Doctor Yu Jiayan: The Passionate Medical Master of the Ming-Qing Transition — He Founded Classroom Teaching, Wrote Complete Case Records, and Laid the Foundation for Warm Disease Theory

Opening: after Xue Lizhai, here comes the “eccentric genius” of late-Ming, early-Qing medicine

Having just finished the whole Xue Lizhai series, Doctor Luo Dalun says: dear friends, good morning everyone — starting today, I’m going to tell you the story of the famous physician Doctor Yu Jiayan.

💬 Note from Doctor Luo: When did Yu Jiayan live? He was a Ming-dynasty man — a man of the late Ming and early Qing. He was born in the thirteenth year of the Wanli reign of the Ming dynasty (1585). The exact year of his death is uncertain — some say he passed away in his eighties, others in his nineties. His life was fascinating: the change of dynasties, the turmoil of troubled times — he experienced all of it, and those experiences shaped his life profoundly.

A failed scholar under Chongzhen: the dynasty changed, so he went home to practice medicine

Yu Jiayan did not start out studying medicine — he walked the old road: the imperial examinations.

💬 Note from Doctor Luo: He took the examinations during the Chongzhen reign. As you know, by the Chongzhen era things were already in chaos — the Ming dynasty was basically finished. Emperor Chongzhen finally hanged himself on Coal Hill, the Qing army came through the passes, and the dynasty changed. Watching this troubled world, he simply went home and began practicing medicine.

A hot temper and an open heart: he could not stand quacks harming people

In his early years of practice, Yu Jiayan had a very distinctive personality — an explosive temper, yet a blazing devotion to his patients.

💬 Note from Doctor Luo: In his own words, he practiced with “pi gan li dan” — laying open his liver and gallbladder — I am giving you my very heart. His stories are delightful: when a patient had been delayed by a quack, he would go up and all but curse the quack, furious; when a patient trusted a quack instead of him, he wouldn’t leave — he’d stand outside the patient’s door and refuse to go: I must treat you! That’s the kind of person he was — extraordinarily, intensely enthusiastic. As for his personality… I can only use the word “violent.” He did things the rest of us could never do — very direct, very endearing, and he truly gave everything for his patients.

During this period he left behind many case records — the book we are about to discuss, Yu Yi Cao (《寓意草》— “Hidden Meanings”). The cases in this book are basically from his early years of practice. Doctor Luo especially points out: people who become masters already think maturely in their early years — in Yu Yi Cao, his medical thinking was already essentially mature.

Qian Qianyi’s honored guest: a famous doctor in the hearts of the Jiangnan literati

Later, Yu Jiayan left his native Jiangxi and came to the Jiangnan region, where he got along especially well with the literati — many people sought his treatment.

💬 Note from Doctor Luo: Who, for instance? Qian Qianyi — the late leader of the Eastern Forest Party, the man the literary world regarded as a grand master. And whom did Qian Qianyi marry? You probably know this story — he married Liu Rushi, one of the Eight Beauties of Qinhuai. She too was a woman with a story. Qian Qianyi admired Yu Jiayan enormously and always kept up good relations with him — by then Yu Jiayan was already very famous.

Rather than shave his head, he became a monk: in the temple he discovered the word “education”

The fall of the Ming and the Qing entry into the passes affected Yu Jiayan deeply. The Qing court ordered everyone to shave their heads — at that time, refusing to shave meant execution. Yu Jiayan wouldn’t shave. What to do? He became a monk — you want me to shave my head? I won’t. I’ll become a monk instead.

Cultivating himself in the temple affected him profoundly. Doctor Luo explains two levels:

💬 Note from Doctor Luo: First, in his later practice he often used Buddhist thought when treating patients — some of the principles he taught contain Buddhist ideas. This is quite unique — usually we say Chinese medicine is close to Daoism, but Yu Jiayan cultivated Buddhism, so his explanations carry Buddhist thinking. Second, in the temple he discovered a problem: before, he had given his patients his heart and soul — he would almost come to your house and stay the night, waiting for your illness to strike so he could treat you — yet patients often refused him and chased him away. Why? In the temple he suddenly understood — what does a temple do? It gives sermons and lectures on the Dharma, with ordinary people sitting below listening. Education is the key! Yu Jiayan suddenly got it.

The founding father of classroom education in Chinese medicine

When he came out of the temple, Yu Jiayan began running schools — that’s today’s term; at the time it was classroom-style transmission of knowledge.

💬 Note from Doctor Luo: First, he taught disciples — training his own students; second, he explained medical principles to ordinary people. His lectures were called “shang tang” — going up to the hall: the teacher lectured at the front, and below there were discussions and debates; students could ask questions. Yu Jiayan pioneered classroom education in Chinese medicine — this is truly remarkable. Previously, Chinese medicine was one master taking a few apprentices; he opened a school, invited many teachers to lecture, and after the lectures there were debates and student questions. Some of his later books are records of answering student questions and debating with students — people recorded them, and they became books. Works like Shang Lun Pian, for instance, are all foundational texts of warm disease (wen bing) theory, with remarkably clear exposition.

Speaking of warm disease, Doctor Luo especially emphasizes:

💬 Note from Doctor Luo: Later, in the Qing dynasty, Ye Tianshi, Wu Jutong and others systematized the whole warm disease theory — but the earliest ideas were proposed by Yu Jiayan. He laid out his warm disease thinking fairly completely — this is quite impressive. Yu Jiayan pioneered classroom education in Chinese medicine — that’s no small thing! The reason we have TCM colleges today, the reason we can teach Chinese medicine to you through audio — the root of it all can be traced back to him.

Doctor Luo’s reflection: patients don’t believe you because they haven’t accepted you in their hearts

Doctor Luo says he read Yu Jiayan’s books long ago and was deeply inspired:

💬 Note from Doctor Luo: Sometimes patients don’t believe you — you can talk to them ten thousand times and it’s useless; you chase after them, and they won’t take your prescription — they secretly throw it away. What does that mean? It means they haven’t accepted the concepts of Chinese medicine in their hearts. What did Yu Jiayan do? He educated people — he wrote up his lectures, turned them into books, and once people read them, they understood. That’s classroom-style education. I think this is wonderful: only when people accept your ideas can they trust Chinese medicine and use its principles to regulate their bodies. If someone hears “yin-yang and the five elements” and decides it’s absolute pseudoscience, superstition — how could such a person ever take herbal medicine? So Chinese medicine must first let people accept its culture before they can accept its treatment methods — this requires education. Yu Jiayan pioneered this long, long ago — truly remarkable.

Discuss the disease before prescribing: that “complete case record” nobody achieves today

Yu Jiayan pioneered many things. He advocated “first discuss the disease, then prescribe” — in his case records, he insisted on first writing clearly how the patient fell ill, how the disease came about, and how it evolved.

💬 Note from Doctor Luo: He wasn’t like some doctors who look at you without a word and immediately write a prescription, leaving the patient in a fog — and if you ask what’s going on, they say: “Do you understand? If you understand, write it yourself!” That’s the attitude. Not Yu Jiayan — he required his students to write out the patient’s condition clearly: how it came, how it went, how it was contracted, how it progressed — all clearly recorded. That way the patient understands in his heart and can persist in taking the medicine.

In the opening essay of Yu Yi Cao, “Discuss the Disease First, Then Prescribe,” Yu Jiayan wrote that he observed how official households — well-off patients’ families — all handled things: examine, immediately settle the formula, never explaining where the disease came from or what medicine responds to what. And the result?

💬 Note from Doctor Luo: Those quacks got by on flattery — after all, they didn’t need to explain anything to you; you wouldn’t understand the prescription anyway. And when the prescription didn’t work, they blamed the medicine: “This medicine is no good — there’s no good medicine out there.” Yu Jiayan said: it’s not that there’s no good medicine — it’s that you never examined the illness clearly and dared not use it. The right medicine exists; it’s precisely because you never really understood the illness that you didn’t use the useful herbs. He called this a ridiculous affair in the medical world.

So Yu Jiayan required case records to be extremely, extremely complete — Doctor Luo sighs: today I don’t think anyone achieves it; no one in the entire TCM world achieves it.

💬 Note from Doctor Luo: What did he require them to record? Let me show you — the year, month, day and place; the patient’s age; whether the body was fat or thin, tall or short; whether the complexion was white or dark, dry or moist; whether the voice was clear or muddy, long or short; the patient’s demeanor — happy or bitter, how the emotions stood — all recorded; on what day the illness began, what medicine was first taken, what was taken next; which drug worked somewhat, which didn’t — all noted; whether day or night was worse, whether cold or heat predominated; likes and dislikes in appetite, and how much; whether stools and urine were loose or dry, present or absent; in the pulse, the three regions and nine positions — which position stood out as unusual; whether the pulse matched the four seasons; whether the pattern was internal injury, external contraction, or both; where the root and branch lay; which treatment method — sweating, vomiting, purging, harmonizing; cold, warm, tonify, drain — was used; which of the seven prescriptions and which of the ten medicinals; consulting the five movements and six qi — which movement, which qi; which of the five flavors; which decoction as the base, with what modifications; and when the effect should appear — all recorded in detail, so that not a hair’s breadth is off. When the patient sees how reasonable your explanation is, he naturally trusts and follows you, and persists in taking the medicine.

Doctor Luo says: this is the standard of practice, a model of diagnosis in Chinese medicine. A doctor who practices like this can rarely go wrong.

Zhang Jingyue’s “Ten Questions”: ask about all the symptoms, and the results naturally improve

Actually, people who thought like Yu Jiayan existed in ancient times. Roughly his contemporary, slightly earlier, was Zhang Jingyue.

💬 Note from Doctor Luo: Zhang Jingyue also emphasized in his books that inquiry should cover “ten questions” — asking a great many questions covering every aspect of the patient’s symptoms. Let me tell you: if you truly ask a patient about all his symptoms, understand every aspect, and then analyze the illness, you’ll have abundant material — and your analysis will be far more accurate. That is being truly responsible to the patient.

But Doctor Luo also understands the frustration of many TCM practitioners: I see over eighty patients a day, three to five minutes each — when is there time to ask? If I asked all those questions, the whole morning would be gone. What to do?

💬 Note from Doctor Luo: I think this comes from not thinking — from not taking diagnosis seriously enough, with the result that treatment isn’t accurate enough. In my Weibo, there are tens of thousands of private messages asking for help — many from people who went to famous doctors at various hospitals, couldn’t be cured, and got worse the more they took medicine. People say they trust Chinese medicine, but Chinese medicine itself has plenty of problems — we must keep improving. The ancients figured all this out long ago; if you don’t study it and say you have no time — that’s not the way! Think about it: in a TCM clinic, while one patient is being seen, all the others sit queuing outside — a whole morning of sitting, genuinely boring. Print this into an intake questionnaire and let patients fill it in while they wait — do you urinate at night, tick or no; do you fear cold, dare you eat cold food, tick the box — collect the information first. Or build a computer program: scan it in, and the main symptoms and abnormal indicators appear immediately — today’s artificial intelligence can absolutely do this. A skilled TCM practitioner can identify a patient’s main problem within thirty seconds, then take the pulse, look at the tongue, and ask targeted questions — far more accurate. Then you won’t have the situation where a few minutes of pulse-taking alone decides everything, the patient doesn’t get better, comes back next time still uncured, and from then on curses Chinese medicine.

Backbone of the Disordered Slips School + advocate of the “Great Qi” concept: the source of Zhang Xichun’s thought

Yu Jiayan had many treatment methods — he was especially skilled at using Shang Han Lun formulas, and studied the Treatise on Cold Damage very thoroughly.

💬 Note from Doctor Luo: He was one of the famous “cuo jian pai” — the Disordered Slips School. He held that the passages in Zhang Zhongjing’s books had been scrambled by later copyists, so you shouldn’t cling to the original order; instead take each formula as it has come down to us, break it apart, and study its thinking anew — once you thoroughly understand the principle inside each formula, that’s very good. In addition, he was an advocate of warm disease theory — many of his ideas became the foundation of later warm disease doctrine.

And one more point, directly connected to the Zhang Xichun we discussed earlier:

💬 Note from Doctor Luo: Yu Jiayan proposed the concept of “da qi” — the Great Qi. Where did Zhang Xichun’s “sinking of the Great Qi” come from? The Inner Canon mentions it, but it was actually Yu Jiayan who began explaining the Great Qi — Zhang Xichun learned it from Yu Jiayan. So this is a very capable doctor, with his own place in Chinese medicine.

Passing away after a game of Go: the last stone placed, and he was gone

After the fall of the Ming, Yu Jiayan practiced in the Jiangnan region, was especially close to Qian Qianyi, and in the end seems to have passed away at Qian Qianyi’s home.

💬 Note from Doctor Luo: His death was a “zuo hua” — a seated meditation death, the way monks pass away. He practiced a discipline called “bu dao dan” — never lying down: for years he never slept lying down; every night he rested sitting in meditation. This is a discipline ordinary people shouldn’t attempt — practiced carelessly, it makes you cough up blood. He also had a hobby: weiqi (Go), at which he was a master, often matching top players. According to the Changshu county gazetteer, he once played a national champion — they played for three days and three nights; when the final stone was placed and he won, he set the piece down and passed away peacefully, sitting upright. Qian Qianyi regarded him as a Buddha — his body did not decay, and Qian kept it enshrined in a shrine. Later, his relatives in Jiangxi felt this wouldn’t do — the dead should return to the earth — so they brought him back to Jiangxi and buried him.

Closing: one contribution would already be remarkable — he made many

Doctor Luo says he has written about Yu Jiayan’s story before; he was a doctor with tremendous personality, a brilliant mind, and many pioneering achievements in Chinese medicine.

💬 Note from Doctor Luo: Classroom education — right? Complete case records — right? And he pioneered the beginnings of warm disease theory. If a person makes one contribution, I think that’s already remarkable — this one made many. If you study Chinese medicine without knowing about Yu Jiayan, you’re missing a piece. His case records contain a great deal of reasoning — he really did write that way, and of course he couldn’t see many patients in a day — but this is the model, the teaching material for later generations. Some of his case records are vividly written; Yu Jiayan’s personality leaps off the page.

Starting tomorrow, we will tell Yu Jiayan’s case records — they won’t be very long, but we’ll introduce his academic thinking clearly.

💬 Note from Doctor Luo: Dear friends, that’s all for today. Thank you very much for listening. Tomorrow we’ll begin introducing Yu Jiayan’s stories. Thank you, and see you tomorrow!

Compiled from Doctor Luo Dalun’s lecture on the case records of Doctor Yu Jiayan; the cases come from Yu Yi Cao (Hidden Meanings, late Ming–early Qing).