4. Loss of yin and loss of yang are the final stages of febrile diseases

"The Plain Questions·On the Harmony of Vital Energy and Heavenly Qi" states: "When yin is balanced and yang is concealed, spirit is well maintained; when yin and yang are separated, vital energy is exhausted." Thus, loss of yin and loss of yang are critical conditions in febrile diseases. For febrile diseases, cold damage often presents with loss of yang as an emergency, while warm diseases often present with loss of yin as a cry for help. In any case, loss of yin and loss of yang are undoubtedly the final stages of febrile disease progression. Clinically, loss of yang manifests as pale complexion, cold extremities, spontaneous cold sweat, and a barely perceptible pulse; loss of yin manifests as high fever, rapid breathing, dry skin, irritability and delirium, with hands and feet still warm. From a modern medical perspective, the former corresponds to shock, collapse, and other forms of circulatory failure; the latter may include respiratory failure and dehydration. Respiratory failure and circulatory failure are inevitable steps on the road to death, signaling that the body's vital centers are about to cease normal functioning—this is quite consistent with the traditional Chinese medicine concepts of loss of yin and loss of yang. If febrile diseases are left untreated or mismanaged, they eventually enter the stages of loss of yin and loss of yang; sometimes loss of yin comes first, followed by loss of yang; sometimes loss of yang comes first, followed by loss of yin. In any case, the two are often causally related, reflecting the principle that "solitary yin cannot arise" and "solitary yang cannot grow."

IV. Conclusion

This article reviews the history of syndrome differentiation for febrile diseases, briefly outlines the basic content of such differentiation, and then presents the author's own insights on the subject. It explores a unified "six-stage differentiation" method for cold damage and warm diseases, hoping to stimulate further discussion and eagerly awaiting feedback and corrections from colleagues.

Notes: ① Wang Andao (Collection of Revisiting Medical Classics), People's Publishing House, 1956, p. 52 ② Shanghai College of Traditional Chinese Medicine, "Lectures on Warm Diseases," Shanghai Science and Technology Press, 1959, p. 11 ③ Jiangsu New Medical College, "Explanations of Warm Disease Studies," Shanghai People's Publishing House, 1973, p. 174 ④ Wu Jutong, "Detailed Discussions on Warm Diseases," People's Publishing House, 1958, p. 56 ⑤ Yan Derun, "Commentary on Shanghan Lun," People's Publishing House, 1956, p. 9 ⑥ Shi Yiren, "Cold Damage and Warm Diseases," Upper People's Publishing House, 1955, p. 28 ⑦ Lu Yuanlei, "Modern Interpretation of Shanghan Lun" (Volume 8), Qianqing Hall, 1953, p. 4 ⑧ Jiangsu New Medical College, "Explanations of Warm Disease Terms," Shanghai People's Publishing House, 1973, p. 161 ⑨ Nanjing College of Traditional Chinese Medicine, "Teaching Materials on Warm Diseases," Jiangsu People's Publishing House, 1959, p. 47 (Gansu "Compilation of Integrated Chinese-Western Medicine Materials," 1979, p. 1)

On Visceral Differentiation

Pei Zhengxue

Visceral differentiation refers to syndrome differentiation and treatment based on the viscera. It is an important component of traditional Chinese medicine's syndrome differentiation and treatment, and serves as the primary diagnostic principle for internal injuries.

I. Formation of the Theory of Visceral Differentiation

The "Inner Canon" created during the Spring and Autumn and Warring States periods provided the basic concepts for the theory of visceral differentiation. For example, "Plain Questions·On the Secret Classic of Spiritual Orchards" introduced the concept of the basic functions of the viscera; "Plain Questions·On the Generation of the Five Organs" outlined the five-color and five-flavor characteristics of visceral diseases, along with their simple pulse and symptom manifestations; "Plain Questions·On Paralysis" discussed the pathological relationships between the viscera and other organs. The "Essential Principles of True Pathogenesis" section of this book summarized the causes and symptoms of visceral diseases in nine concise points, providing an important theoretical basis for the subsequent development of the theory of visceral differentiation. For instance, statements such as "All cases of wind-induced dizziness are attributed to the liver," "All cases of cold-induced contraction are attributed to the kidney," "All cases of qi stagnation are attributed to the lung," and "All cases of dampness and swelling are attributed to the spleen" remain important viewpoints in the theory of visceral differentiation to this day. At the end of the Eastern Han Dynasty, the outstanding clinician Zhang Zhongjing inherited these ideas. While advocating the use of the Six Meridians to treat cold damage, he also emphasized the importance of using visceral differentiation to treat internal injuries, writing "Shanghan Zabing Lun" in six volumes, which advanced visceral differentiation significantly in terms of principles, methods, formulas, and medicines. Later, during the Six Dynasties period, someone claiming to be Hua Tuo wrote "Zhongcang Jing," proposing preliminary rules for diagnosing and treating miscellaneous diseases based on the deficiency and excess of the five viscera and six bowels. Subsequently, Sun Simiao and Qian Zhongyang further supplemented these ideas, forming a theoretical system that generalized various miscellaneous conditions based on the cold, heat, deficiency, and excess of the viscera, serving as the basis for prescribing formulas and medications. By the Jin and Yuan dynasties, Zhang Yuanli, a native of Yishui County in Hebei Province, made the pathogenesis and treatment of visceral syndromes the focus of his lifelong research and achieved significant results. His student Li Dongyuan inherited his teacher's work and placed even greater emphasis on the functions of the spleen and stomach, formulating Buzhong Yiqi Tang, which became a representative formula for warming and tonifying the spleen and stomach in later generations. During the Ming Dynasty, Xue Lizhai, a follower of Li Dongyuan, focused not only on the spleen and stomach but also highlighted the importance of kidney yin and kidney yang. By this point, in the field of visceral differentiation research, two main schools had emerged: the Buzhong School represented by Li Dongyuan's theories, and the Kidney-Tonifying School represented by Xue Lizhai and Zhao Xianke. Their doctrines were mainly centered on warming and tonifying, so they were collectively referred to as the Warming and Tonifying School. Since their academic thoughts originated from Zhang Yuanli (a native of Yishui, Hebei Province), later generations also called this school the Yishui School. The achievements of this school in advancing visceral differentiation, with its innovative ideas and incisive arguments, far surpassed those of their predecessors, ultimately leading to a complete systematization of the content of visceral differentiation.

II. Analysis of the Content of Visceral Differentiation