Discussion on the Application of Ascending and Descending Property of Traditional Chinese Medicine in Compatibility of Clinical Prescriptions

Long CHEN, Luoyu SHI, Donghua LI

Guangxi University of Chinese Medicine, Nanning 530200, China

Abstract Through the method of literature mining, the classics of traditional Chinese medicine, materia medica works, medical cases and documents are studied.Based on common prescriptions for the treatment of diseases such as abnormal Zang-fu viscera and qi movement, dysfunction, etc., and combined with the theory of ascending and descending property of traditional Chinese medicine, the application of ascending and descending property of traditional Chinese medicine in clinical prescription compatibility and the factors affecting the application are summarized.The ascending and descending properties of traditional Chinese medicine have been widely used in prescription compatibility for the clinical treatment of impairment of purifying and descending function of the lung, spleen and stomach’s ascending and descending disorders and heart-kidney noninteractionpatte.

Key words Property of traditional Chinese medicine, Ascending and descending, Prescription compatibility, Clinical application

1 Introduction

The ascending and descending property of traditional Chinese medicine refers to the tendency of the drug to play a clinical efficacy function on the human body.The drug tends to act in opposition to the course of the disease to be treated, which is consistent with the location of the disease to be treated, so as to guide the rules of prescriptions and medicines[1-2].The theory of ascending and descending property of traditional Chinese medicine has experienced long-term development.Zhang Jiegu, the founder of Yi-Shui school of traditional Chinese medicine in the Jin and Yuan dynasties, proposed the ascending and descending properties of traditional Chinese medicine inMedicalOrigin.Since then, the theory has been paid more and more attention by doctors of all dynasties.The ascending and descending property is usually used to treat abnormal Zang-fu viscera and qi movement and dysfunction caused by six exogenous pathogenic factors, internal damage due to seven emotions, fluid-retention and blood stasis, and it is especially effective in the treatment of impairment of purifying and descending function of the lung, spleen and stomach’s ascending and descending disorders and heart-kidney noninteractionpatte[3-6].Based on the study of classics of traditional Chinese medicine, materia medica works, medical cases and documents, the clinical application of the theory of ascending and descending property of traditional Chinese medicine are preliminarily discussed, in order to provide the reference for its clinical application.

2 General situation of the theory of ascending and descending property of traditional Chinese medicine

The earliest prototype of the theory of ascending and descending property can be traced back toHuangdiNeijing.InSuwen·ArgumentonFourQiRegulatingSpiritChapter 2,Suwen·ArgumentonYinYangYingxiangChapter 5 andSuwen·ArgumentonLiuweizhiChapter 68, the characteristics of the four seasons, the surface and interior of yin and yang, the thickness of odor, the growth, transformation, ripening and storage, the transformation of biochemical qi movement, and the relationship between ascending and descending were discussed respectively, which became the theoretical basis of the theory of ascending and descending property of traditional Chinese medicine[7].Based on the homology of theoretical basis and combined with the influence of the theory of TCM therapy and signs, Zhang Yuansu proposed "the ascending and descending diagram of odor thickness, cold heat, yin and yang", and "the ascending and descending method of reinforcement and reduction of drug use" inMedicalOrigin, formally establishing the theory of ascending and descending property of traditional Chinese medicine.The proposal of this theory has better explained the organic unity of "university-human-medicine", and provided guidance and reference for doctors of later generations in clinical drug prescription[1,8-9].

The ascending and descending property of traditional Chinese medicine usually has a dialectical relationship with drug taste, channel tropism, efficacy and clinical diagnosis of diseases, and the essence of its function is to regulate the yin and yang balance of Zang-fu viscera, restore the order of qi movement and comply with the physiological habits of Zang-fu viscera.Both ascending and floating describe the upward, outward and divergent trends of pharmacodynamic effects, while descending and sinking also describe the downward, inward and astringent tendencies of pharmacodynamic effects[1,3].Although there is a similarity of trend between the two, there are differences in degree.Ascending and floating lay more emphasis on the action description of the trend of pharmacodynamic effect, such as invigorating splenic yang, resolving the exterior, purging, calming the adverse-rising energy,etc., and descending and sinking, however, focus on the state description of the trend of pharmacodynamic effect, such as subsiding yang, dissipating cold, clearing heat, promoting emesis,etc., which are often used together in clinical practice.

According to the efficacy, four natures and five tastes of drugs, warm and pungent drugs with the effects of invigorating splenic yang, tonifying qi, resolving the exterior, releasing cold, dispelling wind, lifting depression, promoting emesis,etc., are often classified as ascending and floating drugs, such as ginseng, root of hairy asiabell, astmgali radix, ephedra, cassia twig, asarum, monkshood, rhizoma zingiberis, radix sileris, notopterygium root, rhizoma cimicifugae, radix bupleuri, radix puerariae, platycodon grandiflorum,etc.The cold, bitter, sour, salty and sweet drugs with the effects of clearing heat, discharging fire, purging heat, calming the adverse-rising energy, moistening dryness, softening hard mass, subsiding yang and astringent are classified as descending and sinking drugs, such as gypsum fibrosum, rhizoma anemarrhenae, radix scutellariae, rhizoma coptidis, cortex phellodendri, aprieot seed, tangerine peel, rhizoma pinelliae, magnolia bark, rhizoma alismatis, poria cocos, semen coicis, semen lepidii, inula flower, perillaseed, concha ostreae,etc.[1,9].

3 Application in compatibility of clinical prescriptions

3.1 Application in the treatment of impairment of purifying and descending function of the lungThe lungs are located in the chest cavity, one on each side, covering the heart and connecting with the throat and nose.The lungs are the highest in the viscera, so it is called "baldachin".The lung governs qi, controls breathing, dominates water movement, links with all vessels, and governs coordinative activities of viscera.Lung qi takes dispersing and descending as the basic form of movement.The lung is delicate, not tolerant to cold, heat, dryness and humidity, and vulnerable to exogenous pathogenic factors.The impairment of dispersing function of the lung is mostly due to the invasion of exogenous pathogenic factors; the impairment of descending function of the lung is most caused by visceral miscellaneous diseases and internal injuries.The impairment of purifying and descending function of the lung usually leads to dyspnea, chest tightness, cough and asthma, blockage of muscular interstices, fluid retention, and further leads to cough, asthma, reversed flow of qi, aphonia, edema, phlegm and retained fluid, difficult urination, often accompanied by cold fever, stuffy nose, sore throat and other symptoms[10].

It is a commonly used method in traditional Chinese medicine to treat the impairment of purifying and descending function of the lung by using the ascending and descending property of drugs[2,11].In clinical diagnosis and treatment, many doctors often combine platycodon grandiflorum with purple perilla, aprieot seed with magnolia bark, or tangerine peel with fructus aurantii to regulate the lung qi, and treat cough, asthma, expectoration, chest suffocation and other diseases[12].Therefore, Ye Tianshi[13]pointed out that "for lung diseases, pathogenic factors are dispersed with pungent drugs, accompanied by mild bitterness to reduce qi for treatment".For example, Zhang Zhongjing mainly regulated the dispersing and descending function of the lung with ephedra, platycodon grandiflorum, cassia twig, asarum, aprieot seed, gypsum fibrosum, magnolia bark, rhizoma cynanchi stauntonii, poria cocos, semen coicis, semen lepidii, and Chinese honey locust, thus treating lung diseases[14].

3.2 Application in the treatment of spleen and stomach’s ascending and descending disordersThe spleen and stomach cohabit in the middle energizer.The spleen is below the diaphragm on the left side of the stomach, which is attached to the stomach by a membrane, governing transportation and transformation and managing the blood.The stomach governs intake and decomposition of grain and water, and stands in interior-exterior relationship with the spleen.Spleen qi governs ascending, and stomach qi advocates dredging and descending.Human vital activities depend on the cereal essence of spleen and stomach transportation, so the spleen and stomach is called "the foundation of acquired constitution".Ascending the clear and descending the turbid and joint coordination of spleen and stomach complete the digestion and absorption of food, water and grain and the transportation of cereal nutrients.Therefore, the importance of the ascending and descending function of the spleen and stomach can be clearly seen, so Ye Gui said in theMedicalRecordsforClinicalGuidance·SpleenandStomachthat "the spleen tending to ascent is healthy, and the stomach tending to descend is harmonious.

The spleen and stomach’s ascending and descending disorders is often caused by exogenous pathogenic factors, diet, forced labor and emotions, resulting in excess, less or opposite ascending and descending of spleen and stomach qi movement.It not only leads to dysfunction of cereal essence, but also causes dysfunction of other viscera, resulting in new pathological changes, such as lack of appetite, abdominal fullness and distention, spleen-deficiency diarrhea, sinking of qi due to deficiency of the spleen, epigastric sag and distention, light-headedness, vomiting and hiccupping, continuous diarrhea, splanchnoptosia, abnormal defecation,etc.[10-11,14-16].

In the treatment of spleen and stomach diseases, doctors of all dynasties emphasize the regulation of ascending and descending.Therefore, it is particularly important to regulate the ascending and descending of spleen and stomach by making good use of the ascending and descending properties of traditional Chinese medicine[17].Li Dongyuan, the master of the spleen and stomach theory, often developed the prescription compatible with radix bupleuri, rhizoma cimicifugae and lotus leaf in the treatment of spleen and stomach diseases, to help ascending up spleen-qi and yang; or compatible with tangerine peel, prepared pinellia tuber, rhizoma coptidis, magnolia bark, rhizoma alismatis and other bitter medicine to reconcile stomach qi, resolve turbid and descend qi.For example, Shengyang Yiwei Decoction, Buzhong Yiqi Decoction, Shengyang Buqi Decoction are all helping ascending by descending.When Buzhong Yiqi Decoction is used to treat yin fire caused by gastric qi depression, radix astragali, liquorice and ginseng are used together with rhizoma cimicifugae and radix bupleuri to tonify qi and lift yang, so as to relieve fever with sweet and warm, reduce yin fire and recover[18-19].From the perspective of paying attention to the ascending and descending of spleen and stomach qi movement in the treatment of spleen and stomach diseases, combined with the performance and clinical application of drugs, Ren Lixia[20]classified commonly used drugs into ascending and descending drugs.Ascending drugs include rhizoma cimicifugae, rhizoma gastrodiae, radix astragali, ginseng, platycodon grandiflorum, herba eupatorii, fructus amomi, cassia bark, concha ostreae,etc., which mainly play the functions of lifting, ascending lucidity, and upraising.Descending drugs include radix rehmanniae, cortex phellodendri, radix cyathulae, agilawood, fructus aurantii, tangerine peel, magnolia bark, inula flower, perillaseed, rhizoma pinelliae, betel nut, mulberry bark,etc., which mainly play the functions of descending, rushing down, lowering qi, discharging blood stasis, purging fire, calming the adverse-rising energy, resolving phlegm.Therefore, it reflects the function and importance of ascending and descending property of traditional Chinese medicine in treating spleen and stomach diseases and regulating the rise and fall of spleen and stomach qi movement.

3.3 Application in the treatment of heart-kidney noninteractionpatte and water-fire imbalanceThe heart, the big leader of the viscera, resides in the chest, which governs bloods and vessels, stores spirit, and dominates the whole life activities of the human body, being a yang organ governing unobstruction.Tang Zonghai, a physician of traditional Chinese medicine of Qing Dynasty, described inATreatiseonBloodTroublesthat "the fire, the master of the heart, is transformed into blood to nurture the whole body".The kidneys are located on both sides of the lumbar spine, one on the left and one on the right.Suwen·TreatiseonMaiyaoJingweisaid that "waist, the house of the kidney".The kidney stores essential substances, and governs water, qi absorption and reproduction, which is the foundation of human life as well as yin and yang of the five internal organs.The intersection of heart and kidney is the main manifestation of the physiological connection between heart and kidney.Zhou Zhigan, a medical scientist of Ming Dynasty, described inZhouShenzhai’sSuicideNotethat "the intersection of heart and kidney depends entirely on ascending and descending, and the descending of heart qi is due to the ascending of kidney qi, while the ascending of kidney qi is due to the descending of heart qi".The interaction of diametrically opposed ascending and descending between the heart and the kidney can maintain the coordination and balance of physiological functions of the heart and the kidney[10,20].Exogenous pathogenic factors, internal injury, food and labor, and emotions can cause the disharmony of yin and yang of the human viscera, meridian obstruction, qi and blood disorders, emotional disorders, and further lead to heart-kidney noninteractionpatte.

Different drugs are selected for different heart-kidney noninteractionpatte in the clinic, to reconcile diametrically opposed heart and kidney.For heart-kidney noninteractionpatte caused by fire flourishing heart and kidney, bitter, cold and sweet subsiding drugs can be applied concertedly to nourish kidney yin and reduce heart fire, such as radix scutellariae, rhizoma coptidis, cortex phellodendri, radix rehmanniae, radix asparagi, radix ophiopogonis, radix scrophulariae, fructus schisandrae, angelica sinensis, radix salviae,etc., thereby reducing heart fire and nourishing kidney yin or ascending kidney water and reducing heart fire.For heart-kidney noninteractionpatte caused by heart-kidney yang deficiency, pungent and warm ascending drugs can be applied concertedly to warm heart yang, such as cassia twig, ginger, cinnamon, monkshood, thereby warming kidney water or guiding fire to origin to warm kidney water or supplement true fire and flourish monarch fire.In the treatment of heart-kidney noninteractionpatte, drugs invigorating the spleen and stomach can be applied concertedly to reconcile the ascending and descending of spleen and stomach qi movement, and ease the viscera qi movement, such as ginseng, poria cocos, jujube, rhizoma atractylodis, radix astragali, radix bupleuri, and radix paeoniae alba.In addition, in order to ensure that the drug efficacy can accurately reach the disease location and maintain the trend of drug efficacy, guiding drugs or conductant drugs with special ascending and descending property can be applied concertedly, for example, platycodon grandiflorum can be used to lead drugs upward, and cinnamon can be used to guide fire to origin[9-12,21-22].

4 Factors affecting the compatibility of ascending and descending property of traditional Chinese medicine

The ascending and descending property of each drug is relative and can be transformed or changed under certain conditions.There are two main factors affecting the compatibility of traditional Chinese medicine: traditional Chinese medicine processing and compatibility of prescription.The ascending and descending property of traditional Chinese medicine can be changed by processing methods.Generally, bitter and cold subsiding medicine can change or weaken the nature of cold through stir-baking to yellow, stir-baking to brown, stir-frying with wine, stir-frying with ginger, so as to adapt to the needs of clinical use.For example, purgating drug rheum officinale can purge heat and bowels to treat constipation caused by lower energizer retention of heat; if fried with wine, it can treat upper energizer swelling and pain of eye and upper-energizer heat syndrome following the ascending property of wine; the heat-clearing and fire-clearing drug rhizoma anemarrhenae is used to treat upper energizer fire of lung and stomach; frying rhizoma anemarrhenae with salt can purge lower energizer fire of kidney[1,23].The ascending and descending property of drugs is also affected by compound compatibility.For example, when ascending drugs are compatible with more descending drugs, the ascending and floating property drugs will be restricted to a certain extent.On the contrary, when descending drugs are compatible with more ascending drugs, the descending and sinking property will also be weakened[24].As a result, Li Shizhen said that "ascending and descending property depends on materials, and also on people".The third is the harvest season of drugs, and the fourth is the character of drugs.

In addition, the ascending and descending properties of traditional Chinese medicine are also affected by the harvest season and the drug properties.For example, influenced by the theory of TCM therapy and signs, "the root ascends and the shoot descends, all the flowers rise and all the seed and fruit traditional Chinese medicine fall".Chinese angelica root-tip belongs to root tip, but it activates blood and removes blood stasis, belonging to ascending and floating property.Inula flower, a kind of flower medicinal material, is supposed to be an ascending drug, but it has the effects of reducing qi to resolve phlegm, downbearing counterflow and checking vomiting, belonging to descending and sinking property.Cocklebur fruit, a kind of fruit medicinal material, is supposed to be a descending and sinking drug, but it has the effects of dispersing wind-cold, connecting nasal orifice upward, belonging to ascending and floating property.Although these properties have certain reference significance, it also has certain limitations[1,23-24].

5 Discussion

The theory of ascending and descending property is closely related to the theory of qi movement ascending and descending, which is widely used in the treatment of various viscera and qi movement disorders in TCM clinical practice, especially in the treatment of lung diseases and spleen and stomach diseases.It is of great theoretical significance and practical value to enrich the theory of medicinal properties and guide the clinical application by carrying out the theoretical research on the ascending and descending properties of traditional Chinese medicine.However, the research and development of the theory of ascending and descending property has been faced with several problems[1,25-26].First, the theory has deficiencies, and there are still controversies in the academic circles.Second, few researches on relevant theories and experiments have been carried out, and it has not been paid attention.Third, there is no mature and reliable research method.Fourth, theoretical research is not closely related to clinical practice and lacks the support of big data.In the future, the theoretical research on the theory of ascending and descending properties of traditional Chinese medicine can be started from bioinformatics, and combine clinical research, traditional Chinese medicine pharmacological research and information data organically, so as to better explain the scientific connotation of ascending and descending properties of traditional Chinese medicine.

Conflicts of interest

The authors have declared no conflict of interest.