2. Absorbing the Ying-Xue portion of the Wei-Qi-Ying-Xue differentiation

The six channels of Shanghan encapsulate the eight principles of yin-yang, exterior-interior, cold-heat, and deficiency-excess, integrating theory, methods, prescriptions, and medications into one system. Its influence extends far beyond febrile diseases, becoming a model for TCM's differential diagnosis and treatment of various conditions, praised by Chinese and foreign physicians for over a thousand years. In the context of exogenous febrile diseases, the three yang differentiation accurately elucidates the onset and progression of febrile illnesses; the three yin differentiation partially discusses the management of sequelae after febrile diseases. In particular, the classification and treatment of three yang syndromes are more emphasized by clinical practitioners in the differential diagnosis and treatment of febrile diseases. It summarizes the characteristics of exterior cold with just a few words: "floating pulse, stiff neck and head pain, and aversion to cold"; it precisely depicts the features of interior heat with "body heat, spontaneous sweating, no aversion to cold, but rather aversion to heat"; as for the semi-exterior, semi-interior syndrome, it mainly presents seven symptoms: bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, fullness and discomfort in the chest and hypochondrium, lack of appetite, irritability, and tendency to vomit. These discussions have been proven through the practice of generations of physicians to be of significant guiding importance in the differential diagnosis and treatment of exogenous febrile diseases. Moreover, the six channels of Shanghan provide clinicians with a large number of efficacious prescriptions. The 112 formulas recorded in the "Shanghan Lun" form the foundation of TCM prescription studies, with many later prescriptions derived from them, such as Guizhi Tang, Xiaochaihu Tang, and Baihu Tang, each having dozens of variations. According to the author's personal experience, the six channels of Shanghan are particularly ingenious in regulating autonomic nervous system dysfunction—for example, "heart palpitations and epigastric distention" can be treated with Xiexin Tang; "after severe illness, desire to spit, feeling vague and unfulfilled, with cold sensation in the chest" can be treated with Lizhong Tang—both showing good clinical efficacy. In short, the "Shanghan Lun" is an excellent classic medical text, and the six channels of Shanghan are a diagnostic principle that can guide clinical practice. As far as febrile diseases are concerned, the three yang syndromes accurately reflect the patterns of disease transmission and transformation. However, due to historical limitations, there are still some shortcomings in the differentiation of exogenous febrile diseases. For example, the syndromes described in the three yin portions of the six channels lack reasonable connections among themselves, failing to reveal the characteristics of disease progression and transformation. Taiyin syndrome represents spleen-stomach deficiency-cold; Shaoyin syndrome represents heart-kidney deficiency-cold; Jueyin syndrome represents various forms of mixed cold-heat syndromes. Although these may indeed be complications or sequelae of febrile diseases, in most cases they appear in internal injury syndromes and seem to have little relation to the transmission and transformation of febrile diseases. Recently, Yan Derun said: "In fact, the three yin channels do not transmit to each other, so they should not be treated the same as the three yang channels."⑤ Shi Yiren said: "My view is that the three yang channel syndromes are cold-related illnesses, and the symptoms found should be classified under the 'cold' category; the three yin channel syndromes are changes in organ function arising spontaneously, belonging to the category of miscellaneous diseases, and should be listed under the digestive, circulatory, thoracic, and abdominal systems."⑥ Although their views may not be entirely correct, the assertion that the three yin syndromes "do not transmit" is indeed thought-provoking. What exactly is the nature of Jueyin syndrome? Many commentators on Shanghan focus on the channels themselves, with no consensus. Only Lu Yuanlei has a unique insight: "Since whole-body deficiency-cold is considered Shaoyin, gastrointestinal deficiency-cold is considered Taiyin, and there is no other type of deficiency-cold that can qualify as Jueyin, it must be a makeshift solution—a violation of the principle of adhering strictly to the names of the six channels, like cutting off one's toes to fit the shoes."◎ Lu believes that Jueyin syndrome is truly a "millennial mystery" and loudly calls on his colleagues not to rigidly adhere to old conventions. The "Shanghan Zabing Lun" was compiled at the end of the Han Dynasty and scattered during times of war. Although Wang Shuhe reorganized it, its original complete form remains impossible to ascertain. Generations of physicians, such as Fang Youzhi and Yu Jiayan, have all expressed regret about this. Yu used the metaphor of "cutting up beautiful brocade and patching it with scraps" (from "Shanglun Pian") to describe the imperfections within its beauty. These earlier views have greatly inspired the author, leading to the formulation of the "six-stage differentiation" for febrile diseases, which adopts the three yang portions of the six channels of Shanghan, designating the Taiyang stage as the first segment, Shaoyang as the second, and Yangming as the third, while discarding the three yin portions for use in the differentiation of internal injury syndromes. 2. Absorbing the Ying-Xue portion of the Wei-Qi-Ying-Xue differentiation Due to the prevailing conditions at the time of disease onset, the six channels of Shanghan mostly employed pungent-warm exterior-releasing and emergency reviving-yang methods, while the differentiation and treatment of aspects such as yin injury, wind movement, blood rushing out of control, and heat invading the pericardium were either insufficiently elaborated or completely neglected. Consequently, in terms of prescription formulation and medication, applications related to "clearing heat and detoxifying," "nourishing yin and cooling blood," and "extinguishing wind and opening orifices" were relatively lacking. In this regard, the Wei-Qi-Ying-Xue differentiation in Wendan perfectly compensates for these deficiencies, with the key being the Ying and Xue portions, because in the Wei-Qi-Ying-Xue differentiation, the Wei stage represents exterior heat, while the Qi stage represents interior heat, both sharing great similarities with the Taiyang and Yangming stages of the six channels of Shanghan. Only the Ying-Xue stage fully expresses characteristics such as yin injury, blood rushing out of control, wind movement, and heat invading the pericardium. Therefore, in the "six-stage differentiation" for febrile diseases, the Ying and Xue portions of the Wei-Qi-Ying-Xue are absorbed, placed sequentially after the Taiyang, Shaoyang, and Yangming stages, becoming the fourth and fifth segments of the disease's progression (see diagram). 3. Incorporating several viewpoints from the Sanjiao differentiation

The upper jiao syndrome represents 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 the upper jiao syndrome encompasses both superficial heat in the lung defensive layer and mental confusion caused by heat invading the pericardium, thus enabling the view that "warm pathogens attack the lungs first and then spread to the pericardium"⑧ to be combined with clinical practice. For acute febrile diseases such as meningococcal meningitis, sepsis, and toxic dysentery, at the onset of the disease, superficial heat and mental confusion often occur simultaneously. Observing such cases using the Sanjiao differentiation reveals them to be typical upper jiao syndromes. Wu Jutong said: "The heart is the master of the body and does not allow pathogenic factors to invade, protected by the pericardial barrier. Therefore, when pathogenic factors arrive, the pericardium takes the hit instead."⑨ Thus, "pericardial invasion" refers to the transmission of lung heat to the heart. In the "six-stage differentiation," following the three types of windstroke, cold damage, and warm disease under the Taiyang section, the pericardial invasion type is listed as the fourth type (see diagram).

The middle jiao syndrome involves the spleen and stomach, where there is stomach fire from the Foot Yangming meridian, spleen dampness from the Foot Taiyang meridian, and damp-heat resulting from the combination of the two. The stomach governs dryness, while the spleen governs dampness. When pathogenic factors enter the middle jiao and lean toward the stomach, Yangming real heat manifests; when they lean toward the spleen, Taiyin cold-dampness appears; and when both the stomach and spleen are heavily affected, damp-heat syndrome emerges. Given that the Yangming syndrome in the six channels only emphasizes stomach fire, in the "six-stage differentiation," after the Jing and Fu syndromes under the Yangming section, the damp-heat syndrome is added as the third type in this section (see diagram). 4. Loss of yin and loss of yang represent the final stages of febrile diseases "The Plain Questions · On the Harmony of Vital Energy and Heavenly Qi" states: "When yin is balanced and yang is concealed, spirit is maintained; when yin and yang are separated, vital energy ceases." Thus, loss of yin and loss of yang are critical signs of severe illness. For febrile diseases, Shanghan often ends with loss of yang, while Wendan frequently calls for help due to loss of yin. In short, loss of yin and loss of yang undoubtedly mark the final stages of febrile disease progression. Clinically, loss of yang presents as pale complexion, cold limbs, profuse cold sweat, and a barely perceptible pulse; loss of yin manifests as high fever, rapid breathing, dry skin, agitation and delirium, with hands and feet still warm. From a modern medical perspective, the former corresponds to shock and collapse—circulatory failure; the latter may involve respiratory failure and dehydration. Respiratory failure and circulatory failure are inevitable steps on the road to death, signaling that the body's vital centers are about to cease normal functioning—this aligns quite well with the TCM concepts of loss of yin and loss of yang. If febrile diseases are left untreated or mismanaged, they eventually reach the stages of loss of yin and loss of yang; sometimes loss of yin precedes loss of yang, sometimes the reverse—either way, the two often cause each other, reflecting the principle that "isolated yin cannot arise" and "isolated yang cannot grow." IV. Conclusion This article reviews the history of febrile disease differentiation, briefly outlines the basic content of febrile disease differentiation, and thereby derives the author's own insights into the subject. It explores a unified "six-stage differentiation" method for Shanghan and Wendan, hoping to spark further discussion and receive constructive criticism from colleagues. References ① Wang Andao: "Collection of Retrospective Studies on Medical Classics," People's Health Publishing House, 1956, 9th edition, page 52. ② Shanghai College of Traditional Chinese Medicine: "Lecture Notes on Warm Diseases," Shanghai Science and Technology Press, 1959, 12th edition, page 11. ③ Jiangsu New Medical College: "Interpretation of Warm Disease Studies," Shanghai People's Publishing House, 1973, 3rd edition, page 174. ④ Wu Jutong: "Detailed Explanation of Warm Diseases," People's Health Publishing House, 1958, 5th edition, page 56. ⑤ Yan Derun: "Commentary on the Shanghan Lun," People's Health Publishing House, 1956, 9th edition, page 9. ⑥ Shi Yiren: "Shanghan and Warm Diseases," Upper People's Health Publishing House, 1955, 28th edition, page 28. ⑦ Lu Yuanlei: "Modern Interpretation of the Shanghan Lun," Qianqing Hall, 1953, volume 8, page 4. ⑧ Jiangsu New Medical College: "Interpretation of Warm Disease Studies," Shanghai People's Publishing House, 1973, 3rd edition, page 161. ⑨ Nanjing College of Traditional Chinese Medicine: "Teaching Reference Materials on Warm Diseases," Jiangsu People's Publishing House, 1959, 3rd edition, page 47. Clinical Application of Blood Circulation Promoting and Stasis Resolving Therapy in Dermatology Department of Dermatology, Second Affiliated Hospital of Lanzhou Medical College · Zhu Hanzhang Blood circulation promoting and stasis resolving therapy is an important therapeutic approach in traditional Chinese medicine for treating various diseases. This method demonstrates certain efficacy in treating numerous diseases across different systems, tissues, and organs of the human body, with even better results in the treatment of some skin diseases. Therefore, it opens up a new avenue for dermatological treatment. The Essence of "Blood Stasis"

There are numerous discussions in traditional Chinese medical literature regarding "blood stasis," including "internal accumulation leads to blood stasis," "contaminated blood becomes blood stasis," "blood that has left the meridians becomes blood stasis," and "prolonged illness entering the collaterals causes blood stasis." To clarify the essence of "blood stasis" in traditional Chinese medicine and the mechanism behind the efficacy of "promoting blood circulation and resolving stasis," the Chinese Academy of Medical Sciences and other institutions have conducted experimental and clinical research using modern hemodynamics, especially the theories, technologies, methods, and electron microscopy of modern microcirculation, concluding that the so-called "blood stasis" in traditional Chinese medicine essentially refers to circulatory disorders, particularly microcirculatory disorders (1). Liang et al. applied blood rheology...

Strengthening the Body and Nurturing the Root: Immunity , Gansu Provincial Institute of New Medicine Research, Pei Zhengxue

The human body possesses an inherent ability to resist disease, achieved through both specific and non-specific immunity—this is one of the fundamental concepts of modern immunology. Traditional Chinese medicine had similar views on this matter as early as two thousand years ago, in the field of human pathology. The "Plain Questions · On the Art of Acupuncture and Moxibustion" states: "If righteous qi resides within, evil qi cannot invade." The "Plain Questions · On the Treatment of Febrile Diseases" further says: "Wherever evil qi gathers, qi must be deficient." Among the two factors—righteous qi and evil qi—the traditional Chinese medicine emphasizes the importance of "righteous qi" in disease prevention, explicitly stating that "if righteous qi resides within, the body can avoid interference from evil qi." The "Dialectics of Contradiction" asserts: "External factors are the conditions for change, while internal factors are the basis for change." Since "righteous qi" is an internal factor and "evil qi" is an external factor, TCM's emphasis on the pathogenic role of "righteous qi" deficiency aligns with this view. Based on this, TCM regards "qi deficiency" as the root cause of disease and proposes the therapeutic principle of strengthening the body and nurturing the root, aiming to activate and mobilize the body's own disease-resistant capabilities. This viewpoint shares significant common ground with modern immunology.