Summary of TCM Courses
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All Courses by Ni Haixia
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Comprehensive Guide to TCM Treatments for Common Diseases
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Focused Study on TCM Topics
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Online Reading of TCM Learning Books
Hu Xishu Qibo Youdao 2022-11-18 05:02 Published in Hubei
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1. Hu Xishu’s Discussion on Differentiating and Treating PneumoniaSome Western medicine practitioners asked Mr. Hu how to differentiate pneumonia caused by wind-cold or wind-heat. Mr. Hu answered this question from both Western and Traditional Chinese Medicine (TCM) perspectives.From the perspective of Western medicine, pneumonia can be diagnosed through X-rays and blood, sputum tests, and cultures, identifying bacterial, viral, rickettsial, or mycoplasma infections, which are determined by visual inspection and laboratory tests. TCM, however, was developed thousands of years ago when science was not advanced, and there were no sophisticated instruments to rely on. It relies on the diverse symptoms reflecting the disease’s development patterns, which were established through countless observations, practices, and summaries over many years. The methods of differentiation and treatment were developed through the characteristics of symptoms. Whether it is the six-channel differentiation in the “Shang Han Lun” or the later organ differentiation, they are all based on symptom characteristics. It is impossible to know the specific pathogenic factors causing the disease. Ye Tianshi proposed that “warm pathogens first attack the lungs,” emphasizing the characteristics of warm pathogens in discussing febrile diseases, which has its unique insights. However, some later practitioners mistakenly equate all febrile diseases with wind-warmth, and even some equate pneumonia with wind-warmth, which leads to errors in differentiation and inappropriate treatment (as in case 3). Here, it is worth mentioning the relationship between warm diseases and solar diseases. In the “Shang Han Lun,” warm diseases are also a type of exterior syndrome, which is a positive exterior syndrome, and is actually a type of solar disease. This means that solar diseases have three types, specifically:Wind Stroke: For solar diseases, if there is fever, spontaneous sweating, aversion to wind, and a slow pulse;Cold Damage: For solar diseases, regardless of fever, if there is no sweating, body pain, lower back pain, joint pain, and a tight pulse;Warm Disease: For solar diseases, if there is fever and thirst, but no aversion to cold (similar to the exterior syndrome of Yangming disease).Pneumonia can present as an exterior syndrome, manifesting as wind stroke, cold damage, or warm disease, not limited to warm disease.This is very important for guiding differentiation and treatment. In modern times, with the advent of antibiotics, some believe that diagnosing pneumonia and immediately using antibiotics is the correct treatment principle. Adding symptomatic TCM herbs, the so-called integration of Chinese and Western medicine treatment, is even more foolproof. However, clinical practice is far from this. Many pneumonia patients, after this so-called integration of Chinese and Western medicine treatment, often do not fare well; some have persistent high fevers, some have continuous coughs, and some have poor appetite and nausea, with inflammation uncontrolled and symptoms emerging one after another. Little do they know that pneumonia can be caused by bacteria, viruses, mycoplasma, or chlamydia. Antibiotics cannot cure all pneumonia, and gradually lead to drug resistance and side effects, causing symptoms of pneumonia to recur. Many patients have to turn to TCM, and TCM treatment does not rely on any secret weapons or formulas, but mainly on careful examination, correct differentiation, and appropriate prescriptions. Here, it is emphasized that the primary effort is correct differentiation. Whenever encountering pneumonia patients, one must patiently and carefully inquire, take the pulse, and observe the tongue coating, avoiding the mistake of thinking they can differentiate wind-cold or wind-warm (wind-heat) after just one or two symptoms and immediately prescribing medication. It should be understood that TCM, whether through six-channel differentiation or organ differentiation, is based on many symptoms to summarize the rules of differentiation. Sometimes a single symptom may be the key to differentiation, and missing a symptom may lead to errors in differentiation.Pneumonia is an acute disease that requires precise differentiation and appropriate medication, so that the efficacy and characteristics of TCM treatment for pneumonia can be demonstrated.An elderly woman suffered from pneumonia and was hospitalized for over a week without improvement. After two consultations with Mr. Hu, she recovered. Her relatives, who were military doctors, came to express their gratitude and asked Mr. Hu what secret formula he used. Mr. Hu smiled and said, “Where is there any secret formula? It is just the roots and barks that our ancestors have used for thousands of years. Isn’t it all written above!” He casually pointed to the book “Shang Han Lun.” The military doctor, upon seeing the “Shang Han Lun,” immediately showed respect, flipped through the book, and asked, “Can I learn it?” Mr. Hu replied, “Of course!” From then on, the military doctor self-studied TCM and often came to seek advice, and soon he was able to use TCM to treat pneumonia and various acute and chronic diseases, which is another story.In response to the military doctor’s request, Mr. Hu specifically discussed the rules of differentiation and treatment for pneumonia. Mr. Hu first explained the differences between TCM and Western medicine in treating diseases. Western medicine treats based on the cause; pneumonia is caused by bacterial infection, and using antibiotics that are effective against the bacteria will certainly yield results. However, some pneumonia cases cannot clearly identify the type of bacteria, virus, mycoplasma, or chlamydia, making antibiotic treatment somewhat blind, hence there are many cases of ineffective treatment in clinical practice. TCM treats based on symptom characteristics, symptoms reflect the struggle between pathogenic factors and the body’s righteous qi, and the differentiation derived from analyzing symptoms is the basis for TCM prescriptions. Prescribing based on differentiation is the main practical process of TCM, which has been summarized through generations, decades, centuries, and even thousands of years of repeated practice, resulting in effective rules of differentiation and treatment and effective prescriptions. Ancient texts such as “Yi Yin Tang Ye Jing” and “Shang Han Lun” are among the main works that discuss differentiation and prescription.In ancient TCM, there was no specific name for pneumonia, but similar symptoms existed, such as fever and cough. TCM does not treat pneumonia with a single formula or herb, but rather uses different medications based on the varying symptoms that appear at different stages. A single formula or herb cannot cure pneumonia. Some magazines report the efficacy of certain formulas in treating pneumonia, but their guiding ideology still revolves around antibiotic treatment, which is debatable. Pneumonia is an acute disease, and the struggle between righteous qi and pathogenic qi is intense, leading to diverse symptoms, and thus the appropriate medications for treatment also vary. Commonly seen formulas and syndromes in clinical practice include:1. Ma Huang Tang (Ephedra Decoction) Syndrome. Initial symptoms resemble a cold, main symptoms: fever, chest tightness, shortness of breath, aversion to cold, no sweating, headache and neck stiffness, body aches, dry mouth, thin white tongue coating, floating tight pulse. At this time, the disease belongs to the solar exterior excess syndrome, treated with sweating and releasing the exterior. Ingredients: Ma Huang (Ephedra) 9g, Gui Zhi (Cinnamon Twig) 6g, Xing Ren (Apricot Kernel) 9g, Zhi Gan Cao (Honey-fried Licorice) 3g.Ma Huang is a powerful sweating herb, and when combined with Gui Zhi, it is more effective in inducing sweating. Xing Ren, when paired with Ma Huang, helps to relieve cough and asthma. Gan Cao harmonizes the middle and nourishes the stomach, thus treating pneumonia belonging to the solar disease exterior excess without sweating, body aches, and shortness of breath. This syndrome appears briefly, but seizing the opportunity to use medication promptly can help reduce fever and shorten the course of pneumonia. It should be noted that the Ma Huang mentioned here is a powerful sweating herb compared to other herbs, and its actual sweating power is not very strong. Even when used with Gui Zhi and Xing Ren, it does not induce much sweating. This point can be seen in the preparation method of Ma Huang Tang, which states, “Take warm, cover with a cotton quilt after taking the medicine to induce slight sweating.” Some people misunderstand the function of Ma Huang and are afraid to use it correctly, and even more so to use Ma Huang Tang to treat pneumonia, which is quite regrettable.2. Da Qing Long Tang (Major Blue Dragon Decoction) Syndrome. Symptoms: fever, aversion to cold, body aches, no sweating, irritability, white tongue coating, floating tight pulse. Ingredients: Ma Huang 18g, Gui Zhi 6g, Xing Ren 6g, Sheng Jiang (Fresh Ginger) 9g, Da Zao (Jujube) 4 pieces, Zhi Gan Cao 6g, Sheng Shi Gao (Gypsum) 75-150g.This syndrome is relatively common and can be seen on the first day of illness and within a week, even after a week. The characteristics of this syndrome are the simultaneous presence of exterior cold with phlegm in the solar exterior syndrome and the interior heat of Yangming, thus treatment requires both sweating and clearing heat. When the interior heat is severe, Sheng Shi Gao is used in larger quantities.3. Xiao Chai Hu Jia Sheng Shi Gao Tang (Minor Bupleurum Decoction with Gypsum) Syndrome. Main symptoms: alternating chills and fever, bitter mouth, dry throat, chest and rib fullness, poor appetite, nausea, cough with chest pain, white greasy or yellow tongue coating, wiry thin rapid pulse. Ingredients: Chai Hu (Bupleurum) 24g, Dang Shen (Codonopsis) 9g, Huang Qin (Scutellaria) 9g, Zhi Gan Cao 9g, Sheng Jiang 9g, Da Zao 4 pieces, Ban Xia (Pinellia) 12g, Sheng Shi Gao 75-150g.This syndrome is often seen in pneumonia 2-3 days to about a week after onset, often presenting as a syndrome of three Yangs combined, thus treatment focuses on harmonizing Shaoyang while also clearing Yangming. For alternating chills and fever, a large dose of Chai Hu is used as the main herb, with Huang Qin to clear heat and stop irritability, undoubtedly a key herb for harmonizing Shaoyang. However, the theory of six-channel differentiation in the “Shang Han Lun” tells us that the reason the disease transmits to Shaoyang is mainly due to the loss of stomach qi and deficiency of qi and blood, thus nourishing the stomach qi is also key to expelling pathogens. Therefore, this formula includes Ren Shen (Ginseng), Da Zao, Gan Cao, Sheng Jiang, and Ban Xia to warm the middle and strengthen the stomach. Xu Lingtai said, “The essence of Xiao Chai Hu Tang lies in Ren Shen,” which is indeed a profound statement. If cough and chest pain are prominent, add Jie Geng (Platycodon) and Xing Ren. If thirst and irritability are prominent, add Zhu Ye (Bamboo Leaf) and Mai Men Dong (Ophiopogon), or switch to Zhu Ye Shi Gao Tang with modifications.4. Da Chai Hu Jia Sheng Shi Gao Tang (Major Bupleurum Decoction with Gypsum) Syndrome. Main symptoms: alternating chills and fever, bitter mouth, irritability, dry throat, thirst, chest and rib fullness, hardness in the abdomen, constipation, red tongue with yellow coating, red tongue body, wiry rapid pulse. Ingredients: Chai Hu 24g, Huang Qin 9g, Sheng Jiang 9g, Da Huang (Rhubarb) 6g, Bai Shao (White Peony) 9g, Da Zao 4 pieces, Ban Xia 12g, Zhi Shi (Bitter Orange) 12g, Sheng Shi Gao 75-150g.This syndrome is often seen in pneumonia 3-4 days after onset, more commonly seen in cases where excessive sweating has not resolved the heat. Compared to the previous formula, this is also a syndrome of three Yangs combined, but this is a clear interior heat of Yangming. At the onset, it transmits to Shaoyang, and it is necessary to use Ren Shen, Sheng Jiang, and Gan Cao to tonify the middle and benefit qi, preventing the invasion of pathogens into the interior while assisting the righteous qi in expelling pathogens externally. However, once it has combined with Yangming, it is necessary to use Da Huang to attack the interior, and the tonification of Ren Shen and the harmonization of Gan Cao are not appropriate, thus they are removed. Additionally, due to the obvious interior heat, Sheng Shi Gao is added again. If there is severe thirst, add Mai Men Dong and Di Huang (Rehmannia). If there is severe constipation, add Mang Xiao (Sodium Sulfate) to be taken in water.5. Da Cheng Qi Tang (Major Order the Qi Decoction) Syndrome. Main symptoms: tidal fever, sweating, body aches, heavy body, no aversion to cold, abdominal distension, shortness of breath, wheezing, constipation, abdominal pain with tenderness, irritability, thirst, daytime sleepiness, and in severe cases, delirium. Tongue coating is thick and dry or yellow-brown, tongue body is red, pulse is deep, wiry, slippery, and rapid. Ingredients: Da Huang 12g, Hou Po (Magnolia Bark) 18g, Zhi Shi 9g, Mang Xiao 18g (divided into two decoctions).This syndrome is often seen 2-3 days after pneumonia onset, particularly common in the elderly. When pneumonia presents this syndrome, the interior heat has reached a certain level, and only this formula can save the patient. Therefore, when encountering this syndrome, one must not hesitate and must promptly prescribe medication, knowing that inappropriate use or failure to use can endanger life.The key is to clearly differentiate the syndrome.It should be noted that the above are common syndromes for pneumonia. Due to differences in constitution and the nature of the pathogenic factors, the symptoms of pneumonia at various stages also differ, leading to many observed syndromes. Not only can one see Ma Xing Shi Gan Tang, Bai Hu Tang, Gui Zhi Jia Hou Po Xing Zi Tang, She Gan Ma Huang Tang and other three Yang syndromes, but also Ma Huang Fu Zi Xi Xin Tang, Li Zhong Tang, Si Ni Tang, and Tong Mai Si Ni Tang and other three Yin syndromes. In clinical practice, one must be aware of the various syndromes that appear in pneumonia patients and be able to promptly use appropriate medications to truly achieve the goal of treating pneumonia with TCM.
2. Hu Xishu’s Treatment Cases for Pneumonia
Case 1: Yang, male, 16 years old, medical record number 491385.Initial diagnosis date: July 5, 1965: Yesterday, after playing basketball, he sweated and felt hot, took a cold shower, and by midnight felt chills, body aches, headache, and cough. After drinking hot water and covering with a quilt, there was no improvement, and he developed chills with more pronounced fever, thin white tongue coating, floating tight pulse. Body temperature 39.9°C. Mr. Hu diagnosed it as a solar exterior excess syndrome of Ma Huang Tang, with the following prescription:Ma Huang 9g, Gui Zhi 6g, Xing Ren 9g, Zhi Gan Cao 6g.Second diagnosis on July 7: After taking the above medicine, there was slight sweating, chills and body aches reduced, body temperature 38.5°C. However, due to significant cough and chest pain, he went to the hospital for examination. X-ray examination: large shadow in the right upper lung lobe, diagnosed as pneumonia, treatment wanted to use penicillin, but due to drug allergy, he still sought TCM treatment. Current symptoms: alternating chills and fever, bitter mouth, dry throat, right chest pain, cough, expectorating yellow sticky phlegm, white slightly greasy tongue coating, wiry thin rapid pulse. Body temperature 38.6°C. This indicates that the exterior pathogenic factor has transmitted to Shaoyang and Yangming, treated with Xiao Chai Hu Jia Sheng Shi Gao Tang with modifications:Chai Hu 15g, Huang Qin 9g, Sheng Jiang 9g, Ban Xia 12g, Dang Shen 9g, Da Zao 4 pieces, Zhi Gan Cao 6g, Jie Geng 6g, Gua Lou 15g, Sheng Shi Gao 75-150g.Third diagnosis on July 10: After taking two doses of the above medicine, alternating chills and fever, chest pain have all improved, cough reduced, expectorating a small amount of white phlegm, body temperature 36.6°C. The prescription was modified by reducing Chai Hu to 15g, Sheng Shi Gao to 75g, and adding Xing Ren 9g, and continued for three doses, achieving basic recovery.Case 2: Zhang, female, 51 years old.Initial diagnosis date: September 25, 1964: Recently, due to moving, felt fatigued and weak, last night felt fever and chills, emergency X-ray diagnosed as right upper lobe pneumonia, due to penicillin allergy, sought TCM treatment. Today still has fever, body aches, no sweating, aversion to cold, dry mouth, irritability, chest tightness, occasional cough with chest pain, white greasy tongue coating, floating tight pulse. Mr. Hu diagnosed it as a solar Yangming combined disease, treated with Da Qing Long Tang:Ma Huang 18g, Gui Zhi 6g, Xing Ren 9g, Sheng Jiang 9g, Da Zao 4 pieces, Zhi Gan Cao 6g, Sheng Shi Gao 45g.Result: After taking one dose of the above medicine, sweating occurred, fever subsided, but cough remained, expectorating yellow-white phlegm, treated with Ban Xia Hou Po Tang with modifications, and after a week of adjustment, she recovered.It is very common for pneumonia to present Da Qing Long Tang syndrome, and the efficacy of treating with Da Qing Long Tang is remarkable. Unfortunately, many patients first seek Western medicine, and when it does not work, they turn to TCM, but the syndrome has already changed. Physicians should know the syndrome and use the appropriate formula.Case 3: Wu, male, 22 years old, hospitalized case number 54.Initial diagnosis date: December 15, 1959: Fever and chills for two days, accompanied by headache, sore throat, cough, chest pain, and chest tightness. X-ray examination: atypical pneumonia in the right lower lung. History of hepatitis, pulmonary tuberculosis, intestinal tuberculosis. Often experiences rib pain, fatigue, loose stools, night sweats. Previous physician first used pungent cool herbs (Sang Ye, Yin Hua, Lian Qiao, Bo He, Qiang Huo, Dou Chi, etc.) for one dose, after which sweating occurred but fever did not subside, and continued to use pungent cool herbs urgently, high fever, spontaneous sweating, headache, cough, chest tightness, aversion to wind, rib pain worsened. Blood routine examination: white blood cells 8100, neutrophils 70%. On the 14th, intravenous antibiotics were administered. That night, high fever still did not subside, body temperature 39.4°C, and nasal flaring, head sweating appeared. Mr. Hu was consulted. Mr. Hu noted: morning body temperature 38.2°C, afternoon above 39°C, presenting alternating chills and fever, with bitter mouth, dry throat, dizziness, night sweats, sweating profusely, no aversion to cold, yellow tongue coating, red tongue body, wiry thin rapid pulse, indicating that the exterior has resolved, continuous sweating has severely damaged body fluids, and the pathogenic factor has transmitted to Shaoyang and Yangming. Treated with harmonizing Shaoyang while clearing Yangming, using Xiao Chai Hu Jia Sheng Shi Gao Tang:Chai Hu 15g, Huang Qin 9g, Ban Xia 9g, Sheng Jiang 9g, Dang Shen 9g, Da Zao 4 pieces, Zhi Gan Cao 6g, Sheng Shi Gao 75-150g.Result: After taking one dose of the above medicine, he fell asleep by midnight without experiencing chills or night sweats. On the 16th, still had dizziness, cough with blood-streaked phlegm. The prescription was modified by adding Sheng Mu Li 15g, and after taking one dose, all symptoms disappeared, body temperature normalized. On December 22, X-ray examination: lung shadow absorbed.Case 4: Yue, male, 67 years old, case number: 122745.Initial diagnosis date: July 3, 1965: Chills and fever for five days, accompanied by headache, cough, expectorating yellow phlegm, body temperature 39.5°C. Previously took Sang Ju Yin with modifications (Sang Ye, Ju Hua, Lian Qiao, Bo He, Xing Ren, Jie Geng, Jing Jie, Lu Gen, Huang Qin, Qian Hu, Pi Pa Ye, etc.) for two doses, but fever did not subside. X-ray examination diagnosed as left upper lobe pneumonia. Again used Yin Qiao San with modifications for two doses, sweating occurred but fever still did not subside. Then used Ma Xing Shi Gan Tang with modifications for one dose, sweating profusely but fever increased, body temperature 41.1°C. When Mr. Hu was consulted, the symptoms were: sweating, irritability, occasional delirium, cough with yellow phlegm, abdominal distension, constipation for five days, red tongue with yellow greasy coating, wiry slippery rapid pulse. Mr. Hu believed the syndrome belonged to Yangming interior excess syndrome, treated with Da Cheng Qi Tang:Da Huang 12g (added later), Hou Po 18g, Zhi Shi 12g, Mang Xiao 9g (divided into water).Result: After taking one dose of the above medicine, he had four bowel movements, fever subsided, body cooled. Remaining cough with yellow phlegm, continued with Xiao Chai Hu with Xing Ren, Jie Geng, Sheng Shi Gao, Chen Pi, and after three doses, he recovered.Case 5: Mr. Hu’s own pneumonia case.One year, Mr. Hu himself contracted pneumonia, experiencing severe chills. He prescribed for himself, at that time did not use Da Qing Long Tang, but used Ge Gen Tang with Sheng Shi Gao. After taking this medicine, the fever subsided, but the next day it recurred, and this repeated for two or three days, ultimately he recovered only after taking Da Qing Long Tang. Mr. Hu summarized that using Da Qing Long Tang, Ma Huang is indispensable. He said that if he had started with Da Qing Long Tang, it would not have become so severe later.Additionally, when Mr. Hu was 83 years old, he had a fever of 39.7°C in winter, with symptoms of chest fullness, chills, nasal congestion, white greasy tongue coating, floating wiry pulse. Since it was a three Yang combined disease, he took Da Chai Hu Tang combined with Ge Gen Tang and Sheng Shi Gao, and recovered after one dose.Both Da Qing Long Tang and Ge Gen Tang are sweating agents for solar diseases, and both of these syndromes particularly present with severe chills. Therefore, in clinical practice, if there is no sweating and severe chills in such solar diseases, one must carefully differentiate between these two syndromes: if there are no irritability symptoms, use Ge Gen Tang; if there is irritability and dryness of the mouth and tongue, use Da Qing Long Tang, as Da Qing Long Tang contains Sheng Shi Gao.Case 6: Mr. Hu’s son’s rash complicated with pneumonia.One year, Mr. Hu’s son had a rash, and Mr. Hu was not at home. The family gave the child Niu Huang Wan, which was too cooling. When Mr. Hu returned, the child’s rash had receded, but he was wheezing without sweating, face red, and in a coma, which was very dangerous.At that time, a relative studying medicine prescribed a formula, but Mr. Hu disagreed, as it was all about releasing the exterior, clearing heat, and detoxifying. Later, he used Ma Huang Xing Ren Gan Cao Shi Gao Tang, using less Shi Gao and more Ma Huang. After the child took the medicine, he gradually began to sweat, and later did not take any more medicine and recovered.This illness also complicated with pneumonia. After recovery, the relative asked, “Is it okay to use this if there is no sweating?” Mr. Hu said it was fine; Shi Gao clears heat without necessarily needing to see sweating. This was when Mr. Hu first started prescribing for others, and it was his own son; at that time, Mr. Hu was only 26 or 27 years old, and the child was only four years old.Ma Huang Xing Ren Gan Cao Shi Gao Tang can be used in the early stages of pneumonia, but it should not be used frequently; it must match the condition of sweating and wheezing. If there is no sweating, it can still be used, but differentiation is still necessary, as this syndrome is more common in children.From the above discussions and treatment cases, it can be seen that Mr. Hu’s treatment of pneumonia relies on the six-channel differentiation and classic formulas from the “Shang Han Lun,” and the efficacy is clear, indicating that TCM has had experience in treating pneumonia since ancient times.This means that if one truly masters the six-channel differentiation and formulas from the “Shang Han Lun,” they can effectively treat pneumonia.It should be mentioned that the common Da Qing Long Tang syndrome for pneumonia is characterized by the simultaneous presence of exterior cold with phlegm in the solar exterior heat and the interior heat of Yangming. The use of Da Qing Long Tang induces sweating, releases the exterior, promotes fluid movement, and clears interior heat. The ingredients of Ma Huang, Gui Zhi, Xing Ren, Sheng Jiang, and Da Zao are warm and induce sweating to release the exterior and promote fluid movement, while Sheng Shi Gao is cold and clears interior heat, with all the herbs working together to produce a cooling and clearing effect. It is worth noting that some people categorize febrile diseases based on pathogenic causes as wind-cold or wind-heat, and thus divide treatment into warming or cooling herbs, leading some to believe that the “Shang Han Lun” lacks cooling herbs, which reflects a lack of understanding of the six-channel differentiation theory and the functions of its formulas.In the consultation of case 3, Mr. Hu particularly pointed out: pungent cool herbs only establish a general principle, but do not further clarify the specific syndrome, thus leading to blind treatment, and excessive release of the exterior can severely damage body fluids, causing sweating and fever to persist or worsen. As previously mentioned, categorizing the fever of pneumonia as caused by wind-cold or wind-heat is one-sided; even if it is known to be wind-cold or wind-heat, one must look at the symptoms presented by the patient, as both wind-cold and wind-heat can produce symptoms of heat, cold, deficiency, excess, exterior, or interior in the body, and analyzing these symptoms to determine the appropriate syndrome is essential for clarifying the necessary formulas and medications.Therefore, Mr. Hu emphasizes that in TCM, differentiation and treatment must not only differentiate the six channels and eight principles, but also differentiate the formulas and syndromes. Differentiating the formulas is a continuation of the six-channel and eight-principle differentiation; it is both the specific implementation of differentiation and the basic skill of differentiation. In other words, treating diseases cannot rely solely on general treatment principles such as warming and sweating, cooling and clearing heat, clearing Yangming heat, or promoting lung and resolving phlegm… what is more important is to clarify the appropriate formulas and medications. In other words, differentiating the formulas is more important than differentiating the treatment principles. This has been recognized by physicians throughout history, as the saying goes, “Sticking to one method is not as good as sticking to one formula,” emphasizing the importance of differentiating the formulas. From Mr. Hu’s experience in treating pneumonia, it can be seen that TCM may seem simple, but to truly master it, one must work hard on inheritance and repeatedly experience it in clinical practice to become a proficient TCM practitioner.Note:Mr. Hu practiced medicine mainly in the mid-20th century. Considering the quality of medicinal materials at that time was relatively good, with a higher proportion of wild herbs, and taking into account the potency of the herbs, when learning and applying Mr. Hu’s formulas today, especially the dosage of the main herbs, it is advisable to increase within a reasonable range.
3. Hu Xishu’s Discussion on Differentiating and Treating External Pathogenic Diseases
Common cold, also known as wind-cold, corresponds to upper respiratory infections in Western medicine (inflammation of the nose, throat, and tonsils). The exact time when the term “common cold” was formed is still uncertain; generally, textbooks state it began in the Northern Song Dynasty, referring to Yang Shiying’s “Ren Zhai Zhi Zhi Fang – Various Winds” which cites the “He Ji Ju Fang”‘s Shen Su Yin: “To treat common cold wind pathogens, with fever, headache, cough, and slightly sticky phlegm,” where the term “common cold” is still a verb. In the Yuan Dynasty, Zhu Danxi’s “Dan Xi Xin Fa – Appendix on Cold” states: “There are many symptoms similar to cold… initially having common cold and other mild symptoms, one should not hastily recognize it as cold and treat it recklessly.” Here, the term “common cold” is formally mentioned. It is worth noting that the cold mentioned by Zhu Danxi refers to the third line of the “Shang Han Lun”: “Solar disease, whether fever has occurred or not, must have aversion to cold, body pain, vomiting, and both yin and yang pulses are tight, known as cold.” This means that common cold can be mild or severe, possibly being wind stroke, cold damage, or warm disease, and should not all be treated as cold. In the Ming Dynasty, Gong Tingxian’s “Wan Bing Hui Chun” proposed dividing common cold into wind-cold and wind-heat types as the main categories, and many later practitioners followed this. Ming Dynasty’s Zhang Jingyue’s “Jing Yue Quan Shu – Wind Injury” states: “The disease of wind injury is caused by external pathogens, but if the pathogenic factor is severe and deep, it spreads through the meridians, it becomes cold; if the pathogenic factor is light and superficial, it only invades the skin and hair, it is wind injury.” Here, the term “wind injury” emphasizes a lighter condition than cold damage, which has led to misunderstandings in later generations, resulting in the assertion that “common cold is different from cold damage.”The different understandings of common cold throughout history arise from two main factors: one is based on the cause of the disease, reasoning and categorizing based on the nature of the pathogenic factor; the other is based on the eight principles to categorize; of course, clinical experience also has a significant influence. Some people propose that “common cold is different from cold damage,” which is an ambiguous and unscientific concept. In fact, as early as the Song Dynasty, the six-channel differentiation theory was used to treat wind injury. For example, Chen Wuze categorized wind injury in his “San Yin Ji Yi Bing Zheng Fang Lun – Discussion on Wind Injury” and treated wind injury using six-channel differentiation, such as using Gui Zhi Tang for solar wind injury, Xing Ren Tang for Yangming wind injury, Xiao Chai Hu Tang for Shaoyang wind injury, Gui Zhi Jia Shao Yao Tang for Taiyin wind injury, Gui Fu Tang for Shaoyin wind injury, and Ba Zhen Tang for Jueyin wind injury. This also indicates that the clinical symptoms of common cold can present six-channel syndromes, not just exterior syndromes or solar diseases. Modern Western medicine considers common cold as an upper respiratory infection, and the clinical manifestations also often resemble those of cold damage and various six-channel syndromes. Therefore, using the six-channel differentiation theory can correctly guide the treatment of common cold.
4. Hu Xishu’s Treatment Cases for External Pathogenic Diseases
Case 1: Chen, male, 24 years old, case number 97771.Initial diagnosis date: October 9, 1965: Yesterday, after playing basketball, he took a cool shower, and this morning felt chills and fever (T38.6°C), no sweating, headache, body aches, no thirst, thin white tongue coating, floating tight pulse. This belongs to the solar exterior excess syndrome, treated with sweating and releasing the exterior, using Ma Huang Tang:Ma Huang 9g, Gui Zhi 6g, Zhi Gan Cao 6g, Xing Ren 9g.Result: The above medicine was urgently decocted and taken, and after covering with a quilt, slight sweating occurred, and the fever gradually subsided. No further medication was taken, and after two days of rest, he recovered.Case 2: Liu, female, 28 years old, case number 12517.Initial diagnosis date: August 30, 1965: Yesterday, after getting cold, symptoms appeared: runny nose with clear mucus, sneezing, headache, dizziness, slight aversion to wind and cold, itchy throat, thin white floating yellow tongue coating, thin rapid pulse. This belongs to the solar Yangming combined disease, treated with Sang Ju Yin with Sheng Shi Gao:Lu Gen 15g, Sang Ye 9g, Ju Hua 9g, Lian Qiao 9g, Bo He 6g, Xing Ren 6g, Zhi Gan Cao 6g, Sheng Shi Gao 75-150g.Result: After taking two doses of the above medicine, symptoms resolved.Mr. Hu often used classic formulas, but when encountering the initial stages of common cold and mild Yangming interior heat (often categorized as wind-warm exterior syndrome in warm disease differentiation), he frequently used Sang Ju Yin with modifications, which also yielded good results. This does not lose the essence of six-channel differentiation and the intention of learning contemporary formulas.Case 3: Zhang, male, 44 years old, case number 96718.Initial diagnosis date: February 25, 1965: Since yesterday, he has experienced chills, no sweating, stiff neck and back, headache, leg pain, dry lips, thin white tongue coating, floating tight pulse. This belongs to the solar Yangming combined disease, treated with Ge Gen Tang with Sheng Shi Gao:Ge Gen 9g, Gui Zhi 9g, Ma Huang 9g, Bai Shao 9g, Sheng Jiang 6g, Da Zao 4 pieces, Zhi Gan Cao 6g, Sheng Shi Gao 75-150g.Result: After taking one dose of the above medicine, the cold symptoms resolved.In the above three cases, case 1 is a simple exterior excess syndrome, thus Ma Huang Tang was used to induce sweating and relieve the condition. The latter two cases, although the onset was only one day, both presented as Yangming interior syndromes, thus treatment could not rely solely on sweating methods, but must also clear Yangming interior heat, which is why they quickly recovered. It is noteworthy that although both cases presented as Yangming combined diseases, case 2 used Sang Ju Yin with Sheng Shi Gao, while case 3 used Ge Gen Tang with Sheng Shi Gao. Additionally, in clinical practice, it is common to see cases presenting as Da Qing Long Tang, Ma Xing Shi Gan Tang, which is why different syndromes must be treated with different appropriate formulas. This emphasizes Mr. Hu’s point: clinical differentiation and treatment must not only differentiate the six channels but also the formulas.It can also be seen that common cold, like other external pathogenic diseases, presents with rapidly changing exterior symptoms. The exterior symptoms of common cold are very transient, quickly leading to combined diseases or concurrent diseases, and some may present as combined diseases right from the onset, as seen in cases 2 and 3. Therefore, some textbooks stating that common cold does not undergo transmission is inconsistent with clinical reality.Case 4: Tang, male, 35 years old, case number 37867.Initial diagnosis date: April 24, 1965: Common cold for three days, sore throat, dry mouth, nausea, loss of appetite, headache, dizziness, cough with right upper chest pain, white tongue coating, pulse is wiry, slightly rapid. This belongs to the Shaoyang Yangming combined disease, treated with Xiao Chai Hu Jia Shi Gao Jie Geng Tang:Chai Hu 12g, Ban Xia 9g, Huang Qin 9g, Dang Shen 9g, Sheng Jiang 9g, Da Zao 4 pieces, Zhi Gan Cao 6g, Ku Jie Geng 9g, Sheng Shi Gao 75-150g.Result: After taking three doses of the above medicine, dry mouth and sore throat improved, cough was not significant, but nausea, lower back pain, and coldness in the lower limbs persisted. The prescription was modified by removing Ku Jie Geng, adding Gui Zhi and Chi Shao each 9g, Long Gu and Mu Li each 15g, and after three doses, all symptoms resolved.This patient primarily presented with pharyngitis as an upper respiratory infection, which is common in clinical practice. Most people do not seek medical attention at the initial stage of external pathogenic disease, so by the time they come for diagnosis, the exterior symptoms are no longer obvious, presenting as a half-exterior half-interior Shaoyang syndrome or a combination of Shaoyang and Yangming. Therefore, Mr. Hu often treated with Xiao Chai Hu Tang with modifications. Children more often present with this syndrome during common colds. At this time, if sweating methods are used to release the exterior, it will only harm the body’s fluids and righteous qi, causing the common cold to prolong and worsen. It is not uncommon for patients to self-medicate with many drugs or receive inappropriate treatment, leading to prolonged illness. This serves as a reminder that although common cold is a minor illness, treatment must also be differentiated and treated. To immediately use sweating methods upon seeing common cold is a serious error.Case 5: Zhang, female, 27 years old, case number 125.Initial diagnosis date: September 24, 1965: For a month, common cold symptoms such as dizziness, sore throat, throat itch, nasal congestion, and runny nose have recurred. Previous physicians diagnosed it as “autumn dryness” and wind-heat binding the lungs, using peppermint throat lozenges, Liu Shen pills, Sang Ju Yin, Yin Qiao San, etc., but symptoms did not decrease and worsened, leading her to seek Mr. Hu’s consultation. Current symptoms: dizziness, headache, back pain, chills, throat itch with cough, difficulty expectorating phlegm, especially at night, bitter mouth, dry throat, thin white tongue coating, wiry thin rapid pulse. Mr. Hu diagnosed it as a three Yang combined disease, treated with Chai Hu Gui Zhi Tang combined with Ban Xia Hou Po Tang with Sheng Shi Gao:Chai Hu 12g, Dang Shen 9g, Ban Xia 12g, Huang Qin 9g, Gui Zhi 9g, Bai Shao 9g, Hou Po 9g, Su Zi 6g, Su Ye 6g, Sheng Jiang 9g, Da Zao 4 pieces, Fu Ling 9g, Zhi Gan Cao 6g, Sheng Shi Gao 75-150g.Result: After taking three doses of the above medicine, dizziness, headache, and bitter mouth improved, back pain and cough reduced, but still slightly chilly, pulse was no longer rapid. Treated with Gui Ling Wu Wei Jiang Xin Xia Xing Gan Cao Tang, after six doses, symptoms resolved.This patient initially presented with rhinitis and pharyngitis, diagnosed by Western medicine as upper respiratory infection. The previous physician diagnosed it as “autumn dryness” and used cooling and releasing methods for a long time without effect, which was due to incorrect differentiation and inappropriate formulas. When Mr. Hu consulted, the patient presented with a three Yang combined disease with phlegm, thus using Chai Hu Gui Zhi Tang with Sheng Shi Gao to harmonize the three Yangs, and adding Ban Xia Hou Po Tang to resolve phlegm and descend counterflow, quickly resolving the three Yang syndrome. Later, using Gui Ling Wu Wei Jiang Xin Xia Xing Gan Cao Tang to resolve phlegm and descend counterflow, the patient recovered. This illustrates that common cold and wind injury do not only present with exterior symptoms; if differentiation is not done carefully, using pungent cooling or warming sweating methods upon seeing common cold will only harm body fluids, injure the body’s righteous qi, and prolong or worsen the condition. Only by using six-channel differentiation and clarifying the formulas can one achieve the goal of treating the disease effectively.Case 6: He, male, 8 years old, case number 79322.Initial diagnosis date: October 23, 1965: Common cold with fever for a week, every day at 1:30 PM, fever (around T38°C), sweating, and by midnight, the fever subsides, with good appetite and spirit, bowel movements every one or two days, no other discomfort, white moist tongue coating, weak rapid pulse. This belongs to the solar exterior Yang syndrome, treated with Gui Zhi Tang:Gui Zhi 9g, Bai Shao 9g, Sheng Jiang 9g, Da Zao 4 pieces, Zhi Gan Cao 6g.Result: After taking two doses of the above medicine, there was no fever in the morning, and in the afternoon, there was still a low fever (T37.2°C to 37.5°C), tongue coating was thin yellow, pulse was still slightly rapid. Treated with Gui Zhi Tang combined with Xiao Chai Hu Tang with Sheng Shi Gao for three doses, all symptoms resolved.This case involved a child, and due to their self-awareness and ability to express symptoms being limited, the symptoms were not many, but it was captured as a solar exterior Yang syndrome, and using Gui Zhi Tang to harmonize the Ying and Wei resolved the condition.Case 7: Xu, male, 47 years old, case number 3752.Initial diagnosis date: May 4, 1978: Common cold for two days, right headache, feeling unwell, both hands cold, no sweating, aversion to cold, normal mouth, no desire to drink, pale tongue, thin white tongue coating, deep thin pulse, red throat with many enlarged follicles. This belongs to a virtual cold exterior syndrome, treated with warming Yang and releasing the exterior, using Ma Huang Fu Zi Gan Cao Jia Chuan Xiong Tang:Ma Huang 9g, Zhi Fu Zi 9g, Zhi Gan Cao 6g, Chuan Xiong 9g.Result: After taking one dose of the above medicine, slight sweating occurred, headache resolved, no further medication was taken, and after two days of rest, he returned to normal.He Lianchen’s “Revised National Famous Doctors’ Cases” records cases of Shaoyin common cold, recognizing that due to differences in constitution, the symptoms of common cold can vary, indicating that common cold, like other external pathogenic diseases, can present as solar disease and Shaoyin disease. Strong individuals present with solar disease and are treated with sweating and releasing methods, while those with significant Yang deficiency present with cold exterior symptoms, indicating Shaoyin disease, and while sweating methods are used to release the exterior, warming Yang herbs such as Fu Zi must be added to expel the external pathogenic factor. This is the differentiation of exterior symptoms in the “Shang Han Lun,” which divides them into solar and Shaoyin, both using sweating methods but with different substances.
Bone diseases can be treated with Heibaitong, and skin diseases can be treated with Huoyang oil!