Shang Han Lun Theory of the Six Layers of Disease

                       Classical Chinese Medical philosophy views health and disease through “the eight-principle and six-syndrome differentiation” methods. In ancient times, Chinese medical experts identified concurrent symptoms as patterns and associated them with formulas to treat them. Eventually with repeated clinical success they then recorded these patterns as “formula patterns”.  Later, during the Eastern Han Dynasty between 40 to 200 A.D., Zhang Zhong jing recorded all of these clinical experience handed down from generations in the Shang Han Za Bing Lun (Treatise of Cold Complicated Diseases- 伤寒杂病论) which was later edited and separated in the Shang Han Lun (Treatise of Cold Damage- 伤寒论) and the Jin Gui Yao Lue (Prescriptions from the Golden Cabinet – 金匮要略).  These classics clearly state the appropriate clinical application of a group of symptoms with corresponding formulas as well as suggest modifications according to the change of the disease.  This medical legacy from Zhang Zhong jing is clearly a gem for Chinese medicine clinicians.  The only two major issues we have had since then is maintaining these classics intact (and original) and understanding them correctly and effectively in today’s clinic.  Since modern “TCM” was systemized in the 1950s under the Regime of the People’s Republic of China,we have steered further and further away from the classical origins and meanings of Chinese medicine.  However, with the help of some tenacious classical Chinese medical experts, we have the chance to keep the classical thinking alive and active.  Every dedicated classical Chinese physician always reminds themselves and their colleagues to go back to the original scriptures and find the answers in the original writings.  Meanwhile, these experts also know very well that it takes decades to perfect the skills of classical thinking and clinical application. 


                To begin to understand the philosophy and clinical approach of the classical thinking, we must open our mind to a different way of viewing health and diseases.  For the purpose of this article we will shortly state that the Shang Han Za Bing Lun approach varies greatly from the Huang Di Nei jing (Yellow Emperor Inner Canon – 黄帝内径) and its five-element approach. Dr. Feng Shi Lun (冯世纶) even says that these medical classics belong to two different systems of looking at health and diseases. Needless to say the classical thinking also differs greatly from the systemized TCM zang fu approach.  The Shang Han Za Bing Lun is based on the “eight-principle syndrome differentiation” called “ba gang” (八纲) and “six-syndrome identification” (六经辩证- liu jing bian zheng).  Another strong differentiation we have in the Shang Han Za Bing Lun is the “formula pattern identification” (方证 – fang zheng).  These three main methods to treat diseases in clinic embody the classical approach of the Shang Han Za Bing Lun and can be used to diagnose and treat any disease no matter the disease name. By using the symptoms to differentiate the syndrome and formula pattern we are ot limited to the name or western medical diagnosis to treat our patients.

In China, there is a clear difference between the Chinese medical practitioners that use the TCM zang fu approach in their practice and the ones that use “pure” classical thinking.  Both Dr. Hu Xi Shu (胡希恕) and Professor Feng Shi Lun (冯世纶), like many other classical masters, have spent their life researching and developing the understanding of the Shang Han Lun and Jin Gui Yao Lue. Together they have written over 20 books using different methodology to understand the application of the classics. They have both greatly contributed to the survival of classical thinking.


              Being a classical Chinese physician and treating diseases according to the classical thinking, we must first identify the type of disease through the “eight principles”.  We must determine if it is a hot or a cold disease, or a mixture of hot and cold disease.  We must identify if it is an internal or an external disease or a half internal and half external disease.  We must identify if it is an excessive or a deficiency pattern or if it is a half excess and half deficiency pattern.  Secondly, we must identify which channel or channels have been affected according to the “six-channel pattern identification”. This will lead us directly to the “formula pattern” and guide us to the appropriate formula. Finally we will be able to make modifications to the ingredients and dosages according to the symptoms.


              Since the “eight principle” identification is part of the basic Chinese medical system we will explain the “six syndrome identification” in more details. It is very important to realize that the “six syndrome identification” explains the location of the disease in a layer and depth format and has absolutely no relation to the location of the acupuncture channels. Even if the channels hold the same name they relate to two completely different sets of ideas and applications. In this case, the channel pattern identifies the symptoms and severity of the disease. 

  • In the Tai Yang (exterior yang) syndrome: the disease is related to the external aspect, with symptoms of chills, fever, stiffness, pain the joints, skin diseases, headache and a floating pulse.
  • In the Shao Yin (exterior yin) syndrome: the pathogen is located on the external layers of the body but there is also a deficinecy of fluid. Symptoms include anxiety, drowsiness, chills, cold extremities, aversion to cold, joint and body pain with a deep and constrained pulse.
  • In the Yang Ming (interior yang) syndrome: the pathogen is located in the interior and is characterized by internal excess heat condition with fever without chills, distended abdomen, irritability, easily emotional, constipation and a rapid pulse.
  • In the Tai Yin (interior yin) layer: the syndrome is located in the interior and symptoms include feeling of severe internal cold, chills, with a distended abdomen with occasional pain, diarrhea or loose stools.
  • In the Shao Yang (half-exterior half-interior yang) layer: the symptoms are located in the chest or abdominal areas and can affect any organ or organs, with chest discomfort, pain or stiffness in the rib side, dry mouth, alternating chills and fever with a bitter taste in the mouth.
  • In the Jue Yin (half-exterior half-interior yin) layer: e symptoms are located in the chest or abdominal areas and can affect any organ or organs, they are the counterpart of the Shao yang syndrome with an increase on the symptoms of heat in the upper area and severe cold in the lower limbs or the lower abdomen, thirst, difficult urination, physical weakness, lethargy with a deep and weak pulse.


Once the six syndrome or combination of syndromes have been identified, the next step in the medical approach to Jing Fang is to identify the appropriate formula pattern (方证 – Fang Zheng). This step is actually the key to clinical success with Jing Fang.


It is important to know that there are specific formula patterns which are classified according to each of the six syndrome of six layers of disease, and there are formula pattern that have been identified to treat multi-layers or multiple syndromes at once. However these formula patterns have a very sensitive symbiosis and balance between the ingredients and the ratio of the ingredient and treat a particular combination of symptoms pattern. In this sense if you find the exact formula pattern for the presenting syndrome, your choice will be straightforward and successful.


Classical expert, Dr. Feng Shi Lun says that we must understand the mechanism behind the formula pattern to fully grasp its effect on the body and how they affect the symptoms to get a deeper understanding of the Jing Fang approach to medicine. This is done through many years of clinical practice and deep contemplation. We have the chance to have Dr. Feng insight and learn from his 50 years of clinical experience. Join our Shang Han Lun live Webinar to learn more or join our Shang Han Lun Forum on Facebook Chinese Medicine Traveller.