Shanghan Lun

The Shanghan Lun (simplified Chinese: 伤寒论; traditional Chinese: 傷寒論; pinyin: Shānghán lùn) or Shanghan Zabing Lun (simplified Chinese: 伤寒杂病论; traditional Chinese: 傷寒雜病論; pinyin: Shānghán zábìng lùn), known in English as the Treatise on Cold Damage Disorders or the Treatise on Cold Injury, is a Chinese medical treatise. It is generally considered to have been written by Zhang Zhongjing sometime before 220 AD, at the end of the Eastern Han dynasty. It is amongst the oldest complete clinical textbooks in the world (cf. Carakasaṃhitā and the Hippocratic Corpus), and one of the four canonical works that students must study in traditional Chinese medical education today.

Introduction

This book is well known as one of the classic TCM works either in the history or modern. It was written by Zhang Zhongjing (150~219AD ) who was a great doctor from in The Eastern Han Dynasty. He wrote the book during his clinical practices . So this is a book of practice. It contains a lot of details of daily clinical practice like physical examination, diagnosis, treatment etc. including how to prepare decoctions and careful to the usage of water volume, works after the administration such as “take a cup of hot porridge if stool is not passing and a cup of cold porridge in case the diarrhea occurs continuously---item 141,chapter 7,vol 4 ”

Shang Han [傷寒 shāng hán] is defined in the modern dictionary as typhoid fever; however, Traditional Chinese Medicine is phenomenological and so not all the conditions presenting with similar symptoms would be typhoid fever, indeed the initial symptoms would fit with many everyday colds and flus. The definition in terms of Chinese traditional medicine:

1. Externally contracted heat (febrile) diseases. Elementary questions (su wen re lin) states ‘Heat (febrile) disease are all of the cold-damage type”

Its position in the quartet of Chinese medical classics is subject to debate. Joseph Needham's whose primary interest was in acupuncture and moxa (zhen jiu) says: "...the Shang Han Lun (Treatise on Febrile Disease) of Chang Chung-Ching (+142 to +210), one of the most cardinally important books in the history of Chinese Medicine. It needs no more than a mention here because Chang belonged to a different tradition, and laid more emphasis on drugs and other treatments; he was the first to set forth prescriptions in detail, and the first to classify febrile diseases into six main groups in accordance with the development of the syndromes, using the same terms as those which designate the twelve regular acupuncture tracts but with entirely different significances."

Needham has correctly identified that the Shanghan Lun with its emphasis on drugs (as he refers to Chinese Herbal Medicine) does represent a different approach to that of acupuncture and moxa. The biography of Zhang in which the loss of half his family, seventy percent of them to cold injury, would amply explain his clinical priorities as pragmatic and forceful. However, Needham is arguably overstating some points. It should be mentioned that the Huangdi Neijing does include Chapter 31 on Treatise on Heat (Febrile Disease) [熱論] caused by shang han (cold injury) [傷寒]. Many of the ideas that are considerably developed in the Shanghan Lun are found in this chapter. Also the distinction ("entirely different") between the six 'acupuncture tracts' (generally known as meridians) and the six stages is overstated. The symptoms described in the Shang Han Lun are the ones appropriate to an external arising acute condition rather than the entirety of conditions associated with the six meridians. For example, in Su Wen Chapter 31 the first day of cold injury is described as: 傷寒一日，巨陽受之，故頭項痛，腰脊強。 "Great (Tai) Yang receives it, therefore head and neck pain, the waist (loins) and the spine become rigid." The first article of the Shang Han Lun says: 太陽之為病，脈浮，頭項強痛而惡寒。 "Tai Yang it act as disease, pulse float, head nape of neck stiff (and) pain and dislike cold.". The Shang Han Lun's mention of a floating pulse suggests more exterior location of the disease, and so we find the head and neck pain and/or rigidity, but not the loins (waist and back) pain that would suggest a greater degree of interiorization. This also illustrates that Chinese medicine was an evolving practice. The Chinese were much more willing to amend theory in light of practice than was found in Graeco-Roman and European tradition.

A question that arises is why does shang han (injury by cold) cause re [熱 rè: hot / febrile] disease. The Huangdi Neijing Su Wen describes in accord with Yin and Yang theory that heat can turn into cold and cold into heat. The more sophisticated theory was put forward by Liu Wansu (1120-1200). He developed the theory of similar transformation. The body’s host qi is yang, therefore warm. Hence any evil guest qi, either externally invading or internally engendered, will tend to transform into a warm or hot evil similar to the body’s host or ruling qi. This implies that fever is not indicative of hot conditions per se , but represents the activity of the (yang) host qi. The differentiation of hot or cold conditions is thus not based primarily on the presence of a raised temperature as measured by a thermometer. The differentiation of 'chills' and 'fevers' is thus primarily phenomenological and experiential. Therefore, the Chinese character 熱 may mean heat or fever according to context, and these terms are not synonymous.

As has been mentioned the Shanghan Lun is primarily practical. It does not include a discussion of the theoretical basis of the six stages. These have the same names as the six stages of yin and yang (three of yin and three of yang) and yet we noted that Needham asserted that they were 'entirely different'. Yin and Yang theory is described in the Huangdi Neijing Suwen. The three yin and three yang are most practically applied in the theory of six meridians which is begun in Chapter 6 陰陽離 'Yin and Yang Interplay'. Some half dozen chapters describe six meridians without mentioning the division into arm and leg pairs. It is generally believed from early archaeological finds that the six meridians existed before they became associated with internal organs. At the time of the Nei Jing there were considered to be twelve meridians in all, the six being divided between arm and leg sections, and now associated with organs. Some half dozen chapters of the Nei Jing deal with the six meridians, but differ from the Shanghan Lun in describing a wider range of symptoms. Zhangzhong Zhing focused on exterior symptoms with the Yang, and interior with the Yin. Thus the apparent differences between six meridian symptoms and the six stages described in the Shanghan Lun can be explained. The latter is focused primarily on acute conditions of the cold-damage type and this is how they are generally considered to be applied in modern practice. It was later observed that the theory of six stages did not apply in all cases, and two further theories were developed that were considered more applicable in hot conditions. One is known as the Four Fen: Wei Fen, Qi Fen, Ying Fen, Xue (Blood) Fen, and the other is based upon the San Jiao. There are overlaps between the three theories.

Surviving Editions

1. Sung edition of the Shang han lun. Collated by scholastic ministers Kao Pao-hen, Lin I, and Sun Chi under the order of the emperor and published in 1065. Reprinted in the Ming Dynasty.
2. Cheng Wu-chi's Annotated Shang han lun. Extensively read in Japan and China, was widely circulated in Cheng's time. However, many transcriptions and re-transcriptions have stirred up disagreement as to whether it is true to the original.
3. Chin kuei yu han ching. This book has the same content as the Sung edition with other minor variations in context.
4. Kang Ping edition of the Shang han lun. Kang Ping is the name of the period from 1058-1068 in the Heian era in Japan. It is indispensable for study because it retains the ancient style.

Contents of Shang Han Lun

The Shanghan Lun has 398 sections with 113 herbal prescriptions, organised into the Six Divisions corresponding to the six stages of disease:^[1] The Sung edition is in ten volumes including the first to chapters on pulse diagnosis, the Cheng edition is also in ten volumes but simplified, the Cheng kuei yu han ching is in eight volumes.

This book is only for the usage of medical professional personnel, and you’d better have base knowledge on Traditional Chinese Medicine (TCM ), if not, it will be very difficult for you to fully understand what it says

Stages of disease

• Tai Yang (太陽, greater yang): a milder stage with external symptoms of chills, fevers, stiffness, and headache. Therapy: sweating.
  • This is further differentiated into Tai Yang Wind and Tai Yang Cold.
• Yang ming (陽明, yang brightness): a more severe internal excess yang condition with fever without chills, distended abdomen, and constipation. Therapy: cooling and eliminating.
  • This is further differentiated into Yang Ming Channel and Yang Ming Organ.
• Shao yang (少陽, lesser yang): half outside, half inside half excess and half deficiency with chest discomfort, alternating chills, and fever. Therapy: harmonizing.
• Tai yin (太陰, greater yin): chills, distended abdomen with occasional pain. Therapy: warming with supplementing.
• Shao yin (少陰, lesser yin): weak pulse, anxiety, drowsiness, diarrhea, chills, cold extremities. Therapy: warming with supplementing.
  • This further differentiated into Shao Yin Hot and Shao Yin Cold.
• Jue yin (厥陰, absolute yin): thirst, difficult urination, physical collapse. Therapy: warming with supplementing.

See also

• Chinese herbology
• Chinese patent medicine
• Traditional Chinese Medicine