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UNDERSTANDING QI:

The Four Gentleman Decoction

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Si Junzi Tang, commonly called the Four Gentlemen Decoction or the Decoction of Four Noble Drugs, is one of the well-known formulas of the Chinese tradition.  In most modern texts, it is listed first among the qi-tonic prescriptions.  It was recorded in the Taiping Huimin Hejiju Fang of the Song Dynasty (published around 1110 A.D.), developed from a prescription of the Shanghan Lun, which was written at the end of the Han Dynasty (ca. 220 A.D.).  The name of the formula is unique, and stands in contrast to the standard naming method that had been used at the time, which was either to list the herb ingredients (typically done when there were fewer than five ingredients), to mention the main ingredient, or to mention the action of the formula. The same basic name for the formula is also applied to the modified versions, such as Liu Junzi Tang and Xiang Sha Liu Junzi Tang, also recorded in the Hejiju Fang.

Si Junzi Tang has four ingredients: ginseng, licorice, atractylodes (baizhu), and hoelen (fuling); it is derived from Lizhong Wan (Pill for Warming the Center) of the Shanghan Lun by replacing the warming, spicy ginger with the bland, neutral hoelen.  As a result of this single herb change, the earlier chill-dispelling prescription is altered to form a more moderate spleen-tonifying and moisture-resolving formula. 

By calling the formula “four gentlemen,” one of the implications is that the four ingredients all have an equal status in the formula.  By comparison, many formulas are described as having a ruler (emperor), minister, assistant, and aid (see: Designing a personalized Chinese herb formula).  Despite the formula’s name, some authors differentiate roles for each of its ingredients and specify that the four work harmoniously together (but are not equals).  This explanation is not as satisfactory, since the characteristic of harmonious action among ingredients is attributed to many prescriptions that are named in the ordinary manner.   Thus, for example, in the book Formulas and Strategies (1), which attempts to provide roles for individual ingredients of the formulas it describes, ginseng (or codonopsis, dangshen, used as a substitute) is said to be the ruler; atractylodes is the minister; hoelen is the assistant; and licorice is the envoy, yet each of the herbs has essentially the same function.  Licorice is as much a key herb in the prescription as ginseng, though in many other formulas it is mainly used to moderate the strong flavor of a decoction or harmonize the action of ingredients with diverse properties.

The term junzi is one that is well known in China; it comes from Confucianism, a doctrine that has been prominent throughout Chinese history since Kong Fuzi (Confucius) taught his principles of moral living about 2,500 years ago.  According to Analysis of Chinese Characters (2), jun is “a princely man.”  The character is composed of yin (a magistrate) and kou (mouth; uttering his decrees and orders), thus representing authority. 

In the book, Confucius Lives Next Door (3), T.R. Reid describes the term junzi this way:

It is written with two characters that mean royal [jun] and person [zi].  This tells us that traditionally junzi referred to a prince, an aristocrat, someone who obtained a position of stature and power through birth.  Confucius accepted the basic principle that certain people have the right to hold elite positions, but then he completely changed the rules for joining the ranks of the elite.  To Confucius, the junzi—the term has been variously translated as “the noble man,” “the superior man,” the “gentleman”—was a person who had earned elite status.  To be a gentleman, a person had to spend a lifetime studying and following the rules of virtuous conduct.  Just being born right was not enough.  A gentleman should be judged—just as Martin Luther King, Jr. would put it 25 centuries later—on the content of his character.

The formula is so-named because the inherent character of the four herbs is royal and virtuous.  They have a mild nature and support the body functions; they do no harm and their qualities are well suited to the organ system (stomach-spleen) that they are aimed at treating.

Si Junzi Tang is traditionally to be given to those who are fatigued, pale, and have a quiet voice that results from their lack of qi; the person has a weak appetite, a low body weight, and a tendency to have loose stools.  In general, there will be a tendency towards chilliness, little thirst, and an adverse reaction to eating rich foods, such as abdominal pain.  These problems may have several sources, but all involve a weakening of the central qi.  Among the possible causes are overwork, excessive anxiety and brooding, irregular eating habits, and repeated exposure to unfavorable weather conditions.

The formula may be modified by adding pinellia (banxia) and citrus (chenpi) to yield Liu Junzi Tang (Six Gentleman).  These added herbs invigorate the function of the stomach and resolve phlegm accumulation, a byproduct of stagnancy of food in the stomach.  The formula is used for the same basic condition as Si Junzi Tang, except that there are complications of fullness in the chest, nausea (with possible vomiting), and cough with profuse thin and clear expectoration.  Again, the formula may be modified by further adding saussurea (muxiang) and cardamom (sharen) when there is abdominal fullness and pain.  The resulting formula is called Xiang Sha Liu Junzi Tang (xiang = muxiang; sha = sharen).

Rather, the formula improves the function of the spleen in transforming (fermenting) food essence and fluids (“grains and water”) and transporting those essences throughout the body.  It might, therefore, be better understood as a nutritive formula, not in the sense that it provides nutrients, but that it helps the body to become better nourished by retrieving more from the food and having all the organs and body parts receive the beneficial essence.  One of the primary indicators for use of the formula is pallor (both facial coloration and tongue color) that develops as a result of inadequate nutritional status and poor circulation. 

Ginseng (or the substitute, codonopsis) and licorice are intended to enliven the spleen so as to increase the desire for food, help transform the food to useful nutrition (producing of qi and blood), transport the essences to the spleen, and help the spleen to circulate the fluids.  These herbs are indicated for treatment of poor appetite, lassitude, and tendency to have loose stool (because neither the food essence nor the fluids have been fully extracted from the food; they drain downward with the wastes rather than being borne upward to the spleen and upper burner).  

Atractylodes has the same basic function as ginseng and licorice for tonifying the central organs, but being bitter and spicy, it has an additional property of helping to dry excess fluids that make the spleen sluggish in its activities.  Hoelen also has the same basic contribution to make, but being bland and spongy (in the sense of absorbing fluid), it is helpful in preparing excess fluids for elimination.  While hoelen and atractylodes are especially valued for removing excess fluids impairing the yang aspect of the spleen and stomach, ginseng and licorice have moistening qualities that protect the yin of the stomach and spleen.

These four herbs were deemed, during the Song Dynasty, to be the essential ones for improving stomach-spleen function for the specific symptoms indicated here.  To understand the role of the spleen and its treatment by this formula, one can read the explanation of Li Dongyuan (1180–1251 A.D.) in his Treatise on the Spleen and Stomach (4):

To live, humans must receive qi from water and grains.  So-called clear qi, constructive qi, conveying qi, defensive qi, and the upbearing qi of spring are all synonymous with stomach qi.  Stomach is the sea of water and grains.  Having entered the stomach, food and drink float the essence qi and transport it up to the spleen.  The spleen qi spreads essence which gathers in the lungs and frees the flow of the water passageways, transporting water essence down to the urinary bladder.

One can see that the concern is for getting nourishment from food.  Weakness and lassitude (low energy) are the secondary effects of poor nourishment, so the formula is indicated for treating fatigue in this particular context rather than serving as a sort of energy stimulant.

A typical dosage pattern for Si Junzi Tang is:

Ginseng                   10 g

Atractylodes              9 g

Hoelen                       9 g
Licorice (baked)        6 g

To add citrus and pinellia, about 9 grams of each are used; to add saussurea and cardamom, about 3–6 grams are used.

CAUSES OF QI DEPLETION AND REPLENISHMENT:
A Further Understanding of the Four Gentlemen Decoction
Mencius (Mengzi) was a proponent of Confucianism who lived about a century after Confucius died.  He provided a more detailed explanation of the Confucian philosophy than is found in the original succinct sayings (Analects), and he and his contemporaries gave a description of qi which, to this day, remains of value to those who wish to understand it more fully.  Following is a representation of Mencius’ conception of qi relayed by Benjamin Schwartz (5), for which a lengthy passage is quoted, but edited slightly to improve the readability.  The discussion begins with the matter of remaining serene in the face of outer disturbances, described as maintaining an “unmoved heart,” and proceeds with an investigation of how disturbance and pathological conditions (such as morally wrong behavior) can arise.  In the current Chinese medical jargon, the basis for the unmoved heart corresponds to having strong qi and blood that protects and defends against external influences, so that the shen (spirit) is not disturbed and illness does not arise.  As explained here, that strong qi is courage, will, virtue, and, most importantly, the dedication to living a good life: the life of a noble man (junzi).

The crucial dialogue in the Mencian text opens with a discussion of the unmoved heart.  Mencius—like Confucius and like many of his own contemporaries—remains profoundly concerned with the attainment of an attitude of inner peace, serene courage, and equanimity in the face of the anxiety-ridden world....Mencius points out that some men achieve a posture of stoic indifference to the vicissitudes of the outer world simply by cultivating within themselves a constant disposition of physical courage, and it is in connection with this disposition that the term ‘qi’ is first introduced as a crucial category along side ‘nature’ (xing) and ‘heart’ (xin)....

Courage belongs to qi because it is fundamentally an emotional disposition, and emotional dispositions belong to the category of qi (a kind of psychophysical energy/substance).  It seems possible for some men to cultivate this emotional disposition within themselves, just as others may build up their physique through exercise.  Mencius, however, points out the narrow limitations of an unmoved heart which is maintained simply by this cultivation of physical courage: courage may serve any ends, and since it belongs to the realm of passions and emotions, it may, in fact, become subservient to unworthy purposes.

The man of moral courage, however, is courageous only when he is right.  Confucius is quoted as saying, ‘If in looking within, one finds oneself to be in the wrong, then even though one’s adversary be a coarsely clad commoner, should we not tremble with fear?  If on looking within, one finds that one is right, one should move forward against men in the thousands.’  The Confucian man of unmoved heart obviously requires courage.  His courage is, however, firmly based on unswerving righteousness.  In Mencius as in Confucius, inner equanimity and virtue are inseparable.

The discussion of courage as an emotional disposition introduces the crucial category of qi.  The qi is a kind of energy/stuff (sometimes associated with the blood, as in Confucius’ xueqi: blood-qi) which circulates throughout the body and its organs, and which embraces all vitalities associated with the emotions, the passions, the appetites, and the desires....The constantly circulating and ever-changing passions, emotions, and appetites are the arena in which the disorders and perversions of the human person make themselves manifest within.  It is the turbulence and disorders of the qi that most directly obstruct the growth of the ‘shoots’ of goodness in the human heart.

Mencius does not regard the disturbed (or excessive) vital energy of the qi as the ultimate cause of  evil behavior, for qi is associated with courage, which is in itself good.  Indeed, when he speaks of the disorders of qi—using distinctly physicalist imagery—he speaks not of an excess of qi, but of a deficiency of qi.  How is it then that qi within an individual can become the source of perversity and disharmony?

When the qi ‘fills the body,’ all the senses and physical organs, with all their affective and perceptive properties, function precisely as they should within their proper domains.  One might say that when all parts of the organism are full of qi—distended, as it were, to their proper limits but no further—there is a harmonious and just balance among them.  It is when qi drains out of the body and becomes depleted that imbalances occur which relate directly to imbalances and disorders in the emotions and passions. 

In a passage of the Chuangzi [a text by the famous Taoist, known to us as Chuang-tzu, and a contemporary of Mencius], we find it stated that: ‘If the qi that is stored up in a man becomes dispersed, then he suffers a deficiency.  If it ascends and does not descend, it causes him to be constantly irritable.  If it descends but does not ascend, it causes him to be chronically forgetful.  If it neither ascends nor descends but gathers in the middle of the body in the region of the heart, he becomes ill.’ 

In the Huainanzi [another Taoist text] we find the following highly revealing passage: ‘If the blood-qi can be concentrated in the five organs without drifting away, then the chest and stomach can be replenished and the lustful desires diminish.  When the chest and stomach are full and the desires are diminished, the ears and eyes are clear and the senses of hearing and sight are penetrating: we call this clarity.  The five organs are then subject to the rule of the heart and there is no deviation.  The will dominates and behavior does not go astray.  When the will dominates and behavior does not go astray, the spirit flourishes and the qi does not dissipate.’

What causes the depletion of qi and what causes its replenishment?  The men of mere physical courage try to maintain their qi by cultivating a dominant emotional disposition which can, perhaps, control certain forms of depletion of qi, particularly loss of qi through fear....Yet, connected with the qi, there are many other irrational passions that physical courage cannot control and that may overwhelm physical courage, which is itself an organically-based emotion. Mencius points out that ‘what is not to be gotten from the heart is not to be sought in the qi.’  The spiritual basis of the unmoved heart should rest on something more solid than anything derived from the emotions and passions. 

What is it then, that causes the dispersion of the qi and the disorder of the passions which is sufficient to block the actualization of the heart’s potential for achieving the promise of its nature?  The qi is very much affected by its interaction with the outer world and this interaction occurs in the realm of the senses that provides men with their channels of communication with the outer world.  Kong Fuzi asks, ‘Though men are equally human, why are some great men and some small men?’  The answer is ‘that the organs of hearing [listening] and thinking are unable to think and can be misled by outer things [making a man ‘small’].  That is, the organ of the heart/mind can think: if it thinks it will obtain the right view; if it does not think, it will not obtain it.’ 

It is not the senses, through which interaction with the outer world takes place, that are the locus of evil.  On the contrary, the senses belong to our heavenly nature: they are part of that nature which we share with the animals.  It is entirely natural for the palate to love good tastes, the ear to love good sounds, and the eyes beautiful sights.  Evil somehow arises in the area of the interaction between the qi and the senses.  There is something in the nature of the qi and the senses as they operate within the human being that leads them to become fixated on and obsessed with or excessively repelled by various aspects of the outer world.  The epicurean glutton does not simply enjoy good tastes, he becomes fixated on the limitless quantity and variety of good tastes.  The unthinking senses can trigger either vast excesses of desire or of repulsion which completely upset the balance of the emotions and dissipate man’s vital qi.  Where the vital qi is not drained off by these external obsessions, then the vital qi is maintained in balance....

Finally, how are the senses and the qi controlled?  The key is found in the reference to the capacity of the heart/mind to “think;” there is either the will of the heart/mind to think, or the absence of the will to think....In concrete situations, one must make a choice between good and evil and this is a deliberate act of the intentional will.  It is not the heart as the spontaneous vehicle of the good nature that brings order to the senses and harmony and replenishment to the qi, rather, it is the heart as the intentional organ of willing and thinking.  Mencius does not simply assert that it is the heart that rules over the qi.  He asserts that it is the will....It is only the conscious level of man’s mind that can—by its unceasing, ever-renewed moral effort—lead most humans to salvation....The sages live in a world of harmony with the universe on every level of their being.  Their conscious hearts are always at one with their spontaneous hearts.  Their senses are under the complete control of their hearts and the fully nourished vital energies of qi are fully in balance within the body and in harmony with the cosmic qi....

The senses and the qi can be ultimately controlled only by the determination to act rightly—to accumulate righteousness in all the complex circumstances of life.  A man who concentrates his whole mind on acting rightly will have found the loftiest and truest method of achieving an unmoved heart because he will be in full control of his appetites, emotions, and passions, and will thus constantly nourish his qi.  The qi can then become the ‘flood-like qi’ which contributes to a kind of feed-back process: it is, in turn, a vital energy which nourishes and strengthens the innate propensity to goodness.  One might say that goodness becomes imbedded in the character.  A man who can thus realize all the potentialities of the heart will obviously share the totally unmoved heart of the Confucius of the Analects and will also be a man capable of saving the world [junzi].

In sum, the fullness of qi that brings harmony and serenity arises from one’s will to act rightly, which is the key step to becoming a gentleman (or gentlewoman; in Chinese, the term junzi does not connote a gender).  Both Confucian and Taoist authors, as well as their Buddhist counterparts, seem to ultimately agree in this: the determination to act rightly, and the resulting moral behavior, leads to control over the qi and all good things develop from that.  The herb formula named Si Junzi Tang might also be interpreted as “the decoction of four herbs that aid one in the effort to replenish qi, strengthen the will, sharpen the senses, improve the thoughts, cultivate virtue, and thereby become a superior person.”

REFERENCES

1. Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990 rev. ed., Eastland Press, Seattle, WA.
2. Wilder GD and Ingram JH, Analysis of Chinese Characters, 1974 Dover Publications, NY.
3. Reid TR, Confucius Lives Next Door, 1999 Random House, New York.
4. Yang Shouzhong and Li Jianyong (translators), Li Dongyuan’s Treatise on the Spleen and Stomach, 1993 Blue Poppy Press, Boulder, CO.
5. Schwartz BI, The World of Thought in Ancient China, 1985 Belknap Press, Cambridge, MA.

October 2010

 
Figure 1: Confucius.