2. Clinical Applications of the Spleen-Strengthening and Kidney-Nourishing Method

Disease is the product of the struggle between pathogenic and defensive forces, and the ebb and flow of the illness reflect the waxing and waning of these forces. Among the two pathogenic factors—deficiency of vital energy and pathogenic qi—Traditional Chinese Medicine has always emphasized the primary role of vital energy deficiency, which opens up broad avenues for the clinical application of the Spleen-Strengthening and Kidney-Nourishing Method.

1. Chronic Nephritis

Traditional Chinese Medicine does not have a specific term for nephritis, but based on syndrome analysis, it falls under the category of edema. Zhang Jingyue said, “All conditions involving edema are related to the spleen, lungs, and kidneys. Water is the ultimate yin, so its root lies in the kidneys; water transforms into qi, so its manifestation lies in the lungs; water fears earth, so its control lies in the spleen. When the lungs are deficient, water fails to transform into essence and instead becomes water; when the spleen is deficient, earth fails to control water and instead overcomes it; when the kidneys are deficient, water has no master and runs wild.” This illustrates that the manifestation of edema lies in the lungs, its root lies in the kidneys, and its control lies in the spleen. Edema is divided into yin water and yang water: the former is more associated with the spleen and kidneys, characterized by deficiency and cold; the latter is more associated with the lungs, characterized by excess and heat. Clinically, the former resembles chronic nephritis, while the latter resembles acute nephritis. Therefore, the focus of treatment for chronic nephritis should be on the spleen and kidneys, and the main clinical approach is generally the Spleen-Strengthening and Kidney-Nourishing Method. For example, Liaoning University of Traditional Chinese Medicine treated 100 cases of chronic nephritis using this method, achieving complete remission in 33 cases, basic remission in 13 cases, partial remission in 39 cases, for an overall effectiveness rate of 85%. The PLA’s 281st Hospital reported on the integrated use of traditional Chinese and Western medicine to treat 110 cases of chronic nephritis, employing the Spleen-Strengthening and Kidney-Nourishing Method for the herbal component, resulting in 67 clinically cured cases, accounting for 60.9%, 15 cases of basic cure, and 17 cases of improvement, for a total effectiveness rate of 90%. Pei Zhengxue also frequently uses the Spleen-Strengthening and Kidney-Nourishing Method in clinical practice, achieving remarkable results each time. Patient Wu, male, 29 years old, suffered from acute nephritis four years ago, which progressed to chronic nephritis due to improper treatment. Over the past four years, he has experienced recurrent edema, with proteinuria consistently ranging from + to ++++, and microscopic examination revealing red blood cells and white blood cell casts. In recent months, the edema has worsened, accompanied by fatigue, dizziness, lower back pain, sensitivity to cold, abdominal distension, nausea, and vomiting. Serum non-protein nitrogen reached 115 mg%, tongue swollen and pale with tooth marks, coating slightly yellow and greasy, pulse deep, fine, and wiry. Based on the syndrome of spleen and kidney yang deficiency, the Spleen-Strengthening and Kidney-Nourishing Method was applied, using ingredients such as rehmannia, cornelian cherry, Chinese yam, cortex moutan, poria, alisma, plantago, codonopsis, atractylodes, astragalus, achyranthes, cinnamon, processed aconite, white grass root, cicada slough, motherwort, and su stem, adjusted as needed, for over 100 doses. After treatment, all symptoms disappeared, serum non-protein nitrogen returned to normal, and routine urine tests showed only a few red blood cells under microscopy, with all other parameters normal.

2. Chronic Bronchitis

Traditional Chinese Medicine refers to this disease as “prolonged cough” or “asthmatic cough,” classifying it as an internal injury cough; improper treatment of external infections can lead to internal injury cough. This disease is triggered by external factors, causing repeated exacerbations. Traditional Chinese Medicine has long recognized that the manifestation lies in the lungs, while the root lies in the spleen and kidneys. The manifestation is the symptom, the root is the pathogen, indicating that treating the spleen and kidneys is fundamental to curing this disease. Using spleen-strengthening methods to treat chronic bronchitis is the traditional “nurturing earth to generate metal” approach, while using kidney-nourishing methods is the traditional “warming the kidneys to gather qi” approach. Applying both methods simultaneously constitutes the Spleen-Strengthening and Kidney-Nourishing Method.

Based on the above principles, long-term syndrome differentiation and treatment have yielded good results in the prevention and treatment of chronic bronchitis. For example, the Xiyuan Hospital of the Beijing Institute of Traditional Chinese Medicine achieved an efficacy rate of 95.5% using Guben Wan to treat this disease; the formula combines Liu Jun Zi Tang, Yu Ping Feng San, psoralen, and purple placenta, aiming to strengthen the spleen and kidneys. The Shaanxi Provincial Institute of Traditional Chinese Medicine also used a combination of cinnamon, processed aconite, atractylodes, and dried ginger to formulate Sanzi Yangqin Tang, which was used to treat this disease with good results. Judging from the composition of the formula, it still falls under the Spleen-Strengthening and Kidney-Nourishing Method.

In the summer of 1978, a case of silicosis was encountered: a 60-year-old male patient with facial edema, cyanotic lips, asthmatic cough, thin and clear sputum, difficulty breathing (requiring intermittent oxygen therapy), aversion to cold, intestinal rumbling and loose stools, abdominal distension and poor appetite. A chest X-ray revealed severe emphysema and right heart enlargement, indicating advanced silicosis. Pulse was deep and slippery, both radial pulses weak, tongue purple and dark, coating slightly yellow and greasy. Based on spleen and kidney yang deficiency and inability of the kidneys to gather qi, the Spleen-Strengthening and Kidney-Nourishing Method was applied, using Gui Fu Ba Wei Wan combined with Jin Shui Liu Jun Jian, adjusted as needed, for a total of over 40 doses. All symptoms greatly subsided, and breathing became smooth.

3. Tumors

Traditional Chinese Medicine believes that the key to the occurrence of tumors is deficiency of vital energy. As stated in “Yizong Bibi”: “The formation of accumulations is due to insufficient vital energy, allowing pathogenic qi to take hold.” During the Song and Yuan dynasties, Zhang Yuan, Li Dongyuan, Luo Tianyi, and others all made similar arguments about nourishing vital energy to naturally eliminate accumulations. In recent years, reports of successful tumor treatment through tonifying vital energy have been increasing. For example, Longhua Hospital affiliated with Shanghai University of Traditional Chinese Medicine treated a case of advanced liver cancer using the Spleen-Strengthening and Kidney-Nourishing Method; after two months of ineffective Western chemotherapy, they switched to traditional Chinese medicine, and the patient gradually improved, regaining spirit and having ascites disappear within three months before discharge. Another case involved treating an advanced breast cancer patient, whose tumor completely disappeared after four months. In 1978, Pei Zhengxue admitted a patient with mediastinal tumor, Ju, male, 48 years old, experiencing chest pain, shortness of breath, inner restlessness, dry cough without phlegm, and occasional difficulty swallowing. An X-ray confirmed a mediastinal tumor measuring approximately 10 cm × 9 cm. Given the large size of the tumor, surgery recommended conservative treatment with traditional Chinese medicine, so the Spleen-Strengthening and Kidney-Nourishing Method was applied, using Liu Wei Di Huang Tang combined with Er Chen Tang, adjusted as needed, for over 100 doses. The patient’s subjective symptoms completely disappeared, and an X-ray confirmed that the tumor had shrunk to 4 cm × 5 cm. Subsequently, surgery removed an elliptical tumor measuring 3 cm × 4 cm × 6 cm from the mediastinum, with a smooth surface and no adhesion; the pathology report indicated a nerve fiber tumor.

4. Leukemia

Qin Bowei said, “Overall, leukemia is a deficiency syndrome. Although it may sometimes be infected by external pathogens, it should not be regarded as a typical excess or external infection syndrome.” Yan Dexin also believed, “This disease is fundamentally a deficiency; although there may occasionally be manifestations of phlegm-heat, damp-heat, or blood stasis, these change very rapidly. In fact, it is caused by deficiency, making it a syndrome of underlying deficiency and superficial excess.” According to the theory that the kidneys produce bone marrow, this disease should be related to kidney deficiency; moreover, according to the theory that the middle jiao transforms qi into blood, this disease should also be linked to spleen deficiency. In recent years, more and more places have been treating this disease using the Spleen-Strengthening and Kidney-Nourishing Method. Gu et al. used a combination of Bu Zhong Yi Qi Tang for strengthening the spleen and Jian Bu Hu Qian Wan for nourishing the kidneys to treat a case of subacute myeloid leukemia, achieving good results. Pei Zhengxue admitted a case of acute monocytic leukemia in 1967, applying the Spleen-Strengthening and Kidney-Nourishing Method, heavily relying on taiji ginseng, lu dang shen, ginseng roots, and northern sand ginseng to strengthen the spleen, and Liu Wei Di Huang Tang to nourish the kidneys, for over 400 doses, ultimately achieving complete remission and remaining healthy for more than 30 years.

5. Aplastic Anemia

In recent years, Traditional Chinese Medicine’s understanding of this disease has increasingly leaned toward the concept of underlying deficiency and superficial excess. Since the disease is caused by impaired hematopoietic function of the red bone marrow, and since the kidneys produce bone marrow, kidney deficiency should be related to this disease. Additionally, Traditional Chinese Medicine holds the view that the middle jiao transforms qi into blood, meaning the disease is also linked to spleen deficiency. Shanghai University of Traditional Chinese Medicine’s Shuguang Hospital treated 82 cases of chronic aplastic anemia using the Spleen-Strengthening and Kidney-Nourishing Method, achieving an effectiveness rate of 91.46%. This efficacy was significantly higher than that of the control group treated with other traditional Chinese medicines or with a combination of traditional Chinese and Western medicines. Pei Shen believes, “The kidneys govern bone marrow, while the spleen governs the extremities,” emphasizing that nourishing the kidneys can improve bone marrow hematopoiesis, and strengthening the spleen can enhance peripheral blood counts, proposing that the Spleen-Strengthening and Kidney-Nourishing Method is the primary principle for treating aplastic anemia. Pei Zhengxue also routinely follows the Spleen-Strengthening and Kidney-Nourishing Method when treating aplastic anemia. In June 1975, he treated a patient named Sun, male, 20 years old, with pale complexion, fatigue, loss of appetite, five-heart restlessness, bone-steaming heat, night sweats, dizziness, palpitations, poor sleep, frequent dreaming, and scattered petechiae on gums and skin. Hemoglobin was 5 g, red blood cells 1.7 million/mm³, platelets 29,000/mm³, white blood cells 1,700/mm³. Bone marrow examination showed a significant reduction in all three cell lines, with a relative increase in lymphocytes. Using the Spleen-Strengthening and Kidney-Nourishing Method, ingredients such as codonopsis, atractylodes, astragalus, poria, rehmannia, cornelian cherry, cortex moutan, cinnamon, polygonatum, zhi mu, huang bo, processed aconite, and chicken blood vine were adjusted as needed, for a total of over 100 doses. All symptoms subsided, hemoglobin rose to 10 g, white blood cells reached 4,100/mm³, platelets climbed to 68,000/mm³, and bone marrow examination showed significant improvement, allowing the patient to return to work.

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III. Discussion

Through long-term clinical practice, Traditional Chinese Medicine has come to understand that the kidneys govern the innate, while the spleen governs the postnatal, and has adopted the Spleen-Strengthening and Kidney-Nourishing Method as a fundamental approach to strengthening the body’s foundation, enabling numerous diseases to heal. This is by no means accidental. Recent experimental studies have demonstrated that the spleen and kidneys in Traditional Chinese Medicine play crucial roles in the immune system, endocrine system, metabolic system, autonomic nervous system, and gastrointestinal-endocrine system. Strengthening the spleen and nourishing the kidneys indeed improves the function of these systems. Beyond the primary diseases affecting these systems, all chronic illnesses can, to varying degrees, disrupt their functioning; therefore, the scope of application for the Spleen-Strengthening and Kidney-Nourishing Method is extremely broad. In addition to the chronic bronchitis, chronic nephritis, tumors, leukemia, and aplastic anemia mentioned here, this method can also treat chronic hepatitis, chronic prostatitis, chronic arthritis, various collagen diseases, diabetes, diabetes insipidus, chronic colitis, and many other conditions. The widespread use of this therapy fully demonstrates the superiority of Traditional Chinese Medicine’s principle of treating different diseases with the same method, and experimental research on this therapy eloquently reveals the scientific basis of this principle, presenting the Spleen-Strengthening and Kidney-Nourishing Method to the public in a new light.

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Section 14: Clinical Prescription Formulation

1. Unity of Principle, Method, Formula, and Medication

An effective prescription should embody the unity of principle, method, formula, and medication. Ancient texts say, “Formulate the method based on the principle, formulate the formula based on the method, and prescribe the medication based on the formula.” It is evident that only through the unity of principle, method, formula, and medication can the principle of syndrome differentiation and treatment be followed, leading to better therapeutic outcomes in clinical practice. So what is the principle? The principle refers to the pathogenesis of the disease. In Traditional Chinese Medicine, pathogenesis denotes the causes, location, and dynamic changes of a disease during its course—a concept not derived from experimental research, but rather the result of logical reasoning and syndrome analysis based on clinical symptoms. For example, a patient presents for consultation, and through questioning, it is discovered that the patient indeed exhibits symptoms such as pallor, loss of appetite, general weakness, and shortness of breath. Logical reasoning is then applied to analyze these symptoms and determine the pathogenesis: the spleen governs yellow color, so spleen deficiency leads to pallor; the spleen governs the transformation and transportation of food and water, and also governs thinking, so spleen deficiency results in loss of appetite; the spleen governs muscles, so spleen deficiency leads to general weakness; the spleen governs central qi, so spleen deficiency causes shortness of breath. The analysis reveals that the patient’s primary pathogenesis is spleen qi deficiency. Establishing this point becomes the prerequisite for determining the treatment method; according to the principle of “supplement deficiency and restore damage,” the treatment should focus on strengthening the spleen and replenishing qi.

When formulating prescriptions in clinical practice, determining the treatment method is just as crucial as establishing the pathogenesis. Some say, “The treatment method is determined by the pathogenesis, and the prescription is determined by the method.” Within the unified system of principle, method, formula, and medication, this relationship serves as a bridge connecting the upper and lower levels. Accordingly, prescriptions have traditionally been classified based on the treatment method—for example, exterior-releasing formulas, interior-penetrating formulas, and heat-clearing formulas. If the treatment method is strengthening the spleen and replenishing qi, the choice of prescription will invariably fall within the range of Si Jun Zi Tang, Liu Jun Zi Tang, or Bu Zhong Yi Qi Tang. The formulation of the prescription is based on the principle of deriving the method from the principle and the formula from the method, while also taking into account the patient’s specific characteristics and making adjustments accordingly. To meet these two requirements, one must have a thorough grasp of the principles governing prescription formulation.

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The ancients believed that a compound prescription should consist of four components: the sovereign, the minister, the assistant, and the guide. The so-called sovereign drug is the one that treats the primary syndrome; the minister drug’s role is to assist the sovereign drug in enhancing its efficacy; the assistant drug is used to concurrently treat secondary syndromes and can sometimes alleviate the side effects of the principal drug; the guide drug is often employed to direct the action of the other herbs or to harmonize the entire formula. Among these four components, the sovereign and minister drugs typically represent the core principles of the therapeutic rationale and method, embodying the fundamental treatment aspect of the formula, while the use of assistant drugs is more flexible, often adjusted according to individual patient differences during clinical practice, representing the symptomatic treatment aspect. The Shanghan Lun records the Guizhi Tang formula, which, due to its infinite variations and proven efficacy, has been revered by medical practitioners as the “king of all formulas.” The main syndrome treated by this formula is wind-cold exterior deficiency with disharmony between Ying and Wei qi; Guizhi dispels wind-cold from the exterior and harmonizes Wei qi, thus serving as the sovereign drug, while Shaoyao astringes Yin and regulates Ying qi to prevent Guizhi’s warming and dispersing effect from depleting Yin while still regulating Ying qi, making it the minister drug. Together, these two herbs achieve the effects of dispelling wind-cold from the exterior and harmonizing Ying and Wei qi, reflecting the unity of therapeutic rationale, method, formula, and herbs. Under the condition that the primary syndrome remains unchanged, if stiff neck and back are also present, Gegen is added; if rapid pulse and chest fullness are observed, Shaoyao is removed; if there is slight stiffness in the limbs making flexion and extension difficult, Fuzi is added; if there is asthma, Houpu and Xingren are added; if palpitations and restlessness occur, Yitang and Bai Shao are added. The addition of Gegen, Fuzi, Houpu, Xingren, Yitang, and other herbs to Guizhi Tang aims to tailor the formula to the specific needs of the condition; these drugs generally belong to the category of assistants and guides in the formula, serving the symptomatic treatment aspect and constituting an important element of clinical flexibility for physicians.

II. Clinical Adaptation Based on Syndrome and Disease Combination

The essence of TCM syndrome differentiation and treatment lies in the unity of therapeutic rationale, method, formula, and herbs, a principle that can only be manifested clinically through prescriptions. Many integrative medicine practitioners have boldly innovated in formulating prescriptions by adopting the perspective of combining disease and syndrome, significantly improving therapeutic outcomes. Consequently, the traditional theory of TCM prescriptions has incorporated the new topic of disease-syndrome combination. Disease is a concept recognized in Western medicine, arising from syndrome analysis and etiological investigation—a comprehensive concept formed through logical reasoning about the causes and pathogenesis of a group of symptoms, together with the symptoms themselves. For a prescription to reflect the integration of Chinese and Western medicine, it must first embody the characteristic of disease-syndrome combination. The strength of TCM syndrome differentiation lies in its emphasis on the body’s holistic nature and systemic responses, whereas the strength of Western disease diagnosis lies in its focus on the pathogenicity of the disease and local reactions; the combination of the two approaches facilitates a comprehensive understanding of the condition and enhances therapeutic efficacy.

The Beijing Coronary Heart Disease Collaborative Group formulated the renowned Guanxin II formula, which fully embodies the characteristic of disease-syndrome combination. According to syndrome differentiation, coronary heart disease falls under the category of chest obstruction, a syndrome characterized by stagnation of chest Yang and blockage of the channels, requiring the promotion of Yang and unblocking of stagnation; the Jin Gui Yao Lue recommends using Gualou Xiebai Baijiu Tang to treat this condition, which has shown some efficacy. However, from the perspective of disease diagnosis, this condition is coronary atherosclerosis, leading to thickening of the vessel walls and narrowing of the lumen, resulting in insufficient blood supply to the coronary arteries. Such pathological changes should logically fall under the TCM category of blood stasis; therefore, the Guanxin II formula (containing Chishao, Chuanxiong, Honghua, Jiangxiang, and Danshen), which focuses on promoting blood circulation and removing blood stasis, has achieved good clinical results. When combined with the traditional Gualou Xiebai Baijiu Tang, the therapeutic effect becomes even more satisfactory.

The Shanxi Provincial Institute of Traditional Chinese Medicine formulated the Yishen Tang, which integrates clearing heat and detoxifying with promoting blood circulation and removing blood stasis (Danggui, Chishao, Chuanxiong, Taoren, Honghua, Yimucao, Yinhuahua, Lianqiao, Gongying, Banlangen), and has also demonstrated excellent efficacy in treating chronic nephritis. The formulation philosophy behind this prescription likewise originates from the combination of disease and syndrome.

Western medicine holds that the pathological changes in chronic nephritis are based on the proliferation of glomerular endothelial cells and basement membrane cells; any such proliferative process should logically be classified under the TCM category of blood stasis. Therefore, the Yishen Tang includes a large number of herbs that promote blood circulation and remove blood stasis. At the same time, infection is the primary factor exacerbating chronic nephritis, so the formula incorporates abundant heat-clearing and detoxifying herbs such as Yinhuahua and Lianqiao alongside the blood-promoting agents.

Both the Guanxin II formula and the Yishen Tang are products of applying the disease-syndrome combination approach to clinical prescription formulation, and their clinical efficacy has been widely recognized within the domestic medical community. This eloquently demonstrates that adopting the disease-syndrome combination approach in clinical practice is indeed a correct way to enhance therapeutic effectiveness.

Adopting the disease-syndrome combination approach is currently a prerequisite for clinical prescription formulation in integrative medicine. Consider a patient with prostatitis who presents with difficulty urinating, low back pain, urgency and distension in the lower abdomen, along with dizziness, blurred vision, tinnitus, aversion to cold, and spontaneous sweating. From the perspective of syndrome differentiation, this is a case of kidney Yang deficiency with impaired Yang transformation, warranting the use of Jisheng Shenqi Wan as the primary formula. From the perspective of disease diagnosis, chronic prostatitis is primarily characterized by prostate enlargement and compression of the urinary tract, thus necessitating the addition of herbs that promote blood circulation and remove blood stasis, such as Amber, Wang Buliu Xing, Dajiangjun, and Liangtoujian. A prescription composed in this manner will undoubtedly be far more effective than one based solely on syndrome differentiation.

When treating aplastic anemia, if only the general principles of syndrome differentiation are applied—addressing symptoms such as pallor, fatigue, palpitations, sweating, and epistaxis—the most that can be concluded is deficiency of both heart and spleen with Qi failing to control the blood, leading to the prescription of formulas like Guipi Tang, which yields only moderate clinical results. To further improve the therapeutic efficacy for aplastic anemia, it is essential to adopt the disease-syndrome combination approach to adjust the prescription accordingly—for example, adding Po Guozi, Digupi, and Jixueteng for patients with low white blood cell counts; adding Yuzhu, Huangjing, Shengdi, and Peanut Skin for those with low platelet counts; and adding Shouwu, Dangshen, Huangqi, and Baizhu for those with low red blood cell counts. In addition, the characteristics of bone marrow morphology and peripheral blood morphology are also key considerations in formulating the prescription for this condition: for obvious abnormalities in bone marrow morphology, the treatment should include 30–40 grams of Shanyurou; for abnormalities in peripheral blood morphology, 15–30 grams of Yuanshou should be added.

In treating non-icteric infectious hepatitis, from the perspective of syndrome differentiation, there are cases of spleen-stomach Qi deficiency, liver-Qi stagnation, liver-stomach disharmony, liver-kidney Yin deficiency, and liver-gallbladder fire excess. Each type has corresponding formulas available—for instance, those with spleen-stomach Qi deficiency use Buzhong Yiqi Tang, those with liver-Qi stagnation use Chaihu Shugan San, those with liver-stomach disharmony use Xiaoyao San, those with liver-kidney Yin deficiency use Yiguan Jian, and those with liver-gallbladder fire excess use Longdan Xiegan Tang. From the perspective of disease diagnosis, if liver function impairment is mainly characterized by elevated transaminase levels, herbs such as Gongying, Baijiang, Chuipeng Cao, and Banlangen should be added, or Wumeizi San can be taken separately; if the issue is reduced plasma protein with inverted albumin-to-globulin ratio, then herbs like Dangshen, Baizhu, and Huangqi should be added. Regardless of the type of hepatitis, as long as persistent liver pain is present, Yuanhu and Jianghuang should be included.

In treating chronic nephritis, from the perspective of syndrome differentiation, there are cases of Yang deficiency with water overflow, spleen-stomach Qi deficiency, and internal wind stirring in the liver; each type has its corresponding primary formula—for example, those with Yang deficiency and water overflow use Jisheng Shenqi or Zhenwu Tang; those with spleen-stomach Qi deficiency use Buzhong Yiqi or Liu Junzi Tang; those with internal wind stirring in the liver use Qiju Dihuang Wan or Jianling Tang. From the perspective of disease diagnosis, if urine tests show excessive protein, add Suge, Chan Yi, Yimucao, Qian Shi, and Jin Yingzi; if there is an excess of red blood cells, add Bai Mao Gen, Da Ji, and Xianhe Cao; if there is an excess of white blood cells, add Shan Zhi, Mutong, and Huashi.

The above examples illustrate that when formulating prescriptions clinically, the disease-syndrome combination approach can make the formula better suited to the condition, thereby enhancing clinical efficacy. This approach is also an important component of the application of integrative medicine in clinical practice.

III. Incorporation of Folk Prescriptions

Traditional Chinese medicine is the culmination of thousands of years of experience accumulated by the people in their fight against disease. Although it has evolved into a unique theoretical system, folk single-prescription remedies scattered among the populace continue to serve as a vital source of material for its ongoing enrichment and improvement. As the saying goes, “A single prescription can kill a famous doctor,” meaning that some single prescriptions are even more effective than those prescribed by renowned physicians. We should not be the so-called “classical prescription school” that insists on treating every word in the Shanghan Lun as an inviolable rule; rather, we should advocate for a clinical prescription formulation approach that emphasizes the unity of therapeutic rationale, method, formula, and herbs, while simultaneously integrating disease diagnosis and syndrome differentiation, and also actively incorporating folk single-prescription remedies. Only in this way can we fully enhance the clinical efficacy of prescriptions. Ye Tianshi and Wu Jutong often used soybean rolls to clear heat, Zhang Xichun frequently employed chicken gizzard lining and moneywort to treat urinary stones, and Huang Wendong utilized tea tree roots to calm the mind—all these experiences were drawn from folk single-prescription remedies, which enhanced the clinical efficacy of their herbal prescriptions and became distinctive features of their medication practices. We should extensively collect effective folk single-prescription remedies and flexibly incorporate one or two into our clinical formulations based on actual conditions, often achieving favorable clinical outcomes. For example, adding fish mint and Andrographis paniculata to pneumonia prescriptions, incorporating purslane and bitter root into dysentery prescriptions, including oleander leaves and tea tree roots in heart disease prescriptions, adding plantain and corn silk to kidney inflammation prescriptions, and adding cactus and lantern flower to throat pain prescriptions can often improve clinical efficacy.

IV. Gradual Improvement Through Practice

Although there is a unified principle of therapeutic rationale, method, formula, and herbs, TCM has yet to completely eliminate the influence of empirical medicine. Therefore, when formulating prescriptions clinically, we must not blindly pursue this unity at the expense of individual patient characteristics. For a particular patient, if this unity proves ineffective in clinical practice, we should further investigate the condition and adjust the treatment plan accordingly. For instance, a patient with non-icteric infectious hepatitis presented with fatigue, loss of appetite, spontaneous sweating, deep and weak pulse, and pale tongue—clear signs of spleen-stomach Qi deficiency. Despite multiple attempts to treat with formulas like Buzhong Yiqi Tang, the condition persisted, and liver function tests revealed transaminase levels consistently above 500 U/L. In such cases, treatment should be guided by practical experience and flexible adaptation, rather than rigidly adhering to the unity of formula and syndrome. It may be appropriate to directly administer large doses of heat-clearing and fire-draining herbs such as Banlangen, Baijiang, and Gongying in order to reduce enzyme levels. Another example is a patient with hypertension whose symptoms indicate Yin deficiency and Yang excess; however, prolonged use of formulas that nourish Yin and subdue Yang, such as Qiju Dihuang and Zhen Gan Xi Feng, has proven ineffective. In such cases, administering a few doses of Yang-tonifying herbs like Fuzi and You Gui may yield positive results. Similarly, for a patient with chronic leukemia whose symptoms include fatigue, pallor, excessive sweating, lower back pain, and tinnitus—indicating dual deficiency of spleen and kidney—practical experience has shown that strengthening the spleen and kidneys alone cannot reduce the white blood cell count. To lower the white blood cell count, it is necessary to use herbs that destroy and eliminate white blood cells, such as Sanleng, Ezhushi, Longdan, and Zicao.

Section 15: Writing Medical Records in Integrative Medicine

Western medical record-keeping, from history-taking and physical examination to diagnosis and treatment, has developed into a complete format tailored to Western medical characteristics. Traditional Chinese medical record-keeping, though varying in complexity and style over time and differing from person to person, has always been based on the four diagnostic methods of inspection, auscultation, inquiry, and palpation to reflect the unity of therapeutic rationale, method, formula, and herbs. With the rise of integrative medicine, we now face the new challenge of exploring a standardized format for integrative medical records, and colleagues have already made numerous attempts in this regard. Pei Zhengxue believes that this issue requires further discussion to achieve ideal perfection, because the format of integrative medical records is closely linked to the development of integrative medicine, and among the many factors promoting integrative medicine, this is a particularly important one.

I. The Record Format Must Be Aligned with Medical Characteristics

The format of integrative medical records must adapt to the specific needs of integrative medicine, which begins with the unique characteristics of both systems. TCM is based on syndrome differentiation, emphasizing the holistic view and the body’s reactive capacity, aiming to explore the essence of disease through logical reasoning; Western medicine, on the other hand, is based on disease diagnosis, focusing on the localized aspects and the pathogenicity of the disease, seeking to uncover the essence of disease through experimental research. TCM excels at gaining a macroscopic understanding of disease, while Western medicine excels at obtaining a microscopic understanding; the two systems each have their own strengths. As an emerging discipline, the most vital aspect of integrative medicine is its ability to combine macroscopic and microscopic perspectives, holistic and localized views, and the body’s reactive capacity with the pathogenicity of the disease. Therefore, the establishment of an integrative medical record format must be premised on adapting to these characteristics; otherwise, it will fail to meet the demands of the development of integrative medicine.

II. The Integrative Medical Record Format Must Meet Clinical Needs

Pei Zhengxue has been engaged in integrative medical clinical practice for more than 30 years and has formulated the diagnostic and treatment principle of “Western diagnosis, TCM syndrome differentiation, TCM-based treatment, Western medicine as adjunct” in his integrative clinical work. This principle has been adopted for a long time in the Department of Integrative Medicine at the Gansu Provincial Cancer Hospital and has been elevated in practice to become the guiding policy for the hospital’s integrative clinical diagnosis and treatment, earning the nickname “Sixteen-Character Guiding Principle” among peers. The sixteen characters signify: using modern medical testing methods to clarify the condition and establish a Western diagnosis; conducting syndrome differentiation and treatment, with the clear Western diagnosis enhancing the accuracy of the syndrome differentiation; and prioritizing TCM prescriptions in treatment, with Western medicines generally avoided unless specifically required. For example, in the case of epigastric pain, a Western diagnosis is first used to determine which organ is affected, strictly distinguishing between liver, gallbladder, spleen, stomach, and duodenum diseases; even within stomach-related ailments, gastric cancer, gastric ulcer, gastric perforation, and atrophic gastritis are clearly differentiated. On this basis, syndrome differentiation and treatment are carried out, which undoubtedly improves the accuracy of the syndrome differentiation and also enhances the accuracy of prognosis predictions. More importantly, it promotes the development of traditional TCM syndrome differentiation practices, helps shift the traditional macroscopic syndrome differentiation toward a microscopic approach, and facilitates the integration of traditional TCM with modern multidisciplinary technologies.

Pei Zhengxue began studying TCM 35 years ago with great enthusiasm and sometimes preferred to treat certain outpatients entirely from a TCM perspective. Once, he mistook a patient with exudative pleurisy for having Shaoyang syndrome and treated them with modified Xiao Chaihu Tang, delaying the diagnosis for a month. Later, upon realizing his mistake, he performed a localized percussion examination, confirming the diagnosis of pleurisy, followed by thoracentesis to drain fluid, combined with penicillin and prednisone, leading to a rapid recovery. The treatment process of this patient serves as a thought-provoking lesson: in clinical practice, the Shaoyang syndrome group is not limited to common recurrent colds; liver and gallbladder diseases, pleural diseases, cardiopulmonary diseases, collagen diseases, and others can also manifest this syndrome group at certain stages of illness. If a clear Western diagnosis is obtained before syndrome differentiation and treatment, it can avoid the situation of treating severe illnesses lightly and mild illnesses heavily, allowing the advantages of syndrome differentiation and treatment to be fully realized. After the Western diagnosis clarifies the microscopic understanding of the disease, TCM syndrome differentiation forms a macroscopic understanding of the disease. The former establishes the concept of disease, while the latter forms the concept of syndrome; the combination of the two not only reflects the integration of disease and syndrome but also the integration of macroscopic and microscopic perspectives.

Today, with the highly developed industrial society, the instruments used to observe diseases are becoming increasingly sophisticated, enabling modern medicine to shift its focus from the macroscopic to the microscopic, resulting in a major leap forward. For thousands of years, TCM has relied on sensory observation to understand disease through inspection, auscultation, inquiry, and palpation—this is the hallmark of traditional Chinese medicine. Physicians’ case records are invaluable summaries of clinical experience and should be carefully studied, but some case records are overly simplistic. Western medical records, on the other hand, have a rigorous structure and detailed entries, with thorough physical examinations from head to toe, leaving no detail overlooked, albeit somewhat overly elaborate. In the face of the continuous standardization of TCM diagnoses and the development and improvement of numerous modern tools that allow accurate visualization of internal disease lesions, it is necessary to integrate disease and syndrome, balancing macroscopic and microscopic perspectives, to meet the needs of the development of integrative medicine.

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Chapter 1: Selection of Novels from the Fourth Group of Chengchuan Pancake Stories—The Great Wind Melody

In the early autumn of the 1990s, Beidaihe was picturesque, bustling with tourists. The International Grand Hotel, located at the Tiger Beach, was adorned with colorful lights and fluttering banners, as the Asian Symposium on Digestive Diseases was about to convene here.

Professor Bai Liping’s luxury sedan slowly drove into the hotel lobby, heading straight for the reception area. The welcoming staff politely opened the car door. Professor Bai, nearing sixty, had a rosy complexion and vigorous spirit despite his silver hair. He stepped out of the car under the warm welcome of the female receptionist and walked directly to the conference service desk. He presented his conference invitation, and after reviewing it, the receptionist warmly and respectfully said, “Your room has already been arranged—it’s Room 408. There’s no need to check in or pay; the conference materials will be delivered directly to your room.” She then made the necessary arrangements with the female receptionist.

Professor Bai’s room was a single room, a higher-level courtesy reserved for special guests at the conference. As soon as someone knocked on the door, the female attendant cheerfully delivered the conference materials and several commemorative gifts from the conference, reminding him that he could ring the bell at any time if needed, and someone would promptly attend to him.

After briefly settling in, Professor Bai casually opened the conference materials bag to take a look. Besides a few speeches by leaders, there was a thick volume compiling all the conference papers. Upon opening the table of contents, he was pleased to see that his paper, “Clinical Research on Hepatitis B,” was scheduled as the third presentation in the first academic session following the opening ceremony. Professor Bai Liping has been engaged in medical practice, teaching, and research for exactly thirty-five years. He graduated from the Medical Department of Northwest Medical University in the early 1960s and, influenced by his family’s three-generation tradition of practicing TCM, later specialized in clinical research on the integration of Chinese and Western medicine. He is now a well-known expert in integrated internal medicine in China. After quickly skimming through the collection of papers, he checked the list of attendees and began to browse page by page. He was delighted to see many familiar colleagues attending the conference and promptly took a notepad to jot down their names and room numbers, planning to visit them when he had time. Suddenly, a very familiar name caught his eye: Zhang Yalan, 57, professor at Wuhan Medical University, Room 302. Professor Bai suddenly lost his composure, his hands trembling as if struck by electricity, and the guest list slipped to the floor. After a moment, he finally regained his senses, put on his coat and tie, smoothed his hair in front of the mirror, and hurried out to Room 302. He knocked, but there was no response. The receptionist informed him that the guest had left after checking in, saying she was going to visit friends and might not return tonight. Professor Bai returned to Room 408, lay down on the bed, and memories of the past flashed through his mind.

The seas churn and the clouds rage; the five continents tremble and thunder. —Mao Zedong

In the autumn of 1956, the ancient city of Xi’an was filled with fluttering flags and resounding cheers.

At Bell Tower Square, crowds surged, with various parade groups continuously streaming in. The Northwestern Medical University’s contingent was stuck at Dachai Market, unable to move forward.

Suddenly, the loudspeaker announced Bai Liping’s name, urging him to hurry to the Bell Tower podium to denounce British and French imperialism and support the just struggle of the Egyptian people. The meeting was about to begin, and members of the Xi’an Student Union were discussing related matters. Bai Liping was a second-year student at Northwestern Medical University and had been elected as a member of the Xi’an Student Union just a few months earlier. Upon hearing the announcement, he was extremely anxious and pushed forward frantically. Streets and sidewalks were packed with people, completely jammed; from Dachai Market to the Bell Tower, it was at least a kilometer away. He sweated profusely as he squeezed forward, repeatedly shouting, “Comrade! Excuse me! Excuse me…”

Suddenly, the broadcast of “Unity is Strength” stopped abruptly, and a powerful tenor announced, “The Xi’an-wide rally to denounce British and French imperialism and support the just struggle of the Egyptian people, initiated by the Shaanxi Provincial Student Union, is now officially underway…” The street suddenly fell silent, replaced by the rousing voice of the loudspeaker.

Bai Liping was trapped in the crowd and froze. He knew the Student Union meeting had already begun and that he shouldn’t rush over anymore, so he extricated himself and headed back. After much effort, he finally rejoined his group. Zhang Yalan, a beautiful city girl, came up to him and whispered, “I told you we couldn’t get through—didn’t you believe me? Let’s go back!” She teased him and even made a funny face. “Who would have thought there’d be so many people? The real problem is that our group arrived too late.” As Bai Liping spoke, the loudspeaker had already announced the start of the parade. Down with British imperialism! Down with French imperialism! Strongly support the just struggle of the Egyptian people! The Suez Canal belongs to the heroic Egyptian people! Long live Nasser! The slogans shook the ground and the crowd, and the parade began moving forward.

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Chapter 3: Selection of Poems and Prose

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Chapter 3

Selected Poems and Prose