From Traditional Chinese Medicine Theory and Clinical Case Discussion · Read time 1 min · Updated March 22, 2026

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3. Combining the Holistic View with the Local View

The holistic perspective of TCM is a hallmark of the TCM academic system and the essence of TCM’s syndrome differentiation and treatment. However, understanding a disease also requires a detailed grasp of its specific site of onset; only with accurate insight into this aspect can syndrome differentiation and treatment be truly beneficial. Take exogenous superficial syndromes as an example: traditionally, TCM classifies them into wind-cold and wind-heat types, with diagnostic criteria being headache, fever, chills, body pain, sweating or lack thereof, and floating-rapid pulse for wind-cold, and headache, fever, chills (more heat than cold), thirst, and floating-rapid pulse for wind-heat. Although these diagnostic criteria, derived from the holistic perspective, do reflect the characteristics of wind-heat and wind-cold, beginners often struggle to accurately weigh factors such as whether the pulse is rapid or slow, whether the mouth is thirsty or not, and whether there is much or little sweat. Moreover, individual differences in nerve type, lifestyle, emotional state at the time, and working conditions can also significantly affect the stability of these symptoms. Therefore, distinguishing between wind-cold and wind-heat is merely a textual distinction and far from easy to master. From the perspective of TCM-Western medicine integration, wind-cold is mostly associated with viral infections, while wind-heat tends to fall under bacterial infection categories (such as pharyngitis and tonsillitis).

Under this premise, people began to supplement the shortcomings of the traditional four diagnostic methods of TCM with localized observation—that is, using Western tongue depressors to examine local redness and swelling in the pharynx, enlarged and suppurating tonsils, and follicular hyperplasia on the posterior pharyngeal wall—as additional criteria for diagnosing wind-heat, thereby making the differential diagnosis between wind-heat and wind-cold more precise than before, even for novice TCM practitioners. Taking gynecological bleeding as another example, traditional TCM differentiation often conflates functional uterine bleeding with cervical cancer-related bleeding, and treatment approaches are similarly indiscriminate, frequently leading to misdiagnosis and even causing cervical cancer patients to miss critical treatment windows. If the traditional holistic perspective of TCM is combined with Western medicine’s localized internal examination, the two can be strictly distinguished, allowing TCM to further eliminate confusion in the differentiation and treatment of functional uterine bleeding and better fulfill its role. In summary, the combination of holistic and localized perspectives is an important component of TCM-Western medicine integration in clinical practice, making clinical diagnoses more accurate and significantly improving therapeutic efficacy.

Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases

Published by Hepei Jin Publishing House

The full potential of three aspects—combining the macroscopic and microscopic views, integrating the holistic and localized perspectives, and merging the pathogen perspective with the body’s response perspective—should be fully utilized.

Starting in 1990, with strong support from the Gansu Provincial Health Department, an annual advanced training course for resident physicians in TCM hospitals across the province was held. The course focused on implementing the “Sixteen-Character Method,” and through lectures on common and frequently occurring diseases, the clinical work of the inpatient departments in 73 TCM hospitals throughout the province, under the unified guidance of the “Sixteen-Character Method,” showed marked improvement compared with before. Participants unanimously agreed that this method had universal guiding significance for clinical applications in TCM hospitals, and thus the “Sixteen-Character Method” came to be known as the “Sixteen-Character Policy.” In July 1987 and August 1990, the author was invited to deliver academic reports on the “Sixteen-Character Method” at national academic conferences in Beijing, Kunming, Guiyang, Dalian, and other cities, receiving recognition from fellow scholars. In April 1992, under the author’s leadership, experts in TCM-Western medicine integration from the five northwestern provinces initiated the compilation of a book titled “Practical Internal Medicine of TCM-Western Medicine Integration.” At the plenary editorial meeting held in Lanzhou, the editorial committee unanimously approved the outline, format, and detailed rules drafted by the author, and also determined that the guiding principle for writing the book would be the “Sixteen-Character Policy” proposed by the author, which had been proven effective through years of practice: “Western diagnosis, TCM differentiation, TCM as the mainstay, Western medicine as the auxiliary.”

2. The Connotation and Significance of the Model

The “Sixteen-Character Policy” of “Western diagnosis, TCM differentiation, TCM as the mainstay, Western medicine as the auxiliary” can serve as a temporary clinical model for TCM-Western medicine integration in the field of internal medicine. The “Sixteen Characters” consist of four sentences, forming four consecutive meanings. First is “Western diagnosis,” meaning that after examining a patient, one must first clarify the Western diagnosis. To clarify the Western diagnosis, one must utilize all available Western diagnostic methods.

Once the Western diagnosis is confirmed, the second step in the model—the “TCM differentiation”—can begin. This differentiation is conducted under the premise of a confirmed Western diagnosis and within specific conditions, thereby greatly enhancing the accuracy of the differentiation, much like fishing in a net versus fishing in the open sea—it’s naturally much more precise. The “TCM differentiation” follows traditional principles as much as possible, employing classic differentiation methods such as six meridians differentiation, eight principles differentiation, zang-fu organ differentiation, wei-qi-ying-xue differentiation, three-jiao differentiation, and etiology differentiation, while also incorporating the experience and viewpoints of past medical masters regarding similar conditions. After the Western diagnosis is clarified, the TCM differentiation naturally integrates the Western medicine’s microscopic, localized, and pathogenic perspectives with TCM’s macroscopic, holistic, and bodily response perspectives in the physician’s mind, elevating the understanding of the overall disease to the level of TCM-Western medicine integration. In this way, it not only overcomes the traditional TCM shortcoming of neglecting the local but also corrects the Western medicine bias of ignoring the whole. More importantly, over time, numerous points of convergence emerge between the two medical systems in terms of understanding; these points of convergence represent the shared ground between the two systems. It is anticipated that these points of convergence will first be proposed clinically and then verified through experimental research, and when they return to clinical practice, they will already be widely recognized, embodying both the characteristics of modern TCM and the components of modern science and technology.

As these points of convergence increase, TCM-Western medicine integration evolves from isolated instances to broader applications and deeper exploration. The combination of Western diagnosis and TCM differentiation creates a more precise foundation for formulating TCM prescriptions. The third component, “TCM as the mainstay,” must be considered together with the fourth component, “Western medicine as the auxiliary,” as the two together form a single concept that highlights the therapeutic effect of TCM prescriptions. It is thus evident that the primary purpose of this policy is to develop TCM rather than Western medicine, and further understanding of the overall meaning of TCM-Western medicine integration also serves this purpose. As a clinical model for TCM-Western medicine integration in the field of internal medicine, the “Sixteen-Character Policy” aims to accomplish the great mission of developing contemporary TCM through the principles of “applying ancient knowledge to modern practice” and “using foreign knowledge for Chinese purposes.” Our years of clinical application have shown that prescriptions formulated under this integrated approach not only demonstrate outstanding efficacy but also exhibit high reproducibility.

Part One: Academic Thought

3. Clinical Application of the Model

The clinical model of “Western diagnosis, TCM differentiation, TCM as the mainstay, Western medicine as the auxiliary” can be applied to any internal medicine condition within any system. Let us now illustrate this with examples.

(1) Epigastric Pain

This syndrome is a clinical manifestation caused by multiple diseases. If one proceeds directly to TCM differentiation and treatment without first clarifying the Western diagnosis, it will inevitably be difficult to pinpoint the root cause of the illness; at best, the medication will be ineffective, and at worst, misdiagnosis and improper treatment will occur. Sometimes, conditions such as pancreatitis and gastric perforation are mistaken for ordinary stomach ailments and treated accordingly, leading to delayed diagnosis and even unforeseen consequences. However, if “Western diagnosis” is performed prior to “TCM differentiation,” not only can the above problems be avoided, but TCM can also be further developed through the integration of disease and diagnosis. For the Western diagnosis of epigastric pain, barium meal radiography, gastroscopy, and pathological tissue biopsies should be used, and if necessary, ultrasound examinations can also be conducted to rule out diseases of the liver, gallbladder, pancreas, and spleen, utilizing all available Western diagnostic methods to confirm the true cause of epigastric pain. Common causes of epigastric pain include peptic ulcer disease, chronic atrophic gastritis, chronic superficial gastritis, chronic hypertrophic gastritis, chronic pancreatitis, chronic cholecystitis, and chronic liver diseases. In addition, conditions such as gastric perforation, acute pancreatitis, and liver abscess can also cause severe epigastric pain; if left untreated, they can pose a life-threatening risk.

After confirming the above diagnosis of epigastric pain, proceeding to “TCM differentiation” will naturally be much more accurate. Peptic ulcer disease is often accompanied by heartburn, belching, abdominal distension, loss of appetite, fatigue, and pallor, typically indicating spleen-stomach qi deficiency; commonly used prescriptions include Xiangsha Liujunzi Tang, Huangqi Jianzhong Tang, and Liangfu Wan. Chronic atrophic gastritis often presents with burning pain in the epigastric region and thick, greasy tongue coating, usually indicating damp-heat accumulation in the lower abdomen; commonly used prescriptions include Banxia Xiexin Tang, Huanglian Tang, and Huanglian Jiedu Tang. Biliary tract diseases are often accompanied by bitter taste in the mouth, dry throat, right flank pain radiating to the right back, typically indicating pathogenic invasion of the Shaoyang channel; commonly used prescriptions include Da and Xiao Chaihu Tang, Chaihu Shugan San, Biliary Stone Expulsion Tang, Jinqiancao, Ban Zhi Lian, and Huzhang. Pancreatic diseases often present with pain radiating to the upper left abdomen, accompanied by low back pain, loose or hard stools, and during acute attacks, the pain can be extremely severe, even leading to cold extremities and weak, almost dying pulse—symptoms of yang deficiency; commonly used prescriptions include Chaihu Shugan San, Danshen Yin, Jinlingzi San, Da Jianzhong Tang, Sanhuang Xiexin Tang, and Wuwei Xiaodu Yin. For chronic gastric perforation, TCM still recommends Huoluo Xiaoling Dan and Taohong Siwu Tang with adjustments; for acute perforation, if conservative treatment fails, surgical intervention should be sought immediately.

(2) Chest Pain

Conditions such as coronary heart disease, pleurisy, pulmonary inflammation, lung cancer, pleural mesothelioma, intercostal neuralgia, chronic pancreatitis, liver diseases, heart valve disease, and arrhythmia can all cause chest pain. First, the cause of chest pain must be clarified through Western diagnosis, followed by TCM differentiation. Coronary heart disease falls under the TCM category of “chest obstruction,” and treatment should focus on broadening the chest and regulating qi, dispelling depression and promoting yang, using Gualu Xiebai Banxia Tang as the main prescription. In light of recent TCM-Western medicine integration research on coronary heart disease, blood-activating and stasis-removing medications such as Guanxin II and Guanxin Suhé Wan can also be added. Pleurisy, on the other hand, falls under the TCM categories of “suspended fluid” and “chest constriction,” and clinicians can choose among Ten Zao Tang, Da Xianxiong Tang (pill), and Xiao Xianxiong Tang. Some patients exhibit pathogenic invasion of the Shaoyang channel, and can be treated with Xiao Chaihu and Da Chaihu Tang with adjustments. Pulmonary infections often manifest as lobar pneumonia, bronchial pneumonia, viral pneumonia, chronic bronchitis, emphysema, cor pulmonale, bronchial asthma, and bronchiectasis, among others.

Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases

Published by Hepei Hui Zi Publishing House

All types of pneumonia are collectively referred to in TCM as “real fire accumulating in the lungs” and “phlegm-heat cough,” and should be treated with Ma Xing Shi Gan Tang, Da Qinglong Tang, Xie Bai San, Ting Li Da Zao Xie Fei Tang, and other prescriptions. If necessary, Wu Wei Xiaodu Yin can be added to enhance the heat-clearing and detoxifying effects. Inflammation of the trachea is usually either wind-heat or wind-cold, and can be treated with Sang Ju Yin, Jing Fang Bai Du San, Su Xing San, Ma Huang Tang, Gui Zhi Tang with Hou Pu Xing Zi Tang. Bronchial asthma falls under the TCM categories of “lung distension” and “phlegm wheezing,” and should be treated with Ma Xing Shi Gan Tang, Xiao Qinglong Tang, Su Zi Jiang Qi Tang, and Hou Pu Ma Huang Tang. Emphysema is related to “kidney failing to contain qi,” and if accompanied by infection, it also falls under “upper excess, lower deficiency,” so prescriptions should be chosen from Su Zi Jiang Qi Tang and Du Qi Wan. Bronchiectasis can be either wind-heat or wind-cold, and also falls under lung distension; if there is hemoptysis, it should be treated according to “blood heat running wild” or “qi deficiency unable to control blood.” Cor pulmonale falls under the TCM category of “fluid accumulation in the lungs,” and treatment should focus on draining phlegm and water, calming the spirit, using Ling Gui Zhu Gan Tang, Zhen Wu Tang, and Bai Zi Yang Xin Tang. Intercostal neuralgia is caused by qi stagnation and blood stasis in the Shaoyang region, so one can add qi-moving and blood-activating herbs to Chaihu Shugan San, or use Fuyuan Huo Xue Tang, Taohong Siwu Tang, Huoluo Xiaoling Dan with pangolin scales, soapberry spines, frankincense, myrrh, and other ingredients. Chronic pancreatitis is related to liver qi stagnation and liver wood overcoming earth, so prescriptions such as Chaihu Shugan San, Xiaoyao San, and Da and Xiao Jianzhong Tang are suitable; for severe pain, add Yuan Hu Suo and Chuan Lian Zi.

Liver diseases should be treated primarily by addressing the liver, with emphasis on regulating liver function. In TCM differentiation, the main syndromes are still liver qi stagnation and liver wood overcoming earth, so prescriptions such as Chaihu Shugan San, Danzhi Xiaoyao San, and Qianggan Tang are preferred. Additionally, as mentioned earlier, for those with significant increases in turbidity in liver function, heavy use of astragalus, salvia, and polygonum multiflorum is recommended; for those with markedly elevated transaminases, heavy use of dandelion, houttuynia, white snake tongue grass, and ban zhi lian is advised. The former is due to decreased albumin, which indicates “deficiency,” and therefore requires tonifying treatment; the latter is due to increased transaminases, which indicates “excess,” and thus requires heat-clearing and detoxifying treatment. Heart valves and arrhythmias are usually related to “water qi overwhelming the heart,” “dampness trapping the heart’s yang,” “blood failing to nourish the heart,” and “dual qi and blood deficiency,” and should be treated with Ling Gui Zhu Gan Tang, Zhen Wu Tang, Bai Zi Yang Xin Tang, Zhigan Cao Tang, and Sheng Mai San. Lung cancer and pleural mesothelioma should be referred early to Western specialists for consultation; if the opportunity for surgery is missed, chemotherapy and radiation therapy will be necessary, and at this point, TCM can be used in conjunction with tonifying and consolidating methods to reduce the side effects of chemotherapy and radiation.

(3) Lower Abdominal Pain

Gynecological pelvic inflammatory disease, uterine fibroids, dysmenorrhea, cystitis, bladder and urinary tract stones, bladder cancer, colonic inflammation (both non-specific and specific), appendicitis, and other conditions can all cause lower abdominal pain of varying degrees and natures. First, modern medical physical examinations and laboratory tests should be conducted to confirm the specific disease causing the lower abdominal pain, and then proceed to TCM differentiation.

Whether it’s adnexal inflammation or more widespread pelvic inflammation, gynecological pelvic inflammatory disease is generally classified in TCM as “damp-heat descending,” and if the pain is severe, it may indicate “lower jiao blood stasis.” In such cases, prescriptions such as Simiao San, Wanda Tang, Qingdai Tang, Gui Zhi Fu Ling Wan, Dang Gui Shao Yao Tang, and Taohong Siwu Tang can be selected, with additional heat-clearing and detoxifying herbs like white snake tongue grass, ban zhi lian, dandelion, and houttuynia as needed. Uterine fibroids, depending on the size revealed by ultrasound,

Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases Published by Gansu Science and Technology Press

(5) Dizziness

Hypertension, cerebral arteriosclerosis, hypotension, anemia, otogenic vertigo, neurasthenia, menopausal syndrome, intracranial tumors, and other conditions can all cause dizziness. First, after confirming the Western medical diagnosis, conduct TCM differentiation; this will greatly improve the accuracy of the diagnosis. Hypertension is usually due to yin deficiency with yang excess, where yang excess generates wind. The treatment principle is to nourish yin and subdue yang, calm the liver and extinguish wind. Prescriptions can be adjusted from formulas such as Qiju Dihuang Tang, Zhen Gan Xi Feng Tang, and Jian Ling Tang. For some cases of hypertension with inconspicuous yang excess symptoms, Zhen Wu Tang or Ling Gui Zhu Gan Tang may be used for treatment. Cerebral arteriosclerosis is mostly due to blood stasis, so the treatment should focus on activating blood circulation and removing stasis—this is the saying "treat wind by first activating blood; when blood flows, wind naturally dissipates." Prescriptions can be selected from Xuefu Zhuyu Tang, Guanxin II, and Taohong Siwu Tang.

Hypotension is mostly due to heart-spleen deficiency or qi sinking. The treatment principle is to nourish blood and tonify the heart, and to tonify the middle jiao and benefit qi. Prescriptions can be chosen from Guipi Tang, Buzhong Yiqi Tang, and Shengmai San. Most types of anemia are related to heart-spleen deficiency, heart-kidney disharmony, or qi failing to control blood.

In recent years, many prescriptions have been developed for treating anemia, but most still follow the above principles. The most commonly used formulas include Guipi Tang, Buzhong Yiqi Tang, Liuwei Dihuang Tang, and Xiangsha Liujunzi Tang. By selecting prescriptions based on specific conditions and adding herbs like Tu Si Zi, Nüzhen Zi, Gouqi Zi, He Shou Wu, and Xianhe Cao, the therapeutic effect can be even more satisfactory. Otogenic vertigo is mostly caused by TCM patterns such as "water qi overreaching the heart," "dampness obstructing the heart's yang," "phlegm obscuring the heart's orifices," and "blood deficiency generating wind." The treatment principle is to clear the heart and remove phlegm, calm the heart and promote water metabolism, and warm the yang while transforming phlegm. Prescriptions can be selected from Ling Gui Zhu Gan Tang, Zhen Wu Tang, Wuling San, and Xuanfu Dai Zhe Tang.

Neurasthenia and menopausal syndrome have relatively flexible TCM differentiation, with several common patterns: "heart-spleen deficiency," "heart-kidney disharmony," "excessive fire in the body," "water not nourishing wood," "yin deficiency with yang excess," "blood deficiency generating wind," "internal movement of liver wind," and "floating yang excess." Prescriptions can be chosen from Guipi Tang, Tianwang Buxin Dan, Baizi Yangxin Tang, Xuefu Zhuyu Tang, Ganmai Dazao Tang, Chaihu Jia Longgu Muli Tang, and Yigan Tang.

(From "Research on the Integration of Traditional Chinese and Western Medicine," March 1996)

Modern Research on the Concept of Zang-Xiang in TCM — Pei Zhengxue

The theory of zang-xiang is a crucial component throughout the entire system of TCM scholarship, and understanding zang-xiang is a required course for studying TCM. Modern research on the concept of zang-xiang is also an important pathway for integrating TCM with Western medicine. Over the past several decades, efforts to integrate TCM and Western medicine in this area have yielded abundant results, initially establishing significant points of convergence between the two systems in terms of basic theory. These points of convergence have enabled TCM and Western medicine to develop a common language in academic discourse. As these points of convergence continue to increase and research on each one deepens, TCM and Western medicine will eventually move toward further integration, at which point TCM will embark on a path of comprehensive modernization.

Pei Zhengxue’s TCM—A Discussion on TCM Theory and Clinical Case Studies Published by Gansu Science and Technology Press

Similar to the changes seen in kidney-yang deficiency, the external manifestations of kidney-yang deficiency are positively correlated with aging. The key underlying mechanism lies in the dysregulation of hypothalamic function, thus giving a more precise meaning to the exploration of the essence of kidney-yang deficiency.

Guided by the above theory, domestic scholars have extensively used kidney-tonifying and yang-strengthening medicines to treat aging, and experimental studies have demonstrated that these medicines can enhance T-cell immune function in the elderly. Additionally, they have a clear anti-aging effect on the gonadal axis, thereby confirming the validity of the notion that “the biological clock is the hypothalamus.” The Institute of Integrated Traditional Chinese and Western Medicine at Shanghai First Medical University, following the traditional asthma treatment principle of “treat the lungs in acute cases, treat the kidneys in chronic cases,” has formulated a warming-yang tablet for kidney tonification. In a preventive kidney-tonifying treatment during the remission phase for seven batches totaling 419 asthma patients, the effective rate reached 63.4%–75.0%, whereas the non-kidney-tonifying control group had an effective rate of only 14%–22.2%. Based on these therapeutic effects, endocrine studies were conducted, revealing that even asthma patients without clinical manifestations of kidney-yang deficiency exhibit potential functional changes in the adrenal cortical axis similar to those seen in kidney-yang deficiency. The warming-yang tablet can adjust adrenal cortical function at the microscopic level and improve asthma attacks at the macroscopic level. Furthermore, the tablet also regulates the immune system and the neuroendocrine system, which may be another reason for preventing asthma attacks.

Traditional TCM holds that “the kidneys store essence” and “the kidneys govern reproduction.” In men, the kidneys “store essence,” while in women they “hold the fetus,” indicating a close relationship between the kidneys and reproductive function in both sexes. The Obstetrics and Gynecology Hospital of Shanghai First Medical University treated polycystic ovary syndrome, a condition causing ovulatory dysfunction due to ovarian dysfunction, using a method of kidney-tonifying and phlegm-transforming therapy, achieving an effective rate of 82.7%. To further explore the underlying mechanism, a full set of ovarian function tests was conducted on nine patients (vaginal smear eosinophil count, urinary FSH bioassay, LRH stimulation test), confirming that the true cause of ovarian dysfunction in these nine cases was hypothalamic dysfunction. Subsequently, dynamic hormone changes were measured in another nine patients, further verifying that the effect of kidney-yang-strengthening drugs is a comprehensive action across multiple links—including the hypothalamus, pituitary gland, and ovaries—rather than a single isolated effect.

Huashan Hospital of Shanghai First Medical University treated 100 patients with hydronephrosis caused by ureteral stones using a warming-yang and diuretic therapy, achieving a cure rate of 71%. At the same time, using a hydronephrosis animal model, it was proven that warming-yang and diuretic drugs can increase pressure within the renal pelvis and significantly enhance peristaltic waves, whereas simple diuretics have no such effect. Through the animal hydronephrosis model, cAMP and norepinephrine (NA) levels were measured separately in the hydronephrotic kidney and the healthy contralateral kidney, then the animals were fed warming-yang and diuretic drugs. It was found that the cAMP and NA levels in the hydronephrotic kidney were significantly higher than in the healthy kidney, P < 0.001, proving that warming-yang and diuretics can influence the renal pelvis through catecholamines, thereby enhancing the activity of the renal pelvis and ureter and achieving a diuretic effect. This demonstrates that warming-yang and yang-strengthening drugs, in addition to improving hypothalamic, pituitary, and target gland functions, also have a clear regulatory effect on the autonomic nervous system.

The Shanghai Endocrine Research Institute observed the patterns of sex hormone changes in several diseases most commonly associated with kidney-yang deficiency, such as diabetes, coronary heart disease, sick sinus syndrome, and hypertension, and found that the common pattern among male patients with these diseases is elevated E₂ levels and an increased E₂/T ratio, which is positively correlated with kidney-yang deficiency. Phillips once proposed that an elevated E₂/T ratio might be a risk factor for cardiovascular disease, but no corrective measures were found. After adopting kidney-tonifying therapy, the symptoms of kidney deficiency improved, and the sex hormone changes were corrected. Moreover, the specific symptoms of each disease also improved: blood pressure decreased in hypertensive patients, blood sugar decreased in diabetic patients, chest pain lessened in coronary heart disease patients, and heart rate increased in patients with sick sinus syndrome.

Part One: Academic Thought

In recent years, further research has been conducted on the relationship between sex hormone changes in female patients with diabetes, coronary heart disease, and hypertension and kidney deficiency. By measuring sex hormones in saliva, it was observed that ovarian function in women of childbearing age with these three diseases declines to varying degrees, manifested as lower E₂ levels and a lower E₂/T ratio—exactly the opposite of what is seen in male patients. After applying the same kidney-tonifying and qi-benefiting methods as used for men, the situation improved in the same way. This indicates that kidney deficiency is a common manifestation of hormonal imbalance in both men and women; moreover, as long as the kidney-tonifying and qi-benefiting method captures the diagnostic characteristics of kidney deficiency, it can effectively regulate hormonal imbalances in both sexes. This shows that the kidney-tonifying and qi-benefiting method has a clear bidirectional regulatory effect on hormonal imbalances in men and women.

Pei Zhengxue’s TCM—A Discussion on TCM Theory and Clinical Case Studies Published by Gansu Science and Technology Press

It also returned to normal accordingly. Some people repeated the above experiment on adults with spleen-deficiency symptoms, and the result was the same①. Others conducted pathological observations on gastric tissue from patients who had undergone partial gastrectomy for spleen-deficiency, finding that the regeneration of gastric mucosal epithelial cells was enhanced, while the process of differentiation into mature cells was hindered. Still others performed pathological observations on duodenal tissue from patients with chronic gastritis and peptic ulcers who exhibited spleen-deficiency symptoms, discovering that the mucosal villi were flattened and damaged in many areas, with sparse and falling-off microvilli②.

(3) Spleen and Gastrointestinal Motility

The meaning of spleen-movement dysfunction lies in the alteration of gastrointestinal motility. Patients with spleen deficiency typically experience belching, acid regurgitation, abdominal distension, and loose stools. TCM considers these symptoms as evidence of disharmony in the ascending and descending movements of the spleen and stomach—what is referred to as “disharmony in ascending and descending” is precisely spleen-movement dysfunction. Some people used X-ray imaging to find that most patients with spleen deficiency have reduced gastrointestinal peristalsis and prolonged gastric emptying time①. Others used surface gastric electrical wave measurements as indicators, discovering that patients with spleen deficiency have lower amplitude of surface gastric electrical waves, a phenomenon that is very obvious whether fasting or after eating. After employing spleen-tonifying and qi-benefiting methods, this situation quickly improved. Some people used I¹³¹ isotope tracing to observe digestive tract emptying function, finding that the digestive tract emptying speed of tumor patients with spleen deficiency was significantly faster than that of non-spleen-deficient tumor patients and normal individuals, and could be improved by taking spleen-tonifying and qi-benefiting medicines③.

(4) Spleen and Metabolism

The meaning of spleen-movement dysfunction indicates that the metabolic processes of nutrients are impaired. Some people found that patients with atrophic and superficial gastritis who have spleen deficiency have lower serum citrate dehydrogenase activity than normal individuals (P < 0.01). After treatment with Xiangsha Liujunzi Tang, the activity increased, and although there was a significant difference before and after treatment, the post-treatment level still did not reach normal levels. These patients also had lower serum lactate dehydrogenase activity than normal, which increased significantly after treatment with Xiangsha Liujunzi Tang. Some people observed that in the gastric mucosa unit area of patients with spleen deficiency suffering from epigastric pain, the average number of subcellular mitochondria was significantly lower, while the mitochondria of these patients were swollen, their membranes were damaged, and their cristae were broken④. Mitochondria are organelles responsible for cellular biooxidation of nutrients, containing enzymes necessary for oxidation. Studying the morphology and function of mitochondria in patients with spleen deficiency is very meaningful for exploring the essence of the spleen.

2. The Spleen Governs Middle Qi

Middle qi is the “foundation of postnatal life” and an important component of the body’s “zheng qi.” TCM says, “Where evil gathers, qi must be deficient,” and “If zheng qi remains within, evil cannot invade.” Thus, zheng qi and middle qi to some extent encompass the meaning of immune function. TCM also has the saying, “A strong spleen is not susceptible to evil.”

Some people divided internal medicine inpatients into two groups: those with spleen deficiency and those without. Using indicators such as lymphocyte count in blood circulation, PHA skin test, total rose formation cell ratio, and active rose formation cell ratio, they found that patients with spleen deficiency had a clear tendency toward weakened cellular immunity, and the degree of decline was positively correlated with the degree of anemia and low protein levels in these patients②. Patients with spleen deficiency suffering from chronic bronchitis, peptic ulcers, chronic nonspecific colitis, and chronic hepatitis also

Part One: Academic Thought

The above situation can be seen②. Some people used square capillary electrophoresis to observe lymphocytes in patients with spleen deficiency, finding that the lymphocyte electrophoresis rate was significantly lower, and the decline in lymphocyte electrophoresis ability indicated a decline in lymphocyte electrophoresis activity, which may be one of the reasons for the weakened immunity of patients with spleen deficiency◎. Others studied the SIgA content in the saliva of patients with peptic ulcers and chronic colitis who had spleen deficiency, finding that the content was higher in patients with spleen deficiency, especially in those with dampness accompanying spleen deficiency. After treatment, as the clinical condition improved, the content decreased somewhat.

TCM believes that the appearance of a syndrome is related to individual constitution. HLA is an important immunogenetic marker of the human body, closely related to the body’s immune response and susceptibility to disease. Some people have conducted preliminary research on the association between spleen deficiency syndrome and HLA, finding that spleen deficiency syndrome is significantly related to HLA-B22, while chronic gastritis, chronic nephritis, and peptic ulcers used for comparative observation did not show such a relationship田. This indicates a clear correlation between the essence of spleen deficiency and immunogenetic factors.

3. Liver-Stomach Disharmony

TCM believes that liver-stomach disharmony has two pathological manifestations: one is liver wood overcoming earth, and the other is spleen earth offending wood. The former manifests as pain in the liver region, bitter taste in the mouth and dry throat, irritability, loss of appetite, and fatigue; the latter manifests as bloating in the upper abdomen, intestinal rumbling and diarrhea, nausea and vomiting, and pressure on both sides of the abdomen. From a Western medical perspective, both the former and the latter should involve disturbances in the autonomic nervous system of the gastrointestinal tract. The former is due to increased sympathetic nervous tension, while the latter is due to dominant parasympathetic nervous function. In view of this, domestic scholars have attempted to design some scientific studies to clarify the relationship between liver-stomach disharmony and the autonomic nervous system. It is currently known that the synthesis and secretion of salivary amylase are controlled by the autonomic nervous system.

Patients with liver-stomach disharmony usually present with symptoms of liver depression and spleen deficiency. People still use patients with spleen deficiency as experimental subjects, finding that when patients with spleen deficiency are in a baseline state, their salivary flow rate increases and enzyme activity is also high, indicating that the parasympathetic nerves controlling the salivary glands are relatively hyperactive. However, under acidic stimulation, enzyme activity not only does not increase but actually decreases, and the increase in salivary flow rate is also less than that of normal people, indicating that although the parasympathetic nerves of patients with spleen deficiency are in a state of hyperactivity, their ability to exert pressure is weaker than that of normal people◎. Tracking with I¹³¹ isotope capsules taken orally reveals that patients with spleen deficiency have faster digestive tract emptying, which can be corrected by intramuscular injection of atropine, demonstrating that the parasympathetic nerves of patients with spleen deficiency become more hyperactive during periods of spleen deficiency田.

Research on the functional state of the sympathetic nerves in patients with spleen deficiency is also underway. Skin potential is a sensitive indicator reflecting the central function of the sympathetic nerves; patients with spleen deficiency have significantly lower skin potential than normal people whether at rest or under cold stimulation, and after spleen-tonifying and qi-benefiting treatment, skin potential increases markedly. The VMA content in the urine of patients with spleen deficiency is significantly lower than that of normal people, and skin electrical activity is often parallel to VMA content●. Reduced dopamine β-hydroxylase activity is also a characteristic of patients with spleen deficiency, which increases after treatment田.

From a molecular biology perspective, the reason why the autonomic nervous system can affect the organs it controls is mainly because neurotransmitters released by autonomic nerve endings act on corresponding receptors in effector cells, causing changes in the intracellular cyclic nucleotide content and thereby affecting their functional activities. Domestic researchers have studied changes in cyclic nucleotide levels in the blood of patients with spleen deficiency, but the results are inconsistent. Preliminary findings show that patients with spleen deficiency have lower plasma cAMP levels, which helps explain the low functioning of the sympathetic nerves during periods of spleen deficiency. Although current methods and indicators vary from place to place, and results are not yet fully unified, it can be preliminarily concluded:

Pei Zhengxue’s TCM—Analysis of TCM Theory and Clinical Cases Published by Hefei Sixiang Publishing House

(1) During spleen deficiency, sympathetic nerve function is relatively low, while parasympathetic nerve function is relatively high. (2) Both sympathetic and parasympathetic nerves have reduced ability to exert pressure●.

Part One: Academic Thought Published by Hefei Jiushan Publishing House

Currently, it is generally accepted that when the sympathetic nerves are excited, NE release increases, acting on β-receptors on the cell membrane to activate cAMP-ase (adenylate cyclase, AC), increasing intracellular cAMP levels and raising plasma cAMP levels. Catecholamines can also bind to α-receptors, increasing guanylate cyclase (cGMP-ase) activity and leading to higher cGMP levels. Prostaglandins (PG) can activate cAMP-ase activity in many tissues, increasing cAMP concentration◎, while TXB₂-6K-PGF₁ₐ content imbalance may affect important links in nucleotide metabolism. CA promotes substance metabolism and increases energy mobilization. Increased energy metabolism may be an important manifestation of the overactivity of the sympathetic-nadrenal medulla function.

Pei Zhengxue’s TCM—Analysis of TCM Theory and Clinical Cases Published by Hefei ■ Rui Publishing House

Negative emotions such as dissatisfaction, pain, fear, hatred, and anger arise. The former are positive emotions and feelings, while the latter are negative. Positive emotions can enhance the function of various organs in the body, whereas negative emotions can inhibit organ function. Therefore, people generally believe that mood (emotions and feelings) is an important factor influencing the normal operation of various systems in the human body. Mood can be regulated through personal cultivation and quality orientation, so the directing role of the cerebral cortex is reflected in its regulation of various departments in the body. These emotions, feelings (mood), as well as cultivation and quality orientation, all fall under the category of TCM’s “heart governs spirit,” and their impact on various departments in the body falls under the concept of “the heart is the master of the five viscera and six bowels.”

In summary, most of the heart’s functions in TCM fall under the scope of modern brain functions; however, from the perspective of “the heart governs blood vessels,” it also has the meaning of a modern heart.

Domestic researchers used the Cxz-I type ultrasonic cardiovascular diagnostic instrument to conduct a preliminary observational study on the left ventricular systolic and diastolic functions of patients with heart qi deficiency, heart yin deficiency, and blood stasis in the heart. They found that during heart qi deficiency, the mean value of the distance between the mitral valve and the interventricular septum (EPSS) increased, while the mitral valve amplitude (CHE), stroke volume (SV), average contraction speed of the left ventricular posterior wall (MPMVS), average relaxation speed of the left ventricular posterior wall (MPWVD), ventricular wall thickening rate (△T%), EF slope (MVV), and the ratio of the total amplitude of left ventricular posterior wall movement during the rapid filling phase (R) to the total amplitude of left ventricular posterior wall movement (RPWE) all decreased. During heart yin deficiency, in addition to the increase in EPSS mean value, the diastolic function indicator MVV mean value also decreased significantly. Compared with heart qi deficiency, heart yin deficiency shares the common feature of a decrease in EPSS mean value, but differs in that all other indicators decrease in heart qi deficiency while remaining unchanged in heart yin deficiency, resulting in statistically significant differences between the two. In cases of blood stasis, the SV and MPWVD mean values of the left ventricular contraction function decreased, as did CHE and △T%; the MVV and RPWE mean values of the left ventricular diastolic function also decreased, while the EPSS mean value increased. The above experimental study shows that there is a clear relationship between TCM heart qi deficiency, heart yin deficiency, and blood stasis in the heart and cardiac contractile function, and also demonstrates that the three conditions reflect both their essential similarities and differences in terms of cardiac contractile function, thereby providing a material basis for the traditional pathology of TCM heart qi deficiency, heart yin deficiency, and blood stasis in the heart.

The domestic literature has also observed the cardiac systolic time interval (STI) in patients with coronary heart disease and heart qi deficiency syndrome●, finding that patients with coronary heart disease and heart qi deficiency exhibit prolonged electromechanical systolic time (QS₂), shortened left ventricular ejection time (LVET), prolonged pre-ejection period (PEP), and an increased PEP/LVET ratio, suggesting a close relationship between heart qi deficiency and left ventricular function. Based on the PEP/LVET ratio, considered the most sensitive and reliable indicator of left ventricular function, they set the upper limit of normal at 0.37; any value exceeding this threshold was classified as abnormal left ventricular function. Statistical results showed that the abnormality rate was 94.7% in the heart qi deficiency group with coronary heart disease, 91.7% in the heart qi and yin deficiency group with coronary heart disease, while no abnormalities were found among other patients with coronary heart disease. In addition, some researchers used myocardial imaging to examine left ventricular function in patients with heart qi deficiency, confirming that these patients indeed have left ventricular dysfunction. Furthermore, studies involving 95 patients with different syndrome differentiation types measured the left ventricular systolic time interval, concluding that cardiac dysfunction, reduced cardiac output, and insufficient blood perfusion to systemic tissues are the pathological basis for the development of heart qi deficiency.

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Functions that it does not possess. In traditional Chinese medicine, the lung’s functions extend beyond respiration; concepts such as “the lung governs qi,” “the lung is associated with the skin and hair,” and “the lung and large intestine are interior-exterior counterparts” are all key components of TCM organ theory. In recent years, researchers have conducted experimental studies to explore the essence of these concepts. Although these findings are still preliminary, they do indicate that the functional aspects of the lung in TCM do have a material basis.

1. The Lung and Large Intestine as Interior-Exterior Counterparts

In recent years, domestic research has explored the interior-exterior relationship between the lung and large intestine through experiments, consistently concluding that this traditional TCM organ theory has a material basis. First, it has been observed that severe intestinal dysfunction—such as various forms of paralytic ileus, mechanical obstruction, and necrotizing enteritis—is often accompanied by respiratory failure. A typical example of concurrent intestinal and respiratory disorders is adult respiratory distress syndrome (ARDS). Why do severe intestinal diseases lead to respiratory complications? Modern medicine has yet to provide a complete answer. However, from the perspective of traditional TCM, the consensus across classic texts like the "Inner Canon," "Difficult Classics," "Shanghan Lun," "Jingui Yaolue," and subsequent works from the Tang and Song dynasties regarding the relationship between the lung and large intestine seems entirely logical. This understanding has proven effective when applied clinically.

To further elucidate the underlying mechanism, domestic researchers conducted a systematic study on 48 ARDS patients. They found that among these 48 cases, 25 had pre-existing intestinal dysfunction prior to the onset of ARDS, while 23 did not. The so-called intestinal dysfunction was not merely general gastrointestinal upset; among the 25 cases, 21 had paralytic ileus, 3 had mechanical obstruction, and 1 had mesenteric arterial embolism, with 16 subsequently developing toxic shock. All 25 patients with severe intestinal dysfunction suddenly developed acute respiratory failure 1–3 days after the onset of intestinal symptoms, characterized by rapid breathing—often exceeding 28 breaths per minute—along with decreased arterial oxygen partial pressure (PaO₂ < 8 kPa), elevated A-aDO₂ (greater than 4 kPa during spontaneous breathing and over 13.3 kPa with pure oxygen administration). These findings clearly demonstrate that severe intestinal dysfunction can lead to lung damage.

Building on this understanding, researchers created animal models by clamping the superior mesenteric artery to induce ischemic intestinal dysfunction. As a result, the lungs of these animals exhibited grade II or higher lesions, whereas the lungs of unclamped animals showed no similar changes. Meanwhile, when equal numbers of animals had their renal arteries or lower limb arteries clamped, no corresponding pulmonary changes were observed. Additionally, comparing groups of animals where the superior mesenteric artery was clamped versus those where no arteries were clamped, the clamped group tested positive for endotoxins in their blood after 90 minutes of clamping, while the unclamped group remained negative for endotoxins even after 90 minutes of exposure to the superior mesenteric artery.

These experiments confirm that intestinal dysfunction causes lung pathology, proving that the TCM theory of the lung and large intestine as interior-exterior counterparts has a material basis. Preliminary evidence suggests that this causal relationship may be linked to the production of endotoxins in the bloodstream. Currently, in addition to these experiments, some researchers have created permanent semi-ligation at the distal rectum, resulting in lung pathology. Others have refined the aforementioned clamping and semi-ligation methods, using external ligation to induce reversible narrowing of the distal rectum, thereby triggering a series of pathological changes in the lungs. The results show that this improved model essentially achieves the intended purpose: a series of lung lesions. Beyond confirming the “lung and large intestine as interior-exterior counterparts” theory, this model allows for external release of the narrowing, restoring normal function—a feature that not only enables repeated use of the model but also provides better conditions for in-depth research into the essence of this theory. Under this modified animal model, artificial formation of dry stool accumulation in the large intestine leads to Yangming腑实 signs in the animal model, which in turn can produce specific lung lesions, including pulmonary congestion, pulmonary hemorrhage, and pulmonary necrosis. Electron microscopy reveals swelling and necrosis of alveolar epithelium and macrophages, while other organs remain unaffected. Experiments show that feeding the model animals with Dachengqi Tang significantly improves pulmonary symptoms.

2. The Lung Governs Qi

In TCM, the concept of “the lung governs qi” encompasses not only the lung’s respiratory function but also other intrinsic functions of the lung itself. Research in this area is relatively scarce. According to a report from the Pulmonary Function Research Laboratory of Zhejiang Provincial Hospital of Traditional Chinese Medicine, they selected pulmonary function tests—direct indicators of lung qi activity—to observe and study the lung’s ventilation function. The results showed that in chronic obstructive pulmonary disease, patients with lung qi deficiency generally exhibited abnormal pulmonary function, whereas those without lung qi deficiency mostly maintained normal function, with only a few showing mild abnormalities. Statistical analysis revealed significant differences between the two groups. Among the abnormal cases, most patients with lung qi deficiency suffered moderate to severe ventilation impairment, and these impairments were predominantly mixed-type, significantly more pronounced than in the non-deficient group. Many current literature reports consider closed lung volume, flow-volume curves, and lung compliance to be highly sensitive indicators for early diagnosis of small airway diseases.

In clinical practice of TCM, early stages of such diseases often lack clear diagnostic markers, making the measurement of these indicators particularly important. These indicators, ranging from minor to major, correspond directly to the degree of lung qi deficiency.

The results obtained from 53 patients without lung qi deficiency in this study indicate that approximately half of them already exhibit microscopic changes indicative of lung qi imbalance. This demonstrates that the TCM concept of lung qi and “the lung governs qi” does have a material basis. Although experimental research in this area remains limited, it has already provided preliminary evidence. As future research in this field deepens, the true nature of TCM’s lung theory will inevitably be gradually revealed.

(“Integrated Chinese and Western Medicine Research,” March 1997)

References

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㉑ Liu Youzhang et al. Exploration of the essence of TCM “spleen” at the subcellular level (to be published)

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[Pei Zhengxue’s Traditional Chinese Medicine—Discussion on TCM Theory and Clinical Cases]{.underline}

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Wolf Set al. An experimental approach to psychosomatic phenomena in rhinitis and asthma. J Allerg 1950, 21:1

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B Feng Xuerui et al.—Experimental study on “the lung and large intestine as interior-exterior counterparts”—“Tianjin Traditional Chinese Medicine,” 1988, Vol. 4, p. 235

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②Wandai—Small airway diseases and their early diagnostic methods—“Chinese Journal of Tuberculosis and Respiratory Diseases,” 1979, Vol. 27, p. 113

Basic Principles of TCM Syndrome Differentiation and Treatment by Pei Zhengxue

Over nearly two millennia of development, traditional Chinese medicine has, through dialectical reasoning, symptom-based diagnosis, and identification of root causes, established a series of fundamental principles for syndrome differentiation and treatment, including “Eight Principles Differentiation,” “Zang-Fu Organ Differentiation,” “Six Meridians Differentiation,” “Wei-Qi-Ying-Xue Differentiation,” “Triple Burner Differentiation,” and “Etiology Differentiation.” These diagnostic frameworks serve as the main structure of TCM’s clinical syndrome differentiation and treatment theory, giving TCM its distinctive characteristics. When integrating Chinese and Western medicine and drawing on the best of both traditions, it is essential to first emphasize the basic principles of TCM syndrome differentiation and treatment in order to fully leverage TCM’s unique advantages, such as its “macroscopic” perspective, “holistic view,” and “view of the body’s response.”

[Pei Zhengxue’s Traditional Chinese Medicine—A Precise Discussion on TCM Theory and Clinical Cases]{.underline}

Clinical syndromes are complex and ever-changing, but ultimately they can be categorized into two main types: yin excess and yang excess, or yang excess and yin excess. During syndrome differentiation, one must first distinguish yin from yang, then further differentiate between exterior and interior, cold and heat, deficiency and excess, ensuring a clear hierarchical structure and accurate diagnosis. The “Plain Questions·Great Treatise on the Correspondence of Yin and Yang” states: “Yin and yang are the way of heaven and earth, the framework of all things, the parents of change, the origin of life and death, the abode of the divine, and the foundation of disease treatment—always seek the root cause.” The “Plain Questions” also says: “A skilled diagnostician first distinguishes yin from yang by observing color and feeling the pulse.” Zhang Jingyue further notes: “Whenever diagnosing and treating, one must first examine yin and yang—this is the cornerstone of medical practice. If yin and yang are ignored, treatment will inevitably go awry. Though medical practice may seem complex, it can be summed up in one word: yin and yang.” Clearly, yin and yang play a crucial role in syndrome differentiation and treatment.

(1) Basic Manifestations of Yin and Yang Syndromes

Basic manifestations of yin syndrome: listlessness, dull complexion, vacant gaze, weak voice, feeling cold with cold limbs, slow movements, poor appetite and little drinking, clear and long urination, loose stools, thin white tongue coating, and a slow, fine pulse. In short, any condition involving decline in bodily functions, nutritional deficiency, or organ degeneration generally falls under the category of yin syndrome.

Basic manifestations of yang syndrome: high spirits, flushed face, bloodshot eyes, loud voice, aversion to heat and preference for coolness, restlessness and hyperactivity, thirst and coarse breathing, short and reddish urine, dry and hard stools, thick yellow and dry tongue coating, and a rapid, strong pulse. In short, any condition involving heightened bodily functions, adequate nutrition, or new organic changes in organs generally falls under the category of yang syndrome.

However, the yang and yin syndromes encountered in clinical practice are rarely as straightforward as the examples above. More often, they present as “yang within yin” or “yin within yang,” forming complex syndromes such as “interior-exterior combination,” “cold-heat mixture,” or “deficiency-excess coexistence.” Some patients exhibit yin deficiency with yang excess, others yin excess with yang deficiency, some have both yin and yang deficient, while others have both yin and yang excessive. Given the complexity of yin and yang manifestations in clinical practice, it is essential to accurately determine the true nature of yin and yang, their mutual transformation, and which is dominant, in order to provide a precise basis for treatment.

(2) Yin Deficiency and Yang Deficiency

The kidneys are the foundation of innate vitality, housing both true yin and true yang. The right kidney serves as the “Mingmen,” containing true yang, while the left kidney is simply the “kidney,” containing true yin. When true yin is deficient, it leads to internal fire, flushing of the face and cheeks, lips appearing as if painted red, dry mouth and throat, bone-steaming heat, five-heart discomfort, night sweats and nocturnal emissions, a red tongue with little coating, and a fine, rapid pulse. When true yang is deficient, the complexion becomes pale, there is spontaneous sweating and fatigue, loss of appetite, shortness of breath and reluctance to speak, feeling cold and afraid of cold, abdominal bloating and loose stools, diarrhea at dawn, erectile dysfunction and seminal emission, heaviness in the legs, a swollen tongue with tooth marks, a thin white coating, a large but weak pulse, and a weak pulse at the cun position.

(3) Loss of Yin and Loss of Yang

“The Plain Questions·On the Flow of Vital Energy to Heaven” states: “When yin and yang separate, vital energy ceases.” Loss of yin and loss of yang are signs that yin and yang are about to separate, representing dangerous syndromes that appear during disease progression and serving as a necessary step on the path to death. At such times, it is imperative to make an accurate diagnosis and take immediate, decisive action to implement the most rapid and effective rescue measures, in order to turn danger into safety.

Clinical manifestations of loss of yin include chest tightness and shortness of breath, warm hands and feet, hot skin, thirst for cold drinks, salty and sticky sweat, a red tongue without moisture, and a fine, rapid pulse.

Part One: Academic Thought

Clinical manifestations of loss of yang include a pale face, cold limbs, feeling cold, spontaneous sweating, a pale and swollen tongue, and a floating, hollow or extremely weak pulse.

(5) Dizziness

Hypertension, cerebral arteriosclerosis, hypotension, anemia, otogenic vertigo, neurasthenia, menopausal syndrome, intracranial tumors, and other conditions can all cause dizziness. First, after confirming the Western medical diagnosis, conduct TCM syndrome differentiation; this will greatly improve the accuracy of the diagnosis. Hypertension is usually due to yin deficiency with yang excess, where yang excess generates wind. The treatment principle is to nourish yin and subdue yang, calm the liver and extinguish wind. Prescriptions can be adjusted from formulas such as Qiju Dihuang Decoction, Zhen Gan Xi Feng Tang, and Jian Ling Tang. For some cases of hypertension with unclear yang excess symptoms, Zhen Wu Tang or Ling Gui Zhu Gan Tang may be used for treatment. Cerebral arteriosclerosis is mostly due to blood stasis, so the treatment should focus on activating blood circulation and removing stasis—this is the saying "treat wind by first activating blood; when blood flows, wind naturally dissipates." Prescriptions can be selected from Xuefu Zhuyu Tang, Guanxin II, and Taohong Siwu Tang. Hypotension is mostly due to heart-spleen deficiency or qi sinking, so the treatment should nourish blood and tonify the heart, replenish middle qi, and strengthen qi. Prescriptions can be chosen from Guipi Tang, Buzhong Yiqi Tang, and Shengmai San. Most types of anemia are related to heart-spleen deficiency, heart-kidney disharmony, or qi failing to control blood.

In recent years, many prescriptions have been developed for treating anemia, but most still follow the above principles. The most commonly used formulas include Guipi Tang, Buzhong Yiqi Tang, Liuwei Dihuang Tang, and Xiangsha Liujunzi Tang. By selecting prescriptions based on specific conditions and adding herbs like Tu Si Zi, Nü Zhen Zi, Gou Qi Zi, He Shou Wu, and Xian He Cao, the therapeutic effect can be even more satisfactory. Otogenic vertigo is often associated with TCM patterns such as "water qi overwhelming the heart," "dampness obstructing heart yang," "phlegm obscuring the heart orifices," and "blood deficiency generating wind." The treatment principle is to clear the heart and remove phlegm, calm the heart and promote water metabolism, warm yang and transform phlegm. Prescriptions can be selected from Ling Gui Zhu Gan Tang, Zhen Wu Tang, Wu Ling San, and Xuan Fu Dai Zhe Tang.

Neurasthenia and menopausal syndrome have relatively flexible TCM syndrome differentiation, with several common patterns: "heart-spleen deficiency," "heart-kidney disharmony," "excessive fire," "water not nourishing wood," "yin deficiency with yang excess," "blood deficiency generating wind," "internal liver wind," and "floating yang." Prescriptions can be chosen from Guipi Tang, Tianwang Buxin Dan, Baizi Yangxin Tang, Xuefu Zhuyu Tang, Ganmai Dazao Tang, Chaihu Jia Longgu Muli Tang, and Yigan Tang.

(From "Integrated Chinese and Western Medicine Research," March 1996)

Modern Research on TCM Organ-Image Concepts by Pei Zhengxue

The theory of organ images is a crucial component throughout the entire system of TCM scholarship, and understanding organ images is a mandatory course for studying TCM. Modern research on organ-image concepts is also an important avenue for integrating Chinese and Western medicine. Over the past several decades, efforts in this area have yielded abundant results, initially establishing significant points of convergence between the two medical systems in terms of basic theory. These points of convergence have enabled Chinese and Western medicine to develop a common language in academic discourse. As these points of convergence continue to increase and research on each one deepens, Chinese and Western medicine will eventually move toward further integration, at which point TCM will embark on a path of comprehensive modernization.

Pei Zhengxue's TCM Studies—A Discussion on TCM Theory and Clinical Case Records Published by Gansu Science and Technology Press

Similar to changes seen in kidney-yang deficiency, the external manifestations of kidney-yang deficiency are positively correlated with aging. The key underlying mechanism lies in dysregulation of hypothalamic function, thus giving a more precise meaning to the exploration of the essence of kidney-yang deficiency.

Guided by the above theory, domestic scholars have extensively used kidney-tonifying and yang-strengthening medicines to treat aging, and experimental studies have demonstrated that these medicines can enhance T-cell immune function in elderly individuals. Additionally, they have shown a clear anti-aging effect on the gonadal axis, thereby substantiating the correctness of the notion that "the biological clock is the hypothalamus." The Shanghai First Medical University Institute of Integrated Chinese and Western Medicine, following the traditional asthma treatment principle of "treat the lungs in acute cases, treat the kidneys in chronic cases," has formulated a warming-yang tablet for kidney tonification. This tablet was used for preventive kidney-tonifying treatment during the remission phase in seven batches totaling 419 asthma patients, achieving an effective rate of 63.4% to 75.0%; whereas the non-kidney-tonifying control group had an effective rate of only 14% to 22.2%. Based on these therapeutic effects, endocrine studies were conducted, revealing that even asthma patients without clinical manifestations of kidney-yang deficiency exhibit potential functional changes in the adrenal cortex axis similar to those seen in kidney-yang deficiency. The warming-yang tablet can adjust adrenal cortical function at the microscopic level and improve asthma attacks at the macroscopic level. Furthermore, the tablet also regulates the immune system and the neuroendocrine system, which may be another reason for its effectiveness in preventing asthma attacks.

Traditional TCM holds that "the kidneys store essence" and "the kidneys govern reproduction." In men, the kidneys "store essence," while in women they "hold the fetus," indicating a close relationship between the kidneys and reproductive function in both sexes. The Obstetrics and Gynecology Hospital of Shanghai First Medical University treated polycystic ovary syndrome caused by ovarian dysfunction leading to ovulatory disorders using a method of kidney-tonifying and phlegm-transforming therapy, achieving an effective rate of 82.7%. To further explore the underlying mechanisms, a complete set of ovarian function tests was conducted on nine patients (vaginal smear eosinophil count, urinary FSH bioassay, LRH stimulation test), confirming that the true cause of ovarian dysfunction in these nine cases was hypothalamic dysfunction. Subsequently, dynamic hormone changes were measured in another nine patients, further verifying that the effect of kidney-tonifying and yang-strengthening drugs is a comprehensive action across multiple links—including the hypothalamus, pituitary gland, and ovaries—rather than a single isolated effect.

The Huashan Hospital of Shanghai First Medical University treated 100 patients with ureteral stone-induced obstructive hydronephrosis using a warming-yang and diuretic therapy, achieving a cure rate of 71%. Simultaneously, a hydronephrosis animal model was employed to demonstrate that warming-yang and diuretic drugs can increase pressure within the renal pelvis and significantly enhance peristaltic waves, whereas simple diuretics lack this effect. Using the animal hydronephrosis model, cAMP and norepinephrine (NA) levels were measured separately in the hydronephrotic kidney and the healthy contralateral kidney, then the animals were fed warming-yang and diuretic medications. It was found that the hydronephrotic kidney had significantly higher cAMP and NA levels than the healthy kidney, with P < 0.001, proving that warming-yang and diuretics can influence the renal pelvis through catecholamines, thereby enhancing activity in the renal pelvis and ureter and ultimately achieving a diuretic effect. This indicates that warming-yang and yang-strengthening medicines, in addition to improving hypothalamic, pituitary, and target gland functions, also exert a clear regulatory effect on the autonomic nervous system.

The Shanghai Endocrine Research Institute observed the patterns of sex hormone changes in several diseases commonly associated with kidney-yang deficiency, such as diabetes, coronary heart disease, sick sinus syndrome, and hypertension, and found that male patients with these conditions share a common pattern: elevated E₂ levels and an increased E₂/T ratio, which is positively correlated with kidney-yang deficiency. Phillips once proposed that an elevated E₂/T ratio might be a risk factor for cardiovascular disease, but no corrective measures were found. After adopting kidney-tonifying therapy, the symptoms of kidney deficiency improved, and the sex hormone changes were corrected. Moreover, specific symptoms unique to each disease also improved: blood pressure decreased in hypertensive patients, blood sugar dropped in diabetic patients, chest pain lessened in coronary heart disease patients, and heart rate increased in patients with sick sinus syndrome.

Part One: Academic Thought

In recent years, further research has explored the relationship between sex hormone changes in female patients with diabetes, coronary heart disease, and hypertension and kidney deficiency. Through salivary sex hormone measurements, it was observed that ovarian function in women of childbearing age with these three diseases declines to varying degrees, manifested as lower E₂ levels and a lower E₂/T ratio—opposite to the situation in male patients. After applying the same kidney-tonifying and qi-replenishing methods as used for men, the above conditions also improved. This demonstrates that kidney deficiency is a common manifestation of hormonal imbalance in both men and women; moreover, as long as the kidney-deficiency-specific diagnostic features are grasped, the kidney-tonifying and qi-replenishing approach can effectively regulate hormonal imbalances in both sexes. This shows that the kidney-tonifying and qi-replenishing method has a clear bidirectional regulatory effect on hormonal imbalances in men and women.

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It also returned to normal accordingly. Some researchers repeated the above experiment on adults with spleen-deficiency symptoms, and the results were the same①. Others conducted pathological observations on gastric tissue removed from the stomachs of patients with spleen deficiency, finding that the regeneration of gastric mucosal epithelial cells was enhanced, while the process of differentiation into mature cells was hindered. Still others performed pathological examinations on duodenal tissue samples from patients with chronic gastritis and peptic ulcers who exhibited spleen-deficiency symptoms, discovering flattened and damaged mucosal villi, sparse and easily shed microvilli②.

(3) Spleen and Gastrointestinal Motility

The implication of spleen-movement dysfunction is a change in gastrointestinal motility. Patients with spleen deficiency typically experience belching, acid reflux, abdominal distension, and loose stools, which TCM considers evidence of disharmony in the ascending and descending movement of the spleen and stomach—what is referred to as "ascending-descending disharmony" or "spleen-movement dysfunction." Some researchers used X-ray imaging to find that most patients with spleen deficiency have reduced gastrointestinal peristalsis and prolonged gastric emptying time①. Others used surface gastric electrical wave measurements as indicators, discovering that patients with spleen deficiency have lower amplitude of surface gastric electrical waves, a phenomenon that is very obvious whether fasting or after eating. After employing spleen-tonifying and qi-replenishing methods, this condition quickly improved. Some researchers also used I¹³¹ isotope tracing to observe digestive tract emptying function, finding that the digestive tract emptying speed of tumor patients with spleen deficiency was significantly faster than that of non-spleen-deficient tumor patients and normal individuals, and could be improved by taking spleen-tonifying and qi-replenishing medicines③.

(4) Spleen and Metabolism

The implication of spleen-movement dysfunction is that metabolic processes of nutrients are impaired. Some researchers found that patients with atrophic and superficial gastritis who have spleen deficiency exhibit lower serum citrate dehydrogenase activity compared to normal individuals (P < 0.01). After treatment with Xiangsha Liujunzi Tang, the enzyme activity increased, though there was a significant difference before and after treatment, the post-treatment level still did not reach normal levels. Similarly, these patients also have lower serum lactate dehydrogenase activity than normal, which significantly increased after treatment with Xiangsha Liujunzi Tang. Some researchers observed that in the gastric mucosa of patients with spleen deficiency suffering from epigastric pain, the average number of subcellular mitochondria per unit area was markedly reduced, while the mitochondria of these patients were swollen, their membranes damaged, and their cristae broken④. Mitochondria are organelles responsible for cellular biooxidation of nutrients, containing enzymes necessary for oxidation. Studying the morphology and function of mitochondria in patients with spleen deficiency is highly meaningful for exploring the essence of the spleen.

2. The Spleen Governs Middle Qi

Middle qi is the "foundation of postnatal life" and an important component of the body's "zheng qi." TCM says, "where evil gathers, qi must be deficient," and "when zheng qi resides within, evil cannot invade," indicating that zheng qi and middle qi to some extent encompass immune function. TCM also has the saying, "a strong spleen is resistant to evil."

Some researchers divided internal medicine inpatients into two groups: those with spleen deficiency and those without. Using indicators such as lymphocyte count in blood circulation, PHA skin test, total rose formation cell ratio, and active rose formation cell ratio, they found that patients with spleen deficiency had a clear tendency toward weakened cellular immunity, with the degree of decline positively correlated with the severity of anemia and hypoalbuminemia among patients with spleen deficiency②. Patients with chronic bronchitis, peptic ulcers, chronic nonspecific colitis, and chronic hepatitis who have spleen deficiency also...

Part One: Academic Thought

The above situation can be observed②. Some researchers used square capillary electrophoresis to examine lymphocytes in patients with spleen deficiency, finding that the lymphocyte electrophoresis rate was significantly lower, and the decline in lymphocyte electrophoresis ability indicated a decrease in lymphocyte electrophoresis activity, which may be one of the reasons for the weakened immunity in patients with spleen deficiency◎. Others studied the SIgA content in the saliva of patients with peptic ulcers and chronic colitis who have spleen deficiency, finding that the content was higher in patients with spleen deficiency, especially in those with dampness accompanying spleen deficiency. After treatment, as clinical conditions improved, the content decreased somewhat.

TCM believes that the appearance of syndromes is related to individual constitution. HLA is an important immunogenetic marker of the human body, closely related to immune response and susceptibility to disease. Some researchers conducted preliminary studies on the association between spleen deficiency and HLA, finding a significant correlation between spleen deficiency and HLA-B22, while no such correlation was found in chronic gastritis, chronic nephritis, peptic ulcers, and other diseases used for comparison田. This suggests a clear connection between the essence of spleen deficiency and immunogenetic factors.

3. Liver-Stomach Disharmony

TCM believes that liver-stomach disharmony has two pathological manifestations: one is liver wood overcoming earth, and the other is spleen earth offending wood. The former presents with pain in the liver region, bitter taste and dry throat, irritability, loss of appetite, and fatigue; the latter manifests as fullness and distension in the upper abdomen, intestinal rumbling and diarrhea, nausea and vomiting, and pressure on both sides of the abdomen. From a Western medical perspective, both conditions involve disturbances in the autonomic nervous system of the gastrointestinal tract: the former is characterized by heightened sympathetic nervous tension, while the latter is dominated by parasympathetic nervous function. In light of this, domestic scholars have attempted to design scientific studies to clarify the relationship between liver-stomach disharmony and the autonomic nervous system. It is currently known that the synthesis and secretion of salivary amylase are controlled by the autonomic nervous system.

Patients with liver-stomach disharmony typically present with symptoms of liver depression and spleen deficiency. Researchers still use patients with spleen deficiency as experimental subjects, finding that when these patients are in a baseline state, salivary flow increases and enzyme activity is also high, indicating that the parasympathetic nervous system controlling the salivary glands is relatively hyperactive. However, under acidic stimulation, enzyme activity not only does not increase but actually decreases, and the increase in salivary flow is also less than that of normal individuals, suggesting that although the parasympathetic nervous system of patients with spleen deficiency is in a state of hyperactivity, its ability to maintain tension is weaker than that of normal people◎. Tracking with I¹³¹ isotope capsules orally reveals that patients with spleen deficiency have faster digestive tract emptying, which can be corrected by intramuscular injection of atropine, indicating that the parasympathetic nervous system becomes more tense when the spleen is deficient田.

Research on the sympathetic nervous function of patients with spleen deficiency is also underway. Skin potential is a sensitive indicator reflecting the central function of the sympathetic nervous system; patients with spleen deficiency have significantly lower skin potential than normal individuals whether at rest or under cold stimulation, but after spleen-tonifying and qi-replenishing treatment, skin potential increases noticeably. The VMA content in the urine of patients with spleen deficiency is significantly lower than that of normal individuals, and skin electrical activity is often parallel to VMA content●. Reduced dopamine β-hydroxylase activity is also a characteristic of patients with spleen deficiency, which increases after treatment田.

From a molecular biology perspective, the reason why the autonomic nervous system can affect the organs it controls is mainly because neurotransmitters released by autonomic nerve endings act on corresponding receptors in effector cells, causing changes in intracellular cyclic nucleotide levels and thereby affecting cellular function. Domestic researchers have studied changes in cyclic nucleotide levels in the blood of patients with spleen deficiency, but the results are inconsistent. Preliminary findings show that plasma cAMP levels in patients with spleen deficiency are relatively low, which helps explain why sympathetic nervous function is relatively weak when the spleen is deficient. Although current methods vary across regions and indicators differ, resulting in incomplete consensus, preliminary conclusions can be drawn:

Pei Zhengxue's TCM Studies—Analysis of TCM Theory and Clinical Cases Published by Hefei Sixiang Publishing House

(1) When the spleen is deficient, sympathetic nervous function is relatively weak, while parasympathetic nervous function is relatively strong. (2) Both sympathetic and parasympathetic nervous systems have reduced capacity to maintain tension●.

Part One: Academic Thought Published by Hefei Jiushan Publishing House

Currently, it is generally accepted that when the sympathetic nervous system is excited, NE release increases, acting on β receptors on cell membranes to activate cAMP-ase (adenylate cyclase, AC), increasing intracellular cAMP levels and raising plasma cAMP levels. Catecholamines can also bind to α receptors, increasing guanylate cyclase (cGMP-ase) activity and leading to higher cGMP levels. Prostaglandins (PG) can activate cAMP-ase activity in many tissues, increasing cAMP concentration◎, while TXB₂-6K-PGF₁ₐ content imbalance may affect important links in nucleotide metabolism. CA promotes substance metabolism and increases energy mobilization. Increased energy metabolism may be an important manifestation of overactive sympathetic-nervous-adrenal medulla function.

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Negative emotions such as dissatisfaction, pain, fear, hatred, and anger arise. The former are positive emotions and feelings, while the latter are negative. Positive emotions can enhance the function of various organs in the body, whereas negative emotions can inhibit organ function. Therefore, people generally believe that mood (emotions and feelings) is an important factor influencing the normal operation of various systems in the human body. Mood can be regulated through personal cultivation and quality orientation, so the directing role of the cerebral cortex is reflected in its regulation of various departments in the body. These emotions, feelings (mood), as well as cultivation and quality orientation, all fall under the TCM concept of "the heart governs spirit," and their impact on various departments in the body falls under the concept of "the heart is the master of the five zang and six fu organs."

In summary, most of the heart's functions in TCM fall under the scope of modern brain functions; however, from the perspective of "the heart governs blood vessels," it also has the meaning of a modern heart.

Domestic researchers used the Cxz-I type ultrasonic cardiovascular diagnostic instrument to conduct preliminary observations on the left ventricular systolic and diastolic functions of patients with heart qi deficiency, heart yin deficiency, and blood stasis in the heart. They found that when heart qi deficiency occurs, the mean value of the distance between the mitral valve and the interventricular septum (EPSS) increases, while the mitral valve amplitude (CHE), stroke volume (SV), average contraction speed of the left ventricular posterior wall (MPMVS), average relaxation speed of the left ventricular posterior wall (MPWVD), ventricular wall thickening rate (△T%), EF slope (MVV), and the ratio of the total amplitude of left ventricular posterior wall movement during the rapid filling phase (R) to the total amplitude of left ventricular posterior wall movement (RPWE) all decrease. When heart yin deficiency occurs, in addition to the increase in EPSS mean value, the diastolic function indicator MVV mean value also decreases significantly. Compared with heart qi deficiency, heart yin deficiency shares the common feature of a decrease in EPSS mean value, but differs in that other indicators decrease in heart qi deficiency while remaining unchanged in heart yin deficiency, resulting in statistically significant differences between the two. In cases of blood stasis, the SV and MPWVD mean values of the left ventricular contraction function decrease, as do CHE and △T%; meanwhile, the MVV and RPWE mean values of the diastolic function decrease, while the EPSS mean value increases. These experimental studies demonstrate that there is a clear relationship between heart qi deficiency, heart yin deficiency, blood stasis, and cardiac contractile function, and also reveal that the three conditions reflect both their essential similarities and differences in terms of cardiac contractile function, thus providing a material basis for the traditional pathology of heart qi deficiency, heart yin deficiency, and blood stasis in TCM.

Death of Yin is the extreme stage of Yin deficiency syndrome. According to the principle that "Yin deficiency generates internal heat," patients with death of Yin still exhibit symptoms similar to internal heat, such as warm hands and feet and hot skin. However, as death of Yin progresses further, these internal heat symptoms may disappear due to the principles of "isolated Yin cannot generate life" and "isolated Yang cannot grow." Death of Yang, on the other hand, is the extreme stage of Yang deficiency syndrome. Based on the principle that "Yang deficiency generates external cold," patients with death of Yang still display symptoms resembling external cold, such as pale complexion, cold limbs, and general chilliness. Yet, as death of Yang advances, these external cold symptoms intensify until they ultimately lead to death. All fatal cases end in death of Yang, meaning that death of Yin often precedes death of Yang, which then rapidly follows. The Suwen's "On the Vital Energy and Heavenly Principles" states: "The vital energy is like the sky and the sun; if it loses its proper place, lifespan will be shortened and its brilliance will fade." Thus, among death of Yin and death of Yang, death of Yin signifies a critical condition, and the progression of death of Yin inevitably leads to death of Yang; of course, there are also cases where death of Yang appears first, followed quickly by death of Yin, or where both death of Yin and death of Yang occur simultaneously.

2. Exterior and Interior

Exterior and interior represent two fundamental categories for distinguishing the depth of disease location. Generally speaking, diseases located in the exterior are superficial and mild, making them easier to treat; whereas diseases located in the interior are deep-seated and severe, thus more difficult to treat. Progression from exterior to interior indicates disease development and aggravation; conversely, progression from interior to exterior suggests disease alleviation and recovery. The former is considered "reverse," while the latter is "natural." In addition, there is also a category known as semi-exterior and semi-interior, where the disease location lies between the exterior and interior. Most conditions associated with the Shaoyang Gallbladder Meridian fall into this category.

This chapter is prepared for online research and reading; for external materials, please align with original publications and the review process.

Section Index

3. Combining the Holistic View with the Local View

(5) Dizziness

Modern Research on the Concept of Zang-Xiang in TCM — Pei Zhengxue

Part One: Academic Thought

(3) Spleen and Gastrointestinal Motility

(4) Spleen and Metabolism

2. The Spleen Governs Middle Qi

Part One: Academic Thought

3. Liver-Stomach Disharmony

(1) Basic Manifestations of Yin and Yang Syndromes

(2) Yin Deficiency and Yang Deficiency

(3) Loss of Yin and Loss of Yang

(5) Dizziness

Modern Research on TCM Organ-Image Concepts by Pei Zhengxue

Part One: Academic Thought

(3) Spleen and Gastrointestinal Motility

(4) Spleen and Metabolism

2. The Spleen Governs Middle Qi

Part One: Academic Thought

3. Liver-Stomach Disharmony

2. Exterior and Interior