Liu Wansu

Liu Wansu a physician of the Jin dynasty (about 1110-1200) who was the first of the four great masters of the Jin and Yuan period and who, emphasising the role of fire and heat in disease, founded a school of medicine that profoundly influenced later practice.

Life and Career

Liu Wansu, whose courtesy name was Shouzhen and who is also known by the title of Master of the Simple Question, was born around 1110 in Hejian, in what is now Hebei province, during the Jin dynasty that ruled northern China. He was known as a scholar of the ancient medical texts, and especially of the Simple Questions, the first part of the Yellow Emperor's Inner Canon, from which some of his titles were derived. He devoted himself to the study of the classics and to the practice of medicine.

He lived through a period of disorder, as the Jin state contended with its neighbours and suffered the upheavals of war and epidemic disease. These conditions, together with the prevailing climate of thought, may have inclined him toward an emphasis on the diseases of heat and of internal fire, which he believed were especially common and dangerous. He practised medicine for many years and gathered a wide experience of the fevers and inflammations of his age.

He adhered to the tradition that classified physicians by the methods they emphasised, and he is regarded as the founder of the Cooling School, one of the principal currents of medical thought in the Jin and Yuan period. His teaching attracted followers, and his ideas were debated and developed by the other masters of the age. He stands at the head of the sequence of great physicians whose work reshaped Chinese medicine in this era.

The Doctrine of Fire and Heat

Liu Wansu is best known for his theory that fire, and the excessive heat associated with it, plays a central role in the causation of disease. Drawing on the doctrines of the Inner Canon concerning the five phases and the movements of the vital forces, he argued that the balance of the body is frequently disturbed by an excess of yang or of fire, giving rise to fever, inflammation, thirst, agitation and a host of other complaints. He held that these conditions were more common than the traditional emphasis on cold and deficiency had allowed.

He developed this view into a systematic account of the pathology of heat, describing the ways in which fire arises in the body, how it spreads and how it affects the various organs. He identified the sources of excessive heat in the environment, in the emotions and in the constitution of the patient, and he traced their effects upon the blood, the fluids and the channels. This analysis gave physicians a framework for understanding febrile and inflammatory disease that complemented the older doctrines of cold damage.

His emphasis on fire did not lead him to neglect the opposite condition of cold, and he wrote on the treatment of cold disorders as well, warning against the excessive use of cooling drugs. His approach was one of balance, in which the physician must judge the relative strength of heat and cold in the patient and treat accordingly. Nevertheless it was his teaching on fire that was most distinctive and most influential.

Therapeutic Method

On the basis of his pathology of heat, Liu Wansu developed a therapeutic method centred upon the use of cooling and purging drugs. He employed remedies that were held to clear heat, to reduce fire, to dispel the effects of summerheat and to cool and nourish the fluids of the body, and he rejected the excessive use of warming and tonifying medicines, which he believed aggravated the very conditions from which his patients suffered. His prescriptions were noted for their directness and for their use of a relatively small number of active ingredients.

He paid close attention to the precise preparation and dosage of his medicines, and he insisted that the physician must understand the properties of each drug and the reasons for combining them. He criticised the practice of prescribing by rote and urged that treatment be adapted to the patient and to the changing course of the illness. His clinical writings record many cases in which he altered his remedy as the condition of the patient changed.

He was also skilled in the use of acupuncture and moxibustion, and he applied these methods according to the same principles that governed his use of drugs, selecting points that were held to clear heat and to restore the balance of the channels. His combination of pharmacology and needling, guided by a single theory of disease, made his practice systematic and gave his followers a model to imitate.

The Four Masters of the Jin and Yuan

Liu Wansu is counted as the first of the four great masters of the Jin and Yuan period, a group that also includes Zhang Congzheng, Li Gao and Zhu Zhenheng. Each of these physicians developed a distinctive emphasis within the inherited tradition, and their doctrines, later known as the four schools, came to define the medical thought of the age. Liu Wansu's emphasis on fire and heat was the first of these contributions to take form.

The four masters did not so much break with the classical tradition as reinterpret it in the light of their own clinical experience and of the conditions of their time. Liu Wansu drew heavily on the Inner Canon, and his originality lay in the weight that he gave to one theme within it. This pattern of doctrinal emphasis within a shared tradition was characteristic of the period and gave rise to a lively debate among physicians about the relative importance of heat, cold, deficiency and excess.

His relationship with the other masters was one of both contrast and continuity. Zhang Congzheng, who emphasised the expulsion of pathogenic factors by purging and sweating, extended the active and interventionist side of Liu Wansu's teaching, while Li Gao and Zhu Zhenheng responded to it by stressing the importance of deficiency and of the need to nourish the body. Together they formed a conversation that enriched the medicine of the age.

Influence and Legacy

Liu Wansu's influence on later medicine was profound. The doctrines of the four masters became a central part of medical education, and his particular emphasis on fire and heat informed the treatment of febrile and inflammatory disease for centuries. The warm disease school, which arose in the Ming and Qing dynasties, drew upon ideas that he had helped to establish, and his therapies for heat entered the standard repertoire of pharmacy.

His reputation as a scholar of the Inner Canon gave his teaching weight, and his insistence upon the careful study of the classics and upon reasoned clinical judgement became a model for later physicians. His followers and successors elaborated his ideas, and the debates that he provoked stimulated the whole development of medical theory in the Jin and Yuan period and beyond. The remedies that he devised for clearing heat and reducing fire entered the common stock of prescriptions and were used wherever fever and inflammation demanded treatment.

He died around 1200, at the end of a long life of study and practice. He is remembered as the founder of the Cooling School and as the first of the four great masters, a physician whose single-minded attention to the role of fire in disease opened a new direction in Chinese medicine and whose influence continued to be felt long after his death. His learning and his clinical boldness made him a model for the physicians who followed him in the centuries of debate that his doctrines inspired.

See also

• Four masters of the Jin and Yuan
• Warm disease school
• Traditional Chinese medicine
• Five phases