Zheng Yin Mai Zhi, by the Late-Ming Physician Qin Jingming
Zheng Yin Mai Zhi (Symptoms, Cause, Pulse, and Treatment) is a TCM work completed jointly by Qin Changyu (style name Jingming), a famous physician of the late Ming dynasty, and his grandnephew Qin Zhizhen (style name Huangshi); it is well worth reading.Qin Changyu was a famous physician of Yunjian (present-day Songjiang County, Jiangsu Province) in the late Ming. According to the Songjiang Prefecture Gazetteer, during his lifetime Qin Jingming also wrote Dali Zhezhong, Douzhen Zhezhong, Youke Zhezhong, and Youke Jinzhen, among other works; Zheng Yin Mai Zhi was written in his later years.Qin Changyu was often ill in childhood, which led him to resolve to study medicine. He was especially skilled in treating pediatric diseases and later also became proficient in internal medicine. From the fact that he left behind Douzhen Zhezhong, Qin Changyu was quite experienced in treating smallpox, an infectious disease of the time. Qin Changyu's clinical results were outstanding and he was locally renowned, with patients thronging his door.What one gets from books is ultimately shallow; only practice yields true knowledge. A clinician must have enough patients to accumulate rich clinical experience and to develop original insights. Abundant patient resources gave Qin Changyu the opportunity to know medicine deeply, and some of his penetrating insights remain quite valuable today.In the preface to this book, Qin Changyu wrote: "Taking the pulse to seek the cause and the symptom costs great effort to fathom; it is better to take the symptom as the lead and then seek the cause's origin and the pulse's likeness, and decide what treatment is fitting; then the disease has no way to hide, and the medicine will not be misused. That is why the ancients first valued looking, listening-smelling, and asking, and placed palpation (the pulse) last."The gist of this passage is that it is difficult and unreliable for a doctor to judge a patient's cause and condition purely by taking the pulse. It is better to take the symptoms the patient reports as the lead, seek the cause, use the pulse as support, and judge how the patient should be treated; this way one will not use the wrong medicine. So the ancients valued inspection, auscultation-olfaction, and inquiry most, and placed pulse-taking (palpation) least of all.In the book he also wrote: "In applying medicine, one must seek a well-founded symptom. Yet there are cases where symptom and pulse correspond, and one uses a formula according to the pulse as orthodox treatment; there are also cases where the symptoms are clear but the pulse is obscure, so that it is hard to base a formula on the pulse and one must treat according to the symptom."The meaning is that, when using medicine to treat disease, one must have definite grounds. Some diseases have symptoms that match the pulse, and then using medicine by the pulse is orthodox treatment; but sometimes the symptoms are obvious while the pulse is vague, and it is hard to base a formula on the pulse, so one must use the symptoms as the basis of judgment. In effect, what Qin Changyu advocated was that, whether or not the pulse matches the symptoms, one should judge how to medicate based primarily on the symptoms; the pulse is not important.Only a clinician of rich practical experience could say such a thing. Qin Changyu named this book Zheng Yin Mai Zhi—putting symptoms first, cause second, and pulse diagnosis last. Such a statement still counts as an eye-opening insight today.Qin Changyu in fact grasped the very essence of TCM clinical practice: medicating according to the symptom. In doing so he departed from empty talk and strictly upheld the clinical principle advocated by another clinical master, Zhang Zhongjing—"where there is such a zheng, use such a medicine" (whatever the symptoms, use the matching drug). Symptoms are an objective and reliable basis for medication. If a clinician, throughout life, takes the symptom as the lead, avoids empty talk, and focuses study on memorizing the indications of drugs and formulas rather than judging medication by abstruse reasoning, then his clinical level will naturally be no mean.After years of clinical practice myself, reading Qin Changyu's book now, I feel much as if I had met a kindred spirit. The ancients said that taking the wrong path loses the sheep; if, in TCM clinical practice, the basis for prescribing is too ethereal and complex, then every time one gives a patient medicine it is in effect a kind of gamble—gambling with the doctor's reputation and professional life, and with the patient's health and life. Holding firm to principles and medicating by the symptom greatly raises the cure rate. The life of medicine lies in clinical efficacy; if treatment fails in practice, however eloquent the theory, it is nothing but paper talk.Precisely because Qin Changyu grasped the essence of medicine, he could point out the errors of his medical predecessors with a single, incisive stroke. In his essay "On the Errors of Cause and Symptom and the Mismatched Treatment in Yizong Bidu," he pointed out that Li Shicai mistakenly treated summer-autumn dysentery as spleen deficiency and kidney deficiency, all because Li Shicai clung rigidly to the ancients and disregarded the facts.So he proposed that summer-autumn dysentery should be treated as a damp-heat syndrome, using bitter-cold herbs (Huanglian, Huangqin, Huangbai, and the like). Today we know that summer-autumn diarrhea and dysentery are mostly caused by bacterial infection, not by the spleen deficiency and kidney deficiency some ancient TCM spoke of, and should be treated with antibiotics. And the main component of the bitter-cold herbs TCM uses for diarrhea and dysentery—Huanglian, Huangbai, and others—is precisely the berberine we use today.In today's terms, everything in Qin Changyu's book is solid substance. He focuses on recording what symptoms appear in what disease and what method should be used, with little empty or abstruse talk. Moreover, drawing on a lifetime of experience, he systematically lists the common symptoms seen in clinical practice, noting which method treats each symptom; as the symptoms change, so does the treatment. A book like this can only be written with the utmost effort.After Qin Changyu had written this book himself, he still worried that, being "old and frail, there might be many oversights, so I did not dare to have it carved and transmitted to the world, waiting for worthies of later times to examine it in detail and then publish it." He meant that he feared a book written in old age might have flaws, so he did not dare rashly print it; he hoped that later worthies could review his work, correct his errors, and then it could be engraved and handed down. Qin Changyu's rigor in scholarship puts many scholars today to shame.I often go to the National Library to read, and I see many books that truly are flash in the pan, forgotten within a few years of publication. The reason is none other than that the author merely padded the word count, and readers do not accept it. Only a book into which an author has poured a lifetime's effort can become a work that endures, because such a book has great value.Zheng Yin Mai Zhi not only exhausted Qin Changyu's own effort but also cost his grandnephew Qin Zhizhen a great deal. Qin Zhizhen also wrote a preface to this book, in which he said that, in order to edit and publish his great-uncle's work, he "cut off all social engagements and devoted himself to compilation," and on the basis of his great-uncle's work "further searched widely, elucidating and augmenting it" (as Shen Zongyu, a Hanlin academician of the 43rd year of Kangxi, put it). Precisely because two generations of the family could be so truth-seeking and immersed, Zheng Yin Mai Zhi has such great clinical reference value.Readers often ask me why, having written so many articles, I do not compile them into a book and publish. I would like to take this opportunity to explain: I do not publish books only because I deeply know that, to write a book of truly enduring value, I still need more accumulation—one must temper it over a lifetime of effort to have the ability to write such a book. What is the point, for the sake of fame and profit, of publishing a pile of literary trash that no one will bother to read after a few years?