1 Zhigan Tang with Additions

(1) Zhigan Tang with Additions

Dang Shen 10g, Gui Zhi 10g, A Jiao 10g (dissolved in water), Mai Dong 20g, Sheng Di 20g, Huo Ma Ren 20g (crushed), Sheng Jiang 6g, Da Zao 4 pieces, Dan Shen 30g, Ku Shen 30g. The herbs were decocted and taken as one dose per day.

This formula originates from the Shanghan Lun, where it is stated: “In cases of cold-induced illness, when the pulse is irregular and the heartbeat is rapid, Zhigan Tang is used.” A slow, rhythmic pause signifies “jie,” a rapid, rhythmic pause signifies “dong,” and a regular, steady rhythm indicates “dai.” This formula’s treatment scope encompasses various types of premature beats, double-beat rhythms, triple-beat rhythms, and atrioventricular escape beats. I added Dan Shen 30g and Ku Shen 30g to this formula, increasing the amounts of Sheng Di and Mai Dong to 20g each. Clinical efficacy greatly improved, surpassing many Western medications like Pulse Rate, Isoptin, and Bisoprolol.

(2) Zhuan Lü Tang: Da Zao 4 pieces, Chao Zao Ren 20g, Dan Shen 20g, Bei Sha Shen 20g, Dang Shen 20g, Hu Po 3g (mixed into water), Che Qian Zi 10g. The herbs were decocted and taken as one dose per day. This formula was commonly used by my father, Mr. Pei Shen. Its formulation is simple yet highly effective. My father believed that the three Dang Shen ingredients—Dang Shen, Sheng Di, and Gui Zhi—were the key components of the formula, while Chao Zao Ren and Hu Po were used as auxiliary herbs to calm the mind and soothe the heart. I have tried this formula clinically many times, and it has proven effective; sometimes, combining it with the previously mentioned Zhigan Tang yields even better results.

(3) Guo Zao Pu Dong Tang: Huang Qi 30g, Dang Gui 10g, Dang Shen 10g, Mai Dong 10g, Wu Wei Zi 6g, Dan Shen 20g, Zhi Ke 10g, Jue Jing 20g, Ku Shen 30g, Chi Shao 20g, Hong Hua 20g, Chuan Xiang 10g, Jiang Xiang 10g. The herbs were decocted and taken as one dose per day. This formula was developed based on the experiences of my late father, Mr. Huang Wen Dong, a renowned traditional Chinese medicine practitioner who was a student of Mr. Ding Gan Ren, a prominent figure in modern Chinese medicine, known for his expertise in cardiovascular and cerebrovascular diseases and widely recognized in Shanghai. He served as the Dean of Shanghai College of Traditional Chinese Medicine. The tea tree root was first developed by Mr. Huang. I often use this formula, especially for arrhythmias caused by coronary heart disease, where tea tree root has sedative, diuretic, hypotensive, and cardiotonic effects, making it a key ingredient in the formula.

The four formulas mentioned above can be combined or separated according to clinical diagnosis; you can also select the most effective herbs and formulate your own combination. For decades, these formulas have been used to treat various arrhythmias, and they have always provided satisfactory results.

My experience suggests that the four herbs—Dan Shen, Ku Shen, Sheng Di, and Mai Dong—should be used in larger quantities, ideally between 20–40g each. The amount of tea tree root should be between 20–100g, suitable for patients with elevated blood pressure and coronary heart disease. Additionally, the herbs Changshan and Yuan Hu are often used to treat arrhythmias, with dosages ranging from 8–15g. Recently, in an article published in the Chinese Journal of Traditional Chinese Medicine, dozens of scholars discussed the use of Ku Shen, and they unanimously agreed that Ku Shen is remarkably effective in regulating heart rhythm. Mr. Tang Yipeng from Anhui College of Traditional Chinese Medicine prepared a Ku Shen soup containing 50g each of Ku Shen and Sheng Di; Professor Wang Shujun from China Medical University noted that Ku Shen, Gui Zhi, and Xian Ling Mi are not only effective in treating arrhythmias but also excellent remedies for myocarditis and pericarditis; Dr. Xia Jiande from Wuxi Coal Mine Hospital’s Five-Ingredient Soup contained Bei Sha, Nan Sha, Dang Shen, Gui Zhi, Gan Jiang, Sheng Long Mu, Bai Zi Ren, and others, and was said to be highly effective in treating various arrhythmias; Dr. Yue Maoqing from Shanghai Malu Hospital used a Ku Shen-Fu Mai Tang, incorporating Ku Shen, Dan Shen, Xuan Shen, Gui Zhi, Mai Dong, and other herbs; Dr. Chen Nai Qing from Lianyungang Red Association achieved good results using Dan Shen and Ku Shen.

In summary, I have compiled the following treatment formulas for arrhythmias, primarily using Zhigan Tang, Sheng Mai San, Ku Shen, and other herbs such as Ku Shen, Sheng Di, Dan Shen, Changshan, Yuan Hu, and tea tree root, for readers’ reference in clinical practice.

(1) Basic Formula: Gui Zhi 10g, Dang Shen 10g, A Jiao 10g (dissolved in water), Sheng Di 20g, Dan Shen 30g, Ku Shen 30g, Mai Dong 20g, Changshan 15g, Zhigan Tang 20g, Sheng Jiang 4g, Da Zao 4 pieces. The herbs were decocted and taken as one dose per day.

(2) Adjustments: For coronary heart disease, add 10g of Chi Shao, 10g of Chuan Xiang, 10g of Hong Hua, 10g of Jiang Xiang, and 3g of Han San Qi (divided into doses); for hypertension, add 60g of Hua Niu Xi, 20g each of Sheng Long Mu and Sheng He Shi, 15g of Sheng He Shi, 15g of Sheng Bai Shao, 15g of Sheng Gui Ban, 10g of Shan Yao, and 6g of Huang Bo; for rheumatic heart disease, add 12g of Fu Ling, 10g of Bai Zhu, 6g of Fu Pi, 6g of Sheng Bai Shao, and 15g of Sheng He Shi; for pulmonary heart disease, add 10g of Ma Huang, 10g of Xing Ren, 30g of Sheng Shi; for severe chest pain, add 10g of Gua Lou, 10g of Xie Bai, 6g of Ban Jie Zi, and 10g of Shui Zhi (divided into doses); for severe shortness of breath, add 3g of Wu Wei Zi; for severe palpitations, add 15g of Sheng Long Mu each, 20g of Chao Zao Ren, and 20g of Bai Zi Ren; for poor sleep at night, add 30g of He Huan Pi and 30g of Ye Jiao Teng.

Further Discussion on Chronic Glomerulonephritis

Chronic glomerulonephritis is a common and frequently occurring disease, often affecting children and adolescents, with no significant difference in incidence between males and females. Most cases of chronic glomerulonephritis are direct consequences of untreated or improperly treated acute glomerulonephritis; however, a small number of cases do not have a history of acute illness. The full name of this disease is acute glomerulonephritis, as its pathological changes involve the deposition of antigen-antibody complexes in the basement membrane of the glomeruli. Over the past half-century, the classification and subtypes of chronic glomerulonephritis have undergone several changes: initially, it was divided into hypertensive type, nephritic type, and mixed type; later, within the nephritic type, those without elevated blood pressure, with severe edema, high triglyceride levels, and low calcium levels were classified as nephrotic syndrome; subsequently, cases with only a small amount of occult blood in the urine, without detectable albumin or a slight increase in β2-microglobulin in 24-hour urine were labeled as focal glomerulonephritis (or chronic glomerulonephritis with minimal lesions). In conclusion, with the advancement of medical science, our understanding of chronic glomerulonephritis has steadily grown, and new classifications and subtypes have emerged. In recent years, the incidence of "acute progressive glomerulonephritis" has increased year by year, and the number of patients with renal failure has also risen steadily. Our understanding of chronic glomerulonephritis is undergoing fundamental changes—autoimmune pathological changes play a crucial role in the onset of various glomerulonephritis subtypes. This is precisely where a fundamental transformation in the concept of glomerulonephritis treatment is brewing, and there is no doubt that this will help us overcome this long-standing challenge that has plagued human health.

Traditional Chinese medicine and herbal remedies regarding chronic glomerulonephritis are rooted in discussions related to conditions such as “edema,” “phlegm,” and “water qi.” I believe that Zhang Jingyue’s writings, drawing from the Inner Canon, the Golden Chamber Essentials, and the great achievements of ancient sages, provide valuable references for clinical treatment of chronic glomerulonephritis. Zhang stated: “Water is the ultimate yin, its origin lies in the kidneys; water transforms into qi, its manifestation lies in the lungs; water fears earth, its treatment lies in the spleen.” Zhang believed that the key to treating edema lies in strengthening the spleen and promoting water metabolism—methods such as Wuling San, Wupi Yin, Shili Yin, Linggui Zhigan, Zhenwu Tang, and Fuzi Tang rely on strengthening the spleen to promote water metabolism. Although the essence of water retention due to yang deficiency is kidney yang insufficiency, kidney yang relies on spleen yang to warm it, allowing yang to flourish and water to be controlled! Thus, spleen yang and kidney yang truly complement each other! This is precisely what is meant by “spleen-kidney yang deficiency” in traditional Chinese medicine. Through years of experience, I have found that patients with chronic glomerulonephritis who experience edema, along with dizziness, lower back pain, leg fatigue, cold hands and feet, and spontaneous sweating—symptoms of kidney yang deficiency—are often accompanied by facial puffiness, loss of appetite, fatigue, lack of energy, shortness of breath, and loose stools. These symptoms indicate that spleen yang deficiency is a common manifestation in chronic glomerulonephritis. Therefore, the use of Wupi and Wuling formulas in chronic glomerulonephritis is a valuable contribution to clinical practice.

When treating chronic glomerulonephritis, I typically employ the following five methods, which will be briefly described below.

1. Tonify Qi and Strengthen the Spleen

One of the key principles is that water fears earth; another is that the spleen governs the transportation and transformation of food and fluids. As the ancients said: “The stomach absorbs and transports substances, while the spleen distributes them through moisture.” When spleen qi is abundant, the qi of food and fluids flows smoothly throughout the body—this is what we mean by “spleen qi resides in the center and spreads to all directions.” In addition to Wuling San, Wupi Yin, and Linggui Zhigan, I often use the Ba Shan Si Jun Tang formula: 20g of Roasted Loquat Leaves, 10g of Yam, 20g of Goldthread, 10g of Dodder Seed, 20g of Euryale Seed, 20g of Cornus Fruit, 20g of Ligustrum Fruit, 20g of Blackberry Leaf, 10g of Codonopsis, 10g of Atractylodes, 12g of Poria, 6g of Licorice. The herbs were decocted and taken as one dose per day.

2. Warm Yang and Transform Water

Water is the ultimate yin, its origin lies in the kidneys; when kidney yang is deficient, water becomes stagnant! This is why water retention is often caused by yang deficiency. As the ancients said, “Strengthen the source of fire to dispel yin obstruction,” and based on this principle, formulas like Gui Fu Ba Wei, Ji Sheng Shen Qi, and Zhen Wu are all used to treat water retention. My experience shows that tonifying the kidneys and promoting water metabolism is most effective when patients exhibit obvious edema, low serum albumin levels, and persistent proteinuria in their urine. A commonly used formula is Fuzhi Tang: 12g of Sheng Di, 10g of Shan Yu, 10g of Yam, 10g of Dan Pi, 12g of Poria, 10g of Alisma, 10g of Gui Zhi, 6g of Fu Pi, 30g of Hua Niu Xi, 10g of Che Qian Zi, 20g of Su Geng, 10g of Chan Yi, 20g of Yimu Cao, 10g of A Jiao, 10g of Xue Yu Tan, all decocted and taken as one dose per day.

3. Activate Blood and Disperse Stasis

Over time, disease can penetrate the meridians; when meridians become congested, water channels become blocked, and water accumulates in the skin! Therefore, activating blood and dispersing stasis is a common method for treating edema. The “Yi Shen Tang” from the Shanxi Provincial Institute of Traditional Chinese Medicine combines activation of blood and stasis with clearing heat and detoxification; I have found it highly effective in clinical practice. This formula is particularly useful for chronic glomerulonephritis that repeatedly flares up and persists for a long time, especially when edema is pronounced. Adding to the formula:

10g of Dang Gui, 10g of Chi Shao, 6g of Chuan Xiang, 10g of Tao Ren, 6g of Hong Hua, 10g of Yimu Cao, 10g of Dan Shen, 20g of Yin Hua, 15g of Lian Qiao, 20g of Ban Lan Gen, 10g of Su Geng, 10g of Chan Yi, 6g of Yi Mu Cao. The herbs were decocted and taken as one dose per day.

4. Guide Water to the Plateaus

The lungs are the source of water; as the ancients said, “Drinking enters the stomach, flowing through the vital energy, ascending to the spleen, where spleen qi disperses the vital energy and sends it back to the lungs, where lung qi regulates and directs the flow downward to the bladder.” If lung qi does not ascend, kidney qi cannot descend; therefore, promoting lung qi is another common method for guiding kidney qi to facilitate water metabolism. This method has been valued by physicians throughout history for its effectiveness; some call it the “plateau water-guiding method,” others refer to it as the “lifting the pot and uncovering the lid” method, and still others have further developed theories such as “opening the gates of ghosts, purifying the residence,” “lung and kidney share the same origin,” and “metal and water generate each other.” The formulas I use in accordance with this method include Yue Bi Tang, Ma Xing Shi Gan Tang, and Ma Huang Fu Zi Xi Xin Tang.

Adding to Yue Bi Tang: 10g of Ma Huang, 30g of Sheng Shi, 10g of Xing Ren, 6g of Gan Jiang, 3g of Fan Xin, 6g of Fu Pi, 20g of Da Fu Pi, 20g of Hu Lu Pi, 10g of Che Qian Zi. The herbs were decocted and taken as one dose per day. This formula is particularly suitable for patients with acute or chronic glomerulonephritis who also experience external infections, or who suffer from pulmonary edema or heart failure.

5. Clear Heat and Promote Water Metabolism

Traditional Chinese medicine says that “fire rises upward,” while “water descends downward”; when dampness and heat combine, fire cannot rise upward, and water cannot descend downward, often remaining trapped in the bladder. As the ancients said, “Dampness and heat accumulate in the bladder, and when qi fails to transform them, urinary retention and edema result.” From a Western medical perspective, this is often seen as chronic glomerulonephritis complicated by infection, or as acute urinary tract infections combined with edema. When encountering this situation, I often use Long Dan Xie Gan Tang, which is highly effective.

Fuzhi Tang: 10g of Long Dan Cao, 10g of Shan Zhi, 10g of Chai Hu, 10g of Huang Qin, 12g of Hua Shi, 6g of Mu Tong, 6g of Gan Jiang, 12g of Sheng Di, 10g of Dang Gui, 12g of Poria, 10g of Ze Xie, 10g of Che Qian Zi, 20g of Qian Cao, 15g of Hu Zang, 15g of Ban Zhi Lian, 15g of Yin Hua, 15g of Lian Qiao. The herbs were decocted and taken as one dose per day.

These five approaches offer a general overview of the various aspects of chronic glomerulonephritis, but depending on the clinical diagnosis of chronic glomerulonephritis, additional adjustments can be made based on individual circumstances and symptoms.

1. For patients with obvious edema, regardless of whether the condition is characterized by cold, heat, or a combination of both, you can add Wuling San, Wupi Yin, Da Fu Pi, Hu Lu Pi, or Che Qian Zi.
2. For patients with hypertension, you can adjust the formula with Zhen Gan Xi Feng Tang, Jian Ling Tang, Qi Ju Di Huang, Zhen Wu Tang, and other formulas as appropriate.
3. For proteinuria, you can add Su Geng, Chan Yi, Euryale Seed, Cornus Fruit, Fish Herb, West River Willow, Yimu Cao, He Shou Wu, Dang Gui, Huang Qi, White Barley, White Cowpea, and other herbs.
4. For hematuria, you can add A Jiao, Xue Yu Tan, Sheng Di, Dang Gui, Shan Zhi, Dan Pi, Dan Shen, Large and Small Thistle, and White Cowpea.
5. For renal failure (with urea nitrogen levels higher than normal), you can use Shi Wei, Shui Zhi, Han San Qi, and other herbs.
6. For patients with abdominal pain, you can add Dan Shen, Mu Xiang, and Cao Kou.

In conclusion, although the treatment options for chronic glomerulonephritis are diverse and effective, when patients experience fever due to colds or infections, it is still necessary to combine Western medicine with penicillin injections—this drug is among the least toxic to the kidneys among many antibiotics.

Acute Guillain-Barré Syndrome

In the autumn of 2000 (Gengchen year), a 11-year-old boy from Wushan, Gansu Province, had previously suffered from hepatitis B. Later, he developed cirrhosis with ascites and splenomegaly. After being hospitalized, his ascites disappeared, his spleen returned to normal, and he continued taking traditional Chinese medicine for six months. His appetite increased, his spirits were good, his complexion improved, and his overall condition resembled that of a healthy person. One year later, one day he suddenly experienced difficulty walking in his lower limbs, unable to take steps. Soon after, he developed quadriplegia, with occasional muscle twitching in his facial muscles and abnormal facial expressions. When he came to our hospital for examination, the disease had already persisted for two months. His neurological reflexes—both superficial and deep—had disappeared, and his cerebrospinal fluid showed elevated protein levels with no evidence of cells. Diagnosis: Guillain-Barré Syndrome (GBS). After admission, treatment with hormones, vitamins, and immunomodulators did not yield satisfactory results. Consequently, he was treated with traditional Chinese medicine:

Fuzhi Tang: 10g of Dang Gui, 30g of Huang Qi, 6g of Chuan Xiang, 15g of Chi Shao, 12g of Sheng Di, 10g of Tao Ren, 6g of Hong Hua, 6g of Jiang Can, 6g of Quan Xie, 10g of Cao Kui, 20g of Xing Jin Cao, 20g of Qin Teng, 15g of Chuán Dùn, 10g of Huo Dùn, all decocted and taken as one dose per day. After taking the medicine for 10 doses, the boy was able to walk on his own, albeit with some unusual gait patterns. He could walk independently, without needing assistance from others. After discharge, he continued taking the medicine, and two months later, upon re-examination at our hospital, all symptoms had resolved, and his health returned to normal. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: Green–Barré syndrome is a demyelinating acute radiculitis. The disease occurs worldwide and is commonly seen in children and adolescents. In 1982, the incidence among urban populations in China was approximately one in ten thousand. The causes of this disease can be categorized into two major groups: infection and immunity. The aforementioned patients were originally suffering from chronic hepatitis B, which later progressed to cirrhosis with decompensation. Although they received inpatient treatment, their liver cirrhosis improved, and their hepatitis B also entered the stage of small three-positive, low viral load, with no viral replication; however, the factor of hepatitis B virus infection still remained. After the progression to liver cirrhosis, the patients’ immune function became weakened, leading to the development of immune factors that triggered the onset of the disease. Given this, the onset of this case perfectly aligns with the internationally recognized causes of the disease as currently understood.

This patient underwent traditional Chinese medicine and herbal treatments when Western medical therapies proved ineffective, ultimately achieving complete recovery. Traditional Chinese medicine records on this condition are not explicitly documented; overall, it falls under the category of wind syndromes—terms such as “stroke,” “wind-induced paralysis,” “withered and withered,” and “hemiplegia” all fall within this framework. Based on the principle that “to treat wind, first activate blood; once blood is activated, wind naturally dissipates,” I prescribed Taohong Siwu Tang, supplemented with wind-dispelling herbs like Jiangcan, Quanxie, and Wugong, and supported the treatment with herbs like Qinqiao, Chuan Duan, Shengjin Cao, Niu Xi, and Muguang, which yielded remarkable therapeutic effects.

Currently, there are no established Western medical treatments for this condition, nor are there any universally effective medications available. While traditional Chinese medicine has occasionally shown efficacy, I have recorded these experiences for future clinical reference by colleagues in the medical field.

Treatment of High Fever in Children

High fever in children is one of the most common clinical conditions. After decades of experience, I’ve found that traditional Chinese medicine offers a more convenient approach to treating this condition compared to Western medicine, and it holds certain potential benefits. Western antibiotics are indeed effective in treating high fever in children, as most cases are caused by upper respiratory tract infections. Tonsillitis, pharyngitis, acute bronchitis, pneumonia, otitis media, rhinitis, conjunctivitis, cervical lymphadenitis, mumps—all of these conditions are often accompanied by fever due to bacterial or viral infections. The clinical application of antibiotics truly ushered in a groundbreaking era in the treatment of these conditions. However, as the saying goes, “the higher the Dao, the greater the demon.” Even in the 1940s, when penicillin was first introduced into clinical practice, children’s high fevers—regardless of the underlying cause—could often be treated with 10,000 to 20,000 units administered intramuscularly, 1 to 3 times, and the fever would typically subside. Over time, the effective dosage increased, but even with doses reaching millions of units in recent years, the fever still failed to resolve. Consequently, researchers continued to push the boundaries of antibacterial drug development; over the past half-century, numerous antibacterial agents such as macrolides, aminoglycosides, cephalosporins, and quinolones were introduced. In recent years, bacteria and pathogenic microorganisms have developed a unique class of peptides known as beta-lactamases, which specifically target various antibacterial drugs, rendering them ineffective—and particularly evident in the resistance against penicillin and cephalosporins. To address this issue, researchers began adding beta-lactamase inhibitors like sulbactam and clavulanate to existing antibiotics in an effort to enhance their efficacy. While this led to higher drug costs, making it difficult for many working-class families and low-income individuals to afford treatment, the treatment of high fever in children often faced challenges: patients might remain unresponsive to long-term treatments, or the cost of medication could become prohibitively high, leaving some parents unable to continue using Western medicine.

After more than 40 years of clinical experience, I’ve found that traditional Chinese medicine offers advantages such as effectiveness, affordability, and convenience for treating high fever in children—making it suitable for children in rural areas, factories, mines, and grassroots communities. In some cases, the efficacy of traditional Chinese medicine surpasses that of Western medicine; of course, this is especially true for complex conditions such as autoimmune diseases, blood disorders, severe childhood lung infections, or acute rheumatic fever.

I believe that most cases of high fever in children are caused by upper respiratory tract infections.

Traditional Chinese medicine distinguishes between wind-cold and wind-heat syndromes: cold conditions can transform into heat, while heat can turn into cold—but both can also be accompanied by dampness. When dampness is present, the illness tends to linger for a long time, persisting despite treatment. This phenomenon is often referred to as “dampness is sticky and hard to eliminate quickly.” Wind-cold symptoms are similar to those of viral colds in modern medicine; at the onset, patients often experience nasal congestion, runny nose, cough, and sneezing, followed shortly by fever. Such fevers are usually resistant to antibiotics like penicillin and quinolones, though third-generation cephalosporins such as cefotaxime, ceftriaxone, and cefoperazone can sometimes help reduce fever. Traditional Chinese medicine often uses formulas like Mahuang Tang, Da Qinglong Tang, and Ma Xing Shi Gan Tang, incorporating herbs such as Daqingye, Banlan Gen, Koushan, and Ma Chi Xian, which frequently yield rapid results. Wind-heat symptoms are similar to those of tonsillitis, sinusitis, or bronchopneumonia in modern medicine; antibiotics are often effective in treating these conditions. However, because tonsil enlargement often requires long-term treatment, if the fever subsides and treatment is stopped, the condition may recur. Especially when children catch another upper respiratory tract infection, the fever often returns, and antibiotics become less effective over time—leading to antibiotic resistance and difficulty in reducing fever. Traditional Chinese medicine often employs formulas like Sangju Yin, Yinhui San, Wu Wei Xiao Du Yin, Bai Hu Tang, and Zhu Ye Shi Gao Tang; for patients with significantly enlarged tonsils, herbs like Yuanshen, Beimu, Mujishi, Sanling, and Ezhushi can be added. For patients with rhinitis or sinusitis, herbs like Cangrui Zi, Xin Yi, Chuan Xiong, Bai Zhi, Xi Xin, Fang Feng, and Qiang Du Hua can be used. For bronchopneumonia, herbs like Sang Bai Pi, Di Gu Pi, Ting Li Zi, and Da Zao can also be incorporated. From a Western medical perspective, prolonged illness often suggests rheumatic fever or similar conditions; however, traditional Chinese medicine views these cases as arising from the combination of wind-heat and dampness, and thus recommends formulas like Jiu Wei Qiang Huo Tang, Jing Fang Baidu San, or Qing Hao Bie Jia Tang.

Talking about Joint Pain

Joint pain is one of the most common clinical symptoms. Among my outpatient patients, approximately one in ten suffer from joint pain. Traditional Chinese medicine has a long history of diagnosing and treating joint pain, accumulating thousands of medicinal formulas over millennia—and hundreds of these formulas have proven effective in clinical practice. Yet modern medicine’s understanding of joint disorders has advanced significantly over the past century through continuous research and development—utilizing various imaging techniques, biochemical tests, and disease detection methods to reach new heights of knowledge, far beyond what traditional Chinese medicine could achieve. In my clinical practice, I’ve adopted the sixteen-character principle of “Western diagnosis, traditional Chinese medicine differentiation, traditional Chinese medicine as the primary treatment, Western medicine as a complementary therapy,” emphasizing Western diagnostic approaches to leverage the strengths of Western medicine while compensating for its weaknesses in traditional Chinese medicine. Now, let us discuss the identification of joint disorders, drawing on Western medical terminology and clinical symptoms to offer a brief overview, hoping to benefit fellow traditional Chinese medicine practitioners in the treatment of joint pain.

Joint disorders include rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, osteoarthritis, gouty arthritis, lupus-related arthritis, traumatic arthritis, and tuberculous arthritis. Let us focus on several common joint symptoms and explore my understanding of these joint conditions, aiming to facilitate accurate diagnosis and treatment of joint disorders.

I. Morning Stiffness

Morning stiffness refers to the condition where joints become stiff upon waking, causing varying degrees of difficulty in movement. Once the patient gets out of bed and moves around, the stiffness often resolves quickly. This symptom often indicates that the patient’s joint pain is associated with autoimmune joint disorders—such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (seropositive joint disease), lupus-related arthritis, or systemic sclerosis. Osteoarthritis typically does not present with morning stiffness; gouty arthritis and tuberculous arthritis rarely exhibit morning stiffness as well. For patients experiencing morning stiffness, Western medicine often finds relief quickly with hormones and immunosuppressants like methotrexate and cyclophosphamide. Traditional Chinese medicine, on the other hand, can treat these conditions with Gui Zhi Shao Ya Zhi Mu Tang combined with Ma Xing Yi Ren Gan Cao Tang, with added ingredients like Fuzi, which can be replaced with 15g each of Chuan Cao Wu and Chuan Cao Wu (soaked in water for 1 hour).

II. Relationship Between Pain and Movement

Pain that diminishes after activity often indicates autoimmune joint disorders such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, or lupus-related arthritis. Conversely, if pain persists or increases after movement, it may suggest osteoarthritis, traumatic arthritis, or mechanical joint disease (such as intervertebral disc herniation). The most pronounced increase in pain after movement is typically seen in traumatic or mechanical joint disorders, and the degree of pain is often much more severe than in osteoarthritis.

III. Relationship Between Joint Disorders and Age/Gender

Rheumatoid arthritis is most common among adolescent males and females; ankylosing spondylitis is more prevalent among adolescent males; systemic lupus erythematosus-related arthritis is often observed in adolescent females; while Reiter’s syndrome is more common among adolescent males. Osteoarthritis is a common condition among middle-aged and elderly women—it does not fall under the category of autoimmunity, so clinical diagnosis often lacks specific diagnostic markers. The full term for this condition is degenerative osteoarthritis, whose cause lies in metabolic and endocrine dysfunction in older adults. As gonadal function declines, the functions of the adrenal glands and parathyroid glands tend to become relatively hyperactive, leading to central obesity, bone demineralization, and elevated calcium levels in the blood—resulting in joint damage. X-ray findings in cases of degenerative osteoarthritis include: ① narrowing of the joint space, ② bone demineralization, and ③ enhanced calcification of bone tissue. These changes are particularly prominent in middle-aged and elderly women. Middle-aged men can also develop osteoarthritis, though it is relatively rare. Gouty arthritis is most commonly seen in middle-aged and elderly men, while young women are less likely to develop this condition—women during their reproductive years have high estrogen levels, which promote uric acid excretion, resulting in fewer cases of gout among women of childbearing age.

IV. Relationship Between Joint Disorders and Site of Onset

The joint disorder most commonly affecting the spinal joints is ankylosing spondylitis, also known as seronegative spondyloarthritis, as both the anti-rheumatic factor (anti–“O”) and the rheumatoid factor (RF) are negative. Beyond affecting the spinal joints, this condition can also impact the sacroiliac joints. Because the sacroiliac joints are non-movable and relatively fixed, their pain is often felt as a sense of heaviness or discomfort rather than intense pain, which may go unnoticed by patients. In fact, damage to the sacroiliac joints often persists throughout the entire course of ankylosing spondylitis. In clinical practice, in addition to taking X-rays of the spine in both lateral and frontal views, I also always perform sacroiliac X-rays. Only when both the sacroiliac X-rays are positive and the serological test is negative can this condition be accurately diagnosed.

Rheumatoid arthritis typically begins with the wrist and proximal finger joints; whereas osteoarthritis affects the distal finger joints. Because rheumatoid arthritis often starts with the wrists and proximal finger joints, these three joints are commonly referred to as the “target joints” of rheumatoid arthritis. The distal finger joints affected by osteoarthritis may even show nodular changes on the back of the skin.

If lesions in the elbow or shoulder joints occur on only one side, they are often considered periarthritis of the shoulder or tennis elbow; if lesions affect both sides, rheumatism or rheumatoid arthritis should be considered. If lesions affect the knees, ankles, or toes on both sides, rheumatism or rheumatoid arthritis should also be suspected. Middle-aged and elderly women may consider osteoarthritis instead of rheumatoid arthritis. Only lesions in the ankle or toe joints may indicate gout.

In addition, there are cases of systemic joint and tendon/muscle pain, which often show negative laboratory results; these conditions are often associated with fibromyalgia. Fibromyalgia is common among middle-aged and elderly women. Similar to fibromyalgia, the two conditions are often difficult to distinguish based on symptoms—another example is polymyalgia rheumatica, which frequently affects young women, with anti-rheumatic factor “O” often positive, and cardiac enzyme levels also frequently elevated.

Through these four perspectives, we can gain a deeper understanding of joint disorders and pay closer attention to patients during clinic visits. Rheumatoid arthritis and polymyalgia rheumatica can eventually lead to rheumatic heart disease; rheumatoid arthritis can result in joint deformities, limited mobility, and immune system failure, leading to multiple complications—and ultimately, loss of self-care ability, and even life-threatening conditions. Ankylosing spondylitis primarily affects workers’ capacity. Osteoarthritis and gouty arthritis are age-related conditions with long disease courses; the latter can eventually lead to renal failure and death.

For autoimmune joint disorders—such as rheumatism, rheumatoid arthritis, or lupus—hormones are often the first-line treatment. Ankylosing spondylitis and degenerative osteoarthritis are typically treated with nonsteroidal anti-inflammatory drugs like Indomethacin, Fenbid, Ibuprofen, Analgesic, and Naproxen, which can provide some relief from pain but do not offer a cure. Traditional Chinese medicine offers a variety of treatment options, with generally good overall efficacy. My personal experience shows that for joint pain related to immune mechanisms, Gui Zhi Shao Ya Zhi Mu Tang is the preferred formula, while Sang Zhi Tang is the secondary choice. The former warms yang and clears the channels to relieve pain, while the latter clears heat and clears the channels to relieve pain; the former’s main symptom is chills and cold pain, while the latter’s main symptom is heat and burning pain.

① Gui Zhi Shao Ya Zhi Mu Tang with additions: 10g Gui Zhi, 10g Bai Shao, 6g Gan Cao, 10g Zhi Mu, 6g Gan Cao, 12g Fang Feng, 10g Mahuang, 10g Bai Zhu, 15g Chuan Cao Wu (soaked in water for 1 hour), decocted and taken daily as one dose.

② Sang Zhi Tang with additions: 20g Sang Zhi, 20g Xu Yi Cao, 10g Wei Ling Xian, 20g Qiang Du Hua, 10g Fan Ji, 15g Qing Feng Teng, 15g Hai Feng Teng, 15g Qi Xue Teng, 10g Qinqiao, 1 piece of Ma Qian Zi (fried in oil), decocted and taken daily as one dose.

Additions and subtractions to both formulas: add 20g Xi Xin (soaked in water for 1 hour) for pain; add 30g Sheng Shi Gao for fever; add 20g Bei Xue, 20g Qi Xue Teng, 20g Che Qian Zi for joint swelling; add 10g Mahuang, 6g Xi Xin, 6g Fu Pian for cold sensitivity.

For osteoarthritis and ankylosing spondylitis, Tao Hong Si Wu Tang combined with Huo Luo Xiao Ling Dan is the preferred choice. Additions to Tao Hong Luo Tong Tang: 10g Dang Gui, 6g Chuan Xiong, 10g Chi Shao, 12g Sheng Di, 10g Tao Ren, 6g Hong Hua, 10g Dan Shen, 6g Zhi Mu, 3g Han San Qi (split and taken separately), 15g Chuan Cao Wu (soaked in water for 1 hour), 20g Xi Xin (soaked in water for 1 hour), 20g Jin Mao Gou Ji, decocted and taken daily as one dose. For significant lower back pain, add 15g Du Zhong, 10g Chuan Duan, 15g Chuan Niu Xi, 25g Sang Ji Sheng, 20g Sheng Yi Ren; for patients with sciatica, add 1 piece of Ma Qian Zi (fried in oil), 15g Qing Feng Teng, 15g Hai Feng Teng, 15g Qi Xue Teng, 15g Bai Shao, 6g Gan Cao; for patients with bone demineralization, add 20g Kai Wan, 15g Sheng Long Mu, 5g Wu Che Gu; for joint pain, whether related to autoimmunity or not, apply local hot compresses with herbal residue; additionally, acupuncture, massage, and guasha can also be employed.

For gouty arthritis, I usually adjust the formula according to the patient’s condition, finding it quite effective. Below, I share a formula for your reference: Gout Dispain Tang with additions: 6g Cang Zhu, 6g Huang Bo, 15g Qiang Du Hua, 15g Sang Ji Sheng, 20g Chi Xiao Dou, 10g Wan Can Sha, 30g Muguang, 20g Chou Wu Tong, 10g Han Fang Ji, 12g Tu Fu Ling, 10g Dan Shen, 20g Hu Zhang, 12g Fang Feng, 20g Zhi Mu, 15g Ren Dong, 10g Tao Ren, 10g Ze Lan, 6g Zhu Ru, 3g Xue Jie (split and taken separately), decocted and taken daily as one dose.

For lupus-related arthritis, treatment should be tailored to the overall condition of the patient. If liver and kidney function are not severely impaired, the following formula can be used:

Lupus Arthritis Soup: 10g Yin Yang Huo, 20g Qi Xue Teng, 10g Tu Si Zi, 10g Bai Shao, 15g Chuan Cao Wu (soaked in water for 1 hour), 10g A Jiao (melted and dissolved), 10g Gan Cao, 12g Yuan Shen, 10g Mai Dong, 10g Chuan Duan, 15g Bei Xue, 10g Gui Zhi, 20g Zhi Mu, 10g Mahuang, 20g Sheng Shi Gao, decocted and taken daily as one dose.

For systemic edema, add 20g Da Fu Pi, 15g Hu Lu Pi, 10g Che Qian Zi; for patients with high blood pressure, add 30g Huai Niu Xi, 15g Sheng Long Mu, 15g Sheng Gui Ban, 15g Sheng Bai Shao, 15g Sheng He Shi, 12g Sheng Di; for patients with fever, add 30g Sheng Shi Gao, 20g Zhi Mu, 15g Qing Hao, 15g Bie Jia, 12g Sheng Di, 6g Dan Pi; for patients with liver damage, add 30g Dan Shen, 30g Huang Qi, 10g Dang Gui, 15g Bai Shao, 10g Qin Tiao, 15g Ban Lan Gen; for patients with kidney damage, add 10g Shui Zhi (split and taken separately), 10g Da Huang, 6g Fu Pian, 30g Wu Che Gu, 20g Wu Che Gu Powder.

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Talking about Xi Xin

Modern pharmacological research has shown that Xi Xin possesses analgesic, anti-inflammatory, antitussive, bronchodilatory, cardiotonic, local anesthetic, and antispasmodic properties. Overall, its effects can be summarized into four key categories: ① antipyretic and analgesic, ② bacteriostatic and anti-inflammatory, ③ antitussive and bronchodilatory, ④ cardiotonic and rate-enhancing. The active ingredient in Xi Xin is methyl eugenol, while its toxic component is eugenol ether—this latter compound is highly volatile, and prolonged boiling will remove its toxicity, as the eugenol ether evaporates. There are currently 31 varieties of Xi Xin in China, including 4 variants and 1 subtype. The most authentic variety is Northern Xi Xin, which contains around 40% methyl eugenol; Southern Xi Xin can also be used, but its methyl eugenol content is far lower than that of Northern Xi Xin. Northern Xi Xin is the whole plant of the Aristolochiaceae family, specifically the Northern Xi Xin, characterized by multiple roots, a yellowish color, green leaves, a strong aroma, and a pungent taste. It is mainly produced in Northeastern provinces, though Shaanxi and Gansu also produce it—but its quality is somewhat inferior to that of products from Northeastern provinces.

After more than 40 years of clinical practice, I’ve found that Xi Xin is most effective in treating joint pain associated with rheumatoid or osteoarthritis—Xi Xin provides quick relief. Typically, the dosage ranges from 20 to 30g, and it’s essential to soak it in water for 1 hour before use. When combined with 15g of Chuan Cao Wu (also soaked in water for 1 hour), the therapeutic effect becomes even more satisfactory. I often use Gui Zhi Shao Ya Zhi Mu Tang as a base formula, incorporating Xi Xin and Chuan Cao Wu. I believe that Xi Xin’s analgesic effects surpass those of nonsteroidal anti-inflammatory drugs like ibuprofen, fenbid, indomethacin, and Yan Tong Xi Kang, and its long-term efficacy is unmatched—Xi Xin’s effects are both symptomatic and root-causing. Another condition I’ve used Xi Xin for is slow heart rhythm, with sinus node syndrome being the most effective treatment. This condition involves an impairment in the excitability of the sinoatrial node, partially losing the ability to conduct electrical signals up and down the heart, resulting in a heart rate of 30–50 beats per minute, sometimes reaching over 150 beats per minute due to abnormal electrical impulses. Therefore, this condition is also known as fast-slow syndrome. Although the heart rate may be fast or slow, sinus node syndrome is primarily characterized by a slower heart rate—thus, Xi Xin’s application can indeed address the root cause of the condition. For treating this condition, a dosage of 3–6g of Xi Xin is often paired with 10g of Mahuang and 6g of Fuzi, creating the famous Mahuang Fuzi Xi Xin Tang. Combining this with Tao Hong Si Wu Tang, adding 30g of Dan Shen, 30g of Koushan, 20g of Sheng Di, and 20g of Mai Dong, forms a specialized formula for treating sinus node syndrome, which has been effective for decades. Once the heart rhythm returns to normal, symptoms such as chest tightness, palpitations, and shortness of breath often subside.

Xi Xin’s ability to clear nasal passages is unparalleled by other herbs; this property can be used to treat headaches associated with chronic sinusitis, as well as headaches caused by cerebral arteriosclerosis. I often combine 3–6g of Xi Xin with Chuan Xiong, Jiu Wei Qiang Huo Tang, or Xuan Qi Tang, achieving a feeling of fullness and buoyancy. Some reports suggest that Xi Xin can treat erectile dysfunction; I once added 6g of Xi Xin to Gui Fu Ba Wei, successfully treating multiple patients: elderly individuals often feel cold and lack yang energy, and using Xi Xin in larger doses can alleviate symptoms of yang deficiency and significantly reduce the frequency of colds.

It is said that Hua Tuo, a renowned surgeon during the Three Kingdoms period, once used Xi Xin in combination with麻沸汤 to perform abdominal surgeries on his patients. Modern researchers have found that a 20–50% aqueous extract of Xi Xin can effectively induce block anesthesia, infiltration anesthesia, and surface anesthesia. Additionally, a 3% volatile oil of Xi Xin has been used as an injection, providing remarkable local anesthesia and block effects in otolaryngology and ophthalmology. The name “Xi Xin” comes from the fine, delicate roots of the plant, which have a very pungent taste—hence the name “Xi Xin.”

Looking at the Role of Aspirin Through the Eyes of Mahuang and Gui Zhi Tang

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Input: Aspirin is an ancient antipyretic and analgesic drug that has effects such as promoting sweating, releasing the exterior, clearing heat, and relieving pain; its effects are largely similar to those of traditional Chinese medicine formulas like Mahuang Tang and Gui Zhi Tang. In recent years, Western medicine has gradually deepened its understanding of aspirin, leading to many new perspectives based on experimental research. It was first recognized that the reason aspirin can clear heat and relieve pain lies primarily in its ability to inhibit the production of prostaglandins. When the body is stimulated by pathogenic factors or experiences local inflammation, tissues in the affected area immediately release prostaglandins. Prostaglandins can cause local vasodilation, leading to the infiltration of inflammatory cells and the infiltration of polymorphonuclear leukocytes; these pathological responses, in turn, increase the release of prostaglandins—hence, prostaglandins are also referred to as inflammatory mediators. Another important function of aspirin is its ability to inhibit platelet aggregation. Based on this mechanism, aspirin not only treats all thrombotic diseases but also helps treat coronary heart disease and myocardial infarction, with preventive effects even surpassing therapeutic effects. These mechanisms and clinical applications have greatly expanded the potential uses of aspirin, enabling this ancient drug to play new roles. This leads us to reflect: Mahuang Tang and Gui Zhi Tang, like aspirin, possess the effects of clearing heat, releasing the exterior, and relieving pain. Historically, Gui Zhi Tang was known as the “leader among all formulas,” helping to harmonize the exterior and interior, and to stabilize the internal organs. From this formula, there are now over forty different variations; in addition to Gui Zhi Jia Fuzi Tang and Gui Zhi Shao Yao Zhi Mu Tang, which are used for treating fever and pain, formulas like Ling Gui Shi Gan Tang, Xiao Jian Zhong, Da Jian Zhong, Fuzi Tang, and Zhen Wu Tang can all be used for treating coronary heart disease and heart failure. According to the Shanghan Lun: “If a patient experiences palpitations and restlessness after two or three days of cold exposure, Xiao Jian Zhong Tang is the appropriate choice.” “When there is fullness in the heart, qi rises to the chest, causing dizziness upon standing, with a pulse that is deep and tight; if one applies diaphoresis, it may trigger menstrual irregularities, leaving the body trembling and swaying…” “Fuzi Tang is the remedy for those who experience palpitations in the heart, dizziness, limb tremors, and a feeling of being lifted off the ground.” The records in these texts share similarities with the clinical manifestations of coronary heart disease and heart failure in modern medicine. For decades, I have often used Gui Zhi variations to treat various heart conditions and heart failure, and they have frequently proven effective. I have also found that using Gui Zhi Tang variations to treat lower limb thrombophlebitis has been highly effective. The variation of Mahuang Tang, Ma Xing Gan Shi Tang, is not only effective in treating lung infections but also consistently effective in treating pulmonary congestion caused by chronic heart failure. Its efficacy in treating conjunctival congestion and abnormal growths in the eyes has been particularly satisfactory. The variation of Yue Bi Tang, used to treat edema caused by heart failure, is truly remarkable—its ability to reduce swelling allows patients to regain a slender figure, earning it the name “Yue’s beautiful maid.” The variation of Yang He Tang is considered a sacred formula for treating all chronic carbuncles, boils, and abscesses; the underlying principle behind this formula is quite similar to the modern medical concept of aspirin inhibiting the production of prostaglandins (inflammatory mediators), thereby promoting the resolution of redness, heat, swelling, and pain associated with inflammation.

A Brief Discussion on Aconite-Based Medications

Aconite refers to the tuberous root of the Aconitum plant, commonly known as “Wutou” in China. The small roots that grow from the tuberous root are called “Fuzi,” while the tuberous root without Fuzi is referred to as Tianxiong. Aconite, Fuzi, and Tianxiong share the same flavor, the same properties, and the same points of entry into the body—but they differ slightly in potency! The Aconite grown in Sichuan is considered authentic Aconite, commonly known as Chuanwu; Aconite grown wild or cultivated in various regions is referred to as Cao Wu. Both Chuanwu and Cao Wu share the same properties—same flavor, same points of entry into the body—and their differences lie mainly in potency! All types of Aconite contain aconitine, and the toxicity of Aconite resides entirely in this alkaloid. It is generally believed that taking just 1.5 grams of raw Aconite powder can lead to poisoning; the effects of Cao Wu and Fuzi are slightly less potent than those of Aconite, and their toxicity is also slightly lower. Typically, if Aconite is decocted for more than an hour, its toxicity is significantly reduced, as aconitine loses its toxic effects when heated above 90°C. Based on over 40 years of experience using Chuanwu and Cao Wu, I have found that substituting 15 grams each of Chuanwu and Cao Wu for Fuzi in Gui Zhi Shao Yao Zhi Mu Tang provides remarkably strong pain-relieving effects when treating various rheumatic and rheumatoid joint disorders. However, both Chuanwu and Cao Wu must be decocted for at least an hour before being combined with other herbs for another 30 minutes—only then can we ensure safety. According to the Shanghan Lun: “When a patient with Sunan disease sweats excessively, and the condition persists despite sweating, with symptoms such as aversion to wind, difficulty urinating, slight stiffness in the limbs, and difficulty bending or stretching, Gui Zhi Jia Fuzi Tang is the appropriate treatment.” “For patients with Shaoyin disease who experience diarrhea, Bai Tong Tang is the chosen remedy.” “For Shaoyin disease… when the hands and feet are cold and clammy, the pulse is weak and nearly absent, and the patient feels a need to warm the body, then Fuzi Tang is the appropriate choice.” “After diarrhea, if the patient begins to sweat again, cannot sleep during the day, but remains calm at night… then Jiang Qiang Fuzi Tang is the remedy.” “For Shaoyin disease, if the patient has experienced symptoms for two or three days, with a comfortable mouth and coldness in the back, then Fuzi Tang is the appropriate treatment.” In summary, the clinical symptoms described in the texts—diarrhea, excessive sweating, coldness in the hands and feet, weak pulses, coldness in the back, inability to sleep during the day—represent clinical manifestations of autonomic nervous system dysfunction. The formulas used, such as Gui Zhi Jia Fuzi Tang, Bai Tong Tang, Tong Mai Si Ni Tang, Jiang Qiang Fuzi Tang, and Fuzi Tang, are all preparations derived from Aconite. The use of Aconite formulas to alleviate these symptoms aligns with the Chinese medicine concept of “warming the kidneys and strengthening yang.” What exactly is kidney yang in Chinese medicine? As early as the 1970s, scholars in Shanghai, including Shen Ziyun, conducted experimental studies that demonstrated that kidney yang in Chinese medicine refers to the functional systems of the hypothalamus, pituitary gland, and adrenal cortex. Modern experimental research has shown that raw Aconite can significantly reduce vitamin C levels in the adrenal glands of rats, increase the excretion of 17-hydroxy steroids in urine, and decrease the number of eosinophils in the blood. For some patients with adrenal cortical insufficiency, Aconite exhibits hormone-like effects on the adrenal cortex. Some believe that the manifestation of kidney yang and kidney yin is reflected through the autonomic nervous system; typically, kidney yang is achieved through sympathetic nervous system tension, while kidney yin is achieved through parasympathetic nervous system tension. The autonomic nervous system operates by relying on the functional states of the endocrine system and the immune system. Accordingly, the essence of Aconite-based remedies in regulating autonomic nervous system dysfunction lies in their role in modulating the body’s endocrine and immune systems. In the 1970s, I published a paper titled “Strengthening the Body and Consolidating the Foundation: Immunity,” which focused on the effects of tonifying the kidneys and warming yang on both specific and non-specific immunity. At that time, there were not many experimental studies available for reference, so the arguments presented were somewhat lacking in detail and still needed further confirmation through extensive future research.

Discussing Shaoyin Disease

According to the Shanghan Lun, “In Shaoyin disease, the pulse is weak and fine, yet the patient desires to sleep.” This is the overarching description of Shaoyin disease. The most prominent symptom of this condition is a weak, fine pulse accompanied by a desire to sleep. This condition is similar to peripheral circulatory failure in modern medicine. The Shanghan Lun states: “For Shaoyin disease, if the patient feels cold, curls up in a fetal position, and experiences loose stools, with cold hands and feet, then treatment is unnecessary.” “For Shaoyin disease, if the patient experiences four contractions, feels cold, curls up in a fetal position, has a weak pulse, and is restless but not overly agitated, then death is inevitable.” “If Shaoyin disease lasts for six or seven days, and the patient’s breathing becomes shallow, then death is inevitable.” “For Shaoyin disease, if the pulse is weak and fine, deep and slow, yet the patient desires to lie down, sweats without feeling agitated, and feels the urge to vomit, then death is inevitable.” These four passages illustrate that as peripheral circulatory failure worsens, symptoms such as curling up in a fetal position, loose stools, cold hands and feet, a weak pulse, sweating, shallow breathing, vomiting, restlessness, and a fever lasting five or six days indicate a severe condition requiring urgent treatment or death. Such patients had already reached a state of shock; shallow breathing is a sign of respiratory distress and respiratory failure, indicating that circulatory failure had led to respiratory failure. In ancient times, such patients were inevitably doomed. While the Shanghan Lun emphasized that severe shock could lead to death, it also clearly outlined signs of improvement and recovery—such as the possibility of treatment. For example, the Shanghan Lun states: “For Shaoyin disease with diarrhea, if the diarrhea stops on its own, the patient feels cold and curls up in a fetal position, with warm hands and feet, then treatment is possible.” “For Shaoyin disease, if the patient feels cold and curls up in a fetal position, occasionally feels restless, and wants to remove their clothing, then treatment is possible.” “For Shaoyin disease caused by wind, where the pulse is weak and fine, the pulse is floating, and the patient desires to recover.” “For Shaoyin disease, if the patient experiences vomiting and diarrhea, with hands and feet not cold but instead feeling hot, then death is not inevitable.” These passages emphasize that when symptoms such as “warm hands and feet,” “wanting to remove clothing,” “weak pulse with floating, floating pulse,” and “hands and feet not cold” appear, the disease can be treated or healed, and the patient can survive. From a modern medical perspective, these signs of recovery or treatment are merely external indicators of rising blood pressure and improved shock status—demonstrating how carefully ancient physicians observed and accurately diagnosed shock. Since Shaoyin disease is a group of conditions characterized by peripheral circulatory failure and shock, what causes this shock? Let us look at the Shanghan Lun’s discussion. The Shanghan Lun categorizes and discusses the various symptoms of Shaoyin disease, offering a large number of effective formulas for treating these conditions. The Shanghan Lun states: “For Shaoyin disease, when the patient experiences four contractions, sometimes coughing, sometimes palpitations, sometimes difficulty urinating, sometimes abdominal pain, or sometimes heavy, sluggish bowel movements, then Si Ni San is the appropriate remedy.” This indicates that respiratory, cardiovascular, urinary, digestive, and even dysentery-related conditions can all lead to Shaoyin disease characterized by cold extremities; in such cases, Si Ni San can be prescribed. The Shanghan Lun states: “For Shaoyin disease, if the patient experiences diarrhea, then Bai Tong Tang is the appropriate remedy.” “For Shaoyin disease, if the patient experiences diarrhea for six or seven days, with coughing, vomiting, thirst, and restlessness, then Zhu Ling Tang is the appropriate remedy.” “If the diarrhea continues, the patient experiences coldness in the extremities but no pulse, and experiences nausea and vomiting, then Bai Tong Jia Zhu Ling Tang is the appropriate remedy.” “For Shaoyin disease, if the patient experiences vomiting and diarrhea, with cold hands and feet and restlessness, then Wu Zhu Yu Tang is the appropriate remedy.” “For Shaoyin disease, if the patient experiences abdominal pain, difficulty urinating, and persistent diarrhea, with pus and blood in the stool, then Taohua Tang is the appropriate remedy.” “For Shaoyin disease, if the patient experiences diarrhea, sore throat, chest discomfort, and restlessness, then Zhu Fu Tang is the appropriate remedy.” All six passages discuss treatments for Shaoyin disease caused by diarrhea, proposing effective formulas such as Bai Tong Tang, Zhu Ling Tang, Bai Tong Jia Zhu Ling Tang, Wu Zhu Yu Tang, Taohua Tang, and Zhu Fu Tang. In ancient times, diarrhea was one of the most common ailments, encompassing toxic dysentery and various gastrointestinal infections. Due to the lack of effective antibacterial drugs and techniques for correcting electrolyte imbalances, the illness often progressed slowly, eventually leading to peripheral circulatory failure and even shock, putting patients in critical condition.

The Shanghan Lun states: “For Shaoyin disease, if the patient experiences dry mouth and a dry throat after two or three days, then rapid intervention with Da Cheng Qi Tang is necessary.” “For Shaoyin disease, if the patient experiences sore throat, then Ban Xia San Tang is the appropriate remedy.” “For Shaoyin disease, if the patient experiences sore throat after two or three days, then Ganshu Tang can be used; if the condition does not improve, then Jie Jing Tang can be used.” “For Shaoyin disease, if sores develop in the throat, making it difficult to speak or even to make sound, then Kuai Jiu Tang is the appropriate remedy.” All four passages discuss treatments for Shaoyin disease caused by dry mouth, sore throat, and sores in the throat, proposing effective formulas such as Da Cheng Qi, Ban Xia Tang, Ganshu Tang, Jie Jing Tang, and Kuai Jiu Tang. These passages highlight that febrile illnesses whose initial symptoms manifest as throat problems can also be significant contributors to peripheral circulatory failure and shock.

In conclusion, Shaoyin disease in the Shanghan Lun refers to conditions involving peripheral circulatory failure and shock. The diseases that cause this condition are broadly categorized as serious systemic illnesses affecting the respiratory, cardiovascular, gastrointestinal, acute abdominal, and urinary systems. The Shanghan Lun places particular emphasis on gastrointestinal disorders and acute febrile illnesses starting with throat pain, considering them the most important causes of Shaoyin disease. Modern medicine believes that diseases affecting any system in the body can lead to peripheral circulatory failure (and shock) in critical stages. Acute febrile illnesses—including acute infectious diseases—are more common causes of peripheral circulatory failure. While gastrointestinal disorders (including toxic dysentery) can lead to shock, advances in modern medical treatments—such as antibiotics, fluid infusion, and electrolyte replacement—have significantly improved survival rates. Therefore, the “death” and “untreatable” scenarios discussed in the Shanghan Lun can now be viewed relatively differently.

Traditional Chinese Medicine has extensively studied and explored the “Shaoyin disease” in classical prescriptions. Most practitioners believe that Shaoyin disease arises from deficiency-cold in the heart and kidneys, progressing toward yang depletion. Symptoms such as “weak, fine pulse,” “coldness in the hands and feet,” “chills and fever,” and “excessive sweating” all represent signs of yang depletion. Yang depletion signifies the breakdown of yin and yang; as stated in the Su Wen’s “Yin is peaceful, yang is secret, and spirit is governed,” and “When yin and yang are separated, essence and qi scatter,” Yang depletion is a sign of impending death—much like shock in modern medicine.

Traditional Chinese Medicine Treatments for Itching in the Genital Area

Genital itching is a common condition, often occurring in women, typically resulting from vulvar eczema, vulvar leukoplakia, trichomoniasis, candidiasis, vulvar pruritus, or pubic lice. In men, genital itching often originates from vulvar eczema and vulvar pruritus, though pubic lice are also a common cause—but they are less frequent in women.

When treating this condition, my primary focus is on relieving itching, aiming to first achieve relief from itching or to reduce its intensity. Simultaneously, I address the underlying cause of the condition with specialized treatments. Given that vulvar itching in women is often caused by trichomoniasis, candidiasis, or eczema, I have developed three special topical washes.

① Trichomoniasis Wash: Add 30g of Herba Lysimachiae, 10g of Alum, 30g of Fructus Psoraleae, and 30g of Fructus Mume to 4000ml of water, simmer until 2500ml is obtained, and use for sitz baths for 0.5 hours.

② Candidiasis Wash: Add 20g of Artemisiae Vulgaris, 30g of Garlic, 10g of Alum, and 30g of Herba Lysimachiae to 4000ml of water, simmer until 2000ml is obtained, and use for sitz baths for 0.5 hours.

③ Eczema Wash: Add 20g of Herba Lysimachiae, 30g of Radix Puerariae, 20g of Rehmannia Root, 20g of Herba Lysimachiae, 20g of Alum, and 20g of Pollen, grind into a fine powder, sift through a sieve, and soak in 300ml of 75% alcohol for 7 days. Apply the supernatant to the affected areas.

In addition to topical washes, for all genital itching conditions—regardless of the cause, whether in women, men, or children—patients can take the following formulas.

Yin Zhang Li Xiao Tang: Add 30g of Rehmannia Root, 12g of Herba Lysimachiae, 15g of Vineyard Grapevine, 15g of Plantago Seed, 15g of Radix Puerariae, 10g of Areca Nut, 6g of Licorice, 10g of Angelica Sinensis, 10g of White Peony, 10g of Atractylodes Macrocephala, and 10g of Phellodendron Amurense, decoct in water and take once daily.

These formulas are highly effective for treating genital itching. To aid memorization, I once created a mnemonic device to remember them: Yin Zhang Li Xiao Tang – “Land, Winter, Carriage, Bitter; Licorice, Four, Two, Areca.” “Four ingredients form the Four-Ingredient Decoction, two ingredients form the Wonderful Dispelling Decoction.” Over the past 40 years, I have used these methods to treat genital itching with great success. For patients with vulvar leukoplakia or pubic lice, the aforementioned methods only provide temporary relief from itching; for proper treatment, specialized care is required.

A Brief Discussion on Traditional Chinese Medicine Treatment for Epilepsy

In traditional Chinese medicine, epilepsy is often attributed to phlegm. When phlegm combines with wind, it is called “wind-phlegm”; when phlegm combines with fire, it is called “phlegm-fire.” Wind-phlegm and phlegm-fire can disturb the mind and harm the spirit, as fire tends to rise and wind tends to ascend to the head. Throughout history, traditional Chinese medicine formulas for treating epilepsy have generally focused on addressing wind, fire, and phlegm. Initially, I used Zhang’s Ding Xian Tang to treat this condition, composed of 30g of Blue Stone, 30g of Sea Floating Stone, 10g of Pinellia Ternata, 10g of Bupleurum Chinense, 10g of Agarwood, 10g of Two Black Beans, 20g of Corn Flour, along with 1000g of white flour. The mixture was fermented and formed into 20 white flour cakes, each taken 1–2 times daily. Over time, the treatment proved effective. Later, however, I discovered that this formula was only effective for certain patients—specifically adult males and patients without gastrointestinal issues—who could adhere to the treatment regimen. Because the cakes had a rather unusual taste, women, children, and individuals with poor gastrointestinal function often struggled to complete a full course, which significantly impacted the overall effectiveness of the treatment. In the 1980s, I began experimenting with the following six formulas, adjusting the composition according to the individual’s condition, and achieved good clinical results.

① San Chong Ding Xian Tang: Add 10g of Angelica Sinensis, 6g of Ligusticum Chuanxiong, 10g of Red Peony, 12g of Rehmannia Root, 10g of Peach Kernel, 6g of Safflower, 6g of Ginger Worm, 6g of Whole Scorpion, 1 Spider, 6g of Bupleurum Chinense, 6g of Pinellia Ternata, decoct in water and take once daily. This formula is suitable for the early stages of epilepsy, especially for pediatric patients.

② Huang Chan He Ji: Add 10g of Phellodendron Amurense, 30g of Albizia Bark, 30g of Polygonum Cuspidatum, 10g of Gastrodia Elata, 6g of Licorice, 6g of Rheum Rhabarbarum, 6g of Cicada Wing, 6g of Alum, 6g of Curcuma Longa, and 20g of Tea Leaves, decoct in water and take once daily. This formula is suitable for chronic epilepsy patients with longer intervals between seizures.

③ Zhi Xian San: Add 15g of Cold Stone, 15g of Purple Quartz, 20g of Red Stone, 20g of White Stone, 20g of Raw Gypsum, 20g of Raw Dragon and Oyster, 20g of Raw Hematite, 10g of Cinnamon Twig, 30g of Uncaria Rhynchophylla, 6g of Ginger, 20g of Talc, and 6g of Licorice, decoct in water and take once daily. This formula is a modified version of the Feng Yien Tang from the Golden Cabinet Classic, suitable for patients with epilepsy who frequently experience fever and also exhibit palpitations, chest tightness, and restlessness.

④ Bing Bo Ding Xian Tang: Add 0.1g of Camphor, 1g of Borax, 0.3g of Alum, 3g of Raw Hematite, 3g of Gold and Stone, grind into powder, take once daily, 2–3 times per day. This formula is suitable for patients with frequent epileptic seizures.

⑤ Hei Bai Er Chong Wan: Add 100g of Black and White Two Black Beans, 100g of Acorus Calamus, 100g of White Pepper, and 80g of Skinned Silkworm Pupae (roasted and dried), grind into powder, mix with honey to form pills, 6g per pill, take 2–3 times daily with warm water.

⑥ Kang Xian Wan: Add 100g of Angelica Sinensis, 100g of Ligusticum Chuanxiong, 100g of Red Peony, 120g of Rehmannia Root, 100g of Peach Kernel, 60g of Safflower, 60g of Ginger Worm, 60g of Whole Scorpion, 10 Spider, 100g of Two Black Beans, 100g of Acorus Calamus, 20g of Owl Brain Substance (roasted and dried), 100g of White Pepper, grind into powder, sift through a fine sieve, mix with honey to form pills, 6g per pill, take 2–3 times daily with boiling water. This formula is suitable for severe epileptic seizures when all other treatments have failed.

All six formulas can be selected based on clinical diagnosis and individual needs. I believe that the treatment of epilepsy requires a clear diagnosis from Western medicine. Cranial CT and MRI scans are the best options for diagnosing central nervous system disorders. After excluding space-occupying lesions and organic or inflammatory lesions in the nervous system, this type of epilepsy can be classified as primary epilepsy or functional epilepsy. Primary or functional epilepsy is a suitable indication for traditional Chinese medicine treatment. The six formulas listed above are effective for treating primary epilepsy. If a cranial lesion is confirmed—such as tumors, parasites, traumatic brain injuries, hemorrhages, etc.—then treatment should focus on addressing the underlying cause through Western medicine, surgery, gamma knife therapy, radiofrequency treatment, or laser therapy.

Among traditional Chinese medicines for treating epilepsy, five categories stand out:

① Insect-based remedies: Ginger Worm, Whole Scorpion, Spider, Skinned Silkworm Pupae.

② Blood-activating remedies: Four-Ingredient Decoction, Peach Kernel, Safflower, Leech.

③ Phlegm-clearing remedies: Pinellia Ternata, Bupleurum Chinense, Two Black Beans, Acorus Calamus.

④ Gold and Stone remedies: Red Stone, White Stone, Raw Gypsum, Purple Quartz, Raw Dragon and Oyster, Borax, Alum, Camphor, Ice Flake, Gold and Stone.

⑤ Owl Brain Substance: This substance has proven highly effective in treating epilepsy. To use it: Roast owl brain substance and grind it into powder with other herbs, mix with honey to form pills, take 2–3 times daily, with each pill weighing 6–7g (see Kang Xian Wan for details).

Clinical Cases of Soft Tissue Tumors

Soft tissue tumors refer to malignant tumors that originate in soft tissues. These tumors are often highly differentiated, which is why they are generally insensitive to radiation and chemotherapy. Rhabdomyosarcoma, leiomyosarcoma, fibrosarcoma, neurofibroma, and liposarcoma all fall into this category. Western medicine typically recommends surgery as the first-line treatment, with preoperative radiation or chemotherapy sometimes used in conjunction. I have encountered numerous cases of such tumors, and I have achieved satisfactory results through simple herbal treatment.

In the spring of 2000 (Gengchen year), Wang Mou, a 24-year-old woman from Hexi, developed a lump in her left buttock that was about the size of a fist. After surgical removal by Western medicine, a biopsy confirmed rhabdomyosarcoma. Two years later, the tumor recurred, and a new mass measuring 7cm × 4cm appeared beneath the original incision, causing mild pain and limited movement in the same side of her lower limb. After local radiation therapy, the tumor only showed slight shrinkage, but the patient’s lower limb mobility did not improve. She sought treatment from me. Her pulse was deep, fine, and tense, with a red tongue coated in a light yellowish greasy coating. Her face appeared pale and fatigued, with loss of appetite and general weakness. Her condition was characterized by both qi and blood deficiency, damp-heat stagnation, and qi stagnation with blood stasis.

I prescribed Fufang Zicao Dan: 60g of Red Grass, 20g of Two Flowers, 20g of Perilla Leaf, 15g of Strengthening Herb, 10g of Codonopsis, 10g of Atractylodes Macrocephala, 20g of Astragalus, 10g of Achyranthes Bidentata, 20g of Houttuynia Cordata, 20g of Prunella Vulgaris, 20g of Summer Savory, 20g of Hypericum, 20g of Dandelion, 6g of Coptis Chinensis, 6g of Ledebouriella Divaricata, 6g of Platycodon Grandiflorus, 10g of Triangular Root, 10g of Curcumella, decoct in water and take once daily.

Additionally, I prescribed a topical formula: Wu Wei He Ji: 100g of Five-Flavor Berry, 60g of Radix Rehmannia, 60g of Euphorbia, 30g of Hematite, 20g of Perilla Leaf, 60g of Coptis Chinensis, 6g of Musk, 100g of Summer Savory, 100g of Aconitum, 3g of Frankincense, mix together, apply the powder to the affected area with diluted vinegar. Half a month later, the patient returned for a follow-up visit. They reported having taken 10 doses of the prescribed medication and applied the Wuwei Compound externally, changing the dressing once daily. The swelling had significantly reduced, the left hip and left lower limb no longer caused pain, and the patient’s gait had returned to normal. The physician advised continuing with the same treatment regimen for another month. One month later, the patient came for a check-up; the local swelling had completely resolved, leaving only scar tissue along the edges of the original surgical incision. The external application was discontinued, while the oral formulation was adjusted to include Gynostemma pentaphyllum and Bidens pilosa, with the addition of 10g of leeches. The entire formula was doubled in quantity compared to the original dosage, ground into powder, mixed with honey to form pills weighing 6g each. The patient took 1 pill twice daily, with warm water after meals. Six months later, follow-up examinations showed no recurrence.

Since then, the author has used this formula and similar approaches to treat numerous soft tissue tumors—whether following surgery or after chemotherapy and radiation therapy—and has achieved certain therapeutic results. In practice, the author has found that the purple root in Zicao Dan is the core component of the entire formula. This herb is the dried root of a perennial herbaceous plant from the Boraginaceae family, primarily produced in Xinjiang and Inner Mongolia, and it is considered authentic when sourced from these regions. Traditionally, this herb is used as a primary remedy for cooling blood, detoxifying, and inducing sweating. Some individuals have utilized its oil extract to treat burns, eczema, cervical inflammation, and other conditions. The author believes that taking this herb internally has a notable effect in softening and consolidating tissues; when combined with Herba Lysimachiae, Herba Euphorbiae, and other herbs, the therapeutic efficacy is particularly enhanced.

Discussion on Stomach Pain

The area between the navel and the xiphoid process is commonly referred to as the “stomach region,” and pain in this area is often termed “stomach pain.” Stomach pain can be caused by a variety of diseases. After more than 40 years of clinical experience, the author believes that the most common cause is chronic gastritis. Following this, in order of prevalence, are peptic ulcer disease, cholecystitis (gallstones), pancreatitis, reflux esophagitis, gastric mucosal prolapse, and duodenal diverticulitis. From an overall perspective, traditional Chinese medicine’s treatment of stomach pain offers certain advantages over Western medicine, primarily through flexible syndrome differentiation and a wealth of traditional formulas and single herbs. The author believes that before conducting specific syndrome differentiation, it is essential to first clearly distinguish between the aforementioned Western medical conditions—first performing a Western medical diagnosis. Only after a clear Western medical diagnosis can one proceed with traditional Chinese medicine syndrome differentiation and treatment, which leads to more accurate diagnoses and relatively improved therapeutic outcomes. The Japanese advocate for abdominal palpation, which aims to pinpoint the exact location of the pain, and this practice also carries a certain significance in integrating traditional Chinese and Western medicine. Here, I will summarize the key characteristics of the primary diseases causing stomach pain, and then, based on the principle of syndrome differentiation and treatment, propose effective formulas. These are merely personal experiences; any inaccuracies are welcome to be corrected by fellow practitioners.

I. Chronic Gastritis

Historically, gastritis was classified into three types: superficial, hypertrophic, and atrophic. Recently, experts have discovered that these three pathological changes often coexist within a single stomach. Atrophic gastritis is the most common type, as it is characterized by the most widespread pathological manifestations. Therefore, it is generally referred to as atrophic gastritis. Among those with superficial lesions, some are classified as superficial gastritis. Atrophic gastritis can also be divided into two types based on the presence or absence of gastric parietal cell antibodies: Type A and Type B. Type A shows positive gastric parietal cell antibodies, with the primary lesion located in the body of the stomach. Because the body of the stomach serves as the primary functional area of the digestive system, patients with this type often experience significant digestive dysfunction and increased gastric acid secretion, particularly affecting the absorption of B vitamins, leading to anemia. The infiltration of gastric parietal cells is predominantly lymphocytic, resulting in relatively mild local inflammation. Additionally, since the stomach cavity is relatively large, allergens are relatively diluted, making local pain less pronounced. In summary, this type is characterized by systemic deficiency and feelings of fullness in the stomach region, along with disturbances in digestion and absorption. Patients with this type often present with a thick, plump tongue, a thin white coating, and a deep, fine pulse. From a traditional Chinese medicine perspective, this condition typically reflects spleen and stomach qi deficiency, as well as dampness stagnation in the middle burner. Treatment should focus on tonifying qi and strengthening the spleen, regulating qi and drying dampness; formulas such as Xiangsha Liu Junzi Tang, Liangfu Wan, Da Xiao Jian Zhong Tang, and Lizhong Tang can be used, with additions like calcined waler, raw Longmu, and cuttlebone to enhance effectiveness.

Type B shows negative gastric parietal cell antibodies, with most lesions concentrated in the antrum. Because the body of the stomach is healthy and digestive function is largely normal, patients’ overall condition is often better than in Type A. However, the infiltration of gastric parietal cells in Type B is most frequently composed of neutrophils, resulting in prominent local inflammation. Moreover, the antrum is the anterior portion of the pylorus, where food and liquids pass before entering the pylorus. Due to gastric peristalsis, local irritation often occurs, increasing local pain. In summary, patients with this type generally enjoy good overall health, with little evidence of deficiency-related symptoms, though stomach pain is often more pronounced. Red tongues with yellowish greasy coatings are the most common tongue signs, and patients with a wiry, rapid pulse are also common. Traditional Chinese medicine often identifies this condition as damp-heat in the middle burner, with qi stagnation and blood stasis; treatment focuses on clearing heat and drying dampness, regulating qi and activating blood circulation. Formulas such as Banxia Xiexin Tang, Huanglian Tang, Sanhuang Xiexin Tang, Huanglian Jiedu Tang, Qingwei San, Dandan Yin, and 204 Stomach Medicines (Xiangfu, Yuanhu, Mingfang, Calcined Waler) are often used.

The pathology of superficial gastritis is similar to that of atrophic gastritis; because the condition is relatively mild, clinical treatment often follows the above-mentioned therapeutic approaches.

II. Peptic Ulcer Disease

Peptic ulcers include gastric ulcers and duodenal bulb ulcers, with some patients experiencing both conditions simultaneously. Unlike chronic gastritis, ulcers in this condition appear as ulcerative lesions in the gastric mucosa, accompanied by increased gastric acid production. Clinical symptoms mainly include pain in the upper abdomen and acid reflux. The pain points of gastric ulcers are located approximately one-third below the xiphoid process, slightly to the left; the pain points of duodenal ulcers are located about one-third below the xiphoid process, slightly to the right. In terms of pain intensity, duodenal ulcers are more severe than gastric ulcers. Both conditions are closely related to dietary habits, with pain typically subsiding after eating. For gastric ulcers, pain begins 1 hour after eating and lasts for 2 hours before resolving on its own; for duodenal ulcers, pain begins 2 hours after eating and continues until the next meal—a characteristic feature of duodenal ulcers. Beyond pain, acid reflux, belching, and abdominal distension are also common symptoms in both conditions.

Given that this condition often presents with acid reflux, belching, and abdominal pain, traditional Chinese medicine often treats it based on spleen and stomach deficiency-cold. Furthermore, since both conditions are characterized by pain, traditional Chinese medicine views this as a case where cold causes contraction and obstruction—pain arises when things are blocked, and when things are blocked, pain follows. Ancient physicians believed that deficiency-cold was the primary treatment approach; however, in recent years, Western medicine has identified Helicobacter pylori as a major cause of this condition. After some patients responded effectively to antibiotics such as Lactobacillus and tetracycline, colleagues in the traditional Chinese medicine community quickly adopted formulas like Xiexin, Sanhuang, and Qingwei for clinical use, achieving satisfactory results. Based on my experience, the principles, methods, formulas, and medications for treating this condition should be similar to those used for chronic gastritis—but it is crucial to incorporate larger doses of herbal remedies that help reduce gastric acid production, such as raw Longmu, cuttlebone, and calcined waler. The Left Gold Pill, formulated with a 3:1 ratio of Coptis chinensis to Evodia rutaecarpa, is a powerful anti-acid agent in traditional Chinese medicine. Originally composed of six parts Coptis chinensis and one part Evodia rutaecarpa, my clinical experience has shown that a 3:1 ratio is the optimal choice.

Both chronic gastritis and peptic ulcer disease can lead to persistent stomach pain. When the aforementioned syndrome-specific formulas prove ineffective, patients often exhibit bruising on their tongues, with a majority of pulses that are slippery, rapid, and even astringent. Traditional Chinese medicine interprets this as “chronic illness has entered the network,” and it is necessary to employ formulas that promote blood circulation and resolve blood stasis for effective treatment. According to Western fiberoptic gastroscopy, many cases of stomach pain due to duodenal bulb ulcers are actually duodenal ulcers that are deeply infiltrated, with extensive mucosal erosion. If atrophic gastritis is present, these ulcers often involve intestinal metaplasia or atypical hyperplasia. Through my experience, I have frequently found that the following formulas have been effective for such stomach pain.

Compound Danshen Formula: 10g of Dang Gui, 15g of Bai Shao, 6g of Chuan Xiong, 20g of Huang Qi, 6g of Liang Jiang, 6g each of Zhi Ru Mo and Zhuang Rong, 10g of Danshen, 6g of Tan Xiang, 6g of Sha Ren, 6g of Xiang Fu, 10g of Yuan Hu, 20g of Calcined Waler, 3g of Ming Fang, decocted and taken once daily.

Another formula can also achieve therapeutic effects: Compound Chishi Sa Powder: 200g of Ji Nei Jin, 200g of Wuer Ge, 200g of Bai Shao, 100g of Sheng Cao, 200g of Han San Qi, 200g of Chishi Sa, 100g of Xiang Yuan, 100g of Danshen, 60g of Mu Xiang, 100g of Cao Kou, ground into powder, sifted, and taken 6g each time, twice daily with warm water.

III. Cholecystitis (Gallstones)

Cholecystitis and gallstones often occur together, with the latter frequently being a contributing factor to the former. Approximately one-fifth of patients experience pain in the upper abdomen, but beyond the pain located slightly higher than the stomach and duodenum—often just below the xiphoid process—the pain is often accompanied by right subcostal pain radiating to the right shoulder and back; some patients may only experience pain in the right back. Gallbladder pain is often exacerbated by consuming fatty foods or meat and eggs. Most patients can be diagnosed via ultrasound; however, a small number of patients do not show any signs of inflammatory changes in the bile ducts or gallstones on ultrasound. Such cases of cholecystitis are often misdiagnosed. I frequently encounter patients who suffer from long-term right-back pain, despite trying various treatments without success—ultrasound reveals no signs of biliary or pancreatic disease, yet the patients respond well to liver- and gallbladder-activating medications.

Traditional Chinese medicine has excellent therapeutic effects for cholecystitis and gallstones, often using the basic principle of “evil resides in the Shaoyang meridian, with damp-heat in the liver and gallbladder,” supplemented by formulas that regulate qi, activate blood circulation, and relieve pain. My preferred formula is the Compound Xiaochaihu Tang. Its composition includes: 10g of Chai Hu, 10g of Huang Qin, 6g of Ban Xia, 10g of Dang Shen, 6g of Gan Cao, 10g of Da Huang, 3g of Huang Lian, 10g of Danshen, 10g of Mu Xiang, 6g of Cao Kou, 10g of Yuan Hu, 20g of Chuan Lian Zi, 6g each of Zhi Ru Mo and Zhuang Rong, 30g of Qian Shi, 20g of Hu Zhang, 15g of Ban Zhi Lian, 15g of Zhi Shi, 10g of Bai Zhu, decocted and taken once daily. For shoulder and back pain, add 10g of Qiang Du Hu and 12g of Fang Feng; for constipation, add 10g of Mang Xiao (dissolved in warm water); for high fever, add 30g of Sheng Shi Yang, 10g of Zhi Mu; for loss of appetite, add 10g each of Jiao San Xian; for abdominal distension, add 10g of Hou Pu; for left flank pain, add 10g of Chuan Jiao and 6g of Gan Jiang; for severe stomach pain, add 6g of Ban Xia.

IV. Pancreatitis

Among patients experiencing stomach pain, approximately one-fifth are suffering from pancreatitis. The pancreatic duct and bile duct share a common opening that leads into the duodenum; therefore, roughly half of patients with cholecystitis also develop pancreatitis—meaning that pancreatitis often occurs alongside cholecystitis. The pancreas is a long, horizontal structure located beneath the stomach and above the transverse colon. Due to the extensive air content in the stomach and transverse colon, pancreatic inflammation can easily be misdiagnosed on imaging studies. Diagnosis relies primarily on measuring serum amylase and urinary amylase levels; however, 3 to 7 days after the onset of pancreatitis, these test indicators often return to normal. Thus, pancreatitis is often difficult to diagnose during the acute phase, and most cases of chronic pancreatitis are misdiagnosed—especially when patients also suffer from chronic gastritis or gastric and duodenal ulcers. Some patients have long treated their condition as gastric issues, which severely impacts their recovery.

In my view, patients with stomach pain accompanied by left flank pain, radiating to the left back and waist, should mostly be treated for pancreatitis; if they also experience pain in both flanks, it is likely a combination of pancreatic and biliary disorders. This condition often worsens after consuming fatty foods or high-protein diets. Patients with a history of gallbladder disease or biliary surgery are at higher risk of developing this condition. The syndrome differentiation for this condition generally involves liver qi stagnation, damp-heat in the liver and gallbladder, and qi stagnation with blood stasis; treatment should focus on soothing the liver and resolving depression, clearing fire and drying dampness, and regulating qi and activating blood circulation. Formulas such as the Compound Chai Hu Shu Gan San (also known as the Bile-Pancreas Syndrome Formula) can be used: 10g of Chai Hu, 10g of Zhi Shi, 15g of Bai Shao, 6g of Gan Cao, 6g of Chuan Xiong, 6g of Xiang Fu, 10g of Danshen, 10g of Mu Xiang, 6g of Cao Kou, 10g of Yuan Hu, 20g of Chuan Lian Zi, 6g each of Zhi Ru Mo and Zhuang Rong, 6g of Chuan Jiao, 6g of Gan Jiang, decocted and taken once daily. For severe pain, add 20g of Hong Teng, 20g of Gong Ying, and 20g of Baishang; for constipation, add 10g of Mang Xiao (dissolved in warm water); for back pain, add 15g of Qiang Hu and 12g of Fang Feng; for nausea and vomiting, add 6g of Ban Xia and 20g of Sheng He Shi; for loose stools, reduce the amount of Da Huang to 3g; for severe diarrhea, add Fuzi; for loss of appetite, add Jiao San Xian; for abdominal distension, add 10g of Hou Pu and 10g of Chao Lai Fu Zi.

V. Bile Reflux Gastritis (Esophagitis)

Normal bile flows from the common bile duct into the duodenum, then moves through the duodenum and into the jejunum along with gastric contents. However, when gastrointestinal function is disrupted—or when there are problems with gastrointestinal and pancreatic endocrine function—bile can flow back into the stomach and the lower esophagus, stimulating increased gastric acid production and causing congestion, edema, and ulcers in the gastric and esophageal mucosa. Clinically, there are three main characteristics: ① burning pain in the upper abdomen or lower chest; ② nausea and vomiting, with bile present in vomitus; ③ acid reflux. Esophageal reflux pain often radiates downward from the xiphoid process toward the chest.

What factors cause bile reflux? There are three possible causes: ① post-gastric surgery (gastric resection or gastric bypass); ② chronic gastritis or ulcers; ③ autonomic nervous system disorders of the gastrointestinal tract. Western medicine often uses H₂ blockers to reduce gastric acid production—such as Meclozine, Ranitidine, Losec, and Omeprazole; additionally, medications that increase gastric emptying, like Gastrodin and Motilium, are used. Overall, these treatments are only symptomatic therapies.

Traditional Chinese medicine views this condition as arising from liver wood overcoming earth, stomach qi rising upward, and stomach fire being excessive; treatment should focus on soothing the liver and stomach, lowering rebellious qi, and clearing fire and drying dampness. Formulas such as Si Ni San, Xiao Yao San, Xuan Fu Dai He, Ban Xia Xie Xin, and Xiao Xian Xiong can be used with modifications. My preferred formula often yields remarkable results in clinical practice.

Stomach An San Yi Tang: 10g of Chai Hu, 10g of Zhi Shi, 15g of Bai Shao, 6g of Gan Cao, 10g of Danshen, 3g of Mu Xiang, 3g of Cao Kou, 10g of Huang Lian, 3g of Wu Yu, 10g of Gua Lou, 6g of Ban Xia, 15g of Sheng He Shi, 6g of Chuan Xiong, 6g of Xiang Fu, 10g of Shan Zhi, 6g of Cang Zhu, 6g of Shen Qu, decocted and taken once daily. For chest tightness, add 6g of Hou Pu and 10g of Zhi Shi; for severe stomach pain, add 10g of Huang Qin, 6g of Gan Jiang, 10g of Yuan Hu, 15g of Calcined Waler, 3g of Ming Fang; for constipation, add 6g of Da Huang; for difficulty swallowing, add 10g of Zhe Bei Mu, 10g of San Ling, 10g of E Jiu; for red tongue with bruising, add 10g of Tao Ren and 3g of Hong Hua.

VI. Gastric Mucosal Prolapse

This condition is not uncommon; clinically, it is often misdiagnosed. It occurs when the mucosa in the pyloric region separates from the muscular layer and protrudes into the duodenum. X-ray barium imaging often reveals a central filling defect in the duodenum as the primary diagnostic finding. The muscular layer in the pyloric region is abnormally thickened, forming a rigid pyloric sphincter that controls the flow of gastric contents into the duodenum. Because the tension and relaxation of the sphincter change too frequently, the attached mucosa is prone to separation. The detached mucosa bulges outward and, with gastric peristalsis, enters the duodenal lumen; in severe cases, it can even reach the bulb. These changes lead to three main complications: ① obstruction, ② bleeding, and ③ mucosal congestion, edema, erosion, and ulcers. The primary symptom is pain in the upper abdomen, usually beginning 0.5 hours after eating. The pain is more intense than in chronic gastritis or peptic ulcers, often accompanied by nausea and vomiting. Some patients experience obvious abdominal distension due to pyloric obstruction, even making it difficult to swallow food or fluids. Bleeding is often minor, with occult blood in stool and black stools being more common; massive vomiting is rare. Western medicine once recommended surgery for this condition, but in recent years scholars have raised objections. Today, it is generally believed that, except for cases of severe prolapse causing obvious pyloric obstruction, routine treatment is best managed conservatively by internal medicine. Based on my experience, I use the following formula with modifications: 10g of Wu Ya, 3g of Chen Xiang, 10g of Bin Lang, 6g of Gan Cao, 6g of Xiang Fu, 6g of Chuan Xiong, 10g of Shan Zhi, 6g of Cang Zhu, 10g of Shen Qu, 10g of Ma Huang, 6g of Chen Pi, 6g of Jiang Chong, 6g of Gan Jiang, 6g of Bai Zhi, 3g of Xi Xin, 20g of Jie Bing, 10g of Danshen, 6g of Mu Xiang, 6g of Cao Kou, 6g of Da Huang, 10g of Zhi Shi, 6g of Hou Pu, decocted and taken once daily. This condition often involves pyloric obstruction; when taking medication, it is advisable to take smaller doses multiple times, mixing the first and second decoctions and dividing them into five doses throughout the day, each dose around 100ml.

VII. Duodenal Diverticula

These diverticula are pouch-like expansions or protrusions of the stomach and duodenum walls. In the entire digestive tract, these diverticula account for 10%–20% of cases (autopsy data). Because duodenal diverticula are prone to inflammation and associated symptoms, they are often given attention. Most cases are congenital; gastric diverticula are less common, while duodenal diverticula are more frequent. Symptoms only appear when the diverticula become inflamed—typically presenting as upper abdominal pain, nausea, vomiting, weight loss, and in some cases, diarrhea. Symptoms often subside at night and worsen during the day, and changes in body position can sometimes alleviate the pain. If diverticulitis persists for a long time, it can lead to local bleeding, ulcers, adhesions, gangrene, abscesses, or even perforation; occasionally, it can also progress to cancer. Depending on the location of the diverticulum, jaundice may occur (in cases of ampullary diverticula), along with pancreatitis or duodenal obstruction. Given this, duodenal diverticulitis can sometimes cause severe pain, leading to a high rate of misdiagnosis. Diagnosing this condition is often challenging in Western medicine; diverticula are difficult to locate during surgery, making surgical procedures complicated and causing surgeons to hesitate. Traditional Chinese medicine often employs formulas that promote blood circulation, resolve blood stasis, clear heat and detoxify, and regulate qi to relieve pain; formulas such as Yiren Fuzi Baisang Tang, Dandan Yin, Chai Hu Shu Gan San, and Wuma Heji can be used with modifications. My clinical experience has shown that the following formulas are effective.

① Wuma Jin Gan Wan: 40乌梅 (pitted), 20 Ma Qian Zi (fried in oil), 20 Yu Jin, 3g of Gan Qi, 20 Fire Nitrate, 20 Ming Fang, 100g of Xian He Cao, 100g of Zhi Ke, 30g of Cao Kou, 30g of Mu Xiang, 100g of Danshen, 200g of Sheng Yi Ren, 200g of Baisang, 100g of Fuzi, ground into powder, sifted, and taken 5g each time, twice daily with warm water.

② Compound Chai Hu Tang: 10g of Chai Hu, 10g of Zhi Shi, 10g of Bai Shao, 6g of Gan Cao, 10g of San Ling, 10g of E Jiu, 10g of Wu Yu, 10g of Wu Ya, 10g of Pu Huang, 10g of Wu Ling, 3g of Ma Huang, 6g of Chen Pi, 6g of Jiang Chong, 6g of Gan Jiang, 6g of Bai Zhi, 3g of Xi Xin, 20g of Jie Bing, 10g of Danshen, 6g of Mu Xiang, 6g of Cao Kou, 6g of Da Huang, 10g of Zhi Shi, 6g of Hou Pu, decocted and taken once daily.

All of these conditions can cause pain in the upper abdomen; different conditions may occur individually or in combination with two or three other conditions. Therefore, when a patient experiences upper abdominal pain, doctors must conduct a comprehensive analysis and weigh the appropriate medications—considering which should come first, which should come later, and which should be prioritized. The choice of medication depends on how the formula is adjusted and modified, as well as the direct therapeutic efficacy of the formula.

In addition to the seven conditions mentioned above, other causes of upper abdominal pain include gastric perforation, gastric cancer, liver diseases (hepatitis, liver abscess, liver cysts, liver echinococcosis), and other lower digestive tract disorders that can trigger reactive changes in the stomach. Gastric perforation often occurs as a complication of gastric ulcers and other gastric conditions; the condition is acute and severe, rapidly leading to peritoneal irritation symptoms, requiring immediate surgical intervention. Gastric cancer should also be treated early with surgical intervention; during post-surgical chemotherapy, traditional Chinese medicine can be used in conjunction, helping to alleviate some of the toxic side effects of chemotherapy. Liver disease treatment should also focus on addressing the root cause—such as surgery for liver echinococcosis, liver protection with traditional Chinese medicine for hepatitis, antibiotic treatment for liver abscesses, and, when necessary, surgical drainage.

A Brief Discussion on Gui Zhi Shao Cao Zhi Mu Tang

This formula appears in the “Middle Wind · Joint Pain” section of the Golden Chamber Essentials, where it is stated: “For all joint pains, frailty of the body, swelling of the feet as if they were detached, dizziness, shortness of breath, a feeling of warmth and nausea, Gui Zhi Shao Cao Zhi Mu Tang is the primary remedy.” Throughout history, physicians have often used this formula with modifications to treat various joint disorders, often achieving remarkable results. The formula is designed to dispel wind, eliminate dampness, disperse cold, and relieve pain. My experience has shown that this formula is highly effective in treating rheumatoid arthritis, osteoarthritis, osteoarthropathy, ankylosing spondylitis, and other conditions. Based on my experience, replacing the Aconite with 15g of Strychnos seeds increases the therapeutic efficacy dramatically! Strychnos seeds are native to Sichuan Province, where they are cultivated; while Strychnos seeds are cultivated elsewhere, their properties and effects are similar, and when combined, they complement each other, enhancing their therapeutic benefits. The active ingredients in these two herbs are strychnine alkaloids, including strychnine and bradykinin, which are highly toxic; however, heating them to over 90°C for 1 hour can completely destroy the toxic components while preserving the active ingredients. Given this, when using Strychnos seeds, it is essential to first simmer them for 1 hour. Adding 20g of Asarum sieboldii to Gui Zhi Shao Cao Zhi Mu Tang incorporates the spirit of the Ma Huang, Aconite, and Asarum formula, significantly enhancing the effects of Strychnos seeds—but the amount of Asarum should be carefully controlled, as it contains a high concentration of eugenol, a toxic compound that can be completely destroyed at temperatures above 90°C. Therefore, Asarum and Strychnos seeds must also be simmered for 1 hour before safe use. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: This formula, in addition to being effective for treating the aforementioned arthritis, has also proven effective in treating lupus erythematosus based on its main symptoms as described in "Jinkui." In particular, for patients who have been taking hormones for a long time and are highly dependent on them, it is often difficult to discontinue the medication temporarily. However, after using Gui Zhi Shao Cao Zhi Mu Tang, the hormone can be gradually reduced, leading to further relief of the patient's pain. Upon reflection, I realized that rheumatoid arthritis is a connective tissue disease, now referred to as an autoimmune disorder; in fact, it may be classified as type III hypersensitivity, where antigen-antibody complexes bind and deposit, triggering a series of reactions. Consequently, I expanded the application of this formula to include scleroderma, Sjögren’s syndrome, Raynaud’s disease, subacute thyroiditis, nephrotic syndrome, dermatomyositis, and other conditions—most of which showed certain therapeutic effects. Through practice, I discovered that this formula possesses a notable immune-regulatory effect. Some patients, before and after using this formula, carefully monitored various immune indicators such as IgM, IgG, IgA, CD3, CD4, and CD8, finding significant improvements in all of these parameters, which confirmed the formula’s immune-regulatory properties.

The composition of Gui Zhi Shao Cao Zhi Mu Tang is exceptionally well-balanced; although the formula is named Gui Zhi Shao Cao Zhi Mu, Aconite actually serves as the primary ingredient. Aconite (Aconitum) is known as “a source of fire to dispel yin obstruction,” embodying the principle of “clearing the jade-like sky, purifying ten thousand miles of dust.” This is because type III hypersensitivity involves repeated battles between antigens and antibodies, ultimately leading to the accumulation of deposits—yin obstructions and dust particles. Gui Zhi promotes yang energy, allowing yang qi to flow freely both internally and externally; Bai Shao calms yin, preventing the subtle qi from being consumed by the flow of yang energy; Zhi Mu prevents the pungent heat of Aconite from damaging yin. Together, these three herbs work in harmony around Aconite, each fulfilling its own role, ensuring that Aconite clears the obstructions and sweeps away the dust—and when placed at the beginning of the formula’s name, they truly act as the chief guardians, keeping the master hidden within the inner sanctum while commanding victory from afar. Ma Huang opens the skin pores to welcome sunlight; Bai Zhu nourishes the middle burner, Gan Jiang warms the middle burner, and Gan Cao harmonizes the middle burner—all three herbs aim to strengthen the spleen and stomach, ensuring that Aconite’s forces move smoothly without obstruction.

Discussion on Hypertension

Hypertension refers to what Western medicine calls primary hypertension. This condition is commonly prevalent among middle-aged and elderly individuals, often accompanied by varying degrees of arterial sclerosis. High blood lipids, high blood viscosity, and high uric acid levels frequently coexist with hypertension, collectively known as the “four highs” of old age. Recently, academic circles have begun to include hyperglycemia (diabetes) among the four highs, prompting some scholars to suggest calling it “metabolic syndrome of middle and old age.” The World Health Organization is currently considering whether to adopt this new term.

Traditional Chinese Medicine has long recognized hypertension. As stated in the “Suwen: Adjusting the Circulation,” “When blood and qi travel upward together, they lead to severe collapse.” In the 1930s, Zhang Xichun, drawing from this passage, believed that the “severe collapse” mentioned in the Suwen represented a critical condition of hypertensive cerebral congestion. He argued that the primary approach to treating hypertension should be to promote blood circulation and lower blood pressure. Among many medicinal ingredients, Zhang chose Huai Niu Xi, believing it to be a powerful herb for promoting blood flow downward. From this choice, he developed “Zhen Gan Xi Feng Tang,” pioneering the use of traditional Chinese medicine for lowering blood pressure. Huai Niu Xi is the rootstock of a plant belonging to the Amaranthaceae family, and throughout history, traditional herbalists have long praised it for its ability to activate blood circulation and remove blood stasis. During the Ming Dynasty, Zhang Jingyue noted that it “draws fire downward,” creating the Yu Nu Jian specifically for treating toothache. Folklore even says that the stems and nodes of Huai Niu Xi swell like the knees of a cow—this resemblance to the same Qi makes it effective for treating joint pain in the lower limbs. Traditional Chinese Medicine generally understands hypertension as arising from yin deficiency and yang excess, with yang excess giving rise to wind. Therefore, treatments often focus on nourishing water and calming wood, or calming the liver and suppressing yang. Classic formulas used for this purpose include Zuo Gui Yin, Da Bu Yin Wan, and Qi Ju Di Huang Wan. Pu Fuzhou, with his unique insight, went against conventional practices and adopted a method of warming yang and transforming water to treat hypertension. His primary formula, Zhen Wu Tang with additions, yielded unexpected therapeutic results in clinical practice. Wang Qingren, meanwhile, employed a method of activating blood circulation and removing blood stasis, developing the Xue Fu Zhu Yu Tang to treat similar conditions—a path that was entirely new. Wang’s approach not only proved effective in treating hypertension but also addressed numerous issues associated with hypertension, including arterial sclerosis of the brain and coronary artery disease. In the 20th century, a collaborative research group in Beijing, while studying coronary heart disease, created “Coronary Heart No. II” (Chishao, Chuanxiong, Honghua, Jiangxiang, Danshen), which achieved remarkable therapeutic results and caused a sensation nationwide. Later, this formula was refined into Compound Danshen Tablets, a widely distributed remedy both domestically and internationally. Subsequently, Compound Danshen Drops were developed, becoming among the first formulations approved by the U.S. Food and Drug Administration.

Chinese patent medicines, now available worldwide, have not only made tremendous contributions to the treatment of hypertension and arterial sclerosis but have also generated substantial foreign exchange earnings for China each year, paving the way for the global adoption of traditional Chinese medicine. Drawing on the insights of various schools of thought, and after more than 40 years of experience, I propose the following approaches:

① Activating Blood Circulation and Removing Blood Stasis: This is a fundamental approach to treating hypertension, often referred to as “to treat wind, first activate blood—when blood is active, wind naturally disappears.” The development of hypertension often proceeds in tandem with arterial vascular hardening. When observing the pulse of hypertensive patients, I often find that a strong, tight, and firm pulse is characteristic, and the degree of tension, tightness, and hardness can serve as a reference point for assessing the severity of hypertension. The origin of these characteristics lies in arterial hardening—but though these indicators are not as precise as modern medical measurements such as blood lipids, blood viscosity, Doppler ultrasound, or blood flow imaging, they still offer valuable insights as a development and extension of traditional Chinese medicine’s pulse diagnosis. Hardened vessels indicate blood stasis; therefore, activating blood circulation and removing blood stasis is considered the correct approach. I believe that Taohong Siwu Tang is the preferred formula for activating blood circulation and removing blood stasis. This formula is supplemented with 60g of Gou Teng, and combined with Huang Lian Jie Du Tang to form the following formula: Dang Gui 10g, Chuan Xiong 6g, Chi Shao 10g, Sheng Di 12g, Tao Ren 10g, Hong Hua 6g, Gou Teng 60g, Huang Lian 3g, Huang Qin 6g, Huang Bo 6g, Shan Zhi 10g. The herbs are decocted in water and taken once daily. This formula is highly effective for early-stage hypertension; for patients with poor gastrointestinal function, 3g of Mu Xiang and 3g of Cao Kou may be added as appropriate.

② Nourishing Yin and Tonifying Kidneys: The dizziness, tinnitus, lower back pain, leg fatigue, bone dryness, five internal heat sensations, and night sweats often experienced by hypertensive patients are primarily due to kidney yin deficiency. In most cases, the pulse of hypertensive patients is characterized by a tight, long, and forceful pulse, while the radial pulse is relatively weak—this is also a sign of kidney deficiency. For early-stage hypertension, adopting a formula that nourishes yin and tonifies kidneys can often achieve satisfactory results. While I believe that the “kidney” in traditional Chinese medicine differs significantly from the “kidney” in Western medicine, there are commonalities in the pathogenesis of hypertension. Western medicine suggests that under certain conditions, the kidneys release renin, which then converts angiotensin I into angiotensin II. Angiotensin II directly causes contraction of small arteries throughout the body, leading to increased blood pressure. Can nourishing yin and tonifying kidneys influence the process of renin → angiotensin I → angiotensin II? While experimental studies are still needed to prove this, nourishing yin and tonifying kidneys in traditional Chinese medicine does indeed help reduce blood pressure and alleviate systemic symptoms in early-stage hypertension—this is a fact I have experienced in clinical practice. I believe that Liu Wei Di Huang Tang is the preferred formula for nourishing yin and tonifying kidneys, composed of Goji Berries, Chrysanthemum Flowers, Zhi Mu, Huang Bo, and other ingredients: Sheng Di 12g, Shan Yu 10g, Shan Yao 10g, Dan Pi 6g, Fu Ling 12g, Ze Xie 10g, Goji Berries 10g, Chrysanthemum Flowers 10g, Zhi Mu 10g, Huang Bo 10g, Xian Mao 10g, Yin Yang Huo 10g, Ba Ji Tian 10g, Dang Gui 10g. The herbs are decocted in water and taken once daily. This formula, like the previously mentioned formula for activating blood circulation and removing blood stasis, is effective for treating early-stage hypertension; it is particularly suitable for patients with obvious kidney deficiency. The aforementioned formula for activating blood circulation and removing blood stasis, however, is better suited for patients with less pronounced kidney deficiency. For lower back pain, add 15g of Du Zhong, 30g of Huai Niu Xi, 6g of Chuan Duan, and 15g of Sang Ji Sheng; for headaches, add 10g of Gan He Ye, 20g of Gou Teng, 10g of Tian Ma, 6g of Bai Zhi, 3g of Xi Xin, 15g of Qiang Du Huo.

③ Calming the Liver and Suppressing Wind: In mid- and late-stage hypertension, blood pressure remains consistently high. Not only do patients exhibit kidney yin deficiency, but yin deficiency can also lead to yang excess, which in turn gives rise to wind. At this stage, patients may experience headaches, restlessness, numbness in the hands and feet, and in some cases, facial asymmetry or hemiplegia. From a Western medical perspective, this type of hypertension is often accompanied by arterial sclerosis of the brain, cerebral infarction, and brain atrophy, yet blood pressure continues to remain elevated. Zhang Xichun’s Zhen Gan Xi Feng Tang and Jian Li Tang were originally designed as the preferred formulas for this type of hypertension. Given the prominent neurological symptoms associated with this condition, the formula can be supplemented with blood-activating herbs such as Chi Shao, Chuan Xiong, Hong Hua, Jiang Xiang, and Danshen, forming the following formula: Huai Niu Xi 60g, Sheng Gui Ban 15g, Sheng Jue Shi 15g, Sheng Bai Shao 15g, Sheng Long Mu 15g, Yuan Shen 15g, Tian Dong 15g, Chuan Lian Zi 20g, Sheng Mai Ya 10g, Yin Chen 10g, Gan Cao 6g, Chi Shao 10g, Chuan Xiong 10g, Hong Hua 6g, Jiang Xiang 6g, Danshen 20g. The herbs are decocted in water and taken once daily. For patients with severe headaches, add 6g of Bai Zhi, 3g of Xi Xin, 15g of Qiang Du Huo, and 12g of Fang Feng; for facial asymmetry, add 6g of Jiang Chong, 6g of Quan Xie, and 1 worm of Wugong; for hemiplegia, add 6g of Shui Zhi (for oral administration) and 3g of Han San Qi (for oral administration).

④ Clearing Heat and Discharging Fire: Whether in the early, middle, or late stages of hypertension, patients often experience fever and excessive heat. This is because yin deficiency leads to yang excess, and yang excess gives rise to wind—when wind and fire combine, heat becomes overwhelming. Patients often present with red eyes, flushed face, dry throat, a yellowish, greasy tongue coating, and constipated stools. Herbs such as Huang Lian, Huang Qin, Huang Bo, and Shan Zhi can be used in these cases. I often employ formulas like Ban Xia Xie Xin Tang, Huang Lian Jie Du Tang, Gan Lu Xiao Dan, Bai Hu Tang, and Zhu Ye Shi Gao Tang, adjusting the formulas according to the patient’s condition and observing their responses. These formulas have yielded excellent results. Below is a list of formulas: Sheng Shi Gao 30g, Mai Dong 10g, Fang Feng 12g, Chrysanthemum Flowers 15g, Huang Lian 3g, Huang Qin 10g, Huang Bo 6g, Shan Zhi 10g, Zhi Mu 10g, Ban Xia 6g, Chen Pi 6g, Fu Ling 12g, Danshen 20g, Gou Ding 30g. The herbs are decocted in water and taken once daily. This formula combines Huang Lian Jie Du Tang with Bai Hu Tang; the two Chen Tang formulas aim to strengthen the spleen and stomach to prevent cold and bitter herbs from harming the stomach. Mai Dong nourishes yin, Fang Feng and Gou Ding dispel wind, and Danshen activates blood circulation—these formulas are particularly effective for patients with hypertension experiencing heat and fire. From a Western medical perspective, patients with this type of hypertension often suffer from significant autonomic nervous system disorders, with sympathetic nerve excitation dominating; they may also experience chronic pharyngitis, chronic prostatitis, chronic gastritis, chronic cholecystitis, or chronic oral inflammation. Throughout my career as a physician, I’ve learned that patients with hypertension are especially prone to these inflammatory conditions. The interplay of the “five highs”—hypertension, high blood viscosity, high blood lipids, high uric acid, and high blood sugar—lowers the immune system of hypertensive patients, making it essential to clear heat and discharge fire.

In addition to these four methods, for patients whose blood pressure remains persistently high despite trying multiple medications, I also often use Pu Fuzhou’s Zhen Wu Tang with additions. Although Aconite is the primary ingredient in this formula, it is designed to warm yang and promote water metabolism; when yin deficiency reaches extreme levels, solitary yang cannot arise, and adding a small amount of yang-tonifying herbs can help restore yin fluids. Modern diuretics are also used to lower blood pressure—this is a common practice in hypertension treatment.

Discussion on Aplastic Anemia

Aplastic anemia is often referred to as “recovery anemia,” a condition characterized by impaired hematopoietic function in the bone marrow, resulting in a reduction of all three blood cell lineages. Currently, the exact cause of aplastic anemia remains unclear, though many researchers believe it is linked to autoimmune mechanisms. Western medicine has studied aplastic anemia for over 100 years; although significant progress has been made in treatment, research on hematopoietic growth factors—such as interleukin, macrophage colonies, and erythropoietin—has provided theoretical foundations for understanding the pathology and treatment of aplastic anemia, laying the groundwork for eventually developing effective therapies. Traditional Chinese Medicine has also shown remarkable efficacy in treating aplastic anemia. I have treated aplastic anemia patients for decades, with over a hundred cases treated. My overall experience is that traditional Chinese medicine and herbal remedies not only extend the survival time of patients with aplastic anemia but can also completely cure some patients. Among the aplastic anemia patients I have treated, approximately 12 have been fully cured after follow-up and analysis. This information was compiled and published by my students in the “Chinese Medicine Correspondence Newsletter” (2000.4). Here, I will briefly describe two patients who were cured in the past two years.

Case 1: Ms. Wang, female, 60 years old, with a reduction in all three blood cell lineages. Her hemoglobin had dropped to 20 g/L, her platelet count was 16 × 10⁹/L, and her white blood cell count was 1.2 × 10⁹/L. Bone marrow biopsy confirmed aplastic anemia. Western medical treatment did not yield significant results; for one year since onset, she relied solely on blood transfusions to sustain her life. When I first saw her, her face was pale and yellowish, her appetite was poor, she felt fatigued, lacked energy, her heart rate was 100 beats per minute, she had shortness of breath, and her palpitations and dyspnea worsened with minimal movement. Her six pulses were tense and rapid, her tongue was pale with a white coating. Prescription: Dang Gui 10g, Chi Shao 10g, Sheng Di 12g, Xian He Cao 15g, Tu Da Huang 15g, He Shou Wu 15g, Han Lian Cao 10g, Jiu Xue Teng 20g, Hong Hua 6g, Hei Dou 20g, Shan Yu 6g, Yuan Rou 10g, Ma Qian Zi 1 piece (fried), Tu Si Zi 10g, Nu Zhen Zi 10g, Gu Zi 10g, Da Yun 10g, Lu Rong 3g (divided into two portions), Shui Zhi 10g (divided into two portions). The herbs were decocted in water and taken once daily. After seven doses, she reported slight relief from palpitations and general discomfort, and she continued to take an additional 30 doses on her own. Two months later, her spirits improved significantly, her face began to regain color. Her hemoglobin level rose to 68 g/L, her white blood cell count was 2.4 × 10⁹/L, with 24% neutrophils, 66% lymphocytes, 10% monocytes, and 45 × 10⁹/L platelets. Given the marked improvement in her condition, I increased the dosage of Shan Yu and Yuan Rou to 15g each, instructing her to continue taking 30 doses. Forty days later, she returned for a follow-up visit, looking much better and with a more rosy complexion. Her hemoglobin level had risen to 84 g/L. I adjusted the formula by increasing Shan Yu and Yuan Rou to 15g each, and instructed her to continue taking 30 doses. Two months later, she came for another visit, feeling much better and with a more rosy complexion. I advised her to take the original formula in a 10-fold dose, grinding it into powder, filtering it through a sieve, and taking 6g per dose three times a day after meals to enhance her recovery.

Case 2: Mr. Qiao, male, 16 years old, diagnosed with aplastic anemia through bone marrow aspiration at a hospital. He presented with pallor, nosebleeds, and scattered petechial hemorrhages all over his body. His hemoglobin level was 65 g/L, his red blood cell count was 2.41 × 10¹²/L, his white blood cell count was 3.10 × 10⁹/L, with 32% neutrophils, 68% lymphocytes, and 65 × 10⁹/L platelets. His six pulses were thin and rapid, his tongue was pale and slightly thickened with tooth marks, his tongue coating was thin but greasy—indicating both qi and blood deficiency, and qi failing to govern blood. I prescribed Guipi Tang with additions: Dang Shen 10g, Bai Zhu 10g, Huang Qi 20g, Fu Shen 10g, Yuan Zhi 6g, Chao Zao Ren 15g, Mu Xiang 3g, Yuan Rou 10g, Dang Gui 10g, Shan Yu 10g, Tu Si Zi 15g, Nu Zhen Zi 15g, Jiu Xue Teng 20g, Po Guo Zhi 10g, He Shou Wu 10g, and Chuan Shan Jia 10g. The herbs were decocted in water and taken once daily. After 20 doses, his nosebleeds stopped, the petechial hemorrhages on his body faded, and no new spots appeared. His hemoglobin level had risen to 84 g/L. I removed Yuan Zhi, Zao Ren, and Mu Xiang, adding Danshen 20g, Hong Hua 3g, Lu Rong 3g (for oral administration), and Shui Zhi 10g (for oral administration). I advised her to continue taking 30 doses, and she never returned for follow-up visits. Three years later, a healthy adult came to the clinic, holding a prescription folded like a cardboard sheet. When I looked at it, I realized it was the same formula I had prescribed three years earlier. He said he had taken over 200 doses of this formula, and the more he took, the better he felt. Now his physical strength was normal, his spirits were good, and his appetite was also good. Looking at him, his face was rosy, his energy was abundant. A quick blood test revealed a hemoglobin level of 150 g/L, a red blood cell count of 5.70 × 10¹²/L, a white blood cell count of 4.28 × 10⁹/L, and a platelet count of 160 × 10⁹/L. He had recovered and was advised to continue taking Liu Wei Di Huang and Guipi Wan regularly to maintain his health.

In treating aplastic anemia, traditional Chinese medicine focuses on the spleen and kidneys as key organs for treatment. The spleen is the source of qi and blood; as the “Nanjing” states, “In the middle burner, qi is received and transformed into juice—when it turns red, it becomes blood.” It is evident that blood is a product of the spleen and stomach after receiving water and grains. The kidneys govern bones; bones store marrow, and marrow and blood share a common origin, indicating that bone marrow also plays a role in blood production. Later physicians proposed ideas such as “bone generates blood,” “the liver stores blood,” and “the spleen controls blood.” Based on these concepts, I believe that the key to treating aplastic anemia lies in strengthening the spleen and tonifying the kidneys, followed by regulating the liver and promoting blood circulation. By focusing on these aspects, we can begin to understand the principles behind treating aplastic anemia. Commonly, formulas like Guipi, Si Jun Zi, and Bao Yuan Tang are chosen as first-line treatments; Liu Wei Di Huang and Gui Fu Ba Wei are preferred formulas for tonifying the kidneys. To regulate the liver and promote blood circulation, formulas like Xiaoyao San, Si Wu Tang, Taohong Si Wu, Xiao Chai Hu, and Chai Hu Shu Gan are often used. I believe that while tonifying the kidneys and strengthening the spleen, it is crucial to also use herbs that promote qi and blood circulation—herbs like Chai Hu, Mu Xiang, Chuan Shan Jia, Jiu Xue Teng, Hong Hua, Ma Qian Zi, Chi Shao, and Dang Gui are essential. By promoting qi and blood circulation, the herbs reach the affected areas, while tonifying the kidneys and strengthening the spleen ensures that qi and blood are produced and replenished—these two processes complement each other and enhance one another. In recent years, I have often used herbs like He Shou Wu, Po Guo Zhi, Nu Zhen Zi, Han Lian Cao, Tu Si Zi, Gu Zi, Xian He Cao, and Tu Da Huang to either tonify the kidneys, enrich essence, or generate blood, all of which have proven beneficial for treating aplastic anemia. In particular, I would like to emphasize the special significance of Lu Rong and Shui Zhi in treating aplastic anemia. Lu Rong refers to the young horns of male deer, such as sika or maral, covered in dense hair, which have not yet ossified. Modern pharmacological research has shown that Lu Rong has a clear blood-producing effect, impacting all three blood cell lineages—white blood cells, platelets, and red blood cells. Shui Zhi is the entire body of leeches, including those of the Hirudo family and the Echinococcus family. Traditional Chinese Medicine uses leeches primarily for their blood-drawing and blood-removing properties; modern research has found that leeches contain components like hirudin, heparin, and antithrombin, all of which possess anti-coagulant and thrombolytic effects, making them useful for treating coronary heart disease, thrombophlebitis, and occlusive vasculitis. Based on Tang Rongchuan’s saying, “If blood stasis is not cleared, new blood will never be formed,” I added a small amount of Shui Zhi to the formula for aplastic anemia, discovering that this herb could accelerate the patient’s recovery and encourage healing. Both Shui Zhi and Lu Rong are sensitive to high temperatures; when boiled at around 100°C, their active ingredients can be destroyed. Since both herbs are best consumed as infusions, I finely ground them into 0.25g capsules and named them Sheng Bao Dan, specifically for treating aplastic anemia. Clinical trials have shown remarkable therapeutic results.

Brief Discussion on Itching Skin Conditions

Itching skin conditions are among the most common skin diseases encountered in clinical practice. Traditional Chinese Medicine’s understanding of these conditions is limited to discussions about causes and pathogenic mechanisms such as “wind,” “fire,” “phlegm,” and “blood.” They are also known as urticarial rash, prurigo, wind eczema, ringworm, scabies, and others—but most often lack specific diagnostic criteria, so they are typically treated by relying on Western medical diagnoses, traditional Chinese medicine syndrome differentiation, and traditional Chinese medicine prescriptions as the primary approach, supplemented by Western medical treatments. This is the guiding principle I have followed for decades in treating these skin conditions, and I have achieved satisfactory results in clinical practice. First, it is important to possess a basic understanding of Western medical diagnostics; in general, these skin conditions fall into five major categories:

① Urticarial Rash: Though there are different types—acute, chronic, papular, and more—each case shares a common characteristic: it appears suddenly and disappears quickly, worsening when exposed to wind.

② Eczema: There are various types of eczema, including infantile eczema, localized eczema, and generalized eczema—but they all share a common feature: they involve vesicles, erosions, oozing, crusting, thickening, and lichenification.

③ Dermatitis: There are different types of dermatitis, including neurodermatitis, contact dermatitis, allergic dermatitis, and exfoliative dermatitis—but their common trait is redness, papules, lichenification, and fissures, without erosion or oozing. Exfoliative dermatitis often presents with large amounts of crusts falling off; contact dermatitis usually has a clear history of allergen exposure.

④ Prurigo: Typically, patients first experience itching, which may then develop into various skin manifestations such as papules, blood scabs, scratch marks, nodules, and more—appearing all over the body, in the anal area, genital region, lower extremities, and other areas.

⑤ Ringworm and Scabies: There are types of ringworm, body ringworm, nail ringworm, pityriasis versicolor, tinea corporis, psoriasis, and scabies. Except for psoriasis, all of these conditions are caused by fungi and are contagious. A common characteristic of ringworm is the presence of a layer of white or yellow scales covering the lesions. Psoriasis, on the other hand, is distinguished by red bases and blood dots on the surface, in addition to white scales. Scabies is caused by the parasitic mite Sarcoptes scabiei, commonly occurring in the armpits, groin, and between the fingers and toes—causing blisters, pustules, oozing, and crusting. Task output rules: Translate this markdown block from Chinese to English. Preserve markdown markers, links, and formatting. Keep headings and list structure unchanged. Return only the translated block.

Input: The above five categories of skin diseases all share itching as their distinctive symptom. In Traditional Chinese Medicine, “itch” is regarded as a manifestation of wind; wind is the root cause of all diseases, moving swiftly and changing frequently. Wind can combine with dampness, heat, cold, or dryness. When combined with dampness, chronic conditions often persist, as dampness is sticky and difficult to eliminate quickly. This condition often leads to blood vessel damage over time, which is why “to treat wind, first harmonize blood—once blood is harmonized, wind will naturally subside.” Having practiced in clinical settings for more than 40 years, I have come to understand that the fundamental principles of treating this condition always revolve around dispelling wind, overcoming dampness, clearing heat, detoxifying, promoting diuresis, harmonizing blood, resolving stasis, and dispersing cold. The key lies in integrating Western medical diagnoses and applying a holistic perspective to the diagnosis and treatment of these conditions—this is the most fundamental aspect of treating such cases. Below is a brief overview of commonly used traditional Chinese medicines, which can serve as a reference for clinical prescriptions.

① Wind-dispelling herbs: Jingjie, Fangfeng, Fuping, Jiangchan, Quanxie, Wugong, Wushe, Chanyu, Chaihu, Baixianpi, Baiyi, Mahuang, Guizhi, Cang’erzi;

② Dampness-overcoming herbs: Qianghuo, Duohuo, Leigongteng, Sangzhi, Xuxiancao, Weilingxian, Wujiapi;

③ Heat-clearing herbs: Shengshigao, Shanzhi, Dahuang, Huangbai, Huanglian;

④ Detoxification herbs: Jin Yin Hua, Lianqiao, Gongying, Baishang, Xia Kucuo, Zicao, Longdan Cao;

⑤ Diuretic herbs: Sheng Yiren, Fuling, Ze Xie, Difuzi, Cheqianzi;

⑥ Blood-harmonizing herbs: Danggui, Chuanxiong, Chi Shao, Taoren, Honghua, Roushang, Mòmao, Yimu Cao;

⑦ Stasis-resolving herbs: Shui Zhi, Sanling, Ezhushi;

⑧ Cold-dispelling herbs: Chuanjiao, Chuanwu, Cao Wu, Shechongzi, Fuzi, Xixin.

Below, I will present my clinical formulas categorized by type. Any inaccuracies are welcome to be corrected and commented upon by fellow practitioners.