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Jing Fang Shi Yan Lu (Record of Clinical Experiments with Classical Formulas)

Republic of China Era · Cao Yingfu

Reprinted from Folk TCM Network

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Original Preface

Since my childhood, I have loved reading Zhang Yin'an's commentary on the *Shanghan Lun* (Treatise on Cold Damage Diseases). My late father saw this and was pleased, saying that in one's spare time from studying, if one could gain a slight understanding of medical principles, it would also be a skill to benefit the world. At the age of sixteen, my late father suffered from Dongxie Hanzhong (a severe diarrhea condition caused by cold pathogen directly attacking the spleen and stomach). Physicians prescribed over ten doses of Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian), but his condition worsened; his sweat coagulated like paste, his skin became cold as stone, his spirit seemed ready to fly away, his body swayed as if falling, he startled several times a night, and he was barely alive. Finally, Mr. Zhao Yunquan arrived and administered a large dose of Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) added with Evodiae Fructus (Wuyu) and Caryophylli Flos (Dingxiang). After just one dose, his sweating stopped, body temperature rose, diarrhea ceased, and his spirit settled. After continuous administration, the illness was cured. Mr. Yunquan said: "This year, the Tai Sui is in the Chen position, governed by damp earth qi, and it is the season of late summer with days of continuous rain. Both heaven and humanity are distressed; most syndromes are cold-damp. How can contemporary physicians who do not study the 'Taiyin Chapter' of the *Shanghan Lun* discuss life-saving treatments?" Since hearing these words, I realized that Zhongjing's formulas indeed have the power to rescue people from danger.

Later, I paused medical practice to focus on imperial examinations. During the Guangxu reign, while traveling to Jinling for the examination, I fell ill. A companion who knew some medical prescriptions gave me Pogostemonis Herba (Huoxiang) and Elsholtziae Herba (Peilan) daily. Although sweating occurred, the fever did not subside. Upon arriving in Jinling, my condition became critical. Fortunately, my cousin-uncle Mr. Chen Baohou came to stay with me. He examined my pulse and said: "Your illness should heal quickly, but you have sweated repeatedly, depleting your body fluids." He then purchased large bottles of Lotus Leaf Dew Flower water and over ten Ai Jia Pears from a pharmacy, saying: "Drink when thirsty, eat when hungry!" I followed his advice and consumed them all within half a day. That evening, he brought medicine, utensils for boiling porridge, rice, and charcoal. I had just woken up from sleep; smelling the medicine, Mr. Baohou ordered an attendant to serve a bowl. I felt moist all over my body. By midnight, my clothes and bedding were soaked. Mr. Baohou changed my clothes and bedding. When asked about the prescription, he replied: "It is Guizhi Baihu Tang (Cinnamon Twig and White Tiger Decoction)." At this point, I felt completely relaxed and comfortable, ate two bowls of porridge called for me, slept peacefully until dawn, and was no longer in a sickly state. From then on, I firmly believed in classical formulas. However, due to my father's expectation that I obtain official rank through examinations, I did not have time to devote myself fully to research.

After the Huiai Examination (Metropolitan Examination) in the Jiachen year (1904), the court abolished the imperial examination system. My father passed away that same year. Thereafter, I began to read the full texts of the *Shanghan Lun* and *Jingui Yaolue*. I was thirty-eight years old at the time. From then on, I resolutely developed the ambition to save the world. This beginning actually originated in my family: using large doses of Fuzi Lizhong Tang started with my late mother, Tai Anren Xing, suffering from Dongxie; using Zaojia Wan (Gleditsiae Sinensis Pill) started with my mother suffering from insomnia where she could only sit and not lie down, often vomiting turbid phlegm; using Shizao Tang (Ten Date Decoction) started with my mother suffering from Pharyngitis/Phlegm-fluid retention; using Gancao Fenmi Tang (Licorice, Flour, and Honey Decoction) started with a household maid suffering from Ascaris Jue (Roundworm Reversal); using Dahuang Mudan Tang (Rhubarb and Moutan Decoction) started with Mrs. Pan, mother of Ruohua, suffering from Changyong (Intestinal Abscess). In every case, efficacy was achieved promptly, responding like an echo. Thus, how could the works of the Four Masters of Jin-Yuan possibly glimpse even a fraction of Zhongjing's books? It is said that the words of benevolent men bring great benefits.

I came to Shanghai after turning fifty. During this period, nine out of ten cases treated with classical formulas yielded results. However, being naturally lazy and indulging in poetry, I paid little attention to life-saving treatments as circumstances changed. Consequently, few manuscripts remained; even occasional prefaces were taken away by students. In the Jiawu year (1934), student Jiang Zuojing collected treatment plans and added explanations, naming the collection *Jing Fang Shi Yan Lu*. Over several years, it formed a substantial volume and was about to be published. He asked me for a preface. I smiled and told him: "The publication of this book will shine upon my *Shanghan Jingui Fabian* (Elucidation of Shanghan and Jingui)!" Therefore, I wrote down the details of my usual emphasis on classical formulas.

Two days after Liqiu (Start of Autumn) in the Bingzi year (1936), Cao Jia Da wrote this preface in his Shanghai residence.

Upper Volume

Syndrome of Guizhi Tang I

Patient surnamed Tang, February 18th. Taiyang syndrome, Wind Strike (Zhongfeng), fever, sweating, aversion to wind, headache, nasal congestion, floating and moderate pulse. Treat with Guizhi Tang (Cinnamon Twig Decoction).

Chuan Guizhi (Cinnamomi Ramulus) 3 qian
Sheng Baishao (Paeoniae Radix Alba) 3 qian
Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 1.5 qian
Shengjiang (Zingiberis Rhizoma Recens) 3 slices
Hongzao (Jujubae Fructus) 6 pieces

[Commentary] The *Shanghan Lun* states: In Taiyang disease, with fever, sweating, aversion to wind, and a moderate pulse, it is named Zhongfeng (Wind Strike). It also states: In Taiyang disease, with headache, fever, sweating, and aversion to wind, treat with Guizhi Tang. From these two clauses, we know that Guizhi Tang syndrome is also called Zhongfeng. The phrase "named Zhongfeng" indicates that predecessors originally used this name, and Zhongjing merely adopted it. Strictly speaking, "Guizhi Tang Syndrome" has a broader meaning, while "Zhongfeng" has a narrower meaning. In other words, Zhongfeng is just one type of Guizhi Tang syndrome. Furthermore, this Zhongfeng is not the Zhongfeng found in miscellaneous diseases, i.e., not the stroke known in Western medicine as cerebral hemorrhage or cerebral congestion. Traditional Chinese Medicine disease names often overlap, awaiting organization; this is just one example. Regarding the reason for different syndromes sharing the same name, it is likely because they both involve Wind. Superficial invasion affects only the muscles, which is the Zhongfeng in the *Shanghan Lun*. Deep invasion penetrates meridians and even internal organs, which is the Zhongfeng in miscellaneous diseases. Wind is the chief of a hundred diseases.

The dosage of herbs in Zhongjing's formulas is calculated in jin and liang, appearing heavy at first glance. However, weights and measures differ between ancient and modern times, so they cannot be compared directly. Scholars have conducted numerous textual researches, yielding various ratios, leaving us unsure whom to follow. Moreover, decoction and administration methods differ significantly. Anciently, for Guizhi Tang, only the first decoction was taken, divided into three doses (first, second, third). Nowadays, the first decoction is one dose, and the second decoction is another, creating a significant gap. Setting aside these differences, simply put, my teacher's dosage is approximately one-tenth of the original formula. For example, Guizhi and Shaoyao were originally 3 liang, but the teacher commonly used 3 qian. For milder syndromes or doubtful conditions, I use half that amount, e.g., 1.5 qian each for Guizhi and Shaoyao. Using this standard, the benefits outweigh the drawbacks.

Cao Yingfu says: I have frequently used Guizhi Tang with success. Once, at Mr. Gao Changshun's home, I treated his children with one prescription for both, and both recovered. Generally, in summer, sweat excretion is profuse, and pores open wide. Sleeping with windows open allows external wind to invade the pores, causing Wind Strike, manifested as fever and spontaneous sweating. Therefore, Guizhi Tang is particularly suitable for summer use.

[Additional Commentary] Modern scholar Zhang Taiyan, based on Han Dynasty Wu Zhu coins, estimated that one liang is approximately three qian today. Thus, the original formula's 3 liang per dose equals 9 qian. Divided into three doses, each dose contains only 3 qian. Therefore, using 3 qian today aligns perfectly with ancient methods.

Syndrome of Guizhi Tang II

I once treated a fellow townsman, Yang Zhaopeng, in a certain summer. Previously, he disliked heat, sleeping with windows open. His body sweated profusely, and the cool breeze felt pleasant, so he fell asleep. At midnight, he felt cold. Covering himself with blankets, he slept again, but the coldness did not decrease; it intensified. The next day, upon examination, the patient had sweat on his head and palms/soles, but little sweat on his back or body. I prescribed the original Guizhi Tang: Guizhi 3 qian, Baishao 3 qian, Gancao 1 qian, Shengjiang 3 slices, Dazao 3 pieces. The following day, he did not request a follow-up. Later, he visited me for another ailment and said: "After taking the previous medicine, I sweated considerably, and the illness resolved. How potent the medicine is! But how could you know this was my mild dose?"

[Commentary] Some argue that Zhongjing's pulse-syndrome-treatment methods seem to ignore etiology, pathogenesis, and pathology. This is not true; he simply does not elaborate extensively. Given the completeness of his pulse-syndrome-treatment framework, we need only follow his path to cure diseases effectively. Thus, there are cases where the disease is cured, yet we do not understand why.

Cao Yingfu says: Zhongjing does discuss etiology and pathology. External evil wind causes Wind Strike; to rescue from evil wind, Guizhi Tang is indicated—is this not etiology? Wei Qi (Defensive Qi) failing to harmonize with Ying Qi (Nutritive Qi) causes spontaneous sweating. Wind invades muscles and settles in the Ying level, while Wei Qi remains unharmed. Thus, Wei is strong and Ying is weak. Since the Wei Qi responsible for fluid metabolism is unharmed, pores can sweat naturally. However, the Ying Qi responsible for blood circulation is constrained, preventing muscle-coupling tissues from sweating. This causes a separation between skin/hair follicles and couli (interstices), leading to disharmony. Disharmony means lack of integration. Using Guizhi Tang to induce sweating from the muscle layer restores harmony between Ying and Wei. Is this not pathology? Understanding connections in reading leads to comprehensive comprehension.

Syndrome of Guizhi Tang III

I treated a gentleman from Hubei, Mr. Ye, residing at Xiafei Fang, Xiafei Road. On a night of intense heat, he visited the rooftop garden of the Great World amusement park, exposing his chest to the wind and consuming cold drinks. Initially, he felt very comfortable. Soon after, he experienced chills and headache, rushed home, and lay down. A friend visited, forcing him to get up and sit in the courtyard to socialize. Late at night, after the guest left, his back felt colder, and his headache worsened. He prepared and took Zi Su (Perilla Leaf) and Shengjiang himself, achieving slight sweating, but the symptoms did not resolve.

The next morning, he sought consultation. Supported downstairs, he urgently requested closing doors/windows and vomited a large amount of green turbid phlegm, likely caused by ice drinks. Sweat appeared on both arms, feeling damp to the touch. I immediately prescribed: Guizhi 4 qian, Baishao 3 qian, Gancao 1.5 qian, Shengjiang 5 slices, Dazao 7 pieces, Pingtong (Lemna Minoris Herba) 3 qian.

Pingtong was added because he lacked general sweating and had only slight head sweating. The next day, he did not request a follow-up. One evening, I met him on the street. Mr. Ye bowed and thanked me, saying: "My previous illness was cured with one consultation. Your skills are divine!"

[Commentary] The formation of a specific disease/syndrome often involves multiple etiologies. This case shows that besides wind, there was cold drink consumption. Externally attacked by wind, internally obstructed by fluid retention, the syndrome presented an additional symptom of vomiting compared to the previous case. This demonstrates that patient syndromes change dynamically and do not strictly conform to textbook patterns. Medicinal adjustments reflect the physician's discretion, as seen by the use of five slices of Shengjiang in this formula.

Cao Yingfu says: This gentleman was a friend of my fellow townsman, Mr. Gao Changyou. I met him while treating his wife's neuropsychiatric disorder. His wife ate normally but sang constantly or stayed awake all night. Her pulse was slippery and rapid. Following Dr. Ding Ganren's method, I used one pig heart cut open, stuffed with 2 qian of Chen Sha (Cinnabar) and 2 qian of Gansui (Kansui Root), tied shut, and dried near a charcoal stove. The Gansui and Cinnabar were ground into fine powder. After one dose, he had severe purging, followed by sound sleep and cessation of singing. Later, he was regulated with Shiquan Dabu Tang (Ten Significant Tonifying Decoction) in pill form, and his spirit was better than before the illness. I append this story for discussion.

Syndrome of Guizhi Tang IV (Including Student Case Records)

Mr. Xie during the Sanfu (Dog Days) period. Intense heat presses upon people; ordinary individuals sweat profusely and complain of heat. Yet, Mr. Xie wears thick cotton and heavy quilts, still feeling chilling cold. He does not vomit but suffers from diarrhea, defecating ten-plus times daily, with abdominal pain and tenesmus (feeling of incomplete evacuation). Urine is short and red. Uniquely, his pulse is not deep but floating. The *Shanghan Lun* states: In Taiyin disease, if the pulse is floating, sweating may be induced; Guizhi Tang is appropriate. This case resembles this description.

Chuan Guizhi 1.5 qian
Da Baishao 1.5 qian
Zhi Gancao (Honey-fried Licorice) 1.5 qian
Shengjiang 2 slices
Hongzao 4 pieces
Liushenqu (Medicated Leaven) 3 qian
Gu Yamaicha (Stir-fried Barley and Malt) 3 qian each
Chi Fuling (Red Poria) 3 qian

[Commentary] Before this, Mr. Xie attended a banquet hosted by a friend, enjoying Western food and drinking ice-cold soda until full. Upon returning home, he developed diarrhea that night. It persisted for three days and worsened. Light prescriptions had failed. I treated according to the syndrome, not avoiding Guizhi despite the dog days.

After taking the medicine, the exterior resolved, and diarrhea decreased. With regulation, he recovered.

This case involves diarrhea without vomiting, differing from previous cases, illustrating changing syndromes. Vomiting indicates stomach disharmony; diarrhea indicates intestinal disharmony. However, the ability to vomit or purge indicates that the gastrointestinal tract still possesses anti-toxic and pathogen-expelling functions, preventing disease progression. The *Shanghan Lun·Taiyin Chapter* states: In Taiyin disease, if the pulse is floating, sweating may be induced; Guizhi Tang is appropriate. Scholar Shu suspected an error in this clause, suggesting Lizhong Tang with added Guizhi. While plausible, Lizhong with Guizhi targets the interior, whereas Guizhi Tang targets the exterior. Since the pulse is floating, the exterior syndrome is heavy, making Guizhi Tang appropriate. Furthermore, the text says "yi" (appropriate) rather than "zhu zhi" (mainly treat), clarifying the hierarchy.

Cao Yingfu says: This Guizhi Tang Syndrome IV is essentially a Taiyin disease. Guizhi Tang is the primary formula for floating pulses. Although wearing heavy cotton and quilts with aversion to cold resembles Mahuang Tang (Ephedra Decoction) syndrome, Guizhi Tang syndrome inherently includes mild chills. Moreover, the pulse is floating but not tight, clearly distinguishing it from Mahuang Tang syndrome. Diarrhea was due to food stagnation, so fried Liushenqu and malt were added. Short red urine led to the addition of Chi Fuling. This illustrates the method of modifying formulas according to syndromes.

[Additional Commentary] Starting June 24th this year (25th Year of ROC), the weather suddenly turned hot. Friend Shen Shouhe ate ice cream and caught a slight breeze the previous night. The next day, he fell ill: head distension, aversion to wind, sweating, forehead felt slightly cold, loose stools, recurrence of palpitations (chronic condition), and pulse showed intermittent irregularities (Jiedai). Prescribed Guizhi, Baishao, Zhi Gancao (each 1.5 qian), Shengjiang 1 slice, Hongzao 6 pieces (cut). Taken at night. Woke up the next morning with all symptoms resolved. Only palpitations remained, cured after four doses of Zhigancao Tang (Licorice Decoction). All formulas involved Guizhi. Another day later, Sun Jiaojun drank plum juice, resulting in diarrhea, aversion to wind, cold sweat, head distension, chest tightness, bone soreness, leg weakness, loss of appetite, and vomiting—identical to Mr. Shen's case. Prescribed the same formula as for Shen. However, since Mr. Sun bought medicine at noon, the pharmacy lacked Hongzao, so it was omitted. After one hour, hot sweat covered his body, and he slept comfortably.

Waking up the next morning, he didn't know when the illness had gone. Thus, Guizhi Tang is indeed the first effective formula for summer exterior syndromes caused by excessive cold drinks, not just for winter northern cold damage. Why must cold damage be limited to northern regions and winter months? Such rigidity is extreme. If someone sees my treatment of Shen and Sun and argues: "Guizhi and Shengjiang are acrid-warm; how can one add fuel to the fire in hot weather? Gancao and Hongzao are sweet-greasy; sweetness increases fullness, grease traps pathogens. Sour-astringent Shaoyao is even more inappropriate. None of the five herbs are usable." If patients lack firm faith and hear this critique, might they abandon the prescription? Then, what is the pathology of Guizhi Tang syndrome? What is its pharmacology? Here, explanation is necessary.

Before stating my own views, I briefly cite scholars' opinions for reference. *Yizong Jinjian* (Golden Mirror of Medicine) states: Guizhi is acrid-warm; acrid disperses pathogens, warmth supports Yang and Wei Qi. Baishao is sour-cold; sour astringes sweat, cold nourishes Yin and Ying Qi. Guizhi as sovereign and Baishao as minister implies inducing sweating while containing sweat. Baishao following Guizhi implies gentle sweating while securing the exterior... Lu Jiuzhi said: Guizhi enters Ying and exits Wei. Taiyang governs opening; wind attacks, causing excessive opening, requiring expulsion of wind to restore normal Taiyang Qi. Wind strike is deficient evil, Ying Qi is weak, so slow release is needed. Wind near muscles affects Liver Qi invading Spleen; thus, Guizhi is sovereign, and blood-nourishing/middle-regulating herbs are ministers. Wind transforms into heat, restrained by cool Baishao... Ke Yunbo said: This is the chief of Zhongjing's formulas, a general formula for nourishing Yin, harmonizing Yang, regulating Ying and Wei, resolving muscle layers, and inducing sweating... All these theories revolve around Ying and Wei. Some ancients argued Baishao (sour-cold) should not be in Guizhi Tang, while Mr. Zhu Weiju stated: In this combination, Baishao is the main herb, and Guizhi is an important auxiliary herb.

The standard for applying this formula is hyperactive skin evaporation function with spontaneous sweating; thus, Baishao regulates this hyperactivity. Guizhi merely assists cardiac function; hence, it is also used in Mahuang Tang, proving it is not the main herb. These two views contradict sharply. Tomimoto Uimon's *Kokan Igaku* (Imperial Japanese Medicine) states: In my experience, cases using Baishao, Hongzao, and Gancao always present muscle spasms, most clearly in the straight abdominal muscle... serving as abdominal signs for these three herbs and this formula. Above is purely theoretical; practically, one should follow the master, basing diagnosis on pulse, syndrome, and external signs, ignoring abdominal signs. This view is inconsistent and debatable. Amidst conflicting theories, where shall I turn? Nevertheless, we must seek solutions through experimentation, not confining ourselves to past masters' sayings.

Consider a patient here with Guizhi Tang Wind Strike syndrome: aversion to wind, headache, fever, sweating, presenting sequentially. However, sweating is unsmooth, feeling cool to touch—this is pathological sweat. If the person has strong Zheng Qi (Upright Qi) and self-healing capacity, fever will intensify momentarily, followed by smooth sweating feeling warm, causing all symptoms to vanish. This shows all toxins (external pathogens and internal waste) are expelled with smooth sweating—this is the method of resolution via sweating. If Zheng Qi is insufficient, external aids are needed, such as drinking hot tea, vigorous exercise, or warm baths, all aiding sweating. Methods vary, but result in sweating equally. (On hot days, when comfortable and non-sweating, doing these three things easily induces sweating, proving this.) Once this sweat occurs, the illness soon resolves. However, severe Wind Strike cases cannot be handled by such simple methods. Moreover, drinking too much water overwhelms the stomach, and exercise/bathing risks catching wind. Thus, Guizhi Tang is superior.