Learning TCM: Made or Broken by the Shanghan Lun

The Shanghan Lun (Treatise on Cold Damage) is one of the TCM classics; its full name is Shanghan Zabing Lun (Treatise on Cold Damage and Miscellaneous Diseases), comprising the Shanghan Lun and the Jinkui Yaolue (Essentials of the Golden Cabinet). Zhang Zhongjing's Shanghan Lun raised TCM clinical practice to a much higher level. In my view, what is truly worth learning from it is Zhang Zhongjing's scholarly attitude in writing the Shanghan Lun and Jinkui Yaolue, rather than those books themselves. As for the books themselves, they are indeed good medical works, but in their understanding of disease and level of treatment, they can only be said to remain at a relatively elementary stage.

Saying this will provoke protests in TCM circles. As far as I know, many TCM students are deeply trapped in the Shanghan Lun and Jinkui Yaolue and have created a school Zhang Zhongjing never knew—the Jingfang (Classical Formula) school. The Jingfang school is the most arrogant faction in TCM; its disciples often appear wild and stubborn.

Chinese people have always had the tradition of venerating the past and worshiping authority, so once someone is deified, whoever dares question that god is drowned by the spittle of countless believers. When the Jingfang school encounters difficult diseases, although its practice is not entirely without effect, the effect is not necessarily as remarkable as its adherents confidently believe.

In the Jin-Yuan period, the great physician Li Dongyuan encountered a great post-war plague. At that time, through each of the four city gates of the capital, more than 2,000 coffins were carried out every day, almost all victims of the plague. Inside the city, the disciples of the Shanghan school spent all day researching which formula from the Shanghan Lun or Jinkui Yaolue could save these patients. The result was nothing. Li Dongyuan, hating this past-worshiping way of doing things, created a famous formula called Puji Xiaodu Yin (Universal Relief Toxin-Scattering Drink) and turned the tide.

Li Dongyuan was an innovator in TCM. His mother fell ill; he called in a host of TCM physicians who treated her until she died, without even understanding what disease she had. Li Dongyuan, a wealthy merchant of his generation, angrily taught himself TCM and finally became one of the four great masters of the Jin-Yuan period. This spirit of daring to break convention and valuing practice is precisely the spirit a physician most needs—not worshiping authority but seeking truth from facts.

I believe Zhang Zhongjing himself would not have wanted later medical scholars to take the Shanghan Lun and Jinkui Yaolue as dogma. The human body is complex; on the question of treating disease, any one physician's or medical scholar's experience is very limited. Once trapped in sectarian bonds, one cannot expand one's thinking or efficacy to a wider scope.

A person studying TCM must study the Shanghan Lun and Jinkui Yaolue, but must not be bound by them, nor by TCM's traditional theory. The clinical cure rate of traditional TCM is not high; an old TCM physician with a 30% clinical effective rate is already considered a good one. Such a low clinical efficacy shows that our TCM theory still has large gaps and many holes, requiring successors to study TCM and disease more deeply, continuously develop TCM theory, and strive to improve clinical efficacy.

Practice has shown that modern TCM's pharmacological and toxicological research on Chinese herbs, aided by science and technology, has achieved great results. Preparations extracted from traditional Chinese herbs, for some diseases confirmed beyond doubt by modern medicine, have near-100% clinical efficacy. This progress is worth affirming and is a model for us TCM researchers to learn from.