The Jin Gui Yao Lue (Essentials of the Golden Chamber) is a section on miscellaneous diseases from the Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases) written by the renowned Eastern Han dynasty physician Zhang Zhongjing. It is also the earliest existing specialized text in China discussing the diagnosis and treatment of miscellaneous diseases. The Jin Gui Yao Lue contains foundational theories of Traditional Chinese Medicine (TCM) as well as clinical applications. Studying the Jin Gui Yao Lue plays a unique role in broadening clinical thinking and enhancing the ability to analyze and treat complex miscellaneous diseases, making it an essential classical medical text for learning TCM.
1. Academic Status of the Jin Gui Yao Lue
(1) Exemplifies the holistic medical model of the unity of heaven and humanity
The medical model refers to the standard patterns of thought and behavior used in medicine to understand diseases, treat illnesses, and maintain health. According to the original preface by Zhang Zhongjing, during the late Eastern Han period, a shamanistic model was prevalent in the medical community, which believed that human diseases were caused by spirits and deities, leading to practices such as “humbling oneself to seek the shaman’s help.” However, there were few practitioners who focused on medicine and the study of formulas. In response to this situation, Zhang Zhongjing clearly stated: “Heaven distributes the five elements to operate all beings; humanity embodies the five constants, possessing the five organs, meridians, and collaterals, where yin and yang communicate, and the subtle changes are difficult to fathom.” This emphasizes that humanity is the highest form of life born from heaven and earth, unrelated to spirits, thus when “the body has perished,” “the spirit has vanished.” So how do humans become ill? The first chapter of the Jin Gui Yao Lue states: “All calamities can be categorized into three types.” The first two types refer to natural “wind evils” (a general term for the six excesses), while the third encompasses various factors such as injuries from rooms, sharp instruments, and beasts, with “not violating the laws of the king” clearly placing social factors in an important position. This positions medicine within the overall examination of the relationship between humanity and the natural and social environment, completely excluding the interference of the shamanistic model. By using examples of “arriving but not arriving, arriving but leaving, not arriving but arriving, and arriving too much,” it reveals that when the natural and social environment is unfavorable to humanity (either excessive or insufficient), one should “nurture caution” to prevent illness. Furthermore, after becoming ill, one should not only treat the existing illness but also address the potential for illness to achieve complete health. This holistic medical model based on the unity of heaven and humanity, while derived from the theories of the Nei Jing (Inner Canon), has been implemented in the practices of preventive medicine, therapeutic medicine, and rehabilitation medicine. Thus, it is clearer and more practical than the Nei Jing, providing early materials for the modern transition to a biopsychosocial medical model.
(2) Established the diagnostic and therapeutic principles of syndrome differentiation and treatment
Syndrome differentiation and treatment is a unique method of diagnosis and treatment in TCM, and Zhang Zhongjing is the originator of this method. Although the idea of syndrome differentiation and treatment existed in the earliest medical text, the Nei Jing, it had not yet formed a complete system. Syndrome differentiation and treatment includes two practical activities: “differentiating syndromes” and “discussing treatment,” which are interconnected and reflect the consistency of principles, methods, formulas, and medicines. The Nei Jing evidently did not achieve this, leading to a state where before Zhang Zhongjing, “medical classics” and “classical formulas” were separate. Recent archaeological findings of Han dynasty medical bamboo slips from sites in Inner Mongolia, Gansu, and Changsha have shown that these artifacts, which predate Zhang Zhongjing, also did not reach this height, thus affirming Zhang Zhongjing as the pioneer of syndrome differentiation and treatment.
The implementation of syndrome differentiation and treatment first requires determining the scope of differentiation, which corresponds to the disease names in TCM. For example, if the primary symptom is abdominal distension, it should be treated within the scope of abdominal distension disease. Therefore, TCM disease names are established to limit the scope of differentiation and are a generalization of common symptoms. Then, based on the main symptoms composed of several signs, combined with pulse diagnosis, one conducts “examining symptoms to seek causes”—that is, establishing the location, nature, and severity of the disease. This requires fully utilizing the theories of the Nei Jing, focusing on the organs and meridians, including theories of qi, blood, and body fluids, to conduct a comprehensive analysis of the etiology and pathogenesis. Only then can one enter the stage of “examining causes and discussing treatment.” The so-called “examining causes and discussing treatment” means that based on the differentiation results, one establishes treatment principles and methods, then prescribes formulas accordingly, ensuring that the syndrome and formula correspond, thus achieving the desired therapeutic effect. This process then cycles back to the next round of syndrome differentiation and treatment. Therefore, syndrome differentiation and treatment is a dynamic process focused on the overall adjustment of the patient, with the advantage of continuously making adjustments to gradually release the patient’s own disease resistance and correct the pathological state until the patient’s physical and mental health is fully restored.
The Jin Gui Yao Lue is a specialized text on miscellaneous diseases, and due to the complexity of its pathology, the specific methods of syndrome differentiation are also very rich. The first chapter is titled “Diseases of the Organs and Meridians in Sequence,” which encompasses its core. In essence, all related methods of syndrome differentiation concerning qi, blood, body fluids, and the three burners are included, becoming a source for future generations to continuously develop and supplement various methods of syndrome differentiation. Even today, syndrome differentiation and treatment remains a major characteristic and advantage of TCM. Throughout history, Zhang Zhongjing’s great contributions have been highly praised. The Yi Zong Jin Jian states: “Starting from Zhang Ji’s writings, previous texts had methods but no formulas. The Shang Han Lun and Jin Gui Yao Lue established methods and formats, marking the beginning of having both methods and formulas, truly representing the orthodox lineage of medicine and opening the path for future generations, indeed a sacred text of the medical field.” Zhu Danxi praised it, saying: “The round mechanism and living methods seen in the Nei Jing align with the intentions of Zhang Zhongjing’s writings.” He also stated: “Zhang Zhongjing’s formulas are indeed the standards and guidelines for the medical field for all time; those who wish to create formulas must take from them.” Lin Yi, in the preface to the Jin Gui Yao Lue Fang Lun, pointed out: “When applying formulas to treat corresponding syndromes, the effects are miraculous.” This indicates that the key to TCM efficacy lies in the correspondence between syndrome differentiation and treatment, and the high consistency of principles, methods, formulas, and medicines. This is a crucial aspect we must pay attention to in our clinical work to promote the characteristics and advantages of TCM.
(3) Standardized the principles of formula composition, being the ancestor of formula studies
The Jin Gui Yao Lue contains over 260 formulas, with rigorous formulation principles and orderly combinations. It emphasizes not only the original therapeutic functions of individual herbs but also the synergistic effects produced after the combination of medicines, making them a “well-regulated master” that fits the disease condition. For example, Ma Huang Tang (Ephedra Decoction), originally a strong diaphoretic, when combined with Bai Zhu (White Atractylodes), becomes a good formula for promoting yang, dispelling pathogens, and mildly inducing sweating to eliminate dampness. Gui Zhi Tang (Cinnamon Twig Decoction), used for treating wind-cold in the Taiyang stage, when heavily added with Gui Zhi (Cinnamon Twig), becomes Gui Zhi Jia Gui Tang (Cinnamon Twig Decoction with Additional Cinnamon) for treating the condition of Ben Tun Qi (running piglet qi). Additionally, formulas such as Xiao Ban Xia Tang (Minor Pinellia Decoction), Sheng Jiang Ban Xia Tang (Fresh Ginger and Pinellia Decoction), and Ban Xia Gan Jiang San (Pinellia and Dried Ginger Powder) are all composed of ginger and pinellia, but due to differences in dosage ratios (with Xiao Ban Xia Tang using Pinellia as the monarch herb and Sheng Jiang Ban Xia Tang using fresh ginger juice as the monarch), different preparation methods (such as fresh ginger juice versus dried ginger), and different forms (decoction or powder), the main indications of the three formulas differ significantly. This illustrates the intricacy of their combinations.
In terms of dosage forms, in addition to decoctions, there are pills, powders, tinctures, and various methods of administration such as guiding drugs, sitting medications, fumigating, washing, and nasal insufflation, totaling more than ten types, becoming the precursor to the development of future medicinal forms.
The Jin Gui places great emphasis on the methods of decoction and administration, with detailed records. Its decoction methods include pre-boiling, later addition, separate decoction, re-boiling after straining, and taking with water, with variations in the type of water used, such as clear water, sweet spring water, gruel water, spring water, and vinegar water. In terms of administration methods, there are instructions for taking multiple doses daily, three doses daily, continuous doses day and night, and restrictions on re-dosing within a day, all determined by the needs of the disease, the strength of the constitution, and the toxicity of the medicines, demonstrating scientific rationality.
Since Zhang Zhongjing’s formulas correspond to the pathogenesis, with rigorous and orderly combinations, reflecting the application of a certain therapeutic principle, later generations often treat a formula as a method. Although there are many treatment methods in TCM, they are generally summarized into eight methods, such as sweating with formulas like Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig), vomiting with Gua Ti Tang (Melon Stem Decoction), purging with Cheng Qi (Purge the Qi), harmonizing with Chai Hu (Bupleurum), warming with Li Zhong (Regulate the Middle), clearing with Bai Hu (White Tiger), dispelling with Bie Jia Jian Wan (Soft-Shelled Turtle Pill), and tonifying with Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) and Shen Qi Wan (Kidney Qi Pill). As for various compound formulas that treat both exterior and interior, cold and heat, and combine dispelling and tonifying, there are even more. Ancients said, “Among the eight methods, a hundred methods are included,” which is not an exaggeration. Thus, the Jin Gui has become the basis for establishing formulas throughout history and is regarded as the ancestor of formula texts.
2. The Theory of Organs and Meridians
The organs and meridians are the center of physiological activities in the human body, and abnormalities in bodily functions must primarily involve the organs and meridians, thus forming the basis of pathological changes. In the first chapter of the Jin Gui Yao Lue, titled “Diseases of the Organs and Meridians in Sequence,” it is intended to indicate that miscellaneous diseases should be based on the fundamental theories of the organs and meridians, which is one of the main academic thoughts of the Jin Gui.
Both the Jin Gui Yao Lue and the Shang Han Lun originated from Zhang Zhongjing and were originally one book. Why does the former use the three yang and three yin (commonly referred to as the six meridians) for syndrome differentiation, while the latter uses the organs and meridians? This is because miscellaneous diseases and cold damage have significant differences; miscellaneous diseases often present as chronic processes, with clinical manifestations primarily based on several typical organ and meridian syndromes, and changes are not as rapid as in cold damage, making the disease location easier to define. Practical experience has shown that using organ and meridian differentiation can accurately identify the nature and location of miscellaneous diseases and effectively guide treatment.
The organs and meridians are two interconnected systems. Physiologically, the organs govern the basic physiological functions of the body, especially the five organs, which are at the core. The meridians primarily transport qi and blood, connecting the organs with the skin, flesh, tendons, and bones into a whole, where the meridians serve as the main trunk and the collaterals as branches. Therefore, pathologically, it is essential to have clear distinctions while also considering the overall influence between the organs and meridians. The first chapter of the Jin Gui poses the question: “What are the eighteen yang diseases?” The teacher replies: “Headache, neck pain, waist pain, spine pain, arm pain, and leg pain…” “What are the eighteen yin diseases?” The teacher replies: “Cough, shortness of breath, wheezing, hiccups, throat sounds, intestinal rumbling, bloating, heart pain, and rigidity.” Here, the so-called yang diseases refer to diseases related to the body as connected by the meridians, while the so-called yin diseases refer to diseases of the organs themselves. This is the most basic requirement for diagnosing miscellaneous diseases based on disease location. However, this is not enough; it is also necessary to further clarify the specific organs and meridians, as well as the different levels of qi, blood, and body fluids, and their attributes of deficiency and excess. For example, in the case of stroke, the Jin Gui specifically points out: “If the evil is in the collaterals, the skin will be numb; if the evil is in the meridians, it will be heavy and unresponsive; if the evil is in the bowels, the person will be unrecognizable; if the evil enters the organs, the tongue will be difficult to speak, and saliva will be drooled.” This categorizes stroke patients at different stages according to the locations of the organs and meridians, effectively guiding treatment. Similarly, for water qi diseases, the Jin Gui differentiates between heart water, spleen water, liver water, kidney water, and lung water, as well as the pathological levels of qi, blood, and water. All of these should be based on the physiological understanding of the organs and meridians to achieve in-depth differentiation.
From the connection between the organs and meridians, the pathological changes also have a sequence. The title “Diseases in Sequence” placed after the organs carries profound meaning, hinting at the causal relationship of disease development and the depth of the condition. Generally speaking, external evils tend to affect the meridians in the early stages of disease, and as the disease progresses, it gradually penetrates into the organs, aligning with the statement in the Su Wen (Plain Questions): “When the evil resides in the skin, the pores open; when it opens, the evil resides in the collaterals; when the collaterals are full, it enters the meridians; when the meridians are full, it enters the organs.” However, in miscellaneous diseases, internal injuries are predominant, and there are many cases where the disease first manifests in the organs, such as the Jin Gui stating “liver disease” refers to stagnation of qi and blood in the liver. Initially, there may be no pain, but the desire to drink hot beverages may temporarily alleviate symptoms. However, as the disease progresses, “the person often wants to step on their chest,” which is a later manifestation known as “long-term pain in the collaterals.” Using the formula Xuan Fu Hua Tang (Inula Decoction) to promote circulation and relieve stagnation can yield effective results. This is another example of the disease first affecting the organs before impacting the meridians. Therefore, the changes and developments of diseases, whether diagnosed horizontally or vertically, cannot be separated from the guidance of the theory of organs and meridians.
In terms of treating miscellaneous diseases, the Jin Gui places particular emphasis on the characteristics of the organs. The book states: “Each of the five organ diseases has its own characteristics for recovery; each organ disease has its own aversions, and treatment must follow what they dislike.” This requires that treatment must align with the physiological characteristics of each organ’s qi, adapting the patient’s diet, medications, and living environment to support their righteous qi, thus promoting recovery. The book also states: “For diseases in the organs, if one wishes to attack them, one must attack according to their characteristics, such as for thirst, use Zhu Ling Tang (Polyporus Decoction), and the rest should be similar.” This indicates that when the pathogenic evil deeply enters the organs, it inevitably disrupts the normal functions of the organs, leading to the formation of certain pathological products (such as phlegm turbidity in the lungs, undigested food in the stomach and intestines, blood stasis in the heart, liver, and uterus, and dampness in the kidneys and bladder). Therefore, the external pathogenic evil will inevitably interact with the pathological products of the organs, necessitating their simultaneous elimination. These principles are also formulated based on the theory of organs and meridians.
【Author’s Biography】Jia Yuejin, Chief Physician, Master’s Supervisor, Director of the Preventive Medicine Center at the Affiliated Hospital of Shanxi University of Traditional Chinese Medicine; Leader in Neurology; Executive Member of the Internal Medicine Branch of the Chinese Association of Traditional Chinese Medicine; Executive Member of the Brain Disease Branch of the Chinese Association of Traditional Chinese Medicine; Executive Director of the Second Council of the Sub-health Professional Committee of the World Federation of Chinese Medicine Societies; Executive Director of the Shanxi Association of Traditional Chinese Medicine; Vice Chairman of the Cardiovascular Disease Professional Committee of the Shanxi Association of Gerontology; Member of the Neurology Physician Branch of the Shanxi Physician Association. He has published over ten monographs and more than ten papers. With over 30 years of clinical practice, he specializes in TCM and non-drug therapies for various diseases and the regulation of sub-health states, especially with rich clinical experience in headaches, dizziness, insomnia, depression, as well as stroke, facial paralysis, and pain in the neck, shoulders, waist, and legs. He has conducted in-depth research on the use of medicinal pastes to treat sub-health and chronic diseases.
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