From Prof. Wang Shimin's "Herbs Match Symptoms, Formulas Match Syndromes" to My "Evidence-Based TCM Diagnosis and Treatment"

Professor Wang Shimin, a doctoral supervisor at Shanxi University of Chinese Medicine and recipient of the 2017 title of "National Master of Chinese Medicine," was born in 1935 in Zhidun Village, Yuanshi County, Hebei Province (present-day Zidun Village, Suyang Township). His great-grandfather Wang Changbao was a celebrated local physician, and townspeople once presented him with a gilded plaque inscribed "Healer Peide, Divine Physician." Influenced by his great-grandfather, Wang Shimin resolved from childhood to become a doctor.

In the spring of 1953, Wang Shimin's mother died of tetanus infection because her traumatic injury was not treated in time. Wang Shimin, then in middle school, was deeply stricken.

Misfortunes never come singly. Grief-stricken by the loss of his mother in boyhood, Wang himself developed facial palsy. Despite repeated treatment by both Chinese and Western medicine—acupuncture from head to foot, and many formulas intended for stroke—the effect was poor, and over two years the condition did not resolve.

This piercing pain only strengthened his resolve to study medicine and save others. In 1956, sitting the national college entrance exam, he resolutely applied to the Beijing College of Chinese Medicine (now Beijing University of Chinese Medicine), was accepted, and became one of its first cohort of undergraduates. After six years of diligent study he graduated in 1962. During his internship he studied successively under celebrated masters including Lu Shiru, Kong Sibo, Liu Duzhou, Xie Haizhou, and Yin Huihe, receiving their meticulous instruction; his knowledge grew daily and his experience steadily widened.

After graduation, Wang was assigned to the Shanxi Institute of Chinese Medicine (now Shanxi Academy of Chinese Medicine). The following year he was designated the disciple of Bai Qingzuo, one of Shanxi's four great famous physicians. He attended Bai in clinical consultations, copied prescriptions, and recorded case histories, inheriting and organizing Mr. Bai Qingzuo's clinical experience and absorbing his true teachings.

While working in Shanxi, Wang Shimin kept in close contact with his teachers Liu Duzhou, Xie Haizhou, and Yin Huihe, consulting them on difficult questions, discussing scholarship, analyzing cases, publishing articles, and compiling TCM monographs. He successively assisted the pediatric TCM expert Sun Huashi in collating and annotating Xiao'er Yaozheng Zhijie Shiyi (Explication of Key Therapeutics for Infants) and Youke Jinzhen (Golden Needle of Pediatrics); assisted Mr. Yin Huihe in organizing Zhongyi Neike Xinlun (New Discourse on TCM Internal Medicine); compiled Xie Haizhou Linchuang Jingyan Jiyao (Essentials of Xie Haizhou's Clinical Experience) and Xie Haizhou Yiji Wenji (Collected Medical Works of Xie Haizhou); and helped Mr. Liu Shoushan complete parts of volumes 2 and 3 of Zhongyao Yanjiu Wenxian Zhaiyao (Abstracts of Literature on Research in Chinese Materia Medica).

While engaged in compiling and collating TCM literature, Professor Wang also taught at Shanxi University of Chinese Medicine and practiced clinically. Combining teaching, research, and clinical work, he built a solid theoretical foundation and accumulated rich practical experience.

On the basis of deep, systematic study of herbs and formulas, Professor Wang Shimin summarized the clinical approach of "formulas match the syndrome, herbs match the symptom." He held that the effect of a formula is the combined "synergistic force" of its constituent herbs when compatibly arranged, acting in a targeted way on a particular condition. It is not the action of any single herb, nor a simple pile-up of individual effects: each herb has its own particular strength, and a formula has the marvelous effect of bringing them together. Herbs are the units that compose a formula; a formula is the higher form in which herbs are applied.

Professor Wang made important contributions to the modern study of TCM formulaology. Through long clinical practice, teaching, and research, he felt that only by uncovering the material basis of herbs and formulas could one ultimately reveal the true source of their therapeutic effect. Many ancient and renowned formulas are rigorously composed and reliably effective, yet explanations of their efficacy and mechanisms mostly remain at the level of macro-level direct observation. To explore their micro-level mechanisms from the standpoint of modern science, and to carry the ancient theory of formula compatibility forward so that it is accepted worldwide, experimental research is indispensable.

Research into the efficacy of herbs and formulas was the central work of Professor Wang's life, and he condensed his thought into the six characters "formulas match the syndrome, herbs match the symptom." In my view, these six characters are the true essence of Chinese medicine.

Recently, a teacher interested in TCM asked me a question: what should one begin with when studying Chinese medicine? I answered her: the Yaoxing Fu (Ode to Drug Nature) and the Tangtou Gejue (Verses on Formula Prescriptions)—and best of all, start by memorizing them. These two books are the most basic introductory texts of TCM: Yaoxing Fu is an introduction to Chinese materia medica, and Tangtou Gejue an introduction to TCM formulas.

Many people who study TCM like to read the works of famous masters. When I first studied TCM, I was the same. But after nearly twenty years of practice, I have deeply felt that to achieve good clinical results, what one should study most is Chinese herbs and formulas. And the key to studying herbs and formulas lies precisely in these six characters summarized by Professor Wang: "formulas match the syndrome, herbs match the symptom."

Presuming to do so, I have rephrased these six characters into eight plainer ones: use herbs according to the symptom, use formulas according to the syndrome. Grasp these few words firmly when learning TCM, and you will not go astray.

I should say something about the "symptom" (症) and "syndrome" (证) here. Many TCM works treat "symptom" and "syndrome" as two concepts, and some even distinguish among "symptom," "syndrome," and "disease." With respect, I think this is mere hair-splitting and wordplay. Though forcibly separating them seems arguable, it is actually adding legs to a snake and complicating a simple matter. Symptom, syndrome, and disease—all are the various abnormalities or discomforts manifested by the patient; there is no need to split them into multiple concepts. It is better to regard them uniformly as "indications for medication," which also aligns us with modern medicine.

Our research today finds that the ancients' descriptions of the abnormalities and clinical symptoms of disease basically conform to the objective patterns of disease presentation, and some symptom descriptions are remarkably precise. One could say that ancient TCM was born with the genes of evidence-based medicine.

I call the ancients' systematic descriptive accounts of disease "medication indications" or "formula indications," and regard them as the key and core of TCM clinical diagnosis and treatment. This approach may be simply termed evidence-based TCM diagnosis and treatment.

For example, the indications of Guizhi Tang (Cinnamon Twig Decoction) are "a floating, moderate pulse, spontaneous sweating, fever, aversion to cold, and aversion to wind"—a series of signs that can be elicited by definite examination methods. When this cluster of signs appears, treating with Guizhi Tang yields a high effective rate, and once it works, it works rapidly. Here "floating, moderate pulse; spontaneous sweating; fever; aversion to cold; aversion to wind" are the indications of Guizhi Tang, or, in traditional TCM terms, the "Guizhi Tang syndrome" or the "Taiyang wind-stroke syndrome."

Using herbs and using formulas seem to be two concepts, but they should in fact be unified into one. A single herb is itself a prescription; a compound formula is nothing more than a combination of several single herbs. Sorting it out this way simplifies the problem, making it easier to express and easier for learners to understand and master.

A major shortcoming that gradually emerged in the development of TCM is the creation of a vast vocabulary of specialized terms detached from reality—such as yin deficiency with effulgent fire, kidney yang deficiency, kidney yin deficiency, and so on. As one studies, it is easy to become confused. Simplifying the concepts makes them easier to learn, master, communicate, and spread.

The main TCM knowledge I still study every day is Chinese herbs and formulas. One could say I have always followed the approach of the Yaoxing Fu and Tangtou Gejue, only having broadened the range of herbs and formulas I study considerably. Beyond that, I spend much time reading the case records of other clinicians and learning from their experience in treating disease.

TCM is an experiential medicine, and the key to its clinical efficacy lies in the four characters "treating according to the symptom" (or, in TCM parlance, "syndrome differentiation and treatment"). TCM books are as numerous as cattle in the shed—one can never finish reading them—but the essence of the TCM literature through the dynasties never departs from two keys: the practical efficacy of Chinese herbs and of formulas.

If one studies too much TCM theory, it is easy to be bewildered by various doctrines and finally sink into abstract talk, empty talk, even bizarre talk—bizarre TCM theories I have seen are as plentiful as black cattle, and some have a furtive, underhanded feel, far from open and upright, tarnishing the reputation of Chinese medicine.

Two things keep a person grounded: the concrete efficacy of each Chinese herb and each formula. This herb treats sore throat, that formula treats fever without sweating—it is all plain to see. These are real experiences summed up by working people and physicians through the ages, and they are the most precious part of Chinese medicine.

A given herb relieves a certain symptom, a given formula resolves another. If we keep these in mind, our clinical practice can be purposeful and yield good results. A patient's trust in a doctor arises only from efficacy; however elegant the theoretical rhetoric, if it cannot be translated into real clinical effect and relieve the patient's suffering, patients will easily feel that TCM is cheating them.

Further, using induction, one may group herbs with similar effects into a single category and formulas with similar effects into a single category. Herbs of the same category and formulas of the same category can then be combined together to treat a given disease jointly, producing a more effective result.

Sorted out this way, TCM is no longer complicated. Learning Chinese medicine then leaves only one difficulty: study more of the indications and side effects of herbs and formulas, and memorize more. The more you learn and remember, the more skillfully you can use them clinically. Because what is memorized are objective medication indications rather than prescriptions based on personal subjective feeling, treatment tends to be more reliably effective.

This method was used not only by the ancients but also by medical experts today.

As early as the Spring and Autumn and Warring States periods, China's Shennong Bencao Jing (Divine Farmer's Materia Medica) set out the principles of combining herbs. In its general outline it states that herbs "act singly, mutually reinforce one another, mutually assist one another, mutually restrain one another, mutually antagonize one another, counteract one another, or neutralize one another's toxicity; these seven relationships must be considered when combining them." The ancients emphasized using herbs "mutually reinforcing, each bringing out the best in the other." This idea of combining herbs to strengthen efficacy is very valuable.

The Japanese study Chinese medicine (they call it Kampo medicine) by inductively summarizing the efficacy of herbs and formulas. The most famous Japanese Kampo physician, Yoshimasu Todo, wrote Yakushō (Drug Evidence), a typical work classifying herb efficacy; his other work, Ruijuhō (Classified Formulas), is a representative work grouping formulas of similar effect.

Yoshimasu Todo was enormously influential in the Japanese Kampo world and is hailed as a giant of Kampo medicine. His approach of classifying and grouping like herbs and like formulas pointed the direction and laid the foundation for the scientific development of Japanese Kampo. He influenced many; the most famous modern Japanese Kampo physician, Tōmoto Hiroyasu, was deeply influenced by him.

Tōmoto Hiroyasu's work Kōkan Igaku (Imperial Chinese Medicine) in turn exerted a profound influence on contemporary Chinese TCM. Representative figures of the modern jingfang (classic formula) school in China, Hu Xishu and Liu Shaowu, were both deeply influenced by Tōmoto; their works all bear the imprint of Kōkan Igaku.

But all this collation and research still rested on the study of ancient texts; it did not go further to do creative work on that basis, and was not yet enough to push Chinese medicine forward.

For TCM to innovate, it must make breakthroughs on the shoulders of its predecessors. We ought certainly to study the pharmacology of ancient formulas and Chinese herbs, but we must also boldly innovate—trying to recombine like herbs and like formulas into new, more effective formulas, and, drawing on modern medical research into disease and pharmacology, achieve breakthrough clinical results that the predecessors could not.

I often describe my own approach as the "cocktail" approach of TCM, or the "large compound formula, multi-target" treatment idea, borrowing from the medical thinking of the Chinese-American scientist David Ho. He tried combining multiple drugs to treat AIDS and achieved good clinical results. I try to use the TCM idea of large compound formulas and multiple targets to treat refractory diseases—such as cancer, stroke sequelae, and post-COVID syndrome—and have also achieved some efficacy.

This composing idea is actually not complex: using analogous formulas and analogous herbs together is more effective than relying on a single herb or a single formula. I know that many TCM clinicians are in fact doing the same work—for example, Prof. Jiao Shude's idea of "combining formulas" and Prof. Liu Duzhou's idea of "connecting past and present." In plain terms, all of these merge several kindred formulas into one large compound to produce better results.

It is just that the names they chose are a bit odd, they never fully articulated the idea, and they never undertook specialized research on it. I hope to go one step further on their foundation, and, drawing on Professor Wang Shimin's approach, use experimental research to seek scientific evidence for my own approach to medication.

This is my most important research direction at present. The reason I am now systematically studying Western medicine and will in coming years sit for the Western medical licensing exam is that I wish to absorb modern medical research findings and further refine this innovative idea of mine in the TCM realm. Guided by this idea, I hope to work out some effective formulas for treating refractory diseases.