Sun Simiao’s Fertility Treatments

The following is an excerpt from the 75-page historical introduction to my forthcoming publication Channeling the Moon, a translation and discussion of the first fourteen questions of Qí Zhòngfǔ’s 齊仲甫 Nǚ Kē Bǎi Wèn 女科百問 (“Hundred Questions of Gynecology,” published in 1220 CE). This excerpt includes a brief introduction to the Bèi Jí Qiān Jīn Yào Fāng 備急千金要方 (composed by Sūn Sīmiǎo 孫思邈 in 652) and a survey of the section on fertility. For more, see the information page for my book Channeling the Moon, which will go on sale May 1 in my ONLINE BOOKSTORE HERE. The photographs, most of which have also made it into the book, are from around my home on Whidbey Island, but here you get the colored version.

…After this brief summary of early Chinese classical sources on gynecology, we have finally arrived at the text that many Chinese medicine physicians to this day consider the earliest classic of gynecology: Volumes Two to Four in Sūn Sīmiǎo’s Bèi Jí Qiān Jīn Yào Fāng. The introductory essay of these three volumes on “Formulas for Women” (婦人方 fù rén fāng) begins with this oft-cited statement:

The reason why women have special formulas is that they are different because of pregnancy, childbirth, and landslide collapse damage (i.e., heavy vaginal bleeding). Therefore, women’s diseases are ten times more difficult to treat than men’s.

 

heronsunset.jpg

 

Placed at the very beginning of the main body of the Bèi Jí Qiān Jīn Yào Fāng, the significance of this statement cannot be overrated. The following information attempts to shed light on it from various angles:

I present a summary and brief interpretation of Volumes Two to Four, which includes a case study that analyzes the formulas for “seeking a child” in more detail, in order to give the reader an impression of the general nature and major themes and issues of the text. Comparing the content and structure of Sūn Sīmiǎo’s “Formulas for Women” with earlier and later texts allows us to situate this text in the history of the development of gynecology in medieval China. In addition, it sheds light on Sūn Sīmiǎo’s various roles as an innovative author, as a preserver and transmitter of literary medical traditions, as a cosmologically-inclined practitioner of yǎng shēng  (nurturing life) with a personal stance in promoting women’s health, and even as an advocate for oral traditions that transcended class or gender boundaries.

foggybeach.jpg

Although the categorical confusions, overlap between formulas, and contradictory statements found in these pages indicate the preliminary state of knowledge about women’s health in early medieval China, the material introduced here also points toward the sophisticated understanding of a gendered body with gender-specific etiologies and treatment needs that emerges full-blown in the following Sòng dynasty. Sūn Sīmiǎo’s understanding of women’s weaknesses and vulnerabilities can already be seen as more comprehensive than what is included in a typical modern biomedical dictionary definition of obstetrics and gynecology as the “medical care of pregnant women (obstetrics) and of female genital diseases (gynecology).” As he wrote in the sentence that follows the introductory statement quoted above, which also reflects the organization of formulas in the Bèi Jí Qiān Jīn Yào Fāng, Sūn Sīmiǎo interpreted female difference under the categories of reproduction (consisting of fertility, pregnancy, childbirth, postpartum conditions, and lactation), miscellaneous treatments (including treatments for female genital diseases), supplementing and boosting, and a large section on menstruation and vaginal discharge.

It is impossible to discern at this point the extent to which Sūn Sīmiǎo’s placement of the “Formulas for Women” at the very beginning of the Bèi Jí Qiān Jīn Yào Fāng was motivated by a humanitarian concern for what he clearly perceived as the greater vulnerability and weakness of the female body, in both its physical and psychological aspects. It also appears that he consciously composed and organized the Bèi Jí Qiān Jīn Yào Fāng with the ultimate intention of preserving and prolonging life in the elite tradition of “nurturing life” (養生 yǎng shēng). Therefore, he placed women’s health, interpreted as the foundation for the creation of life, at the beginning of the text, followed by pediatrics, and only then by general medicine. This leads up to instructions for the preservation and prolongation of life based on diet, lifestyle, Qì cultivation, and sexual cultivation, appended with technical instructions for pulse diagnostics and acumoxa therapy. Supporting this argument, he states in his introduction to volume five on pediatrics:

For this reason [I have arranged] these formulas [by placing] those on women first, then those on children, and afterwards those on men and the elderly. This is the meaning of venerating the root.[1]

Whatever Sūn Sīmiǎo’s motivations were, his treatment of women went far beyond ensuring their reproductive capabilities and reflects a genuine concern with what he saw as the special burdens suffered by the female body for the sake of continuing the family lineage.

Fertility

lamb1.jpg

Sūn Sīmiǎo’s formula collection on women starts with the treatment of reproductive problems. As the introductory statement quoted above shows, Sūn Sīmiǎo considered the effects of childbearing to be the single most important factor in the etiology of women’s diseases. The remainder of this first essay in the “Formulas for Women” refines this statement considerably. As additional causes for women’s weak health, it mentions the onset of menstruation at the age of fourteen and external causes like immoderate food and drink, inappropriate sexual intercourse, and most notably, wind entering from below, or in other words, through the vagina. To complicate matters further, he states that “women’s cravings and desires exceed their husbands’ and they contract illness at twice the rate of men.” Next, Sūn Sīmiǎo lays out the significance of childbearing as “the adult role in women’s destiny and fate.” Because childbearing was “the basis of human affairs and the foundation of enlightened rule,” the volumes on women should be “inspected by gentlemen of like intention” and “routinely copied and carried by servants engaged in childrearing.”

Sūn Sīmiǎo has now laid the foundations from which to launch the first aspect of his “Formulas for Women”: a treatment program for “seeking a child” (求子 qiú zǐ), i.e., enhancing fertility. Containing six essays, fourteen medicinal formulas, six moxibustion methods, and three “methods for converting a female [fetus] into a male,” it comprises about six percent of the gynecological material. Before offering treatments, though, Sūn Sīmiǎo warns that even the best medicine is useless if the couple’s basic destinies are mismatched, meaning that their birth signs do not follow the order of generation in the progression of the Five Dynamic Agents, or if the astrological constellations at the time of conceiving the fetus are inauspicious. If their birth signs are in harmony, however, they still must pay heed to Sūn Sīmiǎo’s medical advice and also guard against breaking taboos against sexual intercourse at inauspicious times to ensure their own and their offspring’s future health and good fortune.

The Sòng editors insert a reference here to methods for determining the right time and day for “receiving a fetus” (受胎 shòu tāi), found later in the Bèi Jí Qiān Jīn Yào Fāng in volume 27 on “Nurturing the Inner Nature” (養性 yǎng xìng). It is interesting to note that these “methods for taboos and restrictions [on sexual intercourse]” are, in a manuscript edition of the text, cited in the category for “seeking a child” and therefore considered part of the “Formulas for Women.” Similarly, the Wài Tái Mì Yào 外台秘要 and Ishimpō 醫心方 both devote considerable space to these taboos and prognostications about the child’s and parents’ future in the section on “seeking a child.”

In a slight shift of emphasis, Sūn Sīmiǎo lastly offers a purely medical etiology in the next essay, stating that “whenever people are childless, it is caused by the fact that both husband and wife suffer from the Five Taxations and Seven Damages and the hundred illnesses of vacuity and emaciation, with the disastrous result that the line of descendants is cut off.” This seems to contrast the popular notions of his time, as expressed most notably by the Zhū Bìng Yuán Hòu Lùn 諸病源候論, which states at the very end of Volume Thirty-Eight:

floodedbeach.jpg

When women are without child, there are three reasons:

First, that the tombs have not been worshipped;

second, that the husband’s and wife’s yearly fate (a reference to their astrological constellations) are in a relationship of mutual conquest;

and third, the husband or wife’s illness.

All of these cause childlessness. If it is a case of tombs not having been worshipped or the yearly fates conquering each other, there are no medicines that can be of benefit.


Similar sentiments are expressed in the calendrical and astrological sections on childlessness in the Wài Tái Mì Yào, Ishimpō, and Bèi Jí Qiān Jīn Yào Fāng cited above.

Following this reference to non-medical causes of childlessness, Sūn Sīmiǎo then proceeds to discuss options for medical treatments. These are summarized here in a detailed case study to illustrate the treatment style and underlying etiological reasoning found in Sūn Sīmiǎo’s “Formulas for Women”:

Case Study: An Interpretation of Volume Two, Section One on “Seeking a Child”

beachripples.jpg

In order to prevent or treat the medical cause of infertility, which he has previously identified as the “Five Taxations, Seven Damages, and hundred diseases of vacuity emaciation,” Sūn Sīmiǎo proposes a complex treatment plan: First, the husband is treated for lack of offspring in conjunction with wind vacuity, clouded vision, and weakness and shortage of essential Qì by supplementing his insufficiencies with Qī Zǐ Sǎn 七子散 (Seven Seeds Powder), a formula consisting of twenty-four ingredients in total! The famous Yuán dynasty physician Zhū Zhènhēng 朱震亨 (style-name Dānxī 丹溪) later developed this formula into Wǔ Zǐ Yǎn Zōng Wán 五子衍宗丸 (Five-Seeds Pill for Abundant Descendants), which is still commonly used today as a treatment for infertility. To return to the Bèi Jí Qiān Jīn Yào Fāng, the wife is next treated for lifelong inability to give birth with a “uterus-rinsing decoction,” to be ingested by the patient while she is kept warm by being wrapped in blankets and, in cold weather, placed on top of a brazier. This complex preparation consists of eighteen ingredients that are decocted in equal parts rice wine and water and taken in four doses throughout the day. This treatment is supposed to induce sweating and cause the discharge of the illness in the form of accumulated blood, which will appear as “cold red pus.” Referred to as “this malign substance” in the womb, the root of the illness is identified as an accumulation of cold blood that has caused pain below the navel, irregular menstruation, and inability to receive the fetus. Sūn Sīmiǎo stresses the importance of consuming an entire preparation of this medicine, if at all possible, because the illness might otherwise not be completely eliminated. On the next day, the woman should be treated with a suppository consisting of pulverized drugs (zàojiá, shānzhúyú, dāngguī, xìxīn, wǔwèizǐ, gānjiāng, dàhuáng, fánshí, róngyán (rock salt), and shǔjiāo) filled into a finger-sized silk bag and inserted into the vagina. This is to be applied repeatedly throughout the day while the patient is to remain in her chamber and rest until she discharges a “cold malign substance” in the form of a green-yellow cold liquid, which again represents the illness being expelled below. The treatment should be concluded with Zǐshí Méndōng Wán 紫石門冬丸 (Fluorite and Asparagus Pill), to be taken until the sensation of heat in the abdomen indicates a successful completion of the treatment.

seashells.jpg

Next, Sūn Sīmiǎo lists a number of fairly complex medicinal formulas for the treatment of infertility in conjunction with symptoms such as heat above and cold below, inhibited menstruation, the thirty-six illnesses of the Lower Jiāo, the myriad illnesses of vaginal discharge, and the twelve abdominal conglomerations. While the formulas differ based on the reason for infertility, such as the above-mentioned indications or a “blockage of the uterus that is preventing it from receiving the essence,” they all share the goal of inducing a certain type of discharge below that indicates the expulsion of the illness, whether in the form of “long worms and green-yellow liquid,” or “bean juice or snivel.” Thus, in Sūn Sīmiǎo’s eyes infertility was caused by an accumulation of cold blood in the uterus that was treated by expelling it through the vagina, sometimes in combination with a “scrubbing” of the uterus or internal organs. In the midst of these formulas, we find two formulas with significantly less ingredients, said to be “used by the ancients,” but fallen out of use in Sūn Sīmiǎo’s times. The first one treats the husband for insufficiency of Yáng Qì and inability to cause transformation (i.e., in the woman’s womb) or, if transformation did occur, failure to complete it. The second one seems like a rather standard treatment for women’s infertility. Sūn Sīmiǎo precedes these with the caveat that he has no personal experience using them, but has included them because of their popularity in ancient times.

Throughout this section, Sūn Sīmiǎo’s choice of drug ingredients reveals his underlying etiological ideas as well as treatment strategies. The following discussion of medicinal actions is based on the understanding of a substance’s efficacy during the early Táng period. Thus, I follow the descriptions in materia medica literature roughly contemporaneous to the date of composition of the Bèi Jí Qiān Jīn Yào Fāng. For this purpose, I have relied on a critical edition of the Shén Nóng Běn Cǎo Jīng 《神農本草經》 (Divine Farmer’s Classic of Materia Medica), a Hàn period classic that was edited and annotated by Táo Hóngjǐng 陶弘景 in the early sixth century.[2] The edition used here includes this commentary, while attempting to reconstruct the original appearance of the text and can therefore serve as an accurate reflection of materia medica knowledge slightly prior to the time when the Bèi Jí Qiān Jīn Yào Fāng was composed.

seaweed.jpg

According to the descriptions of the medicinal actions of drugs in this text, the formulas for treating infertility in the Bèi Jí Qiān Jīn Yào Fāng contain ingredients like pòxiāo, mǔdān, and táorén, which eliminate evil Qì, break up accumulations, and treat blood stagnation.[3] These are combined with drugs like xìxīn, gānjiāng, jiégěng, and shǔjiāo, which are warming and treat wind, dampness, cough, and counterflow qì ascent, as well as precipitate Qì. We also see drugs like tiānméndōng, niúxī, wǔwèizǐ, and shānzhūyú, which extend life and supplement insufficiencies, treat taxation damage and emaciation, nourish Yīn, and boost Essence and Qì, in addition to the above characteristics of warming, moving blood, or eliminating wind and dampness. This choice of ingredients suggests an understanding of infertility as caused by the inhibited movement of Qì and blood due to vacuity, leading to cold stagnation and accumulations in the abdomen of something that Sūn Sīmiǎo refers to as “this malign substance.” The frequent use of drugs like xìxīn and fángfēng also indicates the notion that infertility might be caused by externally contracted wind-cold, which must be dispersed and expelled by increasing the flow of blood and Qì with supplementing, warming, and down-draining preparations.

In addition to medicinal formulas, the text lists several moxibustion techniques for treating women’s infertility. The choice of moxibustion points is quite carefully differentiated by the particulars of the condition, such as general infertility, inability to have children because the mouth of the uterus is blocked, inability to complete a pregnancy due to miscarriage with abdominal pain and leaking of red discharge, blockage of the uterus so that she is unable to receive the [male] essence, or red and white leakage. Except for one use of Rángǔ 然谷 (KI-2), which is located on the ankle, the other points are all located in the area between the navel and the pubic bone: Guānyuán 關元 (REN-4), Bāomén 胞門 (KI-13), Qìmén 氣門 (EX-7), and Quánmén 泉門 (“Spring Gate,” an otherwise unattested point location). For the most part, these locations are still used today in the treatment of infertility.

Appended to the chapter on fertility is a short but significant section on manipulating the fetus’ gender. As a brief introductory statement explains, the fetus is created by the interaction and mutual stimulation of Yīn and Yáng. Following the standard medical notions of the time, Sūn Sīmiǎo emphasizes that the outer form of the fetus is not settled until the end of the third month of pregnancy and that the mother’s behavior and environment in pregnancy can therefore affect the physical and psychological characteristics of the future child. This notion is the basis for the popular practice of “fetal education” (胎教 tāi jiào), discussed by Sūn Sīmiǎo in the following chapter on pregnancy-related formulas. Regarding the fetus’ gender, early medieval theories of conception and pregnancy were sometimes contradictory, suggesting that until the third month of pregnancy the gender of the fetus was either not fixed yet or that it could be transformed. By the Sòng period, sexual differentiation had become identified with conception in medical literature, and instructions for changing the fetus’ gender were therefore eliminated from elite doctors’ gynecological texts. On the other hand, instructions for influencing the gender of the fetus during the act of intercourse, as for example by timing it in relationship to the woman’s menstrual cycle, became more important.

Being a formula text with unfortunately only short essays, the Bèi Jí Qiān Jīn Yào Fāng fails to provide a conclusive statement on this issue. Nevertheless, the formulas obviously reflect the belief that gender could be manipulated up to the third month of pregnancy, which, in most cases, meant converting a female fetus into a male. Besides a complex formula of medicinals that mostly boost Yáng, Qì, blood, and Essence, Sūn Sīmiǎo also lists several instructions of a decidedly magical flavor, such as the advice to “take a crossbow string, place it in a crimson bag and have the pregnant woman carry it on her left arm” or to tie it around her waist below the belt. Another piece of advice calls for an ax to be hidden under the woman’s bed. All of these actions needed to be performed secretly, a common feature in magical formulas.

To conclude this brief survey of the information on fertility in the Bèi Jí Qiān Jīn Yào Fāng, the following points should be noted:

treewithcobweb.jpg

  1. This section includes formulas for treating male insufficiency of Yáng Qì, as well as a reference to formulas in the section on “nurturing life” that is aimed at men. This shows that responsibility for the inability to generate new life was not placed exclusively with the woman, but was shared between husband and wife. The creation of the fetus was seen as an act performed by two equal partners, with Yīn and Yáng intermingling and stimulating each other. As the essay states, “Yīn and Yáng blend in harmony, the two Qì respond to each other, and Yáng bestows and Yīn transforms.” Jender Lee has shown that in early medieval Chinese medicine, the treatment of infertility was shifted from sexual cultivation texts directed at men, called “texts of the bedchamber” (房中書 fáng zhōng shū), to medical formula literature on women’s health. In this context, more and more attention focused on ensuring the woman’s reproductive health before and during pregnancy with medicinal formulas, rather than on the avoidance of calendrical and other taboos at the time of conception.

  2. While the male cause for infertility is here simply diagnosed as insufficient Qì (and treated in more detail in the section on “supplementing and boosting through sexual intercourse”), the woman’s condition is carefully differentiated on the basis of a sophisticated diagnosis that takes into consideration the appearance of abdominal masses, sensation of cold, menstrual abnormalities, white or red vaginal discharge, and the anatomical shape of her reproductive organs.

  3. In all cases, treatment was directed at causing the discharge of cold blood, sometimes in connection with heat therapy, and the cleansing of the uterus with cold-expelling and precipitating medicinals. The stagnation and accumulation of pathogenic cold in the body’s center was seen as caused by either the invasion of external wind-cold or a deep-lying insufficiency of Yīn, blood, and Qì, which in any case predisposed the patient to the former.

  4. The complexity of the medicinal formulas, requiring numerous non-household medicinal ingredients, suggests that this sphere of women’s healthcare was not limited to care provided by other female household members or local drug peddlers and midwives, but clearly received the attention of concerned male literati like Sūn Sīmiǎo.

  5. In addition to medicinal formulas, Sūn Sīmiǎo also included magical treatments as well as references, in the very first paragraph, to the superior power of astrology and fate, against which even the finest physician was helpless. Thus, Sūn Sīmiǎo recognized that, in this significant area of women’s health, medicinal formulas did not satisfy his readers’ need for different treatment modalities.

[1] Volume 5 of Sūn Sīmiǎo’s Bèi Jí Qiān Jīn Yào Fāng on pediatrics is available in English in my translation as Venerating the Root, Parts One and Two, published by Happy Goat Productions in 2013 and 2015.

[2] For an English translation of this important classic, see Sabine Wilms, The Divine Farmer’s Classic of Materia Medica.

[3] See the Materia Medica Index in the Appendix for a list of medicinal names, alphabetized by Pinyin with characters and common English and Latin identifications.

A Brief Review of Related Issues on the Problematic Tang Ye Jing 湯液經

The title printed on the front cover, i.e. Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction). Below the title are the five characters ‘Yi Qian Ge Juan Zhuan 一錢閣鐫傳’ (Engraved and Issued by the One-Coin Pavilion).

The title printed on the front cover, i.e. Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction). Below the title are the five characters ‘Yi Qian Ge Juan Zhuan 一錢閣鐫傳’ (Engraved and Issued by the One-Coin Pavilion).

A guest blog by Di Lu

Many scholars and practitioners of Chinese medicine now consider the Tang Ye Jing 湯液經 (Classic of Decoction) as the basic reference for Zhang Ji’s 張機 (style name: Zhongjing 仲景, c. 150-219 AD) Shang Han Lun 傷寒論 (Discourse on Cold Damage). But is such an opinion on the relationship between the two texts unquestionable?

On the Anonymous Text Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)

The Tang Ye Jing (Classic of Decoction) has long been lost since the Eastern Han Dynasty (25-220 AD). The ‘Yiwen Zhi 藝文志’ (Bibliographical Treatise) of the Han Shu 漢書 (History of the [Former/Western] Han Dynasty, c. late 1st century and early 2nd centuries AD) simply records the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction, in 32 juan 卷 [volumes], without author information), and groups it with the other ten medical works under the title of jing fang 經方 (classical prescriptions). Many later authors mentioned the bibliographic record of this text in the Han Shu (Book of Han); but none of them reported his/her reading of the text (strictly under the title of ‘Tang Ye Jing Fa’, or under a similar title [e.g. Tang Ye Jing 湯液經] but containing the same number of volumes), or introduced the content of the text.

On the Text Tang Ye Jing 湯液經 (Classic of Decoction) by Yi Yin 伊尹

At least from the Southern Song dynasty (1127-1279 AD) onward, so far as known, authors of Shi Wu Ji Yuan 事物紀原 (Origins of Things and Matters, first printed in 1197 AD), Yi Shui 醫說 (Discourse on Medicine, 1224 AD) and other works attributed the text entitled Tang Ye Jing 湯液經 (Classic of Decoction; NOTE: lacking the character fa 法) to Yi Yin 伊尹 (c. 1649- c. 1549 BC), without offering any reasons or additional information, without basing such a claim on the above bibliographic record in the Han Shu (History of the [Former/Western] Han Dynasty). But similarly, no one in pre-modern China left a bibliographic record of this text, and/or spoke of any specific content of the text. Did this Tang Ye Jing 湯液經 (Classic of Decoction) ever exist? If so, is it the same as the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)? If so, why does the above bibliographic record in the Han Shu (History of the [Former/Western] Han Dynasty) not ascribe authorship to Yi Yin?

On Yi Yin’s 伊尹 Authorship of Tang Ye 湯液 (Decoction), Tang Ye Jing 湯液經 and Tang Ye Jing Fa 湯液經法

Modern proponents of the Tang Ye Jing 湯液經 (Classic of Decoction) as the progenitor of Zhang Ji’s Shang Han Lun 傷寒論 (Discourse on Cold Damage), as mentioned above, often invoke the following words in Huangfu Mi’s 皇甫谧 (215-282 AD) preface to his own work Zhen Jiu Jia Yi Jing 鍼灸甲乙經 (Classic of Acupuncture and Moxibustion, Selected and Arranged):

Zhong Jing Lun Guang Yi Yin Tang Ye Wei Shi Shu Juan, Yong Zhi Duo Yan.

仲景論廣伊尹湯液為十數卷, 用之多驗.

[Zhang] Zhongjing expanded Yi Yin’s Decoction into more than ten volumes, which were mostly effective in practice.

Lin Yi’s 林億 (active in the 11 century AD) preface to Zhang Ji’s Shang Han Lun (Discourse on Cold Damage) adopts the above words of Huangfu Mi, and adds that ‘Zhong Jing Ben Yi Yin Zhi Fa 仲景本伊尹之法’ ([Zhang] Zhongjing’s [medical knowledge] is rooted in Yi Yin’s norms). The proponents often acquiesce in the equation of the Tang Ye 湯液 (Decoction) with the Tang Ye Jing 湯液經 (Classic of Decoction) or Tang Ye Jing Fa 湯液經法(Models of the Classic of Decoction). In this way, Tang Ye (Decoction) becomes an abbreviation of the latter text title; and Yi Yin also becomes the author of Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction).

However, Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction) consists of 32 juan 卷 (volumes); while Zhang Zhongjing’s expanded edition of Yi Yin’s Tang Ye 湯液 (Decoction) merely contain more than ten juan 卷 (volumes). How could Yi Yin’s Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction) be the same as the anonymous Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)? Why do extant editions of Zhang Ji’s preface to his own work Shang Han Lun (Discourse on Cold Damage) contain no words of the text Tang Ye 湯液 (Decoction), Tang Ye Jing 湯液經 (Classic of Decoction), or Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction)?

Copyright page A, showing the book title Tang Ye Jing 湯液經 (Classic of Decoction), the words ‘Yang Shao Yi Fu Zi Kao Ci 楊紹伊夫子考次’ (Compiled by Teacher Yang Shaoyi) and ‘Di Zi Li Ding Jing Shu 弟子李鼎敬署’ (Respectfully Signed by [Yang’s] Student Li Ding).

Copyright page A, showing the book title Tang Ye Jing 湯液經 (Classic of Decoction), the words ‘Yang Shao Yi Fu Zi Kao Ci 楊紹伊夫子考次’ (Compiled by Teacher Yang Shaoyi) and ‘Di Zi Li Ding Jing Shu 弟子李鼎敬署’ (Respectfully Signed by [Yang’s] Student Li Ding).

On the Reconstruction of Yi Yin’s Tang Ye Jing 湯液經 in 1948

In 1948, Yang Shiyin’s 楊師尹 (style name: Shaoyi 紹伊, 1888-1949) reconstruction of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction), supplemented by Liu Fu 劉復 (style name: Minshu 民叔, 1897-1960), was published by Liu’s Yiqian Ge 一錢閣 (One-Coin Pavilion). This is the only reconstruction of the text Tang Ye Jing 湯液經 (Classic of Decoction), which is believed by some people to be written by Yi Yin, and/or to have truly existed and given birth to Zhang Ji’s Shang Han Lun (Discourse on Cold Damage). Its main text has 160 pages.

The book title printed on the front cover of this reconstruction is ‘Yi Yin Tang Ye Jing 伊尹湯液經’ (Yi Yin’s Classic of Decoction); while the title shown on the copyright pages and the first page of the main text is ‘Tang Ye Jing 湯液經’ (Classic of Decoction).

All images here are from the original edition (1948) of the reconstruction of the Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction) in 1948.

The 1948 reconstruction of the Tang Ye Jing 湯液經 (Classic of Decoction) now has the following two modern versions (the latter one has adjusted the original title to another):

  • Yi Yin Tang Ye Jing 伊尹湯液經 (Yi Yin’s Classic of Decoction), in: Liu Min Shu Yi Shu He Ji 劉民叔醫書合集 (Collection of Liu Minshu’s Medical Works), Chen Guangtao et al. (eds.), Tianjin: Tianjin Kexue Jishu Chubanshe, 2011, pp. 201-345.
  • Tang Ye Jing Gou Kao 湯液經鈎考 (A Study of the Collected Text of the Classic of Decoction), Chen Juwei and Guo Yujing (eds.), Forewarded by Qiu Hao, Beijing: Xueyuan Chubanshe, 2011, Pp. 242.

Yang Shiyin’s 楊師尹 (style name: Shaoyi 紹伊) name indicates Yang’s admiration of Yi Yin. Literally, Shiyin 師尹 means imitating [Yi] Yin; and Shaoyi 紹伊 means introducing Yi [Yin]. According to Yang Shiyin’s own introductory chapter in the reconstructed text,

The first page of the main text, showing the following information: ‘Shang Yi Yin Zhu 商伊尹著’ (Written by Yi Yin of the Shang Dynasty), ‘Cheng Du Yang Shi Yin Shao Yi Kao Ci 成都楊師尹紹伊考次’ (Compiled by Yang Shiyin of Chengdu, whose style name is Shaoyi), and ‘Hua Yang Liu Fu Min Shu Bu Xiu 華陽劉復民叔補修’ (Supplemented by Liu Fu of Huayang, whose style name is Minshu).

The first page of the main text, showing the following information: ‘Shang Yi Yin Zhu 商伊尹著’ (Written by Yi Yin of the Shang Dynasty), ‘Cheng Du Yang Shi Yin Shao Yi Kao Ci 成都楊師尹紹伊考次’ (Compiled by Yang Shiyin of Chengdu, whose style name is Shaoyi), and ‘Hua Yang Liu Fu Min Shu Bu Xiu 華陽劉復民叔補修’ (Supplemented by Liu Fu of Huayang, whose style name is Minshu).

  1. the full title of the text Tang Ye 湯液 (Decoction) mentioned by Huangfu Mi should be Tang Ye Jing 湯液經 (Classic of Decoction);
  2. the author of the Tang Ye Jing 湯液經 (Classic of Decoction) was Yi Yin of the Shang dynasty (c. 1600-1046 BC);
  3. the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction, 32 volumes) was a later text composed on the basis on Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction) and containing all the content of the latter;
  4. the Tang Ye Jing 湯液經 (Classic of Decoction) still existed in the Eastern Han dynasty, and enabled Zhang Ji to read it and expand its content; Shang Han Lun (Discourse on Cold Damage) was not ‘written’ by Zhang Ji, but an expansion of the Tang Ye Jing 湯液經 (Classic of Decoction);
  5. Yang Shiyin’s reconstruction of the text Tang Ye Jing 湯液經, alleged by Yang to be comprised of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction) and extended words by Zhang Ji, was reconstructed on the basis of Wang Shuhe’s 王叔和 (c. 210-285 AD) Mai Jing 脈經 (Classic of the Pulse) and Sun Simiao’s 孫思邈 (581-682 AD) Qian Jin Yi Fang 千金翼方 (Supplement to Prescriptions Worth a Thousand Gold, c. 682) (Wang and Sun’s texts contain words from Zhang Ji’s Shang Han Lun [Discourse on Cold Damage]).

The above points are arbitrary and speculative. None of them is solidly convincing. In particular, the Mai Jing (Classic of the Pulse) adverts to neither Yi Yin nor the Tang Ye Jing 湯液經 (Classic of Decoction). And only the 26th chapter of the Qian Jin Yi Fang (Supplement to Prescriptions Worth a Thousand Gold) mentions ‘Gu Ren Yi Yin Tang Ye 古人伊尹湯液’ (the ancient man Yi Yin’s Decoction), which, however, is not connected with origins of the content of the Qian Jin Yi Fang. Moreover, as mentioned above, extant editions of Zhang Ji’s preface to his Shang Han Lun (Discourse on Cold Damage) also makes no mention of the text Tang Ye 湯液 (Decoction), Tang Ye Jing 湯液經 (Classic of Decoction), or Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction). Some scholars also treat Yang’s opinions, methodology and reconstruction with caution, as evidenced by Qiu Hao’s foreword to the Tang Ye Jing Gou Kao 湯液經鈎考 (A Study of the Collected Text of the Classic of Decoction, Chen Juwei and Guo Yujing eds., Beijing: Xueyuan Chubanshe, 2011, pp. 1-16) and Feng Shilun’s foreword to the Jie Du Yi Yin Tang Ye Jing 解讀伊尹湯液經 (Interpreting Yi Yin’s Classic of Decoction, Feng Shilun 馮世綸 ed., Beijing: Xueyuan Chubanshe, 2009, pp. i-iv).

On the Manuscript Fu Xing Jue Zang Fu Yong Yao Fa 輔行訣臟腑用藥法要 (Auxiliary Knacks of Essential Drug Usage for Viscera)

A text often associated with academic discussions of the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction) is the manuscript Fu Xing Jue Zang Fu Yong Yao Fa 輔行訣臟腑用藥法要 (Auxiliary Knacks of Essential Drug Usage for Viscera, hereinafter FXJ), which is now included in, for example, the Dun Huang Gu Yi Ji Kao Shi 敦煌古醫籍考釋 (Commentary and Research on Ancient Medical Texts Excavated in Dunhuang, Ma Jixing 馬繼興, ed., Nanchang: Jiangxi Kexue Jishu Chubanshe, 1988, pp. 115-137), Dun Huang Shi Ku Mi Cang Yi Fang 敦煌石窟秘藏醫方 (Secret Medical Prescriptions from Dunhuang Grottoes, Wang Shumin, ed., Beijing: Beijing Yike Daxue & Zhongguo Xiehe Yike Daxue Lianhe Chuban, 1998, pp. 1-28), Fu Xing Jue Zang Fu Yong Yao Fa Jiao Zhu Kao Zheng 《輔行訣臟腑用藥法要》校注考證 (Textual Studies, Collation and Annotations of the Auxiliary Knacks of Essential Drug Usage for Viscera, Wang Xuetai, ed., Beijing: Renmin Junyi Chubanshe, 2008, pp. 3-62), and Fu Xing Jue Zang Fu Yong Yao Fa Jiao Zhu Jiang Shu 《輔行訣五臟用藥法要》校注講疏 (Interpretation, Collation and Annotations of the Auxiliary Knacks of Essential Drug Usage for Viscera, Yi Zhibiao, et al., eds., Beijing: Xueyuan Chubanshe, 2009, pp. 250-307).

According to the introductory remarks on FXJ in the above modern publications, FXJ was initially preserved at the Mogao Grottoes of Dunhuang, and then flowed into the hands of a Daoist, who later sold it to the Chinese physician Zhang Wonan 張偓南 at the beginning of the Republican period (1912-1949). Zhang passed the original manuscript of FXJ down to his grandson Zhang Dachang 張大昌, also a Chinese physician. In the summer of 1966, unfortunately, the original manuscript was destroyed in the Cultural Revolution. In 1974, Zhang Dachang sent a copy of the manuscript to the Zhong Guo Zhong Yi Yan Jiu Yuan 中國中醫研究院 (China Academy of Chinese Medicine). Later, the manuscript began to receive increasing attention from historians of medicine. Until now, 21 copies of the original manuscript of FXJ, transcribed by different people in the second half of the 20th century, have been found in China and included in the Fu Xing Jue Wu Zang Yong Yao Fa Yao Chuan Cheng Ji 《輔行訣五藏[臓]用藥法要》傳承集 (Collection of the Circulated Manuscripts of the Auxiliary Knacks of Essential Drug Usage for Viscera, Beijing: Xueyuan Chubanshe, 2008, pp. 3-400).

FXJ, originally authored by Tao Hongjing 陶弘景 (456-536), is a controversial manuscript. Two historians of Chinese history, namely Zhang Zhenglang 張政烺 and Li Xueqin 李學勤, had examined FXJ, and concluded that it could not be counted as an early writing composed by Tao Hongjing, nor could it be a modern forged text. The original manuscript of FXJ is now lost; and available information on the origin of FXJ originates from Zhang Dachang, whose narrative might be unreliable (say, FXJ might be forged or might not be a manuscript from Dunhuang Grottoes). The title of FXJ also does not appear in extant records of Tao Hongjing’s writings. Some scholars treat FXJ a forged text, see, for example, Tian Yongyan 田永衍, ‘Fu Xing Jue Zang Fu Yong Yao Fa Yao Fei Cang Jing Dong Yi Shu Kao——Cong Wen Ben Xing Shi Yu Wen Xian Guan Xi Kao Cha 《輔行訣臟腑用藥法要》非藏經洞遺書考——從文本形式與文獻關係考察 (A Study of the Auxiliary Knacks of Essential Drug Usage for Viscera as a Text not from Dunhuang Grottos——From the Perspectives of Textual Forms and Relationships)’, Nan Jing Zhong Yi Yao Da Xue Xue Bao (She Hui Ke Xue Ban) 南京中醫藥大學學報(社會科學版) (Journal of Nanjing University of TCM [Social Science]), 2015, 16(4): 232-237.

FXJ mentions ‘Tang Ye Jing Fa 湯液經法’ (Models of the Classic of Decoction) three times, and claims that it was written by Yi Yin of the Shang dynasty. Because of this, some historians, such as Ma Jixing 馬繼興, consider that FXJ incorporates some words from the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction). Further, because some prescriptions recorded in FXJ (not associated with the Tang Ye Jing Fa 湯液經法 [Models of the Classic of Decoction]), bear resemblance to their counterparts in Zhang Ji’s Shang Han Lun (Discourse on Cold Damage), some historians of medicine, such as Qian Chaochen 錢超塵, think that FXJ proves Shang Han Lun (Discourse on Cold Damage) to be composed on the basis of Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction). Even if FXJ is not a forged text, such an opinion is still too arbitrary.


Concluding Remarks

Copyright page B, showing the publisher information ‘Liu Shi Yi Qian Ge Zeng Fu Zhen Juan Zhuan Chuan 劉氏一錢閣曾福臻鐫傳’ (Engraved and Issued by Zeng Fuzhen at Liu’s One-Coin Pavilion), and the information on the transcriber and the collator: ‘Di Zi Li Ding Lu Gao 弟子李鼎録稿’ (Transcribed by [Yang’s] Student Li Ding) and ‘Wu Zi Nian Dong Chu Ban Hai Men Shen Dan Jiao Zi 戊子年冬初版海門沈旦校字’ (First Published in the Winter of 1948, Collated by Shen Dan of Haimen).

Copyright page B, showing the publisher information ‘Liu Shi Yi Qian Ge Zeng Fu Zhen Juan Zhuan Chuan 劉氏一錢閣曾福臻鐫傳’ (Engraved and Issued by Zeng Fuzhen at Liu’s One-Coin Pavilion), and the information on the transcriber and the collator: ‘Di Zi Li Ding Lu Gao 弟子李鼎録稿’ (Transcribed by [Yang’s] Student Li Ding) and ‘Wu Zi Nian Dong Chu Ban Hai Men Shen Dan Jiao Zi 戊子年冬初版海門沈旦校字’ (First Published in the Winter of 1948, Collated by Shen Dan of Haimen).

After a brief review of related issues on the Tang Ye Jing 湯液經 (Classic of Decoction), we can confirm that:

  1. There had been an anonymous text entitled Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction, in 32 juan [volumes]) in the Western Han dynasty;
  2. It is unknown whether there truly existed a text written by Yi Yin of the Shang dynasty and entitled Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction);
  3. It is unknown whether the Tang Ye Jing Fa 湯液經法 (Models of the Classic of Decoction) was Yi Yin’s Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction);
  4. It is unknown whether Zhang Ji’s Shang Han Lun (Discourse on Cold Damage) was an expansion of Yi Yin’s Tang Ye 湯液 (Decoction) or Tang Ye Jing 湯液經 (Classic of Decoction);
  5. Yang Shiyin’s reconstruction of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction), published in 1948, can only represent his own faith in the existence of Yi Yin’s Tang Ye Jing 湯液經 (Classic of Decoction).