Xiǎo’ér yàozhèng zhíjué 小兒藥證直訣
Direct Determination of Pharmacy and Symptoms for Children by 錢乙 Qián Yǐ (撰), compiled by 閻孝忠 Yán Xiàozhōng (編集)
About the work
The founding work of post-classical Chinese paediatric medicine, in three juǎn, by 錢乙 Qián Yǐ (1032–1113, zì Zhòngyáng 仲陽) of Yùnzhōu 鄆州 (Shāndōng), compiled in present form by his disciple 閻孝忠 Yán Xiàozhōng in 1119 (Xuānhé 宣和 1), six years after Qián Yǐ’s death. The three juǎn are organised as: juǎn 1 — màizhèng zhìfǎ 脈證治法 (paediatric zàngfǔ doctrine, pulse and symptom diagnosis, therapeutic principles); juǎn 2 — jìshū 紀述 (clinical case-histories); juǎn 3 — fānglùn 方論 (prescriptions). The work establishes virtually every distinctive doctrine of subsequent Chinese paediatric medicine: the chúnyáng 純陽 (pure-yang) infant constitution, the doctrine of paediatric biànzhèng 變蒸 (the fortnightly 31-day developmental crises), the systematic application of the Five Phases to paediatric pathology with the characteristic Qiánshì adjustments (gān cháng yǒu yú, pí cháng bùzú, shèn cháng xū 肝常有餘，脾常不足，腎常虛 — liver always over-vigorous, spleen always insufficient, kidney always deficient), and the canonical prescription corpus. The jicheng.tw recension here transmitted is one of the Qīng-period editorial recensions, distinguished by an appended commentary citing the Wǔyīngdiàn jùzhēnbǎn 武英殿聚珍版 (1773 imperial moveable-type edition) as comparator.
Prefaces
The front-matter is the fùfāng 附方 (appended prescriptions) section with an opening editorial note by Xuéhǎi àn 學海案 — the editorial voice of the Xuéhǎi lèibiān 學海類編 (i.e. the 陶越 Táo Yuè / 曹溶 Cáo Róng late-Míng/early-Qīng anthology, the editorial home of one major Qīng-period recension). The àn notes that the Jùzhēnbǎn (the Qīng imperial Wǔyīngdiàn 1773 Sìkù moveable-type) edition has 26 fewer prescriptions than the present recension and contains 20 prescriptions absent from this one, of which 5 (Lóngnǎo gāo 龍腦膏, Zhīchǐ yǐnzǐ 梔豉飲子, Báihǔ tāng 白虎湯, Gōuténg gāo 鉤藤膏, Wèixiāng sǎn 魏香散) are already in Yán Xiàozhōng’s editorial layer, leaving 15 of unidentified provenance. The àn concludes by appending these 15 (or 20) prescriptions for the convenience of the practising paediatrician — Mùguā wán 木瓜丸, Qīngjīn dān 青金丹, Shēngxī sǎn 生犀散, Lóngnǎo gāo, Zhīchǐ yǐnzǐ, Báihǔ tāng, Dàhuáng wán 大黃丸, Zhènxīn wán 鎮心丸, Gōuténg gāo, Wèixiāng sǎn, Liángjīng wán 涼驚丸, Dúhuó yǐnzǐ 獨活飲子, Sānhuáng sǎn 三黃散, Rénshēn sǎn 人參散, Bīngláng sǎn 檳榔散, Huángqí sǎn 黃耆散, Dìgǔpí sǎn 地骨皮散, Lánxiāng sǎn 蘭香散, Fūchǐ lìxiào sǎn 敷齒立效散, Hépí wán 蚵皮丸 — with complete ingredient lists and dosing. The principal author’s preface (typically Yán Xiàozhōng’s 1119 preface) is not in this front-matter segment.
Abstract
The Xiǎo’ér yàozhèng zhíjué is the canonical foundation of Chinese paediatric medicine and is the principal source-text for all subsequent paediatric authors from the Sòng through the Republican period. Its core theoretical innovations: (1) paediatric zàngfǔ doctrine — the systematic application of the Five Phases to paediatric pathology, with the gān yǒuyú, pí bùzú, shèn xū 肝有餘脾不足腎虛 doctrine as paediatric-specific adjustment; (2) the canonical paediatric prescription corpus — Liùwèi dìhuáng wán 六味地黃丸 (the founding zīshèn 滋腎 kidney-yin-nourishing formula, derived from the Sòng Jīnguì Shènqì wán 腎氣丸 by Qián Yǐ’s removal of fùzǐ and guìzhī — perhaps the single most influential modification in the history of Chinese prescription); Dǎochì sǎn 導赤散 (paediatric heart-fire clearance), Xièbái sǎn 瀉白散 (paediatric lung-fire), Yìhuáng sǎn 益黃散 (paediatric pí supplementation), Báizhú sǎn 白朮散 (the Qiánshì variant of Sìjūnzǐ); (3) the doctrine of biànzhèng 變蒸 — the 31-day developmental crisis cycle, repeating ten times to a total of 320 days, during which zàngfǔ organs are sequentially established; (4) the doctrine of paediatric chúnyáng 純陽 — the infant body as constitutionally yang-replete, with the corresponding therapeutic implication of caution in warming prescriptions; (5) the systematic case-history paediatric yīàn 醫案 — juǎn 2 is one of the earliest yīàn corpora in Chinese medicine; (6) paediatric jīngfēng 驚風 nosology — Qián Yǐ’s threefold classification (jíjīng acute, mànjīng chronic, mànpífēng chronic-spleen) is the foundation for all subsequent paediatric polemic on this category. The 1119 date refers to Yán Xiàozhōng’s compiled text; the underlying clinical and theoretical material is from Qián Yǐ’s medical practice between c. 1060 and 1113.
Translations and research
- Hinrichs and Barnes (eds.), Chinese Medicine and Healing: An Illustrated History. Harvard UP, 2013 — chapter on Sòng paediatrics centred on Qián Yǐ.
- 熊秉真 Xióng Bǐngzhēn (Hsiung Ping-chen), A Tender Voyage. Stanford UP, 2005 — extensive discussion of Qián Yǐ paediatric doctrine.
- Catherine Despeux, “L’ordonnance médicale en Chine ancienne” — context for the Sòng paediatric prescription.
- Xiǎo’ér yàozhèng zhíjué jiàozhù 小兒藥證直訣校注, ed. 李景榮 Lǐ Jǐngróng et al. Beijing: Rénmín wèishēng chūbǎnshè, 1985 — standard punctuated edition.
- 巴茂英 Bā Màoyīng et al. (嚴世芸 Yán Shìyún editor-in-chief), Sòng-Jīn-Yuán mìngyǐng yīzhù 50 zhǒng — modern critical edition series.
- No complete English-language translation located. Selective renderings in clinical TCM textbooks (Bensky-Barolet Formulas and Strategies, Eastland Press).
Other points of interest
The Liùwèi dìhuáng wán — Qián Yǐ’s paediatric modification of the Sòng Shènqì wán by removing fùzǐ and guìzhī — is the most clinically consequential prescription in the history of Chinese medicine, in the literal sense that it founded the entire post-Sòng zīyīn 滋陰 (yin-nourishing) therapeutic tradition. 朱丹溪 Zhū Dānxī’s yáng cháng yǒu yú, yīn cháng bùzú 陽常有餘陰常不足 doctrine and the Míng-Qīng wēnbìng (warm-disease) school both descend from Qián Yǐ’s prescription move. The work’s case-history juǎn 2 is one of the earliest extended yīàn (medical case) corpora in Chinese medicine and is a principal primary source for the social history of Northern-Sòng paediatric practice.