Li Xupeng1 Zhao Lancai2 1 Master’s student, Beijing University of Traditional Chinese Medicine 2 Department of Infectious Diseases, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine 100091 Zhao Lancai, Department of Infectious Diseases, Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine Zhang Xicun, one of the representatives of the school of Chinese and Western medicine in the late Qing Dynasty and early Republic of China. Zhang studied medical theory, referred to the West, sought truth in practice, invented and innovated, and made outstanding achievements in the disciplines of typhoid fever, warming disease and medicine, etc. For external fever, he looked for external causes and emphasized the combination of internal and external causes; in treatment, he emphasized helping the righteous, and always thought of eliminating evil without harming the righteous; in theory, he developed the meaning of “Nei Jing” and integrated the doctrines of typhoid fever and warming disease, and made many innovations; in clinical prescriptions, he taught the ancient but not the ancient, and pushed out new ideas, and used medicine with great insights. In the study, Zhang’s academic thought on external fever is summarized as follows: A. Detailed examination of the cause of the disease, focusing on the combination of internal and external The way to practice medicine is to be able to understand the origin. If the doctor can not identify the cause of the disease, even if the medicine are in accordance with the “Classic”, it is difficult to get results, and even delay the disease, and death. Zhang understands this, attaches great importance to the examination of the cause of disease and disease, such as Zhang’s “medicine in the heart of the West. The reply to the Sangchen Zheji Yiwu book: “a certificate of any time with the change, always the original inconsistency, the spirit of our people to get along with the disease machine. If you are not involved in carelessness, can not carefully examine the disease mechanism, you can miss people’s lives. The medical cases recorded in Zhang’s writings must first list the causes of the disease, detail the patient’s pathogenesis, then deduce the disease mechanism, and finally list the prescriptions and medicines. For example, in the case of Shaoyin warm disease, the patient was febrile, had a weak pulse, was mentally confused, had closed eyes and curled up, and was annoyed with speech. He believes that the disease is due to internal heat, winter injury to cold, winter does not hide essence, winter does not hide essence, kidney yin deficiency, cold in the Sanjiao with the spring Yang back and heat, and take advantage of the essence deficit does not hide and run into Shaoyin, resulting in kidney yin, heart and Yang can not help each other, into the “heat evil deep, gasification of the gap of the marquis”, with Kan Li Huyen Tang plus reduction (raw gypsum, wild ginseng, raw ground yellow, yam, Xuan Shen, Sha Shen, licorice, fresh thatch root) to treat and heal [2]. Another example is that in “Medical Science and Technology. Zhang knew that warm diseases are mostly suffered in winter and develop in spring, and the disease mechanism is from the inside out, and this woman’s pulse is sunken and abnormal because the disease mechanism is depressed and cannot reach outside. The doctor is not afraid to take the cold medicine because of his sunken pulse. Such medical cases of careful examination of the causes and identification of the evidence, with corresponding medicine and evidence, abound in his writings, thus showing his emphasis on detailed examination of the disease mechanism and the combination of internal and external causes. The body of man corresponds to heaven and earth, and between heaven and earth, it is the righteousness, and the life of man lies in the righteousness. The “Suwen – the seventy-second chapter of the theory of thorns” said “the positive qi memory, the evil can not be dry”, “Suwen – the evaluation of the theory of fever 33” said: “where the evil comes together, its qi must be weak”, so the person Therefore, the person must be due to the loss of harmony between yin and Yang, the positive qi turbulence, the evil is waiting to enter, the disease is born. Zhang Xichen deeply understand the original purpose of the Inner Classic, always pay attention to the positive qi, identify the deficiency of yin and yang, use medicine to regulate yin and yang, protect the positive qi, support the positive to get rid of the evil, although the diagnosis and treatment of external diseases also more with the support of the positive products, such as the “medicine in the heart of the West” said: “whether spring temperature or wind temperature, such as both yin deficiency, when the surface, it is appropriate to support the nourishing yin products, the true yin, to supplement the true yin. To help Yin to respond to its Yang …… [4]”. In the use of sweat method to treat warm diseases, the theory of “yin and yang and then sweat” is unique, for example, “Medicine in the heart of the West” said: “the sweat of the person is like the rain of heaven and earth, the yin and yang of heaven and earth and then rain, the person is also yin and yang and then sweat” [5]. Zhang Xichen’s concept of protecting the right qi to expel external evil is always implemented in the treatment of external fever, such as the treatment of sun surface deficiency with sweating Gui Zhi Tang evidence, Zhang advocates the addition of raw astragalus, wind and Zhi Mu on the basis of Gui Zhi Tang to make the addition of flavor Gui Zhi Substitute porridge soup, that “Gui Zhi Tang evidence is due to atmospheric deficiency, resulting in the diffusion of Wei Qi, evil can cross the Wei and invade the camp, so after taking medicine, that is, sipping hot porridge, can subsidize the chest Atmosphere to overcome the evil, but also to promote the passage of ginger and gui to dispel the evil …… plus astragalus ascending to supplement the atmosphere to replace the power of the porridge to supplement the power of the Feng Feng to promote the Ying and Wei to replace the power of the porridge to publish [6]”. To Shao-Yin typhoid fever who began to get a sunken pulse and abdominal pain, in the application of Zhongjing Ma Huang and Herba Fine Pungent Soup with warming and tonic products, such as Shu Di, Yam, Cornu Cervi Pantotrichum, Dry Ginger, Clove, etc., so it can be seen that Zhang can be said to have penetrated the “Nei Jing” “positive deficiency of evil multiplied” and “spirit within the guard, the disease is safe from The deeper meaning of the “Nei Jing” and “the spirit of internal protection, the disease is safe. The great doctors of the past generations have always taken “Spirit”, “Su”, “Typhoid” and “Benjing” as their teachers and strived to improve their medical practice. Zhang Xicun in the path of Chinese medicine, the ancient tradition, some follow, pharmacology respect “Shennong Ben Cao Jing”, medical theory respect “Nei Jing”, “Typhoid”, but he to seek truth from facts, the rough to preserve the essence of the attitude of inheritance of medical art, every party, every use of a medicine, all without detailed examination, clinical evidence carefully experience, such as gypsum after examination and clinical verification, determined that calcined use will lose cold, can not be used for fever, want to be used for fever must use The gypsum can be ground and swallowed, and it must be boldly reused for quick results in severe cases of external heat, which Zhang said was very effective, “the same as the golden elixir”. Zhang’s study of the “Internal Canon”, the clinical test, some insights, the creation of the “theory of the atmosphere”. Atmosphere, the sky is born in water, the dirty system of the vital gate, the less fire is angry, the breath is sprouting, the qi of Qian Yuan Zi Shi, combined with the qi of water and grain, to the chest, the only name is Atmosphere, can support the whole body, for all the qi of the program; if there is an external sensation, the condition is long, the depletion of true yin, the kidney does not accept qi, or improper use of drugs, too much to drain the broken qi products, can also become a dangerous evidence of atmospheric subsidence; such as the “medicine zhizhong ginseng xilu. The sixth issue, volume 3. The patient was afraid of his mother’s reprimand and suffered from an external sensation, and became a warm disease; the warm evil was already depleting qi and hurting yin, plus the fear of his mother’s reprimand, as it is said in the Nei Jing, “fear leads to qi down” and “fright leads to qi disorder”, so the patient became a warm disease and also had a submerged atmosphere. His treatment was based on Bai Hu plus Ginseng Tang, with Sheng Di Yi Zhi Mu, Yam instead of Japonica rice to support Yin, and Cornelian to save the upper part of the Qi; then he used Sheng Ma, Huang Qi, and Sha Shen Mai Dong to promote and tonify the Qi, and the patient was cured. Zhang applied the theory of “Heaven and Man in Unity” and “Yin and Yang in Secret” in the diagnosis and treatment of external fever, which creatively expounded the meaning of the Nei Jing, and his exposition could remedy the bias and save the harm, and his treatment method could serve as a model for future generations. For example, in the Nei Jing, “winter injury in the cold and spring will be sick with warmth” and “winter does not hide the essence of spring will be sick with warmth”, he combined the theory of the unity of heaven and man to elaborate, clear and refreshing, that “the winter cold is cold water division of heaven’s right qi, especially its qi Severe cold is too much, or people living in clothes lack of warmth, or frost and snow and out of the camp, that is, can not resist this gas ear”, the sense that the onset of typhoid, sense and can not be sick, the evil lurking in the Sanjiao fat film, impede the flow of Qi Qi, secretly generate internal heat, to spring back to Yang Sheng, triggering its heat, or more thin by external sensation to stimulate its heat, the heat is internal and warm disease; “People who do not hide essence in winter must have Yin deficiency, the heat generated accumulates in the viscera, and it is constrained by external sensations and starts, the same as those who contain real heat inside”. “winter does not hide the essence of the person, the kidney deficiency, volatile gas take advantage of the deficiency and run into the Shaoyin …… its heat depression in the skin but not very hot, its in the winter, for Shaoyin typhoid fever, that is, Shaoyin evidence, the first appropriate treatment to Huang Lian Agaricus Tang, also in the spring, that is, for Shaoyin warm disease, and foolish treatment of this evidence, always use Bai Hu plus ginseng soup, to The first thing to do is to use three taels of fresh white foxglove to make a decoction instead of water [8]. For those with warm disease whose pulse is floating in yang but not in yin, and who cannot sweat, he used Shu Di and Agaricus blazei to nourish true yin, and added Chicken Zi Huang to increase the fluids of Shao Yin and help the Qi of Shao Yin to reach upward, so that the internal trapped evil heat can penetrate outwardly, and established the method of clearing and nourishing Shao Yin [9]; for patients with internal heat of yin deficiency, he learned from the Tai trigram of Zhou Yi and adopted the meaning of the intersection of heaven and earth, and created the medicine pair of Zhi Mu and Huang Qi to clear deficiency heat. Zhang boldly disagreed with doctrines that were not in line with medical theory, such as the explanation of the Gui Zhi Tang evidence that “the deficiency of the yin component is called with the outside world” and Fang Youcheng’s suggestion that “wind injures the body” and “cold injures the yin” in solar disease. “, said to be corrected, that “the human Ying and Wei, are the outer contours of the body, the Wei analogy is Guo also, Ying analogy is the city also, there is the periphery of the Wei for the Ying, the external evil, how can cross the Wei and hurt the Ying call? Cover the atmosphere in the chest of the person, the breath and Wei Qi related, the atmosphere is filled in the chest ……… to defend the external sensation, so that no body, even if the body, but also stop in the Wei, but not in the Ying, this reason is also obvious, …… … investigate, wind and cold are not separate, that is, typhoid, which originally hosts cold, if but in the guard can also close the sweat carry on, so the use of Gui Zhi Tang, not only to dispel the wind as a matter of business, but also have the function of dispersing cold [10]”. The disease of plague, regardless of Western medicine and Chinese medicine does not have a special treatment, Zhang’s clinical observation, suffering from plague disease at the beginning of the person, the heart is not irritable, the pulse is fine and number and late, the spirit is decrepit and abnormal, the eyes are closed, the mouth and tongue is dry and tongue without moss like a mirror, the person coughing and sore throat, the extreme dryness of the lung, can be rotten and vomit blood [11], is the same as the Shao-Yin heat evidence of the heavy. In view of this, Zhang adapted the Shao-Yin Qing tonic method from Shao-Yin disease Huang Lian Agaricus Tang and created Kan Li Huyen Tang (raw gypsum, Xuan Shen, raw Chinese yam, licorice, wild ginseng, fresh white foxglove root, raw chicken seed yellow) to treat pulmonary plague, which achieved better results. The treatment of pulmonary consumption is considered to be the most dangerous disease by both Westerners and Easterners, but Zhang has been treating the disease for more than 40 years and has cured many of them. This shows that Zhang not only respects the ancient treatment method, but also brings it into play; he also has a lot of innovation in medical theory, which is rare and valuable. Fourth, the composition of the prescription is still simple, the use of drugs more invention The use of drugs is like the use of soldiers, the way of using soldiers is not in the number, in the courage and precision. Zhang Xichen has always advocated simplicity in his clinical evidence and prescriptions. In terms of the clinical diagnosis and treatment prescriptions listed in the entire book of his work “Medicine Zhong Zhong Ginseng Xilu”, there are rarely more than fifteen flavors of medicine used; Zhang believes that the use of clinical medicine, the need to be able to treat the symptoms, can heal the disease, if there is a wide variety of flavors, not only is it difficult to investigate the work of what medicine is lucky to be cured, it is difficult to test the actual power of medicine. In the “Medical Heart of the Central Ginseng West”, he said: “The medicine commonly used by doctors, I always do not use, and those not commonly used, I always like to use. The medicine used by Zhang is his understanding of the product, and his experience in the use of medicine also has many inventions, such as his use of white tiger plus ginseng soup, always with xuan ginseng instead of Zhi Mu, raw yam instead of japonica rice, to nourish yin and water, to regulate the meaning of the less yin, such as the “Medicine in the heart of the Ginseng Record . The sixth issue, volume 3. In this case, the patient had accumulated heat in the internal organs, and then the liver and kidney yin was damaged due to overwork, and was attacked by an external infection, so Zhang took Baihu plus ginseng soup, and replaced Zhi Mu with xuan ginseng and japonica rice with raw yam, because “xuan ginseng is black in color, sweet and slightly bitter in taste, cool and liquid, and is a medicine for clearing the kidney meridian, and can benefit kidney water to nourish liver wood [15]. “It can nourish the liver and kidney and clear deficiency heat, which can help to reduce fever and support positive energy at the same time. Zhang’s prescriptions also carried out his idea of “Chinese and Western” and drew on the achievements of Western medicine at the time, boldly forming prescriptions and creating many combined Chinese and Western medicines and pairs, such as gypsum and aspirin soup and distilled water and gypsum drink, the former only gypsum and aspirin together to treat external fever, scarlet fever, gua rash, etc. Seeing the strong heat around the body and thirst, yellow moss and smooth pulse, it is believed that aspirin is the best at publishing and can be the best medicine to penetrate the gua rash. The latter is to add licorice to the front and use distilled water to decoct the medicine for the treatment of chest heat, and external warmth, chest boredom, wheezing, pulse floating and strong, tongue coating white but not yellow, belong to external wind cold, can add ephedra and remove aspirin. He also innovatively explained the efficacy of Western medicine with the characteristics of Chinese medicine’s flavor and origin, such as the Western medicine chicken bark cream, he believes that “the bark of the chicken bark boiled into cream, the tree was born in South America, the refining of the cream to its golden bark is the top, the system of hydrochloric acid is known as hydrochloric acid Gurney, its nature is particularly cool, for its refining of the bark of the sap, so it can enter the three jiao to reach the coup outside and sweat, the three jiao is the House of Shaoyang, so it can also enter the hypochondrium to search and pick. Therefore, it can also enter the wakefulness to search the root of malaria evil. Zhang’s inventions on drugs are mostly found in his chapter on “Drugs”, where he explains each of the 79 herbs in detail, citing the scriptures and combining clinical experience to enrich and develop the content of traditional Chinese medicine, such as gypsum, which he believes is “cool in nature and can disperse, has the power to penetrate the surface and relieve the muscle, and is the sacred medicine for clearing real heat in the stomach and internal organs of Yangming It is effective for both internal and external injuries”, and its characteristic of reducing fever is “to go out with the heat, so that after decocting gypsum, it can make the heat contained in the pores penetrate …… with the nature of publication, and boil the soup with it as straight as water, and after taking it, its cold power all go out with the power of publication. Peppermint, originally for the warmth of the most good medicine to relieve the table, Zhang’s examination that “mint ancient original name of caustic, to the sparse, not to the medicine, the Classic, the other records are not contained in the Tang Dynasty began to list in the drugs, is the typhoid theory of all prescriptions without the use of mint”, Zhang’s coincidence of Ma Heng Shi Gan Tang, Da Qing Long Tang of ephedra to mint, with the treatment of warmth, that “peppermint taste pungent, gas clear depression fragrant fleeing, nature is flat, less use is cool, its power can penetrate the tendons and bones, the external muscle surface, pronounced through the internal organs, through the meridians, take it can penetrate the cool sweat, for the warmth of the disease should be sweating relief of the important medicine”, and put forward “warm disease sweating with peppermint, as if typhoid sweating with ephedra “The wonderful theory [16]. The first is the use of the meat of the dogwood, which is used in place of the ginseng, art and qi, to astringent sweat and save the body, that “the meat of the dogwood is acidic and warm, and can astringent, invigorate the spirit, solid astringent and slippery, because the thickest wood gas, astringent both strip smooth nature, so it can also open the nine orifices circulation blood …… and converge the right qi not converge the evil qi [17] …… its power to benefit the qi is far less than that of ginseng, but its rescue qi on off is far better than that of ginseng, always because the liver draining too much and off, heavy use of cornelian meat to converge the liver so that it does not draining, then the yuan qi want to off the person can not off “. From the above can be observed, Zhang’s clinical formula is simple, the use of medicine is expensive and precise, more hair of the ancients have not been issued, the legacy of high theory in future generations. Zhang Xichen, at the time when Western medicine was growing in the east, not only collected both Chinese and Western medicine, but also practiced and researched and innovated, and invented all the aspects of the treatment of external febrile diseases due to the evidence, and his knowledge of the nature of medicine and its practical use were even better than those of the ancients. References: [1] Zhang Xicun. Medicine in the Heart of the Chinese Ginseng and Western Records (Middle Book) [M]. Beijing: China Literature and History Press, 2003. p722 [2] Zhang Xichen. Medicine in the Heart of the Chinese Ginseng and the West (Lower Book) [M]. Beijing: China Literature and History Publishing House, 2003. p851~p852 [3] Zhang Xichen. Medicine in the Heart of the Chinese Ginseng and the West (Upper Book) [M]. Beijing: China Literature and History Publishing House, 2003. p216 【4】 Zhang Xichen. Medicine in the Heart of the Chinese Ginseng and the West (Previous Book) [M]. Beijing: China Literature and History Publishing House, 2003. p197 【5】 Zhang Xichen. Medicine in the Heart of the Chinese Ginseng and the West (Previous Book) [M]. Beijing: China Literature and History Publishing House, 2003. p198 【6】 Zhang Xichen. Medicine in the Heart of the Middle and the West (Book I) [M]. Baoding: Hebei People’s Publishing House, 1957. p183 [7] Zhang Xichen. Medicine in the Heart of the Chinese Ginseng and the West (the next book) [M]. Beijing: China Literature and History Publishing House, 2003. p845 【8】 Zhang Xicun. Medicine in the Heart of the Middle and the West (Book II) [M]. Baoding: Hebei People’s Publishing House, 1957. p199 【9】 Zhang Xichen. Medicine in the Heart of the Middle and the West (Middle Book) [M]. Beijing: China Literature and History Publishing House, 2003. p613 【10】 Zhang Xicun. Medicine in the Heart of the Middle and the West (Book I) [M]. Baoding: Hebei People’s Publishing House, 1957. P183 [11] Zhang Xichen. Medicine in the Heart of the Middle and the West (Middle Book) [M]. Beijing: China Literature and History Publishing House, 2003. p659 【12】 Zhang Xicun. Medicine in the Heart of the Middle and the West (Upper Book) [M]. Beijing: China Literature and History Publishing House, 2003. p33 【13】 Zhang Xichen. Medicine in the Heart of the Middle and the West (Middle Book) [M]. Beijing: China Literature and History Publishing House, 2003. p457 【14】 Zhang Xichen. Medicine in the Heart of the Chinese Ginseng and the West (Lower Book) [M]. Beijing: China Literature and History Publishing House, 2003. p859 【15】 Zhang Xichen. Medicine in the Heart of the Middle and the West (Book 3) [M]. Baoding: Hebei People’s Publishing House, 1957. P64 【16】 Zhang Xichen. Medicine in the Heart of the Middle and the West (Book 3) [M]. Baoding: Hebei People’s Publishing House, 1957. p107 【17】 Zhang Xichen. Medicine in the Heart of the Middle and the West (Book 3) [M]. Baoding: Hebei People’s Publishing House, 1957. P34 Additional specific departments