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The Shang Han Za Bing Lun (Treatise on Cold Damage) is the first clinical medical masterpiece in China that combines theory and practice. It is a milestone medical classic, a foundational work of Chinese medicine, and a source of development with exemplary and authoritative significance. It holds important academic value and is a classic work on syndrome differentiation and treatment, making it a must-read for physicians throughout history. The original work by Zhang Zhongjing, the Shang Han Za Bing Lun, was compiled by later generations, with the content on exogenous febrile diseases collected into the Shang Han Lun, while another part mainly discusses internal miscellaneous diseases, named the Jin Kui Yao Lue Fang Lun.
Introduction to the Shang Han Lun
The Shang Han Lun is a classic work of Han medicine authored by Zhang Zhongjing during the Eastern Han Dynasty, which elaborates on the treatment principles of exogenous febrile diseases. The entire book consists of 12 volumes, with 10 volumes and 22 sections currently extant.
There are two circulating editions of this book: one is the Ming Dynasty edition by Zhao Kaimei based on the Song Dynasty Zhi Ping edition (corrected by Lin Yi and others), and the other is the annotated version by Cheng Wuyi from the Jin Dynasty. Additionally, the Mai Jing (Pulse Classic), Qian Jin Yi Fang (Thousand Gold’s Winged Formulas), and Wai Tai Mi Yao (Secret Essentials of External Medicine) all contain content from the Shang Han Lun, regarded as early transmitted versions of the book; the Northern Song corrected version of the Jin Kui Yu Han Jing is also another ancient transmitted version of the Shang Han Lun; in modern times, ancient transmitted versions of the Shang Han Lun have also been discovered in Japan, including the Kang Zhi edition (a Tang dynasty manuscript) and the Kang Ping edition (a copy by Tanba Masatomo).
The Shang Han Lun consists of 10 volumes and 22 sections. The content includes differentiation of Tai Yang disease, Yang Ming disease, Shao Yang disease, Tai Yin disease, Shao Yin disease, and Jue Yin disease, along with their pulse patterns and treatments, which are the main components of the Shang Han Lun; there are also three sections on “Differentiating Pulse Methods,” “Normal Pulse Methods,” and “Examples of Cold Damage,” which discuss the pulse patterns and prognosis of cold damage and miscellaneous diseases, as well as the causes, mechanisms, and transformations of cold damage; it also covers the syndrome treatment of diseases such as spasms, damp-heat, cholera, yin-yang reversal, and post-labor recovery, along with the application scope and contraindications of treatments like sweating, vomiting, and purging. Many scholars in later generations believe that the three sections “Differentiating Pulse Methods,” “Normal Pulse Methods,” and “Examples of Cold Damage,” along with the sections on “spasms, sweating, vomiting, and purging” were not written by Zhongjing but were compiled and added by Wang Shuhe, thus they have often been omitted since the Ming Dynasty.
The author, Zhang Zhongjing, was a physician during the late Eastern Han Dynasty. He was born on the 18th day of the first month in the year 150 AD and passed away in 219 AD at the age of 69. He was born into a declining bureaucratic family. His father, Zhang Zonghan, had served as an official in the court. Due to the unique circumstances of his family, he was exposed to many classical texts from a young age. He had a passion for medicine from an early age, “extensively reading books and enjoying the Daoist arts.” By the age of ten, he had already read many books, especially those related to medicine. His fellow townsman, He Yong, recognized his intelligence and talents and once told him: “You will become a good doctor if you refine your thoughts and do not seek high status.” Eventually, Zhang Zhongjing indeed became a great physician, known as “the Saint of Medicine and the Ancestor of Formulas.” This was certainly related to his “refined thoughts,” but mainly due to his love for the medical profession and his diligence in “seeking ancient teachings and gathering various methods.” In his youth, he studied medicine under Zhang Bozu from the same county. After years of hard work and clinical practice, he became an outstanding physician in the history of Chinese medicine. He Yong praised him in the “Xiangyang Prefecture Annals,” saying: “Zhongjing’s skills are superior to Bozu’s.”Cold damage is a general term used by ancient Chinese for exogenous diseases, not a specific disease name. The ancients often regarded the causes of diseases as pathogens; cold is not merely what is referred to in modern terms as catching a cold, but is a general term for all external evils causing diseases, as referenced in Mr. Hao Wanshan’s lecture video. The cold damage in Zhang Zhongjing’s Shang Han Lun is indeed in this sense and is unrelated to modern typhoid fever. One of the prominent achievements of the Shang Han Lun is the establishment of the six meridian syndrome differentiation system. Utilizing the four examinations and eight principles, it comprehensively elaborates on the differentiation of pulses, examination of symptoms, discussion of treatment, formulation, and medication rules at various stages of cold damage in a systematic manner. It summarizes the main treatment methods for the six meridian diseases of cold damage, such as using Ma Huang Tang (Ephedra Decoction) for “Tai Yang cold damage”; Gui Zhi Tang (Cinnamon Twig Decoction) for “Tai Yang wind stroke”; Bai Hu Tang (White Tiger Decoction) for Yang Ming channel syndrome; Cheng Qi Tang (Purge the Qi Decoction) for Yang Ming organ syndrome; Xiao Chai Hu Tang (Minor Bupleurum Decoction) for Shao Yang disease… It categorizes and summarizes the treatment experiences of different disease stages and symptom types, with clear distinctions between primary and secondary issues, and a coherent structure that organically integrates principles, methods, formulas, and medicines, providing guidance on the essentials of syndrome treatment.Another significant contribution of the Shang Han Lun is its major impact on the study of Chinese herbal formulas. This book records 397 methods and 113 formulas, proposes complete principles for formulating prescriptions, introduces treatment methods such as sweating, vomiting, and purging for cold damage, and specifically applies the eight methods to formulas, introducing representative famous formulas such as Gui Zhi Tang, Ma Huang Tang, Da Qing Long Tang (Major Blue Dragon Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), Bai Hu Tang, Ma Huang Xing Ren Shi Gao Gan Cao Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction), Ge Gen Huang Qin Huang Lian Tang (Kudzu, Scutellaria, and Coptis Decoction), Da Cheng Qi Tang (Major Order the Qi Decoction), Xiao Cheng Qi Tang (Minor Order the Qi Decoction), Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order the Qi Decoction), Da Chai Hu Tang (Major Bupleurum Decoction), and Xiao Chai Hu Tang. Most of the formulas recorded in this book have reliable efficacy, are practical for clinical use, and have been repeatedly applied by physicians over the past thousand years, proving effective time and again. Due to Zhang Zhongjing’s careful selection of herbs, emphasis on compatibility, clear indications, and remarkable efficacy, his formulas have been praised as the “ancestor of numerous formulas” and revered as “classical formulas.”This book summarizes the medical achievements of predecessors and rich practical experiences, integrating the essence of medicine before the Han Dynasty, and combines his clinical experiences to systematically elaborate on various exogenous diseases and miscellaneous diseases through syndrome differentiation and treatment, covering principles, methods, formulas, and medicines, which holds epoch-making significance and serves as a bridge in the history of the development of Chinese medicine, making important contributions to the advancement of Chinese medicine. Moreover, the Shang Han Lun not only proposes guidelines for syndrome differentiation and treatment methods for exogenous diseases but also provides norms for syndrome differentiation and treatment across various clinical specialties in Chinese medicine, thus laying the foundation for syndrome differentiation and treatment, and is revered as a classic by later generations of physicians.– End –
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