5. Aplastic Anemia

In recent years, Traditional Chinese Medicine's understanding of this disease has increasingly leaned toward "deficiency at the root, excess at the manifestation." Since the disease is caused by impaired hematopoietic function of the red bone marrow, and given that "the Kidney generates bone marrow," Kidney deficiency should be related to this disease. Traditional Chinese Medicine also has the theory that "the middle jiao transforms qi into juice, which becomes blood," linking this disease to Spleen deficiency as well. The Shuguang Hospital of the Shanghai College of Traditional Chinese Medicine treated 82 cases of chronic aplastic anemia using the method of strengthening the Spleen and tonifying the Kidney, achieving an effectiveness rate of 91.46%, significantly higher than the control group treated with other traditional Chinese medicines or combined Western and Chinese therapies^⑫^. Pei Shen believes that "the Kidney governs bone marrow, while the Spleen governs the extremities," emphasizing that tonifying the Kidney can improve bone marrow hematopoiesis, and strengthening the Spleen can enhance peripheral blood counts. Therefore, he proposed that tonifying the Kidney and strengthening the Spleen is the main principle for treating aplastic anemia^⑬^. I also follow the method of strengthening the Spleen and tonifying the Kidney when treating aplastic anemia. In June 1975, I treated a patient named Sun, male, 20 years old, with pale complexion, fatigue, loss of appetite, five-heart heat, bone-steaming heat, night sweats, dizziness, palpitations, poor sleep, frequent dreams, and scattered petechiae on the gums and mucous membranes throughout the body. Hemoglobin was 5 g, red blood cells 1.7 million/mm³, platelets 29,000, white blood cells 1,700/mm³. Bone marrow smear showed a significant reduction in all three cell lines, with a relative increase in lymphocytes. Applying the method of strengthening the Spleen and tonifying the Kidney, I prescribed a formula including Codonopsis, Atractylodes, Astragalus, Poria, Rehmannia, Cornus fruit, Moutan bark, Cinnamon, Polygonatum, Anemarrhena, Phellodendron, Aconite, and Chicken Blood Vine, adjusted as needed. After taking more than 100 doses, all symptoms subsided, hemoglobin rose to 10 g, white blood cells reached 4,100/mm³, platelets climbed to 68,000/mm³, and the bone marrow smear improved markedly, allowing the patient to return to work^⑭^.

III. Discussion

Through long-term clinical practice, Traditional Chinese Medicine has come to understand that "the Kidney governs innate qi, while the Spleen governs acquired qi," and has adopted "strengthening the Spleen and tonifying the Kidney" as a fundamental method for reinforcing the body's foundation in clinical practice, enabling numerous diseases to achieve recovery. This is by no means accidental. Recent experimental studies have demonstrated that the Spleen and Kidney in Traditional Chinese Medicine have the following significances: ① immune system, ② endocrine system, ③ metabolic system, ④ autonomic nervous system, ⑤ gastrointestinal and pancreatic endocrine system. "Strengthening the Spleen and tonifying the Kidney" indeed has the effect of improving the functions of these systems. In addition to primary diseases affecting these systems, all chronic illnesses can, to varying degrees, cause disturbances in these areas. Therefore, the scope of application for the method of strengthening the Spleen and tonifying the Kidney is extremely broad. Beyond the chronic bronchitis, chronic nephritis, tumors, leukemia, and aplastic anemia mentioned in this article, the method can also treat chronic hepatitis, chronic prostatitis, chronic arthritis, various collagen diseases, diabetes, diabetes insipidus, chronic colitis, and many other conditions. The widespread use of this treatment fully demonstrates the superiority of Traditional Chinese Medicine's principle of "treating different diseases with the same method," and experimental research on this therapy eloquently reveals the scientific basis of Traditional Chinese Medicine's "treating different diseases with the same method," thereby presenting the method of strengthening the Spleen and tonifying the Kidney to the public in a new light.

Notes: ① Jingyue Quanshu (Volume 1). Shanghai Health Publishing House, 1958, p. 314 ② Jingyue Quanshu (Volume 1). Shanghai Health Publishing House, 1958, p. 397 ③ Li Chunyue. Shanghai Journal of Traditional Chinese Medicine. 1965, (12): 17 ④ Department of Internal Medicine, 285th Hospital of the People's Liberation Army. Tianjin Medical Journal. 1975, (4): 192 ⑤ Respiratory Group, Department of Internal Medicine, Xiyuan Hospital. Reference for Research on Traditional Chinese Medicine. 1977, (1): 2 ⑥ Prevention and Treatment Group for Senile Chronic Bronchitis, Shaanxi Provincial Institute of Traditional Chinese Medicine. Shaanxi New Medicine. 1972, (1): 6 ⑦ Longhua Hospital affiliated with Shanghai College of Traditional Chinese Medicine. Journal of Traditional Chinese Medicine. 1974, (11): 14 ⑧ Qin Bowei et al. Chinese Journal of Internal Medicine. 1960, (8): 5 ⑨ Yan Dexin et al. Shanghai Journal of Traditional Chinese Medicine. 1963, (7): 13 ⑩ Gu Zaishi et al. Shanghai Journal of Traditional Chinese Medicine. 1965, (9): 21 Zhang Zhengxue. Shaanxi New Medicine. 1979, (9): 4 Shanghai College of Traditional Chinese Medicine, Shuguang Hospital (Shanghai Journal of Traditional Chinese Medicine). 1981, (2): 13 Zhang Zhengxue. Zhejiang Journal of Traditional Chinese Medicine. 1983, (3): 123 Shan Xueguoli et al. (Compilation of Materials on Integrated Western and Chinese Medicine). 1978, (2): 39 (Gansu Medicine, 1983, No. 3)

How to Formulate Prescriptions in Clinical Practice

Pei Zhengxue

Formulating prescriptions in clinical practice is a crucial step in treating diseases with Traditional Chinese Medicine, and the quality of the prescription directly affects the therapeutic outcome. How should one formulate prescriptions in clinical practice? This is a question that every practitioner of Traditional Chinese Medicine takes very seriously. Traditional Chinese Medicine has extremely rich discussions on this topic. In recent years, with the vigorous development of integrated Western and Chinese medicine, many colleagues who study Western medicine and practice Traditional Chinese Medicine have boldly attempted to combine disease and syndrome differentiation when formulating prescriptions, injecting new content into this traditional subject of clinical prescription formulation. Out of modesty, I would like to share my humble personal experience and offer some thoughts on this issue.

I. Unity of Principle, Method, Prescription, and Medication

An effective prescription should embody the unity of principle, method, prescription, and medication. As the ancients said: "Formulate principles based on the disease mechanism, formulate prescriptions based on the method, and prescribe medications based on the prescription." It is clear that only through the unity of principle, method, prescription, and medication can we adhere to the principle of syndrome differentiation and treatment, leading to good therapeutic outcomes in clinical practice. So what is the principle? The principle refers to the disease mechanism—the essential logic behind the causes, location, and changes of a disease throughout its course. This disease mechanism is not the result of experimental research, but rather the product of logical reasoning and syndrome differentiation based on clinical symptoms. For example, suppose a patient comes for consultation. Through questioning, it is found that the patient indeed presents with symptoms such as pallor of the face, loss of appetite, fatigue, and shortness of breath. Then, using logical reasoning, the symptoms are analyzed to determine the disease mechanism: the Spleen governs color, so Spleen deficiency leads to pallor of the face; the Spleen governs the transformation of food and water, and also governs thinking, so Spleen deficiency leads to loss of appetite; the Spleen governs muscles, so Spleen deficiency leads to fatigue; and the Spleen governs central qi, so Spleen deficiency leads to shortness of breath and lack of energy. The above analysis shows that the patient's main disease mechanism is "Spleen qi deficiency," and establishing this point becomes the prerequisite for determining the treatment method. According to the principle of "supplementing deficiency" and "benefiting damage," the treatment for this patient should be strengthening the Spleen and benefiting qi. When formulating prescriptions in clinical practice, determining the treatment method, just like establishing the disease mechanism, is an extremely important step. Some say, "the treatment method is determined by the disease mechanism, and the prescription is determined by the treatment method." Within the unified system of principle, method, prescription, and medication, the treatment method plays a bridging role between the two. Therefore, prescription classifications have traditionally been based on the treatment method, such as exterior-releasing formulas, interior-purging formulas, and heat-clearing formulas. If the treatment method is strengthening the Spleen and benefiting qi, the choice of prescription will generally be limited to formulas like Si Jun Zi Tang, Liu Jun Zi Tang, and Bu Zhong Yi Qi Tang. The formulation of the prescription is based on the principle of deriving the method from the principle and the prescription from the method; at the same time, it must also be adjusted according to the patient's specific characteristics. To meet these two requirements, one must be thoroughly familiar with the principles of prescription composition. The ancients believed that a compound prescription should contain four components:君, 臣, 佐, and 使. The君药 is the main drug for treating the primary symptom; the臣药 assists the君药 to enhance its efficacy; the佐药 treats secondary symptoms and sometimes alleviates the side effects of the 主药; and the使药 is often used to guide the action of the prescription or harmonize the ingredients. Among these four components, the君药 and臣药 usually represent the core of the principle and method, embodying the treatment of the root cause in the prescription; the use of 佐药 is more flexible, often adjusted according to individual patient differences, representing the treatment of the manifestation in the prescription. The "Shanghan Lun" records the formula Gui Zhi Tang, which, due to its infinite variations and proven efficacy, is revered by physicians as the "king of all formulas." The main indication of this formula is wind-cold exterior deficiency and disharmony of Ying and Wei qi. Gui Zhi disperses wind and cold while harmonizing Wei qi, making it the君药; Shaoyao gathers yin and regulates Ying qi to prevent Gui Zhi from warming and dispersing yin while regulating Ying qi, making it the臣药. Together, these two drugs disperse wind and cold and harmonize Ying and Wei qi, demonstrating the unity of principle, method, prescription, and medication. Under the condition that the main indication remains unchanged, if the patient also presents with stiffness in the neck and shoulders, add Ge Gen; if the pulse is rapid and there is chest tightness, remove Shaoyao; if the limbs are slightly stiff and difficult to bend and stretch, add Fu Zi; if there is asthma, add Hou Pu and Xing Ren; if there is palpitation and restlessness in the heart, add Yi Tang and Bai Shao. Adding Ge Gen, Fu Zi, Hou Pu, Xing Ren, Yi Tang, and other ingredients to Gui Zhi Tang aims to make the prescription adapt to the specific needs of the condition. These drugs are often classified as佐and使in the prescription, serving to treat the manifestation and providing an important opportunity for physicians to adjust the prescription according to the patient's condition.

II. Flexibility in Combining Disease and Syndrome

The essence of syndrome differentiation and treatment in Traditional Chinese Medicine is the unity of principle, method, prescription, and medication, which can only be reflected in clinical practice through prescriptions, as mentioned earlier. Many practitioners of integrated Western and Chinese medicine have boldly innovated when formulating prescriptions, adopting the perspective of combining disease and syndrome differentiation, which has greatly enhanced the therapeutic effect. Thus, within the traditional theory of prescriptions in Traditional Chinese Medicine, a new topic has been added: "combining disease and syndrome." "Disease" is a concept from Western medicine, the product of syndrome differentiation and reasoning, a comprehensive concept that includes a set of symptoms and the hypotheses about their causes and mechanisms derived through logical reasoning. For a prescription to reflect the perspective of integrating Western and Chinese medicine, it must first possess the characteristic of combining disease and syndrome. The strength of Traditional Chinese Medicine's syndrome differentiation lies in its emphasis on the unity of the body and systemic responses; the strength of Western medicine's disease differentiation lies in its focus on the pathogenicity of the disease and local reactions. The combination of the two helps to comprehensively grasp the condition and improve therapeutic efficacy. The Coronary Heart Disease Collaborative Group in Beijing formulated the famous Coronary Heart II formula, fully reflecting the characteristic of combining disease and syndrome. Syndrome differentiation considers coronary heart disease to fall under the category of chest obstruction—a syndrome of stagnation of yang qi in the chest—and recommends dispelling stagnation and promoting yang qi. The "Jin Kui" uses Gualou Xiebai Baijiu Tang to treat this condition, which has certain therapeutic effects. However, from the perspective of disease differentiation, this disease is coronary artery atherosclerosis, leading to thickening of the vessel walls and narrowing of the lumen, resulting in insufficient blood supply to the coronary arteries. Such pathological changes should logically fall under the category of blood stasis in Traditional Chinese Medicine, and the Coronary Heart II formula (red peony, chuanxiong, safflower, agarwood, dan shen) is a collection of drugs that activate blood circulation and dissolve blood stasis, achieving good clinical results. If used in conjunction with the traditional Gualou Xiebai Baijiu Tang, the therapeutic effect will be even more satisfactory. The Yishen Tang formulated by the Shaanxi Provincial Institute of Traditional Chinese Medicine combines clearing heat and detoxification with activating blood circulation and dissolving blood stasis (dang gui, red peony, chuanxiong, peach kernel, safflower, motherwort, honeysuckle, lian qiao, dandelion, ban lan gen), and has also achieved excellent results in treating chronic nephritis. The rationale behind this formula is likewise rooted in the combination of disease and syndrome. Western medicine believes that the pathological changes in chronic nephritis are based on the proliferation of endothelial cells and basement membrane cells in the renal glomeruli, and any such proliferation should logically fall under the category of blood stasis in Traditional Chinese Medicine. Therefore, the Yishen Tang selects a large number of drugs that activate blood circulation and dissolve blood stasis; at the same time, since infection is the main factor aggravating chronic nephritis, a large number of drugs that clear heat and detoxify, such as honeysuckle and lian qiao, are added to the blood-activating drugs. The creation of the Coronary Heart II formula and the Yishen Tang are both the result of applying the perspective of combining disease and syndrome to clinical prescription formulation. Both formulas have indeed shown therapeutic effects in clinical practice and have been widely recognized by the medical community in China, which eloquently demonstrates that adopting the perspective of combining disease and syndrome when formulating prescriptions is the correct way to improve therapeutic efficacy. Adopting the perspective of combining disease and syndrome is currently a prerequisite for clinical prescription formulation in integrated Western and Chinese medicine. There is a patient with prostatitis who presents with difficulty urinating, lower back pain, and urgency in the lower abdomen; accompanied by dizziness, blurred vision, tinnitus, aversion to cold, and spontaneous sweating. From the perspective of syndrome differentiation,

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From a syndrome perspective, this is a patient with kidney yang deficiency and impaired yang to transform qi; therefore, Jisheng Shenqi Wan should be the principal formula. From a disease differentiation standpoint, chronic prostatitis often manifests as prostate hyperplasia and enlargement, leading to urinary tract compression as the primary pathological change. In such cases, it is also appropriate to add herbs that invigorate blood circulation, resolve stasis, soften hard masses, and disperse nodules, such as amber, Wang Buliu Xing, Dajiangjun, and Liangtoujian. A formula composed in this manner will undoubtedly be far more effective than treatment based solely on syndrome differentiation. When treating aplastic anemia, if one only applies the general principles of syndrome differentiation—addressing symptoms like pallor, fatigue, palpitations, sweating, and epistaxis—one can at best diagnose "heart-spleen deficiency with qi failing to control blood" and prescribe formulas such as Guipi Tang. Clinically, this approach yields only modest results. To further improve the efficacy of treating aplastic anemia, it is essential to adopt a combined approach of disease and syndrome differentiation when modifying the original prescription. For example, for patients with low white blood cell counts, add Po Gu Zi, Di Gu Pi, and Ji Xue Teng; for those with low platelet counts, add Yu Zhu, Huang Jing, Sheng Di, and Peanut Skin; and for those with low red blood cell counts, add Shou Wu, Dang Shen, Huang Qi, and Bai Zhu, among others.

Additionally, the characteristics of bone marrow morphology and peripheral blood morphology are also key bases for formulating prescriptions for this condition. For markedly abnormal bone marrow morphology, the treatment should include 30–40 grams of Shan Yu Rou; for abnormalities in peripheral blood morphology, 15–30 grams of Yuan Rou should be added. When treating non-jaundiced infectious hepatitis, from a syndrome differentiation standpoint, some cases are due to spleen-stomach qi deficiency, others to liver qi stagnation, some to disharmony between liver and stomach, some to liver-kidney yin deficiency, and others to excessive liver-gallbladder fire. Each type has corresponding formulas to choose from: for spleen-stomach qi deficiency, use Buzhong Yiqi Tang; for liver qi stagnation, use Chaihu Shugan San; for liver-stomach disharmony, use Xiaoyao San; for liver-kidney yin deficiency, use Yiguan Jian; and for excessive liver-gallbladder fire, use Longdan Xiegan Tang. From a disease differentiation perspective, if liver function impairment is mainly characterized by elevated transaminases, add Gong Ying, Bai Jiang, Chui Pen Cao, and Ban Lan Gen, or alternatively prepare Wumei Zi San for oral administration; if the main issue is decreased plasma protein with inverted albumin/globulin ratio, then add Dang Shen, Bai Zhu, and Huang Qi. Regardless of the type of hepatitis, if persistent liver pain is present, add Ren Hu and Jiang Huang to the formula.

When treating chronic nephritis, from a syndrome differentiation standpoint, some cases are due to yang deficiency with water overflow, others to spleen-stomach qi deficiency, and still others to internal wind from the liver. Each type has its corresponding principal formula: for yang deficiency with water overflow, use Jisheng Shenqi class formulas or Zhenwu Tang; for spleen-stomach qi deficiency, use Buzhong Yiqi Tang or Liu Jun Zi Tang; for internal wind from the liver, use Qiju Dihuang Wan or Jianling Tang. From a disease differentiation perspective, if urine tests show high protein levels, add Su Geng, Chan Yi, Yi Mu Cao, Qian Shi, and Jin Ying Zi; if there are many red blood cells, add Bai Mao Gen, Da Ji, and Xian He Cao; if there are many white blood cells, add Shan Zhi, Mu Tong, and Hua Shi. The above examples illustrate that, in clinical prescription formulation, adopting a combined approach of disease and syndrome differentiation can better tailor the formula to the specific condition, thereby improving clinical efficacy. This approach is also an important component of integrating traditional Chinese medicine with Western medicine in clinical practice.

III. Incorporating Folk Prescriptions into Clinical Formulations

Traditional Chinese medicine is the result of thousands of years of experience accumulated through the people’s struggle against disease. Although it has evolved into a unique theoretical system, folk single-prescription remedies still serve as a vital source of material that continuously enriches and enhances it. As the saying goes, “A single prescription can be more effective than even a renowned physician,” highlighting the remarkable efficacy of certain folk remedies. We should not adhere to the so-called “classical prescription school” that insists on treating every word in the Shanghan Lun as an immutable golden rule. Instead, we advocate for a balanced approach in clinical prescription formulation that emphasizes the unity of theory, method, formula, and medicine, while simultaneously integrating disease differentiation with syndrome differentiation. At the same time, we should also be open to incorporating folk single-prescription remedies. Only in this way can we fully enhance the clinical efficacy of prescriptions. For instance, Ye Tian Shi and Wu Ju Tong frequently used soybean rolls to clear heat; Zhang Xi Chun often employed chicken gizzard membrane and moneywort to treat dysuria; and Huang Wen Dong utilized tea tree roots to calm the mind. These experiences were all derived from folk single-prescription remedies, which have become a distinctive feature of the medicinal practices of earlier generations because they effectively enhance the clinical efficacy of traditional Chinese medicine prescriptions. Therefore, we should extensively collect effective folk single-prescription remedies and flexibly incorporate one or two into clinical formulations based on actual circumstances, often yielding excellent clinical outcomes. For example, in pneumonia treatment formulas, adding fish mint and Andrographis paniculata; in bacillary dysentery treatment formulas, appropriately adding purslane and sophora root; in heart disease treatment formulas, appropriately adding oleander leaves and tea tree roots; in nephritis treatment formulas, appropriately adding plantain and corn silk; and in sore throat treatment formulas, appropriately adding cactus and lantern grass—such additions often lead to improved clinical efficacy.

IV. Gradual Refinement Through Practice

Although there is a unified principle of theory, method, formula, and medicine, traditional Chinese medicine has not completely eliminated the influence of empirical medicine. Therefore, when formulating clinical prescriptions, we must not blindly pursue this unity while ignoring the individual characteristics of each patient. For a particular patient, if this unified approach proves ineffective in clinical practice, we should further investigate the condition and adjust the treatment accordingly. For example, consider a patient with non-jaundiced infectious hepatitis who presents with fatigue, loss of appetite, spontaneous sweating, a deep and fine pulse, and a pale tongue—classic signs of spleen-stomach qi deficiency. Despite multiple attempts to treat with Buzhong Yiqi Tang and similar formulas, the treatment remains ineffective. Further examination reveals that the patient’s liver function shows persistently elevated transaminase levels above 500 U/L. In such cases, treatment should be guided by practical experience and flexible adaptation, rather than rigidly adhering to the unity of formula and syndrome. It may be appropriate to directly administer large doses of heat-clearing and fire-draining herbs such as Ban Lan Gen, Bai Jiang, and Gong Ying, in order to achieve the goal of lowering enzyme levels. Another example is a patient with hypertension who exhibits signs of yin deficiency and yang excess. However, long-term use of formulas that nourish yin, subdue yang, calm the liver, and extinguish wind—such as Qiju Dihuang and Zhen Gan Xi Feng—has proven ineffective. In such cases, administering a few doses of warming yang herbs like Fuzi and You Gui may produce noticeable effects. Similarly, for a patient with chronic leukemia who presents with fatigue, pallor, excessive sweating, lower back pain, and tinnitus—classic signs of both spleen and kidney deficiency—the white blood cell count remains consistently above tens of thousands. Practical experience has shown that strengthening the spleen and kidneys alone cannot reduce the white blood cell count. To achieve this goal, it is necessary to use herbs that destroy and eliminate white blood cells, such as San Leng, E Zhu, Long Dan, and Zi Cao.

V. Conclusion

In summary, clinical prescription formulation is a crucial component of traditional Chinese medicine practice. On the one hand, we must pay attention to the essence of TCM’s syndrome differentiation and treatment—the unity of theory, method, formula, and medicine—which provides a systematic framework for clinical prescription formulation. On the other hand, we must also consider the integration of disease and syndrome differentiation, allowing for flexible adaptation in practice—this aspect adds flexibility to clinical prescription formulation. The former addresses the general nature of diseases, while the latter focuses on the specific characteristics of individual conditions. Both aspects are equally important for enhancing the efficacy of prescriptions, and neither should be prioritized over the other.

(Chinese Journal of Integrated Traditional and Western Medicine, February 1981)

A Brief Discussion on the Format of Integrated Traditional and Western Medicine Medical Records

Pei Zhengxue

Western medical record-keeping, from patient history and physical examination to diagnosis and treatment, has developed into a complete format that aligns well with Western medical characteristics. Traditional Chinese medical records, though varying in complexity and style from person to person throughout history, have always been based on observation, auscultation, inquiry, and palpation to reflect the unity of theory, method, formula, and medicine. With the rise of integrated traditional and western medicine, a new question has emerged: how should the format of integrated medical records be designed? Many colleagues have already made attempts in this regard. In my view, this issue requires further discussion to achieve an ideal and refined format, because the format of integrated medical records is closely linked to the development of integrated traditional and western medicine. Among the many factors that promote the development of integrated medicine, this is a particularly important one.

I. The Record Format Must Align with the Characteristics of Each Medical System

The format of integrated medical records must meet the needs of integrated medicine, which means we must start by considering the unique characteristics of both systems. Traditional Chinese medicine is based on “syndrome differentiation,” emphasizing the holistic view and the body’s responsiveness, aiming to explore the essence of disease through logical reasoning. Western medicine, on the other hand, is based on “disease differentiation,” focusing on localized issues and the pathogenicity of the causative agent, seeking to uncover the essence of disease through experimental research. The strength of TCM lies in its ability to understand disease from a macroscopic perspective, while the strength of Western medicine lies in its ability to understand disease from a microscopic perspective. These two systems each have their own strengths. As an emerging discipline, the most vital aspect of integrated traditional and western medicine is its ability to combine macroscopic and microscopic perspectives, holistic and localized views, and the body’s responsiveness with the pathogenicity of the causative agent. Therefore, the establishment of an integrated medical record format must be premised on adapting to these characteristics; otherwise, it will fail to meet the requirements of the development of integrated medicine.

II. The Format of Integrated Medical Records Must Meet the Needs of Clinical Practice in Integrated Medicine

I have been engaged in integrated clinical practice for over 20 years, during which I formulated the diagnostic and therapeutic principle of “Western diagnosis, TCM syndrome differentiation, TCM-based treatment, with Western medicine as a supplement.” This principle has been adopted for a long time in our hospital’s department of integrated traditional and western medicine and has been elevated in practice to become the guiding policy for clinical diagnosis and treatment in our department, commonly referred to by colleagues as the “Sixteen-Character Guiding Principle for Integrated Clinical Practice.” The meaning of these sixteen characters is as follows: ① Use modern medical testing methods to clarify the condition and determine the Western diagnosis. ② Conduct syndrome differentiation and treatment; since there is a clear Western diagnosis, the accuracy of syndrome differentiation and treatment is enhanced. ③ Treatment is primarily based on TCM formulas and medicines; unless there are special circumstances, Western medicines are generally not used. For example, in the case of “epigastric pain,” first determine through Western diagnosis which organ is affected, strictly distinguishing between liver, gallbladder, spleen, stomach, and duodenum diseases. Even within the stomach, clearly differentiate between gastric cancer, gastric ulcer, gastric perforation, and atrophic gastritis. Based on this foundation, conducting syndrome differentiation and treatment undoubtedly improves the accuracy of syndrome differentiation and treatment, while also increasing the accuracy of prognosis. More importantly, it promotes the development of traditional TCM syndrome differentiation and treatment methods, helps shift traditional macroscopic syndrome differentiation toward a microscopic approach, and facilitates the integration of traditional TCM with modern multidisciplinary technologies. I began studying TCM 25 years ago with great enthusiasm and sometimes liked to treat certain outpatients entirely from a TCM perspective. Once, I mistook a case of exudative pleurisy for Shaoyang syndrome and treated it with modified Xiao Chai Hu Tang, delaying treatment for a full month. Later, upon realizing my mistake, I performed a local percussion examination, confirmed the diagnosis of pleurisy, drained fluid via thoracentesis, and combined it with penicillin and prednisone, achieving rapid recovery. The treatment process of this patient was deeply instructive: in clinical practice, Shaoyang syndrome is not only seen in recurrent, difficult-to-cure colds, but also in liver and gallbladder diseases, pleural diseases, cardiopulmonary diseases, collagen diseases, and other conditions at certain stages of onset. If there is a clear Western diagnosis before syndrome differentiation and treatment, it can prevent under-treatment of serious illnesses and over-treatment of minor ones, making it easier to fully leverage the advantages of syndrome differentiation and treatment. After clarifying the disease from a microscopic perspective through Western diagnosis, and then forming a macroscopic understanding of the disease through TCM syndrome differentiation, the former establishes the concept of disease, while the latter forms the concept of syndrome. The combination of the two reflects both the integration of disease and syndrome and the integration of macroscopic and microscopic perspectives. Today, with highly developed industry, the medical devices used to observe diseases are becoming increasingly sophisticated. Modern medicine leverages this to shift its focus from broad to detailed, resulting in a major leap forward. For thousands of years, TCM has relied on sensory observation to understand disease, using observation, auscultation, inquiry, and palpation to gain insight into illness—this is a hallmark of traditional Chinese medicine, and the medical records of physicians are valuable summaries of clinical experience that should be carefully studied. However, some medical records are overly simplistic. Western medical records, on the other hand, have a rigorous structure and detailed documentation, but the physical examination section covers the entire body from head to toe, leaving no detail overlooked, regardless of whether there is a lesion or not—making them excessively detailed. In the face of the continuous standardization of TCM diagnoses and the development and improvement of numerous modern tools that allow for accurate observation of the internal pathology of diseases, we should integrate “disease” and “syndrome” into one, balancing “macro” and “micro” to meet the needs of the development of integrated medicine.

III. Conclusion

Based on the above considerations, the format of integrated medical records must consist of both a Western diagnosis section and a TCM syndrome differentiation and treatment section, neither of which can be omitted. The former should include the patient’s chief complaint, medical history, and positive findings from physical examination, laboratory tests, and functional department examinations. The latter should include records of TCM’s observation, auscultation, inquiry, and palpation, as well as discussions on theory, method, formula, and medicine. Following the Western diagnosis, a list of TCM prescriptions with modifications should be appended. The principles outlined above can serve as a reference, with each medical institution adopting slightly different formats based on its specific circumstances. Once the format is mature, experts and masters should convene to uniformly design a standardized format and incorporate it into teaching and medical administrative systems.

(Gansu Journal of Traditional Chinese Medicine, January 1989)

Tang Rongchuan’s “Blood Syndrome Theory”

Pei Zhengxue and Mao Xinmin

“Blood Syndrome Theory” is a specialized monograph on blood syndromes, offering many innovative insights into the subject. Its theories, methods, formulas, and medicines are all rigorously presented, and over the years it has consistently been valued by physicians. The book emphasizes the integration of theory and practice, and in some areas even incorporates Western ideas, giving its arguments strong persuasive power. In addition to providing a relatively systematic exposition of blood syndromes, the book also offers precise explanations of basic TCM theories and various internal and gynecological syndromes related to blood syndromes, making it a highly valuable work in the field of modern TCM literature.

I. Historical Context of “Blood Syndrome Theory”

The author, Tang Rongchuan (name: Zong Hai), was born in Peng County, Sichuan Province, in 1862 and passed away in 1918. This was a period following the Opium War, when China was rapidly descending into a colonial and semi-colonial society. At that time, medical science had become an important tool for imperialist cultural aggression against China, as Chairman Mao once said: “One aspect of imperialism’s effort to numb the Chinese people’s spirit is its cultural aggression policy. This includes missionary work, establishing hospitals, schools, newspapers, and attracting overseas students—all part of this aggressive policy.” (From “The Chinese Revolution and the Communist Party of China”) Facing this cultural aggression from imperialism, a trend emerged in China’s medical community of blindly admiring foreign cultures and rejecting TCM; meanwhile, within the TCM community itself, a group of conservative retrograde elements appeared, viewing the works of Zhang Zhongjing as “golden rules that must never be altered” and opposing any attempt to combine traditional Chinese medicine with modern medicine. Tang Rongchuan lived in such an era, steadfastly researching TCM, learning from the past without being bound by it, and drawing on Western medicine without abandoning TCM. He meticulously studied classics such as the “Inner Canon,” “Shanghan Lun,” and “Jinkui Yao Lu,” deeply comprehending their essence and often achieving “cross-understanding” and “grasping the unspoken meaning.” He also placed great emphasis on clinical practice, always striving to derive practical truths from each case and “discover real principles.” Regarding modern medicine, he neither blindly worshipped it nor categorically opposed it, but instead sought to absorb its essence and integrate it with traditional Chinese medicine. He retained the traditional views of TCM while also embracing the spirit of reform and innovation. Although limited by the historical conditions of the time and unable to completely escape metaphysical constraints, his work nevertheless reflected, to a certain extent, the firm desire of the Chinese people to love and develop traditional Chinese medicine.

II. Enrichment and Development of Basic TCM Theories in “Blood Syndrome Theory”

“Blood Syndrome Theory” offers numerous explanations and discussions on basic TCM theories centered around blood syndromes, with many of its arguments having profound significance for enriching and developing traditional Chinese medicine.