Foundations of Theory for Ancient Chinese Medicine

Guohui Liu explains the key concepts of ancient Chinese medicine so that they can be better understood and put into practice by modern practitioners. With the Shang Han Lun as a basis for discussion, it includes information on Chinese culture and philosophy as well as specific issues such as the six conformations and zang-fu organ theory.

Discussion of Cold Damage (Shang Han Lun) and contemporary texts of ancient China form the bedrock of modern Chinese medicine practice, yet these classic texts contain many concepts that are either hard to understand or confusing. Based on over thirty years' medical practice, and study of the texts, this book explains the concepts involved so that the clinical applications of the ancient texts can be better understood and put into practice. The author looks at the larger context of ancient Chinese culture and philosophy in terms of theoretical knowledge, scholarly approach, and mindset in order to explain the basis for the medical texts. He also discusses the work of later Chinese medical scholars in elucidating the texts. He then goes on to look at more specific issues, such as the six conformations, zang-fu organ theory, the theory of qi and blood, the theory of qi transformation, and how these are understood in the ancient texts. He also discusses shao yang and tai yang theory; the element of time, and its place in understanding six conformations diseases.

This remarkable work of scholarship will clarify many questions about the interpretation of the ancient texts for modern use, and will find a place on the bookshelf of every practitioner of Chinese medicine, as well as on those of scholars of Chinese medicine.

We live in interesting times. While some Chinese medicine colleges have been struggling or even closing, an extraordinary new wave of information loosely called classical Chinese medicine has been flowing towards us, encompassing classical acupuncture styles, classical internal cultivation methods and classical herbalism. The focus for herbal medicine has been on the translation and study of Zhang Zhong-Jing's Shang Han Lun (Treatise on Cold Damage) and Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet). This classical approach is very attractive to us in the West, perhaps because it has the great strength of enabling us to treat the person not the disease. As Westerners, we are perhaps more free to be interested in the classical approach to Chinese medicine than most young doctors in China, who have to attend to careers that are dependent on the hospital system and modern TCM. This can be a problem for old doctors practising in the classical style, who sometimes do not have an obvious successor to take their work forwards. Gao- Hui Liu's Ancient Chinese Medicine has thus been published with auspicious timing. As Liu states in chapter 3:

'Zhang Ji [Zhang Zhong Jing] had noticed the potential ability of the human body to heal itself. He had not only noticed this selfhealing 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 … all 113 formulas can be viewed as following the body trend or natural way to eliminate pathological factors.'

Gao-Hui Liu has done the English-speaking community a great service in writing this book. As non-Chinese speakers, we have very limited access to the ocean of Chinese medicine in China, and Liu provides a useful cultural and historical contextualisation of Shang Han Lun and Jin Gui studies. He starts Chapter 1 with an exploration of the term shang han (傷 寒, cold damage), and helps to dispel the common misconception that the Shang Han Lun is only about external pathogens; in fact it is a complete medical system that can be flexibly applied to any disease, including new diseases of our age.

Chapters 2 to 5 explore the provenance of the Shang Han Lun, including an overview of the important texts written up to and including 1144 AD, when Cheng Wu-Ji wrote the first annotated version (chapter
0, evidence for the influence of Daoism and Confucianism on Zhang Zhong-Jing (chapter 3), and a discussion of differing schools of Shang Han Lun thought from the past to the present (chapter 4). This is particularly interesting, as it is obvious that there has always been robust debate about how to approach these texts. Indeed, on p.81 Liu quotes Wang Guo-Qing, director of Classical Studies at Beijing University of Chinese Medicine, who famously referred to 41 different schools of Shang Han Lun thought!

It is interesting, for example, to learn that the Fire Spirit School (huo shen pai), which is renowned for using large dosages of fu zi (prepared aconite) and has drawn much attention in China since 2007, was a sub-school of Shang Han Lun study that developed in the first half of the 20th century. And of course it makes sense that although the second half of the 20th century saw over 5000 Shang Han Lun articles published in China - showing an apparently healthy resurgence of interest in Shang Han Lun studies - in fact much of this research has been heavily influenced by Western medicine.

medicine. Chapter 5 introduces the liu jing (六 經) – a strenuously difficult term to translate that has become known by most of us as the six divisions. Jing (經) is the character for channel or meridian, but actually has a wide spectrum of meanings ranging from 'classic text' (as in the Yi Jing or Book of Changes) to 'regulate' and 'arrange'. Liu uses the translation 'six conformations', and explores some very different interpretations of this concept, including six channels, six anatomical regions or disease locations, and six differentiating syndromes. He also points out that this term is actually never used in the Shang Han Lun itself, where instead many references are made to the word bing (病, disease).

Up until this chapter, Ancient Chinese Medicine is balanced in its presentation of the various schools of Shang Han Lun study. Then, from the end chapter 5 onwards, starting with his 'Brief introduction to six conformations disease' p.96, Liu sets out his colours in what seems clearly to be the Nei Jing tradition, with its emphasis on understanding the Shang Han Lun according to Nei Jing channel theory, zang-fu theory and the theory of qi transformation. This shift in emphasis occurs seamlessly and without explanation, and the casual reader could be forgiven for thinking that this is without question how the Shang Han Lun is understood today.

However, there is currently debate about whether Zhang Zhong-Jing based his work on the Nei Jing concepts, or whether it is based directly on the Tang Ye Jing Fa (Decoction Classic). This is a lost text, and until the early 20th century, the only reference to it was in the preface of the Zhen Jiu Jia Yi Jing (Systematic Classic of Acupuncture & Moxibustion) by Huang-Fu Mi (215-282AD), which mentions that Zhang Zhong-Jing based a lot of his formulas on it. In 'Shang Han Lun Questions and Answers' (www. youtube.com/watch?v=aw_w0C2Zdqc), Dr Stephen Boyanton describes how a text containing a manuscript of collected texts including a portion of the Tang Ye Jing Fa was discovered in a temple cave in the late 19th/early 20th century. He explains that this manuscript (called the Fu Xing Jue [Extraneous Secrets] and probably by Tao Hong Jing, 456-536AD) has enabled us to see that the Shang Han Lun was most likely based on the Tang Ye Jing Fa, and includes at least 30 of its 60 formulas, either exactlycopied or modified.

This information is referred to in Ancient Chinese Medicine (see, for example, the table on p.50), but the extent of the current debate it is not obvious from this book. In fact, the 20th century doctors Jiang Tai Yin and Chen Yi-Ren opposed the theory of qi transformation (as Liu does quote, pp.107-
0, and the Tang Ye Jing Fa lineage of Hu Xi-Shu and Feng Shi-Lun totally refutes the need for complicated Nei Jing theory in Shang Han Lun study. They understand the liu jing as locations in the body rather than channels; Shao Yin is seen as the yin aspect of the Tai Yang exterior, Tai Yin the yin aspect of Yang Ming interior, and Jue Yin the yin aspect of Shao Yang half interior-half exterior. However, having accepted that Ancient Chinese Medicine is written in the Nei Jing style, Chapters 6 to 9 form an interesting and thorough discussion. It is great to find the theory of ben, biao and zhong qi written down clearly in a textbook, and the review of qi transformation theory is extensive and interesting in itself. However, as a busy clinician, my question is, 'how is this applicable in clinic?', and although Liu does address this in the last section of Chapter 6, it is through theory only, without practical case examples.

The Shao Yang chapter (7) is a discourse on harmonisation and pivoting. 'Half interior half exterior' patterns are the most controversial in China, and Liu points out that although this specific phrase was first used by Cheng Wu-Ji in 1144, there is a similar phrase in clause 148: 'half in the interior half in the exterior'. Chapter 8 discusses the harmonisation of ying and wei, and Chapter 9 goes deep into complicated Yi Jing hexagrams and the zi wu clock to explain Zhang Zhong-Jing's teachings on how long it takes diseases to resolve. There is very little theory in Zhang Zhong- Jing's original text, and some theoretical guidance to access this text clinically is indispensable. Ancient Chinese Medicine is a strong theoretical exposition that clearly presents Nei Jing-style Shang Han Lun theory - to my knowledge for the first time in English. There are copious and detailed references, and while not being an easy read, this is a dense and informative book with a useful historical and theoretical perspective. The danger for the Western reader-clinician is that it makes the Shang Han Lun study sound very complicated, which contrasts strongly with my experience of following a Shang Han Lun doctor in clinic in Beijing, where a simpler interpretation of theory informs the complexity of living patients so well. Nevertheless, Ancient Chinese Medicine is an important contribution to the English Shang Han Lun literature, and helps us to understand the wider historical context of the classical medicine we are beginning to study and practise.

Frances Turner