Exploration and Analysis of Zhang Xichun's Medical Thought in "Medical Meditation and Reference to the West"

: "The Western Records of Chinese Medical Records" is a summary of Zhang Xichun's ten years of clinical experience. The principles of the drugs explained in the book and the use of the prescriptions contained therein have all been tested in practice. The medical cases described in the book fully reflect the author's flexible and flexible medical thinking. The author has often gained new knowledge through reading, and has also benefited from the understanding of the "Shen Nong Ben Cao Jing", "Huang Di Nei Jing", and "Treatise on Febrile Diseases.” Zhang Xichun deeply studies and consults on the classics of doctors, follows the medical principles of the "Yellow Emperor's Internal Classic", and the prescriptions of Zu Zhongjing's "Treatise on Febrile Diseases". He studies the medicinal properties and tastes of the "Shennong's Classic of Materia Medica", and explores its essence in clinical practice, introducing the old to bring forth the new. At the same time, drawing on the strengths of Western medicine, he can often be as effective as a drum and beam, saving people in distress. This article summarizes and discusses some of his medical thoughts, hoping to enlighten and learn from traditional Chinese medicine students. "The Western Record of Meditation" [1] is one of the required books for clinical practice of traditional Chinese medicine, and was once praised by colleagues in the field of traditional Chinese medicine as "the first book that can be learned.” Zhang Xichun has thoroughly read the classics of traditional Chinese medicine, tested and speculated in practice, and enriched its connotation in practice. Using traditional Chinese medicine, he not only attaches importance to previous experience, but also often combines with reality and is flexible.


Abide by the medical principles of the "Yellow Emperor's Internal Classic", and guide the treatment of laws and principles through intensive research.
The elucidation of the principles of traditional Chinese medicine originates from the "Yellow Emperor's Internal Classic", which is respected as "the sect of the highest Tao and the beginning of life" [2] . The medical principles described therein still guide clinical practice, and Zhang Xichun believes that "if you have obtained excellent research, you can open unlimited methods." For example, according to the theory of regulating the meridians in the Internal Classic, "When blood and qi go together, it is a great syncope, a sudden death occurs when qi returns, it is born when qi does not return, and it is death when qi does not return." Zhang Xichun believes that this is the pathogenesis of brain congestion and intracerebral hemorrhage in Western medicine. However, the Internal Classic does not address the cause of the disease, nor does it address the treatment method, and it is also difficult for Western people to treat the disease. Zhang Xichun has insight into the cause of the disease from the theory of the Internal Classic, and believes that treating this syndrome should clear the fire, calm the liver, and guide blood downward, supplemented by lowering the stomach The product for astringing Chong [3] uses Huai Niu Xi and raw ochre to guide blood downward, supplemented by raw oysters, raw dragon bones, raw white peony, raw rehmannia glutinosa, etc. to nourish yin and recuperate yang. It has been developed as a Jianling Tang recipe, which has been used to save many people. Among them, those with mild cerebral congestion, those without blood vessel rupture or without severe blood vessel rupture, can save lives. This method is also applicable to head swelling and pain caused by adverse qi and blood flow, as well as eye formation and clouding. "The Internal Classic also states, 'When the upper Qi is insufficient, the brain is dissatisfied with it.'" Zhang Xichun believes that these two words can actually explain the cause of cerebral anemia. In combination with the discussion on Zongqi in the Internal Classic, he realizes that 'when the upper Qi is insufficient, the brain is dissatisfied. That is, if the Zongqi cannot crown the heart meridians to help it rise, then both the qi and blood in the brain are insufficient.' Therefore, the treatment of cerebral anemia should focus on nourishing the qi and blood, especially strengthening the Zongqi in the chest to help the qi and blood ascend. ", When treating cerebral anemia, you can use Buxue Decoction, with more astragalus to replenish qi and less angelica to replenish blood. This is a prescription for treating cerebral anemia.

1.2
The formula in the "Treatise on Febrile Diseases" of the ancestor is flexible and flexible, creating a wonderful recipe for suitable times.
"Treatise on Febrile Diseases" is the ancestor of prescription books. Zhang Xichun's prescription was also modeled after Zhong Jing. He deeply pondered the meaning of Zhong Jing's prescription, and was able to understand Zhong Jing's prescription in clinical practice and flexibly organize prescriptions for medication. For example, in the Treatise on Febrile Diseases, the external sensation of solar disease is wind heat, which is caused by medical reactions, resulting in wind heat entering through the void and interacting with phlegm and water in the upper energizer, forming a syndrome of chest formation, which is treated with a large depression chest soup. "In the prescription, Gansui was used to attack and expel, which originally had a very rapid effect on treating the syndrome of breast cancer. However, Zhang Xichun personally tested the medicinal power of Gansui and believed that if the pulse was not large and solid, they would not dare to be administered lightly, and few people dared to use this prescription in later generations to treat the syndrome of breast cancer. Therefore, he believed that this prescription should be flexible, and pointed out that Tinglizi had a bitter taste and was good at clearing and descending, and its properties were similar to those of Gansui, but it was non-toxic. Its medicinal power was far inferior to that of Gansui, and its bitter descending could expel phlegm and water in the lungs, acting as a substitute for ochre stone and being good "To reduce phlegm, saliva, and vomiting, the combination of the two drugs in Daxianxiong Decoction can work even without using Kansui." "Those who are also afraid of medicine are still afraid of their fierce power, so they have created a self-made Dang Xiong Tang to replace it." "Treatise on Febrile Diseases" refers to the syndrome of Sun Disease with Aconite Xiexing Heart Decoction. In the original text, if the heart is distempered and the aversion to cold and perspiration is restored, Aconite Xiexing Heart Decoction is the main treatment. The pathogenesis of the disease is that external pathogenic factors are deeply trapped in the chest, and they bind to the steaming qi of the heart fire and form a rash under the heart. Due to the weakness of the yang component, it is difficult to withstand the external cold and the inability to absorb the defensive qi. Therefore, in the treatment, aconite is added to the Xiexin Decoction to supplement the yuan yang of the kidney. However, the combination of severe cold and heat in this recipe is not easy for doctors to attempt. Zhang Xichun proposed using astragalus instead of aconite in the recipe. He believed that there were two original places in the mansion of the sun, one located in the bladder and the other in the chest. The atmosphere contained in the chest was closely related to the sun's defensive qi on the surface. The defensive qi was yang, and the deficiency of the atmosphere in the chest caused the deficiency of the defensive qi but could not consolidate the foundation, and the deficiency of the defensive yang could not prevent the cold. Therefore, Huangqi could be used to supplement the atmosphere in the chest. The use of aconite is to subsidize the mansion of the lower scorched sun, while the use of astragalus is to subsidize the mansion of the upper scorched sun. The qi of the two prefectures originally flows through each other, making this modification easier for clinical use. In Treatise on Febrile Diseases, Guizhi Decoction is known as the most famous prescription for thousands of years. The essence of Guizhi Decoction lies in sipping hot porridge to help perspiration. Zhang Xichun made the argument of "atmosphere", explaining the mechanism of Guizhi Decoction syndrome, and believed that atmosphere originates from the nature, is subsidized by the acquired, and is closely related to Wei Qi. The atmosphere depends on the stomach qi. Those who drink hot Congee after taking cinnamon twig soup are intended to supplement the atmosphere in the chest with the spirit of water and grain, so that the yang qi can cheer up and dispel evils. The water and grain can help sweat, so that the evils on the surface can be resolved with sweat. Zhongjing's later doctors often use the prescription instead of sipping hot porridge, so the prescription can't work. So Zhang Xichun has prepared a modified cinnamon twig soup to replace porridge. On the basis of the original prescription, he added three coins of Radix Astragali, three coins of Anemarrhena asphodeloides, and two coins of Radix Fangfeng. If you use this prescription to warm your clothes, you don't need to sip hot porridge. Because Radix Astragali supplements the spleen and lungs to help the atmosphere, strengthen the defence of qi, prevent the wind, promote the circulation of the camp and guard, and strengthen our ability to remove exterior evils. The two supplements without retaining the evils, dispels the evils without harming the right. With the bitter cold Anemarrhenna asphodeloides, one is a nourishing yin liquid. Second, it is too warm to prevent replenishing qi and transforming fire. This recipe combines Guiqi with Yang, Shaozhi with Yin, and Jiang Fang with Qi to regulate Yin and Yang in order to relieve the symptoms of the muscles. [4] 1.3 "Shen Nong's Classic of Materia Medica" has a dominant sexual taste and is consistent with practice, with other discoveries.
"Shennong Materia Medica Classic" is the earliest monograph on pharmacology in China, summarizing pharmacological knowledge and medication experience before the Han Dynasty. [5] When discussing the properties of traditional Chinese medicine, Zhang Xichun mostly uses the records in the "Shennong Classic of Materia Medica". For example, he often uses gypsum and prefers it. The "Shennong Classic of Materia Medica" states that it has a pungent taste and a slightly cold nature, so it is cool and can be dispersed, and has the ability to penetrate the surface and relieve the muscles. However, most medical practitioners believe that its nature is severe cold, so it is calcined and rarely used. Zhang believes that the nature of dispersing gypsum after calcination is converted into astringency, which can be used to treat exogenous heat diseases, astringent phlegm and fire, making it coagulate but not disperse. It is to transform the use of gypsum into a golden pill into a dove poison. Therefore, using gypsum as a raw material to treat many syndromes of excess heat can be as mild as two or as severe as seven or eight liang. With its slight cold, it can be used boldly, and there is no need to use all the drugs to relieve heat, so there is no harm in cold. For example, Zhang Shi treated a 17 year old child with wind chill. During the fourth to fifth day, he experienced severe fever, yellow and black fur on his tongue, and suffered from taking medication. When forced, he continued to vomit. Therefore, he used raw gypsum decoction alone and took it gently. After using it for the first time, he also decocted two or two pieces of raw gypsum, and the disease recovered again. He also decocted three or two pieces of raw gypsum, and the disease recovered completely. He shared about six or two pieces of raw gypsum throughout the day and night. After the child recovered, his diet also increased, without any disadvantages of cold.
Zhang's family often personally tests the taste and properties of medicines to identify whether the medicines used in the current era are consistent with those recorded in the Classic of Materia Medica. For example, in the "Western Record of Ginseng in Medical Purposes", ginseng is often used in combination with gypsum to replenish qi, nourish yin, and replenish deficiency. In the "Classic of Medicine", it is said that ginseng tastes sweet but not bitter, while ginseng in the current era tastes sweet but slightly bitter, and Codonopsis pilosula tastes sweet but not bitter. Therefore, Zhang's family believes that ancient ginseng is actually Codonopsis pilosula of today. Codonopsis pilosula has weaker tonic power, heat, and mild qi properties than ginseng. More suitable for use in typhoid and plague prescriptions. [6] In practice, Zhang expanded the efficacy and application range of drugs, such as his belief that the acidic and warm taste of Cornus officinalis can (1) greatly astringe vitality, stop sweat, and firm off; He believed that the loss of vital energy was due to the excessive release of the liver, so using cornus officinalis meat to astringe the liver qi and stop the release mechanism could strengthen the vital energy. He had repeatedly used this medicine to save human life in an instant, believing that its "rescue power is ten times greater than that of ginseng and astragalus." 2) Good at treating hemoptysis and hematemesis caused by rupture of internal blood vessels or pulmonary collaterals; 3) "It also has the thickest wood qi and has the ability to regulate the astringency and smooth the flow of blood through the nine orifices. It can treat pain in the heart, abdomen, and limbs caused by stagnation of qi and blood." Another example is Forsythia suspensa, which has a cool nature and a slightly bitter taste. It has the power to lift, float, and disperse, and can circulate qi and blood, penetrate the surface and relieve muscles, relieve wind and heat, and carry toxins out. However, no doctor has claimed that it can produce sweat. Zhang Xichun believes that when using Forsythia suspensa to treat wind-heat exogenous symptoms, it can produce sweat after using one or two times, with a gentle and longlasting effect. Zhang Shi once treated a young man with wind and warmth. He decocted it with forsythia suspense or two, and the patient sweated slightly all night. The next morning, he almost recovered. In addition, Forsythia suspensa is also good at regulating liver qi, which can not only relieve the stagnation of liver qi, but also calm the excess of liver qi. Zhang Shi once treated an elderly woman in her seventies with swelling and pain in her hands and arms for many years, her emotions were irritable, and her pulse was stringy and powerful. Therefore, in the antipyretic and antipyretic drugs, each dose of Forsythia suspensa was mixed with four cents, and the swelling and pain healed within a few days, without anger. Therefore, he believed that Forsythia suspensa was an important drug for regulating liver qi.

Medicines and foods are homologous, and diseases are treated with food.
Chinese yam is not only an important traditional Chinese medicine, but also a common vegetable in daily life. The active ingredients in yams have antioxidant, anti-inflammatory, analgesic, hypoglycemic, and immunomodulatory effects. [7] Zhang Xichun believes that "yam is white in color and enters the lung, sweet in taste and returns to the spleen, thick in liquid and beneficial to the kidney, which can nourish the blood vessels, consolidate qi, soothe the cough, calm the asthma, and strengthen the mind and nurture the spirit." He often uses raw yam decoction and Congee to treat diarrhea, female amenorrhea, asthma, asthma, eclampsia and other diseases. If he treats a woman, the diarrhea lasts for several months, and the condition is critical, and many times he has sought medical advice but failed. Zhang Xichun instructs her to fine raw yam, and take Congee every day. After a few days, she will be healthy.
Persimmon frost is the essence of persimmon. According to the Compendium of Materia Medica, "persimmon frost" can "clear the heart and lung heat, stimulate saliva and quench thirst, dissolve phlegm and soothe cough, and treat sore throat and tongue pain." [8] Zhang Xichun believes that persimmon cream can nourish the qi of the spleen and lungs, cool it, clear lung heat, smooth it, promote phlegm in the lungs, moisten it, and nourish dryness in the lungs. It not only cures diseases, but also satisfies hunger. When used, it is not symptomatic and has no other symptoms. Therefore, persimmon cream cake is used to treat deficiency heat and cough caused by lung and spleen yin deficiency, lack of appetite for food, and all symptoms of yin deficiency. Self-prepared Pearl Jade Erbao Congee, Crystal Peach and other prescriptions will be incorporated into the diet.
Also, raw atractylodes macrocephala is finely rolled and baked with cooked jujube meat, and small cakes are used to treat chronic diarrhea caused by weakness of the spleen and stomach; Chuangyi Pi Cake is used to treat the syndrome of cold and dampness in the spleen and stomach, and chronic diarrhea leading to complete grain stagnation; "Chuangqi Yi Cake is still used for reference in clinical ointments and external plaster applications to treat the syndrome of qi deficiency, excessive phlegm, and stagnation of phlegm."

Integrating China and the West, emphasizing practical results.
Western medicine is specifically recorded in Volume 5, Volume 4, Volume 4, of the Medication Chapter of "Medical Records of Chinese Materia Medica". There are clinical application trials behind each drug. In clinical practice, Zhang Xichun has the courage to use the thinking of traditional Chinese medicine to guide the application of Western medicine. For example, he combined yam and aspirin to form a convenient prescription for treating Guizhi Decoction syndrome. Taking the sweating effect of aspirin and the nourishing yin and qi effect of yam, he achieved the effect of relieving external symptoms, nourishing yin and supplementing qi, which is consistent with his concept of "centering on the west" [9] .Zhang Xichun is particularly experienced and flexible in using "Aspirin". He believes that aspirin has a cold nature, is good at entering the Shaoyang meridian, and has a refreshing nature. It is good at dispersing wind, sweating, and removing heat. It is widely used in clinical applications. It is often combined with traditional Chinese medicines such as antelope horn, gypsum, Maogen, and yam, and has been used in combination with classic prescriptions such as Mahuang Decoction, Mahuang Almond Glycyrrhiza Gypsum Decoction, White Tiger Decoction, Nitrate Aluminate Powder, and Yue Mai Tang to treat colds, febrile diseases, typhoid fever, jaundice, and edema, and has achieved good therapeutic effects [10] .

Combination of internal and external governance, diverse governance methods.
While excelling in internal medicine, Zhang also pays attention to the application of external therapies in the treatment of diseases, which can not only increase the curative effect, but also save critical symptoms. For example, in the treatment of cholera, Sha syndrome and other epidemics accompanied by limb syncope, Zhang believed that it was a hot poison attack, and the phenomenon of "deep heat and syncope" should be used to purge heat and detoxify by scraping, pricking and stabbing evil blood, acupuncture and moxibustion and other methods. For constipation, if decocting Tongli medicine does not work, the method of scallion white ironing can be used. Slice scallion white and stir fry together with vinegar, and iron the navel with heat. If it still cannot be resolved, pour vinegar into the pig's gall bladder, twist the vinegar and bile until they are combined, and then use a bamboo tube to send the bile into the valley to clear the dry knot; For those who have difficulty urinating, a silver catheter can be used to catheterize the urine, followed by applying cantharidin plaster to the waist and using hip baths to help sweat and facilitate urination [11] . In addition, Zhang's external treatment methods for diseases of the five senses are also excellent, such as creating Moyi Water (raw calamine, borax, mint leaves, cicada slough, and bile alum) to treat eye blindness and blinding eyes. "If the eyes are swollen and painful, or if there are eye diseases such as redness and redness, use calamine and borax in combination with coptis chinensis and nails to make a grinding and dispersing powder for the eyes, or use coptis chinensis and fragrant oil to make a Qingnaohuanlian ointment for nasal sniffing." Self-made Yachan Powder for external application to treat Yachan. For throat carbuncle caused by scarlet fever, diphtheria, etc., with symptoms of swelling and pain in the throat, or accompanied by breathing difficulties, it is recommended to take heat clearing, detoxification, and detumescence drugs orally while giving blood letting and heat relieving to the affected areas, feet, small businesses, and moderate areas to alleviate the crisis. This method is of great significance for the treatment of modern acute and chronic pharyngitis, acute and chronic tonsillitis, pediatric herpetic angina, and other throat diseases [12] . The external treatment method applied by Zhang in his clinical practice is effective, innovative, and has detailed and clear usage, contributing wisdom to the external treatment and physical therapy methods of traditional Chinese medicine.

Pay attention to pulse conditions and measure symptoms with pulse.
Zhang Xichun attaches great importance to the application of pulse signals in the diagnosis of diseases, and has a unique understanding of pulse signals. He is often able to infer the pathogenesis and overcome difficulties through pulse diagnosis, eliminating false signals and reserving true ones. For example, Zhang Shi treated a woman with fever due to upper energizer, coughing and aphonia, spitting fishy phlegm, thin and weak body, and strong and stringy pulse. After several doses of treatment with drugs for clearing fire and moistening the lung, they were not effective. Therefore, they were given Qingjin Yiqi Decoction (raw astragalus, raw rehmannia, anemarrhena, licorice, black ginseng, sand ginseng, Sichuan fritillaria, and burdock). In addition to the group of heat and moistening drugs, a single dose of astragalus was added to supplement vitality, and the patient's symptoms were alleviated by several doses. Due to the strong and stringy pulse pattern of the person, it is considered that the deficiency of the lung's gold cannot calm the wood, so the liver and wood are unbridled. Huangqi is used to supplement the qi of the lung and spleen, replenishing the lung's gold to counter the liver and wood, resulting in rapid effects.
"There are many descriptions of pulse diagnosis in the medical case of" Medical Records of Meditation ", including both single pulse and complex pulse." [13] The complex pulse can better reflect its grasp of the pathogenesis of the disease. The frequency of occurrence of stringed and numbered pulses in pulse images is particularly high. This article summarizes the medical records on stringed and numbered pulses contained in this book: the stringed and weak pulse in the left hand can be seen in blood deficiency, qi deficiency, and phlegm; "Concurrent hardness is characterized by liver and blood deficiency, and insufficient body fluid." "The left hand pulse string is hard, strong, and long, which can be seen in yin deficiency of the liver and kidney, and cannot latent yang. Liver fire offends, or due to deficiency, the Chongqi rises, forcing the stomach qi to rise;" Those with hard and heavy strings also have stagnation of liver qi. The left hand pulse is thin and hard, while the right hand pulse is moistened and heavy, due to phlegm and dampness in the middle energizer and insufficient gasification. The pulse of the right hand is thin and weak, with the liver wood multiplying the spleen soil and the spleen not functioning well. The pulse in the right hand is firm and powerful, larger than the pulse in the left hand, indicating that heat enters the Yangming or Qi rushes upward, stomach Qi does not fall, stomach Yin deficiency, etc. Those who press heavily and do not press truthfully all have deficiency of qi and blood; "If it's too late, it's accompanied by cold drinking and chest swelling." [14] . The number of pulses governs both deficiency and reality. When the number of pulses governs deficiency, it includes deficiency of vital energy, injury of spleen and yin, deficiency of blood with heat, deficiency of yin and yang, inability of kidney and yin to rise to the tide, and imbalance between yin and yang; Numerous pulses dominate real-time, including internal movement of the liver wind, incandescence of Yang Ming, internal depression of cold pathogenic factors, and injury caused by hot drugs [13] .Zhang Xichun's understanding of pulse signals stems from long-term clinical practice. The description of pulse signals is often complex, subtle and specific, enriching his understanding of pulse signals.

Summary
Zhang Xichun not only attaches importance to previous experience but also pays attention to practical testing and innovation. He advances with the times and proposes new perspectives and methods. He has made unique achievements in traditional Chinese medicine, making important contributions to the inheritance and development of traditional Chinese medicine. His book, "A Collection of Chinese and Western Medicines", which integrates Chinese and Western medicine, is a rare clinical treasure of traditional Chinese medicine, with bold innovation and ingenious formulation and medication. It is worthy of learning and further exploration by TCM practitioners.