THE JIN-YUAN MEDICAL REFORMS
The history of traditional Chinese medicine is long and complex. The record of events is often broken down into a few major eras during which certain critical developments occurred that influenced practice for many centuries afterward. Thus, for example, considerable attention is given to the Han Dynasty period (220 B.C. to 220 A.D.) when the most famous texts of traditional Chinese medicine were written: Neijing (Suwen and Lingshu), Shanghan Lun (including Jingui Laoyue), and Shennong Bencao Jing. Any overview of traditional Chinese medicine includes a description of the medical developments of what has been called the Jin-Yuan period or Jin-Yuan medical reform. This reform era, which involved the development of four schools of thought about disease causation and treatment strategies, was the result of the efforts of medical activists during the 13th century and beginning of the 14th century. They were protesting common physicians' reliance on certain therapeutic approaches that had been recommended earlier, but were being used indiscriminately: not adjusted for changing circumstances or for differences in geographical location. The Jin-Yuan innovations and revisions have been considered one of the essential evolutionary changes in Chinese medicine, though some consider the four schools to have been only a diversion from the original form of Chinese medicine, at least in terms of theory.
During the Northern Song Dynasty (960-1127 A.D.), the ancient texts of the Han period were revisited, with Zhang Zhongjing's Shanghan Lun and Jingui Laoyue recovered from near complete loss. Cheng Wuji (1062-1155) intensively studied these texts and wrote several books on the subject, his most famous being Zhujie Shanghan Lun (Commentary on the Shanghan Lun). At the same time, Xu Shuwei (1079-1154) also studied Zhang's works and produced an analysis of its content, especially with regard to pulse diagnosis and the theory of using drugs in relation to the intensity of the disease. It is also during this period that the famous prescription collection, the Taiping Huimin Hejiju Fang, was compiled. This formulary, produced in response to Imperial command, provided numerous formulas that were consistent with the Han Dynasty patterns of herb combining. It became the primary reference text for herb formulas.
The relative political and social stability during the preceding Tang Dynasty (618-907 A.D.) and the appearance of stability during the Northern Song Dynasty (which replaced the Tang after a 53 year interim of disruption), also gave a degree of stability-a distinct conservatism-to the medical field. To a large extent, physicians during this time came to view the Han Dynasty as a golden age of Chinese medicine that was to be recaptured, and that this preservation and invigoration of Han medicine had been largely accomplished by the efforts of Tang and Song Dynasty medical experts. Further, the Imperial examination system was put in place during the Song Dynasty. Potential physicians studied the Confucian classics and the officially recognized medical works, particularly those of the Han, Tang, and current Song Dynasty, then took exams to gain official status. This procedure helped establish a national medical authority.
Then, with the rise to power of the Jin tribes in northern China, the Song Dynasty retreated south. The Jin Dynasty (in the north; 1115-1234) coexisted with the Southern Song Dynasty (1127-1280). The Jin eventually gave way to their neighboring Mongolians, who established the Yuan Dynasty first in the north of China and then taking the rest of the country (eventually spreading west as far as Europe). Their capitol was established in what is today Beijing and they maintained control of China for less than a century, from 1280-1368, to be ousted by the Ming. The Jin-Yuan period is the time when the northern tribes had taken control of part or all of China, 1127-1368.
During the Jin-Yuan period, there were many changes in Chinese culture influenced by the consolidation of power under the leadership of the Northerners. Among the most important changes was the development of neo-Confucianism by Zhu Xi (1120-1200). Neo-Confucianism adopted certain naturalistic tendencies that had been within the purview of Taoism. The sense of progressing from the conservative and rigid doctrines of the past to something more appropriate to the new conditions impacted thinking about medicine. In particular, much effort was expended in developing a new understanding of disease causation and corresponding treatment principles.
Zhang Yuansu (aka Zhang Jiegu; ca. 1151-1234) was one of the most influential physicians who lived during the early part of this transitional period. Zhang's students became far more famous than he, so information on Zhang is often a footnote to that provided about his students. Thus, for example, in the book History and Development of Traditional Chinese Medicine (1), which serves as one of the primary references for this article, Zhang is not even described other than brief mention as a teacher of Li Gao (aka, Li Dongyuan). Some details about Zhang Yuansu were gathered together for the introduction to the ITM book, A Bag of Pearls, where the following depiction of Zhang Yuansu and his work are presented, edited here for clarity:
The herbalist Zhang Yuansu produced a medical work called Zhenzhu Nang, literally, A Bag of Pearls (zhenzhu = pearl; nan = bag). The title has a double meaning. On the one hand, it indicates that the fundamental contents of the book are valuable (like a pearl), while the book itself is entirely expendable: it is a bag, not a permanent repository, such as a golden chamber (jingui, as in the title Jingui Yaolue). On the other hand, the title indicates that one must rely on oneself-the training, experience, self-cultivation, and intuition that goes into becoming a medical practitioner-rather than following some dogmatic system that is going to eventually change anyway [this orientation reflected neo-Confucianism].
Zhang's perspective on the practice of medicine is captured in this comment: 'In view of the different conditions between the ancient and modern times, it is impractical to treat new diseases with old methods; therefore, the obsolete traditional formulas are to be replaced by modern prescriptions.' Zhang provided an explanation of the new methodology for understanding and using herbs and for designing prescriptions in his book.
What were the traditional prescriptions Zhang spoke of revising? They were mostly formulas devised many centuries before, such as those of the Shanghan Zabing Lun (Treatise on Shanghan and Miscellaneous Diseases) by Zhang Zhongjing (220 A.D.) and of the Qianjin Yaofang (Prescriptions Worth a Thousand Gold) by Sun Simiao (650 A.D.)-collections of formulas compiled by two of the most famous physicians of early Chinese culture. Zhang Yuansu did not reject the earlier formulas or methods of formulation but merely wished to make the modifications required to update former approaches in light of recent medical conditions.
Zhenzhu Nang, aside from presenting ideas about disease causation, represents the culmination of Zhang's work in integrating two of the principal therapeutic methods of his time. He incorporated medicinal materials into the five element framework (wuxing), which formed the organizing principle of Chinese medicine at the time. Although there were earlier efforts to make such arrangements, such as Tao Hongjing's depiction of the five shen herbs (renshen, danshen, xuanshen, kushen, and shashen; ginseng, salvia, scrophularia, sophora, and adenophora, respectively), Zhang attempted to give a more uniform presentation of the principle. In particular, he helped to more clearly define the association of herb tastes and their effect on the different organs.
Zhang also initiated the concept of herbs entering into and influencing the meridians, a description that is still relayed in modern Chinese herb books, though not much relied upon in modern practice. He remarked: "The method of appropriately using herbs in accordance with the symptom and sign presentation of the patient entails determining substances with the correct qi, taste, yin and yang, and thick and thin properties as well as the pathogenic factor involved and the channel it has entered." The meridian attributions for herbs were an effort to link the physiological effects of herbs with the concept-originally depicted in the Neijing Suwen-of pathogens influencing meridians. This interpretation also links the actions of herbs with the effects induced by acupuncture. He thereby unified the theories of disease causation and treatment and the practices of herbal medicine and acupuncture, two fields that had remained largely separate despite coexisting in the same medical culture.
Li Shizhen, the famous herbalist of the 16th century (author of Bencao Gangmu; Compendium of Materia Medica), said that Zhang's book contributed much to the spread of medical principles. He went so far as to proclaim that not since the Suwen and Lingshu [two parts of the Neijing] had medical principles been explained so lucidly as by Zhang. Aside from the Zhenzhu Nang, Zhang also wrote the influential Yixue Qiyuan (Origins of Medicine), which affected the thinking of physicians for centuries afterward.
Zhang's students, particularly Li Gao, became key participants in two of the four schools of the Jin-Yuan. Each of the schools depicted a certain principal cause of disease and a corresponding therapeutic approach. The four schools may be divided into two subcategories: one based on the idea that diseases are caused mainly by excess (of either fire or pathogens), for which the therapies were mainly those that were used for purging and repressing; the other based on the idea that diseases are caused by deficiency (of either stomach/spleen qi or kidney yin), for which the therapies were mainly those used for tonifying and supporting.
Following is a brief overview of the four schools of the Jin-Yuan reform and their main protagonists, summarized from several medical histories (1-6).
Liu Wansu was a contemporary of Zhang, 30 years his elder. These physicians were probably not influenced by each other's work, but both were influenced by similar conditions in what is now Hubei Province. It is said that Liu decided to take up the study of medicine when his mother fell ill and died for lack of treatment. His family was poor and despite three requests for a doctor's visit, no one came. When Liu was 25, he started to study the Neijing Suwen, and researched its implications, particularly in relation to the cause of disease, for the next 30 years. As a result of these efforts, he wrote the book Suwen Xuanji Yuanbing Shi (Exploration of the Mechanism of Illness Based on the Suwen). He also wrote about the Shanghan Lun in his book Shanghan Zhige (Discussion of Febrile Diseases), and provided details about the principles of designing herb formulas.
His main proposition was that the Suwen indicated six pathogenic influences (wind, cold, summer heat, damp, dryness, and fire), but that all of these ultimately manifest as pathogenic fire. Even pathogenic cold could change into heat or undergo a process of mutual assimilation with fire and heat to yield the fire-type syndrome. He believed that the underlying force behind the six pathogenic influences was fire.
Therefore, cool and cold natured herbs were important to most therapies. Liu did not advocate the position that cool drugs were always to be prescribed; rather, he noted that at this time in Hubei, febrile diseases dominated and, as a result, cooling herbs were frequently needed. In fact, he believed strongly that the kinds of external pathogenic influences vary in a cyclic manner related to the five elements, though this would not necessarily define which specific diseases would occur.
Thus, Liu insisted that the treatment should be designed according to the time and place (that is, the environmental influences), the patient's health condition (e.g., constitutional factors), and the characteristics of the disease (e.g., symptoms), while recognizing that pathogenic fire was an underlying force that often had to be reckoned with. One of his main treatment principles was lowering heart fire and nourishing kidney water to alleviate the fire syndrome. A later commentator, Lu Yuanyin wrote: "Liu felt that the ice and snow of spring were beneficial to the pine and cedar but harmful to the willow." In other words, the cold therapy was suited to those with strong constitution, but not for those who are weak.
Among Liu's famous formulas were Liu Yi San (Six to One Powder), made of just two herbs-talc and licorice-in a 6:1 ratio, and its variants. The main variants were Yi Yuan San (Powder to Benefit Vitality), made by adding cinnabar; Bi Yu San, made by adding indigo (qingdai); and Ji Su San, made by adding mentha to Liu Yi San. A more complex variant is Gui Ling Gan Lu Yin (Cinnamon, Hoelen, and Licorice Combination) also derived from Liu Yi San, by adding two other cold mineral agents-calcite and gypsum-plus the Shanghan Lun formula Wuling San (hoelen, atractylodes, alisma, polyporus, and cinnamon). All of these formulas, which are rich in talc, are classified as therapies for summer-heat syndrome complexed with dampness, usually involving limited production of dark urine.
Today, one of Liu's complex formulas for clearing both internal and external heat is extensively used in China and Japan: Fangfeng Tongsheng San (Siler and Platycodon Formula). Like his other formulas, it contains cold mineral agents (talc, gypsum, and mirabilitum) and licorice.
The situation where febrile diseases again dominated Chinese medical thinking was at the transition from the Ming to the Qing Dynasty (1644; another invasion of northern tribes), during which time the "Warm Disease" school evolved. While Liu's concept involved disease being caused primarily by the six environmental factors with fire as their basis, the Warm Disease school began to incorporate the concept of transmissible causative agents, liqi (pestilential factors) proposed by Wu Youxing (1582-1652). This idea was later formalized in the germ theory of disease that developed in Europe and was accepted in China at the end of the 19th Century after another series of epidemics was successfully controlled by Western medical methods. The term "warm diseases" often implied epidemic febrile diseases.
Zhang Congzheng was a contemporary of Zhang Yuansu and was influenced by the teachings of Liu Wansu. He had great compassion for the poor and downtrodden, and though he had attained an Imperial medical position, he quit after four years to work in his hometown in Henan Province and to travel about as an itinerant doctor. He had found the Imperial social conditions oppressive, and he thought the official formulary (Hejiju Fang, which had just been adopted in 1110) had too much reliance on tonic herbs and drying aromatic agents.
He believed that most diseases result from evils invading the body: the six exogenous pathogens of heaven (wind, cold, summer-heat, dampness, dryness, and fire) and the six exogenous pathogens of earth (fog, dew, rain, hail, ice, and mud). Alternatively, disease could result from improper food intake, particularly from excessive amounts of one or more tastes (e.g., too much sour food, too much spicy food, etc.). He downplayed the role of internally generated disharmonies, such as those due to the emotions or inherent weaknesses, as did Liu Wansu.
Removing evils (exogenous pathogens) and dispelling the food excesses would therefore be Zhang Congzheng's primary objective of treating diseases. Three approaches to removing evils with Chinese herbal medicine had already been adopted by the time of the Shanghan Lun: sweating, emesis, and purgation. He expanded the meaning of each therapeutic category. He advocated using all kinds of therapeutic measures to accomplish elimination by sweating; in addition to herbs, he recommended moxibustion, acupuncture, massage, steaming, washing, and exercising. The category of emesis (inducing vomiting) was expanded to include all upper body elimination other than sweating, with therapies that increased or induced salivation, lacrimation, or sneezing. Purgation (laxative effect) was expanded to include methods that eliminate retained fluids (diuretic method) and that expelled flatus.
He believed that seasonal and social influences were very important, and that formulas had to be changed in accordance with the local conditions. When tonification therapy was deemed necessary, he preferred relying on food therapy rather than herbs such as astragalus and ginseng, which he deemed potentially harmful due to the potency of their tonifying effects.
Some thought Zhang's methods were too risky. As aptly put by Lu Yuanyin: "Chang's treatment is something like an old general confronting the enemy: after crossing the river, he mobilizes the troops at the bank and burns the ships, leaving no escape route. Because the soldiers have to fight for their lives out of desperation, they eventually win the battle. The pity is that when the method fails, the results are ruinous." In other words, if the eliminative method is used but doesn't destroy the pathogen fully, the patient may be too weakened to survive; other methods can't be brought in to save the day.
Zhang is not known for any specific herbal formulas, as he was mainly emphasizing the use of certain basic therapeutic principles, ones that had been addressed before. He was primarily rebelling against what he perceived as an overemphasis on tonifying and warming therapies and the tendency to provide valuable formulas that were not properly selected on the basis of local conditions. Zhang is also well-known for his interest in Confucian philosophy
This is a derivative of the Yi Shui school attributed to Zhang Yuansu (1151-1234), then followed up by his students: Li Gao and Wang Haogu (1200-1264), as well as Li Gao's student, Luo Tianyi (1220-1290). The story is told that Li Gao came from a rich and powerful family in Hubei and was able to spend a great deal of money (a thousand pieces of gold, it is said) to study under one of the most famous physicians in the Province: Zhang Yuansu. Although he had a great interest in medicine, after his studies he became involved in managing the family property. Then, with the Mongolian army invasion, he left Hubei to escape the turmoil of war. During his travels, he ended up using his medical knowledge and abilities to treat the diseases that arose from war and famine.
Li Gao is considered the primary contributor to the lasting impact of the Spleen/Stomach school. He relied on the syndrome discrimination patterns for the zangfu developed by Zhang Yuansu to put forth the doctrine that disorders mainly originate with damage to the spleen and stomach. As indicated in the Neijing, the basis of the body is the qi of the stomach, and this association led to the underlying concept. Li's main book on the subject was the Pi Wei Lun (Treatise of the Spleen and Stomach), which has been translated to English (8).
Li believed that the cause of spleen and stomach damage was from three factors: improper food intake (especially consumption of excess amounts of cold, raw, fatty, or unclean foods), overstrain (causing one to feel exhausted and to lie down in the middle of the day), and mental irritation (excessive emotions that agitate the heart fire and thereby damage the spleen). He proposed that a critical problem was sinking of the middle qi, so he recommended treatments that included raising the qi. Two of his most important Spleen/Stomach formulas were Shengyang Yiwei Tang (Yang Ascending and Stomach Nourishing Decoction) and Buzhong Yiqi Tang (Tonify the Center and Regulate the Qi Decoction). Both formulas include ginseng, astragalus, and atractylodes to tonify the qi, and both utilized bupleurum to raise qi. He also formulated Shengmai San (Pulse Generating Powder), a formula that is widely used in modern Chinese hospitals, and Danggui Buxue Tang, a combination of astragalus and tang-kuei in a ratio of 5:1; used to nourish the qi and blood following extensive blood loss.
Unlike the teachings of Liu and Zhang, for whom tonics and warming therapies were generally disliked, the Spleen/Stomach school relied on these types of remedies and became known as the School of Warm Tonification. Wang Haogu, who became famous for his book Tangye Bencao (Materia Medica of Decoction; 1298), particularly emphasized the use of tonics in the later stage of febrile diseases, when the person was weakened; he argued against using purgatives, as he believed they further weakened the patient.
Zang Lu (1617-1672) was one of the chief protagonists of the Spleen/Stomach school; he was also a proponent of vaccination. During the Qing Dynasty, Ye Gui (1667-1746) pointed out that a missing element in the Spleen/Stomach school was the importance of nourishing stomach yin. Ye, a recognized leader in the Warm Disease school, added that component. Ye Gui also emphasized the value of aromatic orifice opening agents to treat certain febrile diseases.
Xu Danchun (1693-1771) pointed out the circumstances of the Jin-Yuan period that he believed led Li Gao to recommend supplementation of the spleen and stomach, the "central palace" of the body, saying (11): "When in the final years of the Song Dynasty the Chinese territory fell into the hands of the enemy [referring to the northerners], the head of state was weak and his ministers failed to show any strength. At the same time, Zhang Yuansu, Li Gao, and others, in establishing their prescriptions, emphasized supplementation of the central palace."
Zhu Danxi, and his students, Wang Lu (1332-1391) and Dai Sigong (1324-1405), developed this school as a response to the others; thus, it evolved as the last of the four. Zhu Danxi, from Zhejiang Province, was a descendent of Zhu Xi, and carried on the interest in Confucianism. It was said that he was such a diligent student that he would memorize a thousand lines of the Classics each day. He planned a government career and was ready to sit for the examinations at a young age, but he later decided to concentrate on medicine when his mother and teacher each became severely ill and could not be cured even after prolonged treatment. He sought out a good teacher, and decided on Luo Zhiti, a famous physician in Hangzhou. It took significant effort by Zhu to gain Luo's confidence and become his student. His studies went well, and he became a noted physician in a short time. His success was such that he became known as "one-dose Zhu" because he could often cure patients with a single dose of herbs. He was able to cure his mother's prolonged illness.
Zhu studied the other three schools of thought that had developed during the preceding decades, but came to the conclusion that the origin of diseases was different. He believed that the "ministerial fire" tended to flare up and cause serious disorders; it had to be controlled primarily by nourishing kidney yin. Zhu understood that the teachings of the Neijing and subsequent authoritative texts pointed to a physiological role of the ministerial fire in activating the functions of all the zangfu. This fire was like a moving yang that gave rise to human desires. This same fire could become pathological-impairing the yin fluids (yin and blood) and causing fire symptoms-when those desires were excessive. He felt that the kidney yang was usually in plentiful supply, but that the yin was always tending towards deficiency with any adverse influence. He was particularly concerned that excessive sexual desires and activity would deplete the yin, as would fondness for flavorful foods and indulgence in them. He became alarmed at the use of warm, spicy herbs that some doctors relied upon, as these could harm the yin if improperly used.
A representative formula of Zhu Danxi is Da Buyin Wan (Major Yin Nourishing Pill), which contains rehmannia, phellodendron, anemarrhena, and tortoise shell. The first three ingredients would later become the central ingredients of the most widely used formula for the yin-deficiency fire, Zhi Bai Dihuang Wan (Anemarrhena, Phellodendron, and Rehmannia Formula). Another formula for which Zhu Danxi is well-known is Huqian Wan (Tiger's Gate Pill), derived from Da Buyin Wan by adding peony, cynamorium, tiger's bone, and the warming pair of citrus and dry ginger to help protect the stomach and spleen. Although Zhu emphasized yin-nourishing therapies, he considered the role of the spleen and stomach important as a key source of yin-nourishing nutrients. Thus, he contributed some digestive formulas, such as Baohe Wan (Citrus and Crataegus Formula) and Gehua Jiecheng Tang (Pueraria Flower Combination), which treat food stagnation and heat from food excess and alcoholic beverages respectively. Having warned about the potential dangers of intemperance in eating and drinking, he also provided remedies for the problems they caused.
Zhu Danxi wrote several books; some of his most important teachings were gathered and published as Danxi Xinfa (The Essential Methods of Danxi), which has been translated to English (9) along with his book Gezhi Yulun (Extra Treatises of Investigation) as a companion volume (10). The Nourishing Yin school gained more followers around the end of the Ming Dynasty as the result of work by Zhang Jingyue, a competent proponent of using rehmannia and other yin-nourishing herbs. During the Qing Dynasty, the famous Rehmannia Six Formula, originally a pediatric prescription, became the subject of much interest, including development of numerous modifications. Rehmannia Six Formula and its modifications are the basis for much of the modern application of the Nourishing Yin school's basic tenets.
The Jin-Yuan medical reform had lasting impact on the further development of Chinese medicine, at least until Western medicine intervened during the Qing Dynasty period. There were some rebellions against the Jin-Yuan influence even before Western medicine had any impact, particularly during the 18th Century. The concern was that the "real" Chinese herbal medicine was that captured by Zhang Zhongjing in the Shanghan Lun and Jingui Yaolue, and that the reformers were not of the same caliber, producing a less valuable approach. For example, the commentator Xu Dachun opposed the reliance on the Jin-Yuan teachings. He recognized three of the four contributors of that time, discounting Zhang Congzheng, but he included the Han Dynasty authority Zhang Zhongjing in the discussion of the "four masters," and said of their contributions (11):
For a long time already the path of medicine has been obscured by darkness. Among the people of the Ming Dynasty one spoke of "four great masters," referring to Zhang Zhongjing, Liu Wansu, Li Gao, and Zhu Danxi. They were said to have established "everlasting schools of medicine." This is truly nonsense based on ignorance. Zhang Zhongjing is, in fact, a sage who gathered observations and arrived at conclusions that will last forever. His position in medicine equals that of Confucius in Confucisim. Liu Wansu and Li Gao left only one-sided teachings and Zhu Danxi did nothing but consider the words of all the others. He modified here and there, discarded some statements and selected some others, and opened a convenient and simple gate for beginning students.
Actually, these three authors, if compared with Zhang Zhongjing, were unable to recognize one principle out of ten thousand that he saw, and it is absolutely inappropriate to promote the former and name them together with the latter....Now, what are the achievements of these three men? Liu Wansu revered nothing but the Neijing; the fact is, he was unable to grasp its essential meaning. Zhu Danxi's ideas are flat and shallow; he never saw the sources. Li Gao stuck all his life to his doctrine on how to regulate spleen and stomach. He advocated nothing but the use of herbs with an aromatic and dry nature, only a rising effect in one's body. His views were unbalanced, and his patterns for designing prescriptions were chaotic. He misled posterity!.…
It would be wrong to assume that I am stubbornly intending to despise these three authors. The fact is, though, that their doctrines have become popular, and the entire country knows only how to take hold of the remnants produced by these three authors, while no one searches in depth for the teachings of Zhang Zhongjing. As a result, the patterns of the earlier Sages, transmitted by Zhang Zhongjing, have lost strength day by day, and those who die young in the empire will fill the streets for all ages to come. Hence, the harm generated by these three scholars is severe, and an immediate correction of this situation is necessary.
In Japan, the practice of Chinese medicine was greatly influenced by the teachings of Li Gao and Zhu Danxi, and their work inspired the Goseiha School, which still has some followers today, led by the 20th-Century physician Domei Yakazu. However, during the 18th Century, the Goseiha School was all but abandoned, to give rise to the Kohoha School, which rejected the Jin-Yuan reformers as being too impractical and which largely returned to a study of the works of Zhang Zhongjing. The Kohoha School has remained the dominant school of thought in Japan to this day.
The four schools of the Jin-Yuan medical reform era have been incorporated into a much more complex set of approaches to therapy, thus still playing a valuable role. Additions to these four schools include such innovations of the Qing Dynasty period as the Warm Disease school and the blood-vitalizing methods promoted by the medical reformer Wang Qingren.
The introduction of Western medicine has led the development of Chinese medicine away from simplistic theories that attribute diseases primarily to one specific cause or pattern. Nonetheless, some concepts elaborated by the Jin-Yuan schools remain strong:
Also, modern treatment strategies are frequently designed with reference to formulas of the Jin-Yuan period, notably Buzhong Yiqi Tang and Shengmai San from Li Gao and Huqian Wan and Baohe Wan from Zhu Danxi. One of Zhu Danxi's formulas, Danggui Longhui Wan (Tang-kuei and Aloe Pill), was developed into a treatment for leukemia during the 20th Century, with isolation of the most active component, indirubin from indigo (qingdai). The importance of Li Gao and Zhu Danxi are reflected in continued production of their books for use by Chinese medical students, and translation of their key books into English.
The Jin-Yuan reform period alerts modern students and practitioners of traditional Chinese medicine to the dynamic characteristic of this medical tradition. In all instances, the reformers carefully studied all the classic texts and their objections were not directed at the fundamental teachings, but only at what they perceived as improper application of those teachings. They saw that most practitioners simply dispensed formulas according to memorized doctrines, but didn't examine closely enough the factors that were causing disease and the steps involved in resolving the diseases. Yet, these scholars found that they could not find any single explanation of disease or any single treatment strategy that all could agree upon. No sooner would one school arise than another would contradict it. The particular circumstances in which the doctors lived influenced their thinking and they all concluded that it was necessary to take into account local circumstances and pay attention to the unique needs of the individual patient.