Title: Insights on Learning Classical Formulas—What Are the Basic Methods of Differentiating Syndromes in the Six Meridians and Eight Principles?
Author: Wang Xianwu
Affiliation: Beijing Longyuan Traditional Chinese Medicine Clinic
In recent years, I have been studying under Mr. Feng Shilun, a master of classical formulas, and have revisited the “Shang Han Lun” (Treatise on Cold Damage) and “Jin Gui Yao Lue” (Essential Prescriptions from the Golden Cabinet). This has deepened my understanding of the Hu (Xi Shu) – Feng (Shilun) system. Combining this with clinical practice, I have gained new insights into certain passages in the “Shang Han Lun” and would like to share them with everyone. Please feel free to provide corrections if there are any shortcomings.
In recent years, many people have sent me photos of their faces, tongues, and other body parts via mobile phones to seek diagnosis, or have described symptoms for diagnosis, or have provided a Western medical diagnosis or lab report for me to diagnose. Except for critically ill patients, where I conduct detailed inquiries and guide their families in palpation and abdominal diagnosis to assist in treatment, I often politely decline due to incomplete four examinations. I believe that any method of differentiation in Traditional Chinese Medicine (TCM) cannot be separated from the four examinations; without them, differentiation cannot be entirely accurate. Below are some of my humble opinions for reference.
1. The four examinations are the basic methods for judging the characteristics of symptoms in the differentiation of the six meridians and eight principles.
In clinical practice, the four examinations must be comprehensive; observation, listening, inquiry, and palpation are all essential. By utilizing the four examinations, we gather information about the illness, judge the nature and condition of the disease, differentiate the six meridians, identify the appropriate formula, and ultimately achieve a cure. Therefore, Mr. Hu Xishu, a classical formula practitioner, stated, “In TCM, treating diseases is based on differentiation rather than merely identifying the disease; hence this method of treatment is called differentiation-based treatment, also known as differentiation and treatment… and it can only rely on people’s natural faculties to explore treatment methods based on the symptomatic responses of the diseased body.” From this, it is clear that to understand the symptomatic responses of the diseased body, a comprehensive four examination is necessary, and to achieve accurate differentiation, the four examinations must be thorough.
Mr. Feng Shilun stated, “The history and theory of classical formulas are primarily based on the experience of treating diseases summarized from symptomatic responses.” This further emphasizes the importance of the four examinations; without them, it is impossible to judge the characteristics of the symptomatic responses of the diseased body and summarize treatment experiences. Relying solely on a Western medical diagnosis, a lab report, or images of the face or tongue lacks the basis for differentiation, let alone efficacy.
In the “Shang Han Lun,” Article 153 states, “In a Taiyang disease, if the physician induces sweating, and the patient subsequently experiences fever and aversion to cold, and if purging is applied, with a feeling of fullness below the heart, both the exterior and interior are deficient, and both Yin and Yang Qi are exhausted. If there is no Yang, then Yin is alone, and if further burning needles are applied, with chest discomfort and a pale yellow complexion, it is difficult to treat; however, if the complexion is slightly yellow and the hands and feet are warm, recovery is easy.” This is determined through the four examinations, judging the severity of the disease based on symptomatic responses. Article 295 states, “In a Shaoyin disease, if there is aversion to cold, the body is curled up, and there is diarrhea, with cold hands and feet, it is untreatable.” This is also determined through the four examinations, judging the severity of the condition based on symptomatic responses.
In the “Jin Gui Yao Lue, Yellow Jaundice Disease Pulse and Symptom Diagnosis and Treatment,” it states, “In cases of alcoholic jaundice, if there is no fever, the patient is clear and has abdominal fullness with a desire to vomit, and if the pulse is floating, first induce vomiting; if it is deep and wiry, first purge.” This is determined through the four examinations, establishing treatment principles based on symptomatic responses. Without a complete four examinations, how can one know the symptomatic responses of the diseased body? Without understanding the characteristics of the symptomatic responses, how can one judge the severity and urgency of the condition? Can one treat the disease relying solely on a Western medical diagnosis, a lab report, or tongue and facial diagnosis?
2. Differentiation of classical formulas is based on symptomatic characteristics, determining the disease name and judging the transmission of the six meridians, which cannot be separated from the four examinations.
Mr. Hu Xishu proposed that the six meridians in the “Shang Han Lun” are derived from the eight principles, which is well-founded. The names of the syndromes in the six meridians of the “Shang Han Lun” are named based on symptomatic responses, such as “In Taiyang disease, the pulse is floating, the head and neck are stiff and painful, and there is aversion to cold.” “In Taiyang disease, if there is fever, sweating, and aversion to wind, and the pulse is slow, it is called wind stroke.” “In Taiyang disease, if there is fever or no fever, there must be aversion to cold, body pain, vomiting, and the pulse is tight in both Yin and Yang, it is called cold damage.” “In Taiyang disease, if there is fever and thirst, without aversion to cold, it is a warm disease.” This tells us what symptomatic characteristics indicate Taiyang disease, what characteristics indicate wind stroke, and so on. It can be understood that the differentiation of classical formulas is based on symptomatic characteristics, and the determination of the disease name is also based on symptomatic characteristics. Without a complete four examinations, how can one differentiate the eight principles? How can one differentiate the six meridians? How can one determine the disease name and differentiate the formula based on symptomatic characteristics?
In the “Shang Han Lun,” Article 4 states, “If a cold damage occurs on the first day, and the pulse is quiet, it is not transmitted; if there is a desire to vomit, and if there is agitation, the pulse is rapid, it is transmitted.” Article 5 states, “If after two or three days of cold damage, the Yangming and Shaoyang syndromes are not present, it is not transmitted.” Article 16 states, “In Taiyang disease, if after three days of sweating, if there is vomiting, purging, or warming needles, and it still does not resolve, this is a bad disease, and Gui Zhi Tang (Cinnamon Twig Decoction) should not be used.” Observing the pulse and symptoms allows one to know what is being violated and to treat accordingly. This clearly indicates that judging the transmission of the six meridians is based on symptomatic characteristics, and these symptoms require a complete four examinations. “Observing the pulse and symptoms allows one to know what is being violated and to treat accordingly” summarizes the four examinations, and this is the general principle of treating diseases with classical formulas.
3. Differentiating formulas and syndromes cannot be separated from the four examinations.
Formulas and syndromes are an important component of classical formula theory and are key to differentiation. Mr. Hu Xishu emphasized that “Although the six meridians and eight principles are the foundation of differentiation, and based on this foundation, treatment guidelines can be established… because TCM differentiation is not only about differentiating the six meridians and eight principles, but more importantly, it must also use them to differentiate the applicability of formulas and syndromes.” This means that each formula has its inherent applicability, which must be determined through the four examinations; it cannot be established solely based on a facial diagnosis, tongue diagnosis, or hand diagnosis.
“Formulas and syndromes are a continuation of the differentiation of the six meridians and eight principles, representing the cutting edge of differentiation. The efficacy of TCM differentiation primarily hinges on whether the formulas and syndromes are accurately differentiated.” This means that the differentiation and treatment of classical formulas ultimately rely on the formulas and syndromes, and without a complete four examinations, how can one implement the formulas and syndromes?
4. Determining the patient’s response after taking medication and judging the prognosis of the disease based on symptomatic responses cannot be separated from the four examinations.
The formula and syndrome of Gui Zhi Tang (Cinnamon Twig Decoction) in the “Shang Han Lun” is derived from the analysis of differentiation through the four examinations. Whether the response after taking the medication is normal is also judged through the four examinations. The formulas Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction with Cinnamon), Gui Zhi Jia Shao Yao Tang (Cinnamon Twig Decoction with Peony), and Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction with Aconite) are all determined in this way. In the “Jin Gui Yao Lue, Yellow Jaundice Disease Pulse and Symptom Diagnosis and Treatment,” it states that in cases of female labor jaundice, after taking a certain formula, “the disease follows the stool, the urine is yellow, and the stool is black, this is a sign of recovery,” which is determined through the four examinations, based on symptomatic responses to judge the effectiveness of the medication and recovery. Article 37 of the “Shang Han Lun” states, “In Taiyang disease, if ten days have passed, and the pulse is floating and thin, and there is a desire to sleep, the exterior has resolved. If there is chest fullness and pain, administer Xiao Chai Hu Tang (Minor Bupleurum Decoction). If the pulse is only floating, administer Ma Huang Tang (Ephedra Decoction).” This is determined through the four examinations, judging the prognosis and transmission based on symptomatic responses to determine the treatment plan.
Regarding the transmission of the six meridians, there should be some symptomatic responses of the diseased body that coincide with time; it is not a general rule for the occurrence, development, and recovery of diseases. If the symptomatic responses of the diseased body coincide with time, this is also determined through the four examinations. Relying solely on a lab report, a Western medical diagnosis, or a single method such as tongue diagnosis, facial diagnosis, or hand diagnosis, without a comprehensive four examinations, cannot determine which meridian or syndrome it is, nor can it differentiate the formulas and syndromes for treatment, let alone discuss the transmission of the six meridians.
Wang Xianwu Special Topics
1. An 88-year-old patient with recurrent fever for 25 days and no bowel movement for 27 days
2. After taking medication, the patient developed chickenpox; a record of classical formula treatment
3. Is the basic theory of classical formulas merely the correspondence of formulas and syndromes?