A busy herbal pharmacy in one of Beijing's TCM hosptials showing different herbs used in tonic preparations.

Four basic kinds of deficiencies can affect health and require tonification.

What does tonification treat?

Tonification is mainly used to treat a particular deficiency in the body. Symptoms of an asthenia syndrome vary according to the cause, degree of deficiency, and organs involved. It is important to first address the underlying deficiency before applying the appropriate tonification method in order to obtain the maximum benefit for the patient. Deficiency falls into the following classifications:

1. Qi-deficiency
Qi can be interpreted as the "life energy" or "life force," which flows within us. It can also sometimes refer to the physiological functions of organs and meridians. Qi-deficiency manifests as under-functioning of the entire body or certain organs, especially in the respiratory and digestive systems. It usually occurs in cases of chronic illness, improper diet, weakness of old age, overstrain and injury. Clinical symptoms include dizziness, shortness of breath, reluctance to speak, fatigue, and spontaneous sweating. The tongue is pink and pulse is weak. TCM physicians usually focus on boosting the lung and spleen in these situations.

2. Blood-deficiency
Blood is viewed simply as the red fluid inside the blood vessels that provides nutrition for the body. The nutrients transported by the blood are not restricted to physical materials only. Its meaning can be extended to anything that provides nourishment to the body, thus blood deficiency leads to inadequate nourishment of the body. In TCM, asthenia syndrome is closely related to problems of the heart, liver, and spleen; common symptoms include pale complexion, dry skin, dizziness, palpitations, insomnia, numbness in limbs, and in women there may be an abnormal menstrual period. On examination, the tongue is pale and the pulse fine. This kind of deficiency is usually due to major blood loss, spleen weakness, or chronic illness.

3. Yin-deficiency
Yin and yang are relative terms used to describe how the body works and how disease occurs. Yin and yang are two opposite aspects of the body's organs and functions. Yang usually refers to the organ's functions whereas yin is commonly used to refer to an organ's structure. Disharmony in the two aspects is the cause of disease or physiological disorders. When yin-deficiency occurs, the organs will become hyper-functioning due to relative hyperactivity of yang which leads to exuberance and congestion of heat, and is manifested by dizziness, flushing, dryness in the mouth and throat, a fever occurring at the same time of day, spontaneous sweating, constipation, tinnitus (ringing of the ears), discomfort in the eyes, red tongue (with or without fur), and the pulse is fine and rapid. Causes and specific symptoms vary with different organ systems.

4. Yang-deficiency
Yang-deficiency reflects an insufficiency in the body's functionality resulting in a slower metabolism, and is manifested by an internal exuberance of yin-cold. Symptoms include pale and somber complexion, cold body and limbs, an aversion to cold, a desire for warmth, a withered spirit, drowsiness and lethargy, a pale tongue, and a deep, weak pulse. The causes and symptoms vary with different organs.

How is tonification applied to humans?

"Deficiency should be treated by tonifying therapy" is the basic principle of tonification. Suwen (The book of Plain Questions), written during Zhou Dynasty, has defined deficiency as being caused by a "depletion of essential-qi," which can be interpreted as weakness caused by insufficiency of vital energy, making it appropriate for tonifying therapy.

Choosing an appropriate tonification therapy will depend on several factors. It is important to note that traditional Chinese thinking sees an individual as part of nature with which he or she interacts. Climatic and environmental influences cannot be overlooked in treatment. For example, a special tonification therapy may be used to prevent a deficiency that commonly occurs in a particular season. Tonification can, therefore, be used as an illness or disease preventing measure. According to the differential diagnosis and holistic concept of TCM, the following treatments should be noted:

1. Tonification in accordance with seasons
The therapeutic method should be chosen according to climatic changes; Huang Di Nei Jing (The Yellow Emperor's Medicine Classic) has a famous phrase: "nourishing yang in spring and summertime, nourishing yin in autumn and wintertime." TCM believes changes in environmental qi are closely related to movement of qi inside the body, so it is important to take account of climatic changes during treatment. Modern TCM physicians usually apply the following rules:

	E.g. Ephedra can be used with this method. Spring is suitable for the "sheng bu" method: using herbs with a lifting effect results in lifting the yang, inducing sweating and expelling cold-evils.
	E.g. Lotus can be used with this method. Summer is suitable for the "qing bu" method: using herbs with a cold or cool character results in clearing away the heat-evils and promoting fluid metabolism.
	E.g. Ginseng can be used with this method. Autumn is suitable for the "ping bu" method: using herbs with a neutral and mild character results in recovery from general weakness.
	E.g. Deer horn can be used with this method. Winter is suitable for the "zi bu" method: using herbs with a moist and nourishing character results in clearing away dry-evils and keeping in warmth.

2. Tonification in accordance with locality
The therapeutic method should be chosen according to geographical region as claimed by the Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic): "treatment in accordance with local conditions." Nowadays when applying tonification, physicians focus on using cooling tonification in the southern regions of China, and warming tonification in the northern regions of China. This is due to the difference in physical constitutions of the people. Chinese medicine dosages and types of herbs selected to treat deficiencies may also vary depending on the availability of the medial substances in a given region.

Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic)

3. Tonification in accordance with individuality
The therapeutic method should be chosen according to the physique of the individual; as claimed by the Huang Ti Nei Ching (The Yellow Emperor's Medicine Classic): "There are 25 types of yin yang people." Modern physicians have classified people into groups according to different constitutions, such as normal, red-heat, sluggish-cold, fatigue-pale and so on. These also should be considered clinically. For example, the therapeutic aim for the red-heat type is nourishing yin and expelling heat, for the sluggish-cold type invigorating yang and expelling cold, and for the fatigue-pale type replenishing qi and promoting blood production; mild approaches to reinforce the overall qi, blood, yin and yang are used for those with a normal constitution.

4. Tonification in accordance with disease or syndrome
The therapeutic method used should be based on TCM differential diagnosis. The deficiency is identified, and then drugs are applied that replenishes qi, promotes blood production, invigorates yin or nourishes yang. For example, in emergencies or severe cases, rigorous tonifying in which a larger and stronger quantity of tonic is prescribed is used to quickly overcome the serious condition. However, TCM believes this approach damages the spleen and stomach in the long term, leading to problems in digestion and absorption. Therefore gentle tonifying is more commonly employed. Lower dosages used over a long period gradually leads to the desired effect.


What are the methods of tonification?

Extensive medical experience has shown that various approaches can be utilized to reach the goal of tonification:

1.	Special soups are commonly used as tonics. Tonifying by diet: Food and drink are necessities for maintaining functioning and vitality. TCM believes that "inadequate qi will result if dieting for half day, qi depletion will occur if dieting for a whole day." Qi can be interpreted as the life energy of body. Ancient physicians emphasized the tonifying effect of diet, which, similar to herbal applications, is based on TCM principles.
2.	Herbal decoctions sold in restaurants are often kept in big containers. Tonifying by herbs: A proper combination of tonics in prescription can result in effective recovery from a deficiency. This is one of most important and common treatments used in TCM. Sun Simiao (581-682 A.D.), one of the most influential physicians in the history of Chinese medicine, in his best known work Qianjin Yaofang (Precious worth a Thousand Gold for Emergencies) stated: "If you are in your fifties, keep taking a tonic in all seasons, then you will remain healthy and prolong your lifespan." The book also listed some tonic prescriptions.
3.	moxibustion Tonifying by acupuncture and moxibustion: Moxibustion replenishes the yang-qi and expels the yin-cold, invigorates the inborn effectively, warming the spleen and kidney, thereby reviving yang for resuscitation. On the other hand, while some physicians doubt the tonic effect of acupuncture, others have created special acupunctural manipulations for the purposes of tonification.
4.	Tonifying by massage: This is achieved by massaging the relevant acupuncture points through the application of hand technique to vary the effect. The usual points selected are those that possess tonic properties such as the guan-yuan and san-li.
	Sample of acu-pressure points that possess tonic properties.
5.	Tonifying by sexual activities: according to TCM, a healthy and moderate sexual life maintains smooth circulation of qi and blood, improves resistance, and prolongs life.

How does tonification work?

From the viewpoint of TCM tonification works to improve health in three ways:

Organs represented from a TCM perspective. 1.Regulating the balance of yin yang: yin yang disharmony is the cause of disease and physiological disorders. Disharmony means the proportion of yin and yang is unequal and unbalanced. When one aspect is deficient, the other is in excess, thus the therapeutic strategy is to replenish the deficiency and remove the excess, restoring the body to its natural balance. 2.Promoting the function of organs: when the organs work actively, the transformation and transportation of substances are effective; essence stored in the kidney is abundant and full of vitality. In the opposite case, deficiency will develop. Tonification helps to promote organ functioning and recovery from deficiency. 3.Stimulating the circulation of blood and qi: blood and qi should be kept in motion for proper circulation. When deficiency occurs leading to a state of stagnation, they can no longer flow smoothly and nourish the body. Tonification invigorates the source of the qi and blood, stimulates their production, and improves the overall condition of the body.

People first began researching the mechanism by which tonification works at the beginning of the 20th century. From the viewpoint of modern medicine, preliminary scientific research has shown that herb, food, acupuncture, or moxibustion tonification therapies help to:

		Regulate the function of the adrenal cortex
		Enhance the immune system
		Promote the function of the sex organs
		Improve the renal system
		Improve the respiratory system
		Improve the digestive system
		Regulate the nervous system
		Improve the blood circulatory system
		Improve the metabolism

Please note that these are general conclusions only, and that no single herb or food can possess all the above benefits. Different approaches are used to deal with specific problems.

References