Mr. Zhao Bingnan (1899—1984) was a master in modern TCM surgery and dermatology, serving as the deputy director of Beijing Traditional Chinese Medicine Hospital, vice president of the Chinese Association of Traditional Chinese Medicine, and chairman of the Beijing Association of Traditional Chinese Medicine. Mr. Zong Xiuying was born in 1926 into a family of traditional Chinese medicine practitioners in Beijing, with both his grandfather Zong Shiming and father Zong Weixin being renowned doctors in the city. Besides learning medicine from his father, he also studied under famous local masters such as Zhao Shuping and Zhang Juren, eventually becoming a well-known physician himself.
Mr. Zhao was 27 years older than Mr. Zong, and there are no records in books or materials regarding their interactions. However, they did have some connections. In 1956, Mr. Zhao left his long-established clinic to join the newly established Beijing Traditional Chinese Medicine Hospital, where he served as deputy director. Mr. Zong’s father, Weixin, participated in the founding of the hospital in 1956 and later became the head of the internal medicine department, while Mr. Zong also began working in the internal medicine department of the hospital in the same year. This means that Mr. Zong and Mr. Zhao were colleagues, though the nature of their relationship remains unknown.
However, in my case, the two esteemed predecessors have a new connection through my theory of “Water Stagnation and Fluid Deficiency”.
The theory of “Water Stagnation and Fluid Deficiency” was proposed by me based on clinical observations and experiences in 2011, and was first published in 2013 in the book “Thinkers of Traditional Chinese Medicine (Volume 2)”. It was also published on the WeChat account of the “Chinese Medicine Book Friends Association”. In 2016, I delivered a lecture titled “Wuling San and the Syndrome of Water Stagnation and Fluid Deficiency”, which provided a comprehensive discussion of this theory from classical texts to theoretical and practical aspects. In my new book published in 2017, “Seeking Truth in Treatise on Cold Damage (Volume 1)”, I also mentioned the theory of “Water Stagnation and Fluid Deficiency”.
Here is an excerpt from my discussion:
I believe that fluid disorders can generally be categorized into several types: fluid deficiency; fluid excess (this is a convenient way to describe it, but in reality, excess is no longer fluid), which refers to abnormal fluid metabolism leading to the retention of water, dampness, phlegm, and fluids; and a situation where both fluid deficiency and excess coexist, which still pertains to the abnormal metabolism and distribution of fluids, manifesting as water, dampness, phlegm, and fluid retention in certain areas while other areas exhibit fluid deficiency. This can be briefly referred to as the coexistence of water stagnation and fluid deficiency.
Fluid deficiency and fluid excess are both clinically recognized by practitioners, so there is no need to elaborate further. The coexistence of water stagnation and fluid deficiency, while not common, can still be observed in clinical practice and is described in classical texts. For example, the symptoms of thirst and difficulty urinating in the syndrome of Wuling San are due to water stagnation preventing the fluids from ascending, resulting from abnormal fluid metabolism and distribution. Similar pathological changes observed in clinical practice include: simultaneous occurrence of thirst and loose stools, constipation and difficulty urinating, and the presence of both a peeled tongue coating and a greasy tongue coating.
For those with fluid deficiency, the treatment should focus on supplementation and moistening; for those with fluid excess, the treatment should focus on promoting urination and drainage. However, it is more crucial to identify the abnormal links in fluid metabolism for targeted treatment. As for those with the coexistence of water stagnation and fluid deficiency, should the treatment focus on supplementation or drainage? In fact, this is not the key issue. Restoring normal fluid metabolism and distribution is the fundamental approach to treating the disease. For instance, in the syndrome of Wuling San, Zhuling (Polyporus), Fuling (Poria), and Zexie (Alisma) promote urination and drain dampness; Bai Zhu (White Atractylodes) and Fuling (Poria) strengthen the spleen and assist in transportation; Gui Zhi (Cinnamon Twig) warms the channels and promotes qi transformation, facilitating urination and allowing fluids to ascend, thus alleviating thirst without directly treating it.
So how are Mr. Zhao and Mr. Zong related to the theory of “Water Stagnation and Fluid Deficiency”?
Let me start from the beginning.
From 1996 to 1999, I spent three years frequently immersed in the library of Shanghai University of Traditional Chinese Medicine, flipping through books and losing track of time. Naturally, I came across the “Clinical Experience Collection of Zhao Bingnan”, published in 1975 (compiled by Beijing Traditional Chinese Medicine Hospital, hereinafter referred to as Zhao Collection), but I could not grasp its essence.
The reasons were threefold. First, at that time, I lacked clinical experience, especially regarding TCM surgery and dermatology, which deal with diseases manifesting on the surface of the body, and I had no concept of them. Second, there were too many self-formulated prescriptions and various external treatment methods in Mr. Zhao’s book, which overwhelmed me. Third, I had very few opportunities to treat patients, and even if I diligently studied the Zhao Collection, it would be of no use, so I had no motivation to spend time on this book.
In 2001, after starting work, I happened to find the Zhao Collection on a colleague’s desk, flipped through it again, and put it down for similar reasons. Later, the Zhao Collection was republished in 2006 by the People’s Health Publishing House as one of the “Modern Famous TCM Masters’ Classic Reprints·Volume 2”, and I immediately purchased a copy. Good books must be bought, even if I do not have the opportunity to read them seriously at the moment, I may still need to study them in the future.
As time went on, with increasing clinical experience, I began to see more patients with skin diseases, and I started to read the Zhao Collection more seriously.
This brings us to the concept of “Stubborn Dampness” in the Zhao Collection. This concept appears in the notes on cases of “Eczema” and “Generalized Neurodermatitis”, but is only briefly mentioned and rather plain, initially failing to attract my attention.
It wasn’t until 2014, when the People’s Health Publishing House published a book titled “Following Master Zhao Bingnan’s Notes”, that I read an article by Dr. Ma Dading, which was very insightful.
The title of the article is: “Master Zhao Bingnan’s Teaching Notes at the Central Institute of Dermatology”, written by an author who graduated from medical school in 1954 and was assigned to work at the Institute of Dermatology and Venereology of the Chinese Academy of Medical Sciences, where Master Zhao was invited to lecture and conduct consultations weekly, and the author was arranged to study under him.
Mr. Ma described the “Stubborn Dampness Theory” as follows:
Mr. Zhao referred to acute eczema as damp-heat ulcer, while chronic eczema was termed dampness ulcer. Particularly stubborn and long-lasting cases were specifically referred to as stubborn dampness ulcers. In this stage, the skin becomes thickened, rough, scaly, and cracked, and while there may appear to be no signs of dampness on the surface, some TCM practitioners believe it has transitioned to blood deficiency and wind dryness, with dampness no longer being the main issue, merely residual dampness. In response, Mr. Zhao proposed the distinctive “Stubborn Dampness Theory,” asserting that “prolonged illness depletes qi and blood,” allowing dampness to invade deeper layers, becoming more viscous and difficult to eliminate. Due to stubborn dampness obstructing the meridians and hindering the flow of qi and blood, the skin surface becomes malnourished, thus presenting a false appearance of blood deficiency and wind dryness. Mr. Zhao targeted stubborn dampness with the use of the Quan Chong Fang (All-Insect Decoction) to clear the meridians and resolve deep-seated stubborn dampness effectively.
Mr. Ma’s summary is concise and insightful, pointing out that the appearance of blood deficiency and wind dryness in stubborn eczema is a false manifestation, with stubborn dampness being the root cause. He also noted that “Due to Mr. Zhao’s limited publications and the confusion caused by some indirect statements, the original ecological content of Mr. Zhao’s discussions is not well known”, which indeed seems to be the case.
Coincidentally, in 2014, the China Traditional Chinese Medicine Publishing House published “Medical Cases and Discussions of the Three Generations of Medical Masters: Zong Xiuying”, where I read Mr. Zong’s understanding of the “True Dampness and False Dryness” syndrome, which shares similarities with Mr. Zhao’s views and further describes the pulse and symptoms of such patients.
Mr. Zong discovered in clinical practice that symptoms of cracked skin on the hands and feet, although manifesting as dry, thickened, and cracked skin, still exhibit many signs of dampness. For instance, the cracking of the skin on the palms and soles may coexist with surrounding herpes and itching, or local cracking may coexist with heaviness in the limbs, swelling of the hands and feet, lack of thirst, loose stools, a thick and greasy tongue coating, and other symptoms. Mr. Zong believed that these symptoms reflect the manifestation of the “True Dampness and False Dryness” syndrome, and that the primary treatment should focus on eliminating dampness to achieve efficacy.
Mr. Zong’s experiences share many similarities with the theory of “Water Stagnation and Fluid Deficiency”, making it particularly resonant for me.
When I taught various schools of thought at the university, my first lecture discussed the “Communication of the Mind” among physicians, and later I wrote an article titled “Communication of the Mind” (included in my book “Half a Day of Clinical Practice and Half a Day of Reading”), the core idea being that despite differences in time and place, as long as one engages in clinical practice and thoughtful reflection, physicians from ancient to modern times and across cultures can achieve a “Communication of the Mind”. From the perspective of the theory of “Water Stagnation and Fluid Deficiency”, there truly exists a “Communication of the Mind” among Mr. Zhao, Mr. Zong, and myself!
2018.1.22
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