Note from the Audio Organizer: This article is the manuscript of Hu Lao’s academic report on June 28, 1978. Although it is merely an academic lecture, it is actually a high-level summary of Hu Lao’s lifelong research and teaching of the “Shang Han Lun”, representing the main achievements of his studies and reflecting his primary academic viewpoints.
Author Introduction: Hu Xishu is a renowned modern TCM clinical practitioner and educator in China. He is praised by the Japanese TCM community as a “notable researcher of the ‘Shang Han Lun’ with a unique theoretical system and a master of classical formulas”.
Overview of Syndrome Differentiation and Treatment
Syndrome differentiation and treatment, also known as syndrome differentiation and treatment, is the traditional method of treating diseases with formulas and herbs in TCM. It is a significant achievement summarized by our ancestors through long-term struggles against diseases. The so-called “Yi Yin Tang Ye Jing” is the earliest classic that encapsulates this summary. However, like the “Shen Nong Ben Cao Jing” and the “Huang Di Nei Jing”, it is originally the fruit of the labor of the masses, yet it is recorded in the merit accounts of emperors and ministers.
The “Yi Yin Tang Ye Jing” is mentioned in the “Han Shu: Yi Wen Zhi”, and in the preface of the “Zhen Jiu Jia Yi Jing” by Huangfu Mi of the Jin Dynasty, it states, “Zhongjing’s discussions on broad formulas amount to dozens of volumes, and they have been widely verified.” This indicates that Zhongjing’s works are primarily derived from the “Yi Yin Tang Ye Jing”. The term ‘broad’ refers to his personal knowledge and experience, or perhaps some broad collection and elaboration, which later generations have widely verified. Since the “Yi Yin Tang Ye Jing” has been lost, it is often regarded as a unique creation of the Zhang family, leading to unfounded praises such as the ancestor of formulas and the saint among physicians.
One may ask, in an era when science was not developed, how could one explore the laws of disease development based solely on the ever-changing symptoms and formulate various specific treatment formulas based on these laws? If it were not for the long years of repeated observation, practice, and summarization on numerous patients, how could such universally effective conclusions be achieved? Therefore, neither Yi Yin nor Zhang Zhongjing could have made such miraculous inventions; they could only be the rich results gradually accumulated by the vast laboring masses in their continuous struggle against diseases. This has a long historical development process and could not have been created by any one era or individual.
The emergence of the “Yi Yin Tang Ye Jing” marks the maturation of the syndrome differentiation and treatment method, but it did not originate from the distant Shang Dynasty, nor is it related to Yi Yin. As for Zhang Zhongjing, he is merely an outstanding successor of the “Yi Yin Tang Ye Jing”. Since the “Yi Yin Tang Ye Jing” is no longer available, we rely on Zhongjing’s writings, which have been tested through long practice, for reliable conclusions on syndrome differentiation and treatment, thus providing a unique reliable reference for the study of syndrome differentiation and treatment.
Syndrome differentiation and treatment originate from practice, affirming that it is an objectively existing natural law. Because it has been verified in the past, it is verified in the present, and it will inevitably be verified in the future, this is an indisputable fact. However, to this day, this method of syndrome differentiation and treatment still lies dormant in Zhongjing’s works, and no one has truly revealed it. Because of this, it is impossible to further explore its spiritual essence; this article is an attempt to discuss this.
1. Discussion on the Six Meridians and Eight Principles
The “Shang Han Lun” is divided into sections based on the six meridians, leading later annotators to claim that the differentiation of the six meridians is limited to cold damage. In fact, the six meridians originate from the eight principles, which are the general principles of all diseases. For ease of explanation, we will first discuss the eight principles.
The Eight Principles
Refer to the exterior, interior, yin, yang, cold, heat, deficiency, and excess. In fact, within the exterior and interior, there should also be a half-exterior and half-interior. According to the numbers, there are originally nine principles, but since the terms exterior and interior inherently include the meaning of half-exterior and half-interior, it is commonly abbreviated to the eight principles, which will be explained below:
Exterior, Interior, and Half-Exterior Half-Interior:
The exterior refers to the body’s surface, composed of skin, muscles, tendons, and bones, thus referred to as the exterior. If the pathogenic factor concentrates and reacts in this part of the body, it is called an exterior syndrome;
The interior refers to the extreme interior of the human body, composed of the esophagus, small intestine, large intestine, etc., thus referred to as the interior. If the pathogenic factor concentrates and reacts in this part of the body, it is called an interior syndrome;
Half-exterior half-interior refers to the area between the chest and abdomen, where various organs are located, thus referred to as half-exterior half-interior. If the pathogenic factor concentrates and reacts in this part of the body, it is called a half-exterior half-interior syndrome.
In summary, the exterior, interior, and half-exterior half-interior are fixed disease location responses. This means that regardless of the disease, in terms of the response of the disease location, it can be either exterior, interior, or half-exterior half-interior. Although there may be times when two or three of these appear simultaneously, it will never exceed these three.
It must be pointed out here: the disease location referred to here is the location of the pathogenic response, not to be confused with the location of the pathological change. That is to say, even if the pathological change is in the interior, if the pathogenic factor concentrates and reacts in the exterior, it is called an exterior syndrome, or it can be said that the evil is in the exterior or the disease is in the exterior. Conversely, even if the pathological change is in the exterior, if the pathogenic factor concentrates and reacts in the interior, it is called an interior syndrome, or it can be said that the evil is in the interior or the disease is in the interior. The same applies to the others, and will not be elaborated further.
Yin and Yang: Yin refers to the yin nature, and Yang refers to the yang nature.
When a person is ill, there is no change in the body’s functions that is not affected, especially the first change is in metabolic function. And this change is either excessive compared to normal or insufficient compared to normal. If it is excessive, then the ill body will also correspondingly exhibit symptoms of excess, excitement, etc., which are called yang syndromes; if it is insufficient, then the ill body will correspondingly exhibit symptoms of decline, depression, inhibition, etc., which are called yin syndromes. Therefore, although diseases are extremely complex and variable, in summary, they are either yin or yang.
Cold and Heat: From the classification of symptoms, there are cold and heat distinctions, where cold refers to cold nature and heat refers to heat nature.
If the ill body’s response is cold in nature, it is called a cold syndrome; conversely, if the ill body’s response is hot in nature, it is called a heat syndrome. Based on the above explanation of yin and yang, cold is insufficient, belonging to yin, thus cold must be yin; heat is excessive, belonging to yang, thus heat must be yang. However, it should be particularly noted that cold and heat are characteristics of yin and yang. Therefore, if one speaks generally of yin, it does not necessarily mean cold; if one speaks generally of yang, it does not necessarily mean heat. Thus, there are diseases that are neither cold nor hot, but there are absolutely none that are not yin or yang.
Deficiency and Excess: Deficiency refers to the deficiency of the person and the deficiency of righteous qi, while excess refers to the excess of the disease and the excess of pathogenic qi.
If the disease has not yet resolved but the person’s energy and righteous qi are already insufficient, and the body’s response shows a picture of deficiency and decline, it is called a deficiency syndrome. If the disease is progressing and the person’s energy and righteous qi are not deficient, and the body’s response shows a picture of fullness, it is called an excess syndrome. Based on the above explanation, deficiency and excess are also a type of characteristic yin and yang. However, unlike cold and heat, deficiency and excess are not constant. Cold and heat have constants, as mentioned above, cold must be yin, heat must be yang, and there is no variation in any situation.
However, deficiency and excess are different; when they appear in conjunction with cold and heat, they reverse their yin and yang, hence they are said to be non-constant. For example, if one is deficient and cold, it is certainly yin, but if one is deficient and hot, it is conversely yang; if one is excessive and hot, it is certainly yang, but if one is excessive and cold, it is conversely yin. Thus, the so-called yang syndrome can have either heat, or excess, or both heat and excess, or neither heat nor excess, or heat and deficiency; the so-called yin syndrome can have either cold, or deficiency, or both cold and deficiency, or neither cold nor deficiency, or cold and excess.
The relationships between Yin, Yang, Deficiency, Excess, Cold, and Heat can be illustrated in Table 1:
|
Yang Syndrome |
|||||
|
Name |
Yang |
Cold |
Heat |
Deficiency |
Excess |
|
Yang Syndrome |
☆ |
||||
|
Yang Heat Syndrome |
☆ |
☆ |
|||
|
Yang Excess Syndrome |
☆ |
☆ |
|||
|
Yang Excess Heat Syndrome |
☆ |
☆ |
☆ |
||
|
Yang Deficiency Heat Syndrome |
☆ |
☆ |
☆ |
|
Yin Syndrome |
|||||
|
Name |
Yin |
Cold |
Heat |
Deficiency |
Excess |
|
Yin Syndrome |
★ |
||||
|
Yin Cold Syndrome |
★ |
★ |
|||
|
Yin Deficiency Syndrome |
★ |
★ |
|||
|
Yin Deficiency Cold Syndrome |
★ |
★ |
★ |
||
|
Yin Excess Cold Syndrome |
★ |
★ |
★ |
The Six Meridians
Refer to the three yangs: Taiyang, Yangming, Shaoyang, and the three yins: Shaoyin, Taiyin, Jueyin. Although the “Shang Han Lun” refers to them as diseases, they are actually syndromes, and they originate from the eight principles. Here, we will describe their interrelationships:
Based on the above explanation of the eight principles, the so-called exterior, interior, and half-exterior half-interior are all responses of disease locations. The so-called yin, yang, cold, heat, deficiency, and excess are all responses of disease conditions. Clinical practice shows that disease conditions must reflect in disease locations, and disease locations must also reflect due to disease conditions; thus, without disease conditions, there can be no disease locations, and without disease locations, there can be no disease conditions. Therefore, the so-called exterior, interior, and half-exterior half-interior syndromes must always be accompanied by either yin, yang, cold, heat, deficiency, or excess responses.
Similarly, the so-called yin, yang, cold, heat, deficiency, and excess syndromes must also be accompanied by either exterior, interior, or half-exterior half-interior responses. Since cold, heat, deficiency, and excess belong to yin and yang (see Table 1), regardless of whether it is exterior, interior, or half-exterior half-interior, there must be different responses of yin and yang in the disease locations, thus forming six basic types of syndromes, which are the so-called six meridians.
Their interrelationships are shown in Table 2:
|
SixMeridians |
Eight Principles |
|
|
Disease Location |
Disease Condition |
|
|
Taiyang Disease |
Exterior |
Yang |
|
Yangming Disease |
Interior |
Yang |
|
Shaoyang Disease |
Half-Exterior Half-Interior |
Yang |
|
Taiyin Disease |
Interior |
Yin |
|
Shaoyin Disease |
Exterior |
Yin |
|
Jueyin Disease |
Half-Exterior Half-Interior |
Yin |
From the above table, it can be seen that the essence of the six meridians is the six types of syndrome patterns of exterior, interior, half-exterior half-interior, three yangs, and three yins. It is possible that the ancients did not clarify their true origins or thought they were related to meridians, thus naming them after meridians, which is indeed incorrect. A thorough analysis of Zhongjing’s entire book reveals the spirit of differentiation based on the eight principles, which should be recognized, but the term six meridians is still used, which is somewhat unsatisfactory. The differentiation of the six meridians is indeed the differentiation of the eight principles; the names of the six meridians could be discarded, but this article is presented through the elucidation of Zhongjing’s writings for the convenience of readers to study and compare.
As mentioned above, the disease is manifested in the syndrome, and there must be a disease location, and there must also be a disease condition. Therefore, the eight principles are only abstract, while the six meridians have fixed forms. Thus, the “Shang Han Lun” has a summarized outline in each section, which is now recorded in the original text with brief annotations as follows.
Article 1 (Zhao Kaimei’s edition of the “Shang Han Lun” sequence number, same below): “The disease of Taiyang is characterized by a floating pulse, stiffness and pain in the head and neck, and aversion to cold.”
Annotation: Taiyang disease, that is, exterior yang syndrome, is characterized by a series of symptoms such as floating pulse, stiffness and pain in the head and neck, and aversion to cold. This means that regardless of the disease, if the above series of symptoms are present, it can be definitively diagnosed as Taiyang disease, and there will be no error.
Note: It should be noted here that the outline of Taiyang disease is based on clinical symptoms, not based on the direction and distribution of meridians, and has nothing to do with the lung’s governing the exterior.
Article 180: “The disease of Yangming is characterized by fullness in the stomach.”
Annotation: Yangming disease, that is, interior yang syndrome. Fullness in the stomach refers to the pathogenic factor being full in the interior of the stomach and intestines, meaning it is hard and full upon palpation and has resistance and tenderness. Fullness in the stomach is a characteristic of Yangming disease, so any disease that presents with fullness in the stomach can be definitively diagnosed as Yangming disease.
Note: Yangming disease is also based on symptoms, not based on meridians. More importantly, the outline emphasizes fullness in the stomach, while the yangming disease of the organs and meridians must include deficiency in the stomach, cold in the stomach, etc.
Article 263: “The disease of Shaoyang is characterized by bitter mouth, dry throat, and dizziness.”
Annotation: Shaoyang disease, that is, half-exterior half-interior yang syndrome, is characterized by a series of symptoms such as bitter mouth, dry throat, and dizziness. Any disease that presents with these characteristics can be definitively diagnosed as Shaoyang disease.
Note: Bitter mouth, dry throat, and dizziness can be symptoms of liver and gallbladder diseases, but as half-exterior half-interior yang syndrome, it has a broad general meaning, and such symptoms often appear in acute and chronic diseases such as pharyngitis, pneumonia, and gastroenteritis.
Article 273: “The disease of Taiyin is characterized by abdominal fullness and vomiting, inability to eat, and occasional abdominal pain; if purged, there will definitely be hardness below the chest.”
Annotation: Taiyin disease, that is, interior yin syndrome, is characterized by a series of symptoms such as abdominal fullness and vomiting, inability to eat, and occasional abdominal pain. Any disease that presents with these characteristics can be definitively diagnosed as Taiyin disease. This abdominal fullness is a virtual fullness, which is different from the fullness of Yangming disease; if mistakenly treated as real fullness and purged, it will definitely lead to hardness below the chest.
Article 281: “The disease of Shaoyin is characterized by a fine pulse, and the person only desires to sleep.”
Annotation: Shaoyin disease, that is, exterior yin syndrome. This is in contrast to Taiyang disease. It means that if a person has Taiyang disease but presents with a fine pulse and only desires to sleep, it can be definitively diagnosed as Shaoyin disease.
Article 326: “The disease of Jueyin is characterized by thirst, qi rising to the heart, pain and heat in the heart, hunger without desire to eat, and continuous diarrhea after purging.”
Annotation: Jueyin disease, that is, half-exterior half-interior yin syndrome, is characterized by a series of symptoms such as thirst, qi rising to the heart, pain and heat in the heart, hunger without desire to eat, and continuous diarrhea after purging. Any disease that presents with these characteristics can be definitively diagnosed as Jueyin disease. Half-exterior half-interior syndromes should not be purged, especially yin syndromes should not be purged; if mistakenly purged, it will definitely lead to continuous diarrhea.
The above annotations only briefly clarify the main ideas of the original text. By carefully studying the various chapters, one can understand them clearly.
The transmission between exterior and interior and the transformation of yin and yang during the development of diseases often occur from the exterior to the interior, or half-exterior half-interior to the interior, or from the exterior to half-exterior half-interior and then to the interior. All these are referred to as transmission between exterior and interior.
The disease may initially be a yang syndrome, but later transforms into a yin syndrome; or the disease may initially be a yin syndrome, but later transforms into a yang syndrome, which is referred to as the transformation of yin and yang.
Coexisting Diseases and Combined Diseases
When the disease is transmitted between exterior and interior, if the previous syndrome has not yet resolved and the subsequent syndrome appears, resembling the previous syndrome and manifesting in the subsequent syndrome, it is referred to as a coexisting disease. For example, coexisting diseases of Taiyang and Yangming, or coexisting diseases of Shaoyang and Yangming, etc. If the two or three appear simultaneously at the onset of the disease without being transmitted, resembling a combination of diseases, it is referred to as a combined disease. For example, combined diseases of Taiyang and Yangming, or combined diseases of the three yangs, etc.
Sequence of Differentiation of the Six Meridians and Eight Principles
Regarding the six meridians and eight principles, as previously mentioned, I will now briefly discuss the sequence of their differentiation. The disease manifested in the syndrome must have a disease location and a disease condition. Therefore, although the eight principles are the foundation of differentiation, differentiation should start from the six meridians; the “Shang Han Lun” is divided into sections based on the six meridians for this reason. Once the six meridians are differentiated, the exterior and interior are separated, and yin and yang are distinguished, then the analysis of cold, heat, deficiency, and excess can be conducted to clarify the true situation of yin and yang (refer to Table 1). At this point, both the six meridians and eight principles will have no hidden truths.
2. Brief Introduction to Treatment Principles
The so-called treatment principles refer to the treatment guidelines derived from the differentiation of the six meridians and eight principles, which are now described as follows.
Taiyang disease: Since the disease is in the exterior, sweating is appropriate; purging and vomiting are not allowed. Formulas such as Gui Zhi Tang, Ma Huang Tang, and Ge Gen Tang are all classified as sweating agents for Taiyang disease.
Shaoyin disease: This, like Taiyang disease, is also an exterior syndrome and should be treated with sweating, but sweating must be combined with warming and stimulating herbs such as Fu Zi and Xi Xin. Formulas such as Gui Zhi Jia Fu Zi Tang, Ma Huang Fu Zi Gan Cao Tang, and Ma Huang Fu Zi Xi Xin Tang are all classified as sweating agents for Shaoyin disease.
Yangming disease: If there is heat accumulation in the interior and fullness in the stomach, purging is appropriate; but if there is heat without fullness, clearing heat is appropriate. Purging formulas such as Cheng Qi Tang, and heat-clearing formulas such as Bai Hu Tang. If there is fullness in the chest, then vomiting is appropriate, and purging is not allowed; vomiting formulas such as Gua Di San.
Taiyin disease: If the interior is deficient and cold, only warming and tonifying are appropriate; sweating, purging, and vomiting are all prohibited. Formulas such as Li Zhong Tang and Si Ni Tang are all classified as warming and tonifying agents for Taiyin disease.
Shaoyang disease: As a half-exterior half-interior syndrome, the treatment should be harmonizing; sweating, vomiting, and purging are not appropriate. Formulas such as Chai Hu Tang and Huang Qin Tang are all classified as harmonizing agents for Shaoyang disease.
Jueyin disease: Although this is also a half-exterior half-interior syndrome, it should be harmonized with warming and strengthening herbs. Formulas such as Dang Gui Si Ni Tang and Wu Mei Wan are all classified as such.
Warm the cold, cool the heat: Warming the cold refers to cold syndromes, and treatment should use warming herbs to drive away the cold, such as with Gan Jiang, Fu Zi, and Wu Tou; these are all warming herbs to drive away cold. Cooling the heat refers to heat syndromes, and treatment should use cooling herbs to eliminate the heat, such as with Zhi Zi, Huang Qin, Huang Lian, and Shi Gao; these are all cooling herbs to eliminate heat.
Tonify the deficient, attack the excess: Tonifying the deficient refers to deficiency syndromes, and strong tonifying herbs should be used to replenish what is lacking; sweating, vomiting, and purging should be strictly prohibited, such as with Zhi Gan Cao Tang, Jian Zhong Tang, and Shen Qi Wan; these are all tonifying agents for deficiency. Attacking the excess refers to excess syndromes, and sweating, vomiting, and purging should be thoroughly used to eliminate the pathogenic factors, such as with Ma Huang Tang and Cheng Qi Tang; these are all attacking agents for excess.
3. Discussion on Formulas and Syndromes
Although the six meridians and eight principles are the foundation of differentiation, and treatment guidelines can be established based on this foundation, it is still far from sufficient for practical clinical application. For example, Taiyang disease should be treated with sweating, but there are many sweating formulas; can any sweating herb be used with verification? Our answer is: No, absolutely not! Because TCM differentiation is not just about differentiating the six meridians and eight principles, but more importantly, it is also about further differentiating the appropriate formulas and herbs.
Taiyang disease must be treated with sweating, but the sweating formula must be selected according to the overall situation. To be more specific, in addition to the characteristics of Taiyang disease, all other situations must be carefully examined to select a sweating herb that is fully appropriate; only then can the expected therapeutic effect be achieved. For instance, in Taiyang disease, if there are simultaneous symptoms of headache, fever, sweating, aversion to wind, then Gui Zhi Tang is appropriate; if there are simultaneous symptoms of headache, fever, body pain, low back pain, joint pain, aversion to wind, and no sweating but wheezing, then Ma Huang Tang is appropriate; if there are simultaneous symptoms of stiffness and pain in the neck and back, no sweating, and aversion to wind, then Ge Gen Tang is appropriate; if there are simultaneous symptoms of floating pulse, fever, aversion to cold, body pain, no sweating, and restlessness, then Da Qing Long Tang is appropriate.
Although all the above formulas belong to the sweating agents for Taiyang disease, each has its different indications; if used incorrectly, it will not only be ineffective but may also be harmful. The indications of formulas are referred to as formula syndromes; the indication of a certain formula is called a certain formula syndrome, such as Gui Zhi Tang syndrome, Ma Huang Tang syndrome, Chai Hu Tang syndrome, Bai Hu Tang syndrome, Cheng Qi Tang syndrome, etc. Formula syndromes are a continuation of the differentiation of the six meridians and eight principles, and they are the cutting edge of differentiation. The effectiveness of TCM treatment largely depends on whether the formula syndrome is correctly differentiated.
As is well known, there are often doctors in rural areas who have secret formulas for treating certain diseases. Although they know nothing about syndrome differentiation and treatment, they are often effective because they are well aware of the application of their secret formulas. Similarly, even if the sayings of TCM differentiation vary, those that have certain therapeutic effects are also based on this principle. However, readers must note that any effective formula, regardless of whether the user knows it or not, if analyzed for its main treatment (i.e., formula syndrome), will belong to the detailed categories of the six meridians and eight principles; this can be asserted. As for the differentiation of formula syndromes, it is detailed in the various chapters (or can be referred to in the book “Jing Fang Chuan Zhen”). I will not elaborate further here.
4. Discussion on the Essence of the Spirit of Syndrome Differentiation and Treatment
Differentiate the six meridians, analyze the eight principles, and then differentiate the formula syndromes, leading to the implementation of appropriate treatments; this is the entire system of syndrome differentiation and treatment as described above. However, what is the spiritual essence of this method of treating diseases? This still needs further exploration.
Based on the previous explanation of the six meridians and eight principles, we can draw the conclusion: regardless of the disease, the response of the ill body does not exceed the exterior, interior, half-exterior half-interior in terms of disease location, nor does it exceed yin, yang, cold, heat, deficiency, and excess in terms of disease condition, nor does it exceed the three yangs and three yins in terms of type. Verified in clinical practice, these are repeatedly observed facts. Therefore, it can be understood that the so-called six meridians and eight principles are merely the general laws reflected by the ill body. TCM differentiation uses them as the framework, and TCM treatment is also formulated through them. Thus, it can be confidently stated that the main spirit of TCM syndrome differentiation and treatment is based on the general laws of the ill body, emphasizing the universal treatment methods for diseases.
To facilitate readers’ understanding, I will use Taiyang disease as an example to explain as follows:
As previously mentioned, Taiyang disease is not an individual disease, but a general syndrome characterized by a series of symptoms such as floating pulse, stiffness and pain in the head and neck, and aversion to cold. Diseases such as colds, influenza, pneumonia, typhoid, and measles often manifest these Taiyang disease symptoms at the onset; TCM treats them according to the sweating method for Taiyang disease, thus regardless of the original disease, it can be thoroughly cured. Consider that fundamentally different diseases can all manifest the same symptoms of Taiyang disease; is this not a general law of the ill body? The same sweating method for treating Taiyang disease can cure various fundamentally different diseases; is this not based on the general laws of the ill body, emphasizing universal treatment methods for diseases?
Furthermore, regarding the explanation of formula syndromes, the execution of the treatment principles of the six meridians and eight principles must adhere to the strict requirements of adapting to the overall situation. It is evident that TCM syndrome differentiation and treatment also embodies another spirit of adapting to the overall treatment. That is to say, TCM syndrome differentiation and treatment, although based on the general laws of the ill body, emphasizes the universal treatment methods for diseases, but must also be implemented in accordance with the overall situation. If a concise definition of TCM syndrome differentiation and treatment were to be given, it would be: based on the general laws of the ill body, adapting to the overall situation, and emphasizing universal treatment methods for diseases. It is well known that TCM often treats multiple diseases with one formula, while a single disease often requires multiple formulas for treatment; this is a strong proof of this treatment spirit.
Regarding the spirit of syndrome differentiation and treatment, although as mentioned above, what is the essence of treating diseases? This fundamental question has not yet been clarified, and thus it is impossible to know the reason for its effectiveness. To answer this question, it is necessary to clarify why the ill body has such general laws of response as the six meridians and eight principles. Based on the materialist dialectical method, “external causes are the conditions for change, internal causes are the basis for change, and external causes act through internal causes,” this universal truth suggests that the main reason for the ill body’s general laws of response, such as the six meridians and eight principles, is not due to external stimuli of the disease, but rather the internal mechanisms of the body resisting disease.
As is well known, in winter, the cold leads to more urination, and in summer, the heat leads to more sweating. If one were to act contrary to this, a person would not withstand the heat in summer and would not withstand the cold in winter; this is the body’s clever mechanism for resisting external stimuli. If the invasion of disease occurs, it is far beyond the cold and heat of the seasons; the body has its own means of resistance, and what more is there to say! In TCM, this is referred to as the struggle between the righteous and the evil, meaning that there are often diseases that resolve without treatment, which are merely the results of the righteous overcoming the evil. However, often due to the limitations of natural abilities, the body continuously struggles, yet the disease ultimately cannot be resolved; thus, the situation of the righteous and the evil resisting each other is also reflected in the form of syndromes.
For example, the so-called exterior syndrome refers to the body’s desire to use sweating to eliminate the disease response from the surface. The so-called interior syndrome refers to the body’s desire to use defecation or vomiting to eliminate the disease response from the digestive tract. The so-called half-exterior half-interior syndrome refers to the body’s desire to use the functions of various organs to cooperate in eliminating the disease response through respiration, defecation, sweating, etc.This is based on the natural structure of the body, which is a necessary limited way of fighting against diseases. Thus, the exterior, interior, and half-exterior half-interior define that the disease does not exceed the response of the disease location; if the body’s functions are vigorous, there will be a positive type of syndrome response at the disease location; if the body’s functions are weak, there will be a negative type of syndrome response at the disease location.
In summary, when the disease stimulates the body, the body responds with a struggle; if the disease is not eliminated, the struggle continues. Therefore, the six meridians and eight principles are continuously and unceasingly manifested throughout the entire process of disease, becoming the general laws of response that do not exceed the disease.
The ancients had a clear understanding of this. Below are some relevant discussions for reference.
The “Su Wen: Discussion on Heat Diseases” states: “Now, when the evil qi struggles in the bones and flesh, and sweating occurs, it is the evil that is repelled and the essence that wins. When the essence wins, one should be able to eat, and there should be no more heat. If there is a recurrence of heat, it is the evil qi. Sweating is the essence qi. Now, if sweating occurs and there is a recurrence of heat, it is the evil that has won; if one cannot eat, it is the essence that is lacking; if the disease remains, its lifespan can be immediately threatened.”
Annotation: This passage means that when the evil qi and essence qi are struggling in the bones and flesh, this is originally the body’s desire to use sweating to eliminate the pathogenic evil. Therefore, generally speaking, those who can sweat are mostly the evil being repelled and the essence winning. The essence comes from the food qi, which is transformed in the stomach. If the essence truly wins, the person should be able to eat. The evil qi causes fever; if the evil is truly repelled, there should be no recurrence of heat. If there is a recurrence of heat, it indicates that the evil is still present, and sweating indicates that the essence is overflowing. If sweating occurs and there is a recurrence of heat, it indicates that the evil has won and the essence is lost, leading to the inevitable risk of death.
The “Shang Han Lun” Article 97 states: “Blood is weak, qi is exhausted, the pores are open, and the evil qi enters and struggles with the righteous qi. It accumulates under the ribs. The righteous and evil are in contention, alternating between cold and heat, resting at times, and silently not wanting to eat; the organs are interconnected, and the pain must be below, with the evil high and pain below, hence causing vomiting; Xiao Chai Hu Tang is the main treatment for this.”
Annotation: At the onset of a cold, the evil qi and essence qi struggle in the flesh, which is the general pathological process of Taiyang disease. If the essence qi is insufficient to repel the evil from the exterior, it retreats to guard the interior. Thus, the blood is weak, qi is exhausted, and the pores become loose and open, allowing the evil to enter the half-exterior half-interior and struggle with the righteous qi, accumulating under the ribs, leading to fullness in the chest and ribs. This indicates that the righteous and evil are in contention, meaning the righteous is advancing while the evil is retreating, and when the disease is close to the exterior, there is aversion to cold; when the evil advances and the righteous retreats, the disease is close to the interior, leading to aversion to heat, hence alternating between cold and heat. During contention, there may be cold and heat, otherwise, they may temporarily cease, hence resting at times. The heat evil accumulates in the chest and ribs, leading to a lack of desire to eat. The chest and ribs are connected to the heart and lungs, and also involve the liver and spleen, connecting to the stomach and intestines, hence the organs are interconnected. The evil heat stimulates the water qi in the stomach and intestines, causing abdominal pain. The evil is high in the chest and ribs, while the pain is in the stomach and intestines, hence causing the person to want to vomit; this should be treated with Xiao Chai Hu Tang.
Note: Although the above passage from the “Nei Jing: Su Wen” discusses the dead syndrome of yin and yang, it is similar to the mechanism of the body’s desire to sweat in exterior syndromes, especially in the elaboration of either essence winning or evil winning. It is quite detailed. The passage from the “Shang Han Lun” indicates that Taiyang disease transmits from the exterior to the half-exterior half-interior, also due to changes in the body’s disease resistance mechanism. The ancients’ experiences with diseases reached such a profound level, which is precisely what is meant by practice leading to true knowledge.
With the origins of the six meridians and eight principles clarified, it is evident that the differentiation and treatment in TCM is indeed a therapeutic method that adapts to the body’s disease resistance mechanism, and its effectiveness is not coincidental. To further prove that this is not empty talk, I will again use Taiyang disease as an example to explain:
As previously mentioned, Taiyang disease is characterized by a series of symptoms such as floating pulse, stiffness and pain in the head and neck, and aversion to cold. Now, analyzing these symptoms:
Floating pulse: This is due to the fullness of blood in the superficial arteries.
Stiffness and pain in the head and neck: Because the degree of blood fullness in the upper body is even greater, hence the upper head and neck feel more congested and painful.
Aversion to cold: The increase in surface temperature heightens the contrast with the external temperature, hence feeling the unpleasantness of wind and cold.
Based on the above symptom analysis, it is clear that the body has gathered a large amount of body fluid and evil heat in the upper half of the body surface, desiring to sweat but unable to do so. The treatment principle for Taiyang disease is to induce sweating, which is precisely a therapeutic method that adapts to the body’s desire to sweat.
From the above, it can be seen that adapting to the body’s disease resistance mechanism in treatment can be said to be the most ideal therapeutic method. Even the progressive modern Western medicine may also consider it an ideal. However, the essence of TCM syndrome differentiation and treatment is precisely this most ideal method of treating diseases; is this not a significant invention in the field of treatment?
Click “Read the Original” to learn about the classic course of Shang Han Lun!
Click “Table of Contents” to listen to a sample!
↓ ↓ ↓