Sun Yikui: Biographical introduction and legendary story, major works and academic contributions

 ✵Sun Yikui (1520/1522-1619 A.D.), also known as Sun Wenyuan or Sun Dongsu, was a famous herbalist who lived during the Ming dynasty. He was from Xiu Ning in Anhui. His monastic name was Shengsheng Zi. He studied with masters in different areas of the lower reaches of the Yangtze River for over 30 years and started treating people in the early years of Wanli (1573-1620 A.D.). He bacame well knwn for successfully treating people with with severe diseases. He ever sought teaching from herbalist Wang Shishan and Huang Gutan. He is the author of the books Chi Shui Xuan Zhu (The Black Pearl of the Red River),Yi Zhi Xu Yu (The Supplement of the Treatment of Fundamental Points) and Sun Wen Yuan Yi An (Case Records of Sun Wenyuan), which were collected by his sons. In these works, he advocates combining various schools of thought and maintains that herbalists should be familiar with all the theories to master the whole art of healing.

孫壹奎 (Sūn Yīkuí).

  

Brief Introduction
Chinese Name:	孫壹奎 (Sūn Yīkuí)	Alias:	文垣 (Wén Yuán), 東宿 (Dōng Sù)
Popular name:	生生子 (Shēngshēng Zǐ)	English Name:	Sun Yikui, or Yikui Sun (Given/Sur Name)
Hometown:	Xiu Ning, Anhui	Dates:	about 1520 or 1522-1619 A.D.
Main works:	《赤水玄珠》(Chi Shui Xuan Zhu, or The Black Pearl of the Red River) in 30 volumes, 《醫旨緒余》(Yi Zhi Xu Yu, or The Supplement of the Treatment Fundamental Points) in 2 volumes, 《孫文垣醫案》(Sun Wen Yuan Yi An, or Case Records of Sun Wenyuan) in 5 volumes, 《痘疹心印》(Dou Zhen Xin Yin, or The Koan of Exanthema Variolosum) in 2 volumes.
Representative works:	Chi Shui Xuan Zhu (The Black Pearl of the Red River) in 30 volumes,Chi Shui Xuan Zhu Quan Ji (Collected Works of the Black Pearl of the Red River).

Biography and legends:

 Sun Yikui, a famous herbalist who lived during the Ming dynasty and was native to Xiuning, Anhui, has aliases Wen Yuan (文垣 Wén Yuán) and Dong Su (東宿 Dōng Sù), and his monastic name was Shengsheng Zi (生生子 Shēngshēng Zǐ). He was born during the Jiajing years of the Ming dynasty (1520 or 1522 A.D.) and passed away during the Wanli years of the Ming dynasty (1619 A.D.). While on his way to visit his elder brother in Kuocang, he met a Taoist who taught him Taoism. After that, he began studying the works of Huangdi and Shennong, as well as medical texts from various schools, resolving to devote himself to medicine. For over 30 years, he sought teaching from masters throughout the lower reaches of the Yangtze River. He began treating practice in the early Wanli period (1573-1620 A.D.) and became renowned for successfully curing severe diseases. He studied under herbalists Wang Shishan (汪石山 Wāng Shíshān) and Huang Gutan (黄古潭 Huáng Gǔtán).

 Sun Yikui had been more talented and intelligent than others since childhood. He studied Confucianism, traveled to the Kuocang area at age 15 to visit his eldest brother and learn business, and met a Taoist who taught him Taoism and traditional medicine. These teachings were very miraculous and effective in practice. During the Jiajing period of the Ming dynasty (1522-1566 A.D.), many cunning sycophants occupied court positions, obstructing the official advancement of capable and virtuous individuals. As a result, many scholars abandoned their official careers and turned to medical practice. At the same time, Sun realized that members of his father's generation had studied diligently but suffered from poor physical health. His father, devoted to Confucianism, took the imperial examination multiple times without success, eventually falling ill due to overwork and the pressures of an official career. Consequently, Sun gradually changed his life plan and gave up pursuing an official career. After his father fell ill, Sun resolved to study medicine. He studied the classic texts of Huang Di and Qi Bo and read books by renowned herbalists, never ceasing his study for three years. Later, he studied under the herbalist Huang Gutan, a disciple of Wang Shishan. Wang had studied and inherited the theories of Zhu Danxi and was also influenced by Li Dongyuan's theory. He was skilled in the application of Ginseng and Astragalus and emphasized Ying-Qi and Wei-Qi. Huang often held unconventional views, and Sun consulted him when encountering difficult cases, never easily giving up on challenging diagnoses. Sun received thorough training in Huang's advanced healing methods, both in theory and practice. Although Sun was considered part of Zhu Danxi's academic lineage, he did not adopt the theory that "Yang is usually redundant (excessive) while Yin is ever deficient." Instead, he was good at application of warm tonics in academic aspects.

 To elevate his academic level, Sun traveled extensively to the area of the Xiang, Gan, Zhe, and Jiang regions in search of teachers and herbalists. He journeyed from Xin Du (modern-day Xin Du county, Sichuan) to Poyang Lake, Lushan Mountain, the Yuanjiang River, the Xiangjiang River, Su’nan, and Jiang-Zhe. He visited renowned herbalists everywhere, consulting widely and learning deeply. Suffering from asthenia at his prime, he was cured by a skilled herbalist who taught him the essential principles of Qi Bo and Huang Di. He recovered from the deficiency syndrome. This personal experience with illness inspired his determination to master medicine well and relieve the suffering of others. He learned various therapeutic methods; gradually, his knowledge deepened through collaboration with medical practice, and after 30 years of study, he gradually became excellent. He treated patients with consistent success, earning widespread fame near and far. After more than 30 years of study and travel, he settled in Wuxing in the early Wangli period (1573–1620 A.D.) and began clinical practice to save lives. His prescriptions frequently cured severe and chronic lingering illnesses, and he demonstrated high accuracy in diagnosing critical, life-or-death conditions. His reputation quickly rose, and he gained considerable acclaim. Sun Yikui emphasized in-depth theoretical study over reliance on formulaic prescriptions, thereby making significant contributions to medical theory. He conducted profound study on the Life Gate and the Triple Energizer based on the preservation of Yang Qi, closely integrating these concepts with practice.

 Sun Yikui was not only skilled in clinical practice, but he also contributed to the development and elaboration of medical theory. He is famous for his specific theories of the life-gate and the triple energizer. From the prefaces of his works, later generations learned that his medical studies and clinical practice experience were similar to those of the legendary ancient herbalists Cang Gong and Bian Que. He was respected as a renowned herbalist with legendary status in his time. In scholarship, Sun opposed the idea of "using recipe books as a fast track," emphasizing that theoretical study was important. He not only immersed himself in ancient classics such as the Nei Jing (the Inner Canon) and the Nan Jing (the Difficult Classic), but also synthesized insights from various schools after Zhang Zhongjing. Through comprehensive study, he achieved mastery. He held the viewpoint that "a herbalist should reflect on ancient methods and question the era and case in which they were applied, so as to understand the intentions of the ancient herbalists." He proposed reading the works of ancient authors and studying the original intentions and meanings. He provided thorough analyses and emphasized that medical scholars should widely learn from the strengths of other herbalists. His scholarly spirit remains worthy of reference today.

 In practice, Sun Yikui attached great importance to syndrome differentiation and identification. He stated that "all cases, whether serious or mild, big or small, differ in terms of cold, heat, deficiency, excess, external, internal, Qi, and blood." Furthermore, he believed that pathological changes often begin with the same conditions but end differently, so treatment should not regidly adhere to a single method without variation. Based on this guiding principle, he pointed out that the errors and mistakes of contemporary herbalists for abusing herbs with cold and bitter properties in treating syndromes such as fever due to internal injury, asthenic disease, and blood disease, while fearing the use of herbs with warm and diaphoretic properties. He highly valued protection and treatment with the primordial Qi in the Triple Energizer and warned against the abuse of cold herbs. He also pointed out the problems associated with overusing hot and bitter herbs, as well as those used for dredging (draining dampness) and promoting diuresis. He proposed that herbs with pure Yin properties and cold, bitter properties might lead to spleen and stomach weakness and depletion of primordial Qi. Abuse or overdose of herbs for dredging could also result in exhaustion of primordial Qi. If herbs for dredging, eliminating dampness, and promoting diuresis are abused or overdosed, they often lead to Kidney-Qi deficiency. The syndrome of impaired primordial Qi in the Triple Energizer may occur, with pathological manifestations including failure of the kidneys to receive or hold Qi, grain and water cannot be transformed (inability to transform food and fluids), and the failure to distinguish clarity from turbidity (i.e., essence from waste of digested food). In his discussion of pathological changes in the Triple Energizer, herbalist Sun paid close attention to cold and deficiency in the lower energizer. In his treatises on abdominal distension with Qi-deficiency and kidney-type diarrhea, he stated that these conditions are caused by deficiency and cold in the lower energizer. Other conditions, such as urinary retention, enuresis, and urinary incontinence, may also be related. For the treatment of lower wasting-thirst (renal diabetes, lower diabetes) and the inability of the kidneys to receive and hold Qi, he recommended that treatment should also focus on Essence and Qi.

Main books and academic thoughts:

 Sun Yikui is the author of the book Chi Shui Xuan Zhu (The Black Pearl of the Red River) in 30 volumes, Yi Zhi Xu Yu (The Supplement of the Treatment of Fundamental Points) in two volumes, Sun Wen Yuan Yi An (Case Records of Sun Wenyuan) in five volumes, and Dou Zhen Xin Yin (The Koan of Exanthema Variolosum) in two volumes. His sons collected these books, and he advocated combining various schools, maintaining that herbalists should be familiar with all theories to master the art of healing. Through careful and hard study over 30 years, Sun Yikui gradually learned extensive knowledge and acquired rich experience. He finally reached a very high level of mastery in both theory and practice. In theory, his knowledge and experience increased to the point that he could "know the theory in mirrors." In practice, his level increased to the point that he could "effectively cure when a prescription is issued and applied." His medical craftsmanship has reached a very high level of accomplishment, and he has been highly esteemed ever since. During his years of practice, he compiled great works. Those works of him that have survived to this day are the following: Chi Shui Xuan Zhu (The Black Pearl of the Red River), a book in 30 volumes and over 70 sections; and Yi Zhi Xu Yu (The Supplement of the Treatment Fundamental Points), a work of two volumes and over 70 articles. It collects his articles on the Taiji, the theory of Yin and Yang, and the five elements, Zang and Fu viscera, meridians of the hands and feet, the thoracic qi, Wei Qi and Ying Qi, triple energizer, collaterals of the uterus, the life-gate, ministerial fire, and meanings of meridian coordination, discussion, and differentiation of syndrome; Sun Wen Yuan Yi An (Case Records of Sun Wenyuan), in five volumes, contains a total of 398 cases. It is also known by other names including Sheng Sheng Zi Yi An (Case Records of Shengsheng Zi). These three works were collected by later scholars and titled Chi Shui Xuan Zhu Quan Ji (Collected Works of the Black Pearl of the Red River), he proposed in the preface. "The Dao of treatment originated from Ben Cao of Shen Nong, Nei Jing of Huang Di, Tang Ye of Yi Yin, and so on. Those who drink water should know its origins. The residue works of Xuan Yuan and Qi Bo are the top of ancient alchemy in the Kunlun Mountains. After Zhang Zhongjing, those schools are the branches of the Kunlun Mountains. Herbalists will have a refined study if they are professionals, or a miscellaneous study if they are not. Those who hold wills will not be interrupted by them. The ancient story of Weixun shooting the louse is an example of professionalism, thus the book is mainly evidence-based. Regarding treatment skills, the difficulty lies in syndrome differentiation and identification, while using recipes is easier. All cases, whether severe or mild, big or small, have differences in cold, heat, deficiency, excess, external, internal, Qi, blood. If one understands these eight concepts in a real sense, then one will not lose the odds. Ancient wisdom tells us that observing syndromes is like interrogating the enemy, know yourself and the enemy, achieve victories in a hundred battles." These works have an important influence on the later generation of practitioners and left a precious legacy for herbalists. They still contain the wisdom and creative insights of the great herbalist Sun and his legendary story.

 The 30-volume book Chi Shui Xuan Zhu (The Black Pearl of the Red River) published in the 12th year of the Wan Li era (1584 A.D.), is the culmination of his 30 years of experiences. It contains references to 93 classical books and 182 kinds of prescription books. It gives detailed discussions on internal medicine, external medicine, gynecology, pediatrics, the pathogenic reasons and pathogenesis of commonly and frequently encountered diseases, syndromes and symptoms, as well as the treatment principles, methods, prescriptions and applications. The edition begins with quotations from the Nei Jing (the Inner Canon), followed by the syndrome differentiation and treatment experiences of various previous schools, combined with the author's viewpoints. Then, it lists the treatment principles, methods, and prescriptions. The book contains over 70 departments and quotes from about 265 works of literature. The book's main subject is "Ming Zheng" (syndrome identification or differentiation). Its differentiation of obscure and confusing syndrome names from ancient and his time is especially clear. He set the eight principles in syndrome differentiation as "exterior and interior, cold and heat, deficiency and excess, and Qi and blood." The herbs and prescriptions selected are consistent with the syndromes. He discusses various syndromes in relative detail and provides his viewpoints. Regarding legacy works and viewpoints from previous herbalists, he adopted those consistent with practice and guides on syndrome differentiation and treatment. He corrected jaundiced opinions to alert later generations. The selected prescriptions are relatively practical. The book also records many new prescriptions that he established and developed to reflect his emphasis on warming tonification theory. Since the book consistently discusses and combines ancient theories, annotations, and the author's viewpoints, offering many enlightening viewpoints, it was recommended by later generations. However, one small fault was recorded in his article on "asthenia" in the 10th volume. The book's title, Chi Shui Xuan Zhu, comes from the Luofu Taoism tradition and is based on an ancient story about the Yellow Emperor seeking the black pearl, Xuan Zhu, from the Red River (Chi Shui). This story is recorded in the ancient work Zhuangzi·Tiandi (Chuang Tzu·Sky and Land): "The Yellow Emperor traveled north of the Chi Shui (Red River), climbed Kun Lun Mountain, and returned from the south, losing his Xuan Zhua (Black Pearl). He asked Zhi, Lizhu, and Chigou to seek it, but they could not find it. Then he asked Xiangwang, who found it."

 The two-volume book Yi Zhi Xu Yu (The Supplement of the Treatment of Fundamental Points), containing over 70 articles, is the medical academic treatise collection of Sun Yikui. Using the theories of Zang-Fu viscera, Qi and blood, meridians and collaterals, and acupoints, it interprets and explains the theories of Yin-Yang and the Five Elements. It also provides fair commentary on previous schools of thought. Additionally, it contains essential medical discussions and several articles from Ling Shu (The Spiritual Pivot). The discussions are based on the ancient works Nei Jing (The Inner Canon) and Nan Jing (The Difficult Classic), with reference to Zhou Yi (The I Ching, or The Book of Changes), as well as theory from Li Xue (a Confucian school of idealist philosophy from the Song and Ming dynasties). The discussions mainly concern the qualities and functions of the Zang and Fu viscera, syndrome diagnosis and differentiation, and treatment. There is also an in-depth study of the Nan Jing (The Difficult Classic). The author clarifies some controversial topics, including questions of the triple energizer, the Life-Gate, and the Pericardium Collaterals. These discussions greatly influenced later generations. For instance, his discussions on the Triple Energizer—based on the ancient works Nei Jing (The Inner Canon) and Nan Jing (The Difficult Classic)—refute the theory held by several schools that "the Triple Energizer has a physical entity"; his discussions are orderly, clear, and persuasive. The discussion and differentiation of ancient syndromes and diseases remain valid today. The detailed descriptions of the interior are excellent and second to none. The second volume discusses the ancient theory of prescriptions and offers fair commentary on prominent herbalists after Zhang Zhongjing. These articles reflect his lifelong study of traditional Chinese medicine and his principal academic views.

 The book Sun Wen Yuan Yi An (Case Records of Sun Wenyuan) comprises five volumes and contains a total of 398 cases. It is also known as Sheng Sheng Zi Yi An (Case Records of Shengsheng Zi). The book was compiled by his disciples Yu Huang (余煌) and Xu Jingqi (徐景奇), as well as his sons Tailai (泰来) and Penglai (朋来). It is a summary of his clinical practice experience. The cases are named after the locations where they were recorded and detail the treatment procedures, while elucidating the medical theories underlying syndrome differentiation and treatment. The cases mostly concern internal miscellaneous diseases, gynecological syndromes, diseases of the five sense organs, and unusual diseases. These cases demonstrate outstanding therapeutic efficacy and scholarly reference value. In each case, the patient's detailed medical history is recorded; pulse manifestations and syndromes are analyzed; and clinical practice in syndrome differentiation and treatment is guided by the fundamental theories of traditional Chinese medicine.

 The two-volume book Dou Zhen Xin Yin (The Koan of Exanthema Variolosum) is a compilation of numerous prescriptions for exanthema variolosum. It was completed in the Dingyou year of Wangli era (circa 1597 A.D.). Later, much of its content was incorporated into the book Chi Shui Xuan Zhu (The Black Pearl of the Red River), though it remains an independent and historically significant work.

 The works of Sun Yikui constitute a series of texts with high theoretical and clinical reference value for traditional Chinese medicine (TCM). These works were highly recommended by later generations of herbalists.

 The characteristics of Sun Yikui's academic thoughts are as follows: During the Song and Ming dynasties, the Li Xue school was prominent and influenced many branches of learning. Li Xue is a philosophical system integrating Confucianism and Daoism, emphasizing the study of Taiji (the Supreme Ultimate) and Yuan Qi (Primordial Qi). It discusses Taiji as a kind of entity through which to study the generation of the universe and the generation and transformation of all things. Sun Yikui's Taiji theory was influenced by the Li Xue school and by the Zhou Yi (the I Ching, or the Book of Changes), particularly its doctrine that "Yang is noble, Yin is humble, Yang is master of Yin." Drawing on both his teacher’s instruction and extensive clinical experience, he developed a therapeutic principle centered on supporting Yang and suppressing Yin, as well as warming tonification. He also adopted the concept of Taiji (the Supreme Ultimate) from the Li Xue school to elucidate controversial topics such as the life-gate and the triple energizer. His academic thoughts are briefly summarized and introduced in eight points:

 (1) Sun Yikui's life gate theory and his study of the inner scene of the Zang viscera are based on the theory of Tai Ji. The Li Xue school is a confluence of Confucianism and Taoism. Its essential doctrines are represented in the ancient works Zhou Yi, the medical classics Nei Jing (The Inner Canon) and Nan Jing (The Difficult Classic), all of which are related to the theory of Zhou Yi. Sun Yikui holds the view that Taoism is also important for medical studies: "Medical study is based on the gate of life and death. Those who do not understand nature and life should not discuss medical theory. Confucians study the theory of nature to know life—thus, it is a synthesis. Laozi's theory focuses on both nature and life. These theories may certainly serves as references."

 (2) Discussion of medical theory based on Ling Shu, Su Wen, and classical sources. Sun Yikui's theory, as expounded in his book Chi Shui Xuan Zhu, draw upon ancient works such as Ling Shu and Su Wen. For syndromes of each category, he quotes classical discussions from Nei Jing (The Inner Canon). In his work Yi Zhi Xu Yu, he elaborates on topics from Nan Jing, especially those concerning the right kidney, the life gate, and the Triple Energizer. His theory incorporates the strengths of earlier herbalists while also identifying their shortcomings. For example, he disagrees with Danxi's theory that "Yang is usually excessive, whereas Yin is invariably deficient"—a view stemming from the overuse of warm tonics recommended in Ju Fang during that period. Danxi formulated his theory specifically to correct the mistakes of his time; therefore, it should not be applied indicriminately without understanding its historical context.

 (3) Following Nan Jing and advocating theory of "motivating Qi of the life gate": Influenced by the Li Xue school's philosophy, interpreting medical theory through the lens of Zhou Yi became fashionable. Sun Yikui was well-versed in the Zhou Yi before his medical practice. His interpretation of the Tai Ji theory is mainly recorded in Yi Zhi Xu Yu. The life gate theory constitutes his principal contributio. This theory differs from the traditional life gate concept found in ancient texts such as Nan Jing. His life gate theory profoundly influenced later herbalists, including Zhao Xianke and Zhang Jiebing.

 (4) Discussions of Danxi's theory, analysis of ministerial fire, and establishment of the theory that "ministerial fire is healthy fire." The term "ministerial fire" first appears in Nei Jing. Sun Yikui states that the monarch fire (sovereign fire) is the master and the ministerial fire is the functional power; the two mutually support one another. Healthy fire comprises both monarch and the ministerial fire, whereas pathogenic fire includes exogenous fire from seasonal pathogenic factors and endogenous pathogenic fire arising from excessive five internal wills (excessive emotions). Healthy fire sustains the primordial Qi, while the pathogenic fire damages it. Based on this theory, Sun Yikui underscores the importance of Yang Qi and cautions physicians against impairing the ministerial fire. This theory corrects the prevailing prescription trend that overused cold and cooling herbs—trends rooted in Danxi's assertion that "Yang is usually excessive, whereas Yin is invariably deficient."

 (5) Advocacy of the theory that "the Triple Energizer is invisible or intangible." Sun Yikui's discussion of the Triple Energizer follows Nan Jing's proposition that "the Triple Energizer is intangible". He further supports this view based on related statements in Nei Jing and Nan Jing.

 (6) Emphasis on the study and exposition of the inner sceness. Sun Yikui focused on theoretical study and detection of the inner scene. He interpreted the Tai Ji Tu (Diagram of the Supreme Ultimate) and the life gate theory. His study of the inner scenes draws primarily from Zhou Yi (the I Ching), Nei Jing, Hong Fan, and Huang Ting Jing. His understanding of inner scenes is relatively comprehensive and is chiefly recorded in Yi Zhi Xu Yu, where it describes the dynamic transformations of the endogenous activity and embodies the core of the "theory of visceral outward manifestation."

 (7) The motivative Qi of the life gate theory. Developed by Sun Yikui, the motivativing Qi of the life gate theory represents an advancement and refinement of his teacher Wang Shishan's doctrine that "Ying and Wei (Yin and Yang) are one Qi." Sun Yikui also provides a detailed exposition of the thoracic Qi theory as described in the ancient text Ling Shu.

 (8) Identification of syndrome names useful for syndrome differentiation—applications do not adhere to rigid traditional rules. In his long-term clinical practice, Sun Yikui profoundly observed that "in practice, syndrome identification is difficult, whereas prescriotion application is not." Consequently, he placed exceptional emphasis on syndrome differentiation and identification. Integrating theory with practice, he systematically studied diverse syndrome names and clarified chaotic or ambiguous conditions described in ancient texts. He applied the fundamental principles of "cold and heat, deficiency and excess, exterior and interior, and Qi and blood" to differentiate and identify syndromes. The efficacy of his practice is intrinsically linked to the principles of syndrome differentiation. He further advocated that prescription application must be flexible and responsive to individual, while maintaining coherence across theory, therapeutic method, prescription, and herb selection. Sun Yikui's incisive and accurate insights remain highly instructive for both scholarly study and clinical practice.

 Sun Yikui's theoretical contributions: Sun Yikui's theoretical contributions to TCM center on the life gate, the Triple Energizer, ministerial fire, and monarch fire (sovereign fire). These are elaborated in four key aspects.

 (1) The Life Gate and Motivating Qi: The concept of Ming Men (the Life Gate) first appears in Ling Shu·Gen Jie Pian (The Spiritual Pivot: Chapter on Root and Junction), which states: "Tai Yang originates in the ultimate Yin and converges at the Ming Men (Life Gate). The Ming Men is the eyes." However, Nan Jing (The Difficult Classic) presents a divergent interpretation. Herbalists across dynasties studied the Life Gate and elaborated its theory as outlined in Nan Jing (the Difficult Classic). Sun Yikui also made contributions to this theory.

 (2) The Triple Energizer and Ministerial Fire: Sun Yikui's theory of the Triple Energizer draws primarily on Nan Jing (The Difficult Classic), especially Nan Jing·San Shi Ba Nan (The 38th Difficult Issue). His view affirms that the Triple Energizer is intangible. He states that the Triple Energizer and the Pericardium Collateral belong to the ministerial fire and maintain an exterior-interior relationship.

 (3) Monarch Fire (Sovereign Fire) and Ministerial Fire: His theory of ministerial fire is clinically grounded and corrects certain errors in the then-prevalent treatment principle of "nourishing Yin to subdue pathogenic fire." Sun Yikui's discourse on fire is integrally connected to his theories of the life gate and the Triple Energizer.

 (4) Practical Application Methods: Sun Yikui's clinical applications exhibits two defining features. First, he prioritized precise syndrome identification and differentiation. His guiding principle states: "All syndromes—whether severe or mild, major or minor—exhibit distinctions in cold and heat, deficiency and excess, exterior and interior, and Qi and blood." He also criticized the common errors of "overusing cold and cooling herbs to treat fever of endogenous hurt, deficiency, asthenia, and blood-related syndrome, while fearing the use of sweet and warm herbs." Second, his clinical practice and prescription strategies consistently reflect his theories of the Triple Energizer and life gate. He cautioned that not only can purely Yin, bitter-cold formulas damage the Spleen and Stomach and deplete primordial Qi, but also that "spicy-aromatic herbs dissipate Qi, dryness and heat hurt Qi, primordial Qi is exhausted and eliminated." Furthermore, overusing dredging agents exhaust primordial Qi and hurt kidney Qi. Based on Nan Jing theory, Sun Yikui proposed that the syndromes involving the Triple Energizer and primordial Qi should be treated according to three distinct functional divisions.

 Sun Yikui's therapeutic guideline: in clinical treatments, Sun Yikui always prioritized syndrome identification. He articulated the principle that "all conditions—mild or severe—manifest differences in cold and heat, deficiency and excess, exterior and interior, and Qi and blood." Although disease onset often presents similarly, disease progression and terminal manifestations vary widely; therefore, treatment must avoid rigidity and embrace adaptability. He also pointed out the frequent clinical errors—particularly the indiscriminate use of bitter-cold herbs for endogenous heat, deficiency, asthenia, and blood syndromes. These clinial characteristics align coherently with his theories of the Triple Energizer and life gate. In practice, he emphasized protecting the Triple Energizer Qi and warned against overuse of cold and cooling, hot and spicy, dredging and dampness-eliminating herbs. His viewpoints are mainly presented in the treatment of disease conditions such as Qi deficiency and fullness in the middle jiao syndrome, urinary retention and anischuria (urinary incontinence), kidney wasting thirst (renal diabetes) syndrome, kidney deficiency and Qi failing to return to its origin syndrome, etc.

 Sun Yikui's Practical Experience: Sun Yikui is an outstanding herbalist proficient in applying the four diagnostic methods of Traditional Chinese Medicine (TCM). He has a thorough understanding of herbal properties and emphasizes "syndrome identification". Through long-term clinical practice, he has accumulated extensive practical experience. According to the case records in his medical monograph, he specializes in internal medicine and gynecology. He achieved marked therapeutic efficacy in most cases and recorded reflective comments on both the strengths and limitations—as well as the gains and losses—of his treatments. His book credibly integrates theory, therapeutic principles, prescriptions, and herbs, making it a reliable source for study and clinical practice. His theoretical approach to the treatment of four selected syndromes is briefly introduced below:

 (1) Wind stroke: Also known as apoplexy, wind-stroke arises from emotional disturbances—including worry, sorrow, and anger—as well as irregular dietary habits, excessive alcohol consumption and sensual indulgence. These factors disrupt the Zang and Fu viscera and cause imbalance between Yin and Yang. The disorder develops rapidly and manifests with diverse, changeable symptoms—reminiscent of wind—hence the name “wind-stroke.” Earlier herbalists often categorized it as either a meridian-level disordern or an affection of the Zang and Fu viscera. Sun Yikui offers specific discussions and treatment strategies. He holds that the root cause lies in blood stasis and phlegm accumulation, whereas exogenous pathogens constitute only the superficial manifestations. In his work, Chi Shui Xuan Zhu, wind stroke is treated as a distinct category and further classified into Zhen Zhong (true wind stroke), Lei Zhong (wind-stroke-like syndrome), and An Fei (pyretic aphasia with sudamina). This classification aligns closely with clinical reality. Corresponding treatment principles were thus established.

 (2) Consumption: Also termed "asthenia", consumption encompasses various pathogenic mechanisms; its primary pathogenesis involves deficiency of the Zang-Fu viscera, as well as deficiencies of Qi and blood, and of Yin and Yang. It serves as a general term for chronic asthenia syndromes. In Chi Shui Xuan Zhu, Xu Qie (asthenia with fear), Xu Sun (deficiency-induced injury), and Lao Zhai (consumption) are grouped under one category. Sun Yikui's fundamental principle for treating consumption is replenishment. Based on differing pathological attributes, he uses diverse therapeutic methods—including tonifying Qi, replenishing blood, nourishing Yin, and warming Yang, and so on. His approach to consumption reflects distinctive theoretical insights. He not only emphasizing warming and tonifying therapies but also attends carefully to food stagnation and phlegm stasis. Moreover, he identifies three common errors in the treatment of consumption, stresses the importance of protecting the Spleen and Stomach, and advocates flexible—not rigidly adhering to warming-tonification alone.

 (3) Blood syndrome: A blood syndrome (blood disorder) refers to abnormal bleeding—blood escaping from its normal channels. Bleeding from the mouth or nose (upper orifices), from the anus or external genitalia (lower orifices), or extravasation through the skin all fall under this category. Sun Yikui maintains that treatment of blood syndrome should first identify the channel through which the blood escapes. He provides novel and detailed analyses of the underlying pathological reasons and corresponding treatment strategies.

 (4) Abdominal swelling: Abdominal swelling (abdominal distension) is characterized by abdominal swelling resembling a drum, accompanied by symptoms such as abdominal enlargement, sallow-yellow skin, and visible superficial collaterals and vessels. It is considered one of the most challenging conditions in TCM clinical practice. Sun Yikui attributes this condition to deficiency and cold in the Lower Energizer. Its pathological reasons are complicated, and the pathogenesis typically involving fundamental deficiency with superficial excess. Therefore, treatment must be grounded in the underlying pathogenesis.

 Influences of Sun Yikui’s Academic Thoughts on Later Generations: Sun Yikui is a representative physician of the warming-tonification school. Other prominent physicians in this school include Xue Ji, Zhao Xianke, Zhang Jiebin, and Li Zhongzi. Sun Yikui's major contributions lies in his life-gate theory, his theory of the Triple Energizer and ministerial fire, and their clinical applications. His life-gate theory synthesizes related concepts from the Nan Jing (The Difficult Questioning) and the Yi Jing (The I Ching, or The Book of Changes). He also emphasized protecting the Spleen and Stomach. During the Jin and Yuan dynasties, people in northern China suffered prolonged warfare, famine, overwork, and fear—leading to a high incidence of diseases of internal injury. This provided a clinical foundation for ivestigating pathogenesis of Zang and Fu viscera. By the Ming dynasty, analysis of Zang-Fu pathogenesis increasingly centered on deficiency and asthenia syndromes—particularly the recognition of the life gate and the interplay of Water and Fire—thereby laying the groundwork for the application of warming-tonification therapy. The warming-tonification school underscored the vital roles of the Spleen, Stomach, and Kidney Yang in sustaining life. Its practitioners excelled at using warm and sweet tonics, corrected prevailing therapeutic errors of their time, and advanced the life-gate theory in TCM—marking a breakthrough in TCM scholarship. Sun Yikui's influence stems primarily from his methodology, theoretical innovations, and clinical practice. He advocated leaning broadly from others' strengths without succumbing to dogma or prejudice. He also stressed perseverance, continuous self-cultivation, and accumulating personal clinical experience. His principal theoretical contributions are the life-gate theory and the Triple Energizer theory. He emphasized that discussions of the Triple Energizer should focus on its functional dynamics rather than its physical shape. These theories—the life gate and the Triple Energizer—profoundly influenced later physicians. The significance of warming-tonification therapy was gradually recognized and refined, thereby advancing clinical practice. Sun Yikui further deepened and systematized this approach. He established the diagnostic principle of "cold and heat, deficiency and excess, exterior and interior, Qi and blood," standardized syndrome nomenclature, and rendered the principles of “same disease, different treatment” and “different disease, same treatment” more clinically applicable. This integration of systematic principles with flexible application holds enduring practical value.

References:

• 1.Sun Yikui: Biographical introduction and legendary story, major works and academic contributions.

 Edited:May 18th, 2020