V. The Kang Ping Edition and General Principles of Ancient Texts
Here, I would like to briefly discuss the Kang Ping edition. The Kang Ping edition is a version of the “Shang Han Lun” (Treatise on Cold Damage). In the past, when we studied the “Shang Han Lun”, we only regarded it as a medical book, which is actually a significant issue. We should first read it as an ordinary ancient text, meaning that it should be read in the same way as the “Analects” or the “Tao Te Ching”. This is the first step. Only then should we approach it as a medical text. This point is very important.
The formation of ancient texts is not as we modern people imagine, where it is written by one person from start to finish. On the contrary, ancient texts are dynamic and formed over a long period, representing a school of thought. For example, the “Tao Te Ching” is a book of a school, but it does not contain the names of Laozi’s disciples. Laozi himself may have spoken only a thousand words, and during the process of transmission, his disciples added their own thoughts or annotations, which is called “supplementation”. The disciples of his disciples also added their own “supplementations”, resulting in an increasing number of words. On the other hand, the structure of the text also changes during transmission. Laozi’s disciples or their disciples would adjust the chapters according to their understanding.
Understanding this principle, you will realize that the “Shang Han Lun” could not have been written by one person, so we should not pursue consistency in the “Shang Han Lun”. We should recognize that the “Shang Han Lun” was formed gradually, over a time span of possibly hundreds of years or more, which is why there are contradictions within it. The “supplementation” mentioned earlier is one of the reasons why many parts are difficult to understand.
The Kang Ping edition is a very important version of the “Shang Han Lun” because it reflects how ancient texts are formed. In recent years, I have written a new book titled “Seeking Truth in the Shang Han Lun” (Note: The first volume was published in October 2017 by the China Traditional Chinese Medicine Publishing House), with the subtitle “A New Interpretation Based on the Kang Ping Edition”, which re-examines the “Shang Han Lun” by treating the Kang Ping edition as a very important version. If you are interested, you can read it.
VI. Wu Ling San Syndrome and Its Subtypes
Now, let us summarize. From the original texts of the “Shang Han Lun” and the “Jin Gui Yao Lue”, the main manifestations of patients with Wu Ling San syndrome can include fever, which can be “slight fever”, or “headache, fever, and body aches”; there may be thirst, which can manifest as dry mouth, “irritable thirst”, “sweating and thirst”, “thirst with a desire to drink water, but vomiting when water is ingested”, or “desire to drink water but not thirsty” (I do not understand this, so I will not address it), and there may also be “distention”; “difficult urination”, which can be “frequent urination”; “constipation”; “vomiting and diarrhea”; “palpitations”; “dizziness”; and the pulse may be floating and rapid.
In summary, the pathogenesis of Wu Ling San syndrome is actually what we summarized earlier, which includes three situations: exterior syndrome, fluid deficiency, and water retention (which is abnormal fluid metabolism). This is indicated in the original text, and the key point is the abnormal metabolism of fluids.
The patient indicated in the original text has excessive sweating, unresolved exterior syndrome, fluid deficiency, and water retention, all three conditions present. However, in outpatient settings, we may not necessarily encounter such patients, so the key is the abnormal metabolism of fluids, which manifests as water retention. However, this patient may also exhibit signs of fluid deficiency, and it is very likely that this fluid deficiency becomes a prominent manifestation, which can confuse our thinking and hinder our use of Wu Ling San, because you see a very obvious fluid deficiency, and you may hesitate to use Wu Ling San. Now I refer to this situation as “water retention with fluid deficiency”; essentially, it is still water retention and still abnormal fluid metabolism. Understanding its essence allows you to confidently use Wu Ling San!
Finally, I would like to briefly discuss the concept of subtypes. I have not checked the China National Knowledge Infrastructure or literature to see if anyone else has proposed this. I believe I proposed it, possibly ten years ago. In the past, when we learned about pattern differentiation or other related texts, we would discuss how to differentiate patterns, for example, the main symptoms must meet two criteria, and the secondary symptoms must meet two criteria, totaling four criteria to diagnose a certain syndrome. This is actually incorrect! For example, a person with diarrhea can take Wu Ling San, and someone with constipation can also take Wu Ling San; a person with dry mouth can take Wu Ling San, and someone without dry mouth can also take Wu Ling San. So what are the main and secondary symptoms? Sometimes it is difficult to distinguish between the main and secondary symptoms. For instance, Wu Ling San syndrome may have several symptoms mentioned above; which of these symptoms is the main symptom, and which is the secondary symptom? Therefore, this line of thinking is incorrect. This way of thinking comes from Western medicine. For example, rheumatoid arthritis, as I recall, is a standard set by a certain American society, listing several symptoms or laboratory indicators, and if a patient meets several of them, they can be diagnosed with rheumatoid arthritis. But it is inappropriate to directly apply this to our pattern differentiation. Therefore, I want to propose the concept of subtypes. For example, if a person has diarrhea and a slippery tongue, that is a Wu Ling San syndrome; while another person has loose stools and other symptoms, that may also resemble Wu Ling San syndrome. Understanding from this perspective allows us to comprehend the formula-syndrome relationship, as there are many subtypes under one formula-syndrome.
VII. Similar Formulas to Wu Ling San
I would also like to mention similar formulas to Wu Ling San, such as Fu Ling Gan Cao Tang (Poria and Licorice Decoction), Ling Gui Cao Zao Tang (Poria, Cinnamon, and Jujube Decoction), and Ling Gui Shu Gan Tang (Poria, Cinnamon, and Atractylodes Decoction). Fu Ling Gan Cao Tang treats palpitations below the heart; Ling Gui Cao Zao Tang treats palpitations below the navel that may lead to a feeling of running piglet; and Ling Gui Shu Gan Tang treats qi rising to the chest, similar to running piglet.
The purpose of mentioning this is to differentiate these formulas. Similar formulas include Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Heart), Sheng Jiang Xie Xin Tang (Fresh Ginger Decoction to Drain the Heart), and Gan Cao Xie Xin Tang (Licorice Decoction to Drain the Heart). According to my understanding, they are all similar. Why do I say this? First, look at whether these symptoms are all similar. Second, look at whether these herbs are all similar. Then someone may ask, if they are all similar, why did Zhang Zhongjing list these several formulas? The issue lies in what I mentioned earlier: you must understand the “general principles of ancient texts” and know how ancient texts are formed.
The “Shang Han Lun” was not written by Zhang Zhongjing alone; it has been passed down and continuously added to over hundreds of years. For example, if I created a formula, my disciple might sometimes add an herb to it, which would change it into another formula. My disciple’s disciple might not fully follow the teacher’s instructions and add another herb. Later, his junior may have learned something from another teacher and remove an herb. In this way, several formulas would be passed down. If you carefully examine the differences between the several Xie Xin Tang formulas, you will find that the differences are minimal, and the symptoms are also very slight. Of course, according to my view, the study of formulas should not include such exam questions. The “Shang Han Lun” exams may also have such questions, but they are actually problematic. This is my understanding; do you think my explanation makes sense?
VIII. Case Discussions
Next, I will introduce some cases where I used Wu Ling San in clinical practice.
Case 1
Li, male, 5 years old. Initial diagnosis on December 7, 2013.
Parents report: fever for 3 days.
Medical history: fever for 3 days, highest temperature 38°C. No chills, slightly afraid of heat, fatigue, poor appetite, nausea, and loose stools. Started feeling thirsty yesterday, constantly asking parents for water, frequent, short, and yellow urination. No nasal congestion, runny nose, sore throat, or cough. Tongue pale red, pulse slippery.
Prescription: Zhu Ling (Polyporus) 12g, Fu Ling (Poria) 12g, Ze Xie (Alisma) 15g, Bai Zhu (Atractylodes) 12g, Rou Gui (Cinnamon) 4g (added later), Zhi Ban Xia (Processed Pinellia) 12g, Sheng Jiang (Fresh Ginger) 3 slices, 2 doses. Instructed to drink a cup of hot water after taking the medicine, keep warm, and allow the body to sweat slightly.
After taking the medicine in the afternoon, the child sweated slightly, had a runny nose, occasional sneezing, was no longer thirsty, urination returned to normal, and body temperature remained around 37.7°C. After taking the second dose in the evening and drinking hot water, the child continued to sweat slightly, and the fever subsided at night. By morning, all symptoms disappeared, except for one instance of watery diarrhea.
Explanation:
This case involves a 5-year-old child with a fever of 38°C, no fear of cold, slightly afraid of heat, fatigue, poor appetite, and nausea, with loose stools. A prominent symptom is thirst, constantly asking parents for water, and frequent, short, yellow urination, which is quite obvious and different from before the fever. I prescribed Wu Ling San with Ban Xia and Sheng Jiang, instructing him to drink a cup of hot water after taking the medicine and to keep warm to allow the body to sweat slightly. This is the resting method after taking Wu Ling San, which shows that Wu Ling San is for resolving the exterior, and drinking warm water promotes sweating for recovery. After taking the medicine, the child sweated slightly; additionally, the runny nose and occasional sneezing indicate that the exterior pathogen is being expelled; he was no longer thirsty, and urination returned to normal, indicating that fluid metabolism had returned to normal. The body temperature was 37.7°C, slightly lower. Continuing to drink in the evening, the fever subsided by midnight. By the next day, all symptoms had disappeared, except for one instance of watery diarrhea.
Note that Wu Ling San is different from some other formulas. Some formulas are mild and have no side effects, as people often say, Chinese medicine cannot be harmful. However, Wu Ling San is different; it is effective but may give patients some negative impressions, such as causing diarrhea. I have encountered several patients who experienced diarrhea after taking it. You might wonder how this formula could cause diarrhea? Well, it can! Although this is not a high percentage, it is important to inform patients in advance that sometimes diarrhea is not necessarily a bad thing, so they are mentally prepared; otherwise, they may misunderstand and blame you.
What other issues may arise from taking Wu Ling San? It can injure fluids! During the process of promoting urination and expelling water, it may injure fluids, which can be reflected in the tongue appearance, such as dryness of the tongue, or reduced coating, or the tongue becoming red. Because we often prescribe 7 doses at a time, when a person comes in with a slippery tongue and thick greasy coating, and by the next week, they have improved, we still prescribe Wu Ling San. Unexpectedly, the next week, their tongue appearance is different. They may have only needed 3 doses to recover, but we usually prescribe 7 doses.
Thus, Wu Ling San is not a formula that is harmless; it is a very powerful formula, which is why these issues may arise. This is a reminder I want to give everyone. These are experiential insights that you may only understand after treating many patients.
Case 2
Wu, male, 41 years old. Initial diagnosis on April 18, 2015.
Main complaint: back feels cold for over 2 years.
Medical history: back has felt cold for over 2 years, accompanied by spontaneous sweating, slight fatigue, previously had loose stools, but after moxibustion treatment, it has returned to normal. Has athlete’s foot, normal thirst and drinking. Good appetite, sleeps well. Tongue is swollen with teeth marks, pulse is weak.
Prescription: Zhu Ling (Polyporus) 15g, Fu Ling (Poria) 15g, Bai Zhu (Atractylodes) 12g, Ze Xie (Alisma) 18g, Rou Gui (Cinnamon) 6g (added later). 7 doses.
On May 9, the patient reported that after taking 2 doses, the cold sensation in the back disappeared.
Explanation:
This case involves a patient who has felt cold in the back for two years, experiencing this sensation even in April’s weather and during summer. After taking 2 doses of the original Wu Ling San, he improved. This demonstrates the effect of warming yang and transforming water.
Case 3
Huang, female, 57 years old. Initial diagnosis on December 11, 2013.
Main complaint: cold sensation in the back for over 2 months.
Medical history: has felt cold in the back for over 2 months, accompanied by aversion to cold, chest tightness, poor appetite, insomnia, and night sweats. Feels fatigued during the day and does not want to work. Although she feels dry in the mouth in the morning, she does not want to drink; at other times, her mouth is not dry, and she drinks very little. Urinates only twice a day, with yellow color. Mouth feels sticky. Bowel movements are once or twice a day, formed. Has increased vaginal discharge, white with yellow. Generally worries a lot. Facial complexion is dull, tongue is pale, with thin white greasy coating, pulse is deep and wiry.
Prescription: Zhu Ling (Polyporus) 30g; Fu Ling (Poria) 30g, Ze Xie (Alisma) 30g, Bai Zhu (Atractylodes) 30g, Rou Gui (Cinnamon) 10g (added later), Ban Xia (Pinellia) 30g. 7 doses.
On December 15, 2013, during the second diagnosis: the patient returned early for a follow-up due to urgency to return home. She reported that after taking 1 dose, the cold sensation in the back disappeared, appetite improved, and the sticky feeling in the mouth was gone, with a significant reduction in vaginal discharge. Currently, she still has insomnia, fatigue, and a feeling of tightness in the chest. Facial complexion slightly improved, tongue is pale, with thin white slightly greasy coating, pulse is deep and wiry.
Prescription: maintain the original formula. Added Gua Lou Pi (Trichosanthes Peel) 9g, Xie Bai (Garlic Chives) 9g, Si Gua Luo (Luffa Fiber) 30g, Ju Luo (Tangerine Peel) 9g. 10 doses.
After taking the two prescriptions, her son reported that all symptoms had disappeared.
Explanation:
This case involves a cold sensation in the back accompanied by multiple symptoms. The patient feels cold in the back, has aversion to cold, chest tightness, poor appetite, insomnia, and night sweats, and feels fatigued and does not want to work. In the morning, she feels dry in the mouth but does not want to drink, and at other times, her mouth is not dry, so she drinks very little. Because she drinks very little, she also urinates infrequently, only twice a day. Her mouth feels sticky, and she has increased vaginal discharge, with a dull facial complexion and a pale tongue with thin white greasy coating. This is also a Wu Ling San syndrome, with Ban Xia added.
This patient is the mother of a colleague from the clinic. Due to urgency to return home, she came for a follow-up early. She reported that after taking 1 dose, the cold sensation in the back disappeared, appetite improved, and the sticky feeling in the mouth was gone, with a significant reduction in vaginal discharge. Other symptoms were also addressed, so Gua Lou, Xie Bai, Si Gua Luo, and Ju Luo were added. Later, her son reported that all these symptoms had resolved.
Case 4
Li, female, 33 years old. Initial diagnosis on January 10, 2014.
Main complaint: discomfort from qi rising in the stomach for 10 days.
Medical history: for nearly 10 days, the patient has felt a surge of qi rising in the stomach, reaching the throat and causing discomfort, which can only be relieved by expelling it; otherwise, she feels nauseous. She does not feel thirsty and rarely drinks water, urinating 3 times a day, with no discomfort in the back, and normal vaginal discharge. She has a history of athlete’s foot every summer. Tongue has thin white greasy coating, with teeth marks on the sides, pulse is wiry and thin.
Prescription: Zhu Ling (Polyporus) 30g, Fu Ling (Poria) 30g, Bai Zhu (Atractylodes) 30g, Ze Xie (Alisma) 30g, Rou Gui (Cinnamon) 9g (added later). 7 doses.
On March 20, 2014, due to an eye issue, she came for a visit and reported that after taking the above formula for four to five doses, the discomfort from the rising qi in the stomach had resolved.
Explanation:
This case involves the condition known as “running piglet qi”. I remember asking an old doctor if he had ever encountered running piglet qi, and he said he had never encountered it. At that time, I had encountered two cases, and now I have seen about seven or eight cases, which is quite a lot. This patient reported feeling a surge of qi rising in the stomach, reaching the throat, and only feeling comfortable after expelling it; otherwise, she felt nauseous. She also does not feel dry in the mouth and drinks very little water, so she urinates infrequently. She has a history of athlete’s foot in the summer. The original Wu Ling San formula was used. After two months, she returned for an eye issue and reported that after taking four to five doses, this symptom had resolved.
(This article is excerpted from “Half a Day of Clinical Practice, Half a Day of Reading 2” by Xing Bin, published by China Traditional Chinese Medicine Publishing House, 2021, pages 38-73)
Long press the QR code to follow Wang Li’s public account for TCM discussions
(The formulas listed in this column are for reference only; please consult a relevant doctor for use)
Welcome original submissions; this column’s email: [email protected]
Information exchange is voluntary; no remuneration is provided
This public account is for academic exchange only; if there is any infringement, please contact for removal
To my disciples
Li He
Farewellto my disciples three years later, returning home for more than ten days.
Tonight’s wine is fragrant, the books I left behind are gone.
Even with a sick body, what matters in the world?
Why ask about cattle and horses, just let them be.