Outline of TCM Literature in the Han and Three Kingdoms
Professor and Doctoral Supervisor, Shandong University of Traditional Chinese Medicine · Zhang Can
TCM literature is the principal carrier of TCM's great treasure-house, the foundation of its basic theory, the concentration and summary of its clinical experience. Research on TCM literature is thus also the inheritance and excavation of TCM scholarship — of important historical and present significance for TCM's development and elevation.
The birth, formation, and development of TCM literature, like Chinese traditional culture itself, has a long history. Drawing on prior research and personal view, I outline here the development in the Han and the Three Kingdoms.
From the founding of the Han to the unification of the Three Kingdoms under Jin, more than 470 years passed. There were periods of stability — Wen, Jing, Wu, Zhao, Xuan in the Western Han; Guangwu, Ming, Zhang, He in the Eastern Han — when politics and economy were stable, production and culture rose. There were also troubled times: Chu-Han contention, the Xin usurpation, the Three Kingdoms split — when economy fell back and science suffered. But on the whole, Chinese feudal society was in a stable phase; productive power developed; science and culture advanced. The large body of Pre-Qin and Qin literature provided favorable conditions for Han culture. Slips, silk, and other book materials had come into wide use since the Warring States; Qin Shihuang's unification of writing helped further. Two large strands stand out in the documentary work: comprehensive and systematic research on pre-Han and early Han documents; and the formation, on the basis of earlier writings, of a large body of new works. Both are reflected in the medical-literature field. Another feature is the strong fashion of pseudo-antiquity. As Liu An of the Western Han put it in Huainan Honglie: "The common people honor the ancient and despise the present; so those of the Way must attribute their teaching to Shennong and Huangdi, then they can enter into discussion." This is reflected in TCM literature too.
I. Outline of the Literature
(1) Medical Works Listed in the Bibliographies
The "Yiwen Zhi · Fangji Lüe" of the Hanshu lists four classes of medical works in 36 schools and 868 juan: yijing (medical classics) 7 schools, 216 juan; jingfang (formula classics) 11 schools, 274 juan; fangzhong (sexual technique) 8 schools, 186 juan; shenxian (immortals) 10 schools, 200+ juan.
The treatise's preface tells how, at the Han's founding, books were widely collected and the way opened for offerings; by the time of Han Wudi, decades later, some books were tattered and slips had fallen — most of the Han's early holdings had been pre-Han works. Han Wudi commissioned the search for lost books; under Han Chengdi a further search was made. Liu Xiang led the collation: scholar-canons by Liu Xiang, military by Ren Hong, calendrics by Yin Xian, fangji (medical-technical) by the court physician Li Zhuguo. Liu Xiang's son Liu Xin completed the work and presented the Seven Categories, from which Ban Gu later compressed the Hanshu · Yiwen Zhi.
From this we can infer features of the Fangji Lüe listings: (1) These were the books Liu Xiang's team collated — chief medical works only, not the whole of Han's medical holdings, still less every medical book then in the world. (2) Unlike the other categories which often note compilers or transmitters, the Fangji Lüe books are without notes — suggesting most are pre-Han classics that had no clear authorship. (3) The Yiwen Zhi by Ban Gu does not present a complete view of Western Han medical authorship. (4) Liu Xiang's collation was not merely text comparison but a true work of ancient-text organization — book titles, chapter divisions, classifications, and language all received some editorial work; some books may have been newly compiled then.
In the Eastern Han, the Hou Hanshu has no Yiwen Zhi, so we must turn to other materials.
(2) Medical Works Cited in Old Books
In extant Han books, cited medical works fall into two kinds — pre-Han classics, or Han-period compositions. Examples:
1. Shiji · Cangong Zhuan names the books Yang Qing transmitted to Chunyu Yi — likely pre-Han. Chunyu Yi himself taught further books to his disciples Gao Qi, Wang Yu, Feng Xin, Du Xin, Tang An; the passage says: "He taught them the high and low of the channels, and the meeting-points of the strange luo collaterals, where the shu points lie ..." and "the methods of distinguishing flow and counterflow, the theory of drug-method, fixing the five flavors and harmonizing the dosage of decoctions," and "the four seasons corresponding to yin-yang." Whether these are book titles is unclear, but separately transmitted medical books are surely there. The biography also says: "All cases I have diagnosed have Diagnostic Records (Zhen Ji)" — Chunyu Yi himself compiled records of his cases; the cases in the Shiji are a portion.
2. Hanshu · Lou Hu Zhuan: "Lou Hu, courtesy name Juqing, of Qi. His family had been physicians for generations. He followed his father practicing medicine in Chang'an, moving among the noble households. As a youth he recited medical classics, bencao, and fangshu — to tens of myriads of words. Elders loved and esteemed him." This shows: medical lineages of substance; pre-Han medical canons were richly preserved; bencao literature was already in circulation by late Western Han.
3. Hou Hanshu · Fangshu Liezhuan · Guo Yu Zhuan tells of an old man fishing on the Fu river who, healing many with stone needles, wrote Zhen Jing and Zhen Mai Fa. Hua Tuo's biography records him giving a book to the jailer on the eve of his death — the jailer dared not take it, and Hua Tuo burned it. The extant Zhongzang Jing under his name is a later pseudonymous work; the writings preserved in Wang Shuhe's Maijing are likely fragments. Three contemporaries — Shouguang, Tang Yu, Lu Nüsheng — are noted as practitioners of Master Rong Cheng's Method for Women, of the fangzhong line.
Taiping Yulan · Fangshu Bu · Yi 2 cites Yu Kui Zhen Jing · Xu: "Lü Bo of Wu was renowned for his medical art ... compiled Yu Kui Zhen Jing and annotated the Bashiyi Nan Jing, widely circulated."
From such citations we see that, in the Han and Three Kingdoms, there were many medical works extant and many being composed — many no longer recorded today, since lost. What survives is like morning stars.
(3) Citations within Medical Works
Among Han medical works few survive; even early Jin medical works survive only as Maijing and Jiayi Jing. Yet these few preserve glimpses of earlier writings.
1. Shanghan Lun. Extant version is Zhang Zhongjing's posthumous text edited by Wang Shuhe of Jin. Zhongjing's preface lists his sources: Suwen, Jiu Juan, Bashiyi Nan, Yinyang Da Lun, Tai Lu (or Tai Yi), Yao Lu, Ping Mai, Bian Zheng — forming Shanghan Zabing Lun in 16 juan. Yinyang Da Lun is explicitly quoted in the Shanghan Li (exemplars) chapter; Ping Mai may be the Ping Mai Fa and Bian Mai Fa preserved in the text.
2. Maijing by Wang Shuhe of early Jin. The preface says: "I have gathered, from Qibo down to Hua Tuo, the essentials of classics and treatises, into ten juan." The text quotes the Suwen, Zhen Jing; the Si Shi Jing; sayings of Bian Que and Qibo; Zhang Zhongjing on the Pulse; Bian Que Yinyang Mai Fa, Bian Que Mai Fa, Bian Que Hua Tuo Examining Voice and Color Essentials, Bian Que Discerning Reverse-Counterflow Death Pulses; Zhongjing's Shanghan Zabing Lun articles; the Hand-Examination Charts (Shou Jian Tu).
3. Zhenjiu Jiayi Jing by Huangfu Mi of early Jin. Three points from the preface deserve study: (i) "In recent times, the Court Physician Wang Shuhe edited Zhongjing's writings to fine effect" — confirming that, after the dispersal of Zhongjing's text, Wang Shuhe re-edited it and brought it forth. (ii) "By the Seven Categories and the Yiwen Zhi, the Huangdi Neijing was in 18 juan. Now we have Zhen Jing (Channel Classic) 9 juan and Suwen 9 juan, two-times-nine, eighteen juan, that is the Neijing." This is the earliest identification of Suwen and Zhen Jing as the Huangdi Neijing. It also tells us Zhen Jing and Jiu Juan circulated as alternate names for the same book — or two transmission lines — from late Eastern Han on. (iii) "There is also the Mingtang Kongxue Zhenjiu Zhiyao — all bequeathed by Huangdi and Qibo." This is the earliest recording of the acupuncture Mingtang literature. Three points: (a) Mingtang is attributed to Huangdi and Qibo; (b) it formed after Liu Xiang's collation; (c) its full name may be Mingtang Kongxue Zhenjiu Zhiyao. Its substance survives in Jiayi Jing and Waitai Miyao.
Huangfu Mi's preface also says: "Yi Yin with the talent of a near-Sage compiled the Shennong Bencao into the Tangye (Decoctions)." That a Tangye book existed in Shang times is hardly credible. Tongjian records Yi Yin as having written Tangye Bencao — but this is also unreliable. The Dunhuang scroll, Liang Tao Hongjing's Fuxing Jue Zangfu Yong Yao Fa Yao, says: "Shang had the sage minister Yi Yin who compiled the Tangye Jing Fa in three (juan), with 360 formulas. Top class — for the upper-grade drugs of nourishment and supplementation, 120 formulas; middle class — for treatment of disease and expelling evil, 120 formulas; lowest class — for venomous drugs killing worms and expelling evil from abscesses, 120 formulas. In all 360 formulas. Truly the rule of physicians through the ages, the great treasure protecting the lives of the masses ..." And: "From the Han and Jin onward, famous physicians — Zhang Ji, Wei Fan, Hua Yuanhua, Wu Pu, Huangfu Xuanyan, Zhi Fa Cun, Ge Yachuan, General Fan — all took Tangye Jing Fa as model. Their additions and deletions vary, sometimes producing new effect, seeming to disorder the old classic; but the gist remains within compass and square." Also: "Zhang Ji wrote Shanghan Lun; avoiding Daoist terms, his formulas all use non-orthodox names — naming each by some herb to mark the chief drug."
Combining these, Tangye Jing Fa may have been a Han composition under Yi Yin's name, gathering existing famous formulas. Tao Hongjing called these formulas jingfang (classical formulas) because they came from Tangye Jing Fa.
In sum, the literature cited within these three works shows three sorts of medical books in the Han–Three Kingdoms: pre-Han classics still extant; Han-period compilations drawing on pre-Han literature; works composed in the period itself. Many survived then; most were later lost.
(4) Surviving Medical Works
Few works from the Han and Three Kingdoms can today be confirmed as extant. Examples:
1. Huangdi Neijing Suwen. From the Song onward scholars no longer take it as Huangdi-era. Shao Yong placed it in the Warring States; Cheng Hao thought it composed by Warring-States writers; Sima Guang held it was "compiled by physicians in the Zhou-Han interval under the name to gain currency." Recent scholars, by language, scholarly state, and phonology, tend to place its formation in the Western Han, compiled by physicians of the time from pre-Han documents — the nine-juan portion of the Neijing per Huangfu Mi.
2. Lingshu Jing — the Jiu Juan of Zhongjing's preface, the Zhen Jing of Huangfu Mi's preface. Its formation parallels the Suwen. The name Lingshu first appears in Wang Bing's Suwen commentary; it seems Daoist in flavor, possibly given by a Daoist hand in the Northern and Southern Dynasties.
The publication of these two — the Huangdi Neijing — is the comprehensive theoretical foundation of TCM: yin-yang, five-phase, zàng-xiàng, jingluo, acu-points, needle-way, diagnostic method, treatment principle. The cornerstone of TCM theory; venerated thereafter as canon.
Whether the extant Suwen and Lingshu are the Huangdi Neijing listed in the Hanshu · Yiwen Zhi is debated. The arguments against are not decisive. By careful study of astronomy, calendar, language, and phonology, many scholars place its formation in the Western Han. Until decisive proof, we hold to Huangfu Mi's account. The contents of the Jiayi Jing show that the basic content of Suwen and Lingshu was complete in the Han transmission.
3. Shennong Bencao Jing. A pseudonymous work, with no recorded author, not listed in the Hanshu · Yiwen Zhi. Dating is much debated. Tao Hongjing's view (in the Dunhuang fragment of Shennong Bencao Jing Jizhu · Xulu) accepts the Shennong tradition but takes the place-names in the text as later additions; Yan Zhitui takes them as later interpolations; Buddhist monk Zanning (Song) rejects Shennong authorship and assigns the work to later physicians under that name; Luo Mi (Song) notes that bencao is first mentioned in the Han Ji and Yi Lu. The name bencao first appears in Hanshu (Pingdi Ji, Jiao Si Zhi, and Lou Hu Zhuan). Tao Hongjing pointed out the place-names are all Han-system. On balance, Han-period formation is best supported; perhaps begun in the Former Han, completed in the Later. Hence in the late Han to Three Kingdoms there were further works (Wu Pu Bencao, etc.); the bencao learning begins from this.
The original Shennong Bencao Jing is long lost; the extant text is a Ming-Qing reconstruction from Taiping Yulan, Zhenglei Bencao, etc. Bencao Jing gives the functions, indications, and habitats of 365 medicines in three classes (top, middle, low). A Xulu section sets out ruler-minister-aide-courier, yin-yang pairing, the seven feelings of single use, mutual need, mutual use, mutual fear, mutual loathing, mutual opposition, mutual killing; the four qi and five flavors; dosage forms — pill, powder, water decoction, wine soak, paste decoction; timing of dose. The bencao learning begins to develop theoretically. The book is the foundation of bencao study; its function-indication material still has clinical value today. The talk of longevity, becoming immortal in the top-class drugs reflects the influence of Qin–Han fangshi — a historical limitation.
4. Nan Jing (Classic of Difficulties). Extant copies attribute it to Qin Yueren of Lu. But the Shiji · Bian Que Zhuan does not mention it; the Hanshu · Yiwen Zhi does not list it. The Sui Shu · Jingji Zhi and Liang catalogues have Huangdi Bashiyi Nan and Huangdi Zhong Nan Jing without compiler. Only the Jiu Tangshu · Jingji Zhi first records it under Qin Yueren. The earliest reference to the title Bashiyi Nan is Zhongjing's preface to the Shanghan Lun. Tang Yang Xuancao said the Nan Jing explains the Neijing. Yuan-Ming-era Lü Fu first suggested: "The 'classic statements' quoted are mostly not from the Suwen or Lingshu. There was anciently such a book, now lost." On close look, the quoted material divides into three: undifferentiated the classic says (26 questions, a third of the book); titled (the Shi Bian of difficulties 63 and 64); direct (no source). Some accord with Suwen or Lingshu; some are similar in meaning but differ in wording; some are not found; one or two are at variance. It is unlikely that the Nan Jing's classic is the Neijing. Nan Jing is probably a Han pseudonymous work; its classic is a different lineage. The diagnose-by-cunkou-alone, the sanjiao has name but no form, and the mingmen doctrines reflect this other lineage. A feature of Han-period basic-theory literature.
5. Mingtang Jing. Cited heavily in Huangfu Mi's Zhenjiu Jiayi Jing and later (Tang) Yang Shangshan, Wang Tao. The original is long lost. By comparing the citations in Jiayi Jing, Yang Shangshan's Huangdi Neijing Mingtang, and Wang Tao's Waitai Miyao juan 29, we can broadly know the Mingtang Jing was a three-juan work containing channels, the form of viscera and five-storehouse correspondences, 360+ acu-points, and acu-point indications. Likely composed in the late Western Han or in the Eastern Han.
6. Shanghan Lun. Extant text is the Song edition by Lin Yi et al. Pre-Song no such title — Sui-Tang catalogues have Zhang Zhongjing Fang or Zhongjing Yao Fang; Xin Tangshu · Yiwen Zhi has Shanghan Zubing Lun. The current title may be from the Sui-Tang.
7. Jinkui Yaolüe Fang Lun. Also Lin Yi et al.'s edition. The Lin Yi preface tells how Wang Zhu, working at the imperial library, found Zhongjing Yuhan Yaolüe Fang in three juan — upper "shanghan", middle "zabing", lower formulas and women's diseases. The text we have was extracted from this. Compare Ge Xianweng's Zhouhou Beiji Fang preface, which speaks of "Zhongjing, Yuanhua, Liu, Dai's Miyao, Jinkui Lüzhi, Huang Su Fang, nearly a thousand juan..." — the wording is so similar that the Yuhan Yaolüe Fang found by Wang Zhu may be a Northern-and-Southern Dynasties or Sui-Tang abstraction following the Ge Xianweng pattern. In any case, the book preserves the main content of Zhongjing's original Shanghan Zabing Lun.
Between these two and the Zhongjing material preserved in Wang Shuhe's Maijing, the Shanghan Zabing Lun's main content is largely preserved.
Zhongjing, as a Han-era master, made an enormous contribution to medical literature. Shanghan Zabing Lun embodied the medical level of the time, especially in clinical treatment. From its content and preface, it is a product of joining Neijing theory with clinical practice. It treats each disease with theory, statement, principle, method, formula — embodying the li-fa-fang-yao (principle-method-formula-medicine) treatment-theory system. In pattern-discernment, it shows the relations of disease-to-disease, pattern-to-pattern, disease-to-pattern: six-channel pattern-discernment, zàng-fu pattern-discernment, yin-yang/surface-inner/cold-hot/empty-full pattern-discernment. In treatment, the meaning of method is fully shown — bringing treatment from the plain, sensory phase to the phase of rational guidance. Formula-science matured: from simple unstable empirical formulas to named formulas with set indications, relatively stable composition, dose, preparation, instructions for use, and contraindications. So Tao Hongjing said: "Zhongjing's book — the most ancestor of all formulas."
Shanghan Zabing Lun is an epochal work, linking past and future, embodying theory-and-practice combined, establishing the system of bianzheng shizhi, the first comprehensive clinical canon (covering shanghan, zabing, furen diseases). Its influence on later medical development is enormous.
(5) Citations of Han Medical Theory and Sayings
Many old works quote Han-era physicians.
1. Hou Hanshu · Fangshu Liezhuan · Guo Yu Zhuan: "Medicine is meaning. The pores and grain are most fine; following the qi, one uses skill; between needle and stone, a hair's deviation goes amiss. The spirit lives between heart and hand — it may be understood and not spoken." — kin to Lingshu · Jiu Zhen Shi Er Yuan on "the coarse hold form, the superior hold spirit." "Medicine is meaning" became a famous saying of later physicians.
2. Hanshi Waizhuan, juan 1 ch. 20: a passage on yin-yang interchange, fitted to males by 8s and females by 7s of growth cycles — bearing on the tian gui doctrine of the Suwen · Shanggu Tianzhen Lun. Useful as parallel to the Suwen.
3. Hou Hanshu · Fangshu Liezhuan · Hua Tuo Zhuan: Hua Tuo to Pu: "The body wants exercise — but should not be pressed to the limit. Moving and shaking, the grain-qi can drain off, blood-vessels flow through, no illness gets in — like a hinge that does not rot. So the immortals of old practiced daoyin (guiding-and-drawing): bear-stretches, owl-glances, body-pulls — moving the joints to ward off aging. I have an art called the Five-Animal Frolics: tiger, deer, bear, monkey, bird. They too cure disease, and exercise the feet, serving as daoyin. When the body is unwell, get up and do one — be at ease till you sweat, then dust on powder; body grows light and appetite returns." The Tao Hongjing Yangxing Yanming Lu's Daoyin Jing preserves details of the Five-Animal Frolics, likely the legacy method of Hua Tuo.
4. The book Yiwei Tonggua Yan (one of the Yi-wei) discusses the meeting and missing of the 24 climates of the year: when a climate comes when it should not, or fails to come when it should, channels are correspondingly affected. Examples and Zheng Xuan's notes are given (for Xiaohan, Dahan, Lichun, Yushui solar terms — citing the Shou Taiyin, Zu Shaoyin, Zu Shaoyang, Shou Shaoyang channels). Zheng Kangcheng (Zheng Xuan), the Han classical master, in his notes preserves channel material useful for studying jingluo doctrine.
The Yi-wei material on channels shows: (i) the 12-channel set is in place, with the term Shou Xinzhu matching the extant Lingshu · Jing Mai — so the ancestor of the Yi-wei citations is later than the Mawangdui 11-channel set, contemporaneous with the Lingshu. (ii) There are differences from the extant Lingshu · Jing Mai (e.g., Shou Taiyin "rising through 'curse-spittle,' scattering in the nose"; Zu Taiyang "rises from the small-toe end, reaches the two front teeth"; Zu Shaoyin "starts at the foot, ascends and ties"). (iii) The four channels Zheng cites (Shou Taiyin, Zu Shaoyin, Shou Taiyang, Zu Taiyang) all rise from the limb-ends, all with an inward course — different from the extant Lingshu · Jing Mai. So the ancestor of Zheng's citations is a different transmission of jingluo from the extant Lingshu — perhaps another school. In the Han there were several jingluo transmissions; most have been lost.
The Yi-wei material on calendar, phenology, and onset of disease reflects Han meteorological medicine — kin to Lingshu · Jiu Gong Ba Feng, of the same lineage.
5. Chunqiu Yuanmingbao. Extant fragments of medical theory illuminate the variety of Han zàng-xiàng schools. Quoted notes: "The head is the dwelling-place of spirit; round above, image of heaven; storehouse of qi. The brain — zai says 'within'; human essence resides in the brain." / "The eye is the messenger of liver; liver is the essence of wood; the cyan-dragon's seat." / "The nose is the messenger of lung; lung is the essence of metal; the white-tiger's seat." / "The ear is the watchman of heart; heart is the essence of fire; above forms the zhang star; fire completes at five — so the human heart is 5 cun long." / "The genitals are the drain of kidney; kidney is the essence of water; above is the xu-wei star." / "The mouth is the gate of spleen." / "Spleen is the essence of earth; above is the beidou — governs transformation. Pi (spleen) is zhuó zhe — 'concentrating' — like the curl of a dragon, the crouch of a tiger, gathered concentration." / "The stomach is the prefecture of the spleen, receiving qi. The stomach is the bin of grain, so the spleen receives qi." / "Bladder is the bowel of lung. Lung is judgment-and-decision; bladder is also always taut, hence its difficulty of decision."
6. Hanshi Waizhuan on the five storehouses and six bowels — differs from the extant Suwen and Lingshu: "By the root of the human, there are the five storehouses and six bowels. The five storehouses: feeling stored in kidney; spirit stored in heart; hun stored in liver; po stored in lung; will stored in spleen. The six bowels: throat — bowel of intake; stomach — bowel of the five grains; large intestine — bowel of transmission; small intestine — bowel of receiving completion; gallbladder — bowel of essence-accumulation; bladder — bowel of essence-fluid."
7. Baihu Tong · Qing Xing by Ban Gu of the Eastern Han contains zàng-xiàng sayings tied to the five constants (ren-yi-li-zhi-xin), five phases, and five storehouses. Quotes from Chunqiu Yuanmingbao etc. give it documentary value. Other anonymous citations include: "Some say: mouth is the watcher of heart, ear of kidney." / "Some say: liver ties with eye, lung with nose, heart with mouth, spleen with tongue, kidney with ear." / "What are the six bowels? Large intestine, small intestine, stomach, bladder, sanjiao, gallbladder. Bowel — that is, palace and prefecture of storehouses. So the Liyun Ji says: ..." / "The stomach is the bowel of spleen; spleen governs receiving qi; stomach is the bin of grain, so spleen receives qi. Bladder is the bowel of kidney; kidney governs drain; bladder is always somewhat hot, so first to find decision hard. Sanjiao is the bowel of pericardium; the path of water and grain; where qi ends and begins. Upper jiao like an orifice; middle jiao like a webbing; lower jiao like a ditch. Gallbladder — bowel of liver; liver is essence of wood, governs ren (benevolence); benevolence cannot bear, so by gallbladder one decides. Hence liver-and-gallbladder are two — there must be courage ... Small and large intestine — bowels of heart and lung — govern li (rites) and yi (right)..."
These passages show that in Han literature zàng-xiàng doctrine was not a single system but had many schools. A useful background for the development of the field.
(6) Excavated Medical Literature
Many ancient medical scrolls or fragments have been recovered.
1. Liusha Zhuijian. During Stein's 1906–1907 expeditions to Khotan, Niya, Loulan, and the Han-era beacon-towers of Dunhuang, large numbers of Chinese, Sogdian, Kharoshthi, Brahmi documents were found, mostly on wooden slips. The French Sinologist Chavannes systematically organized the Chinese material as Chinese Documents from Stein's First and Second Expeditions. Luo Zhenyu, in 1911, learned of Chavannes' work and obtained the proof; with Wang Guowei, in 1914, they published Liusha Zhuijian in Kyoto. Wang Guowei's preface says: "What came from Dunhuang are all Han-period objects; what came from north of Lop Nor, from late Wei to former Liang; what came from near Khotan, fewer than 20 slips, mostly of uncertain date. The earliest of these may be later Han; the latest, Sui-Tang."
The Fangji Lei · Yifang section of Liusha Zhuijian contains 11 complete and broken slips and a torn paper with three lines. Eleven slips: of these the third and the seventh and following — six in total — are veterinary formulas; the others, though hard to fix, share script and style — likely from a single book. Two prescribers' names appear: Chen Anguo, Cao Xiao. Each formula is preceded by indications, much like later case-records. Probably part of a veterinary formulary. The Hanshu · Yiwen Zhi under shu shu (counts-arts) has Xiang Liu Chu in 38 juan — no veterinary formulary — so the Liusha Zhuijian veterinary formulas have significant value for the history of veterinary literature, and prove the existence of veterinary formulary books in the Han.
2. Wuwei Han Dai Yi Jian. From a Gansu Wuwei Han tomb (1972), dated by the editors to the early Eastern Han. With other artifacts, a batch of medical-formula slips was unearthed. The original collection was disordered with no numbering — only 92 pieces (78 slips, 14 boards) survived editing. The volume holds 30+ formulas: zabing, gold-wound, women, eye, needling, paste medicines. Over 100 drugs are used. Most formulas are nameless, with the simple plain-experience character of early formulas; but a few have names (e.g., Baishui Hou Fang, with a note "the prescription of General Jianwei Geng, good and forbidden, not transmitted for a thousand pieces of gold." This same Zhou Baishui Hou Fang appears in Sun Simiao's Qianjin Yi, juan 12, no. 2 with slight changes — showing transmission over a long span). Also the "Qianjin Gao Yao Fang" — qianjin "worth a thousand gold," likewise has the character of a named formula. These show formula-names beginning to emerge, and formularies moving from purely empirical to theorized maturity. From Neijing formulas, to the Wuwei slips, to Zhongjing's collected formulas — the development line is clearly visible. Wuwei Han Dai Yi Jian has important value for the history of formula-science.
3. Lacquer-Carved Body-Channel Model. In Wenwu journal (1993, no. 2), He Zhiguo and Tang Guangxiao reported a 1993 Sichuan Mianyang Western Han tomb find: a striking human lacquer carving with body-surface red lines, taken to be channels. On the front of the body, two lines from head and neck through chest and abdomen to the feet; on the back, three lines (two from crown down the back to the feet, one from crown to the gluteal cleft); on each arm, three lines from fingertips up to neck, joining head lines, forming a network. Head and hand are most complex — front of head five longitudinal lines, three transverse, joined to trunk and arm lines; on the back five longitudinal lines, distributed and meeting. Lines all in red lacquer, 0.1–0.15 cm wide. Lines are many but ordered. Their distribution resembles the Neijing's 12 channels; the close lines on head and back of hand may be branches.
Combined with the diagram, the figure plainly depicts a channel chart. This lacquer-carving model, together with the Mawangdui and Zhangjiashan channel literature, is reliable evidence for early channel doctrine — and is, as a model-image, the earliest such artifact yet found. By the Western Han at the latest, such models existed. Its scholarly value is precious.
(7) Prenatal-Teaching Literature
Prenatal teaching is old, but is not recorded in extant pre-Han literature; in Han literature it is recorded across many books and discussed in dedicated chapters.
1. Han Jia Yi's Xin Shu, juan 10, "Taijiao Zashi": a thematic discussion. Citing Records of Master Qingshi: "Anciently, the way of taijiao was: when the queen was seven months with child, she went to the curtained room. The Grand Master held a bell at the left door, the Grand Steward held a measure at the right door, the Grand Diviner held milfoil at the hall below; all officials served at the entrance by their offices. During these three months, what the queen sought to hear: if not rites and music, the Grand Master plucked the music and said, I am not familiar with it. If not the proper flavor, the Grand Steward did not dare to season, saying, I dare not offer it to the prince." Example: "Empress Zhou bore King Cheng — she stood and did not lean, smiled and did not cackle, sat alone and was not haughty, and even when angry did not curse — this is taijiao."
2. Da Dai Liji · Bao Fu also gives Records of Master Qingshi — slightly differing wording. Lu Bian (Northern Zhou) annotates Qingshi: "also called Qingshizi." Wang Pinzhen (Qing) says: "The Han Yiwen Zhi · Xiaoshuojia has Qingshizi in 57 chapters. The ancient shi-guan records." So Records of Master Qingshi may be a pre-Han historian's record. Lou Shi in Xin Shu is Yan Shi in Da Dai Ji; Lu's note: "Yan Shi — a side chamber — next to yan qin; also called the side room. From the queen down, those with child or with menses, by gold rings stop their service. The queen at seven months goes to the side room; consorts and concubines at three months to their side chambers — all closing the door."
3. Hanshi Waizhuan, juan 9: "While bearing this child, I do not sit on a mat not properly arranged, do not eat what is not properly cut — this is taijiao."
From these we see: in Han literature, though prenatal teaching is spoken of as a queen's matter, it must have extended to officials and commoners. Already it was known that the pregnant woman's life, diet, and emotion all could affect the child's growth — so prenatal teaching was much valued. The Han is the era of early prenatal-teaching literature.
(8) Daoist Medical Literature
Daoism arose in the late Eastern Han. Its background: the influence of the Qin-Han Heaven-worship and chen-wei prophetic theology; social need for religion; the rulers' (Qin Shihuang, Han Wudi) belief in fangshi alchemy and immortality. Doctrinally, the Lao-Huang school's clear stillness, non-action gave Daoism its frame. The aggravating social tensions of the late Eastern Han prepared a mass base; Zhang Ling in Western Shu founded the Taiping Dao / Wudoumi Dao.
Daoism is theistic: it created many spirits and deified people (Laozi, Zhang Ling). To spread its message, Daoism needed theory and immortality-arts; for life-extending practice it needed medicine. Hence the formation of Daoist medicine.
1. Taiping Jing. Authorship long uncertain. Hou Hanshu · Xiang Kai Zhuan: Xiang Kai, courtesy Gongju, of Pingyuan Xiyang, in the 9th year of Yan-Xi under Han Huandi, memorialized: "Your servant has presented Gong Chong of Langye's [book received from] Gan Ji — Shenshu — without your enlightened ear." And "Earlier under Han Shundi, Gong Chong of Langye came to court, presenting his master Gan Ji's book of 170 juan given by spirits beside the Quyang spring, with pale-white silk, red borders, cyan headings, red eyes — titled Taiping Qingling Shu." Li Xian's note: "The spirit-book — today the Daoist Taiping Jing. The classic is arranged by the jia-yi-bing-ding-wu-ji-geng-xin-ren-gui — each part 17 juan." So Xiang Kai's Shenshu = Taiping Qingling Shu = Taiping Jing.
The surviving Taiping Jing is much damaged. The text covers yin-yang, five-phase, astronomy, calendar, expelling calamity, shou yi (guarding the one), preserving spirit, zhuyou (incantation) cover-texts, etc. It contains natural-scientific knowledge and plain dialectics, but the basic doctrinal frame is the spirit-Way religion. Medical examples (Wang Ming's Taiping Jing Hejiao):
"The True Man asked: why do people often have disease? The Spirit Man answered: it is because the liver spirit has gone — leaves and does not return — so the eyes are dim; the heart spirit has gone — its lips are cyan-white; the lung spirit has gone — its nose is blocked; the kidney spirit has gone — its ears are deaf; the spleen spirit has gone — the mouth knows no sweet; the head spirit has gone — the person darkens ... The pure spirit dwells in places quiet and empty, not foul. To call it back, one must fast and keep contemplation in a hung incense room — a hundred illnesses dissolve. Without fasting, the spirit will not return. All complain to heaven. So humans long stack illness and the dying are not stopping."
Juan 50, Caomu Fang Jue: "Plants that have virtue, have Way, have official rank — these can serve as medicine and are called plant-medicine formulas; these are the divine plants. Treating an affair to immediate cure — heaven's divine plants, which descend to grow on earth. Treating to extend life — heaven's immortal plants, which descend to grow on earth..."
Juan 50, Ci Jue: "Moxa and needle: by these to regulate the 360 channels; to open the head of yin-yang and so remove harm. The 360 channels match the 360 days of the year — each day one channel holds the affair, matching the four seasons and five phases. Flourishing and waning following the four seasons, moving — when there is illness it does not respond, the cycle goes amiss — sometimes knotted or injured, in flow or counterflow — so we must treat them ... This is got from Heaven's classical channel-and-divination book."
Juan 93, Fangyao Yangu Xiangzhi Jue: "Today the Heavenly Master, checking the formulas of the schools, says: formulas curing in 10 out of 10 — let heaven-spirits cure with them; in 9 — let earth-spirits cure; in 8 — let the human essence-spirit cure. Below this, not to be used. ... The twelve-thousand things all receive Heaven-and-Earth's command and act; not one is complete in itself — so they cure each other in mutual subjection."
There are also several "fu wen" (covering-texts, the later fu-talismans) in juan 104–107. They are mostly built by overlaying characters — e.g., four tian stacked, two di with two tu, three yi. Unlike later abstract fu, here the characters are still discernible. They represent Heaven's or spirit-rank will or method, used as divine charge — for protection, for treatment.
These show the rational and semi-rational content in Daoist medicine — e.g., 360 channels open yin-yang's way and remove harm, 360 channels all converge at the crown. The converge at the crown doctrine is absent from extant Suwen and Lingshu; only the Jinkui Yuhan Jing · Zhengzhi Zonglie says "the 365 collaterals all return to the head." Likely sourced here. Another jingluo lineage.
Although such rational content exists, the basic frame of the Taiping Jing is theocratic and fated. Why are people often ill? Heaven jointly accuses them. Plants can cure because they are heavenly divine plants. Needling cures because it derives from heaven's channel-divination book. Formulas may be used because the twelve-thousand things receive Heaven-Earth's command. This heaven is not the physical heaven but the spirit's heaven, the will of God. So Daoist medicine moved under this doctrinal discipline, with theology threaded through.
As a Daoist canon, Taiping Jing is the earliest extant Daoist medical document.
2. Cantongqi (Zhouyi Cantongqi). By Wei Boyang of late Han. Shenxian Zhuan (Ge Hong of Jin) says: "Wei Boyang of Wu, son of a great family — by nature inclined to the Daoist arts, unwilling to take office, dwelt at leisure and nourished his nature... governed the people, nourished the body — that is all... He wrote Cantongqi, Wuxianglei — two juan. They seem to explain the Zhouyi, but in fact borrow the hexagrams to talk about alchemical work. Confucians not knowing the immortals' affairs mostly annotate by yin-yang — they have missed the point."
Although the work has no formal authorship, internal evidence (Yu Yan of Song) hides the name Wei Boyang in the text. Cantongqi's content: though it says it speaks of the Yi, in fact it summarizes and develops the Qin-Han inner-nurture and alchemy arts. As Dong Dening (Qing, 1788) wrote in his preface: "The three pieces in sum lay out the three Ways of great Yi, inner-nurture, alchemy. So the upper book speaks much of the Way of Yi, then of inner-nurture, with alchemy alongside; the middle book chiefly of inner-nurture, then Yi, then alchemy; the lower book chiefly of alchemy, then inner-nurture, then Yi. So the proportions vary across the three books. The master's three pieces image the three powers." The book had great influence in Daoism, continuously transmitted. Its inner-nurture and alchemy especially shaped the Wei-Jin and Northern-and-Southern Dynasties.
These two — Taiping Jing and Cantongqi — as early Daoist canon, have Daoist medical features. Taiping Jing prominently discusses essence-qi-spirit, laying the ground for Huangting Jing. Cantongqi inherits and develops pre-Qin life-cultivation and huangbai alchemy. Daoist fu characters for expelling-evil and curing later became the major device of some sects — with some influence on medicine, though in fact heterodox to it.
II. Scholarly Achievements
The Han and Three Kingdoms is a brilliant period of TCM literature. Its main achievements:
1. Foundation theory built, the scholarly system formed. TCM, on the basis of direct sensory experience and long summary — and especially under the influence of pre-Qin yin-yang and five-phase doctrine, widely applied as explanatory tool — borrowed yin-yang and five-phase as its own theoretical base, explaining physiology, etiology, pathogenesis, diagnostic method, and treatment principle. Han–Three Kingdoms literature, on the basis of pre-Qin medical achievement, expresses this completely. TCM thus moved from sensory knowledge to the rational phase, building a theory grounded in yin-yang and five-phase.
The system also formed zàng-xiàng and channel doctrine — five storehouses, six bowels, twelve channels — as core. By the human and Heaven-Earth participating guiding thought and yin-yang and five-phase theoretical base, the framework of TCM scholarship was set. The medical-classic works compiled in the Han — especially the Huangdi Neijing — are most representative.
2. A body of classical works produced. The works that survive — though much re-edited and reconstructed and unable to fully restore their old face — represent the period's highest scholarship. They have lasting guiding significance for TCM development, and still hold value for inheritance today. So they are honored as classics, with good reason.
3. The foundation of pattern-discernment and treatment. Bianzheng shizhi is a great feature of TCM treatment, lifting treatment from sensory phase to rational phase. Zhongjing's Bian Zheng book likely belongs here; the Sui Shu · Jingji Zhi lists Bian Bing Xing Zheng — perhaps its transmission. Zhongjing's books embody the principles fully — from disease-discernment to pattern-discernment, six-channel to zàng-fu, same disease different treatment to different disease same treatment, formula variation to drug add-or-subtract. Zhongjing summarized the experience of the Han and earlier and lifted TCM treatment to a new level — the foundation of bianzheng shizhi.
4. The maturing of formula-science. Jingfang in the Hanshu · Yiwen Zhi has 11 schools, 274 juan; Tangye Jing Fa 32 juan — all lost. Surviving formulas: a few in Suwen and Lingshu; the Mawangdui Wushi'er Bingfang; the Wuwei Han Dai Yi Jian formulas — all nameless. Zhongjing's books, gathering many formulas (possibly drawing on Tangye Jing Fa), present formulas with name, indication, drug list, dose, decoction, dosing, additions and contraindications — showing maturity. As Tao Hongjing said: "Zhongjing's books are the ancestor of all formulas."
5. The formation of specialty and disease-specific and comprehensive works. Specialty works: needling (Guo Yu's Zhen Jing; pseudo-ancient Mingtang Kongxue Zhenjiu Zhi); women's (Wei Fan's Furen Taizang Jing); pediatric (Wei Fan's Xiao'er Lu Xin Fang); bencao (pseudo-ancient Shennong Bencao Jing; Zhongjing's Yao Lu; Wu Pu Bencao); massage (Hanshu · Yiwen Zhi lists pseudo-ancient Huangdi Qibo Anmo); diagnostic (Zhongjing's Ping Mai). Disease-specific (in Hanshu · Yiwen Zhi): Wuzang Liufu Bi Shi'er Bingfang, Wuzang Liufu Shan Shiliu Bingfang, Wuzang Liufu Dan Shi'er Bingfang, Keji Wuzang Kuangdian Bingfang, Jinchuang Chitan Fang. Comprehensive: Furen Ying'er Fang (women–pediatrics); Zhongjing's Tai Lu (Yu Jiaxi: a women-and-infant formulary — tai refers to women's wombs, lu and lú via lu share sound, equivalent to skull and fontanelle); most representative, Zhongjing's Shanghan Zabing Lun. Most lost; what remains as Zhongjing's books are Shanghan Lun and Jinkui Yaolüe.
6. The maturing of acupuncture-moxa. Suwen and Lingshu gave theoretical guidance; Mingtang provided an applied model. The maturing of Han acu-moxa shows in: (i) channel-system built — comprehensive view of the channels; (ii) acu-point system built — name, location, channel-affiliation, depth of insertion; (iii) needling technique systematized; (iv) indications and contraindications systematized.
**7. The founding of bencao learning.** By extant evidence, pre-Qin had no bencao in name, no specialized work. Most modern scholars date the Shennong Bencao Jing to the Han. The book records each drug's function and indication; discusses commonalities and regularities of drug theory; shows the move from sensory knowledge to theoretical thought. Its publication marks the founding of bencao learning.
8. The organization and listing of medical literature. In the pre-Qin, single chapters circulated separately; in the Han, by official or individual organization, comprehensive medical works grew. Liu Xiang's collation was the first large-scale official organization, fangji part led by the court physician Li Zhuguo. Liu Xiang and Liu Xin compiled the Seven Categories; Ban Gu extracted the Hanshu · Yiwen Zhi. Individual organization is represented by Zhongjing — "I diligently sought the old teachings, broadly gathered many formulas, compiled Suwen, Jiu Juan, Bashiyi Nan, Yinyang Da Lun, Tai Lu, Yao Lu, Ping Mai, Bian Zheng into Shanghan Zabing Lun in 16 juan."
**9. Attention to fangzhong and shenxian studies.** In the Fangji Lüe: yijing-jingfang and fangzhong-shenxian stand parallel — 18 schools, 490 juan the first two; 18 schools, 391 juan the latter two. The historical-social ground: royal-and-noble luxury and the search for life-extension; rulers (Qin Shihuang, Han Wudi) especially keen. To meet patron demand, much fangzhong and shenxian literature appeared and was officially gathered. Setting aside its lewd and fanciful side, much of it is research on sexual medicine and yangsheng, of scholarly value.
10. Attention to prenatal teaching. Taijiao dates back, but in extant ancient texts the Han is most attentive, and the Han had deep influence on later ages. Yan Shi Jiaxun · Jiaozi of Northern Qi: "Anciently the sage-kings had taijiao method: at three months, [the queen] moved to a separate palace; the eye did not look askew, the ear did not hear vainly; sounds, music, and food were regulated by rites." One example.
11. The rise of meteorological medicine. Meteorological medicine studies the effect of weather on the human body and disease. In the Lingshu Jing is Jiu Gong Ba Feng on the taiyi travel through the nine palaces and the eight-wind disease theory — likely from Han or pre-Han, included in the Neijing. The eight-wind doctrine has long history (in Lüshi Chunqiu, Shiji, Huainanzi). On taiyi movement and eight-wind causing illness, the Yi-wei books are clearest. Qian Zaodu juan xia: "So taiyi takes its number to move through the nine palaces." Zheng Xuan's note: "Taiyi — the name of the deity of Beichen. Where it stays each day, taiyi moves between the eight trigrams and stems; called tian-yi or taiyi. Its travels rest within and outside the Purple Palace; the star is so named. The Xing Jing says: tian-yi, taiyi governs the spirit of qi. Movement is like timing. The four cardinal-and-corner directions are the eight-trigram spirits' seats, hence also called palace. The heaven-yi descends — like the Son of Heaven going on inspection — each round returns." Matches Lingshu · Jiu Gong Ba Feng. Tonggua Yan juan xia: "In all these yin-yang clouds, heaven's clouds, the heaven's bian qi. Kan, Zhen, Li, Dui handle them, each trigram six lines — that is, in correspondence with the four seasons' 24 qi, and the human's four limbs' 24 channels — they too persist within the cycle." The 24-qi eight-wind missing-and-meeting bringing channel illness — already cited above. Better detailed than Lingshu · Jiu Gong Ba Feng. Zhongjing's source Yinyang Da Lun — quoted in Shanghan Lun · Shanghan Li — orders meteorological-medical theory by the 24 qi. A different lineage from Jiu Gong Ba Feng. Both are early meteorological-medicine sources; though not the yunqi* doctrine of later ages, kin to it.
12. The early founding of Daoist medicine. Religion, a unique social phenomenon, predates civilization in spirit-activity. Daoism, in the late Han, taking the Yuanshi Tianzun and Taishang Laojun as founders and immortality, clear stillness, non-action as creed, must by its theology meet with the shenxian line of fangji. So Daoist canon contained much medical content; on the basis of pre-Qin xingqi, daoyin, and huangbai arts, with further summary, inner-nurture cultivation methods formed — theoretically distinct in places — opening the road of Daoist medicine.
This is the outline of TCM literature in the Han and Three Kingdoms. All by historical records, prior research, and personal small view. Limits of materials and ability mean error is unavoidable; I welcome correction from specialists.
(Source text continues in the original on cuiyueli.com.)