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'''Zhang Congzheng''' a physician of the Jin dynasty (about 1156-1228) who is remembered for his bold doctrine that disease should be treated by expelling the pathogenic influence from the body and who, by attacking rather than tonifying, won a reputation as one of the four great masters of the age.

== Life and Career ==
Zhang Congzheng, whose courtesy name was Zihe and who is also known by the title of Master of the Deep and Ancient, was born around 1156 in Kaozheng, in what is now Henan province, during the Jin dynasty. He came from a family with a tradition of scholarship, and he received a classical education, but failing to advance in the official examinations he turned to medicine and found in it his true vocation. He studied the ancient medical texts with great thoroughness and sought out teachers who could deepen his understanding.

He was a student of the doctrines of Liu Wansu, the first of the four masters, and he drew upon that teaching in forming his own distinctive view. He practised for many years and attracted a large following, and he was known for his willingness to treat the poor without charge. His career was marked by the troubles of the late Jin period, as the dynasty declined and the country was afflicted by war and disease, conditions that may have sharpened his sense that illness demanded vigorous and decisive action.

He held official positions for a time, serving in the medical administration, but he is remembered chiefly for his clinical practice and for the book in which he set out his methods. He was a bold and confident physician whose approach to treatment, though controversial, was grounded in a close reading of the classical texts. He gathered around him a school of followers who carried his ideas into later generations.

== Attack the Pathogen ==
Zhang Congzheng's central doctrine was that most diseases arise from the intrusion of a pathogenic influence into the body, and that the proper treatment is to expel that influence as directly and quickly as possible. Whether the cause was an external agent such as wind, cold or heat, or an internal disturbance such as the accumulation of food, phlegm or stagnant blood, the physician should act to drive it out rather than to strengthen the patient or merely to soothe the symptoms. This emphasis on active intervention set him apart from those who relied chiefly on tonics.

He identified three principal methods of expulsion, which he called the three methods of attack. The first was the promotion of sweating, to expel an influence lodged in the exterior of the body. The second was the promotion of vomiting, to clear substances that had collected in the upper digestive tract. The third was purging, to remove accumulated material from the lower bowels. Around these three operations he built a comprehensive system of therapy, and he became famous for applying them boldly.

He held that the pathogenic influence, if left in place, would do progressive damage, and that any hesitation allowed the disease to take deeper hold. He therefore favoured decisive treatment at the outset, adapted to the stage and location of the illness, and he was willing to use powerful remedies that other physicians feared. His critics accused him of recklessness, but his defenders pointed to the many difficult cases that he cured.

== Diagnosis and the Whole Patient ==
Although Zhang Congzheng is best known for his aggressive methods, his writings show a careful and discriminating physician. He insisted that diagnosis must be exact and that the three methods of attack must be used only when the condition of the patient warranted them. He distinguished among the various forms of pathogenic influence, tracing their origins and their effects, and he described the signs by which each could be recognised and treated.

He also took account of the constitution, age and circumstances of the patient, holding that the same disease might require different treatment in different people and that the strength of the therapy must be matched to the strength of the sufferer. He warned against the indiscriminate use of purging and vomiting in the weak, the aged and the debilitated, and he recognised that some conditions called for the tonifying methods that he otherwise criticised. His doctrine was thus more nuanced than a simple preference for attack, and it demanded a careful weighing of each case before any remedy was chosen.

He was especially interested in the role of emotion and of the manner of living in the causation of disease, and he wrote of the effects of the passions upon the body and of the importance of moderation in food, drink and conduct. This attention to the whole life of the patient, alongside his emphasis on expelling the pathogen, gave his medicine a broad and human scope, and it shows that his reputation for aggression rested upon a wider understanding of health and illness than his critics allowed. His practice therefore joined vigorous therapy to a sober regard for the patient's strength.

== The Confucians' Duties to Their Parents ==
Zhang Congzheng's ideas were gathered in a work whose title has been rendered as the Confucians' Duties to Their Parents, one of the classic statements of medical doctrine in the Jin and Yuan period. The book is a large collection of discussions and cases, arranged in sections on the treatment of disease by the three methods of attack and on the diagnosis and therapy of a wide range of complaints. It is notable for its frankness and for the vigour of its argument.

The work contains hundreds of recorded cases, many of them described in detail, in which the author explains his reasoning, the remedy chosen and the outcome of the treatment. These case records give a vivid picture of clinical medicine in the period and show how a physician of his school reasoned at the bedside. They also illustrate his readiness to criticise the errors of other physicians and to defend his own methods against their objections.

In the preface and throughout the book Zhang Congzheng set out his view of the physician's calling, insisting that medicine should be studied as a serious intellectual discipline and that practitioners should not rely on hereditary privilege or on empty reputation. He invoked the duty of the educated person to care for the health of parents and family as a motive for the study of medicine, and he urged physicians to pursue learning with diligence and honesty.

== Influence and Legacy ==
Zhang Congzheng became one of the four great masters of the Jin and Yuan period, and his doctrine of attacking the pathogen, with its three methods, was studied and debated by physicians for centuries. His school, known as the Attacking School, offered a powerful alternative to the tonifying approaches that dominated much of the tradition, and it kept alive the insight that many diseases require the active removal of their cause rather than simply the support of the patient.

His emphasis on exact diagnosis, on the recognition of pathogenic influences and on the decisive use of therapy influenced the treatment of acute and infectious disease, and his case records became a model for clinical writing. Later physicians, including those of the warm disease school, drew upon his methods, and his willingness to challenge accepted practice encouraged independence of judgement among his successors.

He died in about 1228, leaving behind a body of doctrine and a collection of cases that preserved his distinctive approach. He is remembered as the most combative of the four masters, a physician whose bold therapies and forceful arguments made him both criticised and admired, and whose insistence that the cause of disease be expelled from the body gave Chinese medicine one of its most enduring therapeutic principles.

== See also ==
* Four masters of the Jin and Yuan
* Traditional Chinese medicine
* Liu Wansu
* Pathogenic factors

== References ==

<ref name="r1">Zhang Congzheng, Ru Men Shi Qin (Confucians' Duties to Their Parents), Renmin Weisheng Press, 1984.</ref>
<ref name="r2">Paul U. Unschuld, Medicine in China: A History of Ideas, University of California Press, 1985.</ref>
<ref name="r3">Fan Ka Wai, The Four Masters of Jin-Yuan Medicine, Chinese University Press, 2003.</ref>
<ref name="r4">Manfred Porkert, The Theoretical Foundations of Chinese Medicine, MIT Press, 1974.</ref>

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[[Category:Medicine]]
[[Category:Science]]
[[Category:Jin dynasty]]

Zhang Congzheng - Revision history

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