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Why do we always feel that the “Shang Han Lun” is excellent, while the “Jin Kui Yao Lue” seems not as good?
Isn’t the “Jin Kui Yao Lue” a book by the Medical Sage Zhang Zhongjing?
In fact, both the “Shang Han Lun” and the “Jin Kui Yao Lue” were originally one book, namely the “Shang Han Za Bing Lun”, both authored by the Medical Sage Zhang Zhongjing.
The title of the “Shang Han Za Bing Lun” is very accurate, as it discusses the content of cold damage and miscellaneous diseases. The original book consists of sixteen volumes, with the first ten volumes discussing cold damage and the last six volumes discussing miscellaneous diseases.
Since the original book has been lost, the cold damage section was compiled and organized into a book by Wang Shuhe, the Grand Physician of the Jin Dynasty, titled “Shang Han Lun”.
Wang Shuhe collected the cold damage section of the “Shang Han Za Bing Lun” but did not see the miscellaneous diseases section; it was not until the Northern Song Dynasty during the reign of Emperor Renzong that Wang Zhu, a Hanlin scholar, discovered a condensed version of the “Shang Han Za Bing Lun” in the remnants of the imperial library, titled “Jin Kui Yu Han Yao Lue Fang”, consisting of three volumes: the first volume discusses cold damage, the second volume discusses miscellaneous diseases, and the third volume contains prescriptions and treatments for gynecological diseases.
By the time of Emperor Shenzong’s Xining era (1068 AD), Lin Yi and others revised it, removing the first volume and retaining the second and third volumes. For clinical convenience, they also listed the prescriptions from the third volume under various syndromes, still compiling it into three volumes.
Additionally, they collected various prescriptions from other medical texts that cited Zhang Zhongjing’s treatments for miscellaneous diseases and some effective prescriptions from later generations, which were appended at the end of each section, “and still named it ‘Jin Kui Fang Lun'”, which is later known as “Jin Kui Yao Lue Fang Lun”, abbreviated as “Jin Kui Yao Lue” or “Jin Kui”.
The earlier cold damage section is called “Shang Han Lun”; if the later miscellaneous diseases section were to be named similarly, it would be called “Za Bing Lun”, making the issue clearer.
In summary, the difference between the two lies in their certainty.That is, the certainty of the “Shang Han Lun” is good, while the certainty of the “Jin Kui Yao Lue” is not as good.
This difference is precisely due to the difference in the subjects of their research, namely cold damage and miscellaneous diseases, which correspond to external pathogenic diseases and internal injuries, as well as acute and chronic diseases.
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For Taiyang wind, Yang is floating and Yin is weak. Yang floating indicates heat is spontaneously generated; Yin weakness indicates sweating occurs. If there is aversion to cold, aversion to wind, fever, nasal congestion, and dry retching, the prescription is Gui Zhi Tang (Cinnamon Twig Decoction). (12)
For Taiyang disease, if there is headache, fever, body aches, waist pain, joint pain, aversion to wind without sweating and wheezing, the prescription is Ma Huang Tang (Ephedra Decoction). (35)
The above two entries are from the “Shang Han Lun”; using them according to the text will yield definite therapeutic effects. All entries in the “Shang Han Lun” that are prescribed have a high certainty of efficacy. In other words, the certainty of the “Shang Han Lun” is good, and only with certainty can there be definite efficacy.
If there is insomnia due to deficiency and irritability, the prescription is Suan Zao Ren Tang (Sour Jujube Decoction). (Blood Bi and Deficiency Disease Chapter 17)
If there is difficulty in urination, the prescription is Pu Huai San (Phragmites Powder), along with Hua Shi Bai Yu San (Talc and White Fish Powder) and Fu Ling Rong Yan Tang (Poria and Salt Decoction). (Xiao Ke and Difficult Urination Chapter 11)
The above two entries are from the “Jin Kui Yao Lue”; using them according to the text does not guarantee effectiveness.
For insomnia due to deficiency and irritability, the prescription of Suan Zao Ren Tang may not necessarily be effective. Why?
Because insomnia due to deficiency and irritability does not only have the syndrome of Suan Zao Ren Tang, meaning that Suan Zao Ren Tang treats only one of many types of insomnia due to deficiency and irritability and cannot cure all cases.
At the same time, the specific conditions that Suan Zao Ren Tang can effectively treat are not clearly stated by Zhang Zhongjing in the text.
For difficulty in urination, the prescription of Pu Huai San, along with Hua Shi Bai Yu San and Fu Ling Rong Yan Tang, is often ineffective when directly applied to difficulty in urination.
Because there are many causes of difficulty in urination, merely having difficulty in urination does not determine the treatment plan, so using these prescriptions is often ineffective.
2
If there is chest obstruction and heart fullness, with Qi stagnation in the chest, fullness in the chest, and counterflow in the hypochondrium, the prescriptions are Zhi Shi Xie Bai Gui Zhi Tang (Bitter Orange, Garlic, and Cinnamon Twig Decoction) and Ren Shen Tang (Ginseng Decoction). (Chest Obstruction and Heart Pain Chapter 5)
In the “Jin Kui Yao Lue”, this format of entry is also common, such as “For those with fluid retention, one should induce sweating; Da Qing Long Tang (Major Blue Dragon Decoction) is the main prescription, and Xiao Qing Long Tang (Minor Blue Dragon Decoction) is also the main prescription”, etc.
Clearly, Zhi Shi Xie Bai Gui Zhi Tang and Ren Shen Tang are not the same.
Although both prescriptions can be used to treat chest obstruction, they cannot be considered equivalent; if they are for the same type of chest obstruction, using these two prescriptions according to the text will not yield the same efficacy.
This is a manifestation of uncertainty. Imagine if Zhang Zhongjing could definitively determine that one prescription is the best for a certain syndrome, he would not need to use another prescription to “also prescribe” it.
There are many similar entries in the “Jin Kui Yao Lue”.
3
Through the above comparison, the differences are clear.
Most of the prescriptions in the “Shang Han Lun” have definite efficacy; many of the prescriptions in the “Jin Kui Yao Lue” have uncertain efficacy.
Why is this so?
It is because the “Shang Han Lun” studies cold damage, which is an external pathogenic disease; the “Jin Kui Yao Lue” studies miscellaneous diseases, which are internal injuries and miscellaneous diseases.
External pathogenic diseases generally have a short course, and the righteous Qi is usually not deficient, with the evil being predominant, the condition is simple, and recognizing the syndrome is easy. As long as the evil Qi is expelled, the disease will be cured, making treatment easier and the effects certain.
Internal injuries and miscellaneous diseases have a long course, often with both evil and righteous Qi involved, the condition is complex, with many threads to follow, making syndrome recognition difficult. Treatment cannot be simplified; it must consider all aspects. Even if the syndrome is accurately identified and the treatment is correct, the efficacy will not be immediate, as the recovery of righteous Qi requires time, and the support of righteousness and expulsion of evil can influence each other.
Simply put, the course of external pathogenic diseases is generally one day or a few days, while the course of internal injuries and miscellaneous diseases can last for months, years, or even decades, so the difficulty of treatment is certainly different. Therefore, Wu Ju Tong said, “Treating external pathogens is like a general, treating internal injuries is like a minister.”
For example, for the initial stage of external cold evil, Taiyang cold damage, using Ma Huang Tang as the main prescription will definitely yield results; most of the time, one dose can induce sweating and alleviate the illness. If acute enteritis presents with the syndrome of Ge Gen Qin Lian Tang, using Ge Gen Qin Lian Tang as the main prescription can generally cure it within three doses, which is comparable to Western medicine’s use of antibiotics.
However, if it is chronic nephritis, some patients may not improve regardless of how long you treat them; even those who can be cured will take years, and this is true for both Traditional Chinese Medicine and Western Medicine; no one can do it quickly.
4
Therefore, the difference between the “Shang Han Lun” and the “Jin Kui Yao Lue” is caused by the difference in their research subjects, not because Zhang Zhongjing’s skills are lacking.
Although we feel that the “Jin Kui Yao Lue” is not as good as the “Shang Han Lun”, to this day, the “Jin Kui Yao Lue” is still the best book for treating miscellaneous diseases.
Many people believe that the prescriptions in the “Shang Han Lun” can treat all diseases, including miscellaneous diseases, which is certainly true; however, it must be clear that the main role of the cold damage prescriptions is to treat cold damage, while treating miscellaneous diseases is a secondary role. That is, using the prescriptions from the “Shang Han Lun” to treat miscellaneous diseases will certainly not be as effective as using them to treat cold damage.
5
Appendix
Examples of entries in the “Jin Kui Yao Lue” with less certainty are as follows:
Blood Bi and Deficiency Disease Pulse and Syndrome Treatment Chapter Six:
If there is insomnia due to deficiency and irritability, the prescription is Suan Zao Ren Tang. (17)
Chest Obstruction and Heart Pain Shortness of Breath Disease Pulse and Syndrome Treatment Chapter Nine:
If there is chest obstruction and heart fullness, with Qi stagnation in the chest, the prescriptions are Zhi Shi Xie Bai Gui Zhi Tang and Ren Shen Tang. (5)
If there is chest obstruction and Qi stagnation, the prescriptions are Fu Ling Xing Ren Gan Cao Tang and Ju Zhi Jiang Tang. (6)
Phlegm and Cough Disease Pulse and Syndrome Treatment Chapter Twelve:
If there is shortness of breath with slight fluid retention, it should be resolved through urination; Ling Gui Zhu Gan Tang and Shen Qi Wan are the main prescriptions. (17)
If there is fluid retention, one should induce sweating; Da Qing Long Tang and Xiao Qing Long Tang are the main prescriptions. (23)
Xiao Ke and Difficult Urination Disease Pulse and Syndrome Treatment Chapter Thirteen:
If there is difficulty in urination, the prescription is Pu Huai San, along with Hua Shi Bai Yu San and Fu Ling Rong Yan Tang. (11)
Water Qi Disease Pulse and Syndrome Treatment Chapter Fourteen:
If there is internal water, the prescription is Yue Bi Jia Zhu Tang; Gan Cao Ma Huang Tang is also the main prescription. (25)
Jaundice Disease Pulse and Syndrome Treatment Chapter Fifteen:
If there is jaundice, the prescription is Zhu Gao Fa Jian. (17)
If there is jaundice, the prescription is Yin Chen Wu Ling San. (18)
Palpitations, Vomiting, Hematemesis, Chest Fullness, and Stasis Blood Disease Pulse and Syndrome Treatment Chapter Sixteen:
If there is fire evil, the prescription is Gui Qu Shao Yao Jia Long Gu Mu Li Shu Qi Jiao Tang. (12)
If there is palpitations, the prescription is Ban Xia Ma Huang Wan. (13)
If there is persistent hematemesis, the prescription is Bai Ye Tang. (14)
If there is insufficient heart Qi, with hematemesis and epistaxis, the prescription is Xie Xin Tang. (17)
Vomiting, Reflux, and Diarrhea Disease Pulse and Syndrome Treatment Chapter Seventeen:
If there is vomiting, and food cannot go down, the prescription is Xiao Ban Xia Tang. (12)
Women’s Pregnancy Disease Pulse and Syndrome Treatment Chapter Twenty:
The Master said: If a woman has a normal pulse, with a weak Yin pulse, and feels thirsty and cannot eat, without cold or heat, it is called pregnancy; Gui Zhi Tang is the main prescription. According to the law, this syndrome should appear within sixty days; if there is a doctor treating it in reverse, it will be aborted if there is vomiting or diarrhea. (1)
If there is persistent vomiting during pregnancy, the prescription is Gan Jiang Ren Shen Ban Xia Wan. (6)
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