The Treatise on Cold Damage Disorders

By Arnaud
May 17, 2023

In the rich and complex tapestry of Traditional Chinese Medicine (TCM), certain threads are more prominent than others. One such thread is the "Shang Han Za Bing Lun" (伤寒杂病论), a vital cornerstone in the foundation of TCM. This seminal work, translated as the "Treatise on Cold Damage Disorders and Miscellaneous Diseases," fundamentally shaped the practice and understanding of TCM, much as the Hippocratic Corpus did for Western medicine.


The story of the Shanghan Zabing Lun

The story of the Shanghan Zabing Lun is as fascinating as the book itself. The author, Zhang Zhongjing, was a renowned physician during the latter years of the Han Dynasty, living from approximately 150 to 219 AD. Known as a saint of medicine in China, Zhang's journey into medicine was not only a pursuit of knowledge but also a deeply personal endeavor. Witnessing the death of nearly two-thirds of his family due to disease over a decade, he was driven to prevent such tragedies from recurring. This period of his life, marked by war, natural disasters, and widespread disease, undoubtedly influenced his approach to medicine, leading to the creation of the Shang Han Za Bing Lun.

Zhang Zhongjing's work was based on a plethora of ancient texts such as the Nei Jing, and the Nan Jing ("81 difficult issues"), as well as the Yin and Yang Da Lun, and Fetal Medicine Record. His writing also drew on his extensive medical experience and that of his contemporaries.

However, the original Shang Han Za Bing Lun was lost due to the ravages of war. It was later collected and compiled by Wang Shuhe of the Jing Dynasty (3 century AD) into the Treatise on Cold Damage Disorders (Shang Han Lun), which survives to this day.

During the Northern Song Dynasty, a more abbreviated version of the Shang Han Za Bing Lun was found on a bamboo scroll. This version is divided into three volumes. The first volume discusses Cold Damage. The second volume discusses miscellaneous diseases. The third volume covers various formulas and theories for gynecology. The latter two volumes were edited into what we now know as the Jin Gui Yao Lue (Essentials from the Golden Cabinet). 

Today, the combined Shang Han Lun and Jin Gui Yao Lue constitute what we refer to as the Shang Han Za Bing Lun ("Treatise on Cold Damage Disorders and Miscellaneous Diseases").


Introducing the principle of diagnosis and treatment based on symptom differentiation

The Shang Han Za Bing Lun was transformational for several reasons. First among which, it established the principle of diagnosis and treatment based on symptom differentiation. It discussed febrile ("Cold") diseases based on the Six Stages theory and miscellaneous diseases based on the ZangFu Organs, integrating the fundamental theories of TCM with clinical practice.

The Six Stages theory outlined the physiological functions and pathological changes in the internal Organs, Meridians, Qi, and Blood as an exogenous disease progresses. The book analyzes, synthesizes, and summarizes the various symptoms that occur during the evolution of the diseases, considering the body's strength in resisting the disease, the properties of the cause of the disease, and the progress and retreat of diseases. It describes the location of diseases by stage, the damage to the internal organs, the characteristics of the symptoms, the tendency of Heat and Cold, the waxing and waning of the "Evil" (pathogenic factor), and the prescriptions thereof.

The Jin Gui Yao Lue, on the other hand, focuses on miscellaneous diseases and their treatment based on internal organs. It deals with 30 different kinds of diseases, from spasms and strokes to confusion and chronic illness, and proposes a theory of disease causes.


The ancestors of prescription books

The Shang Han Za Bing Lun is also notable for its comprehensive collection of prescriptions, containing 269 unique prescriptions using 214 different kinds of medicine. These prescriptions set out strict requirements for their composition and detail how they should be complemented or modified based on the evolution of diseases. The book was revolutionary in its variety of prescription dosage forms, from soups and pills to ointments and suppositories. Many of these prescriptions, such as Bai Hu Tang for malaria and Gui Zhi Tang for common cold, remain clinically relevant today.

The Shang Han Za Bing Lun stands as a testament to the dedication and wisdom of Zhang Zhongjing, a man driven by personal tragedy to contribute significantly to the field of medicine. It also offers us a fascinating glimpse into the ancient world of TCM, reminding us of the depth and complexity of this enduring medical tradition. As we continue to explore the intricate world of TCM, the Shang Han Za Bing Lun remains a beacon, guiding us through the labyrinth of this ancient knowledge.

Article tags: Chinese Medicine theory