Examples of formula for the different levels of shang han lun
Is there a difference between modern herbalism and classical shang han lun herbalism?
The modern day approach to herbalism is to try find a herb that competes with a modern medical pharmaceutical and market it as a “natural” product. For example, there are a number of medications to affect dopamine and then prescribed to treat depression. In competition, herbal companies go out and try to find a herb that can alter dopamine so they can market that as a natural alternative. Just Google herbs and dopamine and you will get the top ten herbs to buy of which ginseng is one of. Many people in modern society want something that has been researched and proven to verify changes in some parameter on a computer screen or in some petri dish. These people also want this from a natural product and for those those requiring to satisfy this simplified thinking, there are ample choices for people to pick from the shelves of health food stores or to buy from herbal company internet sites.
The main difference when you choose a practitioner trained in shang han lun classical herbalism is that there is a diagnosis that goes hand in hand with the prescription.
In modern society, everyone who has depression can choose ginseng because it affects dopamine. When you have depression and see a shang han lun herbalist, there might be a hundred different formulations that could be prescribed. What is prescribed depends on all the other symptoms and constitutional variations that people have.
When did Shang Han Lun herbalism originate?
The use of medicinal herbs in China goes back thousands of years and the first major text on Chinese herbs, The Classic of Herbal Medicine was written by Shen Nong. The book discusses hundreds of herbs and their uses and includes the modern well known herbs such as ginseng, liquorice, ginger and cinnamon. As the knowledge and use of herbs developed in China, physicians found that combining herbs produced better results and classic formulas started to evolve.
The famous physician Zhang Zhong Jing took this combining of herbs to another whole level which culminated with his classic text the Shang Han Lun which dates to around 220 AD. This text book has survived till today and to put a historical significant context on it, this book predates any books ever written in the English language by 800 years. When one studies Chinese medicine in modern day China, the Shang Han Lun is still one of 5 major texts that all students must study as part of their training. Modern day graduates from Chinese medicine universities could opt to specialize in shang han lun herbalism or the more modern Traditional Chinese Medicine system.
Zhang Zhong Jing also wrote a companion book to the Shang han Lun called the Jingui Yaolue (Essential Prescriptions of the Golden Coffer) which discusses additional diseases and formula.
What does the Shang Han Lun translate as?
It has been translated as the Treatise on Cold Injury. This translation may be technically correct, but it doesn’t really help the lay person understand the depth of this classical diagnostic herbal medicine text book. In fact, many western practitioners of Chinese medicine just view the book as a text that discuses how to treat colds and flu. The first chapter of the book does in fact discuss many formula that treat colds and flu which is perhaps why the misunderstanding came about. The reality is that, the modern herbalist using the Shang Han Lun system as outlined by the author Zhang Zhong Jing, can in fact tackle any disease that presents in today’s clinic.
Is the Shang Han Lun a book of formula to treat symptoms or is it a diagnostic text?
The author, Zhang Zhong Jing expanded upon a diagnostic paradigm already discussed in earlier texts such as the Nei Jing from around 300 BCE. The system that he expanded upon is known as the six divisions or six syndromes.
To explain what the six divisions mean in the modern medical realm is actually very difficult because it can’t be simply fitted into anything tangible in modern scientific thought. In the diagram above, the names of the six divisions can be seen such as yang ming and tai yang.
To understand the ancient concept of the six divisions, it is perhaps easier to visualize the human body consisting of three layers from outside to inside, a bit like three onion layers. Then visualize within each layer there being an external and internal layer or a yin and yang component. When a disease enters the body, it settles into one of these layers and causes various symptoms. There could be a number of diseases just within one layer or a number of different diseases in any number of different layers at the same time. The Shang Han Lun practitioner looks to identify which signs and symptoms are in which layer and from there, then determine what is the appropriate formula.
Zhang Zhong Jing had meticulously classified grouping of symptoms so that a specific formula would be the combination of choice for that disease. The diagram above exemplifies this concept. There are in fact hundreds of formula and diseases states that the Shang Han Lun herbal approach can address.
What is an example of one of these diseases lodged in one of the six divisions?
A common problem that we all know of is catching a cold. Symptoms such as a slight fever, chills, achy or tight muscles around the neck and shoulders, nasal congestion and a feeling of weakness have been experienced by us all. Zhang Zhong Jing recorded this as as a disease entering the first layer known as the Great Yang division. The flagship formula for this condition is called Gui Zhi Tang (Cinnamon decoction). In the modern day context, this formula gui zhi tang could also be used for upper respiratory infection, influenza, post partum fever, allergic rhinitis, eczema and many other problems as all those symptoms might all belong to Greater Yang disease syndrome. In another example, the disease would be slightly different where the chills would be more predominant accompanied with a cough. This would then require a different formula or if the person had a severe fever, the formula would be different yet again. By contrast, in modern herbalism, everyone takes just echinacea because it improves “immunity”. One size fits all and it becomes easy to sell something to the public from a health food store or internet site.
Can you have more than one disease lodged in different layers?
We are under constant bombardment from weather and environmental factors bringing in pathogens which then lodge in the various layers. Sometimes the body is strong enough to expel the pathogen by itself and other times the pathogen just lies there dormant. In addition, improper diet, irregular lifestyle and incorrect treatment causes many diseases to arise and also settle into any number of the layers. Emotional stress, phlegm and the state of the blood are further examples that may contribute to disease and present themselves as a collection of symptoms. Zhang Zhong Jing, for example recorded the symptoms associated with malaria and placed the disease as sitting in one of these layers. In another example, the Shang Han Lun describes the symptoms of round worms and how the disease has lodged into the deepest layer.
Are there specific treatment strategies that Zhang Zhong Jin outlined in his Shang Han Lun medical text?
Western medicine is predominately focused on suppressing a symptom or using a poison to kill a virus or pathogen.
The approach in the Shang Han Lun is to eliminate the disease which may involve for example, the strategical use of formula to cause sweating to push out the bug. In other cases, purging may be required and in special cases even formulas causing one to vomit may be used. As this process happens, the symptom picture would change because the disease is moving out of one layer to another.
Are the causes of disease from two thousand years ago and the formula from the Shang Han Lun still relevant today?
This classic textbook also discusses how inappropriate treatment can lead to other diseases. Some of these inappropriate methods include sweating, purging and administration of excessive cold natured medicines.
It is well documented in modern medicine that incorrect pharmaceutical treatment causes iatrogenic disease.
An example of this is the over prescribing non steroidal anti-inflammatory drugs (NSAIDs) causing heart disease. Another example is a patient dying from the administration of the chemotherapy medication when trying to treat the cancer. Now in modern times more than ever, the patient is being put into a different disease state from many of commonly prescribed medicines. One example is the modern treatment of asthma. Some asthma inhalers are prescribed which have the side effect of excessive sweating. This inappropriate sweating weakens the protective function of the skin which allows more cold and wind to penetrate more easily and thus make them more susceptible to catch cold more easily. This extra, cold temperature now coming into the body more easily, is able to penetrate to a deeper level causing chronic cough and phlegm. This phlegm then leads to antibiotics being over prescribed. Antibiotics according to Chinese medical classification, are a very, intensely cold natured medicine which end up damaging the lungs and digestive system. It is well documented from a modern medical perspective that over prescribing antibiotics can lead to diarrhea and yeast infections. A Shang Han Lun practitioner views that antibiotics cause a new disease that penetrates into the Tai Yin level and as a result has to treat the new disease caused by the incorrect treatment.
What other activities can cause disease to penetrate and lodge in any of these six levels?
What will surprise people is that many of these causative disease factors are actually thought to be good for you or are regarded as normal treatment
- Excessive, prolonged sweating such as going to the sauna or partaking in hot house yoga classes
- Antibiotics
- Medications causing nausea as a side effect such as in cholesterol lowering drugs
- Vitamin C transfusions as they are excessively cold
- Vitamin B if they are causing the urine to become yellow
- Laxatives, especially if you require them regularly
Modern day lifestyle choices also can further cause new diseases
- Fatigue from over work
- Excess exercise
- Diets consisting of exclusively raw food and juices because they actually damage the spleen and stomach function
What Shang Han Lun herbalism isn’t
If you looking for a herb to replace a western medical pharmaceutical that is targeted at suppressing a symptom, Shang Han Lun herbalism is not for you. Also, if you are searching for a natural supplement to counteract the side effects that a pharmaceutical medication is causing you, this is also not for you. If you want to do more for your health and wellness instead of just trying to change a few numbers on a blood test reading, and you want to aim for inner health with the aim of being independent of pharmaceutical drug suppression of symptoms, Shang Han Lun herbalism may be something to consider.
Where can I read more about the Shang Han Lun system of herbalism?
There are a number of books available on the Shang Han Lun but are recommended only for those that already have had training in Chinese herbal medicine. However this link may be of interest to some people wishing to expand upon what is written above.
