The Qing Dynasty was a period in which culture and medicine shone in mutual brilliance. Numerous eminent physicians, with profound scholarship and extensive clinical experience, left a resplendent legacy in the development of traditional Chinese medicine (TCM), particularly in the fields of wenbing (warm disease) studies and the integration of Chinese and Western medicine. From the Qianlong period onwards, a group of scholars in the Jiangnan region became renowned for their research into warm diseases. Led by Ye Tianshi, they synthesised the achievements of their predecessors, broke through entrenched doctrines, and pioneered new therapeutic approaches. The flourishing of warm disease theory is inseparable from four great masters, namely Ye Tianshi, Wu Jutong, Xue Xue, and Wang Mengying, collectively known as the Four Masters of Warm Disease.

Ye Tianshi authored Wenre Lun (Treatise on Warm-Heat Disorders), in which he expounded the aetiology of warm diseases and the sites invaded by pathogenic factors. He proposed the theory of weiqi yingxue bianzheng (pattern identification according to defence, qi, nutrient and blood), and elucidated the sequential transmission of pathogens through these levels. The wei (defence) aspect represents the most superficial stage, corresponding to an exterior pattern with relatively mild manifestations and short duration, and is comparatively easy to treat. The qi aspect penetrates more deeply and belongs to the interior; here there is exuberant healthy qi and excess pathogenic qi, resulting in an intense struggle between the two. With timely treatment, the pathogen may be expelled and recovery achieved. The ying (nutrient) and xue (blood) aspects are the deepest and most critical stages; pathogenic heat advances progressively inward while healthy qi declines. If improperly managed, severe and life‑threatening conditions may ensue.

Wu Jutong, regarded as the academic successor of Ye Tianshi, further developed warm disease theory. In Wenbing Tiaobian (Systematic Differentiation of Warm Diseases), he systematically discussed the aetiology, pathomechanism, diagnosis and treatment of warm diseases. He advanced the theory of sanjiao bianzheng (pattern identification according to the triple energiser), stating: “If disease of the upper energiser is not treated, it transmits to the middle energiser (the spleen and stomach); if disease of the middle energiser is not treated, it transmits to the lower energiser (the liver and kidney).” He maintained that warm diseases develop from the upper to the middle and then to the lower energiser, and in severe cases may also reverse‑transmit to the pericardium. Although distinct in emphasis from the wei‑qi‑ying‑xue framework, the two systems are conceptually interconnected and may serve as mutual references.

Xue Xue devoted himself to the study of damp‑heat disorders. His Shire Tiaobian (Systematic Differentiation of Damp‑Heat Disorders) presents detailed clinical observations on aetiology, disease progression, symptomatology and formula selection. He emphasised that damp‑heat disease often arises from “internal damage to taiyin (greater yin), retention of dampness and fluids, and the subsequent invasion of external pathogens, whereby internal and external factors mutually attract one another”. This insight highlighted the characteristic combination of internal and external pathogens in damp‑heat disorders and provided an important therapeutic foundation for later generations.

Wang Mengying, who inherited and synthesised earlier achievements in warm disease studies, is regarded as a culminating figure in the tradition. His representative work, Wenre Jingwei (Warp and Weft of Warm‑Heat Disorders), exerted profound influence. During the cholera epidemics in late Qing Shanghai, when mortality was extremely high and the disease widely deemed intractable, Wang Mengying devoted himself to patient care and, drawing upon rich clinical experience, saved numerous lives, playing a crucial role in epidemic response.

The Qing Dynasty witnessed a rich flourishing of medical scholarship. In addition to the significant development of warm disease studies and the integration of Chinese and Western medicine, many other distinguished physicians emerged, each demonstrating particular expertise in specialised fields such as gynaecology and qi‑blood theory.

Wang Qingren was renowned for his studies in anatomy and qi‑blood pathology. Troubled by inaccuracies in traditional descriptions of zang‑fu (viscera and bowels), he personally conducted anatomical dissections and integrated his findings with clinical observation in Yilin Gaicuo (Correcting Errors in the Forest of Medicine). The work includes anatomical illustrations and aims to rectify misconceptions regarding visceral structures. He asserted: “In practising medicine and diagnosing disease, one must first understand the zang‑fu”, and candidly observed that “writing without such understanding is akin to idle fantasy, while treating disease without it is like a blind person walking at night”. Over more than thirty years, Wang Qingren revitalised the study of qi‑blood theory and anatomical knowledge within TCM.

The diversified development of Qing medicine, whether through the maturation of warm disease theory, the exploration of Chinese-Western integration, or breakthroughs across specialised fields, bequeathed a rich intellectual legacy.

From the early Qing onwards, with the gradual introduction of Western medicine into China, calls for reflection and integration emerged within the TCM community. Physicians advocated principles such as Zhongzhong Canxi (upholding Chinese medicine while incorporating Western insights), Xiwei Zhongyong (using Western medicine in the service of Chinese medicine), and “bridging Chinese and Western medicine with Chinese medicine as the mainstay, adopting Western strengths to remedy Chinese shortcomings, learning from the ancients without rigid adherence, and incorporating Western knowledge without departing from Chinese principles”. These propositions underscored Chinese medicine as the foundation while embracing empirical strengths from Western practice, and cautioned against rigid adherence to tradition that overlooks empirical verification.

Zhang Xichun was a pioneer and leading representative of Chinese-Western medical integration. He argued that Western pharmaceuticals act rapidly on manifestations, whereas Chinese medicinals address root mechanisms in a profound and sustained manner; only through their complementary use could optimal outcomes be achieved. His Yixue Zhongzhong Canxi Lu (Records of Medicine: Upholding the Chinese and Referencing the Western) embodies this integrative philosophy. He also founded the Guoyi Hanshou Xuexiao (National Medical Correspondence School) and the Zhongxi Huitong Yishe (Chinese-Western Integrated Medical Society) to cultivate medical talent. In Shenyang, he established Lida Hospital, regarded as the first modern Chinese medicine hospital in China, and served as its director, actively promoting collaboration between Chinese and Western medicine.

“The contributions of the Four Masters of Warm Disease, Zhang Xichun’s integrative vision, and Wang Qingren’s anatomical and theoretical innovations together constitute vital cornerstones in the inheritance and creative development of TCM, offering enduring inspiration for contemporary medical advancement.”