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Treatise on treatment

by Zhang Jie-Bin (1563-1640)
translation and biographical notes by Steven Clavey

The Lantern: Volume I, Issue 1 - Article #2

In diagnosis and treatment, aim for accuracy and exactitude. Every disease under heaven has a single root, despite many apparent variations; every prescription has a single consistent relationship with the condition it treats, no matter how many herbal constituents are adroitly added or deleted to keep pace with the alterations of the illness.

If the diagnosis of cold is certain, then cold must be completely dispersed. If undeniably heat, then the pathogenic heat must be absolutely cleared.
Once one has pulled up and disposed of the root of the illness, the other symptoms will eventually disappear by themselves. Thus the Su Wen (Plain Questions, chapter 5) states: “In treatment of any illness, aim for the root.”

Before one can aim for the root, using herbs for treatment, one must have determined its nature. If the observation or judgement of the disease state is not sufficiently accurate to begin treatment, it is better to wait a short time to allow the nature of the disease to become clear. Then a detailed examination may be made. Once a sure diagnosis is had, the use of one or two herbs can eradicate the pathogen. Even if the root is, as it were, firmly entrenched, so that the disease is stubborn, extended, and difficult to treat, an accurate diagnosis ensures that six, seven, or eight herbs will be sufficient. And these seven or eight herbs will only assist the main herbs, or guide the effects to this or that channel. The goal and plan behind the prescription has a single purpose. Only this makes a first-class physician.

The doctors these days, though, when they run into a syndrome, act as if they are staring out into the uncharted wastes of a great ocean: they don’t recognise a thing, there is nothing upon which to pin a diagnosis. So when it comes to using herbs, there is no goal, no grasp — no wonder their treatment is completely disorganised. It is like trying to corner and capture wild animals on a vast unbroken plain. They know that for a deficient condition they should tonify, but being afraid that this could cause problems they add dispersing herbs to control the tonifying herbs. They know that an excess condition needs to be dispersed, but for fear that dispersal would be dangerous they add tonifying herbs to control the dispersing herbs.

The most ridiculous thing is that these doctors often use prescriptions that are neither hot nor cold, that contain both tonifying and reducing herbs — and then act as if everything is under control. How could this act to remedy the excesses or deficiencies of the condition, or repair the damage done by the disease? Some even use herbs for wind, herbs for fire, herbs for phlegm, and herbs for food stagnation all together in the same formula, and feel that all bases are now covered.

Again, how can one even talk of treating the root or treating the branch. When they use herbs "to control other herbs" when do they get around to controlling the disease?!

If these people happen to cure a disease, they do not know if it was the effect of the tonification or the effect of the attack on the pathogen. When the patient does not improve, they are not sure whether it is the fault of the dispersing or the tonifying herbs.

They go on and on like this, practising medicine until they are white haired and toothless and still they are no good. A whole life without improvement, simply from not having a clear perception of the problem, and not being able to use the simple essential methods necessary to resolve that specific problem.

If the patient’s problem is simple, this is not greatly important. But if the life of the patient depends on the next moves of the physician, then even if the herbs are correctly selected, if the courage to use the required amounts is lacking, it is equivalent to tossing a glass of water on a raging blaze!At this stage of the game, who is going to try to grab both ends, to tonify and reduce?

The author

This short essay is selected from the Jing-Yue Quan Shu (1563–1640, zi-name (The Complete Works of [Zhang] Jing-Yue), chapter one, section 10. The author, Zhang Jie-BinJing-Yue) was a native of now Shaoxing county in Zhejiang province, famous for its wine.

In his teens he followed his father to Beijing and studied with Jin Ying, a famous physician in the capital.Zhang practised and read extensively, particularly the Huang Di Nei Jing, which he later systematised and published as the Lei Jing (The Classic Classified). This book, the fruit of 30 years research into the Nei Jing, provided a resource for students of the classic with detailed explanations of its core concepts organised by category.

Published at the same time was the Illustrated Wings of the Lei Jing, which illustrated the relationship between energetic permutations and meteorological fluctuations, known as yun qi; and the Appended Illustrations to the Lei Jing, which focused on the crucial relationship between the study of the Book of Changes (Yi Jing) and the study of medicine.

Later in life, Zhang Jie-Bin produced the Complete Works of [Zhang] Jing-Yue (Jing Yue Quan Shu) which described all classes of disease.

Zhang Jie-Bin was a strong proponent of the Gate of Life school of thought that emphasised warm tonification; he invented the Zuo Gui (Return to the Left) and the You Gui (Return to the Right) formulas, among many others still commonly used. One unique feature of his creative treatment approach yet to receive much attention in the West is his combination of military and medical strategy, particularly his "Eight Formations Theory".

The essay reminds us of the importance of "striving for the essential" in diagnosis and treatment. Zhang criticising doctors who are vague about diagnosis and consequently confused about their treatment, producing prescriptions with muddled concepts.Harsh words that certainly hit home, but like the effect of an ice–cold shower, perhaps ultimately revivifying!