2. Improving Microcirculation

The Pathophysiology Teaching and Research Group of the First Shanghai Medical College conducted experimental research on salvia miltiorrhiza’s treatment of microcirculatory disorders in rabbits. By injecting 10% high-molecular-weight dextran saline solution into rabbits to induce peripheral microcirculatory disorders, they observed the microvasculature of the rabbit’s conjunctival sac, noting slow blood cell flow and aggregation into clumps of varying sizes. After treatment with salvia miltiorrhiza injection, blood flow speed significantly increased, the number of capillary networks markedly rose, and red blood cells dispersed to varying degrees, indicating that

salvia miltiorrhiza has the effect of improving microcirculation. The Physiological Teaching and Research Group of the First Shanghai Medical College and other institutions administered salvia miltiorrhiza preparations intravenously to 56 patients with coronary heart disease and observed the peripheral microcirculation of 22 patients, finding that both blood flow speed and flow patterns in the microvasculature had significantly improved. The Chinese Academy of Medical Sciences’ Collaborative Research Group on Invigorating Blood Circulation and Removing Blood Stasis used Tong Mai Ling to treat thromboangiitis obliterans and scleroderma, discovering that before treatment, the number of capillary loops in the nail folds decreased, becoming blurry and disordered, with slow or stagnant blood flow and obvious cell aggregation. After treatment, vessel morphology improved, blood flow accelerated, and cell aggregation lessened or disappeared. Therefore, it is believed that Tong Mai Ling has the effect of improving microcirculation, promoting blood flow speed, enhancing tissue nutrition, and facilitating lesion healing. To further study the mechanism of Tong Mai Ling’s effect on microcirculation, they stimulated the buccal mucosa of rats with hydrochloric acid to induce microcirculatory disorders, then injected Tong Mai Ling, observing that stagnant blood flow decreased and thrombus formation reduced. They also induced acute and chronic bronchitis in rats with sulfur dioxide and observed Tong Mai Ling’s impact on microcirculatory disorders on the tracheal surface, finding that after administration, dilated small veins immediately recovered, blood flow significantly accelerated, and the phenomenon of blood cells adhering to the vessel wall improved. In addition, some people in Tianjin used blood-stasis-removing decoctions, while others in Beijing experimented with dang gui and safflower, discovering that these substances can reduce capillary permeability.

3. Effects on Collagen Fibers

The Chinese Academy of Medical Sciences conducted electron microscopy examinations on burn scars treated with the blood-stasis-removing preparation Tong Mai Ling and found that the drug inhibits fibroblast production of collagen and reduces fibroblasts’ ability to absorb glycine, thereby decreasing collagen synthesis. Beijing and Tianjin used Tong Mai Ling to treat scleroderma; before treatment, patients’ serum had elevated levels of hexose and amino hexose, while after treatment, serum levels of hexose and amino acids significantly decreased, and collagen fibers changed from their original thick, swollen state to a fine state, with the skin also becoming softer. The Shanxi Institute of Traditional Chinese Medicine applied the kidney-nourishing decoction with blood-stasis-removing effects to treat nephritis, achieving remarkable results. They used uranium to induce renal atrophy in rats, causing interstitial membrane-like proliferative changes in the renal parenchyma. Before treatment, these rats were given the kidney-nourishing decoction, and as a result, 65% of the treated rats did not develop proliferative changes, whereas only 21% of the untreated rats avoided such changes. This shows that blood-stasis-removing medicines can reduce fibrous changes in the renal parenchyma, undoubtedly having therapeutic effects on chronic nephritis. The Shanxi Medical College studied the mechanisms of action of Ectopic Pregnancy No. 1 (red peony root, salvia miltiorrhiza, peach kernel) and Ectopic Pregnancy No. 2 (red peony root, salvia miltiorrhiza, peach kernel, san ling, e zhu) in treating ectopic pregnancy, discovering that Ectopic Pregnancy No. 1 has a certain inhibitory effect on the activity of lysyl oxidase in rat blood. Lysyl oxidase activity promotes collagen fiber formation, so it can be affirmed that Formula No. 1 has a certain therapeutic effect on hematoma formation and myofibrosis. The effect of Ectopic Pregnancy No. 2, however, is completely different from No. 1: it does not inhibit lysyl oxidase activity but rather promotes collagenase activity. The purpose of this collagenase activity is to soften already-myofibrosed masses, making them easier for other enzymes to digest or absorb, thus confirming that Ectopic Pregnancy No. 2 has a promoting effect on the dissolution of myofibrosed masses.

4. Effects on Inflammation

Blood-stasis-removing medicines generally have anti-inflammatory effects. Research has proven that ku shen, dan pi, Sichuan lovage, red peony root, and rhubarb can inhibit intestinal pathogenic bacteria; rhubarb, ku shen, red vine, dan pi, and red peony root can inhibit Staphylococcus aureus; rhubarb, dan pi, red peony root, Sichuan lovage, as well as zicao, diyu, huang yao zi, and zijing pi also have antiviral effects. The Nankai Hospital in Tianjin selected commonly used blood-stasis-removing medicines for acute abdominal conditions—dan pi, red peony root, dang gui, peach kernel, safflower, and yuan hu—to prepare intravenous injections. Through applications on cotton ball granulomas, castor oil cysts, turpentine oil cysts, and formaldehyde arthritis in white rats, as well as experiments on the permeability of rabbit skin capillaries, it was shown that blood-stasis-removing medicines can reduce capillary permeability and decrease inflammatory exudation, thereby localizing lesions. Experiments also proved that blood-stasis-removing medicines can increase blood flow in isolated dog intestinal loops, dilate peripheral vessels, and promote absorption of inflammatory exudates. Since the effect of blood-stasis-removing therapy is not merely limited to inhibiting pathogens, but indirectly reduces inflammatory responses by improving capillary permeability and dilating peripheral vessels, the anti-inflammatory effect of blood-stasis-removing therapy has unique significance.

5. Promoting Tissue Repair

Numerous experimental studies have proven that blood-stasis-removing medicines are helpful for tissue repair and regeneration. The Beijing regional collaborative group observed the impact of the Coronary Heart Disease No. 2 formula on the extent of myocardial necrosis. From histological qualitative and quantitative observations, as well as electron microscopic examination of tissue morphology, it was found that Coronary Heart Disease No. 2 can significantly reduce the scope of myocardial infarction. Under electron microscopy, the control group’s myocardial infarction area showed irreversible changes such as complete disappearance of glycogen, severe swelling of mitochondria, disruption of cristae, condensation of nuclear staining, and rupture of the nuclear membrane, whereas the medicated group exhibited much fewer of these irreversible changes in the infarction area. In addition, the Shanxi Institute of Traditional Chinese Medicine used histochemical methods to examine enzyme activity and electron microscopy to observe ultrastructural changes in the myocardium, finding that the degree of mitochondrial damage corresponded closely with the degree of ATPase and succinate dehydrogenase activity destruction. The control group’s myocardium showed significantly lower ATPase and succinate dehydrogenase activity compared with the protected group using blood-stasis-removing medicines, indicating that blood-stasis-removing medicines can protect mitochondria and prevent their destruction, thereby confirming their effectiveness in inhibiting myocardial infarction. Furthermore, numerous clinical trials have also proven that blood-stasis-removing medicines can help liver cells recover quickly after degeneration, accelerate the healing of ulcers caused by thromboangiitis obliterans, and enhance bone growth speed. All of these demonstrate that blood-stasis-removing therapy can promote tissue repair.

6. Effects on the Body’s Immune Cells

The China Academy of Traditional Chinese Medicine conducted clinical hemolysis experiments to observe the impact of blood-stasis-removing formulas designed to prevent ABO-type neonatal hemolysis on antibody-forming cells—B cells—and found that blood-stasis-removing medicines have a clear inhibitory effect on antibody-forming cells, indicating that they can suppress antibody-antigen complex reactions—autoimmune reactions. The China Welfare Association International Maternal and Child Health Hospital also achieved good therapeutic results by using blood-stasis-removing medicines to treat the aforementioned hemolysis, with experimental studies reaching the same conclusion. Based on this reason, clinical use of blood-stasis-removing medicines to treat autoimmune diseases can achieve obvious therapeutic effects, such as systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and nodular periarteritis.

Although blood-stasis-removing therapy has made considerable progress in clinical application and research, its underlying principles are still being further explored. We believe that as long as we persist in the path of integrating traditional Chinese and Western medicine, continuously practice, and constantly summarize our experiences, we will surely enable blood-stasis-removing therapy to achieve greater development and improvement, allowing this pearl in the treasure trove of traditional Chinese medicine to shine even more brilliantly and contribute to public health.

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Section 10: Discussion on Differentiation of Febrile Diseases

Febrile diseases are collectively referred to as Shang Han and Wen Bing. Shang Han is caused by cold pathogenic factors, while Wen Bing is caused by heat pathogenic factors; although the two differ, both can lead to fever, hence the collective term “febrile diseases.” In discussions about febrile diseases, traditional Chinese medicine has historically been divided into the Shang Han school and the Wen Bing school. The Shang Han 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 Wen Bing 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 each held firm to their own views, opposing one another, thus forming the famous Shang Han–Wen Bing debate in the history of traditional Chinese medicine. However, with the development of modern medical science, people have gradually come to realize that Shang Han and Wen Bing both belong to the category of external-febrile diseases. For the same febrile disease, it may simultaneously exhibit both Shang Han and Wen Bing characteristics, or alternate between some clinical manifestations of Shang Han and Wen Bing. Therefore, strictly separating the differentiation methods of Shang Han and Wen Bing is clearly not conducive to the objective needs of clinical diagnosis. Whether it is possible to organically combine the differentiation and treatment approaches of the two schools to form a unified differentiation method for febrile diseases in traditional Chinese medicine is a glorious yet arduous task facing all traditional Chinese medicine practitioners. Pei Zhengxue has put forward his own views on this issue.

I. Brief History of Shang Han and Wen Bing

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The "Plain Questions" in the "Yellow Emperor's Classic of Internal Medicine" states: "When a person is injured by cold, it results in febrile disease." It further says: "Today, all febrile diseases are classified as types of cold injury." This represents the earliest discussion on cold injury, asserting that cold injury is essentially febrile disease. The "Plain Questions" also mentions in the "On the Vital Energy and Heavenly Principles" chapter: "Among diseases caused by cold injury that develop into warm diseases, those occurring before the summer solstice are termed warm diseases, while those occurring after the summer solstice are termed summer diseases." This indicates that warm diseases are included within the category of cold injury. Furthermore, the "Plain Questions" divides febrile diseases into six categories—Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin, and Jueyin (the Six Channels)—though it does not provide detailed explanations of pathogenesis, syndromes, or prescriptions, it nonetheless laid the foundation for the development of Six Channel differentiation. At the end of the Eastern Han Dynasty, the renowned physician Zhang Zhongjing, drawing upon his extensive clinical experience, authored the "Treatise on Cold Injury and Miscellaneous Diseases," and based on the Six Channels from the "Inner Canon," he established the diagnostic principles of cold injury—Six Channel differentiation—thereby systematizing the syndrome differentiation and treatment of exogenous febrile diseases. During the chaotic period at the end of the Han Dynasty, portions of the "Treatise on Cold Injury and Miscellaneous Diseases" were scattered and lost; however, Wang Shuhe of the Jin Dynasty recompiled the work, ensuring its survival to this day. Starting with Cheng Woji of the Song Dynasty, medical scholars successively elaborated on the Six Channels of cold injury, some discussing the Six Channels according to therapeutic methods, others according to prescriptions, still others according to organ systems, some according to the Eight Principles, and yet others according to meridians. In short, people sought to align Six Channel differentiation with evolving clinical practice. Concurrently, physicians also applied effective empirical formulas to clinical practice to supplement the shortcomings of cold injury prescriptions. For example, Qian Zhongyang’s Baidu San, Liu Shouzhen’s Shuangjie San, Zhang Yuansu’s Jiwei Qianghuo Tang, and Li Dongyuan’s Puji Xiaodu Yin—all, to varying degrees, transcended the scope of the pungent-warm exterior-releasing approach outlined in the "Treatise on Cold Injury." This demonstrates that as clinical practice gradually expanded, the original therapeutic approaches for cold injury were continuously refined and enhanced. Notably, during the Song and Jin periods, Liu Shouzhen (1110–?) provided particularly detailed elaborations on febrile diseases, expanding the range of the nineteen fire-related syndromes described in the "Inner Canon" and emphasizing the relationship between fire syndromes and the five qi—wind, cold, dampness, dryness, and summer heat—thus forming the view that "all six qi ultimately transform into fire." In terms of treatment, he strongly advocated clearing heat and draining fire, while pointing out the drawbacks of relying solely on pungent-warm exterior-releasing methods. Liu’s achievements objectively compensated for the deficiencies in the "Treatise on Cold Injury," thereby creating the preconditions for the emergence of warm disease theory. Ming scholar Wang Andao (1332–1391) was the first to clearly distinguish between cold injury and warm disease. He stated: "It is only because people indiscriminately refer to warm diseases as cold injuries... and then use warming herbs that such practices confuse name with reality and endanger lives; shouldn’t we correct this naming?" Wang further explained, from the perspectives of syndromes, pathogenesis, and treatment methods, how warm diseases differ from cold injuries, thus enabling warm disease theory to establish itself as a distinct field. Consequently, posterity reveres Wang as the founder of warm disease theory, a designation that is well-deserved. Later, Ming physician Wang Shishan (1463–1639) introduced the concept of newly acquired warm diseases. He said: "If one is injured by cold in winter... and the illness manifests in spring... this is a latent warm disease. However, there are cases where one does not suffer cold injury in winter but still develops warm disease in spring; these are specifically spring warm diseases, comparable to winter cold injuries, autumn dampness, and summer heat—these are newly acquired warm diseases." Thus, latent warmth and newly acquired warmth became the two primary types of warm disease onset. In the late Ming Dynasty, during the Chongzhen Xin-Si year (1641), epidemics of warm disease swept through provinces such as Shandong, Henan, Hebei, and Zhejiang, yet physicians treating them using cold injury methods found no effect. Wu Youke, however, achieved remarkable success by employing warm disease treatments. He believed that epidemics inherently belonged to the warm category, fundamentally different from cold injury, and subsequently authored the "Treatise on Warm Epidemics," expanding the scope of warm disease theory to encompass all febrile infectious diseases. Shortly thereafter, another prominent warm disease scholar, Ye Tianshi (1666–1745), wrote the "Treatise on Warmth and Heat," establishing the Wei-Qi-Ying-Xue differentiation and summarizing the principles of syndrome differentiation and treatment for febrile diseases. He stated: "Generally speaking, after Wei comes Qi, and after Ying comes Xue. It is acceptable to sweat through Wei, but only when reaching Qi can one clear the Qi; once entering Ying, one can still dissipate heat and transform Qi, as with rhino horn, yuan shen, dan pi, etc.; however, once entering Xue, one must be cautious of blood consumption and blood movement, requiring cooling and dispersing blood, such as with sheng di, dan pi, e jiao, chi shao, etc." Wu Jutong (1736–1820), following in Ye’s footsteps, authored the "Detailed Analysis of Warm Diseases," building upon the Wei-Qi-Ying-Xue differentiation and proposing a new warm disease differentiation framework centered on the Three Jiao.

II. Basic Content of Syndrome Differentiation Between Cold Injury and Warm Disease

1. Cold Injury Syndrome Differentiation (Six Channel Differentiation)

   • Taiyang Syndrome: Headache, fever, chills, floating pulse. If there is no sweating and the pulse is tight, it is cold injury (narrow definition); use Mahuang Tang. If there is sweating and the pulse is slow, it is wind invasion; use Guizhi Tang. If there is thirst and a rapid pulse, it is warm disease (not prescribed by Zhang Zhongjing).

   • Yangming Syndrome: High fever, intense thirst, profuse sweating, and a full, bounding pulse indicate Yangming channel syndrome; if there is distention, fullness, dryness, and constipation, it indicates Yangming腑syndrome. Use Baihu Tang for channel syndrome and Chengqi Tang for腑syndrome.

   • Shaoyang Syndrome: Bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, chest and flank discomfort, irritability and nausea, lack of appetite—use Xiaochaihu Tang; if accompanied by headache, chills, and fever, it is a combined Shaoyang-Shaoyin syndrome, use Chaihu Guizhi Tang; if accompanied by constipation and yellow tongue coating, it is a combined Shaoyang-Yangming syndrome, use Dachaihu Tang.

   • Taiyin Syndrome: Abdominal distention and vomiting, inability to eat, worsening symptoms over time, occasional abdominal pain—use Lizhong Tang.

   • Shaoyin Syndrome: The defining features of Shaoyin disease are a weak, fine pulse and an overwhelming desire to sleep—use Sini Tang.

   • Jueyin Syndrome: Excessive thirst, palpitations, heartburn, hunger without appetite, vomiting worms after eating—use Wumei Wan.

2. Warm Disease Syndrome Differentiation

   (1) Wei-Qi-Ying-Xue Differentiation

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

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

   • Xue-level syndrome: Hot flashes, delirium, convulsions, rashes, bleeding—use Huaban Tang or Angong Niuhuang Wan.

   (2) Three Jiao Differentiation

   • Upper Jiao syndrome: Hand Taiyin Lung syndrome (surface heat), Hand Jueyin Heart Pericardium syndrome (delirium, tongue stiffness, limb coldness).

   • Middle Jiao syndrome: Foot Yangming Stomach heat syndrome, Foot Taiyin Spleen dampness syndrome.

   • Lower Jiao syndrome: Foot Shaoyin Kidney deficiency syndrome (yin deficiency, yang deficiency), Foot Jueyin Liver wind syndrome (alternating cold and heat, limb twitching, urticaria).

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

The Six Channel differentiation for cold injury and the Wei-Qi-Ying-Xue and Three Jiao differentiation for warm disease, though approaching febrile diseases from different angles, each captures certain characteristics of febrile illnesses and has its own strengths and weaknesses in syndrome differentiation and treatment. Pei Zhengxue attempted to combine the three yang aspects of the Six Channels, absorb the Ying-Xue portion of Wei-Qi-Ying-Xue, and incorporate certain insights from Three Jiao differentiation. Inspired by the views of past medical scholars on febrile diseases, he proposed a six-stage differentiation method for exogenous febrile diseases.

• The yin aspect is used for internal miscellaneous disease differentiation.

• Absorbing the Ying-Xue portion of Wei-Qi-Ying-Xue differentiation Due to the prevailing conditions at the time, the Six Channels of cold injury primarily employed pungent-warm exterior-releasing and emergency reviving-yang methods, while insufficient attention was paid—or even completely ignored—to the differentiation and treatment of features such as yin injury, wind agitation, uncontrolled blood flow, and heat invading the pericardium. Consequently, in terms of prescription formulation and medication, applications related to clearing heat and detoxifying, nourishing yin and cooling blood, and calming wind and opening orifices were relatively lacking. In this regard, the Wei-Qi-Ying-Xue differentiation for warm disease effectively made up for these deficiencies. The key to filling this gap lies in the Ying-Xue portion. In Wei-Qi-Ying-Xue differentiation, Wei-level symptoms represent surface heat, while Qi-level symptoms represent internal heat, both of which share significant similarities with the Taiyang and Yangming channels of the Six Channels. Only the Ying-Xue level fully expresses characteristics such as yin injury, uncontrolled blood flow, wind agitation, and heat invading the pericardium. Therefore, in Pei Zhengxue’s proposed six-stage differentiation for febrile diseases, he incorporated the Ying and Xue portions of Wei-Qi-Ying-Xue, placing them sequentially after Taiyang and Shaoyang, followed by Yangming, making them the fourth and fifth stages of febrile disease progression (see diagram above).

• Adopting certain insights from Three Jiao differentiation Upper Jiao disease manifestations represent the early clinical presentation of febrile diseases. The upper Jiao comprises the heart and lungs, which are closely linked and mutually influential. Wu Jutong pointed out that upper Jiao disease includes both surface heat of the lung Wei and the delirium caused by heat invading the pericardium, thus integrating the notion that “warm pathogens initially attack the lungs and then spread to the pericardium” with clinical practice. For acute febrile diseases such as meningococcal meningitis, sepsis, and bacillary dysentery, at the onset of the illness, surface heat and delirium often occur simultaneously; observing such cases through Three Jiao differentiation would classify them as typical upper Jiao disease. Wu Jutong stated: “The heart is the master of the body and should not be invaded by pathogens, as it is protected by the pericardium; therefore, when pathogens invade, the pericardium takes the hit instead.” Clearly, spreading to the pericardium means heat from the lungs spreading to the heart. In the proposed six-stage differentiation, after listing wind invasion, cold injury, and warm disease under the Taiyang section, he added the type of spreading to the pericardium as the fourth type (also see diagram above).

  The middle Jiao syndrome involves the spleen and stomach, where there is foot Yangming stomach fire, foot Taiyin spleen dampness, and a combination of dampness and heat between the spleen and stomach. The stomach is dry, the spleen is damp; if pathogens enter the middle Jiao and lean toward the stomach, it results in Yangming real heat; if they lean toward the spleen, it results in Taiyin cold dampness; if they affect both the spleen and stomach, it results in damp-heat syndrome. Given that the Yangming syndrome in the Six Channels only emphasizes stomach fire, in the proposed six-stage differentiation, after including channel and腑syndromes under the Yangming section, he added damp-heat syndrome as the third type under this section (see diagram above).

• Loss of yin and loss of yang are the final stages of febrile diseases The "Plain Questions" in the "On the Vital Energy and Heavenly Principles" chapter states: "When yin is balanced and yang is concealed, spirit is maintained… When yin and yang are separated, vital energy ceases." Clearly, loss of yin and loss of yang are critical conditions in febrile diseases. For cold injury, it often presents as loss of yang, whereas warm disease frequently manifests as loss of yin. In short, loss of yin and loss of yang are undoubtedly the final stages of febrile disease progression. Clinically, loss of yang is characterized by pale complexion, cold limbs, profuse cold sweat, and a barely perceptible pulse, while loss of yin is marked by high fever, rapid breathing, dry skin, irritability, delirium, and still-warm limbs. From a modern medical perspective, the former corresponds to shock and collapse—circulatory failure—and the latter may involve respiratory failure and dehydration. Both 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 function—this aligns quite well with the traditional Chinese medicine concepts of loss of yin and loss of yang. When febrile diseases are left untreated or mismanaged, they eventually reach the stage of loss of yin or loss of yang; sometimes loss of yin precedes loss of yang, other times loss of yang precedes loss of yin. In any case, the two are often causally related—just as solitary yin cannot generate life and solitary yang cannot sustain it.

Section 11: Organ-Based Differentiation

Organ-based differentiation refers to syndrome differentiation conducted on the basis of the organs. It is an important component of TCM syndrome differentiation and treatment, serving as the primary method for diagnosing and treating internal diseases.

I. Formation of Organ-Based Differentiation Theory

The "Inner Canon," compiled during the Spring and Autumn and Warring States periods, provided the fundamental theoretical framework for organ-based differentiation. For instance, the "Plain Questions" in the "Secret Classic of Spiritual Orchards" introduced the concept of basic organ functions; the "Plain Questions" in the "Five Organs Generating Theory" outlined the five colors and five tastes associated with organ diseases, along with their simple pulse and symptom manifestations; and the "Plain Questions" in the "Wasting Disease Theory" discussed the pathological relationships between organs and other systems. Moreover, the "Essential Treatise on Ultimate Truths" presented the "Nineteen Pathogenic Mechanisms," offering a comprehensive summary of the causes and symptoms of organ diseases, which served as an important theoretical foundation for the subsequent development of organ-based differentiation theory. Statements such as "All wind-induced dizziness originates from the liver," "All cold-induced contraction originates from the kidneys," "All qi stagnation and distension originates from the lungs," and "All dampness-related swelling originates from the spleen" remain crucial tenets of organ-based differentiation theory to this day. At the end of the Eastern Han Dynasty, the outstanding clinician Zhang Zhongjing inherited these ideas, advocating the use of Six Channel differentiation for cold injury while also emphasizing organ-based differentiation for treating internal diseases. His sixteen-volume "Treatise on Cold Injury and Miscellaneous Diseases" significantly advanced organ-based differentiation in terms of theory, methodology, prescriptions, and medications. Later, during the Six Dynasties, someone attributed a work titled "Zhongcang Jing" to Hua Tuo, proposing preliminary rules for diagnosing and treating miscellaneous diseases based on the deficiency or excess of the five zang and six fu organs. Subsequently, Sun Simiao and Qian Zhongyang further refined these principles, developing a theoretical system that summarized various miscellaneous diseases in terms of cold, heat, deficiency, and excess, providing a foundational framework for prescription formulation and medication guidelines. By the Jin and Yuan dynasties, Zhang Yuansu from Yishui County in Hebei Province made the pathogenesis and treatment of organ syndromes the focus of his lifelong research and achieved significant breakthroughs. His student Li Dongyuan carried forward his teachings, placing particular emphasis on the functions of the spleen and stomach, formulating the Buzhong Yiqi Tang, which became a representative formula for tonifying the spleen and stomach in later generations. Ming scholar Xue Lizhai, deeply influenced by Li Dongyuan, not only focused on the spleen and stomach but also highlighted the importance of kidney yin and kidney yang. As a result, in the field of organ-based differentiation research, two major schools emerged: the soil-tonifying school represented by Li Dongyuan’s teachings, and the kidney-tonifying school represented by Xue Lizhai and Zhao Xianke. Their doctrines were predominantly based on warming and tonifying, hence collectively known as the warming-tonifying school. Since their academic thought originated from Zhang Yuansu, later generations also referred to this school as the Yishui School. The achievements of this school in advancing organ-based differentiation, particularly the novelty of their ideas and the precision of their arguments, far surpassed those of their predecessors, ultimately leading to a complete systematization of organ-based differentiation content.

II. Analysis of Organ-Based Differentiation Content

1. Spleen and Stomach Differentiation

   (1) Spleen and Stomach Qi Deficiency

   The basic symptom complex of this syndrome includes pale complexion, poor appetite, fatigue, and lack of energy; if accompanied by edema, abdominal distention, or loose stools, it is called spleen dysfunction; if accompanied by hemoptysis, hematemesis, hematochezia, or epistaxis, it is called spleen non-coordination of blood; if accompanied by drooping eyelids, uterine prolapse, gastric prolapse, or wandering spleen, it is called sinking of central qi. For spleen and stomach qi deficiency, it is advisable to strengthen the spleen and invigorate qi, using Sijunzi Tang (from the "Bureau Regulations") as the base formula; for spleen dysfunction, it is advisable to strengthen the spleen and invigorate qi while also promoting qi circulation and dispelling dampness, using Xiangsha Liu Junzi Tang (from the "Bureau Regulations"); for spleen non-coordination of blood, it is advisable to strengthen the spleen and invigorate qi while guiding blood back to the spleen, using Guipi Tang (by Yan Yonghe); for sinking of central qi, it is advisable to strengthen the spleen and invigorate qi while raising yang and lifting the sinking, using Buzhong Yiqi Tang (by Li Dongyuan).

   (2) Spleen and Stomach Yang Deficiency

   The basic symptom complex of this syndrome includes pale complexion, poor appetite, fatigue, abdominal distention, edema, loose stools, aversion to cold, and spontaneous sweating. This syndrome consists of three parts: ① Spleen and stomach yang deficiency develops on the basis of spleen and stomach qi deficiency, so this syndrome exhibits pale complexion, poor appetite, and fatigue; ② The spleen is responsible for transportation, and when yang is deficient, transportation is impaired, resulting in abdominal distention, edema, and loose stools; ③ Spleen yang deficiency inevitably involves yang deficiency symptoms, so one experiences aversion to cold and spontaneous sweating. For spleen and stomach yang deficiency, it is advisable to strengthen the spleen and warm the center, using Lizhong Tang (by Zhang Zhongjing) or Fuzi Lizhong Tang (by Zhang Zhongjing).

   (3) Cold-Dampness Trapped in the Spleen

   Headache and alternating chills and fever, abdominal distention and fullness, nausea and vomiting, intestinal rumbling and diarrhea, and a floating, moist pulse—these are symptoms of cold-dampness trapped in the spleen, requiring exterior-releasing and cold-dispelling, as well as aromatic decontamination, using Huoxiang Zhengqi San (from the "Bureau Regulations"). Individuals with inherently weak spleen yang, when exposed to wind-cold, experience internal dampness combining with external cold to form this syndrome, so this symptom complex consists of two parts: ① Headache and alternating chills and fever, along with a floating, moist pulse (external cold); ② Abdominal distention, nausea and vomiting, intestinal rumbling and diarrhea (internal dampness).

   (4) Spleen and Stomach Damp-Heat

   Damp-heat combines and stagnates in the spleen and stomach, giving rise to this syndrome. If heat predominates over dampness, one experiences high fever, intense thirst, burning rectal discharge, yellow and greasy tongue coating, and slippery, rapid pulse—clearing heat and drying dampness is recommended, using Gegen Qinlian Tang (by Zhang Zhongjing). If dampness predominates over heat, one feels heavy and sluggish, with no apparent heat, abdominal distention, nausea and vomiting, and intestinal rumbling—aromatic decontamination is advised, using Sanren Tang (by Zhang Zhongjing) or Huopu Xialing Tang (from the "Medical Origins"). When heat dominates dampness, the response is urgent (rapid onset, all due to heat); when dampness dominates heat, the response is slower (dampness is sticky and hard to eliminate quickly). Therefore, the former is characterized by heat and urgency, while the latter is characterized by dampness and slowness.

   (5) Intense Stomach Fire

   Dry mouth, bad breath, oral erosion, toothache and gum swelling, gingival bleeding, burning sensation in the stomach, red tongue with yellow coating, and rapid pulse—clearing stomach fire is recommended, using Qingwei San (by Li Dongyuan). The hallmark of this syndrome lies in the oral cavity, as the mouth is the orifice of the spleen and stomach; moreover, since fire tends to ascend, it directly affects the oral cavity, causing dryness, bad breath, erosion, swelling, and bleeding—all signs of fiery heat.

   (6) Stomach Yin Deficiency

   Burning sensation in the stomach, dry mouth without drinking, red tongue with little coating, fine and rapid pulse, accompanied by bone-steaming hot flushes, five-heart vexation, and night sweats—nourishing stomach yin is recommended, using Yiwei Tang (by Ye Tianshi) or Shashen Mai Men Dong Tang (by Zhang Zhongjing). This syndrome consists of two parts: ① Yin deficiency symptoms: bone-steaming hot flushes, five-heart vexation, night sweats, dry mouth without drinking, red tongue with little coating, and fine, rapid pulse; ② Stomach heat symptoms: burning sensation in the stomach. Although it is stomach heat, it differs from intense stomach fire; this syndrome arises from heat damaging yin, so there is no fiery ascent affecting the oral cavity.

2. Heart Disease Differentiation

   (1) Heart Qi Deficiency, Heart Yang Deficiency, and Loss of Yang

   Palpitations, shortness of breath, and a fine or irregular pulse are the basic symptoms of heart qi deficiency; if accompanied by aversion to cold and spontaneous sweating, it becomes heart yang deficiency, and if heart yang deficiency progresses further, with pale complexion, cold sweat, cold limbs, and a nearly imperceptible pulse, it becomes loss of yang. Heart qi deficiency, heart yang deficiency, and loss of yang are three progressively deepening pathological stages. Extreme qi deficiency leads to extreme yang deficiency, and extreme yang deficiency leads to loss of yang—this is one of the fundamental concepts of TCM pathogenesis. For heart qi deficiency and heart yang deficiency, it is advisable to nourish qi and calm the heart, using Yangxin Tang (by Wang Kentang); for loss of yang, it is advisable to restore yang and reverse the situation, using Shenfu Tang (by Wei Yilin) or Sini Tang (by Zhang Zhongjing).

   (2) Heart Blood Deficiency, Heart Yin Deficiency, and Loss of Yin

   Palpitations, forgetfulness, insomnia, and frequent dreaming are the basic symptoms of heart blood deficiency; if accompanied by hot flushes, bone-steaming hot flushes, five-heart vexation, and night sweats, it becomes heart yin deficiency, and if heart yin deficiency progresses further, with restlessness, difficulty breathing, and warm limbs, it becomes loss of yin. Heart blood deficiency, heart yin deficiency, and loss of yin are three progressively deepening pathological stages. Extreme blood deficiency leads to extreme yin deficiency, and extreme yin deficiency leads to loss of yin—this is one of the fundamental concepts of TCM pathogenesis. For heart blood deficiency and heart yin deficiency, it is advisable to nourish blood and calm the spirit, using Tianwang Buxin Dan (by Wei Yilin); for loss of yin, it is advisable to nourish qi and yin, using Shengmai San (by Sun Simiao).

   (3) Excessive Heart Fire

   Chest heat, restlessness, fine tongue, and rapid pulse are the basic symptoms of excessive heart fire; if accompanied by oral erosion and reddish, bitter urine, it means heart fire has spread to the small intestine (organ heat spreading to viscera). The source of heart fire lies in the chest, and when it becomes excessive, the tendency to ascend intensifies, with the basic symptom complex rooted in this fact. The heart and small intestine are interconnected through meridians, so although fire ascends, it can also descend through the meridians to the small intestine. "The small intestine is the conduit for receiving and transforming substances, expelling waste," and it has the function of separating pure and impure elements; when the small intestine is hot, the urine becomes reddish and bitter. Oral erosion occurs because the moisture in the small intestine rises to the mouth via the fiery nature of the heat. For excessive heart fire, it is advisable to drain fire and calm the spirit, using Huanglian A Jiao Tang (by Zhang Zhongjing); for heart fire spreading to the small intestine, it is advisable to guide the heat downward, using Daochi San (by Qian Yi).

   (4) Phlegm Obscuring the Heart Orifice

   Confusion of consciousness (restlessness, mania, laughter, speech), slippery pulse, and greasy tongue are the basic symptoms of this condition, requiring phlegm elimination, heart orifice opening, and spirit calming, using Shengtie Luo Yin (by Cheng Zhongling). The heart governs the spirit, and when the heart orifice is blocked, consciousness becomes confused; the slippery pulse and greasy tongue are phlegm-related pulse and tongue manifestations, indicating that the blockage of the heart orifice is caused by phlegm.

   (5) Heart Blood Stasis

   Pain in the front of the heart, radiating pain to the arms, palpitations and shortness of breath, purple-dark tongue, and a sticky, irregular pulse are the basic symptoms of this condition, requiring blood circulation promotion, stasis resolution, and yang activation, using Guanxin II (by the Beijing Regional Collaboration Group) or Gualou Xiebai Banxia Tang (by Zhang Zhongjing). A sticky, irregular pulse and a purple-dark tongue indicate blood stasis, while pain in the front of the heart and palpitations and shortness of breath show that the site of blood stasis is in the heart.

3. Liver Disease Differentiation

(1) Liver Qi Stagnation

  Bitter taste in the mouth, dry throat, irritability, chest and flank discomfort, and a taut pulse are the basic symptoms of this syndrome; if accompanied by abdominal distention and loss of appetite, it is liver-stomach disharmony; if accompanied by something stuck in the throat that cannot be swallowed or spat out, it is liver qi ascending (meihe qi). For liver qi stagnation, it is advisable to soothe the liver and relieve stagnation, using Chaihu Shugan San (by Zhang Jingyue); for liver-stomach disharmony, it is advisable to soothe the liver and harmonize the stomach, using Xiaoyao San (from the "Bureau Regulations"); for liver qi ascending, it is advisable to soothe the liver and lower the qi, using Banxia Houpu Tang (by Zhang Zhongjing). The liver is naturally inclined to flow freely; when it stagnates, it rebels against the stomach (liver-stomach disharmony) as the first manifestation, and when it ascends, it rushes to the throat (meihe qi) as the second manifestation—both are products of liver qi stagnation.

(2) Liver-Gallbladder Real Fire

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Bitter taste in the mouth, dry throat, irritability and anger, fullness and discomfort in the chest and hypochondrium, dizziness and headache, tinnitus and vertigo, flushed face and red eyes, palpitations and shortness of breath, scanty and reddish urine, and a wiry yet rapid pulse—these symptoms indicate Liver Fire excess, which should be treated by clearing the Liver and draining the Fire using Longdan Xiegan Tang (from “Yizong Jinjian”). This syndrome is often caused by prolonged stagnation of Qi transforming into Fire; therefore, the core symptom complex consists of two parts: ① bitter taste in the mouth, dry throat, irritability and anger, and fullness and discomfort in the chest and hypochondrium (Liver Qi stagnation); ② dizziness and headache, flushed face and red eyes, scanty and reddish urine, and a rapid pulse (Fire ascending upward). Palpitations, shortness of breath, tinnitus, and vertigo are manifestations of the governing and assisting Fire syndromes.

(3) Liver Yin Deficiency

Dizziness and vertigo, lumbago and tinnitus, bone-steaming heat and tidal fever, vexing heat in the five centers, night sweats, numbness and tremors in the hands and feet, a red tongue with little coating, and a wiry, fine, and rapid pulse—all these symptoms suggest a pattern of Yin deficiency. Treatment should focus on nourishing water to contain wood, using Qiju Dihuang Wan. Since the Liver and Kidney share a common origin, Liver Yin relies on Kidney Yin for nourishment; thus, the manifestations of Liver Yin deficiency comprise three components: ① dizziness and vertigo, lumbago and tinnitus (Kidney deficiency syndrome); ② bone-steaming heat, vexing heat in the five centers, and night sweats (Yin deficiency syndrome); ③ numbness and tremors in the hands and feet (Yin failing to nourish the sinews).

(4) Internal Liver Wind (All wind-related dizziness and vertigo are attributed to the Liver)

① Wind arising from extreme heat (wind-fire interaction) High fever, palpitations, convulsions, syncope, and a wiry, rapid pulse—treatment should focus on clearing fire and calming the spirit, using Lingyang Gouteng Tang (Yu Genchu).

② Wind arising from Yang excess (all sudden, violent rigidity is due to wind) Severe headache, hemiplegia with aphasia, facial deviation, convulsions, and coma—treatment should focus on calming the Liver and extinguishing the wind, using Zhen Gan Xi Feng Tang (Zhang Xichun).

③ Wind arising from blood deficiency (blood failing to nourish the sinews) Tremors, numbness, and convulsions—treatment should focus on nourishing blood and extinguishing wind, using Da Ding Feng Zhu (from “Wenbing Tiaobian”).

(5) Cold Stagnation in the Liver Meridian

Cold pain in the lower abdomen, retraction of the scrotum, and heaviness and drooping of the testicles—treatment should focus on warming the Liver and dispersing cold, using Nuan Gan Jian (Zhang Jingyue). The lower abdomen, scrotum, and testicles all lie along the Foot Jueyin Liver Meridian.

4. Lung Disease Differentiation

(1) Lung Cold Cough

Headache, fever, chills, cough, clear and thin sputum, and a floating, tight pulse—treatment should focus on releasing the exterior, dispelling cold, and relieving cough, using Ma Huang Tang (Zhang Zhongjing). This syndrome represents both wind-cold exterior syndrome and cough.

(2) Lung Heat Cough

Headache, fever, thirst, excessive drinking, irritability, cough and wheezing, a red tongue, and a rapid pulse—treatment should focus on clearing heat, dispersing lung qi, and relieving cough, using Ma Xing Shi Gan Tang (Zhang Zhongjing). This syndrome represents both wind-heat exterior syndrome and cough.

(3) Lung Dryness Cough

Dry mouth, dry throat, dry nose, cough with phlegm, sticky and difficult-to-expectorate phlegm, and a tongue with little fluid—treatment should focus on clearing dryness and rescuing the lungs, using Qing Zao Jiu Fei Tang (Yu Jiayan). Dryness manifests as three dry conditions; this syndrome combines the triad of dryness with cough and sticky phlegm.

(4) Phlegm Turbidity Obstructing the Lungs

Stagnant phlegm obstructing the lungs, coughing and wheezing that make it impossible to lie down—treatment should focus on guiding phlegm and dispersing lung qi, using Su Zi Jiang Qi Tang (from “Jufang”) or Ting Li Da Zao Xie Fei Tang (Zhang Zhongjing).

(5) Lung Qi Deficiency

Pale complexion, shortness of breath and reluctance to speak, spontaneous sweating and fatigue, cough and phlegm, a plump, pale tongue, and a moist, fine pulse—treatment should focus on tonifying qi and replenishing the lungs, using Bu Fei Tang with added herbs (an empirical formula).

(6) Lung Yin Deficiency

Cough with phlegm, sticky and difficult-to-expectorate phlegm, blood in the phlegm, bone-steaming heat and tidal fever, vexing heat in the five centers, and night sweats—treatment should focus on nourishing yin and clearing the lungs, using Baihe Gujin Tang (Zhao Zai’an). This syndrome comprises both yin deficiency symptoms and lung cough symptoms.

5. Kidney Disease Differentiation

Dizziness, tinnitus, lumbago, leg fatigue, and a weak cun pulse indicate kidney deficiency. If accompanied by bone-steaming heat, tidal fever, vexing heat in the five centers, and night sweats, it is kidney yin deficiency; if accompanied by aversion to cold and spontaneous sweating, it is kidney yang deficiency. For kidney yin deficiency, treatment should focus on nourishing yin and tonifying the kidneys, using Liu Wei Di Huang Tang (Qian Zhongyang). For kidney yang deficiency, it can be further divided into four types, each requiring separate treatment.

① Kidney not storing essence Basic symptoms of kidney yang deficiency include nocturnal emission and impotence; treatment should focus on strengthening the kidneys and consolidating essence, using Bu Wan (a verified formula).

② Kidney not receiving qi Basic symptoms of kidney yang deficiency include shortness of breath and喘息; treatment should focus on warming the kidneys and accepting qi, using Du Qi Wan (from “Yizong Jiren Bian”).

③ Decline of Mingmen fire Basic symptoms of kidney yang deficiency include diarrhea at dawn; treatment should focus on warming the kidneys and stopping diarrhea, using Si Shen Wan (from “Neike Zhaiyao”).

④ Yang deficiency with water overflow Basic symptoms of kidney deficiency include generalized edema; treatment should focus on warming yang and transforming water, using Zhen Wu Tang (Zhang Zhongjing).

Appendix: Lower-jiao deficiency-cold: nocturia, enuresis, frequent urination, and coldness in the lower abdomen—treatment should focus on warming and tonifying the lower jiao, using Suo Quan Wan (from “Furen Liangfang”). Bladder damp-heat: urgency, frequency, pain during urination, and acute distension in the lower abdomen—treatment should focus on clearing heat, eliminating dampness, and promoting urination, using Ba Zheng San (from “Jufang”).

The organ-based syndromes introduced above may appear individually in clinical practice, but in most cases, several organ syndromes occur simultaneously. Examples include Heart-Spleen deficiency syndrome, Spleen-Kidney yang deficiency syndrome, and Liver-Kidney yin deficiency syndrome. Heart-Spleen deficiency syndrome is a combined manifestation of heart-blood deficiency and spleen-Qi deficiency, featuring both paleness of the face, poor appetite, fatigue, and shortness of breath associated with spleen-Qi deficiency, as well as palpitations, forgetfulness, insomnia, and excessive dreaming associated with heart-blood deficiency. The therapeutic formula for this syndrome is Gui Pi Tang, which contains both spleen-tonifying herbs such as Dang Shen, Bai Zhu, and Huang Qi, and heart-nourishing herbs such as Yuan Zhi and Zao Ren. Once one understands the individual organ syndromes, it becomes easier to analyze their combined clinical presentations.

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III. Progress in Integrating Traditional Chinese Medicine and Western Medicine in Organ-Based Differentiation

1. Immunological Aspects

In recent years, numerous domestic experimental studies have suggested that methods of strengthening the spleen and tonifying the kidneys can improve the body’s immune function. Among them, spleen-strengthening methods tend to enhance non-specific immunity, while kidney-tonifying methods tend to enhance specific immunity. Non-specific immunity refers to defense mechanisms that lack selectivity, such as the skin-mucosal barrier, the blood-brain barrier, the blood-fetal barrier, the reticuloendothelial system, and the phagocytic activity of neutrophils. Specific immunity, on the other hand, is highly targeted and only acts against corresponding pathogens; its function is carried out by immune-active T cells and antibodies present in body fluids that specifically recognize antigens.

The spleen and stomach occupy the central position, and the “Wei Qi” that enables the body to perform defensive functions originates from food and water and is generated in the spleen and stomach. Therefore, the strength of spleen and stomach function directly affects the abundance of Wei Qi. The “Ling Shu·Ben Cang Pian” states: “Wei Qi is what warms the muscles and flesh, fills the skin, nourishes the pores and skin, and controls opening and closing.” It also says: “When Wei Qi is balanced, the muscles and flesh are relaxed, the skin is smooth and supple, and the pores and skin are tightly closed.” This demonstrates that Wei Qi is an important factor in clearing foreign pathogens from peripheral tissues such as muscles, skin, and mucous membranes, playing a role similar to the skin-mucosal barrier. When Wei Qi encounters invading pathogens, it mounts a vigorous defense, and the intense struggle between the two leads to disease. The “Su Wen·Mao Lun” states: “Wherever Wei Qi resides, it combines with pathogenic factors to cause illness.” This phenomenon is very similar to the phagocytic activity of the reticuloendothelial system. Sometimes, Wei Qi can even surround invading pathogens, causing local abscesses, as described in the “Su Wen·Feng Lun”: “Wind qi enters the meridians together with the Sun, spreads among the muscles and flesh, interacts with Wei Qi, and because the pathway is blocked, the muscles swell and ulcers form.” This shows how similar Wei Qi is to the phagocytic action of neutrophils in immunology. Moreover, Wei Qi’s protective effect is not limited to the skin, muscles, and pores; it also protects internal organs. The “Ling Shu·Wei Qi Xing Pian” states: “It initially enters the yin meridians, often flowing from the Shaoyin meridian to the heart, then to the lungs, then to the spleen, and finally back to the kidneys, completing a cycle.” This indicates that Wei Qi can circulate through various organ meridians, much like the dispersed reticuloendothelial system and the systemic circulation of body fluids.

The above discussion shows that Wei Qi has a function similar to non-specific immunity in modern immunology; however, the primary factor determining the abundance of Wei Qi is the strength of spleen and stomach function. The traditional approach of using Bu Zhong Yi Qi Tang to strengthen spleen and stomach function, thereby preventing colds, is a clinical application of this principle. Recent domestic experimental studies have shown that Bu Zhong Yi Qi Tang can indeed improve protein metabolism in tumor-bearing organisms and increase non-specific immunity. For example, the Isotope Laboratory of the Beijing Tuberculosis Research Institute injected animals intravenously with a colloidal solution of 131I-labeled plasma proteins and measured the clearance rate in the blood as an indicator of the phagocytic function of the reticuloendothelial system. They found that spleen-strengthening herbs such as Dang Shen, Bai Zhu, and Huang Qi enhanced the phagocytic function of the reticuloendothelial system, whereas the control group containing yin-nourishing and heat-clearing herbs such as Sha Shen, Bai He, Bei Mu, and Huang Qin had no such effect. The Oncology Group of the Beijing Institute of Traditional Chinese Medicine also found that Dang Shen could increase the number of white blood cells in peripheral blood. Jiang Tingliang injected rabbit serum with extracts of this herb, increasing the proportion of neutrophils in the peripheral blood. These experiments suggest that spleen-strengthening herbs like Dang Shen can enhance the defensive function of white blood cells and boost non-specific immunity. The Guang’anmen Hospital of the China Academy of Traditional Chinese Medicine measured the phagocytic function of macrophages in 89 patients with malignant tumors, finding that their phagocytic rates were significantly lower than normal. After treating five cervical cancer patients with spleen-strengthening and vitalizing therapies, their macrophage phagocytic function markedly improved. These data demonstrate that spleen-strengthening methods can indeed enhance the defensive capabilities of macrophages, neutrophils, and the reticuloendothelial system, providing experimental evidence for the view that spleen-strengthening can regulate non-specific immunity.

The kidneys are the foundation of innate vitality and the source of life. The “Su Wen·Sheng Qi Tong Tian Lun” states: “When yin is balanced and yang is concealed, spirit is maintained.” It also says: “When yin and yang are separated, essence is lost.” This shows that the balance of yin and yang is a prerequisite for maintaining a normal ecological state. The fundamental basis of yin and yang is the kidneys, hence the terms “original yin” and “original yang.” Imbalances in kidney qi are often the key factor leading to overall imbalances in yin and yang. Modern immunology holds that the functions of T cells dependent on the thymus and B cells independent of the thymus are the main components of specific immunity, and the precursors of these two types of cells are stem cells located in the bone marrow. The “Su Wen·Yin Yang Ying Xiang Da Lun” states: “The kidneys generate bone marrow.” From this, we can infer that the transformation of bone marrow stem cells into T cells and B cells is closely related to the kidneys. Therefore, by regulating kidney yin and kidney yang, we can hope to improve the body’s specific immune response. For example, the Shanghai Cancer Research Institute used crude fetal alpha-globulin as an antigen to immunize rabbits, inducing an immune response, then divided them into groups to administer kidney-yin-tonifying drugs and kidney-yang-tonifying drugs, measuring the resulting antibody levels. The results showed that kidney-yang-tonifying drugs accelerated the formation of antibodies, while kidney-yin-tonifying drugs extended the lifespan of antibodies, demonstrating that kidney-tonifying therapy can improve specific humoral immunity. The Department of Traditional Chinese Medicine at the Affiliated Hospital of Guangzhou Medical College conducted rose-petal tests on patients with chronic bronchitis due to kidney deficiency to measure their specific cellular immunity. They found that the ratio of T cells in these patients was generally low, but after administering kidney-tonifying herbal medicines, the ratio gradually increased, and clinical symptoms also improved accordingly. According to the Chronic Bronchitis Office of the Henan Provincial Health Department, from the perspective of specific humoral immunity, measuring the IgA content in the sputum of chronic bronchitis patients revealed that after treatment with kidney-tonifying drugs such as rabbit placenta, the IgA content in the patients’ sputum tended to increase. The First Outpatient Clinic of the Chengdu Military Region examined more than 50 patients with chronic bronchitis due to kidney deficiency, measuring their serum IgG and IgA levels, which were all below normal. After applying warm kidney-yang-tonifying medications via navel patches, these indicators all increased to varying degrees. From these materials, we can see that kidney-tonifying methods can enhance the conversion of T cells into lymphoblasts and promote the release of lymphokines, while also strengthening the function of immunoglobulins in body fluids, thus providing experimental evidence for the argument that kidney qi has specific immune functions.

2. Endocrine Aspects

In recent years, materials combining organ-based differentiation with endocrine aspects are still mainly focused on the spleen and kidneys.

The kidneys are the foundation of innate vitality and the source of life, making them extremely important organs for the human body. As stated in the “Su Wen·Shang Gu Tian Zhen Lun”: “At seven years old, a girl’s kidney qi is strong, her teeth change, and her hair grows; at fourteen, she reaches puberty, her Ren channel is open, her Tai Chong channel is robust, her menstruation occurs regularly, and she can bear children; at forty-nine, her Ren channel becomes weak, her Tai Chong channel declines, her pubertal energy is exhausted, her reproductive tract closes, and she loses the ability to bear children.” Shen Kuo said: “If a woman lacks the power of the kidneys, she will have no desire.” He even extracted sex hormone crystals of a certain purity from human urine, calling them “Qiushi,” to treat diseases related to growth, development, and sexual characteristics (endocrine disorders). This shows that traditional Chinese medicine has long attributed endocrine dysfunction to the kidneys. After the Ming Dynasty, the school of warming and tonifying emerged, with more discussions about the kidneys and the Mingmen. Zhang Jingyue said: “The Mingmen is the root of original qi, the abode of water and fire, the place where the yin qi of the five organs cannot be nourished without it, and the yang qi of the five organs cannot be activated without it. The Mingmen has a ‘fire point,’ which is the original yang, the fire of life itself.” This statement suggests that the kidneys and the Mingmen are closely linked to the body’s energy metabolism. In the early 1960s, Shen Ziyin and others at the First Medical College of Shanghai began experimental research aimed at clarifying the relationship between the kidneys and adrenal gland endocrine functions. They first noticed that six different systems of diseases—functional uterine bleeding, bronchial asthma, pregnancy toxemia, systemic lupus erythematosus, coronary heart disease, and neurasthenia—each exhibited clinical manifestations of kidney yang deficiency at a certain stage of their development. At that time, if roughly the same kidney-tonifying therapy was administered, all six diseases would show some improvement. From this, they inferred that there might be a common link of metabolic dysfunction in the pathological processes of these six diseases, and that this metabolic dysfunction was the underlying factor, while the external manifestation was kidney yang deficiency. Since kidney-tonifying therapy could alleviate and eliminate kidney yang deficiency symptoms, it undoubtedly could also regulate the underlying metabolic dysfunction. Later, through a series of experiments, they finally discovered that the 24-hour urinary excretion of 17-hydroxycorticosteroids in patients with kidney yang deficiency was significantly lower than normal, and after kidney-tonifying treatment, it returned to normal levels. At the same time, the kidney yang deficiency symptoms also improved accordingly. The level of 17-hydroxycorticosteroids in urine reflects the synthesis, secretion, and catabolism of adrenal cortical hormones in the body; any imbalance in any of these three processes will lead to changes in the urinary 17-hydroxycorticosteroid levels. Such imbalances are usually closely related to the hypothalamus-pituitary-adrenal cortex system. Based on this conclusion, it became clear why traditional Chinese medicine’s kidney-tonifying therapy could treat so many different diseases. In addition to the aforementioned six diseases, Pei Zhengxue often used kidney-tonifying therapy to treat aplastic anemia, leukemia, tumors, hypertension, chronic nephritis, prostatitis, lumbar muscle strain, rheumatoid arthritis, and other conditions, achieving varying degrees of clinical efficacy. With a clear understanding of the above mechanism, this provided an important avenue for exploring the reasons behind these therapeutic effects.

The spleen is the foundation of acquired vitality, and like the kidneys, it is another extremely important organ for the human body. Since the spleen is responsible for transporting and transforming food, producing the five flavors, people generally believe that the spleen in traditional Chinese medicine has the absorption and digestion functions of the small intestine in modern medicine. In recent years, the similarities between the spleen and the pancreas in modern medicine have gradually attracted attention, leading to a preliminary exploration of the relationship between the spleen and the endocrine system. The “Su Wen·Tai Yin Ming Lun Pian” states: “The spleen and stomach are connected by a membrane, and they can transport their bodily fluids.” This shows that the anatomical location of the spleen is similar to that of the pancreas. The “Su Wen” also says: “People with spleen problems experience heaviness, constant hunger, and muscle wasting.” This is very similar to the symptoms of diabetes. Ming Dynasty scholar Zhang Jingyue developed this idea further: “Middle consumption refers to middle-jiao disease; people eat a lot and feel hungry, but their muscles don’t grow—they become thinner day by day. The problem lies in the spleen and stomach, which causes middle consumption (from ‘Jing Yue Quan Shu’).” This clearly points out that diabetes, a disorder of pancreatic endocrine function, is one of the diseases of the spleen. Modern medicine has discovered the gastrointestinal and pancreatic endocrine systems. In 1964, someone abroad injected glucose solution into the duodenum, and the insulin concentration in the blood rapidly increased, far exceeding the level achieved by injecting glucose directly into the bloodstream. Later, special endocrine-function APUD cells were discovered in the upper intestinal mucosa, secreting several peptide hormones (such as gastrin, glucagon, secretin, cholecystokinin, and enterogastrone) into the bloodstream to regulate digestion, absorption, storage, and decomposition. This regulatory function often operates under the participation of the vagus nerve, and this endocrine system including the vagus nerve is called the gastrointestinal and pancreatic endocrine system. The spleen in traditional Chinese medicine has functions very similar to this endocrine system. Hou Can from the Sun Yat-sen Medical College analyzed spleen-deficiency symptoms such as excessive salivation, dampness, abdominal distension, loose stools, acid regurgitation, and nausea, concluding that when the spleen is deficient in yang, the tension of the vagus nerve increases. Someone measured the true cholinesterase activity of patients with spleen yang deficiency and found it higher than that of the normal control group, supporting this view. Hou also participated in measuring the autonomic nervous system function of 53 patients with chronic dysentery due to spleen deficiency, discovering that 53% had parasympathetic dominance, while only 5% had sympathetic dominance. The New Jiangsu Medical College conducted experiments using isolated rabbit intestinal tubes and found that spleen-strengthening formulas such as Bu Zhong Yi Qi Tang inhibited excessive intestinal peristalsis, further supporting the above view.

In the aforementioned gastrointestinal and pancreatic endocrine systems, the parasympathetic nervous system only transmits information and regulates the increase or decrease of secretions. For example, antidiabetic drugs promote increased insulin secretion, leading to hypoglycemia; this increased insulin secretion, in turn, reflexively triggers: increased gastrin secretion (promoting gastric acid and pepsin secretion), increased secretin secretion (promoting pancreatic enzyme release), and increased cholecystokinin secretion (promoting bile secretion), fully activating the gastrointestinal and pancreatic endocrine systems and preparing them to participate in digestion and absorption. This shows that the spleen in traditional Chinese medicine essentially has the same digestive, absorptive, and metabolic functions as the modern gastrointestinal and pancreatic endocrine systems, with pancreatic endocrine function playing the dominant role. The fact that traditional Chinese medicine has long attributed diabetes to the spleen and achieved good results by treating it with spleen-strengthening methods provides a preliminary answer to this question.

Traditional Chinese medicine has always attached great importance to the relationship between the spleen and the kidneys. Zhang Jingyue said: “At birth, humans rely on the source of essence and blood; after birth, they depend on food and water. Without essence and blood, there is no foundation for the body; without food and water, there is no way to build up the body. Essence and blood are governed by the Mingmen, while food and water are governed by the spleen and stomach. Thus, the Mingmen receives innate qi, while the spleen and stomach receive acquired qi. Therefore, the sea of food and water primarily depends on innate qi, while the sea of essence and blood must rely on acquired qi for support. Consequently, from birth to old age, anyone whose innate foundation is insufficient can compensate for it through acquired cultivation, and even achieve half of the innate strength through acquired efforts.” After clarifying the endocrine relationship between the spleen and the kidneys, understanding Zhang Jingyue’s view becomes even more precise. The kidneys have the function of the hypothalamus-pituitary-adrenal cortex system, while the spleen has the function of the gastrointestinal and pancreatic endocrine system. The former uses 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 of opposites.

Section 12: Application of Bowel-Purging Therapy in Internal Medicine Emergencies

Bowel-purging therapy, also known as bowel-purging and heat-clearing therapy, is a method of purging the bowels to eliminate internal heat. Pei Zhengxue has used this method to rescue patients with internal medicine emergencies, achieving good therapeutic results.

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Case 1: Mr. Wang, male, 51 years old, worker, presented to the emergency department on August 6, 1982. Three days prior, the patient experienced severe upper abdominal pain, described as knife-like, radiating to the left chest, waist, shoulder, and back, accompanied by nausea, vomiting, pallor of the face, cold extremities, and hypotension. A consultation with Traditional Chinese Medicine was subsequently requested. Physical examination revealed a body temperature of 37.8°C, pulse rate of 102 beats per minute, respiratory rate of 28 breaths per minute, blood pressure of 8.0/5.3 kPa (60/40 mmHg), pale complexion, distressed expression, clouded consciousness, nuchal rigidity, no abnormalities on auscultation of both lungs, normal cardiac silhouette, and a grade II systolic blowing murmur heard at the apex. The abdomen was slightly distended, with marked tenderness and mild rebound tenderness in the left upper quadrant; the liver and spleen were not palpable, and no pathological reflexes were elicited. Laboratory tests showed a white blood cell count of 18,000/mm³, with 84% neutrophils and 16% lymphocytes, serum amylase of 1,260 U (Somogyi method), and urinary amylase of 445 U (Winslow method). Diagnosis: Acute pancreatitis with shock. TCM differentiation: Red tongue with thick, greasy yellow coating, deep, fine, and rapid pulse, dry stools, combined with severe chest and abdominal pain, pallor of the face, and cold extremities—indicating internal excess yang and external obstruction of yin, with internal stagnation of Yangming腑实 and external obstruction of yin leading to limb coldness; the more intense the heat, the deeper the cold. Treatment principle: Clear fire and attack the solid condition to address the root cause, using a modified Dachengqi Tang formula: 10 g each of rhubarb, mirabilite, citrus aurantium fruit, bupleurum, and white peony; 6 g each of Corydalis, melia seeds, magnolia bark, and scutellaria; 3 g each of coptis, agilawood, and cardamom; decocted in water and taken twice daily for two consecutive doses. Concurrently, fluid replacement and intramuscular injection of penicillin and streptomycin were administered. On the following day, upon re-examination, the patient’s abdominal pain had significantly subsided, consciousness improved, and he passed large amounts of dark, turbid, watery stool; blood pressure rose to 13.3/10.7 kPa (100/80 mmHg). However, the patient still experienced intermittent exacerbations of pain in the left upper abdomen, radiating to the left chest, waist, and shoulder, accompanied by bitter taste in the mouth, dry throat, abdominal distension, and bowel sounds. Pulse was wiry and rapid, tongue red with greasy yellow coating. Syndrome indicated residual internal heat, with pathogenic factors residing in the Shaoyang channel; treatment principle: resolve both exterior and interior conditions, using a modified Dachaihu Tang formula: 10 g each of bupleurum, scutellaria, citrus aurantium fruit, and rhubarb; 15 g of white peony; 6 g each of chuanxiong, xiangfu, corydalis, and melia seeds; 3 g of coptis; 20 g each of coix seed and red vine; decocted in water and taken once daily for a total of six doses. Upon subsequent re-examination, the patient’s mental state improved, blood pressure stabilized, tongue coating became thinner, pulse remained wiry, with only occasional dull pain in the left upper abdomen. Serum amylase decreased from 1,260 U to 60 U, and urinary amylase from 224 U to 120 U; the patient continued to take Shugan Wan pills (produced by the Yuxian Pharmaceutical Factory in Henan Province), one pill morning and night, to promote recovery.

Case 2: Mr. Chen, male, 68 years old, retired worker, first visited on April 7, 1983. One day prior, the patient developed sudden chest tightness and coughing with hemoptysis, bright red blood mixed with foam; bleeding persisted throughout the day, totaling about half a sputum basin. He had previously been diagnosed at another hospital as “bronchiectasis complicated by massive hemorrhage.” He had a history of chronic bronchitis but no tuberculosis, heart disease, or liver and stomach disorders. Physical examination revealed a body temperature of 38°C, respiratory rate of 20 breaths per minute, pulse rate of 102 beats per minute, and blood pressure of 13.3/8.7 kPa (100/65 mmHg). The patient appeared thin and jaundiced, with clear consciousness, symmetrical chest that was slightly barrel-shaped, deformed intercostal spaces, hyperresonance on percussion, and relatively deep respiratory movement on both sides; coarse breath sounds with scattered dry rales were heard in both lungs, cardiac silhouette was small, no obvious murmurs were detected in any valve area, A₂>P₂, with A₂ slightly accentuated. The abdomen was flat and soft, with no tenderness in the gastric region; liver and spleen were not palpable, and ascites sign was negative. Chest X-ray showed markedly thickened lung markings, increased translucency, and widened lung fields, suggesting chronic bronchitis combined with emphysema and bronchiectasis. Laboratory tests showed a white blood cell count of 18,600/mm³, with 82% neutrophils and 18% lymphocytes, and erythrocyte sedimentation rate of 2 mm/h. Diagnosis: Bronchiectasis, emphysema, and massive hemoptysis. TCM differentiation: Red tongue with thick, greasy yellow coating, full and rapid pulse, dry stools, fullness and oppression in the chest and diaphragm, coughing, shortness of breath, and phlegm obstructing the airways, with foamy bloody sputum. Syndrome indicated excessive fire in the lungs and stomach, with fire driving blood. Treatment principle: Clear fire from the lungs and stomach, cool the blood to stop bleeding, using a modified Liangge San formula: 10 g each of rhubarb, mirabilite, forsythia, scutellaria, gardenia, bletilla, trichosanthes, and tangerine peel; 6 g each of coptis, fritillaria, and licorice; 3 g of peppermint; decocted in water and taken once daily (along with 800,000 units of penicillin intramuscularly every 8 hours and 0.5 g of streptomycin intramuscularly every 12 hours), for a total of four doses. Upon re-examination, the hemoptysis had stopped, tongue coating became thinner, though still greasy yellow, chest fullness and dyspnea were alleviated compared with before, phlegm remained copious, now yellow and thick purulent sputum, diarrhea occurred 2–3 times daily, with brownish-black, foul-smelling, watery stools, pulse wiry and rapid. The previous prescription omitted mirabilite and bletilla, and five additional doses were administered. Upon further re-examination, all symptoms except chest fullness and shortness of breath had resolved, pulse was weak and wiry, tongue pale with slight greasy yellow coating. The patient was instructed to take Maiwei Dihuang Wan twice daily, one pill each time, to promote long-term recovery.

In the treatment of the above cases, although Western medicines were used concurrently, the application of the “Tongfu” method undoubtedly played an important role in controlling the condition. In Case 1, the Tongfu method promoted pancreatic juice drainage and enhanced pancreatic excretion, potentially facilitating the resolution of congestion and edema. In Case 2, the Tongfu method seemed to alleviate pulmonary edema and congestion, thereby aiding in the relief of pulmonary hemorrhage. Furthermore, the “Sanhuang Xiexin Tang” is a well-known fire-clearing and hemostatic agent, highly effective in treating pulmonary hemorrhage. Traditional Chinese medicine holds that the lungs and large intestine are paired organs, and clearing the gastrointestinal tract is akin to removing the fuel from under the pot—eliminating the root cause. Adding coptis further emphasizes the idea that clearing the heart means clearing fire, and clearing fire means stopping bleeding. The Tongfu method is indeed effective in treating various acute conditions, but its primary indication for such treatments is internal accumulation of real heat, which aligns perfectly with traditional concepts. Pei Zhengxue believes that internal accumulation of real heat can lead to conditions such as yang excess obstructing yin (shock), heat stirring wind (convulsions), blood rushing out uncontrollably (bleeding), and even heat invading the pericardium (coma). All these dangerous conditions share a common pathogenesis of heat accumulation, thus providing ample scope for the Tongfu method in treating acute illnesses. The application of the Tongfu method should be tailored to the specific condition to prevent excessive diarrhea and subsequent complications; in other words, once the syndrome of internal heat accumulation changes, treatment should be adjusted according to the new clinical presentation to achieve complete recovery.

Section 13: Spleen-Strengthening and Kidney-Nourishing Method