Discussion of Cold Damage with Commentaries for the Clinic

Description

This book is a new translation and annotated guide to the text and clinical applications of Zhang Zhong-Jing’s Discussion of Cold Damage (Shäng hán lùn), which since the 3rd century has been the most important classical reference for treating externally-contracted diseases in traditional East Asian medicine. The core of the book are translations of the 398 main paragraphs of the Song dynasty edition (11th century), which covers tài yáng, yáng míng, shào yáng, tài yïn, shào yïn, jué yïn as well as sudden turmoil, yin-yang exchange, and relapse after recovery due to consumption.

Each entry begins with the original text of the paragraph in Chinese and its translation. This is followed by an explanation of the text and its significance, touching upon the specific clinical relevance of the passage as well as background issues. For paragraphs that include herbal formulas, the original Chinese is presented together with a translation and brief explanation of the composition. Methods of preparation, both original and modern, are included.

A distinguishing feature of this book are the commentaries that are provided for each paragraph, selected from amongst the most respected scholar-practitioners on the Discussion of Cold Damage during the past thousand years. The reader is thereby given direct access to how prominent physicians have interacted with this text in the past, illuminating some of the more practical approaches to it. Carefully selected case histories are appended to relevant paragraphs to help the reader gain insight into the clinical utility of the formulas they contain.

Throughout the book the authors, both of whom are practitioners with many decades of experience in Chinese medicine, provide their own comments about issues raised in the text. This includes textual interpretation as well as discussion of the clinical aspects of the paragraphs.

There is also a glossary, table of people noted in the text, bibliography, and full index.

Read the Table of Contents and Introduction (PDF)

Read an Excerpt: Paragraph 26 (PDF)

Read an Excerpt: Paragraph 351 (PDF)

Contents

List of Tables

Introduction

Chapter 1: Differentiating the Pulse and Symptoms of Tài Yáng Diseases along with Treatment

Chapter 2: Differentiating the Pulse and Symptoms of Yáng Míng Diseases along with Treatment

Chapter 3: Differentiating the Pulse and Symptoms of Shào Yáng Diseases along with Treatment

Chapter 4: Differentiating the Pulse and Symptoms of Tài Yïn Diseases along with Treatment

Chapter 5: Differentiating the Pulse and Symptoms of Shào Yïn Diseases along with Treatment

Chapter 6: Differentiating the Pulse and Symptoms of Jué Yïn Diseases along with Treatment

Chapter 7: Differentiating the Pulse and Presentation of Sudden Turmoil Disease along with Treatment

Chapter 8: Differentiating the Pulse and Presentation of Yin-Yang Exchange and Relapse After Recovery due to Consumption along with Treatment

 Appendix 1: Discussion of Cold Damage Measurements Through the Ages

Appendix 2: Glossary

Appendix 3: People Noted in the Text

Appendix 4: Bibliography

Endnotes

Formula Index (see Resources tab)

General Index

Reviews

STEVE CLAVEY, THE LANTERN:

I really don’t think that the readers of The Lantern need an explanation of why the Shang Han Lun (Discussion of Cold Damage) is such a crucial text for Chinese medicine studies.

So let’s go right to the most important question for a book review: How does this translation compare to the several that are already out?

Shang Han Lun: On Cold Damage by Craig Mitchell, Feng Ye, and Nigel Wiseman

The Mitchell-Feng-Wiseman Shang Han Lun: On Cold Damage is fabulous for learning the language of the Shang Han Lun, including pinyin with tones and characters for each passage, and explanations of the nuances of various technical terms that are important for Shang Han Lun studies. But the attention to language--which I hasten to say is highly valuable for the Shang Han Lun literature in English as a whole--can tend to obscure the immediate clinical application of each clause.

Shang Han Lun Explained by Greta Young and Robin Marchment

Young and Marchment’s Shang Han Lun Explained is great on content, clinically handy and concise and includes case histories, but is heavily pinyin oriented. This is perfect for Australia where pinyin is the standard for both teaching and prescription guidelines, but may be somewhat off-putting elsewhere. Too, the book layout in Shang Han Lun Explained is rather cramped and dense, whereas the Eastland book layout and design is, as usual, a delight and makes reading a pleasure.

Simple differences in word choice can make the difference between easy comprehension and confusion that brings the reader up short, wondering Huh?

As a small example, chosen at random from Young and Marchment’s text, paragraph 238 starts off: “Yang Ming disease, there is purgation, if there is anguish and vexation …”

The Bensky translation is more clear: “For yáng míng diseases that have been purged, if there is anguish and vexation …”

Again, Shang Han Lun Explained describes the traditional dosages, but does not explain until an appendix at the end what may be meant by “liang” or “sheng.” The cooking method does explain that “one dou” is “(2L)” and “2 sheng” is (400 mL), but it is inconsistent and the reader is often left having to stop reading and run some simple math through her head to get the complete directions. Discussion of Cold Damage: with commentaries for the clinic avoids this by clearly writing out both the traditional dosages (ie liang or sheng) but also describes the process in modern measurements.

Discussion of Cold Damage by Guohui Liu and Henry McCann

Guohui Liu and Henry McCann’s Discussion of Cold Damage is the scholar’s dream, going into great depth on almost every possible point. This true wealth of detail can however tend to overwhelm the most clinically important issues. This pitfall is avoided in the Eastland book. For example, Liu’s book goes into seven pages of detail on Clause 100, paying especial attention to the question regarding the meaning of “yang pulse” and “yin pulse.” The Eastland book, true to its principle of adhering to the consensus of the commentators of the last thousand years, translates it as floating and deep pulse and allows the commentators to make the case for this choice.

Verdict

In short, the Ma and Bensky Discussion of Cold Damage with Commentaries for the Clinic is excellent for actual clinical use. It cuts right to the chase, with everything aimed at clarity to help you understand and employ the Shang Han Lun as you are dealing with patients.

In fact, I have already adopted this as my go-to reference text for Shang Han Lun, despite having numerous Chinese editions and all the other English translations mentioned here.

It is easy to read, and easy to take in, and the eye is allowed to go where it needs in a text that is complex by its nature. The characters for each classical paragraph appear, but the pinyin is not, which has the effect of making the text much less cluttered.

The translation follows, and in some cases an alternate translation where there are questions about exactly what this two thousand year old text was saying. This is relatively rare, however. Again, notes on translation choices appear where such a choice affects the whole text, such as paragraph nine which is the first place in which the term jīng (經, here translated as “warp” as in “warp and weft”) appears. Appendix two also has a useful glossary of other terms that need explanation.

The paragraphs of the classic are in the order of Song dynasty text, which is not the case the Shang Han Lun Explained or the Mitchell-Feng-Wiseman Shang Han Lun: On Cold Damage. This may not matter to a lot of readers, but experts such as Liu Duzhou have recommended that part of one’s investigations into the Shang Han Lun should be to think about the order of the paragraphs and what Zhang Zhongjing, that master of compressed meaning, may have been trying to convey underneath the words, so to speak.

Also there are real clinical gems based on deep experience found at least every few pages that make a careful reading of the text invaluable. For example, in the discussion of how to use Gui Zhi Tang (Cinnamon Twig Decoction), besides the use of congee or other hot cereal, it says:

In addition, the patient should be encouraged to close their eyes and rest. As noted in chapter 76 of Divine Pivot and elaborated upon in the nineteenth century work Bases of Medicine (醫原 Yī yuán), the eyes are an important route for protective qi to enter and leave the body. This not only affects the process of sleep, but just closing the eyes keeps the protective qi inside and facilitates its harmonization with the nutritive. This applies to any treatment for colds and flus, not just those treated by this formula, because closing the eyes for a few hours or through the night often helps to promote a therapeutic sweat.

The depth of clinical experience by the authors shows through here. Another example is the extremely interesting discussion of Jueyin disorders, which is too lengthy to include here, but well worth reading.

Facing the inevitable difficulties in such an old text, common-sense solutions are found by Ma and Bensky that are based on a thousand years of interaction with the text by deeply experienced clinicians, so that we benefit not only from the original classic, but from lifetime after lifetime of those who used the text everyday as they faced patients.

Here is an example of an almost Gordian-knot level difficulty:

One of the more frustrating controversies surrounding Discussion of Cold Damage relates to dosage. This has been a hot topic recently, especially in mainland China. Our position is that for at least the last 500 years, the vast majority of practitioners in China have used the conventional conversion of dosages given in the following table. This means that almost all the experience that we have access to has relied on this general range of dosage and so we should, in general, follow it. Table 1-3 gives the conversion commonly used in schools and colleges of traditional medicine in China today. For more detail, see Appendix 1: Measurements.

Furthermore, there are numerous tables that actually clarify the topic under discussion, such as differentiating true and false heat, tables that differentiate related formulas with clinically similar presentations, or that differentiate potentially confusing symptom presentations (eg a comparison of organ clumping, clumping in the chest, focal distention and suspended thin mucus) and even one differentiating the eleven different types of focal distention and linking them to the treatment principles and formulas used for each, and, importantly, the various inversion disorders, how to differentiate, and how to treat them.

Some of the other translations also include case histories, but this book has the advantage of Dan Bensky’s experience and acumen as well as Ma Shouchun’s almost 40+ years of clinical practice and his own cases.

I do, however, have one bone to pick with this otherwise excellent clinical text:

“This book is not a formulary. As such our explanations of the formulas are concise and provide only the bare minimum of information necessary to understand how the formulas are put together, as a basis for how to use them in clinic.”

Ok. But while I expected to find, as usual with Eastland Press books, a list of formula names only using the Eastland Press translation (instead of a pinyin list in case one cannot guess how the name might have been translated) what I did not expect was to find no list of formulas at all!

Yes, you can look them up in the index, but again only in Eastland translation. You won’t find, for example “Gui Zhi Tang” in the index, you have to search for “Cinnamon Twig Decoction.” Easy enough in this case. But what if you want to find the original Shang Han Lun clause for the use of Da Xian Xiong Tang? “Major” one could guess, but “xian xiong”? You are reduced to looking up “major” in the index, then paging through to find “Major Decoction for Pathogens Stuck in the Chest.”

A couple of extra pages with both English and pinyin formula names, and the related clause number, would be very welcome in the next edition.

This however is only a minor sour note in an otherwise angelic choir.

Conclusion

Ma and Bensky’s Discussion of Cold Damage with Commentaries for the Clinic is the product of twenty years of careful study and thought into this crucial classical text by both authors, and it shows. Nothing is rushed, everything--again as is usual for Eastland Press--has been triple-checked and considered and put forth in a way that makes comprehension easy. It is, in fact, a delight to read and a joy to use.

PHIL GARRISON, THE JOURNAL OF CHINESE MEDICINE:

Several years ago, I reviewed Gouhui Liu’s Discussion of Cold Damage (Shang Han Lun): Commentaries and Clinical Applications (2015) for the October 2015 edition of the Journal of Chinese Medicine. Now, almost eight years later, I am pleased to provide a review of Discussion of Cold Damage with Commentaries for the Clinic by Shouchun Ma and Dan Bensky. As individuals who are familiar with and have studied the text will know, the Shāng Hán Lùn (傷벽論) is a relatively small collection of short, pithy statements about the treatment of different symptom presentations with specific formulas; historically, however, it is the commentaries that have been at the centre of this tradition. Beginning in the Sòng (芥) dynasty, a renewed interest in the Shāng Hán Lùn gave rise to what Stephen Boyanton has called ‘literati medicine’. This renewed interest in the Shāng Hán Lùn sparked a rich tradition of commentaries that continue into the present day. With the foregoing in mind, it is often the commentaries that an author chooses to include that make a new English translation worthwhile.

For many years, the Craig Mitchell, Nigel Wiseman and Feng Ye translation of the Shāng Hán Lùn (1999) served not only as the best English version of the text, but the de facto standard in the field. As I noted in my review of the Guohui Liu edition (JCM, number 109, October 2015, pp59-60), this new translation had the potential to be a ‘revelation’ for teachers in the field, since it did ‘nearly everything that the Mitchell et al. translation of the Shang Han Lun does … better’. So where does this new translation by Shouchun Ma and Dan Bensky fit in? Simply put, it may be the best version of the text for master’s level students. It includes a translation of the text, along with selected commentaries from roughly the last one thousand years, as well as clinical notes. My primary critique of the Liu version was that it might be too ambitious, noting that this ‘massive work may be more useful to doctoral level students and experienced practitioners than to master’s level students and new practitioners’. Viewed in this light, I believe the Ma and Bensky version is a welcome addition to the available English versions of the text, and has the potential to replace the Mitchell et al. version as the standard for master’s level students and faculty. When one considers that the Ma and Bensky edition is the cheapest of the aforementioned translations, a compelling case can be made for it filling this role. Further, the inclusion of case histories from Shouchun Ma’s more than fifty years of clinical experience make this edition a strong contender as the best choice for English-speaking clinicians.

The text begins with a brief introduction and discussion of the authors’ chosen terminology. It then provides overview of the layout for each entry, which is broken up into the following sections: Main text & translation, Explanation, Formulas and their explanations, Selected commentaries, Discussion and Case histories.

The ‘Main text & translation’ sections are relatively straightforward; the Chinese characters for each line are provided, along with a translation. Serious scholars may take note that Ma and Bensky have preserved the line order from the Sòng dynasty, which is also true of the Guohui Liu edition, but different from the Mitchell et al. edition which opts for a more modern organisational approach. As I noted in my review of Liu’s edition, the preservation of the Sòng dynasty order may prove confusing to some students. One notable example of this concern is that the formula Xiao Chai Hu Tang, the exemplar formula for shào yáng stage disorders, is found in the chapter on tài yáng.

The ‘Explanation’ section of each entry is analogous to the ‘Synopsis’ section in the Mitchell et al. translation, and provides ‘as cogent an explanation as [the authors] can manage of the text and its significance’ (Ma & Bensky, 2023, p. xv).

The ‘Formulas and their explanations’ sections‘ include the original Chinese, a translation of the ingredients and instructions for preparation, a description of how the formula is most often prepared in China at present [set off in brackets], and a brief explanation of our understanding of the composition of the formula, which is usually in line with modern textbooks’ (Ma & Bensky, 2023, p. xv). Students familiar with the formula explanations found in Scheid, Bensky, Ellis and Barolet’s Formulas & Strategies (2015) will feel right at home here, as many of the explanations have a similar feel to those found in that book. Some scholars, however, may take issue with some of the descriptions of the herbal properties and actions in this section, since they are undoubtedly modern, and often incongruent with the properties and actions found in more classical materia medica texts — specifically the Shén Nóng Běn Cǎo (神農굶꿇), which would likely be more in line with the herbal theory available in Zhāng Zhòng Jǐng’s time. That said, while the explanations of formulas might rely on a more modern understanding of herbs and their functions, the descriptions of the properties and actions of a particular herb provided in this section may prove to be a net positive for master’s students, since these descriptions will be more in line with the properties and actions found in their master’s level curriculum, where Bensky is a co-author of both the Materia Medica and Formulas & Strategies texts used in many Chinese medicine programs.

Out of all the sections for each entry, I find the ‘Selected commentaries’ to be the most useful from a pedagogical perspective. Ma and Bensky provide a ‘selection of translated commentaries’ so students can see the ‘diverse opinions’ on each line (Ma and Bensky, 2023, p. xvi). This section will be of particular interest to professors who either lack the translational skills—or time—to translate commentaries themselves, and they may serve as a means of facilitating in-class discussions about the meaning of each line. Among the commentators cited are Wáng Hào-Gǔ from the Jin-Yuan dynasty, Zhāng Jiè-Bīn from the late Ming dynasty and Xú Dà-Chūn and Kē Qín from the Qing dynasty.

The ‘Discussion’ section includes commentary from Shouchun Ma ‘about different aspects of the paragraph in question. These can be textual issues or those related to different interpretations of the text, but more commonly they deal with certain clinical implications of the paragraph’ (Ma & Bensky, 2023, p. xvi). I particularly enjoyed reading Ma’s comments on wind-strike: ‘Sensitivity to drafts is different from chills. In sensitivity to drafts, the person feels chilled only upon exposure to drafts. In chills, the person feels chilled even if there are no drafts and, in extreme cases, will feel chilled even when next to a fire or lying under blankets. While it is often difficult to absolutely distinguish these two symptoms, each has its particular emphasis. For example, sensitivity to drafts is often accompanied by sweating, as wind has a tendency to open up and drain out. By contrast, patients with chills often do not sweat, as cold contracts’ (Ma & Bensky, 2023, p. 4). In addition to the comments provided by Ma, these discussions often cite other notable practitioners including Zhèng Qīn-Än of the ‘Fire Spirit School’ (huǒ shén pài), who may be familiar to some.

Lastly, we find a section on ‘Case histories’ that are relevant to specific lines. While each line does not always include a case history, Ma and Bensky have chosen case histories in which the formulas have only undergone ‘slight modification,’ if any (Ma & Bensky, 2023, p. xvi). This was a wise decision, as it ensures that the cases presented are relevant to the lines to which they are attached. Having these case studies as a reference is likely to be a valuable resource to both students and faculty members who may not have clinical experience with specific formulas.

At the end of each chapter, we find a summary of key concepts called ‘General Thoughts’. While far from comprehensive, these summaries can help to focus the reader on some of the overarching themes of each of the six stages, and may be particularly beneficial to students. Several appendices are provided in the back of the book: a discussion on dosage measurements, a glossary of key terms and a list of commentators (including dates). These additional appendices, while not likely to be of interest to students, may help provide context for faculty members and clinicians.

Thus far, we have considered what is found within this particular edition of the Shāng Hán Lùn so, at this juncture, it might be worth discussing what is missing. The most obvious omissions are an in-depth history of the text and the preface to the Shāng Hán Lùn. The former concern can easily be overcome if the professor, student or clinician who seeks to understand the text has access to the Mitchell et al. edition. Ma and Bensky address the latter concern by stating that the preface ‘was almost certainly written hundreds of years after the text itself ’ (Ma & Bensky, 2023, p. xi). These are relatively minor issues, and may even go unnoticed by some, but they are nonetheless worth mentioning.

As stated early on, the Shāng Hán Lùn is a relatively short text when read on its own. For over twenty years, students, teachers and practitioners have relied upon the Mitchell et al. translation as the standard. In 2015, Guohui Liu introduced his own offering , which was truly staggering in its scope. Keeping this in mind, one may wonder if another translation is truly necessary. In the case of Shouchun Ma and Dan Bensky’s Discussion of Cold Damage with Commentaries for the Clinic, I believe the answer to that question is a resounding ‘yes.’ Ma and Bensky have produced an English edition that will satisfy professors, students and practitioners. In addition to translations of the individual lines, it includes thoughtful discussions and commentaries but, perhaps more importantly, the discussions and commentaries do not feel overwhelming. Coupled with the reasonable price-point that is less expensive than the other two English translations referenced throughout this review, I believe it will find a place in many master’s-level classrooms and practitioner’s bookshelves.

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Michael Huber, ABZ München:

 "Discussion of Cold Damage with Commentaries for the Clinic helps readers understand the import of this text through both insightful translation and clear explanations. In doing so, the authors present an interpretation of the text shaped by many years of clinical experience, while at the same time offering the reader the opportunity to understand other interpretations. An absolutely unique feature are the case studies for almost all of the 113 formulas. This is must-read for all who want to seriously study the Shang Han Lun."

Resources

Special Supplement to the Print Edition: A two-part Formula Index, alphabetized by a) English formula name and b) pinyin, was created after the book went to press. It is now available to our readers as a free download (purchasers of the eBook will have the Index included).

View or download the Formula Index (PDF)

Correction to the Print Edition: A correction has been made to two cells in Table 1-11, pages 306-307. The updated table is available for readers of the print edition (purchasers of eBooks always receive the most current version).

View or download Table 1-11 (PDF)