| 1 IntroductionThe research of history of diseases is an important part of the studies on medical history. Unfortunately, so far there is no such research on the history of prevention and treatment of the history of pestilence in modern traditional Chinese medicine (TCM). The sudden attack of SARS in 2003 demonstrates the significance of the studies on this topic. The present research is a dissertation on this topic under the supervision of my teacher.1.1 The Definition of Related TermsModern time: about a century from 1840-1949.Prevention and treatment in TCM: Mainly referring to the TCM prevention and treatment measures performed by professional TCM physicians, together with some methods absorbed from western medicine and the setting up of institutions, as well as historical facts jointly accomplished by both TCM and western medicine.Pestilent diseases: diseases caused by exogenous pathogens with virulent infectivity and liable to fulminating spreading, which are quite similar to acute infectious diseases of modern time.Research on history of pestilent diseases: within the category of research on history of diseases, including the studies on disease name, etiology, pathogenesis, manifestations, diagnostics, treatment, and epidemiology, and the development of recognition and its rules.Significant pestilent diseases: the five significant pestilent diseases are defined by high virulence and the degree of its serious damage, including plague, cholera, diphtheria, and rotten scarlet throat (RST, Scarlet Fever). In addition, the "significance" referring to the pestilent diseases, the pestilent convulsion, selected here belongs to a frontier topic for study and is just at the preparing stage of summarizing experience toTCM art at that time.The definition and nomenclature of the five pestilent diseases in this article are based on the standards promulgated by the Committee for Terms in TCM (CTTCM) in Chinese Terms in Traditional Chinese Medicine and Pharmacy and State Standard, Clinic terminology of traditional Chinese medical diagnosis and treatment-Diseases.Plague: caused by Pasteurella pestis, manifesting sudden onset, high fever, bleeding, nodular pains, or hemoptysis, coughing sputum, or even sudden death.Cholera: caused by Vibrio cholerae, manifesting severe vomiting of swilled-rice water, collapsed eyes, convulsion of the calf, depletion of body fluid, or even sudden death due to collapse.Diphtheria: manifestations include white membrane difficult to tear off in the pharynx, throat, and nose, with fever and sore throat.Scarlet Fever: characterized by fever, swelling and painful rotted throat, with diffused scarlet spots over the whole skin.Pestilent Convulsion: caused by pestilent pathogen, manifesting severe headache, chilliness, fever, no sweating, numb and cold limbs, stiff nape, unable to move the body, opisthotonos, flexed arms, flushed face, red eyes, dilated pupil, lockjaw, followed by coma, white and thick greasy fur, tense and string pulse.History of Prevention and Treatment of Significant Pestilence of modern TCM: referring to the studies on prevention and treatment of plague, cholera, diphtheria, scarlet fever and pestilent convulsion in modern TCM from 1840-1949, including the recognition and practice on the titles, diagnostics, etiology and pathogenesis, prevention and treatment of these diseases in modern TCM.12 Purpose and Tasks of the ResearchPurpose: To systematically study the historical facts of prevention and treatment of these diseases and summarize the experiences in modern TCM so as to support and elevate the level of these works in contemporary TCM.Tasks: To reveal the original historical conditions on top of which to summarize the experiences, the achievements, so as to draw instructions for contemporary TCM as best as possible in these aspects.13 Methodology for Writing the DissertationBased on the definition of the ideas, the materials and the coverage of the thesis can be precisely handled.Collect all available first-hand materials to ensure the reliability of the thesis. Theoriginal sources of modern writers are the main basis, together with all relevant writing materials under the guidance of dialectical materialism, and historical materials as evidences to make analysis and descriptions.To use computer for indexing, inputting, and compiling of the thesis.2 Main Contents of the Thesis2.1 Prevention and Treatment of Plague in Modern TCMThe five significant great epidemics of plague is first reviewed, including the 1894 epidemic in Hong Kong, the 1910 epidemic in Northeast China, the 1917 epidemics in Inner Mongolia and Shanxi, the second epidemic in 1920 in Northeast China, and the 1947 epidemic in Inner Mongolia, demonstrating the prevalence of plague in modern China.Based on textual research, it is recognized that the first monograph on plague in China was The Treatment for Plague, written by Wu Xuanchong of Wuchuan County, Guangdong Province published in 1891, on which other similar monographs like Luo Zhiyuan's Collections of Plague, were all based. It is exactly in Wu's book that the title of plague first appeared and applied until now in China. The name of plague was further sub-classified during the Republican period through the absorption of the classification of plague in western medicine by some TCM physicians that had contacts with western medicine.Early physicians claimed that plague was caused by li (pestilent) qi, or dryness pathogen. In the 1030s, some TCM physicians with Li Jianyi and Shi Yiren as representatives, absorbed the results of research in western medicine, and the recognition on the cause, pathogenesis and way of infection became gradually mature. The physicians at the end of the Qing dynasty mainly diagnosed the disease on the basis of its symptoms and epidemics. The diagnosis, differential diagnosis, division of stages of the disease were further improved after the introduction of western medicine into China.In treatment, by inheriting the experiences of their ancestors, the modern physicians summarized and created some effective prescriptions. Luo Zhiyuan's Modified Jie du huo xue Decoction, Ran Xuefeng's Tai su qing zaojiufei Decoction, and Jijiu tong qiao huo xue Decoction, and Li Jianyi's Eryijie du Decoction and Er yi jie du Injection all played a positive role in the treatment of plague. Li Jianyi's Er yijie du Injection was a discovery of creative significance in 1932-1935.As to the prevention, the traditional measures such as hygienic methods,medications, and migration to other locations were the common approaches, but ineffective to plague. In the Republican period, western methods such as isolation and antiseptics were adopted by some TCM physicians like Wu Ruifu. 2.2 Prevention and Treatment of Cholera in Modern TCMAs a traditional name of disease, huo luan (cholera) was first appeared in Huangdi Neijing which refers to vomiting, diarrhea, and upset as its main manifestations. After the introduction of western medicine, this title was inherited and applied to the disease caused by Vibrio cholerae. With severe vomiting and diarrhea of swilled-rice water without abdominal pain, but with collapsed eye-sockets, calf convulsion, or even systemic collapse. This manifestation superseded the original TCM idea and continued to use until now in TCM. It is exactly due to this reason that confusion was existed in the title for cholera. Some TCM physicians found that the manifestations of cholera was quite different to the huo luan in ancient classics, and, therefore new titles like diaojiao sha, bie luo sha, fu yin, shi yi huo luan were named. In the Republican period, some TCM physicians adopted the western name of cholera, and the original implication of huo luan became faded away. It can be claimed that the first monograph on cholera is Xu Zimo's Diao jiao sha fang lun (On the Prescription of Suspended Leg Sha-syndwme), published in 1845. It is commonly claimed that cholera was first introduced into China from India in 1817-1820. China was involved in all the six great epidemics of cholera in modem age, with severe outcome. Modern TCM did make great contributions to the prevention and treatment of cholera.The ideas on etiology and pathogenesis were varied. Early idea was focused on heat and cold theory when insisting on the idea of traditional theory, modern TCM also accepted the western theory and integrated it in with the relevant parts during the turn of 20th century. Early modem physicians always diagnosed by manifestations and epidemic conditions, featuring a diagram of tongue picture. Some TCM physicians insisted the four diagnostic methods, while other physicians applied an integrated approach which enriched the diagnostics for pestilence in TCM.Since the recognition on the etiology and pathogenesis were varied, many kinds of therapies were applied, including acupuncture. The principles included warm dredging, dispelling heat, detoxifying, aromatic resuscitation, etc. External therapy included acupuncture, moxibustion, plastering, and scrapping relieving methods which also enriched the TCM treatment. Since the 20th century, some TCM physicians gave positive appraisal to western methods of transfusing fluid. Medications with bothtraditional and western medicines were applied.For treatment, TCM advocated hygienic approaches for daily life. After the acception of bacteria theory for the disease, the emphasis was laid on food and drink, and hygienic surroundings.Historical facts proved that TCM did make great contributions to the prevention of cholera. In 1888, the spreading of cholera in north Jiangsu province, under the advocation of some gentlemen and famous TCM physicians, a non governmental institution, a Xinghua Shijiju was set up in which TCM physicians received patients in turns. Over ten thousand patients were rescued. During the 1919 epidemic, the TCM director in which TCM physicians received patients in turns. Over ten thousand patients were rescued. During the 1919 epidemic, the TCM director Yang Haoru and the physicians Chen Shizhen, Zhang Hanqing of the outer hospital of the capital police hospital established provisional clinics in Langfang to rescue the victims of cholera. In 1921, a Shenzhou Pestilence Hospital was set up in Shanghai to treat cholera patients with both western and traditional methods. In 1945, cholera was prevalent in Chengdu, TCM Association strived for the treatment of cholera when they were expelled and belittled by the government. TCM physicians like Ran Xuefeng, Zhang Xichun, Liu Fu, Fan Wenfu, and Zhu Weiju treated cholera either by setting up clinics or created new recipes for the multiple approaches to treat cholera.23 Prevention and Treatment of Diphtheria in Modern TCMBased on the available sources, it is claimed that Shi yi bai houjie yao was the first monograph containing the title of diphtheria, written by Zhang Shanwu in 1864.The titie of diphtheria was unified in 1880. Early physicians used to claim that it was caused by pestilent qi, or dryness qi, or coal toxicity, while later physicians, by combining new ideas, accepted the microbial theory. Diagnosis mainly depended on the manifestations. The diagnosis in the Republican period became more mature after the acceptance of western ideas. Physicians like Cao Bingzhang even used some western instruments like tongue presser and laryngoscope for diagnosis.Various hypotheses were proposed by physicians like Chen Yuchun and Zhang Shanwu for the principles of "cooling, moistening and nourishing yin". They proposed the recipes of Chu wen hua du Powder, Shen gong pi xie Powder, Shen xian huo ming Decoction, Long hu erxian Decoction, andXiong huangjie du Pill, etc., for treatment based on differentiation of different syndromes, while physicians like Nai Xiuzi, Liu Changqi, advocated the recipes of Yang yin qingfei Decoction and that formulated byZheng Honggang and his son, and Zhang Shanwu's recipe. Since Nai Xiuzi over-emphasized the principle of "avoiding relief of superficies" and its popularization, a lot of later physicians, with Zhang Caitian and Yun Tieqiao as representatives, opposed his idea. Zhang insisted that the principle of detoxifying and clearing fire should be the orthodox treating principle, while Yun Tieqiao and Shi Jinmo advocated the use of Ma xing shi gan Decoction. Huang Weihan advocated that there were either cold or heat nature and should be treated accordingly. In 1891, diphtheria serum treatment was used clinically. Chen Genru, for instance, advocated the use of serum for the treatment. Many physicians, including Cao Bingzhang, Yang Xiling, Zhu Zhensheng, Lu Yuanlei, Shi Yiren, and Shi Jinmo, all claimed that, when using the traditional methods, western serum methods can be applied at the same time so as to elevate the clinical efficacy. The contention and multiple explorations on this aspect reflected the active anti-diphtheria campaign against the disease.Regarding the prevention, healthcare measures like care on food and drink, daily life were advocated. The significance of moving from carbon poisoning to better ventilated places were emphasized.2.4 Prevention and Treatment of Scarlet Fever in Modern TCMChen Gengdao's Yi sha cao and Cheng Yongpei's Dan shajing yan chanjie were the representative works on this disease, demonstrating that there were rich experiences in ancient China. The prevention and treatment of this disease was embodied in the inheritance of ancient experiences, yet, with some progress.Regarding the title of this disease, modern physicians continued to use the traditional name Ian hou dan sha, Ian hou sha, at the same time, new titles were applied, including ma zheng, sha hou, hou sha, yi hou sha, xing hong re. Among them, hou sha, and xing hong re were more popularly used. Physicians who received more western medicine, like Zhang Xichun, He Lianchen, Shi Jinmo, and Qian Jinyang maintained that the titles of xing hong re and Ian hou dan sha were alternative names for the same disease, while Wang Fengchun claimed that the tides should be carefully used and not to be confused.Modern TCM physicians recognized the causes and pathogenesis through multifarious approaches. By inheriting ancient ideas, it was claimed that the pestilent poisons invade the lung and the stomach through the nose and mouth, manifesting rashes and rotten throat, with strong infectivity. Some physicians explored the relation between living behaviors and environment. Later, they gradually accepted westerntheory, claiming that though western and traditional recognition on this disorder was different, yet, and the real nature of them being the same.Regarding its diagnosis, the disease was recognized on the basis of symptoms and epidemic condition. Progress was manifested in the differential diagnosis among it and diphtheria, measles. This was beneficial to its treatment.The treatment was inherited from fore-runners like Chen Gengdao and Cheng Yongpei. It was emphasized that the first treatment should be focused on diaphoresis, avoiding cold drugs at the early stage. Modern physicians with rich experiences in this aspect included Wang Desen, Xia Chunnong, Cheng Jingyu, Cao Xinyi, Ding Ganren, He Lianchen, and Yang Xiling. By inheriting the ancient experiences, Ding Ganren classified his recipes into internal medication, blowing recipes, external application, and plastering. The internal recipes including Jie ji tou sha Formula, Jia jian ma xing shi gan Decoction, Jia jian sheng ma ge gen Decoction, Jia jian hei gao Decoction, Liang ying qing qi Decoction, Bai du Decoction, and Jia jian zhu ye shi gao Decoction, were all formulated by Ding himself with creative significance. Since the difference between diphtheria and RST was definite, the effects of treatment were gradually improved.For the prevention, medications were encouraged by early physicians, which was rather simple. Since the 20 century, prevention gradually became perfect. Cao Bingzhang's Hou sha zkeng zhi yao lue offered the prevention in three categories, the physician's prevention, prevention in daily life, and prevention prior to illness, which were integrated methods of western and traditional approaches.25 Prevention and Treatment of Prevalent Convulsion in Modern TCMFalling under the category of convulsion disease, prevalent convulsion was rather scarcely recorded during the period from ancient to the Republican stage. After 1918, this disease became prevalent in Jiangsu and Zhejiang Provinces. Physicians were engaged in the investigation of this new disorder with certain positive results.Most modern TCM physicians claimed that prevalent convulsion was similar to the convulsion in ancient works, the difference being its epidemic nature, hence the titles of jing wen, Ju wen, yijing, epidemic cerebro-spino-meningitis, and ji toufeng, etc. In 1929, this disease was prevalent in Shanghai, the Shenzhou Medical Association organized discussions through workshops and correspondence, and a conclusion was drawn, claiming that the opisthotonos belonged to convulsion and its infectiousness being its unique feature, hence, pestilent convulsion. Some physicians compared it with the epidemic infectious cerebro-spinal-meningitis. Since the title of meningitis was verypopular among the people, hence, Yan Cangshan's Yi bingjia ting zi liaoji was changed to a title of Nao mo yan jia ting zi liaoji. Lu Yuanlei and Shi Jinmo even advocated the direct use of the western name of meningitis, but without supporters. It is obvious that the use of the title yijing (pestilent convulsion) was the endeavor of TCM to maintain its own academic position under the challenge of western medicine.Some TCM physicians insisted to explain the etiology and pathogenesis of this disease by traditional approach, saying that it was a kind of "hidden q?' (Zhang Shengfu) and was caused by wen du (warm poison) (Gu Yunruo), while most physicians claimed that since this disease always happened in spring and winter, hence, it was due to abnormal climatic factors. Physicians like Yun Tieqiao, Shi Yiren, claimed that it was an infectious disease caused by meningococcus.Diagnosis was based on the manifestations and its infectivity. The conclusion drawn through the discussion organized by the Shanghai Shenzhou Medical Association claimed that: symptoms included primordial chilliness and fever, severe headache, sour and numb limbs, fidgety nausea, sweating or non-sweating, and when the disease progressed, opisthotonos, convulsive nape, unconsciousness, red and fixed eyes, lockjaw and delirium, and at the last stage, scorched lips and tongue, cold limbs, or madness, asthma, petechiae, rotten sores over the whole mouth cavity. Liu Caiwu also classified it into three types, including acute convulsion, sub-acute convulsion, and secondary convulsion.Regarding its treatment, since the use of serum was very expensive and its difficult accessibility, it left a huge room for TCM to play its role. There were many discoveries. Yun Tieqiao, for instance, invented An nao Pill, while Yan Cangshan, based on his experience on treating 2000 cases at the Shanghai Siming Hospital, applied Jiajian ge gen Decoction, newly formulated recipes like Ge gen zhi chi Decoction, Ling yang shu jing Decoction, Xi ling jie du Decoction, Ju hua da dian Drink, Ling yang xi feng Decoction, etc. Important, creative, and effective contributions were made by these physicians through inventions and discoveries.For prevention, emphases were laid on health-care and medications. Liu Caiwu overlooked the isolation measures of western medicine.Physicians of this stage also paid high attention to the summarization of experiences. Monographs, including Jiang Bishan's Fu wen zheng zhi shi yan tan (1923), and Yan Cangshan's Yi jing jia ting zi liao ji (1932) were the examples with clinical significance. In 1935, Shen Qinglang compiled Nao mo yan xin shu which collected... |
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