Study On The Formation Of The Doctrine Of Epidemic Febrile Diseases Of Wen Yi Lun And Zheng Zhi Xin Chuan

Research ObjectivesIn early 2003,a pandemic disease known as Serious and Acute Respiratory Syndrome (SARS) broke out in the Guangdong Province and then spread to a number of provinces in the People's Republic of China(PRC),including the Hong Kong Special Administrative Region(HKSAR),creating serious medical and social problems.In face of this sudden attack of epidemic disease,and the subsequent acknowledgement of the effective intervention of Traditional Chinese Medicine(TCM) in epidemic febrile diseases(EFD), people began to take a fresh look at TCM in order to find combating methods from the medical archive of TCM.Wu's(吴有性) "Wen Yi Lun"(WYL)《温疫论》is regarded as the ultimate source of the doctrine of epidemic febrile diseases(DEFD)(温病学)and included in the PRC's key fundamental research plan(973 Plan) promulgated by China's TCM Science Society.In reading Wu's WYL and comparing it with Yuan's(袁班) "Zheng Zhi Xin Chuan"(ZZXC)《证治心传》,the author discovers that there are common grounds in their understandings of EFD,albeit that Yuan demonstrates a wider and deeper understanding of the EFD. Some of the contents in ZZXC,like "EFD attacks the upper body","Wei(卫),Qi(气), Ying(营),Xue(血) is the route of transformation of the EFD" and "seasonal characteristic of the FED" are strikingly similar with that promulgated by TCM practitioners of the later years,including Ye Tian-shi(叶天士) and Lei Feng(雷丰).In this connection,WYL and ZZXC are both important academic documents and deserve our thorough research and discussion.This constitutes the major objective and value of this research.Research Method1.Data CollectionThe fundamental research work begins in libraries of Hong Kong,the Guangzhou TCM University Library and the Reserve Library of the History of TCM Teaching Unit. Initially,information gathering of the different versions of WYL and ZZXC are conducted through tracking the "All China United Books Catalog" for the existing versions of the two books,and then the different versions available in the market,ranging from the 16 parts "Wen Yi Lun Supplementary" published by the People's Sanitary Publishing Company to the currently most popular WYL version by Zhang Zhi Bun published by the Peoples Sanitary Publishing Company in 2007.The latter is adopted as the major reference for the study,while reference has been made to the "Wen Yi Lun Supplementary" published by the People's Sanitary Publishing Company in 1955 and Fan's "Wen Yi Lun New Supplementary".A comprehensive and detailed literature review had been conducted based on these major references.As for Yuan's ZZXC,there are very few existing versions:mainly a hand written version,a lead print version and versions subsumed in "San San Yi Shu"(SSYS)《三三医书》and "Guo Yi Xiao Cheng Shu"《国医小丛书》.Upon examination of the documents in hand, it is decided that,for the purpose of this research,the version subsumed in SSYS Vol.2 published in 1923 by the Hangzhow San San Yi Xie would be adopted,while making reference to the version subsumed in the SSYS Vol.2 page 601-603,published by Beijing TCM publishing company in October 1998.As this thesis traces back to the Chin,Han and Sung,Gin,Yuan TCM references for their influences on Wu and Yuan,while following up to the Ching dynasty for the influences of Wu and Yuan,a series of classic TCM references are required.In view of the fact that there would be tremendous difficulties in gathering the original documents,versions edited by recent authors such as Jiang's "A Collection of All the Best Old and New TCM Books" and Woo's "A Collection of the Famous TCM Practitioners of the Ming and Ching Dynasty"(including 13 famous Ming and 17 famous Ching TCM Practitioners' full collections,respectively) by China's TCM Publishing Company,1999,have been used for reference.Besides,checking had been made on the National Knowledge Infrastructure(CNKI) for journals of the past 20 years on EFD,for methods of diagnosis,treatment and medicines, This included a focus on the findings of the State's major researches relating to the analysis, assessments and comments on Wu and Yuan's two publications.Finally,a review and analysis of recent and historical medical publications of the western world,including those on eco-epidemiology,was made with a view to compare Wu and Yuan's school of thoughts on the causes and preventions of EFD.Major reference consulted includes:1.Felissa R.Lashley,RN & Jerry D.Durham "Emerging Infectious Diseases - Trends and Issues,Springer Publishing Company,2002"2.David A Warrel,Timothy M Cox,John D Firth & Edward J Benz Jr "Oxford Textbook of Medicine(4th Edition)",Oxford University Press,2003 3.U.S.Department of Health and Human Services -National Institutes of Health "Understanding the Immune System - How It Works",NIH Publication,20032.Data AnalysisIn view of the special characteristic of this thesis,which requires a combination of the historical study of TCM which emphasizes on(1) the explorations of theories;and(2) review of reference documents,this research adopts both lateral and vertical approaches in study and analysis.The lateral approach refers to the study of both Wu and Yuan's books of the same late Ming dynasty for integration,and through the review of their academic characteristics,conclusions on their contributions to the theory and practices of the EFD can be drawn.The vertical study approach consists of two parts based on historical development.The first part consolidates the academic successes on EFD before the Ming dynasty, focusing on their influences on the thinking of Wu and Yuan,e.g.how classics including Wang Di Nei Ching《黄帝内经》,Nan Ching《难经》and Treatise on Exogenous Febrile Diseases《伤寒论》classify the concept of EFD,and the discussions of the causes and systems of transformation of EFD in Chu Bing Yuan Hou Lun.《诸病源候论》The second part investigates the way Wu and Yuan had influenced EFD studies in the Ching dynasty,in particular their influences on the four famous scholars - Ye,Sit,Wu and Wang - and those subsequent to their period.The ancillary part elaborates on the contributions of Wu and Yuan on the construction of the modern theories of EFD and relates it to the western medical science in terms of the causes and prevention of infectious diseases through exploring their common grounds.Research ResultsThe structure of the thesis findings consists of two parts:(Ⅰ) Part 1 consists of the review of the two famous EFD writings which were written in the late Ming dynasty.Firstly,based on the review of the different versions of the Wen Yi Lun and Zheng Zhe Xin Chuan,it is found that there are numerous versions of WYL,up to over 80 before the establishment of the People's Republic of China(PRC),which have been separately stored in 69 institutions including the Beijing Library,China TCM Research Society Library,etc. With the establishment of PRC,the editing,explanation and publishing of WYL are given due attention by the scholars,and about 10 versions of new editions have been published. On the other hand,there are limited editions of ZZXC,with only one hand written version, one lead printed version and a version subsumed under two seminal works of "San San Ye Shu" and "Guo Ye Xiao Chung Shu".Secondly,based on the consolidation of the academic achievements of ZZXC and WYL,it is found that: 1.Wu put forward the concept of "Nue Qi"(戾气) causing EFD and described its characteristic as infectious,epidemic,targeting,specific,etc.Regarding its cure,Wu put forward the concept of "Niu Chuan Ghe Duen"("扭转截断"),i.e.dredging "Mou Yuen"(膜原),changing the location of diseases,early expulsion of guest evils, cutting off the cause of diseases,cures for the nine transfers,etc.2.Yuan put forward the cause of EFD as due to infection by "Nue Qi" and that EFD usually enter the body from the upper respiratory system.He diagnosed the transformation of EFD by way of the routing of Wei(卫),Qi(气),Ying(营),Xue(血) and emphasized on the distinction between Epidemic Febrile Diseases and Exogenous Febrile Diseases,as well as cure based on the Yin Yang and relative strengths of the diseases.3.The common findings from Wu and Yuan suggested that the cure for EFD usually should adapt to changes and target at the root cause e.g.diagnosis of EFD should focus on the tongue,pulse together with other factors,the observation of every minor details. Discharge(攻下) method should be used at an early stage before the patient becomes weak.In using the discharge method,tongue and pulse should be closely monitored, and the dosage used should also be commensurate with the seriousness of the disease and strength of the patient.Both Wu and Yuan emphasised the exercise of great care in aftercare of the patient to avoid medical complications.4.Both Wu and Yuan made valuable contributions in the study of EFD with regard to:■Developing the concept of"Nue chi" and "Yee chi";■Locating the channels of infections and affected parts as related to mouth and nose,upper respiratory system;■Cure by Wu's Nine transfer cures and Yuan's "Wei(卫),Qi(气),Ying(营),Xue (血)" along normal(顺传) and reverse(逆传) sequence of transformation;on diagnosis of diseases,both Wu and Yuan had their own elaborations on the use of tongue and pulse as references for diagnosis;on treatment of EFD,both discussed the use of discharge(攻下) method and the method of preservation of fluids in the body(养阴).Yuan had special expertise in monitoring Yin Yang and relative strengths of the patient and their aftercare.(Ⅱ) Part 2 Focuses on how Wu's WYL and Yuan's ZZXC had influenced the famous TCM practitioners in EFD of the Ching dynasty,,highlighting their linkage with the top four famous TCM practitioners in EDF,i.e.Ye,Sit,Wu and Wang.For instance,Ye's "Wei(卫),Qi(气),Ying(营),Xue(血)" and "examination of the tongue and teeth in diagnosis",Wu's "Evil Qi entering from the mouth and nose", "modifications and improvements on the cheng qi tang(承气汤)","analysis of the change in symptoms after discharge","the usage of wang lian and wang shum","preservation of the body fluid to improve the dryness of the body and simultaneously using both built-up and discharge methods,etc.",Sit's usage of the concept of"Evil hiding in mou yuen(膜原) and "dragging on between the tired host and the guest(主客交)","wang's supplementing the pulse by the tongue in diagnosis" and Lui's "Treatise on Seasonal Diseases《时病论》"are all related to either Wu or Yuan or both.All these constitute an important part of the thesis.The way Wu's WYL and Yuan's ZZXC had played an important role in the formation and development of the doctrine of EFD is not limited to their influences on the big four. Their influences also extended to Dai's "Promulgation of EFD《广温疫论》" and Ho's "Promulgation of EFD - Re-edition《重订广温疫论》",Ma's "EFD - Source Revealed《温疫发源》" and "The Debate on EFD《温疫辨论》",etc.,all of which focus on EFD as their major context.They are also covered in the investigations of this thesis. The ancillary part of the thesis establishes that the doctrine of EFD is becoming the source in construction of modern eco-epidemiology.The author has been working as a town planning professional for many years and well aware of the fact that,despite the advance of medical sciences in the 20^th century,the threat of diseases against human has never been weakened,chronic diseases maintain a high rate of occurrence whereas the emergence of new viruses continues to attack human.These threats have forced EFD scholars to rethink about the contradictions between their own traditional methods of treatment of diseases and the modern mode of diseases,trying hard to find ways for combating the enemies of human health in the 21st century.Eco-epidemiology is the new concept or term which has been repeatedly mentioned,used and practiced in the modern study of epidemiology.The author understands that the principles governing the causes of EFD within the doctrine of EFD have common grounds with that of eco-epidemiology of the western world.Nevertheless,such understanding is very premature and inadequate.In view of the above, this part of the study is only included as an ancillary part of the thesis for reference of the readers.Research ConclusionsIn Chinese,there is a saying that "through the study of history,we know our position in the present and by looking at the mirror,we see our own shape." Through studying and comparing Wu and Yuan's ways of thinking,it is confirmed that both are important contributors to the history of development of the doctrine of EFD,especially Yuan's ZZXC should not be left anonymous in the theory and practice of the doctrine of EFD.This thesis systematically reviewed Wu and Yuan's books on issues including the ways through which EFD is transmitted,locations in the body where the diseases are affecting,how the symptoms and diseases are transformed,principles governing their treatment and clinically what combinations of herbal medicines should or could be prescribed.The conclusion is that both Wu and Yuan have significant influences on the thinking of the top four TCM practitioners in EFD of the Ching dynasty,as well as on many other important writings by famous TCM practitioners on EFD.As once said by the famous Lingnan TCM practitioner Mr.Chen Yam-mei,"In general,the way in which academic thinking is evolved hinges on the trend of evolution of nature,such that the environment's need is met,and so that the school of thoughts are created and become a school of thought.Could the doctrine of EFD be an exception? For the five hundred years from the Ching dynasty to the present,there are increasing numbers of scholars devoting themselves to the study of EFD,and their methods are gradually approaching perfections.In this regard,this period has become the golden age in the study of EFD."...