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The late master particularly emphasized the physiological characteristics of children's bodies, stating that they essentially belong to "Zhi Yang Zhi Yin" (referring to the fact that a child's Yang Qi and Yin Essence are not yet fully developed), and originally are not what is called a "Pure Yang Body". Their conditions easily shift from deficiency to excess or from excess to deficiency, and easily change from cold to heat or from heat to cold. Therefore, one must fully apply the differentiation principles of the Four Diagnostic Methods (Inspection, Auscultation and Olfaction, Inquiry, Palpation) and the Eight Principles (Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency, Excess). One should carefully examine the pulse and respiration, observe the fingerprint, inspect the facial complexion, scrutinize the changes in the five sense organs and nine orifices, listen to the voice, and observe movements and postures. By observing external manifestations, one can deduce the internal state of the viscera. For example, frowning and frequent crying indicates abdominal pain; restless sleep indicates disharmony of Stomach Qi; sour and foul-smelling stool indicates food stagnation; craving for eating dirt indicates intestinal parasites; sitting and lying while preferring coolness indicates impending irritability and heat; stretching the body and seeking warmth indicates aversion to wind and cold. Borrowing the methods of ancient sages to identify diseases serves as the basis for one's own differentiation. Judgments must be accurate, and treatment must be cautious. One must not abuse bitter-cold medicines to damage Yang Qi, nor use warm-dry medicines to scorch Yin fluids. This is the principle that the Zhi Yang Zhi Yin constitution cannot withstand vigorous attacking methods. One must never claim that a child's body belongs to Pure Yang and thus recklessly use bitter-cold and cloying medicines, thereby harming vital energy.

Another characteristic of children is their innocence, simplicity, and liveliness. They do not suffer from diseases caused by internal injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). The main factors causing illness are mostly the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) from outside or epidemic pathogenic qi occurring out of season. Furthermore, children have delicate skin and flesh, loose interstices (skin texture and sweat pores), and weak defensive power against external pathogens. Generally, they are prone to catching wind-cold leading to cough, and especially susceptible to acute infectious diseases. If a child shows listlessness, aversion to cold, and fever, one should pay attention to whether it is Shang Han (Cold Damage) or Wen Bing (Warm Disease). The general principle is to prioritize releasing the exterior and expelling pathogens. This is even more applicable to acute infectious diseases. Because the Qi of the meridians and viscera in children is not yet full, the condition is most likely to transmit and transform. Even if there is coma and delirium, with heat entering the Pericardium, it is still appropriate to employ methods to transfer heat from the Ying (Nutritive) level to the Qi level and to clear heat and open the orifices. Treatment should change with the variation of the condition, so that one has a firm grasp in mind, and the disease cannot hide its form.

Children's gastrointestinal tracts are fragile. Coupled with parental indulgence leading to overeating, symptoms of food injury and cold injury are common. I have seen cases of sudden fever without symptoms like runny nose or cough. In such cases, one should inquire about dietary habits, checking for belching with a rotten smell and anorexia, to distinguish between fever due to food injury and fever due to external contraction, avoiding confusion. There are also cases of persistent low-grade fever, loss of appetite, gradual emaciation, and sallow complexion, which indicate food stagnation forming masses. The most common scenario is that a child initially has a good appetite and appears chubby and cute. However, due to lack of self-control, the gastrointestinal tract is gradually damaged, absorption function declines, and malnutrition results from indigestion. As the saying goes: "If you want a child to be safe, keep them slightly hungry and slightly cold." This is another characteristic of pediatric healthcare.

Measles is the most common disease in children. *You You Ji Cheng* (Complete Works on Pediatrics) states: Although measles originates from fetal toxin, it often carries seasonal epidemic features, caused by abnormal climate changes and transmission among males and females. The treatment method prioritizes venting and erupting, allowing the measles toxin to exit outward. Hence, there is the saying: "When treating measles, prioritize releasing the exterior and venting; once the rash appears and the toxin resolves, there is no cause for worry." The late master's method for treating measles also adhered to this standard. However, for special circumstances, he did not rigidly stick to established methods. In the summer of 1945, continuous heavy rains fell in Chengdu, flooding streets and alleys. Around the Start of Autumn, many children had fevers, but the measles remained hidden under the skin and did not erupt. Doctors' attempts at venting failed. After deep contemplation, the late master suddenly realized that due to the rainy summer season, heat transformed into dampness. It should be treated according to Shi Wen (Damp-Warmth). He changed to a method of unblocking Yang and promoting diuresis to resolve dampness, allowing heat to dissipate. The measles toxin erupted spontaneously. Although no venting was used, the fever subsided, consciousness cleared, and the patient recovered. Seeing the efficacy of this method, he urgently informed his colleagues, who tried it and all achieved immediate results. When asked why, the Master said: "This conforms to the principle of *Nei Jing*: 'First determine the annual Qi, do not violate the harmony of Heaven.' Measles occurring in the damp-warm season should indeed be treated this way; the same applies to other Warm Diseases."

After the late master came to Beijing, his medical reputation was high, and many patients sought treatment for difficult and critical cases, especially complications of acute diseases. Many cases were caused by excessive use of cold medicines, resulting in Cold invading the Middle Jiao. He decisively used warm methods to save them, achieving remarkable results frequently. Thus, some called him a practitioner of the Acrid-Warm School or the Classic Formula School, but this was actually a misconception. He used warm methods to treat acute febrile diseases solely to rescue from deviation and adapt to changing conditions. For instance, Epidemic Encephalitis B falls within the categories of Shu Wen (Summer-Warmth) and Shi Wen (Damp-Warmth) in Traditional Chinese Medicine. A patient, Zhang XX, female, 4 years old, had been ill for seven days. She had taken TCM cold medicines and undergone Western medicine hibernation therapy and ice cooling. The teacher was consulted at midnight. The patient had sweated for the first three days but had no sweat for the next four days. Her temperature remained above 39°C, but her skin was cold, limbs were cool, respiration was weak, and she was in a deep coma. She had not passed stool recently, her pulse was concealed, tongue was normally red, and coating was hidden. The Master said: "Currently, Zheng Qi (Upright Qi) is weak, and the pathogen has sunk inward, presenting a critical sign of Internal Closure and External Collapse. Urgent measures are needed to support Zheng Qi, open closure, and combine warm and clearing methods: American Ginseng (decocted separately), Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill), and Suhexiang Wan (Styrax Pill), each 1 pill, ground into juice together, divided into ten doses, taken with American Ginseng water, one dose every hour. We will discuss further when the condition shows signs of improvement."

Follow-up visit: After taking the medicine, slight sweating appeared on the chest and both arms, skin temperature slightly returned, limbs remained cold, respiration improved slightly, phlegm increased, complexion was bluish-yellow, eyelids were edematous, and the pulse slightly emerged. The critical signs decreased by one degree, and vitality increased by one degree. Continue the original method, changing to every two hours. Observe temperature, blood pressure, pulse, and sweating. Later, the interval was extended to every three hours, then every four hours. This continued for fifteen days until internal closure gradually opened and white papules appeared. Subsequently, methods included unblocking bi syndrome, clearing toxicity, extinguishing wind; unblocking Yang, resolving dampness, and unblocking collaterals; nourishing blood, relaxing sinews, and activating collaterals. Finally, Da Huoluo Dan (Great Luo-Nourishing Pill) was added, one pill daily. After fifty days of treatment, internal closure opened, external collapse reversed, Zheng Qi slowly recovered, and pathogens receded daily. Consciousness cleared. Not only was the child's life saved, but no sequelae remained.

Suhexiang Wan is known to everyone as an acrid-warm method to open closure. In this case, ice trapped the heat pathogen, causing internal closure and external collapse. Only warm opening could initiate the resolution of closure. However, since Encephalitis B is fundamentally a heat disease, although the pathogenic heat is trapped, Niuhuang Qingxin Wan (a cool-opening method) is still needed to assist. These methods complement each other. Moreover, borrowing the power of American Ginseng to tonify Zheng Qi, how could one worry about external collapse not being secured or internal closure not being opened?

There was another case of a three-year-old girl suffering from adenovirus pneumonia, categorized in TCM as Dong Wen (Winter-Warmth). Due to excessive cold medicines, Lung Yang was severely damaged. Qi was weak, respiration faint, wheezing and coughing incessant. Temperature was still high, but sweat was cold and limbs were cool. Stomach Yang was also failing, with watery diarrhea. Pulse was fine and minute, tongue was not red, and coating was thin and white. The Master diagnosed it as cold damaging Yang, resulting in cold Lungs and cold Metal. He used Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction), a sweet-warm formula, to rescue Stomach Yang and restore Lung Yang. Administered in small amounts frequently, like the rising sun illuminating the sky, Yang Qi gradually revived. Diarrhea stopped, sweat was no longer cold, limbs were no longer cool, respiration became steady and quiet, coughing became forceful, pulse gradually rose, and tongue quality turned rosy. The critical condition turned stable. This demonstrates that treating heat does not preclude using heat; understanding flexibility allows one to fearlessly use warm methods for warm diseases.

The late master had distinct originality in pediatric differentiation and treatment. He inherited the theoretical system and treatment principles of Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) and studied extensively the works of pediatric experts since the Northern Song Dynasty, such as Qian Yi, Chen Wenzhong, and Chen Fuzheng, adopting their merits. He scientifically addressed the two opposing schools of Cold and Warm therapies initiated by Qian Yi and Chen Wenzhong. He stated that those skilled in using cold medicines who slander warm ones are biased; similarly, those accustomed to using warm medicines who criticize cold ones are also lacking in comprehensiveness. He consistently advocated absorbing the strengths of various schools, clearing when necessary, warming when necessary, without personal bias, applying methods freely, which constitutes the practice of a superior physician. The aforementioned cases, where warm methods were reluctantly used to open closure, suppress heat, and restore Yang due to specific conditions, represent only one aspect of his pediatric experience. His experiences in other aspects are extremely rich and will not be listed here.

Prescriptions and Medications: Light, Agile, and Pure

Ye Tianshi, a representative of the Warm Disease School in the Qing Dynasty, was renowned for his skill in prescribing light and agile formulas, praised by the medical community. The late master followed Ye's example, excelling not only in agility but also striving for purity. He said: "Agility means flexible application, conciseness, appearing ordinary yet hitting the mark perfectly. Purity means harmony and appropriateness, eliminating clutter, strict compatibility, and avoiding superficiality." Of course, this "light" does not refer to the "light" in the Ten Categories of Drugs (where light drugs can remove excess) or light dosage. This "pure" does not mean seeking stability by only using safe medicines. Rather, it is seeing miracles in bland prescriptions and achieving effects through simplicity. It is the result of decades of practice, tempered repeatedly, achieving the ease of handling heavy matters with light touch, and reaching perfection through careful consideration.

When prescribing, the late master did not simply copy ancient formulas nor abandon ancient methods to create bizarre ones. In his forties, he created Er Xian Yin (Fresh Reed Root and Fresh Bamboo Leaf Decoction). For external febrile diseases where Lung and Stomach fluids are damaged, preventing heat from exiting, causing persistent fever, irritability, and thirst, where exterior-releasing agents and purgatives are contraindicated, this formula generates fluids, reduces fever, lightly vents, and guides pathogens out of the exterior. It is like sweet rain after a long drought, instantly dispelling irritability and heat. If heat enters the Blood level causing epistaxis, add fresh Imperata Rhizome, and using child's urine as a guide is also excellent. This formula imitates Baihu Tang (White Tiger Decoction) in intent but is fresh in method. He always won critical cases with light and agile methods. In 1956, he consulted on a critical case of Encephalitis B where the patient was placed in an iron lung due to respiratory failure. At that time, survival rates for such artificial respirators were low. Observing the condition closely, he determined it was still between the Wei (Defensive) and Qi levels. He urgently prescribed Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction), a light acrid-cool formula, ultimately saving the critical situation. An elder senior colleague, witnessing this, admired the Master's skill in using light methods, sighing that he could never catch up. He once discussed the rationale of Baihu Tang, stating that although it is a heavy acrid-cool formula, it is cool, sweet, and moistening, cool without congealing, and clearing without obstructing. Although powerful, it still maintains the light and clear nature to lift Qi-level heat pathogens outward. If one recklessly adds bitter-cold herbs, it becomes a dead tiger devoid of vitality, unable to achieve the effect of clearing Qi and expelling pathogens. This expands the meaning of "agility." He taught people not to recklessly add bitter-cold herbs, seeking purity within agility. Even when adding ingredients, one must avoid complexity. For Yinqiao San (Honeysuckle and Forsythia Powder), a neutral acrid-cool formula, he added one ingredient, Scallion White, effectively recreating Congchi Tang (Scallion and Fermented Soybean Decoction), doubling its venting power without compromising purity.

In medication, he paid attention to proportion, maintaining principles within flexibility, emphasizing compatibility, and embedding variation within stability. He said: "Each disease has its characteristics; one must differentiate medicines carefully to ensure the medicine matches the syndrome precisely." Generally, using medicine is like using troops; precision is valued over quantity. His prescriptions were concise, usually six or seven herbs, sometimes two or three, rarely exceeding eleven or twelve. He opposed chaotic mixing, which might cancel each other out. Once, a student treated influenza by combining acrid-cool and acrid-warm herbs. He criticized this, saying: "Cold pathogens require acrid-warm herbs; warm pathogens require acrid-cool herbs. Using both indiscriminately leaves the cold pathogen cold and the warm pathogen warm; how can the disease resolve?" His dosages were very light. He often compared treating disease to rowing a light boat; with little effort, the journey is fast. He praised Li Dongyuan's Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), where each herb weighed only a few fen, yet significantly regulated the Qi mechanism of the Middle Jiao. Conversely, if dosages are too large, the medicine exceeds the disease site, doing harm rather than good. Zhang Zhongjing's Wuling San (Five-Ling Powder) was measured only by coin scoops. Certain herbs, such as Amomum Fructus (Sha Ren), Cardamomi Fructus (Dou Kou), and Myrrhae Resina (Ding Xiang), in small doses soothe the Spleen, resolve dampness, awaken the Stomach, and regulate Qi; in large doses, they dry the Stomach, damage fluids, and consume Qi. Currently, there is a tendency to increase dosages blindly when ineffective, without considering whether the error lies in drug selection or dosage. If doubling the dose remains ineffective, blaming the severity of the disease instead of recognizing prescription errors is misguided. He selected herbs with extreme caution, avoiding excess or deficiency. Following *Nei Jing*: "Whether toxic or non-toxic, there are fixed regulations. For highly toxic drugs, stop when six-tenths of the disease is gone; for commonly toxic drugs, seven-tenths; for slightly toxic drugs, eight-tenths; for non-toxic drugs, nine-tenths. Do not exceed these limits, lest you injure Zheng Qi." He believed that not only toxic herbs should not be abused, but also bitter-cold and warm-dry herbs should be controlled. Of course, "if there is a disease, there is no injury." When the disease exists, the medicine acts upon the disease. When toxic herbs are needed, one should not be overly cautious or afraid to use them, delaying treatment. But generally, with abundant TCM varieties, one can surely choose safe and effective options. He emphasized that the more complex the disease, the more precise the medicine. The key is to grasp the focus and hit the vital point. For collapse syndromes: Shenfu Tang (Ginseng and Aconite Decoction) for Yang collapse, Shenmai San (Ginseng and Ophiopogon Powder) for Yin collapse, Dushen Tang (Single Ginseng Decoction) for Qi collapse, and Danggui Buxue Tang (Angelica Tonifying Blood Decoction) for Blood collapse. Sometimes only one herb, at most three. Medicine is not valuable because of its price, but because it hits the target. The cost of medicine does not determine the efficacy. Even if expensive herbs are needed, substitutes can be found. *Benjing Fengyuan* records: Urial Horn (Yangjiao) differs slightly in nature and flavor from Antelope Horn (Lingyangjiao), but their effects are roughly similar. In rural areas, he also used Water Buffalo Horn as a substitute for Rhino Horn, with comparable efficacy. Additionally, his prescriptions were written clearly and neatly, specifying raw/processed forms, decoction order (first/last), ensuring no omissions, facilitating pharmacy identification and patient attention, avoiding errors. His style of purity was evident everywhere.

In summary, the late master's characteristics in prescribing were: agile with principles, not frivolous; pure without flaw, not rigid; wise and upright, flexible and simple. He treated patients better than relatives, with meticulous care, discussing the disease before the medicine, rigorously. He achieved the ability to treat severe diseases with light formulas and major illnesses with small prescriptions, gradually forming a medical style characterized by few herbs, small dosages, low cost, good efficacy, and practicality.

Summary

The late master was born in the late Qing Dynasty. After the establishment of the Republic of China, TCM was once abolished. With the liberation of the country, the nihilistic attitude of despising and discriminating against TCM was criticized, and TCM, a unique bloom of Eastern culture, was reborn. The Master generously took inheriting, developing, and cultivating talents as his mission, striving in medical, teaching, and scientific research practices, achieving great success.

His scholarly characteristics were diligence, perseverance, strictness, and application. He loved the TCM cause, diligently exploring this great treasure trove, but did not remain complacent or stick to conventions. He always attached great importance to ancient medical theories, yet proposed his own views with critical trust. His explanations of many theories were profound and distinctly original. He supported the integration of TCM and Western medicine, advocating the absorption of modern scientific knowledge to enrich, develop, and innovate Chinese medicine.

He was a clinician rich in practical experience. Tracing back to *Nei Jing* and *Nan Jing*, inheriting from Zhang Zhongjing, and drawing widely from various schools throughout history, he adhered to differentiation and treatment as the fundamental principle of clinical practice. He proposed that for internal injuries and miscellaneous diseases, the focus should be on differentiating deficiency/excess and cold/heat, while for external seasonal diseases, the focus should be on differentiating exterior/interior and cold/heat, concretizing the Eight Principles. He specialized in Internal Medicine, particularly Warm Diseases, discarding the sectarian disputes between Shang Han and Wen Bing schools. He analyzed the similarities and differences between Warm Diseases and Cold Damage, elucidating the two major methods of "Exterior" and "Venting" and the significance of "Preserving Fluids," making it clear and understandable. He was also proficient in Gynecology and Pediatrics, paying attention to the physiological and pathological characteristics of women and children. For gynecology, he focused on regulating Qi and nourishing Blood, soothing the Liver, and harmonizing the Spleen. For pediatrics, given the Zhi Yin Zhi Yang constitution, susceptibility to cold/heat and deficiency/excess, he emphasized defending against external pathogens and preventing food injury.

The late master's methods for treating diseases were comprehensive, flexible, and broad. Especially in prescribing, his light and pure approach seemed plain yet perfect, reaching the realm of handling heavy matters with light touch and perfection. His differentiation was accurate, prescriptions appropriate, herbs few, dosages small, costs low, and efficacy high, possessing a unique, practical medical style. In his later years, his prestige grew daily. Patients often traveled far and waited long, their conditions often critical or deviant. Rescue methods often involved warming Yang, securing collapse, and tonifying/supporting Zheng Qi. He valued both Classic Formulas and Contemporary Formulas, suitable for warming/tonifying and clearing/draining, never biased. A life of true reading and serious practice.

Recalling the Scholarly Experience of My Father, Mr. Pu Fuzhou

Pu Zhixiao

If Not a Good Minister, Then a Good Physician

My father was born in the 14th year of Guangxu (1888) in Xixigou, about five miles northwest of Zitong County Town, Sichuan. There were seven siblings, and my father was the eldest. At that time, the family's main source of income relied solely on my grandfather's medical practice, and the family家境 was relatively poor. When my father attended private school as a child, he had to rely on his grandmother's maiden family (the He family) for support. At fifteen, he began studying medicine with his grandfather and became a practicing doctor three years later.

In his early years of practice, my father was also very enthusiastic about social welfare causes. Zitong was barren and the people were poor. Once people got sick, they had no recourse. So, in 1935, he organized the Tongji Free Medical Clinic, providing free medical care to those who could not afford it. Later, he advocated establishing the Pingmin Education and Rehabilitation Factory. The Tongji Clinic operated until liberation, while the factory closed midway due to various reasons. In addition, he generously contributed to local public works such as building bridges and repairing roads, leading these efforts willingly, which is still praised today. Mr. Xue, a contemporary survivor, said: "Old Pu was benevolent throughout his life, establishing many charitable causes without seeking fame or position."

However, in the old society, relying solely on individual strength was impossible to save the vast population. My father had many practical plans, such as converting dry land in Xixigou to paddy fields and turning barren hills into orchards. Despite much effort, they were not realized. Particularly, the issue of collecting "rotten grain" awakened him. "Rotten grain" referred to public grain that could not be collected. Year after year, the number grew larger. Originally thinking that poor farmers could not pay due to natural disasters and human calamities, he organized manpower to verify and found that most were falsely reported by landlords to enrich themselves at the expense of the public. He resolved to handle this impartially. Unexpectedly, this action faced opposition from gentry, including threats and extortion. My father deeply felt the corruption and darkness of the current politics, so he closed his door to read and devoted himself to medicine. In spring 1955, upon returning to Zitong, he said: "In my youth, I modeled myself after Fan Zhongyan, wanting to contribute the strength of an ordinary man to society. Who knew that the only path I could walk was medicine!" This was a portrayal of his thoughts at that time.

Diligent Study, Devoted to Medicine