Western Perspectives on the Clinical Application of Classic Prescriptions

Western Perspectives on the Clinical Application of Classic Prescriptions

Pei Zhengxue

So-called classic prescriptions refer to the formulas found in "Shanghan Lun" and "Jin Gui Yao Lue." Originally, these two books were part of a single work called "Shanghan Zabing Lun," authored by Zhang Zhongjing, a great clinical physician in late Eastern Han China. Zhang experienced three centuries of devastating epidemics sweeping across Asia, accumulating extensive clinical experience in the course of his frequent medical practice. He then wrote "Shanghan Zabing Lun," which soon fell into disrepair due to frequent wars and the scattering of bamboo slips. Later, Wang Shuhe, the Imperial Physician of the Western Jin Dynasty, compiled the sections dealing with exogenous diseases into a separate book titled "Shanghan Lun." More than 500 years later, Wang Zhu, a scholar at the Northern Song Dynasty's Imperial Academy, discovered fragments of "Shanghan Zabing Lun" and reorganized the chapters on treating miscellaneous diseases into a new volume, naming it "Jin Gui Yao Lue." The classic prescriptions recorded in "Shanghan Lun" number 112, while those in "Jin Gui Yao Lue" total 262, excluding any formulas that appear in both books. Altogether, there are approximately 300 classic prescriptions.

Over more than a thousand years of clinical application, successive generations of physicians have highly praised the remarkable efficacy of these classic prescriptions, giving rise to a large number of doctors specializing in treating diseases with classic prescriptions and scholars dedicated to studying them, collectively known as the "classic prescription school." With over forty years of clinical experience, I firmly believe that "classic prescriptions" are indeed a treasure of traditional Chinese medical scholarship—simple in composition yet remarkably effective in clinical practice, and the theories derived from them form the core of traditional Chinese syndrome differentiation and treatment. In today's era of advanced diagnostic technology, how can "classic prescriptions" be integrated with modern science and technology to benefit humanity? Through long-term clinical practice, I have accumulated some experience, which I will share below. Any shortcomings are welcome to be criticized and corrected by my colleagues.

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Pei Zhengxue's Traditional Chinese Medicine—Theory and Clinical Case Studies

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It refers to feverish conditions resulting from external pathogenic factors combined with bacterial infections of the pharynx and upper respiratory tract. Mahuang Tang is the first-choice formula for treating exterior syndromes. Guizhi Tang is the first-choice formula for treating interior syndromes. As for the syndrome of exterior heat (warm disease), "Shanghan Lun" does not provide a specific formula; later, Wu Jutong of the warm disease school created Sangju Yin and Yinqiao San, which proved highly effective and thus supplemented the deficiencies of "Shanghan Lun."

1. Mahuang Tang

Mahuang 10 g　Guizhi 10 g　Xingren 10 g　Gancao 6 g　Shengjiang 6 g　Dazao 6 pieces

Decocted in water and taken orally, usually one dose per day. This formula is highly effective against common colds and influenza, and also shows definite efficacy against various types of rhinitis, including acute and chronic rhinitis as well as sinusitis. If accompanied by throat pain and enlarged tonsils, add Erhua, Lianqiao, Gongying, Baijiang, Shandougen, and Shegan; for chronic rhinitis, add Cang’erzi, Chuanxiong, Baizhi, Xixin, Zhike, Qiangdugu, and Fangfeng. When Mahuang Tang is combined with Shengshigao, it becomes Daqinglong Tang. According to "Shanghan Lun," "For Taiyang Zhongfeng, with floating and tight pulse, fever and chills, body pain, no sweating but restlessness, Daqinglong Tang is the principal formula." This indicates that if Mahuang Tang syndrome is accompanied by restlessness, Daqinglong Tang should be used, as restlessness is a clinical manifestation of exterior cold transforming into internal fire. From a modern medical perspective, this means an infection or exacerbation of infection in the upper respiratory tract. Clinical practice confirms that Daqinglong Tang is indeed an excellent formula for treating acute bronchitis caused by the common cold. If Guizhi is removed from this formula, it becomes the best remedy for acute bronchitis and bronchopneumonia, known as Maxing Ganshi Tang. According to "Shanghan Lun," "After sweating to release the exterior, do not use Guizhi Tang again; if sweating leads to wheezing without high fever, use Mahuang Xingren Gancao Shigao Tang." This suggests that after releasing the exterior through sweating, the patient's high fever seems to subside, but wheezing becomes more pronounced, indicating that the wind-cold has transformed into internal fire. From a modern medical standpoint, this means secondary bronchopneumonia has developed.

This formula has undergone long-term clinical trials, and most physicians have confirmed its remarkable efficacy in treating infections of the bronchi and lungs. In this formula, I added Sangbaipi 10 g, Digupi 10 g, Tinglizi 10 g, Dazao 4 pieces, Huangqin 20 g, and Yuxingcao 30 g, which can help treat pneumonia in children, sparing most young patients the need for intravenous infusions and injections—a particularly convenient and cost-effective option for children, especially in cases such as lobar pneumonia, viral pneumonia, emphysema complicated by infection, and heart failure complicated by lung infection. According to "Shanghan Lun," "If Shanghan exterior syndrome remains unresolved, with water qi in the lower abdomen, dry vomiting, fever and cough, or thirst, diarrhea, choking, difficulty urinating, distension of the lower abdomen, or wheezing, Xiaoqinglong Tang is the principal formula." Xiaoqinglong Tang is Mahuang minus Xingren, plus Ganjiang, Xixin, Wuweizi, Banxia, and Baishao, making it the principal formula for Mahuang Tang syndrome when it transforms from yin to cold, resulting in water qi in the lower abdomen and symptoms such as cough, wheezing, diarrhea, and choking.

From a modern medical perspective, common colds accompanied by asthma, diarrhea, and hiccups are indications for this formula. In clinical practice, I often find that Ganjiang, Xixin, Wuweizi, and Banxia in this formula have obvious effects on relaxing the trachea, smoothing the gastrointestinal muscles, and raising blood pressure, which can be explained as "suppressing parasympathetic nervous system tension." Therefore, Xiaoqinglong Tang can be used to prevent seasickness and motion sickness, as well as to treat diarrhea, hiccups, stomach pain, difficulty urinating, and distension of the lower abdomen.

2. Guizhi Tang

Guizhi 10 g　Baishao 10 g　Gancao 6 g　Shengjiang 6 g　Dazao 4 pieces

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Decocted in water and taken orally, usually one dose per day. This formula is effective for mild cases of the common cold and for post-cold sequelae, with its main function being the treatment of residual symptoms and complications after fever. Hence, previous generations said, "Guizhi Tang harmonizes the Ying and Wei energies externally and calms the internal organs internally." According to "Shanghan Lun," "For Taiyang Zhongfeng, with Yang floating and Yin weak, Yang floating means spontaneous heat, Yin weak means spontaneous sweat, accompanied by shivering, chilly winds, hot flashes, and nasal congestion with dry vomiting, Guizhi Tang is the principal formula." This indicates that the main indication for Guizhi Tang is Taiyang Zhongfeng—that is, headache, fever, chills, chilly winds, sweating, floating and slow pulse, and so on. The descriptions of Yang floating and Yin weak, shivering, chilly winds, and hot flashes are merely further elaborations and descriptions of pulse and syndrome.

Nasal congestion is a respiratory symptom, while dry vomiting is a digestive symptom, indicating that if there are mild respiratory symptoms or mild upper digestive symptoms during an exogenous illness, Guizhi Tang is also indicated. I believe the value of Guizhi Tang lies in its ability to harmonize the Ying and Wei energies. In traditional Chinese medicine, Ying and Wei encompass the autonomic nervous system in modern medicine, and the indications for Guizhi Tang are largely limited to conditions related to this aspect. According to "Shanghan Lun," "For Taiyang disease, if qi rises upward after treatment, Guizhi Tang can be used; otherwise, it should not be used." Here, "qi rising upward" refers to ascending qi, specifically the reversal of stomach qi or lung qi. The clinical manifestations of the former include hiccups, vomiting, and nausea, while those of the latter include coughing and wheezing. From a modern medical perspective, both are manifestations of increased parasympathetic nervous system activity, indicating dysfunction of the autonomic nervous system.

According to "Shanghan Lun," "For Taiyang disease, if the neck and back are stiff and sweaty, with cold winds blowing, Guizhi Jia Ge Gen Tang is the principal formula." "For asthmatics, Guizhi Tang plus Houpu and Xingzi is better." "For Taiyang disease, if the pulse is rapid and the chest is full after treatment, Guizhi Qu Shaoyao Tang is the principal formula; if there is slight chills, Guizhi Qu Shaoyao plus Fuzi Tang is the principal formula." "For Shanghan two or three days, if there is palpitations and restlessness in the heart, Xiao Jianzhong Tang is the principal formula." The main symptoms described in these passages—such as sweating and cold winds, stiffness in the neck and back, sweating, continuous leakage, feeling cold, difficulty urinating, slight stiffness in the limbs, difficulty bending and stretching, rapid pulse and full chest, slight chills, palpitations and restlessness in the heart—are all closely related to autonomic nervous system dysfunction after fever. Some say that during fever, sympathetic nervous system activity increases; after fever, autonomic nervous system dysfunction occurs, and most of these symptoms fall into this category.

I deeply understand that the subtlety of using Guizhi Jia Ge Gen Tang, Guizhi Jia Fuzi Tang, Guizhi Qu Shaoyao Tang, and Guizhi Qu Shaoyao plus Fuzi Tang lies precisely in addressing these post-fever symptoms. This fully demonstrates the "external harmony of Ying and Wei" effect of Guizhi Tang, which is exactly the weak link in modern medicine. The advantage of traditional Chinese medicine in treating colds and post-fever sequelae lies precisely in this aspect.

Beyond its "external harmony of Ying and Wei," what truly deserves attention about Guizhi Tang is its outstanding "internal calming of the organs." I have many thoughts on Guizhi Tang's "internal calming of the organs," mainly in the following three aspects: