V. Limitations and Shortcomings of "On Blood Disorders"

V. Limitations and Shortcomings of "On Blood Disorders"

"On Blood Disorders" is indeed an excellent work of traditional Chinese medicine, particularly in its diagnostic and therapeutic approaches to blood disorders, which hold great clinical significance. However, due to historical limitations, the author of this book has not yet completely escaped the constraints of metaphysics. On the one hand, he believes that "the yin and yang of heaven can cause human diseases, but in reality, it is not heaven that makes people sick; rather, it is the imbalance of qi and blood within the body that leads to illness when influenced by the imbalances of heaven." On the other hand, he also believes that "dreams are the manipulation of soul and spirit... The soul is good, the spirit is evil; dreams involving the soul are mostly good, while those involving the spirit are mostly bad." This shows that two different sets of ideas coexist in the author's mind: the former has a progressive, materialist flavor, while the latter has a superstitious, idealistic tint. The book also exhibits this contradictory tendency in its argumentative style. While the author boldly criticizes the erroneous views of predecessors, he attributes the root of these errors to ignorance and superficial understanding of the "Inner Canon" and Zhang Zhongjing's works. He freely expresses his own opinions and puts forward insights that others have not yet reached, yet he credits the "unparalleled correctness" of the "Inner Canon" and Zhang Zhongjing's works as the source of these insights. This clearly shows that although the author is a progressive physician striving for innovation and opposing conservatism, he still cannot completely break free from the limitations of his era and make bold strides forward. This is a common characteristic shared by all reform-minded thinkers in China during the 18th and 19th centuries—a natural product of historical constraints. It merely represents the reformist aspirations of the bourgeoisie and petite bourgeoisie in colonial and semi-colonial societies. Although these aspirations had a certain progressive significance at the time, they ultimately lacked the thorough revolutionary spirit possessed by the modern proletariat. The author of "On Blood Disorders" approached the creation of this work with precisely such ideological tendencies. Furthermore, the book excessively relies on analogies and imagery in its argumentation. While this method can enhance persuasiveness to a certain extent, overuse inevitably leads to forced connections. For example, the author equates male hematuria with female metrorrhagia, and female metrorrhagia with lactation—these are all erroneous conclusions resulting from such argumentative techniques. In addition, in the section on tuberculosis, the author repeatedly emphasizes that tuberculosis worms are transformed from blood stasis and that "if you wrap your palm with cloth and wait for a long time, hair will grow about an inch"—all of these arguments lack clinical evidence.

[Note]

(1) See "The Chinese Revolution and the Communist Party of China" (Volume 2 of "Selected Works of Mao Zedong," pages 592–593)

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My late father was frail and prone to illness, so I began studying medical books at a young age and would immediately adjust treatments whenever he fell ill. In June of the year Guiyou, he suddenly developed hematemesis, which later turned into hematochezia. Despite consulting numerous medical texts, my attempts at treatment were ineffective; even after seeking advice from renowned experts, no definitive solution could be found—only symptomatic medications were prescribed, waiting for the illness to subside on its own. Consequently, I turned to medical literature, paying particular attention to blood disorders. At that time, local residents greatly admired the "Great Method of Blood Loss" written by our esteemed elder, Mr. Yang Xishan, believing it contained secrets unknown to others regarding blood disorders. I obtained a copy of this book, treasuring it as a precious treasure. Since my father was ill, I made extensive efforts to acquire it, but unfortunately, the book’s discussions on medicines and treatments were not detailed enough, and its application in actual treatment yielded little effect. Disappointed, I returned to studying the "Inner Canon" and Zhang Zhongjing's works, drawing parallels and gaining new insights, finally realizing the deeper meanings behind their words and successfully treating seven or eight out of ten blood disorder cases. Now that my father has passed away and my wife, Mrs. Feng, has also developed a blood disorder, I am able to formulate prescriptions safely. Reflecting on this, I feel deeply regretful that I did not start earlier, as I could have saved my father’s life if I had acted sooner. Nevertheless, I am grateful that this book might still save future generations.

A self-narration by Tang Zonghai of Rongchuan

[Note]

(1) Léi: frail. (2) Yàng: illness. (3) Zhé: always. (4) Wǎng: none. (5) Míngxiù: famous veteran. (6) Sì: wait. (7) Biàn: same as piàn. (8) Cháng: once. (9) Xǔ: boast. (10) Chāo: copy. (11) Hóngbǎo: hóng means big, so hóngbǎo refers to something extremely precious. (12) Cuò: finally. (13) Qǐnkuì: qǐn means sleep, kuì means food, so qǐnkuì means eating and sleeping—here it is extended to mean being immersed in something. (14) Jīngqī: an old-fashioned humble way to refer to one’s wife. Jīng refers to using thorns as hairpins, also implying poverty. (15) Lòu zāi: how ugly! (16) Yuán: therefore. (17) Yǐngxiǎng zhī tán: talking about influence, following the crowd, or going along with others. (18) Wùdào bù zǎo: realizing the truth too late.

[Commentary] This preface recounts the author’s journey of studying blood disorders. When he was young, his father suddenly suffered from hematemesis, and despite consultations with many renowned doctors, no cure was found. He searched through all medical books but still couldn’t find a definitive answer, even the “Great Method of Blood Loss” written by the then-famous Yang Xishan lacked sufficient detail. Later, his father eventually passed away, which served as a strong motivation for him. He then resolved to delve deeply into the study of blood disorders. Starting with the "Inner Canon" and Zhang Zhongjing’s works, he grasped the underlying principles while refusing to be bound by ancient texts. Through arduous effort, he finally mastered the methods for treating blood disorders. From the author’s research process, we can see that he is a diligent and ambitious physician with a rigorous academic spirit—he learns from the past but does not blindly follow it. He believes that “it is shameful to possess a skill or talent that could help others at the time but refuse to share it,” and that one should summarize and publish one’s clinical experience to benefit future generations. It is precisely for this reason that "On Blood Disorders" can “express what the ancients wanted to say or fill the gaps left by predecessors,” striving for solid reasoning and effective results rather than mere speculation.

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Qi. For example, sweating serves to regulate defensive qi, but we must also avoid using fire-based therapies that harm water yin. Therefore, we use white peony to nourish yin and stimulate sweat production, and pollen to generate fluids and replenish sweat. From this perspective, we can see that nourishing water is equivalent to tonifying qi. However, formulas like Bu Zhong Yi Qi Tang, Liu Jun Zi, and Shen Qi Wan are all tonifying qi—why don’t they nourish water? Because intangible water yin is born below and nourishes above, so it is meant to nourish qi; this kind of water should be nourished. On the other hand, tangible water quality enters the mouth and is transformed below, so it is meant to transmit qi; this kind of water should be drained. If water quality stagnates, qi will be blocked, so Bu Zhong Tang uses Chenpi and Bai Zhu to control water; Liu Jun Zi uses Lingzhi and Banxia to facilitate water flow; Shen Qi Wan also uses diuretic herbs to assist Gui and Fu, with Gui and Fu transforming water into qi, and Lingzhi and Ze helping to drain qi. Zhen Wu Tang especially relies on Bai Zhu and Lingzhi to drain water, so treating water-related issues is also treating qi, while nourishing water yin is also tonifying qi—these two approaches can coexist without contradiction (7). Moreover, if water-related problems are not resolved, water yin cannot be generated either, so Wu Ling San removes water-related issues and simultaneously disperses fluid to quench thirst and induces sweating to reduce fever, because once water-related problems are cleared, water yin can spread. However, if water yin is not nourished, water-related problems cannot be solved either, so Xiao Chai Hu Tongda Jin Ye allows for better regulation of waterways. In short, when water flows, qi flows; when water stops, qi stops. Only those who understand this can talk about regulating qi. Why do we say that fire transforms blood? Blood color is the color of fire—fire is governed by the heart and generates blood to nourish the entire body. Fire is yang and produces yin blood, which in turn nourishes fire, so fire doesn’t flare up, and blood flows downward, stored in the liver, residing in the Blood Sea, traveling throughout the body via the Chong, Ren, and Dai channels to warm the limbs. Men cannot observe the transfer of blood directly (8), while women can observe the transfer of blood during menstruation. Blood flows into the Blood Sea, and the heart’s fire follows downward, so blood is abundant while fire isn’t overly intense, which is why men don’t get sick and women can conceive. If blood is deficient, the liver loses its storage capacity, wood flourishes and fires up, the heart loses its nourishment, fire intensifies and damages blood—so blood disorders are essentially fire disorders, and the treatment should focus on heavily nourishing blood, such as Gui Pi Tang and Di Qi Tang. However, since blood is generated by fire, if we nourish blood without clearing fire, fire will eventually become too intense and unable to generate blood, so nourishing blood must include fire-clearing herbs. Si Wu Tang uses white peony, Tian Wang Bu Xin Tang uses Er Dong, Gui Pi Tang uses Zao Ren, and Zhang Zhongjing’s Zhi Gan Cao Tang uses Er Dong and Ajiao—all of these are fire-clearing methods. As for Liu Huang Tang and Si Sheng Wan, they mainly focus on aggressively draining fire, which is too much fire and反而 loses its transformative power; suppressing it is actually nurturing it, so fire-clearing is equivalent to blood-nourishing. There are also cases where fire is insufficient and blood cannot be generated—Zhang Zhongjing’s Zhi Gan Cao Tang uses Gui Zhi to invigorate the heart’s fire, and Ren Shen Yang Rong Tang uses Yuan Zhi and Rou Gui to strengthen the heart’s fire—both are methods to nourish fire and generate blood. For those with cold blood or blood stasis, using Gui Zhi, Xi Xin, Ai Ye, and Gan Jiang—medicines that receive fire energy to warm them—shows that treating fire is treating blood. Blood and fire are originally one family, so knowing this allows us to talk about regulating blood! Water, fire, qi, and blood are inherently interconnected, but they also depend on each other; therefore, water-related illnesses affect blood, and blood-related illnesses affect qi. If the water yin component of qi is insufficient, yang qi will overpower yin and dry up the blood; if the blood component of yin is insufficient, fluids will (3) The Kan trigram in the Book of Changes: "Yi" refers to the "Book of Changes," and Kan is one of the Eight Trigrams, represented by the symbol ☵, symbolizing water. The central line is a yang line, hence the saying "a yang is born in water." (4) The North: According to the Five Elements theory, the North belongs to water. (5) Dai Ze: meaning to receive favor. (6) Wei Ke: cough due to lung weakness. (7) Bing Xing Er Bu Bei: "Bèi" means to violate or contradict. "Bing Xing Bu Bei" means the two can coexist without conflict. (8) Chan Yan: meaning to observe and verify. (9) Tu Gao Mai Dong: In Wei Yingwu's poem "Poems from the West Study Room," there is a line that says, "Spring sunshine causes the earth's energy to stir, and the first dew begins to form." "Tu Gao Mai Dong" refers to the rising of the earth's vital energy. [Commentary] This article uses numerous clinical examples to illustrate the relationships among yin, yang, water, fire, qi, and blood in the human body. The author believes: "The two characters 'yin and yang' are essentially water and fire, and the two characters 'water and fire' are essentially qi and blood. Water transforms into qi, and fire transforms into blood." This idea reflects the "interdependent roots of yin and yang" theory in the "Inner Canon." Traditional Chinese medicine has many discussions on this topic, such as "qi is the commander of blood, and blood is the mother of qi," "excess qi becomes fire," and "blood follows qi." The author, however, focuses on the view that "water transforms into qi" and "fire transforms into blood," thereby further elucidating the dialectical relationship among qi, blood, water, and fire. He believes that water can transform into qi in the lower dantian near the navel, and qi, following the solar meridians, spreads outward to become defensive qi. Qi rises to the lungs to oversee respiration, and the functions of the five zang organs and six fu organs, as well as their mutual connections, all rely on qi for maintenance. Qi can also transform into water—for example, when qi reaches the skin, it can produce sweat; when qi rises to the lungs, it can generate bodily fluids; and when qi transforms downward, it can become urine—these all demonstrate this point. Qi and water not only mutually generate and depend on each other physiologically, but also causally influence each other pathologically. For instance, if solar qi fails to reach the surface, sweat cannot be produced externally; internally, bodily fluids cannot be generated, and phlegm and dampness accumulate. Similarly, if lung qi does not function properly, kidney turbidity cannot be reduced, leading to urinary retention, and if kidney yang is insufficient, it cannot control water, resulting in drinking and diarrhea. In terms of treatment, the author believes: "Qi and water are fundamentally one family, so treating qi is treating water." He cites examples such as ginseng tonifying qi and generating fluids, and Xiao Chai Hu Tang harmonizing stomach qi and facilitating bodily fluids, illustrating the clinical rule that qi and water can be treated together. In addition, the author provides examples of how water deficiency can lead to lung weakness (lung qi not being expressed) and blockages (kidney qi not descending and organ qi not flowing), as well as external heat (disharmony between nutritive qi and defensive qi), demonstrating that not only can qi-related illnesses lead to water-related illnesses, but water-related illnesses can also lead to qi-related illnesses. For qi-related illnesses caused by water, treatment should follow the principle of "treating water is treating qi." For example, Qing Zao Jiu Fei Tang generates fluids to tonify lung qi; Zhu Ling Tang drains water to treat phlegm and qi; and Du Qi Wan supplements water to benefit kidney qi. Continuing the discussion on the surgical perspective. In summary, the central idea of "On Yin and Yang, Water and Fire, Qi and Blood" is the product of combining the theory of Yin and Yang with clinical practice, further elaborating on the perspectives of the opposition and unity, as well as the waxing and waning and transformation of Yin and Yang. Through abundant clinical examples, the author reveals the dialectical relationships among Qi, blood, water, and fire, particularly providing an in-depth discussion on the mutual generation between Qi and water, and between blood and fire, thereby enriching the diagnostic content of traditional Chinese medicine in this regard.