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Case 3, a male patient surnamed Dong. Upon observation, his complexion was pale, his expression was trance-like and scattered, his lips were cyanotic with alae nasi flaring (nasal flaring), his four extremities were cold and inverted (cold limbs), his back felt cold accompanied by aversion to cold. His head was dizzy and painful, the whites of his eyes were red, he felt thirsty and desired cold drinks but did not wish to swallow. This is what the *Neijing* (Classic of Internal Medicine) refers to as "the deeper the heat, the deeper the cold limbs" (Re Shen Jue Yi Shen). This pathological presentation belongs to a warm disease syndrome consolidated by dampness. It is urgent to employ acrid-cool herbs to dispel warmth, clear heat and diffuse turbidity, assisted by heavy doses of aromatic and acrid-dispersing agents to肃ify (clear and settle) the pathogen.

Prescription: Charred Schizonepeta Spike (Jiesui Tan) 1.5g, Fresh Rhizome of Acorus Tatarinowii (Xian Jiujie Changpu Gen) 12g, Stem of Patchouli (Guang Huo Geng) 9g, Raw Gypsum (Sheng Shigao) 30g (decocted first with Ephedra Herb/Mahuang 0.6g), Green Bamboo Shavings (Qing Zhuru) 15g, Hang Chrysanthemum and Chu Chrysanthemum each 9g, Fresh Imperata Rhizome (Mao Gen) and Fresh Phragmites Rhizome (Wei Gen) each 30g, Mint Leaf (Bohe Ye) 4.5g (added later), Cardamom Seed (Kou Ren) 1.5g, Roasted Kudzu Root (Wei Gegen) 1.5g, Fresh Lotus Root (Xian Ou) 30g, Honeysuckle Flower (Jinyinhua) 12g, Talc (Huashi) 12g, Gentian Root (Dan Cao) 9g, Stir-fried Gardenia Fruit (Chao Zhizi) 9g, One fresh Lotus Leaf (Xian Heye), Almond Paste (Xingren Ni) 9g (ground together with Perilla Seed/Suzi 4.5g), An Gong Niu Huang Wan (Pill) 1 pill (dissolved in decoction), Su He Xiang Wan (Pill) 1 pill (dissolved in decoction), Antelope Horn (Lingyang Jiao) 0.6g, and Rhino Horn (Xijiao) 0.6g (decocted separately and mixed in). Instructed to use watermelon juice and Chinese Pyrus Juice (Biqi Zhi) as substitutes for water.

The above were witnessed personally during my early years attending consultations with my late master. The three critical patients recovered quickly, and the memory remains vivid to this day; therefore, it is recorded here.

Appendix: Discussion on the Properties of Gypsum

(This text is a record of a lecture given by the Master before his death, noted by the author.)

Gypsum is a specific herb for cooling, reducing fever, releasing the muscle layer, and venting rashes. Generally, it is said to have an acrid-cool taste, but in reality, the taste of gypsum is salty with astringency; generally, it is believed to be greatly cold in nature, but in reality, its nature is cool and slightly cold. For both internal injury and external contraction diseases, if the condition truly belongs to heat, there is no case where it is unsuitable to administer gypsum. Alas, modern physicians, without investigating its properties, mistakenly believe it to be greatly cold and dare not use it. Consequently, patients seeing gypsum in prescriptions also fear it like tigers and wolves. Such errors spreading widely, becoming habitual without scrutiny, is a flaw that confuses me greatly and cannot be explained; it is like discarding jade liquid and abandoning golden elixir, leading to the inability to save patients, which is truly lamentable. I have examined its properties and tasted its flavor myself. The *Shennong Bencao Jing* (Divine Farmer's Materia Medica) states its nature is slightly cold and suitable for postpartum women, treating dry mouth, scorched tongue, and inability to breathe; this is one who truly understands gypsum. The *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet) and *Shanghan Lun* (Treatise on Cold Damage) use gypsum in eleven formulas, thereby expanding its use; this is one who truly understands gypsum. According to Zhang Zhongjing's method of using gypsum, he focuses on four aspects: irritability, thirst, wheezing, and vomiting. For example, in the Xiao Qing Long Tang (Minor Blue Dragon Decoction) pattern, where there is fluid retention in the epigastrium, lung distension, cough with qi rebellion, floating pulse, irritability, and wheezing, gypsum is added; the use of gypsum in Da Qing Long Tang (Major Blue Dragon Decoction) is also due to the presence of irritability; the use of Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is due to severe irritability and unrelenting thirst, dry tongue, and vexation; the use of gypsum in Zhu Pi Da Wan (Bamboo Peel Large Pill) is due to middle-jiao deficiency with vexation and confusion. These are methods of applying gypsum based on irritability. Generally, when yin qi is deficient and yang qi surges violently, this violent yang may gather in the stomach or invade the heart, generating irritability. Gypsum can transform this violent yang and resolve the accumulation in the stomach, thus treating irritability. The Bai Hu Jia Ren Shen Tang pattern mentions great thirst, severe irritability and unrelenting thirst, and desire to drink water. Although the Bai Hu Tang pattern does not explicitly mention thirst, stating "heat in the interior" implies thirst is present. These are methods of applying gypsum based on thirst. Generally, when warm-heat pathogens transform into fire and injure fluids, fluids fail to ascend, causing thirst. Gypsum can purge fire and moisten dryness, thus treating thirst. Yue Bi Jia Ban Xia Tang treats wheezing and lung distension by combining Pinellia Tuber (Banxia) with gypsum to break fluid retention and suppress sinking; Xiao Qing Long Tang plus gypsum treats irritability and wheezing; Mu Fang Ji Tang uses gypsum for wheezing and fullness; Ma Xing Shi Gan Tang uses gypsum for sweating and wheezing. These are applications of gypsum based on wheezing. Generally, the wheezing in these four patterns is due to heat in the middle jiao forcing qi upward. Using gypsum to resolve the heat in the middle allows qi to descend naturally, curing wheezing. The desire to vomit in Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) pattern, and the vomiting/reversal in Zhu Pi Da Wan pattern, are methods of applying gypsum based on vomiting. Generally, vomiting in these two patterns is caused by heat leading to deficiency and deficiency causing qi rebellion. Using gypsum resolves heat, qi calms naturally, and vomiting stops. Following Zhang Zhongjing's methods, administration is invariably effective.

For the herb gypsum, when encountering heat patterns, use it boldly. It can revive the dying, its merit is like gold liquid, achieving unexpected effects without risk of failure. If the dose is too small, efficacy cannot be expected; vulgar practitioners calcining it leads to many drawbacks. The explanation of gypsum by the modern scholar Zhang Xichun is not empty words; the criticism of gypsum by the Japanese physician Yoshitsugu Higashimura is indeed a piercing remark. I follow the great principles of the sages, refer to the refined discussions of later scholars, verify through clinical practice, and am familiar with the therapeutic capabilities of gypsum. Its heavy weight purges flaming fire; its light qi releases the muscle layer, generates fluids, relieves vexation and thirst, reduces fever, treats mania, and disperses excess heat from exterior contracted warm pathogens, allowing them to exit through pores. Its cool nature is not colder than other cooling herbs, but its heat-reducing effect far surpasses others. It is particularly effective for headache like splitting and high fever like fire in cold damage; it soothes the spleen and benefits qi; when evil heat is removed, the spleen is soothed and primal qi returns; it promotes lactation; when yang dryness is moistened, milk flows like a spring. It can also be used in surgery to treat ulceration of sores, removing rot and generating flesh; used orally to treat mouth and tongue erosion; it is a crucial herb for macules and rashes caused by stomach and lung heat. Other remarkable efficacies are too numerous to list, except that it is contraindicated in qi and blood deficiency patterns.

The Scholarly Spirit and Medical Achievements of My Late Master Pu Fuzhou

Gao Huiyuan

[Brief Biography of Pu Fuzhou] Pu Fuzhou (1888-1975), from Zitong, Sichuan. Three generations of medical practitioners, his grandfather was especially renowned. He inherited family learning at age fifteen and practiced independently in his hometown three years later. Later, he practiced medicine in Chengdu, gaining increasing reputation. After liberation, he was transferred to the China Academy of Chinese Medical Sciences in 1955. Devoting over seventy years to the cause of Traditional Chinese Medicine (TCM), his medical theory was profound and experience abundant. He excelled in internal medicine, gynecology, and pediatrics, particularly in treating warm diseases, offering unique insights in many fields of TCM academia, making him an outstanding contemporary TCM scholar and clinician. Busy with clinical duties throughout his life, he had no time for writing. In his later years, his disciples compiled and published works such as *Pu Fuzhou Medical Cases* and *Medical Experience of Pu Fuzhou*.

My late master Pu Fuzhou was an outstanding contemporary TCM scholar. Throughout his more than seventy-year medical career, he took revitalizing national medicine as his responsibility, meticulously studied medical theories, practiced diligently, worked conscientiously, and remained steadfast. His rigorous scholarly spirit and outstanding medical achievements were deeply respected by the medical community. Here, based on my shallow experiences studying under him, I briefly introduce his scholarly spirit and main experiences:

Rigorous Scholarship, Model for Our Generation

My late master had many characteristics in his scholarship, summarized as follows: First, emphasizing "Diligence." He was extremely hardworking in reading and thinking. Whenever it was dawn or late at night, the light on his desk would always turn on promptly, and he would read bent over his desk, tirelessly. He often said that at these times, his mind is clear and efficiency is highest, and secondly, there are no daytime distractions, allowing for concentrated energy. Thus, regardless of weather or seasons, he persisted in studying for four to five hours every morning and evening for decades without interruption. For the books he read, he also thought seriously, understood deeply, absorbed the essence, and discarded the dross, never being careless. He required the same of his students. He earnestly taught: Classic works must be read carefully and pondered deeply; theories of various schools should be broadly collected and absorbed; basic knowledge books should be read frequently and memorized firmly. Truly taking one step at a time, solidly understanding the books.

He never felt ashamed to ask questions of those below him in status. When in Zitong, admiring the fame of Elder Gong, he followed humbly for several years without ceasing. Elder Gong was deeply moved and, before passing away, transmitted to him the secret formula for internal eye diseases, Jiu Zi Di Huang Wan (Nine Seeds Rehmannia Pill). He extensively collected effective folk therapies, gathering them as he heard them. When interacting with famous figures in the medical field, he was always open-minded, good at using others' strengths to make up for his own weaknesses, and never harbored sectarian prejudices. He often said, "Learning involves both asking and studying; one must not only study diligently but also ask well. Only studying without asking cannot stimulate thought; only asking without studying cannot clarify principles." One must have the spirit of asking about everything to make progress in knowledge.

Second, persisting in "Perseverance." He believed that TCM theory is profound; without tenacious perseverance and the恒心 (perseverance) to learn until old age, it is difficult to master and comprehend. Every time he read a TCM document, whether a major work or a short essay, he insisted on being meticulous, starting from the beginning, word by word, chapter by chapter, draining the pond to catch all fish, leaving nothing omitted. Even after reading twice or thrice, he did not change this method. I followed my late master for seventeen years and saw with my own eyes that he systematically read the *Neijing*, *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold), *Waitai Miyao* (Secret Essentials from the Outer Cabinet), *Zhengzhi Zhunsheng* (Standard for Diagnosis and Treatment), *Zhangshi Yitong* (Compendium of Zhang's Medicine), and *Bencao Gangmu* (Compendium of Materia Medica) once each, and the *Shanghan Lun*, *Jinkui Yaolue*, *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases), *Wenre Jingwei* (Coordinates of Warm and Heat), *Hanwen Tiaobian*, *Shanghan Zhizhang* (Handbook of Shanghan), *Jinkui Yi* (Supplement to Jinkui), and *Yixue Xinwu* (New Insights into Medicine) twice. Without persistent and tenacious will, this would be impossible. He often said: Learning has no limits; every reading brings new inspiration.

Third, demanding "Strictness." He believed that whether scholarship is rigorous is not only a matter of scientific attitude but also an important methodological issue. He established three rules for himself: 1. Love reading, must seek thorough understanding. When seeing key points, take notes to deepen memory; when having doubts, repeatedly verify to ensure clarity. Do not be like Tao Yuanming picking chrysanthemums under the eastern fence (implying superficiality). 2. Teach cautiously, must be prepared. When lecturing on original texts, themes must be clear and arguments evidence-based; when analyzing, explain profound theories in simple terms to attract interest. Learn from Han Changli who transmitted the Way and resolved doubts. 3. Be cautious in clinical practice, must not be sloppy. When asking about illness, observe and recognize in detail to understand causes; in syndrome differentiation and treatment, be bold yet careful, addressing the main pathology. Emulate Sun Simiao, whose medical skills were proficient. I remember a consultation discussion for a severe case of epidemic encephalitis B. Colleagues analyzed: High fever burning to touch, chest and abdominal fullness, no bowel movement for three days, deep and rapid pulse, yellow and greasy coating, indicating purgation is needed. He strongly opposed this consensus, pointing out that although there was fullness, it was not firm; the pulse was not deep and solid but slippery at both chi positions; the coating was not old yellow but thick and greasy. Purging was not necessary; bowel movements would occur spontaneously. Just as we were seriously analyzing and opinions were converging, a nurse reported that loose stool had passed. Everyone present sighed in admiration. They praised his accurate diagnosis, attributing it entirely to his rigorous medical practice, not easily overlooking any symptom or pulse in distinguishing subtle details. This highly responsible style deserves to be learned and promoted.

His requirements for students were also extremely strict. I once treated a chronic nephritis patient with typical kidney deficiency symptoms, using Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Schisandra Berry (Wuweizi), Dodder Seed (Tusizi), and Goji Berry (Gouqizi). After seeing this, the teacher criticized me severely: "You only know how to use tonification methods, completely forgetting 'tonify without stagnation.'" This made me remember it to this day. Under the direct guidance of my late master, I compiled a book *Wenbing Shuyi* (Explanation of Warm Diseases). Before starting to write, the teacher warned: Any scientific monograph must have inheritance and creativity. Writing about warm disease theory, one must first inherit the academic experience and theoretical system already possessed by warm disease experts, while simultaneously absorbing modern achievements and personal practical experiences. The title could be *Shuyi* or *Jiyi*. During the compilation process, I consulted literature, selected materials, synthesized data, drafting, discussing, and revising simultaneously. For every chapter, my late master personally reviewed it, giving serious guidance, adding or deleting, carefully discussing and polishing. For example, whether arguments were correct, citations reliable, syndrome differentiation reasonable, treatment appropriate, language fluent and concise—all were meticulously corrected. He encouraged me not to fear difficulties, sparing no effort. Through six revisions and three drafts, I not only mastered basic writing skills but also improved independent scholarly ability, research ability, thinking ability, and written expression ability. This work reflects the characteristics of my late master's warm disease academic thoughts and poured much of his heart into it.

Finally, implementing "Application." He believed in applying what is learned and combining learning with application. If one only learns without applying, even with much reading, one is merely buried in piles of old papers. Even if expressing opinions, they are mostly mere textual studies, serving as footnotes for ancients. Therefore, he strongly advocated that learning theory is for using theory and developing theory. This is also the sophistication of his scholarship.

Exquisite Theory, Forming a Unique School

Premier Zhou Enlai once said multiple times: "Old Pu is a brilliant doctor and also understands dialectics." In just two short sentences, how high the evaluation! The reason my late master was brilliant mainly manifested in that he was both a clinician rich in practical experience and a TCM theorist who understood dialectical materialism. He praised Chinese medicine and pharmacology as part of the essence of Eastern culture, possessing its unique theoretical system. Classics such as the *Neijing* and *Shanghan Lun* are crystallizations of the TCM theoretical system with dialectics as its core, and must be seriously inherited and developed. He opposed the erroneous attitude of those who believe TCM has only experience and no theory, failing to cherish national cultural heritage. He also said that the basic theory of the *Neijing* is scientific; the *Shanghan Lun* follows the theoretical guidance of the *Neijing* to guide practice, summarizing and elevating the TCM theoretical system. This shows he had in-depth research and correct understanding of these two classics and made exquisite elaborations on some theoretical issues within them.

He cherished national medical classics, believed in their theoretical value, yet never stuck to outdated views or closed himself off. His interpretations of the *Neijing* did not fall into the rut of old commentators. For example, regarding the views on "Winter injury by cold leads to warm disease in spring" and "Winter failure to store essence leads to warm disease in spring," he broke away from the latent qi theory that cold pathogen acquired in winter causes warm disease in spring. Instead, drawing analogy from winter failure to store essence, he realized that those who lose consolidation in winter or suffer cold damage in winter must have deficient qi. Thus, when pathogens gather in spring, it is naturally easy to contract warm disease. How could cold pathogen remain latent for so long without causing disease, only emerging from winter to spring? Even explaining it via incubation period is forced.

Regarding the understanding that "treating disease must seek the root," he made in-depth elaborations, proposing several relationships in handling syndrome differentiation to seek the root:

(1) Syndrome differentiation to seek the root, correctly handling the relationship between local and whole.
Humans are unified organic bodies. Understanding the essence of disease is often more accurate from the whole perspective than from the local. Any local symptom of a disease is closely related to the whole; one cannot one-sidedly focus on the local while ignoring the whole. He treated a case of urinary retention and a case of urinary incontinence. From local symptoms, they were different, but from the whole perspective, both were due to deficiency of middle qi. Thus, symptoms are phenomena, while deficiency of middle qi is the essence. Therefore, both achieved the same effect using modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If one only sees urinary retention and uses diuresis, or incontinence and uses astringency, without seeking the root, one moves further from the classic principles.

(2) Syndrome differentiation to seek the root, correctly grasping the relationship between righteous qi and pathogenic factors.
The *Neijing* says: "When righteous qi exists within, pathogenic factors cannot interfere; where pathogenic factors gather, qi must be deficient." This explains that the process of occurrence, development, and outcome of human diseases is a process of struggle, victory/defeat, and waxing/waning between righteous qi and pathogenic factors. My late master proposed preventing disease early to maintain righteous qi; eliminating pathogens when diseased without injuring righteous qi. He instructed medical practitioners to pay attention to righteous qi as the foundation, mastering the dialectical relationship of supporting righteous qi to eliminate pathogens and eliminating pathogens to nourish righteous qi. If one only sees the disease and not the person, solely focusing on eliminating pathogens while ignoring righteous qi, it fundamentally deviates from the original meaning of seeking the root in treating disease.

(3) Syndrome differentiation to seek the root, correctly distinguishing the different emphases between internal injury and external contraction.
Eight Principles (Ba Gang) are an important guideline for TCM syndrome differentiation and treatment. My late master emphasized that for external contraction diseases, the focus is on differentiating exterior/interior and cold/heat. Because all acute febrile diseases, whether warm-heat or cold damage, initially have pathogens in the exterior and defensive level, releasing the exterior is the primary principle. Exterior cold is dispersed with acrid-warm herbs; exterior heat is vented with acrid-cool herbs. Timely treatment solves problems easily. If it transmits to the interior, or to Yangming, or enters the qi level, clearing heat and withdrawing fever is the correct treatment. For chronic internal injury diseases, the focus is on differentiating deficiency/excess and cold/heat. It is generally believed that miscellaneous diseases from seven emotions internal injury are mostly deficiency. However, there is also excess within deficiency, deficiency within excess, or great deficiency resembling excess, and great excess resembling deficiency, all requiring careful differentiation. One cannot uniformly classify them as deficiency syndromes. At the same time, internal injury diseases also have cold and heat, such as yang deficiency leading to cold and yin deficiency leading to heat, which are distinctly different from the cold and heat of external contraction diseases. These must be carefully distinguished and not treated uniformly. My late master's application of the Eight Principles theoretically highlights the different emphases between external contraction and internal injury, fully conforming to the purpose of seeking the root in treating disease, and deeply comprehending and elevating the true meaning of the *Neijing*.

My late master elucidated classic principles thus, and similarly elucidated theories of later physicians, often having creative insights.

Regarding the view "Yang is often in excess, Yin is often insufficient." He said, Danxi's establishment of this theory is worthy of doubt. Yang is qi and fire; is qi really in excess? Is fire really in excess? Then, since all zang and fu organs have yin and yang, which is yang in excess and which is yin insufficient? Moreover, when yin is balanced and yang is secured, spirit is governed. Once there is bias, disease must arise. How can it be that yang is often in excess and yin often insufficient, yet people do not get sick? According to the human body, it is not that fire is in excess, but that water is insufficient. This was the original intent of Wang Tai pu (Wang Bing). This viewpoint was not corrected until Zhang Jiebin. Writing books and establishing theories to teach future generations, little realizing that a single error in thesis can harm people. However, Danxi's creation of some yin-tonifying formulas, such as Da Bu Yin Wan (Great Supplement Yin Pill), is his important contribution.