Discussion of Cold Damage (Shang Han Lun) Commentaries and Clinical Applications

A major new translation of the Chinese classic Shang Han Lun by scholar and medical doctor Guohui Liu makes this foundational text fully accessible to English speaking clinicians for the first time. Extensive study and research underpins the translation; the author's understanding of both classical and modern Chinese enables him to interpret fully the ancient work within the theory of Chinese medicine. An extensive commentary explains the translation, the difficulties with the text, how it has been subsequently translated and expands on the theory laid out in the original text to reach an understanding that can be applied in the clinic for diagnosis and treatment. The value of this classic text lies primarily in its establishment of a basic framework for differentiation and treatment, but it also presents 112 formulas and 88 medicinal substances, which are commonly applied in clinical work for various conditions. In this edition, the 112 formulas are fully explained in the context of the clinical experiences of well-known ancient and modern doctors, and they are also laid out in two appendices, cross referenced to the text.

In the preface to Discussion of Cold Damage: Commentaries and Clinical Applications, a massive work that is the culmination of 20 years of research into the Shang Han Lun, author Guohui Liu states: ‘I feel that the time has come to provide readers with a relatively definitive version, a relatively comprehensive view and a more in-depth understanding of this classic’. This is, indeed, a lofty goal for one of the primary classics of Chinese medicine, and begs the obvious question: Did the author succeed?

To answer this question, one must examine the text from the vantage point of the three groups of people who are most likely to utilise it: teachers, students, and practitioners. One must also consider whether the reader has a familiarity with the Chinese language, and how serious they are about the Shang Han Lun. In addition, a comparison to the previously accepted standard - in this case the translation of the Shang Han Lun by Craig Mitchell, Feng Ye and Nigel Wiseman (1999) - is in order.

The book begins with a foreword, the author’s preface, the original preface to the Shang Han Lun and the preface to the Song dynasty version. The bulk of the text comprises the author’s translation and elucidation of the source text, and the book ends with a series of appendices and indices. More important, however, is the layout of the translation. Each chapter begins with a very brief, one-totwo paragraph summary. For each line, the traditional characters are presented with their respective pinyin underneath. Then, Liu offers a synopsis, followed by a translation. After the translation is a section called ‘Difficult or Doubtable Points’, followed by commentary. In lines related to formulas, their dosages and modifications follow the translation, and after the commentary there are additional sections that analyse the formula, discuss the key signs and symptoms for which to apply it, relate the clinical experience of ancient and modern practitioners, and suggest modern clinical applications. Occasionally, Liu includes charts and diagrams to help readers grasp key concepts.

For the teacher who does not read Chinese and is teaching students with little to no Chinese language experience, this book will be a revelation. It does nearly everything that the Mitchell, Ye and Wiseman translation of the Shang Han Lun does, and does it better. The notes about key terms and Chinese characters are more extensive, the explanations of each line are more in-depth and the commentaries are more numerous. Liu’s Discussion of Cold Damage also differs from the Mitchell et al. translation in that it preserves the line order from the Song dynasty edition (more on that later), and presents the text in traditional Chinese characters.

As a comparison, let us look at line 12 (the first line that discusses Gui Zhi Tang) in Liu’s translation and the Mitchell et al. translation: both texts provide commentary on the phrase, 'yáng fú ér yīn ruò' (陽浮而 陰弱) by Cheng Wu-ji and Cheng Yingmao; both texts discuss the meaning of the terms 'qù pí' (去皮) and 'wǔ xīn' (五 辛) in Zhang Ji’s formula notes; and both offer commentary on the formula, its uses, and the actions of the individual herbs that comprise it. Liu’s discussion of line 12, however, is simply more extensive (seven and a half pages as opposed to five). From a teacher’s perspective, then, Liu’s book provides far more material from which to draw (the main text in Mitchell et al. is found in pages 27-605, while the main text in Liu is found in pages 21-893: a difference of nearly 300 pages).

Perhaps more importantly for teachers and students without Chinese language training, the wealth of commentaries translated from ancient and modern practitioners open a door to this classic that would otherwise be inaccessible. Rather than provide commentary from one particular school or lineage, Liu provides a cross-section of commentaries from different scholars that often represent divergent opinions and schools of thought. In this way, Liu leaves room for the reader’s own interpretation, which can be useful for stimulating critical thinking and class discussions. Thus, the book will likely be seen as indispensable to the vast majority of English-speaking teachers. The student perspective is slightly different, and includes cost as a factor. This book is roughly twice the price of the Mitchell et al. translation. When one considers that this book lacks a comprehensive introduction -both to the Shang Han Lun itself, and to each of its chapters - the price increases to nearly $250 to obtain this information (which is provided in Liu’s other book, Foundations of Theory for Ancient Chinese Medicine, reviewed in issue 109 of the JCM by Frances Turner). For many students, the cost will be seen as prohibitive - an unfortunate, but nonetheless accurate reality. Of course, for dedicated students with a desire to study the Shang Han Lun, this book and its companion volume are great investments. Still, the question remains whether this is the appropriate text for the majority of English-speaking students.

A above, Liu has chosen to preserve the line order from the Song dynasty edition, which may prove confusing to new students of the Shang Han Lun. For example, line 96, which first introduces Xiao Chai Hu Tang, is listed in the chapter on taiyang disease. Mitchell et al. follow the approach of many modern Chinese textbooks, and place line 96 in the chapter on shaoyang disease. This subtlety, though basic to scholars, may be lost on students. In this sense, the line order of Liu’s translation - while historically more accurate - may actually be a hindrance in the classroom. For students with no prior experience with the Shang Han Lun, the more modern organisational approach employed by Mitchell et al. will likely make more sense as an introduction to the text. Further, given that the Mitchell et al. translation is academically sound, a teacher must be able to justify to their students why Liu’s translation is worth the additional cost. In my estimation, the Mitchell et al. translation could be purchased with Liu’s Foundations of Theory for Ancient Chinese Medicine for less than the cost of Discussion of Cold Damage: Commentaries and Clinical Applications, and would still serve as a more-than-sufficient introduction to the classic for most students.

Practitioners with a serious interest in the Shang Han Lun will find a wealth of useful clinical information contained in this tome. Liu has done an admirable job of infusing the commentary and clinical experience of numerous ancient and modern practitioners with his own, including interpretations of certain phrases to practical advice about formula dosage and modification. The clinical notes on line 12, for instance, tackle the practicality of asking modern patients to adhere to the original method of administration for Gui Zhi Tang (i.e. wrapping themselves in a blanket and taking the decoction with rice porridge) and suggest two possible alternatives for the porridge: the addition of Huang Qi (Astragali Radix) or the imbibing of hot, boiled water. As an additional example, the clinical notes on line 96 discuss the importance of using the proper amount of Chai Hu in relation to the other herbs in Xiao Chai Hu Tang. In sum, the commentaries on the clinical application of certain lines and formulas provide a way for practitioners to immediately utilise this text in their clinics.

Before concluding, I would like to offer a few minor criticisms of the text. The first is a practical matter: the lack of dates for scholars and their commentaries. In Foundations of Theory for Ancient Chinese Medicine, Liu provided dates alongside each scholar or commentary he discussed. This convention is absent in Discussion of Cold Damage, and I think that is a mistake. Liu addresses this absence of dates in his preface, saying he excluded them ‘so as not to distract the reader’. A table of authors and dates is included in Appendix 2, but it would have been far more useful to simply embed the dates in the text itself rather than force the reader to flip back-and-forth between the chapter and appendix (which is far more distracting than placing the dates in the text). Further, it is perplexing that Liu did not include a separate column in Appendix 2 for the commentaries attributed to each author. As a teacher, the ability to search for a particular commentator or commentary would have been a welcome addition, and it would have been extremely valuable to have a separate appendix or index dedicated to the authors and commentaries included in the text. Additionally, a glossary of terms and/or dictionary - like those provided in Mitchell et al.’s translation - would have been highly useful for students of Chinese language with an interest in the text.

So, did the author succeed in creating ‘a relatively definitive version’ of the Shang Han Lun? The answer to that question depends on whether the book is viewed as a stand-alone work, or whether it is viewed together with its companion volume, Foundations of Theory for Ancient Chinese Medicine. In truth, Foundations of Theory for Ancient Chinese Medicine feels like the missing introduction to, or perhaps a teacher’s manual for this text. Viewed together, the texts are indispensable; viewed separately, the present book is the best choice for classroom teachers, but may not be the best entry-point for new students of the Shang Han Lun. To put it another way, while the text is undoubtedly a valuable resource for teachers at all levels, Liu’s massive work may be more useful to doctoral level students and experienced practitioners than to master’s level students and new practitioners. Despite my minor quibbles with certain aspects of the text, I believe it is a welcome addition to the study of the Shang Han Lun in the West, and will serve as a shining example of how—with the right blend of scholarship and clinical experience—the classics can be relevant to the modern practice of Chinese medicine.

Phil Garrison