Vacuity patterns include qì, blood, yīn, and yáng vacuity, which always involve the five viscera. These may be due to earlier-heaven (congenital) factors or to later-heaven (acquired factors), the latter including poor diet, taxation fatigue, affect-mind disturbances, and improper care after illness.

Qì, blood, yīn, and yáng are all interrelated. Qì and blood are mutually dependent in that blood is the mother of qì, and qì is the commander of the blood. Blood is produced by the action of qì, so the treatment of blood vacuity involves the use of qì-boosting medicinals. Conversely, qì cannot be exuberant or move freely without adequate supplies of blood. Therefore, qì-supplementing formulas often include blood-supplementing agents in the role of assistant. Dual vacuity of qì and blood naturally requires dual supplementation of qì and blood.

Yīn and yáng are similarly independent; they are rooted in each other. formulas used to treat vacuity of either of these invariably include assistant agents that supplement its opposite. This is called seeking the yīn in yáng, and seeking the yáng in yīn. Yáng supplementing agents are warm and dry and hence can damage liquid, which can be prevented by the inclusion of enriching and moist yīn-supplementing medicinals in formulas. Yīn-supplementing medicinals can cause congealing and stagnation, which can be prevented by including yáng-supplementing medicinals in formulas. Dual vacuity of yīn and yáng naturally requires dual supplementation of yīn and yáng.

Five-phase interaction cycles should also be considered. One principle is In vacuity, supplement the mother. For example, lung qì vacuity can be treated by supplementing the spleen (banking up earth to engender metal). Spleen yáng vacuity can be treated by supplementing the life gate, embodying the principle of supplementing fire to engender earth. Liver yáng vacuity can be enhanced by supplementing the kidney, which is the principle of enriching water to moisten wood.

In supplementing yīn and yáng, the importance of the spleen and kidney is paramount. The spleen is the root of later heaven and the source of production of qì and blood. The kidney is the root of earlier heaven, the house of true yīn and true yáng. So supplementing the spleen and supplementing the kidney play key roles in the treatment of vacuity patterns in general.

Cautions

First, it is important to distinguish true vacuity from false vacuity. A patient apparently suffering from repletion who also displays signs of vacuity may have true vacuity and false repletion. Treatment of this condition as a repletion pattern makes the vacuity even worse (traditionally called evacuating vacuity). Similarly, apparent vacuity with repletion signs may actually be true repletion and false vacuity, which, if treated as vacuity, would only serve to worsen the repletion (replenishing repletion).

Second, if supplementing medicinals fail to produce the desired effect, this may be because of spleen-stomach weakness. In such cases, treatment should first be to adjust spleen-stomach function, with formulas that fortify the spleen, harmonize the stomach, rectify qì, or abduct food stagnation to enable the supplementing agents to be absorbed.

Subcategories

1. Qì-supplementing formulas
2. Blood-supplementing formulas
3. Dual qì-blood dual supplementation formulas
4. Yīn-supplementing formulas
5. Yáng-supplementing formulas
6. Dual yīn-yáng dual supplementing formulas

1. Qì-Supplementing Formulas

Qì-supplementing formulas treat qì vacuity, which manifests in fatigue and lack of strength, scantness of breath (slight breathlessness), hasty breathing on exertion, laziness to speak, faint low voice, pale white or withered yellow complexion, reduced eating, sloppy stool, pale tongue with white fur, and a pulse that is vacuous and weak. In some cases, there may be vacuity heat and spontaneous sweating or failure qì’s retentive function causing prolapse of the anus or prolapse of the uterus.

Main agents

• Rén shēn (人参 Ginseng Radix, ginseng)
• Dǎng shēn (党参 Codonopsis Radix, codonopsis)
• Huáng qí (黄芪 Astragali Radix, astragalus)
• Bái zhú (白朮 Atractylodis Macrocephalae Rhizoma, white atractylodes)
• Gān cǎo (甘草 Glycyrrhizae Radix, licorice)

Often used in tandem with these are qì-rectifying, dampness-percolating, yáng-upbearing, blood-supplementing, yīn-nourishing, and wind-coursing medicinals.

Representative formulas

• Sì jūn zǐ tāng (四君子汤 Four Gentlemen Decoction)
• Shēn líng bái zhú sǎn (参苓白朮散 Ginseng, Poria, and White Atractylodes Powder)
• Shēn líng bái zhú sǎn (参苓白朮散 Ginseng, Poria, and White Atractylodes Powder)
• Yù píng fēng sǎn (玉屏风散 Jade Wind-Barrier Powder)
• Shēng mài sǎn (生脉散 Pulse-Engendering Powder)

2. Blood-Supplementing Formulas

Blood supplementing formulas treat blood vacuity, which is intimately related to the heart, liver, and spleen. Signs include withered-yellow facial complexion, dizzy head and vision, pale lips and nails, heart palpitation, insomnia, a pale tongue, and a fine pulse. In women, there may menstrual irregularities with pale menstrual discharge or even amenorrhea.

Main agents

• Shú dì huáng (熟地黄 Rehmanniae Radix Praeparata, cooked rehmannia)
• Dāng guī (当归 Angelicae Sinensis Radix, chinese angelica)
• Bái sháo (白芍 Paeoniae Radix Alba, white peony)
• Ē jiāo (阿胶 Asini Corii Colla, ass hide glue)
• Lóng yǎn ròu (龙眼肉 Longan Arillus, longan flesh)

Combined with these according to need are qì-supplementing, qì-rectifying, and stasis-dispelling agents.

Representative formulas

• Sì wù tāng (四物汤 Four Agents Decoction)
• Dāng guī bǔ xuè tāng (当归补血汤 Chinese Angelica Blood-Supplementing Decoction)
• Guī pí tāng (归脾汤 Spleen-Returning Decoction)

3. Dual Qì-Blood Dual Supplementation Formulas

These formulas treat dual vacuity of qì and blood, manifesting in lusterless facial complexion, dizzy head and vision, heart palpitation fearful throbbing, reduced eat, fatigue, shortness of breath, laziness to speak, a pale tongue and a pulse that is vacuous and forceless.

Main agentsFormulas use qì-supplementing medicinals such as the following:

• Rén shēn (人参 Ginseng Radix, ginseng)
• Dǎng shēn (党参 Codonopsis Radix, codonopsis)
• Huáng qí (黄芪 Astragali Radix, astragalus)
• Bái zhú (白朮 Atractylodis Macrocephalae Rhizoma, white atractylodes)

These are combined with blood-supplementing agents such as

• Shú dì huáng (熟地黄 Rehmanniae Radix Praeparata, cooked rehmannia)
• Dāng guī (当归 Angelicae Sinensis Radix, chinese angelica)
• Bái sháo (白芍 Paeoniae Radix Alba, white peony)
• Ē jiāo (阿胶 Asini Corii Colla, ass hide glue)

Representative formula: Bā zhēn tāng (八珍汤 Eight-Gem Decoction) .

4. Yīn-Supplementing Formulas

Yīn-supplementing formulas treat yīn vacuity. Yīn vacuity is closely associated with the five viscera, especially the kidney, but also the heart, liver, spleen, and lung. Yīn vacuity signs include emaciation, dizzy head, tinnitus, tidal heat and tidal reddening of the cheeks, vexing heat in the five hearts, night sweating, insomnia, aching lumbus, seminal emission, cough with expectoration of blood, a red tongue with scant fur, and a pulse that is find and rapid.

Main agents

• Shú dì huáng (熟地黄 Rehmanniae Radix Praeparata, cooked rehmannia)
• Mài mén dōng (麦门冬 Ophiopogonis Radix, ophiopogon)
• Shā shēn (沙参 Adenophorae seu Glehniae Radix, adenophora/glehnia)
• Ē jiāo (阿胶 Asini Corii Colla, ass hide glue)
• Guī bǎn (龟版 Testudinis Carapax et Plastrum, tortoise shell)

Because yīn vacuity can easily cause fire transformation, heat-clearing agents can be used with the above. Yáng-supplementing and qì-rectifying medicinals can be added according to need.

Representative formulas

• Liù wèi dì huáng wán (六味地黄丸 Six-Ingredient Rehmannia Pill)
• Dà bǔ yīn wán (大补阴丸 Major Yīn Supplementation Pill)
• Zhì gān cǎo tāng (炙甘草汤 Honey-Fried Licorice Decoction)
• Bǎi hé gù jīn tāng (百合固金汤 Lily Bulb Metal-Securing Decoction)

5. Yáng-Supplementing Formulas

Yáng-supplementing formulas treat yáng vacuity, which is closely related to the bowels and viscera, notably the heart, kidney, and spleen. Heart yáng vacuity and spleen yáng vacuity tend to be treated with interior-warming formulas. Here the discussion focuses on kidney yáng vacuity, which manifests in somber white facial complexion, cold limbs, aching pain in the lumbus and knees, weak legs, inhibited urination, or frequent urination and dribble after voiding, lesser-abdominal tension, impotence and premature ejaculation in men, uterine cold and infertility in women, a pale tongue with white fur, and a pulse that is sunken and fine, especially at the cubit position.

Main agents

• Fù zǐ (附子 Aconiti Radix Lateralis Praeparata, aconite)
• Ròu guì (肉桂 Cinnamomi Cortex, cinnamon bark)
• Bā jǐ tiān (巴戟天 Morindae Officinalis Radix, morinda)
• Ròu cōng róng (肉苁蓉 Cistanches Herba, cistanche)
• Yín yáng huò (淫羊藿 Epimedii Herba, epimedium)
• Lù jiǎo jiāo (鹿角胶 Cervi Cornus Gelatinum, deerhorn glue)
• Xiān máo (仙茅 Curculiginis Rhizoma, curculigo)

These are often combined with urine-disinhibiting and yīn-supplementing agents.

Representative formulas

• Shèn qì wán (肾气丸 Kidney Qì Pill)
• Yòu guī wán (右归丸 Right-Restoring[Life Gate] Pill)

6. Dual Yīn-Yáng Dual Supplementing Formulas

These formulas treat dual vacuity of yīn and yang, which is marked by dizzy head and vision, limp aching lumbus and knees, impotence, seminal emission, fear of cold and cold limbs, spontaneous and night sweating, postmeridian tidal heat. Treatment involves a combination of yīn-supplementing agents and yáng-supplementing agents.

Main agents

• Shú dì huáng (熟地黄 Rehmanniae Radix Praeparata, cooked rehmannia)
• Guī bǎn (龟版 Testudinis Carapax et Plastrum, tortoise shell)
• Hé shǒu wū (何首乌 Polygoni Multiflori Radix, flowery knotweed)
• Shān zhū yú (山茱萸 Corni Fructus, cornus)
• Gǒu qǐ zǐ (枸杞子 Lycii Fructus, lycium berry)

These are combined with yīn-supplementing agents such as:

• Fù zǐ (附子 Aconiti Radix Lateralis Praeparata, aconite)
• Ròu guì (肉桂 Cinnamomi Cortex, cinnamon bark)
• Bā jǐ tiān (巴戟天 Morindae Officinalis Radix, morinda)
• Ròu cōng róng (肉苁蓉 Cistanches Herba, cistanche)
• Yín yáng huò (淫羊藿 Epimedii Herba, epimedium)
• Lù jiǎo jiāo (鹿角胶 Cervi Cornus Gelatinum, deerhorn glue)
• Xiān máo (仙茅 Curculiginis Rhizoma, curculigo)

Representative formulas

• Dì huáng yǐn zǐ (地黄饮子 Rehmannia Drink)
• Guī lù èr xiān jiāo (龟鹿二仙胶 Tortoise Shell and Deerhorn Two Immortals Glue)

Supplementing Formulas

Qì-Supplementing Formulas

• Sì jūn zǐ tāng (四君子汤 Four Gentlemen Decoction)
• Liù jūn zǐ tāng (六君子汤 Six Gentlemen Decoction)
• Xiāng shā liù jūn zǐ tāng¹ (香砂六君子汤¹ Costusroot and Amomum Six Gentlemen Decoction¹)
• Bǎo yuán tāng (保元汤 Origin-Preserving Decoction)
• Shēn líng bái zhú sǎn (参苓白朮散 Ginseng, Poria, and White Atractylodes Powder)
• Qī wèi bái zhú sǎn (七味白朮散 Seven-Ingredient White Atractylodes Powder)
• Zī shēng wán (资生丸 Life-Promoting Pill)
• Bǔ zhōng yì qì tāng (补中益气汤 Center-Supplementing Qì-Boosting Decoction)
• Jǔ yuán jiān (举元煎 Origin-Lifting Brew)
• Shēng xiàn tāng (升陷汤 Fall-Upbearing Decoction)
• Shēng yáng yì wèi tāng (升阳益胃汤 Yáng-Upbearing Stomach-Boosting Decoction)
• Yù píng fēng sǎn (玉屏风散 Jade Wind-Barrier Powder)
• Shēng mài sǎn (生脉散 Pulse-Engendering Powder)
• Rén shēn gé jiè sǎn (人参蛤蚧散 Ginseng and Gecko Powder)
• Rén shēn hú táo tāng (人参胡桃汤 Ginseng and Walnut Decoction)
• Bǔ fèi tāng¹ (补肺汤¹ Lung-Supplementing Decoction¹)
• Dú shēn tāng (独参汤 Pure Ginseng Decoction)

Blood-Supplementing Formulas

• Sì wù tāng (四物汤 Four Agents Decoction)
• Jiāo ài tāng (胶艾汤 Ass Hide Glue and Mugwort Decoction)
• Shèng yù tāng (圣愈汤 Sagacious Cure Decoction)
• Táo hóng sì wù tāng (桃红四物汤 Peach Kernel and Carthamus Four Agents Decoction)
• Bǔ gān tāng (补肝汤 Liver-Supplementing Decoction)
• Yǎng xīn tāng (养心汤 Heart-Nourishing Decoction)
• Dāng guī bǔ xuè tāng (当归补血汤 Chinese Angelica Blood-Supplementing Decoction)
• Dāng guī shēng jiāng yáng ròu tāng (当归生姜羊肉汤 Chinese Angelica, Fresh Ginger, and Goat Meat Decoction)
• Guī pí tāng (归脾汤 Spleen-Returning Decoction)

Dual Qì-Blood Dual Supplementation Formulas

• Bā zhēn tāng (八珍汤 Eight-Gem Decoction)
• Shí quán dà bǔ tāng (十全大补汤 Perfect Major Supplementation Decoction)
• Rén shēn yǎng róng tāng (wán)
(人参养荣汤(丸) Ginseng Provisioning-Nourishing Decoction (Pill))
• Zhì gān cǎo tāng (炙甘草汤 Honey-Fried Licorice Decoction)
• Jiā jiǎn fù mài tāng (加减复脉汤 Pulse-Restorative Variant Decoction)
• Tài shān pán shí sǎn (泰山盘石散 Rock of Tàishān Fetus-Quieting Powder)
• Bǎo chǎn wú yōu sǎn (保产无忧散 Carefree Pregnancy Powder)

Yīn-Supplementing Formulas

• Liù wèi dì huáng wán (六味地黄丸 Six-Ingredient Rehmannia Pill)
• Zhī bǎi bā wèi wán (知柏八味丸 Anemarrhena and Phellodendron Eight-Ingredient Pill)
• Qǐ jú dì huáng wán (杞菊地黄丸 Lycium Berry, Chrysanthemum, and Rehmannia Pill)
• Dū qì wán (都气丸 Qì-Gatheriing Pill)
• Mài wèi dì huáng wán (麦味地黄丸 Ophiopogon and Rehmannia Pill)
• Ěr lóng zuǒ cí wán (耳聋左慈丸 Deafness Left-Benefiting Loadstone Pill)
• Zuǒ guī wán (左归丸 Left-Restoring[Kidney Yīn] Pill)
• Zuǒ guī yǐn (左归饮 Left-Restoring[Kidney Yīn] Beverage)
• Dà bǔ yīn wán (大补阴丸 Major Yīn Supplementation Pill)
• Èr zhì wán (二至丸 Double Supreme Pill)
• Hǔ qián wán (虎潜丸 Hidden Tiger Pill)
• Yī guàn jiān (一贯煎 All-the-Way-Through Brew)
• Shí hú yè guāng wán (石斛夜光丸 Dendrobium Night Vision Pill)
• Bǔ fèi ē jiāo tāng (补肺阿胶汤 Ass Hide Glue Decoction)
• Yuè huá wán (月华丸 Moonlight Pill)
• Èr jiǎ fù mài tāng (二甲复脉汤 Double-Armored Pulse-Restorative Decoction)

Yáng-Supplementing Formulas

• Shèn qì wán (肾气丸 Kidney Qì Pill)
• Bā wèi wán (八味丸 Eight-Ingredient Pill)
• Bā wèi dì huáng wán¹ (八味地黄丸¹ Eight-Ingredient Rehmannia Pill¹)
• Shí bǔ wán (十补丸 Ten Supplements Pill)
• Yòu guī wán (右归丸 Right-Restoring[Life Gate] Pill)
• Yòu guī yǐn (右归饮 Right-Restoring[Life Gate] Beverage)

Dual Yīn-Yáng Dual Supplementation Formulas

• Dì huáng yǐn zǐ² (地黄饮子² Rehmannia Drink²)
• Guī lù èr xiān jiāo (龟鹿二仙胶 Tortoise Shell and Deerhorn Two Immortals Glue)
• Èr xiān tāng (二仙汤 Two Immortals Decoction)
• Qī bǎo měi rán dān (七宝美髯丹 Seven-Jewel Beard-Blackening Elixir)