4. Contraindications for Medication in Blood Disorders

4. Contraindications for Medication in Blood Disorders

Tang Rongchuan considers sweating and vomiting to be contraindicated, as they can cause qi to rise and blood to overflow, exacerbating the condition. As for purging methods, they are an important therapeutic approach for blood disorders, since “eight or nine out of ten cases of blood disorders involve excessive qi and intense fire; when qi surges and cannot be contained, it is precisely the right time to descend and curb its momentum. In the case of Yangming syndrome, there is an urgent need to descend and preserve yin; similarly, for Shaoyin syndrome, there is also an urgent need to descend and preserve yin. For blood disorders with extremely high levels of qi and fire, the greatest fear is losing yin; descending is precisely saving yin, while purging is tantamount to replenishing it.” He believes that descending methods are effective for blood disorders, both in suppressing the surge of qi and in preserving yin that would otherwise be depleted, but “it is essential to act at the right moment—if evil qi lingers too long and righteous qi has already weakened, or if diarrhea occurs… then one can only proceed cautiously.” As for harmonizing and tonifying methods, they are also indispensable in treating blood disorders. Harmonizing methods address both exterior and interior syndromes, balancing lung qi and liver qi, and regulating central qi. In addition, there are tonifying yin and yang, removing stasis and blood, draining water and qi—these are all different forms of harmonizing methods. Within these methods, there are distinctions between tonifying the lungs, spleen, and kidneys, with yin and yang playing a decisive role: in blood disorders, tonifying yin is far more common, accounting for about eight or nine tenths of cases, while tonifying yang is rare, representing only about one or two tenths. The implementation of tonifying methods must occur only after evil qi has been eliminated and blood stasis has been removed; otherwise, it may lead to the undesirable consequence of closing the door to catch the thief.

After Reading “Selected Comments on Medicine”

Yu Ying’ao and Pei Zhengxue

At the end of the Ming Dynasty, the renowned Zhejiang physician Pei Yizhong authored “Pei Zi’s Commentary on Medicine” (shortened to “Commentary on Medicine”), consisting of four volumes, first published in the seventeenth year of the Chongzhen reign (1644). This work is not listed in any official medical bibliographies from the Ming or Qing dynasties. In 1959, it was included in the “National Joint Catalog of Traditional Chinese Medicine Books” compiled by the Library of the Institute of Traditional Chinese Medicine and other institutions. Currently, the Sichuan Provincial Library holds the original edition of this book, while the Rare Books Collection of the Institute of Traditional Chinese Medicine houses a Qing Dynasty edition printed during the Shunzhi period.

Pei Yizhong, courtesy name Zhaoqi, pseudonym Fu’an Jushi. His exact birth and death dates remain unknown. According to the preface of “Commentary on Medicine,” Pei came from a family of hereditary physicians. Upon beginning his medical studies, he devoted seven full years to studying the “Plain Questions,” the “Spiritual Pivot,” and the works of other great masters, believing he had gained considerable insight. Later, as he practiced medicine, he frequently encountered difficult or perplexing cases. Realizing his limited knowledge, he intensified his studies, eagerly exploring and reading extensively from ancient and modern medical texts and related works, almost to the point of neglecting sleep and food. Through this relentless pursuit, his medical skills improved dramatically, saving countless lives, and eventually leading him to write this book in his later years. Pei also authored “Pei Zi’s Commentary on Medicines,” “Compilation of the Essence of the Spirit,” “Key Points of the Forest,” “Compendium of Diagnosis and Treatment,” and “Revised and Expanded Original Formulas for Treating Diseases Based on the Mysteries of the Plain Questions,” but unfortunately none of these works were ever published.

“Pei Zi’s Commentary on Medicine” is classified as a medical essay. The entire book lacks a table of contents and comprises 148 sections, including discussions of clinical experiences across various specialties and related theories of clinical medicine. It was revised by his son Pei Han and edited by his grandson Pei Jin Yan. At the time of its initial publication, it received sponsorship or prefaces from prominent figures such as Mao Huaimei, Jin Tan, Jiang Fushan, Zhang Zhenzhong, and Zhao Shengbo. In the preface written by Chen Zizun, it is stated that Pei’s medical practice “saved countless lives through myriad methods; young children, elderly people, officials in green robes, and students in blue uniforms—all praised his virtue.” He enjoyed widespread acclaim in the Jiangsu and Zhejiang regions.

In the 19th century, the famous physician Wang Mengying selected and commented on 50 sections of “Commentary on Medicine,” which were later published in the “Eight Volumes of the Qianzhai Medical Collection” and the “Fourteen Volumes of the Qianzhai Medical Collection,” under the title “Selected Comments on Medicine.” The book was untitled, with the following inscription on the cover: “Original work by Pei Zhaoqi, reviewed by Yang Suyuan, and selected by Wang Mengying.” Due to the refined selection process, the commentary reflects Pei’s academic experience and important clinical insights, making the review section highly informative and truly a masterpiece that closely integrates theory with clinical practice. Today, copies of “Commentary on Medicine” are hard to find; below, we mainly draw on “Selected Comments on Medicine” to present and excerpt Pei’s clinical and academic insights.

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

Published by Taiwan Qiyue Publishing House

He once vividly described it as follows: “When hunger and satiety are balanced, food itself acts as medicine; when temperature is appropriate, clothing serves as medicine; when activity and rest are regular, daily routines become medicine… If one knows how to nourish essence but not how to restrain desires, knows how to cultivate qi but not how to maintain silence, knows how to protect the spirit but not how to eliminate worries, then where can one possibly find medicine? The ‘Plain Questions’ are the six classics of medicine. But if one follows the seasons, limits desires, moderates diet, and avoids being invaded by evil qi, one will never need to resort to medicine. For those whose five emotions are the source of illness, the five emotions themselves serve as medicine.” He equates dietary habits, daily routines, health preservation, and emotional regulation with the therapeutic effects of medicine, asserting that “one must know where the illness comes from and where it should go—that is the true medicine.” Based on this principle, practices such as abstaining from hunger (“not eating”), avoiding thirst (“not drinking”), as well as everyday measures like avoiding wind, refraining from alcohol, escaping the summer heat, or keeping warm, are all considered “medicine” for disease prevention or broad-spectrum therapeutic interventions. The emphasis here is on adapting to the natural rhythms of the seasons, preventing illness before it occurs, and correctly adjusting or correcting factors that could harm the body. This perspective of integrating diet, daily routines, and health preservation with broad-spectrum therapeutic approaches is generally misunderstood and overlooked by many, often unbeknownst to patients themselves, reflecting Pei’s strong preventive mindset.

Published by Taiwan Qiyue Publishing House 141

Dizziness, tinnitus, muscle twitching, and a sense of confusion that makes it impossible to sleep—these symptoms have come and gone intermittently for half a year. Later, after four months of obstruction, the abdomen felt as if pregnant, leading doctors to suspect pregnancy and provide prenatal care. Then one day, a small amount of dark purple blood was discharged, revealing amenorrhea. Several doses of medication to induce menstruation were administered, but instead of relieving the condition, the abdomen became increasingly nauseous and vomited, with food spilling out of the throat, burning sensation in the throat, and a black, dry tongue—none of the doctors could explain the situation. I (Pei) examined the patient and found six tense, slippery pulses, especially pronounced in the two cun points. I said: “This is stubborn phlegm blocking the blood pool, causing stagnation and congestion. The menstrual cycle is blocked because of this.” …It is imperative to prioritize clearing phlegm first, so I prescribed Shigun Tan Wan, eighty pills, followed by seventy more, with slight abdominal pain. The next day, I administered the same dosage again, but the abdominal pain became unbearable. Late at night, four or five pieces resembling pig liver were expelled, each several feet in size, followed by fragments of broken fat membranes—countless tiny particles resembling pomegranate seeds, red and white intertwined and falling down—totaling two or three dou, after which the abdomen suddenly flattened and the pain disappeared. Most remarkably, the sputum produced was about a bowlful, all green like grass juice, and the saliva at the corners of the mouth suddenly turned as hard as violin strings.” Pei thus realized that Zhu Danxi’s claim that “eight or nine out of ten cases of phlegm-related disorders are truly strange” indeed made sense.

Subsequently, he switched to using orange peel, scutellaria, coptis, citrus aurantium, pinellia, bamboo sap, ginger juice, and finally six君子汤 and润下丸 to adjust the treatment, achieving success. He also treated another case of amenorrhea: “Excessive use of blood-tonifying drugs led to blood stagnation and decreased appetite, accompanied by chills, fever, and vomiting. Doctors still believed the problem was blood stasis affecting the heart and intensified the treatment, causing the patient to suddenly lose consciousness, clench teeth, drool, and exhibit stroke-like symptoms. The pulse was faint and weak, and pressing on the heart revealed a tight, urgent feeling. I said: ‘This is phlegm and fluid accumulation.’ After investigation, it turned out that the patient had been harmed by the medication, not by the surge itself. Only by urgently inserting a goose feather to probe the stomach could four or five liters of acidic liquid be extracted, and the patient regained consciousness. First, I used herbs to dry and loosen the stomach, then supplemented with spleen-strengthening and stomach-nourishing medicines, waiting until the patient’s eating and living habits returned to normal before administering the menstrual-inducing pill, at which point the blood finally flowed.” These two cases of amenorrhea—one resolved through phlegm treatment, the other determined to be caused by drug-induced fluid accumulation—were successfully treated step by step, demonstrating Pei’s meticulous syndrome differentiation and exceptional prescription-making skills.

Clinical physicians employ various prescribing strategies when treating patients, with some referring to them as “kingly” or “tyrannical” approaches. Generally, medications with mild or tonifying properties are considered “kingly,” while those with strong or aggressive effects are labeled “tyrannical.” Regarding the distinction between “kingly” and “tyrannical” drugs, Pei believes: “There is no such thing as ‘kingly’ or ‘tyrannical’ drugs; nor is there such a thing as ‘kingly’ or ‘tyrannical’ usage. …The effectiveness of a drug depends on how it is used—licorice, ginseng, and astragalus are ‘kingly’; aconite and nitrate are also ‘kingly’… So the distinction between ‘kingly’ and ‘tyrannical’ lies not in the drug itself, but in how it is used—and even more so in whether it is used wisely or unwisely…” This viewpoint is based on practical results and evidence-based medicine, rather than judging drugs solely on their strength or tonifying/purifying effects.

Regarding the treatment of certain internal medicine conditions, Pei places great emphasis on moxibustion, even believing that some conditions are best treated with moxibustion first, followed by medication. He says: “Whenever there is phlegm or fluid accumulation in the chest or abdomen, or stagnation, distension, pain, acidity, burning, vomiting, or diarrhea—conditions that come and go intermittently and persist for years—urgent action is needed to achieve complete recovery, lest other diseases develop later and complicate matters. However, the recommended treatment sequence is to apply moxibustion first, followed by herbal medicine.” This is because taking medication early in such cases can easily damage the spleen and stomach, depleting vital energy; whereas applying moxibustion first does not interfere with digestion or weaken the body’s energy. Wang Shixiong believes that especially for conditions caused by cold and damp stagnation, it is even more beneficial to use moxibustion to warm and promote circulation—this is a sound therapeutic approach that clinicians can consider when devising treatment plans.

Pei attaches great importance to preserving stomach qi, particularly for elderly patients, believing that focusing solely on medication should not hinder eating. “It is better to skip medication because of food than to skip food because of medication.” He also offers views on dietary restrictions and recommendations for patients during and after illness that are consistent with syndrome differentiation and scientific principles. He believes that “during illness, it is indeed advisable to restrict food intake, especially beverages. Everyone knows that food can harm the body, but few realize that drinks can do the same—not just tea, soup, juice, wine, ice, spring water, melons, and fruits, but even excessive medication can be considered harmful to the drinker. The symptoms include mild bloating and intestinal rumbling, leading to vomiting, and severe cases where the abdomen feels as tight as a drum, leading to

142 Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Case Records

Published by Taiwan Qiyue Publishing House

Asthma turns into hiccups, and in severe cases, the jaw clenches tightly, saliva drips from the corners of the mouth, and the person loses consciousness, resembling a stroke—those afflicted with this condition are everywhere…” Such drink-related injuries are quite common in clinical practice today, yet physicians often overlook them and find it difficult to identify these conditions. Similarly, after illness, dietary restrictions should be adjusted appropriately based on the specific condition. However, Pei opposes overly strict dietary restrictions, believing that such measures are detrimental to post-illness recovery.

For instance, when dealing with comatose patients, physicians often emphasize that “the heart stores the spirit,” attributing the root cause of the condition to the heart. Pei, however, discovered that “the root cause of coma lies in the stomach; only when the stomach is clean can the spirit be clear.” Although “the heart is said to store the spirit, it is actually the qi that controls the spirit. Qi originates from the stomach; if the stomach qi is not clear, the spirit cannot be properly guided back to its resting place, and the mind will inevitably become confused.” He cited examples such as drunkenness, overeating, phlegm blockage in the middle jiao, and internal excess of Yangming qi to illustrate this point, combining theoretical exploration with clinical application—a lesson worth learning.

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In summary, Pei Yizhong was not satisfied with the medical achievements already attained by his predecessors. His work "Yan Yi" presents unique scholarly insights that remain firmly grounded in orthodoxy. He was also adept at observing and summarizing certain regular patterns. For example, pediatric physicians generally hold the following views: children from wealthy families tend to have delicate constitutions and are prone to illness, whereas children from poor families often enjoy robust health and rarely fall sick. Pei analyzed five main causes of illness in children:

First, excessive warmth; second, overconsumption of fluids; third, emotional instability and frequent anger (resulting from parents' indulgence, children's willfulness, and easy temper); fourth, "suppressing crying" (i.e., parents discouraging their children from crying out of fear that it might harm their health); and fifth, harm caused by medication (such as taking too many drugs for minor or no illnesses). These are all common issues among children raised in affluent households, while poor families tend to experience the opposite effect. Therefore, Pei believed that "poor families actually follow a more appropriate approach to raising children," because children from impoverished backgrounds, constrained by family finances, typically do not suffer from overfeeding, excessive warmth, or overmedication, nor are they overly pampered or willful. Moreover, young children tend to have an excess of yang energy, making them susceptible to heat-related ailments; thus, crying can help release this excess heat, which is beneficial for children's health—something pediatricians should pay attention to.

The preface written by Zhao Shengbo states: "...Pei has mastered both ancient and modern knowledge, possesses profound insight into the relationship between heaven and humanity, and combines the talents of an immortal with the compassion of a bodhisattva... Reading his words feels like hearing what Xuanzang and Qi had long wished to express but never fully articulated, as well as what other great masters wanted to convey but were unable to do so due to various constraints..." Considering that few editions of "Yan Yi" have been published, it is difficult for readers to access. Therefore, we have selected and briefly introduced key points from "Selected Comments on Yan Yi" above. Any inaccuracies are welcome to be pointed out.

(Journal of Zhejiang College of Traditional Chinese Medicine, June 1981)

My Journey in Integrating Traditional Chinese and Western Medicine

Pei Zhengxue

I was born in February 1938 in Wushan County, Gansu Province. In 1961, I graduated from the undergraduate program at Xi'an Medical University in China and later served as chief physician, researcher, department head, and vice president at the Gansu Provincial Academy of Medical Sciences, specializing in the integration of traditional Chinese and Western medicine in gastroenterology, hematology, and cardiovascular diseases. I once led a key project funded by the Provincial Science and Technology Commission titled "Research on Hepatitis B." Over the years, I have edited or authored 14 monographs on the integration of traditional Chinese and Western medicine, including "Practical Internal Medicine through the Integration of Traditional Chinese and Western Medicine," "Pharmacopoeia of Traditional Chinese Medicine," "Commentary on Blood Disorders," "Diagnosis and Treatment of Hepatitis B," "New Compilation of Warm Disease Theory," "Selected Cases of Pei Shen's Medical Practice," and "Pharmacological and Clinical Applications of Rhubarb," among others. I have also published more than 70 academic papers, winning two provincial awards for scientific and technological progress, seven awards for outstanding publications, and one international gold award for traditional medicine worldwide. I have traveled to the United States and Japan to give lectures. Currently, I serve as a member of the Gansu Provincial Committee of the Chinese People's Political Consultative Conference, a director of the Chinese Society for the Integration of Traditional Chinese and Western Medicine, and an editorial board member of the "Chinese Journal of Integrated Traditional Chinese and Western Medicine."

I come from a family of three generations of traditional Chinese medicine practitioners. My grandfather was a scholar during the Qing Dynasty who practiced medicine in our hometown and enjoyed great prestige throughout several southern counties. My father graduated from the liberal arts department of Central University but later switched to medicine, gaining fame across Shaanxi and surrounding areas.

After graduating from the medical department of Xi'an Medical University in 1961, although I spent most of my career practicing Western internal medicine, growing up immersed in the family tradition of thinking in terms of traditional Chinese medicine sparked a deep interest in TCM within me. When encountering patients whose conditions proved difficult to treat with Western medicine alone, I often combined Western medications with traditional Chinese herbal formulas, achieving notable therapeutic effects in cases such as aplastic anemia, leukemia, systemic lupus erythematosus, and rheumatoid arthritis. I recall January 1967, when I was working in the internal medicine department of a hospital in the Tianshui region. A 16-year-old male patient named Ma, referred from Lanzhou, had been treated unsuccessfully at another hospital there, showing no improvement after chemotherapy, with a hemoglobin level of only 3 g/dL and in critical condition. After applying a traditional Chinese medicine treatment aimed at "strengthening vital energy and consolidating the root," his condition gradually improved significantly. Subsequent chemotherapy further led to partial remission in bone marrow examinations. Thereafter, I continued to combine traditional Chinese medicine with chemotherapy. After a year of treatment, his condition completely improved, and bone marrow tests showed complete recovery.

This case was presented at the Suzhou Hematology Conference in 1973 and received widespread attention from all attendees, leading to the designation of the primary formula used in treating this case as the "Lanzhou Formula," which was subsequently promoted nationwide. The patient is still alive today, having survived for over 30 years. This case provided me with profound insights and intensified my pursuit and desire to study Chinese medicine. Thus, starting in the 1960s, I began self-studying classic texts such as "Shanghan Lun," "Jin Gui Yao Lue," "Wen Bing Tiao Bian," and "Neijing Zhi Yao." At the same time, I carefully read representative works by modern scholars of the fusion school, including Tang Rongchuan, Zhang Xichun, Shi Jinmo, Yu Wuyan, and Shi Yiren. Their theories and practices offered me new inspiration, revealing that earlier generations, constrained by historical circumstances, had not yet achieved a thorough understanding of modern Western medicine. Although their practical applications yielded good results, they failed to develop a systematic theory of integrating traditional Chinese and Western medicine, thereby limiting the broader impact on future efforts in this field. Shi Jinmo left behind very few writings, though several case studies compiled by his disciples demonstrated excellent therapeutic outcomes, with prescriptions reflecting an integrated perspective of both traditions. Zhang Xichun's "Medical Insights from Both East and West" leaned more toward practice than theory, while Yu Wuyan and Shi Yiren both exhibited a spirit of exploring the integration of theory and practice, albeit sometimes rushing ahead and stretching the connection too far. Only Tang Rongchuan, in his "Blood Disorder Treatise," subtly revealed some genuine insights into the integration of traditional Chinese and Western medicine.

Taking advantage of the two years I was sent to the countryside during the Cultural Revolution, I wrote "Commentary on Blood Disorders," which was published by the People's Health Publishing House in 1978. In 1973, I was transferred to the Gansu Provincial Institute of New Medicine, where I taught courses on traditional Chinese medicine at the provincial Western medicine class, covering subjects such as "Shanghan Lun," "Jin Gui Yao Lue," "Pharmacopoeia of Traditional Chinese Medicine," and "History of Chinese Medicine." Through teaching and learning, my foundation in traditional Chinese medicine strengthened considerably, reaching a new level.

I came to believe that "prescriptions" are the core of traditional Chinese medical scholarship—they connect theory above with medicine below, serving as the frontline of clinical practice. No wonder there is a saying: "Memorize the soup base and you can go anywhere." I focused my research on prescriptions, culminating in the publication of "New Compilation of Pharmacopoeia of Traditional Chinese Medicine" in 1980. This book integrates theory, method, prescription, and medicine into one, making bold attempts to standardize diagnosis based on syndrome differentiation in traditional Chinese medicine.

Through teaching, writing, and clinical practice, I realized that traditional Chinese prescriptions are effective, but they are based solely on "syndrome" rather than the modern medical concept of "disease." If we could integrate "syndrome" with "disease," that would be the minimum requirement—and the top priority—for integrating traditional Chinese and Western medicine. To achieve this goal, I proposed the sixteen-character principle of "Western diagnosis, Chinese syndrome differentiation, primarily Chinese medicine, supplemented by Western medicine" in the 1980s. I subsequently wrote more than ten papers elaborating on this principle from different angles and was invited to deliver lectures on it in over ten cities across the country.

The Gansu Provincial Health Department also commissioned the Provincial Society for the Integration of Traditional Chinese and Western Medicine to organize four training sessions for attending physicians at traditional Chinese hospitals across the province, focusing on the theory and clinical application of the "sixteen-character principle." Participants hailed this principle as the "sixteen-character guideline" for developing modern traditional Chinese medicine. Over the past decade and more, guided by this principle, I have published over seventy academic papers and authored twelve books on the integration of traditional Chinese and Western medicine, including "Diagnosis and Treatment of Hepatitis B," "New Compilation of Warm Disease Theory," "Selected Cases of Pei Shen's Medical Practice," "Pharmacological and Clinical Applications of Rhubarb," and "Integrated Treatment of Common Diseases Using Traditional Chinese and Western Medicine," along with the previously mentioned two works, totaling twelve published titles. Recognizing the need to summarize the entire field of internal medicine in terms of integrated treatment using the "sixteen-character guideline," in February 1992 I organized twenty-one renowned experts in the integration of traditional Chinese and Western medicine from the five northwestern provinces of China to compile a monumental work on integrated internal medicine: "Practical Internal Medicine through the Integration of Traditional Chinese and Western Medicine."

This book was officially published in 1995, spanning 1.5 million characters and bound in a large hardcover volume. In 1996, it won the Third International Gold Award for Outstanding Contribution to Traditional Medicine, and I was invited to the United States to receive the award and give lectures. On February 23, 1998, coinciding with my 60th birthday, my workplace—the Gansu Provincial Academy of Medical Sciences—held a grand symposium celebrating the 40th anniversary of my contributions to the integration of traditional Chinese and Western medicine, attended by numerous provincial officials and colleagues.

Although I am now in my sixties, I still aspire to continue shining and contributing to the cause of integrating traditional Chinese and Western medicine, embodying the spirit of "an old ox knows its days are short, yet it still strides forward without being urged on."

(Expert Collection of the Chinese Society for the Integration of Traditional Chinese and Western Medicine, 1998)

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Middle Section

This section comprises 25 articles that the author published in domestic journals across China between 1980 and 2000, focusing on clinical research and reports, with particular emphasis on liver diseases, blood disorders, kidney diseases, and pancreatic ailments.