Shen XX, female, 25 years old. Suffered from dysmenorrhea (painful menstruation) for over ten years; various medications yielded little effect. Instructed to apply "Baobao Yitianling" (Baby One Patch Spirit) before each menstrual onset, changing the patch every two days. After three months, the pain ceased as expected.

Ephedrae Herba (Mahuang, 麻黄)
Mr. Li Hanqing, former director of the Shanxi Provincial Institute of Traditional Chinese Medicine and a renowned late senior TCM practitioner, stated: "All schools claim that Mahuang is pungent, bitter, and warm, promoting Lung Qi, opening the interstices (Couli), penetrating hair follicles, dispersing wind-cold, and possessing the function of inducing sweating to release the exterior. It is the herb with the strongest sweating action. If combined with Cinnamon Twig (Guizhi), its sweating effect is even stronger. If used carelessly by deficient individuals, it may cause unceasing leakage of sweat." He further said: "Commentators on the *Treatise on Cold Damage* (*Shanghan Lun*) describe its sweating action as more terrifying than snakes and scorpions, which is why I was reluctant to use it for a long time. However, one year, when encountering a large number of cold damage cases, I initially treated them with small doses of Ephedra Decoction (Mahuang Tang). Not a single case sweated after one dose. Reluctantly, I increased the dosage of Mahuang to 18 grams, yet still no patient sweated. Later, upon careful inspection, I found that the Mahuang sold in pharmacies had been stored for over ten years. I then switched to fresh Mahuang collected from the wild. The result was that all patients recovered after one dose, revealing that the efficacy of Mahuang differs between new and old herbs."

Rhei Radix et Rhizoma (Dahuang, 大黄)
Historical medical texts consistently describe Dahuang as a potent purgative. However, clinical effects vary. Upon detailed examination, this is often related to the following factors:
1. Origin: Xining Dahuang has a stronger purgative effect than Sichuan Dahuang.
2. Processing: Raw usage has a stronger purgative effect than processed usage.
3. Compatibility: Combined with Qi-regulating or purgative herbs, the purgative effect is strong; combined with diuretic herbs, it is weak.
4. Syndrome: The purgative effect is weak in syndromes of excess heat damaging fluids, but strong in syndromes of Yang deficiency with cold-dampness.
5. Frequency of use: The first dose has a stronger effect than the third or fourth doses. Therefore, to achieve a purgative effect, the dosage often fluctuates between 1 and 160 grams.

Toxicity · Efficacy · Constitution
In clinical practice, it is frequently observed that patients exhibit extreme variability in their response to certain drugs based on dosage. Some patients require very high doses for good efficacy, while others achieve good results with very low doses. For example: with Aconiti Lateralis Radix Praeparata (Chuanwu, Chuanwu), Aconiti Kusnezoffii Radix (Caowu, Caowu), and Aconiti Radix (Fuzi, Fuzi), some patients experienced numbness, convulsions, palpitations, and coma at doses as low as 0.5 grams. With Dahuang, some patients tolerated doses up to 200 grams without abdominal pain or diarrhea, while others developed severe abdominal pain and diarrhea at just 0.5 grams. With Rehmanniae Radix Praeparata (Shudi, Shudi), some patients tolerated 250 grams without stomachal oppression, while others developed obvious epigastric distension at only 3 grams. With Atractylodis Macrocephalae Rhizoma (Baizhu, Baizhu), some patients experienced constipation with trace amounts, while others suffered worsened diarrhea with large doses. With Carthami Flos (Honghua, Honghua), some patients miscarried at 0.5 grams, while others achieved fetal stabilization at 15 grams. With Mahuang, some patients did not sweat even at 60 grams, while others experienced palpitations and unceasing sweating at only 0.3 grams. And so on. This highlights the significance of dosage size.

Reading ancient materia medica works carefully, authors typically discuss flavor, meridian tropism, efficacy, and clinical application together, rather than listing them separately, and rarely specify dosages or itemize entries. When describing efficacy, they necessarily mention syndrome nature; when describing toxicity, they list constitution and syndrome nature. That is, when listing efficacy or toxicity, there is no connection to constitution and syndrome nature, nor is there any indication of the magnitude of efficacy or toxicity based on these factors. Therefore, when studying and reviewing the efficacy and toxicity of each drug, it must be linked to constitution and syndrome nature.

The Dual Nature of Drug Functions
Every drug possesses a dual nature, though some are more obvious than others. For example: Dahuang can both purge bowels to relieve constipation and astringe to stop diarrhea; Juglandis Semen (Hetaoren, Hetaoren) can both bind the intestines to stop diarrhea and reduce urination/incontinence, and also moisten the intestines to relieve constipation and dissolve stones. Therefore, clinically, when applying a specific function of a drug, processing methods are often used to eliminate or reduce opposing components to achieve a specific therapeutic goal. For example: Dahuang is often processed into Prepared Dahuang (Shujun, Shujun) to reduce its purgative effect; Myristicae Semen (Roudoukou, Roudoukou) is often roasted (Wei Roudoukou, Wei Roudoukou) to reduce its lubricating effect.

The dual nature of some drugs is manifested through their flavor, meridian tropism, and functions. For example: the bowel-moistening and fire-supplementing anti-diarrheal effects of Realgar (Liuhuang, Liuhuang) are reflected by its sour and warm flavor, entry into the Gate of Life (Mingmen, Mingmen) and Large Intestine meridians, and its function of supplementing fire and assisting Yang; the bowel-relieving and anti-diarrheal effects of Ginseng Radix et Rhizoma (Renshen, Renshen) and Baizhu are reflected by Renshen’s sweet, slightly bitter, and slightly warm flavor, entry into the Spleen and Lung meridians, and its function of tonifying Spleen and Lung, and Baizhu’s sweet, bitter, and warm flavor, entry into the Spleen and Stomach meridians, and its function of tonifying Spleen and boosting Qi; the bowel-relieving and anti-diarrheal effects of Cistanche Deserticola (Roucongrong, Roucongrong) are reflected by its sweet, salty, and warm flavor, entry into the Kidney and Large Intestine meridians, and its function of tonifying Kidney and strengthening Yang. Therefore, when clinically applying a drug for treatment, one should particularly value its flavor, meridian tropism, and function, rather than being overly constrained by its ability to treat specific diseases.

The dual nature of some drugs is manifested through their characteristics regarding certain syndromes. For example: Cuscutae Semen (Tusizi, Tusizi) is rarely recorded in books as having bowel-relieving or anti-diarrheal effects, but when applied to patients with simultaneous Liver and Kidney deficiency and Yin-Yang insufficiency, it exhibits excellent bowel-moistening and anti-diarrheal effects; Cornus Officinalis Fruit (Shanzhuyu, Shanzhuyu) and Schisandrae Fructus (Wuweizi, Wuweizi) are clearly listed in books as having astringent and consolidating properties, but rarely listed as promoting urination; however, when clinically applied to patients with Kidney Qi deficiency and difficult urination, they exhibit good diuretic effects; Saposhnikoviae Radix (Fangfeng, Fangfeng) and Angelica Pubescentis Root (Duohuo, Duohuo) are mostly listed in books as dispelling wind and releasing the exterior, overcoming dampness and relieving pain, expelling wind and relieving spasms (for Fangfeng); and dispelling wind, overcoming dampness, relieving pain, and releasing the exterior from cold (for Duohuo), but rarely listed as having anti-diarrheal or bowel-relieving effects; however, when clinically applied to diarrhea and constipation caused by wind pathogen entering the interior, they exhibit excellent anti-diarrheal and bowel-relieving effects. Amomi Fructus Rotundus (Sharen, Sharen) is listed in books as regulating Qi and relieving pain, warming the Stomach and stopping vomiting, but rarely mentioned as having astringent and consolidating effects; however, when used for damp-heat or cold-damp diarrhea, spermatorrhea, or enuresis, it exhibits excellent astringent and consolidating effects. Gardeniae Fructus (Zhizi, Zhizi) and Coptidis Rhizoma (Huanglian, Huanglian) are described in books as clearing fire and relieving irritability, draining heat and promoting dampness (for Zhizi); and clearing heat, draining fire, clearing heat, and drying dampness (for Huanglian), but rarely mentioned as causing diarrhea or vomiting as side effects; however, when clinically applied to patients with Spleen-Stomach deficiency-cold, vomiting and diarrhea side effects often occur. Therefore, when clinically applying each drug, the nature of the syndrome must be considered first.

Certain characteristics of the dual nature of some drugs can only be manifested through compatibility between drugs. For example: Perillae Folium (Zisuye, Zisuye) is primarily known for releasing the exterior and dispersing cold, regulating Qi and expanding the middle; but when combined with Huanglian, it clearly exhibits anti-emetic effects. If combined with Medicated Leaven (Shenqu, Shenqu) for vomiting due to food stagnation, it often yields unexpected results. Tangerine Peel (Chenpi, Chenpi) and Licorice Root (Gancao, Gancao) are not listed in books as capable of relieving constipation, but their combination often achieves this effect. And so on, too numerous to enumerate.

In summary, every drug has a dual nature. Therefore, when clinically applying each drug, one must pay attention to using appropriate methods to bring out its effective functions.

Drug Rash · Function · Efficacy
Searching through works of pharmaceutical experts before the Qing Dynasty, no records of drug rash were found. Recent searches of TCM journals report that allergic reactions to Chinese herbal medicines, especially drug rashes, are quite common. In my 40+ years of clinical practice, I have occasionally seen drug rashes appear. These rashes resemble translucent millet grains, look like small hemorrhagic spots, or appear as large patches of urticaria.

Regarding this situation, there are two different views among practitioners. One view holds that since TCM literature lacks mentions of herbal allergies, it must be the safest, with no side effects or allergic reactions. Therefore, some pharmaceutical experts, to boast about safety, often label products as "pure herbal preparations." The other view argues that because past TCM observations of conditions were not meticulous, records of drug allergies were omitted. Recently, due to careful observation of certain conditions, herbal allergies have been discovered. Thus, they believe the boasting about pure herbal preparations is wrong and unscientific.

Which of these two views is correct? Which is wrong? As a scientific worker, one must have a clear attitude. However, making such a clear statement is extremely difficult. Because the phenomenon of drug rash was certainly discovered by practitioners over thousands of years, why did they not record it? There must be deep reasons. Why is it recorded recently? There must also be deep reasons.

In Autumn 1951, I treated a patient, female, 45 years old. She suffered from frequent paroxysmal severe abdominal pain and irregular menstruation. Checked at various hospitals in Beijing and Baoding, diagnosed with chronic gastritis and chronic pelvic inflammatory disease. Western medicine treatment for several years was ineffective. TCM treatment for several years was also ineffective. Recently, she suddenly caught a cold, with headache, body ache, and abdominal pain. Invited me to consult. Her pulses were wiry, tight, and rapid; tongue coating was white. Synthesizing pulse and symptoms, diagnosed as Wind-Cold exterior contraction. Urgently prescribed one dose of Ginseng and Imperata Decoction (Renshen Baidu San, Renshen Baidu San). Three hours after taking the medicine, she suddenly found her headache, body ache, and abdominal pain intensified. Then, abruptly, the abdominal, body, and head pains decreased significantly, but widespread urticaria-like rashes appeared all over her body. The patient and family were terrified and urgently invited me back. One doctor said: "This is a drug rash caused by drug allergy. It must be treated urgently, otherwise she will enter the realm of darkness." I was also panicked and didn't know what to do. My father examined her and said: "This is like the onset of Battle Sweat (Zhanhan, Zhanhan). It is a sign that pathogens are moving from the interior to the exterior to be expelled. It is not an allergic reaction. Do not fear." About an hour later, the patient's rash receded, itching stopped, and headache, body ache, and abdominal pain disappeared. Subsequently, all symptoms vanished, and she recovered.

Another example: Winter 1965, a male patient, 38 years old. Abdominal and head/body pain for 7-8 years. Consulted many TCM and Western doctors, always ineffective. Invited Mr. Bai Qingzuo to treat. Prescribed 10 doses, all ineffective. Suddenly one day, head, body, abdominal, and stomach pains intensified, accompanied by unbearable restlessness, feeling like wanting to die. After about an hour, sudden widespread rash appeared, with unbearable itching. Urgently went to a hospital emergency room. They said: "This is a drug rash caused by drug allergy, due to misdiagnosis/treatment by TCM. Should invite another TCM doctor." I happened to be on duty, also felt helpless, and reluctantly invited Mr. Bai again for consultation. He said: "It is not a drug rash. It is a case where the medicine matches the syndrome, and the Healthy Qi (Zhengqi, Zhengqi) wants to drive the pathogen out. Do not treat it. Wait for the Qi to recover, and it will heal itself." However, some cases required multiple episodes of rash expulsion before healing. He suggested continuing the original prescription. After taking the medicine, indeed, rash appeared all over the body again, all symptoms vanished, and she recovered.

End of 1993, treated a person, female, 50 years old. For over ten years, dizziness and vertigo, paroxysmally worsening, chest fullness and pain, shortness of breath, irritability, palpitations. Diagnosed with coronary atherosclerotic heart disease, cerebral arteriosclerosis, and Meniere's disease. Long-term Western and TCM treatment was ineffective. Pulse was soggy and slow; tongue coating was white. Diagnosed as Qi and Yin deficiency, Phlegm stagnation and Qi knotting. Prescribed tonifying Qi and nourishing Yin, regulating Qi and resolving Phlegm, Modified Ten-Ingredient Warm Gallbladder Decoction (Jiajian Shiwei Wendan Tang, Jiajian Shiwei Wendan Tang). On the 4th dose, suddenly felt severe mental agitation and stifling chest pain. Several hours later, numerous needle-point-sized rashes appeared all over the body. Two days later, they gradually subsided, and most symptoms disappeared. Eventually, she recovered.

Reviewing the ancients' theory of Battle Sweat (Zhanhan, Zhanhan), Zhang Jingyue in *Complete Works of Jingyue* (*Jingyue Quanshu*, Jingyue Quanshu) said: "Battle (Zhan, Zhan) and trembling (Li, Li) are different. Battle comes from the exterior, trembling from the interior. Whenever Cold Damage is about to resolve and sweat is imminent, if the Healthy Qi is internally solid, the pathogen cannot contend with it, and sweat appears naturally without battle. Knowing there is no battle means the constitution is not deficient. If the person is originally deficient, the pathogen contends with the Healthy Qi. Mildly it is trembling (Zhen, Zhen), severely it is battle (Zhan, Zhan). If Healthy Qi defeats the pathogen, battle occurs followed by sweating and resolution. Thus, contention between pathogen and Healthy Qi on the exterior is battle, which leads to recovery. Contention on the interior is trembling, which is more severe. Lunzi said: 'When Yin is attacked by pathogen, internal trembling must occur.' Battle indicates Healthy Qi is about to recover; trembling indicates Pathogenic Qi is rampant. Therefore, in Cold Damage, on the 6th or 7th day, if there is only trembling without battle, eventually becoming cold reversal, it is mostly incurable. This is because Healthy Qi is centrally deficient, Yin pathogen is internally excessive, Healthy Qi cannot defeat the pathogen, and is instead defeated by it. In such cases, unless using large doses of great tonifying and warming agents, and moxibustion to restore Yang, how else can it be defended against?" Qing Dynasty Dai Tianzhang in *Differentiation of Plague* (*Wenyi Mingbian*, Wenyi Mingbian) said: "For seasonal epidemics, regardless of initial onset or transmission, Battle Sweat is a good omen. Battle means pathogen and Healthy Qi contend; sweating means Healthy Qi drives the pathogen out. However, there is distinction between thorough and unthorough resolution. Those who resolve thoroughly sweat profusely; after sweating, the body cools, mouth is not thirsty, tongue coating clears, urination and defecation are clear, chest/abdomen/flanks have no obstruction or knotted pain. Only then is it complete resolution via Battle Sweat. Otherwise, residual pathogen remains and fever returns. There are those who need to battle-sweat two or three times to resolve, those who battle-sweat once and cannot battle again, waiting for repeated purging to retreat, and those who cannot battle-sweat again, adding sinking fatigue and death! It all depends on the strength of the Root Qi." The reason predecessors did not record drug allergies is similar to this principle. If Healthy Qi is internally solid, the disease is cured after medication. If the person is originally deficient, after medication, pathogen contends with Healthy Qi. Mildly, general discomfort; severely, widespread rash. If Healthy Qi defeats the pathogen, all symptoms are resolved. In summary, the emergence of drug rash indicates Healthy Qi is about to recover, and is not harmful. If Healthy Qi is centrally deficient, Yin pathogen is internally excessive, Healthy Qi cannot defeat the pathogen, and is instead defeated by it, there may be post-rash cold reversal, or even death. This also requires attention.

Abdominal Palpation is Essential for Critical Diseases
The Epigastrium and Abdomen are the dwelling places of the Spleen and Stomach. The Spleen and Stomach are the Foundation of Post-Heaven, located in the Middle Jiao, connecting above and below, serving as the pivot of ascending and descending movements. The ascending of Liver Qi, descending of Lung Qi, descent of Heart Fire, ascent of Kidney Water, exhalation of Lung Qi, and inhalation of Kidney Qi are all completed with the assistance of the ascending and descending movements of the Spleen and Stomach. Therefore, Li Dongyuan said: "If Spleen and Stomach are deficient, the Nine Orifices are blocked," and "If Stomach is deficient, all organs become diseased." Therefore, besides abdominal diseases and Cold Damage/Warm Diseases requiring emphasis on abdominal palpation, the diagnosis and treatment of critical diseases should also emphasize palpating the Deficiency/Excess nature of the abdomen and the location of this Deficiency/Excess.

For example: In Shock within the Syndrome of Jue-Tuo (Cold Extremities and Collapse), if the epigastrium and abdomen are not palpated, it is often difficult to distinguish between Deficiency and Excess syndromes. I once treated patient Duan XX, male, 50 years old. Coronary atherosclerotic heart disease, angina pectoris for over 3 years. Around 9 PM last night, sudden abdominal discomfort, two episodes of diarrhea. Urgently took 2 tablets of Berberine. Two hours later, not only did symptoms not improve, but they worsened. Urgently sent to hospital. Observed black tarry stools, consciousness in a hazy state, extremities, ear shells, and forehead cold as ice. Blood pressure 50/30 mmHg, fecal occult blood +++. Urgently gave Western medicine treatment. By 4 PM that day, symptoms still did not improve. Added Chinese herbs Sanqi (Notoginseng Radix et Rhizoma, Sanqi) and Yunnan Baiyao (Yunnan Baiyao, Yunnan Baiyao) for combined treatment. By 6 PM, still no improvement. Urgently invited me to consult. Observed unclear consciousness, cold forehead, chin, and ear shells, feet cold to knees, hands cold to elbows, thin yellow tongue coating, pale-dark tongue body, pulse deep, minute, and nearly imperceptible. Palpated abdomen from xiphoid process to lower abdomen, all soft. Synthesizing pulse and symptoms, pondered: This is a syndrome of severe decline of Yang Qi nearing exhaustion, complicated by stagnant heat? Planned to urgently warm Heart, Spleen, and Kidney Yang, assisted by draining fire. Prescription: Ginseng Radix et Rhizoma (Renshen, Renshen) 10g, Aconiti Radix (Fuzi, Fuzi) 10g, Atractylodis Macrocephalae Rhizoma (Baizhu, Baizhu) 10g, Zingiberis Rhizoma (Ganjiang, Ganjiang) 10g, Glycyrrhizae Radix et Rhizoma (Gancao, Gancao) 10g, Coptidis Rhizoma (Huanglian, Huanglian) 10g, Cinnamomi Cortex (Rougui, Rougui) 9g.

Visited the next afternoon. Consciousness clear, urination and defecation normal, extremities warm, blood pressure 100/70 mmHg. Took 2 more doses consecutively, recovered.

Another example: Patient He XX, female, 36 years old. Ectopic pregnancy, intestinal obstruction, shock. Previous treatment with blood transfusion and Single Ginseng Decoction (Dushen Tang, Dushen Tang) showed no improvement. Urgently invited for consultation. Observed cold extremities, cold forehead, ear shells, and chin as ice, unclear consciousness, pulse minute and nearly imperceptible. Also observed abdominal fullness and distension, obvious resistance and tenderness in the epigastrium. Synthesizing pulse and symptoms, diagnosed as severe decline of Yuan Qi (Original Qi), Fu Organ Excess complicated by Blood Stasis. Planned to use Ginseng Radix et Rhizoma (Renshen, Renshen) to greatly tonify Yuan Qi, Immature Bitter Orange (Zhishi, Zhishi) and Magnolia Bark (Houpo, Houpo) to break Qi stagnation, Peach Kernel (Taoren, Taoren) to invigorate Blood, and Morning Glory Seed (Erchou, Erchou) to purge downward. Next day, consciousness cleared, blood pressure rose from 40/20 mmHg to 100/78 mmHg.

Intestinal Obstruction in the Syndrome of Guan-Ge (Obstruction and Rejection): Recent physicians follow the principle that the Six Fu Organs prefer smooth flow, strongly advocating purgative methods to treat intestinal obstruction. However, clinical application often fails. Carefully considering the reason, it is failure to differentiate Deficiency/Excess and Cold/Heat. Differentiation of Deficiency/Excess and Cold/Heat especially requires abdominal palpation. I once treated patient Geng XX, male, 78 years old. Suffered from small intestine hernia for decades. Previously, each episode improved quickly with manual elevation. But two days ago, due to excessive walking, sudden unceasing abdominal pain, inability to pass stool, unceasing vomiting. Doctors initially tried manual elevation, ineffective. Then treated with Compound Da Cheng Qi Decoction (Fufang Dachengqi Tang, Fufang Dachengqi Tang) and black bean oil enema, still ineffective. Observed unclear consciousness, cold hands and feet, abdominal distension, but soft upon palpation, vomiting and hiccuping, food/drink continuously flowing from mouth corners, white tongue coating, deficient-rapid pulse. Synthesizing pulse and symptoms, pondered: Abdominal distension large but soft upon palpation indicates Deficiency complicated by Qi stagnation. Treatment should warm the Middle, strengthen Spleen, regulate Qi, and reduce distension. Prescription: Magnolia Bark (Houpo, Houpo) 24g, Ginseng Radix et Rhizoma (Renshen, Renshen) 10g, Zingiberis Rhizoma (Ganjiang, Ganjiang) 12g, Fresh Ginger (Shengjiang, Shengjiang) 10g, Roasted Licorice Root (Zhigancao, Zhigancao) 10g.

After one dose, much flatus passed, stool moved, abdominal distension significantly reduced. Continued one more dose, all symptoms disappeared, recovered.