How did you develop an interest in Shang Han Lun?
My interest in the Shang Han Lun was a result of my search for source materials in Chinese medicine, and my fascination with medical anthropology. Perhaps it has something to do with my Jewish background, as in Talmudic scholarship there is a strong incentive toward accessing source material and commentaries. I’ve always had the incentive to dig into the classical literature of Chinese medicine, but it took many years to find reliable translations. I also began studying medical Chinese relatively late, about ten years ago.
When I first heard the Shang Han Lun the translations that were available were not very good, such as OHAI’s “Treatise on Febrile Disease, or the New World Press translation. I couldn’t make the text work for me. The Mitchell, Wiseman and Feng’s translation allowed me to finally immerse in the text, as in includes glossaries, and the Chinese, Pinyin and English translation are all pegged to each other.
How did you learn your Chinese?
I began with a tutor ten years ago, Fred Wong, and then continued mostly on my own. I utilized such texts as Paul Unschuld’s “How to Read Chinese”, and the Wiseman “Chinese Medical Chinese” series and Paradigm Press character series.
Are there any kinds of issues that you think the classic formulas are particularly well suited for treating?
Quite frankly, everything; the classic formulas of the Shang Han Lun and Jin Gui Yao Lue are the essence of simplicity, but they can treat rather complex patterns by specific modifications or combining with other prescriptions from the texts. You can think of the classic formulas as the trunk of the great tree of Chinese herbal prescriptions. The Shang Han Lun is the template for later schools of thought and prescriptions, such as the Spleen/Stomach current and Warm Disease current.
I usually do not modify the formulas very much. These classic formulas tend to be good for cases that require finding the key to specific qi transformations. For example, using Si ni san to treat dribbling urination by unblocking qi transformation in the San Jiao channel. Sometimes I combine a couple formulas together. They are really quite elegant in the way a simple addition or subtraction can shift the emphasis of the prescription.
The use of classic formulas is more about matching a formula to a particular presentation, than it is about considering the Zang/Fu. Much of the schooling in modern Chinese medicine schools revolves around Zang/Fu diagnosis. How do you reconcile these two approaches in your clinical work?
I see it as having different prisms, which allow you to observe different phenomena. I call it the “Picasso Principle”, in that one can view a patient from several angles at the same time. The Shang Han Lun provides other views of symptomatic phenomena effecting our patients, by seeing a continuum of change of medical conditions through a six channel warp or gradation.
What are your thoughts about constitution and the treatment of illness?
I think it is both important and quite underemphasized in modern TCM. For me, constitution is about observing the manner in which people tend to get ill. It comes from both their constitution and any changes brought about due to damage to the system over time, from illness, medications, poor diet, or emotional taxation. People get habituated to how they get sick, stuck in specific patterns; addressing constitution helps in these situations.
Many people believe that the classic formulas of the Shang Han Lun are only for treating acute illness or the aftermath of acute illness. However many doctors use these classic formulas to treat chronic illness as well. Can you give us an example of using a Shang Han Formula to treat a chronic condition.
It is important to remember that the original name of the book was Shang Han Za Bing Lun, or “Treatise on Cold Damage and Complex (Miscellaneous) Ilnesses”. And do keep in mind that the Jin Gui Yao Lue is very much focused on chronic illness. There are sections on gynecology, water swelling diseases, skin problems, malaria-like disorder, and diseases of taxation.
If you read the Shang Han Lun/Jin Gui commentaries, you will find it is talking about all kinds of approaches to treatment and strategies, not just external contractions/wai gan. Really, it is a template for getting into a deeper level of understanding and application of medicine.
The other thing to remember about the Shang Han Lun is that it treats those illnesses that have become complex because they did not resolve, or were aggravated (huai bing) by inappropriate treatment. Purging/precipitation is not just about the misuse of da huáng. Modern use of laxatives, or the currently popular colon cleansers, which purge people when they are in the midst of a tài yáng illness. These products, or enemas, are recommend for the common cold. Or large doses of Vitamin C which cause diarrhea. Another example would be the excessive use of diuretics that dry people out and as a result cause tremors and shaking. These are examples of the “mistakes” that Zhang Zhong-Jing talks about that can be reinterpreted in line with modern treatments or lifestyle.
Any tips you have for our readers on ways of approaching the study of the Shang Han Lun and Jing Gui Yao Lue?
First of all, while it is important to read the book itself, and re-read it again and again; in addition, it is essential that you find a teacher who has experience. We are fortunate these days that there is are people like Arnaud Versluys who has developed extensive courses on both the Shang Han Lun and Jin Gui Yao Lue, and quality translations like the Mitchell/Wiseman/Ye translation. Soon we will have a Wiseman/Ye translation of the Jin Gui Yao Lue as well.. To really make the material yours, constant review and study are required. I remember seeing Miki Shima at a conference once a few years ago. His copy of Mitchell’s translation was beaten and battered and had the cover torn off; the margins were filled with his own notes and observations. This kind of constant review, this kind of going back over the material again and again as we gain more experience is essential to unlocking its wealth.