Hu Xishu, a TCM Titan Who Sought Truth and Was Practical

Whenever a consultation was held on the ward, with sages gathered and masters aplenty, only Mr. Hu (Xishu) could stand against the majority. Not only was his pattern differentiation accurate without error, but his formulas—though a mere few herbs, unremarkable to look at—produced extraordinary and often unexpected effects. This he drew from the learning of Zhongjing.

— Professor Liu Duzhou, formerly of Beijing University of Chinese Medicine, praising his colleague Professor Hu Xishu.

Professor Hu Xishu was a landmark figure in contemporary Chinese medicine. Born in 1898 and deceased in 1984 at the age of 86, he was an emeritus professor at Beijing University of Chinese Medicine. In 1956, when Beijing College of Traditional Chinese Medicine (the predecessor of BUCM) was founded, Professor Hu, then 60, was transferred there in 1958 as professor of internal medicine and consultant to the academic committee of the affiliated hospital.

Many famous TCM physicians switched to medicine in midlife—for example, Zhu Danxi and Li Dongyuan among the four great masters of the Jin-Yuan period (both took up medicine after family illnesses, and became grand masters), as well as Zhang Xichun, the most renowned TCM physician of the Republican era. Hu Xishu also turned to TCM in midlife.

In 1919 Hu Xishhu entered the Beijing Tongcai Commercial Vocational School (a predecessor of Beijing Jiaotong University). After graduation, he taught English for three years (1924-1927) at the Shenyang County Middle School, Liaoyang County Middle School, and Liaoning Provincial Middle School. From 1928 to 1935 he served as a civil servant for seven years, holding posts such as chief of the accounting section of the Harbin Electric Company, chief of the enterprise section of the Special Municipal Public Bureau, and chief of the business section of the Municipal Administration Office.

After Japan's invasion of China, Hu Xishu refused to serve the Japanese and fled to Beijing in 1936. It was then that he began formally practicing medicine in Beijing, drawing on the TCM knowledge he had acquired earlier. He was already 38, approaching forty. But because of his outstanding efficacy, Hu Xishu soon became renowned in the medical community, and patients thronged to him.

Hu Xishu was devoted to TCM education and determined to train successors. In the early years after the founding of the People's Republic, he co-founded schools with renowned senior physicians Chen Shenwu and Xie Haizhou to teach Chinese medicine. In 1952, the Beijing Municipal Health Bureau approved the TCM school run by Hu and others as a pilot, founding the Beijing Private TCM School, which operated until Hu was transferred to the public Beijing College of Traditional Chinese Medicine.

Hu Xishu's résumé is legendary enough, but in fact he had deep TCM foundations. From 1915 to 1919, while attending the Fengtian Provincial First Middle School, he loved football, was energetic, lively, active, and bright. His Chinese literature teacher, Mr. Wang Xianghui, spotted Hu and the other promising students, specifically invited them to his room for tea, and asked them to study TCM with him. Mr. Wang Xianghui was a jinshi (presented scholar) trained by a juren of the Imperial Academy in the late Qing; in his early years at the Imperial Academy he had studied medicine under an imperial physician of the late-Qing Imperial Medical Office, later taught Chinese, and practiced medicine in his spare time, enjoying an excellent reputation among patients. When he found good seedlings, he wanted to pass his medical skill to them.

Mr. Wang lived in the late-Qing-to-early-Republican era, a period of the most active scholarly exchange in China. At that time the TCM community, influenced by Western medicine and Japanese scholarship, generally held that Chinese medicine must progress and integrate with modern science. Among Wang's students, Hu Xishu learned best. When he graduated from middle school, he sat the TCM examination organized by the Shenyang Municipal Public Office and obtained a TCM practitioner certificate (equivalent to today's TCM physician qualification).

Hu Xishu's academic thought was deeply influenced by his teacher. Wang mainly taught Hu and the others Zhang Zhongjing's Shanghan Lun and similar works—Wang spent two years finishing his lectures on the Shanghan Lun. Moreover, influenced by new ideas, Wang emphasized integrating TCM with modern science; he disliked interpreting the Shanghan Lun through yin-yang and five-phases cosmology or zang-fu theory, and instead emphasized TCM pattern differentiation, reading the Shanghan Lun through six-channel and eight-principle differentiation.

Hu Xishu inherited and further developed this academic feature. During Hu's student years, large numbers of Chinese studied in Japan, and Japanese kanpo medicine (Chinese traditional medicine transmitted to Japan, called kanpo by the Japanese) began flowing back into China. Most popular of all was Tang Ben Qiuzhen's Kokan Igaku (Imperial-Han Medicine, still in print by China Press of Traditional Chinese Medicine). Tang's medical thought deeply influenced Hu. Hu himself said: "The more books I read, the more confused and bewildered I became. Later I obtained Kokan Igaku, and greatly admired Tang Ben Qiuzhen's discourses, feeling I had met a kindred spirit too late. I studied it morning and evening, and suddenly enlightenment came; my clinical efficacy improved greatly thereafter."

Tang Ben Qiuzhen was a grandmaster of Japanese kanpo medicine. After his Kokan Igaku appeared, Japanese kanpo circles successively published the "Kokan Igaku" series. Tang's influence on Chinese TCM was great: both Liu Shaowu's "three-branch, six-disease" thought and Hu Xishu's formula-pattern thought trace their roots to Tang's Kokan Igaku.

Japanese scholarship on Chinese traditional medicine has a long history, and Japanese kanpo circles, like the Chinese, formed various schools. The most famous is the Kohō-ha (Ancient School)—what Chinese TCM calls the Jingfang (classical formula) school. Its representative was Yoshimasu Todo; Tang Ben Qiuzhen inherited Yoshimasu's thought. Tang had originally studied Western medicine but switched to TCM after his own daughter died of typhoid fever despite Western treatment. Hence Tang's works blend Chinese and Western knowledge well, and he contributed greatly to the scientization of TCM.

Yoshimasu Todo's representative works are Yakushō (Pharmacological Evidence) and Ruiji Hō (Categorized Formulas). He was the first Japanese scholar to study TCM using induction. His works avoid empty talk; through historical literature he induced and summarized the medication indications for various herbs and formulas. The very titles Yakushō and Ruiji Hō reflect his academic character.

Yoshimasu's thought was remarkably advanced. His lifelong focus was the medication indications of each herb and each classical TCM formula—an outlook strikingly like modern evidence-based medicine. Readers interested in his thought may read Yakushō and Ruiji Hō; Chinese editions have been published by China Press of Traditional Chinese Medicine.

To illustrate Yoshimasu's approach, here is how he discusses Gypsum (Shigao) in Yakushō:

Gypsum mainly treats vexation and thirst; secondarily it treats delirious speech, irritability, and bodily heat.

Examination of Evidence

The White Tiger Decoction pattern says: delirious speech, enuresis.

The White Tiger plus Ginseng Decoction pattern says: great vexation and thirst.

The White Tiger plus Cinnamon Decoction pattern says: the body has no cold, only heat.

The Yuebi Decoction pattern says: not thirsty, continuous spontaneous sweating, no great heat. ("Not thirsty" does not mean entirely without thirst; "no great heat" does not mean no heat at all. Explained in the Gaiden.)

The Mahuang Xingren Gancao Shigao Tang pattern is not fully recorded. (Explained in Ruiji Hō.)

In the above two formulas, Gypsum is each half a jin.

The Major Blue-Green Dragon Decoction pattern says: irritability and agitation.

The Mu Fangji Tang pattern is not fully recorded. (Explained in Ruiji Hō.)

In the above two formulas, Gypsum is each the size of a chicken egg.

Reviewing all the formulas above, it is clear that Gypsum mainly treats vexation and thirst. Whenever a disease presents with irritability, bodily heat, delirious speech, mania, toothache, headache, or sore throat accompanied by vexation and thirst, giving Gypsum confirms the effect.

From the character of Yoshimasu's works, his forte was using induction to work out the indications of herbs and formulas and apply them clinically. The great advantage of such research is objectivity. Even today, induction remains a primary method of scientific inquiry. Yoshimasu was somewhat eccentric—for instance, he obstinately held that "all disease is one poison," to the point that even his own students could not stand it—but his contribution to the scientization of TCM is undeniable.

For a long time, even up to today, many TCM learners lack Yoshimasu's scientific spirit. He was born in 1702 and died in 1773—more than two hundred years ago. Yet today, still, many who study TCM rely not on observed and induced facts and laws but on metaphysical theory to speculate and deduce. Medicine, a practical science built on experience, once tied to such metaphysics, is burdened with endless empty talk.

Yoshimasu brought Zhang Zhongjing's principle of "treating according to the pattern" (using the herb corresponding to the presenting syndrome) to fullest expression—and this is also Hu Xishu's most distinctive academic feature. Hu strongly rejected the traditional TCM habit of "explaining disease" through yin-yang, five phases, and zang-fu theory. In his essay "Formula-Pattern Correspondence: The Apex of TCM Pattern Differentiation," he wrote: "If there is the pattern, use the corresponding herb; why drag in citations and debate? In the old society, to show off Confucian elegance to the rich and powerful and make a living selling skill, such pitiable posturing is no longer necessary today."

Hu believed TCM was formed in ancient times thousands of years ago. "At that time there were neither progressive scientific foundations nor sophisticated instruments, so it was impossible, as modern Western medicine does, to seek disease diagnosis and treatment by targeting the lesion's substance and pathogenic factors. Instead, physicians relied on their natural senses and the diseased body's reactions to disease to explore methods and experience. Through repeated practice, they not only advanced the four examinations, understanding of herb properties, and accuracy of formula composition, but also, amid ever-changing diseases, summarized general laws of response, and on that basis successfully tested various proven formulas that generally treat disease."

He regarded TCM proven formulas as "the rich fruits won by countless ordinary people in their long, unceasing struggle against disease, yet recorded in the merit books of emperors and generals." Hu believed Zhang Zhongjing's greatest contribution was recording these ancient proven formulas and organizing them through six-channel and eight-principle differentiation, making clinical practice more systematic. Zhang was a great clinician and theorist whose research method was precisely induction.

Hu Xishu was one of the most straight-talking scholars in TCM; he never spoke empty or conventional words. The hallmark of his scholarship was seeking truth and being practical, which is also why his clinical results were outstanding. Medicine is a science; only by approaching it with truth-seeking and practicality can one learn truly useful knowledge and skill. TCM's development has been contaminated by too much flimsy, empty material—what Hu called the conventional talk "in the old society to show Confucian elegance to the rich and powerful."

Hu's remark cuts deep. In ancient times, doctors' social status was actually low; many famous physicians turned to medicine only after failing the imperial examinations. Even as doctors, they felt inferior to scholar-officials, so many authors of classical TCM works liked to advertise themselves as Confucian scholars.

Li Yanwen, father of Li Shizhen (author of the Bencao Gangmu), was a "bell doctor"—a country practitioner who walked the streets ringing a bell to treat patients and sell herbs. Li Yanwen felt the low social status of physicians keenly and hoped his son Shizhen would take the imperial-examination path. But Shizhen failed in the examinations and finally turned to medicine.

In classical TCM works we often see phrases like "we Confucians," with authors linking themselves to Confucianism. TCM theory was also tied to Confucian classics such as the Yijing—in fact, this tie caused a major regression in TCM efficacy, pulling it toward idealism and directly harming the scientific rigor of Chinese traditional medicine.

The Jingfang (classical formula) school is the TCM movement that corrected this. Japan's Ancient School advocated studying the Han-dynasty originals, uncontaminated by later medical theories laced with yin-yang, five phases, and Yijing ideas. Yoshimasu's inductive method is not outdated even today; modern life science still uses induction as an important tool. Of course, with the rise of experimental science, life science increasingly uses experimental methods, and TCM research has advanced greatly with experimental science.

Hu Xishu greatly influenced contemporary Chinese TCM; he is a representative of the Jingfang, or formula-pattern, school. In both clinical practice and teaching, he emphasized herb-pattern and formula-pattern correspondences as the apex of TCM pattern differentiation. My own years of practice bear this out: to achieve outstanding clinical results, TCM physicians must firmly grasp formula-pattern and herb-pattern correspondences, undistracted by yin-yang, five phases, zang-fu theory, or Yijing thought.

As a Jingfang scholar, Hu's weakness—and the greatest weakness of the entire Jingfang school—is conservatism: failure to go beyond the ancients and innovate in TCM. Hu indeed grasped the key to TCM clinical practice, but most of his life was spent studying Zhang Zhongjing's teachings and the proven formulas of the Shanghan Lun and Jingui Yaolue. For a medical scientist, this is not enough.

We should go further: learn from the ancients' experience in creating formulas and devise new ones for intractable modern diseases such as cancer, neurological diseases, and diabetes. Effective formulas are always worked out through practice. Although the formulas in the Shanghan Lun and Jingui Yaolue are excellent, ancient average lifespans and living conditions differed greatly from modern ones, so their epidemic diseases were not ours. We should learn the ancients' experience in creating proven formulas, combine them with modern experimental science, and devise new prescriptions for modern common diseases.

We can draw on Yoshimasu's example, using induction to study and organize ancient medical works and modern research, sorting out predecessors' experience and inducing the combined characteristics of herbs, formulas, and diseases, on which to try new therapeutic approaches. TCM compound formulas and the modern cocktail therapy share a strikingly similar philosophy. With enough effort to learn from predecessors and research new approaches, new proven formulas for modern epidemics can be worked out, and their efficacy can be reproducible.

Clinging to ancient formulas is not entirely useless against new modern epidemics—classical formulas do have some effect on modern diseases—but the Jingfang school's overvaluation of ancient formulas, as if they alone can solve all today's intractable diseases, is unrealistic. The times are progressing; we must progress too, learning to use modern scientific knowledge and thought to further develop Chinese medicine and let it play a greater role in more intractable modern diseases.