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Why do we always feel that the ‘Shang Han Lun’ is excellent, while the ‘Jin Kui Yao Lue’ seems not as good?
Isn’t the ‘Jin Kui Yao Lue’ a book by the Medical Sage Zhang Zhongjing?
In fact, ‘Shang Han Lun’ and ‘Jin Kui Yao Lue’ were originally one book, namely ‘Shang Han Za Bing Lun’, both authored by the Medical Sage Zhang Zhongjing.
The title of ‘Shang Han Za Bing Lun‘ is very accurate, as it discusses the content of cold damage and miscellaneous diseases. The original book consists of sixteen volumes, with the first ten volumes discussing cold damage and the last six volumes discussing miscellaneous diseases.
Since the original book has been lost, the cold damage section was compiled and organized into a book by Wang Shuhe, the Grand Physician of the Jin Dynasty, titled ‘Shang Han Lun’.
Wang Shuhe collected the cold damage portion of ‘Shang Han Za Bing Lun’ but did not see the miscellaneous disease section; until the Northern Song Dynasty, during the reign of Emperor Renzong, Hanlin scholar Wang Zhu discovered a condensed version of ‘Shang Han Za Bing Lun’ in the remnants of the imperial library, titled ‘Jin Kui Yu Han Yao Lue Fang’, consisting of three volumes: the first volume discusses cold damage, the second volume discusses miscellaneous diseases, and the third volume contains treatments and gynecological diseases.
By the time of Emperor Shenzong’s Xining (1068 AD), Lin Yi and others revised it, removing the first volume and retaining the second and third volumes. For clinical convenience, they also listed the prescriptions from the third volume under various syndromes, still compiling it into three volumes.
Additionally, they collected various prescriptions from other medical texts that reproduced Zhang Zhongjing’s treatments for miscellaneous diseases and some effective prescriptions from later generations, which were appended at the end of each section, “and still named it ‘Jin Kui Fang Lun'”, which is later known as ‘Jin Kui Yao Lue Fang Lun’, abbreviated as ‘Jin Kui Yao Lue’ or ‘Jin Kui’.
The earlier cold damage section is called ‘Shang Han Lun’, and if the later miscellaneous disease section were to be named similarly, it would be called ‘Za Bing Lun’, making the issue clearer.
In summary, the difference between the two lies in their certainty.That is, the certainty of ‘Shang Han Lun’ is good, while the certainty of ‘Jin Kui Yao Lue’ is not as good.
This difference is precisely due to the difference in the subjects of their studies, namely cold damage and miscellaneous diseases, which correspond to external pathogenic diseases and internal injuries, as well as acute and chronic diseases.
1
For Taiyang wind, Yang is floating and Yin is weak. Yang floating indicates heat is spontaneously generated; Yin weakness indicates sweating occurs. If there is aversion to cold, aversion to wind, fever, nasal congestion, and dry retching, Gui Zhi Tang (Cinnamon Twig Decoction) is indicated. (12)
For Taiyang disease, headache, fever, body aches, lower back pain, joint pain, aversion to wind without sweating and wheezing, Ma Huang Tang (Ephedra Decoction) is indicated. (35)
The above two entries are from ‘Shang Han Lun’, and using them according to the text will yield definite therapeutic effects. All entries in ‘Shang Han Lun’ that are indicated have a high certainty of efficacy. In other words, ‘Shang Han Lun’ has good certainty, and only with certainty can there be definite efficacy.
For deficiency labor and insomnia, Suan Zao Ren Tang (Sour Jujube Decoction) is indicated. (Blood Bi and Deficiency Labor Disease Chapter 17)
For difficulty in urination, Pu Hui San (Purslane Powder) is indicated, along with Hua Shi Bai Yu San (Talcs and White Fish Powder) and Fu Ling Rong Yan Tang (Poria Decoction with Salt) also indicated. (Xiao Ke and Difficulty in Urination Chapter 11)
The above two entries are from ‘Jin Kui Yao Lue’, and using them according to the text does not guarantee effectiveness.
For deficiency labor and insomnia, Suan Zao Ren Tang is not guaranteed to be effective. Why?
Because deficiency labor and insomnia can have multiple patterns, meaning that Suan Zao Ren Tang only treats one of the many patterns of deficiency labor and insomnia and cannot cure all cases of deficiency labor and insomnia.
At the same time, the specific conditions that Suan Zao Ren Tang can effectively treat are not clearly stated by Zhang Zhongjing in the text.
For difficulty in urination, Pu Hui San is indicated, along with Hua Shi Bai Yu San and Fu Ling Rong Yan Tang, but this entry directly applied to difficulty in urination is often ineffective.
Because there are many causes of difficulty in urination, merely having difficulty in urination does not determine the treatment plan, so using these prescriptions is often ineffective.
2
For chest obstruction and heart distension, with Qi stagnation in the chest, fullness in the chest, and counterflow under the ribs, Zhi Shi Xie Bai Gui Zhi Tang (Bitter Orange, Garlic, and Cinnamon Twig Decoction) is indicated, and Ren Shen Tang (Ginseng Decoction) is also indicated. (Chest Obstruction and Heart Pain with Shortness of Breath Chapter 5)
In ‘Jin Kui Yao Lue’, this format of entry is also common, such as “For those with fluid retention, one should induce sweating; Da Qing Long Tang (Major Blue Dragon Decoction) is indicated, and Xiao Qing Long Tang (Minor Blue Dragon Decoction) is also indicated,” etc.
Clearly, Zhi Shi Xie Bai Gui Zhi Tang and Ren Shen Tang are not the same.
Although both formulas can be used to treat chest obstruction, they cannot be considered equivalent; if they were the same type of chest obstruction, using these two formulas according to the text would not yield the same efficacy.
This is a manifestation of uncertainty. Imagine if Zhang Zhongjing could definitively determine that one formula was the best for a certain syndrome, he would not need to use another formula to “also indicate” it.
‘Jin Kui Yao Lue’ contains many similar entries.
3
Through the above comparisons, the differences are clear.
Most of the formulas indicated in ‘Shang Han Lun’ have definite efficacy; many of the formulas indicated in ‘Jin Kui Yao Lue’ have uncertain efficacy.
Why is this so?
It is because ‘Shang Han Lun’ studies cold damage, which is an external pathogenic disease; ‘Jin Kui Yao Lue’ studies miscellaneous diseases, which are internal injuries and miscellaneous diseases.
External pathogenic diseases have a short course, generally with no deficiency of righteous Qi, primarily with excess pathogenic factors, the condition is simple, and recognizing the syndrome is easy; as long as the pathogenic Qi is expelled, the disease will resolve, making treatment straightforward and the effects certain.
Internal injuries and miscellaneous diseases have a long course, often with both excess pathogenic factors and deficiency of righteous Qi, the condition is complex, with many threads, making syndrome recognition difficult; treatment cannot be simplified and must consider all aspects; even if the syndrome is accurately identified and the treatment is correct, the efficacy will not be immediate, as the recovery of righteous Qi requires time, and the support of righteousness and expulsion of pathogenic factors can influence each other.
Simply put, the course of external pathogenic diseases is generally one day or a few days, while the course of internal injuries and miscellaneous diseases can last months, years, or even decades, so the difficulty of treatment is certainly different. Therefore, Wu Jutong said, “Treating external pathogens is like a general, treating internal injuries is like a minister.”
For example, for the early stage of external cold evil, Taiyang cold damage, using Ma Huang Tang, the efficacy is definite; most of the time, one dose can induce sweating and improve the condition; for acute enteritis presenting as Ge Gen Qin Lian Tang syndrome, using Ge Gen Qin Lian Tang can generally cure within three doses, which is comparable to Western medicine’s use of antibiotics.
However, for chronic nephritis, some patients may not improve regardless of how long you treat them; even those who can be cured will take years, and this is true for both TCM and Western medicine; no one can do it quickly.
4
Therefore, the difference between ‘Shang Han Lun’ and ‘Jin Kui Yao Lue’ is caused by the difference in their subjects of study, not because Zhang Zhongjing’s skills are lacking.
Although we feel that ‘Jin Kui Yao Lue’ is not as good as ‘Shang Han Lun’, to this day, ‘Jin Kui Yao Lue’ is still the best book for treating miscellaneous diseases.
Many people believe that the formulas in ‘Shang Han Lun’ can treat all diseases, including miscellaneous diseases; this is certainly true, but it must be clear that the primary role of the cold damage formulas is to treat cold damage, while treating miscellaneous diseases is a secondary role. That is to say, using the formulas from ‘Shang Han Lun’ to treat miscellaneous diseases will certainly not be as effective as using them to treat cold damage.
5
Appendix
Examples of entries in ‘Jin Kui Yao Lue’ with less certainty are as follows:
Blood Bi and Deficiency Labor Disease Pulse and Syndrome Treatment Chapter Six:
For deficiency labor and insomnia, Suan Zao Ren Tang is indicated. (17)
Chest Obstruction and Heart Pain with Shortness of Breath Pulse and Syndrome Treatment Chapter Nine:
For chest obstruction and heart distension, with Qi stagnation in the chest, fullness in the chest, and counterflow under the ribs, Zhi Shi Xie Bai Gui Zhi Tang is indicated, and Ren Shen Tang is also indicated. (5)
For chest obstruction with Qi stagnation, shortness of breath, Fu Ling Xing Ren Gan Cao Tang (Poria, Apricot Kernel, and Licorice Decoction) is indicated, and Ju Zhi Jiang Tang (Tangerine Peel, Bitter Orange, and Ginger Decoction) is also indicated. (6)
Phlegm and Cough Disease Pulse and Syndrome Treatment Chapter Twelve:
For shortness of breath with slight fluid retention, one should resolve it through urination; Ling Gui Zhu Gan Tang (Poria, Cinnamon, and Licorice Decoction) is indicated, and Shen Qi Wan (Kidney Qi Pill) is also indicated. (17)
For those with fluid retention, one should induce sweating; Da Qing Long Tang is indicated, and Xiao Qing Long Tang is also indicated. (23)
Xiao Ke and Difficulty in Urination Pulse and Syndrome Treatment Chapter Thirteen:
For difficulty in urination, Pu Hui San is indicated, along with Hua Shi Bai Yu San and Fu Ling Rong Yan Tang. (11)
Water Qi Disease Pulse and Syndrome Treatment Chapter Fourteen:
For internal water, Yue Bi Jia Zhu Tang (Yue Bi Decoction with Atractylodes) is indicated; Gan Cao Ma Huang Tang (Licorice and Ephedra Decoction) is also indicated. (25)
Jaundice Disease Pulse and Syndrome Treatment Chapter Fifteen:
For all types of jaundice, Zhu Gao Fa Jian is indicated. (17)
For jaundice disease, Yin Chen Wu Ling San (Yin Chen and Five Poria Powder) is indicated. (18)
Palpitations, Vomiting, Hematemesis, Chest Fullness, and Stasis Blood Disease Pulse and Syndrome Treatment Chapter Sixteen:
For fire evil, Gui Qu Shao Yao Jia Long Gu Mu Li Shu Qi Jiao Tang is indicated. (12)
For palpitations under the heart, Ban Xia Ma Huang Wan (Pinellia and Ephedra Pill) is indicated. (13)
For persistent vomiting of blood, Bai Ye Tang (Cypress Leaf Decoction) is indicated. (14)
For insufficient heart Qi, with vomiting blood and epistaxis, Xie Xin Tang (Drain the Heart Decoction) is indicated. (17)
Vomiting, Reflux, and Diarrhea Disease Pulse and Syndrome Treatment Chapter Seventeen:
For all vomiting, if food cannot go down, Xiao Ban Xia Tang (Minor Pinellia Decoction) is indicated. (12)
Women’s Pregnancy Disease Pulse and Syndrome Treatment Chapter Twenty:
The Master said: If a woman has a normal pulse, with a weak Yin pulse, and feels thirsty and cannot eat, without cold or heat, it is called pregnancy; Gui Zhi Tang is indicated. According to the law, this syndrome should appear within sixty days; if there is a doctor who treats it contrary to this, it should be aborted. (1)
For persistent vomiting during pregnancy, Gan Jiang Ren Shen Ban Xia Wan (Dried Ginger, Ginseng, and Pinellia Pill) is indicated. (6)
Note:Cover image source from Shetu Network.
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