EXPLORATION OF THE CULTURAL LANDSCAPE FOR WRITING DISCUSSION OF COLD DAMAGE
Medicine is a product of human society, and Chinese medicine is deeply rooted in traditional Chinese culture in regard to basic theory, academic contexts, and way of thinking. In the past 200 years, and especially in the past 50 years, scholars have published many articles and book chapters which discuss the cultural landscape, particularly the social and economic conditions, against which Zhang Ji wrote Discussion of Cold Damage. However, none of them have systematically explored this cultural landscape. As we know, Zhang Ji summed up the medical achievements gained before and during the Han Dynasty (206 BC to 220 AD) and developed new and practical differentiation and treatment systems for various kinds of diseases, systems which later had a tremendous influence on the theory and practice of Chinese medicine. Therefore, in order to thoroughly understand the theories and treatment approaches in Discussion of Cold Damage, one must study the cultural landscape on which the theories and treatment approaches of this classic were created and developed.
Culture is a fruit produced by the activity of human society. It basically stems from philosophical thinking. In the early stages of medical practice in China, Chinese medicine was based on sporadic accumulation of experience, though the knowledge of medicine was continually evolving. However, the medical knowledge of the time was superficial and scattered. When scholars and practitioners started to use both ancient and contemporary philosophy to view and guide medical practice, Chinese medicine gradually began to develop into a systematic, practical and effective discipline. During the Qin Dynasty (221–206 BC) and early Han Dynasty, the theory of qi, the theory of yin and yang, and the theory of five elements were blended into Chinese medicine, and several important books such as The Yellow Emperor’s Inner Classic (黃帝內經 huáng dì nèi jīng), Materia Medica by Shen Nong (神農本草經 shén nóng běn cǎo jīng) and Difficult Questions (難經 nàn jīng), were produced. But what did the cultural landscape look like when Zhang Ji started to write Discussion of Cold Damage?
Cultural landscape when Zhang Ji wrote Discussion of Cold Damage
In Chinese history, the Spring and Autumn period (770–476 BC) and the Warring States period (476–221 BC) are the two eras when philosophers, such as Confucius, Lao Zi, Zhuang Zi, Xun Zi and others, abounded like stars in the galaxy. Of course, their doctrines—particularly those of Confucius and Lao Zi—have played an important role in the development of Chinese culture and Chinese medicine, especially since the Han Dynasty.
At the beginning of the Western Han Dynasty (206 BC to 24 AD), the economy was very bad and people were very poor as a result of one war after another due to peasant uprisings and the warlords fighting to control the country. In order to let peasants have a peaceful life for the recovery of the economy, the emperors and central government adopted the theory of Daoism, especially the statement, “when nothing is done, nothing is left undone,” which appears in Chapter 48 of Morals Classic (道德經 dào dé jīng),1 and this granted more freedom for local government and people. Daoism flourished at the beginning of the Western Han Dynasty. This flourishing is documented in the Historical Book for the Han Dynasty (漢書 hàn shū) written by Ban Gu (also known as Ban Meng-Jian, 32–92 AD), an historian of the early Eastern Han Dynasty (24–220 AD).2 According to Zhang Heng-Liu and colleagues, in the section “Record of Art and Culture” (藝文志 yì wén zhì) of that book, which contains a list of books published c. 88 AD, Daoism held a prominent place in the literature of that era.3
Liu Che (140–87 BC), who was the seventh emperor and “Brave Emperor of the Han Dynasty,” noticed that too much freedom for the people, especially for the local government controlled by royal family members, had compromised the power of the central government while the economy had begun to improve. Liu accepted the idea from Dong Zhong-Shu (179–104 BC) in 134 BC to “turn down all doctrines but respect the doctrine of Confucius,” though in fact Dong’s idea of Confucius’ teachings was not based on the original doctrine of Confucius but rather was a “doctrine” that Dong himself had established, one that was based mainly on the doctrine of Confucius but had been combined with other doctrines as well—a new branch of Confucianism, as it were. According to this branch, everything had been put in its natural order, such as emperor and government ministers, father and sons, husband and wife. It was believed that the emperor was carrying out orders from gods in heaven and had the legal right to govern the country. This idea fitted very well with the intention of Liu Che to strengthen his power to control the country as a unified domain. However, this “unified domain” was broken apart by wars between warlords and peasant uprisings at the end of the Eastern Han Dynasty, and the country fell into chaos again. At that time, other philosophies (especially Daoism) were revived.
There is general agreement that Zhang Ji lived at the end of the Eastern Han Dynasty, and this was the social and cultural landscape in which he wrote Discussion of Cold Damage. How did this landscape influence Zhang Ji’s writing? This question is answered in the next section.
Influence of Confucianism and Daoism on Zhang Ji
Evidence that Zhang Ji was influenced by Confucianism and Daoism is that he applied the concept of harmony, which was put forward by both (see Chapter 7 for further details). In Discussion of Cold Damage, there are many lines related to disharmony in the body and to the treatments to recover harmony. For example, Zhang Ji held the disharmony between the nutritive qi and the defensive qi responsible for spontaneous sweating (see lines 53, 54 and 95).
Compared with Hua Tuo, who lived at the same time as Zhang Ji, Zhang Ji was much less famous in his lifetime, though there are many legendary stories about him today. Among these stories, the story recorded in Book Reviewed by the Emperor of the Tai Ping Era (太平禦覽 tài píng yù lán), published in 983 AD, demonstrates that Zhang Ji was very fond of Confucianism. Chapter 722, “Supplementary Biography for Mr. He Yong” (何颙別傳 hé yóng bié zhuàn), states:
A fellow called Zhang Zhong-Jing, who was about 15 years old and came from the same town, paid a visit to Mr. He Yong (c. 168 AD) and wanted to learn from him. Mr. He told him, “You have a thoughtful mind, but it is not so charming. You can become a famous doctor.”4
Given that He Yong served as a scholar and official in the highest institute and was quite famous for studying Confucianism, and because the country still functioned very well under Confucius’ doctrine, when Zhang Ji was a teenager he was obviously very interested in studying Confucius’ doctrine and becoming an official.
It was a tradition for authors who wrote books related to Chinese medicine during the Qin Dynasty and the Han Dynasty to absorb the essence of ancient Chinese philosophers. For example, Bamboo Slips in the Han Dynasty Dug from Zhang Jia-Shan (張家山漢簡 zhāng jiā shān hàn jiǎn), which is believed to have been written before The Yellow Emperor’s Inner Classic, states: “To preserve health for the body, one must follow the principle of heaven and earth and act as a bellows. The shape changes but not the form. The more it moves, the more it yields.”5 This sentence is almost the same as the second part of Chapter 5 of Morals Classic (道德經 dào dé jīng), which states: “The space between heaven and earth is like a bellows. The shape changes but not the form. The more it moves, the more it yields.”6
In the preface of Discussion of Cold Damage, Zhang Ji cites the following sentence from Confucius:
Confucius says: “Those who know naturally from birth are greatest; those who understand by study are second to them; those who understand by broadly listening and memorizing are inferior.” I have been respecting remedial arts for a long time and would like to follow this advice in my practice.
Zhang Ji also advocated the medical ethic that reflects benevolence and filial piety and duty, which is one of the fundamental concepts of Confucianism. For example, in the preface of Discussion of Cold Damage, he encourages medical practitioners in the following way:
Pay attention to medicine and proficiently study the remedial arts to treat the illnesses of emperors and parents above, then relieve the suffering of the poor and the lowly below, and finally, take care of one’s own health as the center for preserving life.
In this context, the words “above” and “below” are literal translations of the characters “上 shàng” and “下 xià,” respectively, which reflect another basic concept of Confucianism in the regard of classifying people according to their age, education level, economic status and political position in society. Craig Mitchell and colleagues wrote that “in Confucian philosophy, above, below and center describe social levels relative to the individual: above the individual are the sovereign and the individual’s parents; below the individual are those less fortunate; the center is the individual himself.”7
Additional concrete evidence that Zhang Ji studied Confucius is that he wrote in the preface of Discussion of Cold Damage, “If readers follow what I have written in this book, they will understand most of medicine.” The words “they will understand most of medicine” share the exact structure of a sentence from the second section of the fourth appendix of the Book of Changes (周易 zhōu yì), which says that “if the wise look at this summary for one hexagram, he or she will understand most hexagrams,”8 and there is general agreement that the whole appendix of the Book of Changes was written by Confucius and his followers.
In contrast to Confucianism, Daoism is not directly mentioned or cited by Zhang Ji. However, after carefully reviewing the literature that explores the sources for the formulas in his work, all contents of Discussion of Cold Damage, and related stories, one finds that Zhang Ji indeed applied Daoist doctrines, in his practice and his book, in the treatments for various kinds of diseases.
Indirect evidence to support that Zhang Ji was influenced by Daoism is a story in the preface of Acupuncture Jia and Yi Classic (針灸甲乙經 zhēn jiǔ jiǎ yǐ jīng) published c. 256 AD. In that story, a very interesting case study is recorded as the following:
[Zhang] Zhong-Jing visited Wang Can, who was an official next to the prime minister and was about 20 years old. He told Mr. Wang, “You have suffered from the disease which can make eyebrows fall out at the age of 40, and you will die a half year after the falling out of the eyebrows. However, you can avoid this consequence if you take Five Stones Decoction.” Mr. Wang was very annoyed by Zhang’s words and did not take the decoction, though Mr. Wang did receive the prescription. Three days later, [Zhang] Zhong-Jing visited Mr. Wang and asked, “Have you taken the decoction?” Mr. Wang replied, “I did.” [Zhang] Zhong-Jing said, “The color and expression on your face tell me that you have not taken the decoction. Why did you not take good care of your life?” Mr. Wang did not reply. Sure enough, Mr. Wang’s eyebrows fell out 20 years later, which was exactly what [Zhang] Zhong-Jing had predicted, and Mr. Wang died 187 days after the falling out of his eyebrows.9
Jiang You-Li agrees about the influence of Daoism on Zhang Ji:
Alchemy was very popular in the Western Han and Eastern Han Dynasty because of the close relationship between medicine and Daoism. The famous physicians and their books must have been affected by this relationship and stamped with this practice. Zhang Ji could not have been any exception to this influence…Five Stones Decoction consisted of five stones, although we do not know what exactly these five stones were. But it must have been relevant to five-stone powder (also called cold-stone powder) and five-miracle pills, which was very popular during that time.10
In the preface of Discussion of Cold Damage, little is revealed about where Zhang Ji learned to make his 113 formulas, though the books that might be related to Chinese herbs in this preface are called “胎臚藥錄 tāi lú yào lù.” It is believed that these two books, which were written before Zhang Ji was born, are related to herbs used to treat women’s disorders.11 Fortunately, Huang Fu-Mi, who lived very close to the time when Zhang Ji lived,12 has offered valuable information about the origin of Zhang Ji’s formulas. In the preface of his book, Acupuncture Jia and Yi Classic published c. 256 AD, he wrote that “[Zhang] Zhong-Jing has studied and developed the formulas from Classical Methods to Make Formulas (湯液經法 tāng yè jīng fǎ),13 and has written a book that has more than thirty chapters. The formulas recorded in his work are often effective in clinical practice.”14
According to Liu Yong-Min’s study, the three-chapter version of Classical Methods to Make Formulas, which Zhang Ji used as an important reference book, was written by some Daoist alchemists;15 therefore, it is reasonable to deduct that Zhang Ji’s writing was influenced by Daoism. Although Classical Methods to Make Formulas was available to readers during the Han Dynasty (206 BC to 220 AD) and the Northern and Southern Dynasties (420–589 AD), it seems that this book completely disappeared after the Song Dynasty (960–1279 AD), making it impossible to precisely know how Daoism influenced Zhang Ji’s writing and practice, especially in regard to creating his formulas. Fortunately, the Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs (輔行訣臟腑用藥法要 fù xíng jué zàng fǔ yòng yào fǎ yào), which contains a lot of important information (especially formulas from Classical Methods to Make Formulas), was rediscovered by Zhang Guang-Rong, a veterinarian, in 1918.
According to Wang Shi-Min, Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs was written by Tao Hong-Jing (also known as Tao Tong-Ming, 456–536 AD) and his followers, all of whom were Daoists,16 between the Northern and Southern Dynasties and the Tang Dynasty (420–907 AD), and the formulas in it were adapted from Classical Methods to Make Formulas. In Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs, Tao Hong-Jing, a Daoist medical practitioner who lived a couple of hundred years after Zhang Ji, first proved what Huang Fu-Mi had said in the preface of Acupuncture Jia and Yi Classic—that Zhang Ji had followed Classical Methods to Make Formulas in developing his formulas. Tao wrote:
During the Han Dynasty (206 BC to 220 AD) and Jin Dynasty (265–420 AD), all well-known physicians, such as Zhang Ji, Wei Si, Hua Yuan-Hua,17 Wu Pu,18 Huang Fu Xuan Yan,19 Zhi Fa-Shi, Ge Zhi-Chuan,20 Fang Jiang-Jun and others were all people of virtue, and all of them studied and followed Classical Methods to Make Formulas, diligently treating illness and benefiting mankind. They modified the formulas in this book and either specialized or found new applications for these formulas. Their practice seems not to have complied with the classic texts, but their objectives were in accordance with medical guidelines.21
But what did Zhang Ji actually learn from this book? Tao Hong-Jing answered as follows:
There are two dan formulas, six-gods22 formulas, big and small formulas in Classical Methods to Make Formulas to treat externally contracted diseases and contagious diseases. In the past, Zhang Ji, who was from Nanyang county, adapted these formulas and wrote Discussion of Cold Damage. Since his book offers detailed treatment approaches, it has been well respected and followed by subsequent scholars and practitioners.23
What is the relationship between the two dan formulas, six-gods formulas and the major and minor formulas in Classical Methods to Make Formulas and the formulas in Discussion of Cold Damage? Wang Shi-Min states the following in his study on this question:
There are 56 formulas recorded in Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs, among which…two dan formulas include five formulas (major, minor, yin and yang dan, and right yang dan decoctions), six-gods included 12 formulas [two types for each] (six gods: bluegreen dragon, white tiger, red bird, black warrior, hook old, flying snake)…Minor Yang Dan Decoction in Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs is identical to Cinnamon Twig Decoction (guì zhī tāng) in Discussion of Cold Damage…24
Table 3.1 provides a comparison (with slight adjustments) among the formulas in Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs and Discussion of Cold Damage.
Based on Table 3.1 and the discussion above, it is clear that most important formulas in Discussion of Cold Damage, such as Cinnamon Twig Decoction (guì zhī tāng), White Tiger Decoction (bái hǔ tāng), Ephedra Decoction (má huáng tāng), Decoction to Drain the Epigastrium (xiè xīn tāng), Major Bluegreen Dragon Decoction (dà qīng lóng tāng), Minor Bluegreen Dragon Decoction (xiǎo qīng lóng tāng), Coptis and Ass-Hide Gelatin Decoction (huáng lián ē jiāo tāng), Scutellaria Decoction (huáng qín tāng), Minor Bupleurum Decoction (xiǎo chái hú tāng) and True Warrior Decoction (zhēn wǔ tāng), are indeed very similar to their counterparts in Classical Methods to Make Formulas. Since both Huang Fu-Mi and Tao Hong-Jing mentioned that Zhang Ji developed his formulas based on Classical Methods to Make Formulas (湯液經法 tāng yè jīng fǎ), which was written earlier than Discussion of Cold Damage, and there are so many similarities among the formulas in these two books, the conclusion can be made that the formulas in Discussion of Cold Damage stemmed from Classical Methods to Make Formulas, i.e. Classical Methods to Make Formulas is the major source for formulas in Discussion of Cold Damage. What is more, this relationship has demonstrated that Zhang Ji was indeed influenced by Daoism, as bluegreen dragon, white tiger, red bird and black warrior are four gods worshiped by Daoists.
What is the difference between Black Warrior Decoction in Classical Methods to Make Formulas and True Warrior Decoction in Discussion of Cold Damage? In fact, they are similar in terms of meaning and their ingredients. One of the differences between them is the name has something to do with the taboo of using the personal names of emperors in Chinese history (see line 82 in section two of Discussion of Cold Damage for further details). If one reads Discussion of Cold Damage carefully, one should notice that Zhang Ji mostly used the names of herbs for naming the formulas. But why did he have such practice in the regard of naming the formulas? Tao Hong-Jing first offered a relatively reasonable answer to this question. He wrote that “Zhang Ji avoided using the Daoist name when writing Discussion of Cold Damage. Therefore, the formula he recorded did not bear the original Daoist name; rather, he named it after herbs, using chief herbs to name formulas.”26 It was a tradition to use chief herbs to name formulas between the Qin and Han Dynasties. For example, the authors who wrote The Yellow Emperor’s Inner Classic had methods to name formulas such as Pinellia Decoction in Chapter 71 of Spiritual Pivot. In the case studies from Chun Yu-Yi, a well-known physician early in the Western Han Dynasty, there were formulas named after herbs such as “Pinellia Pill” and “Scrophlaria Decoction.”25 Therefore, it was reasonable for Zhang Ji to follow this tradition and name a formula after the chief herb in the formula. However, Zhang Ji did not completely give up all four-god decoctions in Daoism that are in charge of wind, dryness, fire and water. He used three of them for naming the formula, i.e. Bluegreen Dragon Decoction for wind, White Tiger Decoction for dryness and Black Warrior Decoction, which is changed to True Warrior Decoction in the later version of this book, for water, but he did not use Red Bird Decoction for fire, though there is Ass-Hide Gelatin Decoction (huáng lián ē jāo tāng) for fire. Apparently, Zhang Ji was hesitant to completely follow Classical Methods to Make Formulas and use Daoist names for naming all these formulas related to the four gods in Daoism.
Why did Zhang Ji struggle with this issue? In order to answer this question, one must review the cultural landscape in which Zhang Ji lived when he started to write Discussion of Cold Damage. As mentioned above, the doctrine of Confucianism had become the ruling ideology since 134 BC and the influence of Daoism was much less in various aspects. Zhang Ji grew up in this situation and became fond of Confucianism when he was a teenager. But this does not mean that Daoism disappeared from his mind, his practice and his writing. In fact, Daoism was revived at the end of the Eastern Han Dynasty when Zhang Ji started to learn Chinese medicine from the books that contain the profound philosophy of Daoism such as The Yellow Emperor’s Inner Classic and Classical Methods to Make Formulas. At the end of the Eastern Han Dynasty, especially in 184 AD, there was a famous peasant uprising which was organized by a network of Daoists. Therefore, on one hand, as a commissioner of Changsha county, an official of government who was supposed to follow Confucius’ doctrine, Zhang Ji had to deal carefully with something that was relevant to Daoism, and on the other hand, he did believe that ideas from Daoism were good for preserving the people’s heath, because in the statement in the preface of his work he put forward that to study and practice medicine is to “take care of one’s health as the center for preserving life,” which reflects some ideas from Daoism. This is probably why he did not use all Daoist names from Classical Methods to Make Formulas to name formulas in Discussion of Cold Damage and did not mention that book as one of his references in the preface of his work.
Like discussing the influence of Confucianism, the impact on Zhang Ji’s writing by Daoism can also be found in the text of Discussion of Cold Damage. One of the most important schools of thought in Morals Classic (道德經 dào dé jīng) is to follow the principles of nature. In Chapter 25 of Morals Classic (道德經 dào dé jīng), Lao Zi (also known as Li Er or Li Dan, c. 471 BC) pointed out that “man follows the earth. The earth follows heaven. Heaven follows the Tao. Tao follows what is natural.”26 Following Lao Zi’s thought, Zhang Ji attached great importance to the natural healing ability of the human body when treating various kinds of diseases. In Discussion of Cold Damage, there are as many as 11 lines devoted to “automatic recovery,” which demonstrates that Zhang Ji had noticed the potential ability of the human body to heal itself. He had not only noticed this self-healing ability but also observed that the human body is capable of finding natural ways to get rid of pathological factors, which are the promotion of sweating, promotion of vomiting, promotion of urination, purging and bleeding. In his book, Zhang Ji has 25 lines that use the characters “愈 yù” or “解 jiě,” which mean “recovery,” from the natural approach to eliminate pathological factors, for which there are ten lines related to promotion of sweating, seven lines related to purging and one line related to the promotion of urination. Of course, if one does not count on these characters in place of the formulas he recommended and one analyzes these treatment approaches, all 113 formulas can be viewed as following the body trend or natural way to eliminate pathological factors. Moreover, recognizing such potential healing ability in the human body, Zhang Ji discusses how to predict when a disease is about to resolve in 25 lines of his book.
Besides the thought to follow the principles of nature, reverse thought in Morals Classic (道德經 dào dé jīng) is another one to influence Zhang Ji’s differentiation of disease in Discussion of Cold Damage. Reverse thought stresses mutual dependence and mutual transformation in two things that are opposed to each other. It requires one to view an objective from the opposite angle, which might be completely opposite to the direction of the movement of this objective, and to verify one thing through disapproving another thing. Lao Zi discusses this kind of thought in many chapters of Morals Classic (道德經 dào dé jīng). For example, in Chapter 2, he points out:
Under heaven all can see beauty as beauty only because there is ugliness. All can know good as good only because there is evil. Therefore, having and not having arise together. Difficulty and easy complement each other. Long and short contrast each other, high and low rest upon each other; voice and sound harmonize each other; front and back follow one another.27
In Chapter 58, Lao Zi writes: “Happiness is rooted in misery. Misery lurks beneath happiness.”28 In Chapter 40, he writes: “Returning is the motion of the Tao.”29 In Chapter 78, he writes: “A positive word sounds like a negative word.”30
Life is a process during which one disapproval comes after another disapproval. Because of this continual disapproval, one is born, grows, matures, gets old and dies. Likewise, the pathology of the disease process is the disapproval for normal physiology in the human body. In Chinese medicine, we often know the normal function of zang-fu organs through their clinical manifestations due to their dysfunctions, i.e. through their disapprovals. In fact, progression or regression of a disease is also the process of one disapproval coming after another disapproval. Carefully searching and studying a symptom or sign that disapproves of or disagrees with the previous one or other symptom and sign is a key to identifying this progression or regression in various kinds of diseases. Deeply understanding this philosophy stemming from Daoism, Zhang Ji created a special sentence which is called the sentence of showing manifestation that is opposite to the common condition and/or is unexpected according to regular thinking (反見證 fǎn jiàn zhèng). The way for him to present this reverse thought in his writing is to use the character “反 fǎn” or “復 fù,” which can be translated as “but,” “rather than,” or “instead.” For example, in line 287, Zhang Ji writes:
In shao yin disease, there is a tight pulse. On the seventh or eighth day, there is automatically diarrhea, and the pulse suddenly becomes feeble, but the hands and feet become warm and the tight pulse is gone. This indicates that the disease is about to resolve. Although there is vexation and diarrhea, there will be automatic recovery.
In this line 287, Zhang Ji demonstrates what a key role the disapproval or disagreeable and unexpected symptom or sign plays in disease differentiation in his clinical practice. Yes, a feeble pulse indicates yang deficiency in shao yin deficiency, but it does occur after the tight pulse, which disapproves of or disagrees with the other symptoms and signs of yang deficiency and is unusual. Yes, the hands and feet should be cold as there is yang deficiency in shao yin disease, but the hands and feet become warm instead, which also disapproves of or disagrees with the combination of diarrhea and a feeble pulse or other symptoms and signs that might relate to yang deficiency, and the presentation of warm hands and feet is unusual. When analyzing these two symptoms and signs in combination, Zhang Ji would naturally know that yang qi is in the process of recovery. This is why he predicts that the disease is about to resolve though there is vexation and diarrhea. One must also learn that it is crucial to dynamically observe the change in symptoms, signs and pulses clinically for precise differentiation in time. According to my study, Zhang Ji deliberately used this special sentence in Discussion of Cold Damage to detect progression or regression of diseases. There are as many as 37 lines (more than 8% of the lines of this classic) devoted to this kind of thought: lines 11, 23, 24, 68, 89, 90, 104, 105, 110, 120–123, 126, 130, 136, 141, 182, 196, 215, 279, 287, 292, 301, 317, 322, 333–335, 341, 342, 347, 362, 363, 369, 377 and 384.
Knowing there is a possibility for such disapproval or disagreeable and unexpected symptoms or signs that present during the progression of a disease, Zhang Ji tried to exclude these symptoms or signs to determine whether or not a disease had progressed from one conformation to another. For example, in line 5, he writes that “neither yang ming syndrome nor shao yang syndrome is observed, though Cold Damage has been going on for two or three days. This indicates that there is no progression in tai yang disease.” Such practices have been seen not only in disease differentiation but also in treatment approach. Zhang Ji used this thought to remind us of what treatment should be employed, what treatment should not be used, and what the consequence would be if the wrong treatment were applied. For example, in line 34, Zhang Ji states:
A syndrome in tai yang disease that should be treated by Cinnamon Twig Decoction (guì zhī tāng) is purged instead. Consequently, incessant diarrhea ensues. If a cu pulse is felt, it indicates that the exterior syndrome has not been resolved; if there is panting and sweating, Pueraria, Scutellaria and Coptis Decoction (gé gēn huáng qín huáng lián tāng) should be prescribed.
Yes, wrong treatment should not be done in light of the theory of Chinese medicine. However, since there is always limitation for practitioners in the regard of their knowledge and skill, it is possible for them to make mistakes in differentiation and treatment when dealing with a disease. Knowing such possibilities (disapproval or disagreement with correct treatment) as much as possible, one cannot only avoid making the same mistakes but also learn what the consequences would be from this wrong treatment and get a clue as to what treatment would be appropriate for correcting these mistakes. Of course, our disease differentiation and treatment skills will be much improved by going through this process. In Chinese society, there is a famous proverb which states that “failure can be the mother of success.” This is why Zhang Ji spent so much time and used so many lines to discuss deteriorated syndromes due to wrong treatment. Unfortunately, such wonderful skills in Discussion of Cold Damage stemming from reverse thoughts in Daoism have been largely ignored by contemporary scholars and practitioners. Now, the time has come to repay a visit to this insightful school of thought, that is, we must improve our study of Discussion of Cold Damage in order to make our treatment more effective in the clinic for various kinds of diseases.
Exploring the cultural landscape for writing Discussion of Cold Damage has been the only purpose of this chapter. Studying and understanding this cultural landscape, especially the philosophy that influenced Zhang Ji when he was writing this classic, is to open another window for readers to truly understand the content of Discussion of Cold Damage instead of only elaborating this classic according to contemporary theory in Chinese medicine. Understanding this can bring our knowledge to a deeper level and eventually improve our disease differentiation and treatment skills in our daily practice.
1Jia-Fu Feng and Jane English. Tao Te Ching. New York: Vintage Books, 1972: 57
2Although the “Han Dynasty” is referred to in the title, Historical Book for the Han Dynasty only covers the Western Han Dynasty. The book is considered to be written by Ban Gu, but he did not finish the book before he died so it was completed by his sister, Ban Zhao, and another scholar, Ma Xu.
3Zhang Heng-Liu et al. Explanation and Clinical Application for Discussion of Cold Damage (shāng hán lùn jiě dú yǔ lín chuáng yìng yòng). Shanghai: Publishing House of Shanghai University of Traditional Chinese Medicine, 2006: 2
4Li Fang et al. Book Review by Emperor in Tai Ping era (tài píng yù lán). Beijing: Chinese Publishing House, 1960: 3197
5Gao Da-Lun. Study on Qi Cultivation: Book on Bamboo Slips Dug from Tombs in Han Dynasty at Zhang Jia Mountain (zhāng jiā shān hàn jián yǐn shū yán jiū). Chengdu: Bashu Publishing House, 1995: 63
6Jia-Fu Feng and Jane English, op. cit., p.10
7Craig Mitchell et al. Shāng Hán Lùn on Cold Damage. Brookline: Paradigm Publications, 1999: 31
8Li Wen-Bo. General Explanation for the Book of Changes (yì jīng tōng jiě). Beijing: China Publishing House of Contributing to Public, 2008: 326
9Huang Fu-Mi. Acupuncture Jia and Yi Classic (zhēn jiǔ jiǎ yǐ jīng). Shanghai: Business Publishing House, 1955: 1
10Jiang You-Li. Taoist Culture and Chinese Medicine (dào jiā wén huà yǔ zhōng yī xué). Fuzhou: Fu Jian Science and Technology Publishing House, 1997: 213
11Guo Zhong-Guo. “Preliminary exploration of the meaning of Tai Lu and Yao Lu.” Forum for Doctors to Practice Chinese Medicine, 2001 (1): 52
12According to Du Yu-Mao, Zhang Ji was born c. 151 AD and died c. 220 AD. See Du Yu-Mao, “Exploration of several issues related to Zhang Ji’s life.” Journal of Shanxi College of Traditional Chinese Medicine, 1982 (2): 38
13There is general agreement that Classical Methods to Make Formulas (tāng yè jīng fǎ) was written by Yi Yin, a famous minister of the early Shang Dynasty (c. 1600 BC). According to Liu Yong-Min (see footnote 15), however, Classical Methods to Make Formulas (tāng yè jīng fǎ), which had 32 chapters as recorded in Record of Art and Culture of the Han Dynasty (hàn shū yì wén zhì), was not written by Yi Yin; instead, it has only three chapters and was written after the time when Materia Medica by Shen Nong (shén nóng běn cǎo jīng) was written but before Zhang Ji’s work was written.
14Huang Fu-Mi. Acupuncture Jia and Yi Classic (zhēn jiǔ jiǎ yǐ jīng). Shanghai: Business Publishing House, 1955: 1
15Liu Yong-Min. “A study of Classical Methods to Make Formulas and Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs: Discussing the great influence of early Taoist culture on traditional Chinese medical science.” Dunhuang Research, 2010 (3): 60
16Wang Shi-Min. “Exploration of the relationship among Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs, Classical Methods to Make Formulas and Discussion of Cold Damage and Miscellaneous Diseases.” Journal of Traditional Chinese Medicine, 1998 (11): 694
17Hua Yuan-Hua was an honorific name for Hua Tuo.
18Wu Pu was a student of Hua Tuo.
19Huang Fu Xuan Yan was an alias for Huang Fu-Mi.
20Ge Zhi-Chuan was a style name for Ge Hong (also known as Ge Ya-Chuan), a Taoist medical doctor who lived c. 284–364 AD.
21Yi Zhi-Biao et al. Study on Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs (fù xíng jué zàng fǔ yòng yào fǎ yào yán jiū). Beijing: Learning Garden Publishing House, 2009: 16
22According to Wang Xue-Tai, a scholar who was in charge of reconstructing this book in the early 1970s, “there are only four classic formulas recorded in this book. The six-gods formula appears to have been mistaken for the four-gods formula.” See Wang Xue-Tai, Textual Research, Commentary and Annotation for Rhymed Formula for Keys to Employ Herbs According to Zang-fu Organs (fù xíng jué zàng fǔ yòng yào fǎ yào jiào zhù). Beijing: People’s Military Medical Press, 2008: 28
23Yi Zhi-Biao et al., op. cit., p.20
24Wang Shi-Min, op. cit., p.694
25Han Zhao-Qi. Commentary on Historical Records (shǐ jì pǐng zhù běn). Changsha: Yue Lu Press, 2004: 1415–1416
26Jia-Fu Feng and Jane English, op. cit., p.50
27Ibid., p.3
28Ibid., p.105
29Sha Shao-Hai and Xu Zi-Hong. Complete Translation of Lao Zi (lǎo zǐ quán yì). Guiyang: Guizhou People’s Publishing House, 1989: 80
30Ibid., p.158