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1. The Birth and Death Years of Chen Yan There are different accounts regarding the birth and death years of Chen Yan. In the article "Biographies of Ancient Famous Doctors: Chen Yan" in the 4th issue of the 7th volume of "Shanxi Chinese Medicine" in 1991, Changqing stated: "Chen Yan, courtesy name Wuze, alias He Xi Dao Ren, was from Hexi, Qingtian (now Qingtian County, Zhejiang) in the Song Dynasty. He was born around the third year of Xuanhe in the Northern Song Dynasty (1121 AD) and died in the first year of Shaoxi in the Southern Song Dynasty (1190 AD), living approximately 69 years." According to Changqing, Chen Yan lived through the reigns of Emperor Huizong (Zhao Ji) of the Northern Song Dynasty, Emperor Qinzong (Zhao Huan) of the Jingkang era, and the reigns of Emperor Gaozong (Zhao Gou), Emperor Xiaozong (Zhao Shen), and Emperor Guangzong (Zhao Dun) of the Southern Song Dynasty, spanning five emperors and eight reigns. However, in the book "Research on the Yongjia Medical School" by Liu Shijue, it is stated: "Chen Yan... was active around the Shaoxing and Chunxi periods (1131~1189)." This view originates from the discussion in "A Brief History of Chinese Medicine" by Jia Dedao.

Although the two accounts differ, they are not far apart. It is generally agreed that Chen lived during the late Northern Song and early Southern Song periods, primarily during the Southern Song era. 2. The Native Place of Chen Yan The preface of Sanyin Jiyi Bingzheng Fanglun is signed by "Qingtian Hexi Chen Yan Wuze." Qingtian County, Zhejiang Province, was part of Kuocang County during the Sui Dynasty. It was established in the early Jingyun period of the Tang Dynasty (710 AD) and has been maintained through successive dynasties, named after Qingtian Mountain. Because it was formerly part of Kuocang, some also refer to him as Kuocang Chen Yan. For example, in the "Zhi Zhai Shu Lu Jie Ti" by Chen Zhensun, in the section on "Delivery and Feeding of Infants: Baoqing Ji, Volume One," it is mentioned: "Recently, Chen Yan of Kuocang evaluated its merits and demerits in Sanyin Jiyi Bingzheng Fanglun." In the same book, under the entry for "Sanyin Jiyi Fang, Volume Six," it is stated: "Written by Chen Yan Wuze of Kuocang. The three causes are internal, external, and neither internal nor external causes, a theory derived from Jingui Yaolue. The prescriptions and discussions he presents are often from ancient texts."

In summary, Chen Yan's ancestral home being in Qingtian County, Zhejiang Province was originally beyond doubt. However, recent scholar Liu Shijue has reached a different conclusion in his Research on the Yongjia Medical School after a detailed investigation of the term "Hexi." This has become a new theory, recorded for reference, as stated in his text: "Chen's ancestral home being in Qingtian seems unquestionable, as the Prefectural Gazetteer of Chuzhou, the Qingtian County Gazetteer, the Jingji Fanggu Zhi, and the Chinese Medicine Encyclopedia all clearly document it. The source likely stems from Chen's self-prefaced note in Sanyin Fang, which reads 'Qingtian Hexi Chen Yan Wuze.' However, it is precisely because of this signature that it has been deduced that Chen's ancestral home should belong to present-day Jingning County, Zhejiang Province, rather than Qingtian."

Hexi, also known as Muhexi, is recorded in both the Jingning County Annals and the Qingtian County Annals: 'It is traditionally said that Fu Qiubo bathed his cranes here, hence the name of the stream.' Fu Qiubo, a legendary figure from the time of Huangdi, 'authored the Xianghe Jing (Classic of Crane Physiognomy), and was said to have cranes from Qingtian that he carried with him, thus he lived in seclusion by the Hexi stream, building a platform for fishing.' The area named after the stream includes Muhe Township and Hexi Town. Located more than five hundred li southwest of Qingtian County, it was part of Qingtian County during the Song Dynasty. In the third year of the Ming Jingtai era (1452), the Minister of War Sun Yuanzhen, while inspecting Zhejiang, found the mountainous area difficult to govern and thus proposed the establishment of Jingning County by dividing the Rouyuan and Muhe townships of Qingtian County, with the county seat at Hexi Town...

Today, the city of Qingtian is also named after the crane, as there is Qingtian Mountain to the north of the city. Legend has it that 'a pair of white cranes nest here every year, and their offspring fly away when grown, hence the mountain is also known as Taihe Mountain. Taoist texts regard it as one of the thirty-six sacred grotto-heavens,' also called 'Yuanhe Dongtian, with a circumference of forty li.' The town named after this is Hecheng Town. Thus, Hexi and Hecheng are both named after cranes, but the cranes referred to are not the same. The renowned Song Dynasty physician Chen Wu-zhai is believed to be from Hexi, specifically from Hexi Town in today's Jingning She Autonomous County, Zhejiang Province."

Although Mr. Liu's research is detailed, his premise is that 'Hexi' is a place name. However, there are also records indicating that Chen used 'Hexi' as a pseudonym, and it was not uncommon in ancient times to include both one's courtesy name and pseudonym in the preface of a book. Therefore, the claim that Chen Yan hailed from today's Jingning County, Zhejiang Province, requires further verification. Of course, Liu Shijue stated: 'Chen long resided in Wenzhou, engaged in medical theory research and clinical practice, also teaching students and promoting medical education.' This is credible, as his contemporary, Chen Wu-zhai's friend and student—Yongjia Lu Zuchang—referred to him as 'a fine physician of our hometown,' and Ming Dynasty Yongjia Jiang Zhun also called him 'Yongjia Chen Yan Wuze.' Ancient Yongjia is present-day Wenzhou, Zhejiang.

III. Chen Yan's Works

(A) Books Acknowledged to be Authored by Chen

1. Yiyuan Zhizhi (Six Volumes) Completed in the 31st year of Shaoxing, Xinsi (1161), as mentioned in the preface of Sanyin Jiyi Bingzheng Fanglun: 'In the Xinsi year of Shaoxing, I compiled six volumes of prescriptions for my cousin Ye Jue Bocai, first discussing yin-yang abnormal pulse syndromes, then the causes, annotated Maijing, categorized into eighty-one sections, with several prescriptions, titled Yiyuan Zhizhi. Bocai, while in the capital, intended to have the book published through influential people, but passed away before it could be done.' Additionally, Sanyin Jiyi Bingzheng Fanglun‧Liaojian Zhu Yi Zhengzhi also states: 'In the Xinsi year, I once wrote Zhizhi.' The so-called Zhizhi is an abbreviation for Yiyuan Zhizhi.
2. Sanyin Jiyi Bingzheng Fanglun (also known as Sanyin Jiyi Bingyuan Luncui) in eighteen volumes was completed between the years of Guisi (1173) and Jiawu (1174) during the Qiandao and Chunxi periods, which was 12 years after the completion of Yiyuan Zhizhi. Chen Yan in the "Treatment of Various Epidemics" section of Sanyin Jiyi Bingzheng Fanglun said: "I... until Guisi, again wrote this book." The so-called "this book" refers to Sanyin Jiyi Bingzheng Fanglun or Sanyin Jiyi Bingyuan Luncui, as clearly stated in the preface of Sanyin Jiyi Bingzheng Fanglun: "In Chunxi Jiawu, I again discussed with my friends Tang Zhideyuan and Tang Qingdefu that the essence of medical affairs lies in the three causes, and the initial differentiation of causes does not exceed the pulse. Thus, citing Maijing, it is said that the point before the pass is the master of human life. The left is Renying (ST9), the right is the wrist pulse. For Renying (ST9) indicates external causes, the wrist pulse indicates internal causes. Those not corresponding to Renying (ST9) or the wrist pulse are neither internal nor external causes. If one understands the three causes, there is no hidden aspect of disease. Therefore, it is said that the essence of medical affairs lies in this. Hence, I compiled applied prescriptions, classified into 180 categories, obtaining more than 1050 prescriptions, titled Sanyin Jiyi Bingyuan Luncui." The National Chinese Medicine Book Union Catalog
3. 02959 has recorded this book and provides 22 versions available for consultation.Song Chen Wu-zhai Three Causes Celestial Control FormulaTwo Volumes with Illustrated Explanation Volume One

   National Chinese Medicine Library Union CatalogEntry 03125 records this book, attributed to Song Dynasty'sChen Yan (Wuze) as the author, with Qing Dynasty'sMiao Wen (Fangyuan) as the commentator.The Union Catalogprovides four versions, the earliest being the block-printed edition from the second year of Jiaqing, Ding Si (1797).

(2), Possibly a book written byChenclan

Other suspectedChenclan's books, due to uncertain attribution, remain undecided, hence only their titles are listed for reference. Such works roughly include:Compendium of Materia Medica, Essentials of Women's Health, Maritime Formulas, etc.

1. Compendium of Materia Medica According toLi Jingwei's editedChinese Medicine Biographical Dictionarypage 309: "(Chen Yan) advocated the use of 'name, form, nature, and function' four characters to 'readMaijing, examinedisease origins, deduce formula indications, and summarize materia medica'. During the Qiandao period (1165~1173), Compendium of Materia Medicaused these four characters to itemize and explain drugs. The book does not clearly state the author's name, only having a preface by Daoist Hexi. Based on the content of the surviving entries, it is speculated that it might also be written byChen Yan." Zheng Jinshengalso believes this book was written byChen Yan. In the preface he wrote forLiu Shijue'sResearch on the Yongjia Medical School, he said: "When people praiseLi ShizhenBencao Gangmufor dividing drug descriptions into eight items, few know that 'itemized drug description' was actually advocated byChen Yan, and directly applied inCompendium of Materia Medica."
2. Essentials of Women's Health Japan'sTamba MototsuguChinese Medical Texts Examination (People's Medical Publishing House 1956 edition) page 983 mentions thatMedical Library Catalogonce recorded a book byChen HexiEssentials of Women's Health, with missing volumes.Yan ShiyunGeneral Examination of Chinese Medical TextsVolume 3 page 3862 also records it, but without in-depth examination. SinceChen Yanalso had the alias 'Daoist Hexi', it is listed here for reference. According toMedical Library Catalogby Ming Dynasty'sYin Zhongchun. Jiaxing County Chronicles: HermitsVolume 7 states: Yin Zhongchun, styledDonggao. He lived in seclusionsouth of the city, in a thatched house with reed walls, unbothered by rain, playing the qin and selling medicine, living a simple life. He loved to purchase ancient calligraphy and incomplete books, repairing and collating them. Throughout his life, he was aloof and rarely associated with others, avoiding the prominent.
3. Hai Shang Fang Guo AichunChinese Provincial Medical Records Examination (Volume 1) Page 991, after the entry for "Sanyin Jiyi Bingzheng Fanglun in 18 volumes," it immediately records "Hai Shang Fang Song Dynasty‧Chen Yan. Seen in the 40th year of Jiaqing Zhejiang General Chronicle Volume 55 Art and Literature Records." The above record suggests that Hai Shang Fang might also have been written by Chen Wu-zhai.

IV. Chen Yan's Academic Thought, Methods, and Achievements

(A). Chen Yan's Academic Thought and Methods

Chen Yan's academic method can be summarized in one sentence—using Confucianism to govern medicine, which is most vividly reflected in his Sanyin Jiyi Bingzheng Fanglun‧Taiyi Xiye. He said: "The state appoints officials in civil, military, and medical fields, all for the welfare of the people, and none can achieve this without learning from the ancients. The way of learning from the ancients, though varied, is fundamentally the same. A scholar must read the Five Classics, Three Histories, and the works of various philosophers to be considered learned. For a physician, the classics... histories... philosophers... and various schools... are essential." He completely applied the methods of Confucian scholarship to medicine. Of course, emphasizing the return from breadth to simplicity was his consistent proposition and characteristic, which was related to the historical context of his time. According to Jia DedaoZhongguo Yixue Shilue: "The medicine of the Two Jin and Southern and Northern Dynasties was characterized by the proliferation of 'formulary books,' culminating in the Tang Dynasty's Qianjin Fang and Waitai Miyao. By the Northern Song Dynasty, this trend continued to develop. Taiping Shenghui Fang and Shengji Zonglu are concentrated expressions of this trend. Taiping Shenghui Fang contains 16,834 prescriptions, and Shengji Zonglu exceeds 20,000... This situation not only makes it difficult for patients to choose but also leaves professional doctors often at a loss. More importantly, it severs the theoretical connection between disease and treatment, turning treatment into a trial of prescriptions. This is a very undesirable result of the unlimited development of formulary books... In the Song Dynasty, many doctors sought to correct this tendency in practice, steering the boundless formulary books towards systematic and simplified development. For example, Chen Yan's Sanyin Fang attempted to categorize all diseases into three causes and then treat according to the cause... aiming to systematize the theoretical approach to treatment methods, thereby achieving the goal of simplification." (See Zhongguo Yixue Shilue P142) Yuan Dynasty's Zhu Zhen-hengGezhi Yulun‧ministerial fire discussion (Beijing: People's Medical Publishing House, 1st edition, September 1956, p. 106) commented on Chen Yan with the words "通敏" (comprehensive and insightful), stating: "With Chen Wu-zhai's comprehensive and insightful nature, and his discussion of monarch fire in terms of warmth and vigor (note: 'vigor' should be 'knowledge'), and ministerial fire in terms of daily use, yet not delving deeply, it is no wonder that later generations were not without confusion and blindness, alas!" This is based on the breadth and depth of his scholarship.

1. Extensive Knowledge of Various Schools

   (1). Extensive Reading of Medical Texts

   Chen Wu-zhaiThe extensive reading of medical books can be glimpsed from the discussion in the "Taiyi Xiye" chapter of Volume 2 of Sanyin Jiyi Bingzheng Fanglun, which states: "To be a scholar, one must read the Five Classics, Three Histories, various philosophers, and the Hundred Schools. For physicians, the classics are Suwen and Lingshu; the histories are the various materia medica; the philosophers are Nan Jing, Jia Yi, Taisu, and Zhongzang; the Hundred Schools include Guiyi, Longshu, Jinzu Ciyao, Tongren, nose, Youyou Xinshu, Chanke Baoqing, and so on. If a scholar does not read the Five Classics, how can they understand morality, life, benevolence, righteousness, rites, and music? If a physician does not read Ling and Su, how can they understand the transformations of yin-yang, virtue, governance, and decrees? If a scholar does not read the histories, how can they discern the worthiness of talents, gains and losses, rise and fall? If a physician does not read materia medica, how can they know the names, properties, flavors, and methods of nurturing life and prolonging years? If a scholar does not read the philosophers, how can they uphold orthodoxy and defend teachings, and discern the purity and flaws of knowledge? If a physician does not read Nan and Su, how can they understand the divine, sacred, skillful, and ingenious, and the profound principles and mysteries? If a scholar does not read the Hundred Schools, how can they understand laws, calendars, systems, and the auspicious and inauspicious? If a physician does not read miscellaneous texts, how can they know the pulse, acupoints, bone cavities, and strange diseases and syndromes?" This is just a brief overview, and the books cited also include: Taiping Shenghui, Chengxian Jixiao, Shengong Wan Quan, Taiping Huimin Heji Jufang, Yangsheng Biyong, Yannian Fang, Jingxin Lu, Xu Zhi-caiZhu Yue Yangtai Shangtai Fang, Yuanhe Jiyong Jing, and many others.

   (2) The Exploration of Other Books

   As can be seen from the above, Chen Yan was actually a scholar well-versed in both Confucianism and medicine, so his reading range was certainly not limited to medical texts alone, which is also reflected in his works. Here are a few examples:

   Su ZheLongchuan Luezhi (Ten Volumes): Su Zhe (1039-1112), courtesy name Ziyou, self-styled Yingbin Yilao in his later years, was a native of Meishan, Sichuan, and a famous politician and writer of the Song Dynasty. Longchuan Luezhi was written during his later years in seclusion in Longchuan, Xunzhou, mainly recalling his participation in various political activities throughout his life, but it also includes some Su Zhe personally heard and experienced medical and health-related anecdotes. Therefore, the sources of information are considered reliable.

   Longchuan Luezhi Volume 2 "Discussion on Medical Techniques: Triple Energizer" reads as follows: "There was a recluse in Pengshan who was well-versed in ancient medical techniques, different from the methods used by contemporary physicians, and few knew of him. Shan Xiang studied under him and mastered his techniques, thus becoming famous for his medical skills. During the Zhiping era, I met Xiang in Guangdu, and we discussed the similarities and differences between ancient and modern techniques. Xiang briefly explained his views and then sighed, saying: 'The ancients discussed the five zang-organs and six fu-organs, but some of their theories were erroneous, and these errors have been passed down without scrutiny. If I were to tell people about this now, who would believe me? The ancients said: the left kidney, its corresponding organ is the bladder; the right kidney, Mingmen (GV4), its corresponding organ is the triple energizer, which stores essence in men and connects to the uterus in women. Logically, the triple energizer should be like the bladder, with a visible form, but Wang Shu-he said the triple energizer has a zang but no form, isn't that a great error! The triple energizer has a form like the bladder, so it can store and connect; if it were formless, how could it store and connect? Moreover, why is it called the triple energizer? The triple energizer is distributed in the human body, with differences in the upper, middle, and lower parts. When the mind is calm and desires do not arise, essential qi disperses in the triple energizer, nourishing the skeleton. When desires arise, the heart fire blazes, drawing the essential qi of the triple energizer into the Mingmen (GV4) organ, where it is expelled, hence this organ is called the triple energizer. The world has inherited Shuhe's errors without realizing it, which is truly lamentable.' I was very intrigued by his explanation. Later, when I was an official in Qizhou, there was a scholar Xu Dun, Shi Shoudao's son-in-law, who had studied medicine in Weizhou in his youth and had heard the teachings of Gao Min, and had a profound understanding of treating illnesses. I told him about Xiang's words, and Dun happily said: 'Once, Qi experienced a great famine, and beggars cannibalized each other. There was one person whose flesh was completely eaten away, but his bones and meridians remained intact. Dun, due to his medical studies, went to observe his five zang-organs and saw a fatty membrane the size of a hand below the right kidney, opposite the bladder, with the Erbai (EX-UE2) meridian emerging from it, passing through Jiaji (EX-B2) and connecting to the brain. I thought this was what the conduction exercise practitioners called the Jiaji (EX-B2) double gates (some texts say passes), but I did not realize that the fatty membrane the size of a hand was the triple energizer. Shan Jun's words match what I saw, and they can correct the ancients' errors!'"

   Revisiting Chen YanSanyin Jiyi Bingzheng Fanglun Volume 8 "Clarification on the Triple Energizer as the Essence Organ," the text states: "The ancients referred to the left kidney as the kidney organ, with its associated organ being the bladder; the right kidney as Mingmen (GV4), with its associated organ being the triple energizer. The triple energizer has a fatty membrane about the size of a hand, directly opposite the bladder, with the Erbai (EX-UE2) meridian emerging from its center, and the Jiaji (EX-B2) meridian ascending to connect with the brain. Therefore, the classic says: 'Men store essence, women connect with the womb.' By reasoning, the triple energizer should be as described above, having a visible form. Bian Que however, stated: 'The triple energizer has a position but no form,' meaning that the upper and middle energizers are like foam and mist, and the lower energizer is like a drain, not fully visible, hence it is said to have a position but no form. Yet Wang Shu-he and others, misunderstanding the original intent, hastily claimed it to be formless and merely a name, leading later generations to perpetuate this error. Moreover, a name should correspond to a reality; without reality, what is there to name? If it truly had no form, how could it store essence and connect with the womb? What then is the so-called triple energizer? The upper jiao is at Tanzhong (CV17), internally corresponding to the heart; the middle jiao is at Zhongwan (CV12), internally corresponding to the spleen; the lower jiao is below the navel, which is the motive qi between the kidneys, distributed throughout the body, differing in upper, middle, and lower parts. When a person is tranquil and free from desires, the essential qi disperses within the triple energizer, nourishing all the meridians; but when thoughts arise and desires flare up, the essential qi of the triple energizer is drawn together and flows out, along with Mingmen (GV4), hence this organ is called the triple energizer. Scholars who do not understand this may well sigh in frustration."

   By comparing the two, it is easy to conclude that: Chen Yan undoubtedly derived the factual part of this account from Longchuan Lüezhi, with only slight adjustments made to the order of speech and the details of medical principles. The former vividly and intuitively discusses the reasons, while the latter clearly explains the medical principles in a structured manner.

   Shilin Bishu Lu (2 volumes): Chen YanSanyin Jiyi Bingzheng Fanglun quotes this book in the discussion of the "Sheng Sanzi Formula" in Volume 6, stating: "It is mentioned in Shilin Bishu Lu that during the Xuanhe period, this medicine was highly popular in the capital, especially among the students of the Imperial College, who firmly believed in it, resulting in countless deaths." Shilin Bishu Lu refers to the book Bishu Lu Hua by Ye Mengde (1077-1148), courtesy name Shaoyun, also known as Shilin, from the Song dynasty. Additionally, the book mentions non-medical texts such as Guang Five Elements Ji, Liu Gen Biezhuan, Qian Pu, Dao Zang, and Nei Dian.

   (3) Exchange with Teachers and Friends

   While books are undoubtedly important, exchanging and discussing with knowledgeable scholars, teachers, and friends is a more direct and essential condition for academic progress. This also falls under the category of being well-versed in various schools of thought. Sanyin Jiyi Bingzheng Fanglun‧Preface mentions, "In the Jiawu year of Chunxi, I discussed with my friends Tang Zhi Deyuan and Tang Qing Defu that the essence of medical practice lies in the three causes, and the initial step in identifying causes is through pulse diagnosis. We then cited Maijing, which states that the area before the Guan pulse is crucial for life. The left side corresponds to Renying (ST9), and the right side to the wrist pulse." It is likely that Tang Zhi (courtesy name Deyuan) and Tang Qing (courtesy name Defu) were also knowledgeable in medicine and pharmacology, enabling them to attentively listen to Chen's famous assertion that "the essence of medical practice lies in the three causes, and the initial step in identifying causes is through pulse diagnosis." This is Chen's own account. Later, Lu Zuchang in Yijian Fang Jiumiu stated, "Our local skilled physician Chen Wu-zhai gained insights and wrote... I (referring to Lu) suffered from a strange illness in my youth and, through certain encounters, developed a passion for discussing medicine. Every time I met with Chen, we would engage in deep discussions..." This is an account from someone who exchanged ideas with him. It is believed that such informal yet beneficial academic exchanges were not uncommon at the time.

2. Summarized by the Three Causes

   Chen shi is a physician who combines both practice and theory. Extensive reading and broad knowledge are not his goals; he is a doctor who truly practices "observing the myriad to grasp the one." In his work Sanyin Jiyi Bingzheng Fanglun‧Taiyi Xiye , he states: "To enable scholars to grasp everything at a glance, broad as it may be, if one cannot return to simplicity, how can one know what to follow? What I now present is a collection of the essence of meridians, sinews, and marrow, which is also the way of returning to simplicity." He speaks as he practices, and it can be said that Chen Yan Sanyin Jiyi Bingzheng Fanglun has its theoretical starting and ending points in the two words "three causes," as the saying goes, "The essence of medical practice lies in the three causes." As for the details of his academic characteristics and how he flexibly applies the concept of "three causes" across various diseases, these will be discussed in detail in his academic discussions, and here we only provide a general overview.

   (1) Inherited and developed the etiological theories of Huangdi Neijing and cold-damage disease Zabing Lun, and established the "Three Causes Theory": For related content, see the chapter on "Sanyin Jiyi Bingzheng Fanglun Academic Achievements and Theoretical Contributions".

   (2) In practice, inherited and developed the compilation method of Taiping Huimin Heji Jufang from extensive to concise, closely practical: Fan Xingzhun said in A Brief History of Chinese Medicine: "Chen YanSanyin Jiyi Bingzheng Fanglun although named after the 'Three Causes' of Jin Gui, actually elaborates on the studies of Taiping Huimin Heji Jufang." In fact, Chen Yan not only elaborated on the studies of Taiping Huimin Heji Jufang in selecting prescriptions and using medicines, but more importantly, inherited and developed the approach of Taiping Huimin Heji Jufang from extensive to concise in the rationale of prescriptions. It should be said that the approach from extensive to concise and closely practical was an inevitable requirement of the era of great development and enrichment of Chinese medicine prescription books in the Song dynasty. Chen Yan and his disciples' works met the needs of the era's development.

   (3) Particularly notable is that he established the method of syndrome differentiation based on causes on the foundation of ancient pulse, disease, syndrome, and treatment: Chen Yan said in Sanyin Jiyi Bingzheng Fanglun‧Five Categories General Rules: "All who study medicine must understand the five categories and seven matters. The five categories are pulse, disease, syndrome, treatment, and their causes; the seven matters are the causes further divided into three. Therefore, understand disease through pulse, differentiate syndrome through disease, and apply treatment according to syndrome, then the task is complete. Thus, the Classic says: 'Having this pulse but not this diagnosis is wrong.' Investigate the three causes clearly, do not confuse internal and external, correlate with pulse and syndrome, and achieve perfection." He emphasized the three causes on the foundation of ancient emphasis on pulse, disease, syndrome, and treatment, making it one of the five categories of medicine and three of the seven matters. How did he practice, establish, or construct such a three-cause syndrome differentiation system based on pulse, disease, syndrome, and treatment?

   Jia Dedao provided a rough analysis: "In practice, he also attempted to classify all diseases according to the three causes. For example, the arrangement of this book, apart from the first volume discussing pulse, volumes two to seven are external causes, including apoplexy, cold in the middle, summerheat stroke, dampness stroke, Bi disease, beriberi, common cold, cold-damage disease, dampness injury, diseases caused by five circuits six qi, and pestilence, malaria, hernia, Juebing, convulsive disease, tetanus, etc.; the eighth volume is internal causes, including five zang-organs six fu-organs deficiency and excess cold and heat syndrome treatment, chronic cold, abdominal mass, five fatigues six extremes, qi disease, dysphagia, etc. From the eighth volume onwards, the classification is not very clear, and some diseases such as nosebleed, nine pains, cholera, cough, lumbago, etc., are discussed separately according to the three causes. Obviously, Chen encountered difficulties here. If only speaking generally, all diseases are inseparable from the three causes, which can barely pass, but to classify all diseases according to the three causes is even more unfeasible. Because the occurrence of all diseases is related to internal and external causes, and cannot be isolated to internal or external causes. Moreover, his so-called internal causes, when investigated, are still inseparable from external causes. Because all emotional changes are caused by external social conditions." (See A Brief History of Chinese Medicine P179)

(2) Chen Yan's Academic Contributions and Historical Status

The detailed discussion of the academic achievements of Chen Yan can be found in a dedicated chapter. Here, we hope to examine Chen Yan and his works from a more macroscopic perspective. From a broad historical viewpoint, we must acknowledge that Chen Yan's Sanyin Jiyi Bingzheng Fanglun is not a large collection of medical formulas. However, it is intriguing that Chen Yan not only titled this book with the highly comprehensive name "Sanyin Jiyi" but also firmly anchored its title in the term "Fanglun" (方論, formula discussion), rather than the five branches and seven aspects of pulse, disease, syndrome, and treatment that he frequently emphasized. This, undoubtedly, is a manifestation of the so-called "emphasis on formulas" (重方思想). The idea of valuing formulas and medicinal prescriptions has been consistent throughout history. Briefly stated: the Hanshu‧Yiwen Zhi already had a category for "classical formulas," and Zhang Zhong-jing is a typical representative of the classical formula school; the Sui Shu-Jingjizhi records the Sihai Leiju Fang in 2600 volumes, accounting for the majority of the medical texts in that catalog; the works of Tang dynasty's Sun Si-miao are explicitly titled Qianjin Yaofang and Qianjin Yifang; the Song dynasty's Taiping Shenghui Fang; and the Ming dynasty's Puji Fang are all monumental works. The late renowned Chinese medicine bibliographer Li Maoru from Shanxi once said, "The emphasis on formulas was particularly evident in the Qing dynasty. In China, there were Wang Zi-jie's Jiangxueyuan Gufang Xuanzhu and cold-damage disease Gufang Tong, while in Japan, there were Tōdō's Hōki and Hōkyoku." In fact, the continuous emergence of large-scale formula books is a manifestation of the "emphasis on formulas," and the focus on moving from breadth to conciseness, as well as the attempt to unify and standardize theories to govern various formulas, should also be seen as a necessary and reasonable expression of the "emphasis on formulas."

Certainly, Chen Yan chose a theoretical system for governing various methods based on a comprehensive grasp and understanding of disease patterns, a practical system that starts from the cause of disease. His Sanyin Jiyi Bingzheng Fanglun is precisely the embodiment and result of this attempt, rather than a simple enumeration of clinically effective formulas. From this perspective, Chen Wu-zhaiSanyin Jiyi Bingzheng Fanglun is far superior to his student Wang ShuoYijian Fang. In other words, Chen Yan achieved the examination and selection of various formulas through theoretical reflection and understanding of the patterns of disease. Therefore, while Chen Yan most brilliant discussions lie in his etiological classification and exploration of various diseases, his deeper or ultimate goal is to point out a correct way to apply these formulas. Chen Wu-zhai used his three-cause theory to guide practice and verified the theory with the formulas he selected. Even today, although not all the formulas selected by Chen are commonly used by most clinical practitioners, his effort to understand and grasp the formulas from a theoretical height is a goal recognized and pursued by most clinicians, which may be the value and soul of his book.

Of course, to achieve the unity of disease patterns and formula theory, it requires a great deal of effort to explore and practice from the vast sea of ancient medical books and formula books, a process that is arduous. He said: "In our great Song dynasty, the flourishing of culture is most abundant, difficult to enumerate... Our dynasty's Taiping Shenghui, Chengxian Jixiao, Shengong Wan Quan are all seen in Chongwen, Mingyi Bielu is not just filling a library! To let scholars see everything at a glance, broad as it is, if one cannot return to simplicity, then how to follow. What I now describe is to gather the essence of various meridians and sinews, it is also the way of returning to simplicity."

Where possible, Chen Yan also paid attention to tracing the origins of the selected formulas from a philological perspective. For example, after the decoction method of Toxin-Vanquishing Powder in volume six of Sanyin Jiyi Bingzheng Fanglun, he said: "Chu Yu investigated the formula, knowing it came from Daozang, and narrated: Unless one is an outstanding individual with a will that meets the divine, one would not dare to do this," etc., exploring the origin of the formula. After the decoction method of Angelica and Peony Powder in volume seventeen of the same book, he added: "Yuanhe Jiyong Jing says: Originally the six qi meridians pill, it can dispel wind, replenish labor, nourish true yang, dispel evil heat, moderate the center, calm and harmonize the spirit, and moisten the complexion. Dispels evil cold, warm miasma, seasonal epidemics. Anqi Xiansheng bestowed it to Li Shaojun as a long-term medicine, later Zhang Zhongjing modified it for women with abdominal pain during pregnancy, using four taels of Peony Root, one tael each of Alisma, Poria, Sichuan Lovage Rhizome, two taels each of Chinese Angelica, White Atractylodes Rhizome, can also be made into honey pills for consumption," also with this meaning, although the lineage of Angelica and Peony Powder he pointed out still needs further confirmation. But being able to pay attention to the textual research of formula transmission and changes is also an aspect of his emphasis on formulas. Following Chen Yan's line of thought, a simple textual research can be done on the "Seven Qi Decoction" involved in volume eight of his book. From the novelty of formula comparison, it is not difficult to see Chen's emphasis and prudence on the selected formulas.Sanyin Jiyi Bingzheng FanglunVolume 8 "Treatment of Seven Qi Syndromes" contains two formulas: Seven Qi Decoction and Major Seven Qi Decoction. The text is as follows:

"Seven Qi Decoction" treats zang-fu organs when the spirit and qi do not remain in their proper positions, leading to emotions such as joy, anger, worry, thought, sorrow, fear, and shock becoming stagnant and not flowing, thereby accumulating phlegm and fluids, forming hard masses like clods, causing colicky pain in the heart and abdomen, inability to eat, and intermittent attacks that feel like death when they occur. Pineilia, washed to remove slipperiness, five taels; Ginseng; Cassia; Central Bark; Liquorice Root, roasted, each one tael. The above ingredients are ground into powder. Each dose is four qian, boiled with half a cup of water, seven slices of ginger, and one jujube until reduced by seven-tenths. Strain and take before meals.
"Major Seven Qi Decoction" treats unregulated joy and anger, combined worry and thought, frequent sorrow and fear, or occasional startling, leading to disharmony of the visceral qi, aversion to cold and fever, heart and abdominal distension and fullness, flanking the ribs, blocking the throat as if a roasted mass, unable to swallow or spit out, all caused by the seven qi. Pineilia, washed seven times, five taels; White Poria, four taels; Magnolia Bark, prepared with ginger and fried, three taels; Perilla Leaf, two taels. The above ingredients are ground into powder. Each dose is four qian, boiled with half a cup of water and seven slices of ginger until reduced by seven-tenths. Strain and take before meals.

Among them, "Major Seven Qi Decoction" is actually the Zhang Zhong-jingJingui Yaolue‧Chapter 22 on Pulse Diagnosis and Treatment of Women's Miscellaneous Diseases's "Pinellia and Magnolia Bark Decoction", Jingui Yaolue original text is as follows: "If a woman feels as if she has a roasted mass in her throat, 'Pinellia and Magnolia Bark Decoction' is prescribed. 'Pinellia and Magnolia Bark Decoction' formula: Pineilia, one sheng; Magnolia Bark, three taels; Poria, four taels; Fresh Ginger Rhizome, five taels; Dry cultivated purple perilla leaf, two taels. The above five ingredients are boiled with seven sheng of water until reduced to four sheng. Divide into four warm doses, taken three times during the day and once at night."

Zhao Huaizhou and Jia Ying comrades once pointed out in the article "Preliminary Study on the Lost Formula 'Ginseng Decoction' of Zhongjing" (see Shanxi Chinese Medicine 1998, Issue 5, pages 46~47) that there is a hidden "Ginseng Decoction" in the Cold Damage Disease Treatise, with the following possible composition and preparation method:

"Ginseng, three taels; Cinnamon Twig, three taels; Pineilia, half sheng (washed); Dried Ginger, three taels; Chinese Date, twelve pieces (crushed); Liquorice Root, two taels (roasted). The above six ingredients are chewed, boiled with seven sheng of water until reduced to three sheng. Strain and take warm, one sheng per dose, three times a day."

This formula is essentially the same as the "Seven Qi Decoction" in Sanyin Jiyi Bingzheng Fanglun. Considering that Zhang Zhong-jing mostly named his formulas by listing all or part of the ingredients, we have reason to believe that not only is the "Major Seven Qi Decoction" recorded in Sanyin Jiyi Bingzheng Fanglun a formula of Zhongjing, but also the accompanying "Seven Qi Decoction" might be a formula of Zhongjing, only that both formulas had their names changed when included in the Cold Damage Disease Miscellaneous Diseases Treatise. The "Seven Qi Decoction" was renamed "Ginseng Decoction"; the "Major Seven Qi Decoction" was renamed "Pinellia and Magnolia Bark Decoction".

If the above考证 is accurate, and Chen Yan was able to compare and identify the two related formulas of 仲景—Pinellia and Magnolia Bark Decoction and Ginseng Decoction—without having seen the relevant文献资料 of the selected "Seven Qi Decoction" (i.e., the lost formula "Ginseng Decoction" of 仲景), it would be quite remarkable. This is because he essentially affirmed the同源性 of the two formulas from a theoretical perspective. His student 王硕, when mentioning this in 易简方‧Four Seven Decoction, said: "(Four Seven Decoction) is also known as Magnolia Bark Pinellia Decoction (仲景 formula name) and Major Seven Qi Decoction (Chen Yan formula name). Taiping Huimin Heji Jufang contains Seven Qi Decoction, which uses five taels of Pinellia, one tael each of Ginseng, Cinnamon Bark, and Liquorice Root, decocted with water for oral administration." Although he also compared the药物组成 of the "Seven Qi Decoction" from Taiping Huimin Heji Jufang, which is similar to the lost formula Ginseng Decoction of 仲景, with "Major Seven Qi Decoction" or "Four Seven Decoction," he did not mention his teacher's Sanyin Jiyi Bingzheng Fanglun, for reasons unknown. From the Song and Yuan dynasties onward to the Ming dynasty, Zhang Jie-bin in Jingyue Quanshu‧古方八阵‧和阵 listed the 54th formula as "Seven Qi Decoction" and the 48th as "三因 Seven Qi Decoction," also mentioning 三因 in one instance while avoiding it in another.

In summary, we believe that Chen Yan and his Sanyin Jiyi Bingzheng Fanglun are not only the founders of Chinese medicine etiology and the methods of syndrome differentiation in Chinese medicine, but also a unique gem in the academic medical field of "heavy formula thought."

V. Chen Yan's Disciples

According to Jia Dedao in his Brief History of Chinese Medicine, it is recorded: "Wang Shuo, courtesy name Defu, a native of Yongjia. He is said to be a student of Chen Yan, and once held a minor official position as 'Chengjielang, Supervisor of the Wine Tax Office in Fuyang County, Lin'an Prefecture.' His works include Yijian Fang in one volume... After its publication, the book had a significant impact. According to Liu Chenweng, 'Since the Yijian Fang was circulated, the four large formulas were abandoned, down to Sanyin, Baiyi, and various organ formulas were abandoned, even Taiping Huimin Heji Jufang was abandoned.' Later, there were Sun Zhi's Revised Yijian Fang Theory, Lu Zuchang's Sequel to Yijian Fang Theory, Shi Fa's Sequel to Yijian Fang Theory, and Xu Ruoxu's Yijian Guiyi, etc. Although opinions varied, they were all responses to this book. A small work causing such a great stir is relatively rare in the history of Chinese medicine."

Additionally, according to the Song Dynasty's Lu Zuchang from Yongjia in his Corrections to Yijian Fang, it is recorded: "Among the seventy or so disciples who followed the master, most did not enter the inner circle, only copying the master's work Sanyin and considering their learning sufficient, claiming to cure all diseases and leaving, hence their short lives and lack of fame. Shuo, although once a student of the master..." This provides a glimpse into the fact that Chen Yan used his Sanyin Jiyi Bingzheng Fanglun as a teaching material for his disciples. Moreover, Lu Zuchang's description, "The master valued people over wealth, was dedicated to ancient teachings, thoroughly understood principles, established theories, and formulated prescriptions. His pulse diagnosis was as insightful as Lu Bian drinking the water of the upper pool and discerning the three causes; his treatments did not require Hua Tuo's surgical methods to distinguish the four treatments. I suffered from a strange disease in my youth, and through our encounters, I became obsessed with medical theory. The master, at every meeting, would engage in deep discussions, considering the changes in the universe, the alternation of seasons, the transformations of qi, and the myriad ways diseases arise, exploring the profound mysteries." not only vividly portrays Chen Yan but also introduces his interactions with Chen Yan, making it a rare historical account. It should be noted that there is relatively accurate historical evidence confirming that Chen's disciple was indeed Wang Shuo, while Lu and Chen had a relationship that was both mentor and friend.

Recently, Liu Shijue authored a book titled Research on the Yongjia Medical School, published by Chinese Medicine Ancient Books Publishing House in May 2000. The book provides detailed and meticulous research and introduction to the disciples of Wang Shuo and their works, represented by the Chen family. He slightly expanded the scope of the named disciples of the Chen family, which, although speculative, is not entirely impossible. Below is a summary of the key points:

During the Chunxi to Chunyou periods of the Southern Song Dynasty, approximately between 1174 and 1244 AD, which coincided with the peak of academic activities of Liu Wan-su, Zhang Zi-he, Zhang Yuan-su, and Li Dong-yuan in the north, and the formation of the Hejian and Yishui schools, the Wenzhou region of Zhejiang in the south also saw the emergence of the "Yongjia Medical School" led by Chen Wu-zhai, with Chen's disciples Wang Shuo, Sun Zhining, Shi Fa, Lu Zuchang, and Wang Wei as the backbone, Sanyin Fang as the theoretical foundation, and Yijian Fang as the academic center. Chen Wu-zhai became the founder of the Yongjia Medical School because, in addition to practicing medicine and helping the world, he also wrote books, taught students, and had more than 70 disciples after the completion of Sanyin Fang. Most of the physicians of the Yongjia Medical School were either direct disciples of Chen or privately admired his teachings. Lu Zuchang had a deep relationship with Chen Wu-zhai, and the two engaged in long-term medical discussions, with a relationship that was both teacher-student and friend-like.

The representative figures and works of the "Yongjia Medical School" also include: Wang Shuo's Yijian Fang, Sun Zhining's Zengxiu Yijian Fanglun and Cold-Damage Disease Summary, Shi Fa's Xu Yijian Fanglun and Chabing Zhinan, Lu Zuchang's Yijian Fang Jiumiu, and Wang Wei's Xu Yijian Fangmai Lun, among others.

Wang Shuo inherited Hejiju Fang's research direction of returning from complexity to simplicity, and he went even further in seeking simplicity and ease. However, he did not inherit Chen Wu-zhai's fundamental method of "reducing complexity by grasping the essentials." He "reduced complexity" without "grasping the essentials," lacking the thought and means to manage complexity with simplicity, and made no theoretical innovations or methodological improvements. Therefore, his Yijian Fang has inherent methodological flaws; Sun Zhining compiled Zengxiu Yijian Fang Lun , wrote Cold-Damage Disease Brief , and did a lot of work for the publication and dissemination of Yijian Fang , becoming a key supporter of Wang Shuo among the Yongjia medical school; Shi Fa ... in the third year of Chunyou, Guimao (1243), wrote Xu Yijian Fang Lun , addressing the various shortcomings of Yijian Fang , correcting its mistakes, and supplementing its deficiencies. ... Shi was proficient in pulse diagnosis, emphasizing the differentiation of the deficiency and excess, cold and heat of diseases, so his criticism of Yijian Fang mainly focused on Wang Shuo's neglect of pulse manifestations and the lack of emphasis on syndrome differentiation; by supplementing treatment methods and formulas based on criticism and syndrome differentiation, he improved the overall understanding of syndrome differentiation and treatment. ... This objective and calm academic debate, free from personal bias, enriched the content of Yijian Fang and formed the academic center of the Yongjia medical school, promoting the development and progress of medicine at that time; Lu Zuchang was vehement in speech but lacked sufficient reasoning, far inferior to Shi Fa , who was calm and well-reasoned, "correcting its mistakes and supplementing its deficiencies." Therefore, although Lu was older than Shi , people referred to Shi , Lu , and Yijian Fang Jiuliu could only serve as an appendix to Xu Yijian Fang Lun , republished as Xu Yijian Fang Lun Houji ; Wang Wei Xu Yijian Fang Mai Lun differed from many Yijian Fang works that focused on the organization and application of formulas, forming its own system with unique characteristics. Though not extensive, it was "small but complete, with all five zang -organs," forming a complete content of principle-method-recipe-medicinal and a theoretical system centered on diagnostic methods and treatment approaches.