The world’s most famous clinical medical book, the Shang Han Za Bing Lun, was written by Dr. Zhang Zhong Jing around 200 B.C. It includes the Shang Han Lun and the Golden Chamber. The Shang Han Lun covers diseases due to external attack, also known as “traumatized by coldness.” The Golden Chamber covers all the clinical difficulties and complications of internal damage. The Shang Han Za Bing Lun is the oldest complete clinical textbook in world medical history, and the Shang Han Lun and the Golden Chamber are two of the four most important medical classics which students must study in Chinese medical education.

The Shang Han Lun has 397 sections with 112 herbal prescriptions. The discussion is based on the Six Divisions. The Golden Chamber has 25 chapters with 262 herbal prescriptions. The discussion is based on Zang Fu diagnosis.

In today’s medical practice, the Shang Han Lun and the Golden Chamber still play a crucial role. As soon as you walk into the palace of Chinese medicine, Dr. Zhang Zhong Jing and his knowledge are everywhere. From simple prescriptions like Gui Zhi Tank (Cinnamon Twig Decoction) to more advanced issues like autoimmune disorders, we can often find precious guidelines from Dr. Zhang Zhong Jing’s treasure chest.

Writing Style
1. Dr. Zhang Zhong Jing wrote with short sentences and simple words – direct and to the point – but his words were layered with deep and varied meanings. This made his book a very helpful clinic manual for doctors to use in their practice, but it also presupposed a certain level of knowledge and understanding for the doctor to be able to use it. The writing style leaves much room for the reader’s interpretation; for example, in Golden Chamber, Chapter 22, Dr. Zhang Zhong Jing used “Zang Zao” to indicate the condition is either organ dryness or organ irritability with symptoms of emotional disorders which directly guides one to Gan Mai Dao Zao Tang (licorice jujube wheat decoction).

This section clearly guides doctors to use such treatment for women’s emotional disorders due to dryness or irritability. However, it also leaves a big mystery for doctors to resolve, such as the original meaning of “zang,” which can refer to the heart, liver, chong meridian, uterus, and others. Then when “zang” is combined with “zao,” which can mean dryness or irritability, the result is more than ten different meanings. Different interpretation of the words and different combinations can give multiple interpretations of Zhang Zhong Jing’s words. The more experienced the doctor, the more he or she can correctly interpret Zhang Zhong Jing’s meaning.

2. Dr. Zhang Zhong Jing used an amazing description of pulse to indicate etiology and pathology of diseases. This description made pulse diagnostic skill more practical and useful due to its direct connection to the illness. For example, in Golden Chamber, Chapter 9, Dr. Zhang Zhong Jing described Yang pulse as weak and Yin pulse as wiry. Yang indicates Cun pulse; Yin indicates Qi pulse. The pulse itself illustrates the weakness of Yang and the excess of Yin. Also, Yang indicates upper body, which is the chest; Yin indicates lower body, which is the abdomen. Yang indicates physical Yang Qi deficiency; Yin indicates pathological Yin evil Qi excess as cold, phlegm, and blood stagnation.

This excess Yin evil Qi from Yin location would easily take over Yang location while Yang Qi is deficient. This etiology clearly guides the treatment to sedate Yin evil Qi and promote chest Yang Qi. According to the detection of cold, phlegm, or blood stagnation, one would then choose warming, transforming, or invigorating methods to promote chest Yang Qi.

3. In the Shang Han Za Bing Lun, readers can easily find that there is more theoretical discussion devoted to unusual cases rather than usual cases. This is because Dr. Zhang Zhong Jing expected doctors who were able to read his book would already have a good understanding of the basic treatment for usual cases. They would use Dr. Zhang Zhong Jing’s extensive knowledge for the more difficult cases they could encounter in clinical practice. For example, under usual circumstances, when we are treating a complicated condition such as a mixture of acute external attack and chronic internal disorders, we have to make our choice between branch and root in order to treat one first before the other. Obviously, our usual choice would be to treat the branch first, which is the acute external attack. But in Shang Han Lun section 91, Dr. Zhang Zhong Jing referred to a totally different treatment principle according to how severe the condition is to choose whether branch or root should be treated first. As an example, when diarrhea due to spleen Yang deficiency is more severely threatening the patient’s life than an acute common cold, the priority of treatment should be clearly chosen by doctors with no hesitation, even though such a choice might not be able to match the usual treatment principle.

4. Dr. Zhang Zhong Jing always had very special structure for his herbal prescriptions. Most herbal prescriptions form the Shang Han Za Bing Lun only have a few herbs. Each herb has been carefully selected with a very clear assignment; for example, Zhi Zi Dou Chi Tang (Gardenia and Soybean Decoction) and Ma Huang Gan Cao Tang (Ephedra and Licorice Decoction). Sometimes, even simply changing the dosage on a few of the herbs in the prescription would significantly change the main function of the prescription. For instance, Xiao Chen Qi Tang (Minor Order the Qi Decoction) and Hou Pu San Wu Tang (Magnolia and Three Substance Decoction) have exactly the same herb selection (Da Huang, Hou Pu, and Zhi Shi) and can be used for constipation due to excess condion, but Xiao Chen Qi Tang uses Da Huang as chief to purge the heat-related constipation, while Hou Pu San Wu Tang uses a heavy dose of Hou Pu to focus on Qi stagnation-related abdominal distention and constipation.

The Academic Value of the Shang Han Za Bing Lun
As we know, the Shang Han Za Bing Lun is the earliest complete clinical medical text in medical history; its academic value has always been at the foundation of Traditional Chinese Medicine. Following are four aspects of its academic value:

The Shang Han Za Bing Lun summarized medical science up to the Han Dynasty. According to Dr. Zhang Zhong Jing’s original preface, he gathered all ancient medical theory and herbal prescriptions before his time, specifically mentioning the following books: Su Wen, Jou Juan, Ba Shi Yi Nan, Yin Yang Da Lun, and Tai Lu Yao Lu. This information, combined with his personal experience as a doctor, contributed to the creation of this amazing book, the Shang Han Za Bing Lun. He humbly said, “Even though doctors are not able to cure all diseases, they can discover the course of diseases by using certain theories, and guide themselves to treatment principles. If my book can help doctors do that, it would overwhelmingly satisfy my expectations by more than 50 percent.”

The Shang Han Za Bing Lun was the first book to combine theory, diagnostic skill, treatment principles, herbal prescriptions, acupuncture, and life style recommendations. Most of the content is still being used in today’s medical profession.

The Shang Han Za Bing Lun was not the first book to mention the Six Divisions and Zang Fu, but Dr. Zhang Zhong Jing is credited with completing these theories. Any one of the Six Divisions is one stage of disease, but at the same time, it is also an independent system from other systems. For example, Tai Yang syndrome as the first stage of an external attack could later change into Shao Yang syndrome, or it could stay in the Tai Yang system to change into the Tai Yang Fu organ syndrome. Shao Yang syndrome could also be under external attack without coming through Tai Yang stage. Zang Fu systems are mainly used in the Golden Chamber.

The Shang Han Lun is also important because of its great influence on the development of the medical profession. For example, Wen Bing Xue (Febrile Disease Theory) was very much based on Dr. Zhang Zhong Jing’s theories of similarity and differentiation of infectious disease. Even modern western medicine has benefited from Dr. Zhang Zhong Jing’s theory such as decreasing water retention in the head to resolve dizziness and headache, and harmonizing among different systems to promote immune system function.

Shang Han Za Bing Lun’s Mistakes
Just like little flaws would never conceal the beauty of jade, recognizing mistakes in the Shang Han Za Bing Lun does not change even one little bit Dr. Zhang Zhong Jing’s position as the greatest master in Chinese medical history. It certainly would be beneficial to learn from other’s mistakes in order to avoid repeating those mistakes. Perhaps this would satisfy Dr. Zhang Zhong Jing’s expectations for more than 50 percent. We can find the following kinds of mistakes in the Shang Han Za

Bing Lun:
The Shang Han Za Bing Lun has such a long history that it has been lost and found many times. Each time the book was restored, some things were probably lost and some were probably added. That is why sometimes when we are reading we have a hard time making a reasonable connection between two sentences.
There were many doctors in history who worked hard to discuss, reorganize, and republish this book. This definitely helped to develop Shang Han Za Bing Lun theory, but this sometimes caused confusion due to the mixing of Zhang Zhong Jing’s original theories with other doctors’ theories.

Some errors are due to the limitation of Zhang Zhong Jing’s knowledge and experience. For example, “Five to six pieces of dry stool in the stomach,” or “Palpation of boils to determine if there is pus by feeling hot or not.” However, the Shang Han Za Bing Lun can take you to a new world. In this world, there is beauty you can enjoy, there is mystery to challenge you, and there are mistakes to give you warning. You can find out for yourself if you enter this world. By reading the Shang Han Za Bing Lun today, you can become a better doctor tomorrow.

J. Min Fan is going to present a workshop in Shang Han Lun theory at Pacific Symposium 2001. For more information, contact J. Min at Pacific College of Oriental Medicine (619) 574-6909.