Classical Physician Zhang Jingyue:
The Rehmannia Doc
Zhang Jingyue (c.1563-1640; original name: Zhang Jiebin) had an immense influence on the development of Chinese medicine at a time when the Ming Dynasty was collapsing to give way to the Qing Dynasty, the transition of power occurring in 1644. The two major works coming from Zhang’s years of learning and medical practice are the Leijing (a study of the Neijing) and Jingyue Yixue Quanshu(Collected Works; usually called simply Jingyue Quanshu); both of them are massive compilations (32 volumes and 64 volumes respectively). The Leijing basically combines the contents of the Neijing Suwen with that of the Lingshu, rearranging them according to topical categories and adding lengthy explanations of difficult or controversial passages. The first two sections of the Leijing, devoted to “nourishing life” and “yin/yang,” are relevant to the discussion to be presented here, but it is the information from the Quanshu, Zhang’s final preserved publication, that will be the focus of this paper.
Jingyue Quanshu was completed in 1624. It summed up not only the therapeutic concepts and formulations of the author, but also of his predecessors. He analyzed the strong points of the schools of medicine that evolved during the Jin-Yuan period and persisted into the Ming Dynasty. Zhang belonged to the school of “warm tonification” (Chinese: wenbu) that came to the forefront in the mid-16th century. In this endeavor, he participated with the contemporary physician-scholars Xue Ji (1488-1558), Sun Yikui (1522-1619), Zhao Xianke (c.1567-c.1644) and Li Zhongzi (1588-1655). This conceptual framework of tonification followed from the views of Li Gao, who was a key contributor to the Jin-Yuan reforms.
Xue Ji (author of Neike Zhaiyao; A Synopsis of Internal Medicine)emphasized tonification of the spleen and stomach, using herbs such as atractylodes (baizhu), ginseng (renshen), astragalus (huangqi), and licorice (gancao). Zhao Xianke (author of Yiguan; Key Link of Medicine) further developed the teachings of Xue Ji with emphasis on the role of the gate of life (Chinese: mingmen). His efforts focused upon the idea of balancing the yin (water) and yang (fire) of the kidney and of the mingmen, using formulas such as Zhi Bai Dihuang Wan. Both Sun Yikui (author of Yi An; Medical Records), and Zhang Jingyue also followed this mingmen focal point, with their own slight modifications; in fact, this emphasis gave the warming tonification school the additional title of the mingmen school. Sun Yikui and then also Li Zhongzi (who, like Zhang Jingyue, wrote a commentary about the Neijing), began to move away from strict adherence to the importance of warming tonification, considering it one of several potentially useful approaches, but Li especially helped bring forward the concepts of this school into the evolving medical concepts of the Qing Dynasty period. Of these five leaders of warming tonification, our attention turns to the one who had the broadest impact on the later evolution of Chinese medicine.
Zhang Jingyue was born in what is today Shaoxing County of Zhejiang Province (see map, right: the county in red; the province in orange); his hometown was near the eastern coast of China, south of Shanghai and east of Hangzhou. In his teens, Zhang went with his father to Beijing, where he eventually studied medicine, and became one of the Imperial physicians working for the Emperor Wanli. The situation in China when Zhang began practicing medicine in Beijing is laid out in Ray Huang’s 1982 book: 1587, A Year of No Significance: The Ming Dynasty in Decline (1). That book, aside from describing the social and political situation, nicely presents insights into how yin and yang were understood: they were especially utilized as terms depicting the management of government affairs and making strategic plans for battle. Zhang Jingyue, 24 years old in 1587, also frequently used the battle theme to describe his medical ideas; this orientation came out of his initial pursuit of a military career. Zhang depicted herbs as being like a deployment of troops against the enemy, the disease. He is well known for having elaborated the Eight Principles (bagang): yin/yang; biao/li; xu/shi; han/re, which apply the framework of the yin/yang concept. These eight principles (or yin/yang plus six principles) were utilized first to aid in diagnosis of disease and then to classify formula actions, which Zhang laid out as the “eight tactical arrays (bazhen).”
This period—the latter part of the Ming Dynasty—was important for the future course of Chinese medicine in many ways. For example, it was at this time that Li Shizhen (1518-1593) compiled his Bencao Gangmu, which was turned over to the Wanli Emperor; the Emperor retained it in the Ministry of Rites, which was an action that actually inhibited its circulation. The Bencao Gangmu was published in 1596 (after Li Shizhen had died), but it wasn’t distributed until a revised version—with some of Li’s other writings included—was published in 1603, when Zhang Jingyue was 40 years old, and not yet an author.
Matteo Ricci, a Catholic priest from Italy, lived in Beijing around 1600-1610. He translated a number of western works on anatomy and science into Chinese; he introduced the methods of preventing epidemics that had been developed in Europe (though they wouldn’t be widely incorporated in China until the late 1800s).
Gong Tingxian (1522-1619) published his major work, Wanbing Huichun, in 1587 (that is, in the “year of no significance”); it greatly influenced Kampo medicine. The book was brought to Japan by one of Gong’s students and it turned out to be the last major Chinese medical work to inspire their system of medicine before it evolved on its own among Japanese physicians.
Put simply, Zhang Jingyue’s life spanned a distinctive turning point in Chinese medical history; like the phoenix rising out of the ashes, a new phase of Chinese medicine was rising out of the downfall of the Ming Dynasty. One may think also of Zhang Zhongjing, who worked in the declining years of the Han Dynasty; his works are guessed to have been published around the last year of the Han.
The relationship of yin and yang that came to Zhang Jingue’s attention was described in Ray Huang’s book about the conditions in 1587. In that year, Shen Shixing, the Grand-Secretary to the Wanli Emperor, made this observation: “The professed moral tone of government that enabled the bureaucrats to justify their lines of action was the yang, and their hidden desires and motivations was the yin.” He was noting that the lower echelon bureaucrats—who worked behind the scenes and unobserved—could undertake the initial “skirmishes” in the political maneuvers, and then the senior members would finally become involved, waiting for the time to be ripe to initiate a final showdown in which the decisive political change would become public (yang). Put more simply, the aspect that was exposed—the moral tone that was professed to the public—is yang, while that aspect which was hidden—the desires and motivations of the powerful ministers—was the yin; discerning the appropriate timing for blending and transitioning from yin to yang was the essential political skill. Shen went on to point out that “The mixing of yang with yin being a matter of degree, [one’s] adherence to principle therefore varied not only from one person to another but from time to time within the same person.” Simplifying: the yin and yang are not separate but coexist within each individual and each situation. Conditions are fluid and one must evaluate them repeatedly and make adjustments.
The military hero, General Qi Jiguang (1528-1588), is said to have relied upon “a dialectic approach” in describing tactics in battle. As relayed by Huang: “Every posture had its duality: the static and kinetic aspects, the guarded and unguarded positions, the frontal and lateral alignment, the defensive and offensive potentials—in short, the yin and yang.” He considered that to succeed in battle one had to lure the opponent in until the proper time for a reversal; the “mastery of the art depended upon proper rhythm—or perfect timing in transforming the yin to the yang.” Looking at the bigger picture of the army in the society, at a most difficult time in the history of the Empire (the declining years of the Ming Dynasty), Qi believed that “the way to boost the fighting strength of the army had to come through compromise, mainly the blending of the yin with the yang.” In essence, if either the yang or the yin is overemphasized, weakness results; both are necessarily present in directing affairs of state and in leadership of war, but their relative preponderance and their interaction is critical. One then has to focus upon bringing about transformation at the right moment. The starting point for the process is developing the yin; the timing involves shifting to the yang; in the interim, there is some blending of the two.
That which is hidden (yin) has a certain power. When the yin is unleashed (from its place of obscurity), it can catch the opponent unaware on indefensible terrain, because the offense comes unexpectedly—before there is time to select and attain the desirable defensible terrain. As a result, the enemy can be defeated, even if the attacker has other weaknesses. One may think of the “crouching tiger” that is very still but has great potential held in reserve in the compression of its muscles into its low and drawn-back position, a yin quality. The tiger then waits quietly and springs forward at the right moment as yin transforms to yang and the action has its intended consequences.
That which is evident (yang) also has power, but unless that power can be concealed within the yin (delayed in exposing it), the extent of the power is revealed to all, and an opponent can opt to take prudent evasive action (yin) to become hidden by terrain or separated by distance, especially when that which has been revealed appears to be too strong (because the strength has been evident, there is time to take appropriate compensatory action). An army cannot run away for long, but it can retrench into an area offering greater protection and opportunity (yin), or it can join a larger reserve force (also yin). Large forces are slow moving (yin) and must be maintained in a protected area (yin) with plenty of supporting resources (yin), such as food and water. It can then wait for an appropriate time to make use of its ready forces that now become evident (yang). All this military thinking has application to medical matters.
Evolving Medical View
Paul Unschuld, in his book Medicine in China: A History of Ideas (2), provides the following background on Zhang Jingyue’s thinking (p. 199). Note: I have updated the physician name spelling; Unschuld has translated qi as “influences,” which I retain, and in brackets I provide background information for the physicians mentioned.
Up to the age of 40 , Zhang Jingyue followed the teachings of Liu Wansu [1120-1200; leader of the “cold/cooling school,” considering most ailments as involving pathogenic fire that was to be cooled] and Zhu Danxi [1281-1358; leader of the “nourishing yin school,” considering that the ministerial fire of mingmen easily tended to flare up, representing a pathological excess of yang qi, due to deficiency of kidney yin]. But then, as a result of his own experiences, he began to have doubts, and the precepts of Zhu Danxi in particular—namely, that a pathological surplus of yang qi is frequently present in the body—now seemed to him completely untenable. In accordance with the conclusions of Xue Ji [ca. 1488-1558] and Li Gao [1180-1251; leader of the “spleen/stomach school,” considering many health problems to arise from damage to the spleen/stomach through diet, overstrain, and mental agitation, recommending warming tonification of spleen qi, and giving rise to the “school of warm tonification”], he too now considered the yang component in the organism to be of primary importance and therefore advocated constant replenishment of the body with yang influences to treat and prevent illness.
Zhang Jingyue’s arguments were formulated as follows: The influences that flow through the body form the yang component, while the structure of the body itself constitutes the yin component. Yin-Yang dualism requires that the yin component cannot exist without a yang component and vice versa. Applied to man, this signifies that bodily structure requires yang influences to come into existence and that the yang influences, in turn, requires this structure as their supporting mechanism. All living beings are therefore brought into existence by yang influences and given a physical structure by yin influences. This process of genesis proceeds indefinitely, ensuring the continuation of existence. An imbalance of yin and yang influences leads eventually to death. In this connection, Zhang Jingyue cited the following two statements in the Huangdi Neijing: “When yin and yang influences work together, it is of great importance that the yang influences remain tightly sealed. In this way, strength can be maintained” and “Yang influences possess for man the same significance as does the sun for the heavens.”
Zhang himself remarked: “This red globe of the sun is of utmost significance for heaven. The original yang influences alone represent the supreme value for man.” He then contrasted the precepts of Zhu Danxi with his own doctrine that the yang component could not form a pathological surplus, further supporting his views as follows: “The only possibility one need fear in regard to the yang component is that it might be insufficiently developed and, in the case of the yin component, that it might be overly developed. The yin component is, however, by itself incapable of reaching a state of excess, for this it requires a deficiency of yang….”
With all his emphasis on the fundamental requirement for yang in life and health, Zhang Jingyue nonetheless became known as the “rehmannia doc.” He believed that to get adequate yang influences in the body, it was essential to assure that the yin was replete: supplementing yang without nourishing yin was a wasted tactic. He had learned well from the military strategists: the activity of yang needed a reserve, the yin had to be full. Sun Yikui had put it poetically (3):
…[ministerial fire] is the fire within water, it is the dragon and thunder fire. When the dragon and thunder fire is wetted by yin and saturated with rain, its flames blaze up ever more. It may burn houses or decimate forests with a ferocity that cannot be resisted. Only when a ray of sunlight hits it will the fire extinguish itself. This is how water causes fire to blaze and fire causes fire to be extinguished.
The kidney yin (water) does not extinguish ministerial fire; it enhances it. Since the mingmen school professed the value of this fire, it promoted the nourishing of yin to cause it to blaze more brightly. For Zhang, rehmannia (the processed root, called shudi) was the key herb for nourishing the yin, especially when the aim was to enhance yang. Huang Baoming, summarizing Zhang’s work (4), wrote:
Rehmannia possesses “thick” (concentrated) taste and light qi. Within it, there is “yang in the midst of yin.” It has the ability to tonify the genuine yin of the five solid organs, making it an ideal herb for tonification….Its characteristics of calmness, heaviness, mild sweetness, and guarding action allow this herb to complement and/or counteract the side-effects of other herbs. These characteristics rebalance the yin and yang, water and fire, qi and blood, and the various organs, ultimately achieving the purpose of healing diseases.
Dihuang Zhang: The Fearless Rehmannia Doc
Today, rehmannia is often thought of first and foremost as the “cloying” herb, sticky sweet to the point of being nauseating. This herb thus comes with descriptions of being heavy, indigestible, and unpleasant, even though it is apparently necessary for modern practitioners to use cooked rehmannia because of its frequent appearance in traditional formulas. However, this is not the reputation it held in Zhang’s time. Rather, it was thought of as warming, fast acting, and dynamic in a gentle manner, efficient and peaceful in its effects. That it was somewhat difficult on the digestive system was evident, but not considered highly problematic. While today we learn about the use of alisma (zexie) or cardamom (sharen) to counter the rich nature of rehmannia (shudi), Zhang didn’t concern himself with that approach, and though he used and developed formulas similar to Rehmannia Six Formula (Liuwei Dihuang Wan), he did not include alisma. Indeed, the original purpose of alisma in the base formula (Rehmannia Eight Formula; Bawei Dihuang Wan), was not for countering the moistness of rehmannia but for regulating water movement in the body, in much the way it was used in Wuling San.
When the modern physician Huang Baoming wrote about the use of rehmannia by Zhang Jingyue, he felt compelled to conclude the article with his thoughts on the “problem” of rehmannia saying (4):
Some scholars consider rehmannia to have an undesirable stagnated, greasy, slippery, and wet nature. However, Zhang’s experience and clinical effects demonstrated that it is quite safe. He contended that since “Cui’s Pill for Kidney Qi” [this is one of the names given to Jingui Shenqi Wan, the Rehmannia Eight Formula of the Jingui Yaolue] may be used in the treatment of floating phlegm, then why worry about its stagnated and greasy nature. Furthermore, the Pill of Eight Ingredients [another name for the same formula] is prescribed when the kidney is unable to hold essence, despite the herb’s slippery and wet nature. Still, suspicion of its stagnated and greasy nature exists and there is questionable application when tonifying blood. However, one ought to know that when the blood is deficient, it is like dry earth, an intense drought needing rain, withering yang desiring moisture. Zhang consistently advocated the use of rehmannia without fear. As a Chinese saying goes, “the incidence of choking should not deter one from eating.”
As an example of his fearless use of rehmannia even in cases of phlegm excess, he presented the formula Jin Shui Liu Jun Jian (Formula of Metal and Water based on Liu Junzi Tang). This formula includes the phlegm-resolving herbs fresh ginger (shengjiang), hoelen (fuling), pinellia (banxia), and citrus (chenpi), with rehmannia, tang-kuei (danggui) and baked licorice (zhigancao); viewed another way, this is Erchen Tang with rehmannia and tang-kuei. In modern presentations, advocates of Chinese medicine are sufficiently averse to using cooked rehmannia in cases of treating phlegm excess that they specify raw rehmannia for this prescription as though it belonged to the original formula, but that was not Zhang’s way. He recommended the formula for deficiency cold of lung and kidney, with flooding of water transforming into phlegm causing cough, vomiting, profuse sputum, and asthmatic breathing. The cooked rehmannia was to nourish the kidney yin, so as to help invigorate the kidney yang, to control the water and warm the lung, thereby resolving the phlegm accumulation.
Two British doctors working in China at the end of the 19th century, Smith and Stuart, compiled a book about Chinese herbs (5) relying on the Bencao Gangmu and the reports of contemporary Chinese physicians. Regarding the preparation of shudihuang, they wrote that it is “made by taking juicy roots, washing in spirits, filling with the seeds of the bastard cardamom [sharen], steaming on a willow frame in a porcelain vessel, drying, and resteaming and redrying nine times.” The nine-fold processing is a reflection of ancient alchemical manipulation, and it was believed to enhance the warming and nourishing properties of the herb, helping to develop the yang within the yin. Its properties were: “to harmonize, increase, and cool the blood, and to strengthen the marrow. It is considered highly tonic…” The cooling of blood is associated with nourishing the blood, and thus retiring the heat. Including cardamom in the processing was a nod to the desire to alleviate the slippery nature of cooked rehmannia without requiring herbalists to add the ingredient to their formulas. As to the applications, it is “used in all wasting diseases and weakened conditions of the body. In diseases of pregnancy, puerperal difficulties, diseases of children, and wasting discharges, it is specially recommended.” The applications of Chinese herbs for pregnancy, postpartum recovery, and for young children were tackled by Zhang Jingyuen in the Quanshu, but also as a result of further developments in the uses of Rehmannia Six Formula during the Qing Dynasty period.
Mingmen: The Key to Life
In Zhang’s teaching, the kidney plays a special role in the whole dynamic of human physiology. It was thought by many doctors of his time that the yin essence was retained in the left kidney (the kidney of water) and the yang essence in the right kidney (the kidney of fire); this concept was not based on any observation about the two kidneys themselves but on the long-standing tradition that the left was the yin side of the body and the right the yang side. The life gate (mingmen) was traditionally associated with the right kidney. The “fire” of the mingmen is identified as the “ministerial fire;” this designation distinguishes it from the fire of the heart, which is the “imperial fire” (the heart being the organ associated with the fire element). The mingmen, interpreted as a physiological-anatomical unit, is the storehouse of the jing (essence) and shen (spirit) that generates the qi. Sometimes, the mingmen was said to be located between the kidneys (e.g., by Zhao Xianke and Sun Yikui), rather than associated with the right kidney; the acupuncture point mingmen (GV-4) is located between the kidneys. Some thought the mingmen was equivalent to the kidneys (e.g., Hua Shou of the Yuan Dynasty). Zhang Jingyue maintained the idea of the left and right kidneys being the resource of yin and yang respectively, but considered the mingmen to encompass both kidneys and to be the basis of all bodily health. He wrote (2):
The mingmen controls both kidneys and both kidneys belong to the mingmen. Mingmen is the mansion of both water and fire, the house of yin and yang, the sea of essence and blood, the nest of life and death. If the mingmen is depleted and damaged, the five zang and six fu lose their sustenance, and the yin and yang will become sick, causing all types of disorders.
He also considered that the mingmen included the essence chamber of reproduction that corresponded to the womb in women and the semen reservoir (prostate) in men. His primary effort was to harmonize the many statements about mingmen in the ancient texts, which was a daunting task, but he wanted to counter the tendency for speculation that was not connected to the original descriptions.
Zhang considered that if the ministerial fire was too strong it could be regulated by focusing proportionately more on nourishing of yin, but even then, not to the exclusion of nourishing yang. Zhang opposed the idea of incorporating cold or cool herbs with the purpose of inhibiting ministerial fire. Thus he differed from Zhu Danxi, a proponent of nourishing yin, who utilized phellodendron and other herbs that were deemed suitable for treating fire associated with yin deficiency. An example of a well-known Zhu Danxi formula is Hu Qian Wan (Pill of Hidden Tiger). It is comprised of the yin nourishing rehmannia and tortoise shell (guiban) with the deficiency-heat clearing herbs phellodendron (huangbo) and anemarrhena (zhimu), along with nine other ingredients. The formula was used for flaccidity of muscles and bones leading to difficult walking; the flaccidity and accompanying withering of the legs was thought to be a secondary effect of the yin being burned up by a feverish condition, hence the idea of clearing the heat. As a bone-fortifying and muscle strengthening ingredient, tiger bone (hugu), derived from the tiger leg, was one of its original ingredients.
Rehmannia is now recognized as the key herb for nourishing yin and blood, and Zhang Jingyue is partly responsible for that emphasis. Zhang had organized 186 prescriptions of his own, presented in his Quanshu, of which 48 contained rehmannia. About this herb, he said (4):
Rehmannia is needed to guard the yin in cases of deficiency that involve scattering of the spirit; the heaviness of rehmannia is needed to counter the rising fire of yin deficiency; the calming quality of rehmannia is needed for pacifying the agitation of yin deficiency; the mild sweetness of rehmannia is needed for relaxing the impulsive nature of yin deficiency; rehmannia is needed to restrict the flooding of water evil in cases of yin deficiency; rehmannia is needed to retrieve the scattered genuine qi back to its origin in the kidney; in yin deficiency with damage to the essence-blood and extreme emaciation, it is used to thicken the gastro-intestinal tract; the blood nourishing of rehmannia is used with dispersing agents for diaphoresis because sweat is transformed from blood; the yin nourishing of rehmannia is used with warming agents for retrieving yang qi because yang is rooted in yin.
Of the warming tonification formulas that he presented, only a few are commonly used today and the best known of these are the kidney nourishing formulas; there is the pill and decoction for the left kidney, the pill and decoction for the right kidney, restoring the kidney pills, and great tonifying the original formula. In the table below, the herbs are laid out to show the similarities of the formulas (6):
The group of rehmannia, dioscorea, lycium fruit, and cornus is in all six formulas; the kidney yang (right kidney) formulas include eucommia, cinnamon bark, and aconite.
To appreciate the modern views on the benefits of rehmannia, one can turn to an explanation of the well-known Rehmannia Six Formula (Liuwei Dihuang Wan; developed by Qian Yi of the Song Dynasty, as a pediatric remedy for weak vitality). For example, the Advanced Textbook on Traditional Chinese Medicine and Pharmacology (7) presents the current explanation of the formula based on TCM principles, giving a good overview of the treatment of kidney deficiency:
This prescription is indicated for disorders due to kidney yin insufficiency and upward attack of deficiency fire. The lumbus houses the kidney, which controls the growth of bones, marrow, and teeth, so insufficient kidney yin may give rise to soreness and weakness of the lumbus and knees and loose teeth. The brain is the “sea of marrow,” and kidney yin deficiency may impede the production of marrow and the function of the brain, causing dizziness. When kidney yin is deficient, the essence cannot be sent to the ears, resulting in tinnitus and deafness. Since the kidney stores the essence, the ministerial fire may disturb the spermatic chamber when kidney yin is deficient, leading to nocturnal emission. Yin deficiency may lead to internal heat generation, resulting in hectic fever, a hot sensation in the soles and palms, diabetes, and night sweating. Yin deficiency in the lower body may induce an upward attack of deficiency fire, causing dry throat and red and dry tongue with little coating. The principle of treatment is to nourish yin and invigorate the kidney.
Addendum: On Herb Prescribing
The following brief passage from the first chapter of Jingyue Quanshu is entirely relevant to herb prescribing issues that are present today as well as in Zhang’s time. This translation is from Steven Clavey (8):
In diagnosis and treatment, aim for accuracy and exactitude. Every disease under heaven has a single root, despite many apparent variations; every prescription has a single consistent relationship with the condition it treats, no matter how many herbal constituents are adroitly added or deleted to keep pace with the alterations of the illness. If the diagnosis of cold is certain, then cold must be completely dispersed. If undeniably heat, then the pathogenic heat must be absolutely cleared. Once one has pulled up and disposed of the root of the illness, the other symptoms will eventually disappear by themselves. Thus the Su Wen (chapter 5) states: “In treatment of any illness, aim for the root.” Before one can aim for the root, using herbs for treatment, one must have determined its nature. If the observation or judgment of the disease state is not sufficiently accurate to begin treatment, it is better to wait a short time to allow the nature of the disease to become clear. Then a detailed examination may be made. Once a sure diagnosis is had, the use of one or two herbs can eradicate the pathogen. Even if the root is, as it were, firmly entrenched, so that the disease is stubborn, extended, and difficult to treat, an accurate diagnosis ensures that six, seven, or eight herbs will be sufficient. And these seven or eight herbs will only assist the main herbs, or guide the effects to this or that channel. The goal and plan behind the prescription has a single purpose. Only this makes a first-class physician. The doctors these days, though, when they run into a syndrome, act as if they are staring out into the uncharted wastes of a great ocean: they don't recognize a thing, there is nothing upon which to pin a diagnosis. So when it comes to using herbs, there is no goal, no grasp – no wonder their treatment is completely disorganized. It is like trying to corner and capture wild animals on a vast unbroken plain. They know that for a deficient condition they should tonify, but being afraid that this could cause problems they add dispersing herbs to control the tonifying herbs. They know that an excess condition needs to be dispersed, but for fear that dispersal would be dangerous they add tonifying herbs to control the dispersing herbs. The most ridiculous thing is that these doctors often use prescriptions that are neither hot nor cold, that contain both tonifying and reducing herbs – and then act as if everything is under control. How could this act to remedy the excesses or deficiencies of the condition, or repair the damage done by the disease? Some even use herbs for wind, herbs for fire, herbs for phlegm, and herbs for food stagnation all together in the same formula, and feel that all bases are now covered. Again, how can one even talk of treating the root or treating the branch? When they “use herbs to control other herbs” when do they get around to controlling the disease?! If these people happen to cure a disease, they do not know if it was the effect of the tonification or the effect of the attack on the pathogen. When the patient does not improve, they are not sure whether it is the fault of the dispersing or the tonifying herbs. They go on and on like this, practicing medicine until they are white haired and toothless and still they are no good. A whole life without improvement, simply from not having a clear perception of the problem, and not being able to use the simple essential methods necessary to resolve that specific problem. If the patient’s problem is simple, this is not greatly important. But if the life of the patient depends on the next moves of the physician, then even if the herbs are correctly selected, if the courage to use the required amounts is lacking, it is equivalent to tossing a glass of water on a raging blaze! At this stage of the game, who is going to try to grab both ends, to tonify and reduce?