4　Passion， Inspiration and Critical Thinking in TCM

Question： It was said that as an apprentice of your uncle you got a good understanding ofmedicine by learning and thinking，is that true？

Answer： In 1955，at the age of 17，I was appointed to be a physician in TCM department of county hospital by Heath Bureau ofWuyuan County and also got a position in Association of Medical Workers there.Meanwhile，Icontinued learning from my uncle Pan Xihuang(潘希璜)，vice-president of county hospital and famous veteran doctor.As formy uncle's medical skill Iadopted themethods ofwatching，reciting，thinking，taking notes and asking questions.My uncle was quite satisfied with them and even let me first diagnose patients and then talk about the principles，methods，recipes and medicines.Sometimesmy uncle had the same ideas and some ofmy creative thinking earned his praise.Such away of learning does great good tome.

For instance，a patient with colicky pain in the left lower abdomen and vomiting yellow water took the recipes of clearing heat，draining dampness，relieving stranguria，nourishing kidney and purging fire，which all produced no effects.The first visit discovered that the patient had suchmanifesations as left lumbar distending pain radiating to left lower abdomen，bloody urine for over twomonths without frequency，urgency and pain，dark red tongue with thin white coating，and wiry and thready pulse.I planned tomake syndrome differentiation and treatment from the perspective of combined stasis and water leading to qi stagnation，and obstruction resulting in pain.

Treatment:resolving stasis to stop bleeding，draining water to relieve stranguria and regulating qi to remove pain.

Formula:Sheng Pu Huang 10g，Huai Hua Mi 20g，Ou Jie Tan 20g，Han Lian Cao 20g，Jin Qian Cao 30g，Dong Kui Zi15g，ShiWei 15g，Bai Mao Gen 30g，Yu Jin 10g，Guang Mu Xiang 19g，and Wu Yao 15g.

After the patient had taken four doses，two calculuses got out in the size ofmung bean，and bloody urine and lumbar pain disappeared.I considered obstruction causing pain as the general rule of pain in acute abdomen，and through syndrome differentiation identified as the basic pathogenesis qi stagnation caused by combined stasis and water，and adopted the method of resolving stasis to stop bleeding，relieving stranguria to drain water and regulating qi to remove pain.Excellent clinical effects were achieved with calculus discharged，bleeding stopped and pain relieved.

My uncle considered thatmy treatment laid great emphasis upon regulating qi movement and that qi-regulating and stasis-resolving medicines made it easier to expel calculus out because they expand urethra and improve the local blood circulation.The practice shows that relieving stranguria combined with regulating qi ensures better effects to expel calculus out.

My uncle praisedme formy insight in disease differentiation and flexibility inmedication.He taughtme tomake syndrome differentiation from four aspects—location，manifestations，conditions and cause of disease—and said，"When the pathogen invades，itmust be located in a certain place；when the disease occurs，itmust have itsmanifestations and conditions；when it comes to its etiology，itmust have its cause.When the location is clear，its nature will be understood；when the manifestations and conditions are distinct，the pathogen can be identified；when the cause is known，then a doctor knows the onset，development and treatment of the disease."Thismethod indeed serves as the fundamental principle of clinical syndrome differentiation.

Question： It is said that you were good at employing Long Dan Xie Gan Tang when an apprentice of your uncle，could you talk about it？

Answer： This formula comes from Yi Fang Ji Jie (《医方集解》，Medical Formulas Collected and Analyzed )and is composed of Long Dan Cao，Huang Qin，Zhi Zi，Ze Xie，Mu Tong，Che Qian，Dang Gui，Sheng Di，Chai Hu and Sheng Gan Cao.This formula is intended to clear the excess fire in the liver and gallbladder and purge the damp-heat in the lower energizer.

I think it haswide application and good effects to all kinds of syndromes caused by up-flaming of excess fire in the liver and gallbladder or downward flow of damp-heat.The key for clinical syndrome differentiation is bitterness in the mouth，dark urine，red tongue with yellow coating，wiry，rapid and powerful pulse.Sincemostmedicines in the formula tend to be bitter in flavor，cold in property and do harm to the spleen and stomach，it is forbidden for syndromes of deficiency-cold in the spleen and stomach and yang hyperactivity due to yin deficiency.This formula earns high approval among doctors past and present for its excellent clinical effects.Long Dan Cao，greatly bitter in flavor and cold in property，"excels in purging excess fire in the liver and gallbladder and clearing damp-heat in lower energizer"( Yao Pin Hua Yi ，《药品化义》， Transforming the Significance ofMedicinal Substances )，therefore，it's used as the sovereign medicinal and the formula is named after it；Huang Qin clears the fire in liver and lung，and Zhi Zipurges the fire in triple energizer.These two help the sovereign medicine accomplish the main task.Mu Tong，Che Qian and Ze Xie dispel dampness by draining water and remove damp-heat in liver and gallbladder from the urine.Since the excess fire in livermeridian must consume yin and blood stored in the liver，Sheng Di and Dang Gui are used to nourish yin and blood，emolliate the liver and support the healthy qi.Besides，the liver，of yin in nature and of yang in function，prefers free activity rather than constraint，and internal accumulated fire causes the staganation of liver qi，therefore，Chai Hu is used to soothe the qi of liver and gallbladder，and guide medicines to liver meridian.Finally，Sheng Gan Cao harmonizesmedicines of different properties to prevent bitter and cold medicines from damaging the spleen and stomach，and to soothe the liver so as to avoid its transverse invasion.This formula，characterized by the combination of tonifying and purging，soothing and nourishing，descending and ascending，can achieve the effect of dispelling the pathogenic qiwithout damaging the healthy qi ， for instance，purging the fire without damaging the stomach.That iswhy it is titled the good formula to purge the liver.

Another example is that I have my own understanding about line 303 in Shang Han Lun :"in shaoyin disease that has lasted more than two or three days，the patient has vexation in the heart and inability to sleep，Huang Lian E Jiao Tang can be used for the treatment".This formula is composed of Huang Lian，Huang Qin，Bai Shao，Ji Zi Huang and E Jiao and was originally used by Zhang Zhongjing(张仲景)to treat yang hyperactivity syndrome due to yin deficiency in shaoyin disease.

"Lastingmore than two or three days，vexation in the heart and inability to sleep"are typical symptoms of heat transformation syndrome of shaoyin disease.In clinical practice，there are also other manifestations like dry throat and mouth，red tongue with scanty or yellow coating，and thready and rapid pulse.The pathogenesis is non-interaction between kidney and heart because of insufficiency of kidney water and hyperactivity of heart fire.Since this syndrome is both deficiency yin and excess fire，Huang Lian E Jiao Tang is used to restore coordination between heart and kidney by purging fire and nourishing yin.

In the formula，Huang Lian and Huang Qin，bitter in flavor and cold in property，clears the heart fire，E Jiao and Bai Shao nourish yin，and Ji Zi Huang works to settle heartand calm mind.These five combine tomakewater ascend and fire descend，and to coordinate heart and kidney，eliminating sleeplessnesswith vexation in heart.This formula，focusing on clearing fire with nourishing yin as its supplement，is only applied to shaoyin syndrome of excess heat damaging yin，rather than shaoyin syndrome of yin deficiency and fire exuberance.That is because the former is syndrome of external contraction with excess pathogen while the latter syndrome of internal injury with deficiency healthy qi.That iswhy Wu Jutong(吴鞠通)says，"If the fire is still exuberant，Ding Feng Zhu and Fu Mai Tang are prohibited；and if the syndrome is of more deficiency than pathogen，Huang Lian E Jiao Tang is banned."

The key points for syndrome differentiation are vexation in the heart，red tongue with scanty coating，and thready and rapid pulse.Actually，this formula is themodification of Xie Xin Tang with removal of Da Huang and addition of E Jiao，Ji Zi Huang and Bai Shao.It，focusing on clearing fire with nourishing yin as its supplement，is suitable for shaoyin syndrome of excess heat damaging yin.Iusually use it to cure such diseases caused by exuberant fire and yin deficiency，as insomnia，high blood pressure，palpitation and anxiety and it achieves excellent effects. Gsh0itu0Q6ZIE90kve+omclD6G9mBv0LO7j3OMgHHubuwCjBr6GQl6nwRDYkMQ0i