Research On Zang-Fu Viscera Pathogenesis Theory Of Yishui School During Jin-Yuan Era

The Jin-Yuan era is a period of prosperity for the development of Chinese medicine scholastic thoughts. Jin-Yuan medicine is thought to be an important historical stage of inheriting the legacy of Qin, Han, Jin, Tang, Song dynasties, while ushering in the two later dynasties of Ming and Qing. All doctors have their inventive discoveries, forming various schools of medical theories with unique characteristics. What is known as "Yishui school" in Chinese medical history is one such major school that emerges during this era. Pathogenesis theory is a core component of basic theory of Chinese medicine. Yishui school gradually perfected their theory of pathogenesis which assumes the role of inheriting the past and ushering in the future. It is an important contribution in the history of Chinese medicine.At present, there is no literature of comprehensive study on the Yishui school pathogenesis theory and theory of syndrome differentiation of zang-fu viscera, as well as their impact on the later generations. The content of medical theory in Yishui school is very rich. A comprehensive study and display of its medical contents will not only enrich the theoretical system of Chinese medicine but also serve as basic material for further development of Chinese medicine. At the same time the Yishui school medical theories are closely related with clinical practice. The Yishui doctors provide rich clinical experience for our reference. They are still important in providing guidance for clinical practice today.This research uses the major writings of the four most important doctors, Zhang Yuansu, Li Dongyuan, Wang Haogu, Luo Tianyi of Yishui school as main research material. At the same time it is supplemented with other related material including medical records, writings of doctors and related literature throughout the generations. While relying on the research result and research methods of predecessors, this thesis also analyzes, expounds and reorganizes the original texts on pathogenesis theory related content using methods of philology and medical history research. It seeks to investigate on the genesis and development of its medical content and explain the content of the theory.The main scholastic content of Yishui school is the study on zang-fu pathogenesis theory. Modern Chinese medicine defines pathogenesis as mechanism of genesis and development of disease. Tracing its origin the term "pathogenesis" is first found in "Theory of Vital Importance" of Suwen which defines its meaning. This shows the meaning of pathogenesis in Nei jing refers to the most important point or key point of disease. At the same time it implies the etiology of disease. Therefore, a good understanding of pathogenesis is the key to effective treatment. That is why starting from the foundational classic text of Neijing, Chinese medicine always seeks to find out the root cause of disease. The nineteen items of pathogenesis actually propose a method for grasping pathogenesis. It is a method of examining the symptoms in order to find the root cause, meaning arriving at a theory of pathogenesis by detailed observation of symptoms. A model is established for syndrome differentiation since then. It has become the guiding principle of pathogenesis in Chinese medicine, and serves as its foundational theory.The understanding of pathogenesis from Neijing onward, including Neijing, aside from referring to the critical point of disease, it also includes the process of genesis, development, life and death reversal, and the reason of change in the process of disease. There are very specific explanations on the meaning of pathogenesis. The understanding of pathogenesis in Chinese medicine is based on its understanding of human pathology, including its peculiar view of human zang-fu viscera and qi-blood body fluid. It uses the Yin-yang theory and theory of five elements and its logical tool. Its premises and methodology are sharply differently from that of modern medicine. Any study on pathogenesis should notice their differences.The main body of this thesis seeks to discover the specific content of theory of pathogenesis from the original writings of the four main doctors of Yishui school. Special attention is put on the founder of Yishui school Zhang Yuansu. Since current literature is very deficient on the study of Zhang Yuansu, in-depth research on his medical propositions is especially meaningful. The research shows the pathogenesis theory of Zhang Yuansu is a system of zang-fu viscera pathogenesis syndrome differentiation based on the five Zang-organs and six Fu-organs as focal point, trying to differentiate cold, heat, deficiency or excess, and using pulse symptom to judge disease condition. The theory is a complete system covering pathological change, life and death reversal, clinical principles, methods, prescriptions and medicine. In the matter of manifestation and root cause, after thorough analysis it is found that what Zhang Yuansu means disease of root cause refers to zang-fu viscera disease, while manifestation disease refers to meridian disease. For Zhang Yuansu,. treating disease at its root cause means identifying which of the five zang-fu viscera is responsible for the disease. This is the root cause of the disease and also where pathogenesis arises. Having been influenced by Liu Wansu, Zhang Yuansu assimilated Liu Wansu’s six climatic factors pathogenesis theory to become part of his zang-fu pathogenesis theory. In constructing the main body of his zang-fu pathogenesis theory Zhang Yuansu attempts to incorporate the "Seven major chapters" with the pathogenesis content of Neijing.Zhang Yuansu formulated a more balanced and comprehensive zang-fu pathogenesis theory. This provides a solid foundation for later generation to continue adding more details on top of it. On the other hand, Li Dongyuan emphasizes more on the spleen-stomach system among the five zang-fu viscera. He thinks the spleen-stomach system is critical in the genesis of disease. He proposed the very famous slogan of "various diseases arise after the spleen-stomach is hurt". He provides in-depth analysis of the etiology and pathogenesis of exogenous febrile diseases and endogenous febrile diseases from the point of view of spleen-stomach internal disorder. He also describes in detail the method of symptom differentiation. Li Dongyuan asserts that the reason for endogenous febrile disease is the weakness of spleen-stomach. As for the pathological mechanism, Li Dongyuan proposes the concept of "yin fire". The so-called "yin fire" proposed by Li Dongyuan is due to weakness in spleen-stomach, causing deficiency of primordial qi. Instead of going upward the spleen qi reverses downward towards kidney, causing the hyperactivity of ministerial fire. This causes the body to generate heat as a symptom of abnormal fire. As for Wang Haogu he proposes the yin syndrome theory and three-burner syndrome differentiation system. In his yin syndrome theory Wang Haogu considers the yang disease symptoms such as fever, dysphoria, thirst desiring to drink cold water, etc as manifestation symptoms only, or even as fake phenomena. The root of yin syndrome is coldness. The cause is rooted in the degradation of spleen and kidney functionality. He also pointed out that if the patient suffers from kidney yang deficiency, it is inappropriate to use elevating and dispersing yang qi. This is sharply different from Li Dongyuan’s proposal of using method of elevating and dispersing yang qi to treat spleen-stomach diseases. Wang suggests one must differentiate whether the root cause is in the kidney or spleen-stomach system. This widens the thinking for syndrome differentiation. Since the three-burner system has no specific anatomical shape and position, being the so-called "one with name but without shape", it has caused much debate over the generations. However, the understanding of the functionality of three-burner system is quite unanimous. Most think that the main function of the three-burner system is the path of qi as well as path of food. Wang Haogu separates three-burner system into upper burner, middle burner and lower burner in consideration for their disease etiology and pathogenesis. This is a further development on top of Zhang Yuansu’s three-burner cold-heat-deficiency-excess pathogenesis. This theory coupled with the clinical practice of treating the three-burner cold and heat with specific medicine, it forms the preliminary three-burner syndrome differentiation and treatment system.In terms of zang-fu viscera pathogenesis theory Luo Tianyi mainly elaborates the spleen-stomach theory of Li Dongyuan, and establishes the three-burner syndrome differentiation system. As for the cause of spleen-stomach impairment, he does not differ from what Li Dongyuan says, being mainly due to inappropriate food consumption and over-fatigue. However, Luo Tianyi further theorizes that drink and food should be treated separately, since injury due to drink and injury due to food are different both in terms of pathogenesis and method of treatment. While putting emphasis on spleen-stomach, he also notices that three-burner is closely related to the spleen-stomach. The description of Luo Tianyi on three-burner has further development from that of Zhang Yuansu and Wang Haogu. The symptoms he mentions about the three burners obviously cover the five Zang-organs and six Fu-organs. His upper burner diseases include heart and lung diseases. His middle burner diseases include spleen-stomach diseases. His lower burner diseases include liver and kidney diseases. The way Luo Tianyi treats three burners as three separate systems for treatment actually applies three-burner syndrome differentiation to the whole body, forming the preliminary model of an independent syndrome differentiation system.The influence of zang-fu viscera pathogenesis theory of Yishui school on later generations is mainly on three aspects. Namely, spleen-stomach theory, kidney-vitalgate theory and three-burner syndrome differentiation theory. In terms of spleen-stomach theory, the spleen-yin theory of Miao Xiyong and the stomach-yin theory of Ye Tianshi are also discussed. Xue Ji inherits various sects of the Yishui school and further develops on both the spleen-stomach and kidney-vitalgate. For kidney-vitalgate the contributions of Sun Yikui, Zhang Jiebin and Zhao Xianke are also discussed. The descriptions of three-burner system of various sects of Yishui school finally bring about the establishment of a three-burner system syndrome differentiation.