Hearth Interactive

Once in a Lifetime, part 1

Preface to the Treatise on Cold Damage

Zhang Zhongjing, Treatise on Cold Damage and Miscellaneous Diseases, preface

Written
c. 200–206 (within ten years of the start of the Jian'an era, 196)
Place
Han China
Language
Classical Chinese
Kind of source
medical
Reading time
5 minutes
Difficulty
Moderate
Intensity
Low: deaths reported, nothing graphic

Epidemics of the late Han (c. 196–217)Doctors and medical ideasFamily and loss

Once in a Lifetime themes: Exhaustion, Aftermath

Versions

The edited translation, in simplified modern English. Bracketed words were added for clarity; [...] marks a cut. Tap a note number to read the note. Point at or tap a phrase to see the original behind it. Phrase links checked in a separate review.

Here is what I have to say. Whenever I read how Yueren made his diagnosis on arriving in Guo, or how he read the face of the Lord of Qi,1 I never fail to sigh with deep feeling at his brilliant talent.

It amazes me that the learned men of our time pay no attention to medicine and never study its methods with care. With medicine they could treat the illnesses of their rulers and parents above them and rescue the poor and humble from hardship below them. In between, they could keep themselves safe and whole for many years, and so care for their own lives. Instead, they race after glory and power and stand on tiptoe to look up to the mighty and the rich. Tireless and anxious, they care for nothing but fame and profit. They decorate the branches but throw away the root; they make the outside shine and let the inside wither. If the skin is gone, what will the hair cling to?

Then, without warning, they meet the qi of harmful winds2 and fall ill with some grave and unusual disease. Only when trouble comes and disaster strikes do they start to tremble. Swallowing their pride, they bow low and look up hopefully to shamans and priests.3 When they have nothing left to try, they leave it all to Heaven, fold their hands, and accept defeat. They carry a life that could last a hundred years and hold the most precious vessel there is, and they hand it all over to some ordinary doctor to do with as he pleases.

Alas, alas! Their bodies die, and their spirit fades away to nothing. They turn into something else, sunk deep beneath the springs [of the underworld]. All anyone can do is weep, and the weeping does no good. How painful! The whole world is lost in a daze, and no one wakes up. People do not value their own lives, and if they treat life so cheaply, what is all their glory and power worth?

In public life they can neither care for others nor understand them; in private life they can neither care for themselves nor understand themselves. When disaster strikes, they find themselves in danger, confused and in the dark, as dull as wandering ghosts. How sad! These men who chase what the world admires race after empty show instead of making the root strong. They forget their own bodies and give themselves up to things, until they are in as much danger as someone walking on thin ice or at the edge of a deep gorge. That is how far they have fallen!

My clan was once large, more than two hundred people. Yet in the less than ten years since the Jian'an era began,4 two out of every three of us have died, and seven out of ten of those deaths came from Cold Damage.5

I was moved by all those we had lost, and I grieved that no one could save them from dying before their time. So I worked hard to search out the teachings of the ancients and gathered remedies far and wide. I drew on the Basic Questions, the Nine Scrolls, the Eighty-One Difficult Issues, the Great Treatise on Yin and Yang, and the Tailu Record of Drugs.6 I also added methods for judging the pulse and telling one illness from another. From all this I made the Treatise on Cold Damage and Miscellaneous Diseases, sixteen scrolls in all. It cannot cure every disease, but I hope that with it a reader can look at an illness and know where it comes from. Anyone who studies what I have gathered here will understand more than half.

Heaven spreads out the Five Phases to keep all things moving. People receive the five constants, and so they have the five organs.7 The channels and the acupoints, and the ways yin and yang meet and flow together, are dark, deep, and subtle, and their changes are almost impossible to fathom. Without great talent and fine understanding, who could get to the bottom of them? In ancient times there were Shennong, the Yellow Emperor, Qibo, Bogao, Leigong, Shaoyu, Shaoshi, and Zhongwen. In the ages after them came Changsang and Bian Que, and in the Han dynasty, Gongsheng Yang Qing and Master Cang.8 Since then, I have heard of no one like them.

Look at the doctors of today. It never occurs to them to search out the meaning of the classics to widen what they know. Instead, each one simply carries on his family's methods and follows the old ways from start to finish. When they examine a sick person and ask about the illness, all they care about is smooth talk. They sit with the patient only a moment before writing out a prescription.

They feel the pulse at the wrist but never farther up the arm, and they hold the hand but never check the feet. They never compare the pulses at the neck, the wrist, and the foot.9 They count the beats but stop before they reach fifty, and they cannot tell how soon a patient will die. They do not have the faintest idea of the nine places to take the pulse, and they never look closely at the nose, the brow, or the forehead. This is what people call peering through a tube, and nothing more.

With methods like these, it is truly hard to tell the dying from the living! Confucius said, "Those who are born knowing are the highest. Those who learn come next. Those who hear much and remember widely come after them."10 I have long been devoted to the healing arts. Let me humbly try to live by these words.

Notes

  1. Qin Yueren was the real name of Bian Que, a famous early physician known mostly through legend. He was said to have revived a prince of Guo and seen the Lord of Qi's coming death in his face. back
  2. Chinese doctors believed illness often entered the body from outside, carried on wind, cold, or other harmful qi. Qi was the vital breath or energy that Chinese thinkers saw in the body and in the world. back
  3. Religious healers who treated illness by contacting spirits or by prayer. People in early China consulted them alongside doctors. Heaven was the highest power in the universe, believed to rule human fate. back
  4. The Jian'an era began in 196 CE, so Zhang wrote this before about 206. back
  5. In Han Chinese medicine, a family of fever illnesses believed to begin when cold invades the body from outside. Historians cannot match it to one modern disease. back
  6. The medical classics of Zhang's day. The Basic Questions and the Nine Scrolls are traditionally identified as the two parts of the Yellow Emperor's Inner Classic. The last two are lost, though parts of the Great Treatise may survive in the Basic Questions; the meaning of "Tailu" is uncertain. back
  7. The Five Phases (wood, fire, earth, metal, water) explained change in nature and the body. The "five constants" are usually taken here as their regular qi in each person; each organ matched a phase. Yin and yang were paired opposites; channels carried qi. back
  8. Shennong, the Divine Farmer, and the Yellow Emperor were legendary sage-rulers; the others were legendary doctors. Changsang taught Bian Que. Yang Qing (gongsheng was his rank) taught Master Cang, a doctor of the second century BCE. back
  9. Chinese doctors diagnosed by feeling the pulse at several points: on the wrist, on the neck, and on the foot. They also read signs in the color of different parts of the face. back
  10. Drawn from two sayings of Confucius (551–479 BCE) in the Analects (16.9 and 7.28). Zhang's final words echo Yan Hui, Confucius's favorite student, in Analects 12.1. back