Shang Han Lun

Beware: Long Post, hopefully interesting and helpful!

To be able to treat the manifestations of Covid-19, one must understand, not just the nature of how a virus manifests in the body but also how the body works to process it and the outside world in general.  In a previous post, I discussed the two vectors that are involved with the way an illness like Covid 19 manifests in the body and the idea of using herbs to help the body process it.  I described health and a healthy immune system not as a function of being able to keep things or get things out, but as a function of being permeable and able to be in relationship with and able to process the things that come in from the outside world.  For me, the physiology that is inherently described within the Shang Han Lun is key to being able to help a body process the world in general and a virus in particular.

I want to start this multi-post discussion with transparency as to my own bias.  We all have a particular way of viewing the way the body works and how healing happens.  I am sharing my way.  Though my way has developed over 40 years of study and practice, it is still simply the way medicine makes sense to me.   My perspective is not something I’ve made up, rather it is a way the classics have come alive and become useful for me.  To the extent that the classics are consistent, my views here are consistent with them. I’ve been influenced by amazing teachers and I’ve found that, as my understanding has evolved into what I am sharing, my clinical results, including results with acute respiratory illnesses, have profoundly improved.  That’s all I have to go on.

So let’s start there:  Many practitioners understand the fundamental structure of the Shang Han Lun, (Treatise on Damage from Cold), in contrast to Wen Bing theory.  There is a strong wave of thought that states that we must apply Wen Bing theory in order to successfully treat a strong virus.  I’d like to start with challenging assumptions that have been made about these two approaches, Shang Han vs Wen Bing.

In general, it is generally accepted that both Shang Han Lun and Wen Bing Tiao Bian(Systematic Differentiation of Warm Pathogen Diseases) are both classical texts.  There is a general belief that “cold damage is the contraction of a cold pathogen, and warm disease is the contraction of a warm pathogen.”[1]   This puts Shang Han and Wen Bing as a sort of Yin Yang pair, both equal, two sides of a coin.  It also assumes that the Shang Han Lun, like Wen Bing theory, is about outside evils.  In addition, there is the general concept that “Cold damage ….generally views things as moving from exterior to the interior. On the other hand, warm disease considers ….things as moving from upper to lower[1].”   These are all mistaken ideas and lead to a lot of clinical confusion.  In my opinion, it is imperative, especially in these times, that we tease this apart.  The misunderstanding about the structure of the Shang Han Lun, leads to an inability to use the formulas appropriately or to abandoning the powerful potential of these formulas.  There is a common, erroneous impression that, without Wen Bing theory, we would not be able to treat modern viral illnesses or heat illnesses. Nothing could be further from the truth. It’s important to remember that Zhang Zhong-Jing wrote about his motivation to write/compile the Shang Han Lun as a response to the fact that most of his family died due to epidemic illness.

There is no single Wen Bing Text.  There are more than 20 books written by various doctors though the most well known one is the Wen Bing Tiao Bian by Wu Ju-Tong.  It is not a classical text and Wen Bing theory is not classical theory.  The Shang Han Lun was written or compiled by Zhang Zhong-Jing before 220 AD, toward the end of the Han dynasty.  It is a classic text in that it is the foundational for all of the herbal medicine practiced since then, and is the basis for many Wen Bing formulas.  The Wen Bing Tiao Bian was written in 1798, which makes it a modern text with modern theory, rather than a classical text.   Many of the formulas in this text were originally from the Shang Han Lun.  When one understands the Shang Han Lun theory, you see that all of the ideas and formulas from the Wen Bing texts can be understood from the point of Shang Han Lun theory.  In other words, Shang Han Lun theory is all encompassing.  It treats both diseases that manifest as cold and those that manifest as heat as well as dampness, damp-heat, phlegm-heat.  We can say that Wen Bing theory is an elaboration on the Shang Han Lun.  We can understand the very useful ideas within any Wen Bing formula with Shang Han Lun theory.

It is a misunderstanding to think of the Shang Han Lun as being about the movement of pathogens from the outside to the inside.  In the first place, nothing in classical theory is linear, i.e. going in a straight line from outside to inside.  Everything occurs in a cyclical manner including the movement of the conformations of the Shang Han Lun. In addition, the Shang Han Lun is not about the movement of pathogens at all.  It is about function and it is about how the influences of the world, like wind or cold or viruses, affect function.

Wen Bing theory in contrast is definitely about pathogens that get in and go deeper and deeper. It is a theory that says that pathogens must be removed.  You have to find out where they are lodged and get them out.  The development of Wen Bing theory represents a profound shift in the whole concept of how our bodies exist in relation to the outer world.  It is dualistic in that it is my body against the world.  The paradigm of bad things getting in that need to be gotten out, that is absent in Shang Han Lun theory, is expressed in Wen Bing theory.  For me it is interesting to see the development of medical theory through time into something that separates us from the world around us.  Classical theory does not do make this separation.

I’m going to start this discussion with a very brief introduction to the physiology of the Shang Han Lun as I understand and use it.  The 6 conformations of the Shang Han Lun represent the complete function of the body, broken down into 6 parts.  As nothing in Chinese medical theory is linear, these 6 parts form a circle, with each part representing a movement of the life-force that is essential for life.  The movement of the life-force is circulating constantly in this way and also follows the relative movement of the sun around the earth.  Yang conformations are above the horizon and Yin conformations are below the horizon.

Below is an extremely brief introduction to the Shang Han Lun physiology.  From here we can look at formulas and understand how they help the body process the outside world including viruses.

Yang Conformations

Yang Conformations

Tai Yang function is a rising function that goes up and out. The pathology of Tai Yang is active when our bodies are not able to match the outer movements of up and out so that the surface cannot resolve properly.  Herbs are given that are pungent, warm and light in order to restore the up and out function.

Yang Ming function is a downward movement that brings warm life-force down and in.  The pathology of Yang Ming is active when this movement is blocked so that the warm life-force builds up to create heat.  Yang Ming can be blocked in the chest, epigastric region, abdomen, or bladder.  Bitter cold or cold ingredients are used to open up the area of Yang Ming that is blocked so that normal downward movement is restored and therefore pent up heat is allowed to circulate physiologically.

Shao Yang is a pivot function that pivots the life-force that Yang Ming has brought down into the proper position as the ministerial fire so that the life-force can be functional in our body.  The pathology of Shao Yang is the failure of the pivot to move properly like the hinge on a door.  The heat that has been brought down by Yang Ming cannot pivot into position in the Dan Tian and so it gets pent up.  There is also a lack of warmth moving into the next conformation, Tai Yin and so there is weakness and lack of transformation in the middle. Specific herbs that unblock the pivot are used to restore the proper movement of this hinge mechanism.

Yin Conformations

Yin Conformations

Tai Yin absorbs and steams upward the warmth, nourishment and moisture from the products of digestion as it moves down the digestive tract.  Tai Yin pathology can be summarized as lack of absorption of warmth, nourishment and moisture so that there is fluid loss or accumulation rather than absorption.  The treatment of Tai Yin restores the storage function of absorption and steaming.

Shao Yin receives, absorbs, contains and stores the ministerial fire and the physiological moisture that comes from Tai Yin.  Pathology of Shao Yin is a lack of fire or lack of ability to contain fire and/or a lack of water or ability to contain water.  This is treated with herbs that encourage the reception and containment of fire and water.

Jue Yin is the upward movement of blood so that it warm, moist blood is circulated throughout the body.  Blood is the mixture of the heat and fluids that originated in Shao Yin.  This blood moves toward the upper body and surface, becoming the harmonized Ying/Wei of Tai Yang. Pathology of Jue Yin is a lack of harmony of the heat and/or liquid of the blood.  Jue Yin treatment is directed at harmonizing the heat and liquid aspects of the blood.

Since the life-force is warm, any upset to the movement or storage of the life force is considered damage from the opposite of the life-force: cold.  So, in this broad sense of meaning, “Cold” simply means “the opposite of the healthy movement of the life-force.”  This means that damage from cold can block the circulation of the warm life-force and result in extreme heat.  Even in a Bai Hu Tang presentation, which is due to a block of the Yang Ming in the chest/stomach, though very hot, is still due to a block.  This block is cold in that it is stagnant and Yin in nature.  The results are Yang in nature.  This means that any “hot pathogen” is the result of lack of proper function and represents the need to re-establish function.  Any “excess hot pathogen” is nothing but own life-force failing to circulate properly, therefore building up.  A “virus” can be seen to damage the functions of our body.  This is what creates the heat and it is not that it is a hot pathogen itself.   How the symptoms manifest show us exactly which function is disabled.

Extreme heat illnesses all involve Yang Ming.  Yang Ming function is one of bringing in the life force in a vertical downward movement.  Since the life-force is warm, a blockage of Yang Ming function easily develops into strong heat illness.

However, it is very important to understand that the initial stages of an acute respiratory illness on into more critical stages very often include dysfunction of Tai Yang fas well as Yang Ming.  In fact, often the three Yang are all involved.  If Tai Yang is not functioning well, the life-force movement up and out can be blocked and this block will create and intensify the Yang Ming heat.  Imagine the life-force as it moves up and out in our bodies.  Now imagine that it is not able to open on the surface to resolve.  It is this resolution through our pores that helps to cool our bodies.  What happens then, to the warm life-force?  It builds up.  As it does, it gets hot and as it get hot, it damages Yang Ming function.  This is when the heat gets extreme.  However, if the surface is unresolved, Yang Ming herbs that promote the downward movement such as Shi Gao must be used with herbs to resolve the Tai Yang.  Without this, the bitter cold or cold herbs will make things worse.  When Zhang Zhong-Jing warms against purging in Tai Yang patterns, the character used is 下，which simply means to go down.  If the body needs up and out function to be restored, it is inappropriate to  unilaterally give herbs that induce downward movement.

This discussion hopefully highlights why simply giving bitter cold or cold herbs may cause more problems and why a formulas such as Ma Xing Shi Gan Tang (also known as Shi Gan Ma Huang Tang) or She Gan Ma Huang Tang can be so useful.  Part of what I am saying as well is that I think that we will work much more accurately and safely if we understand and use Wen Bing ideas in the context of this Shang Han theory of how the body works.

How do we tell if the surface is still unresolved?  Are there alternatives to using Ma Huang in order to resolve the exterior?  I’ll go into this in more detail in the next post!  Stay tuned and let me know your thoughts and responses.  I so hope this is helpful.

 

 

[1]Qin Bo-Wei The Lantern Volume 8 No.2, May 2011, translated by Jason Blalak

[1] Ibid