The Sorrowful Grandeur of the Jian'an Spirit and Zhang Zhongjing's Compassion to Save the World
To understand the Medical Sage Zhang Zhongjing, one must set him against his contemporaries. His exact birth and death years are unknown, but one thing is certain: he was a physician of the Jian'an era.
Zhang was already practicing medicine at the start of the Jianan reign period. This is evidenced, first, by the preface to his Shanghan Lun (Treatise on Cold Damage), in which he recounts how epidemics during the Jian'an years took a heavy toll on his own family, and how this moved him to devote himself to medicine to save lives. Second, it is evidenced by the preface to Huangfu Mi's Zhenji Jiayi Jing (Systematic Canon of Acupuncture and Moxibustion), which records Zhang treating Wang Can (Wang Zhongxuan), the foremost of the "Seven Masters of Jian'an." Thus Zhang and Wang Can were contemporaries.
Huangfu Mi was born in 215 CE (the 20th year of Jian'an) and died in 282 CE. It is entirely natural that he knew about the Jian'an era; he merely exaggerated in order to deify Zhang's medical skill. Perhaps medical circles of the time passed on rumor as fact, so that even Huangfu Mi came to believe the legend that Zhang predicted Wang Can would "die with his eyebrows falling out" after age forty.
As I pointed out in an earlier article, Wang Can did not die of "falling eyebrows" but in the great epidemic of 217 CE (the 22nd year of Jian'an). This is confirmed by official histories and by the writings of literary contemporaries such as Cao Pi, who knew Wang Can well. So the legend is certainly false. Wang Can was frail and often ill, and Zhang may indeed have treated him, but there was no miracle in which Zhang predicted his "falling eyebrows" death and it came true.
Zhang Zhongjing's medical heir was Wang Shuhe, the imperial physician of the Western Jin, born around the 15th year of Jian'an. When Wang Shuhe compiled and edited the Shanghan Lun, he referred to Zhang as "Master." Given their lifetimes, it is quite likely Wang studied under Zhang. Parts of the Shanghan Lun are Zhang's own words; other parts are Wang Shuhe's.
Because official histories are silent and contemporary writings give no exact dates, Zhang's true birth and death years are hard to establish. But it is certain that he was already practicing medicine in the Jian'an era.
Jian'an was the fifth reign title of Emperor Xian at the end of the Eastern Han. Many people may not be familiar with the "Jian'an era," but nearly every Chinese knows the Three Kingdoms period. The Jian'an era is precisely the famous Three Kingdoms period; Zhang Zhongjing was a contemporary of Cao Cao, Cao Pi, Liu Bei, and Zhuge Liang.
The Jian'an era was one of constant warfare, rampant plague, and widespread suffering among the people.
How widespread was the plague? Zhang Zhongjing wrote that of his own clan of over two hundred people, two-thirds died within less than ten years, most from cold damage (shanghan). The celebrated "Seven Masters of Jian'an"—Kong Rong, Chen Lin, Wang Can, Xu Gan, Ruan Yu, Ying Yang, and Liu Zhen—five died at once in the epidemic of 217 CE (I wrote four in a previous article, a counting error): Chen Lin, Wang Can, Xu Gan, Ying Yang, and Liu Zhen. Ruan Yu (father of Ruan Ji of the Seven Sages of the Bamboo Grove) died in 212, and Kong Rong in 208. In other words, the 217 epidemic wiped out all the Jian'an masters still living—such was its ferocity.
We also know this was an age of warlord division and the Three Kingdoms' struggle. Plague, war, and famine together depopulated whole regions.
Thus the poetry and fu prose written by the literati of the Jian'an period all carry a tone of lofty resolve and desolation—the famous "Jian'an fenggu" (Jian'an spirit) in the history of Chinese literature.
In Zhongguo Lidai Zhengzhi Deshi, Qian Mu points out that the Han government was a "scholar-official government," a government of educated men. By the Eastern Han, hereditary feudalism (outside the imperial house) had effectively been abolished, replaced by the xiaolian recommendation system. Each commandery of at least 200,000 households recommended one filial and incorrupt scholar yearly, whom the central government examined before appointing. Thus the scholars of the time, at a subconscious level, all carried the ideal of "taking the world as their own responsibility."
With human tragedy so deep, the verses of Jian'an scholars could hardly avoid a desolate tone. The poetic style of Du Fu of the Tang traces back to Wang Can, the first of the Seven Masters. (Of course, if such verses appeared today, they would easily be dismissed as so-called negative energy and denounced online.) Yet history judges the Jian'an spirit highly; a just historical verdict takes many years to arrive, because political influence is hard to avoid.
The writings of Jian'an literati—including the Cao father and sons, Cao Cao, Cao Pi, and Cao Zhi—are all imbued with this noble, mournful tone. Though the Cao family held high status, they too were moved by the times.
Cao Cao wrote in "Song of the Hao-li": "White bones lie exposed on the wild; for a thousand li no cock crows. Of a hundred people, one survives; thinking of it breaks the heart." The scene is unspeakably grim. In his letter to Wu Zhi, Cao Pi, recalling old friends, is equally mournful: "Reading the writings of those gentlemen, I wipe my tears. I grieve for the departed and think of myself… As Boya broke his strings after Zhong Ziqi died, and Confucius overturned his sauce tub on hearing Zilu's death, so do I grieve that a kindred spirit is hard to meet and pity that disciples cannot be matched. They were, in their day, outstanding talents. Those still living have not measured up. The young are to be feared, and the future cannot be dismissed, yet I fear you and I will not live to see it."
Cao Cao reached the pinnacle of power, and Cao Pi actually became emperor; what they experienced and witnessed left them deeply sorrowful. Cao Zhi, the politically fallen Prince of Chenliu, wrote with even more melancholy. The rest of the scholars' verses are equally heart-rending.
Wang Can (style name Zhongxuan) wrote in "Seven Sorrows": "Going out the gate, I see nothing but white bones covering the plain. On the road a starving woman holds her child and abandons it in the grass. She glances back at its cries, then wipes her tears and does not return. 'I do not even know where I shall die—how can we both survive?' She drives her horse away, unable to bear those words. Southward I climb the bank of Emperor Wen's tomb, looking back at Chang'an. Understanding the sorrow of those below the spring, I sigh until my heart aches." Later readers believe Du Fu's famous "Three Officers and Three Partings" derives from Wang Can's "Seven Sorrows."
The Jian'an spirit, noble and mournful, gut-wrenching, had its real-world basis. Though later tales that Zhang was recommended as xiaolian and served as Administrator of Changsha are unreliable, the preface and text of the Shanghan Lun show that Zhang himself was highly cultured. His writing is vivid, rousing, and distinctly Jian'an in flavor. Had he not been a physician but a literary man, his talent would not have ranked below the Seven Masters.
Consider the preface Zhang wrote for the Shanghan Lun:
"I read that when Bian Que diagnosed the state of Guo and observed the hue of the Marquis of Qi, I could not but sigh at his brilliance. I wonder at the scholars of today, who pay no heed to medicine and the medicinal arts, who above should treat the illnesses of rulers and parents, below rescue the destitute, and in the middle preserve their own bodies and nourish their lives. Instead they race after glory and power, tiptoeing toward the mighty, busy and hustling, caring only for fame and gain. They exalt the branches and neglect the root, making the outside splendid while the inside withers. When the skin is gone, on what will the hair adhere? Suddenly struck by pathogenic wind and seized by unusual illness, only then do they tremble; humbling themselves, they implore shamans and priests, and when all is exhausted they resign to Heaven, helpless before defeat. They carry a lifespan of a hundred years, that most precious vessel, and hand it over to ordinary doctors, to be disposed of as they please. Alas! Their bodies are already dead, their spirits gone, turned to dust, buried in the deep springs, while others weep in vain. How painful! The whole age is benighted, none awakened, not treasuring life. If they so value lightness of life, what glory and power have they? Forward, they cannot love and know others; backward, they cannot love and know themselves. When disaster strikes and they are in dire straits, muddled and foolish, like wandering ghosts. Alas! Men of the age race after vanity, not securing their root, forgetting their bodies for things, in peril as if on thin ice—driven to this extreme!
"My clan was once large, over two hundred. Since the Jian'an era began, in less than ten years, two-thirds have died—seven-tenths of them from cold damage. Moved by the loss of the past and grieved that untimely death could not be saved, I diligently sought the ancient teachings and widely collected the prescriptions, drawing on the Suwen, the Jiujuan, the Eighty-One Difficulties, the Yinyang Dalun, and the Tailu Yaolu, together with pulse examination and pattern differentiation, to compose the Shanghan Zabing Lun in sixteen fascicles. Though I cannot cure every disease, this may let one see a disease and know its source. If you seek what I have gathered, you will understand more than half.
"Heaven spreads the five phases to move the myriad creatures; man receives the five constants to possess the five organs. The meridians, network vessels, and transport points where yin and yang meet are dark, subtle, and endlessly changing. Unless one has high talent and fine insight, how can one fathom their principle? In high antiquity there were Shennong, Huangdi, Qibo, Bogao, Leigong, Shaoyu, Shaoshi, and Zhongwen; in middle antiquity there were Changsang and Bian Que; in the Han there were Gongyang Qing and Cang Gong. Beyond these, I have not heard. Look at today's doctors: they do not ponder the classics to extend their knowledge, but each inherits family techniques and follows the old ways from start to finish. In examining illness they are glib; after facing a patient for a moment, they prescribe decoctions. They press the cun pulse but not the chi, take the hand but not the foot; they do not compare the three divisions of renying, fuyang, and cunkou; they count less than fifty breaths before deciding; they have no notion of the nine indicators, and fail to inspect the hall and brow. It is merely peeping through a tube. To distinguish life from death—how hard it is!
"Confucius said: those born knowing are highest; those who learn are next; those who learn through wide hearing are next. I have long valued the medicinal arts; let me act on these words."
A man who could write such a preface was, in that social setting, by no means of low birth. As Qian Mu observed, though Han talent selection was relatively fair and no longer hereditary among the powerful, education was costly, so most true scholars still came from established families. To reach such literary cultivation, Zhang would have needed an expensive basic education; his family was therefore not poor.
Zhang's literary talent also shows in the Shanghan Lun's text, as in the line on Guizhi Tang (Cinnamon Twig Decoction): "Wind strike of Taiyang, yang floating and yin weak; yang floating means spontaneous fever, yin weakness means spontaneous sweating. With chilly aversion to cold, shivering aversion to wind, gentle fever, nasal sounding and dry heaving, Guizhi Tang governs." Leaving aside its clinical value, the prose itself is of high literary quality.
So like most Jian'an intellectuals, Zhang carried the subconscious ideal of taking the world as his responsibility. Men like Cao Cao and Cao Pi pursued it through political struggle. Men like Wang Can and Chen Ling pursued it by attaching themselves to rulers like the Cao brothers. Zhang Zhongjing pursued his ideal through medicine.
In his time, doctors were few, and as plague recurred, limited medical resources were severely overstretched, so consultations were rushed. Zhang criticized his contemporaries' hasty practice: "In examining illness they are glib; after a moment they prescribe decoctions…" This sloppy practice remains common today, though perhaps now it stems less from doctors alone than from too many patients and scarce resources.
"Moved by the loss of the past and grieved that untimely death could not be saved," Zhang rose up to study medicine and save the world. Between the lines of the Shanghan Lun we see a man meticulous to a hair's breadth: where one pattern differs from another by the subtlest margin, he points it out and treats it differently—something only an experienced clinician can do.
Between the lines we also see how poor the medical level was. Doctors lacked correct guidance on using formulas and herbs, leading to frequent errors such as "this was originally a Taiyang disease, but the doctor wrongly purged it," causing many medical mishaps. Many patients died not of disease but of medicine. This grieved Zhang deeply, so he "diligently sought the ancient teachings and widely collected the prescriptions," and, combining them with his own clinical experience, wrote the Shanghan Lun, hoping later readers would "see a disease and know its source."
This grand compassionate spirit arose in the very same social soil that bred the Jian'an spirit. Most of the "scholars of today" Zhang criticized were not actually mere fame-seekers; they too held, in different fields, the same wish to rescue the people from suffering.
But reality's cruelty far exceeds what human effort can change. After every major disaster in Chinese history, society fell into turmoil, the ruling order tottered, and governance invariably turned harsh. So it was in the Han, so in the Yuan, so in the Ming.
Thus after the Jian'an spirit, Chinese scholars entered the age of "Wei-Jin Xuanxuan" (mysterious learning), producing recluses like Ruan Ji, Ji Kang, and Liu Ling of the Bamboo Grove, who avoided politics and devoted themselves to the study of human nature and destiny. Ruan Ji and his peers were roughly Zhang's juniors—Ruan Ji's father Ruan Yu was Zhang's contemporary. Zhang may be said to have pioneered the Wei-Jin turn; he, and later Huangfu Mi and Wang Shuhe, avoided politics and studied medicine to save lives. Ji Kang of the Bamboo Grove also loved to discourse on nourishing life.
If we understand Zhang against this great backdrop, we grasp the Shanghan Lun more deeply. We also understand why he grieved so over medical conservatism and creatively established the far-reaching six-meridian pattern differentiation system of Chinese medicine. Later generations call him the Sage of Medicine; the title is well deserved.