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Thermal Disease Balanced and Corrected

— A Re-examination of the Theory and Practice of the Warm Disease School

By Chai Zhongyuan

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Preface by Professor Jiang Chunhua

Mr. Chai Zhongyuan recently asked me to write a preface for his book *Thermal Disease Balanced and Corrected*. I therefore wrote: Mr. Chai's academic thought advocates "a hundred schools of thought contending," opposing the hegemony of a single school. He is concerned that the medical field has been dominated by the Ye Tianshi (Ye Gui) school for nearly two centuries, and currently permeates the whole country, with medical colleges and universities revering Ye as their ancestor. It seems as if the development of medicine reached its peak with Ye, and that only Ye is uniquely correct and error-free. If this mindset is not broken through, academic progress is unlikely. I highly agree with his words. The opening of Ye Tianshi's *Treatise on Warm Pathogens* states, "Warm pathogens enter from above, first attacking the Lung; in severe cases, they reverse-transmit to the Pericardium." This resulted from a misunderstanding of the theory of Yuan Ti'an from the Ming Dynasty. Yuan originally stated that pathogens of the four seasons attack specific areas: Wind-Warmth in spring first attacks the Lung, while pathogens in summer, autumn, and winter have their respective targets and do not necessarily enter from above to attack the Lung. Yuan established mild acrid-cool formulas (light and clear formulas with acrid-cool properties) specifically for warm pathogens located in the upper body, not as a general method for treating all seasonal diseases. Ye mistakenly treated it as a universal method for all warm diseases, which is why its harmful influence spread widely. Today, Mr. Chai has extensively collected discussions on both Warm Diseases and Cold Damage (*Shanghan*) to compile *Thermal Disease Balanced and Corrected*, placing Ye's learning alongside other schools' learning, measuring and correcting them. This provides those engaged in this field with the correct path, contributing to people's health. I am pleased to write this preface as follows.

First Medical College of Shanghai, Jiang Chunhua

June 1984

Preface by Researcher Xiong Liaosheng

Mr. Chai Zhongyuan is a distinguished talent in the medical field, intelligent and eager to learn, unashamed to ask questions of those with lower status. Over recent years, his books *Analysis of Jingyue's New Formulas* and *Research on Kidney Treatment* sought opinions from various parties and have been published successively, receiving high praise from readers. This year, he compiled a collection of modern scholars' theories on warm diseases, adding his own insights, titled *Thermal Disease Balanced and Corrected*. I read it with joy and said: The dispute between Cold Damage and Warm Disease theories has been obscure and blocked for over two thousand years, with confused voices everywhere. To balance and correct it, and to say what others have not said, requires true knowledge and penetrating insight. Otherwise, how could one achieve this? The teachings of Qibo, Huangdi, and Zhang Zhongjing can now be made clear to the world! The publication of this new book will surely promote the contention of a hundred schools and revitalize Traditional Chinese Medicine (TCM). I have high hopes for it, so I happily write this preface to inform readers.

Chongqing Institute of Traditional Chinese Medicine

The eighty-year-old Xiong Liaosheng

June 10, 1984, at Jilu, Yuzhou

Preface by Deputy Director Wang Xu'ao

Scientific progress lies in academic prosperity; academic prosperity depends on academic democracy. As long as different academic viewpoints exist, different academic schools must arise. Academic contention among different schools enlivens the academic atmosphere and promotes the development of medical science. The rise of philosophers during the Spring and Autumn and Warring States periods, and the contention of a hundred schools, promoted the rapid development of China's science and culture. In the Jin and Yuan dynasties, the academic contention among Liu Hejian, Li Dongyuan, Zhang Zihe, and Zhu Danxi had a huge impact on the development of medicine in the Ming and Qing dynasties. The continuation of the contention of a hundred schools promotes the emergence of updated and more complete medical theories and schools; it is the driving force of scientific development and an important condition for medicine to move forward.

Every achievement in any discipline is limited by its era and cannot be perfect. Even for the Warm Disease school of the Ming and Qing dynasties, which was once extremely prosperous, while we see its important academic achievements, we must not ignore certain shortcomings and deficiencies. Applying the dialectical materialist viewpoint of dividing things into two aspects, taking the essence and discarding the dross, and inheriting critically, is the correct stance we should adopt towards our motherland's medical heritage. Academically, we must advocate the contention of a hundred schools, convince people with reason, and test truth with practice. Through discussion, evaluation, analysis, and exploration, we can distinguish right from wrong to achieve the goal of improving the academic level of TCM. All abusive criticism, sectarian views of "masters and slaves," factional thoughts of supporting one's own side and attacking others, historical nihilism, and erroneous viewpoints denying everything absolutely cannot replace true academic contention nor promote the forward development of TCM academia.

This summer, I was fortunate to read Comrade Chai Zhongyuan's new book *Thermal Disease Balanced and Corrected*. I deeply feel that Mr. Chai has profound medical knowledge and substantial practical experience. Particularly regarding exogenous febrile syndromes (Zheng), he has unique insights and novel ideas. The book traces back and searches broadly, collecting previous scholars' theories, extracting key points, and freely expressing the author's views. It extensively criticizes the Warm Disease school, such as Ye Tianshi in the Qing Dynasty. The writing is sharp, and the insights are novel, which undoubtedly helps promote academic contention and enliven the academic atmosphere.

For nearly a century, the Warm Disease theory of the Ye school indeed occupied an important position in China's medical field. There were many who echoed common theories and many who followed others' clamor, but few who criticized current evils or demanded change. Academic viewpoints holding different opinions from the Ye school have gradually become unknown to later generations. The author, aiming to "make a small contribution to promoting the contention of a hundred schools and playing a role in enlivening the academic atmosphere," collected the theories of Lu Jiuzhi, Yun Tieqiao, and others. Through introduction, evaluation, inspiration, and exploration, it truly inspires students, broadens horizons, and reveals the secrets of predecessors. I shamefully admit my shallow knowledge and half-understanding of Cold Damage and Warm Disease theories. Reading this book refreshed my mind and ears, and I benefited greatly. This book has certain reference value for further studying exogenous febrile diseases, the origins, occurrence, development, and interrelationships of Cold Damage and Warm Diseases. The author's method of organizing the motherland's medical heritage undoubtedly plays a positive role in promoting the development of TCM. Having these views after reading, I wrote this preface.

Guyue Wang Xu'ao

July 1984, Hangzhou

Self-Preface

As Xie Songmu said: "There are many sects in Warm Disease theory, not just a few families like Ye and Wu. Ancient theories expounding on Warm Diseases often existed outside Ye and Wu. The Warm Diseases of Ye and Wu are merely a part of Warm Disease theory and are insufficient to represent the entirety of Warm Disease theory." Yet, when modern people discuss post-Qing dynasty TCM regarding exogenous febrile diseases, they open with Ye and Xue, and close with Wu and Wang, as if only the Ye-Wu school exists!

History proves that to promote the development of scientific undertakings, one should advocate "the contention of a hundred schools" and avoid "revering only Confucianism." Whenever and wherever, in any field, if the study of one family or school occupies a ruling position academically for a long time, there are many drawbacks. TCM is no exception. "Contention of a hundred schools" leads to the revival of medical arts; "revering only Confucianism" leads to ideological rigidity. This is an inevitable law. However, the Ye school's theory has almost dominated TCM research on exogenous febrile diseases for nearly two centuries! Some have pointed out: Due to the Ye school's long-term dominance of the medical field, contemporary physicians habitually used light and clear methods without regard for treatment results. This drawback became an invisible trend over a hundred years ago. Lu Jiuzhi, witnessing this disaster, vigorously wrote *Shibu Zhai Yi Shu*. Although his language may be somewhat extreme, it is truly a good medicine for saving the times. Others believe that contemporary physicians' frequent misdiagnoses and repeated mistakes, along with a stagnant academic atmosphere and rigid academic thought, show that the drawbacks of the late Ye school have already caused infinite harm. Of course, people within the Ye school firmly deny such statements, viewing them as attacks, and thus oppose them fiercely. But this at least shows that evaluations of the Ye school's warm disease theory differ, and disputes exist, which is an objective reality.

In the past thirty years, the "Two Hundred Flowers" policy has always been advocated, but medical works criticizing the Ye school are rarely reprinted. Medical articles criticizing the Ye school are hard to come by. Coupled with the fact that the unified textbook *Warm Diseases* for national higher medical institutions reveres Ye and Wu's learning, academic viewpoints criticizing Ye school physicians have gradually become unknown to later generations. The TCM community turns a blind eye to this, allowing "advocating 'contention of a hundred schools' verbally, but 'revering only Confucianism' in practice" to become an accomplished fact. This is truly undesirable.

Perhaps someone might say: In 1978, Professor Jiang Chunhua clearly published an article criticizing Ye's theory in the *New Medicine and Pharmacy Journal* and conducted discussions. But dropping a stone in still water is not like a raging torrent. Under the historical conditions where medical journals across the country published a large number of articles containing Ye school viewpoints, Professor Jiang's work can only be described as rare feathers and horns, footsteps in an empty valley. It is difficult to serve as evidence for the grand occasion of "contention of a hundred schools and blooming of a hundred flowers." When Professor Jiang's article came out, the medical world was abuzz, yet contemporary physicians did not forgive him. Therefore, rather than saying this event reflects the TCM community's seriousness in implementing the "Two Hundred Flowers" policy, it is better to say it reflects how solid the current ideology is that regards the Ye school theory as the orthodox lineage of physicians and views criticisms of Ye as heterodox paths!

Yun Tieqiao said: "The distinction between Warm Diseases and Cold Damage can be called the crux of TCM. The medicine of the Ming and Qing dynasties only spun around this issue. Sectarian views and the rise of erroneous theories all started here. Works filled libraries, yet medicine remained obscure and blocked." I believe the situation of modern medical history is not entirely so; Yun's words stem from indignation. But one thing can be confirmed from this: At Yun's time, many physicians were dissatisfied with the status quo and demanded change. They hoped to eradicate erroneous theories, excavate predecessors' experiences, discard the dross, take the essence, absorb new knowledge, integrate thoroughly, open new paths, and achieve new progress in the field of exogenous febrile diseases. Yun's school fiercely countered the abolitionists, severely criticized current evils, revered classical studies, and advocated the integration of Chinese and Western medicine. Their purpose was to revive the declining lineage of Qibo and Huangdi and carry it forward.

The Ye school theory is a product of a specific era and cannot be perfect. Viewed through today's eyes, in fact, there are many flaws. Plus the drawbacks of its late followers, it naturally attracts dissatisfaction from physicians demanding change. Thus, following Lu Jiuzhi, famous experts standing on the opposite side of the Ye school theory to study exogenous febrile diseases once surged like wind and clouds, with no lack of people. They wrote books and established theories, raised banners in academic circles, set up separate gates against Ye, Wu, and others, competing to show off their beauty, thereby igniting the famous Cold-Warm controversy. Physicians like Lu Jiuzhi, Yun Tieqiao, and Zhu Weiju, a batch of physicians collectively classified by modern people as belonging to the Cold Damage school, and Warm Disease physicians like Liu Baoyi, under the historical condition of "medicine takes Ye's theory as its ancestor, and the whole world follows the same style," did not echo common theories nor follow vulgar trends. Targeting the Ye school theory, each expressed their own views and refuted them, proposing many unique new insights. This greatly enriched TCM research on exogenous febrile diseases and also promoted the development of the contention of a hundred schools, which undoubtedly played a positive role in modern Chinese medical history. Unfortunately, in the past thirty years, due to the aforementioned reasons, scholars of this school were often slandered by others as conservative factions who defend old ways and hinder the development of TCM. Their academic thoughts, distorted to varying degrees, are no longer truly understood by later generations. Whether the serious situation of "lack of successors and skills" in the TCM community now is related to this problem is well worth our deep reflection. An ancient poet wrote: "The vitality of the nine provinces relies on wind and thunder; it is sad that ten thousand horses stand mute. I advise the Lord of Heaven to shake himself again and send down talents without sticking to one pattern." I believe that if our TCM community wants to strive for self-improvement, revitalize and rise, and create a new situation for great development, it must first "have philosophers rise and a hundred schools contend," breaking the stagnant air caused by one family or school occupying the ruling position in the medical field for a long time.

Physicians of the past Cold Damage school, seeing that Ye had been worshipped as an idol for a long time, and disliking that members of that school revered Zhongjing while outwardly complying but inwardly violating, mostly utilized Zhongjing's prestige. By elucidating his learning, they refuted and attacked them. Members of the Ye school, however, were quite sensitive to such attacks. On one hand, they enthusiastically praised Ye's theory even more; on the other hand, they seized upon the weak point of some members of the opposing school advocating classical studies and advocating excessive treatments, accusing them of "restoring the past" and excluding them. Recently, some have claimed that Ye school medical works are also classics of TCM, and criticizing their books is forgetting one's ancestors. I say that if one must float with the tide, keep silent, and avoid the suspicion of "defending old ways" and "forgetting ancestors," then the whole world will continue to sing in tune, unable to distinguish wheat from weeds. This would not only be greatly detrimental to the prosperity of TCM but also cause infinite harm to patients. Zhongjing and Tianshi certainly made outstanding contributions to Chinese medicine, and their innovative spirit is particularly valuable. However, we should only give them a certain historical status using a historical materialist viewpoint. We must not bow down to the feet of ancients because of this. We must know that worshipping authority, following old routines, adhering to prejudices, and being arrogant are huge inertial forces hindering the development of TCM. They have always prevented people from exploring truth and obtaining true insights. Great men are not saints, and classics are not heavenly books. If one clearly sees flaws in their learning, why remain silent and forbid speaking! I am deeply dissatisfied with this and have the views mentioned above. Therefore, not presuming my shallow knowledge, I collected previous scholars' theories, introduced, evaluated, inspired, and explored them, freely stating my own views, compiling them into a collection named *Thermal Disease Balanced and Corrected*. I hope to refresh the minds of future readers. If this can make a small contribution to promoting the contention of a hundred schools and play a role in enlivening the academic atmosphere, even if contemporary physicians do not forgive me for this, what excuse do I need! As soon as the manuscript was completed, it was sent to Professor Jiang Chunhua of the TCM Group of the State Science and Technology Commission and Researcher Xiong Liaosheng of the Chongqing Institute of TCM for review. At that time, both elders were in poor health. I am indebted to them for writing prefaces for this small book while ill. I am also grateful to Deputy Director Wang Xu'ao of the Zhejiang Provincial Health Department for taking time to write a preface. This added brilliance to the small book. With the support of the County Association for Science and Technology and the County Health Bureau leadership for printing, this book could meet more readers sooner. At this moment of completion, I attach a few words to record the support of senior leaders and to express the author's sincere gratitude!

Written by Chai Zhongyuan of Shangyu at his residence on Longshan, Baiguan

Summer of the Jiazi Year

Volume One: Introduction and Evaluation of Physicians and Medical Works; Initial Exploration of the Origins of Physicians Criticizing the Ye School Theory

TCM research on exogenous febrile diseases flourished greatly in the late Qing Dynasty. At that time, there were many schools, among which the Ye-Wu school had the greatest influence. It is unnecessary to hide the fact that this school deliberately constructed theories in the field of exogenous febrile diseases, desiring to stand shoulder-to-shoulder with Zhongjing's theory. Precisely because of this, it attracted the dissatisfaction of many scholars studying Cold Damage. They believed that the Ye school theory had many theoretical flaws and its therapeutic effects were not impressive. Relying on this to confront Zhongjing's theory was arrogant. Witnessing current evils, and given the specific historical condition at that time when abolitionists fiercely attacked *Treatise on Cold Damage*, they proposed counter-criticisms and launched attacks, thus igniting the Cold-Warm controversy. For academic development, carrying out the contention of a hundred schools and expressing views freely is undoubtedly a good thing. This article intends to trace the sources and analyze the flow of physicians who had objections to the Ye school theory, making a brief exploration. However, some important physicians, such as Lu Jiuzhi, have special articles dedicated to their introduction and evaluation, so this article briefly mentions them. Readers can refer to the following text.

Exploring the Sources

I. The Initial Period of Criticizing the Ye School

The earliest person to criticize Ye's theory was Xu Dachun (1693-1771) from Wujiang. Xu's courtesy name was Lingtai, also known as Daye. In his later years, he lived in seclusion at Huixi, hence his pseudonym Old Man of Huixi. He was famous alongside Ye Gui and was a renowned physician of the Qing Dynasty. He had rich experience and was knowledgeable and talented. He authored *Discussions on the Origins of Medicine*, *Commentary on the Classic of Difficult Issues*, *Record of Hundred Kinds of Shen Nong's Divine Farmer's Materia Medica*, *Cautious Words on Illness*, *Classification of Cold Damage Formulas*, and *Lantai Guideline*, among others. His scholarship possessed a critical spirit. Besides writing *Critique of Medical Continuity* to specifically attack Zhao's learning, he also carefully commented on *Orthodox Manual of External Diseases* and *Clinical Guide*. His commentary on the *Guide* contained both praise and criticism. Although criticism outweighed praise, his arguments were balanced and generally appropriate, making them acceptable to those within the Ye school. This is why Xu's commented *Clinical Guide* circulated widely under the historical condition where Ye school physicians dominated the medical field, while it was actually difficult to find copies without Xu's comments.

Ye and Xu were contemporaries, though Xu was younger. Someone within the Ye school discussed Xu's commentary on the *Guide*, saying it "although has minor irrational remarks, cannot cover its overall excellence." This merely complained about some wording, implying a lack of respect for seniors, but basically held a positive attitude towards the criticism. Only Wang Mengying, in order to maintain the dignity of Ye's theory, refuted Xu, listing items he considered inappropriate in the commentary. However, the number was very small, showing that there were few points in Xu's criticism that could be nitpicked.