III. Conclusion

Prescribe blood-activating and stasis-resolving formulas; each formula can treat numerous different diseases. Take the Xuefu Zhuyu Tang as an example—it can treat up to 20 conditions. The Hualuo Xiaoling Dan formulated by the renowned modern physician Zhang Xichun is commonly used to treat injuries from falls and blows, rheumatoid arthritis, chronic pelvic inflammatory disease, old ectopic pregnancy, chronic osteomyelitis, and other ailments. In clinical practice, the author often uses Chaihu Shugan San with modifications to treat acute and chronic hepatitis, acute and chronic pancreatitis, gastric and duodenal ulcers, chronic gastritis, intercostal neuralgia, and breast disorders in women, all of which have shown certain therapeutic effects. Additionally, Taohong Siwu Tang with modifications is used to treat coronary heart disease, cerebral arteriosclerosis, menstrual irregularities in women, pelvic diseases, and various injuries from falls and blows. In recent years, the widely emphasized “Tongfu Method”—that is, using modified Chengqi Tang—has achieved remarkable clinical efficacy in treating a variety of acute abdominal conditions, including acute cholecystitis, cholelithiasis, acute pancreatitis, acute intestinal obstruction, and acute icteric infectious hepatitis. III. Conclusion “The principle of ‘treating different diseases with the same method’ runs through every aspect of both the theoretical framework and clinical practice of Traditional Chinese Medicine, thereby forming an important characteristic of the academic system of our national medicine. Whether in terms of reinforcing vital energy or eliminating pathogenic factors, because it embodies the academic idea of ‘treating different diseases with the same method,’ TCM is able to adapt its limited principles and prescriptions to infinitely varied clinical needs. This objectively suggests to people that, by looking beyond the complex and changing external manifestations of diseases to explore their underlying essence, any ‘different diseases’ that are treated with the same method must inevitably share certain common internal connections in terms of etiology and pathology. With the advancement of integrated Chinese and Western medicine and the gradual deepening of experimental research on TCM theory, some substantial breakthroughs have already been made in this regard. For instance, Shen Ziyin and others at Shanghai Second Medical College, through experimental studies on renal parenchyma, revealed that the TCM concept of “kidney qi” corresponds to the modern medical hypothalamus–pituitary–adrenal cortex system. Similarly, experimental studies conducted by Beijing Normal University and others on the nature of spleen deficiency have shown that TCM’s spleen deficiency is closely related to the body’s autonomic nervous system, metabolic system, endocrine system, and immune system. These studies have provided an intrinsic material basis for TCM’s “treating different diseases with the same method” in tonifying the kidney and strengthening the spleen, thus allowing the traditional TCM theory of “treating different diseases with the same method” to shine even more brightly. It is hoped that the work of integrating Chinese and Western medicine will be carried out more extensively and deeply, and that the traditional theories of our national medicine will continue to evolve and innovate, radiating even greater brilliance in the global medical community. 26 Discussion on Syndrome Differentiation in Febrile Diseases Pei Zhengxue Febrile diseases are collectively referred to as Shanghan and Wenbing. Shanghan is caused by cold pathogens, while Wenbing is caused by heat pathogens; although they are different, both can lead to fever, hence the collective term “febrile diseases.” In the study of febrile diseases, TCM has traditionally been divided into the Shanghan School and the Wenbing School. The Shanghan School focuses on the cold causes and yang-deficiency characteristics of febrile diseases, emphasizing methods such as pungent-warm exterior-releasing and emergency restoration of yang; the Wenbing School, on the other hand, emphasizes the heat causes and yin-depletion characteristics of febrile diseases, focusing on pungent-cool exterior-releasing and nourishing-yin cooling methods. For a long time, these two schools have held opposing views and engaged in mutual contention, resulting in the famous Shanghan–Wenbing debate in the history of our national medicine. However, with the development of modern medical science, people have gradually come to realize that Shanghan and Wenbing both belong to exogenous febrile diseases; for the same febrile disease, it is possible to simultaneously exhibit both Shanghan and Wenbing characteristics, or to alternate between certain clinical manifestations of Shanghan and Wenbing. Therefore, completely separating the diagnostic and therapeutic approaches for Shanghan and Wenbing is clearly not conducive to the objective needs of clinical diagnosis. The question of whether we can organically combine the diagnostic and therapeutic methods of the two schools to form a unified TCM approach to diagnosing febrile diseases is a glorious yet arduous task facing all TCM practitioners. The author, humbly offering his own superficial views on this issue. I. A Brief History of Shanghan and Wenbing The Suwen: “On Heat Disorders” records: “When a person is injured by cold, it results in a febrile disease.” It also states: “Now, all febrile diseases are essentially cases of Shanghan.” This is the earliest discussion regarding Shanghan, asserting that Shanghan is indeed a type of febrile disease. The Suwen: “On the Vital Energy’s Flow to Heaven” further notes: “When a disease caused by Shanghan develops into Wenbing, if it occurs before the summer solstice, it is called Wenbing; if it occurs after the summer solstice, it is called Shu.” This indicates that Wenbing is included within the scope of Shanghan. The Suwen: “On Heat Disorders” then divides febrile diseases into six categories—Juyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin (the Six Channels)—although it does not provide detailed information on pathogenesis, symptoms, or prescriptions, it nonetheless laid the foundation for the emergence of Six Channel syndrome differentiation. At the end of the Eastern Han Dynasty, the renowned physician Zhang Zhongjing, drawing on his extensive clinical experience, authored the Treatise on Cold Damage and Miscellaneous Diseases, and based on the Six Channels described in the Inner Canon, he established the Shanghan syndrome differentiation rules—Six Channels differentiation—which systematized the diagnosis and treatment of exogenous febrile diseases. During the chaotic period at the end of the Han Dynasty, the Treatise on Cold Damage and Miscellaneous Diseases was fragmented and scattered; later, Wang Shuhe of the Jin Dynasty recompiled it, ensuring its survival. Starting from the Song Dynasty, under Cheng Woji, physicians successively elaborated on the Six Channels of Shanghan, some discussing the Six Channels according to therapeutic methods, others according to prescriptions, still others according to organs, eight principles, meridians, and so forth—essentially, everyone sought to align Six Channel differentiation with the ever-evolving clinical practice. At the same time, physicians also applied some effective prescriptions clinically to compensate for the shortcomings of Shanghan prescriptions, such as Qian Zhongyang’s Baidu San, Liu Shouzhen’s Shuangjie San, Zhang Yuansu’s Jiwei Qianghuo Tang, and Li Dongyuan’s Puji Xiaodu Yin, all of which, to a certain extent, went beyond the scope of pungent-warm exterior-releasing in the Treatise on Cold Damage. This shows that as clinical practice became increasingly rich, people continuously enriched and improved the original therapeutic methods outlined in the Treatise on Cold Damage. In particular, during the Song and Jin periods, Liu Shouzhen’s elaboration on febrile diseases was especially detailed; he expanded the scope of the nineteen fire-related syndromes described in the Inner Canon, emphasizing the relationship between fire-related syndromes and the five elements of wind, cold, dampness, dryness, and heat, thereby forming the view that “all six elements ultimately transform into fire.” In terms of treatment, he strongly advocated clearing heat and draining fire, and pointed out the drawbacks of relying solely on pungent-warm exterior-releasing. Liu’s achievement objectively compensated for the deficiencies of the Treatise on Cold Damage, creating the preconditions for the emergence of the Wenbing school of thought. Ming’s Wang Andao (1332–1391) was the first to clearly distinguish between Shanghan and Wenbing, stating: “It is only because people indiscriminately refer to Wenbing as Shanghan... and use warm and hot medicines that the name becomes confused with reality, causing harm to people’s lives. Shouldn’t the name be corrected?” Wang also explained the differences between Wenbing and Shanghan from the perspectives of symptoms, pathogenesis, and treatment methods, thus enabling the Wenbing school of thought to begin to stand out on its own. In light of this, posterity revered Wang as the founder of the Wenbing school of thought, which is entirely justified. Subsequently, Ming’s Wang Shishan (1463–1539) proposed the concept of “newly acquired Wenbing,” saying: “If one is injured by cold in winter... and the illness breaks out in spring... this is latent Wenbing; there are also cases where one is not injured by cold in winter but still contracts an epidemic, which is specifically spring epidemic qi, and can be called spring epidemic, just like winter’s Shanghan, autumn’s dampness, and summer’s heat—this is newly acquired Wenbing.” Thus, latent qi and newly acquired qi became the two main types of Wenbing. At the end of the Ming Dynasty, in the year Xinsi of the Chongzhen reign (1641), epidemics broke out in provinces such as Shandong, Henan, Hebei, and Zhejiang, and doctors tried treating them with Shanghan methods without success; Wu Youke, however, found that treating them with Wenbing methods worked immediately. He believed that epidemics inherently belonged to the category of warm and hot diseases, fundamentally different from Shanghan, and wrote the Treatise on Epidemics, expanding the scope of Wenbing to include all febrile infectious diseases. Later, another prominent Wenbing scholar, Ye Tianshi (1666–1745), wrote the Treatise on Warmth and Heat, establishing the Wei-Qi-Ying-Xue syndrome differentiation and summarizing the principles of diagnosing and treating febrile diseases. He said: “In general, after Wei comes Qi, and after Ying comes Xue. It’s okay to sweat through Wei, but only when Qi arrives can you clear Qi; once you enter Ying, you can still penetrate the heat and transform Qi, such as with rhino horn, yuan shen, dan pi, etc.; but once you enter Xue, you risk depleting blood and stirring up blood, so you must cool blood and disperse blood, such as with sheng di, dan pi, e jiao, chi shao, etc.” Wu Jutong (1736–1820) followed Ye’s teachings and wrote the Detailed Explanation of Wenbing, building on the “Wei-Qi-Ying-Xue” differentiation to propose a three-jiao-based Wenbing diagnostic outline—Three-Jiao Differentiation. He said: “Wenbing enters through the mouth and nose; nasal qi connects to the lungs, oral qi connects to the stomach; if lung disease reverses, it affects the pericardium; if upper-jiao disease is left untreated, it spreads to the middle-jiao, affecting the spleen and stomach; if middle-jiao disease is left untreated, it spreads to the lower-jiao, affecting the liver and kidneys; starting from the upper-jiao and ending with the lower-jiao.” By this point, the Wenbing school of thought had formed a complete system encompassing principles, methods, prescriptions, and medicines. II. Basic Content of Shanghan and Wenbing Syndrome Differentiation (1) Shanghan Syndrome Differentiation (Six Channels Differentiation)

1. Taiyang Syndrome Headache, fever with aversion to cold, floating pulse. ① If there is no sweat and the pulse is tight, it is Shanghan (narrow sense); use Mahuang Tang. ② If there is sweat and the pulse is floating, it is Zhongfeng; use Guizhi Tang. ③ If there is thirst and the pulse is rapid, it is Wenbing (Zhongjing did not formulate a prescription).
2. Yangming Syndrome High fever, intense thirst, profuse sweating, and a full, bounding pulse indicate Yangming channel syndrome; if there is distention, fullness, dryness, and hardness, it is Yangming organ syndrome. Use Baihu Tang for channel syndrome; use Chengqi Tang for organ syndrome. 29
3. Shaoyang Syndrome Bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, chest and flank discomfort, irritability and nausea, loss of appetite—use Xiao Chaihu Tang; if accompanied by headache, aversion to cold, and fever, it is Shaosha He syndrome; use Chaihu Guizhi Tang; if accompanied by constipation and yellow coating on the tongue, it is Shaoyang–Yangming combined syndrome; use Da Chaihu Tang.
4. Taiyin Syndrome Abdominal distention and vomiting, inability to eat, self-benefit, occasional abdominal pain—use Lizhong Tang.
5. Shaoyin Syndrome Shaoyin disease is characterized by a weak, fine pulse and a strong desire to sleep—use Sini Tang.
6. Jueyin Syndrome Thirst, palpitations, heartburn, hunger but no desire to eat, vomiting worms after eating—use Wumei Wan. Wenbing Syndrome Differentiation (2) Wei-Qi-Ying-Xue Syndrome Differentiation Wei-level syndrome: headache, fever with aversion to cold (more heat than cold), thirst and dry throat, cough, floating and rapid pulse—use Sangju Yin and Yinqiao San. Qi-level syndrome: high fever, intense thirst, profuse sweating, abdominal distention and pain, severe constipation, large, bounding pulse, dry and yellow tongue—use Baihu Tang and Chengqi Tang. Ying-level syndrome: tidal fever, restlessness and vague speech, red tongue with little coating, fine and rapid pulse—use Qingying Tang with modifications. Xue-level syndrome: tidal fever, restlessness and vague speech, convulsions and palpitations, rashes, bleeding—use Huaban Tang and Angong Niuhuang Wan. (3) Three-Jiao Syndrome Differentiation Upper-jiao syndrome: ① Hand Taiyin Lung syndrome (external heat). ② Hand Jueyin Pericardium syndrome (confusion, slurred speech, limb weakness). 30 Middle-jiao syndrome: ① Foot Yangming Stomach heat syndrome. ② Foot Taiyin Spleen dampness syndrome. Lower-jiao syndrome: ① Foot Shaoyin Kidney deficiency syndrome (yin deficiency, yang deficiency). ② Foot Jueyin Liver wind syndrome (alternating cold and heat, limb twitching, scar-like lesions). III. Preliminary Exploration of the “Six-Stage Differentiation” for Febrile Diseases The Six Channels differentiation of Shanghan and the Wei-Qi-Ying-Xue and Three-Jiao differentiation of Wenbing, though approaching from different angles, each capture certain characteristics of febrile diseases. In the process of diagnosing and treating febrile diseases, each has its strengths and weaknesses. The author attempts to adopt the three yang parts of the Six Channels, absorb the Ying-Xue part of the Wei-Qi-Ying-Xue, and incorporate certain viewpoints from the Three-Jiao, inspired by the insights of past physicians on febrile diseases, to propose a “six-stage differentiation” method for exogenous febrile diseases, aiming to offer a humble suggestion for discussion and criticism from colleagues. Taiyang · Shaoyang · Yangming · Ying level · Xue level · Wang Channel Organ Dampness Syndrome Syndrome Syndrome Diagram of the “Six-Stage Differentiation” for Febrile Diseases (1) Adopt the three yang parts of the Six Channels differentiation The Six Channels of Shanghan encapsulate the eight principles of yin-yang, interior-exterior, cold-heat, and deficiency-excess, integrating principles, methods, prescriptions, and medicines into one cohesive whole. Its influence extends far beyond the realm of febrile diseases, becoming a model for TCM’s diagnosis and treatment of various syndromes. For over a thousand years, it has been praised by both Chinese and foreign physicians. In the context of diagnosing exogenous febrile diseases, the three yang parts of the Six Channels accurately describe the onset and progression of febrile diseases; the three yin parts discuss the management of post-febrile sequelae. In particular, the classification and treatment of the three yang syndromes in the diagnosis and treatment of febrile diseases are more highly valued by clinicians. It uses just a few words—“floating pulse, stiff neck and head, and aversion to cold”—to summarize the characteristics of exterior cold; and “body heat, spontaneous sweating, no aversion to cold, but rather aversion to heat”—to accurately depict the features of interior heat. As for the semi-exterior, semi-interior syndrome, it mainly includes seven symptoms: bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, chest and flank discomfort, reluctance to eat, and irritability with nausea. These descriptions have been proven through the practice of generations of physicians to be of great guiding significance for the diagnosis and treatment of exogenous febrile diseases. Moreover, the Six Channels of Shanghan provide clinicians with a wealth of prescriptions with proven efficacy; the 112 prescriptions recorded in the Treatise on Cold Damage form the foundation of TCM prescription studies, and many subsequent prescriptions have been derived from them, such as Guizhi Tang, Xiao Chaihu Tang, and Baihu Tang, with dozens of variations for each. According to the author’s personal experience, the Six Channels of Shanghan are uniquely ingenious in regulating disorders of the body’s autonomic nervous system—for example, “stiffness below the heart” is treated with Xiexin Tang; “after a serious illness, feeling thirsty and unable to settle down, with a chill in the chest” is treated with Lizhong Tang—and all of these have shown good clinical results. In short, the Treatise on Cold Damage is an excellent classic medical text, and the Six Channels of Shanghan are a diagnostic rule that can guide clinical practice. For febrile diseases, the three yang syndromes accurately reflect the patterns of transmission and transformation of febrile diseases. However, due to historical constraints, there are still some shortcomings in the Six Channels’ differentiation of exogenous febrile diseases. For example, the symptoms described in the three yin parts lack reasonable connections with each other, making it difficult to see the characteristics of the disease’s progression and transformation. Taiyin syndrome is spleen-stomach deficiency-cold; Shaoyin syndrome is heart-kidney deficiency-cold; Jueyin syndrome is various forms of mixed cold-heat syndrome. Although these may indeed be complications or sequelae of febrile diseases, in most cases they appear in internal injury syndromes and seem to have no obvious connection with the transmission and transformation of febrile diseases. Recently, Yan Derun said: “As for the three yin channels, they do not actually transmit to each other, so they should not be treated the same as the three yang channels.” Shi Yiren added: “My view is that the three yang channel syndromes are cold-related illnesses, and the symptoms discovered should be listed under the cold-related section; the three yin channel syndromes are changes arising from the body’s own organ functions, belonging to the miscellaneous diseases category, and should be listed under the digestive, circulatory, thoracic, and abdominal sections.” Although their arguments may not be entirely correct, the claim that the three yin symptoms “do not transmit” is certainly thought-provoking. What exactly is the nature of Jueyin syndrome? Many commentators on the Treatise on Cold Damage simply discuss it channel by channel, with no consensus. Only Lu Yuanlei has a unique insight: “Since the entire body is deficient in cold—Shaoyin is gastrointestinal deficiency-cold—there is no other kind of cold deficiency that could qualify as Jueyin—so it must be a makeshift solution, a forced application of the Six Channels’ names, a case of cutting off one’s toes to fit the shoes.” Lu believes that Jueyin is truly a “millennial mystery” and loudly calls on his colleagues not to rigidly adhere to conventions. Looking at the Treatise on Cold Damage and Miscellaneous Diseases, compiled at the end of the Han Dynasty, it was fragmented and scattered during the wars, and although Wang Shuhe later recompiled it, its original integrity remains unverifiable. Generations of physicians, such as Fang Youzhi and Yu Jiayan, have expressed regret about this. Yu used the metaphor of “cutting up beautiful brocade and patching it with scraps” (“Shang Lun Pian”) to describe the imperfections in its beauty. These previous views have greatly inspired the author, who has therefore adopted the three yang parts of the Six Channels in the “six-stage differentiation” for febrile diseases, designating Taiyang as the first stage, Shaoyang as the second, and Yangming as the third, while discarding the three yin parts to use them for diagnosing internal injury syndromes. (2) Absorb the Ying-Xue part of the Wei-Qi-Ying-Xue differentiation Due to the limitations of the prevailing conditions at the time, the Six Channels of Shanghan mostly relied on pungent-warm exterior-releasing and emergency restoration of yang methods, while the diagnosis and treatment of the aspects of febrile diseases involving yin-depletion, wind-induced movement, blood rushing out of control, and heat entering the pericardium were either insufficiently elaborated or not addressed at all. Consequently, in terms of legislation and medication, the application of methods such as “clearing heat and detoxifying,” “nourishing yin and cooling blood,” and “suppressing wind and opening orifices” was relatively lacking. In this regard, the Wei-Qi-Ying-Xue of Wenbing perfectly compensates for these shortcomings, with the key being the Ying and Xue parts, because in the Wei-Qi-Ying-Xue differentiation, the Wei-level syndrome represents exterior heat, while the Qi-level syndrome represents interior heat, and the two share significant similarities with the Taiyang and Yangming of the Six Channels. Only the Ying-Xue level fully expresses the characteristics of febrile diseases such as yin-depletion, blood rupture, wind-induced movement, and heat entering the pericardium. In view of this, the “six-stage differentiation” for febrile diseases incorporates the Ying and Xue parts of the Wei-Qi-Ying-Xue, listing them sequentially after Taiyang, Shaoyang, and Yangming, making them the fourth and fifth stages of the disease’s progression. (3) Adopt certain viewpoints from the Three-Jiao differentiation Upper-jiao syndromes represent the early clinical manifestations of febrile diseases; the upper-jiao includes the heart and lungs, which are closely linked and mutually influential. Wu Jutong pointed out that upper-jiao syndromes include both the exterior heat of the lung defense and the confusion caused by heat entering the pericardium, thus making the view that “warm pathogens first attack the lungs and then spread to the pericardium” compatible with clinical practice. For acute febrile diseases, such as meningococcal meningitis, sepsis, and bacillary dysentery, at the onset of the disease, exterior heat and confusion often occur together; observing these syndromes through the Three-Jiao differentiation reveals that they are typical upper-jiao syndromes. Wu Jutong said: “The heart is the master of the body and does not allow pathogens to invade, because it is protected by the pericardium. Therefore, when pathogens arrive, the pericardium takes the hit instead.” It is evident that “spreading to the pericardium” means that lung heat spreads to the heart. In the “six-stage differentiation,” following the three types of Zhongfeng, Shanghan, and Wenbing under the Taiyang section, the reverse-pericardium type is listed as the fourth type. The middle-jiao syndromes involve the spleen and stomach; here there is the stomach fire of the foot Yangming, the spleen dampness of the foot Taiyin, and the combined damp-heat of the spleen and stomach. The stomach is dry, the spleen is damp, and when pathogens enter the middle-jiao and lean toward the stomach, it manifests as Yangming real heat; when they lean toward the spleen, it manifests as Taiyin cold-dampness; and when both the spleen and stomach are heavily affected, it manifests as damp-heat syndrome. Given that the Yangming syndrome in the Six Channels only emphasizes the aspect of stomach fire, the “six-stage differentiation” adds the damp-heat syndrome as the third type under the Yangming section, following the channel and organ syndromes. (4) Death from yin and yang is the final stage of febrile diseases The Suwen: “On the Vital Energy’s Flow to Heaven” says: “When yin is balanced and yang is concealed, the spirit is healthy”; “When yin and yang are separated, the vital energy is extinguished.” It is evident that death from yin and yang is a critical symptom of febrile diseases. For febrile diseases, Shanghan often presents with death from yang, while Wenbing often presents with death from yin; in short, death from yin and yang is undoubtedly the final stage of febrile disease progression. Clinically, death from yang is manifested by pale complexion, cold limbs, spontaneous sweating, and a barely perceptible pulse; death from yin is manifested by high body temperature, rapid breathing, dry skin, restlessness and vague speech, and still-warm hands and feet. From the perspective of modern medicine, the former is akin to shock or collapse—circulatory failure; the latter may involve respiratory failure and dehydration. Respiratory failure and circulatory failure are inevitable paths leading to death, precursors to the central nervous system’s imminent cessation of normal function, which is quite consistent with the TCM concepts of death from yin and yang. When febrile diseases are left untreated or misdiagnosed, they eventually enter the stage of death from yin and yang; sometimes yin dies first, followed by yang; sometimes yang dies first, followed by yin; in any case, the two are often causally related, which is why “solitary yin cannot generate life” and “solitary yang cannot grow.” 34 IV. Conclusion This article reviews the history of syndrome differentiation in febrile diseases, briefly outlines the basic content of such differentiation, and then derives the author’s own insights on the subject, preliminarily exploring a unified “six-stage differentiation” method for Shanghan and Wenbing, with the hope of sparking discussion and receiving constructive criticism from colleagues. 35 On the Methods of Strengthening the Spleen and Tonifying the Kidneys Pei Zhengxue The spleen governs the middle qi, while the kidney governs the original qi; the middle qi is also called spleen qi, and the original qi is also called kidney qi, and together they constitute the vital qi. The Suwen: “On the Lost Art of Acupuncture” says: “When vital qi resides within, pathogenic factors cannot invade.” The Suwen: “On the Evaluation of Heat Disorders” further states: “Wherever pathogenic factors gather, the qi must be deficient.” It is evident that the presence of vital qi in the human body plays a crucial role in preventing disease. Based on this, TCM regards “deficiency of vital qi” as the root cause of disease and proposes the grand strategy of reinforcing and consolidating vital qi. Since vital qi is composed of both middle qi and kidney qi, in the strategy of reinforcing and consolidating vital qi, strengthening the spleen and tonifying the kidneys are undoubtedly the two most important components. I. The Interrelationship Between Strengthening the Spleen and Tonifying the Kidneys