Filed under Jing Fang
Jing Fang Treatment of Contemporary Diseases based on the Six Channels Identification Theory
By Professor Feng Shi Lun
In order to have a comprehensive understanding of Jing Fang, one must read Zhang Zhong Jing’s Shang Han Lun (Discussion on Cold Damage) and understand the core, essential concepts of Six Channel theory.
- The six channels discussed in Shang Han Lun differ from the six channels discussed in Nei Jing. Any confusion may be attributed to the initial editing and annotation of Shang Han Lun by Wang Shu He and Cheng Wu Ji respectively, since their explanations were based on the theory in Nei Jing. However, the origin of Shang Han (Cold Damage) theory emanates from the era of Shen Nong, right up to the Han dynasty.
- Basic Six Channel theory is derived from the theory of Ba Gang Bian Zheng or Eight Principles of Pattern Differentiation. The Huang Di Nei Jing (Yellow Emperor’s Internal Classic) proposed the categories of disease location as either interior or exterior, but it was the Han dynasty text Shang Han Lun which presented in detail the theory of a further location with the concept of ‘neither interior nor exterior’ or ‘half interior and half exterior’. This was incorporated as an integral part of the six channel pattern identification system and is still relied on today.
- Six channel theory serves as an outline of a broad range of symptoms reflecting patterns associated with each of the channel. For example, Tai Yang disease is an exterior yang pattern; Shao Yin disease is an exterior yin pattern; Yang Ming disease is an interior yang pattern; Tai Yin disease is an interior yin pattern; Shao Yan disease is a half exterior and half interior yang pattern while Jue Yin disease is half exterior and half interior yin pattern.
The Essence of the Six Channels in Shang Han Lun
Professor Feng would like to illustrate the clinical base of Jing Fang by citing one of his case studies:
Xie x; female 51 years old
First consultation: 26th September 2004: The patient contracted a cold after having been soaked by rain.
S/S: Fever (38.6o C), aversion to cold, severe headache, generalized body aches, clear nasal discharge. After one week of Western treatment, she suffered from low grade fever (37.5o C), accompanied by sweating and aversion to wind, particularly after exertion. Her sweating had worsened, and there was a dull headache. Her nasal discharge had worsened after exposure to cold wind, and she had a white tongue coat and a floating and weak pulse.
Diagnosis: Fever, sweating, aversion to wind and a floating and weak pulse is indicative of a Tai Yang pattern. The pattern is one of deficiency, ie wind strike pertaining to a Gui Zhi Tang formula pattern.
Formula: Gui Zhi Tang (Gui Zhi 9g; Bai Shao 9g; Sheng Jiang 9g; Da Zao 4 pieces; Zhi Gan Cao 6g)
After one pack of medication, her body temperature had returned to normal. The same formula was continued for two more packs to consolidate the treatment. Recovery was complete.
Definition of Jing Fang
- Jing Fang refers to formulas from Shen Nong Ben Cao Jing (The Divine Farmer’s Materia Medica); Tang Ye Jing Fa (Canon of Decoction Methods) also known as Yi Yin Tang Ye Jing (The Yi Yin Decoction Canon)and Shang Han Za Bing Lun (Discussion of Cold Damage and Miscellaneous Disease), which together, form the foundation of the Chinese medicine system. The fundamental theory expressed in these classics has had a far-reaching impact on the field of Chinese medicine. Its charm resides not only in the formula prescription and herbs, but also in its unique theoretical philosophy. The term ‘Jing Fang’ is found in Han Shu: Yi Wen Zhi (The book of Han: Annals of Dynastic Literature) which states: “Jing Fang incorporates the property of the herbs (ie cold or warm) and the severity of disease (ie superficial or deep). The efficacy of treatment depends on discernment and selection of the flavour and property of the herbs, and thus targets the relevant pathogen and restores the harmony of the five zang and six fu organs. This objective is indeed to restore the balance of yin and yang.
- Zhang Zhong Jing was an outstanding contributor to the theory and clinical applications of Jing Fang and was regarded as a medical sage.
- The theory and philosophy of Jing Fang: This is first recorded in Han Shu: Yi Wen Zhi (The book of Han: Annals of Dynastic Literature) mentioned above. The contemporary Shang Han specialist Professor Hu Xi Shu dedicated a lifetime of research into the practical application of Jing Fang theory. In additions to pattern identification according to the Six Channels, the key focus of Jing Fang is the eight guiding principle: ie the categorization of symptoms according to yin and yang; exterior and interior; heat and cold and deficiency and excess.
- Jing Fang theory: This differs from the theory expressed in Huang Di Nei Jing (Yellow Emperor’s Internal Classic). The text Han Shu: Yi Wen Zhi (The book of Han: Annals of Dynastic Literature) categorised ancient medical schools of thought into the Yi Jing Pai (School of Medical Canons) and the Jing Fang Pai (School of Classic Formulas). The Nei Jing is a representative of the school of Medical Cannon while Jing Fang Pai as associated with Tang Ye Jing (Decoction Canon) and Shang Han Za Bing Lun. It could be said that Shang Han Lun and Huang Di Nei Jing belong to two different schools of medicine.
- The Essence of the Six Channels: In the early 1960s, Professor Hu Xi Shu unequivocally identified the correlation between Six Channel theory and the Eight Guiding Principles. His academic viewpoint was highly regarded by his peers and was published in the People’s Daily Newspaper. Why do we argue that the origin of Six Channel theory stems from the Eight Guiding Principles? This viewpoint was first put forward by the contemporary practitioner Zhu Wei Ju (祝味菊) who said: “All diseases, including externally contracted and interior miscellaneous diseases, can be said to fall within the scope of the Eight Guiding Principles. In Shang Han Lun the term Eight Guiding Principles was not mentioned, however the basic premises were discussed. It is a myth to suppose that the theory of the Eight Guiding Principles is a modern treatment strategy when in reality it emanates from as far back as the Shen Nong (Divine Farmer) period of approximately 4000 BC.
Based on the concept of the Eight Guiding Principles, Zhang Zhong Jing further developed the theory of Six Channel Pattern Identification. As mentioned, the Eight Guiding Principles incorporate the concepts of yin and yang, manifested as either exterior or interior, cold or heat, and deficiency or excess. Prior to Shang Han Lun, our ancestors differentiated diseases only as either exterior or interior, with the corresponding treatment being sweat promotion for exterior patterns, and heat clearing for interior patterns. In addition to the categories of exterior and interior, there should have been a third category, namely half exterior and half interior (constituting the diagnosis and treatment strategy for a pattern incorporating both exterior and interior, as well as half exterior and half interior).
Shang Han Lun [Clause 148] states: Shang Han for five or six days, if there is sweating from the head, mild aversion to cold, cold hands and feet, fullness below the heart, no desire to eat, a hard stool and a thready pulse, this is a mild yang bind, there will be both exterior and interior signs. A submerged pulse, it is also in the interior. Sweating indicates the mild yang; if it were pure yin bind, there would be no more exterior signs, it would have entirely entered the interior; this is half in the exterior and half in the interior. Although the pulse is submerged and tight, it does not mean a Shao Yin disease. The reason being, yin has no sweat, here there is sweating from the head, and so we know it is not Shao Yin, one may give Xiao Chai Hu Tang; if it is not fully cleared, once a stool is passed, it will resolve. In fact, this describes the concept of half exterior and half interior. As well as describing the concept of ‘half exterior and half interior’, Zhang Zhong Jing advocates a harmonizing strategy for this disorder.
- Patterns of exterior , interior, or half exterior-half interior reflect the disease location. For example, an exterior pattern implies skin, muscle, sinews, whilst an interior pattern implies the internal constituent parts of the body such as the oesophagus, stomach, spleen, and small and large intestines (ie the digestive tract). A pattern of half exterior and half interior, on the other hand, implies the area between the exterior and interior which includes the chest, abdomen and their associated zang. It must be understood that the pathogenic location refers to the location where there is a pathogenic reaction. This is not necessarily the location of the disease. For example, if the disease is in the interior, but the reactive point is in the exterior, it is regarded as an exterior pattern, and thence the corresponding treatment would be to promote sweating. On the other hand, purging or heat clearing would be the treatment for an interior pattern. As for the half exterior and half interior pattern, due to the absence of an exit point, the treatment strategy would be to harmonise, and to regulate heat and cold.