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[Background Information]
Book: Zhi Yi Bi Bian (Must-Distinguish Medical Knowledge)
Author: Li Guanxian
Dynasty: Qing
Chapter: Appendix on Taichan Jindan / Miscellaneous Discussions (11 items)
Category: Medical Discourse

Someone asked: Is it appropriate to use "Taichan Jindan" (Fetal and Postpartum Golden Pill) to regulate menstruation? The answer is: No. "Taichan Jindan" is indeed a good prescription, but since its name implies fetal and postpartum use, it was established for the periods before and after childbirth. The formula uses Placenta Hominis (Ziheche, Human Placenta) as the sovereign drug, assisted by Cinnamon Twig (Rougui), taking the meaning of warming and promoting free flow. When pregnancy approaches full term, cooling drugs are no longer suitable; taking one or two pills of "Taichan Jindan" can facilitate delivery; after childbirth, blood stasis is most taboo; taking one or two pills can dispel stasis. I treated a woman in the Banner Camp who suffered a miscarriage at five or six months of pregnancy, with the second fetus not expelled and severe abdominal pain. I administered one pill of "Taichan Jindan" with Xionggui Tang (Safflower and Angelica Decoction). After only a few doses, the placenta was expelled and the abdominal pain stopped. This shows it is a blood-activating and stasis-resolving agent, truly suitable for pre- and postpartum conditions. As for women with irregular menstruation, are all cases caused by deficiency-cold and stasis? If menstruation is overdue due to uterine deficiency-cold, then "Taichan Jindan" can be taken; otherwise, if menstruation is not overdue but becomes frequent, how can "Taichan Jindan" be taken? As for those prone to habitual abortion (slippery fetus) who wish to use "Taichan Jindan" to secure the fetus, this so-called securing is actually inducing labor, which is truly laughable.

Diseases arise endlessly, but treatment methods always revolve around the four characters: Yin-Yang and Five Elements. Heaven generates all things through Yin-Yang and Five Elements; physicians treat all diseases through Yin-Yang and Five Elements. In essence, the generation and restriction of the Five Elements do not exceed Yin-Yang. Yin-Yang refers to Qi and Blood; Qi is Yang, and Blood is Yin. Qi and Blood refer to Water and Fire; Qi is Fire, and Blood is Water. Qi is formless, while Blood has form. Qi moves attached to Blood, and Blood cannot move independently without Qi. Without Yin, Yang cannot generate; without Yang, Yin cannot transform. When Yin and Yang are harmonious, all things are born. The human body is a small universe where Yin and Yang must be balanced. Physicians who bias towards cooling drugs or bias towards warming drugs are not adhering to the correct path.

Medicine has fixed principles and flexible methods. Wang Taipou said: "When cold is not resolved by cold drugs, it indicates a lack of Water (Kidney Yin); one should strengthen the master of Water to control the sunlight (deficient fire). When heat is not resolved by hot drugs, it indicates a lack of Fire (Mingmen Fire); one should benefit the source of Fire to eliminate the yin shadow (cold pathogen). This is a fixed principle." Another discussion on the eyes states: "Ability to see far but not near is blamed on lack of Water; ability to see near but not far is blamed on lack of Fire." The eyes are the light of Water Essence; lacking water, one may nourish water arbitrarily. However, texts state that eyes do not get sick without fire, and eye diseases have no cold pattern. Assuming one supplements fire arbitrarily because of inability to see far, would it not damage the eyes? Many people are nearsighted from birth and often cannot tolerate hot drugs. This situation requires referring to treatment methods and not solely blaming a lack of fire.

The way of using medicine applies primarily when life is in danger. When the disease is severe and the medication is too weak to save the patient, it is necessary to increase the method (dosage or strategy). Otherwise, the method should initially be mild, gradually increasing if effective. One should not take the heavy dosages of ancient formulas as the standard. Moreover, examining ancient dosages compared to modern ones, they are not particularly heavy. For example, Zhang Zhongjing's formulas often used jin (catties) or sheng/he (volume measures), seeming large. However, when he used powder, it was merely a fangcunbi (a square-inch scoop); pills were sized like wutong seeds, with only thirty pills taken, seeming very small. Why such a discrepancy between pills, powders, and decoctions? Examining *Qianjin Fang* and *Bencao*, three ancient liang are equivalent to one modern liang, and three ancient sheng to one modern sheng. Thus, the "liang" amounts to only three qian today! Furthermore, Zhang Zhongjing's decoctions were divided into three doses, leaving only one-third. Calculated together, does one ancient liang equal only one modern qian? There are differences between ancient and modern times, north and south regions, strong and weak constitutions, and rigid and soft drugs. Physicians who know how to adapt will surely gain something.

When a person is ill, it is like a locked mechanism; treating a disease is like unlocking it with a key. An incompetent locksmith, even with great effort, cannot open the lock and may even break it. A skilled locksmith needs only a copper wire to gently flick the lock open. Similarly, an incompetent physician, even with heavy medications, cannot resolve the disease and may worsen it; a competent physician can save the patient with just one herb. Beginners in medicine should assess their capability; if unable, they should wait for a skilled physician. They must not rashly prescribe without understanding the condition, damaging the patient. Even if experts exist later, they may be powerless. A lock can be damaged, but can a person be damaged?

Using medicine to regulate patients is like watering flowers. Some need clear water, some need fertilizer. Once the right method is chosen and watering is moderate, without excess or deficiency, the plants will flourish naturally. Regulating patients is the same. Some need clearing and nourishing, some need vigorous tonification, some need Qi tonification, some need Yin tonification. One must seek appropriateness to be effective, not to treat vaguely. Some seek quick results, thinking Ginseng tonifies Qi, so why is Qi still deficient after taking Ginseng? Rehmannia tonifies Yin, so why is Yin still deficient after taking Rehmannia? They do not understand that medicinal cultivation is like watering flowers; proper watering helps growth, but the water itself is not the plant. For instance, Peony prefers thick manure; adding manure does not turn the Peony into manure. Therefore, for Qi deficiency, Ginseng is suitable, helping Qi generate, but Ginseng is not Qi itself; for Yin deficiency, Rehmannia is suitable, helping Yin generate, but Rehmannia is not Yin itself. Skilled regulators use appropriate medicines to assist the vital energy of life. If one treats herbal roots and barks as direct substitutes for Qi and Blood, filling excessively, it is like over-fertilizing flowers, suppressing their vitality. Our use of medicine must be moderate and not rigid. Those skilled in tonification include unblocking within tonification, like writing articles filled only with substantive words without functional words—can it form a coherent text? In short, without understanding Confucian studies, one cannot understand medical principles.

Some expensive medicines, seemingly beneficial, can actually be harmful; Ginseng is one such example. According to *Bencao*, Ginseng can restore Yuan Qi in the realm of nothingness, turning weakness into strength and providing rescue. But if Qi has reached the "realm of nothingness," how can Ginseng generate Qi for someone with no Qi? However, this is merely ineffectual; there are more harmful cases. Why? Wealthy people, with arrogant and luxurious habits and unrestrained lust, consider themselves weak and want to take Ginseng at the first sign of illness. Incompetent doctors, ignorant of this, comply. My close relative, Mrs. Ding Wu, had lung heat causing hoarseness. A doctor, catering to the patient's wishes, prescribed several liang of Ginseng, resulting in complete loss of voice. I was called to treat her, advised stopping Ginseng, and prescribing Xiebai San (White Flower Decoction) for a few doses, leading to recovery. My close friend, Old Man Wu Zaixiao, had rising Liver Fire causing dizziness and sweating. His family and another doctor considered it deficiency and prescribed daily Ginseng, worsening the sweating and dizziness. I was called to treat him, intending to calm the Liver. Although he trusted me, others argued against stopping Ginseng for Yin-nourishing drugs. I reasoned that days of Ginseng showed no effect and the disease progressed; continuing would kill him. Having previously helped his family, I could argue firmly. His son, claiming medical knowledge, loved Ginseng, and the other doctor agreed. Fortunately, the old man trusted me completely and took my prescription. I focused on calming the Liver and nourishing Blood, regulating for a month until recovery. What benefit did Ginseng provide? I witnessed others: Mr. Zhao, a wealthy neighbor. His father died of bloody dysentery due to Ginseng; his brother died of carbuncles due to Ginseng. Wu Jingxian caught a seasonal pathogen. Mr. Zhao, a friend of Wu's father, sent Ginseng. Wu refused, but others insisted on accepting it from the benefactor. The doctor encouraged it, leading to death from trapped pathogen. Everyone knows these cases. Who is at fault for harming people with supposed beneficial drugs? I have practiced for forty years. Mostly middle-class patients, few wealthy ones, mostly unable to afford Ginseng, which I rarely use. Even for the wealthy, if the condition does not suit Ginseng, I forbid it. If Ginseng were essential for survival, how many poor people would survive?

Some extremely cheap medicines, seemingly useless, are highly beneficial; Black Sesame Seed is one. I once treated abnormal Liver Qi distension and pain with rebellious Qi vomiting. Previous doctors used Erchen Tang, Cyperi Rhizoma, and Aucklandiae Radix to smooth Qi without effect. Adding Qi-breaking drugs like Aurantii Fructus, Trogopterori Faeces, Linderace Cortex, and Aquilariae Lignum added no effect. I reasoned that although Liver Qi rebellion requires smoothing, the Liver is a rigid organ, best treated with softness. Previous drugs were too rigid. Treatment should use sweet to relax and nourish Yin to calm the Liver. However, without Qi-moving herbs, quick effect is hard. Qi-moving herbs tend to be dry and warm. I thought of Sesamum Indicum (Black Sesame): straight outside, connecting inside; black color reaches Kidney directly; slightly cool nature, no rigidity. I used one branch, aided by three qian of Citrus Reticulata 'Chachi' (Jinju Bing). One dose brought effect, several doses cured it. Whenever it recurred, this formula worked quickly. Since then, I always use it for Liver Qi issues, achieving success. It is said that softening and unblocking suits the Liver best. I realized that the Qi of all organs values unblocking. *Neijing* says: "Unblocking means no pain, pain means unblocking." Extending this meaning: unblocking means no distension, distension means unblocking; unblocking means no rebellion, rebellion means unblocking. Treating Qi diseases generally benefits from unblocking, not just the Liver channel. I treated asthma for years, caused by rebellious Kidney Qi. I used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) modified, five qian per dose, taken with decoction of Black Sesame. It gradually improved and did not recur. I also treated Liver Qi invading Stomach, causing food stagnation threatening to become Ge Syndrome (dysphagia). Using moistening Liver-calming and Stomach-unblocking herbs, plus Black Sesame and Jinju Bing, cured it in ten doses. I encountered bloating resembling single-abdominal distension. Using Ganmai Dazao Tang (Licorice, Wheat, and Jujube Decoction) plus Black Sesame and Jinju Bing, cured it after a month. Countless other Qi disorders responded. Relatives now advise keeping Black Sesame at home for Qi symptoms. Wealthy lords love Ginseng and ignore this cheap herb's wonder. Not recorded in Bencao, I discovered it ten years ago. Initially for Liver Qi, I found it treats many diseases, even ascites. I do not claim unique discovery but publish it for public benefit.

I compare medical books to Confucian classics. *Neijing* is the Wujing (Five Classics); Zhang Zhongjing's *Shanghan Lun* and *Jingui Yaolue* are the Sishu (Four Books). Post-Han medical books are numerous but not pure. Only Yu Jiayan's expansion of Zhang Zhongjing's work is profound and broad, revealing hidden meanings, akin to Zhu Xi's annotations in Confucianism. Although Ke Qin came later, trying to overshadow Yu to promote his own work, like critics after Zhu Xi, he could not extinguish Zhu's orthodoxy. I admire Yu because his book details *Shanghan* and *Jingui*, aiming to be the successor to Zhang Zhongjing. His *Yi Men Falü* is brief on miscellaneous diseases. Fortunately, *Feng Shi Jin Nang* is excellent, with deep discussions, especially detailed in pediatrics, surpassing Qian Yiyi. For example, in smallpox, I used it to treat family cases successfully, unseen in current pediatrics. Thus, besides Yu, I revere Feng and encourage future study of his work.

Although I am not skilled in surgery, I treated over ten cases of Syphilis (Yangmei Chuang) without external cauterizing drugs, all cured promptly, applying Feng's smallpox methods. Current surgeons treat Syphilis mainly with purgatives. This toxin must be raised and transmitted outward. Like smallpox, if raised and transmitted like flourishing flowers, it naturally forms pustules and scabs, proceeding smoothly. Raising and transmitting requires internal support. Baoyuan Tang: Ginseng, Astragali Radix, Cinnamon Twig, Glutinous Rice, Lithospermi Semen, Glycyrrhizae Radix, serves as the main formula. If Da Huang (Rhubarb) is used recklessly, Qi and Blood descend and weaken, causing smallpox to collapse inward. How can the toxin transmit? How can life be saved? Smallpox is congenital toxin; Syphilis is acquired toxin. Congenital toxin requires transmission with internal support, not damaging Qi and Blood. Acquired toxin requires transmission; can we damage Qi and Blood with purgatives without internal support? Abundant Qi and Blood help push out toxins easily without sequelae; weak Qi and Blood make it hard to expel toxins, causing endless trouble. Thus, never damage Qi and Blood. Smallpox and Syphilis share the same principle. I equate them; listeners may be confused. I treated few smallpox cases, all cured; more Syphilis cases, all cured. Applying *Jin Nang* principles yielded great results. Future generations, though perhaps not treating Syphilis, may have many children susceptible to smallpox. Studying Feng's book will prevent harm from current pediatricians.

Briefly describing Syphilis treatment: Early stage, fire-toxin is heavy, stool is difficult. Must first unblock. Longdan Xiegan Tang (Gardenia and Gentian Decoction) plus Da Huang for three doses. Stop when stool flows. This toxin mostly affects Liver and Kidney, hence this formula first. If appearing on the face, toxin moved from zang to fu. Face belongs to Yangming, which governs muscles. Use Hejian Fangfeng Tongsheng San (Saposhnikovia and Mint Powder). Contains dispersing, purging, cooling, and detoxifying herbs, plus Qi and Blood balancing agents. Take three to four doses. Stop when stool flows. Both formulas use two liang of Smilax Glabra Rhizome (Tufuling) decocted to cook the medicine. Avoid tea, fearing it dissolves drug properties. Then examine constitution. If Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction) plus anti-toxin herbs like Honeysuckle Flower and Sophora Flower. If Blood deficiency, use Siwu Tang (Four Substances Decoction) plus anti-toxin herbs, increasing Honeysuckle and Sophora, plus Blood-nourishing and cooling herbs. Also decoct Tufuling. Prepare Wubao Dan (Five-Treasure Pill): Cinnabar 5 fen, Succinum 5 fen, Murrayae Semen 5 fen, Margarita 5 fen, ground fine. Add Borneolum Syntheticum 2.5 fen, Bovis Calculus 5 fen, grind again. Mix with 2 liang of refined flour. Store in porcelain bottle. Take 5 fen with Tufuling decoction. Daily avoid tea, replacing with Tufuling decoction. With this treatment, mild cases cure in one course, severe in two. I saw cases of excessive purging leading to loss of appetite and foul-smelling sores. I used Guipi Tang (Restore the Spleen Decoction) combined with modified Wubao Dan. Three doses stopped the odor; sores healed in ten days. One case was Mr. Wu, another old friend Bai Suian, now 84 and healthy. Ask him to verify.

Most laughable is local pediatrics. Practitioners are uneducated, taught only dispersing and digesting formulas like Zhang Zihe's Sanshengyangqin Tang: Perillae Fructus, White Mustard Seed, Raphani Semen. Plus Qianghuo, Saposhnikovia, Bupleuri Radix, Puerariae Radix, Aurantii Fructus, Trogopterori Faeces, Crataegi Fructus, Magnoliae Officinalis Cortex, etc. Ten-plus digestive herbs. Taught pulse records saying: "Caught cold, stagnation. Milk and food mixed, fear transformation into convulsions." They immediately practice medicine. Every case, they use these phrases to prescribe, warning parents not to feed milk or rice drink due to severity. Daily dispersing and digesting. If fever persists for days, they do not change the original formula. Even after ten days, slight modifications only. If parents give rice drink, they blame it. Due to dry drugs, Blood is depleted, failing to nourish sinews, causing convulsions. They say: "Acute convulsion, I warned you." Days without full milk and dispersing drugs lead to faint Qi. They say: "Chronic convulsion, I warned you." Until death, neither doctor nor victim realizes, thinking the doctor was prescient. Most hateful are "convulsion-soothing" women with no training, committing atrocities. Children have no convulsion, but due to wrong drugs, Qi and Blood are weak, often dying from a single soothing stroke. Joy, anger, worry, thought, sorrow, fear, and fright are Seven Emotions. Fright arises from shock. Can fright come from exterior contraction? We internal medicine doctors do not treat pediatrics, but save many children via internal medicine. Cao Gengzhi's granddaughter was dying under pediatric care. A convulsion-soothing woman was hired. I advised stopping drugs, feeding milk and porridge. She recovered in days. Wei Tingzhang's second son, eight months old, had persistent fever from exterior contraction. A doctor used excessive dispersing, forbidding milk and rice drink. Days passed, near death, doctor refused treatment. I visited, Wei begged for help. I probed his mouth; he gripped my finger, indicating hunger. I pretended to have a miracle cure requiring milk first. Family doubted he could swallow. I insisted, suggesting mother lie down to nurse. Mother complied, baby drank well and slept peacefully. I told them no medicine tonight, I would return tomorrow. Next morning, baby had eaten much and slept well, seeming cured. Family asked for medicine. I laughed, saying: "What medicine? Just milk!" The child had been over-treated with dispersing and digesting drugs. What exterior contraction? What stagnation? Starved to death! Survival was fate. Family grateful, named child after me. At Jiang's house, I diagnosed illness. They asked for pediatric advice. Pulse record showed phlegm-wheeze like sawing wood, harsh drugs. I asked where the child was. Nurse held baby nearby, no sawing sound, only weak spirit. I palpated pulse, said: "Excessive dispersing and digesting, likely forbidden milk, causing deficiency phlegm. Feed milk immediately, no medicine needed." Family followed, cured in days. Pediatric errors are many. I listed a few. Future internal medicine students must pay attention to pediatrics.

All famous medical books include pediatrics, which should be studied well. *Feng Shi Jin Nang*, starting from infants and ending with smallpox, is especially important. If one studies internal medicine thoroughly, pediatrics will be covered. Families with many children will avoid pediatric errors.