Zhang Zhongjing: The Medical Sage Who Revolutionized Ancient Chinese Medicine

Today we’ll talk about Zhang Zhongjing, a pioneering physician of the Eastern Han Dynasty who overcame such challenges as war, famine, and personal adversity to become the “Medical Sage” of Traditional Chinese Medicine.

Transcript

Zhang Zhongjing: The Medical Sage Who Revolutionized Ancient Chinese Medicine

Today we’ll talk about Zhang Zhongjing, a pioneering physician of the Eastern Han Dynasty who overcame such challenges as war, famine, and personal adversity to become the “Medical Sage” of Traditional Chinese Medicine.

This year marks the 1875th anniversary of the birth of Zhang Zhongjing, a famed ancient Chinese pharmacologist and physician. On February 15, a grand blessing ceremony was held in Nanyang, Henan Province, the hometown of the medical sage, to honor the ancient scholar and to pray for health and well-being for all people. 

Vibrant traditional folk performances such as dragon and lion dances, and “land boat rowing” were featured at the event. At the foot of Medical Sage Mountain, traditional opera performances were held for three consecutive days, allowing traditional Chinese opera and traditional Chinese medicine culture to shine together. The event also featured renowned TCM experts offering free consultations, providing personalized health advice, and bringing millennia-old medical wisdom to modern life. 

Zhang Zhongjing was born into a declining bureaucratic family in the city of Nanyang in Henan Province during the Eastern Han Dynasty, which lasted from the year 25 to 220. His father, Zhang Zhonghan, was a scholar and served as an official in the imperial court. Due to the unique conditions of his family, Zhang Zhongjing had the opportunity to access many classical texts from a young age. He was diligent and studious, widely read, and had a deep passion for medicine. Inspired by the story of Bian Que Diagnosing Duke Huan of Qi from historical records, he greatly admired Bian Que’s exceptional medical skills. This sparked a strong interest in medicine, laying the foundation for his future as a renowned physician.

At that time, society was plagued by political darkness and corruption in the imperial court. Peasant uprisings erupted one after another, wars were incessant, and chaos abounded. The common people suffered greatly from the ravages of war and epidemics, with many dying untimely deaths. Instead of seeking solutions, the government officials were preoccupied with power struggles, waging wars, and oppressing the people. This environment made Zhang Zhongjing detest officialdom, disdain a career in politics, and sympathize deeply with the suffering of the people. He developed a desire to study medicine to save lives. Around the year 161, when he was about 10 years old, he became an apprentice to Zhang Bozu, a physician from his hometown, to study medicine.

Zhang Bozu was a well-known medical practitioner at the time. He was calm in temperament, lived a simple life, and devoted himself to the meticulous study of medicine. Every time he diagnosed patients and prescribed treatments, he did so with great care and deliberation. Nearly all the patients he treated recovered, earning him deep respect from the people. Zhang Zhongjing studied medicine under him with utmost dedication. Whether it was going out to diagnose illnesses, copying prescriptions, preparing medicines, or gathering herbs in the mountains and processing them at home, he never shied away from hardship or fatigue. 

Zhang Bozu greatly admired this student and passed on all his lifelong medical experience to him without reservation. In addition, Zhang Zhongjing extensively read medical texts and absorbed the expertise of various physicians for clinical diagnosis, making rapid progress. He soon became a renowned doctor in his own right, even surpassing his teacher. 

In ancient feudal society, superstitious practices and witchcraft were rampant. Witch doctors and self-proclaimed sorcerers took advantage of this and swindled money as they deceived the common people. Many poor families, when faced with illness, would turn to these grifters to exorcise “evil spirits” and cure diseases with magical potions. As a result, innocent lives were lost to illness, leaving families both bereaved and impoverished. Zhang Zhongjing harbored a deep hatred for these con artists. Whenever he encountered them deceiving the people and endangering lives, he would step in, confidently confronting and debating them. He used the tangible results of medical treatment to refute superstitious beliefs and urged people to trust in proper medicine.

On one occasion, he encountered a woman who alternated between crying and laughing, constantly plagued by paranoia. The family, deceived by a witch doctor, believed she was “possessed by evil spirits” and planned to have the witch “exorcise” her. After observing the patient’s complexion and symptoms and inquiring about her condition, Zhang Zhongjing told the family, “This is not a case of possession by evil spirits but rather the result of severe emotional distress.” He devised a treatment plan and administered acupuncture. After a few days, the woman’s condition gradually improved, her paranoid symptoms disappeared, and further treatment led to a full recovery.

To help more patients break free from superstitious beliefs and recover quickly, Zhang Zhongjing diligently explored new medical methods and developed many innovative treatments. For example, he encountered a patient suffering from severe constipation, unable to eat and extremely weak. After careful examination, Zhang determined the patient’s condition was caused by high fever. At the time, the usual treatment for constipation was to prescribe a laxative; however, this patient was too weak to withstand the effects of such strong medicine. Yet, without the medicine, the problem would persist, and the fever-causing toxins would remain trapped in the body. 

After careful consideration, Zhang decided to try a new approach: he figured, if the patient couldn’t take the medicine orally, it would have to go in the other way. He took some honey, boiled it until it thickened, and then shaped it into thin, elongated “medicinal sticks.” I won’t describe the rest, but suffice it to say that the treatment was a success. The fever-causing toxins were eliminated, and the patient’s condition improved immediately. Today, these kinds of medicines are known as suppositories, and this was the earliest recorded use of them in Chinese medical history. 

On another occasion, Zhang Zhongjing was traveling when he saw a crowd gathered around a man lying on the ground surrounded by several women weeping bitterly. He learned that the man had attempted to hang himself due to extreme poverty. By the time he was discovered and rescued, he was already motionless. 

Realizing that not much time had passed, Zhang quickly had the man placed on a wooden board and covered him with a quilt to keep him warm. He then asked two strong young men to kneel beside the man, massaging his chest while moving his arms up and down in a rhythmic motion. Meanwhile, Zhang himself straddled the board, placing his hands on the man’s lower back and abdomen, applying pressure in sync with the arm movements. Within half an hour, the man began breathing faintly on his own. After a while, the man regained consciousness. The method Zhang employed is now widely recognized as an early form of artificial respiration, a cornerstone of modern emergency medicine.

Bianzheng Shizhi (辨证施治), translated as “syndrome differentiation and treatment,” is a fundamental concept in traditional Chinese medicine. It refers to the process of using various diagnostic methods to identify different syndromes, analyzing the patient’s physiological characteristics, seasonal factors, regional environment, and lifestyle habits to determine the root cause of the illness, and then prescribing an appropriate treatment plan.

Once, two patients came to Zhang Zhongjing simultaneously, both complaining of headaches, fever, coughing, and nasal congestion. After questioning them, he learned that both had been caught in a heavy rain. Zhang took their pulses and diagnosed them both with a common cold. He prescribed the same dosage of ephedra decoction to both patients to induce sweating and reduce fever.

The next day, a family member of the first patient rushed to Zhang, reporting that after taking the medicine, the patient had sweated profusely, but the headache had worsened. Puzzled, Zhang feared he had made a diagnostic error and hurried to check on the second patient. That patient, however, reported that after taking the medicine, they had sweated and felt significantly better. Zhang was baffled – why did the same illness and the same medicine produce such different results? 

He carefully recalled the details of the previous day’s consultations and remembered that while taking the first patient’s pulse, he had noticed sweat on the patient’s wrist and a weak pulse, whereas the second patient had no sweat on their wrist. He realized he had overlooked these subtle differences during the initial diagnosis. By administering a sweat-inducing medicine, he had weakened them further. Realizing his mistake, Zhang Zhongjing immediately adjusted the treatment and prescribed a new formula. As a result, the patient’s condition quickly improved.

This incident reinforced the importance of meticulous observation and individualized treatment in TCM and left a profound impression on Zhang Zhongjing. He realized that even for the same illness, such as a cold, the external symptoms and underlying conditions could differ, and that treatment strategies must be tailored to the specific circumstances of each patient and cannot be applied rigidly or uniformly.

During the Jian’an era of the Eastern Han Dynasty from 196 to 220, Zhang Zhongjing met several times with a famous poet and court official named Wang Zhongxuan. He discerned that Wang Zhongxuan showed the early signs of leprosy and warned him, saying, “You have an illness that requires early treatment. If left untreated, by the age of 40, you will lose your eyebrows, and within six months of that, your life will be in danger. I advise you to take a few doses of Wushi Tang (五石汤) as soon as possible.”

Wushi Tang, or Five Minerals Decoction, is a traditional Chinese herbal formula that was used to treat various ailments, particularly those related to internal heat, toxicity, or severe illnesses. 

At the time, Wang Zhongxuan was only in his twenties. Contracting a disease like leprosy was not only life-threatening but also carried significant social stigma. That’s why Zhang Zhongjing did not explicitly name the illness but only described its symptoms. And even though Wang Zhongxuan understood the implication, he dismissed it as an attempt to frighten him and ignored Zhang’s advice.

Some time later, the two met again, and Zhang asked, “Have you taken the Wushi Tang?” Wang Zhongxuan said he had, but Zhang Zhongjing observed his complexion and said, “Judging by your appearance, you clearly haven’t taken it. Why would you ignore a doctor’s advice and devalue your own life? I urge you to take the medicine soon, or you will face serious consequences.” Despite this warning, Wang Zhongxuan did not follow Zhang Zhongjing’s instructions. True to Zhang’s prediction, 20 years later, Wang Zhongxuan began to lose his eyebrows, and within six months, he passed away. This talented literary figure’s untimely death was a tragic loss, underscoring not only the accuracy of Zhang Zhongjing’s diagnostic skills, but more generally, the importance for us all to heed competent medical advice.

Although Zhang had despised officialdom and disdained a political career since childhood, his father, who had served as a court official, placed great importance on the imperial examination system as a means to secure an official position and urged his son to take the exams. Naturally, Zhang Zhongjing did not want to defy his father’s wishes and risk being seen as an unfilial son, so during the reign of Emperor Ling, which lasted from 168 to 188, he took the exams and earned the title of juren (举人), a successful candidate in the provincial examination. Later, during the Jian’an era, from 196 to 219, he was appointed as the prefect of Changsha in Hunan Province by the imperial court.

Even as an official, Zhang Zhongjing continued to use his medical skills to alleviate the suffering of the common people. In feudal times, officials were not allowed to casually enter private homes or interact closely with the public. However, without direct contact with the people, how could he diagnose them or improve his medical expertise? 

To overcome this, Zhang Zhongjing devised a solution: on the first and fifteenth days of each month, he would open the doors of his government office, set aside administrative duties, and allow sick patients to enter. He would sit solemnly in the main hall, carefully diagnosing and treating each person one by one. Over time, this practice became a tradition. Later, doctors who sat in pharmacies to treat patients were commonly referred to as “sitting hall doctors” (坐堂医生) in honor of Zhang Zhongjing.

Even though Zhang Zhongjing possessed extraordinary medical skills, naturally there were some diseases he could not cure. And during the late Eastern Han Dynasty, frequent wars led to widespread plagues. In the Jian’an era, epidemics broke out five times, claiming countless lives and turning once-thriving towns into empty shells. Among the diseases, typhoid fever was the deadliest. For example, Zhang Zhongjing’s own family, which originally had over 200 members, lost two-thirds of its members in less than a decade, with seven out of 10 deaths caused by typhoid fever.

Amid this chaos, some incompetent doctors took advantage of the situation. They did not carefully diagnose patients, often skipping proper pulse examinations and hastily prescribing medicines, all while profiting from the suffering of others. Still, some doctors, though trained by renowned physicians, lacked ambition and clung to outdated practices. Instead of diligently studying new medical formulas and improved techniques to alleviate the people’s suffering, they pursued power and prestige. 

Zhang Zhongjing was deeply angered by such behavior and harshly criticized these individuals. Determined to control the spread of plagues and find a cure for typhoid fever, he devoted himself to studying ancient medical texts, integrating their fundamental theories and incorporating the successful treatment methods of other physicians. He combined this knowledge with his own clinical experience to research treatments for typhoid fever and various other diseases. In the year 205, he began writing his seminal work, Shanghan Zabing Lun (伤寒杂病论), or Treatise on Cold Pathogenic and Miscellaneous Diseases.

This book also established three world firsts: it was the first to document artificial respiration, medicinal enema, and the treatment for biliary ascariasis. The book encapsulates Zhang Zhongjing’s lifelong medical experience and stands as one of the most influential works in the history of Chinese medicine. As such, it has become an essential textbook for medical studies in later generations, highly regarded by both medical students and practicing physicians.

The book contains a notable passage: “At its highest level, medicine serves to heal the ailments of the nobility; at its most basic, it rescues the poor from suffering; and at its core, it preserves and nurtures our well-being.” This reflects the profound compassion of Zhang Zhongjing as a great physician, earning him the revered title of “Sage of Medicine” from later generations.

Zhang Zhongjing continued to write and dedicated himself to medical research until his death. Later, in 285, Zhang’s remains were transported back to his hometown for burial. A memorial temple, the Medical Sage’s Shrine, and a tomb were built in Nanyang to honor his legacy. Zhang Zhongjing’s contributions to medicine not only saved countless lives during his time but also laid the foundation for future generations of physicians, cementing his status as one of the greatest medical figures in Chinese history.

Well, that’s the end of our podcast. Our theme music is by the famous film score composer Roc Chen. We want to thank our writer Lü Weitao, translator Wang Yuyan, and copy editor Pu Ren. And thank you for listening. We hope you enjoyed it, and if you did, please tell a friend so they, too, can understand The Context.