Li Shizhen was a great medical scientist of the Ming Dynasty in China. His greatest contribution was his extensive research and compilation, which took thirty years and involved studying over eight hundred medical texts, resulting in the creation of the Ben Cao Gang Mu (Compendium of Materia Medica). Although this book is primarily a pharmacological work, it elaborates on many aspects of Zhang Zhongjing’s Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases), providing profound insights and making significant contributions to the study and promotion of Zhang Zhongjing’s theories. This article aims to explore this aspect further.
The Ben Cao Gang Mu lists Zhang Zhongjing’s works in the Preface of Volume One, including: Jin Kui Yao Lue (Essentials of the Golden Coffer), Shang Han Lun (Treatise on Cold Damage) (annotated by Cheng Wujin), and Jin Kui Yao Lue. Based on the titles listed and the era in which Li Shizhen lived, the texts he referenced and viewed were likely the Song Dynasty’s corrected editions published by the Medical Book Bureau, rather than the Ming Dynasty’s reprints by Zhao Kaimei in the twenty-seventh year of the Wanli era (1599). This is because Li Shizhen passed away in the twenty-first year of the Wanli era (1593). Although Zhao Kaimei’s reprint closely resembles the original text, it is still different from the Song Dynasty’s Shang Han Lun and Jin Kui Yao Lue. Therefore, the relevant content of Zhang Zhongjing’s works cited by Li Shizhen can serve as an important basis for the collation and research of the current editions of Zhang Zhongjing’s works. Additionally, Li Shizhen may have seen earlier versions of the Shang Han Lun predating the Song edition, which would further enhance the significance of this research.
In the Ben Cao Gang Mu, Volume Twelve, on Ren Shen (Ginseng), it states: “Ren Shen, pronounced ‘shen’, is sometimes abbreviated as ‘shen’.” “Ren Shen, when aged and gradually matured, has roots resembling a human form, thus it is called Ren Shen, the divine herb. The character ‘shen’ implies gradual growth. The character ‘shen’ is derived from ‘shen’, which also means gradual growth. Due to the complexity of the character, it was later simplified to ‘shen’ for convenience. However, the long-standing error cannot be changed; Zhang Zhongjing still used the character ‘shen’ in the Shang Han Lun.” In Volume Thirteen, on Ci Hu (a type of herb), it states: “The character ‘ci’ has two pronunciations: ‘ci’ and ‘zi’. The ‘ci’ in ‘ci ginger’ and ‘ci grass’ is pronounced ‘zi’, while ‘ci hu’ is pronounced ‘ci’… The ancient version of Zhang Zhongjing’s Shang Han Lun still used the character ‘ci’.” Here, Li Shizhen explicitly refers to the “ancient version of Zhang Zhongjing’s Shang Han Lun“, which should not be overlooked and deserves careful consideration.
According to Zhao Huaizhou, a member of the Li Shizhen Academic Research Association of the Chinese Association of Traditional Chinese Medicine, in his article “The Song Edition of the Shang Han Lun Seen by Li Shizhen”, he states: “The use of the characters ‘ci’ and ‘shen’ is a characteristic of the version of the Shang Han Lun that Li Shizhen saw, which is not present in the annotated Shang Han Lun or the Song edition.” Therefore, the relevant content of Zhang Zhongjing’s works cited by Li Shizhen can serve as an important basis for the collation and research of the current editions of Zhang Zhongjing’s works. For example, in Volume Sixteen, on Qu Mai (a type of herb), it states: “For difficulty in urination with water retention, the Gua Lou Qu Mai Wan is indicated. Ingredients include: 2.5 qian of Qu Mai, 2 liang of Gua Lou root, 1 piece of Fu Ling, and 3 liang each of Shan Yao (Chinese yam), ground into powder, mixed with honey to form pills the size of a wutong seed, taken three pills at a time, three times a day. If unknown, increase to seven or eight pills when urination improves and the abdomen feels warm.” This is attributed to Zhang Zhongjing’s Jin Kui formula.” The Jin Kui Yao Lue Fang Lun states: “For difficulty in urination, with water retention, the person suffers from thirst; the Gua Lou Qu Mai Wan is indicated.” The formula includes: 2 liang of Gua Lou root, 3 liang each of Fu Ling and Shan Yao, and 1 piece of Fu Zi (Aconite), prepared with 1 liang of Qu Mai. The five ingredients are ground into powder, formed into pills the size of a wutong seed, taken three pills at a time, three times a day. If unknown, increase to seven or eight pills when urination improves and the abdomen feels warm.” Comparing the two, aside from minor textual differences, there are two significant differences: one is the inclusion of Shan Yao and Fu Zi, and the other is the dosage of Qu Mai. Of course, we do not rule out the possibility that Li Shizhen made arbitrary deletions or mixed various sources when citing materials. This is because Li Shizhen often did not copy original texts verbatim but rather reworked them, sometimes even synthesizing the ideas of two or three sources into one, resulting in significant deviations from the original text, which was a common practice in book compilation at that time. Even so, the Ben Cao Gang Mu still provides many research avenues for studying related issues.
Li Shizhen would categorize and summarize Zhang Zhongjing’s discussions on the same issues scattered across different texts, consolidating similar formulas, symptoms, herbs, and contraindications, conducting comparative analyses, and supplementing and elaborating based on his clinical experience. For example, Li Shizhen gathered all the passages related to the Gua Ti San from Zhang Zhongjing’s Shang Han Lun and Jin Kui Yao Lue for discussion and added his own insights. In Volume Thirty-Three, on Tian Guo (Sweet Melon), it states: “Zhang Ji said: If the disease resembles the symptoms of Gui Zhi (Cinnamon Twig), with no headache, no stiffness in the neck, a floating pulse at the cun position, a feeling of fullness and hardness in the chest, and qi rising to the throat, causing difficulty in breathing, this indicates cold in the chest; it should be expelled. If there is a summer heat syndrome with body heat and pain, and a weak pulse, this indicates injury from cold water; it should be expelled. If there is a Shao Yang disease with headache and alternating chills and fever, and a tight pulse, this indicates phlegm in the diaphragm; it should be expelled. If there is fullness and pain in the chest, inability to eat, and a desire for pressure, with turbid saliva and diarrhea for more than ten times, and a weak pulse at the cun position, this indicates it should be expelled. If there is restlessness and inability to sleep, without sweating or purging, this is called ‘real vexation’, and it should be expelled. If there is food retention in the upper abdomen, it should be expelled, and the Gua Ti San is the main remedy. However, those with blood deficiency should not take Gua Ti San.” Li Shizhen believes that “Gua Ti is a medicine for clearing damp-heat from the Yangming channel, thus it can eliminate phlegm and dampness from the chest and abdomen, as well as treat jaundice and damp-heat syndromes. For those with weak stomachs or post-illness or postpartum, caution should be exercised when using expelling medicines, especially Gua Ti.”
The herb Jie Geng (Platycodon) is known for its ability to open and disperse lung qi, expel phlegm, and carry medicines upward. In Volume Twelve, on Jie Geng, it states: “Zhang Zhongjing’s Shang Han Lun treats cold and solidified chest with Jie Geng, Bei Mu (Fritillaria), and Ba Dou (Croton), aiming to warm the middle and dissolve accumulation. It also treats lung abscess with Jie Geng and Gan Cao (Licorice), aiming to clear the lung and expel phlegm and blood, and to supplement internal leakage. For the treatment of Shao Yin syndrome with sore throat lasting two to three days, it also uses Jie Geng and Gan Cao, aiming to disperse cold and clear heat, thus harmonizing cold and heat. Later generations renamed it Gan Jie Decoction, which treats various throat and tongue diseases.” Li Shizhen summarizes the effects of Bai Mi (White Honey) into five categories: clearing heat, tonifying the middle, detoxifying, moistening dryness, and relieving pain. In Volume Thirty-Nine, on Honey, it states: “Bees collect nectar from non-toxic flowers, fermenting it into honey, which is said to be a miraculous creation from decay… Zhang Zhongjing treats Yangming syndrome with dryness and constipation using honey decoction, which is indeed a miraculous formula of the ages.” Based on this, he summarizes the effects of honey as “harmonizing the nutritive and defensive qi, moistening the internal organs, unblocking the three jiao, and regulating the spleen and stomach”, praising honey decoction as “a miraculous formula of the ages”, which is not an overstatement.
Regarding contraindications, Li Shizhen summarizes Zhang Zhongjing’s discussion on the misuse of fire needles leading to changes in symptoms, warning future generations. In Volume Six, on Fire Needles, it states: “Zhang Zhongjing said: In cases of Tai Yang syndrome, adding warming needles will certainly cause shock. For those with weak nutritive qi, adding burning needles will cause blood flow to stagnate, further increasing heat and restlessness. In cases of Tai Yang disease, purging leads to fullness under the heart, with both exterior and interior being deficient, and both yin and yang being exhausted; if burning needles are added, it will lead to chest distress, a blue-yellow complexion, and moist skin, which are difficult to treat. These are all due to the ignorance of those using needles regarding the principles established by the ancients, leading to harm.”
Mr. Yue Meizhong states: “The greatest merit of Zhongjing’s book is that it discusses symptoms without delving into pathology, provides formulas without explaining pharmacology, allowing readers to experience it themselves; its essence often lies in the unspoken.” As a master of materia medica, Li Shizhen was naturally well-versed in the medicinal experiences of past physicians. The Ben Cao Gang Mu elaborates on the implications of Zhang Zhongjing’s prescriptions and medicinal uses in great detail, presenting unique insights. In Volume Nine, on Wu Se Shi Zhi (Five-Color Stone Resin), it states: “Zhang Zhongjing used Tao Hua Tang (Peach Blossom Decoction) to treat dysentery with pus and blood, taking the heavy astringency of Chi Shi Zhi (Red Stone Resin) to solidify the lower jiao blood; the spicy warmth of Gan Jiang (Dried Ginger) warms the lower jiao qi and supplements deficiency; the sweet warmth of Jing Mi (Polished Rice) assists Shi Zhi and Gan Jiang in moistening the intestines and stomach.” Li Shizhen analyzes the compatibility of the three medicines in Tao Hua Tang and their warming and astringent effects, especially detailing the main herb Chi Shi Zhi as having the effects of “tonifying heart blood, generating muscle, thickening the intestines and stomach, eliminating water dampness, and solidifying prolapse.” The Wu Mei Wan (Mume Pill) is a specific formula for treating roundworms, and Ke Qin summarizes its action as: “Roundworms become quiet when they encounter sourness, retreat when they encounter spiciness, descend when they encounter bitterness; there is no better formula for killing worms than this.” The compatibility significance revealed by Ke Qin is still adopted in textbooks today, and this idea originated from Li Shizhen’s discussions. In Volume Twenty-Nine, on Mei (Plum), it states: “The diseases primarily treated by Wu Mei and Bai Mei are all based on the principle of sour astringency. Only Zhang Zhongjing’s Wu Mei Wan and the roundworm formula utilize sourness to stop the worms, which is slightly different.” In Volume Thirty-Two, on Shu Jiao (Sichuan Pepper), it states: “Dai Yuanli said: Whenever a person vomits and cannot retain medicine, there must be roundworms in the diaphragm. Roundworms react to medicine, causing the medicine to be expelled without the roundworms being eliminated. However, if ten grains of fried Chuan Jiao (Sichuan Pepper) are added to the vomiting medicine, the roundworms will retreat. This indicates that Zhang Zhongjing’s use of Shu Jiao in the Wu Mei Wan is based on this principle.” Regarding the combination of Gan Sui and Ban Xia (Pinellia) in the Gan Sui Ban Xia Tang, Li Shizhen states in Volume Seventeen, on Gan Sui: “The kidney governs water; when it condenses, it becomes phlegm, and when it overflows, it leads to swelling. Gan Sui can drain the kidney’s dampness, treating the root of phlegm. It should not be overused; if there is a middle disease, it should be stopped. Zhang Zhongjing treats heart retention with Gan Cao (Licorice) to counteract its opposite effects.” Regarding the compatibility of Shen Qi Wan, the modern concept of “three tonics and three purges” also originates from Li Shizhen’s discussions. In Volume Nineteen, on Zea (Alisma), it states: “Zhongjing’s Di Huang Wan uses Fu Ling and Zea to drain the bladder’s evil qi, not to connect them. The ancients used tonics while also draining evils; when the evils are removed, the tonics become effective. This is a profound principle. Later generations did not understand this principle and focused solely on tonics, leading to the harm of excessive tonification over time.” In Volume Fourteen, on Mu Dan (Peony), it states: “The root of Mu Dan treats the blood of the hand and foot’s Shao Yin and Jue Yin channels. The hidden fire refers to yin fire. Yin fire refers to mutual fire. The ancient formula only used this to treat mutual fire, thus Zhang Zhongjing’s Shen Qi Wan includes it. Later generations only used Huang Bai to treat mutual fire, not knowing that Mu Dan‘s efficacy is even greater. This is a secret that has been unknown for a thousand years, now brought to light.” Regarding Zhang Zhongjing’s use of water for decoction, Li Shizhen elaborates on its implications in Volume Five, on Flowing Water: “Sweet flowing water is indicated for five labors and seven injuries, kidney deficiency, spleen weakness, excessive yang and deficient yin, inability to close the eyes, and for cholera with vomiting and diarrhea, and for post-cold syndrome leading to a desire to run away.” “Labor water refers to floating water; Zhang Zhongjing calls it sweet flowing water. Use two dou of flowing water, place it in a large basin, and scoop it high to aerate it thousands of times until bubbles rise, then use it for decoction. The nature of water is originally salty and heavy; when aerated, it becomes sweet and light, thus it does not assist kidney qi but benefits the spleen and stomach.” In Volume Five, on Hot Soup, it states: “Zhang Zhongjing treats fullness under the heart, pressing it moist, with a floating pulse at the guan position, using Da Huang (Rhubarb) and Huang Lian (Coptis) in a soup, taking its thin qi to drain the false heat.” Regarding the preparation and decoction methods of the medicines in Zhang Zhongjing’s formulas, Li Shizhen also provides profound insights. In Volume Seventeen, on Fu Zi (Aconite), it states: “When used raw, Fu Zi disperses; when cooked, it strongly tonifies. When used raw, one must know the method of yin control, removing the skin and navel before use. When cooked, soak it in water, roast it until it cracks, remove the skin and navel, slice it while hot, and roast it again until both inside and outside are yellow, removing the fire toxin before use.” “Also, for any use of Wu Fu medicines, it is advisable to take them cold; heat causes cold. The cold yin is below, and the deficient yang rises. Treating it with cold will only exacerbate the yin condition and worsen the illness; treating it with heat will cause rejection and not be absorbed. Hot medicines with cold drinks, after swallowing, the cold body dissipates, the hot nature emerges, and the illness qi recedes. This does not violate its nature and brings great benefits; this is the essence of reverse treatment.”
In evaluating the gains and losses of previous scholars, the transmission of Zhang Zhongjing’s writings has been long, and errors and misinterpretations are inevitable. The annotations and explanations of physicians throughout the ages reflect diverse opinions, often leading to misinterpretations and superficial treatments, resulting in academic divergence and difficulty in reaching a consensus. Li Shizhen was able to closely connect theory with practice, repeatedly scrutinizing and selecting the best. When encountering errors, he would argue repeatedly, striving for excellence. Zhi Shi (Bitter Orange) was considered the same as Zhi Ke (Bitter Orange Peel) before the Tang Dynasty, differing only in usage. The name Zhi Ke first appeared in the Tang Dynasty’s Yao Xing Lun (Treatise on Medicinal Properties), and the Song Dynasty’s Kai Bao Ben Cao distinguished them based on their different therapeutic uses. In Zhang Zhongjing’s formulas, Zhi Shi actually refers to what is now known as Zhi Ke. Later physicians differentiated the effects and indications of Zhi Shi and Zhi Ke; Wang Haogu stated: “Zhi Ke is for the upper, Zhi Shi is for the lower; the upper governs qi, the lower governs blood. Thus, Zhi Ke treats diseases of the chest and diaphragm, while Zhi Shi treats diseases of the heart, abdomen, spleen, and stomach, which are largely similar.” Li Shizhen deeply analyzed Zhang Zhongjing’s use of Zhi Shi in different situations, believing that “the two can be distinguished, but they can also be used interchangeably.” In Volume Thirty-Six, on Zhi, it states: “The effects and uses of Zhi Shi and Zhi Ke are the same; since ancient times, there has been no distinction. Since the Wei and Jin Dynasties, the uses of Zhi Shi and Zhi Ke have been divided. The ancient Zhang family and the Dongyuan Li family further divided them into treatments for the upper and lower. Generally, their effects can all benefit qi; when qi descends, phlegm and wheezing stop; when qi moves, fullness and distension dissipate; when qi flows, pain and stabbing stop; when qi benefits, heaviness is relieved. Thus, Zhi Ke benefits the chest and diaphragm, while Zhi Shi benefits the intestines and stomach. Therefore, Zhi Shi does not only treat the lower, nor does Zhi Ke only treat the upper. From the Feimen to the Poimen, all are governed by the lungs, and the three jiao are interconnected, being one qi. Thus, the two can be distinguished, but it is also fine if they are not.” The function of Suan Zao Ren (Sour Jujube Seed) is generally believed to nourish liver blood and calm the spirit. The Jin Kui Yao Lue states that the Suan Zao Ren Tang (Sour Jujube Decoction) nourishes blood, calms the spirit, clears heat, and relieves vexation, primarily treating “deficiency of liver blood leading to insomnia and restlessness.” However, Li Shizhen disagrees, believing that Suan Zao Ren is not a heart medicine but a gallbladder medicine, with the roasted version primarily treating “gallbladder deficiency leading to insomnia” and the raw version treating “gallbladder heat leading to good sleep.” In Volume Thirty-Six, on Suan Zao, it states: “Suan Zao has a sour taste and astringent nature, thus it governs liver diseases, cold and heat binding qi, sour arthralgia, and lower abdominal fullness and pain. Its seeds are sweet and moistening, thus when cooked, they treat gallbladder deficiency leading to insomnia, thirst, and deficiency sweating; when raw, they treat gallbladder heat leading to good sleep, both being medicines for the Jue Yin and Shao Yang. Today, people only consider it a heart medicine, which is a misunderstanding of this principle.” Gua Lou (Trichosanthes) was previously considered “bitter, cold, and non-toxic”. However, Li Shizhen believed it to be “sweet, not bitter”. By analyzing Zhang Zhongjing’s Gua Lou Xie Bai Tang (Trichosanthes and Garlic Decoction) for treating “chest obstruction”, “solid chest”, and “retained qi in the chest, causing fullness”, he explains that Gua Lou opens the chest, benefits qi, and clears phlegm. In Volume Eighteen, on Gua Lou, it states: “Zhang Zhongjing treats chest obstruction and pain radiating to the heart and back, cough with sputum, and dyspnea, as well as solid chest pain, all using Gua Lou. This is due to its sweet and cold nature not disturbing the stomach qi, allowing the fire of the upper jiao to descend and phlegm qi to lower.” Cheng Wujin did not understand this meaning and claimed it was bitter and cold to drain heat. This is because he did not taste the flavor, which is not bitter, but rather followed the text blindly.” Li Shizhen’s extensive research and exploration of Zhang Zhongjing’s theories in the Ben Cao Gang Mu has made significant contributions, worthy of further study and discussion by us.
If you wish to participate in discussions related to ancient texts, please reply to the WeChat public account 【Shan Ben Gu Ji】 with the message: Group Chat
Welcome to join the Shan Ben Gu Ji learning and exchange community.