Zhu Zhenheng

Zhu Zhenheng a physician of the Yuan dynasty (1281-1358) who is regarded as the last and most synthesising of the four great masters of the Jin and Yuan period and who, holding that the human body is perpetually deficient in yin, taught that disease should be treated by nourishing the vital fluids and restraining the flames of excess.

Life and Career

Zhu Zhenheng, whose courtesy name was Yanxiu and who is also known by the title of Master of the Purport of the Standard, was born in 1281 in Yiwu, in what is now Zhejiang province, during the Yuan dynasty. He came from a family of scholars and received a rigorous classical education, and for a time he pursued the official examinations and the career of a government servant. In middle life, persuaded by the example of a teacher and by his own reading, he turned to medicine and devoted himself to it with the same seriousness that he had brought to his other studies.

He was a student of the doctrines of the earlier masters of the Jin and Yuan period, and he studied the writings of Liu Wansu, Zhang Congzheng and Li Gao with care, weighing their rival emphases against one another and against the classical texts. This breadth of study, combined with his own extensive clinical experience, allowed him to form a view that sought to reconcile their insights rather than to choose among them.

He practised medicine in the region of his birth for many years and acquired a great reputation for skill, especially in the treatment of difficult and chronic disease. He taught a large number of students, and his fame spread through the country, so that his name came to stand for the most learned and balanced of the physicians of his age. He lived to be seventy-seven and remained active in practice until near the end of his life.

The Doctrine of Nourishing Yin

Zhu Zhenheng's most distinctive teaching was his doctrine of the perennial deficiency of yin. Building on the physiology of the Inner Canon, he held that the human body in its ordinary condition tends to have insufficient yin, the cooling and nourishing aspect of the vital forces, and that the yang, the warming and active aspect, tends therefore to become excessive. This imbalance, he argued, is the root of many chronic diseases, and especially of the disorders of later life.

He reasoned that the demands of living, the passions, the strain of work and the natural processes of aging all consume the yin, while the fire of the body, unchecked by an adequate supply of cooling moisture, rises and damages the system. The result may appear as fever, restlessness, dryness, bleeding, cough and a range of other complaints. His account of this condition gave physicians a new way of understanding the diseases of depletion and of the internal fire that arises when the vital fluids are exhausted.

His doctrine implied that treatment should aim above all to nourish the yin and to conserve the body's fluids, and that remedies which dissipate or warm may do harm by consuming what little cooling moisture remains. He therefore favoured nourishing and cooling drugs, and he warned against the excessive use of the tonifying and stimulating remedies that some of his predecessors had favoured. In this he offered a corrective to the earlier masters and drew their teachings toward a balanced centre.

The Yin Yang Doctrine and its Sources

Zhu Zhenheng set out his views in a work known as the Purport of the Standard, or more fully as a discussion of the doctrines of the Inner Canon and their relation to the theory of yin and yang. In this book he reviewed the physiology of the body, the causes of disease and the principles of treatment, and he argued for his characteristic emphasis on the conservation of yin. He drew extensively upon the classical texts, quoting and interpreting them in support of his position.

He also wrote a famous supplementary essay on the doctrine of the all-pervading fire, in which he distinguished the fire that is part of the natural warmth of the body from the fire that arises pathologically when the yin is depleted. This distinction allowed him to explain how a substance necessary to life could also become the source of disease, and it gave his theory a subtlety that appealed to later physicians.

A further essay dealt with the digestive centre, the spleen and stomach, which he regarded as the foundation of the body's vitality. He acknowledged the importance of these organs, as his predecessor Li Gao had emphasised, but he insisted that the care of the spleen and stomach must be balanced by attention to the yin, so that nourishment did not turn into an accumulation of heat. In this way he integrated the doctrines of his predecessors into a larger whole.

Synthesis of the Four Masters

Zhu Zhenheng is often described as the great synthesiser of the four masters. He studied the doctrines of Liu Wansu, with their emphasis on fire and heat, of Zhang Congzheng, with their emphasis on attacking the pathogen, and of Li Gao, with their emphasis on the spleen and stomach, and he sought to understand the truth in each. He held that the four masters had each grasped one aspect of a single reality and that the complete physician should master them all and apply them according to the case.

He therefore resisted the factionalism of the medical schools of his day and urged physicians to judge every case on its merits rather than to follow a single teacher. He himself used the methods of all the schools, now expelling a pathogen, now tonifying, now cooling and nourishing, according to the condition before him. This flexibility and breadth of learning made him the most comprehensive of the four masters and the natural culmination of their age.

His teaching was transmitted by a large body of students and followers, and it shaped the medicine of the Ming and Qing dynasties. Physicians who came after him regarded him as the most balanced and learned of the masters, and his writings were studied as a guide to the whole inheritance of the Jin and Yuan period. His influence on the theory and practice of traditional medicine has been enduring.

Influence and Legacy

The doctrine of nourishing yin, which Zhu Zhenheng brought to its fullest development, became a central theme of later Chinese medicine. It entered the mainstream through the teachings of his followers and influenced the treatment of the diseases of depletion, of aging and of chronic internal disorder. The formulas that he devised for nourishing the fluids and cooling the fire were added to the standard repertoire and are still employed today.

His insistence on studying all the masters and on judging each case individually encouraged a spirit of balance and comprehensiveness that characterised the best medical thought of the following centuries. His writings were consulted by physicians throughout the Ming and Qing dynasties, and his commentaries on the classical texts contributed to the ongoing work of interpreting the ancient canon. Later writers treated his collected works as a guide to the whole inheritance of the Jin and Yuan period, and his reputation as the most learned of the masters endured.

He died in 1358, in the troubled closing years of the Yuan dynasty, having lived through a long period of change and having outlived the founding masters of the medical age to which he belonged. He is remembered as the last of the four great masters and as the physician who gathered their diverse insights into a single tradition, giving Chinese medicine a synthesis that endured for many centuries and continues to be studied throughout the world. His teaching that each case must be judged on its own merits remains a guiding principle of traditional practice.

See also

• Four masters of the Jin and Yuan
• Yin and yang
• Traditional Chinese medicine
• Li Gao