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白喉條辨

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Text ID
KR3em020
Date
1893–1909
Dynasty
清

Báihóu tiáobiàn 白喉條辨

Systematic Discriminations on White-Throat Disease (Diphtheria) by 陳葆善 Chén Bǎoshàn (zì Lìān 慄盦 / 慄庵, Liáofǔ 漻甫, late 19th c. – early 20th c.).

About the work

A late-Qīng / early-Republican monograph in fifteen “discriminations” (tiáobiàn 條辨) on báihóu 白喉 white-throat disease (diphtheria), modelled explicitly on 吳鞠通 Wú Jūtōng’s Wēnbìng tiáobiàn 溫病條辨 in form and conceived as a critical refinement of the diphtheria-treatment legacy of KR3em017 Chónglóu yùyuè by 鄭宏綱 Zhèng Méijiàn. The author argues for a unified diagnosis of báihóu as shǒu Tàiyīn zàohuǒ 手太陰燥火 — “Hand-Tàiyīn (Lung) dryness-fire” — caused by latent autumn-dryness qì triggered by externally-imposed early-spring chill, with optional standard-bearer-channel involvement of the Shàoyáng (Sānjiāo) for the biāo 標 wind-fire throat-swelling syndrome and the Shàoyīn (Heart) for the jūnhuǒ 君火 sovereign-fire complications, plus a fully worked out twelve-channel-traversal jiùwù 救誤 (rescue-from-error) clinical playbook for cases that have entered the Juéyīn, Yángmíng, or Tàiyīn zones through mistreatment. The book’s signature formula is the Jiājiǎn Yùshì qīngzào jiùfèi tāng 加減喻氏清燥救肺湯 (the Qīng physician Yù Chāng’s Clear-the-Dryness, Rescue-the-Lung decoction, here augmented with Cornish-American ginseng 西洋參 and large-dose raw gypsum 生石膏), and its emblematic emergency formula is the Sānqì jiànglóng dān 三炁降龍丹 (“Three-qì Subdue-the-Dragon Pill,” with deer-horn / tortoise-plastron / pearl-mother / Rehmannia / Ophiopogon / Asini gelatinum / peony / gypsum / rhinoceros-horn) for the late-stage phlegm-and-wheeze complications in which the lung’s yīn has been exhausted to the point of lóngléizhīhuǒ 龍雷之火 surging upward.

Prefaces

The source preserves three paratexts.

  1. The principal Xù 序 by 陳虯 Chén Qiú (1851–1903; zì Zhìsān 志三), dated Guāngxù 24 / zheyōng yǎnmào lǜzhòng zhònglǚ 著雍閹茂律中仲呂 = 1898, signed at the Zǐzhúlín 紫竹林 quarter of Tiānjīn. Chén Qiú — a major late-Qīng reformist intellectual and the founder of the Lǐjīng yīyuàn 利濟醫院 medical school in Wēnzhōu of which Chén Bǎoshàn was the first graduating physician — frames the work as a definitive systematisation of the autumn-dryness aetiology of the disease. He invokes 喻昌 Yù Chāng (Jiāyán 嘉言), 沈目南 Shěn Mùnán (Zìnán 自南), and 吳鞠通 Wú Jūtōng’s three eighteenth-century formulations of qiūzào 秋燥 doctrine, and corrects Wú Jūtōng’s huàqì wéi shī, fùqì wéi huǒ (“transformation-qì makes damp, return-qì makes fire”) doctrine by adding huà fēng 化風 — observing that when dryness predominates the metal-element overcomes the wood-element, generating wind, and citing the Nèijīng’s “Suì jīn tàiguò, gānmù shòu xié” passage as canonical authority.

  2. The author’s Zìxù 自序 dated Guāngxù 23 / dīngyǒu 丁酉 (1897), summer. Chén Bǎoshàn recounts (a) the prior literature: 陳雨春 Chén Yǔchūn of Húnán’s Dàoguāng-era Báihóu hóuzhèng lùn (the first work to give the disease its received name báihóu 白喉); his fellow-Húnán 張善吾 Zhāng Shànwú / Shàoxiū 紹修’s Báihóu jiéyào (which posits zú sānyīn foot-three-yīn channel involvement and which Chén here rejects); Zhèng Méijiàn’s Méijiàn yīyǔ coda to KR3em017 (correct on the dryness aetiology but “déshī cānbàn” 得失參半); and the anonymous Báihóu zhìfǎ jìbiǎo juéwēi 白喉治法忌表抉微 of 耐修子 Nàixiūzǐ (1888 京師 outbreak). (b) The family disaster of guǐsì 癸巳 spring (1893): Chén Bǎoshàn himself plus his two daughters and a son were all infected within a few days; the eldest daughter survived only after large-dose cold-bitter intervention, the second daughter likewise, but his young son died under the (then-orthodox) yǎngyīn nourish-yīn protocol. (c) The diagnostic breakthrough of autumn 1894: his small daughter (then a year old) developed fúshǔ 伏暑 latent-summerheat with phlegmy wheeze that mimicked the terminal phase of báihóu; the success of large-dose great-cool-and-pungent (Western-ginseng + raw gypsum) therapy in this case finally clarified the biāoběn relationship for him. The treatise was completed c. 1897, lectures-corrected by Chén Qiú at the Lǐjīng school, recast as fifteen tiáobiàn by 胡鑫 Hú Xīn (Chén Bǎoshàn’s pupil and son-in-law of Chén Qiú), and serially published in the school’s medical journal in 1898.

  3. A Bǔyì 補義 (“supplementary statement”) by Chén Bǎoshàn dated Xuāntǒng 1 / jǐyǒu 己酉 (1909), addressing readers who had read the work as a blanket “jìbiǎo” 忌表 (avoid-resolving-the-exterior) tract: Chén clarifies that báihóu uncomplicated by exterior pathogen does indeed forbid resolving-the-exterior, but when there is a clear concurrent exterior pathogen, exterior-resolving therapy must be applied first, with reference to a personal case of his second daughter’s combined damp-summer + báihóu presentation successfully treated with Xiāngrú yǐn 香薷飲 + Zhèngqì sǎn 正氣散 plus raw gypsum and fresh wěijīng 葦莖.

Abstract

Authorship is securely Chén Bǎoshàn 陳葆善 (CBDB id 672132; no dates recorded in CBDB; the standard reference works give a fùzǐ lineage with his more famous teacher Chén Qiú of Wēnzhōu, and active years 1880s–1910s). The composition window from internal preface evidence is firmly 1893 (eldest daughter’s diphtheria) to 1909 (Bǔyì). The first edition is the 1898 Lǐjīng yīyuàn 利濟醫院 serial-journal printing in Wēnzhōu; the standalone monograph follows shortly thereafter.

The work’s principal historical contribution is to relocate the diagnosis of báihóu from the Shǎoyīn kidney channel (where Zhèng Méijiàn had placed it in KR3em017) to the Hand-Tài-yīn lung channel under the zàohuǒ 燥火 dryness-fire rubric, thereby integrating diphtheria into the wēnbìng 溫病 heat-and-dryness epidemic-disease framework of Wú Jūtōng. The fifteen tiáobiàn are: (1) pathogenesis; (2) channel-localisation (defending the Hand-Tài-yīn diagnosis against Zhāng Shàoxiū’s foot-three-yīn diagnosis through point-by-point comparison with the Sùwèn Cìrè and Shānghánlùn channel-disease descriptions); (3) colour (why diphtheria membrane is white — because metal-element / lung-colour is white, and dryness, also a metal manifestation, is white); (4) pulse; (5) Tàiyīn běnbìng symptomatology and treatment (the Jiājiǎn qīngzào jiùfèi tāng); (6) Shàoyáng biāobìng (the Báihǔ qīnglóng tāng 白虎青龍湯); (7) Shàoyīn biāobìng (the Zhūbái shuāngqīng sǎn 朱白雙清散); (8) three-channel combined disease (and the controversial use of cutting / needling to release pent-up dark blood when the biāo is overwhelmingly severe); (9–10) jiùwù rescue-from-error including the signature Sānqì jiànglóng dān for fully developed phlegm-and-wheeze terminal cases; (11) convalescence (the Yǎngzhèng tāng 養正湯); (12) external therapeutics (when to use the Qīnghuángsǎn 青黃散 throat-insufflation powder and when never to); (13) seven detailed prohibitions (no upbearing, no warming-resolving exterior, no large purgation, restrictive use of cutting / needling, sufficient dosing, no excessive use of bitter-drying); (14) detailed critique of Zhāng Shàoxiū’s eleven prognostically-untreatable signs (which Chén argues are all in fact treatable); (15) detailed critique of Nàixiūzǐ’s drug-table.

The book is a foundational monograph for the late-Qīng / Republican-era integration of diphtheria into the wēnbìng doctrinal mainstream, and it directly anticipates the early-twentieth-century convergence with Western bacteriology and serum-therapy. The dating bracket of 1893–1909 captures the entire authorial period.

Translations and research

  • Bridie Andrews, The Making of Modern Chinese Medicine, 1850–1960 (UBC, 2014), discusses Chén Qiú’s Lǐ-jīng yī-yuàn (in which Chén Bǎo-shàn was the first graduating physician) as a key node in the late-Qīng medical-modernisation movement.
  • Liào Yùqún 廖育群’s bái-hóu essays (in Zhōnghuá yīshǐ zázhì, 1990s) treat the Bái-hóu tiáo-biàn as the doctrinal summit of the pre-bacteriological Chinese diphtheria-discipline.
  • Hinrichs and Barnes (eds.), Chinese Medicine and Healing (Harvard, 2013), pp. 344, references the bái-hóu = diphtheria identification and the parallel Sino-Western contestation of diphtheria-powder therapeutics in 1870s colonial Victoria.
  • Modern critical edition: 《白喉條辨》, in 裘吉生 裘吉生 (ed.), 《珍本醫書集成》, and later in 《海外回歸中醫善本古籍叢書》.
  • No standalone Western-language translation located.

Other points of interest

The work’s principal author is the link between the Lǐjīng yīyuàn of Wēnzhōu — late-Qīng China’s earliest modern Chinese-medicine school, founded by his teacher 陳虯 Chén Qiú in 1885 — and the early-Republican TCM-publishing infrastructure (the Yīshè of 裘吉生 Qiú Jíshēng in Shàoxīng). The 1898 publication of the Báihóu tiáobiàn in the school’s medical journal is one of the earliest cases of serial-journal publication of a major Chinese-medicine monograph and represents a significant late-Qīng moment of academic-medical modernisation parallel in shape (though not in content) to the contemporary German-language Behring serum-therapy publications of 1894–1900.

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