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E.g., he used Four Reversals Decoction (Sini tang 四逆湯) to treat vomiting due to cold in the stomach, a use which can also be found in the Treatise, but he used Poria-5 Powder (Wuling san 五苓散) to treat vomiting of blood Wang Shuo’s Easy and Simple Formulae differed greatly in style from Chen’s Formulae for the Three Causes. Chen’s book contains more than one thousand formulae divided into eighteen fascicles and heavily interspersed with short doctrinal treatises. Moreover, it decidedly favors the literati-physician medicine approach as revealed by both the quantity of doctrine included and its commitment to addressing the problem of the diversity of illness by means of medical doctrines found in the Northern Song medical canon. By contrast, Easy and Simple Formulae is a single fascicle, contains only forty formulae, and emphasizes diagnosis by symptomatology without overt reference to doctrine. This last point drew the criticism of some of the younger members of the Yongjia cluster. Shi Fa (施發, fl. early 13th c., styled Zhengqing 政卿), for example, complained, “But he makes no distinction between patterns of vacuity and repletion, cold and heat.
In spite of approaching medicine from a very different vantage point, Wang Shuo continued Chen Yan’s practice of using formulae from the Treatise on Cold Damage for illnesses other than cold damage. Unlike Chen, however, he does not apply the Treatise’s formulae to miscellaneous diseases whose symptoms differ markedly from the symptoms they due to overeating, a use which has no parallel in the Treatise. See Sanyin ji yibingzheng fang, juan 9 and 11, shangwei tuxue zhengzhi and han’ou zhengzhi, in ibid., 109, 135.
Further Easty and Simple Formulae (Xu yijian fanglun 續易簡方論), juan 6, in Liu Shijue, Yongjia Yipai Yanjiu, 234.
originally treated in the Treatise. Furthermore, Wang explicitly addresses the novelty of this
practice. In discussing True Warrior Decoction (Zhenwu tang 眞武湯), Wang says:
Taking this medicinal is appropriate not only in cases of yin-pattern cold damage; it is also suitable for all people who suffer from vacuity-taxation with fear of cold, high fever, cough, and dysentery to take it.
Wang uses this formula to treat a miscellaneous disease with the same symptoms as the cold damage illness for which it was originally designed, but is aware of the fact that doing so may be seen as innovative. Altogether, Wang includes seven formulae from the Treatise. For five of these, he includes miscellaneous diseases among the illnesses they treat. In all of these cases, the miscellaneous diseases being treated have symptoms identical or nearly identical to the cold damage illness the formula originally treated. Thus, while Wang never explicitly cites the Treatise as an authority, he is implicitly relying on it while simultaneously stretching the limits of its clinical applicability.
The Hejian Current
was the founder and central figure of the Hejian current. Liu was a prolific writer and a famous physician. He is known to have authored four books, and numerous others are attributed to him or claim to present his teachings. He was heavily influenced by the Inner Classic’s doctrine of movements and qi, proclaiming that “… the essentials of the medical teachings lie in the five
of this doctrine in which the six qi were primarily understood not as external climatic factors, but Thoughts on the Origin of Illnesses according to the Mysterious Pivot of the Questions on the fundamental (Suwen xuanming yuanbing shi 素問玄機原病式, 1186), author’s preface, p. 4a, in Siku Quanshu.
as internal conditions of the body. In particular, he focused on the problem of heat or fire, arguing that all of the six qi could generate or be generated by fire or heat.377 Although it is not certain that Liu Wansu himself wrote a text devoted to the Treatise on Cold Damage, texts purporting to present his teachings on cold damage constitute almost half of all known Hejian current texts (see Table 5-1). Moreover, the texts that Liu is known to have written clearly attest to the value he attached to Zhang Ji and the Treatise. Liu saw Zhang Ji as a minor sage, not the equal of the Yellow Emperor or Divine Farmer but far beyond what his
contemporaries could easily understand:
Zhongjing was a minor sage. Although Zhongjing’s books have not completely encompassed the teachings of the sages, they fall only a little short of the sages. Their language is abstruse, such that for those who study it nowadays, it is still difficult.
Therefore [the medicine] that contemporary people practice is all nothing more than [what is found in] recent formularies.378 He lamented that in spite of their best efforts, previous cold damage authors, such as Zhu Gong,
doctrine of the five movements and six qi.379 E.g., Formulae Clarifying the Yellow Emperor’s Questions on the fundamental (Huangdi Suwen xuanming lunfang 黃帝素問宣明 論方, 1186), juan 8, p. 1a-b, in ibid.; for a more detailed discussion of Liu Wansu’s ideas, see Simonis, “Mad Acts, Mad Speech, and Mad People in Late Imperial Chinese Law and Medicine,” 74–86.
Suwen xuanji yuanbing shi, author’s preface, p. 2a, in Siku Quanshu.
Suwen xuanji yuanbing shi, author’s preface, p. 3a, in ibid.
Like Cheng Wuji, Liu Wansu (and other Hejian-current authors) emphasized Inner Classic doctrine in interpreting the Treatise on Cold Damage but drew from very different parts of the Inner Classic and often arrived at very different conclusions. Cheng used the Inner Classic in a piecemeal fashion, drawing from whatever sections of the text he found useful in explaining a given line of the Treatise, but Liu had a more focused approach, emphasizing those parts of the Inner Classic which were devoted to either cold damage or the doctrine of movements and qi— to which Cheng paid little attention.380 In particular, Liu focused on the Treatise on Fever (Re lun pian ), which allowed him to argue that “[The patterns seen in] the transmission of [cold damage] through the six channels from shallow to deep are all heat patterns. It is not an illness of
on the ambiguity of the character re, which literally means “heat” but in medicine also means “fever.” When speaking of cold damage as a “heat/febrile illness (rebing ),”382 most interpreters of the Treatise, like Han Zhihe quoted above, saw the cause of the illness as cold which resulted, somewhat paradoxically, in a febrile illness. “Heat” for these authors primarily meant “fever,” and the key factor that needed to be treated was the cold. This point of view resonated well with the Treatise itself, which prescribes warming formulae for the early stages of cold damage. The Hejian current approach, however, took the phrase “heat/febrile illness” more literally. After describing an argument identical to Han’s, Direct Examination of Cold Damage
pathological heat, and therefore cooling formulae were necessary to treat it.
A series of charts, usually appended to the front of Cheng’s commentary on the Treatise, does deal in detail with the doctrine of movements and qi, but the attribution of these charts to Cheng is unclear and neither the charts nor the doctrine of movements and qi are discussed in the remainder of the commentary.
Direct Examination of Cold Damage (Shanghan zhige 傷寒直格, late 12th c.), preface, p. 1a, in Siku Quanshu.
This is a quote attributed to Liu by the unnamed author of the preface, possibly the compiler of the text Ge Yong (葛 雍, dates unclear).
This phrase can also be rendered “hot illness” but I have reserved the term “hot disease” for the more specific usage of this phrase to refer to cold damage illnesses which do not manifest until summer, see the discussion of the broad meaning of cold damage above and in Chapter 1.
Shanghan zhige, juan zhong, p. 1b, in Siku Quanshu; Ding Guangdi, “Shen tao Jin-Yuan sidajia lun huo,” in Zhang Zihe yanjiu jicheng, ed. Qian Chaochen and Wen Changlu (Beijing: Zhongyi Guji Chubanshe, 2006), 591– 592.
The Hejian current’s approach to cold damage was unique but quite popular during the Jin and into the Yuan. It expanded on Song efforts at dealing with warm diseases and other heat illnesses that could arise in the course of cold damage, but overturned the unspoken Song rule that the Treatise had primacy over the Inner Classic in cold damage doctrine. In spite of the importance that Liu Wansu and his followers gave to Inner Classic cold damage doctrine, the treatment methods and formulae of the Treatise remained central to their clinical recommendations. In this regard, they closely resembled their Song predecessors, and they also continued the Song practice of restricting the use of the Treatise’s methods and formulae to actual cases of cold damage.384 Zhang Congzheng and his Attacking Method Zhang Congzheng (張從正 1156-1228, styled Zihe 子和) is an excellent example of the fuzziness of medical currents’ borders. His indebtedness to Liu Wansu is undeniable, but his ideas diverged from Liu’s in important ways.385 For this reason, some authors view him as part of the Hejian current while others do not.
A native of Sui Prefecture in what is now Henan province, Zhang was born into a family of physicians. He would eventually become an imperial physician, and his methods were influential enough that Li Gao would complain of their ascendancy in the capital on his arrival there, and Zhu Zhenheng would begin his medical career as Zhang’s avid admirer. Although there is no evidence that Zhang ever studied with Liu Wansu, he was heavily influenced by Liu’s Fabien Simonis states that Liu used the Treatise to argue for his heat etiology of madness (see Simonis, “Mad Acts, Mad Speech, and Mad People in Late Imperial Chinese Law and Medicine,” 82), but the passage cited is actually found in Suwen, juan 12, pian 45, p. 12b-13a. See Chen Yongguo, Chongguang Buzhu Huangdi Neijing Suwen, 92–93.
Ding Guangdi, “Shen tao Jin-Yuan sidajia lun huo,” 592–593; Simonis, “Mad Acts, Mad Speech, and Mad People in Late Imperial Chinese Law and Medicine,” 83.
ideas, as indicated by his use of Liu’s formulae and praise of his methods: “One can only use Liu Hejian’s acrid and cool formulae. For patterns [of illness caught] within three days, eight or nine out of ten will fully recover 止可用劉河間辛涼之劑，三日以裏之證，十痊八九.”386 Like Liu, he was also heavily influenced by the Treatise on Cold Damage. His debt to Liu and Zhang Ji was so great that Zhang Yizhai (張頤齋, fl. Yuan dynasty), in his preface to Zhang’s
The major point on which Zhang Congzheng’s methods diverged from Liu Wansu’s was his emphasis on the three “attacking methods (gongfa )” as principal treatments for all
(tu ).389 These methods had along history, particularly in the treatment of cold damage. Zhang,
however, drawing primarily on Inner Classic doctrines, generalized their application, arguing:
It is not the case that this thing, illness, is something the body usually possesses. Whether it comes from outside and enters or is generated from within, it is always evil qi. When evil qi overcomes the body, it is acceptable to rapidly attack it.390 Although his rationale was largely derived from the Inner Classic, the formulae that Zhang used, were often chosen from the Treatise. Because he used these methods in treating all types of Confucians Serve their Parents (Rumen shiqin 儒門事親, early 12th c.), juan 1, pian 3, in Zhang Congzheng, Zihe yiji, ed. Chen Zengying et al., Zhongyi guji zhengli congshu (Beijing: Renmin Weisheng Chubanshe, 1994), 34.
This text is a compilation of the work of Zhang and his students/admirers. For a discussion of its complex textual history see, Okanishi Tameto, Sō izen iseki kō, 826; Qian Chaochen and Wen Changlu, eds., Zhang Zihe yanjiu jicheng (Beijing: Zhongyi Guji Chubanshe, 2006), 5–7.
This preface is found in a Yuan manuscript edition, ssee Okanishi Tameto, Sō izen iseki kō, 826–827.
Zhang actually broadened the meaning of the three attacking methods such that vomiting included all methods that “move upward 凡上行者,” sweating included all methods that “release the exterior 凡解表者,” and sweating included all methods that “move downward 凡下行者;” see Rumen shiqin, juan 2, pian 13, in Zhang Congzheng, Zihe yiji, 64–65.
Rumen shiqin, juan 2, pian 13, in ibid., 63.
illnesses—cold damage and miscellaneous diseases alike—Zhang broke down the Song dynasty division between these two.
An excellent example of Zhang Congzheng’s use of the Treatise’s formulae to treat miscellaneous diseases has been highlighted by Fabien Simonis.
In treating a case of postpartum “heart-wind,” a form of madness, Zhang used a purgative formula found in the Treatise:
“Whenever woman suffers heart-wind after childbirth … it is appropriate to use Stomach
formula, for a miscellaneous disease: “When a child has unceasing watery diarrhea, she can take Poria-5 [Powder] and Assist the Original [Powder] in equal portions …