References

Traditional Chinese medicine has always attached great importance to the relationship between the spleen and the kidney. Zhang Jingyue said: "At birth, a person's existence depends on the source of essence and blood; after birth, it relies on the nourishment of food and water. Without essence and blood, there is no basis for forming the body; without food and water, the body cannot grow strong. Essence and blood are governed by the Mingmen, while food and water are governed by the spleen and stomach. Therefore, the Mingmen receives innate qi, while the spleen and stomach receive acquired qi. Thus, the sea of food and water mainly relies on innate qi, whereas the sea of essence and blood must rely on acquired qi for support. Consequently, from birth to old age, if one's innate foundation is insufficient, as long as one receives the nurturing power of acquired qi, one can compensate for the deficiency of innate qi and achieve half of its strength." After clarifying the endocrine relationship between the spleen and the kidney, understanding Zhang Jingyue's view seems more accurate. The kidney has the functions of the hypothalamus–pituitary–adrenal cortex system, while the spleen has the functions of the gastrointestinal and pancreatic endocrine system. The former utilizes energy substances to carry out life activities, while the latter absorbs and produces energy substances to supply the former. The two mutually promote and restrain each other, existing in a dynamic equilibrium of unity and opposition.

References ① Shen Ziyin et al.: Preliminary Exploration of the Rules for Integrated Western and Traditional Chinese Medicine Diagnosis and Treatment Based on Kidney Yin and Kidney Yang, Shanghai Journal of Traditional Chinese Medicine, Vol. 1, No. 10, 1962 ② Gu Tianjue et al.: Observation on Changes in 17-Hydroxysteroid Excretion in Urine of Patients with Kidney Deficiency, Chinese Journal of Internal Medicine, Vol. 1, No. 307, 1964 ③ Zhang Zehao: Discussion on the Principles of Strengthening Vitality and Nourishing the Root in Traditional Chinese Medicine, Chongqing Pharmaceutical, Vol. 3, No. 6, 1977 ④ Li En: The Relationship Between Biochemistry and Traditional Chinese Medicine, New Pharmaceutical Research, Vol. 1, No. 42, 1977 ⑤ Hou Can: A Preliminary Exploration of the Essence of the Spleen in Traditional Chinese Medicine, New Pharmaceutical Journal, Vol. 10, No. 5, 1977 ⑥ Pei Zhengxue: Strengthening Vitality and Nourishing the Root and Immunity, Collection of Materials on the Integration of Traditional Chinese and Western Medicine, Vol. 2+15, 1978

Moreover, it marks the true progress of science. This demonstrates that the selection of research topics is extremely important in the entire research process and is also quite challenging. It requires people to have a correct worldview and to be guided by proper thinking methods. One must not only choose problems that need to be solved in the present era but also select topics that can be completed through effort based on the current level of scientific development. Einstein spent the latter half of his life trying to solve the more abstract problem of the "Unified Field Theory." However, the current level of science is still far from achieving this goal, and scientific observation instruments have not kept pace with it. Although the problem is very important, it mercilessly consumed decades of the great scientist's later life. Newton wasted twenty-five years of his later life on the absurd hypothesis of "God's existence," which serves as a warning to us. Correctly interpreting experimental results is also extremely important. In the 18th century, Cavendish's experimental results revealed the role of oxygen, thereby refuting the meaningless phlogiston theory, but unfortunately, this led to the promotion of false arguments. In this research work, Priestley in Britain also made similar mistakes until Lavoisier established the theory of combustion, finally resolving the issue. Although Cavendish and Priestley both came close to the truth, they unfortunately missed it.

In fact, scientific research is quite complex and requires researchers to possess multiple talents: talent in instrument manufacturing, talent in observational experimentation, talent in abstract thinking, and talent in computational reasoning. Moreover, it also requires all aspects of people's psychological activities: motivation, willpower, personality, abilities, interests, and so on. As a scientific and technological worker who is committed to serving the motherland, dedicating oneself wholeheartedly, and working tirelessly until death, one must cultivate and improve oneself in many ways. True all-rounders are rare, and collaborative efforts are always possible.

Let us conclude this article with a verse by the famous poet Goethe: "The vast world, the magnificent life, year after year, sincere and diligent, Constantly exploring, constantly innovating, Often repeating endlessly, never stopping; Loyal to tradition, Yet eager to embrace the new, With a cheerful mood and pure goals, Ah, this way we move forward one step further!" Discussion on the Differentiation of Febrile Diseases Pei Zhengxue, Gansu Provincial Institute of New Pharmaceutical Sciences

Febrile diseases are collectively referred to as cold damage and warm diseases. Cold damage is caused by cold pathogens, while warm diseases are caused by heat pathogens. Although the two are different, they can both lead to fever, hence the collective term "febrile diseases." In the discussion of febrile diseases, traditional Chinese medicine has historically been divided into the cold damage school and the warm disease school. The cold damage school focuses on the cold causes and yang-deficiency characteristics of febrile diseases, emphasizing methods such as pungent-warm exterior-releasing and emergency yang-restoring therapies; the warm disease school focuses on the heat causes and yin-depletion characteristics of febrile diseases, emphasizing methods such as pungent-cool exterior-releasing and yin-nourishing, fire-lowering therapies. For a long time, the two schools have held firm to their own views and opposed each other, forming the famous cold damage–warm disease debate in the history of traditional Chinese medicine. However, with the development of modern medical science, people have gradually realized that cold damage and warm diseases both belong to exogenous febrile diseases; for the same febrile disease, it is possible to simultaneously exhibit both cold damage and warm disease characteristics, or to alternate between some clinical manifestations of cold damage and warm disease. Therefore, completely separating the diagnostic methods for cold damage and warm disease is clearly detrimental to the objective needs of clinical diagnosis. Whether it is possible to organically combine the diagnostic and therapeutic approaches for the two, forming a unified diagnostic method for febrile diseases in traditional Chinese medicine, is a glorious yet arduous task facing all traditional Chinese medicine practitioners. The author, without presumptuousness, hereby offers his humble opinion on this issue. I. Brief History of Cold Damage and Warm Disease

The "Plain Questions · Discussion on Fever" states: "When a person is injured by cold, it leads to febrile disease," and further adds: "Nowadays, all febrile diseases are of the cold damage type." This is the earliest discussion regarding cold damage, considering cold damage as a type of febrile disease. The "Plain Questions · Discussion on the Flow of Vital Energy" says: "If a disease caused by cold damage develops into a warm disease, those occurring before the summer solstice are considered warm diseases, while those occurring after the summer solstice are considered summer diseases." This indicates that warm diseases are included within cold damage. The "Plain Questions · Discussion on Fever" further divides febrile diseases into six categories: Juyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin (the Six Meridians). Although it does not detail the pathogenesis, syndromes, or prescriptions, it provides a basis for the emergence of Six Meridians differentiation. At the end of the Eastern Han Dynasty, the renowned physician Zhang Zhongjing, drawing on his rich clinical experience, wrote the "Treatise on Cold Damage and Miscellaneous Diseases" and, building upon the Six Meridians in the "Inner Canon," established the cold damage differentiation rule—the Six Meridians differentiation—making the diagnostic and therapeutic approach for exogenous febrile diseases more systematic. During the chaotic period at the end of the Han Dynasty, the "Treatise on Cold Damage and Miscellaneous Diseases" was scattered, but Wang Shuhe of the Jin Dynasty recompiled it, ensuring its survival. Starting from Cheng Wuji of the Song Dynasty, physicians successively elaborated on the Six Meridians of cold damage, some discussing the Six Meridians based on treatment methods, others based on prescriptions, others based on organs, others based on the Eight Principles, others based on meridians—essentially attempting to align the Six Meridians differentiation with the ever-evolving clinical practice. At the same time, physicians also applied some effective prescriptions clinically to supplement the shortcomings of cold damage prescriptions, such as Qian Zhongyang's Baidu San, Liu Shouzhen's Shuangjie San, Zhang Yuanshi'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 gradually enriched, people continuously supplemented and improved the original treatment methods for cold damage. In particular, Liu Shouzhen of the Song and Jin dynasties (1110–) provided especially detailed elaborations on febrile diseases, expanding the scope of the nineteen fire-related syndromes in the "Inner Canon"; he emphasized 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 originate from fire." In treatment, he strongly advocated clearing heat and draining fire, pointing out the drawbacks of relying solely on pungent-warm exterior-releasing. Liu's achievement objectively compensated for the shortcomings of the "Treatise on Cold Damage," creating preconditions for the emergence of the warm disease school. During the Ming Dynasty, Wang An Dao (1332–1391) was the first to clearly distinguish between cold damage and warm disease, stating: "It is only because the world indiscriminately calls warm diseases 'cold damage'... and uses warming medicines, that names confuse reality and harm people's lives. Shouldn't such naming be corrected?"① Wang also explained the differences between warm disease and cold damage from the perspectives of syndromes, pathogenesis, and treatment methods, thus allowing the warm disease school to begin to stand out. In light of this, posterity regards Wang as the founder of the warm disease school, which is indeed justified. Later, Wang Shishan (1463–1539) proposed the concept of newly contracted warm disease, saying: "If one is injured by cold in winter... and then develops symptoms in spring... this is latent warm disease; there are also cases where one is not injured by cold in winter but still develops warm disease in spring, which is specifically spring warmth, comparable to winter cold damage, autumn dampness, and summer heat. This is newly contracted warm disease."② Thus, latent warmth and newly contracted warmth became the two main types of warm disease development. At the end of the Ming Dynasty, during the Chongzhen Xinsi year (1641), epidemics broke out in provinces such as Shandong, Henan, Hebei, and Zhejiang, and doctors treated them with cold damage methods, but to no avail; Wu Youke, however, treated them with warm disease methods and succeeded. He believed that epidemics fundamentally belonged to the category of warm diseases, completely different from cold damage, and wrote the "Treatise on Warm Epidemics," expanding the scope of warm disease to include all febrile infectious diseases. Later, another prominent warm disease expert, Ye Tianshi (1666–1745), wrote the "Treatise on Warm Heat," establishing the Wei-Qi-Ying-Xue differentiation and summarizing the rules for diagnosing and treating febrile diseases. He said: "The general principle is that Wei comes before Qi, and Ying comes before Xue. Wei can sweat, Qi can clear the air, Ying can penetrate the heat and transform it, such as rhino horn, yuan shen, dan pi, etc.; Xue, however, may consume blood and stir up blood, so it must cool the blood and disperse it, such as sheng di, dan pi, e jiao, chi shao, etc."③ Wu Jutong (1736–1820) inherited Ye's teachings and wrote the "Differentiation of Warm Diseases," proposing the Three Jiao as the framework for warm disease differentiation—Three Jiao differentiation—based on the "Wei-Qi-Ying-Xue" differentiation. He said: "Warm diseases enter through the mouth and nose; nasal qi connects to the lungs, oral qi connects to the stomach; if lung disease spreads backward, it affects the pericardium; if upper jiao disease is not treated, it spreads to the middle jiao, affecting the spleen and stomach; if middle jiao disease is not treated, it spreads to the lower jiao, affecting the liver and kidneys; starting from the upper jiao and ending with the lower jiao."④ Thus, the warm disease school has formed a complete system of principles, methods, prescriptions, and medicines.

II. Basic Content of Cold Damage and Warm Disease Differentiation

1. Cold Damage Differentiation (Six Meridians Differentiation)

1. Taiyang Syndrome: Headache, fever with chills, floating pulse. ① If there is no sweat and the pulse is tight, it is cold damage (narrow sense); use Mahuang Tang. ② If there is sweat and the pulse is slow, it is wind invasion; use Guizhi Tang. ③ If there is thirst and the pulse is rapid, it is warm disease (Zhongjing did not prescribe a formula).

2. Yangming Syndrome: High fever, intense thirst, profuse sweating, and a large, full pulse—this is the Yangming meridian syndrome; if there is bloating, fullness, dryness, and hardness, it is the Yangming腑 syndrome. Use Baihu Tang for the meridian syndrome; use Chengqi Tang for the腑 syndrome.

3. Shaoyang Syndrome: Bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, chest and flank discomfort, restlessness and nausea, reluctance to eat—use Xiao Chaihu Tang; if accompanied by headache and fever, it is the Shaoshao combined syndrome, use Chaihu Guizhi Tang; if accompanied by constipation and yellow tongue coating, it is the Shaoyang–Yangming combined syndrome, use Da Chaihu Tang.

4. Taiyin Syndrome: Abdominal distension and vomiting, inability to eat, extreme weakness, occasional abdominal pain—use Lizhong Tang.

5. Shaoyin Syndrome: The Shaoyin disease is characterized by a weak, fine pulse and a strong desire to sleep—use Si Ni Tang.

6. Jueyin Syndrome: Thirst, palpitations, heart pain and heat, hunger but unwillingness to eat, vomiting worms after eating—use Wumei Wan.

2. Warm Disease Differentiation

1. Wei-Qi-Ying-Xue Differentiation

Wei-level syndrome: Headache, fever with chills (more heat than cold), thirst and dry throat, cough, floating and rapid pulse—use Sangju Yin and Yinqiao San.

Qi-level syndrome: High fever and intense thirst, profuse sweating, abdominal distension and pain, severe constipation, large and full pulse, dry and yellow tongue—use Baihu Tang and Chengqi Tang.

Ying-level syndrome: Hot flashes and intense thirst, restlessness and delirium, red tongue with little coating, fine and rapid pulse—use Qingying Tang with added ingredients.

Xue-level syndrome: Hot flashes and intense thirst, confusion and delirium, convulsions and palpitations, rashes and bleeding—use Huaban Tang and Angong Niuhuang Wan.

2. Three Jiao Differentiation Upper Jiao Syndrome: ① Hand Taiyin Lung Syndrome (surface heat). ② Hand Jueyin Pericardium Syndrome (confusion, delirium, tongue stiffness, limb numbness). 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, addiction and madness).

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III. A Preliminary Exploration of the "Six-Stage Differentiation" for Febrile Diseases

The six-channel differentiation in Shanghan and the Wei-Qi-Ying-Xue and Sanjiao differentiations in Wendan, though approached from different angles, each capture certain characteristics of febrile diseases. In the differential diagnosis and treatment of febrile diseases, each has its strengths as well as its weaknesses. The author attempts to adopt the three yang portions of the "six channels," absorb the Ying-Xue portion of the "Wei-Qi-Ying-Xue," and incorporate several viewpoints from the "Sanjiao." Inspired by the insights of past medical practitioners on febrile diseases, a "six-stage differentiation" method for exogenous febrile diseases is proposed, with the aim of sparking further discussion and receiving constructive criticism.

Diagram of the "Six-Stage Differentiation" for Febrile Diseases

Self-Energizing Ability One

1. Adopting the Three Yang Portions of the Six-Channel Differentiation