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Book Title: *Thirty Years of Clinical Experience* Chapter: Main Text (1/32) Category: Comprehensive

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Author: Zou Mengcheng

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Content Summary

This book is a collection of selected clinical experiences and theoretical insights from the author's thirty years of clinical practice. The entire work consists of eighty-one articles divided into nine parts. It includes verified cases for treating difficult and miscellaneous diseases; frequently effective standard prescriptions; unique pulse diagnosis methods; and personal reflections on treating cancer. Particularly, for conditions such as herpes zoster, acute appendicitis, cerebral concussion, and cerebral contusion, the author diligently seeks guidance from ancient teachings, applying them to modern contexts. For malignant tumors, sequelae of stroke, facial nerve paralysis, pulmonary tuberculosis, schizophrenia, atrial fibrillation, hyperthyroidism, allergic dermatitis, asthma, and other diseases, the author draws upon numerous prescriptions, discards the outdated, and introduces the new, achieving significant results. These are unreservedly presented to readers in relevant chapters. The book is rich in content and concise in style, offering high reference value for TCM clinicians, educators, and researchers.

Preface I

Cao Mengde once recited these famous lines: "The old steed in the stable still aspires to gallop a thousand li; the hero in his twilight years still harbors an indomitable spirit." As someone who has cultivated the medical field for decades, summarizing one's clinical experience and academic theory to contribute to human health and the development of TCM academia is both my wish and my responsibility. However, due to being constantly overwhelmed by clinical duties and having reached the age of eighty with declining energy, my manuscript has remained unfinished for many years.

Now, Mengcheng has surpassed others through his own efforts. He is my student, one of the outstanding among my many students. Through decades of diligent and tireless pursuit and effort, he has achieved gratifying results. *Record of Exploration and Research in Thirty Years of Clinical Practice* not only embodies his concentrated academic experience but also serves as a report of achievements to the motherland and its people. Mengcheng is a person who is diligent without slackening and never satisfied with his learning. He holds great respect for his teachers, memorizing even their briefest instructions. Therefore, the content of the book naturally reveals his transmission relationship with various masters.

In my personal view, this work of Mengcheng has five characteristics: First, rigorous attitude and reliable data. Whether in scholarship or conduct, Mengcheng has always been rigorous, adhering to seeking truth from facts and avoiding hypocrisy and superficiality. Before writing, he followed up directly or indirectly on all cases involved in this book. Only when the efficacy was definite did he use them as data. Moreover, the plain language throughout the book reflects his rigorous spirit from another perspective.

Second, precise syndrome differentiation and meticulous attention to detail. For example, in Article 13 "Complications Arising from Mismedication for Exterior Wind-Heat," Shen suffered from fever and mental confusion, which was differentiated as wind-heat combined with phlegm damaging body fluids. He recovered after modification using Jiajian Weirui Tang (Modified Polygonatum Decoction). Similarly, severe fright cases were treated with tonification; cerebral contusion with calming liver and extinguishing wind; pediatric pneumonia with clearing intestines and draining heat; and atrial fibrillation with nourishing heart and calming spirit. The syndrome-based treatment of these numerous cases was relatively refined and accurate, thus achieving high efficacy.

Third, concise prescriptions and light, agile medication. Many unique verified prescriptions in the book use extremely simple ingredients, often relying on single herbs for effect, which is a very important characteristic. Fewer yet more precise ingredients confront the disease directly, often achieving unexpected success, while avoiding the drawback of mutual restraint among drugs in compound formulas. For instance, using single herb Daihe Shi (Hematitum) for cerebral concussion, wine-decocted Hong Teng (Sargentodoxae Caulis) for acute and chronic appendicitis, and frosted Sang Ye (Mori Folium) decoction for washing conjunctivitis, all exhibit concise efficiency and rapid cure. Meanwhile, when using compound formulas, dosages are often lighter. Case observations show that the expected therapeutic effects were still achieved. This is a valuable application attempt that reduces the impact of drugs on the patient's body and saves medicinal materials, possessing value for further experimental research.

Fourth, deep investigation and creation of new prescriptions. Four special prescriptions used in the book—"Pianku Jianquan Tang" (Paraplegia Recovery Decoction) for rehabilitating hemiplegia from stroke; "Shengyu Zhengrong Tang" (Shengyu Face-Correcting Decoction) for correcting facial nerve paralysis; "Zhen Gan Di Tan Tang" (Calming Liver and Washing Phlegm Decoction) for treating schizophrenia; and "Baihe Changfei Yin" (Lily Lung-Unblocking Drink) for eliminating chronic bronchitis—are all new prescriptions created by Mengcheng after years of clinical experimental research. They often achieve expected effects when treating indicated conditions. This is another important contribution to Chinese medicine.

At the same time, other prescriptions and methods introduced in the book also possess characteristics of simplicity, high efficiency, and reproducibility, making them worthy of promotion and application.

Fifth, comprehensive consideration and practice of holistic equilibrium therapy. "Holistic Equilibrium Therapy" is a treatment principle that Mengcheng has consistently adhered to and continuously explored over a long period, showing special efficacy in treating chronic, persistent, and complex difficult and miscellaneous diseases.

This viewpoint is not explicitly stated in the book because it is currently still in gestation and not yet mature. However, the process of syndrome differentiation and treatment in many complex cases in the book consistently embodies this point. "Holistic Equilibrium Treatment" is an innovation in Mengcheng's academic views. Although similar academic thoughts exist in the works of ancient sages, they are mostly scattered and preliminary, lacking sublimation and crystallization. Guided by the spirit of inheritance and development, Mengcheng is conducting in-depth research. This line of thought and method is already vividly apparent between the lines of this book. Readers with keen insight will surely find resonance.

Mengcheng possesses a spirit of forging ahead in his career. After thirty years of unusual practice and research, he has finally achieved today's success. "Guard against arrogance and rashness, make persistent efforts, and strive for greater achievements!" This is my encouragement and expectation for Mengcheng.

Wu Zhutian, Shanghai University of Traditional Chinese Medicine Affiliated Shuguang Hospital, Age 88, January 5, 1998

Preface II

I left my motherland and Shanghai to study in the United States and subsequently practiced medicine there for exactly ten years. During this period, I often recalled my relatives and friends in Shanghai. Mengcheng was a classmate and close friend with whom I studied medicine in Shanghai in my early years. Academically, whether in theory or practice, he has always been a person striving tirelessly. Seeing his first book, *Record of Exploration and Research in Thirty Years of Clinical Practice*, makes me very happy, so I am excited to write this preface.

In the colorful garden of our motherland's medicine, rare flowers and grasses can be found everywhere; if you know how to collect them, you will certainly reap rewards. *Record of Exploration and Research in Thirty Years of Clinical Practice* is a collection of Mengcheng's partial clinical insights over several decades and a small display of gathering treasures in the medical garden. "Spring colors cannot be contained within the garden; a branch of red apricot leans over the wall." It is not only a good book that integrates principles, methods, prescriptions, and herbs but also unreservedly exposes his experience to readers and the medical community. This precious spirit moves me deeply. Judging from the content, it focuses on medical technology. However, as the book states, modern medicine defines health as including both physiological and psychological aspects, with the feedback and influence of psychology increasingly showing important roles.

"The formless governs the power of intention" is a bold attempt by the author to apply traditional Chinese medical theory to study psychological feedback phenomena in the medical field, which is very meaningful. Self-cultivation and perfection of the mind are the best ways and methods for people to obtain a healthy psyche, and mental health is an effective prerequisite and guarantee for physical health. Only through long-term training of constantly overcoming and replacing unhealthy psychology with healthy psychology can one reach a noble psychological realm, thereby enjoying the fruits of physical health and longevity. Our motherland's medicine has stepped out of the country and entered the golden hall of world medicine. It is a brilliant pearl that will inevitably make significant contributions to human health. On this occasion, I wish that Mengcheng's work would shine brightly and remain evergreen.

Director of the American Center for Natural Medicine
President of the National Holistic Medical Research Association
Doctor of Acupuncture, American University of Oriental Medicine
Zhang Runping
January 24, 1998, Los Angeles

Self-Preface

I have loved Qi-Huang studies (TCM) since childhood. In my youth, living in my hometown, my mother suffered from sudden severe epigastric pain and vomited blood filling a basin. Although medicines were administered repeatedly, there was little effect. At this moment of helplessness and dilemma, my aunt invited the nearby famous doctor Mr. Zou Yunxiang. At that time, Mr. Yunxiang had not yet taken office in Nanjing. He asked about symptoms and felt the pulse, remaining calm and composed. After the diagnosis, he instructed: "Taking Ginseng powder will surely stop the bleeding." Following this method, improvement was seen in one day, and bleeding stopped in three days. Subsequently, after slight regulation, the epigastric pain resolved, and everything became peaceful thereafter. Seeing the miraculous skill of the master, I felt increased reverence and admiration. Observing that many relatives, friends, and neighbors were ill and urgently needed medical treatment, and seeing my grandmother suffer from senile dementia until her death without treatment, Mengcheng often felt sorrowful resolve, firmly establishing the ambition to study medicine. Only after practicing medicine for years did I realize that the profound subtleties of the medical way are not accessible to those who merely scratch the surface. Moreover, possessing a dull nature, I had not penetrated the core essentials of Xuanyuan and Qibo. Lacking divine, sacred, skilled, and clever abilities, I feared that even one mistake among a thousand considerations might bring disaster to others. Therefore, I diligently sought ancient teachings, extensively collected prescriptions, analyzed and dissected them, discarded shortcomings, and utilized strengths. Whenever I had some understanding, I wrote it down for future reference. Over tens of years, notes accumulated to a foot in height. This was still insufficient; I desired to carry my luggage to famous schools and widely seek the heart-to-heart transmission from various masters. Thus, I became a disciple of Mr. Wu Zhutian and received earnest teachings from Professor Jiang Chunhua for twelve years. Furthermore, introduced by Master Wu, I attended consultations with Mr. Yang Yongxuan to learn acupuncture. From this, I received extensive education, covering principles, methods, prescriptions, and herbs, and gained much experiential knowledge. Alas, Mengcheng's capacity is narrow, unable to absorb everything comprehensively. Recently, urged frequently by friends and feeling the sense of twilight in myself, I slightly organized my notes, selected parts, compiled them into a volume, hence the creation of this book.

This compilation originally belonged to casual records for self-reference, not for writing books to establish theories. Therefore, the style of each article varies, and the format is indefinite. No fundamental changes were made during this organization. I merely strive to offer true data and insights to readers and share them with enthusiasts. How much is worthwhile remains for later generations to judge. If even fragments hold meaning, I hope everyone follows the teachings of *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold), saving the suffering of the people with a great compassionate heart, serving patients wholeheartedly. If this can be done, then Mengcheng's wish is fulfilled. Errors are inevitable in the book; if corrected, I would be extremely fortunate.

During the compilation of this book, Comrade Liu Luhai, Comrade Wang Guoxian, and various masters and friends provided much concern and support. Hereby, I express my gratitude!

Zou Mengcheng Dagenfu, written at a guest room in Shanghai
October 13, 1999

Discussions on Writing

Clinical Practice Requires Distinguishing Similarities and Differences

Treating diseases prioritizes recognizing syndromes, which is a consistent consensus among physicians of all dynasties. As *Linzheng Zhinan* (Guide to Clinical Practice) states: "The medical way lies in recognizing syndromes, establishing laws, and using prescriptions; these are the three key points," "Among the three, recognizing syndromes is particularly crucial." The key to recognizing syndromes lies in syndrome differentiation. What is syndrome differentiation? The term "syndrome" refers to a concept reflecting the essence of a certain stage of a disease during its occurrence and development. Syndrome differentiation is based on comprehensively collecting material from the four diagnostic methods, applying basic theories such as the four diagnostics, eight principles, zang-fu organs, etiology, and pathogenesis, to analyze, reason, and synthesize judgments, thereby deriving a relatively reasonable syndrome diagnosis. However, due to factors such as the patient's constitution, chronic diseases, severity of illness, emotions, variations in medication response, missed or incorrect treatments, as well as environmental, climatic, and regional factors, the syndrome condition often becomes intricate, presenting approximate, similar, or pseudo-similar syndromes that confuse perception, making it difficult for physicians to diagnose accurately at once, distinguishing true from false. A slight oversight leads one into a fog. For example, extreme yin excess repelling yang outward may present with red face, red eyes, cracked lips and tongue, waving hands and kicking feet, and delirious speech—a scene of fire and heat. Initially appearing as a yang syndrome, it is actually internal true cold with external false heat. Extreme yang heat repelling yin inward may present with cold limbs, deeper heat leading to deeper cold, rigid lying like a corpse, no drinking or eating, no breath from mouth and nose, and cold extremities—a scene of yin cold. Initially appearing as a yin syndrome, it is actually internal true heat with external false cold. Similarly, cancer patients may have solid pulses despite solid evidence, commonly showing limb lethargy, dizziness, blurred vision, poor appetite, and mental fatigue, seeming like a deficiency syndrome; whereas those with middle qi injury from overwork may show epigastric and abdominal distension, discomfort after eating, qi stagnation, and imperfect bowel movements, seeming like an excess syndrome. The above are merely a few examples; in clinical practice, the number of similar/different syndromes is too numerous to recount. Thus, Li Shicai sighed, "All kinds of similar/different symptoms cannot be counted one by one." And Lin Peiqin said in the preface of *Leizheng Zaican* (Compendium of Differentiated Treatments): "The difficulty of life-saving lies in recognizing syndromes; the difficulty of recognizing syndromes lies in differentiation," "Moreover, regarding one symptom, complexities and similarities arise." Therefore, distinguishing true from false and analyzing similarities/differences is an indispensable major link in syndrome differentiation.

Because the main basis for syndrome differentiation is the various materials obtained from the four diagnostics, analyzing similarities/differences must also start from deeply and meticulously analyzing and comparing such materials. Based on my shallow understanding, emphasis seems to be placed on analyzing chief symptoms, pulse qualities, and tongue appearances.

One: Distinguish Chief Symptom Characteristics, Deduce Differences Within Similarities. Syndrome differentiation applies TCM basic theories to analyze, screen, classify, and arrange material from the four diagnostics (inspection, auscultation/olfaction, inquiry, palpation), then summarize and integrate, starting from identifying the chief symptom. The ability to correctly select and identify the chief symptom is an important marker of correct syndrome differentiation. Incorrect selection of the chief symptom often leads to erroneous syndrome diagnosis.

To prevent omissions and errors in identifying chief symptoms, one must deeply analyze the characteristics of the preliminarily identified chief symptom, outline the preliminary syndrome profile, and then seek support for the initial impression of the chief symptom from diagnostic materials not yet included in the chief symptom scope. Simultaneously, special attention must be paid to diagnostic materials that do not match or are even completely opposite to the initial impression of the chief symptom. One must carefully analyze their etiology, pathogenesis, and diagnostic significance to obtain a reasonable explanation, ensuring consistency. If inconsistent or divergent, it should attract attention, be seriously pondered, and stripped of falsehood to retain truth. If false images cannot be excluded, one should expand thinking and re-conduct comprehensive analysis and understanding.

In the transition between spring and summer of the Yihai year (1995), I diagnosed a man in his fifties. He reported that when he first fell ill, it was midsummer, a time for wearing thin clothes, yet he wore woolen clothing and continued to feel aversion to cold. His measured temperature did not rise. This symptom persisted until midsummer before subsiding. Since then, for several years, chills and fever occurred frequently, but the temperature was not very high, usually between 37.2°C and 38.5°C. Previously, a single dose of medicine cured common cold fever; now, repeated medications were ineffective, necessitating intravenous glucose infusion to reduce fever. However, after the fever subsided, he felt steaming heat in the bones remained, accompanied by a sense of drowsiness all day. Night sweats appeared on the chest and back every night. Coughing started at midnight and was less frequent during the day. The characteristic of the cough was itching and soreness in the throat triggering coughing; severe itching often caused choking urgency, sometimes with blood in sputum, and he twice expectorated large amounts of dark purple blood. Two chest fluoroscopies within one year showed nothing abnormal except "deepened hilar markings." The preliminary diagnostic opinion was "Chronic Bronchitis? Fever under investigation." Medication was intermittent for two years without effect. My diagnosis revealed a small wiry pulse, pale red tongue body, thin white coating, and other symptoms as described above. Thus, I analyzed the syndrome: Among the patient's chief symptoms, fever and cough seemed to belong to exterior contraction, yet there were no exterior symptoms such as aversion to cold, runny nose, sore throat, or aversion to wind, clearly indicating it was not an exterior contraction. The characteristic of the fever was low temperature but recurrent episodes, with poor response to exterior-releasing antipyretics and antibiotics. This type of fever lacked features of exterior contraction and positive inflammatory fever, instead presenting characteristics of chronic long-standing illness. The bone-steaming phenomenon after fever subsided suggested this heat should be considered yin-deficiency tidal fever. Cough worse at night and lighter during the day, dry cough without phlegm, and throat itching triggering cough indicated lung yin deficiency and wood-fire insulting metal. Combined with night sweats and hemoptysis, the four chief signs of Pulmonary Tuberculosis (cough, hemoptysis, tidal fever, night sweats) were present. Pulse and tongue appearance were consistent with this inference. Therefore, this disease should primarily be considered Pulmonary Tuberculosis, yin deficiency with fire hyperactivity syndrome. The absence of lesions in two fluoroscopies might be related to machine performance; changing to a chest X-ray clearly showed right upper lobe pulmonary tuberculosis. Symptomatic treatment was given, and the illness gradually improved.

For atypical symptoms where it is difficult to analyze chief symptoms representing the essence of the disease, one should analyze and reason based on related factors such as medical history, constitution, climate/environment at onset, and medication variations, penetrating phenomena to grasp the essence.