Golden Chamber Essentials
The Golden Chamber Essentials (Jin Kui Yao Lue) is a section of the Shang Han Za Bing Lun written by the renowned Eastern Han physician Zhang Zhongjing. It is also the earliest existing text in China that discusses the diagnosis and treatment of miscellaneous diseases. The Golden Chamber Essentials contains foundational theories of Traditional Chinese Medicine (TCM) and has a clinical nature. Studying the Golden Chamber Essentials uniquely broadens clinical thinking and enhances the ability to analyze and treat complex diseases, making it an essential classical text for learning TCM.
【Original Text】
Question: What are the eighteen types of Yang diseases? Teacher: Headache, neck pain, waist pain, spine pain, arm pain, and foot pain. What are the eighteen types of Yin diseases? Teacher: Cough, shortness of breath, wheezing, hiccups, throat obstruction, intestinal sounds, bloating, heart pain, and rigidity. Each of the five organs has eighteen diseases, totaling ninety diseases. Additionally, there are six subtle conditions, each with eighteen diseases, making a total of one hundred and eight diseases. The five strains, seven injuries, six extremes, and thirty-six diseases of women are not included.
Clear evils reside above, turbid evils reside below, major evils affect the exterior, minor evils affect the interior, dietary evils, enter through the mouth, leading to food stagnation. The five evils affect people, each with its own rules, wind affects the front, cold affects the back, dampness harms the lower body, fog harms the upper body, wind causes floating pulse, cold causes tight pulse, fog harms the skin and pores, dampness flows into the joints, food harms the spleen and stomach, extreme cold harms the meridians, extreme heat harms the collaterals. (Thirteen)
【Notes】
① Yang diseases: belong to the exterior and are located in the meridians.
② Yin diseases: belong to the interior and are located in the organs.
③ Throat: similar to choking, refers to obstruction in the throat.
④ Five strains: The Su Wen (Plain Questions) and Ling Shu (Spiritual Pivot) both attribute the five strains to prolonged viewing harming blood, prolonged lying harming qi, prolonged sitting harming flesh, prolonged standing harming bones, and prolonged walking harming tendons. The Sources of Disease states: Qian Jin Fang lists mental strain, emotional strain, worry strain, heart strain, and fatigue strain as the five strains. The Sources of Disease also mentions lung strain, liver strain, heart strain, spleen strain, and kidney strain.
⑤ Seven injuries: The Sources of Disease states that excessive eating harms the spleen; excessive anger harms the liver; heavy lifting and prolonged sitting in damp places harm the kidneys; cold drinks harm the lungs; worry and overthinking harm the heart; wind, rain, cold, and heat harm the body; excessive fear harms the spirit, totaling seven injuries. This text’s Xu Lao Bing Pian mentions food injury, worry injury, drink injury, sexual injury, hunger injury, labor injury, and meridian qi injury, totaling seven injuries.
⑥ Six extremes: The Sources of Disease and Qian Jin Fang both mention qi extremes, blood extremes, tendon extremes, bone extremes, muscle extremes (the Qian Jin Fang refers to marrow extremes), and essence extremes as the six extremes.
⑦ Thirty-six diseases of women: The Sources of Disease and Qian Jin Fang both mention twelve rashes, nine pains, seven harms, five injuries, and three stubborn conditions.
⑧ Dietary evils: Dietary evils refer to food-related issues. The term ‘dietary evils’ indicates the harm caused by excessive or improper food consumption. It is also noted that the character for ‘dietary’ is pronounced similarly to ‘fragrant’; thus, it refers to food that is overly rich and causes stagnation. This interpretation can also be referenced.
⑨ Five evils: refer to wind, cold, dampness, fog, and dietary evils.
⑩ Front: refers to before noon.
【Translation】
Question: What are the eighteen types of Yang diseases? Teacher: Headache, neck pain, waist pain, spine pain, arm pain, and foot pain. What are the eighteen types of Yin diseases? Cough, shortness of breath, wheezing, hiccups, throat obstruction, intestinal sounds, bloating, heart pain, and rigidity. Each of the five organs has eighteen diseases, totaling ninety diseases. Additionally, there are six subtle conditions, each with eighteen diseases, making a total of one hundred and eight diseases. The five strains, seven injuries, six extremes, and thirty-six diseases of women are not included.
Clear evils refer to fog and dew evils, which primarily harm the upper body; turbid evils refer to water and damp evils, which primarily harm the lower body. Major evils refer to wind evils, which primarily harm the exterior; minor evils refer to cold evils, which primarily harm the interior. Dietary irregularities enter through the mouth and lead to stomach issues. The five types of evils (wind, cold, dampness, fog, and dietary) each have specific rules: wind evils primarily affect the morning, cold evils primarily affect the afternoon, dampness harms the lower body, fog harms the upper body, wind causes a floating pulse, cold causes a tight pulse, fog harms the skin and pores, dampness easily flows into the joints, dietary irregularities harm the spleen and stomach, extreme cold harms the meridians, and extreme heat harms the collaterals.
【Summary】
This section presents a classification method for diseases based on organs and meridians, highlighting the pathogenic characteristics of various causes.
【Selected Notes】
Especially regarding the head, neck, waist, spine, arms, and feet, these are considered Yang diseases as they are located outside the body; cough, shortness of breath, wheezing, hiccups, throat obstruction, intestinal sounds, bloating, heart pain, and rigidity are considered Yin diseases as they are located within the body. The external conditions include diseases of the nutritive and defensive qi, which are distinct, thus one disease can manifest in three forms, leading to a total of eighteen, hence the term eighteen Yang diseases. Each of the five organs has eighteen diseases, and each of the six subtle conditions also has eighteen diseases, all arising from the six evils. The six evils include wind, cold, heat, dampness, dryness, and fire, and the organs affected by these evils each have three aspects: qi, blood, and the combination of both, leading to a total of eighteen diseases. Following this logic, the five organs total ninety diseases, and the six subtle conditions total one hundred and eight diseases. As for the five strains, seven injuries, and six extremes, these arise from lifestyle, diet, and emotional states. The thirty-six diseases of women pertain to menstrual, childbirth, lactation, and discharge issues, which are not caused by external evils, hence they are not included. Clear evils refer to wind and dew evils, thus residing above; turbid evils refer to water and earth evils, thus residing below; major evils refer to wind, which, although significant, are dispersed and affect the exterior; minor evils refer to cold, which, although minor, are sharp and affect the interior. Dietary evils refer to food and drink that enter through the mouth and harm the stomach. Therefore, evils have distinctions of clarity and turbidity, size, and location, and the human body also has distinctions of upper and lower, exterior and interior, each following its own rules, hence the saying that each has its own method. Thus, wind is Yang and affects the front, cold is Yin and affects the back, dampness is turbid and harms the lower body, fog is clear and harms the upper body, meridians are Yin and harmed by cold, and collaterals are Yang and harmed by heat. In summary, it is simply the principle that Yang evils are associated with the upper body, Yin evils with the lower body, heat evils with Yang, and cold evils with Yin.
Danbo Yuanjian: The Taoist Herbal Preface states that although there are many causes of diseases, they all relate to evils; evils are deviations from the norm, referring to conditions that are not in accordance with the body’s natural laws. Wind, cold, heat, dampness, hunger, satiety, labor, and rest are all considered evils, not just ghostly or epidemic influences. This section clarifies the meaning of evils.
The Medical Canon of the Golden Mirror states that the terms eighteen and ninety, etc., are from ancient medical texts and are difficult to interpret today. Xu Zhongke: This section discusses the differences between Yin and Yang diseases and the distinctions of the five evils affecting people, encouraging mutual reference and inquiry.
【Analysis】
Each type of pathogenic evil has its own characteristics, and the diseases it causes manifest differently in the human body. Practitioners must understand the pathogenic characteristics of these evils, analyze clinical data, and seek the underlying causes to provide reliable evidence for treatment.
Regarding the five strains, the Sources of Disease (Volume Three: Xu Lao) also discusses the strains of the lungs, liver, heart, spleen, and kidneys, as well as the five types of emotional strains: mental strain, emotional strain, heart strain, worry strain, and fatigue strain. Regarding the seven injuries, the Sources of Disease (Volume Three: Xu Lao) states: “The seven injuries are: first, Yin cold; second, Yin atrophy; third, interior urgency; fourth, essence connection; fifth, essence deficiency; sixth, lower Yin dampness; seventh, clear essence; eighth, frequent painful urination.” Additionally, it discusses excessive eating harming the spleen, excessive anger harming the liver, heavy lifting and prolonged sitting in damp places harming the kidneys, cold drinks harming the lungs, worry and overthinking harming the heart, and wind, rain, cold, and heat harming the body, as well as excessive fear harming the spirit.
The major and minor evils in the text refer to the major wind evils that are dispersed and the minor wind evils that enter through gaps. The Golden Chamber Essentials Heart Classic interprets the major evils as wind evils and the minor evils as dietary evils. The Medical Canon of the Golden Mirror interprets the major evils as external influences and the minor evils as emotional disturbances. The phrases “extreme cold harms the meridians” and “extreme heat harms the collaterals” refer to extreme cold food harming the meridians and extreme heat food harming the collaterals.