Origin and Inheritance of Health Preservation Concepts in Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun)

Abstract

By analyzing the structure and academic characteristics of early Western Han medical texts such as Prescriptions for Fifty-Two Diseases (Wu Shi Er Bing Fang) and Prescriptions for Health Preservation (Yang Sheng Fang), and considering the development of philosophical thinking during the pre-Qin and Han periods, this study summarizes how Zhongjing Zhang's Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun) inherited pre-Qin and Han philosophical thought while further integrating Daoist “natural law” cosmology, Confucian “benevolence” social ethics, and the “isomorphic unity of heaven and humanity” medical theory in Yellow Emperor's Inner Classic (Huang Di Nei Jing). It proposes health preservation concepts encompassing heaven-human, body-spirit, and benevolence perspectives, along with dietary hygiene, representing the medical embodiment of pre-Han “virtue cultivation” and “body nurturing” life philosophies that profoundly influenced subsequent traditional Chinese medicine health preservation theory and practice.

 

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Keywords

health preservation - Treatise on Cold Damage and Miscellaneous Diseases - Shang Han Za Bing Lun - Zhongjing Zhang - heaven-human view - body-spirit concept - benevolence concept

The compilation of Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun) not only propelled the transition of Chinese medicine from empirical practice to theoretical medicine but also established practical techniques for later traditional Chinese medicine (TCM) health preservation. Tracing its theoretical origins, the work creatively integrated Daoist “natural law” cosmology,[1] Yellow Emperor's Inner Classic (Huang Di Nei Jing)'s “hisomorphic unity of heaven and humanity” medical system,[2] and Confucian “benevolence” social ethics,[3] forming health preservation concepts that encompass heaven-human, body-spirit, and benevolence perspectives. This achieved the transformation of “virtue cultivation” and “body nurturing” life philosophies from metaphysical speculation to practical application. Focusing on Zhongjing Zhang's academic characteristics, this paper systematically elaborates his health preservation concepts to reveal his pivotal role in connecting traditional philosophy with clinical medicine in the history of TCM health preservation development.

From Experience to Standardization: Holistic Characteristics of Zhongjing Zhang's Health Preservation Concepts

As the earliest extant specialized text on disease diagnosis and treatment, Prescriptions for Fifty-Two Diseases (Wu Shi Er Bing Fang) and Zhongjing Zhang's Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun) together constitute the inheritance lineage of Qin-Han medicine. Their medical practices demonstrate evident continuity: in pharmacopeia, core herbs like Huangqin (Scutellaria Baicalensis), Banxia (Pinellia Ternata) appear frequently in both texts, confirming the stable transmission of early empirical materia medica; diagnostically, both follow the “one syndrome-one formula” correspondence principle, showing significant commonality with Prescriptions for Health Preservation (Yang Sheng Fang) and Miscellaneous Treatment Prescriptions (Za Liao Fang) in diagnostic logic.[4] [5] Notably, Zhongjing Zhang elevated this “formula-syndrome correspondence” into a dynamic “syndrome differentiation and treatment” system. By constructing complete symptom clusters, it reveals the patterns of healthy qi-pathogen waning and waxing during disease progression and proposes therapeutic principles like “supporting yang qi” and “preserving body fluids.” This approach combining disease treatment with healthy qi preservation simultaneously transcends empiricism of Prescriptions for Fifty-Two Diseases (Wu Shi Er Bing Fang) and profoundly reflects Zhongjing Zhang's core health preservation principle that “self-healing occurs through spontaneous yin-yang harmonization.”

Compared with the “disease syndrome correspondence” and parallel listing compilation style seen in early Western Han medical texts like Prescriptions for Fifty-Two Diseases (Wu Shi Er Bing Fang) and Prescriptions for Health Preservation (Yang Sheng Fang), Zhongjing Zhang systematically reconstructed clinical experience by establishing a well-structured “syndrome differentiation and treatment” clinical decision-making system through three dimensions: disease location integration, formula-syndrome correspondence, and dosage standardization. This not only marks the crucial transition of Chinese clinical medicine from empirical accumulation to disciplinary systematization,[6] but also embodies Zhongjing Zhang's health preservation philosophy of “treating disease by addressing its root cause.” By systematically grasping disease progression patterns, he integrated treatment with health preservation, realizing a holistic health concept of “preventing disease before its onset and preventing deterioration after onset.”[7]

In specialized disease diagnosis and treatment, the compilation of Book of Childbirth (Tai Chan Shu) and Synopsis of the Golden Chamber (Jin Gui Yao Lue): Pulse Patterns and Treatment of Women's Miscellaneous Diseases demonstrates the transition of early TCM gynecology from fragmented experience to specialized systems. Both focus on women's unique physiological stages. Book of Childbirth (Tai Chan Shu) centers on maternal health care, emphasizing physiological care from pregnancy to postpartum,[8] whereas Synopsis of the Golden Chamber (Jin Gui Yao Lue): Pulse Patterns and Treatment of Women's Miscellaneous Diseases is grounded in pathological diagnosis, pioneering a disease classification framework with “pregnancy disorders,” “postpartum disorders,” and “women's miscellaneous diseases” as its main categories.[9] Zhongjing Zhang reconstructed gynecological diagnosis and treatment through syndrome differentiation thinking, such as distinguishing “abnormal uterine bleeding” into “deficiency-cold of the thoroughfare and conception vessels” (treated with Mense–Warming Decoction) and “internal blood stasis obstruction” (treated with Cinnamon Twig and Poria Pill). This transition from “maternal care” to “disease diagnosis and treatment” not only marks TCM gynecology's gradual separation from internal medicine, forming a clinical specialty prototype rooted in visceral and meridian theory,[10] but also provides systematic theoretical support for later gynecological specialty practice.

 

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From Heaven Law to Humanistic Practice: New Connotations of Zhongjing Zhang's Health Preservation Elements

Heaven-Human View (Natural Philosophy)

The medical concept of “humans corresponding with heaven and earth” proposed in Yellow Emperor's Inner Classic (Huang Di Nei Jing) and the “natural law” philosophy of “Dao models itself after nature” in The Classic of the Way and Virtue (Dao De Jing) together constitute the dual dimensions of pre-Qin heaven-human thought.[11] The former reveals the rhythmic synchronicity between the human body and nature through “spring sprouting and summer growing,” while the latter emphasizes human respect and compliance with natural laws through the philosophy of “non-action” (Wu Wei).[12] Although both focus on “heaven-human relationships,” the former emphasizes physiological “heaven-human rhythm correspondence,” while the latter leans toward philosophical “heaven-human unity.”[13] [14] Building on the “heaven-human rhythm correspondence” in Yellow Emperor's Inner Classic (Huang Di Nei Jing), Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun) provided medical interpretations of “heaven distributes the five elements, humans embody the five constants,”[15] redefining “heaven-human” relationships with two breakthroughs: First, it concretized “heaven” as a natural factor central to disease occurrence and progression, emphasizing nature's influence on human life activities. It established a pathological system of “seasonal qi successively damaging the five zang organs,” reflected in Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun)'s medication principles, such as adjusting Cinnamon Twig Decoction dosages according to seasonal characteristics by adding Shaoyao (Paeoniae Rubra Radix) in spring or Huangqin (Scutellariae Radix) in summer, transforming the abstract principles in Yellow Emperor's Inner Classic (Huang Di Nei Jing) into “seasonal adaptation” clinical guidelines. Second, it developed the Daoist philosophy of revering and complying with heaven, proposing methods like dietary regulation and Daoyin breathing exercises to influence and intervene in human healthy qi (health status). This breakthrough marked the transition of “heaven-human view” from pure philosophical speculation to clinical practice. Thus, revering and complying with heaven became not only external conditions for life existence but also models for health preservation and disease treatment. Natural pathogenic factors like “six excesses” were incorporated into the “etiology-pathogenesis-treatment principle” diagnostic system, giving concrete natural substance to the “virtue cultivation” and “body nurturing” life philosophies. This pioneered a medical approach that takes heaven (nature) as the basis and humans as the application, laying the foundation for the later “three adaptations” (to time, place, and individual) theory.

 

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The Concept of Body and Spirit

In the Preface to Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun), Zhongjing Zhang criticized the societal pursuit of his time, stating, “They strive only for fame and profit, adorning the superficial while neglecting the fundamental. They embellish the exterior but wither the interior. If the skin does not exist, where will the hair attach?” This critique resonates theoretically with the “unity of body and spirit” advocated in Yellow Emperor's Inner Classic (Huang Di Nei Jing). Such discourse also aligns in value orientation with the philosophical proposition in The Classic of the Way and Virtue (Dao De Jing): “Manifest plainness and embrace simplicity, reduce selfishness and diminish desires.”[16] Both oppose excessive mental and physical exhaustion. Zhongjing Zhang placed great emphasis on explaining the harm of excessive desires from the perspective of human health. Based on medical practice, he creatively employed the “skin-and-hair metaphor” to establish a direct connection between social behavior (pursuit of vanity) and physiological pathology (internal organ deterioration), highlighting his medical life view of “the unity of body and spirit.” Notably, under the Daoist health-preserving concept of “attaining emptiness and maintaining tranquility,” Zhongjing Zhang proposed the medical principle of “restraining desires to preserve the body,” transforming the abstract Daoist philosophy into concrete health-preserving norms such as “moderation in eating and drinking and regularity in daily life.”

 

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The Concept of Benevolence

In the Preface to Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun), Zhongjing Zhang lamented, “I grieve for the loss of the past and mourn the untimely deaths that could not be saved.”[15] This compassionate statement deeply echoes the Confucian ethical view of “the benevolence others,” and the two exhibit complementary characteristics in practice. Tracing its ideological origins, the Confucian classic Analects (Lun Yu) emphasizes, “The benevolent love others.” Mencius (Meng Zi) further extends benevolent governance to societal care: “Respect the elderly in one's own family as well as the elderly in other families; care for the young in one's own family as well as the young in other families.” This ethical requirement of extending one's care to others[17] aligns intrinsically with Zhongjing Zhang's medical compassion of “saving the poor and lowly from distress” when he witnessed rampant epidemics. Zhongjing Zhang's breakthrough lies in transforming “benevolent intent” into “benevolent practice,” constructing a system of Chinese medical diagnosis and treatment. He translated the Confucian moral ideal of “universal love” into the medical practice of “preserving the body and nurturing life.” Particularly in Synopsis of the Golden Chamber (Jin Gui Yao Lue), he proposed the preventive medical idea of “the superior physician treats disease before it arises” and elaborated on diagnostic methods such as “seeing liver disease, one knows it will spread to the spleen.” This shift from moral ideals to technical rationality not only demonstrates Zhongjing Zhang's inheritance of Confucian benevolence, but also establishes a professional norm unifying medical ethics and clinical practice.

 

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From Concept to Principle: The Inheritance and Transmission of Zhongjing Zhang's Health-Preserving Principles

In ancient China, dietary hygiene, as a crucial aspect of health-preserving practices, always held a central position. From the pre-Qin period onward, people recognized the close relationship between diet and health, gradually forming corresponding concepts of dietary hygiene. Confucian classics such as Analects (Lun Yu) proposed the dietary pursuit of “food cannot be too refined, and minced meat cannot be too fine”[18], and explicitly stated the hygiene principle of “not eating spoiled fish or rotten meat.” This discourse not only reflects the ancients' emphasis on ingredients but also demonstrates a profound understanding of food hygiene issues during the Spring and Autumn period. Zhongjing Zhang inherited this dietary hygiene principle as well. He not only adhered to the rule of “avoiding spoiled food” but also established systematic criteria from a medical perspective. For example, “filthy rice, spoiled meat, and stinky fish all harm the body when eaten” reveals the damage caused by spoiled food. Through detailed rules such as “pork that floats in water should not be eaten,” “fish without intestines or gallbladders should not be eaten,” and “meat with red spots should not be eaten,”[15] he incorporated the observation of food morphology into the food safety assessment system, making it more scientific and practical.

Zhongjing Zhang's breakthrough lies in further expanding the pre-Qin dietary hygiene concepts. His proposition that “all foods and flavors are meant to nourish life; if consumed improperly, they may instead cause harm”[15] established for the first time the principle of “selecting food based on syndrome differentiation,” advocating dietary contraindications tailored to disease characteristics. By following the principle of “regulating the cold, heat, bitterness, sourness, pungency, and sweetness of food,” he extended dietary intervention to pharmacological treatment. Although a complete theoretical system of dietary regulation had not yet been formed, these innovative elements laid the foundation for later generations to construct systematic theories of dietary therapy and health preservation, transforming the scattered dietary experiences of the pre-Qin and Western Han periods into medical theories.

Later physicians deeply inherited and innovatively developed Zhongjing Zhang's dietary hygiene and health-preserving concepts in clinical practice and theoretical advancements. Hong Ge of the Jin Dynasty, in Handbook of Prescriptions for Emergencies (Zhou Hou Bei Ji Fang), inherited Zhongjing Zhang's operational principle of “selecting food based on syndrome differentiation” and developed systematic hygiene-based disease prevention methods.[19] Simiao Sun of the Tang Dynasty, in Essential Prescriptions Worth a Thousand Gold (Qian Jin Yao Fang), not only adhered to Zhongjing Zhang's core view that “spoiled food harms the body,” but also creatively proposed the concept of “dietary therapy,” integrating dietary hygiene with disease treatment to construct a systematic dietary therapy framework.[20] Qianguan Pu of the Song Dynasty, in Essential Records for Preserving Life (Bao Sheng Yao Lu), introduced principles such as balancing cold and heat and maintaining orderly eating habits,[21] further refining Zhongjing Zhang's dietary regulation theories. Sihui Hu of the Yuan Dynasty, in Principles of Correct Diet (Yin Shan Zheng Yao), combined Mongolian imperial dietary experiences[22] to inherit and develop Zhongjing Zhang's food contraindication theories, forming more comprehensive seasonal health-preserving rules. Shizhen Li of the Ming Dynasty, in Compendium of Materia Medica (Ben Cao Gang Mu), reinterpreted Zhongjing Zhang's food safety concepts from a pharmacological perspective, providing scientific explanations for the toxicity mechanisms and detoxification methods of various foods.[23] Tingxian Gong of the Qing Dynasty, in Longevity and Life Preservation (Shou Shi Bao Yuan), proposed the health-preserving principle of “nourishing primordial qi and strengthening the spleen and stomach.” Through continuous expansion and innovative transmission by later physicians, Zhongjing Zhang's dietary hygiene and health-preserving concepts have propelled the development of TCM health preservation and modern preventive medicine.

 

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From Speculation to Practice: The Modern Value and Guiding Significance of Zhongjing Zhang's Health-Preserving Concepts

As an integral part of TCM health preservation, Zhongjing Zhang's health-preserving concepts—encompassing the heaven-human, body-spirit and benevolence perspectives, and hygienic principle—hold profound guiding significance for contemporary society. In optimizing modern healthcare systems, his “treating disease before it arises” concept provides theoretical support for public health system construction, promoting a shift from “treatment-centered” to “health-centered” medical models.[24] In enriching health management theories, these concepts deepen the understanding of “physical and mental health” and establish personalized health management methods based on “health preservation based on syndrome differentiation,” creating an integrated “medical-dietary combination” intervention model.[25] In practical guidance, the heaven-human view emphasizes the unity of humans and the natural environment, offering a theoretical basis for contemporary ecological health concepts. It inspires people in fast-paced modern life to align with natural rhythms, achieving sustainable health management. The concept of the unity of body and spirit advocates holistic care for both physical and mental health, and provides practical value for modern individuals balancing stress and preventing chronic diseases. Particularly in today's growing focus on mental health, its comprehensive nurturing philosophy carries even greater relevance. These concepts not only enrich contemporary health management theories but also offer valuable insights for constructing a health model with Chinese characteristics.[26]

 

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Conclusion

Zhongjing Zhang Zhang's Treatise on Cold Damage and Miscellaneous Diseases (Shang Han Za Bing Lun) inherited pre-Qin and Han philosophical thought while further integrating Daoist “natural law” cosmology, Confucian “benevolence” social ethics, and the “isomorphic unity of heaven and humanity” medical theory in Yellow Emperor's Inner Classic (Huang Di Nei Jing). It proposes health preservation concepts encompassing heaven-human, body-spirit, and benevolence perspectives, along with dietary hygiene, representing the medical embodiment of pre-Han “virtue cultivation” and “body nurturing” life philosophies that profoundly influenced subsequent TCM health preservation theory and practice.

 

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Conflict of Interest

The authors declare no conflict of interest.

CRediT Authorship Contribution Statement

Qingya Li: Conceptualization, project administration, funding acquisition, and writing original draft. Shuohan Su: Investigation and writing original draft. Qian Wang: Investigation and project administration. Long Feng: Project administration and investigation. Haiyan Zhang: Conceptualization and supervision. Liran Xu: Writing-review and editing and supervision. Dongyang Li: Supervision and project administration. Xiaodan Yin: Writing-review and editing.

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Publikationsverlauf

Eingereicht: 21. April 2025

Angenommen: 19. Juli 2025

Artikel online veröffentlicht:
30. September 2025