The book Shanghan Zabing Lun (伤寒杂病论)[1] is the earliest foundational book in Chinese herbal therapy. It was written by Dr. Zhang Zhongjing (张仲景) more than 2000 years ago. Many therapeutic principles or rules in herbal therapy in later Traditional Chinese Medicine (TCM) have been developed from this book and the herbal formulas in this book are called Classical herbal formulas. This book was later separated into two books: Shanghan Lun (伤寒论), and Jin Kui Yao Luo (金匮要略), by another doctor, Dr. Wang Shuhe (王叔和).

In the book Shanghan Zabing Lun, Dr. Zhang Zhongjing introduced the Six Disease diagnosis system[2] for the diagnosis and treatment of exogenous diseases and that of various miscellaneous diseases. The methodology of this TCM system is to diagnose the disease into six groups of diseases, and then identify the herbal formula that is needed for the treatment. The process of identifying the herbal formula that should be used for the treatment is called Indication diagnosis. The herbal formulas are already in the hands of the TCM doctor, so what he needs to do is to tell which formula is suitable for treatment. Therefore, it is said that it is very important to set up and to establish the indices for which disease conditions should be treated by each herbal formula. Without knowing which disease condition is suitable to be treated by the herbal formula, it is impossible to have a satisfactory healing effect even if the Six Disease diagnosis is correct.

However, the book by Dr. Zhang Zhongjing did not give clear or thorough indications, nor explanations, for why a given clinical condition should be treated by the use of the herbal formula that he recommended. The book looks pretty much like a clinical menu, not a textbook that tells everything in detail. Later TCM doctors have used these formulas in clinics for more than two thousand years and have accumulated very rich experiences in the use of them. However, up until now, there has been no accordant agreement or an authorized conclusion about the indication in the uses of each herbal formula. Different doctors have different opinions about when and how to use each herbal formula that was introduced in the book by Dr. Zhang Zhongjing. The indications introduced in the TCM textbook (about Shanghan Lun) is only one opinion among many other opinions.

For several reasons, it has been difficult up until now to set up a unanimous agreement on the indications or indexes for the use of Classical herbal formulas. We do not intend to discuss such reasons here. This book aims to supply readers with information for the Indication diagnosis for the Classical herbal formulas. From many doctors’ experiences here, we can feel that the formula indications in Shanghan Lun become more vivid. I do not believe that I am among the experts, so I am hesitant to make a “summary” for the indications for the Classical herbal formulas. Readers can set up his or her own summary of the indications or indexes for each herbal formula from these different TCM doctors.

This book collects the views and opinions of some of current TCM doctors, not those of the past or ancient times. I believe that when the past doctors studied and practiced the Classical herbal formulas, they had already learned the experiences and ideas of doctors before them. When we learn from the current doctors, it means that we, as students, stand up on the shoulder of those doctors, who again stand on the shoulders of past and ancient doctors.

We highly respect these earlier doctors for their careful study and practice of Chinese Classical herbal formulas. For this reason, we include the Chinese name in parentheses following each Pinyin name.

Translation

Translation of Chinese into English has never been a simple thing to do, especially in translating Chinese herbal therapy into English. It is not easy to find an exact English word to describe the Chinese meaning, not to speak of the fact that, in TCM, for a given paragraph of Chinese, different people could have very different understandings. This is absolutely true in learning Shanghan Lun. One of the ways to prevent the misunderstanding of Chinese TCM concepts is to use a capital letter of the first letter of a word. For example, “Liver” is a TCM concept. It includes the anatomic organ, the liver, but also includes Liver meridian and the emotion. “Kidney” includes the anatomic organ kidney, but also means the reproductive system, the bone, the memory, the libido, and so on.

The use of herbal therapy

In this book, we included the original dosage in liang, shen, or qian, and so on. We also include the dosage suggested in the textbook or recommended by some current doctors. It is the choice of the reader to decide to follow the recommended dosage, or to the use of original dosage from the book Shanghan Lun, and to regard one ancient liang as the current 15.625 grams, or as only 3 grams, as introduced in the TCM textbook.

Also, we list the original way to cook the herbs. The amount of water added for cooking is for the original dosages, as one ancient shen is equal to a current 200ml. If the current herbal dosage in a formula is chosen to follow, the total amount of water does definitely not need to be so much. Instead, you can add the herbs and water to a cooking pot, let the level of water in the pot be about 3cm over the level of herbs in the pot. Bring to boiling for several minutes, then simmer until there is about 200ml of water left. Collect the herbal tea. Add more water to the pot, so that the water level the same as the level of the herbal residue. Bring to boiling again until there is about 100-150ml of water left. Collect the second herbal tea. This boiling may or may not be repeated a third time. Pull all the herbal tea together. Drink the herbal tea twice or three times per day. Unless specifically indicated, the dosage list for most of the herbal formulas is once-per-day dosage.

Alternatively, we can use current herbal granules. This means that the herbs have been cooked, condensed, and dried into granule form. To use, just add the herbal granules into a cup, add warm water to dissolve it, and drink it. Most of the time, the granule form of the herbs works with pretty much the same effectiveness as the original manually cooked herbal tea. In our clinic, we use both acupuncture and the herbal granules. We let clients drink the herbal tea first, then perform acupuncture. So, the acupuncture and the herbal tea work at the same time and we feel that the healing effect is very quickly felt. For example, if a client feels very hot, and sweats, we could help the client feel cooler within 15 to 20min of drinking the herbal tea. A good thing about Classical herbal formulas is that they need only four to six ingredients in most of the formulas. It is easy to prepare the herbal tea in the clinic before acupuncture than using Conventional herbal formulas, which in most cases contains ten to fifteen ingredients, or even more.

Acupuncture is becoming more popular nowadays in Western countries. But acupuncture is only one part of the whole TCM system. In China, most TCM graduates, conservatively let's say more than 90% of them, are practicing herbal therapy, not acupuncture. We strongly recommend that acupuncturists also learn Chinese herbal therapy. With both acupuncture and Chinese herbal therapy, the success of clinical practice would for sure be much higher.

In the last part of this book, we list an identification list for herbal formulas according to body symptoms or body signs. It is used only as a reference.

The “indications”, “Key points of the indications”, and “Current applications” in most formulas are cited from websites of Yibian Wan (医砭) and TCM 100 (金匮名医验案精选).

[1] Shanghan: diseases caused by exogenous reasons. Zabing: a disease caused by various reasons other than the exogenous reasons, such as improper diet, emotion, sexual life, heavy mental or labor work, and so on. Shanghan Zabing Lun: therapeutical principles and rules of herbal therapy.

[2] Initially, this book separates the exogenous diseases into six groups, and the group is called “disease”. However, aftertime TCM doctors call the six disease diagnosis as six “Jing” diagnosis system. The Jing here may mean meridian or principle. Therefore this diagnosis system is also called Six Jing diagnosis system.