On Reading Old Medical Books and Clinical Practice
In reading old books one must know the period background — institutions, customs, the evolution of language. With the things the ancients left us, we must analyze and recognize them by the standpoint of historical materialism. Only thus can we know what real situation of the time the ancients were writing for. To weigh the ancient by the eye of today is often to mistake the ancients or to chastise them unfairly. Because all these old writings are products of their own social periods, each has its historical limits — they are not to be glossed over by guesswork.
For example, Zhang Zhongjing's Shanghan Lun was written after more than half his clansmen died of shanghan. Li Dongyuan's Discourse on Spleen and Stomach was written in the chaos and parting of the Jin-Yuan era. Ye Tianshi's Wenre Lun was written in the peace at hand of the Qing. Without understanding the period background, without analyzing by historical materialism, one would charge Zhongjing with neglecting warm-heat, Dongyuan with confinement to internal damage, Tianshi with violating the old classics — falling into the idealist error. Of philology of language and writing, the more so does it have its periods. Without understanding this, reading the ancients' writing through the habits of modern language — often one is misled and cannot grasp the true intent.
For example, the Phlegm-Rheum, Cough chapter of Zhang Zhongjing's Jinkui Yaolüe. Tan-yin has two senses: in the chapter title, tan-yin is the general name for fluid-disease; in the articles within, tan-yin refers to fluid in the bowels that shakes and gurgles. The Japanese Tamba said "tan was originally written dan" (淡, bland). Wang Xizhi's Chu Yue Tie: "dan-oppression and dry-retching." Song Huang Boyan's Faqie Kanwu says: "dan, the dan of ancient dan-liquid." If we take tan-yin in today's sense "thick is tan, thin is yin", we lack the historical view of language and lose the term's true meaning. There are many cases of this kind; not investigated, they leave one staring uselessly at the old text.
In Reading, Choose Sticky over Slippery
Work solidly, taking the old writings sentence by sentence, character by character. Sticky means: where you do not understand, do not let it pass; ask teacher or friend, consult lexicons — only when understood, go on. Looking sticky and hard, hard to advance — yet day by day, month by month, from little to much, shallow to deep, a thousand-mile course built of small steps. When work runs deep and cultivation arrives, what looks slow turns swift, like sudden understanding. Slippery means: read on by the lip, without seeking deep understanding. So one day — so every day — outwardly fast, in fact as if not read. Such self-deceiving reading is a strict caution. Some, after the shallowest taste, think they have gained — in fact they have only chased shadows, blurred impressions, fine-flowering without fruit. The root is self-complacency. So one cannot learn. Reading earnestly is easy to say, hard to do. Often one searches every book for a single character, asks every teacher and friend for a single meaning. To keep one's books open and not let a single character pass — this needs resolve and perseverance.
In Clinic, Choose Clumsy over Clever
In seeing the signs, press on to the disease's essence; do not stop at the surface of cold-hot-deficiency-excess. In building the formula, attend to primary-and-secondary combination; do not face the case with rote formulas. With great cases or mixed cases, attend the more carefully — work the finer, so every thread fits the pathogenesis. "Great cleverness looks clumsy" — this is the principle.
In short: no learning is got by shortcut, no success without effort. Both slippery and clever hold a piece of luck-seeking — peeping at scholarship by appearance, unsettled at one's post in work. Solid and earnest, diligent and faithful — this is what Chairman Mao taught us as the attitude for all learning and work.
Medical Law Must Seek the Fine
In recent years in clinic I have met some cases — illness complex but with possibility of recovery. Yet on starting treatment, things would not resolve as I wished; sometimes the medicine even worked against, and side-issues sprouted. My own bitterness aside, the trouble was that the patient's suffering was not resolved — I had much to answer for in my own breast.
At first I told myself: the case is severe, the medicines have limited reach; disease has its specifics, medicine its limits. Later, watching senior practitioners and friends handle great cases and complex ones — even in dire and pressing circumstances they were not careless, not flustered. They had order, had method, treated fittingly. On one or two herbs, on one or two qian of dose, they weighed each carefully, never lightly; and in the end they got results — even chronic incurables responded. Their reasoning and methods seemed plain, their formulas common. So I often asked the secret. They said: medical art enters the fine; then great cases and complex cases can be set in order. I awakened. By this hint, I returned to the books and saw that my earlier reading had not penetrated — I had grasped only the broad meaning, not mastered the fine rules; only paddled around the gate, not entered the inner hall. No wonder I could not lift a great case, could not order a complex one. The ancient poem says: "In late life one grows finer in the rules of poetry." Having received this lesson in clinic, I take it as "in late life one grows finer in the rules of medicine" and use it to caution myself.
I have thought: fine is not lightness or fragmentation. Light drifts to thinness, thinness has no force; fragmentary falls into scatter, scatter cannot concentrate. Entering the fine requires order and structure.
Take a formula's combinations as example. The Shanghan Lun on "sweat issuing and panting, without great heat — give Mahuang Xingren Gancao Shigao Tang": in the formula, mahuang paired with shigao. Mahuang, pungent-warm; shigao, pungent-cold-cool. Cool checks warm, so that mahuang cannot run free with its strong dispersing power, yet does not block the issuing of sweat. Meanwhile pungent and pungent are of the same qi attracting one another; and pungent-cool also has surface-penetrating function — so for lung heat with panting it can clear and resolve. Mahuang paired with shigao in truth contains mutual checking and mutual dependence. If instead of pungent-cool shigao one used bitter-cold huanglian or huangqin — though these can also check mahuang's pungent-warm nature, descent runs counter to surface-release: the pulling effect is opposite, the diffusing power blocked. How then could it reach the aim of clearing, diffusing, and ordering the lung? Also, the mineral shigao doubles the dose of the herb mahuang — the weight is exactly judged. Such formula-combinations, in step with the pathogenesis — this is entering the fine.
Or: the Yu Pingfeng San of Shiyi Dexiao Fang. Huangqi supplements the three burners and fortifies the wei; in a supplementing prescription it is the wind drug. Fangfeng moves through the whole body; among wind drugs it is the moistening drug. Huangqi loathes fangfeng, yet this formula takes mutual loathing as exactly the use of mutual need. Fangfeng assists huangqi to secure the surface and not retain evil; pungent-moist, it does not damage fluids. To substitute pungent-drying qianghuo or duhuo would not suit a pattern of weak wei with long sweating.
The fineness of the Qing warm-heat physicians' methods surpasses earlier ages. A few examples to show.
Wenre Jingwei · Chen Pingbo's Warm-Externals Chapter: "Wind-warm pattern, body scorching, great thirst, cough with vexation, deranged speech as in dream, pulse wiry-rapid, dry retching — this is heat scorching lung and stomach, wind-fire turning within. Use lingyang horn, chuanbei, lianqiao, maidong, shihu, qinghao, zhimu, huafen and the like — to drain heat and harmonize yin." Wang Shixiong's note: "With cough and oppression, do not give maidong straightaway, suspect its nourishing nature." (Wang Yuzhen's note: "Xu Huixi held that maidong fills lung qi, not for replete cough — quite right.") "Is it for the great thirst? Already there are zhimu and huafen, enough for the task. With wood-fire upward-rushing causing dry retching, qinghao though clearing shaoyang is suspect for upbearing. Remove these two, add zhizi, zhuru, pipa leaf — fine!" Yang Zhaoli said: "Discussing herbs to the finest detail — readers must not pass it lightly."
Wenre Jingwei · Xue Shengbai's Damp-Heat Chapter, article 20: "Damp-heat pattern, after several days, sweat issues but heat not gone, or convulsion, or sudden unrelenting headache — ying fluid greatly depleted, jueyin wind-fire rising. Use lingyang horn, manjingzi, gouteng, xuanshen, shengdi, nüzhenzi and the like." Wang Shixiong: "In Wu's text there is no nüzhenzi but baishao." Yang Zhaoli: "Baishao is not as good as nüzhenzi." Wang again: "For manjing one had better substitute juhua, sangye." Yang: "Manjingzi is the least apt — the substitution is excellent." Wang Yuzhen: "Gouqizi may also be used, no fear of its richness." In these two articles the various commentators weigh medicines against the pattern and signs so that they match the pathogenesis. Entering the fine — fit standard for later students.
Excerpt from Yue Meizhong on Medicine.