Mitchell, C. 1999, 'Introduction', in C. Mitchell, Y. Feng & N.

Wiseman, Shang han lun = On cold damage: translation and

commentaries, Paradigm Publications, Brookline, MA, pp.1-19.

Introduction

The Shiing H an Lun ({%~it "On Cold Damage") is the oldest survlVlng, the
most copiously commented, and the most revered Chinese medical text devoted to
externally contracted disease (j~~(pq wai gan bing). It also presents the oldest
extant systematized body of knowledge concerning the origin and development of
such diseases and their treatment, not by acupuncture, but principally by a highly
sophisticated use of medicinals combined in formulae that are skillfully modulated
to deal with a vast variety of disease manifestations.
The Shiing Han Lun originally formed part of the now inextant Shiing Han Za
Bing Lun ({%~~(pqi-Q: "On Cold Damage and Miscellaneous Diseases"), a com-
prehensive clinical manual written by the Eastern Han physician Zhang JI (circa
150-219 C.E. ). The sections relating to externally contracted disease, which Zhang
JI ascribed chiefly to contraction of wind and cold ("cold damage"), were reorga-
nized by Wang Shu-He (.:E,f;(ffi) (210-285) in the Wetrtern Jin period (265-316) to
form the Shiing Han Lun, and the sections relating to other diseases of internal me-
dicine ("miscellaneous diseases") were later arranged to form the Jzn Gui Yao Lue
(.~~~W! "Essential Prescriptions of the Golden Coffer"). Wang Shu-He's origi-
nal version of the Shiing Han Lun has been lost, but several versions were handed
down to the Song period (960-1279), when the text was edited and printed. Medical
scholars of the Song onwards showed great interest in the text and produced a large
body of commentary. The corpus of knowledge concerning "cold damage" that has
been passed down to us is a large and complex elaboration of Zhang JI's original
ideas, to which many medical writers have contributed over the last millennium. In
the Ming and Qing Dynasties, the Shiing Han Lun further provided the basis for
a new systematic analysis of externally contracted disease, the doctrine of warm
disease (U!(pq'$:i.)l, wen bing xue shuo), in which heat rather than cold was identi-
fied as the major cause of disease. Despite the ~mergence of this new doctrine, the
Shiing Han Lun has never been eclipsed, and in the curricula of Chinese medical
schools in China today, it occupies an equally if not more important place.
The Shiing Han Lun's descriptions of externally contracted diseases and their
treatment reflect a theoretical understanding which ostensibly descends from the
Huang Di Nei Jzng (~W j7;J g "The Yellow Emperor's Inner Canon"), Nan Jzng
(Xi~ "The Classic of Difficult Issues") and Ben Cao Jfng ( :;$: 1f!: t "The Materia
2 INTRODUCTION

Medica Canon"), but which evinces major advances in the integration of theo-
retical knowledge with clinical observation and practice. In the Shiing Han Lun,
externally contracted disease in all its varied manifestations and possible courses is
understood in terms of evils, most notably wind and cold, which invade the body
from outside and pass through the channels and network vessels (;~~ jfng luo),
causing disturbances of aspects of bodily function that can be recognized by dis-
tinct constellations of signs known as ilE zheng, "patterns." Each pattern can be
treated by a variety of methods (sweating, vomiting, precipitation, harmonization,
warming, clearing, dispersion, and supplementation), using medicinal drugs that
are combined on the basis of their therapeutic effects into a limited number of for-
mulae whose constituents can be varied to address different presentations. It is for
this reason that the Shiing Han Lun is regarded as the basis of the approach to
diagnosis and treatment that in the Qing dynasty came to be called "determining
treatment on the basis of patterns identified" (JhiEi-Q:~ bian zheng lun zhi), which
is now considered to be the quintessence of Chinese medical genius, yet is somewhat
erroneously regarded as having been the mainstream of healing practices in China
since time immemorial.

THE AUTHOR

Zhang JI, whose style was Zhong-Jing (11flit), lived in the Eastern Him (:Jf-rX
dong hdn) Dynasty, from circa 150 to 219 C.E. No record of him from his own time
survives, and the earliest records date from the Jln Dynasty. He is believed to have
been born in Nie-Yang (~~S) in what is today Nan-Yang (1HS) county of He-Nan
(7iiJlJ) Province. According to Song records, he was the Grand Protector (::t"f tai
shOu) of Chang-Sha (-K rY).
As to Zhang JI's medical training, we have little definitive knowledge. He is
believed to have studied medicine under Zhang B6-Zu (5JE18t!l.). Nevertheless, what
texts he studied, indeed what texts were available to him, are not fully known.
In the Zhen Jiii. Jiii Yi Jfng ("The Systematized Canon of Acupuncture and
Moxibustion"), Huang-Fu Ml ( ffilj) states that Zhang JI (5H!l, style {!flit Zhong-
Jing) had expanded the (no longer extant) Yf Yin Tang Ye ("YIYin's Decoctions")
into several tens of fascicles, providing very effective remedies, and that Imperial
Physician Wang Shfi-He, in reediting and selecting from Zhang JI's work, enhanced
its essence. '
Huang-Fu Ml elsewhere expresses his high opinion of Zhang JI's medical skills
with the following anecdote:

(Zhong-Jing] had an audience with the Privy Secretary (1'tf $ shi zhiing)
Wang ZhOng-Xuan (:::Efljl'lif), who that year was over twenty. He said to him,
"Sir, you are sick. [At the age of] forty, (your] eyebrows will fall out and
within half a year [you] will die. If (you] take Five Stones Decoction now,
(you] can avoid [this]. Wang ZhOng-Xuan took his words as an offense, (and
although] he accepted the formula, did not ingest it. Three days later, upon
seeing Wang ZhOng-Xuan, Zhong-Jing asked, "Have you taken the formula?"
Wang Zhong-Xuan replied (that he had] already taken it. ZhOng-Jing said,
"(Your] complexion is not that of (one who] has taken [a medicinal] decoction.
Why (do you thus] make light of (your] life?" Wang ZhOng-Xuan remained in-
 INTRODUCTION 3

credulous. Twenty years later, sure enough, [Wang ZhOng-Xuan's] eyebrows

did fall out, [and] on the 187th day he died. [Thus], in the end, it was as
[ZhOng-Jing had] said.

As to Zhang JI's personal motive for writing Shang Han Za Bing Lun, we know
that during the final years of the Eastern Han Dynasty, continual war and strife led
to the outbreak of many epidemics. According to Zhang JI's original preface, which
is not fully authenticated (seep. 29), we learn that he apparently lost approximately
two thirds of his family members during this period and he reported that seven
tenths of these deaths were due to externally contracted disease. He sought the
counsel of ancient books, reviewed the remedies applied in his time, and combined
these findings with his own clinical experience. Out of that process grew the sixteen
fascicles of Skiing Han Za Bing Lun.

THE HISTORY OF THE TEXT

The original Shiing Han Za Bing Lun covered a broad area including the inter-
pretation of pulses, cold damage and six channel pattern identification of treatment,
miscellaneous disease (including women's and children's disease), and dietary con-
traindications. The text of the Skiing Han Za Bing Lun did not survive the turbu-
lence of the Three Kingdoms period (220-265) fully intact, but in the Western Jln
period which followed, Wang Shu-He collected and arranged surviving fragments,
and is believed to have organized all the parts relating to externally contracted
disease into the book we know as the Shang Han Lun. From the various extant
versions of the text and parts of it included in other works, it is no longer possible
to determine the exact contents and sequence of either the Shang Han Lun or Shiing
Han Za Bing Lun. Wang Shu-He included elements of the Shang Han Lun in his
Mai Jzng ("The Pulse Canon"), but in the order of methods of treatment. Modern
scholars believe that this is most likely to have been the order of Skiing H an Za
Bing Lun and that, in the creation of the independent Skiing Han Lun, the contents
dealing with externally contracted disease were reordered to follow the sequence of
the channels.
During the upheavals of the Eastern Jln and Northern and Southern dynasties,
the Skiing Han Lun text was not widely available. In the Tang Dynasty, Sun
SI-Miao (f1J,,~,~) drew from the Skiing Han Lun in Bei Ji Qian Jzn Yao Fang
("A Thousand Gold Pieces Prescriptions for Emergencies"), but the full text was
apparently not available to him until later. When compiling the Qian Jzn Yi Fang
("Wings to the Thousand Gold Pieces Prescriptions") toward the end of his life, he
included most of the text, and this therefore constitutes the earliest known version
of the Skiing Han Lun.
Since the W di Tai Mi Yao ("Essential Secrets from Outside the Metropolis")
quotes over 200 lines of the Shang Han Litn, we infer that its author, Wang Tao
(.:.~) (707-772 c.E., Tang), placed great emphasis on the contribution of the
Shang Han Lun to the understanding of externally contracted disease. The first
fascicle gives the views of eight medical scholars on the Shiing Han Lun, while
the second brings together the views of different scholars on twenty cold damage
patterns. Wang Tao's importance with regard to the Shang Han Lun thus lies in
his presentation of a diverse group of pre-Tang writings discussing the Skiing Han
4 INTRODUCTION

Lun. Nevertheless, he did influence later scholars greatly since he did not include
the full text, but only quoted it.
In the Song Dynasty, the government established a Medical Literature Editing
Bureau (~ IE ~ ~ JijJ jiao zkeng yf skii ju) responsible for collecting, editing, and
publishing medical works, which now, with the invention of wood-block printing,
could enjoy a wider circulation than had previously been possible. The Bureau's
official version of the Skiing Han Lun was prepared under the supervision of Lin
Yl (#fZ.) and subsequently published. Unfortunately, no copy of this first printing
survives, and the earliest extant text is a Ming reprint (1056 C.E.) by Zhao Kai-Mei
(~ 7f ~ ), which nevertheless is believed to be identical. The term "Song version"
now refers to this.
The Song version contains more than most modern versions of the Skiing H an
Lun. Ming scholars argued that the first four and the last seven fascicles should
be discarded on the grounds that they contained matter that either did not relate
to externally contracted disease or that was more representative of Wang Shu-He's
thought than Zhang JI's.

THE RELATioNsHIP oF THE SHA.Nc HA.N LiJN To THE su w:EN

In his original preface, Zhang JI mentions a number of books he had studied.

All of these but the Nei Jfng and the Nan Jzng are no longer extant. Consequently,
our picture of the theoretical origins of the Skiing H an Lun is not entirely clear.
The Nei Jzng devotes considerably more text to discussion of externally contracted
disease than the Nan Jzng, and given the importance accorded to it over history,
considerable effort has been made to tie the theories of the Skiing Han Lun in with
it.
Below we present three passages from the Su Wen ("Elementary Questions"),
the first part of the Nei Jzng, discussing externally contracted disease:

Su Wen (Re Lun):

The Yellow Thearch says: Now [as we know], all heat [effusion] disease is
of the cold damage category....
Qi-B6 says:
On the first day of cold damage, greater yang (ju yang) is affected, and
signs include stiffness and pain in the head and nape, and stiffness in the
lumbar spine.
On the second day, yang brightness (yang ming) is affected. Since the
yang brightness governs the flesh, and its channel passes up the side of the
nose to connect with the eyes, there is generalized heat effusion (i.e., fever),
eye pain, and dry nose.
On the third day, the lesser yang ( shao yang) is affected. Since the lesser
yang governs the gallbladder, and its channel passes through the rib-side
and connects with the ears, signs include pain in the chest and rib-side, and
tinnitus.
On the fourth day, the greater yin ( tai y'in) is affected. Since the greater
yin channel passes through the stomach and connects with the throat, signs
include fullness in the stomach and dry throat.
 INTRODUCTION 5

On the fifth day, the lesser yin ( shao yzn) is affected. Since the lesser yin
channel passes through the kidney, connects with the lung, and penetrates
through to the root of the tongue, signs include dry mouth and tongue, and
thirst.
On the sixth day, the reverting yin (jue yzn) is affected. Since the revert-
ing yin channel passes through the genitals and connects with the liver, signs
include agitation and retracted scrotum.

Su Wen (Yin Yang Ylng XHmg Da Lim):

[When there are] irregularities of joy and anger, and excesses of heat and
cold, life is insecure. Hence weighted yin must [become] yang, and weighted
yang must [become] yin. Therefore it is said that in winter [there is] damage
by cold and in spring there must disease [caused by] warmth.

Su Wen (Tiao Jing Lun):

The Thearch says: The classics say that when yang is vacuous, there
is external cold, when yin is vacuous, there is internal heat; when yang is
exuberant there is external heat, when yin is exuberant there is internal cold.
I have already asked about this, [but] I do not know why it is so.
Qi-B6 says: Yang receives ql from the upper burner to warm the area of
the skin and the divided flesh. Now, [when] cold ql is in the outer body, the
upper burner is blocked. When the upper burner is blocked, cold ql alone
remains in the outer body, hence there is cold shivering.
The Thearch says: What ofyin [being] vacuous [and] engendering internal
heat?
Qi-B6 says: [When] there is taxation fatigue, the body's ql becomes de-
bilitated, and grain ql is not exuberant; the upper burner fails to move, and
the lower [stomach] duct is blocked; stomach ql is hot, and heat ql fumes into
the chest, hence there is internal heat.
The Thearch says: What of yang [being] exuberant and engendering ex-
ternal heat?
Qi-B6 says: When the upper burner is blocked and inhibited, the skin
becomes tight, the interstices become blocked, and the mysterious houses
[sweat pores] are blocked, [so that] defense ql cannot discharge outward; hence
there is external heat.
The Thearch says: What of yin [being] exuberant [and] engendering in-
ternal cold?
Qi-B6 says: Reverse ql ascends counterflow, cold ql accumulates in the
chest and does not drain [away]; [because] its does not drain [away], warm
ql departs; cold alone remains, so blood congeals; [when blood] congeals,
the vessels become blocked, and the pulse becomes exuberant and large, and
rough; hence [there is] cold strike.

From the first of these quotations, we see that the Nei JZng agrees with the
Shiing Han Lun in categorizing heat disease as cold damage, and in understanding
cold damage as a progression through the six channels. The names of the channels
are the same except that greater yang is referred to as JB ju yang in the Nei Jfng.
6 INTRODUCTiON

Furthermore, the two texts both ascribe unique sets of signs to disease in each of
the channels. Nevertheless, they agree only partially on which signs are associated
with each channel. In the comparison set out below, we provide full enumerations
of the channel disease signs listed in the Nei Jzng, but, for the sake of simplicity,
we have chosen only the main signs given in the Skiing Hdn Lun.
Greater yang
N J: Stiffness and pain of the head and nape; stiff lumbar spine
SH: Floating pulse; stiffness and pain in the head and nape; aversion to cold; heat
effusion
y ang brightness
N J: Generalized heat effusion; eye pain; dry nose; sleeplessness
SH: Generalized heat effusion; spontaneous sweating; thirst with desire to drink;
dry bound stool; tidal heat effusion; delirious speech
Lesser yang
NJ: Chest and rib-side pain; deafness
SH: Bitter taste in the mouth; dry throat; dizzy vision; chest and rib-side fullness;
alternating [aversion to] cold and heat [effusion]
Greater yln
NJ: Abdominal fullness and dry throat
SH: Abdominal fullness; vomiting; inability to get food down; diarrhea; periodic
abdominal pain
Lesser yln
NJ: Dry mouth and tongue with thirst
SH: Pulse that is faint and fine; desire only for sleep; aversion to cold; lying curled
up; counterflow cold of the extremities
Reverting yln
NJ: Vexation and fullness; retracted scrotum
SH: Dispersion-thirst; ql surging up into the heart; pain and heat in the chest;
hunger with no desire to eat; vomiting of roundworms after eating; incessant
diarrhea

The signs differ in that in the Nei Jzng they are all classifiable as heat or
repletion; in the Skiing Hdn Lun, repletion and heat signs are associated with three
yang, while cold and vacuity signs are associated with the three yin. The Skiing
Hdn Lun therefore envisages a much larger scope for externally contracted disease.
Furthermore, by associating heat and repletion patterns with the three yang, and
cold and vacuity signs with the three yin, it represents a more systematic application
of the yin-yang doctrine.
The signs given in the Su Wen are clearly associated with the channel pathways
(or associated with the bowels and viscera to which the channels home). Those given
in the Skiing Hdn Lun are less consistently associated with particular locations on
channel pathways. For example, the signs given for greater yang in the Su Wen
are located on the pathway of the greater yang channel (stiffness and pain of the
 INTRODUCTION 7

head and nape, stiff lumbar spine); those given in the Shiing Han Lun (floating
pulse, stiffness and pain in the head and nape, aversion to cold, heat effusion) are
predominantly general exterior signs. Such differences prompted Mei Chun-Hua (~
ff~) to comment, "One cannot use the six channels ... of the Su Wen to explain
the six channels of Shang Han Lun."
A further major difference between the Shang Han Lun and Su Wen is seen in
the timing of passage from channel to channel. The Su Wen places the timing of
developments in the foreground, describing signs in a one-channel-per-day scheme.
The timing of channel passage in the Shang Han Lun is much more complex. Al-
though many lines state what signs occur at a specified number of days after onset,
the timing is much less rigid, and is certainly not one of daily change. Attempts
have been made to reconcile the differences in timing by suggesting that Su Wen
presents a standard pattern that is not always seen in practice. A more cogent view,
however, is that while the Su Wen statements represent a neat theoretical scheme,
Zhang JI worked from clinical observation. Although the degree to which numbers
of days given by Zhang JI are to be taken literally has given rise to much unresolved
debate, it is obvious that the Shiing Han Lun does not follow a one-channel-per-day
scheme.
We can therefore conclude that although similarities do exist between the Shiing
Han Lun and Su Wen, they are only partial, and that however much Zhang JI
drew on the Su Wen, the Shang Han Lun 'represents a thorough reworking of ideas
contained in it. Ke Qin sums up the differences in the following words:

In the Su Wen ("Elementary Questions"), the six channels [the three yin
and three yang] only have exterior and interior repletion and heat patterns, no
vacuity and cold patterns. As to treatment, we see only treatment by sweating
and precipitation, no use of supplementation and warming. In Zhong-Jing,
the six channels are broader in scope, including different aspects: cold, wind,
warmth, and heat evils; diseases caused either by external or internal evils;
the passage of diseases from exterior to interior; and diseases that are due
to cold or heat and to vacuity or repletion. The Shiing Han Lun is totally
inclusive.

A further major difference between the Nei Jzng and the Shang Han Lun lies
in the relative importance of drug and acupuncture therapy. The Nei Jzng provides
considerably more detail on needle therapy than on medicinal therapy, while the
reverse is the case in the Shiing Han Lun.

THE DEVELOPMENT OF SHANG HAN LUN THOUGHT

Before the appearance of the Song version, the value of the Shiing Han Lun
was asserted by influential figures in the development of Chinese medicine over
the centuries, such as Huang-Fii Mi (~ ffit~), Sun SI-Miao (f'J1,~,~), and Wang
Tao (~). According to Sun SI-Miao, in southern China in the 7th century
(Tang Dynasty), the Shiing Han Lun was jealously guarded by those who possessed
copies. In the 8th century (Tang Dynasty), it was designated as an examination
text for medical officials. Yet it was in the Song-Jin-Yuan (st:it:71:, 960-1368) that
the Shang Han Lun began to make its fullest impact. This is partly due to the
8 INTRODUCTION

invention of printing, which allowed the text to become widely available. More
importantly, however, developments in medical thought provided an environment
more conducive to the recognition of Zhang JI's ideas. Before that period, medicinal
therapy in general remained conservatively based on a pragmatic, symptomatic
approach.

Although they held their classic, the Han Shen-nung pents 'ao ching
[Shen N6ng Ben Ciio Jzng], in great respect, its insights represented only
a starting point for their own concerns and not, as was the case for
followers of the Huang-ti nei-chingjNan-ching [Huang Di Nei JzngjNan
Jzng], the ultimate and complete stage in a particular field of knowledge.
Unschuld 1985: 167

In the Song-Jin-Yuan, efforts were made to apply the yin-yang and five-phase
doctrines in the analysis of drug actions.

While the interest generated by Wang Shu-ho [Wang Shil-He] (210-285),

for example, in pulse diagnosis had been continued in more than seventy ti-
tles by the beginning of the Sung [Song] period, and while during the same
interval more than ninety works had been devoted to acupuncture and more
than fifty to physiology, not even ten authors followed the direction taken
by Chang Chi [Zhang JI]. It was only during the Sung [Song] and Chin [Jin]
epochs that a larger circle of scholars became interested in the surviving frag-
ments of Chang Chi; during the course of these two dynasties alone, so many
revisions or commentaries appeared on the problems of cold-related illness
that more than eighty titles have survived to the present day. The contrast
becomes even more striking when we compare the ten titles devoted specifi-
cally to the treatment of such illness written before the Sung period with the
more than three hundred encyclopedic works containing prescriptions for all
kinds of illness~s that appeared during the same time. The Chang Chi re-
naissance during the Sung-Chin-Yiian [Song-Jin-Yuan] era was due primarily
to two characteristics of his writings. To scholars of the twelfth, thirteenth,
and fourteenth centuries, it was significant that Chang Chi had been the
first to combine the use of drug therapy with the theory of systematic cor-
respondence. In addition, Chang Chi, with his interest in the effects of cold
on illness, was the first and virtually only author whose work was devoted
exclusively to a specific etiology. All authors of the Sung-Chin-Yiian medi-
cal texts adopted these elements, which had virtually lain dormant for some
1,000 years, as the point of departure for their own, further-reaching delib-
erations. Consequently, in almost all of their works, drug prescriptions and
theoretical considerations are linked on the basis of systematic correspon-
dence. Unschuld 1985: 168

Song scholars approached the Shiing Han Lun in a number of different ways.
In the early period after the publication of the Song version, scholars such as Pang
An-Shf (~3/:a-t, style 3(~ An-CMng) and Zhu Gong (*~tz;, style W$ Yl-ZhOng)
believed that since Zhang JI's original text had not survived intact and had been
reworked by Wang Shu-He and others, the Song version could be improved by re-
ordering the lines and filling in apparent gaps in the content. These scholars took
as their basis not only the text of the Shiing Han Lun but all of what had allegedly
 INTRODUCTION 9

survived from the Shiing Han Za Bing Lun. In some cases, they even introduced
parts of the Jfn Gui Yao Lue, and incorporated ideas concerning externally con-
tracted disease that had developed over the eight centuries since Zhang JI's time.
This approach, however, was eventually superseded by that of Cheng W u-Ji (PX: 7[: ~
), who believed that the Song version in its order and contents was, if not the origi-
nal text, the most faithful representation of Zhang JI's understanding of externally
contracted disease, and that the text could be made clearer by carefully researched
commentary. Cheng Wu-JI was highly influential because his Zhu Jie Shiing Han
Lun (tEMfh*it "Annotated Shiing Han Lun"), which contained the text of the
Song version altered in minor details and furnished with a detailed commentary,
came to replace the Song version.
Over recent decades, commentated editions of the Bhang Han Lun have estab-
lished a new order that makes the clinical study of the text much easier. This is
the sequence adopted in the present volume, although the Chinese text in Song
order is presented in Appendix I. In this new order, the basic six-channel order
of the Song version is retained, but the individual lines are ordered according to
the various formulae used. In the process of rearrangement, some lines appear in
a chapt!(r relating to a different channel than in the original Song version. Lines
that cannot be ordered according to this schema are related to appendixes, mostly
placed at the end of each chapter. Notably relegated to these appendices are lines
containing inconsistencies and ambiguous phrases, lines suspected of having been
added by transcribers, and lines that do not contain formulae or any clear indica-
tions as to where they might belong in the sequence. The meanings of such lines
have been subject to ceaseless debate among medical scholars over the centuries.
For students whose aim is a clinical grasp of the doctrine of cold damage, these
appended lines can be ignored. It should be noted that in the present volume the
lines are numbered according to their order in the Song version. Since these do not
coincide with the order of their appearance, a Song Version Line Number Index has
been included at the end of the book.

THE CONTENTS OF THE SHANG HAN LiJN

The Concept of Cold Damage

The term "cold damage" ({'f] * shiing hdn) has both broad and narrow mean-
ings. Su Wen states, "Now all heat diseases are of the cold damage kind." The
58th difficulty of the Nan Jfng states, "There are five [types of] cold damage: wind
stroke, cold damage, damp warmth, heat disease, and warm disease." According to
Zhang Zi-He (s:IE-Tffi), "In spring, it is warm disease. In summer, it is summer-heat
disease. In fall, it is malaria and diarrhea. In winter, it is cold ql and cough. In the
four seasons, all ql that is not right ql is called cold damage." The broad meaning
of cold damage is all externally contracted disease; the narrow meaning is external
contraction of wind-cold and the resultant diseases. The text of the Shiing Han
Lun provides a great deal of information regarding the pathological changes, pat-
terns, and treatment of diseases resulting from external contraction of wind-cold,
but more importantly, it deals with cold damage in the broad sense. It discusses
 10 INTRODUCTION

the six excesses as the cause of disease and combines internal and external factors
in an analysis of pathomechanisms, signs, and treatment.

Six-Channel Pattern Identification

The Skiing Han Lun attributes cold damage to the invasion " of the body by
evils such as wind and cold, and explains the vast variety of manifestations of cold
damage in terms of the way in which these evils affect various parts of the channel
and network vessel system. As a rule, evils first affect the greater yang ( tai yang),
and then, if the disease does not terminate there, they progress through the various
channels according to certain partially predictable patterns. In some cases, however,
' disease evils directly affect channels other than the greater yang.
Disease in any of the six channels takes the form of different disease patterns
that are reflected in various constellations of signs and pulse conditions. It is for
this reason that each chapter title contains the words "Pulses and Signs." These
disease patterns reflect certain specific etiologies.
The brief outline below presents the various patterns arising in disease of each
of the six channels. Readers should note that many of the technical terms appearing
in this outline are explained in the chapters ahead and may be accessed through
the index.
Greater Y ang Disease (::t ~B m tai yang bing): The greater yang controls
the construction and defense, and governs the exterior of the body, which serves
as the body's external barrier. Externally contracted evils usually first affect the
exterior. Accordingly, many of the signs associated with greater yang appear in the
early stages of disease. The essential features of greater yang disease are a pulse
that is floating, headache, stiffness and pain of the head and nape, heat effusion,
and aversion to cold.
The most important forms of greater yang disease exterior disease are wind
strike and cold damage, which are differentiated on the basis of the patient's con-
stitution and the strength of the evil. Wind strike ( $ JXl zhong feng) is attributed
to "construction-defense disharmony" (E J.! /f ffi ying wei bit M) characterized by
"strength in defense and weakness in construction" ( J.! 5$ g ~~ wei qiang y{ng ruo).
The major signs are aversion to wind and cold, heat effusion (~Jt.': fa re, i.e., fever),
stiffness and pain of the head and nape, spontaneous sweating, noisy nose, dry retch-
ing, and a pulse that is floating and moderate. The special signs associated with this
pattern are spontaneous sweating and a pulse that is floating and moderate; hence
it is also called exterior vacuity. Cold damage (195* skiing Mn) is characterized by
aversion to cold, heat effusion, stiffness and pain of the head and nape, generalized
pain in the body and/or bones and joints, absence of sweating, panting (any form
of difficult breathing or breathlessness), retching counterfiow, and a pulse that is
floating and tight. The defensive yang is obstructed and the construction yin is
stagnant; consequently sweat cannot issue, and the pulse is floating and tight. This
form of greater yang disease is often referred to as exterior repletion.
Greater yang disease can undergo a variety of irregular developments, which are
known as transmuted patterns (1:iJI bian zheng). These include heat patterns (r.~
i.lE re zheng), vacuity cold patterns (m'*iJI xu Mn zheng), chest bind patterns (t2i
)JijiJI jie xiong zheng), and glomus patterns UNiJI pi zheng). Also figuring among
 INTRODUCTION 11

the transmuted patterns are the interior patterns of greater yang disease affect-
ing the greater yang bowel-the bladder-these being water amassment and blood
amassment. In greater yang water amassment (::tJB'I' 7}( tdi yang xu shui), an unre-
solved external evil enters the bladder and the yang ql. is unable to transform water.
The major signs are heat effusion, sweating, vexation thirst or thirst with desire
to drink, vomiting immediately upon the ingestion of water, inhibited urination,
lesser abdominal fullness, and a pulse that is floating and rapid. In greater yang
blood a massment, (:t:JB li rtn. tai yang xu xue), heat evil penetrates deep into the
lower burner aRd binds the blood. The signs are a tense, bound lesser abdomen or
lesser abdominal hardness and fullness, mania or similar conditions, and uninhibited
urination.
In greater yang disease, there are also concurrent patterns, such as exterior
vacuity with concurrent stiffness of the nape and back, or with cough and panting, or
with water-rheum. There are also transmuted patterns due to incorrect treatment,
such as inappropriate promotion of sweating, use of precipitation, and/or use of fire
therapies.
Yang Brightness Disease (~B~~ yang ming bing): The main feature ofyang
brightness disease is yang hyperactivity and heat exuberance. An evil can directly
enter the yang brightness channel from the exterior, but it usually passes into the
channel from the greater yang. Yang brightness disease is generally characterized
by generalized heat effusion, spontaneous sweating, aversion not to cold but to heat,
and a pulse that is large. Distinction is made' between a heat pattern and a repletion
pattern. In the yang brightne.ss heat pattern (~B ~ r!.~ ilE yang ming re zheng), also
called a yang brightness chan~el pattern (~B~;?:ilE yang ming jfng zheng), an evil
enters the channel, transforms to heat, and scorches liquid and humor. In addition
to the general yang brightness disease signs just listed, this pattern is characterized
by dry mouth and tongue, and a great thirst that is unquenchable. If the evil
transforms into heat and causes waste matter in the intestines to form a repletion
bind, this is called a yang brightness repletion pattern (~B ~ ~ iiE yang ming shi
zheng), also known as a yang brightness bowel pattern (~B~ ll!f.fiiE yang ming fu
zheng). Here, the generalized heat effusion takes the form of tidal heat effusion
(fever at a certain time each day). Other specific signs include delirious speech,
sweat streaming from the extremities, abdominal distention with fullness and pain,
hard stool, and a pulse that is sunken and replete.
Lesser Yang Disease (Y~B~ shao yang bing): Lesser yang disease manifests
as a half exterior half interior pattern (;&milE bdn biiio bdn li zheng ), perhaps
more accurately described as a "halfway pattern" since it is correctly conceived as
disease located neither in the exterior nor in the interior, but between the two. It
can be the result of an evil passing into the lesser yang from another channel or may
~ate in this channel itseli.-nle-essenbalfeaturesareml.t.m:__t_ast.Unt~-~lith,
dry throat, and dizzy vuifW.. Other major signs are alternating aversion to cold
and heat effusion, fullness in the chest and rib~side, taciturnity with~.o-desiiefor
food or drink, heart vexation, fre'quent retching, and white tongue fur. The pulse
of lesser yang disease is one that is fine and stringlike. There is neither the aversion
to cold that typically marks greater yang exterior patterns nor the exuberant heat
that characterizes yang brightness disease. Accordingly, promotion of sweating and
precipitation cannot be used; the appropriate treatment is harmonization.
12 INTRODUCTION

The lesser yang is often referred to as the "pivot" (f!K shu), the central element
of the three yang. When disease evil enters the lesser yang, it causes inhibition of
the pivot (f!KM./fflj shu jz bu li). Alternating aversion to cold and heat effusion,
for example, is a manifestation of "right and evil struggling by turns" (lE !f~ 51~
zheng xie fen zheng). Aversion to cold occurs when evil qi prevails; heat effusion
occurs when right qi prevails, but right qi is unable to repel the evil through the
exterior, and the evil qi is unable to adyance into the interior. Thus in lesser yang,
the disease, as it were, oscillates on the pivot. Basically, the pivot is one aspect of
the "qi dynamic" (E(M. qi jz). Inhibition of the qi dynamic in lesser yang disease
can have varied consequences, notably disturbance of spleen and stomach function.
It is for this reason that retching is one of the main signs of lesser yang disease.
Though lesser yang disease is typically a halfway pattern, there may be concur-
rent exterior or interior patterns. Lesser yang with a concurrent exterior pattern
may manifest in heat effusion, mild aversion to cold, vexation pain of the joints and
extremities, mild retching, and propping bind below the heart; lesser yang with a
concurrent interior pattern can manifest in alternating aversion to cold and heat
effusion, interior heat bind, persistent retching, distress below the heart, depression
and vexation, and absence of stool. '
Greater Yin Disease (::;t~JHi1i tai yzn bing): Greater yin disease is an inte-
rior vacuity cold pattern of spleen yang vacuity, and is characterized by abdominal
fullness, vomiting, inability to get food down, severe diarrhea, and occasional ab-
dominal pain. Greater yin disease can result from an unresolved yang channel
disease damaging spleen yang, from direct invasion of wind-cold, or from internal
damage engendering cold-rheum. When the spleen yang is vacuous, cold and damp-
ness become exuberant, and movement and transformation are impaired. If greater
yin disease progresses further, it may become spleen-kidney vacuity cold and form
a lesser yin vacuity cold pattern.
Lesser Yin Disease ( y ~JHi1<1 shao yzn bing): Lesser yin disease, a pattern
of interior vacuity, usually develops from disease that starts in one of the other
channels, although it can be the result of an evil penetrating directly into the
interior in someone with a vacuous constitution. It includes serious conditions that
may be fatal. The major manifestations of lesser yin disease are a pulse that is fine
and faint, and a desire to sleep. Distinction is made between cold transformation
and heat transformation patterns. Cold transformation (*1-t hdn hua) is the result
of heart-kidney yang qi debility and in addition to the above signs also includes
aversion to cold, curled-up lying posture, heart vexation, vomiting and diarrhea,
thirst with desire for hot fluids, small intake of fluids, clear uninhibited urination,
and reversal cold of the extremities. In severe cases, when the yang qi is repelled by
the yin cold, one may see no aversion to cold, heat effusion, red face, and vexation
and agitation, which indicates true cold and false heat (~*f~ft.: zhen hdn jia re).
Heat transformation (ft.:ft re hua), a result of yin vacuity, is characterized by heart
vexation and inability to sleep, dry sore throat, diarrhea, thirst, crimson tongue,
and a pulse that is fine and rapid.
Reverting Yin Disease (~~Ji~ jue yfn bing): Reverting yin disease generally
develops some time after the onset of cold damage disease. It is more complicated
and severe than disease of any other channel. The main forms are as follows:
upper-body heat and lower-body cold patterns; reverse-flow patterns; and patterns
 INTRODUCTION 13

characterized by either diarrhea, reverse-flow, retching, or hiccup. The upper-body

*
heat and lower-body cold (_t_ r!~ T shang re xia htin) complex is characterized by
dispersion-thirst (severe thirst unallayed by fluid intake), ql. surging upward to the
heart, vexing heat in the heart, hunger with inability to eat and vomiting of round-
worms, and unceasing diarrhea. Reversal-heat exuberanJ and retaliation (/9!Xf.~!l1
~ jue re sheng fu) patterns are characterized by reverse-flow and heat effusion.
The reverse-flow (/9!X~ jue ni), which is severe palpable coldness of the extremities
stretching up to the elbows and knees (also called "reversal cold of the extremities"
=f. }E /9lX it sh6u zu jue leng), is accompanied by diarrhea, and alternates with heat
effusion. The reverse-flow marks the prevalence of yln, whereas the heat effusion
marks the retaliation of yang. Diarrhea, as it occurs in reverting yin disease, can
occur in cold or heat patterns, or in cold-heat complexes. Reverse-flow is the single
most important sign of reverting yin disease. It occurs not only in the reversal-heat
exuberance and retaliation pattern described above, but is also seen in a number of
other conditions: visceral reversal, cold reversal, heat reversal, roundworm reversal,
collected water reversal, and phlegm repletion reversal. Retching can be differenti-
ated into lower burner cold vacuity type, counterflow ascent of turbid yin type, and
a third type observed in heat patterns when a shift to the lesser yang takes place.
Hiccup can be differentiated into vacuity cold and repletion heat types.

Eight-Principle Pattern Identification

The notion of the eight principles, though it was not formalized until much
later in history, is implicit in Shiing Han Lun pattern identification. Externally
contracted disease ("cold damage" in the broad sense) is the result of disease evils
entering the body and the body's response to them. The different manifestations
of disease are explained in terms of the outcome of the struggle between right and
evil. Six-channel pattern identification provides the framework for understanding
the specific ways in which externally contracted disease develops. Underlying it,
however, are the notions of exterior-interior, cold-heat, vacuity-repletion, and yln-
yang, which constitute a more general framework. This is reflected in line 7, p. 50,
which says: "When an illness [is characterized by] heat effusion and aversion to
cold, it is springing from yang; when [an illness is characterized by] the absence of
heat effusion and [the presence of] aversion to cold, it is springing from yin."
In the theory of the Shiing Han Lun, greater yang, yang brightness, and lesser
yang are called the three yang; greater yin, lesser yin, and reverting yin are called
the three yin. Broadly speaking, disease of the three yang is characterized by
exuberant right ql (strong resisthnce) and repletion of evil ql (powerful threat to
resistance), and takes the form of heat or repletion, which in the eight principles are
both yang patterns. By contrast, disease of the three yin is generally characterized
by debilitation of right ql with the continuing presence of evil ql, and largely takes
the form of cold or vacuity patterns, which in the eight principles arc both yin
patterns.
The first of the eight principles are exterior and interior. These two terms
are somewhat confusing because they are used in different senses. In the Shiing
Han Lun, the greater yang is exterior, the lesser yang lies between exterior and
interior, and the other channels are all interior. In another sense, however, the
three yang are all exterior, while the three yin are all interior. In this sense, the
14 INTRODUCTION

greater yang is exterior while the greater yin is interior. Within the yang channels,
the difference between exterior and interior is reflected in a sharp difference in
treatment: effusing the exterior (promoting sweating) in the one case and attacking
the interior (precipitation) in the second. For this reason, the concepts of interior
and exterior are of great importance in deciding treatment.
Cold and heat are the principles by which the nature of a disease is identi-
fied. Acute conditions attributable to exuberant yang evil usually manifest in heat
patterns; chronic conditions and ones due to exuberant yin evil are mostly cold
patterns. Diarrhea, for example, can be due either to cold or to heat, which have
to be differentiated by the presence or absence of thirst. In sorrle cases, either the
cold or heat may be false (see line 350, p. 545, and line 317, p. 478).
The importance of vacuity and repletion is reflected not only in the overall
difference between the three yang and three yin, as explained above. Judging the
precise state of right ql in relation to evil ql can be of crucial importance even within
one channel. For example, line 70, p. 133, states, "After sweating is promoted, if
[there is] aversion to cold, [this] is because of vacuity. If aversion to cold is absent,
and only heat [effusion] [is present], this indicates repletion."

Bowel and Visceral Pattern Identification

Like eight-principle pattern identification, the notion of bowel and visceral pat-
tern identification was not formulated until later in the development of Chinese
medicine. Yet, like the eight principles, it also helps our understanding of the
Shiing Han Lun since diseases of the channels can affect their associated bowels
and viscera.
In greater yang disease, an exterior evil that fails to resolve can pass into the
bladder, the bowel of the greater yang. This evil can impair ql transformation and
cause water-ql to collect internally, manifesting in inhibited urination or thirst with
desire to drink, but with immediate vomiting of fluids ingested.
The stomach and the large intestine are both yang brightness bowels. When
evils enter the yang brightness and damage the fluids, manifestations can include
generalized heat, sweating, and dry mouth and tongue. When dryness-heat in
the stomach and intestines causes stoppage of bowel ql, there is constipation with
abdominal distention and fullness with pain that refuses pressure.
The gallbladder and the triple burner are the bowels of the lesser yang. When
gallbladder fire flames upward, there is bitter taste in the mouth, dry throat, and
visual dizziness. When regulated flow through the waterways of the triple burner
is impaired, one of several things may happen: water may collect below the heart
giving rise to heart palpitations and inhibited urination; water-cold may invade the
lung, giving rise to cough; or inhibition of the lesser yang pivot could prevent cold
rheum from transforming, giving rise to alternating aversion to cold and heat effu-
sion, heart vexation, chest and rib-side fullness with slight bind, inhibited urination,
thirst and retching, and sweating only from the head.
The spleen is the viscus of the greater yin. When it is affected by externally
contracted disease, spleen yang is devitalized, and movement and transformation
is impaired. When the spleen viscus is vacuous, and cold, cold-damp collects and
 INTRODUCTION 15

causes abdominal fullness and vomiting, inability to get food down, spontaneous
diarrhea, and periodic spontaneous abdominal pain.
The heart and kidney are the viscera of the lesser yin. When in externally
contracted disease they become vacuous, and ql and blood become insufficient, there
is a faint pulse, desire only for sleep, aversion to cold, curled-up lying posture (in
severe cases, reversal cold of the extremities), diarrhea, and retching counterfiow. If
the heart fire becomes hyperactive and kidney yin is insufficient, signs of yin vacuity
heat such as vexation in the heart, sleeplessness, dry throat, red tongue body, and
a pulse that is fine and rapid may be observed.
The liver is the viscus of the reverting yin. When it is affected by disease, a
cold-heat complex arises and liver ql ascends counterfiow, giving rise to dispersion-
thirst (a thirst unallayed by drinking), heat and pain in the heart, hunger with no
desire to eat, and vomiting of roundworms on ingestion of food, or diarrhea.

Diagnostic Difficulties
The major difficulty in learning the Shiing Han Lun approach to externally
contracted diseases lies in the correct identification of pat,terns. Single signs rarely
provide conclusive evidence for diagnosis and a basis for treatment. While a pulse
that is stringlike and chest and rib-side fullness are each more or less a sure sign of
lesser yang disease in the context of externally contracted disease (not beyond this,
however), aversion to cold, sweating, or vexation, for example, can be observed in
diseases of all channels. The majority of major signs can occur in the disease of
more than one channel. Since in each case the pathomechanism is different, the
precise nature of a specific sign and combinations in which it occurs can vary. The
art of diagnosis therefore lies in viewing each sign in its wider context and grasping
the pathomechanism from a synthesis of all signs present.
Below are a number of examples of such signs, the different conditions in which
they may be observed, and their different pathomechanisms.
Aversion to wind/aversion to cold (~Jxt.- ~1[: wufeng, wu hdn): Aversion
to wind is a feeling of cold when exposed to wind; aversion to cold is a feeling of
cold. The distinction between aversion to wind and aversion to cold is ambiguous
because in greater yang disease the two terms seem to be used indiscriminately.
It is, however, worth noting that "aversion to wind" does not occur in the lines
presenting disease of the three yin.
GREATER Y ANG: Aversion to wind or to cold is a basic sign of greater yang.
It is due to impairment of the normal function of defense ql when evil qi is in
the exterior of the body.
Y ANG BRIGHTNESS: Y ang brightness disease is typically characterized by heat
effusion with aversion to heat rather than cold. Nevertheless, heat effusion
is sometimes accompanied by aversion to cold, as in line 168, p. 323, where
heat in both the interior and exterior manifests in great thirst, dry tongue
fur, vexation, and aversion to cold. Aversion to cold here results from damage
to liquid and ql on the one hand causing the interstices of the flesh to loosen,
and on the other causing yang ql to become depressed in the interior.
16 INTRODUCTION

LESSER Y ANG: In line 99, p. 418, aversion to wind occurs with heat effu-
sion, stiffness and pain of the head and nape, and fullness below the rib-side.
This pattern is not a pure lesser yang pattern, and the aversion to wind is
considered to be a greater yang sign.
Heat effusion (ft.:, :&1?.: re, fii re): In this text, we render titft.: fii re as "heat
effusion" rather than "fever," since the Chinese term is somewhat wider in meaning
than the familiar English term. Heat effusion is associated with many conditions
and occurs both in externally contracted disease and miscellaneous disease (~m
za bing, disease due to causes other than external evils). In externally contracted
diseases of the three yang channels, heat effusion is a manifestation of the struggle
between right qi and evil qi; it does not necessarily indicate the presence of evil
heat. In diseases of the three yin, right qi is not strong enough to counter evil ql;
hence heat effusion is absent, and instead only aversion to cold is present.
GREATER Y ANG: In exterior patterns, evil ql is in the exterior of the body, im-
pairing the normal function of defense ql; hence heat effusion is accompanied
by aversion to wind or cold.
Y ANG BRIGHTNESS: In yang brightness disease, the disease evil transforms into
heat and enters the interior. In heat patterns, heat effusion is accompanied
by aversion to heat rather than aversion to cold. In repletion patterns, the
heat is not so exuberant, and so the heat effusion is tidal, i.e., occurs in the
afternoon.
LESSER Y ANG: In lesser yang disease, the struggle is taking place between the
interior and exterior, so heat effusion alternates with aversion to cold.
Sweating Uf t:b han chii): Sweating occurs in a variety of patterns. A distinc-
tion is made between spontaneous and night sweating. Spontaneous sweating (
yf zi hdn) is so called because it occurs spontaneously without exertion. It has nu-
merous causes. Night sweating (~ yf dao han) is sweating during sleep that ceases
on awakening. The Chinese term literally means "thief sweating," reflecting that
it occurs when the patient is unaware of it. The English term "night sweating" is
somewhat unsatisfactory because it suggests that sweating during daytime sleep is
excluded, which is not the case. Night sweating is usually a sign of yin vacuity, but
examples of this are not found in the Shiing Han Lun. In the externally contracted
disease patterns described in the Shiing Han Lun, spontaneous sweating is much
more common, although it is often simply referred to as sweating. Night sweating
in the Shiing Han Lun is mentioned only in yang brightness disease and lesser yang
disease. ,
GREATER Y ANG: Here, sweating is observed in exterior vacuity wind strike,
while absence of sweating is a sign of exterior repletion cold damage. In exte-
rior vacuity, the defense qi is vacuous and is easily damaged when an external
evil is contracted. When this happens, it fails to contain construction-yin,
which discharges outward in the form of sweat. This is known as "insecurity
of the defensive exterior" (Jl ~ ::f [ll!J wei biiio bu gu). Conversely, in exterior
repletion, the interstices and fleshy exterior are secure.
Y ANG BRIGHTNESS: Sweating is copious and streams outward, in contrast to
that which occurs in greater yang wind strike, which is scant and issues slowly.
In heat patterns, the sweat is said to be copious over the whole body, whereas
 INTRODUCTION 17

in repletion patterns, it is said to stream from the limbs. In both these cases,
sweating is spontaneous sweating. Line 201, p. 390, and line 268, p. 448,
describe conditions in which night sweating is a sign of exuberant internal
heat forcing the fluids out to the exterior. In yang brightness disease, there is
also sweating only from the head after heat has been reduced by precipitation.
LESSER Y ANG: Line 269, p. 442, the last line of lesser yang in the present text,
speaks of "sweating after the eyes close," which is the same as night sweating.
It is explained there as being a sign of yang exuberance. During sleep, yang
enters the interior so defense yang decreases. Consequently, interior heat
becomes exuberant and distresses humor, which discharges outward in the
form of sweat.
Pulse that is floating (/l7X r- mai ju): A pulse that is pronounced at the
superficial level.
GREATER Y ANG: A floating pulse in greater yang disease reflects exterior evil
in the exterior being resisted by right qi.
Y ANG BRIGHTNESS: In yang brightness disease, the pulse is typically large.
Nevertheless, line 221, p. 312, describes a condition of rampant dryness-heat
in both the interior and exterior that gives rise to a pulse that is floating
and tight; line 176, p. 316, describes a similar condition where a pulse that is
floating and slippery is an outward manifestation of exuberant internal heat.
GREATER YIN: In greater yin disease, a pulse that is floating may indicate a
concurrent greater yang exterior pattern (as in line 276, p. 456).
LESSER Y'IN: A pulse that is floating is not normally observed in lesser yin
disease. When the cubit pulse is floating as described in line 290, p. 521, it
means that the yang qi is returning.
REVERTING YIN: A pulse that is slightly floating in reverting yin can be a sign
that the disease is moving outwards prior to recovery (line 280, p. 460).

-Passage and Transmutation

Passage (11f chuan) means the development of the disease along a particular
course; transmutation (~ bian) means change in the nature of disease contrary to
the normal laws. These are dependent upon a number of factors:

relative strength of right and evil qi

administration of appropriate or inappropriate treatment

constitution of the patient

presence or absence of other illnesses

As a general rule, externally contracted disease begins in the exterior, and if

it fails to resolve there, passes to the interior. Greater yang exterior patterns give
way to either yang brightness or lesser yang disease. Lesser yang often progresses to
yang brightness. Disease of the three yin is usually a later development occurring
when the body is severely weakened by the struggle against the disease evil. This is
 18 INTRODUCTION

the general pattern, but in some cases, if right ql. is restored and the evil ql. weakens,
the disease may pass from the interior to the exterior. -
ombination disease and dragover disease both involve more than one channel.
Any pattern of two or three channels is called combination disease (i't~ he bing).
There is greater yang and yang brightness combination disease, greater yang and
lesser yang combination disease, and three-yang combination disease. When the
signs of one channel abate as those of another develop, this is called dragover disease
(:Jt~ bing bing). In the Skiing Han Lun, there is greater yang and yang brightness
dragover disease and greater yang and lesser yang dragover disease. In addition, in
debilitated patients, disease evils under some circumstances do not go through the
three yang, but instead enter the three yin channels directly. This is called direct
strike [on the yin channels] (][ r:p zhi zkong ).

Treatment
The Skiing Han Lun text makes reference to several different forms of treatment
including acupuncture, moxibustion, fuming, and drug therapy. Zhang JI mostly
recommends medicinal treatments; only occasionally does he suggest acupuncture.
Other treatments mentioned in the Skiing Han Lun are those that patients have
previously received, and often they are specifically stated to have been inappropri-
ate.
The medicinal therapy applied by Zhang JI is based on the notion that each drug
has certain properties that affect the body in a specific way. Different medicinals
are combined in innumerable ways to cope with the complex manifestations of
externally contracted disease. The treatments are not symptomatic, but address
specific pathomechanisms.
One treatment alone stands out as being based on different notions. The formula
Burnt Pants Decoction ( skiio kun siin), a decoction made from the ash of the crotch
of underpants, seems to based on an older, magical conception of yin and yang.
According to Skiing Han Lun, when the body is severely weakened by externally
contracted disease, the disease is easily transmitted through sexual intercourse. A
condition transmitted to a person in this way is treated by the burnt crotch of the
underpants of a person of the opposite sex. This formula is not applied in modern
practice.
Zhang JI uses medicinal formulae to promote sweating (rf kan), promote vomit-
ing (ll tu), precipitate (T xia), harmonize (fD he), warm (ill! wen), clear U~ qzng),
supplement (H bu), and disperse (~ xiiio), although the last three of these terms
do not appear in the therapeutic sense in the Skiing Han Lun. Through the lines of
the Skiing Han Lun, we can see that the notions of "supporting yang ql." (tUB~
fU '!)ting qi) and "preserving yin humor" (t ~Jj ~l cun yfn ye) constitute the basic
; approach to dispelling evil. In other words, the spearhead of Zhang JI's treatments
consists in enhancing the body's power to dispel evil. In diseases of the three yang,
the object is to dispel evil, but the treatments are mostly designed to adjust bodily
functions in such a way as to release or expel the evil. For greater yang disease, the
main approach is to resolve the exterior. In exterior repletion this involves opening
the interstices, causing cold to dissipate by the promotion of sweating. In exterior
I vacuity, it entails harmonizing construction and defense in order to resolve the flesh
 INTRODUCTION 19

and dispel wind. In yang brightness disease, heat patterns are treated by clear-
ing, whereas repletion patterns are treated by precipitation. In lesser yang disease,
where inhibition of the pivot gives rise to half exterior half interior patterns, the
treatment is harmonization and resolution. Disease of the three yin mostly mani-
fests in vacuity patterns, for which the treatment is primarily to support right qi.
For example, greater yin disease manifests in vacuity cold-damp patterns, so that
the treatment is primarily to warm the cent er, dissipate cold, and dry dampness.
Lesser yin disease manifests in heart-kidney debilitation with insufficiency of ql and
blood, there being, however, a distinction between cold transformation and heat
transformation. Cold transformation is treated by supporting yang and repressing
yin, while heat transformation is treated by fostering yin and clearing heat. Revert-
ing yin disease manifests in a variety of complex patterns, where heat is treated by
clearing, cold is treated by warming, and cold-heat complexes are treated by dual
application of warming and clearing.

THE LANGUAGE OF THE SHANG HAN LiJN

The main body of the Shang Han Lun is divided into short lines describing
patterns and their treatment, and sometimes their etiology. The content is not only
clinically oriented and matter-of-fact, but is also reasonably uniform. Accordingly,
its expression is also quite consistent as regards both terminology and sentence
patterns. Since our translation is highly literal, these and other features of the
language of the Skiing Han Lun will also be apparent to the English-speaking reader.
Nevertheless, certain variations in terminology and certain specific sentence patterns
may be troublesome to the English-speaking reader, and these are discussed here.
Learners of Chinese wishing to read the original text are referred to Appendix 11 for
a comprehensive analysis of the grammar and vocabulary of the Shang Han Lun.

Terms
The Skiing Han Lun is a book offering treatments for various different man-
ifestations of cold damage. Accordingly, terms can be divided into three broad
categories: sign names, pattern names, and formula (and drug) names. Pattern
names and formula and drug names are the most consistent; each term denotes
only one concept and, discounting abbreviated forms, is the only term to denote
that concept. '
Sign names are more numerous and more variable. The notion of heat effusion
appears as '& r?,: fa re and ~ f!-': shen re, and simply as f.~ re. Other clusters of
terms to a greater or lesser degree synonymous include:

( 0 ) T> tl~ ilt {kou) bu neng shi, inability to eat

ilt T> T shi bu xia, inability to get food down
T> ~ tJ\ ilt bu yu yfn shi, no desire for food or dririk
::f f~ H~ bu de mian, inability to sleep
::ff~Ci~ bu de wo, inability to sleep
T> 1~ Ci~ ~ bu de WO mei' inability to sleep