Four Gentlemen is the quintessential formula to address Qi and Spleen Qi deficiency. Spleen Qi acts as the foundation for postnatal Qi in the body and is responsible for extracting the essence from food, or Gu Qi, and transporting it to the rest of the body. When Spleen is strong, the essence of food is properly transformed into Qi to supply energy to the body, and to build Blood. The Spleen is also responsible for the raising of Qi, and its deficiency is reflected in occasional sensations of heaviness in the body, or occasional loose stools. Typically, patterns involving Spleen Qi deficiency are precipitated by increased activity and improve with rest. As the Spleen controls the Blood, muscles, and four limbs, when Spleen is strong, Blood is supported in the vessels, muscles have tenacity, and the four limbs have appropriate strength.

Excessive regular consumption of cold liquids are weakening to the Spleen, leading to occasional lack of appetite and the generation of internal Dampness. External Dampness due to climate are likely to contribute to internal Dampness, which will contribute to Spleen Qi deficiency. Overwork, excessive worries or a poor diet can all aggravate or cause Spleen Qi deficiency. When Spleen is deficient, occasional loose stools, a lack of appetite, or occasional weak limbs can be experienced.

This pattern of Spleen Qi deficiency arises “first” and is often a precursor to other Spleen  patterns, such as Spleen Yang deficiency, Spleen Qi sinking, Spleen not holding Blood, or Spleen Blood deficiency. Four Gentlemen tonifies Qi, strengthens the Spleen and expels Dampness.

The chief herb, White Asian ginseng root and rhizome strongly augments Original Qi and Spleen Qi, and is the quintessential herb used for Qi tonification. It is used in this formula rather than Chinese red ginseng root and rhizome because it is slightly cooler in nature and less drying. White Asian ginseng root and rhizome works synchronously with White atractylodes rhizome to strengthen Spleen and dry Dampness.

Poria strengthens the Spleen, drains Dampness, and mitigates the cloying nature of honey fried Chinese licorice root and rhizome, which strengthens the Spleen and harmonizes the actions of the other three herbs.

Four Gentlemen can be given on its own for basic signs of Qi deficiency, or given in combination with any formula where the Spleen needs further support or protection.

Four Gentlemen is a widely used formula, and is also incorporated as a foundation for many other formulas addressing Qi deficiency such as Six Gentlemen, Shen Ling Spleen Support, Ten Treasures, Women’s Precious, Gather Vitality and Arouse Vigor.

Origins and Development
Four Gentlemen is the foundational formula for Qi tonification and Spleen Qi deficiency. This formula was first presented in 1078-85 A.D. in the Imperial Grace Formulary of the Tai Ping Era.