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Source: Kunlun Strategy Network
Author: Li Zhizhong, Researcher and Chief Physician at the Beijing Cui Yueli Traditional Medicine Research Center
The “Shang Han Za Bing Lun” (Treatise on Cold Damage and Miscellaneous Diseases) by Zhang Zhongjing during the Eastern Han Dynasty is the first clinical monograph in Traditional Chinese Medicine (TCM). The “Shang Han Lun” (Treatise on Cold Damage) is a classic on the differentiation and treatment of exogenous diseases. During the Ming and Qing Dynasties, the Warm Disease School, represented by Wu Youke, Ye Tianshi, Wu Jutong, and Wang Mengying, made significant contributions to the prevention and treatment of exogenous diseases. The “Wai Gan Wen Re Lun” (Treatise on Exogenous Warm Diseases) and “Wen Bing Tiao Bian” (Differentiation of Warm Diseases) are considered classics in TCM for the prevention and treatment of exogenous diseases, comparable to the “Shang Han Lun”.
In TCM, exogenous diseases correspond to infectious diseases in Western medicine. When the infectious nature is too strong and spreads too quickly, it is referred to as an epidemic or plague.
This article will discuss some insights and experiences from the following three aspects, and I welcome criticism and guidance.
1
The Advantage of Treatment Lies in Differentiation and Treatment
In early 2003, the First Affiliated Hospital of Guangzhou University of Chinese Medicine admitted 45 SARS patients, all treated primarily with Chinese medicine, with no cases using any antiviral Western medicine, achieving a 100% cure rate, and no medical staff were infected. Aside from necessary symptomatic and nutritional support from Western medicine, only 4 cases used routine doses of steroids. This fact undeniably proves the advantages of TCM in treating SARS.
(1) Western Medicine Aims to Eliminate Viruses While TCM Supports the Human Body
In treating exogenous diseases, the basic concept of Western medicine is to wage war within the human body to eliminate viruses. The fundamental principle of TCM is to support the human body. Supporting the human body means considering the many factors related to the disease as a whole, including heaven, earth, and humanity. The treatment goal is tightly focused on the relationship between the evil and the righteous in the disease process.
For example, in the case of fever, TCM focuses on clinical manifestations such as chills and fever, fever without chills, alternating chills and fever, steaming heat, tidal fever in the afternoon, true cold with false heat, true heat with false cold, and heat returning after cold (these manifestations are referred to as syndromes in TCM). These phenomena are first viewed as specific manifestations of the struggle between evil and righteousness in the disease process. Then, through the four examinations (inspection, listening, inquiry, and palpation), the relationship between evil and righteousness in the disease process is assessed, grasping the characteristics of the disease’s mechanism, including exterior and interior, cold and heat, deficiency and excess, as well as severity and urgency. In TCM, high fever in the “Three Yang” stage is not necessarily alarming, while the absence of fever, returning heat after cold, and cold limbs in the “Three Yin” stage are prominent indicators of critical illness.
In terms of treatment, pathogenic microorganisms are the primary enemies faced by Western medicine, which naturally leads to the principle of eliminating pathogenic microorganisms in treating exogenous diseases. In TCM, the focus is first on the living, holistic patient. This means observing the various pathological manifestations and their trajectories during the disease process. Based on these manifestations and their changes, the internal mechanisms of the disease process are determined. Finally, treatment is conducted based on the disease mechanism, guiding the treatment to transform the internal mechanism of the struggle between evil and righteousness into a healthy state where righteousness overcomes evil. This is the entire process of differentiation and treatment in TCM. Therefore, TCM’s differentiation and treatment involve identifying the cause and mechanism, examining the cause and mechanism for treatment. If one abandons the search for cause and mechanism, it becomes symptomatic treatment rather than TCM’s differentiation and treatment.
(2) A Successful Diagnostic and Treatment System for Exogenous Diseases
In the history of TCM development, the “Four Great Classics” of TCM, which are highly revered, include the “Shang Han Lun” and the Warm Disease School, which together account for half of the content. The “Shang Han Lun” starts from the concept of the interaction between internal and external causes leading to disease, focusing on the relationship between evil and righteousness, and comprehensively understanding the clinical manifestations of the disease through the four examinations. This allows for a judgment on the etiology and pathogenesis of the disease’s evolution, thus transcending the limitations of external cause determinism from a holistic perspective that emphasizes the relationship between heaven and humanity. Anyone familiar with TCM principles knows that for thousands of years, TCM has been able to adapt to the ever-changing diseases with unchanging principles, and this fundamental advantage lies here.
The differentiation of the six meridians in the “Shang Han Lun” aims to “preserve stomach qi and maintain body fluids”. The later Warm Disease School’s differentiation of Wei, Qi, Ying, and Xue, as well as the differentiation of the San Jiao, also adheres to this principle, further enriching and perfecting the scientific system of TCM for the prevention and treatment of exogenous diseases.
(3) Focus on the Three Yang, Treat at the Tai Yang
During the SARS outbreak in Hong Kong in 2003, I first proposed the principle of focusing on the Three Yang and treating at the Tai Yang.
The first layer of meaning in focusing on the Three Yang is to place the emphasis of differentiation and treatment on the Tai Yang, Shao Yang, and Yang Ming stages of the six meridian diseases in the “Shang Han Lun” at the onset of exogenous diseases. The Three Yang diseases in the “Shang Han Lun” represent the stages of the disease process where the evil is strong and the righteous is real. These three stages also include combinations of Tai Yang and Yang Ming, Tai Yang and Shao Yang, Three Yang diseases, and the characteristics of the disease and mechanism in these stages. The Three Yang diseases in the “Shang Han Lun” share a theoretical foundation with the Wei and Qi diseases in the Warm Disease School, as well as the upper and middle Jiao diseases.
The second layer of meaning in focusing on the Three Yang is to place the formulas for treating Three Yang diseases at the core of exogenous disease treatment. Thus, it can be said that the formulas recorded in the “Shang Han Lun” and the Warm Disease School during the “Three Yang” or “Wei and Qi” stages are the most important arsenal for TCM in treating exogenous diseases.
This arsenal includes major formulas such as Ma Huang Tang (Ephedra Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), Yue Bi Tang (Yue Bi Decoction), Ge Gen Tang (Kudzu Decoction), Qing Long Tang (Blue Dragon Decoction), Zhi Zi Chi Tang (Gardenia and Soybean Decoction), Chai Hu Tang (Bupleurum Decoction), Bai Hu Tang (White Tiger Decoction), Cheng Qi Tang (Purgative Decoction), Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction), Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction), Huang Qin Tang (Scutellaria Decoction), Ge Gen Qin Lian Tang (Kudzu, Scutellaria, and Coptis Decoction), Xiao Xian Xiong Tang (Minor Chest Distress Decoction), Yin Qiao San (Yin Qiao Powder), Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction), San Ren Tang (Three Nut Decoction), Huang Qin Hua Shi Tang (Scutellaria and Talcum Decoction), Xin Jia Xiang Ru Yin (Newly Added Elsholtzia Decoction), Huo Xiang Zheng Qi San (Agastache Powder), Xing Su San (Apricot and Perilla Powder), Sang Xing Tang (Mulberry and Apricot Decoction), Qing Zao Jiu Fei Tang (Clear Dryness and Rescue the Lung Decoction), Yu Nu Jian (Jade Woman Decoction), Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), Pu Ji Xiao Du Yin (Universal Detoxifying Decoction), and others. Additionally, formulas such as Qian Jin Wei Jing Tang (Thousand Gold Reed Decoction), Qiang Huo Sheng Shi Tang (Notopterygium Decoction), Qing Wen Bai Du Yin (Clear Epidemic and Eliminate Toxins Decoction), Sheng Jiang San (Ginger Powder), Jia Wei Xiang Su Yin (Modified Perilla Powder), Jing Fang Bai Du San (Schizonepeta and Siler Powder), Ren Shen Bai Du San (Ginseng Powder), Shuang Jie San (Double Relief Powder), Liang Ge San (Cooling and Clearing Powder), and Fang Feng Tong Sheng San (Siler and Unblocking Powder) should also be included in this arsenal.
The nearly forty commonly used formulas selected from TCM classics and later physicians may seem complicated at first glance, but if categorized based on the Three Yang diseases and Wei and Qi syndromes, as well as the six excesses (wind, cold, summer heat, dampness, dryness, fire) and the five internal evils (wind, fire, dampness, dryness, cold), each category will only have three to five typical formulas. This means that once the disease mechanism is clearly diagnosed, the corresponding typical formulas for various exogenous diseases and epidemics will immediately come to the physician’s mind. The formulas in this arsenal are well-known to clinical TCM practitioners, and if young TCM practitioners think carefully, they will be able to make reasonable selections based on the meanings of the six excesses and five internal evils. Over fifty years ago, when I first entered clinical practice, there was a shortage of medical resources, and exogenous diseases were prevalent throughout the year. The above forty formulas were compiled during that time and have been repeatedly used with great benefit.
The Three Yang diseases represent the stages of the disease process where the evil is strong and the righteous is real. It is often said that “Three Yang diseases are easy to treat, while Three Yin diseases are difficult to treat.” This is a summary of TCM’s thousand-year practice and emphasizes the true meaning of focusing on the Three Yang.
Treating at the Tai Yang means addressing the Tai Yang disease or Wei stage at the onset of exogenous diseases, ensuring that effective formulas are used promptly to cure the disease in its early stages.
In 2003, during the SARS outbreak, I proposed the “Three Firsts” for treating SARS: “Grasp the first stage of exterior syndrome treatment, grasp the first method of dispersing cold and inducing sweating, and choose the first formula for clinical initiation.” Thus, treating SARS became as simple as treating a common cold. During multiple public lectures, I summarized the advantages of TCM in prevention and treatment of SARS in two sentences: prevent SARS before it becomes a cold, and treat SARS at the same time as a cold.
In 2003 in Hong Kong, I participated in the treatment and related theoretical and clinical research of suspected SARS cases, early, late, recovery, and post-recovery phases. The discussions in various media about the formulas for treating SARS included Ma Huang Tang, Gui Zhi Tang, Ge Gen Tang, Da Qing Long Tang (Major Blue Dragon Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), Yue Bi Tang, Ma Xing Shi Gan Tang, Xiao Chai Hu Tang (Minor Bupleurum Decoction), Da Chai Hu Tang (Major Bupleurum Decoction), Chai Hu Gui Zhi Tang, Xiao Xian Xiong Tang, and Sheng Jiang San. Based on the principle of “focusing on the Three Yang and treating at the Tai Yang,” I tailored seven different formulas based on the evolution from shallow to deep and my long-term experience in treating exogenous diseases. Despite significant resistance to TCM participation in treatment at that time, I became more convinced of the rationality of these seven formulas from limited treatments and subsequent reflections and summaries. The seven formulas are as follows:
First, if the disease initially presents with predominant external cold and mild fever, with obvious exterior obstruction symptoms, use Gui Zhi Ma Huang Ban Tang (Cinnamon and Ephedra Half Decoction) or Jia Wei Xiang Su Yin (Modified Perilla Decoction).
Second, if the disease presents with exterior cold obstruction and significant internal heat, use Gui Zhi Ma Huang Ban Tang (Cinnamon and Ephedra Half Decoction) minus Gui Zhi, adding Chai Hu, Huang Qin, and Ge Gen.
Third, if the disease begins with typical external cold and internal heat, use Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) minus Ren Shen (Ginseng) and adding Ge Gen, with a focus on Chai Hu and Ge Gen.
Fourth, if the disease presents with significant internal heat and obstruction in the San Jiao, use Chai Hu Gui Zhi Tang minus Gui Zhi and Ren Shen, adding Jiang Can (Silkworm), Chan Yi (Cicada Slough), and Sheng Shi Gao (Raw Gypsum).
Fifth, if the disease presents with cough, white phlegm, and difficulty expectorating, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) adding Fu Ling (Poria), Xing Ren (Apricot Kernel), Ge Gen, Jiang Can, and Chan Yi.
Sixth, if the disease has heat obstructing the lungs, use Xiao Chai Hu Tang minus Ren Shen combined with Ma Xing Shi Gan Tang and Sheng Jiang San.
Seventh, if the disease presents with yellow, sticky phlegm that is difficult to expectorate and wheezing, combine the above formula with Xiao Xian Xiong Tang; if there is constipation, increase Da Huang (Rhubarb) to purge lung heat and relieve intestinal obstruction.
The above seven formulas, modified during the SARS outbreak, have also been frequently used in treating avian influenza, H1N1 influenza, and pediatric exogenous fevers. It is often said: “Treating exogenous diseases is like a general, while treating internal injuries is like a minister.” Treating exogenous diseases requires the decisiveness of a general, ensuring immediate results and effective treatment. The greatest characteristic of classic formulas is that they contain few ingredients, use large quantities, are highly effective, and yield quick results. The average number of ingredients in the decoctions of the “Shang Han Lun” is 4.7, while in the “Wen Bing Tiao Bian” it is 6.3. The teachings of my predecessors, Chai Haoran and Liu Duzhou, regarding internal injuries and miscellaneous diseases state: “Good formulas do not exceed 12 ingredients.” In treating exogenous diseases, I have never seen them prescribe more than 10 ingredients. If clinical differentiation is carefully considered, formulas composed of seven or eight ingredients often lead to rapid recovery within one to three doses.
In summary, the clinical characteristics of TCM in treating exogenous diseases can be summarized as individualized treatment, timely treatment, flexible medication, clear thinking, and remarkable efficacy. As long as the principle of “focusing on the Three Yang and treating at the Tai Yang” is followed in differentiation and treatment, every young TCM practitioner can achieve immediate results and effective treatment.
During the SARS outbreak, someone once asked me what I wanted to express the most. I summarized it in two points: Western medicine, take a step back; TCM, I am coming forward; early prevention and treatment should primarily rely on TCM, while severe cases should combine TCM and Western medicine. Nearly twenty years have passed, and I reiterate this point today.
2
Prevention Focused on the Human Body
In TCM, all exogenous diseases caused by the six excesses of wind, cold, summer heat, dampness, dryness, and fire arise from the interaction of internal and external causes, with internal causes being the decisive factor. Today, when discussing TCM’s prevention of exogenous diseases, it is especially important to correctly understand the relationship between external and internal causes.
Firstly, the relationship between external wind, cold, summer heat, dampness, dryness, and fire and humans is both adversarial and symbiotic. External viruses and bacteria can cause illness, but humans can also develop immunity to viruses and bacteria. Without the existence of viruses and bacteria, the human immune system would not need to exist. The statement in the “Jin Gui Yao Lue” (Essential Prescriptions from the Golden Cabinet) that “humans are endowed with the five constants and grow according to the wind and climate. Although the wind and climate can nurture all things, they can also harm all things, just as water can float a boat but can also capsize it” reveals the symbiotic relationship between external viruses and bacteria and humans, emphasizing the human-centered approach. This aligns with Mao Zedong’s philosophical principle in “On Contradiction” that external causes are conditions, while internal causes are the basis.
Secondly, the best expectation for the coexistence of evil and righteousness is the state of “Yin Ping Yang Mi” (Yin is balanced and Yang is hidden). Since both are beneficial and harmful, the optimal state of their relationship is the “Yin Ping Yang Mi” described in the “Huang Di Nei Jing” (Yellow Emperor’s Inner Canon). The state of Yin Ping Yang Mi is also connected to the goal of achieving harmony in the “Zhong Yong” (Doctrine of the Mean).
Some facts from the SARS outbreak in Hong Kong in 2003 are still worth pondering today.
Firstly, with a population of nearly 7 million, there were 1,755 SARS cases, accounting for only 0.0025% of the total population. This low incidence rate is significantly different from previous epidemics.
Secondly, among the 1,755 cases, at least 70% had mild symptoms, and without effective Western medicine, their body temperature returned to normal within about three days. Why is this?
Thirdly, a study by the University of Hong Kong on April 12, 2004, estimated that approximately 35,000 residents were infected with the SARS virus but did not develop symptoms. When combined with the 2003 case numbers, nearly 37,000 people had been infected with the SARS virus. Beyond the 35,000 asymptomatic carriers, there were certainly many more close contacts. However, this did not lead to more severe transmission; how can this be explained?
Fourthly, during the SARS outbreak, there was a surge in calls for research on SARS vaccines both domestically and internationally. Subsequently, avian influenza and H1N1 influenza followed, and the efforts to develop vaccines fluctuated. Over the past year, the rampant spread of the novel coronavirus has once again sparked a global surge in vaccine development. However, the fluctuating situation of vaccine development in various countries deserves in-depth research in conjunction with TCM theories and the experiences of countries worldwide.
In terms of exogenous diseases, epidemics, and infectious diseases, TCM does not agree with external cause determinism. The “Huang Di Nei Jing” states: “Wind, rain, cold, and heat cannot harm the body without deficiency; if one suddenly encounters a storm and does not fall ill, it is because there is no deficiency, so the evil cannot harm them. This must be due to the deficiency of both the evil wind and the person’s body, leading to illness.” The phrase “two deficiencies meet” is very insightful, indicating that when the body’s righteous qi is insufficient, external evils can invade, and the two factors must align for exogenous (viral or bacterial) diseases to occur. Thus, while viruses and bacteria are common in nature, exogenous diseases and epidemics are not. The determining factor for the occurrence of exogenous diseases is the individual and their internal causes. Therefore, the assertion that “where evil gathers, qi must be deficient” and “when righteous qi is preserved internally, evil cannot invade” is undoubtedly an unshakeable truth.
Human-Centered Preventive Measures are Comprehensive and Proactive
During the SARS outbreak in Hong Kong in 2003, I repeatedly emphasized eight key points for the prevention of exogenous diseases in media and discussions with students and community groups.
First, regulate diet: eat less rich and heavy foods to prevent excessive dampness and heat accumulation in the body.
Second, be cautious in daily life: balance work and rest to avoid overexerting Yang qi, which can increase internal heat.
Third, adapt to temperature changes: adjust clothing according to the weather to reduce the chances of catching a cold.
Fourth, avoid anger: maintain a calm mindset to prevent internal heat from rising.
Fifth, drink plenty of water: enhance fluid metabolism to eliminate internal heat.
Sixth, ensure regular bowel movements: prevent constipation to avoid retention of damp heat and toxins.
Seventh, avoid warming tonics and prefer cooling foods: refrain from using ginseng and other tonics indiscriminately, and advocate for light diets.
Eighth, stay away from viruses and avoid infection: cooperate with Western medicine for protection and maintain personal hygiene.
Among these eight points, maintaining a calm mindset is the most challenging yet crucial. I once mentioned four phrases in a lecture: “A clear mind is like a mirror, a calm heart is like water; when both are clear and calm, what illness can there be?” Achieving a clear mind means understanding profound principles and possessing great wisdom. By grasping the philosophical theories of TCM in disease prevention and treatment, one can naturally maintain a clear mind in the face of illness, without fear or anxiety. The mind is the sovereign organ; if one can maintain a calm heart in the face of illness, they will not create psychological fears that deplete energy and spirit. The human brain accounts for about 1/40 of body weight but consumes over 1/3 of the body’s nutrients and oxygen. If one overuses their brain or remains anxious for long periods, the brain’s consumption of nutrients and oxygen may double. TCM emphasizes the role of the mind and wisdom as the leading force in the body, and the physiological characteristics of the brain are also an important aspect that cannot be ignored in disease prevention and treatment.
To combat viruses externally and eliminate them internally, preventive Chinese medicine can be appropriately administered to at-risk populations. I believe that the principles for formulating preventive Chinese medicine are twofold: first, observe the heavens and the earth while considering the individual, regulating the three Jiao to protect the lungs. The goal is to ensure smooth qi flow throughout the body while focusing on protecting the lungs, which are located in the upper Jiao and are responsible for the body’s qi. Second, guided by the knowledge of the five movements and six qi, and based on the characteristics of the current exogenous disease and susceptible populations, formulate preventive prescriptions based on the aforementioned treatment formulas. Preventive medications should not be taken excessively; one or two days is sufficient. It is crucial to avoid habitual reliance on heat-clearing and detoxifying methods, especially not to cool the body further, which could exacerbate deficiencies and harm the body’s Yang qi.
3
Returning to Theoretical Roots in the Name of Revival
For a long time, people have forgotten the traditional philosophical principle of the unity of heaven and humanity, the consistent foundation of TCM in theory, law, formulas, and medicines, the diagnostic and treatment advantages characterized by differentiation and treatment, and the fact that specialized treatment for specific diseases is an empirical method rather than the main body of TCM clinical practice. When the concept of integrating TCM and Western medicine was first proposed, the intention was to encourage cooperation between practitioners of both fields, allowing for mutual complementarity of their strengths. However, this has been distorted by some into a push for the Westernization of TCM, leading to a degradation of TCM’s theoretical characteristics and clinical advantages.
In my work “Qiu Shi TCM Series”, I pointed out that TCM is the most complete traditional medicine in the world in terms of foundational scientific systems, the most mature clinical differentiation and treatment techniques, and the most outstanding and reliable clinical efficacy. TCM is the only traditional medicine that can coexist with mainstream medicine (i.e., Western medicine) and complement its strengths. In the long-term comparative study of the two medical systems, I emphasized the following four aspects:
First, the foundational scientific system of TCM, represented by the “Nei Jing”, matured thousands of years ago, while the modern Western medical system has been established for less than two hundred years. The maturity and development of TCM are not necessarily linked to Western modern science.
Second, TCM studies the holistic phenomena of humans based on the interaction of heaven, earth, and humanity, while Western medicine studies the structure and function of local tissues based on human anatomy. The holistic phenomena of humans and the structure and function of local tissues are not observed or studied from the same dimension.
Third, TCM’s research method is a comprehensive-deductive approach based on philosophy, while Western medicine’s research method is an analytical-inductive approach based on physics and chemistry. The two research methods are parallel and cannot be exchanged or replaced.
Fourth, the comprehensive-deductive method is a rational thinking research method within the philosophical system, focusing on the movement and change of macro phenomena, while the analytical-inductive method is an experimental research method within the physics and chemistry system, focusing on the structure of micro phenomena. The two research methods are determined by the essential differences in their respective research subjects.
Ultimately, the distinction between TCM and Western medicine is not a subjective or objective issue, nor is it a matter of idealism or materialism, ancient or modern, or backward versus advanced. The difference between TCM and Western medicine lies in the temporal and spatial dimensions; TCM emphasizes time and the holistic phenomena of the human body’s movement and change, while Western medicine emphasizes space and the structure and function of local entities. The research subjects and methods of both will always exist in this manner.
Based on the above, it can be affirmed that TCM and Western medicine must coexist and be equally valued in foundational theory, and they must respect each other, complement each other’s strengths, and work together organically in clinical treatment.
(Some content has been omitted during reprinting)
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