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(3) The application of treatment principles possesses both principality and flexibility, with flexibility inherently residing within the principality. For instance, when treating a patient with a specific disease, there should be a fixed treatment method. However, if ten TCM physicians are invited to diagnose separately, they may prescribe ten different formulas. Although the herbs and formulas differ, if all were tried, they might each yield certain therapeutic effects. This can be termed "no fixed method." In reality, TCM treatment is not without standards; rather, under the guidance of certain treatment principles, it allows for diverse medication pathways and high flexibility. This is what is meant by "within the fixed method lies no fixed method," achieving the goal of curing the disease through different routes. This demonstrates that its flexibility does not deviate from the principality, i.e., "within the no fixed method lies the fixed method."

Therefore, if one can recognize and master the laws of these principles, holding the general outline allows one to manage complexity with simplicity, act from a commanding position, handle matters with ease, and apply them freely. A foreign playwright once summarized the performance style of Chinese opera as "free activity within rules." It seems this comment also applies to TCM. The so-called "rules" are the prerequisite for "free activity"; the more one masters the "rules," the freer one can be in "activity," which is the so-called "practice makes perfect." The reason why one can achieve "no fixed method within the fixed method" and ultimately cure diseases is precisely due to "the fixed method within the no fixed method."

(4) Mastering formulas rather than being mastered by them. The specific application of formulas must be conducted under the guidance of theory (Li) and principles (Fa). "Mastering formulas" means freely applying and controlling formulas without losing sight of theory and principles; otherwise, one will be controlled by the formulas and become "enslaved by formulas."

"Being enslaved by formulas" is a necessary stage for beginners. "Mastering formulas" relies on "being enslaved by formulas," and "being enslaved by formulas" needs to develop into "mastering formulas." How can one relatively complete this process of maturing from mechanically "being enslaved by formulas" to flexibly "mastering formulas"? I have two insights:

First, "medicine values diverse formulas," meaning one needs to familiarize oneself with various established formulas of predecessors. Familiarity does not mean rote memorization of herb names but deepening understanding through theory and principles. For every syndrome, at least five or more formulas should be firmly remembered. In clinical practice, one must adhere to "using formulas" (sticking to validated formulas) and avoid "piling up herbs" (randomly combining herbs). Generally, the four aspects of theory, principles, formulas, and herbs require comprehensive coverage. Among medical case records, *Xie Yinglu's Medical Cases* has a characteristic feature: "in prescribing and using herbs, it excels in selecting established formulas." At the end of each case, it attaches one or two established formulas upon which it is based, without bias toward classical or contemporary formulas. For beginners, this book is undoubtedly the best model of medical cases and is worth reading.

Second, when studying formula explanations from various schools, one should be good at comparing and analyzing to distinguish quality and follow the good. For example, regarding the indications for *Yupingfeng San* (Jade Windscreen Powder), *Chengfang Qieyong* states: "Treats incessant spontaneous sweating, Qi deficiency with weak exterior susceptibility to wind-cold." *Lantai Guifan*, however, claims: "For those where wind-pathogen lingers and does not disperse for a long time, even if there is incessant spontaneous sweating, it is suitable." Comparing the two, *Chengfang Qieyong* appears narrow and limited, becoming ordinary.

Whereas *Lantai Guifan*'s statement "treating wind-pathogen lingering and not dispersing" seems abstract, it actually grasps the key to applying this formula. Its brilliance lies in its broad scope; any disease that can be explained by lingering wind-pathogen can be treated, not limited to Yang deficiency with spontaneous sweating. Over many years, I have frequently used this formula with modifications to treat allergic rhinitis, bronchial asthma, chronic urticaria, neurodermatitis..., achieving certain effects. This illustrates that Xu Huixi's annotation "treating wind-pathogen lingering and not dispersing," though seemingly empty, is actually comprehensive and accurate, much more precise and concise than other books.

In summary, after forty-plus years of clinical practice, my achievements are few, and lessons numerous. Now, disregarding my inadequacy, I tentatively offer these shallow opinions. If inappropriate, I respectfully request correction.

Drawing Strength from All Schools, Walking One's Own Path

Qiu Xiaomei, Chief Physician of Gynecology, Zhejiang Provincial Hospital of TCM

[Author Profile] Qiu Xiaomei (1910–), from Hangzhou, Zhejiang. Engaged in TCM clinical teaching, treatment, and scientific research for over fifty years, specializing in gynecology, with considerable expertise in common menstrual, leukorrhea, pregnancy, and postpartum disorders. Author of *Selected Clinical Experience of Qiu Xiaomei in Gynecology*. Currently serves as Standing Director of the Zhejiang Branch of the China Association of Chinese Medicine and Deputy to the Zhejiang Provincial People's Congress.

I was born into a teacher's family and was frail and sickly in childhood. At eighteen, while attending high school at Hangzhou Hongdao Girls' Middle School, I had to drop out due to frequent epistaxis (nosebleeds) and rest at home. My father knew a little medicine. Neighbors often came to our home for remedies for minor ailments, and I saw many poor patients die tragically because they lacked funds for medical care and medicine. From myself to others, I deeply felt that "human life is of utmost importance, precious as a thousand gold pieces," and thus harbored the desire to study medicine, resolving to become a doctor who could relieve people's suffering. This was also my parents' long-cherished wish. Consequently, I became a disciple of Qing Hua, a famous old TCM physician in Hangzhou. At that time, the teacher was already in his eighties. After only five years of instruction, he passed away from stroke. From then on, while inheriting Teacher Qing Hua's legacy, I independently hung a plaque for "Chongde Pharmaceutical Bureau" inside Tongyi Hall Pharmacy in Guanqiao, Hangzhou, and continued to self-study medical texts. Initially focusing on pediatrics and gynecology, I later specialized in gynecology. To date, my fifty-year career in Huangdi's Yellow Emperor's Inner Canon medicine has reached my seventies. Truly, "achievements remain unestablished, while the setting sun suddenly flows westward." In the vast and profound ocean of our motherland's medicine, I have only picked up a few shells.

Reading Classics with Diligence, Deep Thought, Broad Learning, and Strong Memory

At the beginning of my apprenticeship, the teacher first gave me four books: *Yixue Xinyu* (Medical Insights), *Binhu Siyan Maijue* (Binhu Four-Character Pulse Rhymes), *Yaoxing Zongfu* (General Odes on Herb Properties), and *Tangtou Gejue* (Rhymes of Formulas). For three months, I did not see the teacher. When he finally came, we sat down, and he began questioning me while flipping through the books. For example: "What are the Four Essentials for Preserving Life and the Eight Methods of the Medical Gate?" I answered: "Preserving life requires attention to diet, caution against wind and cold, cherishing spirit, and guarding against anger; the Eight Methods are methods of treatment, namely sweating, vomiting, harmonizing, purging, dissipating, tonifying, clearing, and warming." He asked again: "Pulses have essential rhymes, treatments have established formulas, where are they?" I continued: "Pulses are divided into floating, sinking, slow, and rapid; the essence lies in the three characters: Stomach Qi, Spirit, and Root. Humans correspond to Heaven and Earth, and pulses must respond to the four seasons. Among the four seasons, Stomach Qi is the foundation. Spring strings, Summer surges, Autumn hairs, Winter stones. Where Stomach Qi generates, there is Spirit. Human pulses are like tree roots." Fortunately, during these three months, I did not slacken off. The teacher was relatively satisfied with my answers, saying, "It seems you are determined to study medicine." Then, the teacher asked me to play chess with him. After playing, he said, "Treating diseases and using herbs requires courage. From your chess playing, you show some courage." Only then did he formally accept me as a disciple. Afterwards, the teacher repeatedly warned me: "Studying medicine requires unwavering determination; where determination is weak, wisdom cannot reach. Reading requires diligence and tirelessness; thorough reading and deep thought will naturally reveal the meaning." During the five years of apprenticeship, I assisted in prescriptions by day and studied by night. At that time, besides requiring daily recitation of prescribed readings, the teacher set several thinking questions daily for me to answer, checking and correcting them strictly. In those days, studying medicine and reading was truly difficult, bearing the heavy burden of life. Forced by family poverty, I taught Chinese classes at an elementary school every afternoon to subsidize household expenses and buy books. Under a dim kerosene lamp at night, I often stayed until midnight or even all night. Those years, though hard, laid the foundation for my entry into the medical field. I not only read many medical classics and learned some clinical experience but, more importantly, cultivated the ability to seek knowledge in studying medicine.

Regarding reading medical classics, I believe one should start with *Neijing* (Inner Canon), *Nanjing* (Classic of Difficult Issues), *Shanghan Lun* (Treatise on Cold Damage), and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), then proceed step by step, extensively reading works from various schools. Studying gynecology shares the same foundation as internal medicine, but women's diseases are more numerous than men's due to special physiological conditions such as menstruation, pregnancy, childbirth, and nursing. Their temperaments are often prone to depression, leading to specific diseases within certain scopes. Therefore, their pathology, diagnosis, and treatment differ from general internal medicine. This is what is meant by "medicine is difficult, but treating women is even more difficult." The theories of gynecology in our motherland's medicine have ancient origins and are rich and abundant. I believe the following main classics must be studied diligently: The three chapters on women's diseases in *Jingui* specifically discuss gynecological diseases. "Discussions on Pulses, Syndromes, and Treatments of Women's Pregnancy Diseases" discusses symptoms such as bleeding during pregnancy, abdominal pain during pregnancy, and edema during pregnancy; "Discussions on Pulses, Syndromes, and Treatments of Women's Postpartum Diseases" proposes treatments for three syndromes—spasms, depression/dizziness, and difficulty defecating—and establishes treatments for postpartum abdominal pain, fever, vomiting, and dysentery; "Discussions on Pulses, Syndromes, and Treatments of Women's Miscellaneous Diseases" studies heat entering the blood chamber, Zang Zao (visceral agitation), amenorrhea, dysmenorrhea, metrorrhagia, urinary retention, yin sores, and vaginal blowing. The theories and formulas described in these three chapters serve as the standard for subsequent generations to treat and research gynecological clinical diseases. Chao Yuanfang's *Zhubing Yuanhou Lun* (Source Book of Diseases and Syndromes) describes 243 discussions on women's miscellaneous diseases, researching the sources of various diseases and the essentials of nine pulse diagnoses, making it the first specialized pathology book. Sun Simiao's *Qianjin Yaofang* (Essential Prescriptions Worth a Thousand Gold) dedicates six volumes to women's prescriptions, summarizing various miscellaneous diseases with organ Zang-Fu cold/heat/excess/deficiency as the general principle for formulating and dispensing drugs. Chen Ziming's *Furen Daquan Liangfang* (Great Good Prescriptions for Women) systematically summarizes gynecological diseases, believing that liver and spleen damage is the main pathogenesis of menstrual diseases. Xue Lizhai's *Xueshi Yi'an* (Xue's Medical Cases) emphasizes congenital and acquired foundations, advocating simultaneous tonification of the spleen and stomach. *Fu Qingzhu Nuke* (Fu Qingzhu's Gynecology) presents one case per disease and one formula per case, clearly categorized and concisely expressed, with unique experiences. *Ye Tianshi Nuke Quanshu* (Complete Gynecology of Ye Tianshi) thoroughly distinguishes regulating menstruation, promoting conception, protecting childbirth, and raising infants, clearly structured; although symptoms vary endlessly, it handles them with ease, truly being the treasure raft of gynecology. For those aspiring to study gynecology, these medical works must be read thoroughly, scrutinizing key points word by word. The ancients said: "Books on the desk should be few, books in the heart should be many." This is particularly important for students of medicine. Regular reading accumulates desk books into the heart; in clinical application, it is like retrieving items from a bag, accessible at hand.

Searching Widely and Encompassing · Humble Request for Advice

*Xueji* (Record of Learning) says: "Learning alone without friends leads to ignorance and narrow-mindedness." Studying our motherland's medicine and delving into classic works relies on teachers' education and guidance, requiring a humble spirit, willingness to take anyone knowledgeable as a teacher, especially seeking advice from learned contemporary doctors. In the past, Sun Simiao would travel thousands of miles to submit to decisions from anyone who excelled in one aspect; Fu Qingzhi regarded stable hands, farmers, and commoners as both friends and teachers. Remembering the excellent academic style of ancient medical masters—"regardless of nobility or baseness, age or youth, where the Dao exists, there the teacher exists"—is greatly beneficial to one's studies.

In my early years while sitting in Tongyi Hall Pharmacy, I often squeezed time to watch medicines being weighed and mixed in the shop, learning to observe the weight of herbs used by famous doctors, the compatibility of Sovereign, Minister, Assistant, and Courier, and paying special attention to rescue formulas for critical patients. With any slight insight, I recorded it in a notebook named *Qinji Mianwang Lu* (Record of Diligent Memorization to Avoid Forgetfulness). Meanwhile, I consulted pharmacists about the raw and cooked distinctions of herbs, processing differences, and for uncommon herbs, carefully distinguishing their aroma and flavor. One day, seeing a leather sachet, an old pharmacist told me: "This is Musk. Its aromatic penetrating power is extremely strong; smelling it causes dizziness." To accurately understand its properties, I intentionally smelled it with my nose. Indeed, I immediately felt dizzy and wanted to fall. From this, I gained experience in identifying genuine vs. fake Musk and realized that for herbs with overly potent properties, dosage must be handled with extreme caution and never taken lightly.

I was fortunate to practice clinically with Ye Xichun, a famous old TCM physician in Zhejiang. Master Ye's exquisite and unique medical skills provided me with many valuable inspirations. For example, treating deficiency-cold dysmenorrhea, the routine approach uses *Wenjing Tang* (Warm the Menses Decoction). This formula is mostly effective, but sometimes ineffective. Master Ye did not stick rigidly to established formulas but decisively and boldly prescribed *Guizhi Tang* (Cinnamon Twig Decoction) plus Rougui (Cinnamon Bark). This was Master Ye's innovation, and its efficacy was indeed more significant and stable than *Wenjing Tang*. I reasoned that his heavy use of the two Cinnamons aimed at assisting Yang and tonifying to expel cold and invigorate blood, a method of warming the cold. Master Ye's selection of herbs and formulation was ingenious, with specialized usage and heavy dosages, emerging like a sudden force and establishing a unique school, giving me immense enlightenment. As the Southern Qi famous doctor Chu Cheng said: "Using medicine is like using soldiers; using a doctor is like using a general. There are no incurable diseases in the world, only doctors who are bad at treating them; there are no irreplaceable herbs in the world, only people who are bad at substituting them." I feel that a good doctor should have courage and insight, be strategic, and dare to express independent views. For instance, a woman pregnant for seven months had persistent high fever. Our hospital's internal medicine department performed an abortion, but the fever did not subside. She was referred to me for consultation. Seeing the patient sweating profusely, there was a risk of Yin and Yang separation, and her life was in imminent danger. At this moment, I believed the patient had mixed excess and deficiency. One must first support the Righteous Qi before dispelling the Pathogenic Factor; if Righteous Qi is not supported, the Pathogen cannot be expelled. I proposed urgently using *Dushen Tang* (Single Ginseng Decoction) for rescue, prescribing Biezhi Shen (Korean Red Ginseng) 6g, to be taken for three doses. Using Ginseng for a high-fever patient seemed inappropriate, causing opposition and doubt initially. It was decided to try one dose first. After taking it, the sweating stopped, and the fever subsided. Taking two more doses, followed by clearing-heat agents, she finally turned from critical to safe.

Daring to Question Antiquity and Innovate Bravely

Inheriting and developing our motherland's medicine requires learning from antiquity without being bound by it, not confined to one-sided views, not clinging to one school's words. Based on drawing strengths from all schools and integrating analysis, one should be good at adapting and daring to forge one's own path. Southern Song famous doctor Chen Ziming, for women suffering from Zang Zao sadness, prescribed Dazao Tang (Jujube Decoction), "matching symptoms with herbs, cured in one dose." Modern menopausal syndrome and adolescent tension syndrome belong to the category of Zang Zao diseases. In my clinical practice, I also adopted Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) but found that many cases did not achieve satisfactory results. To explore new paths, on one hand, I continued to study ancient medical classics, seeking roots theoretically. *Suwen: Shanggu Tianzhen Lun* (Plain Questions: Discussion on the Heavenly Truth of Ancient Times) states: "At fourteen, Tian Gui arrives, the Ren Mai becomes patent, and the Taichong Mai becomes vigorous." This indicates that at age fourteen, the Chong and Ren meridians gradually become vigorous, menstruation occurs regularly, marking the onset of menarche. At this time, Qi and Blood are insufficient, Liver and Kidney are deficient, and Yin and Yang are unbalanced, making irritability prone around menstruation. *Suwen: Shanggu Tianzhen Lun* also states: "At forty-nine, the Ren Mai is deficient, the Taichong Mai declines, and Tian Gui exhausts." This indicates that around age forty-nine, the function of the Chong and Ren meridians is in a transitional period of gradual decline, making bodily balance prone to imbalance. Clarifying the pathology and etiology, on the other hand, comprehensively analyzing clinical cases revealed that patients were mostly of the Yin deficiency with Liver hyperactivity type. Understanding this, I believed the treatment should focus on calming the Liver, tranquilizing the mind, subduing Yang, and nourishing Yin. After a period of exploration, I created "Erchi Anshen Tang" (Two Teeth Calming Spirit Decoction: Qinglongchi [Dragon Tooth], Zi Beichi [Purple Conch Tooth], Lingcishi [Magnetite], Fushen [Poria with Wood]), aiming to nourish Heart Spirit, open orifices, calm fright, and guard the Spirit. Clinically combined with Ganmai Dazao Tang, the efficacy was significant. For example, a nineteen-year-old young woman developed mania after drinking alcohol due to stimulation, with unclear consciousness, shouting and cursing randomly, even burning things. She was treated at Shaoxing Psychiatric Hospital with Chlorpromazine, Diazepam, and Thioridazine, with slight improvement. After discharge, taking two placenta pieces caused relapse. She was subsequently admitted to Huzhou Psychiatric Hospital, received electroconvulsive therapy four times, took increased doses of Chlorpromazine, etc., hospitalized for four months with apparent improvement, but relapsed ten days after discharge. Later diagnosed at Shanghai Psychiatric Hospital as "Menstrual Psychosis" (onset 7-10 days before menstruation until 4-5 days after cleaning), controlled with contraceptives. When visiting our outpatient clinic, the patient had confused speech, unpredictable crying and laughing, headache, irritability, mental fatigue, phlegm sound in throat, fixed gaze, malar flush, wiry-thin pulse, thin coating, red-purple tongue body. Syndrome differentiation: Yin deficiency with Yang hyperactivity, Spirit not abiding in its residence. Thus, I prescribed Erchi Anshen Tang plus Danggui (Angelica Sinensis), Chuanxiong (Szechwan Lovage Rhizome), Chishao (Red Peony Root), Zelan (Dewberry Herb), Yimucao (Motherwort Herb), taken for three doses. Second visit: Speech clearer, consciousness quieter, able to sit for a while, dream sleep hazy, phlegm difficult to cough out, headache and irritability intermittent, bitter taste, dry lips, scanty yellow urine, lower abdominal distension/pain indicating impending menstruation. Modified previous formula replacing Chuanxiong with Jiangcan (Bombyx Batryticatus), instructed to continue for five doses. Third visit: Menstruation arrived, bright red color, small amount with slight clots, sleep relatively peaceful, speech clear and responsive, headache and abdominal pain disappeared, appetite slightly improved, instructed to stop all Western medicines, take Erchi Anshen Tang plus Huangqin (Scutellaria Baicalensis), Huanglian (Coptis Rhizome), Huaixiaomai (Common Wheat), Zhigancao (Honey-fried Licorice), Hongzao (Jujube), advance ten doses. Subsequently continued the previous formula for forty-five doses. Menstrual cycle returned on schedule, color and volume normal, all upper symptoms disappeared, and she could participate in light labor. Over decades, drawing on collective strengths and adapting ancient methods, I have successively summarized and organized twenty-eight effective empirical formulas, including Erchi Anshen Tang.