Pang Anshi: Biographical introduction and legendary stories, major works and academic contributions

: ✵Pang Anshi: a physician renowned for several of his medical works. The most widely read of these was a detailed and comprehensive treatise on various kinds of febrile diseases, titled Shang Han Zong Bing Lun (The General Treatise on Cold-Induced Diseases.

龐安時 (Páng ānshí).

Brief Introduction
Chinese Name:	龐安時 (Páng ānshí)	Alias:	安常 (ān cháng)
Popular name:	蘄水道人 (Qí Shuǐ Dào Rén, or Qi River Taoist)	English Name:	Pang Anshi, or Anshi Pang (Given/Sur Name)
Hometown:	QiShui,Qizhou of Song.	Dates:	about 1042-1100 A.D.
Main works:	《傷寒總病論》(Shang Han Zong Bing Lun, The General Treatise on Cold-Induced Diseases) in 6 volumes, 《難經辨》(Nan Jing Bian, or Discussion on the Classic of Questioning), 《難經解義》(Nan Jing Jie Yi, or Interpretation of the Classic of Questioning), 《主對集》(Zhu Dui Ji), 《本草补遗》(Ben Cao Bu Yi), etc.
Representative works:	Shang Han Zong Bing Lun (The General Treatise on Cold-Induced Diseases)

Biographical introduction and legendary stories

Pang Anshi: A famous physician who lived during the Song Dynasty and authored several renowned works. The most widely read of these was a detailed and comprehensive treatise on cold-induced diseases and warm diseases titled Shang Han Zong Bing Lun (The General Treatise on Cold-Induced Diseases).

Pang Anshi (1042–1099 or 1100 CE), also known as An Chang or Qishui Daoren (Qi River Taoist), was a native of QiShui in Qizhou (an ancient toponym of the Song dynasty, corresponding to present-day Xishui County, Hubei Province). He was honored as "Bei Song Yi Wang" (Master Herbalist of the Northern Song Dynasty). Born into a family of physicians, Pang Anshi was intelligent and eager to learn from an early age. His father, a hereditary physician, taught him "Pulse Formulas." As a youth, Pang Anshi remarked, "Reading this book alone is insufficient." He therefore studied other pulse theories found in the works attributed to Huang Di and Bian Que. Soon, he mastered the theories in classical medical texts and developed original insights. Whenever he debated medical topics with others, he consistently prevailed. His father was greatly astonished, as Pang Anshi had not yet reached the age of twenty. At twenty, he suffered an illness that left him deaf. Despite this, he continued studying ancient herbal classics—including Ling Shu (The Spiritual Pivot), Tai Su (The Grand Simplicity of the Inner Canon), and Jia Yi Jing (Zhen Jiu Jia Yi Jing, or The ABC Classic of Acupuncture and Moxibustion)—as well as other foundational medical texts. Owing to his extensive reading, Pang Anshi became thoroughly familiar with the major medical works of his time. He mastered diverse treatment methods and excelled in managing acute conditions. He not only treated patients without seeking personal gain but also invited those seeking care to reside in his home. He personally attended to them until their recovery, after which he bid them farewell. In his later years, Pang Anshi integrated theories from multiple schools with his own clinical experience. He compiled and edited the six-volume medical work Shang Han Zong Bing Lun (General Theory of Cold-Induced Diseases), supplementing and interpreting Zhang Zhongjing’s ideas. The book emphasizes the interpretation of febrile diseases and distinguishes them clearly from cold-induced diseases. Later generations regarded this conceptual advancement as a significant contribution to the development of exogenous disease theory.

Pang Anshi developed a passion for medical texts in childhood and possessed an exceptional memory. He meticulously studied the ancient classics Nei Jing (The Inner Canon), Nan Jing (The Difficult Classic), and Shang Han Lun (The Treatise on Cold-Induced Diseases), along with numerous other medical works. He was deeply versed in diverse classical texts and schools of thought. His rigorous thinking yielded many accurate and penetrating insights into medical theory and practice. He devoted himself especially to cold-induced diseases. His profound study and extensive clinical practice enabled him to apply medicine, acupuncture, or massage with remarkable ease—and with consistently evident therapeutic effects. Yet he remained an independent thinker who did not rigidly adhere to prior doctrines. With boldness and deep reflection, he pursued novel theories and innovations. For example, Pang Anshi established a patient residence—where individuals could stay during treatment—an innovation in the TCM system during the mid–Northern Song dynasty. He also sought to alleviate patients’ burdens by preparing herbal remedies for them. Upholding the belief that “being a physician is not for profit,” he frequently treated patients, and nine out of ten recovered. His exemplary medical ethics remain difficult for later physicians to emulate.

In his writings, Pang Anshi stated: "I have read all the medical texts available to me; among them, Bian Que’s teachings are the most profound. He incorporated his treatment methods into the Nan Jing (The Difficult Classic), though not all details were included—perhaps hoping future generations of physicians would gradually grasp them through clinical practice." Pang frankly acknowledged: "My medical skill derives from Bian Que’s Nan Jing (The Difficult Classic). In clinical practice, judging whether a patient’s condition is treatable aligns closely with the principles set forth in this text." Pang Anshi held that the two most critical pulse positions to observe were “Ren Ying” and “Cunkou.” Pang Anshi composed a 10,000-character treatise entitled Nan Jing Bian (Discussions on the Difficult Classics), intending to transmit his Nan Jing (the Difficult Classic)–based expertise to posterity. He also observed that certain herbs appeared relatively late in historical records and were unknown to earlier generations. People at that time could not distinguish the medicinal properties of these plants. After practical application, however, the herbs were found to be effective. To preserve them for future generations, he wrote a book titled Ben Cao Bu Yi (Addendum to the Materia Medica).

When Pang Anshi fell ill at the age of fifty-eight, his disciple asked him to treat himself. He replied with a smile, "I have received an accurate diagnosis. Moreover, respiration reflects the pulse condition, and my stomach Qi is collapsing—I am about to die." A few days later, Pang passed away peacefully while seated among his guests.

Major works and academic contributions

Pang Anshi was a master of cold-induced disease and conducted in-depth research on epidemic febrile diseases. He was well-versed in internal medicine, pediatrics, and gynecology and possessed extensive clinical experience. He provided thorough analyses of both cold-induced disease and epidemic febrile disease.

Interpretation of the Theory of Cold-Induced Disease: In treating cold-induced disease, Pang Anshi held that pathogenic factors and pathogenesis were the primary determinants. He also considered secondary factors—including constitution, geography, and climate—to inform diagnosis. While he inherited the classical view that severe pathogenic cold was the principal cause of cold-induced disease, he emphasized that its manifestations vary according to individual cases, season, geographical location, and constitutional predisposition. These variations give rise to distinct syndromes: (1) cold-induced disease (cold affection), (2) wind-affection syndrome (Zhong Feng), (3) wind-warm syndrome, (4) febrile or warm disease, (5) diseases caused by dampness (dampness-related disease), and (6) summer-heat disease, these are different syndromes. Drawing upon discussions in the Shang Han Li, he further elaborated on cold-induced disease—primarily recorded in volumes 1–3 of his work, Shang Han Zong Bing Lun. He emphasized that toxic pathogens constitute the common etiological basis of all exogenous febrile diseases. Conversely, he also stressed the importance of underlying constitutional factors and maintained that external pathogenic factors act upon—and are conditioned by—internal deficiencies. Furthermore, he recognized that exogenous diseases are closely linked to seasonal climates, regional geography, and residential environment. For example, when severe pathogenic cold invades the body in different seasons, it may develop into different diseases: (1) cold-induced disease (cold affection), (2) febrile disease, (3) summer-heat pyrexia, and (4) dampness-related disease (diseases caused by dampness)—each accompanied by characteristic syndromes shaped by climatic shifts. Likewise, patients residing in mountainous regions more frequently present with wind affection syndrome (Zhong Feng) and cold-induced syncope; conversely, those living on plains more commonly develop summer-heat disease and dampness-related disorders—demonstrating that disease occurrence correlates strongly with habitat. Pang Anshi treated cold-induced diseases in accordance with Zhang Zhongjing’s principles, yet adapted his methods flexibly, tailoring therapy to individual patients and local environmental conditions. Through extensive clinical practice, he developed a diverse repertoire of therapeutic approaches for cold-induced diseases.

Interpretation of the Theory of Epidemic Febrile Disease: Pang Anshi clearly distinguished cold-induced disease and warm disease as two distinct categories of exogenous febrile disease—differing in etiology, pathogenesis, and treatment. His discussion of warm disease appears mainly in volumes 4–6 of Shang Han Zong Bing Lun. His theory profoundly influenced the later development of the seasonal febrile disease doctrine. Regarding epidemic febrile disease—or warm disease—he classified it into two major types: latent pathogenic Qi (latent pathogens, or warm disease caused by latent pathogens) and epidemic disease (tian xing). Pang Anshi insisted that epidemic febrile disease and cold-induced disease must be differentiated and treated separately—a view that significantly advanced the seasonal febrile disease doctrine in later generations. Although he acknowledged that warm disease falls under the broad category of cold-induced disease in classical nosology, he clarified that its immediate pathogenic mechanism involves cold toxin (Han Du) clashing with Yang Qi. He further identified newly emergent pathogenic influences—including tian xing (epidemic Qi) and abnormal Qi of the four seasons (aberrant seasonal Qi). He discussed two types of acute-onset diseases, and five types of diseases emerging after an incubation period. Pang Anshi observed in his extensive clinical practice that, among epidemic febrile diseases, epidemic heat syndrome may be the most severe and life-threatening—based on analyses of the Zang-Fu viscera and meridian channels found in classical texts such as the Shang Han Zan Bing Lun (the Treatise on Cold-induced and Miscellaneous Diseases) and discussions from Qian Jin Yao Fang (the Supplement to the Invaluable Prescriptions), Drawing upon theories of the four seasons, the Five Elements (the five phases), the channels and collaterals, and the Zang-Fu viscera, he differentiated five types of epidemic heat syndromes—or warm diseases—as follows:(1) Blue-Vein Warm Disease, (2) Red-Pulse Warm Disease, (3) Yellow-Flesh Warm Disease, (4) White-Qi Fox Warm Disease, (5) Black-Bone Warm Disease. These five warm disease patterns are briefly described below:

(1) Blue-Vein Warm Disease: This syndrome manifests during the three months of spring. It originates from the Shao Yin and Shao Yang channels. The liver’s Zang and Fu are simultaneously affected by Yin and Yang toxin Qi. Characteristic symptoms include rigidity and spasm of the back, followed by chills and subsequent fever. It presents in two principal patterns: Deficiency pattern of the Fu-viscera and Excess pattern of the Zang-viscera.

(2) Red-Pulse Warm Disease: This syndrome manifests during the three months of summer. It originates from the Shao Yin and Tai Yang channels. The heart’s Zang and Fu are simultaneously affected by Yin and Yang toxin Qi. Primary symptoms include generalized fever and subcutaneous swelling with pain. It presents in two principal patterns: Yang toxin pathogens invade the Zang-viscera, or Yin toxin pathogens impair the deficient Fu-viscera.

(3) Yellow-Flesh Warm Disease: This syndrome manifests during the 18 days marking the transitional phase between seasons. It originates from the Tai Yin and Yang Ming channels. The spleen’s Zang and Fu are simultaneously affected by Yin and Yang toxin Qi. Characteristic symptoms include heaviness of the head, nuchal rigidity, and generalized stiffness of skin and muscle. It presents in one principal pattern: the excess pattern of the Zang-viscera being hurt by Yang toxin pathogens.

(4) White-Qi Fox Warm Disease: This syndrome manifests during the three months of autumn. It originates from the Tai Yang and Tai Yin channels. The lung’s Zang and Fu are simultaneously affected by Yin and Yang toxin Qi. Clinical presentation varies according to the nature of the pathogen. It presents in two principal patterns: the deficiency pattern and the excess pattern.

(5) Black-Bone Warm Disease: This syndrome manifests during the three winter months. It originates from the Tai Yang and Shao Yin channels. The Zang and Fu viscera are simultaneously affected by Yin and Yang toxin Qi. Symptomatology depends on whether Yin or Yang toxins predominate. It presents in two principal patterns:the Fu deficiency pattern and the Zang excess pattern.

Pang Anshi emphasized heat toxin as a central pathological factor and introduced a novel therapeutic framework for later herbalists managing pestilential disorders. Moreover, he compiled the Pi Wen Yi Lun (Treatise on Pestilential Disorders), which includes specific prescriptions for treating epidemic diseases as well as preventive protocols—thereby embodying his conviction that prevention is paramount in epidemic disease control. Pang Anshi’s systematic explication of warm disease—and, more broadly, epidemic febrile disease—provided foundational insights that profoundly influenced subsequent generations of physicians and the evolution of febrile disease theory.

Books and Works: Pang Anshi highly valued the ancient classic Nan Jing (The Difficult Classic). He wrote and compiled works known in antiquity, including Nan Jing Bian (Discussion on the Classic of Questioning), Nan Jing Jie Yi (Interpretation of the Classic of Questioning), Zhu Dui Ji, Ben Cao Bu Yi, and Shang Han Zong Bing Lun (The General Treatise on Cold-Induced Diseases) in six volumes. Over the years, most of these works have been lost; however, one survives: Shang Han Zong Bing Lun (The General Treatise on Cold-Induced Diseases) in six volumes.

The book Shang Han Zong Bing Lun (The General Disease Theory on Cold-Induced Disease, or he General Treatise on Cold-Induced Diseases) comprises six volumes and was completed in the third year of the Yuanfu era (1100 CE; Yuanfu was the reign title of Emperor Zhezong of the Song dynasty, 1098–1100 CE). Its main content is briefly introduced below: Volume I discusses the preface and diseases of the six channels. Volume II discusses the applicability of various therapeutic methods—such as diaphoresis, emesis, purgation, and moxibustion. Volumes III–V address syndrome differentiation and treatment of cold-induced diseases, along with prescriptions. Volume VI records miscellaneous prescriptions for cold-induced diseases and pregnancy, as well as general acupuncture methods for cold-induced and summer-heat diseases. It also discusses symptomatology and differential diagnosis of cold-induced versus warm diseases, and cautions regarding relapse after remission. The text synthesizes theories from various schools and integrates clinical experience. It is an early specialized commentary on the Shang Han Lun (Treatise on Cold-induced Diseases) and exerted considerable influence. Although compiled primarily to explicate the Shang Han Lun (the Treatise on Cold-induced Diseases), it offers detailed interpretations of syndrome differentiation and treatment for warm diseases. It advanced the novel view that warm diseases should not be treated mechanically using methods prescribed for cold-induced diseases (e.g., diaphoresis or purgation). Moreover, it established numerous new and effective prescriptions for warm diseases and significantly influenced the formation and development of the Warm Disease Theory (the doctrine of seasonal febrile diseases) in later centuries.

References:

1.Pang Anshi: Biographical introduction and legendary stories, major works and academic contributions

Edited:May 18th, 2020