Zhang Zhongjing, the Medical Sage, and His Book the Shanghan Zabing Lun (Treatise on Cold Damage and Miscellaneous Diseases)
Zhang Zhongjing was a famous physician of the late Eastern Han dynasty, yet the Sanguozhi (Records of the Three Kingdoms) and the Hou Hanshu (Book of the Later Han) mention not a word about him, while Hua Tuo, a contemporary, has a biography. Thus almost no reliable historical material survives about Zhang Zhongjing's life.
Huangfu Mi, a Western Jin physician, mentioned Zhang Zhongjing in the preface to his Zhenjiu Jiayi Jing (Systematic Canon of Acupuncture and Moxibustion): "When Zhongjing saw Wang Zhongxuan, Palace Attendant, then in his twenties, he said to him: 'Sir, you have an illness. At forty your eyebrows will fall out; half a year after they fall you will die. If you take Wushi Tang (Five-Stone Decoction) you can avoid this.' Wang Zhongxuan found the words offensive, accepted the decoction but did not take it. Three days later, seeing Zhongxuan again, Zhongjing asked: 'Have you taken the decoction?' Zhongxuan said: 'I have.' Zhongjing said: 'Your complexion plainly shows you have not taken it; why do you so lightly value your life!' Zhongxuan still said nothing. Twenty years later his eyebrows indeed fell out, and 187 days later he died, exactly as Zhongjing had said. Even Bian Que and Cang Gong could not have done more in these two matters. Hua Tuo was by nature malicious and proud of his skill, and finally died by execution. Zhongjing expanded the Yiyin Tangye (Yiyin's Decoctions) into several dozen volumes; their application is often verified. The recent imperial physician Wang Shuhe edited and arranged Zhongjing's writings, selecting and discussing them with great precision; his points are applicable in practice."
Wang Zhongxuan was one of the Seven Masters of Jian'an; he did not die of eyebrow loss but of a great plague in the 22nd year of Jian'an. Among the Seven Masters, Xu Gan, Wang Zhongxuan (Wang Can; Zhongxuan was his courtesy name), Liu Zhen, and Chen Lin all died in the great plague of the 22nd year of Jian'an; this is recorded in reliable history. From this alone we can judge that Huangfu Mi's account of Zhang Zhongjing diagnosing Wang Zhongxuan is not very reliable. Later generations' fabrication that Zhang Zhongjing predicted Wang Zhongxuan's eyebrow-loss death at forty and that it came true may be merely exaggeration to deify Zhang Zhongjing's medical skill. But it is true that Zhang Zhongjing and Wang Zhongxuan were contemporaries.
The preface to the Shanghan Zabing Lun says: "My clan has always been large, numbering over two hundred. Since the Jian'an era, in fewer than ten years, two-thirds have died, and of these, seven in ten died of cold damage." Professor Liu Duzhou believed that "Jian'an" might be a scribal error for "Jianning," but Old Master Liu's view may not be correct. Zhang Zhongjing was a contemporary of Wang Zhongxuan of the Seven Masters, so "since the Jian'an era" is not erroneous. Jian'an was the reign title of Emperor Xian of Han; from the reigns of Emperors Huan and Ling through Emperor Xian in the late Eastern Han, plagues raged continuously for many years.
Whether these plagues were all caused by the same pathogen we do not know, but it is possible. Plagues were continuous in those years, causing a catastrophe in which nine in ten homes were empty. The late-Han plagues were sometimes nationwide and sometimes localized, raging off and on for nearly a hundred years, similar to the late Ming. It is entirely plausible that over a hundred members of Zhang Zhongjing's family died since the Jian'an era.
Professor Liu Duzhou believed that only the 22nd year of Jian'an had an exceptionally great plague, and that Zhang Zhongjing's preface saying "since the Jian'an era, in fewer than ten years, two-thirds died" could not mean that so many in the Zhang clan died of plague in the first ten years of Jian'an. But he did not realize that some localized outbreaks during Jian'an were also terrifying.
In the Seven Sorrows Poems of his contemporary Wang Zhongxuan, there are these lines: "Going out the gate I see nothing / but white bones cover the plain. / On the road a hungry woman / holds her child and abandons it in the grass. / Looking back at its wailing, / she wipes her tears but does not return. / 'I do not even know where I shall die, / how can we both survive?' / She drives the horse and leaves, / unable to bear these words. / Southward I climb the bank of Baling, / turn my head and gaze at Chang'an. / Understanding those who dwell beneath the spring, / I sigh until heart and liver break."
From Wang Zhongxuan's poem we can see how deep the humanitarian disaster caused by war, plague, and famine was. We can only say that the plague of the 22nd year of Jian'an was the largest in scale; we cannot say that plagues before the 22nd year were not deadly. Since the Jian'an era, localized plagues causing severe humanitarian disaster in many places were quite normal. Moreover, "since the Jian'an era, in fewer than ten years" does not necessarily mean the ten years from Jian'an 1 to Jian'an 10; it can perfectly well mean that during the Jian'an era, within fewer than ten years, over a hundred members of the Zhang family died.
Born in such an age of plague-torn chaos, and a physician himself, Zhang Zhongjing could not but be moved by the epidemics of his time. Cao Zhi wrote that then "every family had the grief of corpses unburied, every household the wailing of lamentation." In his Letter to Wu Zhi, Cao Pi wrote: "In past years epidemics raged; many of my relatives and friends suffered the disaster. Xu, Chen, Ying, and Liu all passed away at once—how bitter beyond words!" Zhang Zhongjing lived in the same age; he was also cut to the heart by the horrific tragedy wrought by the rampant plagues.
So in the preface to his Shanghan Zabing Lun he lamented: "It is strange that today's scholars pay no heed to medicine and do not diligently study the arts of healing: above, to cure the illnesses of their rulers and parents; below, to rescue the needy from distress; in the middle, to preserve their own bodies and whole lives and nourish their years. Instead, they race after glory and power, hastening to the powerful and privileged, busy only with fame and gain. They exalt the branches and neglect the root, beautify the exterior and wither the interior. If the skin is gone, on what can the hair adhere?"
Later people also said Zhang Zhongjing had served as Prefect of Changsha; this claim is also unreliable and is probably another lie invented to deify him.
First, Zhang Zhongjing himself never mentioned serving as Prefect of Changsha, and the histories contain no record of it. From his own preface we can see that he was highly critical of his contemporaries' "racing after glory and power," which makes it unlikely he would have been a prefect. Moreover, Wang Shuhe, the Western Jin imperial physician who edited and arranged the Shanghan Lun, did not mention a word about Zhang Zhongjing being Prefect of Changsha.
That Zhang Zhongjing's writings survived and circulated at all is entirely due to Wang Shuhe. The Han and Wei fell and the Western Jin rose; the Western Jin was not far from the Han and Wei period, and Wang Shuhe was likely a disciple or later-generation disciple of Zhang Zhongjing, so his record of Zhang Zhongjing's life is more reliable than later accounts. In addition, Huangfu Mi, also a Western Jin physician, did not mention Zhang Zhongjing serving as Prefect of Changsha in his Zhenjiu Jiayi Jing.
It was not until the Song dynasty that Lin Yi, Gao Baoheng, and others said Zhang Zhongjing had served as Prefect of Changsha, so this claim is probably also a later fabrication to raise Zhang Zhongjing's status.
Zhang Zhongjing was honored as the Medical Sage only after the Song dynasty; before that he did not hold such an exalted position. His works did not circulate widely for a long time: Sun Simiao of the Tang spent his whole life collecting medical books and only obtained Zhang Zhongjing's works in his old age. This shows that in the Tang, Zhang Zhongjing's works were not widely read. In his lifetime, his medical fame was surely far below Hua Tuo's. Patients then did not unwaveringly trust him; this can be seen in the original text of the Shanghan Lun edited by Wang Shuhe, which mentions patients deliberately feigning illness to test the physician's level—this is probably a real clinical experience of Zhongjing's.
Most of the formulas in Zhang Zhongjing's Shanghan Lun were collected from the now-lost Yiyin Tangye Jing (Canon of Yiyin's Decoctions). Huangfu Mi said Zhang Zhongjing "expanded the Yiyin Tangye into several dozen volumes," showing that his Shanghan Lun was no rootless stream. The Tangye Jing is now lost, but it may still have existed in the Western Jin; Huangfu Mi should have been well acquainted with its contents, which is why he said so. The Tangye Jing was probably one of the earliest works specifically collecting TCM empirical formulas.
Thus Zhang Zhongjing was a physician who, on the basis of broadly absorbing the strengths of others, creatively proposed the TCM principles of six-meridian and eight-principle pattern differentiation and treatment. As for the classic famous formulas he used, they mostly came from clinical trials conducted by earlier generations on human beings; they are highly reliable. Not only were they often verified in the past, but even today their efficacy should not be underestimated.
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