|School||Beijing University of Traditional Chinese Medicine|
|Course||Clinical basis for TCM|
|Keywords||Shang Han Lun erroneous therapy deteriorated case Disquisition the theory|
This thesis is entitled Theoretical Study of Erroneous Therapy concerning Shang Han Lun. The objective of this thesis is to amass, systematize and distill Zhang Zhongjing’s theory on misdiagnosis through the study and examination of Shang Han Lun and other ancient and contemporary traditional Chinese medicine literature. The ultimate purpose of such theoretical study is to provide references and guidance in the practice, research and teaching of traditional Chinese medicine.This thesis adopts traditional literature methods. Taking advantage of modern library resources, this paper exhausted all relevant treatise on erroneous therapy both in Shang Han Lun and in two other classic pieces of work prior to the Qin and Han dynasties as well as works of later generations. The author integrates readings of both original text and interpretations of later generations and conducts a thorough analysis of the theory on misdiagnosis on a multi-level, multi-angle basis.Zhang Zhongjing in the Han Dynasty effectively integrated the evidence of treatment tabu, the evidence of mistaken treatment, retrieval the mistaken treatment, prognosis of the evidence of mistaken treatment, the evidence of prescription tabu, the evidence of mistaken use of medicine all together into provisions of Shang Han Lun, guided by the theory of "treat-when-not-ill" in Huang Emperor’s Inner Classic. Among others, the most valuable discussions appear to be on the prevention of misdiagnosis and on remedying misdiagnosis. In addition to a significant number of successful cases, Shang Han Lun also recorded certain misdiagnosed cases. Shang Han Lun also kept some cases where the test use of medicine helped determine the identify of a disease. This thesis summarized and distilled the theory on erroneous therapy and further explored Zhang Zhongjing’s thoughts on misdiagnosis and erroneous therapy and how to prevent and remedy such. The thesis consists of five parts:Part One: A comprehensive review of Erroneous Therapy exposition prior to the Qin and Han dynasties. Before Shang Han Lun was published, two classic pieces of work also discussed Erroneous Therapy. Yellow Emperor’s Inner Classic mentioned many times the misdiagnosis caused by poor medical skills that could worsen the symptoms or even endanger lives. Classic on Medical Problems discussed misdiagnosis caused by misapplication of Xu and Shi. Classic on Medical Problems developed from Yellow Emperor’s Inner Classic in disease diagnosis in that the treatment of Shang Han has progressed from acupuncture treatment in Inner Classic to combined "diaphoresis therapies and purgative therapies" medicine treatment. Further, it points out the consequences of improper application of the "diaphoresis therapies and purgative therapies" treatment. This is an important basis for Zhang Zhongjing in his emphasis on the Erroneous Therapy caused by the misapplication of "diaphoresis therapies and purgative therapies" in his works of Shang Han Lun.Part Two: Exploration of the theory on misdiagnosis in Shang Han Lun. This Part amasses and summarizes relevant discussions and provisions on misdiagnosis in Shang Han Lun and examines the causation and rationale of misdiagnosis as well as the type of remedy of misdiagnosis in order to distill the theory in misdiagnosis prevention and misdiagnosis remedy in Shang Han Lun. Erroneous treatments of diaphoretic, or emetic, or purgative therapies or acupuncture with warming needles would weakening of Yin, Yang or both and the weakening of genuine qi and the invasion of evil. The author believes that misdiagnosis is an important external causation of deteriorated case while difference in human bodies being the internal causation. The author further believes that the fundamental rationale behind deteriorated case is the"disharmony of Yin and Yang, the weakening of genuine qi and the invasion of evil."Due to the intricate appearances of all kinds of deteriorated case, Zhang Zhongjing proposed the principle of "Observing the pulse and symptoms carefully and treat the patient accordingly."In treating deteriorated case, first is to discern the authenticity of chills and fever and then follow the order of external and internal treatment. Symptoms such as weakening of Yin, Yang, disturbing of blood and spirit (heart-throb, irritation of mind, inability to sleep and delirious speech) due to the erroneous treatments of diaphoretic, or emetic, or purgative therapies or acupuncture with warming needles are all provided ways of treatment accordingly. They are relieving exterior syndrome, cleaning interiors, nurturing Yin, purgative therapies, harmonizing, settling and suppressing, warming yang, to name but a few.Part Three: the study of misdiagnosis theory after Han Dynasty. Since the publication of Shang Han Lun, the future generation of traditional Chinese medicine practitioners had varied views and opinions on misdiagnosis and deteriorated case. While no one specialized in the study of erroneous therapy, practitioners have all realized the harm caused by erroneous therapy and have commented or discussed it in their works. Lessons learned from failures sometimes may make more sense than successful experiences. Thus, constantly examining and discovering mistakes and insufficiencies in practice would enlighten and guide us and hence advance the development of traditional Chinese medicine.Part Four: the guiding function of misdiagnosis remedy thinking in Shang Han Lun in practice. The reasons for misdiagnosis are primarily that of the doctors and that of the patients, with the former being dominant. As doctors, we should first diligently consult traditional works, amass and generalize from the literature on misdiagnosis to effectively reduce the occurrence of misdiagnosis. In addition, we must attach importance to medical practice and master the application of the classic treatment theories.Part Five: examples of misdiagnosis and mistaken treatment cases. The author selects certain typical misdiagnosis and deteriorated cases as examples to illustrate how mistakes were made from misjudgement of syndrome and from misapplication of treatment methods. Analyse the reason of mistaken discrimination and mistaken treatment can take advance of clinical technique, reducing clinical accident.Continue rootleing the experience in ancient bookmaking is important. Coordinate the report of cases, the defect of other people can reduce happening of mistaken treatment and clinical accident. Reflecting on errors can help us think critically and avoid repeated mistakes in the future so as to improve our ability to distinguish different syndrome and to treat effectively.