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About the Shang Han Za Bing Lun

10 March 2014

In this article, I want to give a bit of extra attention to the classical text Shang Han Za Bing Lun, because it is this style of herbal medicine practice that inspires me most about Chinese medicine.

The Shang Han Za Bing Lun was written roughly 1800 years ago in the Han dynasty by a physician and scholar named Zhang Zhong Jing. The title is translated as the Treatise on Cold Damage and Miscellaneous Disease.

Zhang Zhong Jing

Zhang Zhong Jing

Not long after it was published, Zhang Zhong Jing’s text was lost during the wars that ravaged China during the following Three Kingdoms period.  Next came the Jin dynasty and text resurfaced and was reworked by a gentleman named Wang Shu He into two separate volumes.

Now today, we have the Shang Han Lun (“Treatise on Cold Damage”) and the Jin Gui Yao Lue (“Essential Prescriptions from the Golden Cabinet”). They are both clinical hand books. They are primarily books of herbal medicine prescriptions though there is the occasional acupuncture point suggestion.

Theoretically, within the two volumes is an explanation for any illness that could strike human kind. Zhang Zhong Jing does not claim that his books can cure all illnesses, but the materials do allow the practitioner to understand all illnesses.

The first volume, the Shang Han Lun, is for all illnesses acquired from the exterior, such as those caused by a pathogen or the six qi (climatic influences, for example exposure to too much dampness, warmth/heat, cold, dryness or wind).

The second volume, the Jin Gui Yao Lue, explains and treats all illnesses acquired from internally, and from neither internally nor externally. Internally generated illnesses are those that result from poor diet and lifestyle habits and the emotions. Examples of none internal and none external problems are physical traumas, or eating contaminated or poisonous foods.

Of course naming every disease in existence would be difficult, however, every disease process which could potentially affect a human being is within this work. This provides a huge amount of flexibility and allows Chinese medicine to understand and treat new diseases that were not around at the time of the Han dynasty.

A clinical hand book

In the preface to the Shang Han Lun, Zhang describes the social environment at the time of compilation. It was a time of immense turmoil. There was warfare, famine and disease epidemics.

He reported that in the last ten years, two thirds of his family members had died a premature death due to some kind of strife. He lets us know that the theoretical basis for his work was the other theoretical texts of classical Chinese medicine that were circulating at the time. He mentions the Huang Di Nei Jing, the Nan Jing and the Shen Nong Ben Cao Jing.

It was both the environment of so much disease and death and emergency, and that the theory of Chinese medicine was already more than adequately covered elsewhere, that brought the Shang Han Za Bing Lun to be written with very little explicit theoretical explanation. It was written as a clinical handbook – a book to save lives.

There are roughly 315 prescriptions within the 2 volumes. Some are rare and would be used once in a practitioner’s career, others are prescribed multiple times a day.

Shang Han Lun

The first volume of Zhang Zhong Jing’s medical masterpiece is concerned with illnesses acquired from the exterior. This includes pathogens which can invade the body, illnesses that develop as a result of the body’s inability to maintain balance with the outside environment. Zhang estimates that these account for about 70% of all illnesses.

It is the Shang Han Lun where the concept disease conformations comes into mainstream use. Basically there are 6 conformations, or layers, within the body. When a disease strikes from the exterior, it must penetrate the more superficial layers before it can get to the deeper layers.

How deep a pathogen can go partly depends on the strength of the pathogen. If an illness is able to take hold in the deeper layers, it becomes chronic and potentially more difficult to treat. An example is a blood borne virus. Once in the deeper blood layer, it can remain there for life, though the patient may be asymptomatic.

The depth of an illness also depends on the strength of the body’s resistance. A common example is the response of a child to a common cold versus that of an adult. Because a child is bursting with energy and is not yet depleted by the act of living, their response is strong and swift. They get acutely sick with a high fever and sweats, but it is all resolved within a few days. The disease does not make it past the outer layer or two.

For an adult, it is common for a disease to get to the second or third layer in before there is any response. This produces a different set of symptoms. It is also more likely to hang around for a bit longer and produce things like a persistent cough or fatigue.

In very depleted adults, such as those suffering from chronic fatigue syndrome, there is no response at all, and the problem lays hidden until a later time when the body has enough energy to respond.

The text details the characteristic symptoms and pulses (see Chinese medicine pulse diagnosis) for each layer to guide diagnosis, and lists the appropriate prescriptions for treatment.

Jin Gui Yao Lue

This second volume is for internally generated, and complex diseases. Internally generated diseases are those that result from poor, long term, diet and lifestyle practices, but also from the emotions and one’s mental health.

Complex diseases are those that do not follow the linear and predictable pathways of progression that we see in the Shang Han Lun. There can be a direct strike onto the inner layers instead of progressing from the outer layers inwards. There can also be more than 3 layers involved concurrently.

Because of the complex nature of the Jin Gui Yao Lue diseases, it is no longer possible to neatly categorise problems by conformation. Instead they are listed under broad disease headings, like Vomiting Disease, Diabetic Disease, Malaria-like Disease, Arthritic Disease, etc.

Whilst some of the diseases of the Jin Gui Yao Lue may seem to come from external triggers. The sequence of events are allowed to take place because of a weak internal environment due to diet and lifestyle.

I find these chapters fascinating. So many are so relevant to the health of our modern society like treatments for diabetes and stroke.

Especially relevant to my individual practice is the chapter on Deficiency Taxation which are basically fatigue syndromes. In having a heavy focus on the treatment of chronic fatigue and associated illness in my clinic, I draw heavily upon the prescriptions in this chapter.

Also of note is that the text contains, among one of the first in recorded history, an area of medical specialty. That is the specialty of gynaecology and obstetrics. Of the roughly 73 disease of the Jin Gui Yao Lue, 36 are devoted to all issues of menstruation, fertility, pregnancy, after-labour care, breast feeding, and menopause.

While the Shang Han Za Bing Lun may have been written 1800-2000 years ago, it is still very relevant today. Human physiology is almost identical to the way it was back then, and humans still get sick from an almost identical set of causes. These texts continue to provide answers to many difficult health problems including many for which modern medicine has little or no solution. Zhong Zhong Jings’s contribution to medicine and the relief of human suffering, is immeasurable. If only he knew that he would still be saving lives, globally, 2 millennia later ….