“Shang Han Lun” is a specialized text that elaborates on the differentiation and treatment of various externally contracted diseases and miscellaneous disorders. It is the first comprehensive ancient medical work in China that connects theory with practice regarding principles, methods, prescriptions, and medicines. “Shang Han Lun” is the section on cold damage from the “Shang Han Za Bing Lun” written by Zhang Zhongjing during the late Eastern Han Dynasty, approximately completed between 200-210 AD. At that time, due to the brutal political oppression and economic exploitation of peasants by the ruling class, peasants were forced to revolt multiple times against the landlord class, leading to frequent wars, which caused the book to be lost in part. Later, Wang Shuhe from the Jin Dynasty compiled the cold damage section of the original text into a book named “Shang Han Lun”. During the Song Dynasty, it was further corrected by Lin Yi and others. The entire text is divided into ten volumes, containing three hundred ninety-seven sections, with one hundred twelve formulas after excluding repetitions and lost formulas.
1. The Academic Status of “Shang Han Lun”
”Shang Han Lun” is the first clinical work in China that is complete in principles, methods, prescriptions, and medicines, and it holds significant achievements and value in the history of the development of TCM. Following the classical theoretical works of TCM such as the “Nei Jing” and “Nan Jing”, it systematically reveals the diagnostic and treatment patterns of externally contracted febrile diseases and certain miscellaneous disorders, developing and perfecting the theoretical system of the six meridian differentiation, thus laying the foundation for the differentiation and treatment of TCM clinical medicine. The theoretical system and methods established by “Shang Han Lun”, which integrate principles, methods, prescriptions, and medicines, possess a high level of scientific and practical value. It is applicable not only to externally contracted febrile diseases but also to internal injuries and miscellaneous diseases, and has long guided the clinical practice of physicians throughout the ages, significantly influencing the academic development of TCM. Since the Jin Dynasty, physicians have placed great importance on the study and research of “Shang Han Lun”, referring to it as “the sacred book of medicine that opens the path to all matters”. Therefore, “Shang Han Lun” is a must-read book for inheriting and promoting the heritage of TCM.
2. Six Meridian Differentiation
”Shang Han Lun” uses the six meridians as the guiding principle for differentiation and treatment. However, historically, there have been many ambiguities regarding the essence of the six meridians. The reasons for this are manifold, but the most important is the confusion between the concepts of the six meridians, six meridian diseases, and six meridian differentiation. Therefore, to fully grasp the six meridian differentiation, we need to clarify the concepts of the six meridians, six meridian diseases, and six meridian differentiation.
The six meridians are Taiyang (Greater Yang), Yangming (Bright Yang), Shaoyang (Lesser Yang), Taiyin (Greater Yin), Shaoyin (Lesser Yin), and Jueyin (Reverting Yin). Each of the six meridians is further divided into hand and foot meridians, thus belonging to the twelve meridians and their associated organ systems, which is a physiological concept.
Six meridian diseases are the result of analyzing, summarizing, and categorizing the various symptoms exhibited by the human body after being affected by external pathogens based on the fundamental theories of TCM. They represent different stages in the development of externally contracted diseases and can also be seen as syndromes that are interrelated yet relatively independent, which is a pathological concept.
Six meridian differentiation is a method and system for differentiation and treatment. It is based on the physiological functions and pathological changes of the organs and meridians associated with the six meridians, combined with factors such as the strength of the body’s resistance to disease, the nature of the pathogenic factors, and the progression or urgency of the disease, to analyze, synthesize, and summarize the various symptoms that occur during the onset and development of externally contracted diseases. This allows for the judgment of the location of the pathological changes, the nature and characteristics of the syndromes, and the trends of the balance between pathogenic and healthy qi, which serves as the premise for determining the basic principles of treatment and prescription.
As previously mentioned, six meridian diseases are the result of using the method of six meridian differentiation, guided by the fundamental theories of TCM, to analyze and summarize the various symptoms exhibited during the onset and development of externally contracted diseases based on a comprehensive analysis of multiple internal and external factors affecting the human body. They also serve as the basis for guiding the principles of treatment and prescription. Furthermore, from the titles of each section in “Shang Han Lun”, which are titled “Differentiation of XX Disease Pulse and Syndrome and Treatment”, it can be seen that six meridian differentiation also requires distinguishing the four aspects of disease, pulse, syndrome, and treatment from each type of disease. Thus, what is commonly referred to as six meridian differentiation is actually a shorthand for identifying the above four aspects. Below is a brief overview of the content of six meridian diseases and six meridian differentiation:
Taiyang, also known as Greater Yang, governs the nutritive and defensive qi and represents the exterior of the body, serving as a barrier for the other meridians. When the wind-cold pathogen attacks the exterior, Taiyang is the first to be affected, thus Taiyang disease represents the early stage of externally contracted diseases. Since the pathological changes primarily occur at the exterior, Taiyang disease is characterized by “floating pulse, stiffness and pain in the head and neck, and aversion to cold”. Any externally contracted disease that initially presents this pulse and syndrome can be classified as Taiyang disease. Due to differences in the constitution of the patient and the nature of the pathogenic factors, there are mainly three types of Taiyang disease: wind stroke, cold damage, and mild exterior obstruction. The main pulse and symptoms of wind stroke include aversion to wind and cold, fever, stiffness and pain in the head and neck, spontaneous sweating, nasal congestion, dry retching, and a floating and relaxed pulse. The pathogenesis is due to the wind-cold attacking the exterior, the defensive qi being unable to protect the exterior, and the nutritive qi leaking out, leading to disharmony between the nutritive and defensive qi. Due to the characteristics of spontaneous sweating and a relaxed pulse, it is also referred to as an exterior deficiency syndrome. The main pulse and symptoms of cold damage include aversion to wind and cold, fever, stiffness and pain in the head and neck, body aches, low back pain, joint pain, no sweating but wheezing, and a floating and tight pulse. The pathogenesis is due to the wind-cold attacking the exterior, the defensive yang being obstructed, the nutritive qi being stagnant, and the lung qi being unable to disperse. Due to the characteristics of no sweating and a tight pulse, it is also referred to as an exterior excess syndrome. The main pulse and symptoms of mild exterior obstruction include fever and aversion to cold, with more heat than cold resembling a malarial pattern, and intermittent occurrences, along with body itching and no sweating. The pathogenesis is due to the exterior syndrome not resolving for a long time, and the pathogenic factors gradually becoming lighter, yet the exterior remains obstructed without sweating, causing the pathogenic factors to linger. Additionally, during the course of Taiyang disease, depending on the severity of the pathogenic factors and the relative excess or deficiency of the organ yin and yang, or the presence of pre-existing conditions, the symptoms may often have mixed or changing characteristics. Among them, if Taiyang disease is predominant but also has accompanying symptoms, it is referred to as Taiyang disease with accompanying symptoms, such as Taiyang wind stroke with wheezing or continuous sweating. If due to misdiagnosis or the natural progression of the disease, the symptoms change and do not belong to the category of six meridian diseases, it is referred to as a transformation syndrome, such as water retention, blood retention, chest obstruction, fullness syndrome, or heat counterflow.
Yangming governs dryness, with abundant qi and blood, thus when the pathogen enters Yangming, it often transforms into dryness. Whether the Yangming itself is affected by the pathogen or the pathogenic factors are transmitted from other meridians, the symptoms are mostly of a nature characterized by internal excess dryness and heat, thus Yangming disease is summarized by “excess in the stomach”. However, this summary is only a generalization of the condition. Yangming disease, depending on its dryness and heat combining with the residuals in the intestines, can fill the entire body, leading to symptoms of high fever, spontaneous sweating, no aversion to cold but aversion to heat, a surging pulse, and thirst with a desire to drink, which is termed Yangming heat syndrome. If the dryness and heat pathogen combines with the residuals in the intestines, causing dry stool obstruction and the qi of the bowels to be unblocked, leading to tidal fever, delirium, cold sweating of the hands and feet, abdominal fullness and hardness, and no bowel movement, with a deep and solid pulse, it is termed Yangming excess syndrome. There is also the syndrome of spleen constraint, where stomach heat constrains the transport function of the spleen, leading to hard stools and no bowel movement for over ten days without discomfort, which is also categorized under Yangming excess syndrome. Although Yangming disease is primarily characterized by internal heat and dryness excess syndrome, there are also cases caused by Yangming deficiency or middle cold, referred to as Yangming cold syndrome or deficiency syndrome. Additionally, the Yangming section includes transformation syndromes such as jaundice syndrome and blood heat syndrome.
Shaoyang governs the ministerial fire and the pivot mechanism. When ill, the gallbladder fire rises, and the pivot mechanism is impaired, thus summarized by “bitter mouth, dry throat, and dizziness”. The main pulse and symptoms include alternating chills and fever, fullness in the chest and hypochondria, lack of desire to eat or drink, irritability with a tendency to vomit, a white tongue coating, and a wiry and thin pulse. Shaoyang disease can be transmitted from other meridians or can be affected by its own meridian. When the disease enters Shaoyang, it has already left the exterior of Taiyang and has not yet entered the interior of Yangming; in terms of the depth of the three Yang syndromes, Shaoyang is a half-exterior, half-interior syndrome. Because it is situated between the exterior and interior, Shaoyang disease can have different syndromes that are both exterior and interior. If it accompanies Taiyang’s exterior, symptoms may include alternating chills and fever, irritability, fullness in the chest and hypochondria, slight constipation, thirst without vomiting, and sweating from the head. If Shaoyang disease is mismanaged and the pathogenic factors spread, affecting both the exterior and interior, with a combination of deficiency and excess, symptoms may include fullness in the chest and sweating from the head. If Shaoyang disease is mismanaged and the pathogenic factors spread, affecting both the exterior and interior, with a combination of deficiency and excess, symptoms may include fullness in the chest, irritability, difficulty urinating, delirium, and heaviness throughout the body, making it difficult to turn over.
Taiyin governs dampness and the transportation of refined essence, relying on the warmth of yang qi. When the disease enters Taiyin, it is primarily characterized by the inability of the spleen yang to function, leading to cold dampness obstruction, thus summarized by “abdominal fullness and vomiting, inability to eat, and spontaneous diarrhea with abdominal pain”. Taiyin disease can be transmitted from the three Yang meridians or can be affected by its own meridian, which is a Taiyin exterior syndrome; if the spleen and stomach are not in harmony, leading to abdominal fullness and pain, or severe pain, it is termed Taiyin abdominal pain syndrome; if cold dampness obstructs the interior, leading to yellowing of the body and eyes, it is termed Taiyin jaundice syndrome.
Shaoyin includes the heart and kidney organs, with diseases having two pathways of cold transformation and heat transformation. Shaoyin cold transformation syndrome arises from the deficiency of heart and kidney yang, and insufficient qi and blood, thus characterized by a fine and weak pulse, with a desire to sleep as the main symptom. This syndrome is often accompanied by no heat, aversion to cold, curled up posture, irritability or restlessness, clear diarrhea, clear urination, and cold hands and feet. In severe cases, there may be a significant deficiency of yang qi, with internal cold and excessive yin, leading to false heat symptoms such as no aversion to cold, fever, red face, irritability, and a pulse that is fine and almost imperceptible. Shaoyin heat transformation arises from insufficient kidney water and rising heart fire, leading to symptoms such as restlessness, dry throat, sore throat, or clear diarrhea, thirst, red tongue with little or no coating, and a thin and rapid pulse. Additionally, Shaoyin disease may also accompany the exterior symptoms of Taiyang, heat transformation injuring fluids, urgent diarrhea due to the convergence of heat and yin, and various other syndromes. Jueyin disease is more complex, with mixed cold and heat symptoms, and various syndromes. The main symptoms of Jueyin disease include “thirst, qi rising to the heart, heat in the heart, hunger without desire to eat, vomiting of roundworms, and persistent diarrhea” which represent the typical symptoms of mixed cold and heat. Jueyin cold symptoms are represented by the formula of Dang Gui Si Ni Tang, with the pathogenesis being insufficient liver blood, cold congealing the meridians, primarily manifesting as cold hands and feet, with a pulse that is fine and almost imperceptible. If there is a history of prolonged cold, it can be treated with Dang Gui Si Ni Tang plus Wu Zhu Yu and ginger. If liver cold invades the stomach, causing turbid yin to rise, leading to dry retching and headache, it can be treated with Wu Zhu Yu Tang. Jueyin heat symptoms arise from damp-heat accumulation in the liver channel, obstructing the qi mechanism, leading to symptoms of severe diarrhea, thirst, and a desire to drink, which can be treated with Bai Tou Weng Tang. The Jueyin heat-recovery syndrome is a pathological reflection of the changes in yin and yang during the disease process, characterized by alternating cold and heat. If yin evil prevails, there will be cold diarrhea; if yang qi prevails, there will be fever. Due to the instability of yin and yang, cold and heat symptoms may alternate, and generally, the duration of each can be used to infer the changes in yin and yang, the progression of pathogenic factors, and to assess prognosis.
The Jueyin section also includes the differentiation of counterflow syndromes, vomiting syndromes, hiccup syndromes, and diarrhea syndromes. The pathogenesis of counterflow syndromes is characterized by “the qi of yin and yang not connecting properly”, manifested as cold hands and feet, with mild cases showing coldness in the fingers and toes, and severe cases showing coldness beyond the elbows and knees. There are many causes for the improper connection of yin and yang qi, thus counterflow syndromes can be diverse, such as roundworm counterflow, cold counterflow, heat counterflow, water retention causing counterflow, and phlegm obstruction causing counterflow, each treated according to its syndrome. Vomiting syndromes can be differentiated into those caused by yang deficiency and yin excess, those caused by Jueyin transforming into Shaoyang, and those caused by internal abscesses. Hiccup syndromes can be divided into deficiency cold hiccups and excess heat hiccups. Diarrhea syndromes can be differentiated into deficiency cold diarrhea, excess heat diarrhea, and mixed cold and heat diarrhea. All of these should be differentiated and treated based on the examination of symptoms and seeking the underlying causes.
【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 the field of brain diseases; 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 Geriatric Society; 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 the treatment of various diseases using TCM and non-drug therapies, and in regulating sub-health states, especially with rich clinical experience in headaches, dizziness, insomnia, depression, as well as stroke, facial paralysis, and neck, shoulder, waist, and leg pain. He has conducted in-depth research on the use of medicinal pastes to regulate sub-health and chronic diseases.
