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Oksana Nachataia. About treatise “Shang Han Lun” and its relevance in our days.

Dear colleagues! Today is the last day of March. I look out the window and see the real January snow, there are dense clouds in the sky – somehow atypically for the middle of spring. I read about the height of epidemic of flu in St. Petersburg with a significant excess of the epidemic threshold, I read about the flu in European countries. Friends write me about the abnormal cold in Spain and Portugal. And these thoughts pushed me to write a few words about the famous Chinese treatise TCM “Shang Han Lun” and its relevance in our days. It is known, that like any living organism, a person is part of the biosphere and continuously in contact with the environment. Of course, the progress and achievements of medicine increasingly protect a person from the harsh climate and severe infections, making life more and more long and comfortable. But the problem of morbidity due to variousclimate influences is still on the agenda in the most acute way. It’s no secret that this is one of the top topics for both scientific research and practical medicine. To address these issues, it is obviously necessary to have a deep understanding of the mechanisms of interaction between person and nature, and in this matter additional sources of information can be very useful. A real storehouse of knowledge in this area is considered to be one of the most studied treatise of TCM “Shang Han Lun”. For example, recognized experts of our time in the field of TCM and, in particular, Shang Han Lun, spoke about this in a single key. “To understand any complex phenomenon, the most important thing is understanding the essence” (Professor Liu Gong Wang of Tianjin University of TCM). “If you notice something, you need to grasp the gist. If you write a treatise – expound profundity “(Han Yu.” In pursuit of the Teacher “). As the well-known reader knows, Shang Han Lun is dedicated to the diagnosis and treatment of diseases acquired as a result of the external environment. Specialists in the field of Chinese medicine note that in this classic work the pattern of development of infectious diseases and climatic lesions was first revealed, as well as key mechanisms of interaction between the human body and the environment were described. This, for example, is the concept of fighting between the protective qi and pathogenic source, when the superiority of the struggle in one direction or another determines the main signs of the disease and its development. As is known, the real scientific breakthrough at that time in China was the creation the complete system of the “six meridians” by Zhang ZhongJing. We can say that this is the key to understanding not only the acute symptoms of febrile illnesses, but also their far-reaching complications. Equally significant is the principle of diagnosis and treatment of a patient based on his general condition (that is, a holistic approach to the body). As you know, these principles of clinical thinking are firmly entrenched in Chinese traditional medicine, becoming an integral part of it, which continue to exist up to the present time. As historians describe, the creation of Shang Han Lun was truly a titanic work. Historical analysis indicates that the scientific origins were the extensive theoretical knowledge of the previous period, from the deep antiquity to the Han period, an in-depth study of the Han and pre-Han pharmacies, and the general results of Zhang Zhongjin’s long clinical practice. Based on his own clinical research, having gone through a long and difficult path in the epoch of epidemics and social upheavals, he eventually formed the first whole work in the country, combining theory and practice. Its logical principle of “syndrome – a method of treatment – a prescription” is fundamental for Chinese medicine and now. The famous Japanese expert in the field of TCM, Dr. Nakama, noted that “the postulate on the relationship between the syndrome and the prescription is the starting point of all three treatises – “Shang Han Lun”, “Jin Kui Yao Lue” and “Wen Bing”.” It is very interesting historical data that for centuries the Shang Han Lun was a rare value for Chinese doctors. For example, four centuries after the establishment of the Shang Han Lun, the legendary TCM doctor Sun Si Miao bitterly complained that he was not able to get Shang Han Lun, so necessary for his scientific research, as other masters keep him secret (“The Chinese scientific index on Chinese medicine”. Zhong Guo Yi Yao Ke Zhi Chu Ban She., Shang Han Lun Jian Yi).

As is known, the value of Shang Han Lun for modern medicine is not only in the theoretical explanation of the mechanisms of febrile illnesses, but also in practical pharmacology. TCM historians note that during the reign of the Qin and Han dynasties, pharmacology was already developed to a certain level, but the creation of Shang Han Lun just indicates that progress has reached an unprecedented height. The doctors of later eras found stable combinations created by Zhang Zhongjing as  understandable, the recipe as accurate, and the effect of the medications as  unquestionable. Therefore it is not surprising that this knowledge has successfully passed the test of time, and this treatise is deservedly considered “an ancestor of pharmacology”. Recipes of Shang Han Lun are concise and simple at first sight. But, interestingly, the “plants – keys” crystallized for certain syndromes from this treatise. As is known, these “stable combinations” significantly improve the effect of complex and voluminous practical recipes with their proper designation.

If we still touch on the theoretical points a little, then on the basis of the study of the Shang Han Lun it is possible to see the difference in the perception of the same phenomenon from the positions of TCM and Western medicine – two views from different perspectives. These thoughts are widely expressed. For example, when determining a pathogen, Western medicine often raises the question “what is a pathogen?”, It determines the morphology, type, strain of a virus, a bacterium or other infectious agent. At the same time, Chinese medicine usually asks the another question: “What is the body’s response to the pathogen?” And already this criterion becomes the starting point in the further actions of the doctor. Moreover, a pathogen is often understood as an infectious agent in combination with a certain climatic factor, when they both strengthen each other. It can be the body’s response in the form of cold, in the form of heat or intoxication and so on. These two different views could greatly enrich the thinking of the modern practitioner.

Returning to the basic postulates of Zhang Zhong Jing, according to experts in the field of Shang Han Lun, the development of the disease is determined by three factors. The first one depends on the degree of strength of the body’s defenses. The second factor depends on the strength and nature of the pathogenic origin. The third factor is determined by the availability of proper treatment, as well as lifestyle. All three factors remain extremely important for comprehension, especially in the conditions of a modern, rapidly changing reality. Ancient system of diagnostics according to the “eight fundamental principles”, further perfected in Shang Han Lun the system of “six meridians” and created later by Wu Ju Tong and Ye Tian Shi system of “four barriers” are algorithms of clinical thinking that in no way contradict to each other, form the outline and the foundation of Chinese medicine. These algorithms allow you to flexibly form an idea of ​​the causes, pathogenesis and treatment strategies for modern exogenous diseases. It is no secret that modern person faces global changes in the life environment. This largely determines the profile of morbidity and puts all new tasks before medicine. Here is one example. In conditions of climate change and unprecedented migration of the population, a person faces a completely unknown, alien to his place of residence, a viral, bacterial and other infection that is much more difficult than the usual “home” cold. On the other hand, because of factors that weaken protective qi, a person becomes exposed to infectious lesions even in a favorable climate and comfortable conditions. In such cases, a flexible system of clinical thinking is needed, and these are exactly the requirements of Chinese medicine algorithms. Thus, Chinese phytopharmacology is distinguished both by traditional dogma and by certain flexibility in the preparation of recipes, which allows maximum personification of the treatment in any situation. Extremely interesting Shan Han Lun and in terms of long-term complications after suffering infections and climatic lesions. As is known, Shang Han Lun “connects” seemingly independent diseases into a single pathogenesis, and this is especially interesting for specialists adhering to an integrative approach. For example, the general features of the syndromes of the Yang meridians include the presence of syndromes of excess, heat, active struggle of protective forces and pathogenic source. That is, from modern positions, inflammation prevails here in various variants, then the infection process is chronic, which gradually depletes the organism and leads to complications. The disease of the “three yin” is for the most part chronic, characterized by the syndromes of deficiency, the prevalence of cold, exhaustion. From the perspective of modern medicine, it can be assumed that these syndromes are often a platform for further development, for example, endocrine and metabolic disorders. Therefore, the ancient approaches to the treatment of syndromes of both Yin and Yang meridians can be extremely important for the complex treatment of modern common diseases, for example, diabetes, metabolic syndrome, fatty hepatosis, atherosclerosis and others. In conclusion, I would like to note an interesting description of the recommendations on lifestyle in terms of climate, described in the SHLL. And many of these recommendations are used. Clearly indicated the ability of a cold climate to cause febrile illness. “In the frigid winter cold all life is hiding, and if the noble husband will take care of himself, he will not get sick from the cold and will be able to resist him. The name of this disease is fever. ” Of course, one can not adhere to such archaic conclusions in view of the modern rhythm of life, but, perhaps, adherence to such covenants and there is a competent implementation of the principle of “life in harmony with nature”, which is so much talked about.

As a doctor of Western medicine, I try to adhere to an integrative approach and maximize the approximation of ancient knowledge to modern practice. Although, of course, such global works as Shang Han Lun are of great interest in the cultural and historical terms. Without claiming a global analysis of the treatise, which is possible only as a result of the joint work of a large scientific community, I merely expressed some hypotheses based on the experience of my teachers and my own experience. I will be very grateful for any criticisms, objections and additions, as well as the conduct of the discussion. Thank you for attention!