoviae] can be combined; qiānghuó is effective at drying dampness and relieving pain, and fángfēng is acrid and sweet, so it has a mildness that works well in fatigue situations. Fángfēng can move both to the interior and exterior and is especially good at ascending to the head and opening the xuánfǔ there. The combination is indicated for upper body symptoms like headache, dizziness, shoulder and upper back pain, etc. (Hú et al., 2024)
Cháihú and gégēn [Radix Puerariae] are combined to lift the central qì and descend turbidity; cháihú can also course liver qì and gégēn can relieve neck pain and spasm. (Hú et al., 2024)
Chuānxiōng, gégēn [Radix Puerariae] and qiānghuó may be combined for whole-body pain with chronic fatigue. Chuānxiōng is a blood quickening herb that ascends as well as resolves the exterior. Chuānxiōng enters the shàoyáng channels, where gégēn enters the foot yángmíng channel and qiānghuó enters the foot tàiyáng channel (Hú et al., 2024).
An example of a formula that uses both supplementing and dispersing strategies is Tiānchóng Dìngxuàn Yǐn [Heavenly Insect Dizziness-Stabilizing Brew, 天虫定眩饮]. The formula contains huángqí and zhìgāncǎo [Radix Glycyrrhizae Praeparatae] to supplement qì and raise yáng; báisháo, dāngguī [Radix Angelicae Sinensis], and jīxuèténg [Radix Spatholobi] to nourish and quicken blood; and the secret sauce of wind herbs and insects to open the xuánfǔ, unblock the channels and calm wind: gégēn, tiānmá, chuānxiōng, qiānghuó, and fángfēng, combined with dìlóng, jiāngcán, and tǔbiechóng [Eupolyphaga]. (Li et al., 2024)
Floral Medicinals
Another interesting take on opening xuánfǔ comes from Huáng & Huáng (2024). Their paper discusses the use of floral medicinals [花类药], whose characteristics are as follows
花类药物载轻薄升浮之体、承芳香味烈之气、秉轻灵宣透之性，且无辛温燥热之弊，更无峻猛伤正之害…
Floral medicinal substances carry a light, agile, ascending and floating body, bear a fragrant, aromatic flavor and potent qì; hold a light, quick, diffusing and penetrating nature; furthermore they are without the drawbacks of being too acrid and warm or hot and dry; and lack the harshness which could damage the correct (qì). (Huang & Huang, 2024).
This can be seen as an example of the axiom “light [medicinals] can eliminate repletion [轻可去实]”.
Flowers have a rising action in Chinese medicine and thus are especially suited to treating issues affecting the upper part of the body. Floral medicinals open the xuánfǔ so that the evil is naturally eliminated, thus facilitating the spreading of the qì mechanism, the regulation of the blood and fluids, the flow of the liquids and humors, the diffusion of yíng and wèi, and the quieting of the spirit mechanism, so that the blood pressure will return to normal.
Huáng & Huáng (2024) outline the pathology of the xuánfǔ in different organs, which was discussed in the previous post. The recommended floral medicinals for each of the organ xuánfǔ mentioned are:
Liver xuánfǔ blocked by depressive fire: Flowers are acrid and cool, can calm liver and purge fire. Recommended to use sānqīhuā [Flos Notoginseng] and huáihuā [Flos Sophorae Japonicae].
Heart xuánfǔ blocked by blood stasis: Flowers with stronger acrid and aromatic properties are more effective in these cases; an example is hónghuā [Flos Carthami].
To open spleen xuánfǔ and raise the clear: Use aromatic substances to dispel turbidity. Géhuā [Flos Puerariae] can arouse the spleen and transform turbidity to raise the clear yáng of spleen earth, and open the spleen xuánfǔ that have been blocked by turbidity. Also recommended is hòupòhuā [Flos Magnoliae], which is aromatic and mostly acts on upper and middle jiao, so it’s more effective at opening and diffusing than hòupò [Cortex Magnoliae]
To open lung xuánfǔ: Use cold acrid and bitter herbs to eliminate wind heat and open the lungs, like júhuā [Flos Chrysanthemi] and jīnyínhuā [Flos Lonicerae].
To open the brain xuánfǔ, calm the spirit and resolve depression: pay attention to regulating emotions, use méiguīhuā [Flos Rosae Rugosae] and bǎihéhuā [Flos Lilii]
Conclusion
This has been a brief review of a few papers, but I think it is enough to give an idea of some of the basic ideas behind using Chinese herbal medicine to treat according to xuánfǔ theory. Next time I plan to review some articles on treating xuánfǔ with acumoxa, and offer some of my own ideas on that particular subject. Thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Hú, Y., Yè, Z., Qín, K., & Wáng, M. (2024). Professor Wang Mingjie's experience in treatment of chronic fatigue syndrome based on xuanfu theory. Journal of Chengdu University of TCM, 47(4), 51-55
Huáng, Y., & Huáng, F. (2024). The application of flower medicine in treating hypertension based on the xuanfu theory. Clinical Journal of Chinese Medicine, 16(29), 105-109. doi:10.3969/j.issn.1674-7860.2024.29.020
Lǐ, L., Yè, Q., Lèi, R., Jiāng, Y., & Wáng, M. (2024). Professor Wang Mingjie’s characteristic experience in treating wind syndrome based on xuanfu theory. Journal of Chengdu University of TCM, 47(6), 8-11
Liú, Q., Zhào, Z., Zhāng, X., Zhāng, Y., Zhào Y., Lǐ Y., Zōu Y., & Lǔ, Y. (2024). Deconstructing action mechanisms of wind medicines in Shengyang Sanhuo Decoction based on xuanfu theory. Shanghai Journal of Traditional Chinese Medicine, 58(9), 24-27. DOI：10.16305/j.1007-1334.2024.2312043
Yè, Q. (2024). Research on xuánfǔ theory. Journal of Chengdu University of Traditional Chinese Medicine, 47(6), 1-3.
Zēng, R., Wáng, M., & Jiāng, Y. (2023). Wang Mingjie's experience in using wind medicine to treat migraine based on Xuanfu theory. Jiangxi Journal of Traditional Chinese Medicine, 6(54), 486, 41-43