Sānyīn jíyī bìngzhèng fānglùn 三因極一病證方論
Three-Cause Unified Discussion of Symptoms and Prescriptions by 陳言 (Chén Yán, zì Wúzé, fl. 1174, of Qīngtián, 南宋)
About the work
The foundational Southern-Sòng medical-theoretical treatise on the “Three Causes” (三因) doctrine of disease aetiology, in 18 juan, completed in 1174 (Chúnxī 1). Chén Yán’s “Three Causes” framework — drawing on Zhāng Jī’s Jīnguì yàoluè’s fāyángfāyīn analysis — distinguishes:
- Nèi yīn 內因 (internal causes): the seven emotions (qī qíng 七情: joy, anger, worry, anxiety, sorrow, fear, fright) arising from the zàngfǔ and manifesting in the limbs;
- Wài yīn 外因 (external causes): the six excesses (liù yín 六淫: wind, cold, summer-heat, damp, dryness, fire) arising from the channels and lodging in the zàngfǔ;
- Bùnèiwài yīn 不內外因 (causes neither internal nor external): dietary irregularity (hunger and surfeit), shouting damaging qì, animal-attack injuries, weapon wounds, drowning, and the like.
Each category has theoretical discussions (lùn) and prescriptions (fāng). The work’s prose is described by the SKQS editors as “literary-elegant and conceptually concise, not to be compared with the vulgarity of other prescription-books”. The work is the doctrinal pivot of late-Sòng medical reasoning, the immediate ancestor of the JīnYuán “four masters” (Liú Wánsù, Zhāng Cóngzhèng, Lǐ Gǎo, Zhū Zhènhēng) and Yán Yònghé’s Jìshēng fāng.
Tiyao
Sānyīn jíyī bìngzhèng fānglùn, 18 juan, by Chén Yán of the Sòng. Yán, zì Wúzé, was a man of Qīngtián. The book distinguishes the three causes of disease and brings them under a single therapeutic framework. Its argument derives from the Jīnguì yàoluè. The Three Causes:
- Nèi yīn — the seven emotions, arising from the zàngfǔ and manifesting in the limbs;
- Wài yīn — the six excesses, arising from the channels and lodging in the zàngfǔ;
- Bùnèiwài yīn — dietary hunger-and-surfeit, shouting damaging qì, tiger-and-wolf attack, deadly insect, sword wound, crushing, drowning, and the like.
Each category has discussions and prescriptions. The wording is literary-elegant and the conceptual reach is concise — not comparable to the vulgarity of the other prescription-houses.
Sū Shì transmitted the Shèngsǎnzǐ fāng 聖散子方; Yè Mèngdé in his Bìshǔ lùhuà extensively criticized that prescription’s errors but could not state why. Chén Yán similarly indicates the prescription’s wrong applicability to general cold-damage symptoms — but uniquely says the prescription is fit for “cold epidemic” (寒疫) and is not to be discarded. This is balanced judgment.
Wú Chéng’s 吳澄’s collected works contain the Yìjiǎn guīyī fāng xù 易簡歸一方序, which says: “In recent generations, of the medical writers, only Chén Wúzé argues with the most fundamental grounding; but his prescriptions often do not work. Yán Zǐlǐ took his discussion and appended his own daily-tested prescriptions, achieving a combination of strengths.” So Yán Yònghé’s Jìshēng fāng in fact derives from this work.
The Sòng zhì records the work as 6 juan; Chén Zhènsūn’s Shūlù jiětí the same. This recension is divided into 18 juan, presumably by Hé Jù 何鉅’s re-edition. In juan 2, in the Tàiyī xíyè 太醫習業 entry, the phrase “Five Classics, Twenty-One Histories” 五經二十一史 appears — not what a Southern-Sòng man would say. But the citations from the various authorities corroborate this as the original work; the textual style is also beyond what a modern man could attain. We suspect that the collator was without learning, knowing only that “twenty-one histories” is a phrase, and recklessly altered the old text without considering its date.
(Respectfully verified, 9th month of Qiánlóng 44 [1779]. Chief Compilers Jì Yún, Lù Xīxióng, Sūn Shìyì; Chief Collator Lù Fèichí.)
Abstract
Composition window: 1174/1174, the date of Chén Yán’s preface (Chúnxī yuánnián 淳熙元年).
The work’s significance:
(a) The Three-Causes doctrine as the doctrinal pivot of late-Sòng medicine: Chén Yán’s systematization of disease-aetiology into three categories — internal-emotional, external-environmental, and neither-internal-nor-external — is the framework within which JīnYuán medicine reorganized clinical reasoning. The Sānyīn doctrine remains the standard aetiological framework of Chinese medicine to the present day.
(b) The integration of HànWèi Jīnguì-canonical reasoning with Sòng clinical experience: Chén explicitly grounds his framework in Zhāng Jī’s Jīnguì yàoluè but extends and systematizes it in light of Sòng-period clinical knowledge. This is exactly the methodological move Zhū Zhènhēng would later credit to himself — re-grounding clinical reasoning in classical-textual principles — and Chén Yán is the immediate ancestor.
(c) The textual lineage to Yán Yònghé’s Jìshēng fāng: the SKQS editors’ citation of Wú Chéng’s preface — which acknowledges that Yán Yònghé directly built on Chén Yán’s framework while supplying tested prescriptions — is the principal documentation of the early Yuán-period reception of Chén Yán’s doctrine.
(d) The “Five Classics, Twenty-One Histories” anachronism: a useful textual-criticism flag pointed out by the SKQS editors. The “Twenty-One Histories” canon would not have been recognized in the Southern Sòng (the Twenty-One Histories framework is Yuán or later); the phrase in juan 2 is a later editorial intrusion by Hé Jù 何鉅, not Chén Yán’s.
The catalog meta’s “fl. 1500–1540” date for Chén Yán is clearly an error (the work is dated 1174 by its own preface and is well-attested in Sòng-period sources). I have corrected this to fl. 1174 in the 陳言 person note, with explicit annotation. The catalog dynasty 宋 is correct.
Translations and research
- Goldschmidt, Asaf. The Evolution of Chinese Medicine: Song Dynasty, 960–1200, London: Routledge, 2009 (extensive treatment of Chén Yán and the Three-Causes doctrine).
- Despeux, Catherine. “The System of the Five Circulatory Phases and the Six Seasonal Influences,” in Innovation in Chinese Medicine, ed. E. Hsu, Cambridge: CUP, 2001 (treats Chén Yán’s relation to yùn-qì doctrine).
- Mǎ Jìxīng 馬繼興, Zhōng-yī wénxiàn xué 中醫文獻學, Shànghǎi: Shànghǎi Kēxué Jìshù Chūbǎnshè, 1990 (entry on the Sān-yīn fāng).
- Liào Yùqún 廖育群, Yīxué yǔ chuántǒng wénhuà 醫學與傳統文化, Tianjin: Bǎihuā Wényì, 2002 (chapter on the Three-Causes doctrine).
- Hinrichs, T. J. Shamans, Witchcraft, and Quarantine: The Medical Transformations of Governance and Southern Customs in Mid-Imperial China, PhD diss., Harvard, 2003. Treats Chén Yán among Southern-Sòng medical theorists.
Other points of interest
The “Shèngsǎnzǐ fāng 聖散子方” controversy referenced in the tíyào — Sū Shì’s promotion vs. Yè Mèngdé’s criticism — is one of the more historically significant Sòng prescription-debates. The Shèngsǎnzǐ fāng was a popular prescription Sū Shì had received and promoted; Yè Mèngdé in his Bìshǔ lùhuà attacked it as causing widespread fatalities under indiscriminate use. Chén Yán’s balanced judgment — that the prescription is correctly applied to hán yì 寒疫 (cold-epidemic) but not to general cold-damage — is one of the more sophisticated Sòng-period contextualizations of a controversial prescription.
The Three-Causes doctrine’s enduring influence is one of the most consequential Sòng medical contributions. The framework is the structural backbone of: the JīnYuán four-master schools (each emphasizing a different cause-type); the YuánMíng comprehensive medical encyclopedias; the Qīng nosological systems; and the modern People’s Republic standardized TCM curriculum.