The Classics Series Continues
I had previously written a brief article introducing the Huangdi Neijing last year. (link) As one may recall, this book is considered the basis for all theory of Traditional Chinese Medicine. However, one may think of the Neijing as a foundation, upon which more expanded theories were built. Also, the Neijing contains scanty information on herbology, and whatever information in it is not used by true TCM practitioners. Where, then, do we get our earliest sources for formulae and herbal medicine theory? Enter the Shang Han Lun (伤寒论) a masterpiece of medical literature written by Zhang Zhongjing (张仲景).
Zhang Zhongjing
Zhang Zhongjing’s original name was Zhang Ji (张机) and he was estimated to have been born around 150 AD. He was the first to classify diseases not merely according to individual signs and symptoms but according to pattern discrimination (辩证 or bian zheng). What this means is that instead of just looking at the symptoms individually and basing treatment on that, the physician looks at the big picture to figure out the underlying pathology and work from there. To fully expound on this will take another article in itself, however. He is also considered the founder and seminal practitioner of the Cold Damage school of Chinese Medicine.
Not much was recorded about Zhang’s life. Later biographies claim that he was from Nanyang County of Henan Province. According to Song Dynasty records, Zhang was Grand Protector of Changsha city in Hunan province. Interestingly, Changsha is my wife’s hometown.
It is safe for us to assume that the reason Zhang is thought to have political power is the fact that he needed such power and wealth in order to finance his own medical education. His motivation to study medicine was a genuine desire to help sick people.
Here is an excerpt from a preface allegedly written by Zhang Zhongjing to his book. It helps give us insights into his character:
My family was formerly large, …(counting) over two hundred members… in less than ten years, two-thirds have died, seven tenths of them from Cold Damage… I have diligently sought the guidance of the ancients, widely collected the various remedies, and consulted (ancient books) to create the Shang Han Za Bing Lun totalling sixteen fascicles. (from a translation by Mitchell, et al)
Wait a minute, Shang Han Za Bing Lun? I thought he wrote the Shang Han Lun? What’s the deal? More on that later.
Although this book cannot completely cure all diseases, it provides the means to understand the origins of illnesses encountered. If (the reader) follows the materials herein collected, (he should be able to) think out over half (of all medical problems).
Compare Zhang Zhongjing to modern day quacks who claim to be able to cure all illnesses. Zhang knew his limitations, and freely admitted that his work is not enough. Still a magnificent work, though! Not bad for someone who started the study of medicine relatively late in life.
Dr. Tan-Gatue with a statue of Zhang Zhongjing, ancient Chinese Medicine and Acupuncture legend. In the background is an enlarged reproduction of the Shang Han Lun written on bamboo strips.
Shang Han Lun
Zhang Zhongjing actually wrote a book called the Shang Han Za Bing Lun, which roughly translates into Treatise on Cold Damage and Miscellaneous Diseases. Mitchell, et al write that it covered more than just Cold Damage, but also gynecology, pediatrics and dietary treatment. So what happened? The time Zhang lived was marked by civil war and was known as the Three Kingdoms era. The text did not survive intact but had to be pieced together later on by Wang Shuhe. Wang separated the chapters dealing with Cold Damage into what we now call the Shang Han Lun and the rest into the Jin Kui Yao Lue or “Essentials of the Golden Cabinet”
So what exactly is so special about the Shang Han Lun?
Structurally, the book is was rearranged by Wang into ten volumes. What is unique here is that the text introduces a system of classification for diseases caused by what we term “Cold Damage” or Shang Han （伤寒）. While literally dealing with “cold”. It may be argued that the term shang han may refer to any disease contracted from the environment. Personally, and I mean personally, I consider Cold Damage to have it’s western medicine equivalents in seasonal viral infections and their complications, mostly.
Going on that track, imagine this. What’s the western medicine treatment for the common cold or mild flus? Mostly it’s keep them hydrated and treat the symptoms. Zhang classified the stages of these febrile diseases in accordance with the six meridians. He imagined the disease as starting it’s invasion from the outside coming in. The most external diseases, manifesting with what we would term early flu like symptoms, would be classified as Taiyang or Greater Yang disease. This would be followed by Shaoyang, Yangming, Taiyin, Shaoyin and Jueyin disease and so on and so forth. The great part is that Zhang would not only have a specialized treatment for each stage, he would also have specialized treatments for the SUB-stages.
In addition, Zhang also noted that many of the contemporary physicians of his time would make mistakes in their diagnoses and treatment. He anticipated these common mistakes and incorporated them in his text. Imagine him predicting that healers might make certain errors and give wrong treatment- and he would give instructions on how to correct such wrong treatment.
All in all, she Shang Han Lun contained 112 herbal prescriptions, most of which are used to day even for diseases that are not necessarily Cold Damage. The Jin Kui Yao Lue contained 262 prescriptions. Together, I believe it is safe to say that Zhang Zhongjing’s formulas are among the most influential in history. Later schools would create their own formulae, but they would still be based on Shang Han Lun formula structure and they would still classify diseases by syndrome, much like the Shang Han Lun did.
All in all, I would not hesitate to say that the Shang Han Lun is probably the single most influential medical text of ancient China.
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