The Earliest Medical Literature — The Nanjing (Classic of Difficult Issues)

The Nanjing is a theoretical work of Chinese medicine. Its original title was the Huangdi Bashiyi Nanjing (The Yellow Emperor's Classic of Eighty-One Difficult Issues), in three fascicles. The work is traditionally attributed to Qin Yueren, but according to textual scholarship, it is a work written under a pseudonym. It was likely completed before the Eastern Han dynasty (with some arguing it dates to the Qin-Han transitional period). The book is compiled in a question-and-answer format — that is, a format of hypothetical questions and answers that explain difficult and doubtful issues — hence the title Nanjing (Classic of Difficult Issues). Its contents include such fundamental theories as pulse diagnosis, the meridians and collaterals, the zang-fu organs, yin and yang, disease causes, pathology, the nutritive and defensive qi, acupoints, and needling techniques, while also enumerating a number of disease patterns. The work is primarily focused on basic theory, combined with some clinical medicine. Within basic theory, special emphasis is placed on pulse diagnosis, the zang-fu organs, the meridians, and acupoints. Specifically, Questions 1 through 22 discuss pulse diagnosis; Questions 23 through 29 discuss the meridians and collaterals; Questions 30 through 47 discuss the zang-fu organs; Questions 48 through 61 discuss diseases; Questions 62 through 68 discuss acupoints; and Questions 69 through 81 discuss needling methods. The text's scholarly insights into the mingmen (life gate) and sanjiao (triple burner), as well as its discussion of concepts such as the seven pivotal gates (the seven critical passageways of the digestive tract) and the eight meeting points (the confluence sites of essence qi for the zang, fu, sinews, marrow, blood, bones, vessels, and qi), enriched and developed the theoretical system of Chinese medicine. This classic also explicitly proposes that “there are five types of cold damage” (including wind-strike, cold damage, damp-warmth, heat disease, and warm disease), and offers extensive elucidation on topics such as the five accumulations of the zang organs and dysentery, which have drawn the attention of successive generations of physicians. The entire text is concise in content and exquisitely subtle in its analysis. Among the classical works of Chinese medicine, it is often mentioned in the same breath as the Neijing (Inner Canon) and is considered one of the most important classical medical texts. It has been transmitted in numerous printed editions and annotated versions.