Chapter 646: Xixin

Chapter 646: Chapter 646: Xixin

Hiss—

The few TCM interns present turned pale.

Even Hu Qiming looked horrified.

’Is he really going to try it?’

’Use himself as a guinea pig?’

Li Xu saw their reactions and sighed. "For the disciples of many old TCM masters, the very first lesson is to personally taste Aconite and other potent herbs. If you don’t even dare to use it on yourself, how can you dare to use it on a patient? How can you dare to entrust a patient’s life to this bowl of medicine?"

Everyone exchanged glances, their hearts filled with a jumble of emotions.

There was both admiration for Li Xu and fear of this tradition of "testing medicine on oneself."

The department heads from Western medicine, on the other hand, glanced at one another. Though they said nothing, their eyes were full of disapproval.

In their view, Li Xu’s so-called "caution" was far too crude and primitive.

Before a Western drug is brought to market, it undergoes countless pharmacological studies, animal trials, and three phases of clinical trials. Only with the support of tens of thousands of data points would they dare use it on a patient.

’And you? After taking a few sips yourself, you dare to give a dying patient an overdose of a toxic herb based on nothing but a gut feeling?’

’How could he be so reckless?’

’There’s no scientific basis or safety guarantee whatsoever.’

’He’s simply gambling with people’s lives.’

The department heads from Western medicine all shook their heads. They had strong objections but held their tongues due to Li Xu’s current status and the family’s attitude.

...

As if reading their minds, Li Xu sighed and said, "I know you all think it’s highly unscientific to determine a dosage based on one’s own experience taking the medicine. After all, I am not ill, while the patient is critically ill. Our bodies’ tolerance levels are naturally not the same."

The TCM interns all nodded.

This was indeed the core conflict.

Li Xu said with a sigh of resignation, "It is correct to maintain a healthy skepticism of the medication experiences of our predecessors. But I’m having you taste Aconite, to poison yourselves and then use an antidote, not to determine a specific therapeutic dosage. It’s to prove that we have the means to counteract the toxicity of Aconite, to prove that these antidotes are effective, so that they will not cause harm when used on a patient."

"When using this class of herbs, we must be more cautious than anyone. I also wish that medical research institutions could provide reliable conclusions. But among those institutions that study Chinese medicine, how many people truly understand TCM? They use lab mice for experiments—can that simulate the qi, blood, yin, and yang of a human body?"

"Medicine is a discipline that emphasizes practice. We must not revere empty talk and look down on clinical experience. The current pharmacological research from medical institutes cannot fully represent the complex reactions of Chinese herbs within the human body. Until there is a better way, we can only rely on personally testing these toxins and herbs to accumulate firsthand experience."

"Once you’ve truly tried it, you will discover that Zhongjing was right. Zhongjing’s classic formulas, backed by eighteen hundred years of clinical experience, have saved countless lives. Isn’t that more reliable than cold, hard laboratory data? Isn’t that enough to prove their safety and efficacy?"

The TCM interns looked at one another, their pens hovering in mid-air. They wanted to take notes but didn’t know what to write.

This went far beyond the scope of their textbooks, touching upon the very soul and pain points of Traditional Chinese Medicine.

Lin Guorui also let out a soft sigh, his heart filled with a myriad of emotions.

Though Li Xu’s words were radical, they also laid bare the current awkward predicament of Traditional Chinese Medicine.

Li Xu looked at them and concluded in a sincere and heartfelt tone:

"At your current level of skill, I am strongly against you daring to use large doses of Aconite on patients. That would be irresponsible to the patient, and also irresponsible to yourselves."

"I suggest you follow experienced old TCM masters to observe more and learn more. Only when you have observed enough, learned enough, and tasted enough, and feel confident in your heart, can you apply it in a clinical setting. Because we are here to save people, not to harm them."

"But, regarding the true dosages and combinations in Zhongjing’s classic formulas, once you have relevant clinical experience and are on the basis of a completely correct diagnosis, you can use them boldly. Because—Zhongjing is never wrong."

...

Lin Guorui looked at the prescription, his palms growing slightly sweaty.

Every herb, every dosage...

He couldn’t help but feel emotional.

Although Li Xu’s use of herbs was truly bold, one could even say it challenged the very limits of the modern Materia Medica, he was by no means being reckless.

In recent years, many in the folk TCM community have revered the "Fire God School," impulsively prescribing hundreds of grams of Aconite and a large handful of ginger and Gui.

But many of them only knew one part of the story, not the whole. They would recklessly increase dosages, paying no attention to precise combinations or carefully diagnosing the patient’s yin-yang deficiency or excess. The results were often counterproductive, sometimes even fatal.

But Li Xu’s prescription was different.

The dosages on it, though astonishing, were all well-founded—they were strictly converted from the true dosages in Zhang Zhongjing’s classic formulas!

For instance, Aconite, ephedra, and especially the highly controversial Xixin.

Currently, the national Materia Medica explicitly states that the dosage of Xixin should not exceed 3 grams, which corresponds to the ancient saying, "Xixin must not exceed one mace."

This regulation was, to a large extent, influenced by Li Shizhen’s Compendium of Materia Medica.

In his book, Li Shizhen quoted the Song Dynasty scholar Chen Cheng, who believed that if Xixin was used alone or taken as a ground powder, its dosage must not exceed a mace, otherwise it would cause qi to block up and lead to death.

This single sentence, like a magical tightening hoop, has constrained Traditional Chinese Medicine for several hundred years.

Countless later physicians watched as their patients suffered from cold coagulation and blood stasis, writhing in agony. They held the sharp sword of Xixin in their hands but dared not draw it, able only to watch their patients suffer or try to get by with some mild, ineffective herbs.

This is why many knowledgeable figures in the world of TCM secretly cursed Li Shizhen for "misleading future generations."

It wasn’t until 1981, with the excavation of an Eastern Han Dynasty tomb that unearthed Han Dynasty weights and measures, that the age-old mystery of the dosages in Zhongjing’s classic formulas was finally revealed.

With one Han Dynasty tael calculated as being equivalent to approximately 15.625 of today’s grams, a look into the Treatise on Cold Pathogenic and Warm Pathogenic Diseases reveals that Zhongjing used Xixin in 16 different decoction formulas.

Among them, 8 formulas used a dosage of 3 taels (about 45 grams), 5 formulas used a dosage of 2 taels (about 30 grams), and even the True Martial Soup, used for treating yang deficiency with rampant water, used 1 tael (about 15 grams).

In pill formulas, such as the famous Wumei Pill, Zhongjing used a full 6 taels of Xixin.

Only in one powder formula, Hou’s Black Powder, was the amount of Xixin a mere 3 candareens.

Therefore, many later physicians speculated that people in the Song Dynasty were accustomed to taking powdered formulas. Xixin contains volatile oils, and if the powder is swallowed directly, its toxicity is indeed very strong and can easily lead to respiratory paralysis.

Chen Cheng at the time had likely heard about a prisoner who died suddenly after mistakenly ingesting Xixin powder. Without conducting a detailed investigation, he made a sweeping judgment that Xixin must not exceed a mace.

And when Li Shizhen was compiling the Compendium of Materia Medica, the sheer volume of information was immense, so he directly quoted this view. However, he overlooked the record in Shennong’s Materia Medica that lists Xixin as a "top-grade, non-toxic" herb, and more importantly, he ignored the large-dose applications in decoctions within Zhongjing’s classic formulas.

Thus, Xixin was unjustly maligned for several hundred years.