In the Northern Song Dynasty, in Xinxiang, Henan, the Taizong emperor decreed that “the Hanlin Medical Officials should each present their family traditions and experience formulas.” The Jinan military governor Gao Jichong compiled his family’s collection of the “Shang Han Lun” into the official records, which was initially included in the “Tai Ping Sheng Hui Fang”. In the second year of the Zhiping era, the Medical Book Correction Bureau, led by Lin Yi and others, revised the “Shang Han Lun” based on Gao Jichong’s version; in the third year of Zhiping, they also revised the “Shang Han Lun”‘s internal and external versions, the “Jin Gui Yu Han Jing”. Based on Wang Zhu’s discovery of the “Jin Gui Yu Han Yao Lue Fang” in the damaged bamboo slips, they revised the middle and lower volumes into the “Jin Gui Yao Lue” and attributed it to Han’s Zhang Ji. The Song version of the “Shang Han Lun” has long been lost, and the various versions we see today are mostly based on the Ming dynasty’s Zhao Kaimei’s revisions or re-revisions; compared to Jin Chengwuji’s “Annotated Shang Han Lun”, there are only a few differences in wording, so they basically restore the original appearance of the Song version of the “Shang Han Lun”. However, it is strange that since the Northern Song court published the “Shang Han Lun”, Confucian physicians began to interpret it using the theories of the “Nei Jing”; through the Song, Yuan, Ming, and Qing dynasties, as the number of annotations increased, various schools gradually formed, including the pattern differentiation school, the re-editing and error-correcting school, the old theory maintenance school, the five movements and six qi school, and the modern Chinese-Western integration school. According to incomplete statistics, there are no less than 1,600 specialized works related to the “Shang Han Lun” in China, and Japanese Hanfang scholars have over 300 works; the theory of the three yin and three yang six diseases that opened the door to Zhongjing has now produced more than forty schools of thought. Although each has its own path, in clinical applications of the “Shang Han Lun” formulas, practitioners still mainly rely on memorizing the texts, and to this day, they have not grasped the essentials! However, a statement from an anthropologist may point us in the right direction to open the door to Zhongjing: “If you understand the origin, you will gain insight into the essence.”
1. The Medical Classics and Formulary Practitioners of the Han and Tang Dynasties
According to Ban Gu’s “Han Shu: Yi Wen Zhi: Fang Ji Lue”, during the Western Han Emperor Cheng’s reign, due to the scattering of books, the courtier Chen Nong was sent to seek lost texts from all over the world. The court physician Li Guozhu compiled medical texts into seven medical classics and eleven formulary classics; among them, “medical classics” refer to the original human blood vessels, meridians, yin and yang, exterior and interior, to identify the root of all diseases, the distinction between life and death, and to apply needles, stones, decoctions, and fire to treat, adjusting all medicines to their appropriate uses, achieving the right dosage, just as a magnet attracts iron, using things to interact, the clumsy lose the principle, mistaking recovery for severity, and life for death; while “formulary classics” refer to the cold and warmth of herbs, measuring the depth of diseases, using the flavors of medicines, discerning the five bitter and six pungent flavors, to resolve blockages and release knots, reversing to the norm. If the appropriate measures are lost, heat increases heat, cold increases cold, and the essence and qi are internally injured, which is what is lost. Hence the saying: “If there is illness and no treatment, one often gets Chinese medicine.” Wei’s Huangfu Mi also said in the “Zhen Jiu Jia Yi Jing: Preface”: “The way of medicine has been flourishing for a long time.” “The Yellow Emperor consulted Qi Bo, Bo Gao, and Shao Yu, examining the five organs and six bowels internally, and the meridians, blood, and qi, colors and signs externally, comparing them with heaven and earth, verifying them with people and things, understanding the essence of life, exhausting the divine and extreme changes, and thus the way of acupuncture was born.” “In ancient times, Shen Nong began to taste herbs and know all medicines”; “Yi Yin, with the talent of a secondary sage, compiled the “Shen Nong Ben Cao”, creating the “Tang Ye”; “Han’s Zhang Zhongjing discussed the broad “Tang Ye” in ten volumes, which was widely verified; in modern times, the chief physician Wang Shuhe compiled Zhongjing’s lost theories very precisely, all of which can be applied; thus Zhongjing’s methods are based on Yi Yin’s methods, and Yi Yin is based on Shen Nong’s classics.” The relationship between Chinese medicine acupuncture and Zhang Zhongjing’s academic origins is discussed very clearly.
During the Southern and Northern Dynasties, when Yuan Xiaoxu wrote the “Seven Records”, he still classified medical texts into eight types of medical classics and one hundred and forty types of formulary classics; during the Republic of China, the scholar Yang Shaoyi once again proposed: “The Nei Jing belongs to the Qi Huang school, while the Shang Han Lun belongs to the Nong Yin school.” In fact, the Qi Huang school is the medical classics school, using the “Huang Di Nei Jing” as the theoretical foundation, treating diseases with needles, stones, decoctions, and fire, which is the inheritance of today’s Chinese acupuncture. The Nong Yin school is the formulary school, using the “Shen Nong Ben Cao Jing” as the foundational knowledge, treating diseases with empirical formulas, which is the Chinese medicine of the Han and Tang dynasties; this is qualitatively different from the Chinese medicine developed by Confucian physicians after the Northern Song under the guidance of Qi Huang’s techniques!
2. Zhang Zhongjing is a Successor of Yi Yin’s “Tang Ye” Method
Chen Shou wrote a biography of Hua Tuo in the “Records of the Three Kingdoms”, but did not mention Zhang Zhongjing; by the time of the Southern and Northern Dynasties, Song’s Fan Ye’s “Book of the Later Han” only mentioned Zhang Zhongjing in the biography of He Yong, where He Yong said: “You use your thoughts precisely, your rhythm is not high, and you will surely become a good doctor later”; it can be seen that Zhang Zhongjing had already begun to study medicine at that time; but it cannot be ruled out that Huangfu Mi’s admiration for Zhang Zhongjing in the “Zhen Jiu Jia Yi Jing: Preface” may have influenced Fan Ye’s writing! However, Zhang Zhongjing only appears in historical records in this one instance. In Tang’s Gan Bozong’s “Famous Doctors Record”: Zhang Zhongjing “was recommended for filial piety and integrity, and served as the governor of Changsha”, mostly due to his medical skills being associated with his position! Because if Zhang Zhongjing truly was the governor of Changsha and was skilled in medicine, the “Book of the Later Han” would not have recorded it this way! The Northern Song’s Lin Yi and others’ “Shang Han Lun: Preface” is clearly a copy of Huangfu Mi and Gan Bozong’s writings; as for Ming’s Li Lian’s “Supplement to Zhang Ji’s Biography” and Qing’s Lu Jiuzhi’s “Supplement to the Book of the Later Han: Zhang Ji’s Biography”, their credibility is relatively low due to the long distance from the Han! Huangfu Mi in the “Zhen Jiu Jia Yi Jing: Preface” stated: “Zhongjing discussed the broad Yi Yin’s “Tang Ye” in ten volumes, which was widely verified; in modern times, the chief physician Wang Shuhe compiled Zhongjing’s lost theories very precisely, all of which can be applied.” During the Southern and Northern Dynasties, Liang’s Tao Hongjing’s “Essential Methods for Medicinal Use in the Five Zang Organs” also stated: “For external pathogens, the treatment of the formulary is as follows: there are two types of Dan, four types of Shen, etc.; in the past, Nanyang’s Zhang Ji compiled a section of the “Shang Han Lun” based on these formulas, which was clear in treatment, and later scholars all revered it”; “Zhang Ji compiled the “Shang Han Lun”, avoiding the Daoist title, hence all his formulas are not proper names, but are named after certain medicines for identification.” Both Huangfu Mi and Tao Hongjing were renowned physicians of their time and were not far from the Han; combined with the articles in the “Shang Han Lun”, it can be concluded that Zhang Zhongjing’s discussion of the broad “Tang Ye” is undoubtedly true.
According to historical records: during the Eastern Han, the Zhang family in Nanyang, Henan, was a prominent family. Although Zhang Zhongjing did not stand out in the court, it is very likely that he was literate and studied medicine! During the late Eastern Han when epidemics were rampant, it is reasonable that Zhang Zhongjing combined his medical practice to elaborate on the “Tang Ye” method and wrote it on bamboo slips; thus, Zhang Zhongjing is a successor of Yi Yin’s “Tang Ye” method, not the legendary “governor of Changsha”!
3. Wang Shuhe Compiled the “Zhongjing’s Lost Theories” into the “Shang Han Lun”.
When reading the texts of the “Shang Han Lun”, it can be found that some texts are incomplete in meaning, some are incoherent, and some are clearly erroneous; it can be seen that Wang Shuhe, upon discovering Zhang Zhongjing’s “discussion of the broad Tang Ye”, had undoubtedly lost some texts! Huangfu Mi in the “Zhen Jiu Jia Yi Jing: Preface” only mentioned Zhang Zhongjing’s discussion of the broad “Tang Ye”, while Wang Shuhe compiled “Zhongjing’s lost theories”; Tao Hongjing in his “Essential Methods for Medicinal Use in the Five Zang Organs” specifically stated: “For external pathogens, the treatment of the formulary is as follows: there are two types of Dan, four types of Shen, etc. In the past, Nanyang’s Zhang Ji compiled a section of the “Shang Han Lun” based on these formulas, which was clear in treatment, and later scholars all revered it”; moreover, he also extracted twelve formula patterns from the two types of Dan and four types of Shen. According to the “Yang Dan”, it is the formula for ascending yang, with Huang Qi (Astragalus) as the main ingredient; the Yin Dan is the formula for supporting yin, with Chai Hu (Bupleurum) as the main ingredient; the Qing Long is the formula for dispersing, with Ma Huang (Ephedra) as the main ingredient; the Bai Hu is the formula for collecting heaviness, with Shi Gao (Gypsum) as the main ingredient; the Zhu Niao is the formula for clearing and nourishing, with Ji Zi Huang (Egg Yolk) as the main ingredient; the Xuan Wu is the formula for warming and moistening, with Fu Zi (Aconite) as the main ingredient. These six formulas are the essence of the six harmonies, ascending and descending yin and yang, interchanging metal and wood, and balancing water and fire, thus they are divine medicines. Zhang Ji compiled the “Shang Han Lun”, avoiding the Daoist title, hence all his formulas are not proper names, but are named after certain medicines for identification.” Although Tao Hongjing’s discussion is not entirely accurate, it can be confirmed that Tao Hongjing had seen the “Tang Ye” and Wang Shuhe’s compiled “Zhongjing’s lost theories”, and it was not hearsay! Based on Tao Hongjing’s description, and referencing Sun Simiao’s “Qian Jin Yi Fang”‘s “Shang Han Lun” and Gao Ben, the Song version of the “Shang Han Lun”, it can be known that Zhang Zhongjing’s “discussion of the broad Tang Ye” should be a small booklet primarily focused on deducing formula patterns. Unfortunately, Wang Shuhe did not understand Zhang Zhongjing’s theories of the three yin and three yang six diseases, mistakenly believing that Zhang Zhongjing was discussing the treatment of febrile diseases, thus when compiling “Zhongjing’s lost theories”, the following issues arose:
- Zhang Zhongjing’s articles should appear in large paragraphs like case studies, while Wang Shuhe organized them into a list format, disrupting the original system of the “discussion of the broad Tang Ye”.
- For the lost texts, Wang Shuhe not only made errors but also supplemented them with the theories of medical classics, leading to many inconsistencies in meaning.
- For the texts that were not lost, Wang Shuhe not only made extensive modifications but also added pulse signs; and explained them using the theories of medical classics, especially using pulse signs for explanations, which is very absurd!
- He collected many empirical formulas from other formulary practitioners for treating febrile diseases, which, although not greatly harmful to Zhang Zhongjing’s “discussion of the broad Tang Ye”, most of the formula patterns were not very rigorous.
- He gathered a large number of irrelevant and empty discussions from medical classics regarding the treatment of febrile diseases, confusing Zhang Zhongjing’s three yin and three yang theory system.
- Wang Shuhe also interspersed his own understanding and immediate insights regarding febrile diseases within the texts. Therefore, Wang Shuhe was both a promoter of Zhang Zhongjing’s “discussion of the broad Tang Ye” and the first to misunderstand and confuse it!
4. Lin Yi and Others Confused Zhang Zhongjing’s Academic Origins
During the Northern Song, Lin Yi and others revised the “Shang Han Lun” based on Gao Jichong’s version, and the only reference texts available were Sun’s version and the content of the “Pulse Classic: Volume Seven”; moreover, whether in literary records or archaeology, no other versions were found for reference at that time. Since Gao’s version was full of errors and lacked proper differentiation, Sun’s version became particularly important; as for the versions of the “Shang Han Za Bing Lun” from Guilin, Changsha, and Fuling discovered in the 1930s, they are all later forgeries! If we compare the Song version of the “Shang Han Lun” with Gao’s version, Sun’s version, and the content of the “Pulse Classic: Volume Seven”, it is not difficult to find:
- “The Collection of Shang Han and Sudden Illness” is content newly added by Lin Yi.
- Lin Yi, in the “Shang Han Lun: Preface”, quoted the “Zhen Jiu Jia Yi Jing: Preface” stating: “Yi Yin, with the talent of a primary sage, compiled the “Shen Nong Ben Cao”, creating the “Tang Ye”; Han’s Zhang Zhongjing discussed the broad “Tang Ye” in ten volumes, which was widely verified; in modern times, the chief physician Wang Shuhe compiled Zhongjing’s lost theories very precisely, all of which can be applied; thus Zhongjing’s methods are based on Yi Yin’s methods, and Yi Yin is based on Shen Nong’s classics.” He also quoted the “Famous Doctors Record”: “The works he authored are profound and subtle, and their methods are simple and detailed, not something shallowly knowledgeable people can reach.” This clearly discusses Zhang Zhongjing’s academic origins and writing characteristics. However, in the “Collection of Shang Han and Sudden Illness”, it states: “He diligently sought ancient teachings, broadly collected various formulas, compiling the “Su Wen”, “Nine Volumes”, “Eighty-One Difficulties”, “Yin Yang Great Theory”, “Tai Lu Yao Lu”, and “Ping Mai Bian Zheng”, into the “Shang Han Za Bing Lun” comprising sixteen volumes”; this clearly confuses Zhang Zhongjing’s academic origins, and the title of the “Shang Han Za Bing Lun” contradicts itself.
In fact, the term “The Collection of Shang Han and Sudden Illness” first appeared in the “New Book of Tang: Yi Wen Zhi”; the number of volumes does not match, and the meanings of “sudden” and “miscellaneous” are different! Additionally, the first paragraph of this “collection” is very stylistically rich, clearly reflecting the literary style of the Wei and Jin dynasties; this contradicts the descriptions of Zhang Zhongjing in the “Book of the Later Han: He Yong’s Biography” and the “Famous Doctors Record” that he had “low rhythm” and “his words are profound and subtle”, thus it cannot be attributed to Zhang Zhongjing. The third paragraph also contains similar wording found in Sun Simiao’s “Qian Jin Fang”, indicating that the author of this “collection” imitated Sun Simiao’s writing. Especially since this “collection” was written in the name of Zhang Zhongjing, it has misled many people, including some of today’s so-called experts and scholars studying the “Shang Han Lun”.
5. The “Jin Gui Yao Lue” is Not Solely the Work of Zhang Zhongjing
During the Northern Song, “Hanlin Scholar Wang Zhu discovered in the archives the “Jin Gui Yu Han Yao Lue Fang” in three volumes: the upper volume discusses febrile diseases, the middle volume discusses miscellaneous diseases, and the lower volume contains formulas and treatments for women.” The Medical Book Correction Bureau, Sun Qi and Lin Yi, mistakenly believed it to be an abridged version of the “Shang Han Za Bing Lun”, and “because its febrile disease text is mostly abridged, they divided it from miscellaneous diseases down to dietary prohibitions, totaling twenty-five chapters, removing duplicates, and compiling two hundred sixty-two formulas, forming three volumes: upper, middle, and lower, still named “Jin Gui Fang Lun”.” “However, there may be evidence without formulas, and formulas without evidence, which may not be fully prepared for urgent treatment”; “They also collected scattered formulas from various schools and attached them to the end of each chapter to broaden their formulas”; “to facilitate urgent use”; and attributed it to Zhang Zhongjing, which is now the “Jin Gui Yao Lue”. In fact, as long as we compare the “Jin Gui Yao Lue” with Wang Shuhe’s “Pulse Classic” volumes eight and nine, we can see that their contents are very similar. It is evident that “Hanlin Scholar Wang Zhu discovered in the archives the “Jin Gui Yu Han Yao Lue Fang” in three volumes: the upper volume discusses febrile diseases, the middle volume discusses miscellaneous diseases, and the lower volume contains formulas and treatments for women”; someone has independently compiled Wang Shuhe’s “Pulse Classic” volumes seven, eight, and nine. The “Jin Gui Yao Lue” is simply the “Jin Gui Yu Han Yao Lue Fang” with the section on febrile diseases removed, with other chapters slightly adjusted, and with excerpts from ancient medical literature such as the “Nan Jing”, “Shang Han Lun”, “Qian Jin”, and “Wai Tai” attached at the beginning, forming the “Zang Fu Jing Luo First Disease”; additionally, some empirical formulas were selected from the “Qian Jin” and “Wai Tai” and attached to the end of some chapters. If we compare it with the directory of the eleven formulary practitioners of the Western Han, we can see that the “Pulse Classic” volumes eight and nine compile the empirical formulas of the formulary practitioners treating miscellaneous diseases and women’s and children’s diseases from the Wei period and earlier, along with some relevant theories from medical classics. In fact, Wang Shuhe clearly stated in the “Pulse Classic: Preface”: “Now compiling from Qi Bo to Hua Tuo, the essential decisions of the classics, combined into ten volumes. The roots of all diseases, each following their respective categories, symptoms, and signs, are all included.” Therefore, the “Jin Gui Yao Lue” is not Zhang Zhongjing’s personal work!
6. Correct Interpretation of the “Shang Han Lun” and “Jin Gui Yao Lue” Although the Song version of the “Shang Han Lun” is far from Zhang Zhongjing’s “discussion of the broad Tang Ye”, and the “Jin Gui Yao Lue” is not Zhang Zhongjing’s personal work; however, aside from the attached formulas in the “Jin Gui Yao Lue”, they are all Han-transmitted formulary classics; the so-called Han-transmitted formulary classics are the empirical formulas passed down through generations summarized by the formulary practitioners of the Han dynasty in their medical practice. Starting from the Northern Song, Confucian physicians began to believe that “techniques cannot be relied upon, but must seek their principles”; thus, they began to interpret the empirical formulas in the “Shang Han Lun” and “Jin Gui Yao Lue” using the theories of the “Su Wen”, “Zhen Jing”, and “Nan Jing”. However, the “Zang Fu Jing Luo” theory in the “Su Wen”, “Zhen Jing”, and “Nan Jing” is a “heaven-human model” deduced by the Eastern Han medical classics, which greatly differs from the true structure and physiology of the human body. Therefore, starting from the Northern Song, through the Jin, Yuan, Ming, and Qing dynasties, until now, the interpretations of the “Shang Han Lun” and “Jin Gui Yao Lue” have become increasingly chaotic! However, modern febrile disease experts Liu Shaowu and Liu Huisheng have successfully interpreted the modern anatomical and physiological basis of Zhang Zhongjing’s three yin and three yang six diseases using modern medical knowledge; and the formulary master Hu Xishu has also correctly analyzed the true meaning of Zhang Zhongjing’s yin and yang six diseases, and has well explained formulas such as Ma Huang Tang and Gui Zhi Tang using modern medical knowledge. In fact, the empirical formulas of Chinese medicine and modern medicine are only a step apart! If Chinese medicine can liberate its thoughts, just as the Confucian physicians after the Northern Song used the theories of the “Su Wen”, “Zhen Jing”, and “Nan Jing” to interpret the “Shang Han Lun” and “Jin Gui Yao Lue”, using Zhang Zhongjing’s three yin and three yang six diseases theory combined with modern medical knowledge to reinterpret the empirical formulas in the “Shang Han Lun” and “Jin Gui Yao Lue”, it would not only be easy to understand but could also express its true connotation in modern language; moreover, using Zhang Zhongjing’s three yin and three yang six diseases theory, it could also classify and apply the empirical formulas of other formulary practitioners from the Han and Tang dynasties and later generations!
