|
At the 2007 meeting of the Japan Society of Oriental Medicine,
the most prestigious organization of traditional medicine
practitioners in Japan, Dr. Makizumi Kazuhiro MD gave a shocking
presentation on the
Shang-han Lun (Harmful Cold Treatise), the bible of Japanese
traditional medicine. According to him, the most popular text of
the Shang-han Lun is
a much-simplified version based on a text which was transformed
in the Song Dynasty era (960-1279). Thus, the content of the
Shang-han Lun could
be much altered from the original text. The way Dr. Makizumi
investigates and confirms the evidence could be inherited from
his father, who was a professor of forensic medicine, and
impresses us very much. I would like to introduce here his
presentation translating with minimal changes. |
An Innovative Study of
the Reconstruction and Transformation
of the Shang-han Lun
Makizumi Kazuhiro, MD
About Existing Texts
The original text of the
Shang-han Lun was supposed to have been created by Zhang Zhong-Jing
in the Han Dynasty. This original text has not survived. The text we
depend on today is based on the so-called
Song Transformed Text, or the
Newly Compiled Text, which
Lin Yi et al of the Bureau of Compiling of Medical Texts reorganized in
the Northern Song Dynasty era (960-1127). Unfortunately, this
Newly Compiled Text was lost,
also.
Years later, in the Ming Dynasty era (1368-1644),
Zao Kai-Ming published the
Zhong-jing Qu Sho (Zhong-jing’s Complete Books) which contains a
reprinted version of the Song Ban (woodblock) edition. A real copy of
this Kai-ming published Shang-han
Lun still exists, and is regarded as the best maintained original of
the Kai-ming published
Shang-han Lun.
While focusing on the Song Ban
Shang-han Lun, I would like to discuss the circumstances before and
after its creation. First of all, the name of the
Song Ban Shang-han Lun came
from the index of the Kai-ming published
Zhong-jing Qu Shu. The letter
“ban” means “wood plate,” but in this case “a woodblock for printing.”
This is why we use this name for this text.
The contents of the Song Ban
Shang-han Lun can be divided into four sections: diagnostic
technique, general theory of clinical practice, diagnostic
discrimination technique, and clinical practice in detail. This last
section is discussed from two different viewpoints; one, Three Yin and
Three Yang, and the other, “Do and Do-not.” It is a complete clinical
textbook.
The books containing quotations from the
Shang-han Lun, and published
before the Song Dynasties (960-1279) are listed on the footnotes below:
Thus we find many books quoting from the
Shang-han Lun, some of which
were compiled by Lin Yi et al in the Song era, and some were not. When
we organize the contents of these books, we find several versions of
texts, which correspond to sections of the
Shang-han
Lun.
Revision of the Treatment Principles of the
Su-wen
The quotes from the Shang-han Lun
found in the books published before the early Northern Song Dynasty and
the Song Dynasty eras are based on the treatment principles laid out in
the Fever Theory Chapter of the
Su-wen). That is, “Yang-bing ha-han, Yin-bing tu xia (the Yang
Diseases should be sweated, and the Yin Disease should be induced to
vomit or purgated.)”
Therefore, I (Makizumi) researched the three Yin and three Yang section
of the Song Ban Shang-han Lun
to determine if it follows the same steps or not. In the Yang-ming
Diseases chapter, it prescribes Gui-zhi Tang (Cinnamon Decoction) and
Ma-huang Tang (Ephedra Decoction) as the sweating methods. Also it
prescribes Gui-zhi Tang jia Shao-yao (cinnamon decoction plus peony) and
Da-huang Tang (Rhubarb Decoction) in the Tai-yin Disease chapter, and
Cheng-qi Tang (invigorate qi decoction) in the Shao-yin and Jue-yin
Disease chapters. We can understand that these prescription principles
follow the principles of the Su-wen.
On the other hand, the Song
Ban Shang-han Lun discusses
the inducement of vomiting and purgation already in the Tai-yang Disease
chapters, as well as Cheng-qi Tang purgation in the Yang-ming Disease
chapters, harmonization in the Shao-yang Disease chapter, and the
interior warming method in the Yin Disease chapters. Those treatment
principles differ from the Su-wen’s
principles.
The dissuading descriptions of over-sweating and purgation of Yang-ming
Diseases, and the interior warming method of the Yin Diseases in the
Song Ban Shang-han Lun are
different from the Fever Theory in the
Su-wen. Meanwhile, the
sweating method of the Yang-ming Disease and purgation of the Yin
Diseases are based upon the treatment principle of the
Su-wen. From this, it is
possible to recognize that the
Song Ban Shang-han Lun is the text which records two different
principles of two different philosophies, side by side.
A Narrow Sense and A Broad Sense Shang-han
According to the Fever Theory in the
Su-wen and 58th Difficulty in
the Nan Jing (Difficulty
Bible, by Bian-que?, in ?), the term “Shang-han (harmful cold)” has two
meanings, not only the meaning in a narrow sense, which means an attack
of Han-ye (cold evil), but also the meaning in a broad sense, which puts
all feverish diseases together broadly under the term of Shang-han.
The Shang-han Lun before the
Song Dynasty discusses, in the narrow sense But the
Song Ban Shang-han Lun even
discusses Shi-qi Bing (seasonal qi diseases) and Re Bing (febrile
diseases), putting its center of gravity on the broad sense Shang-han.
This shifting from the narrow sense Shang-han to the broad sense
Shang-han could be analyzed in two ways, as follows:
In the Shang-han Lun before
the Song Dynasty, the narrow sense Shang-han diseases were routinely
sweated, using fu-zi (aconite) formulas as the sweating method. To sweat
using fu-zi was a specialized prescription only for the narrow sense.
The Song Ban edition suppresses proscribing sweating by using fu-zi in
its chapter of Shang-han Li (examples), and also avoids over-sweating in
its Three Yin and Three Yang section. This attitude differs from the
Shang-han Lun before the Song
Dynasty.
Speaking of sweating by fu-zi, the
Wei-tai Mi-yao Fang (Secret
Prescriptions of Officials, by Wan Tao in 762) records Fa-han Dou-zhang
San (sweating and correcting damp evil powder) and Shang-han Fa-han
Shen-dan Wan (harmful cold sweating divine cinnabar pills) quoting from
the Cui-shi Fang (Dr. Cui’s formulas). Both formulas contain fu-zi or
wu-tou (aconiti carmichaeli). In the section of Shang-han Sweating
Pills, Volume Nine of the
Qian-jing Yao-fang (Prescriptions Worth a Thousand Gold for
Emergencies, by Sun Si-miao in 659), it also records Shan-dan Wan
(divine cinnabar pills) with fu-zi and wu-tou. Even though the
Song Ban Shang-han Lun
prohibits the use of Shen-dan Wan in its chapter of Shang-han Li, this
formula was considered to be a Shang-han sweating formula before the
Song Dynasty.
In Volume Nine of the Tai-ping
Sheng-hui Fang (Tai-ping Era Sacred and Blessing Prescriptions,
978?), it prescribes Gui-zhi Tang (cinnamon decoction) and Ma-huang San
(ephedra powder) for the first day of the Shang-han diseases. Both
formulas here contain fu-zi or wu-tou. The portion of the text
pertaining to Gui-zhi Tang is similar to the text in the
Song Ban Shang-han Lun. The
ingredients of Ma-hang San here are ma-huang, gui-xin (cinnamon core),
gan-cao (licorice), xing-ren (apricot kernel) and fu-zi. This could be
understood as an modification of Ma-huang Tang in the Song Ban Shang-han
Lun.
Those prescriptions from the Duo-Tang eras (581-907) to the early North
Song Dynasty era make us believe that the sweating method using fu-zi
formulas for the narrow sense Shang-han in the Yang disease periods was
a conventional method in these days.
Purgation of Yang-ming Diseases
The purgation method using rhubarb in the Yang-ming disease period was a
prescription method for the broad sense Shang-han, such as febrile
diseases and seasonal diseases. In the
Song Ban Shang-han Lun, it
prescribes Cheng-qi Tang and Yin-chen-hao Tang (artemisia decoction) in
the Yang-ming disease chapters? When we check the frequency of the
prescriptions for each disease period in these volumes, we find that
fu-zi was frequently prescribed for the narrow sense Shang-han in the
Yang disease periods, and on the other hand, the use of rhubarb in the
Yang-ming disease period is marked as the prescription for the broad
sense Shang-han.
When we refer to the I Shin Po
(Medical Core Prescriptions, by Tanba Yasuyori in 947, Japan),
Yin-chen-hao Tang was discussed as a prescription for the post Shang-han
Jaundice, which belongs to the seasonal diseases, thus is in the broad
sense Shang-han. It also quotes from the
Qian-jing Yao-fang a
prescription for treating Shang-han jaundice, Ma-huang Zhun-jiu Tang
(ephedra hot liqueur decoction). In this case Shang-han is the narrow
sense Shang-han. Thus, in the era of Tanba Yasuyori, the recognition of
Yin-chen-hao Tang for the broad sense Shang-han and Ma-hunag Zhun-jiu
Tang for the narrow sense Shang-han both could have existed.
On the other hand, the Song Ban
Shang-han Lun talks about Yin-chen-hao Tang in the Yang-ming disease
chapter, but not Ma-huang Zhun-jiu Tang in the Three Yin and Three Yang
section.
Therefore, it is possible for us to conclude that the
Song Ban Shang-han Lun is a
textbook, which recommends avoiding sweating with fu-zi in cases of the
narrow sense Shang-han, and discusses the use of rhubarb for the
Yang-ming disease period as the broad sense Shang-han.
Problems in Cheng Wu-ji’s Zhu-ji
Shang-han Lun
According to Dr. Kosodo Hiroshi (Kitazato Oriental
Medicine Institute, Japan), there is no record of publishing the
Song Ban Shang-han Lun after
the Northern Song Dynasty until the
Zhong-jing Quan Shu
(Zhong-jing’s Complete Books in 1599) published by Zao Kai-ming in the
Ming Dynasty (1366-1644). Thus, the
Zhu-ji Shang-han Lun and the
Song Ban Shang-han Lun are
alike in appearance but quite different in nature. When we compare the
Zhu-ji Shang-han Lun (1144)
with the Song Ban Shang-han Lun
while regarding the latter as a trusted copy of the
Song Compiled Shang-han Lun,
we find the former preserved the specialized Chinese characters in the
latter such as “ying (hard).” Non-the-less, it omitted all notes in
small characters, overlapped text, and all texts with one Chinese
character indentation.
a) Omission of Notes in Small Characters:
In the second article of the Yang-ming Disease Chapter of the
Song Ban Shang-han Lun, it
says that “When the Yang-ming is diseased, the stomach family is replete
(yang ming zhi wei bing wei jia shi).” Following this line, it notes in
small characters that, “one makes (this character) cold (yi zuo han).”
Both the Qiang-jing Yi-fang (Supplement to the Prescriptions Worth a
Thousand Gold, by Sun Si-miao in 682) and the Tai-ping Shen-hui fang, in
the Yang-ming Diseases of the Shang-han Upper Section in Volume Nine of
the former, the Yang-ming Disease of Volume Eight in the latter, say
“when Yang-ming is diseased, the stomach family is cold (yang-ming bing
wei jia han)” and clearly record that a concept of “inside of the
stomach cold (wei zhong han)” existed as a medical consensus in the
Duo-Tang eras.
As the Song Ban Shang-han Lun
shifted its weight on the broad sense Shang-han, it had to correspond to
the swift change of the morbid state due to fever from the evil nature
and adopted the concept of “the stomach family repletion” as its main
definition. Even so, it also preserved the existence of the Bible
recognition of the morbid state, “inside of the stomach cold,” noting it
in small characters.
We find these notes in small characters everywhere in the Song Ban
Shang-han Lun, and that those notes in many cases are in accord with the
quotes from the Shang-han Lun in other Bibles. Thus, these notes in
small characters are very important characteristics of the
Song Ban Shang-han Lun,
serving as guiding posts for the Duo-Tang era medicine. The
Zhu-ji Shang-han Lun omitted
all of these notes.
b) Omission of Overlapped Texts:
For example, the text of Clause 321: Da Cheng-qi
Tang (major invigorating qi decoction) in the Three Yin Three yang
Section of the Song Ban text
has a note in small characters mentioning Da Chai-hu Tang (major
bupleurum decoction). The same text in the “do and do not” section also
records two decoctions, Da Cheng-qi Tang and Da Chai-hu Tang, together.
This means that the Song Ban
displays its flexible attitude, saying that? more than one prescription
can correspond to one morbid state. This flexible attitude of having
multiple prescriptions for one morbid state can be found in the
Mai Jing and the
Qiang-jing Yi-fang, showing
the flexible attitude corresponding of Duo-Tang era medicine. Recording
��multiple prescriptions for one morbid state” is another important
characteristic of the
Song Ban Shang-han Lun.
As Cheng Wu-ji’s Zhu-ji Shang-han
Lun abbreviated those notes in small characters and overlapped texts
in the “do and do-not” section, the concept of Duo-Tang era medicine
such as “multiple prescriptions for one morbid state” becomes unclear,
and a text and a prescription becomes a one-to-one correspondence as
���one prescription for one morbid state��� in the
Shang-han Lun. These
abbreviations in the Zhu-ji
Shang-han Lun could be the origin of the theory of “Fang Zheng
Xiang-dui (prescription and evidence correlation)” in the Edo era
(1603-1867) Japan.
c) Omission of Texts with One Character Indentation:
The first clause of the Tai-yang disease chapter in the
Song Ban Shang-han Lun starts
with “Tai-yang zhong feng, gui-zhi tang zhu zhi (In case of Tai-yang
wind stroke, the cinnamon decoction treats it.)” with the text indented
one character. 15 indented clauses of instructions of prescriptions
follow this clause. The clause with “Tai-yang bing mai fu (In case of
Tai-yang diseases, the pulse becomes floating),” which is supposed be
the first clause of the Tai-yang disease chapter, is actually the
seventeenth clause. This clause should be known as the first clause of
the large character body text. When the texts with one character
indentation are compared with the body texts, we find the expressions
associated to the Shang-han Lun
before the Song Dynasty. This comprises an important characteristic of
the Song Ban Shang-han Lun,
but the Zhu-ji Shang-han Lun
and the texts after the Zhu-ji
Shang-han Lun never remarked on it.
d) The Mainstream of the Shang-han Lun Study Today:
Adding to these abbreviations, the
Zhu-ji Shang-han Lun contains
Cheng Wu-ji’s own ideas, such as “transferring the Yin disease purgation
method to the Yang-ming diseases.” It should be recognized as an
independent text being totally different from the
Song Ban
Shang-han Lun.
The mainstream of the
Shang-han Lun research being
done in Japan, China and USA today has been studying the simplified
texts reconstructing the Zhu-ji
Shang-han Lun. Such research using the simplified texts would let us
understand at least the old state of the
Shang-han
Lun.
Shinjiro’s Impression:
I have been believing that the
Shang-han Lun survived throughout history, maintaining its original
form, just like a coelacanth. The former professor of Kyoto University,
Yamada Keiji remarked in his book,
How Chinese Medicine Was Created
(Iwanami, 1999) that, “There was not a single
Shang-han Lun existing in all
of history. People of three periods of Chinese history saw the
Shang-han Lun differently
with their own eyes. History has left us three
Shang-han Luns, each of which
was seen by people of three different periods and each of which trapped
the minds of the people who belonged to each of those three periods.
Researchers who tried to reconstruct the
Shang-han Lun believed that
they could go back to the original text. In reality, they arrived at the
destinations, not the starting point in history. Furthermore, the
Shang-han Lun which the
Japanese doctors in the Edo era generally saw, was far different from
the Shang-han Lun which the doctors in China of the same era saw. This
difference reflects the difference between Chinese medicine and Japanese
Kanpo today.” Even after reading this book, I believed that the root and
the trunk of the Shang-han Lun
did not change throughout history, even if it is changed in the details.
Dr Makizumi awakened me from this illusion. The text we read today as
the Shang-han Lun is based on the text rewritten in the Song Dynasty.
Modern TCM (Traditional Chinese Medicine) was built based on the medical
philosophy which was created by standing on the further transformed text
of the Shang-han Lun. Is the
Shang-han Lun fabricated? Has
the original Shang-han Lun
been lost forever? I still believe that we can reconstruct the original
Shang-han Lun someday.
According to Dr. Makizumi the Ko-hei and Ko-ji
versions of the Shang-han Lun,
which I wrote about in NAJOM #37, are the books fabricated in the Edo
era (1603-1867), because it is obvious that those texts were created
from the much-simplified text of the
Zhu-ji
Shang-han Lun.
