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Article Recommendation Star Rating:
Doctors and Medical Students:★★★★★
(Have you thought about this issue?)
TCM Enthusiasts:★★★☆☆
(Experts online are offering advice; I hope you can have a certain judgment ability.)
Non-medical Friends:★☆☆☆☆
(After understanding the “inside story,” I hope you can seek a “clear” TCM practitioner when needed, rather than a “famous” one.)
It is well known and agreed that distinguishing between cold and heat in the early stage of exogenous diseases is essential.
Currently, TCM textbooks differentiate cold and heat based on the severity of chills and fever, but clinical facts show that the severity of fever and chills cannot distinguish the cold-heat attributes of early-stage exogenous diseases.
In the early stage of exogenous cold evil, the symptoms of Ma Huang Tang (Ephedra Decoction) often present with high fever and severe chills; while in the early stage of exogenous heat evil, the symptoms of Yin Qiao San (Honeysuckle and Forsythia Powder) and Sang Ju Yin (Mulberry Leaf and Chrysanthemum Drink) often do not present with high fever.
This indicates that the current TCM theory cannot distinguish the cold-heat nature of early-stage exogenous diseases. If the cold-heat nature of early-stage exogenous diseases cannot be clarified, misdiagnosis in the early stage of exogenous diseases becomes inevitable.
I
Every year, the flu epidemic, the 2003 SARS outbreak, the 2005 avian influenza, and multiple swine flu outbreaks (H1N1, H7N9) have repeatedly warned humanity that the threat of infectious diseases has not been eliminated;
At the same time, it also tells us that Western medicine is not sufficient to eliminate the threat of infectious diseases to humanity.This means that TCM must participate in the prevention and treatment of infectious diseases.
From both a medical responsibility perspective and the need for the development of TCM itself, TCM’s participation in the prevention and treatment of infectious diseases is essential.
With the premise that TCM must participate in the prevention and treatment of infectious diseases, the question to consider is whether the theories and methods of TCM for preventing and treating infectious diseases are mature?
Infectious diseases belong to the category of exogenous diseases in TCM, can TCM accurately identify the nature of early-stage exogenous diseases?
For example, during the 2003 SARS outbreak, there were at least a dozen different disease names, such as summer heat, winter warmth, cold damage, spring warmth, wind warmth, plague, celestial disease, epidemic disease, lung toxic epidemic, lung damp epidemic, lung closure epidemic, lung obstruction epidemic, and atypical pneumonia toxic epidemic.
Clearly, if all these TCM practitioners with different disease names were to treat patients, some treatments would certainly be incorrect.
This also tells us that the treatment theories and methods of TCM for exogenous diseases cannot correctly guide clinical practice, and TCM’s participation in the prevention and treatment of infectious diseases is prone to misdiagnosis, especially in early treatment.
II
For exogenous diseases, correct treatment in the early stage is crucial, as misdiagnosis in the early stage is often fatal. As stated in the “Neijing”, “Those who are good at treatment address the skin and hair… treating the five organs is half dead and half alive.”
The essence of the problem is that the academic community generally neglects to use TCM’s own theories to guide the differentiation and treatment of early-stage exogenous diseases;
it is one-sidedly believed that the early stage of exogenous diseases is a warm disease and cannot use warming herbs; even if treatment is incorrect, using cooling herbs is considered more prudent than using warming herbs.
In fact, whether using cold and cooling formulas incorrectly treats exogenous diseases caused by cold evil, or using warm and hot formulas incorrectly treats exogenous diseases caused by heat evil, the consequences are severe.
In Zhang Zhongjing’s family, seven out of ten people died from exogenous diseases caused by cold evil; if misdiagnosis occurred, how could it be ruled out that they did not die from incorrect treatment with cold and cooling formulas?
The famous cold and cooling faction Liu Hejian from the Jin-Yuan period once suffered from cold damage and was treated for a long time without recovery, later cured by Zhang Yuanshu; the modern famous doctor Yun Tieqiao’s three children died due to being misdiagnosed with warm disease treatment for cold damage, and so on.
Clearly, without establishing a correct differentiation and treatment system for early-stage exogenous diseases, and without addressing the issue of misdiagnosis in early-stage exogenous diseases, TCM’s participation in the prevention and treatment of infectious diseases and intervention in sudden public health events will be difficult, which will also have a serious impact on the development of TCM.
III
Currently, the outbreak of the novel coronavirus pneumonia in Wuhan has affected the entire country and shocked the world.
TCM has already joined the tide of fighting the epidemic; even those who are not directly involved in clinical diagnosis and treatment are offering advice, and various prevention and treatment plans are emerging in abundance.
Let me ask: Are all these different plans effective? Can they achieve the best therapeutic effect? What is the theoretical basis for each person’s proposed plan? Is TCM’s theory really this colorful?
Infectious diseases belong to the category of exogenous diseases in TCM; can the theories of TCM for exogenous diseases, especially the differentiation and treatment theories for early-stage exogenous diseases, effectively guide clinical practice? I am confused!
This question has troubled me for decades, and I have no place to find answers, so I can only think for myself.
Whether TCM can survive and develop depends on whether it has therapeutic efficacy. The foundation of efficacy is correct medical theory.
Is TCM’s theory standardized? Is the differentiation and treatment theory for early-stage exogenous diseases correct? Over the decades since the founding of the country, has there been any standardized research on TCM’s theories?
Preface to the Reconstruction of the Diagnosis and Treatment System for Early Stage Exogenous Diseases
For a long time after becoming a doctor, I felt fear regarding the treatment of early-stage exogenous diseases because I could not distinguish the cold-heat nature of early-stage exogenous diseases.
This prompted me to focus on and think about this issue; I found that the inability to distinguish the cold-heat nature of early-stage exogenous diseases is not only my problem but also that of the vast majority of doctors, including many famous doctors.
Clearly, my doctoral advisor, Professor Shi Zhensheng, also encountered this problem.
Professor Shi has an empirical formula—Jing Fang Yin Qiao Tang (Schizonepeta and Honeysuckle Decoction), composed of Jing Jie (Schizonepeta), Fang Feng (Siler), Su Ye (Perilla Leaf), Yin Hua (Honeysuckle), Lian Qiao (Forsythia), Dan Zhu Ye (Lophatherum), Fu Ling (Poria), and Chen Pi (Aged Tangerine Peel), used when the cold-heat nature of early-stage exogenous diseases is unclear, and many doctors have mentioned this formula to me.
This indicates that everyone is paying attention to this issue, but it has not been resolved, so misdiagnosis in early-stage exogenous diseases is severe.
What puzzles me is why such a serious problem is ignored by the entire academic community?
I
Now I realize how difficult it is to explore this issue!
First, the problem itself involves the entire theoretical system of TCM.
From the theory of causes of exogenous diseases in the “Neijing”, which refers to exogenous diseases as “cold damage,” to the “Nanjing” which generalizes the concept of cold damage, to the “Shanghan Lun” which refers to the early stage of warm diseases as “Taiyang disease,” to the formation of the warm disease school during the Ming and Qing dynasties, proposing the differentiation of Wei Qi Ying Blood and San Jiao, accompanied by the cold-warm debate which further generalized the concept of warm diseases, up to the current textbooks which describe wind-heat exterior syndrome and spicy-cooling exterior resolving.
This has formed a substantially erroneous yet superficially complete system, which cannot be resolved in a short time from a local perspective.
Secondly, although the vast majority of people encounter the same problem as I do, they do not believe that TCM’s theory regarding exogenous diseases has issues, so if someone questions the existing theory of exogenous diseases, they will instinctively oppose it.
For example, on August 4, 2003, I published an article titled “The Early Stage of Warm Diseases is Not Exterior Syndrome” in the China Traditional Chinese Medicine News, and someone told me, “Are you trying to deny warm disease theory?”
I wanted to discuss this issue with many scholars, but they believe that this issue does not need to be discussed; you cannot change this theoretical system;
Because my energy and time are limited, I prepared to guide my graduate students to explore this issue, and my friends also advised me that this issue is too risky, and the defense would not be easy to pass;
To this day, there are still people who think I am trying to deny the theoretical system of TCM.
However, I have confirmed that TCM’s theory regarding the early stage of exogenous diseases is incorrect, and I will persist in exploring this issue.
II
As my research deepens, my understanding of this issue has become clearer, and my arguments more substantial. I have published multiple papers and conducted dozens of specialized lectures, which have sparked strong reactions.
Now, more and more people are willing to discuss this issue with me, and many scholars have expressed their support for me.
Doctoral student Dong Zhengping from the 2009 cohort completed his doctoral dissertation titled “Exploration of the Diagnosis and Treatment Model for Early Stage Exogenous Diseases Based on TCM’s ‘Four Evils’ and ‘Eight Qualities’ Factors” under my guidance;
Master’s student Shi Yue from the 2011 cohort completed her master’s thesis titled “Questioning the ‘Exterior Resolving’ of Spicy-Cooling Formulas” under my guidance;
Master’s student Li Pei from the 2011 cohort completed her master’s thesis titled “Exploration of Spicy-Cooling Exterior Resolving Medicines Based on the Differentiation and Treatment Ideas of Xiao’s Exterior Syndrome.”
All three graduate students’ topics revolve around the differentiation and treatment system for early-stage exogenous diseases and are all questioning the theoretical system in current textbooks, receiving strong support and enthusiastic encouragement from the attending experts from the proposal to the defense.
III
After more than 30 years of confusion and over 10 years of exploration, I have gained a preliminary understanding of the differentiation and treatment system for early-stage exogenous diseases.
Although it is only preliminary and certainly superficial, I am eager to share it with the world.Because many doctors are still experiencing the confusion I once faced, and countless patients are suffering from the disasters caused by misdiagnosis.
However, the book title was quite challenging to decide; ultimately, I had no satisfactory choice, so I tentatively named it “Reconstruction of the Diagnosis and Treatment System for Early Stage Exogenous Diseases.”
This book title may seem arrogant, and people may question: Do you have the ability to reconstruct the differentiation and treatment system for early-stage exogenous diseases? Everyone has every reason to question my ability.
From another perspective, the confusion in the differentiation and treatment theory for early-stage exogenous diseases, the severity of misdiagnosis in early-stage exogenous diseases, has visibly affected the survival of TCM and hindered its development.
It is shocking that no one has conducted research on such a significant issue, nor proposed a solution!
In this regard, who else but me can reconstruct the differentiation and treatment system for early-stage exogenous diseases?
I feel desolate; what is the academic community researching? Is it not as Zhang Zhongjing angrily criticized, “Diligently pursuing only fame and profit”?
IV
I would like to thank my doctoral student Dong Zhengping, and master’s students Shi Yue and Li Pei! Thank you for your trust and the hard work you have put in!
I would also like to thank my new friend Mr. Liu Guantao from the China Traditional Chinese Medicine Publishing House! Thank you to my old friend Ms. Nong Yan from the China Traditional Chinese Medicine Publishing House! Thank you for your understanding and help, and for the effort you put into the publication of this book!
Xiao Xiangru
July 15, 2014, in Beijing
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You May Also Like, click to read the original text:
Xiao Xiangru: The Current Understanding of TCM Regarding “Causes of Exogenous Diseases” is Basically Incorrect!
The Reasons for Misdiagnosis in Early Stage Exogenous Diseases (Part 1) — Zhang Zhongjing’s “Contradiction”
The Reasons for Misdiagnosis in Early Stage Exogenous Diseases (Part 2) — Ye Tianshi and Wu Jutong’s “Fallacies”
