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Mr. Liu specializes in treating exogenous diseases, particularly in the treatment of colds, influenza, and other exogenous febrile diseases, and has many original insights in terms of syndrome differentiation, treatment principles, prescriptions, and medication.
(1) Principles and Methods, Respecting the Classics
Firstly, Mr. Liu’s understanding of colds, influenza, and other exogenous febrile diseases is deeply rooted in classical texts.
The “Nanjing – Difficulty 58” states: “There are five types of cold damage: wind stroke, cold damage, febrile diseases, damp-warm diseases, and warm diseases.”
This indicates that in Traditional Chinese Medicine (TCM), cold damage is broadly defined, encompassing all exogenous febrile diseases. Therefore, Mr. Liu believes that colds and influenza also fall under the category of broad cold damage.
Secondly, in diagnosis and treatment, Mr. Liu adheres to Zhang Zhongjing’s six meridian syndrome differentiation, particularly focusing on treating Taiyang (Greater Yang) meridian diseases. In prescriptions, he often selects formulas from the “Shang Han Lun” (Treatise on Cold Damage).
In the “Medical Cases of Liu Huimin”, a total of 12 cases of colds and influenza are recorded, with 10 cases using prescriptions derived from Zhang Zhongjing’s formulas such as Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), Da Qing Long Tang (Major Blue Dragon Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), Ge Gen Tang (Kudzu Decoction), and Ma Huang Xing Ren Gan Cao Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction). This shows that Mr. Liu emphasizes classical texts and skillfully utilizes classical formulas in clinical practice.
(2) Respecting the Ancients but Not Sticking Rigidly to Them, Flexibly Modifying Prescriptions
Mr. Liu does not rigidly adhere to ancient texts but flexibly modifies prescriptions based on the syndrome. He uses the appropriate herbs for the corresponding symptoms, which can be described as “similar in form”. For example,
For severe chills, he combines Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig), adding Qiang Huo (Notopterygium) to assist in dispersing cold;
For cough with phlegm, he often uses Jie Geng (Platycodon) and Chuan Bei Mu (Fritillaria), pairing them with Xing Ren (Apricot Kernel) to stop cough and transform phlegm;
For sore throat, he uses Jie Geng and She Gan (Belamcanda) to clear the lungs and benefit the throat;
For loss of appetite, he prefers Shen Qu (Massa Fermentata) and Mai Ya (Barley Sprout) to aid digestion and strengthen the stomach;
If a child has a high fever that does not subside, fearing that the heat may provoke convulsions, Mr. Liu often selects Gou Teng (Uncaria) and Bo He (Mint) to clear heat and cool the liver, stopping convulsions, effectively “cutting off” the progression of the disease.
In addition to modifying prescriptions according to symptoms, Mr. Liu also creates new formulas inspired by classical formulas, which can be described as “similar in spirit”. For instance, in the “Medical Cases of Liu Huimin”, there are three newly created formulas for treating colds or influenza: Cold and Fever Relieving Decoction 1, Cold and Fever Relieving Decoction 2, and Exogenous Cough Formula. The first Cold and Fever Relieving Decoction includes Ma Huang, Xuan Shen (Scrophularia), Ge Gen, Sheng Shi Gao (Gypsum), Shan Yao (Chinese Yam), Gou Teng, Bo He, Jie Geng, She Gan, Chai Hu (Bupleurum), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube), which has the effects of dispersing exterior pathogens, relieving fever, clearing lung qi, and benefiting the throat, primarily treating colds or influenza with symptoms of persistent fever, stiff neck, body aches, chills without sweating, and sore throat with cough. This demonstrates Mr. Liu’s adeptness in using classical formulas, whether “similar in form” or “similar in spirit”.
Shandong Province TCM Research Institute Director Liu Huimin’s Prescription: Cold and Fever Relieving Decoction
[Ingredients] Ma Huang 5g, Xuan Shen 9g, Ge Gen 9g, Sheng Shi Gao 15g, Shan Yao 18g, Gou Teng 9g, Bo He 6g, Jie Geng 6g, She Gan 6g, Chai Hu 6g, Sheng Jiang 3 slices, Da Zao 3 pieces.
[Method] Decoction twice, taken warm in two doses. After taking the first dose, drink a bowl of hot rice soup after about 15 minutes to induce slight sweating. After half an hour, take the second dose.
[Effects] Disperses exterior pathogens and relieves fever.
[Indications] Cold or influenza.
[Note] This dosage is for children around 10 years old; adults should adjust the dosage accordingly.
(3) Skillfully Using Potent Sweating Agents
Mr. Liu believes that in exogenous febrile diseases, patients have not been afflicted for long, and their vital energy is generally not deficient. At this time, the focus should be on dispersing exterior pathogens. He often follows the saying, “Treating exogenous diseases is like commanding an army; it is crucial to be vigorous and decisive,” generally advocating the use of potent sweating agents to expel pathogens. In Mr. Liu’s book “Selected Essentials of TCM for Cold Damage Diseases”, he records three commonly used representative formulas for treating Taiyang diseases—Jia Jian Gui Zhi Tang (Modified Cinnamon Twig Decoction), Jia Jian Ma Huang Tang (Modified Ephedra Decoction), and Jia Jian Ge Gen Tang (Modified Kudzu Decoction).
Jia Jian Gui Zhi Tang: Gui Zhi 12g, Ma Huang 9g, Bai Shao (White Peony) 18g, Xing Ren 12g, Sheng Shi Gao 24g, Zhi Mu (Anemarrhena) 12g, Shan Yao 30g, Sheng Jiang 9g, Da Zao 5 pieces.
Jia Jian Ma Huang Tang: Ma Huang 12g, Gui Zhi 9g, Xing Ren 12g, Bai Shao 12g, Ban Xia (Pinellia) 9g, Fang Feng (Siler) 9g, Sheng Shi Gao 30g, Shan Yao 36g, Jie Geng 10g, Sheng Jiang 9g.
Jia Jian Ge Gen Tang: Ge Gen 15g, Ma Huang 9g, Gui Zhi 9g, Zhi Mu 12g, Sheng Shi Gao 24g, Shan Yao 30g, Bai Shao 12g, Sheng Ma (Cimicifuga) 9g, Gan Cao (Licorice) 3g, Sheng Jiang 9g, Da Zao 5 pieces.
In all three formulas, Ma Huang and Gui Zhi are used together. Ma Huang is well-known for its strong sweating ability, as stated in the “Shen Nong’s Herbal Classic” that it “is more powerful than those with strong qi”. The “Herbal Benefits and Harms” praises it for being “light and dispersing, with the fastest effect”. Zhang Xichun even calls Ma Huang “the main herb for inducing sweating”. When combined with Gui Zhi, the effect of sweating and dispersing is enhanced. Moreover, the dosages of these two herbs are relatively large, and they are often paired with Sheng Shi Gao to strengthen the effect of dispersing and expelling pathogens, making them indeed potent sweating formulas.
In addition, Mr. Liu believes that even if children suffer from exogenous diseases, if the condition is severe, adult dosages can be used for treatment. For instance, Mr. Liu once treated an 11-year-old patient with a cold who had severe chills and fever, body aches, nasal congestion, runny nose, no sweating, cough, bitter mouth, nausea, loss of appetite, yellow urine, dry stool, yellow tongue coating, and a rapid pulse. Mr. Liu diagnosed it as exogenous wind-cold with lung and stomach heat accumulation, and the treatment should focus on inducing sweating and dispersing pathogens, as well as clearing the lung and stomach. The prescription was: Ma Huang 9g, Qiang Huo 6g, Chai Hu 9g, Gui Zhi 9g, Bai Shao 12g, Shan Yao 30g, Zhi Mu 15g, Sheng Shi Gao 24g, Chao Xing Ren 9g, Zhu Ru (Bamboo Shavings) 9g, Sheng Jiang 6g, Da Zao 4 pieces, and roasted Gan Cao 6g, decocted in water. In this formula, Ma Huang and Gui Zhi work together, with Chai Hu and Qiang Huo assisting in dispersing pathogens; Sheng Shi Gao, Zhi Mu, and Zhu Ru are used together to clear lung heat and stop nausea, indicating that the selected herbs are all potent. Furthermore, the dosages of the herbs are all typical adult dosages, which can be considered effective. After taking one dose, the patient sweated, the fever subsided, and the body temperature returned to normal.
However, in treating exogenous febrile diseases, Mr. Liu does not always use potent formulas; he often adjusts the treatment based on the severity of the condition, using heavier herbs for severe cases and lighter herbs for milder cases. He places great emphasis on the influence of seasonal climate on the disease, stressing the importance of adapting to the time.
For example, in winter, when the patient’s pores are closed, Mr. Liu will heavily use Ma Huang, Gui Zhi, and Qiang Huo to induce sweating;
In spring or autumn, he often uses Ge Gen, Bo He, and Su Ye (Perilla Leaf), and even when using Ma Huang, he uses it in small amounts;
In summer, he often uses Xiang Ru (Elsholtzia) and Fu Ping (Duckweed) as gentle sweating agents.
(4) Emphasizing Simultaneous Exterior and Interior Resolution, Skillfully Using Sheng Shi Gao
Based on years of clinical experience, Mr. Liu believes that early-stage exogenous febrile diseases are not limited to exterior symptoms, especially for patients whose fever does not subside after taking medication, which often indicates that the exterior pathogen has not been resolved and has transformed into interior heat, accompanied by varying degrees of interior heat. If only exterior resolution is attempted, the interior heat will be difficult to resolve; conversely, if only interior heat is cleared, the exterior pathogen will not disperse.
Therefore, Mr. Liu emphasizes “clearing interior heat while dispersing the exterior”, and both should be performed simultaneously to achieve the effect of resolving both exterior and interior. The prescription often includes Ma Huang and Gui Zhi for exterior resolution, along with Sheng Shi Gao and Zhi Mu to clear the interior.
For example, the commonly used formulas by Mr. Liu, such as Da Qing Long Tang, Ma Huang Xing Ren Gan Cao Shi Gao Tang, and those recorded in the “Selected Essentials of TCM for Cold Damage Diseases” like Jia Jian Gui Zhi Tang, Jia Jian Ma Huang Tang, and Jia Jian Ge Gen Tang, are all formulas that resolve both exterior and interior. Resolving the exterior helps to clear the interior, and clearing the interior benefits the resolution of the exterior; the two complement each other. Therefore, resolving the exterior and clearing the interior is Mr. Liu’s most commonly used method for treating exogenous febrile diseases and is one of his diagnostic and therapeutic characteristics.
From the perspective of his prescriptions, Mr. Liu not only uses exterior-dispersing and sweating herbs but also skillfully employs Sheng Shi Gao. Sheng Shi Gao is cold in nature, clears heat and drains fire, and is a key herb for treating intense interior heat.
The “Medical Records of Traditional Chinese Medicine” states that it is “cooling yet dispersing, with the ability to penetrate the exterior and resolve muscle tension” and further explains that “it expels heat from the exterior, which is why after decocting Sheng Shi Gao, it can cause the internal heat to escape through the pores”.
Mr. Liu learned and worked at the Lida TCM Hospital founded by Mr. Zhang Xichun in his early years, thus he was greatly influenced by Zhang’s use of Sheng Shi Gao. Sheng Shi Gao, being pungent and cold, resolves muscle tension and penetrates heat, while its sweet and cold nature clears and drains interior heat. “Its pungent, dispersing, and cooling properties can assist Ma Huang and Gui Zhi in reaching the exterior, and it can also transform the heat accumulated in the chest into sweat, following Ma Huang and Gui Zhi to disperse it” (as stated in the “Medical Records of Traditional Chinese Medicine”). When Sheng Shi Gao is combined with Ma Huang and Gui Zhi, it enhances exterior resolution without the risk of generating heat; conversely, when Sheng Shi Gao is combined with Ma Huang and Gui Zhi, it clears and drains interior heat without the concern of cooling too much. Therefore, the combination of Sheng Shi Gao with exterior-dispersing herbs achieves the goal of resolving both exterior and interior.
In the “Medical Cases of Liu Huimin”, a total of 12 cases of “colds and influenza” are recorded, with Sheng Shi Gao used in 11 cases, with dosages ranging from 12g to 24g depending on the severity of the condition. This indicates that the frequent and heavy use of Sheng Shi Gao is another characteristic of Mr. Liu’s treatment of exogenous febrile diseases.
(5) Emphasizing the Importance of the Spleen and Stomach, Always Caring for Stomach Qi
In treating colds, influenza, and other exogenous diseases, Mr. Liu advocates for expelling pathogens as the primary focus, often using potent medications such as Ma Huang, Gui Zhi, and large doses of Sheng Shi Gao. If not careful, this can easily lead to excessive sweating, damaging body fluids, or coldness harming the stomach. TCM believes that the stomach qi is fundamental; with stomach qi, one lives; without stomach qi, one dies. Mr. Liu also emphasizes that the spleen and stomach are the foundation of postnatal health and are indeed the source of fluid production. Therefore, in clinical practice, Mr. Liu pays attention to both the compatibility of herbs and the method of taking medicine.
While using Ma Huang, Gui Zhi, Sheng Shi Gao, and other herbs for exterior resolution and interior clearing, he often combines them with Huai Shan Yao (Chinese Yam). This herb is sweet and neutral in nature, and it has been recorded in the “Shen Nong’s Herbal Classic” as being effective for “injuries to the middle, replenishing deficiency, expelling cold and heat evil qi, and benefiting qi and strengthening muscles”. The “Compendium of Materia Medica” also states that it can “benefit kidney qi and strengthen the spleen and stomach”. Shan Yao nourishes the spleen and stomach, preventing excessive coldness from Sheng Shi Gao from harming stomach qi. Additionally, Mr. Liu often uses Shan Yao in larger quantities than Sheng Shi Gao, reflecting his emphasis on the spleen and stomach. Furthermore, Mr. Liu also emphasizes caring for stomach qi in the method of taking medicine. He instructs patients to “drink a bowl of hot rice soup after taking the first dose, and after half an hour, take the second dose to induce sweating,” and he writes this in detail on the prescription. This method imitates Zhang Zhongjing’s practice of taking congee after the Gui Zhi Tang to induce sweating. The reasons are twofold: first, to use the essence of food to warm the middle burner, ensuring that sweating has a source without harming the spleen, stomach, body fluids, and yang qi; second, to fill the stomach with food essence, invigorating stomach qi to assist in expelling pathogens. This shows that in treating colds, influenza, and other exogenous febrile diseases, Mr. Liu uses potent medications while also caring for the vital energy, expelling pathogens without harming the vital energy.
Mr. Liu emphasizes in treating colds, influenza, and other exogenous febrile diseases:
Focusing on Taiyang meridian diseases,
Skillfully using potent sweating agents,
Advocating for simultaneous exterior resolution and interior clearing in the early stages of exogenous diseases, and skillfully using and heavily relying on Sheng Shi Gao,
While also emphasizing the importance of caring for the spleen and stomach,
All of these provide valuable experience for our understanding and treatment of exogenous febrile diseases.
Source: “Experience Records of Nine Famous Doctors from Shandong University of Traditional Chinese Medicine”, edited by Liu Yu.
Medical Case: Liu, Male, 12 years old
Initial diagnosis four days ago after sweating and swimming, developed a high fever that night, with a temperature of 40°C, persistent without subsiding, headache, body aches, no sweating, nausea, thirst, and irritability. After treatment with both TCM and Western medicine, the effect was not significant, so he came to Mr. Liu for diagnosis and treatment. Currently, the symptoms include fatigue, flushed face, shortness of breath, thick white tongue coating, and a tight and rapid pulse.
Diagnosis: Cold dampness binding the exterior, transforming into heat entering the interior.
Treatment principle: Induce sweating and disperse the exterior, clear heat and eliminate irritability, expel dampness and unblock the obstruction, harmonize the nutritive and defensive qi.
Prescription: Modified Da Qing Long Tang
Ma Huang 6g, Gui Zhi 9g, Chao Xing Ren 12g, Zhi Mu 15g, Zhi Gan Cao 6g, Sheng Shi Gao (crushed) 24g, Shan Yao 30g, Ge Gen 12g, Fang Feng 9g, Sheng Jiang 6g, Da Zao 5 pieces (3 doses, decocted twice, taken warm in two doses).
After the first dose, drink a bowl of hot rice soup, and after half an hour, take the second dose to induce sweating.According to the prescription, this formula is for cold dampness binding the muscle layer; if treated improperly, it can transform into heat entering the interior, hence the use of modified Da Qing Long Tang with Ge Gen to resolve muscle tension and disperse pathogens, clear heat and eliminate irritability, harmonizing the nutritive and defensive qi, using Zhi Mu and Shan Yao to generate fluids and stop thirst, and using Fang Feng to expel cold dampness.
Feedback: After taking two doses, the symptoms were cured.
Pulse Commentary: Da Qing Long Tang is a potent sweating formula, originally indicated for “Taiyang wind stroke, floating tight pulse, fever, chills, body aches, no sweating, and irritability”, suitable for robust young adults with exogenous febrile disease symptoms of fever, chills, no sweating, irritability, and a floating and strong pulse. The original formula uses a large amount of Ma Huang, up to six taels, and is combined with the sweet and cold Sheng Shi Gao to resolve exterior cold and clear interior heat.
Mr. Liu is skilled in using Da Qing Long Tang. After Chairman Mao developed a fever from a cold, many doctors were at a loss, and ultimately, Mr. Liu was called to use this formula, which resolved the fever in one dose. It is worth noting that this formula should be used cautiously for patients with weak constitutions and weak pulses; in clinical practice, medication should be stopped as soon as sweating occurs, and it should not be taken in excess.
Practitioner Profile
| Second from the left: Liu Huimin |
Liu Huimin, a TCM expert, hails from Yishui, Shandong. He was a disciple of the famous doctor Zhang Xichun during the Republic of China and was highly regarded by Mr. Zhang. After the founding of the country, he served as the founder and first president of Shandong University of Traditional Chinese Medicine and as the chairman of the Shandong Provincial TCM Association. He has treated Chairman Mao, Premier Zhou, and other central and provincial leaders multiple times. Engaged in TCM for sixty years, he focuses on clinical practice and excels in treating internal medicine, with unique insights into gynecological and pediatric diseases. Male, Han ethnicity, originally named Cheng En and De Hui. A renowned TCM practitioner. He is from Hujiacun, Huangshanpu Township, Yishui County. He has loved medicine since childhood. In 1916, he apprenticed with local TCM practitioner Li Bu’ao, learning to identify herbs and follow patients, deeply inheriting his teachings. A few years later, he practiced medicine while diligently studying TCM. In the 1920s, he went to Fengtian (now Shenyang) to study and work at the “Fengtian Lida TCM Hospital” founded by the famous doctor Zhang Xichun. After two years, he was admitted to the “Shanghai College of Traditional Chinese and Western Medicine”. After graduation, he returned to his hometown to continue practicing medicine, and his skills improved significantly.
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2019/12/22
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