Chao Yuanfang on Epidemics
Originally published on June 10, 2020, the following is my translation of Cháo Yuánfāng’s 巢元方 three essays on Epidemics, found as Volume 10 of the Zhūbìng yuánhòu lùn《諸病源候論》(“Discussion of the Origins and Signs of the Various Diseases,” from 610 CE)
卷之十 疫癘病諸候（凡三論）
Volume Ten: The Various Signs of Epidemic Diseases (Three Essays Altogether)
Essay 1: The Signs of Epidemic Disease 疫癘病候
This disease is in the same category as conditions like seasonal Qì, and [pathological] warmth and heat, etc. They are all due to the fact that within a single year the nodal Qì[1] is not harmonious and that winter-cold or summer-heat deviate from the season, or possibly there is fulminant wind or severe rain, or fog and dew fail to disperse. As a result, the people suffer from an increase in epidemics. Because the disease does not recognize old age or youth and affects everybody similarly without exception, as if it were the malevolent Qì of demons, we call it “epidemic disease.”
其病與時氣、溫、熱等病相類，皆由一歲之內，節氣不和，寒暑乖候，或有暴風疾雨，霧露不散，則民多疾疫。病無長少，率皆相似，如有鬼厲之氣，故云疫癘病。
The text Yǎngshēngfāng (“Formulas for Nurturing Life”) states: Fēng Jūndá always rode a black ox, Lady Lǔ always rode a multi-colored ox, Mèng Zǐchuò always rode a multi-colored horse, and Yǐn Gōngdù always rode a black mule.[2] Among the people of their time, nobody knew their names and who they were and therefore said: ‘If you want to avoid dying, ask for the Daoist Master Black Ox.’ If you want to get this color, a multi-colored ox is best, a black ox is second-best, and a multi-colored horse is below that still. These three colors represent the Qì of flowing with the current of life. It is said that the black ox of the ancient past was actually the essence of the cypress tree (arborvitae), that the multi-colored ox was actually the predecessor of the ancient Divine Ancestor, and that the multi-colored horse was actually the ancestor of the Divine Dragon. It is said that when the Daoist masters ride these to travel on the road, the malign specters among the myriad things and the demons of epidemic Qì will bow down deeply in submission to them.
《養生方》云︰封君達常乘青牛，魯女生常乘駁牛，孟子綽常乘駁馬，尹公度常乘青騾。時人莫知其名字為誰，故曰︰欲得不死，當問青牛道士。欲得此色，駁牛為上，青牛次之，駁馬又次之。三色者，順生之氣也。云古之青牛者，乃柏木之精也；駁牛者，古之神宗之先也；駁馬者，乃神龍之祖也。云道士乘此以行於路，百物之惡精，疫氣之厲鬼，將長揖之焉。
The text Yǎngshēngfāng, in the “Methods on Guiding and Pulling”[3] states:
The path to extending the years [of life] lies in visualizing and holding in one’s mind the redness of Heart Qì, the green-blue of Liver Qì, the white of Lung Qì, the yellow of Spleen Qì, and the black of Kidney Qì. Emit these and circulate them throughout the body, while at the same time asvoiding the evil spirits. If you want to avoid and repel the multitudes of evil and hundred demons, constantly visualize that your heart is a blazing fire like the [Big] Dipper, resplendent and brightly radiating, and then the hundred evils will not dare to encroach upon you. By means of this, you are able to enter right in the middle of warm epidemics.
《養生方‧導引法》云︰延年之道，存念心氣赤，肝氣青，肺氣白，脾氣黃，腎氣黑，出周其身，又兼辟邪鬼。欲辟卻眾邪百鬼，常存心為炎火如斗，煌煌光明，則百邪不敢干之。可以入溫疫之中。
Essay 2: The Signs of Epidemic Blister Sores 疫癘疱瘡候
When heat toxin is exuberant, this results in the formation of blister sores, with sores distributed all over the body, resembling fire sores. If [the patient’s] complexion is red with whiteness on the head,[4] the toxin is light, but when the complexion is black with purple stasis, the toxin is severe. This disease is also called “pea sores.”
熱毒盛，則生疱瘡，瘡周匝遍身，狀如火瘡，色赤頭白者毒輕，色黑紫瘀者毒重。亦名豌豆瘡。
Essay Three: Signs of Pestilential Qì[5] 瘴氣候
The conditions of “bright-green grass pestilence” and “yellow leaf pestilence” from southern China[6] resemble the “Cold Damage” that occurs in the north. Because the southern region is warm, at the time of Tàiyīn[7] the plants fail to turn yellow and drop, and [animals and insects that should be] underground and hibernating fail to be dormant and hidden away [as they should in accordance with the cycle of the seasons]. Because of the warmth, miscellaneous toxins are born. For this reason, in southern China, from the second month of spring to the second month of summer “bright-green grass pestilence” is active, and from the last month of summer to the first month of winter “yellow leaf pestilence” is active.
夫嶺南青草、黃芒瘴，猶如嶺北傷寒也。南地暖，故太陰之時，草木不黃落，伏蟄不閉藏，雜毒因暖而生。故嶺南從仲春訖仲夏，行青草瘴，季夏訖孟冬，行黃芒瘴。
When appraising the nature of medicinals to use, in treating cold damage in southern China, [keep in mind that] the seasonal Qì is warmer and make the cooling medicinals slightly colder than in the north. At the time when you apply hot medicinals, also reduce their amounts by removing two thirds. Nevertheless, the outside signs of this disease are slightly delayed, following the progression through the channels, which is no different from [the progression in] cold damage. This being so, when Yīn and Yáng both contract disease, as a combination of both exterior and interior, you need to clearly know the source of the problem and must not wantonly attack with decoctions and moxibustion.
量其用藥體性，嶺南傷寒，但節氣多溫，冷藥小寒於嶺北。時用熱藥，亦減其錙銖，三分去二。但此病外候小遲，因經絡之所傳，與傷寒不異。然陰陽受病，會同表裡，須明識患源，不得妄攻湯艾。
In a case where a patient suffers from chronic heat and has now contracted pestilential toxin, the toxin is further aggravated upon acquiring this heat. Even though the signs in the outer body are fully exuberant, if [the toxin] is still in the exterior and has not yet entered the intestines and stomach, there is no harm in [treating it with] warmth and promoting sweating (to expel it). In cases where it has already entered the inside, there is no harm in neutralizing it and moving it out through elimination in the lower body.[8]
假令宿患痼熱，今得瘴毒，毒得熱更煩，雖形候正盛，猶在於表，未入腸胃，不妨溫而汗之。已入內者，不妨平而下之。
If the patient suffers from cold as their root condition and now contracts warm pestilence, even in cases of fulminant and severe heat with vexation and fullness, if you see cold [underneath], you must principally use warm medicinals to promote sweating. But if there is no thirst after you have made them sweat, you may want to use cold medicinals to expel it through downward elimination.
假令本有冷，今得溫瘴，雖暴壯熱煩滿，視寒正須溫藥汗之，汗之不歇，不妨寒藥下之。
Now, medicinals that treat disease by promoting elimination through downward movement fall into the category of inferior substances. The nature of these medicinals is harsh and toxic and they are specifically indicated for violent attack. These must not be taken habitually, and once the critical condition is gone, you must stop. If the disease has persisted for several days but not yet entered the inside, you may not give disinhibiting medicinals[9] in anticipation [of the disease progressing to the inside], because once the medicine is all used up, the stomach will be deficient, and the disease will invariably take advantage of this deficiency to enter there. This then is not a condition that can be treated lightly. If the treatment does not lead to a cure, [the disease] will mature into jaundice. And if the jaundice is not cured, it will become corpse jaundice. Regarding the critical condition of corpse jaundice, the pestilential Qì that is found in southern China is something that the local population suffers from continuously and chronically without recovering and that transforms into this disease. As such, there is no need for treatment. As for visitors from the north, you must still deliberate carefully to rescue them.
夫下利治病等藥在下品，藥性凶毒，專主攻擊，不可恆服，疾去即止。病若日數未入於內，不可預服利藥，藥盡胃虛，病必乘虛而進。此不可輕治。治不瘥，成黃疸；黃疸不瘥，為尸疸。尸疸疾者，嶺南中瘴氣，土人連歷不瘥，變成此病，不須治也。嶺北客人，猶得斟酌救之。
Conditions that manifest with heat first and cold later erupt in Yáng. Cases that manifest without heat and only with aversion to cold erupt in Yīn. In cases that erupt in Yáng, attack the patient’s outside. In cases that erupt in Yīn, attack their inside.
病前熱而後寒者，發於陽；無熱而惡寒者，發於陰。發於陽者，攻其外；發於陰者，攻其內。
In the first and second day of the disease, the pestilential Qì is in the superficial layer of the skin. Therefore the patient suffers from headache and aversion to cold and rigidity and heaviness in the lumbar area and back. If the cold Qì is located in the exterior, making the patient sweat and needling them will invariably lead to a cure. By the third day and beyond, the Qì floats upward and congests the heart and chest area, causing headache and fullness in the chest, and oppression. It is suitable to use medicinals that induce vomiting, and making the patient vomit will invariably lead to a cure. By the fifth day and beyond, the pestilential Qì is deep and bound up in the zàng and fǔ internal organs. For this reason, we see abdominal distention and heaviness of the body, and vexing pain in the bones and joints. You must [treat it] by inducing [expulsion of the disease through] downward movement.[10]
其一日、二日，瘴氣在皮膚之間，故病者頭痛惡寒，腰背強重。若寒氣在表，發汗及針必愈。三日以上，氣浮於上，填塞心胸，使頭痛胸滿而悶，宜以吐藥，吐之必愈。五日以上，瘴氣深結在臟腑，故腹脹身重，骨節煩疼，當下之。
Sometimes a person contracted disease a long time ago but has only now informed the doctor. The doctor knows that the disease is deep and that it has already become bound up. This is not a case where you can effuse the exterior[11] and resolve it through the superficial layer of the flesh. What you must do is to ask for the roots and branches in how the patient contracted the disease. Then in prescribing medicine, you can specifically tailor it to this precise sequence.
或人得病久，方告醫，醫知病深，病已成結，非可發表解肌，所當問病之得病本末，投藥可專依次第也。
Footnotes:
[1] I.e., the particular Qì in each of the 24 divisions of the traditional Chinese calendar.
[2] These are four mythological Daoist immortals and doctors, all famous for the skill at “nurturing life.”
[3] “Guiding and pulling” is the early Chinese term for physical exercises to guide Qì through the body through breath, meditation, and stretches, as the precursor of modern Qigong.
[4] This most likely means that the black head on the hair loses its glossy darkness, a common sign in Chinese medical texts for a decline in health.
[5] Another potential translation for the Chinese term zhàngqì could be “miasmatic Qì.” It is also sometimes, less accurately, translated as malaria.
[6] These are two technical terms referring to spring and autumn epidemics related to seasonal pestilential (or “miasmatic”) Qì that occur in southern China, roughly in the area of modern Guǎngdōng and Guǎngxī.
[7] Tàiyīn means “supreme Yīn,” which here refers to the most Yīn of times, so the darkest, coldest time of the year around the winter solstice, or the season of winter in general.
[8] In other words, even though there are signs of fully developed heat in such a patient with underlying pathological heat, if the toxin has not entered the inside, you can treat it by effusing it through the exterior through heat and promoting sweating. If it has entered into the inside, you can “balance” the patient, i.e., balance the heat and cold, and eliminate the toxin by guiding it downward and outward through defecation and urination.
[9] I.e., medicinals that promote the expulsion of toxins by increasing urination and defecation, but often also more specifically referring to substances that cause loose bowel movements.
[10] I.e., defecation and urination.
[11] This is a technical term that means to get rid of the toxin by moving it out through the surface, specifically through sweating. in this case, the disease has become bound deeply inside the body and can no longer be expelled through the surface.
