Enqin Zhang
This article was originally a speech delivered by Professor Enqin Zhang at the “2024 Darcy Manor International Summit on TCM in the UK”, and now published after editing)
Abstract: The Qilu School of Medical Thought refers to both a school of thought and an academic group that originated in the land of Qilu (present day Shandong province, China ), was rooted in Qilu culture, and retained certain cultural characteristics, originating during the Spring and Autumn/Warring States Period, and passed down to this day. Jing fang (Classical formulas) refers to the prescriptions recorded in Shang Han Za Bing Lun (Treatise on Febrile Diseases and Miscellaneous Diseases) written by Zhang Zhongjing in the Eastern Han Dynasty, which was later divided into two books: Shang Han Lun (Treatise on Febrile Diseases) and Jin Kui Yao Lue (Synopsis of the Golden Chamber). The characteristics of Jing fang can be summarized as: “popular, simple, inexpensive and effective”. The author believes that the method of studying and researching classic prescriptions includes: correctly understanding and mastering the original text, prescriptions and usage; paying attention to the clinical application and modern pharmacological research, and trying to find effective ingredients and mechanism of action of classical prescriptions.
Keywords: Qilu TCM school, classic prescriptions, clinical application, pharmacological research
1.The origin and meaning of the name “Qilu”
Qilu is the name of a region in China, referring to present-day Shandong province. The name originated from the two states of Qi and Lu in the pre-Qin Dynasty era. At the end of the Warring States Period, the cultures of Qi and Lu gradually merged into one. During the time before Qin, today’s Shandong province was divided into the states of Qi and Lu. Qi State had Linzi as its capital, and a large area of land east of Shandong; while Lu State had Jining, Qufu as its capital. It was a small piece of land west of Shandong. In 256 BC the state of Chu conquered Lu, and in 221 BC, Qin conquered Qi. Due to the amalgamation of the two cultures after they were conquered, “Qilu” became a unified culture, and the unified cultural circle formed the regional concept of “Qilu”. This area is roughly equivalent to the territory of the later Shandong Province, so it became an alternative name of Shandong Province.
2.The Concept of Qilu School of Medical Thinking
The Qilu School and academic group originated in the land of Qilu. It was rooted in Qilu culture, beginning in the Spring and Autumn and the Warring States Periods, and has been passed down to this day.
Qilu culture has a long history. During the Spring and Autumn, and the Warring States Periods, the first strand of theory in the history of traditional Chinese medicine, the Bian Que School of thought, was established and represented by Bian Que (who was a native of Changqing District, Jinan, Shandong province today). Formed in the land of Qilu, it soon became a school of medical thought with great social influence, and eventually developed into the Qilu school, representing the regional characteristics of Shandong province. The Qilu school has formed its own unique system in TCM theory, diagnosis and treatment techniques, which has had a significant impact on the development of the broader concepts of TCM.
In the history of the development of traditional Chinese medicine, there have been many famous doctors in Qilu, from the famous doctor Bian Que (AKA Qin Yueren) in the Spring and Autumn Period, Chun Yuyi in the Han Dynasty, and the famous doctor Wang Shuhe during the Jin Dynasty. Qian Yi, a great pediatrician in the Song Dynasty, Cheng Wuji, a famous doctor during the Jin and Yuan Dynasties, and Huang Yuanyu, a master of the Sutra sect in the Qing Dynasty. Among contemporary famous doctors Liu Huimin, Zhou Fengwu, my former tutor from when I was a postgraduate student, Professor Li Keshao, and my former clinical mentor Professor Lu Tongjie. Each had their own strengths, and inherited and improved upon the academic system of the Qilu School.
3. Academic Characteristics of Qilu School of Medical Thought
The Qilu school has a history of more than 2,000 years. Its general characteristics are that each school of thought within it is rich and varied, and as a result, a hundred flowers bloom. Drawing on one anothers strengths, it includes many famous doctors. Its characteristics are as follows:
(1) Pay attention to pulse diagnosis
Pulse diagnosis has a long history. Sima Qian (a historian from the early Han) spoke highly of Bian Que’s pulse diagnosis in Historical Records, saying, “To this day, Bian Que is first in pulse diagnosis”. Following Bian Que, Chun Yuyi during the Han Dynasty also attached great importance to pulse diagnosis. Pulse diagnosis was used in 20 of the 25 medical records in his Clinical Records. In the Jin Dynasty, Wang Shuhe summarized the experience of previous studies on pulse and wrote the first monograph on pulse studies that has come down to us, the Mai Jing (Classics of the Pulse), which made important contributions to the development of pulse studies. Huang Yuanyu of the Qing Dynasty also attached great importance to pulse diagnosis. In his works, he wrote a “Special Chapter on Pulse Interpretation” to discuss the twenty four types of pulse conditions in detail.
（2）Paying equal attention to classics and clinical practice
The Qilu School has always attached great importance to the research and study of classics and using them to guide clinical practice. In the Jin Dynasty, Wang Shuhe spared no effort to compile Shang Han Zabing Lun from the scattered source material; in the Song Dynasty, Cheng Wuji was the first person to annotate the Shang Han Lun; in the Qing Dynasty, Huang Yuanyu was a representative figure of the Sutra School, annotating the Su Wen in his Suwen Xuanjie/Questions and Answers for Plain Questions, Lingsu Xuanjie/ Questions and Answers to Miraculous Pivot and Shang Han Lun Xuan Jie/Questions and Answers to Treatise on Febrile Diseases. Huang Yuanyu annotated 11 classic works in total. My former tutors, the contemporary Professor Li Keshao’s Shang Han Jie Huo Lun/ The Theory of Solving Problems of Treatise on Febrile Diseases, and Professor Xu Guoqian along with Professor Zhang Canjia, the former president of Shandong University of TCM, had made great contributions in correcting ancient TCM classics such as the Huangdi Neijing, and the Zhenjiu Jia Yi Jing. They also required the students, including me, to be proficient in reciting from the Huangdi Neijing and Shang Han Lun and other classic medical books, laying a solid foundation for future clinical diagnosis and further study.
The most important reason why the Qilu School survives and continues to be passed on and evolve is clinical efficacy. One of the characteristics of Qilu School is that it emphasizes practical results and regards clinical efficacy as the highest criterion for evaluating doctors.
Bian Que was a highly skilled general practitioner. During his travels around the states of ancient China, he engaged in different medical work such as internal medicine, surgery, gynecology, and pediatrics, according to needs. The famous doctor Chun Yuyi was proficient in medical skills, and his clinical records passed down to later generations reflect his superb medical skills. From a clinical perspective, Wang Shuhe’s Mai Jing systematically summarized the twenty-four conditions of the pulse, and specifically explained the morphological standards of each pulse condition, providing a basis for pulse syndrome differentiation. Qian Yi first created the five-organ syndrome differentiation based on the physiological characteristics of children. Clinical diagnosis started from the five organ syndrome differentiation to treat various pediatric diseases.
（3）Embracing Inheritance and Innovation Simultaneously
Since Bian Que, the Qilu School has focused on innovation in patterns of thinking. Bian Que boldly innovated, pioneering pulse theory, and the use of iron needles to replace stone needles for treating diseases. This was a major change in the history of traditional Chinese medicine and acupuncture techniques. Chun Yuyi created the first medical records; Wang Shuhe compiled the first monograph on pulse theory, the Mai Jing. Qian Yi pioneered pediatrics, and was particularly good at adapting ancient prescriptions and daring to innovate new prescriptions. He removed aconite and cinnamon from the classic herbal prescription Jingui Shenqi Wan, creating Liuwei Dihuang Wan. Cheng Wuji was to create a precedent for the theory of prescription.
The descendants of the Qilu School also pay attention to learning from the ancients’ideas rather than following fixed prescriptions. They are good at absorbing modern medical theories, emphasizing the combination of syndrome and treatment rules of contemporary diseases, focusing on the combined use of traditional Chinese medicine properties, and making full use of Zhang Zhongjing’s prescriptions to treat various modern diseases. Professor Li Keshao, the founder of the Qilu Shanghan Lun School, broke down the theory of transmission of the six-channel diseases and established a theory of “pattern transmission of febrile diseases” and “transfer of attributes”. He believed that exterior syndrome (symptoms of aversion to cold and fever) is different from Taiyang disease, and the six-channel diseases are not transmitted sequentially. All six-channel diseases have exterior symptoms, not only Taiyang disease. He also broke with the theory that Wuling San’s pathology was caused by water stagnation in the urinary bladder and pointed out that the symptoms of Wuling San are not due to the accumulation of water in the urinary bladder, but a failure of the qi transformation of the San Jiao. His representative work Shang Han Jie Huo Lun (The Theory of Solving Problems of Treatise on Febrile Diseases) is unique in the study of the Shang Han Lun. It has become the representative work of the Qilu Shanghan Lun School.
Professor Wang Xinlu, the former president of Shandong University of TCM, represents the Qilu Internal Medicine School, and he continues to innovate, proposing five classic prescriptions for treating seasonal diseases. He created the “blood turbidity” theory, and the “brain-blood” syndrome differentiation system based on the changes in the types of diseases dealt with in a contemporary clinical setting. At the same time, this theory integrates the pharmacological results of modern TCM research, and pioneers the “aiding medicine theory”: That is, when a Chinese medicine doctor treats modern diseases, they should comprehensively analyze the patient’s information collected from both the traditional diagnostic methods and modern medical examinations, and combines this with the current pharmacological and other research. Therefore the treatment is on the basis of traditional Chinese medicine syndrome differentiation plus modern “Micro-Targeted Therapy”.
（4）The integration of traditional Chinese medicine, Qilu culture, and the Qilu School is an important part of the treasure house of traditional Chinese medicine. The school not only has outstanding academic achievements and far-reaching academic thoughts, but also has rich academic resources and obvious academic value. The Qilu School is deeply rooted in the soil of Qilu culture, so it is not only an important part of traditional Chinese medicine, but also an important part of Qilu culture.
Qilu culture has a certain influence on the construction of the medical theory of Qilu School, the medical thinking mode of Qilu School, the treatment methods of Qilu School, and the medical inheritance and education concept of Qilu School. The development of Qilu School has enriched Qilu culture. The connotation of the two blends with each other and has far-reaching influence.
4. The transmission method of Qilu School
Qilu School is based on the nourishment of Qilu culture and was inherited by famous doctors such as Bian Que, Chun Yuyi, Cheng Wuji, Huang Yuanyu, etc. It still has influence throughout the country. The Qilu School experienced a glorious history with the prosperity of the Qilu culture. However, after the Song Dynasty, due to the southward shift of the cultural center, it went into decline. Therefore, it is necessary to further organize and excavate the Qilu School to promote its prosperity and development.
（1） Looking deeply at and sorting the academic thoughts of famous doctors
Taking in and studying the clinical experience and academic ideas of famous traditional Chinese medicine practitioners is urgently needed to promote the academic development of traditional Chinese medicine, accelerate training, and improve clinical capabilities. Physicians from the Qilu School have had a profound influence on the development of traditional Chinese medicine since the Spring and Autumn and the Warring States Period. Famous doctors have emerged in large numbers throughout the ages, and their academic thoughts and clinical experiences are worthy of further study and summarization. According to the “Chinese Provincial Medical Records Examination”, there were more than 300 Qilu school physicians registered in the Qing Dynasty, and they collectively wrote more than 450 books, far exceeding the total of all physicians before the Ming Dynasty. Therefore, it is necessary to sort out the academic thoughts of famous doctors of the Qilu School, salvage and preserve the diagnosis and treatment materials of famous doctors, refine the academic thoughts and clinical experience of famous doctors, and promote their legacy.
（2）Strengthening training and improving the quality of those inheriting the lineage
The continuity of talent is the lifeblood of a medical tradition. The cultivation of talent should equally emphasize both the traditional master-apprentice transmission and more formal education in institutions. It should combine basic education with clinical teaching, allowing students to learn medical fundamentals while simultaneously following their mentors in clinical practice. The duration of this mentorship should be extended to enhance clinical practice. Additionally, young and middle-aged scholars of traditional Chinese medicine should be encouraged to apprentice under the distinguished and experienced masters who are still active today, ensuring that the unique medical skills of these seasoned practitioners are passed down to future generations.
Flexibility and diversity in training methods should be emphasized, including the implementation of various forms of continuing education after formal schooling ends. Furthermore, in the process of talent development, there should be a focus on cultivating thinking skills and improving clinical capabilities, following the principle of “respecting tradition without being confined by it,” and fostering the ability to adapt creatively.
For example, my senior classmate, Professor Jiang Jianguo, a representative of the Qilu School scholarship of the Shang Han Lun, has advocated exploring difficult and controversial issues from Shang Han Lun for their perspectives on academic thinking in order to cultivate outstanding doctors.
Please allow me to take this opportunity to talk about my experience. Dr. Zhang Enqin, one of the heirs of the Qilu School. I was a postgraduate student majoring in Shang Han Lun at Shandong University of Traditional Chinese Medicine from 1979 to 1982. My tutor was the famous Shang Han Lun expert Professor Li Keshao. After graduation, I continued to study as an apprentice following Professor Lu Tongjie, a famous clinical expert and director of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. I persisted in clinical practice with Professor Lu , two days a week for 9 years. Professor Lu unreservedly taught me his valuable experience in using classic prescriptions to treat difficult diseases. With the encouragement of my former mentors, Professors Li Keshao and Lu Tongjie, I compiled and published the book “Research on Classic Prescriptions” published by Yellow River Press in 1987, which summarized clinical reports on classic prescriptions at home and abroad for treating various diseases in the last century. At the same time, I cooperated with Professor Liu Weixin, a Western medicinal pharmacologist, and his team, to conduct pharmacological experiments on 100 classical prescriptions, and promoted the research method of combining the clinical application of classic prescriptions with pharmacological approaches.
In 1990, I edited the world’s first bilingual TCM textbooks “A Practical English-Chinese Library of TCM“ published by Shanghai University of Traditional Chinese Medicine Press, composed of 14 books, comprehensively and systematically introducing traditional Chinese medicine to the West, from basic theory to clinical application, English-Chinese comparison, and integration of traditional Chinese medicine and Western medicine.
In 1992, I compiled“ Shang Han Lun Study Guide” published by People’s Medical Publishing House , which added the theoretical and clinical research results on Shang Han Lun in the past 20 years. It has become a textbook for traditional Chinese medicine schools in many countries, and has contributed to the promotion of classical education in traditional Chinese medicine in Western countries.
I founded a TCM school, the UK Academy of Chinese Medicine in London in 2012. Thanks to everyone’s efforts, we have trained a large number of Chinese medicine, acupuncture practitioners, and massage therapists in the UK. We have also successively cooperated with Hunan University of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, and Shanghai University of Traditional Chinese Medicine to organize and teach the master and doctoral level courses in traditional Chinese medicine and acupuncture, providing the UK with a number of senior Chinese medicine and acupuncture talents.
（3）Emphasize Academic Innovation and Promote the Application of Clinical Diagnosis and Treatment Experience
For a medical school of thought to survive and develop, it must continuously deepen and innovate its existing theories and methods. Otherwise, the school will gradually wither and fade from the historical stage. The development of the Shanghan school is sufficient to prove this point. To better inherit and develop a school of thought, it is essential to focus on academic innovation. The ultimate goal of passing on and developing a medical tradition is to highlight its unique academic strengths, continuously improve the clinical efficacy of traditional Chinese medicine, and better serve the public. Therefore, it is necessary to promptly translate research results into clinical applications and to widely promote and apply specialized diagnostic and treatment techniques, fully demonstrating their effectiveness.
In short, the Qilu School has many talents and has numerous representative books. These books cover almost all fields of TCM theory and clinical practice, enriching the treasure house of Chinese medicine. The academic thoughts, inheritance methods and culture of Qilu TCM School have a profound impact on the development of traditional Chinese medicine. Continuing research, delving into, and organization of Qilu School will have a positive effect on promoting the development of traditional Chinese medicine world-wide.
5. Studying methods and clinical application of classic prescriptions
（1）The Concept of Jing Fang/Classical Prescriptions
Regarding Jing fang/ classical prescriptions, there are two main sayings: First refers to empirical formulas that doctors have found to be truly curative during the treatment process; Second refers to the classic prescriptions in Zhang Zhongjings Shang Han Lun and Jingui Yao Lue.
Before the Ming and Qing Dynasties, the term“Jing fang” mainly referred to empirical formulas, those that were regarded as particularly effective. The Jing fang school that existed during the Han Dynasty also referred to this idea. In the early Qing Dynasty, another branch emerged, the ancient Jing Fang School. They called the prescriptions used in Zhang Zhongjing’s works Jing Fang; while the formulas created by later generations of doctors and the formulas for treating epidemiological and other disease were termed Shi Fang (Popular formulas).
At present, the majority view in the field of traditional Chinese medicine refers to the prescriptions recorded in Shang Han Za Bing Lun by Zhang Zhongjing in the Eastern Han Dynasty. This text comes down to us as two books, the Shang Han Lun and Jin Kui Yao Lue as edited by Wang Shu He during the Western Jin Dynasty. It is relative to the time when it appeared after the Song and Yuan Dynasties. The Shang Han Lun contains 113 prescriptions, and Jin Kui Yao Lue contains 205 prescriptions, so, excluding 38 duplicate prescriptions, there are 280 prescriptions in total. Shang Han Lun utilizes 90 medicinal herbs, and Jin Kui Yao Lue 192, excluding 76 duplicates, a total of 206 medicinal herbs are represented in these texts. Jing fang are the “ancestors of medical prescriptions”. Later generations of practitioners called Shang Han Za Bing Lun the “book of living people” and the “ancestor of prescriptions”, and praised Zhang Zhongjing as the “sage of medicine”. Traditional Chinese medicine experts within China and abroad often use classical prescriptions as their basis and develop a series of new prescriptions based on the principles of syndrome differentiation and treatment. The characteristics of Jingfang can be summarized as “popular, simple, inexpensive, and effective”. Therefore, the “classical prescriptions” recognized by later generations refer to the prescriptions recorded in Zhang Zhongjing’s Shang Han Zabing Lun.
（2）Classification of Jingfang / Classical Prescriptions
Gui Zhi Tang / Cinnamon Twigs Decoction types
Ma Huang Tang / Ephedra Decoction types
Ge Gen Tang/Pueraria Decoction types
Chai Hu Tang/Bupleurum Decoction types
Xie Xin Tang/Heart Draining Decoction types
Bai Hu Tang/White Tiger Decoction types
Cheng Qi Tang / Qi Ordering Decoction types
Xian Xiong Tang / Chest Purging Decoction types
Wu Ling San / Five Ingredients including Poria Powder types
Ling Gui Ji/Poria and Cinnamon Twig Preparation types
Si Ni Tang/ Cold Extremities Decoction types
Li Zhong Tang / Middle Regulating Decoction types
Fu Zi Tang / Aconite Decoction types
3）Methods for studying and researching classic prescriptions
1) Correctly understand and master the original prescription and text, including the usage and notes of the prescription. For example, Shang Han Lun clause 177 states:“during febrile disease, knotted pulse, palpitations, Zhi Gan Cao Tang/Prepared Licorice Decoction is the governing prescription”. The original text briefly explains that the main indications of Zhi Gan Cao Tang are severe palpitations and irregular pulse. I use this formula to treat arrhythmia patients whose electrocardiogram shows premature contractions or atrial fibrillation, which is effective.
Another example is the note at the end of the recipe for Da Cheng Qi Tang/Major Order the Qi Decoction: “For the four ingredients, use a bowl of water. Boil two substances first, take five liters, remove the dregs, add Da Huang, and boil down to two liters, remove the dregs, add Mang Xiao. Bring it to a boil over low heat, then take it if it is warm enough, but do not take the rest of the herbal decoction if constipation resolves” Zhang Zhongjing introduced the method of decoction in detail in the usage and note after this prescription, and especially emphasized that “if the patients symptoms resolve dont take the rest” to avoid harm to the human body caused by overdose of Da Cheng Qi Tang.
2) Extensively collect experience and literature on the application of modern classical prescriptions. For example, Dang Gui Bei Mu Ku Shen Wan (Chinese Angelica Fritillaria and Sophora pill), in Jin Kui Yao Lue Chapter 20 on Treatment of Women’s diseases during the Pregnancy, it says that this prescription was used to treat “difficulty urinating during pregnancy”. Today I use this formula for treating chronic prostatitis in men which is effective. Another example is the Ban Xia Xie Xin Tang, in clause 149 of the Shang Han Lun and Chapter 17 Jin Kui Yao Lue the formula was originally used to treat “fullness below the heart” caused by improper purging during febrile diseases. Right now I apply this formula widely for treating superficial gastritis, and gastric and duodenal ulcers caused by Helicobacter pylori infection with reliable results.
It is generally believed that Zhang Zhongjing’s Wen Jing Tang is a prescription to aid pregnancy and regulate menstruation, and it is also one of the prescriptions for treating women’s menopause today. The formula is rarely used with men. For example, Chapter 22 of Jin Kui Yao Lue on “Diagnosis and Treatment of Women’s Miscellaneous Diseases and Pulse Patterns” says:“The woman was fifty years old and had been ill for ten days with fever. At night, she felt irritable in her lower abdomen and her palms were hot. It was very annoying, and her lips and mouth were dry… use Wen Jing Tang to treat it”. However, Professor Huang Huang, a famous modern master of classical prescriptions, believes that men and women are both human beings, and if women can be treated with Wen Jing Tang why not men as well? Professor Huang introduced the idea of using Wen Jing Tang to treat low sperm motility, low sperm count, insomnia in elderly men, and “male menopausal syndrome”. Professor Huang’s experience in classic prescriptions has broadened our horizons.
3) Strengthen pharmacological research and experiments, and try to find the effective ingredients and mechanism of action of the prescriptions. For example, the mechanism of action of Wu Mei Wan (Black Plum Pill) in treating Hui Jue (biliary ascariasis). In the past, traditional Chinese medicine theory believed that the characteristics of roundworms are: “ When exposed to sour, they become still; when exposed to bitter, they become calm; and when they encounter spicy, they lower their heads and retreat.” Among the ingredients of the prescription, Wu Mei tastes sour, Coptis tastes bitter, and Asarum is pungent. Wu Mei Wan treats biliary roundworms through three flavors: sour, bitter, and pungent. Modern pharmacological research has found that after taking Wu Mei Wan, the roundworm body becomes anesthetized and loses the inherent ability to adhere to the bile duct wall; increased bile secretion has Increased impact against roundworms causing these inactive roundworms to return to the intestine through relaxed the sphincter of Oddi; after taking Wumei Pills, the pH of the bile has been changed, making the bile more acidic. The roundworm itself has the characteristic of disliking acid and preferring
Alkali environments. This change is not conducive to the survival of roundworms in the biliary tract, and the roundworms have to return to the intestines through relaxation of the sphincter of Oddi. This is the mechanism of action of Black Plum Pill in treating biliary ascariasis.
In short, I believe that promoting the clinical application of classical prescriptions and strengthening pharmacological research on classic prescriptions will help broaden the thinking of traditional Chinese medicine, promote the development of traditional Chinese medicine academics, serve society, and benefit mankind.
參考文獻
References
1. History of Chinese Medicine], edited by Li Jian, Science Press 2022-05.
2.［Historical Records］, by Western Han Dynasty historian Sima Qian
3. ［Shang Han Jie Huo Lun/ The Theory of Solving Problems of Treatise on Febrile Diseases］ by Li Keshao, Shandong Science and Technology Press, 1978
4. “School inheritance/A brief analysis of the academic characteristics and inheritance methods of Qilu Medical School ” by Sun Huiming et al., “Journal of Traditional Chinese Medicine” 2020/03/16
5. ［Research on Classical Prescriptions］ chief editor Zhang Enqin, Yellow River Publishing House, 1987
6. ［A Practical English-Chinese Practical Library of Traditional Chinese Medicine Library］ 14 volumes, chief editor Zhang Enqin, Shanghai University of Traditional Chinese Medicine Press, 1997.
7.［Shang Han Lun Study Guide］ by Engin Can, People’s Medical Publishing House 2022
Author information:
Professor Enqin Zhang, president of UK Academy of Chinese Medicine, a fellow member of ATCM, and a senior member of the Royal Society of Medicine. He practices at Kings Cross TCM & Herbal Center UACM, London, and also as a distinguished Professor at Shaanxi University of Chinese Medicine, a visiting professor at Shanghai University of Chinese Medicine and Zhejiang University of Chinese Medicine, and teaches masters and doctoral courses on Chinese medicine and acupuncture at London. Telephone number: 004478 461 93488. WeChat: drzhang1953; Website: www.uacm.co.uk
