Transcript
Acupuncture CEU Online Course:
Series: Overview of TCM Classics and Doctrines
Author: Dr. Daoshing Ni, Yo San University of Traditional Chinese Medicine

Class: Shang Han Lun

Thank you for participating in our other lecture today we are going to be talking about Shan Han Xue Pai.

Basically Cold injury Doctrine.

And this is one class in the course of overviews of TCM Classics and doctrines.

So Shan Han Xue Pai is a pretty influential school of thought.

It’s probably one of the most comprehensive, one of the most studied Doctrines in all the TCM School thoughts.

And we should really start looking at.

The author and Dr. Zhang, Zhong Jing is considered to be the father of TCM.

Zhang, Zhong Jing and sometimes we call him Zhong Jing was born about 150 AD passed away 219 AD.

He was born and raised in Henan province and he’s at that time, a Reputable physician.

Has the same reputation has position such as Hua Tuo.

He has Incorporated his clinical experience collected many years of other people’s of experience together in established,

several very interesting and Innovative fundamental works for TCM,

six channel differentiation for injury by Cold Pathogens what we call Lio Jing Bian Zheng.

Second he looked closely into Zang Fu differentiation for miscellaneous conditions, and we must understand during that time,

which is a good solid 2000 years ago.

They don’t really have a robust understanding of Zang Fu differentiation yet,

so Jin Kui Yao Lue – his other book, actually explains a little bit and delves into the Zang Fu understandings.

So Shang Han Za Bing Lun

It’s an authoritative publication it’s a must-read for all practitioner TCM.

It was lost during wartime and it was, thank heaven, republished and rediscovered and revised during the Song Dynasty.

In this book there’s two portion,

the Shang Han portion, cold injury portion and then the Jin Kui portion which is Jin Kui Yao Lue or sometimes we call that miscellaneous disease portion.

If we look at the Shang Han Lun portion, which is where we are really focusing on today, this book has 10 sections.

Section 1, it dwelves directly into diagnosis, mainly pulse diagnosis of Shang Han.

What are the pulses of people who are injured by Cold pathogens.

Section 2 new goes into etiopathology, progression of the disease, analysis of Wen and summer heat diseases. so already a lot point.

Zhang, Zhong Jing really recognize that Shang Han is really not pathology of all diseases,

but there are other pathologies that’s caused by wind pathogen, summer heat.

Section 3 to 6 this is the main bulk pack of his writing,

and this really focus on the explanation elaboration introduction to his idea of disease progression, we call it six Channel differentiation,

and it’s diagnosis and treatments.
Section 7 to 10,

it’s on the area of treating cholera specific special topics on treating cholera and how to help people to recover. The Recovery Care portion,

so if you look at the content,

it’s really based on the Suwen chapter 31, discussion of febrile diseases. It classifies febrile diseases into six stages,

the Taiyang stage, the Yangming stage, and the Shaoyang stage – which tell us the three yang stage conditions.

Anit further progresses to the Taiyin stage, the Shaoyin stage, and the Jueyin stage. These are the 3 yin diseases so these are the yin portion of diseases.

So to really understand Shang Han well, it is very important for us to really delve

into what is the basis for injury by cold? Dr. Zhang, Zhong Jing tells us that it really comes from Nei Jing Suwen chapter 31.

In this chapter discusses and it basically the title of this chapter is the discussion of febrile disease has basically disease that has fever.

And Huang Di, if we look at some of the passages, I’m going to go through the passage with you here, Huang Di inquired.

What we know of febrile disease today belong to Shang Han category.

Some people died and some recovered from it.

The ones that died usually occur within six to seven days from the onset of the disease.

The ones that lived usually took more than 10 days to recover.

Why is this? This is Huang Di asking Qi Bo, his Court physician. And Qi Bo replied:

The Giant Yang (at that time they used the term Giant Yang) basically it’s what we call Ju Yang,

it’s no different than Tai Yang, it means Tai Yang,
Tai Yang connects with all six yang channels,

Its channel branches to DU16 Feng Fu point, in the back of the head,

Therefore it is the representing channel of the Qi of Biao.

So it’s this channel we need, is the channel that really fights off,

pathogens, fights of, it’s like the front line, is the front line in dealing with any kind of infections and outside exogenous attacks.

So Qi Bo continues to say, ‘when a person is attacked by a cold pathogen,’

‘The person will exhibit febrile diseases,’

‘most of the time, even though the fever can be severe, the person will eventually recover and will not die – most of the time.’

‘But if both yang and yin channels are simultaneously attacked by the cold pathogen,’

‘and if our channel – if our body is weak – then death,’

‘frequently is inevitable because our body cannot handle the attack.’ Especially when it is attacked both portion about body and this is Qi Bo elaborated to Huang Di.

Continuing on, Huang Di inquired further, ‘well I would really like to know more about the disease progression.’

Qi Bo replied, ‘well if we break it up in two days on the first day of Shang Han,’

‘Ju Yang (Tai Yang) is attacked, exhibiting a certain type of stiffness.’

‘or headache.’ So you have a headache, neck pain, back pain, and some stiffness that’s kind of like the first day symptoms.

And ‘second day on the second day,’

Yang Ming is attacked.’ well ‘Yang Ming Masters over our flesh, our muscles, our tissues,’

‘and it’s channel runs parallel to the nose and branches into the eyes. Therefore it exhibits fever,

Eye pain and dry nose and difficulty lying down because of fever and the restlessness.’

‘On the third day Shao Yang channel is attacked.

‘Shao Yang masters over gallbladder as we know. it’s Channel traverses through the hypochondria (the rib area) and branches to the ears.’

So therefore during this period of time with Shao Yang disease it will exhibit the symptoms of rib pain and hearing loss.

‘At this point all the three yang channels have been attacked.’

‘but has yet to enter the Zang organs. Proper diaphoretic treatment methods can dispel the disease.”

So it’s saying here is that it doesn’t matter which yang Channel.

diaphoretic method is suitable for all three yang channels. This is what the Huang Di Nei Jing is telling us.

‘On the fourth day, Tai Yin is attacked’

‘Tai Yin channel traverses through the stomach region and branches to the throat, therefore symptoms of abdominal fullness and dry throat.’

‘On the 5th day

Shao Yin is attacked. Shao Yin channel traverses through the kidneys and branches into the lung,

and also ends at the root of the tongue,

therefore symptoms of dry mouth, dry tongue, and thirst.” “On the sixth day, Jue Yin is attacked.

Jue Yin traverses through the genitalia and branches to the Liver, therefore restlessness and scrotum shrinkage is noted,

‘At this point, all three Yin and Yang channels, have been attacked.’

‘All the five Zang and six Fu organs are all diseased.
Our nutritive Ying,

‘Our defensive Wei both stopped flowing and being functional. Therefore, Five Zang are stagnant

‘When the Five Zang and the Zang Fu is that stagnant – especially the Five Zang – Death is inevitable.

‘But if the Cold pathogen,’ Qi Bo continues, ‘did not attack both Yin and Yang channels,

on the seventh day, Tai Yang disease decreases and the headaches are better.

On the eighth day, Yang Ming disease decreases, and the fever is better.’

So he is saying on the 8th day the fever dies down.
‘On the ninth day, Shao Yang disease decreases, and the hearing returns.’

On the tenth day, Tai Yin disease decreases, and the abdominal fullness is down and the appetite is back.”

“On the eleventh day, Shao Yin disease decreases, thirst and dry throat abated. The person is able to sneeze.

On the twelfth day, Jue Yin disease decreases,

testicles relax, pelvic soothed, pathogenic influences are gone and the person is recovered.”

Now you look at this kind disease looking a certain you know about 11 to 12 days a of recovery,

this sounds like a flu. And this most likely is influenza, commonly known as the flu.

As you can see some of the disease symptoms are not very strong and somewhat weaker,

now when we go to Nei Jing now or we go to Shang Han, Zhang, Zhong Jing was able to break it down even more in detail for us on this disease progression.

If we look Shang Han Lun: Differentiation and Treatment Principles, we will realize Zhang, Zhong Jing really incorporated the Zang Fu differentiation,

Elaborated upon channel and Zang Fu progressions

And he was able to establish eight main methods of treatment,

start with diaphoresis- sweating method – emesis – vomiting method. Purgation –

pooping and peeing method, cleansing clean the heat, harmonizing harmonizing,

warming – warming the cold away. Tonification, tonifying deficiencies. Dissolution, the last one is dissolving any kind of tumor nodules and blockages.,

this becomes the eight,

fundamental treatment principles of treatment methods in Chinese medicine. Many apply to herbal medicine

So looking further into the publication history Shang Han Za Bing Lun is just a fantastic book,

it was known to be published around the Three Kingdoms era and was lost during the war time.

And it was able to be republished, rediscovered,

in sections of Dr. Sun, Si Mao’s Qian Jin Fang 千 金 方 (Thousand Golden Formulas)

and Dr. Wang, Shu He’s Mai Jing 脉经 (The Classics of Pulse) So these two book we are able to get a glimpse of Shang Han Za Bing Lun and this is how,

this wonderful and important book was passed down.

So if we look at later on there are so many people who revere Shang Han Lun as the Bible of TCM,

because Huang Di Nei Jing, even though it has a lot of theories,

the applicable part, where we are really starting to see syndrome, treatment principles where we start to see disease progression ways we start to see all the 100

or so formulas that can be used and still used today,

we find this in Shang Han Lun

this book became the number one most revered and most well studied Classics in all TCM fundamentals.

So there are a lot of elaborators, there’s a lot of translators there’s a lot of elucidators,

try to learn try to understand what Zhang, Zhong Jing was trying to teach them,

the elaborated on his work, make it better or make it so they share their understanding and they’re their lifetime clinical work. Based on this Theory,

so there’s a lot of types of related publication and a lot of TCM physicians that focused on Shang Han Lun,

and last count publications, of physician, is 600 plus known publication and physicians.

And it’s two major major types of looking at Shang Han Lun two major types of scholarly work,

one is a translation and elucidation is a direct translation of the work. And second is specific topic discussions for example how does Shang Han Lun deal with,

colitis, how does Shang Han dealing with,

a woman’s disease. how does Shang Han deal with parasites, situation these are special topics discussion and later on a lot of doctor,

trying to look at special topic and trying to see if they can use the school of thought of Shang Han Lun to be able to treat them,

okay so we see quite a bit.

Now last time I went through Jin Kui Yao Lue. but quickly Jin Kui Yao Lue is another book within this Shang Han Za Bing Lun

Sometime you just call the Jin Kui and sometimes we have the long name Jin Kui Yao Lue. 3 section,

external medicine,

Emergency care and dietary guidance. is also based on Nei Jing Suwen.

Is not based on the Shang Han the febrile disease discussion but rather is based on the Zang Fu theories of the Nei Jing.

Now again Jin Kui was also lost just like Shang Han Lun,

and again it has two types of two types of publication. where it’s a translation, or were elucidation work the second is special topic discussion,

and there’s a hundred plus TCM physician and Publications that devoted their energy and their life force to trying to help other people understand,

what Jin Kui Yao Lue is.

So what is the definition of Shang Han Lun? I think you have to really understand this whole book in the very first thing we need understand is what Shang Han means,

the book cover definition of Shang Han is that today’s like in chapter 31 it says today’s febrile disease all belong to the classification of Shang Han,

so the Nei Jing any was very explicit. Here’s what the Nei Jing says today.

Okay it did not say yesterday – did not say into the future – but what it said at that current time.

All febrile disease that are unknown to all belong to the classification of Shang Han.

So actually later on us we discover,

a lot of infectious disease are not just a lot of febrile diseases are not just from Shang Han,

it can be from parasites it can be from heat, wind heat can be from damp heat, it can be from wind pathogens,

so therefore is still correct that Nei Jing says at this time today’s febrile diseases, belong to the classification of Shang Han,

all disease are due to the wind cold invasion during that time,

so therefore Shang Han, it’s about discussion of wind cold invasion, and miscellaneous disease and the disease progression that comes after that and how he transforms into different diseases.

Having said that, the truth is this book is not really all about cold injury. it is about how our body react to the pathogen,

how our bodies become diseased, bit by bit by bit. How our body weakens and eventually demise. Or how our bodies are able to.

Work through different phases of disease recover quickly recover slowly,

and gets rid of a lot of these different symptoms. So it’s a brilliant book in the sense that it’s a very first book that really give us a whole concept of disease progression,

Now does Shang Han six Channel differentiation only apply to febrile diseases?

I don’t think so, if you look at a lot of the Masters of Shang Han Lun, such as in Beijing […].

He is a very famous physician and studied Shang Han Lun is whole life,

and if you look at these formulations he have used widely. As We Know,

all the Shang Han formulas for all the internal medicine conditions, it is a lot of them.

And the reason is not because that he is trying to break away for no good reason he break away because he knows is that the disease progression for the Shang Han,

the six Channel differentiation can be applied to many different diseases – chronic diseases.

Rheumatoid arthritis situations,

chronic conditions that lasts for a long time. you can still see the six Channel differentiation in some of this condition that’s what when we,

whe are we not learning about the cold pathogen. Reedy we are we learning about the progression of diseases .We learning about how a body fights disease and how we can help,

the body fights Disease by using proper formulas in certain stages not too early and not too late and that’s how we can help the body.

So Shang Han Lung and her focus is that singular Shang Han condition occurs less compared to combined with miscellaneous a diseases,

therefore, discussion of both shang-han and miscellaneous diseases together is logical,

so what do we mean by miscellaneous diseases. You can envision going back in time I mean Zhang, Zhong Jing in 100, 200 AD, two thousand years ago.

Okay so at that time and life expectancy wasn’t that high – the best 30, 40 years. What are people dying of? Well they’re not dying they’re not really dying of chronic old age disease,

most women don’t even make it through menopause, a lot of time they’re dying of infections, dying of influenza simple flu while I shouldn’t say simple flu,

realities if you look at it today
a lot of,

immunocompromised patient senior citizen, young kids are very much negatively impacted and even death from flu epidemics even today,

so this is not a condition to just sneeze about it’s something we have to really pay attention to and trying to stop this infection in this dreaded disease and its track.

Then done a lot of times we have to combine with a discussion of miscellaneous diseases because,

infectious disease can also bring on miscellaneous diseases, also our own bodies weakness in the balance also allows this disfunction of certain Zang Fu functions and it creates,

miscellaneous diseases. Well so we are focusing on Constitution we are focusing on disease progression,

focusing on etiology pathology we looking at the differences between person to person there for the discussion,

only in Shang Lan is call injury by cold, it is absolutely not comprehensive enough for this book.

So again the focus is constitution, disease progression, etiology ,pathology and not just injury by cold.

There for six Channel differentiation reading incorporates the understanding of both Shang Han and Za Bing,

Shang Han and Za Bing. So six Channel differentiation is really not just endogenous disease, it’s exogenous disease. And if you can understand and see that,

oh my God you can apply this school of thought into everything you treat.

That’s why this book, this publication, that’s why this concept framework is so popular, even today with a good TCM and physician.

Shang Han Lun elaborates upon the condition due to pathogenic wind cold through the characteristics of six channel So the essence, again repeat again, of Shang Han is of six Channel differentiation.

And six Channel differentiation is based on the physiological and pathological expression of both the Zang Fu and the Jing Luo, both the organs and Meridian.

Therefore the essence of Shang Han is six Channel differentiation and not wind cold Invasion. I have to repeat that again.

So the true definition is the study of Shang Han Lun is the study of six Channel differentiation,

SCD and how SCD is apply to all diseases including infectious exogeneous and miscellaneous endogenous diseases regardless the nature of the pathogen.

So Suwen says, The physician

who diagnoses well will first inspect color and palpate pulse to differentiate yin and yang,

that’s the reason why all diagnostic methods in TCM originate from differentiation of yin and yang and this is where.

a big part

Off the six Channel differentiation also included the eight principles of differentiation. okay so in looking at paired.

Polarity imbalances and there’s four of them

Is this a yin type of imbalance in a sense is this yin form of disease is it a cold type of disease, or is this a yag type of disease like a heat type of disease,

is this weak, is it strong in the nature of the imbalance.

The second polarity is the nature of pathogens. what’s the characteristic of a pathogen? is it cold?

Is it hot or heat?
so you’ve yin-yang.
you have cold or heat.

Now so you have the invasion so there must be a nature of anti-Invasion Factor we call it anti-pathogenic factors this will be your body.

Is your body in good balance? is your body in excess or deficient? okay excess or deficient,

and now if the whole body is excess or deficient, maybe there’s some organ that’s excess or some organ is deficient so.

That’s the nature of your body the antipathogenic factor.

Then the fourth pillar is the location of the disease. Where is the disease.

Is it in the exterior more or is deep inside interior okay so you have therefore Yin/Yang, Biao/Li

Han/Re, Xu/Shi, or four pillar 8 principles of differentiation. 8 principle differentiation.

So if you look at the differentiation process.

Shang Han really takes us
from two dimension to three dimensions.

The eighth principle differentiation is two two-dimensional is either Yin condition or Yang condition, Heat or Cold, Excess or Deficient

so those are what we called bipolar you know polarity that’s a very true dimensional way of looking at it.

Six Channel differentiation the six Channel differentiation is changing from a two-dimensional Paradigm to a three-dimensional Paradigm in how we look at things.

If differentiation
it’s like pinpointing a location – like GPS – trying to pinpoint a location.

Yin and Yang differentiation would be trying to find a neighborhood, okay where where do you live? you learn which neighborhood you live in like in Los Angeles – which is a big city.

so you got to kind of refine it like, you live in Korea Town.

OK, the 8 principle differentiation is like finding a street – like, where do you live in Korea Town?

Which street do you live on? I live on Vermont Avenue.

Now the six Channel differentiation is like finding the house on the street.

So you’ve got to go from neighborhood, to
the street, to the actual house.

So you differentiating from very rudimentary

General differentiation, to two dimensional differentiation, to a three-dimensional differentiation.

And if you look at the six Channel differentiation in the positional relationship the Taiyang, the most yang, embraces all.

it is the most Yang Qi of the body Embraces everything inside of it so Taiyang is – in position or location – is really our outer layer.

The outer layer is our skin.

It’s our skin its the top layer of everything.
Then if you go inward, you go to Yangming,

Shaoyang, Taiyin, Shaoyin, Jueyin.

So the normal Channel progression,

in a disease behaves (disease never really behaves because each individual have different progressions) but, in a normal progression,

we’re talkin about the disease going from Taiyang channel to the Yangmin channel to the Shaoyang Channel.

OK. Now Taiyang disease, or what we call Taiyang Bing denotes pathogenic invasion of the foot urinary bladder channel.

Yangmin Bing denotes pathogenic invasion of the foot stomach channel.

Shaoyang Bing denotes pathogenic invasion of the foot gallbladder channel. And so on,

Taiyin Bing denotes pathogenic invasion of the foot spleen channel. Shaoyin, the kidney.

Jueyin, the liver. Now, when we look at these channels,

we didnt see any see any hand channels. we only talked about a foot channels, but no hand channels. It’s on purpose.

The pecking order is that the foot channels are the main channel because they have a direct connection to the associated organs. And the hand channel does not.

Hand channels are the secondary channels due to their indirect connection to the associated Zang Fu.

Hand channels are the secondary channels, the action is most distal more indirect. so that’s the pecking order.

In each of the six Channel disease therefore it has a primary effect and a secondary effect. The primary effect is usually the Foot Channel. The secondary of fact is usually the hand Channel.

The Taiyang disease affects primarily the foot channel of the urinary bladder.

And secondarily the hand channel of the small intestines.

While Yangmin disease affects the function of the stomach and the secondary would be the hand channel of large intestine.

When we have a Shaoyang disease it attacks mainly the foot channel the gallbladder and secondarily lthe hand channel of Sanjiao.

On and on. OK. This gives you some idea of the sister relationship of the foot and the hand channels.

So the main symptoms.

You know when we looked earlier when, we looked at Huang Di Nei Jing, give us a very good idea, shall we say a starter, like an appetizer,

It told us, day one is your stiffness and neck pain. And it tells us a fever comes on the second day,

right if you remember that, and it tells us the third day is a Shaoyang syndrome which is having ear congestion – hearing loss – and you’re having rib pain,

Taiyin is the spleen channel, and so on. So very minimal symptoms. Zhang, Zhong Jing actually elaborated further,

saying Taiyang Bing, the main symptom is going to be a severe headache with neck stiffness now he has a zeroed in specifically where,

Yangming disease, you’re going to have facial flushing, forehead pain, and dryness of nose besides the fever.

Shaoyang disease, you’re going to have hearing loss, chest hypochondriac distension, and bitter taste in the mouth.

And Taiyin disease, you have abdominal distention, which is exactly what the Nei Jing says. And Shaoyin disease is sore throat.

OK. Jeuyin disease is vertex headache,

and an emesis of the mucus of the spirit.

Then he talked about disease transmission.

We talked about the normal transmission we call that regular transmission,

then we also have exterior to Interior transmission recall a Biao-Li transmission,

then we also talked about the over-reaching progression. Overreaching is Yue Jing Chuan so impatient just want to go to na the next stop,

you want to skip the next train station go to the train station afterwards – okay that’s call over-reach progression.

The regular progression we talked about before Taiyang to Yangmin, Yangmin too Shaoyang. Your regular disease,

In the Biao-Li, the pathogen does not just attack Taiyang, but goes in laterally direct deeper into the Shaoyin disease,

okay that’s called it the direct Biao Li transmission,

then you have the Shaoyang for example. Shaoyang disease instead of the next stage it goes straight to Jueyin,

it goes directly to its related yin organs so that is what we called exterior and interior transmission.

Then you have the over-reaching transmission,

so this can be chaotic can be confusing.

Taiyang goes to Jueyin directly, all the way to the end.

Taiyang goes to Taiyin. OK, so this is over-reach.

Going beyond to the next pulse, you should go to the pulse afterward or any stages afterwards this is over-reach.

Now that’s the disease progression.

There are also combinations of diseases. There is simultaneous combination.

You know their are influenza, where it hits you so quickly that it takes on both

Taiyang and Yangming channel all together at one time. We call that a simultaneous combination.

Or we can have ordered combination disease. you get Taiyang first and the next immediate is Yangming.

And on the second day now you have Taiyang and Yangming all,

together now. The first day you may just be Taiyang so that’s called the ordered combination disease.

So let’s talk about He Bing – simultaneous combination disease. The four kinds.

These four kinds of Taiyang and Yangming together as one combination,

taiyang and Shaoyang one combination together. then you have Yangming and Shaoyang as a 1 combination and you can have all the three yang diseases combined together.

Simultaneous combination, He Bing tends to denote Yang Channel diseases, not Yin Channel diseases. Ordered combination,

is a progression and combination at the same time. for example you start with Taiyang disease.

And you don’t have Yangming to begin with. Then Taiyang progresses to Yangming.

It goes through Yangming, but the Taiyang disease has not finished yet,

so now you have a combination of both Taiyang and Yangming. We call this ordered or orderly combination disease or we call it Bing Bing.

Oh you have Taiyang for example, and now the disease progression goes to Shaoyang. But your Taiyang disease is not gone yet.

Okay it’s still there so now we have both.

Even though there’s a progression now we have ordered combination. Taiyang and Shaoyang. really two kinds the Taiyang combined with Yao Ming and taiyang combined with Shaoyang. Progressed and combined,

progressed and combined.

Treatment principle in general, is the first order of things. Trying to self regulate Yin and Yang.

okay. how do we get the Yin and Yang, how do we get the eight principles to regulate.

How do we regulate Yin and Yang, how do we get rid of excess, tonify deficiency ,how do we get rid of heat, get rid of cold, how do we work on the true Qi of the body. So that’s one.

Second is to protect stomach Qi. Save the Jin Ye, save the body fluid.

When you have febrile disease, the number one danger is dehydration.

When you have dehydration, water as you know, is probably the most important element for survival. You can live without food for a while but you cannot live without water now the whole body is exactly like that,

Our cells can live without food for a while because they do have a store of energy. But you cannot live without water for a while so when you have febrile disease the dehydration sets in,

it can become dangerous, so therefore the second the first order of,

matters to take care of is to make sure to protect the stomach Qi, because when you protect the stomach Qi the body can continue to produce and enhance its bodily fluid production,

now the second order of things is to further differentiate and look at the methods of treatment. Do we need to sweat, do we need to vomit, do we need to harmonize, do we need to dissolve,

do we need to tonify, do we need warm. All these methods of treatment come into play,

so let’s go through them.
Sweating, Han, diaphoresis is relief of pathogens through sweating.

Emesis is to relieve a pathogen through vomit.

Purgation is to relieve a pathogen through bowel movement and urination,

Qing is cleansing – relief of the pathogen through internal dissipation.

He – harmonization – is to neutralize pathogens and also enhance the flow of Qi throughout the body,

Wen is to warm, to warm up the yang Qi. It is to treat situations where the yang Qi is deficient.

Bu – tonifying the body.

Xiao is to dissolve, dissolution. Dissolve and shrink the pathogen. So these are the eight methods of treatment.

Now, the uniqueness of the Shang Han Lun is that it established the eight methods of treatment. And it is still in use today,

it is simple, this formula does not have a lot of herbs – very tight,

and the formula and syndromes correspond together. If you have this syndrome – you have this set of symptoms – then use this formula.

Very tight integration and direct correspondences on what you have and what you going to do about it.

What you have – what kind of disease – and what kind of treatment is clear. The herbal formula is right there,

and flexibility. there’s a lot of flexible modification. Zhang, Zhong Jing spends a lot of time in looking at what you can do to different herbs for different symptomatic changes.

Now there are,

Twelve categories of formulas, about 113 formulas. You have the Gui Zhi Tang category, Ma Huang Tang, Xiao Chai Hu Tang,

Zhi Zi Gu Tang, and the Xie Xin Tang, Bai Hu Tang, Cheng Qi Tang, Li Zhong Tang, Zhen Wu Tang, Si Ni Tang, Wu Ling San, miscellaneous other formulas. You can classify these are all,

some of the major formulas, where the Shang Han Lun formulas get classified into.

Zhang, Zhong Jing also brought us
the First Union of Li Fa Fang Yao,

He believed that to really be a good doctor, it is not about just throwing any herbs and try something. It’s about reasoning.

What is the rationale of using a certain herb, and to have that reasoning, to have a rationale, you really have to have a good grasp of the principles,

of disease. The understanding of etiology, pathology, the diagnostic methods, and the characteristic of the herbs. So the reasoning is very important once you know the reasoning,

of why people get sick, then you can come up with a diagnosis and the methods of treatment,

okay. look, you got Taiyang has been constrained – well it’s diaphoresis method, let’s sweat it out.

Okay so that is a methodology for example. And then you have a formula. A formula is a composition,

different herbs. Obviously we do know that a formula can have just one herb. One herb can be a formula,

but majority of time that’s not the case. In the majority of time, a formula is a complex organization of several herbs working together synergistically,

okay. So it can be 3 or four herbs to 25 herbs. There are some formulas as large as 50 herbs

so the formula will come into play. Then not the least,

is the individual herb. How do the individual herbs work together in a formula with each other.

How do they work synergistically – or not work synergistically. What happens when you combine together.

The Shang Han Lun really gives us the first union – the first taste of this: Reasoning, Method of treatment, Formula,

and Herbs. This Li – Fa-Fang-Yao, all 4 things combined together to create a model of doctoring.

So when we learn Shang Han Lun, we need to learn the understanding of Yin Yang,
Zang Fu and Channels,

Etiopathology in Six Channels.
Symptoms and signs

Appropriate use and right dosage of the herbs, and decoction methods of formulas. And we need to carefully analyze each verse.

So if you look at all the verses of Shang Han Lun it has 398 total verses,

How fascinating that Taiyang disease occupies 178 verses.

It is probably the largest number. Why? Why does Zhang, Zhong Jing spend so much time on Taiyang?.

Okay we’ll come back to that. Yangming is 84 verses. Shaoyang is 10 verses.

Taiyin is 8 verses. Shaoyin is 45 verses. Jueyin is 56 verses.

Cholera is 10 verses. Miscellaneous is 7 verses.

The major group is the Taiyang Bing -178 verses. Because when somebody gets a disease – the first day or second day –

if you can get rid of a Taiyang disease right there, you don’t have to bother with anything else. There is an incentive

to get someone well within one or two days. At the beginning of their influenza, of their disease, right off the bat.

Then you don’t have to deal with all the rest of it, and frequently we make mistakes.

As doctors we make mistakes – a lot of time, we make a mistake when the disease is it the first day or second day.

Taiyang disease – we thought oh this is Shaoyang disease, and we started to pacify the Qi already, or clear the liver. Or is it too early,

what happens when you purge, it weakens your body. So the Taiyang disease therefore becomes a totally different disease progression,

that’s why Taiyang disease has so many verses.

And the next is Yangming, well you know what one day two days, but it is still not too late when you get to third and fourth,

now you get to the next progression – hey if you can catch it in time. And you have all these diseases that go down to the next progression,

So he spends a lot of time – 84 verses – that is the second most verses,

Once you goes beyond Yangming, then it moves pretty rapidly.

Through Shaoyang, so basically you got 10 verses. Or Taiyin is 8 verses – because at this point the disease has an upper hand – it’s on the move.

Now when you get to Shaoyin injury, and as you’re getting to the end of the Yin channels, if you don’t recover if you don’t fight properly.

Death can become the next option. And that’s not an option. So therefore you start to see 45 verses in Shaoyin,

OK. So you can see a lot of verses in the beginning Taiyang and Yangming, a lot of versus at the end and at basically Jueyin and Shaoyin diseases.

Cholera, there is 10 verses. Cholera,

I think in this book, is probably one of the earliest documentations of Cholera, and how to treat it. Zhang, Zhong Jing that’s brilliant. Probably about 500 or 600 years earlier than the Western counterpart.

So Shang Han, in summary, is the study of disease progression due to pathogenic

Wind Cold invasion in a narrow definition,

The Shang Han in a broader definition, is the study of disease progression due to pathogenic invasion – it doesn’t necessarily have to be Wind Cold invasion.

And the Key Learning in the Shang Han Doctrine, the school of thought, is the Six Channel Differentiations.

That is a brilliant Masterpiece of studying disease progression that you can apply into Internal Medicine into many different chronic disease – it does not have to be just exogenous diseases.

And the other thing we want to learn is the disease transmission, the movement of a disease, and the management of the disease.

Thank you so much for your time today and I hope you have enjoyed this session and I will see you next time.

Acupuncture CEU Online Course:

Series: Overview of TCM Classics and Doctrines

Author: Dr. Daoshing Ni, Yo San University of Traditional Chinese Medicine

Class: Shang Han Xue Pai
(Cold Injury Doctrine) Shang Han Lun and Jin Kui Yao Lue

1. Shang Han Za Bing Lun

• Author: Zhang, Zhong Jing 张仲景 (Zhang, Ji 张机), 150-219 AD
• Born and raised in Henan Province, as reputable as Hua Tuo 华佗.
• Incorporating his clinical experience and established
  • six channel differentiation for injury by cold pathogens. (Liu Jing Bian Zheng 六经辨证)
  • Zang fu differentiation for miscellaneous conditions.

2. Shang Han Za Bing Lun

• An authoritative publication, a must read for all practitioners of TCM.
• It was lost through wartime, republished and revised in the Song Dynasty
• Two portions:
  • Shang Han Lun 伤寒论
  • Jin Kui Yao Lue 金匮要略

3. Shang Han Lun 伤寒论

Publication Overview

• 10 sections, 22 chapters, 113 formulas.
• Section 1 pulse diagnosis of Shang Han
• Section 2 etiopathology, progression, analysis of Wen and Summer Heat diseases
• Section 3 to 6 six channel differentiation and treatment
• Section 7 to 10 cholera, recovery care

4. Shang Han Lun Content Overview

• Based on Suwen chapter 31 Discussion of Febrile Disease – six channel differentiation
• Classified febrile diseases into six stages:
  • Taiyang Bing 太阳病
  • Yangming Bing 阳明病
  • Shaoyang Bing 少阳病
  • Taiyin Bing 太阴病
  • Shaoyin Bing 少阴病
  • Jueyin Bing 厥阴病

5. Discussion of Febrile Disease 熱論

Chapter 31 Huang Di Nei Jing

• Huang Di inquired, “What we know of febrile disease today belong to Shang Han category. Some died and some recovered from it. The ones that die usually occur within 6 to 7 days from the onset of the disease. The ones that lived usually takes more than 10 days to recover. Why is this?”
• Qi Bo replied, “Giant Yang (Ju Yang)(Tai Yang) connects with all six Yang Channels. Its channel branches to DU16 Feng Fu, therefore it is the representing channel of Biao Qi (Exterior Qi).”
• “When a person is attacked by a Cold pathogen, the person will exhibit febrile diseases. Most of the time, even though the fever can be severe, but the person will eventually recover and will not die. But if both Yang and Yin channels are simultaneously attacked by Cold pathogen, death is inevitable.”
• Huang Di inquired, ”I would like to know more about the disease progression.”
• Qi Bo replied, “On the first day of Shang Han, Ju Yang (Tai Yang) is attacked exhibiting headache, neck pain, back pain with stiffness. On the second day, Yang Ming is attacked. Yang Ming masters over flesh and tissues and its channel runs parallel to the nose and branches into the eyes. It exhibits fever, eye pain, dry nose, and difficulty lying down. On the third day, Shao Yang is attacked. Shao Yang masters over Gall Bladder, its channel traverses through hypochondria and branches to the ears. It exhibits symptoms of rib pains and hearing loss.”
• “At this point, all three Yang channels have been attacked but has yet to enter the Zang organs. Proper diaphoretic treatment methods can dispel the disease.”
• “On the fourth day, Tai Yin is attacked. Tai Yin channel traverses through the stomach region and branches to the throat, therefore symptoms of abdominal fullness and dry throat. On the fifth day, Shao Yin is attacked. Shao Yin channel traverses through the kidneys and branches into the lung and the root of tongue., therefore symptoms of dry mouth, dry tongue, and thirst.”
• “On the sixth day, Jue Yin is attacked. Jue Yin traverses through the genitalia and branches to the Liver, therefore restlessness and scrotum shrinkage. At this point, all three Yin and Yang channels, five Zang and six Fu organs are all diseased. Ying Wei stopped flowing and functioning. Five Zang are stagnant, death is inevitable.

• “But if the Cold pathogen did not attack both Yin and Yang channels, on the seventh day, Tai Yang disease decreases and the headaches are better. On the eighth day, Yang Ming disease decreases, and the fever is better. On the ninth day, Shao Yang disease decreases, and the hearing is returning. On the tenth day, Tai Yin disease decreases, and the abdominal fullness is down and the appetite is back.”

• “On the eleventh day, Shao Yin disease decreases, thirst and dry throat abated. The person is able to sneeze. On the twelfth day, Jue Yin disease decreases, testicles relax, pelvic soothed, pathogenic influences are gone and the person is recovered.”

This is most likely influenza commonly known as the flu.

6. Shang Han Lun: Differentiation and Treatment Principles

• Incorporated Zang Fu differentiation
• Elaborated upon channel and Zang Fu progressions
• Established eight methods of treatment.
  • Han 汗 Diaphoresis
  • Tu 吐 Emesis
  • Xia 下 Purgation
  • Qing 清 Cleansing
  • He 和 Harmonization
  • Wen 温 Warming
  • Bu 补 Tonification
  • Xiao 消 Dissolution

7. Shang Han Lun: Publication History

• Published around three kingdom era.
  • Lost during wartime
• Re-published in sections of Dr. Sun, Si Mao’s Qian Jin Fang 千 金 方 (Thousand Golden Formulas) and Dr. Wang, Shu He’s Mai Jing 脉经 (The Classics of Pulse)

8. Shang Han Lun: Types and Players

• Related publications and physicians 600+
• Two types
  • Translation/elucidation
  • Specific topic discussions

9. Jin Kui Yao Lue:  Overview

• Other names
  • Jin Kui 金匮
  • Jin Kui Yao Lue Fang Lun 金匮要略方论
• 3 sections, 25 chapters based on disease types, 262 formulas.
• Includes diseases in internal medicine, gynecology, external medicine, emergency care, and dietary guidance.
• Based on Neijing Suwen’s Zang Fu theories.

10. Jin Kui: Publication History, Types and Players

• Lost until Song Dynasty.
• Two Types:
  • Translation/elucidation
  • Specific topic discussions
• 100+ physicians and publications

11.“Book Cover” Definition Shang Han

• “Today’s febrile diseases all belong to the classifications of Shang Han”
  • Suwen Chapter 31 Discussion of Febrile Diseases
• All diseases are due to Wind Cold Invasion
• Shang Han is about discussion of wind cold invasion and miscellaneous diseases

12. Shang Han Lun and her focus

• Singular Shang Han condition occurs less compared to combined with miscellaneous diseases, therefore discussion of both Shang Han and miscellaneous diseases together is logical.
• Constitutions, disease progression, etiologies, pathologies differ from person to person; therefore discussion of only Shang Han is not comprehensive.

• Therefore six channel differentiation incorporates the understanding of both Shang Han and Za Bing

• Shang Han Lun elaborated upon the conditions due to pathogenic Wind Cold through the characteristics of six channels. The essence of Shang Han is the Six Channel Differentiation.

• Liu Jing Bian Zheng

• Six channel differentiation is based on the physiological and pathological expressions of Zang Fu and Jing Luo

• Therefore, the essence of Shang Han Lun is Six Channel Differentiation and not wind-cold invasion

13. True Definition

• Shang Han Lun is the study of Six Channel Differentiation (SCD) and how SCD is applied to all diseases including infectious diseases and miscellaneous diseases regardless the nature of the pathogens.

• Physicians who diagnose well will first inspect color and palpate pulse to differentiate yin and yang: Suwen, Neijing

All diagnostic methods in TCM originates from differentiating yin and yang

• Ba Gang Bian Zheng 八纲辩证
• Eight Principles of Differentiation (EPD)
• Differentiation Process
• From Two Dimensions to Three Dimensions

If Differentiation is like pinpointing a location; YYD would be to fine the neighborhood; EPD is like finding the street; SCD is like finding the house on the street.

• Six Channel Differentiation
• Positional Relationship
• Six Channel Differentiation
• Normal Channel Progression

14. Six Channel Differentiation:

• Taiyang Bing denotes pathogenic invasion of the Foot Urinary Bladder Channel
• Yangming Bing denotes pathogenic invasion of the Foot Stomach Channel
• Shaoyang Bing denotes pathogenic invasion of the Foot Gall Bladder Channel
• Taiyin Bing denotes pathogenic invasion of the Foot Spleen Channel
• Shaoyin Bing denotes pathogenic invasion of the Foot Kidney Channel
• Jueyin Bing denotes pathogenic invasion of the Foot Liver Channel

15. Pecking Order:

• Foot Channels are the main channels due to their direct connection to the associated Zang Fu
• Hand Channels are the secondary channels due to their indirect connection to the associated Zang Fu

16. Six Channel Differentiation: Table

17. Main Symptoms of Six Channel Differentiation:

• Taiyang Bing – occipital headache or neck stiffness
• Yangming Bing – facial flushing, forehead pain, dryness of nose
• Shaoyang Bing – hearing loss, chest and hypochondriac distension, bitter taste
• Taiyin Bing – abdominal distension
• Shaoyin Bing – sore throat
• Jueyin – vertex headache, emesis of mucus

18. Disease Transmission: Three Common Occurrences

• Regular Transmission (Yi Ban Chuan Jing 一般传经)
• Biao-Li Transmission (Biao Li Chuan Jing 表里传经)
• Overreach Progression (Yue Jing Chuan 越经传)

19. Regular Progression Transmission (Yi Ban Chuan Jing 一般传经)

• Tai Yang Stage
• Yang Ming Stage
• Shao Yang Stage

20. Biao-Li Transmission (Biao Li Chuan Jing 表里传经)

• Overreach Transmission (Yue Jing Chuan 越经传)

21: Disease Types

• He Bing 和病– Simultaneous Combination Disease
• Bing Bing 并病– Ordered Combination Disease

He Bing 和病– Simultaneous Combination Disease –Four Kinds

Bing Bing 并病– Ordered Combination Disease – Two Kinds

22. Six Channel Differentiation: Treatment Principles

• First Order
  • Yin Yang Self Regulation
  • Protect Stomach Qi, Save Jin Ye – Body Fluids 津液
• Second Order
  • Eight Methods of Treatments

23. Eight Methods of Treatments Zhi Liao Ba Fang 治疗八法

• • Han 汗 Diaphoresis – Relieve of pathogens through Sweating
  • Tu 吐 Emesis – Relieve of pathogens through vomiting
  • Xia 下 Purgation – Relieve of pathogens through bowel movements and urination
  • Qing 清 Cleansing – Relieve of HEAT pathogens through internal dissipation
  • He 和 Harmonization – Neutralize pathogens
  • Wen 温 Warming – Warming up Yang Qi
  • Bu 补 Tonification – Tonifying Body
  • Xiao 消 Dissolution – Dissolve and Shrinking Pathogens

24. Six Channel Differentiation: Formulary

Uniqueness of Shang Han Lun

• Established Eight Methods of Treatment
• Simple and tight formulation
• Formula and Syndrome (Fang-Zheng 方证) direct correspondences
• Flexible Modifications

25. Formulary from Shang Han Lun: 12 categories 113 formulas

• Gui Zhi Tang 桂枝汤
• Ma Huang Tang 麻黄汤
• Xiao Chai Hu Tang 小柴胡汤
• Zhi Zi Gu Tang 栀子鼓汤
• Xie Xin Tang 泻心汤
• Bai Hu Tang 白虎汤
• Cheng Qi Tang 承气汤
• Li Zhong Tang 理中汤
• Zhen Wu Tang 真武汤
• Si Ni Tang 四逆汤
• Wu Ling San 五苓汤
• Miscellaneous 其他杂方

26. First Union of Li Fa Fang Yao 理法方药

• Fa – Method
• Fang – Formula
• Yao – Herbs
• Li – Reasoning

27. Learning Shang Han Lun

• Yin Yang
• Zang Fu and Channels
• Etiopathology in Six Channels
• Symptoms and signs
• Appropriate use, right dosage, and decoction methods of formulas
• Carefully analyze each verse

28. Contents of Shang Han Lun

• 398 total verses
  • Taiyang Bing – 178 verses (1-178)
  • Yangming Bing – 84 verses (179-262)
  • Shaoyang Bing – 10 verses (263-272)
  • Taiyin Bing – 8 verses (273-280)
  • Shaoyin Bing -45 verses (281-325)
  • Jueyin Bing – 56 verses (326-381)
  • Cholera – 10 verses (382-391)

• • Miscellaneous and Recovery – 7 verses (392-398)

29. Summary

• Shan Han is a study of disease progression due to pathogenic Wind-Cold invasions in a narrow definition
• Shan Han is a study of disease progression due to pathogenic invasion in a broader definition
• Key Learning:
  • Six Channel Differentiations
  • Disease Transmission, Movement and Management