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Zhang Jingyue believed: "All cases of warm diseases and heat diseases caused by external pathogens originate from cold, which is what modern physicians refer to as Shanghan (Cold Damage)." "When treating Shanghan, if the climate is cold and internal Yang Qi (Vital Energy) is weak, with no internal heat pathogen but the exterior syndrome remains unresolved, it is appropriate to use acrid-warm-hot formulas to disperse it. If the climate is hot and internal Fire Qi is abundant, while the exterior syndrome remains unresolved, it is appropriate to use acrid-sweet-neutral formulas to disperse it."⑤ "Chaihu (Bupleuri Radix) has a nature that excels in draining and dispersing, thus greatly promoting sweating," "Those who use Chaihu utilize its cool-dispersing property."⑥ "If used appropriately, it yields excellent results for all meridians."⑦ Based on this understanding, Zhang Jingyue formulated various prescriptions within the 'San Zhen' (Dispersal Array), using Chaihu (Bupleuri Radix) as the principal herb. For instance, if the pattern suits cool dispersal, he combined it with Huangqin (Scutellariae Radix), Shaoyao (Paeoniae Radix), etc., to create Yi Chaihu Yin (First Bupleurin Decoction), "suitable for initial invasion of the Six Meridians where both interior and exterior present heat"; if the pattern suits warm dispersal, he combined it with Xixin (Asari Radix), Shengjiang (Zingiberis Rhizoma Recens), etc., to create Er Chaihu Yin (Second Bupleurin Decoction), "suitable for pathogenic factors invading the Three Yang Meridians or concurrent Three Yang diseases where cold predominates, and also usable for initial invasion of the Three Yin Meridians."⑧ If the pattern suits neutral dispersal, he combined it with Fangfeng (Saposhnikoviae Radix), Chenpi (Citri Reticulatae Pericarpium), etc., to create Zheng Chaihu Yin (Regular Bupleurin Decoction). These examples illustrate that Zhang Jingyue did not restrict the use of Chaihu (Bupleuri Radix) solely to the Shaoyang (Lesser Yang) meridian, but also employed it to treat warm diseases. Zhang Zhicong criticized the view that "Chaihu should not be used when the disease is in the Taiyang (Greater Yang) meridian," stating, "Chaihu (Bupleuri Radix) is a herb that reaches outward from the Taiyin Earth Soil and Yangming Central Soil to the Taiyang meridian. Therefore, in Zhongjing's *Shu Bing Lun* (Treatise on Acute Diseases), it is stated that if Shanghan or Wind Strike does not resolve from the exterior, and Taiyang Qi rebels in the Central Soil, unable to pivot and move outward, Xiao Chaihu Tang (Minor Bupleurin Decoction) is used to convey Taiyang Qi to the muscle surface. This indicates that Chaihu (Bupleuri Radix) is not the primary herb of the Shaoyang meridian. Later generations claimed that using Chaihu for Taiyang diseases draws the pathogen into the Shaoyang meridian; this is baseless talk."⑧ Tang Yingchuan also wrote *On Chaihu*, criticizing Li Shicai's views, saying: "Chaihu (Bupleuri Radix) has indeed not been fixed as a Shaoyang herb," "I have used it for mild cases of initial wind-pathogen invasion and for chronic conditions where pathogenic factors linger and exterior heat fails to resolve, achieving miraculous effects," "The various Chaihu Yin formulas, Chaiqin Jian, and Chaihu Baihu Jian in Zhang Jingyue's *New Formulas* are applied effortlessly and logically. This truly demonstrates knowledge of Chaihu's utility and aligns with my own thoughts."⑩ Tracing back to physicians before the Qing Dynasty, there were many who held similar views, such as Li Dongyuan, who did not advocate limiting the scope of Chaihu (Bupleuri Radix) to the Shaoyang meridian alone. Records in *Bencao Gangmu* (Compendium of Materia Medica) state: "There are five types of exhaustion (Lao), diseases affecting the Five Zang Organs... Li Dongyuan stated that herbs with heat should be added with Chaihu, without heat, do not add. He also stated that malaria of all meridians should use Chaihu as the sovereign herb. For sores and ulcers of the Twelve Meridians, Chaihu must be used to dissipate accumulations. Thus, lung malaria, kidney malaria, and sores of the Twelve Meridians with heat can all utilize it." Such records serve as evidence. Additionally, modern scholar Professor Wu Kaopan also believed: The theory of restricting drugs based on meridians requires further study.⑾

III. Critical Discussion

I believe that Chaihu Yinzi (Bupleurin Drink) in the *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet) - Miscellaneous Treatment Formulas is used to clear deficiency-heat of the Five Zang Organs. The fact that Xiao Chaihu Tang (Minor Bupleurin Decoction) is placed in the Taiyang Chapter rather than the Shaoyang Chapter seems to provide collateral evidence that Zhongjing did not limit the use of Chaihu (Bupleuri Radix) to the Shaoyang meridian. Zhang Jingyue, in compiling *Gu Fang Ba Zhen* (Eight Arrays of Ancient Formulas), listed Xiao Chaihu Tang (Minor Bupleurin Decoction) in the Dispersal Array rather than the Harmonizing Array, which is reasonable. However, Wu Yiluo, in *Cheng Fang Qie Yong* (Practical Use of Established Formulas), reversed this by categorizing all key formulas from Zhang Jingyue's new Dispersal Array into the Harmonizing Category, which completely contradicts Zhang Jingyue's original intent in formulating these prescriptions. Modern materia medica classify Chaihu (Bupleuri Radix) under herbs that disperse wind-heat, an approach consistent with Zhang Jingyue's recognition that "using Chaihu utilizes its cool-dispersing property." "Chaihu (Bupleuri Radix) has a good antipyretic effect,"⑿ which has been confirmed by clinical practice.⑩ Yet, in the current national unified textbook *Wenbing Xue* (Warm Disease Studies) dedicated to exogenous febrile diseases, it is rare to find a single prescription using Chaihu (Bupleuri Radix), indicating that Ding Shi et al.'s argument that "Chaihu is contraindicated in warm diseases" still has influence. He Lianchen said: "In recent times, people favor Qinghao (Artemisiae Annuae Herba) and fear Chaihu (Bupleuri Radix) like a tiger,"⑩ which is not an exaggeration. Observing previous physicians' use of Chaihu (Bupleuri Radix), such as Tao Jie'an's Chaige Jiexu Tang (Cinnamon and Kudzu Decoction to Release the Muscle Layer) for concurrent Taiyang-Yangming disease and Zhang Jingyue's various Chaihu Yin formulas, none restricted drug use by meridian, and they were also used to treat warm diseases. Later generations, fearing the depletion of Yin fluids, almost abandoned its use, which is a significant loss in the pharmacological methods for treating exogenous diseases. Medication always requires differentiation of syndromes and weighing pros and cons. Warm disease specialists regard acrid-warm herbs like Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) as snakes and scorpions, and fear acrid-cool Chaihu (Bupleuri Radix) like a tiger, even advocating its prohibition. This is giving up eating for fear of choking, just as ancient physicians indiscriminately used Chaihu (Bupleuri Radix) to tonify the five exhaustions and seven injuries represent two extremes of failing to correctly understand Chaihu (Bupleuri Radix). This shows how crucial correct rational understanding is for clinical medication! Besides cooling and dispersing stagnant heat, Chaihu (Bupleuri Radix) excels in soothing the Liver and relieving fullness. Although not exclusively governing the Shaoyang meridian, it remains an essential herb for the Liver and Gallbladder meridians. Xu Huixi, in analyzing Chaihu (Bupleuri Radix), ignored this, stating, "Previous physicians identified it as a Shaoyang herb, knowing its branches but not its root." He directly concluded it was a "Gastrointestinal herb" (*Shennong Bencao Jing Baizhong Lu*), against which Zhou Yan refuted him effectively. In summary, theories should not be taken to extremes; bias leads to deviation. This is a critical point to note when discussing herbs.

References

① Cited from *Dictionary of Chinese Materia Medica*, p. 837, Shanghai People's Publishing House, 1977.
② Li Shicai, *Yizong Bidu · Bencao Jingyao Shang*.
③ Chen Xiuyuan, *Jingyue Xin Fang Bian*, Shanghai Wenhua Book Bureau, Guangyi Book Bureau edition.
④ Cited from *Bencao Haili*, p. 34, China Ancient Books Publishing House, 1982.
⑤ Zhang Jingyue, *Jingyue Quanshu*, p. 132, Yuezhi Lou Edition.
⑥ Ibid., p. 914.
⑦ Ibid., p. 976.
⑧ Ibid., p. 155.
⑨ Cited from *Dictionary of Chinese Materia Medica*, p. 1836, ibid.
⑩ Tang Lishan, *Wu Yi Hui Jiang*, p. 35, Shanghai Science and Technology Press, 1983.
⑪ Wu Kaopan, "Discussion on the Dispersal Array of New Formulas," *Shaoxing Traditional Chinese Medicine* (Internal Publication) 2:6, 1983.
⑫ Pharmacy Teaching and Research Group, Shanghai College of Traditional Chinese Medicine, *Clinical Manual of Chinese Materia Medica*, p. 36, Shanghai People's Publishing House, 1977.
⑬ *Abstracts of Literature on Chinese Materia Medica*, p. 463, 1963.
⑭ Yu Genuchu, *Tongsu Shanghan Lun* (Popular Treatise on Cold Damage), Vol. II, p. 11, Liuyetang Bookshop.

Brief Discussion on Predecessors' Understanding of Infectious Diseases and Their Prevention Principles

China's understanding of infectious diseases can be traced back to the Oracle Bone Script era. "'Jiangji' (Descending Illness) and 'Yuji' (Rain Illness) in Oracle Bone Script imply that heaven descends illness upon humanity like rain, meaning many people could suffer from the same disease simultaneously or transmit it from person A to person B. This undoubtedly refers to infectious or epidemic diseases."① Lin Qianliang analyzed the character "Ji" (Disease/Illness) in Oracle Bone Script, stating: "First, it depicts not one but two people bedridden; 'two' implies 'many'. Second, below it is the shape of 'Zhi' (Foot/Toe); toes are organs of walking. Thus, characters in ancient scripts with foot shapes often imply walking or flowing. Therefore, this 'Ji' character emphasizes diffusion, suggesting many people suffering from one disease simultaneously, clearly related to infectious and epidemic diseases."② Thus, the Chinese people had certain understandings of infectious diseases very early on, making this character undoubtedly the earliest written record concerning infectious diseases.

By the Western Zhou Dynasty, with developments in agriculture and astronomy, people recognized not only the impact of climate on crops but also on infectious diseases. Records in *Liji · Yueling* (Book of Rites · Monthly Ordinances) include "If autumn ordinances are followed in early spring, the people will suffer great epidemics," and "If summer ordinances are followed in late spring, the people will suffer many epidemic diseases." 'Yi' (Epidemic) refers to infectious disease. This is the earliest written record linking the occurrence of infectious diseases to climate.

In China's earliest medical formula book, *Wushi'er Bingfang* (Prescriptions for Fifty-Two Ailments), bites from rabid dogs and normal dogs are listed separately, indicating ancient people had some understanding of rabies. Furthermore, records in *Zuo Zhuan* about "citizens chasing mad dogs" show that as early as the Spring and Autumn period, people knew to prevent rabies by eliminating mad dogs. This is the earliest written record regarding rabies prevention. Later, *Zhouhou Beifang* (Handbook of Prescriptions for Emergencies) recorded "To treat dog bites, apply brain tissue to the wound; it will not recur." This represents a development in rabies treatment. From the perspective of applying immune response principles for disease prevention and treatment, this is also the world's earliest written record. Thus, China has long led the world in many aspects of understanding and preventing infectious diseases.

In the *Neijing* (Inner Canon), compiled around the Warring States period, *Suwen Yipian · Cifa Lun* (Supplement to Basic Questions · Methods of Needling) contains: "Yellow Emperor asked: I hear that when the Five Plagues arrive, they infect each other, regardless of age, with similar symptoms. If no treatment is provided, how can transmission be prevented? Qibo replied: Those not infected have righteous Qi (Upright Energy) stored within, so evil cannot invade; avoid toxic qi." Based on this text, we have reason to believe that enhancing the body's immune function and avoiding contact with pathogens are the two main points for preventing infectious diseases, a concept inherent in Traditional Chinese Medicine since ancient times.

In the early Eastern Han Dynasty, epidemics were frequent. However, due to the prevalence of the "Theory of Heaven-Man Induction," which attributed epidemics to plague ghosts, a custom of "driving out plagues at year-end" formed. Wang Chong (27–97) rigorously refuted this. Wang Chong argued that so-called plague ghosts were actually toxic and fierce Qi that caused many deaths among those exposed. Since "Qi stagnation generates heat," and "extreme heat becomes poison" (*Lunheng · Yan Du Pian*), "Poison acts like weapons on humans; when it strikes a person, they die immediately" (*Ding Gui Pian*). This is the earliest written record explaining pathogens from a materialistic viewpoint and refuting superstitious activities. It had a profound impact on later generations. Wang Chong believed Qi has harmony and disharmony; disharmonious Qi is collectively called Evil (Xie). Besides toxic Qi that spreads, there are epidemic pestilence Qi and foul Qi, etc. (this can be seen as the embryonic stage of classifying infectious disease pathogens). Epidemic pestilence Qi is highly contagious and harmful, often occurring in years of famine, as stated in *Mingyi Pian*: "In years of famine, the roads are filled with the starving; warm air and epidemic pestilence destroy entire families of thousands." These insights represented progress over simply attributing pathogens to generic toxic Qi. Wang Chong also used metaphors like "Among plants, there are Croton seeds and wild kudzu; consuming them causes bloating and often death," and "Spiders weave webs; flying insects pass through, some escape, some are caught," arguing that "Disaster Qi affecting humans is similar. Unluckily touching it leads to death; luckily escaping leads to life" (*Xingou Pian*). This emphasized the importance of avoiding pathogen contact. Additionally, Wang Chong recognized that infectious diseases could spread through "contaminated Qi," stating "Dead bodies piled up, ten coffins buried, yet people say the burial day is unlucky rather than Qi contamination" (*Bian Sui Pian*), which was foolish. In summary, Wang Chong's understanding of infectious diseases in *Lunheng* was profound, and his medical thought significantly influenced later generations. However, since he was not a physician and *Lunheng* was not a medical text, it was overlooked, though it deserves attention from TCM researchers. Liu Xi's *Shiming* in the Han Dynasty stated: "Zhubing (Transmitting Disease): One dies, another gets it, Qi pours into each other." This aligns with Wang Chong's "Qi contamination" theory. Both indicate that China already knew certain infectious diseases were transmitted via air as early as the 3rd–4th centuries.

At the end of the Eastern Han Dynasty, frequent wars led to "great epidemics after great armies." From the Preface to *Shanghan Lun* (Treatise on Cold Damage): "My clan members were numerous. Since the Jian'an era began, less than ten years have passed, yet two-thirds have died, seven out of ten from Shanghan." Clearly, infectious diseases were prevalent. However, Zhang Zhongjing (150–219) categorized pathogens using the Six Qi framework, hence calling it Shanghan. Moved by past losses and helpless against premature deaths, Zhongjing "diligently sought ancient teachings and extensively collected prescriptions," compiling the 16-volume *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases). He established the Six Meridian Differentiation method, laying the foundation for TCM syndrome differentiation and treatment. From then on, there were standards for treating infectious diseases. Although the *Shanghan Lun*'s methods for treating epidemics seem incomplete by modern standards, it remains China's earliest formula book for treating infectious diseases.

Shortly after, Cao Zhi (192–219) also identified the epidemic origin as Liqi (Pestilential Qi). In *Cao Ji Quanping*: "In the 22nd year of Jian'an, pestilential Qi spread; every family mourned dead corpses, every room echoed with wailing. Some entire households perished, some whole clans were wiped out." This text corroborates that Zhongjing's broad sense of Shanghan included infectious diseases.

During the Jin Dynasty, Ge Hong (281–341) wrote *Zhouhou Beifang* (Handbook of Prescriptions for Emergencies), recording various acute infectious diseases with detailed symptom descriptions. His understanding of etiology basically inherited the idea of "toxic pestilential Qi" as the pathogen but explicitly proposed "poisons differ, causing different diseases," foreshadowing Wu Youke's later theory that "chicken plague kills chickens, swine plague kills pigs; each disease has its own specific poison." This book not only recorded large-scale epidemics ("In the 4th year of Yonghui, this sore flowed from west to east across the seas," "After death, it transmitted to others, even wiping out families") but also detailed studies on the sand flea (vector of scrub typhus), observing its morphology, habits, and transmission mode ("If deep, pick out the bug with a needle, just like a scabies mite, visible moving only when held against light"). The chapter "Fifteen Formulas for Treating Miasma, Pestilence, and Warm Toxins" is considered China's earliest specialized article on epidemic prevention. Therapeutically, it not only valued clearing heat and detoxifying methods but also extensively used simultaneous exterior-interior resolving methods, influencing later handling of epidemics. Due to its rich content on epidemic prevention and treatment, modern medical historian Chen Bangxian believed: "Ge Hong's contribution to medicine lies in two areas: one is the understanding of infectious diseases; the other is alchemy, pioneering pharmaceutical chemistry."

In the Sui Dynasty, Chao Yuanfang et al. authored *Zhubing Yuanhou Lun* (General Treatise on the Origins and Manifestations of All Diseases, 610), calling epidemic pathogens "Guili Qi" (Aberrant Qi), stating "When people contract aberrant Qi and become ill, the disease Qi transmits and infects others, even wiping out families." They believed "This is all due to discordant seasons and improper regulation of warmth and coolness." This understanding continues the lineage of epidemic records in *Liji* and *Lunheng*. Wu Youke's later "Liqi Theory" (Pestilential Qi Theory) was proposed on the basis of these earlier ideas.

During the Southern Song Dynasty, continuous wars prevented farming, leading to famines. The *Rumen Shiqin · Ti You Suo Yu* chapter states: "In the year of Xingding, there was a great famine, so people gathered hundred herbs to eat." With corpses filling the fields, infectious diseases were common. Zhang Hezi (c. 1156–1228) stated the epidemic origin at that time was Zhangli (Miasma Pestilence). In the *Nüe* (Malaria) chapter, he said: "During chaotic times, laws were confused, corvée labor was heavy, morning spears and evening halberds left no rest. Internal fire and external fire moved together, especially among officials. How could they be treated the same as peaceful people? I personally witnessed the 6th year of Taihe (Bingyin), when southern campaigns launched massively. By the next year when troops returned, that year's miasma pestilence killed countless people." This likely refers to a major outbreak of malignant malaria.