West often views TCM as a single identifiable coherent system, but this is not historically true. West often concentrates on one of many different conceptualized systems of medicines, that of systematic correspondences, and neglects changing paradigms within Chinese thought and plurality of different opinions. Example of this kind of representation in the west is from Manfried Pokert, who stresses those aspects of TCM that offers superior effects over West techniques that he views as inadequate due to over reliance on causation and deductive reasoning. Other approach used by West stress linear development of scientific "truth" so early development of "scientific" ideas in China seem to predict later developments in medicine. Example is work of Needham. Final approach is through medical anthropologist who study individual practitioners in the field, depicting "medicine as a cultural system". This can greatly simplify results in a vast and complex country. In China there have existed different conceptualized systems, some overlapping, some antagonistic, all of which represent Chinese culture. This suggests a historical approach might be optimal. Since 1500 BCE Chinese have practiced:
- oracular medicine
- demonic medicine
- religious healing
- pragmatic drug therapy
- Buddhist medicine
- medicine of systematic correspondences,
- Western medicine.
Not practiced in linear succession, but rather in diverse and long -lasting fashion. New mixed with old. Must consider the core paradigm of a practice - which explains the illness, and the "soft" edges of practice. In China two basic paradigms seem to underlie Chinese medicine:
Both of these views have impacted Chinese medicine, not just Yin Yang and 5 elements.
When comparing different medical traditions within and between cultures, must identify contents of different systems and determine if they have any social significance. Use a 4 step method:
Shang Culture: Illness and Healing
History of this time compiled during subsequent Zhou (Chou) dynasty, but influenced by politics of time. Lots of archaeological evidence, especially inscribed bones and tortoise shells. Culture based on agriculture and livestock. Most people live as peasants in Stone Age conditions. Community consists of live and dead. Ancestors rule world, but depend on living for provisions. Ti supreme or divine ancestor who provides harvest and military help. Need to ascertain through auricle the will of Ti. Lead to scapulimancy (See History of Science - East).
Response to illness: Evidence deals mostly with upper stratum view of illness. They had an awareness of illness and notion of disease. Disease: deviation (from a normal state) within a specific set of ideas concerning causation, character, and treatment of illness as conceived by people. Imply that illness may be manifested differently in different cultures. For example a Western heart attack might be "blow of a demon". Shang familiar with different forms of illness, but recognize just few diseases - most important - Curse of Ancestor, which had symptoms like toothache, headache, leg pain, etc. Poor harvest and misfortune in war considered symptoms of same disease - "curse of ancestor".
Oracle inscriptions show 3 cause of illness:
Include wu shamans which pacify evil winds. Since basically only one type of disease, need unique healer, who did not direct attention to patient and carry out therapy. Shang only required social therapy - to adjust relationship between two groups, living and dead. King alone, or diviners in his service, could consult ancestors and interpret auricle. Therefore he was sole practitioner of ancestor therapy. Extent to which rest of population participate unknown.
Zhou Period: Demonic Medicine
Zhou conquer Shang. Developed agricultural skills, including irrigation. Zhou period many parallels to Western feudalism. Rulers subdivide area into 1000 districts. Throughout the Zhou period, area plagued by wars and hostilities among individual states, and foreign invaders. Patricide, fratricide within ruling families,and moral decay made it one of the bloodiest periods in China history. Eventually few large states reemerge.
As result partly of new inventions and technology (production of iron and salt), monetary economy, and mobile population, first one state then another gained power and prestige. Led to tensions and Period of Warring States, just before unification. Horrific slaughtering of people, led to complete annihilation of enemy. As early as Warring States, medical ideas that gained acceptance were those viewed as consequences of contemporary political conditions and social structures, namely demonic medicine. But also during this period, ideas started to develop that influence people after fall of Zhou and start of unification, namely Yin/Yang and 5 Element theories, as well as Taoism and Confucianism.
Concept of Demonological Therapy: Although still practiced divination, diminished significance of ancestors, which was replaced with ideas that demons partly or fully responsible for misfortune, including illness. Adopted wu - group of shaman-like practitioners, believed to have magical powers. Pictograph indicates dancer, who probably tried to bring rain to Northern China. Wu also try to reduce violent storms and excessive rain. During Warring States period, system of communication between ancestors and living broken down; led to creation of demon myths. Wu practitioners utilized contacts with deities to restrain spirits and demons. Practiced exorcism.
Like ancestor therapy, demonic medicine based on belief in existence of beings, visible and invisible, that inhabit universe. Unlike Shang, no longer any direct connection between individual and demons. Also, adherence to social conventions no longer protect individual from future adversity.
Practice of Demonological Therapy: Little info. available. Probably passed down orally. Practitioners tried to keep skills secret. Used exorcisms, prisoner sacrifice, incantations, other magical attempts. Used medicinal drugs to expel or destroy demons , and continually refined in subsequent centuries. "Classic of Interdictions" (Chin-ching) by Sun ssu-miao - oldest collections of demonic spell medicine. Exorcist or sufferer seek alliance with supernatural authorities. In addition used acupuncture - in 5th cent. BC, exact location of 13 points (demon camp, demon hearts, demon path, demon bed, demon hall, etc.) for treatment of demon-related illness
All of these methods for prevention and treatment of illness (caused by demons) became permanent part of medical care in China and continued to be practiced today. Popularity caused not so much by popular Taoism and Buddhism, but rather in prevailing social atmosphere of uncertainty which made them attractive to the rural population until present century.
Concept of Ku: Demonic forces transformed in regional and cultural fashion to fit experiences of groups. Example is ku, which described as cause of illness, but also in preventative and therapeutic applications. Ku, a worm spirit, offers a great example of how a parasitic infection, transformed by demonological concepts, developed into explanatory model that convinced educated and uneducated for centuries.
Ku in Chinese literature: A human host fills container with poisonous insects, worms, or snakes, and after 100 days, they destroy or devour one another until only one remains. Assume survivor contain poisons of all. Then place this animal with another into a vessel where they ate. The seed of the male floats to the surface and makes ku poison. Host picks up seed with eye of needle and must find a person whom he can administer the ku seed in food or drink. When they do, it develop into worms, which gnaws at victim, produces pain, swollen abdomen, emaciation, and death. Proof of ku poisoning when worms crawl from corpse. As a reward for finding ku parents and a secondary host in which seeds can mature, ku spirit presents primary host with all possessions of deceased. If person can't find secondary host within one day, or if he permits harm to befall the ku spirit, he is killed by the ku spirit. Hence primary host might have to find relative in own household. Only one way to rid oneself of obligations of ku spirit. Must gather in a blanket a large amount of valuable objects (gold, silk, silver) and the ku spirit and leave it in a field. If person finds it and can resist taking it home, he is new host.
Nature of ku poisoning change over centuries from an internal threat to conflict between Chinese and less civilized neighbors. Chinese children most likely victim of poisoning by non-Chinese people. Eventually stigma placed on those who where wealthy and clean, since they had possibly achieved position by use of ku. Ku viewed as reality as late as the 1800's. Primary host considered criminal. If prepare and administer ku, were executed, occasionally with whole family.
Concepts of demonic medicine mirror human experience during period of Warring States. Increasing amorality and uncertainty of existence reflected in way different ages perceive nature of illness and prevention, treatment.
Unification, Confucianism, and the Medicine of Correspondence
Medicine of correspondence reflects ideas and sociopolitical structures resulting from efforts to overcome chaos of Warring States and conditions during unification. Conceptual framework of medicine of systematic correspondence derived from 5 main features (as well as certain aspects of Confucianism):
PARADIGM OF CORRESPONDENCE
Two sets: magical and systematic. Both based on principle that phenomena of visible and invisible world stand in mutual dependence through association with certain lines of correspondence. Manipulate one element in specific line of correspondence can influence other element in same line. Lines of magical correspondence are usually separated from each other and can't exert systematic mutual influence. However, magical concepts refined and combined with elements from Yin/Yang and 5 elements and all lines of correspondence integrated into one detailed system of correspondence.
Magic Correspondence: China shares with other cultures belief in magical system of healing. Two kinds
Systematic Correspondence: During last centuries of Zhou, realized that most if not all natural occurrences and abstract concepts can be incorporated into single system of correspondence, basis of which provided by Yin/Yang and 5 element Theories. Both could be considered logical and systematic extensions of homeopathic magic. This rose to conceptual dominance in Chinese natural philosophy of systematic correspondences, using holistic and inductive thinking, one of most decisive periods of Chinese intellectual history. Distinct feature of emerging Greek and Chinese philosophy in last half of last millennium BCE was attempt to explain phenomena of world as natural occurrences without referring to mysterious forces such as Gods or ancestors.
4th cent. BCE realization that world dualistic and complementary. Natural events explained by model of ceaseless rise and fall of opposite yet complementary forces - Yin and Yang (See History of Science - West). Oldest text applying Yin/Yang to medicine is Huang-ti nei-ching or The Yellow Emperor's Classic of Internal Medicine (or Nei-Ching). Collections of 81 treatises, early ones dating from 2nd cent. BCE. Several schools developed. One offered 4 fold subcategorization by dividing yin and yang into yin and yang subcategories. Applied to seasons. Summer pure yang, yin phase of winter emerge with remaining yang phase of summer. Second school, 6-fold subcategories. (Ex: great yang phase, minor yang, and yang brilliance phase for yang.) Both contradict each other but both reject 3rd school, 5 Element theory. Shows important feature of Chinese medicine. Whenever antagonistic subparidigms arise within one major paradigm, resulting contradictions never resolved as in West. Not resolved in a dialectical sense, in that synthesis achieved from thesis and antithesis, or in revolutionary sense (Kuhnian) in that more successful thought dominate until new paradigm shift. Instead build bridges to reconcile opposing views and permit practitioners to use all concepts available. The Huang-ti nei-ching presents all schools of thought. For example book resolves problem of even number of Yin/Yang categories with odd number of 5 phases in that one of 5 phases recognized as being central or neutral.
Tsou Yen (about 350-270 BCE) generally viewed as creator of 5 element (or phase) theory that influenced systematic correspondences and medicine. Chose 5 lines of correspondence. Didn't use abstract terms but rather tangible natural phenomena: metal, wood, water, fire, and earth. Easy to understand foundation for the 5 lines of correspondence, while conveying number of mutual relationships among various lines. Best know of the total of 16 are relationships of mutual destruction: water overcomes fire, fire melts metal, metal overcomes wood, wood overcomes soil, soil overcomes water; and mutual generation: water produces plants and trees, wood brings forth fire,fire produces ashes (soil), soil brings forth metal, when heated, metals produce steam - water. Actually term 5 element should be avoid, since better translation 5 phases, to reflect dynamic motion. Chinese did refer to "elements" which included the five above and one more, grain.
Different schools shared belief that number 5 underlies natural phenomena. Different opinions arose about assigning occurrences to specific categories. Certain elements associated with one of 5 possible categories unambiguously. For rest, subjective. In Han period, some saw inconsistencies and contradictions and rejected entire system. Best known critique by Wang Ch'ung (1st cent. ACE). But these voices ignored. Became a part of Confucian philosophy, so didn't recognize critiques.
Dominated for 2000 years and made the medicine of systematic correspondence the official and orthodox system of healing for 2000 years. Confucianism oriented completely around organization of earthly social life. In place of divine or other transcendental laws, Confucian political doctrine incorporated theories of Yin-Yang, and especially the 5 Elements (Phases), to explain social and political changes. Link 5 elements and conquest to change (new phases) in ruling houses - Mandate of Heaven. Conduct of emperor could stimulate growth of trees, storms, etc. Each dynastic history in Confucian China includes chapters describing exceptional events and usually occurrences of past Link sociopolitical ethical norms with natural philosophy of 5 Elements.
FUNDAMENTAL PRINCIPLES OF MEDICINE OF SYSTEMATIC CORRESPONDENCE
Last 3 cent. BC, develop system of healing whose theoretical principles correspond to social-political order of Confucian ideology. Therefore this system of healing and its development, continuously depended on Confucianism. System influence by demonic medicine, theories of Yin-Yang and 5 Elements, homeopathic magic, and structural features associated with unification.
Demonic Influences/Political Influences: Body "hit" (chung) by outside agent; it possesses "guards" (wei) to deal with intruders. Internally, if one component shows signs of weakness, others "subdue" (k'e) neighbor or "seize" (ch'eng) territory. Forces "evil" (hsieh) if they invade territory other than their own. Diseases occasionally caused by "malevolent" (factors), but mostly "evil" used for pathogens. But meaning of old terms changed. Evil not embodied by demons, but rather abstract and empirically visible influence and emanations. New designation for influences and emanation in medicine of systematic correspondences is ch'i. Hence forth, agents of illness not represented by hsieh-kuei ("evil demons") but rather by hsieh-ch'i ("evil influences or emanations). Demonic medicine based on view that people constantly subject to action of demons; medicine of systematic correspondence assume people live in harmony with influences and emanations of all natural phenomena. Parallel skepticism of Confucius regarding demons.
CONCEPTS OF WIND AND CHI
Consider change in belief of disease causing wind - transition from demonic concepts to ideas of influence originating from natural environment. End of 3rd cent. BCE, divination developed that didn't use tortoise shells or milfoil, but based on observation natural phenomena, mostly with wind and rain. Wind was perceive as demon in 2nd cent. BCE, but alternative arose: Wind exclusively natural phenomena but portent of future activated as response of heavens to travel of Tai-i, head of demon spirits. Tai-i soothsayers used belief in 8 palaces in 8 directions of compass which Tai-i occupy on "pa-cheng" dates. If wind on these days come from where Tai-i residing, called wind of repletion and was auspicious omen. If from opposite direction, wind of depletion, unfavorable. Used for divination not just about agriculture (which likely could be correct) but on military affairs, etc.
Medical applications derive from this. EX: inevitability of illness if someone struck by depletion wind. Maybe can escape demons but what about wind? Knew some illnesses were major vs. minor, some stay healthy, and some get ill without wind exposure. Idea develop that severity depend on both winds of repletion and depletion both in environment and within self. The San-hsu-san-shih first to suggest that it is condition of organism the predispose someone to injury from wind. Susceptibility depend on 3 things:
If all 3 befall one at the same time, greatest vulnerability to depletion wind So far wind not connected to system of correspondence or Yin/Yang. Changes in Huang-ti nei-ching. Organism and illness integrated in yin/yang categories. For first time, wind appear as illness restricted to yang region of body, and new term for corresponding injury to yin region - pi. Eventually wind liberated completely form demonic basis and integrated into nature-based system of correspondences. In T'ai-su, two essays clearly integrate wind into systematic correspondence of yin/yang and 5 elements. Also wind new designation of illness themselves that are caused by wind.
In Han and pre-Han eras, spirit or demon wind reside in caves, tunnels, valleys, etc. Term feng-hsueh used for wind caves. hsueh used in acupuncture literature to designate holes in skin through which chi able to flow in and out.
In addition to wind as pathogenic agent, a more general and comprehensive concept was introduced, namely of environmental influences that affect organism from from outside but are present within organism as well. Environmental influence designated by word chi. Character chi consist of two distinct segments: a pictogram indicating "rising vapor" placed above the pictogram of "rice" or "millet". Entire character could be read generally as "vapors rising from food". At same time in Greece, Hippocratic medicine developed central concept of pathogenesis, translated as vapors rising from food as well. Probably coincidental, but noteworthy. But pictogram chi in China in 3rd and 2nd cent BCE used in broader context. Meanings included: that which fills the body; that which means life, breath, and vapors. Late Chou, early Han, substances believed by some to consist of finest vapors, designated chi. Chi float through air, and together with blood, through organism. Basic translation of energy represents misconception not supported by ancient sources.
With ideas that environmental influence could cause illness, wind relativized and represented just one of variety of influences. Most important for several centuries. Likewise, depletion and repletion took on new meaning. Evil influences presented in great number represent repletion
Idea that can accommodate to seasons and reduce illness suggested some responsibility for all illness and health. Also the medicine of illness, which made well-being of organism dependent upon proper balance of body's own influences and those absorbed from outside, again suggested person responsible for illness and health. If conducted one's life in harmony with other influences, guaranteed health. Avoid all extravagances. Followers of medicine of influence, as opposed to demonic medicine, thought it was worthwhile to subject oneself to rules of conduct to maintain health. Fit well into Confucian society.
STRUCTURE AND FUNCTION OF ORGANISM
Vessels: 1970's excavated graves near Ch'ang-hsa, capital of Hunan province, found medical text from 3rd cent BCE. Ma-wang-tui texts. Early evidence for beginnings of medicine of systematic correspondence, and physical exercises that became part of Taoist practice. Texts refer to 11 vessels permeating body, some yang, some yin. At certain points in body. 6 arise from feet, 5 from the hands. Nothing said about content of vessels. Other texts (Mo-fa) suggests filled with vapor called chi. Each of 11 vessels associated with specific symptoms or illness. in Mo-fa suggest illness associated with deficiency or excess in vessel. Compare with Huang-ti-nei-ching texts, find marked differences. If historically Ma-wang-tui text first, and words of physician Shun-yu I of 2nd cent BCE, then ideas of Nei-Ching conceived late 2nd or 1 cent BCE. In Nei-ching, 12 vessels called conduits, linked to each other and passed by continuous circulatory flow.
The emperor asked: "I should like to hear which influence [chi] causes man's depots to suffer from sudden pain". Chi Po replied: "The flow in the conducting vessels never stops; [it moves] in an annular circuit without a break. When influences of cold enter the conduits, [this flow] is retarded. [The contents of the conduits] congeal and do not move. If [the influences of cold} settle outside of the vessels, there will be only a little blood [moving; if they] settle within the vessels, the chi influences cannot proceed. As a result there is sudden pain."
Similar but different from the west. Circulation, but unclear what circulates and to where it flows. Many schools of thought: a circulation of subtle influences (chi), blood, or both, and finally both in different vessels. Nei-ching present different concepts and terms, partly overlapping, partially antagonistic, which transmitted to our times. According to one belief, constructive influences (ying-chi) - generated by stomach and spleen- circulated through vessels (served function of generating blood and nourished body? - or maybe same as blood?) while protective influences (wei-chi) - equated by some authors with influences controlled by lung - circulated outside vessels. Acupuncture, dominant therapeutic technique introduced by Nei-ching texts, always directed at conduit vessels, where needles influence movement of chi influences, not blood. Blood letting also appear in Nei-ching. Predate manipulation of chi. Later recommended by few authors, for treatment of leprosy, etc. Pulse diagnosis detect mainly chi flow, not necessarily blood.
No force or motor required for circulation in Nei-ching, but conceptual link between heart and vessels: Heart masters the vessels or blood belongs to heart. Also links between chi influences and lung; inhalation and exhalation corresponding to entering and leaving of body chi. No indication in Nei-ching of heart and lungs fulfilling pump-like or bellow-like function.
Organs: How did concept of circulation of chi and blood emerge, and why during 2nd or early 1st cent. BCE? Whatever case, vessels occupy central position in Chinese medicine. In Ma-wang-tui text, 4 of 11 vessels linked to organs, in Nei-ching, each 12 conduit vessels linked with one of 12 organs. In nei-ching, and in medicine of systematic correspondences, organs divided into two groups with different functions. Tsang (kidney, liver, heart, spleen, lung and heart-enclosing network) all inside and hence Yin, and second, Fu, (stomach, small intestine, large intestine, bladder, gall bladder and Triple Burner), all exterior and Yang. Triple Burner only one without anatomic correlate in west. It was added later; not mentioned in texts prior to Han era. May have replace the throat, which was 6 fu organ in 2nd cent. BCE. Tsang and fu organs interrelated through 12 main conduits. In illness, flow of chi influences and of blood through conduits and secondary, tertiary ducts locally interrupted.
Chi: Life depends on primordial influences (yuan-chi) which are innate to the organism. May be depleted through excess consumption and influences form outside. In addition, organism produces chi, such as constructive influences (ying chi) and protective influences (wei-chi). Health maintained as long as external influences enter organism in sufficient proportions, and are conveyed to organs, assimilated and excess released.
An exact understanding of body never developed from this healing system and not even tried until 100-200 years ago. Approx. 0 BC/AD, mentioned that conditions of organs and blood vessels could be determined by post-mortem exam. Some text show weight and size of organs. After Han dynasty, continue to discuss nature and location of organs, but anatomical approach never tried seriously. Only in 8th cent. BCE that Wang-Ching-jen attempt to convince people that understanding of function meaningless without structure, but to no avail . Chinese medical philosophy of health and illness based on analogical (derived from analogy) rather than anatomical evidence. Hence the factors stimulating and guiding these analogies cannot have originated within the body. Instead, they should be searched for in the environment of philosophers who created the ideas.
Impulses behind this novel understanding of structure/function discernible from unique circumstances surroundings unification of empire, which during 3 and 2nd cent. BCE produced first social and economic institutions. Decreasing number of competing states struggling for sole control of China and start of Chin and Han dynasties marked by changes in economic system. In feudal times, settlements small and self-sufficient. Shih Huang-ti, founder of Chin dynasty, quickly move 120,000 families into capital. For such densely populated cities needed monetary economy, increase in trade, standardization of weights, measures, script, and forced construction of roads and canals (Great Canal, Great Wall), and granaries. Han govt. buy grain when abundant, store it, then sell it when prices start to rise. Centers of populations that were isolated in Zhou period came into contact. Hence new mobility of people and goods. All these innovative changes provide Chinese with concept of integrated and complex systems, the individual parts of which function only as long as their relations with remaining parts not disturbed. Health of whole depend on exchange of resources among its parts. Support for this ideas comes from words. Literal translation of organism - "storage facility" or "depots" and "grain collection centers" or "palaces". These "depots" and "palaces" connected by system of conduits or transportation channels, designated by terms ching and lo. These later two terms no appear in Ma-wang tui text,but do in nei-ching texts. All important elements of transformed state economy - granaries (depots) and centers of consumption (palaces) as well as transportation network were represented in the organism. In this respect, even the idea of Triple Burner becomes understandable. The organ that simultaneously at 3 locations in body contributed to transformation of raw materials by means of heat into useful products. This can be seen as an organic analogy to smelters and saltworks vital to the state.
Likewise concept of transportation channels or conduits, reflected a transfer of an understanding of vital importance of waterways to state to the organism. Irrigation has played a huge role throughout Chinese documented history - to open clogged waterways, to drain flooding, to irrigate the soil - all responsibilities of government to ensure richness of land. Other terms in Nei-ching designated system of transportation channels within organism, including gutter, ditch, to pour, to irrigate, etc. Term ching, designating 12 major transportation channels, directly refers to large rivers (ching-shui) running from mountains to oceans.
Symbolism seen by Chinese philosophers in all these and other environmental facts summarized by Confucian author in 3rd cent. BCE: "
"Flowing water and the pivot of a door do not rot because of their constant movement. The relationship between form and influences (chi) is the same. If the form does not move, the essence (ching) does not flow; if the essence does not flow, the influences will stagnate".
Hence conception of ceaseless flow transferred to organisms. Later extended, under evidence offered by transformed social and economical environment, to conception of liquids (blood) and goods (finest-matter influences -Chi) circulating in body.
DIAGNOSTIC PRINCIPLES OF SYSTEMATIC CORRESPONDENCE
As depletions or excess in state, especially as result of failure of transportation system or obstruction of canals, whether due to human failure or catastrophe, interrupt harmonious flow of goods, depletion (hsu) and repletion (shih) in body's depots (tsang) and palaces (fu) as well as obstructions of transportation channels (chig) are 3 central diseases in system of correspondences. Primarily result of inability or willful negligence - of man to adapt his behavior to influences of environment. Method did exist to protect oneself from influences - based on understanding of correspondences between structure/function of organism, on one hand, and the macrocosmic environment on other. Link provide by lines of association of yin/yang dualism and 5 Elements (Phases) which encompassed the depot, palace, body, spirit, blood, emotions, and multiplicity of influences (chi) that enter from outside or present on inside. Since direction, taste, seasons, food, odor, etc., incorporated into the system of correspondences, possible to assess a code of behavior on basis of natural and moral principles. Conversely, in illness, color of specific region in face, condition of skin, pitch of voice, odor of breath, longing for food, condition of body orifices, ones emotional state, and condition of movement in vessels indicate which depots, palaces, channels affected and which influences must be increased or decreased.
Special contribution made in Nan-ching (Classic of Difficult Issues) to exam movement in vessels for diagnostic purposes. Nan-ching is considered the mature classic of systematic correspondences. Displays much innovative thought and consistent. 81 chapters called nan, structured like a dialog. Interprets Nei-ching and adds new concepts. Same terminology as Nei-ching but different purpose. Nan Ching classic that provoke most commentaries in subsequent centuries. Pushes into recesses Nei-ching with its unsystematic, partly pre-systematic correspondences by 1st cent. ACE. Only after Song era that conservative commentators considered Nei-ching, the older text, as only source of truth. Ever since, Nan-ching termed a "commentary" (even in the west), compiled to elucidate more complex ideas of Nei-ching. Nan-ching helped solved contradiction between discovery of chi circulation in the organism, and diagnostic principles in Nei-ching. In Nei-ching, 12 conduits connected to each other, but individual movement in each channel important for determining presence and location of illness. Specifies numerous points on all 12, spread over all body, where movement in and out can be felt. Special importance are jen-ying holes on both sides of larynx, and the chi-kou holes near the wrist. In Nan-ching, show theoretical consequence of discovery of circulation of chi for diagnosis. If the contents circulate, no need to check circulation at various points for each conduit separately. Just need one spot - the "influence opening" at wrist. Nan-ching develop numerous systematic correspondences, not necessarily compatible with each other. Example: the Heart.
The Heart considered one of 5 phases. 5 phases related to each other through mutual control.(generation or destruction), which offers way to understand mutual interactions of 5 depots (6th - heart shield disregarded in context of 5 Phase diagram).
FIGURE: FIVE ELEMENTS (PHASES) AND 5 DEPOTS (YIN ORGANS)
5 external evil influences capable of harm, and each enter through one specific depot (organ). Here is the text and corresponding figure describing how heart problems are linked to the systematic correspondence.
FIGURE- HEART AND THE FIVE ELEMENTS (PHASES)
"The heart is depicted here as one of the 5 Phases. The 5 Phases are related to, and may influence, one another in various ways, with the so-called sequence of mutual generation and of mutual destruction (or mutual control) being considered as the major parameters offering an understanding of the mutual interaction of the five depots in the organism (the 6th depot, the pericardium surrounding the heart, was disregarded in the context of the 5 Phases paradigm). 5 external evil influence were known to be capable of harming the organism and each of them was believed to be able to enter the body through but one specific depot.
Heat corresponds to fire and so does the heart. Hence evil influences of heat can enter the organism only through the heart. Similarly, both wind and the liver correspond to the phase of wood; hence wind will always harm the liver first. Humidity and the kidney are associated with the phase of water; hence humidity will always harm the kidneys first. Cold and the lung are associated with the phase of metal; hence cold will always harm the lung first. And, finally, the evil influences associated with unrestrained eating and drinking, weariness, and exhaustion, as well as the depot spleen correspond to the phase of soil. Hence such influences will always harm the spleen first. However, the individual depots that have been affected by wind, heat, humidity, and so forth may transmit these evil influences to other depots in the organism, and when a physician is confronted with a patient he must find out the current situation of this transmission. He has to examine whether the illness is still in the stage of primary affection.
In the case of the heart, the physician might realize that the patient was harmed by heat, and if these heat-influences were still confined to the heart, the heart would be diagnosed as being hit by its "regular evil". If, however, the hart was recognized to be subject to a secondary affection, the physician would have to determine the source of the evil influences within the organism, and label the illness according. IN the sequence of mutual generation of the 5 phases, wood generated fire. The liver, accordingly, is the mother depot of the heart. Evil influences transmitted from mother to child are called "depletion evil; they need a therapeutic approach that differs from a "repletion evil" which is present when evil influences were sent form the child depot, in this case from the spleen. If the affection originated from the kidneys, it should be labels as "destroyer evil" since water associated with the kidneys is capable of destroying fire (associated with the heart, according to the sequence of mutual destruction of the 5 Phases. Prognosis in such a case is rather bleak. However, if the lung had been harmed by cold first, and had then transmitted these influences to the heart, this would constitute a "weakness evil". Since fire can overcome metal, but not vice versa, prognosis in this case would be rather favorable.
Consequently the physician should treat the depots where the illness is situated at the moment of diagnosis, but he should also take care of the depot affected primarily; the latter must have some problem, otherwise it could not have been affect by evil influences form outside. Finally, the physician should be able to determine which depot might be affected next. Once he understood all this, he could prescribe the treatment needed to cope with this particular case successfully. The issue to be solved as a necessary consequence of the "discovery" of the circulation of the chi-influences through the organism was how to gain all the data necessary to assess the status of a given patient through examining the movement in his conduit vessels at one single location only. "
Pulse Diagnosis: In system of systematic correspondences, like correspond to like. Body has upper (yang) and lower half (yin), left (yang) and right (yin), and location of organs (lung-top, heart-next to top, spleen-center, liver-next to bottom, and kidney-bottom), and should reflect movement of chi. Wrist most useful site for diagnosis The influence opening of either right or left hand could be touched slightly -enable one to perceive a movement in vessels revealing the condition of lung and heart, both located above the diaphragm. Press down to bone and slightly lifting the finger enable one to examine liver and kidneys, both located below diagram, The movement of vessels indicating condition of spleen examined in center. Another pattern in Nan-ching distinguishes 5 levels and 5 pressures. Other systems of more complexity used. Physician free to chose among all different patterns, were only indirectly compatible with one another in that all based on systematic correspondences. Patterns mostly couldn't be reconciled with each other. But either or questions posed by scientist using deductive reasoning never concern Chinese who thought in systematic correspondence terms. This phenomena one of basic characteristics distinguishing traditional Chinese thought from modern Western science. Dismiss those ideas that try to eliminate this distinctive feature from traditional Chinese thought by isolating a set of coherent and consistent set of patterns form ancient Chinese sources.
Acupuncture: Technique to regulate movement of chi influences through the body's transportation channels. Described for first time by Ssu-ma Ch'ien in his biography, in the Shih-chi (90 BCE) of physician named Shun-yu I. He was accused of malpractice. Two trials, 167 and 154 BCE. He knew of movement of chi in organism,but concept of circulation had not yet appeared. Acupuncture needles, according to Shun-yu I, suitable to cause influences which had moved upward in organism to descend again, and vice versa; to cause inward and outward flow of chi; to affect evil influences which had entered organism, and reverse course. Later in Nei-ching texts, acupuncture used also to stimulate circulation of chi by exerting influence on function of the depots and palaces, and obstructed channels.
In earlier texts of Ma-wang-tui, discuss spells, magic rituals, gymnastics, sexual practices, drugs, massage, bathing, etc., based on magic and systematic correspondence, and demonological concepts and experience. Discuss moxibustion - burning powdered mugwort plants on skin as sole stimulus for influencing content of 11 vessels. However, no mention of acupuncture. Suggest they didn't know about it since everything else mentioned. Origin of acupuncture not clear. No known source prior to Shih-chi in 90 BCE mentions it. Some consider use of bamboo or bone needles in Zhou as early evidence. Clearly described in Nei-Ching. Get some clues form Chinese literature showing multi-linear development of acupuncture.
In 2nd cent. BCE, acupuncture adopted, supplant moxibustion as dominant conceptually integrated technique of medicine of systematic correspondence. Origin of more than 300 holes mentioned in Nei-ching unknown. Probably historical changes resulting from different schools. Suggest empirically, not theoretically determined. Nan-ching disregard conventional circuit needling - since all points in contact through circulation. Developed different set of points, but although gain acceptance and remained, in theory, as diagnostic tools, its system of acupuncture didn't receive much attention. Chinese still not concerned with paradox of unique points in individual conduits, even though circulation is connected.
Finally, drugs were known and used, yet a pharmacology of systematic correspondence not developed prior to 2nd cent ACE. Why? Belief in drugs as preventative or curative free person form perceived necessity to follow life style as basis of health. In system of correspondence, health was an integral personal and social health. If use drugs, link with social health severed, and social order no longer guaranteed. Acupuncture differed from drugs since it reinforced system of correspondence.
Taoism and Pragmatic Drug Therapy
Remember, Taoism and Confucians both arose during disruptive times prevailing during Period of Warring States (481-221 BCE).
Influence of Taoism on Huang-ti Nei-ching: Chuang Tzu (Zhou) said: " To complete the years of life and not suffer an early death halfway along: these are the fruits of knowledge." Concept of allotted life time recorded in Nei-ching. Statement refers to the 100 years that men in antiquity could live with full possession of physical and mental health, while 50 years normal for men. But also other views expressed in Nei-ching as well. Clearly Confucian, Taoist, Legalist, and other thought it in as well. Eventually, Taoists concerned with achieving immortality, abandoning belief in continual process of transformation underlying nature. New philosophy of Taoism individualistic. Search for immortality led in many directions. One belief was that physical life determined by certain "influences of finest matter" (ching-chi) led to development of techniques to absorb influences. Led to breathing techniques, gymnastic techniques to ensure circulation of these influences and assimilation through skin free from disturbances, and sexual techniques. Another concept proposes that water is basic element of physical existence.
Second approach to achieve immortality rested on supplying body with substances which were effective according to some evidence. More important to health than previous approach. Again two currents of thought. First was that certain substances like precious metals contained principle of immortality. Ex: gold, since incorruptible and since it was yellow, it was assigned to earth and to the center. Another was mercuric sulfide (HgS) or cinnabar, which, in pure form, is sole nontoxic mercury compound. Procedures to make such substances probably made China birthplace of alchemy.
Second current concerned with plants, in search of "herb of immortality". Later half of 1st cent BCE well documented use of plants to cure illness. From the Ma-wang-tru texts, suggest that medical substances emerge from two origins. First, those used to treat external afflictions like wounds, lesions, etc.. 2nd. from experience with oral ingestion of plant, animal, or mineral substances. Possible transmission from India in 4 or 3 cent BCE of report of a plant that confer immortality, allow contact with Gods, and possibly raise dead. First emperor of Chin, Shih Huang-ti tried to get this plant (soma toadstool). Never did, but got advisor to get herb chih which no one had ever seen. Never did, so sent people to distance land of immortals to get it. Again, never found.
After upheavals, Emperor Wu of Han tried again. During his reign, Liu An (179-122 BCE), also known as Huai-nan-tzu, Taoist philosopher seeking longevity, describe first incorporation of Chinese medicinal herbs into therapy, while mystizing their origins. Shen-nung, legendary personality in late 2nd cent BCE, wrote or compiled or was written about in Classic of Shen-nung, or She-nungs Classic on Drugs. (Shen-nung pen-ts'ao ching) Identified as founder of drug knowledge, originator of pharmaceutical literature. This book and Nei-Ching contain differences which suggest all can't be put at feet of Taoists.
Drug knowledge during 1st cent ACE, remained unaffected by theories of systematic correspondence. Just primitive categorization (based on if drug Yin or Yang). No consider theory of 5 elements (Phases). Second difference lies in antithetical classification of drug effects into hierarchical positions that derived from human society. In Nei Ching, drugs defined as rulers, ministers, assistant, and aide drugs. (Confucian influence clear) In Shen-nung, all drugs divided into groups, including,those that prolong life and lead to immortality (designated rulers, without poisons) and those that combat acute disease, termed assistants, and aides. That some drugs classified both rulers and aids. Not authoritarian intervention into lives but strive to bring harmony (Taoist influence).
Summary: Taoist influence support over 2000 years two major therapeutic approaches - demonic medicine and pharmaceutical medicine. Beliefs of demon causing illness and illness preventing and curing medicines both contradict idea that only life style in accordance with specific moral code guarantee health. Rise of Taoist church and gain of political power, however, led to connection of health and moral norms.
Buddhism entered China in first cent. ACE with Buddhist communities existing from 65 ACE. infiltrated all aspects of society by 4th cent. ACE. Healing system introduced differ from pure Chinese system since conceptually more intricate. Aspects of demonology, mythology, moral concepts, and 4 Elements, which like 5 Elements of China but derive from moral system of Buddhist religion. Buddhism had 4 Noble Truths and 8-fold path. Buddha summarize as: "Do no evil; perform good deeds and purify the spirit".
Buddhist healing: Literature shows parallels to sayings of Hsiao Tzu-hsien (489-537 ACE). Buddhist medicine directed toward elimination of individual suffering, no ideal of earthly existence or harmonious society. Many different concepts and doctrines used for healing. Buddha himself credited with the therapeutically diverse doctrines including demonology, drug therapy, systematic correspondences, etc. Christ, in contrast, assigned God sole power over illness. Goal of Buddhism was termination of existential suffering. Buddha often termed "king of physicians". 4 Noble Truths often formulated in terms similar to diagnosis, etiology, remedy, and therapy.
Mahayama school - principle of universal sympathy and compassion toward all people. Each person had duty to care for and treat sick. Treatment based on intricate concepts of body structure and cause of illness. According to dominant natural philosophy of Chinese Buddhist literature, body composed of 4 elements:
Illness arise when one or more of 4 elements is increased or decreased. Imbalance can cause 101 afflictions with each element. Toward end of 6th cent. ACE, 6-part etiology of illness.:
Treat 1 and 2 with medicine and diet; 3, improved meditation, regulation of breathing; 4 and 5, incantations, introspection; and 6, introspection, confession, contrition, and penitence.
Early hospitals established by Buddhist to care for people (700 ACE). With decline of Buddhism to folk religion during subsequent centuries, interest in such charitable institutions die out. Only purely religious elements of Indian healing gain a foothold. in China. Of 6 part etiology above, only illness caused by disharmony among 4 elements, meditations, and previous lives was new.
Why did surgery never develop in China? To simple to blame Confucianism dogma concerning invulnerability of human body. Christian doctrine in early Middle Ages oppose surgery as much as Confucians. Cataract surgery isolated example that never expanded.
Sung Neo-Confucianism and Medicine
Tang Dynasty: By 300 ACE all essential features of TCM had been created. In Tang dynasty, Buddhism was main religion of the people. Even thought Tang one of golden ages in China, with literature and art flourishing, and cosmopolitan cites with population in the millions, an age of peace and with extensive foreign contacts, no new medical concepts developed. With temporary displacement of Confucianism, interest in old texts waned. Wang Ping added cosmobiological elements to systematic correspondence, which expanded systematic lines of correspondence. Macrocosmic concepts of 60 yr. moon-sun cycle of Chinese calendar linked will illness through yin-yang and 5 elements.
Song Dynasty: Found itself surrounded by hostile states. Society also change. Increasing social and economic differentiation. Growth of cities continue with exodus of peasants. New techniques in agriculture and manufacturing required organization of individual enterprises into guilds. Large areas depend on one economic product, and regional distinctions emerge; mutual economic interdependence replace self sufficiency of individual regions. Reorganization brought two contradictory directions of development. Restrict individual and regional competencies while at same time increasing dependence on the whole with each unique function important. Allow for predominance of Confucian thought. Technical and other knowledge refined, so this period one of high points in technological and scientific progress in China. Taoism also reemerge, whose detailed analyses of nature and natural law provide now useful insights. (Ex: development of gunpowder during Song). Buddhism declined, despite emperors great interest. Monks life used to be tax-free. Strapped for funds, emperor sold certificate to anyone to become Monk. Led to many monks with no spiritual link to Buddhism. Another factor in decline was development of alternative of neo-Confucianist like Zhu Xi (Chu Hsi), who incorporated more metaphysical principles derived from Taoism and Buddhism into Confucianism. Neo-Confucianism offer comprehensive, naturalistic, and organic world view. Study of classics renewed.
Medical Thought: For 1000 yr. until Song, TCM develop along lines depicted in Nei-ching and Shen-nung. Demonic medicine still practices. Taoist and Buddhist exorcisms practiced. Hence pluralism of healing techniques. Tradition of systematic correspondences, including acupuncture, underwent some change over centuries, but literature of drug therapy, which essentially unchanged by concepts of systematic correspondence through 1126 ACE, had much progression. Number of medicinal plants, animals, and minerals increase, and drug prescriptions revised with new information. Due to large group of naturalists and observers. She-nung held with respect but considered starting point for new insights. Intellectual pursuits in Song as applied to medicine had two effects:
Although many new ideas formulated, not written down formally until subsequent dynasties, often described as Chin-Yuan medicine. Should be called Song-Yuan medicine to reflect neo-Confucian ideas. 4 main works form core of this medicine that influenced Song practitioners: Nei-Chng (has foundation of systematic correspondence, Shen-nung pen-ts'ao (which contains detail information on drugs), and two other sources, author Chang Chi, and Tang cosmobiology (wu-yun liu-ch'i)
Chang Chi: Author of 2 works, Shang-han lun (On the Cold-Induced Bodily Injuries) and chin-kuei yu-han yao-lueh (Survey of Most Important elements form the Golden Chest and Jade Container). His work taken seriously only in Song-Yuan period. Chang was first to combine sue of drug therapy with systematic correspondence. With his interest in in effects of cold on illness, first and only author whose work was devoted exclusively to specific cause of disease. Great effect on other authors in Song period and later. From then on drug prescriptions linked on basis of systematic correspondence. Song authors identify highly specific personal or nonpersonal factors (reductionist approach) responsible for disease. Stands in start contrast to Nei Ching, in which treatment not necessarily depend on cause (wind, for example).
Tang cosmobiology (wu-yun liu-ch'i): Concept of correspondence between cosmically determined seasonal cycles and phenomena within individual, introduced by Wang Ping during Tang, did create interest until the Song era. Can't understand Song-Yuan medicine with understanding 5 elements (phases) of circulation (wu-yun) and 6 climatic influences (liu-ch'i):
5 elements (phases) of circulation (wu-yun): 5 different time periods that make cycle. All equal duration - 1 yr. Primary phases - correspond exactly to calendar, and guest phases - actual seasonally related phases, which fluctuate yr. to yr. Each one associated to one of 5 elements (phases). First phase of circulation ensure orderly progression of seasons and formation of associated climates. In systematic correspondence, circulatory phase (1st) correspond to soil and stimulate formation of moisture. 2nd phase correspond to metal an causes dryness. 3rd phase corresponds to water and gives rise to wind. 4th phase correspond to wood and gives rise to wind. 5th phase correspond to fire, brings forth heat. Irregularities occur. Ex: influence of phase only partially developed, produce insufficient supply of expected seasonal climates. Each phase can also be excessive.
6 climatic influences (liu-ch'i): associated with yin/yang and 5 elements (phases). To get correspondence with 5 elements, one of elements subdivided . Fire replaced by rule fire and minister fire. 2nd calendar system, used to designate 6 climatic influences. Encompass entire range of climatic conditions (chi) that affect people. Again two parts. Constellation of primary influences (chu-ch'i) - unchangeable climatic influences that should occur during the year, and guest influences - actual weather conditions.
Function of organism determined by influences that affect it during each season. Some claim each season dominated by certain climatic influences which cause illness. Other reject or changes this interpretation of wu-yun liu-chi theories. Argue that good health was completely possible if people able through appropriate conduct, to adapt himself.
Consider briefly 4 main theoreticians of these eras:
Illness in stomach and digestive region prevent above.
Pharmacology of Systematic Correspondence:
Pharmacology here is science of drug properties and reactions in body. Nei Ching mention about 12 drug name, but needle treatment sole form of therapy in Nei-ching; result of needle treatment interpreted on basis of systematic correspondence. In Han first categorization of primary substance qualities as colors(yellow, green, black, red and white) and flavors (acrid, sweet, sour, bitter, salty) along lines of 5 element theory. Next secondary qualities that natural substances can develop in the body (hardening, collecting, dissipating, calming, and moistening). Through association of primary and secondary qualities with the 5 kinds of grain, fruit, domestic animals, and vegetables on one hand, and with 5 bodily depots on the other, conceptual tool provide to regulate intake of substance and to add or decrease any of those qualities in accordance with changed condition, such as illness.
These ideas appeared in the Su-wen, the version of Nei-ching that was revised by Wang Ping in Tang era, and then again in the Song. Hence by end of 7th cent, essential ideas for creation of pharmacology of systematic correspondence present. Development of concrete pharmacology of systematic correspondences undertaken in Su\ong-Chin-Yuan period: attempt to analyze primary qualities of each drug, and to ascertain secondary qualities, so all dimensions of healing, from systematic correspondence to diagnosis to remedy and therapeutic effects incorporated within one theory. Permit argument that certain drug x, on basis of primary qualities y and z, developed secondary qualities, p and q in the body, and could then influence symptoms a, b, and c.
First had to establish exact primary qualities of each drug. (thermal influence, color, flavor, and additionally weight, form and odor. Had to detail information about manner and location of its effects to incorporate into Yin/Yang and 5 element theory.
4-fold categorization of drug qualities: Assume primary quality flavor (wei) associated with yin, and primary quality thermo-influence (chi) with yang. Now yin/yang follow cyclical transformation, so have continuous transition of mature yin (yin in yin) to immature yang (yang in yin) to mature yang (yang in yang) and to immature yin (yin and yang). Secondary qualities developed by drug in the body were brought into harmony with system: purgative (hsieh), penetrating, heating, and dissipating. With 4-fold scheme, how drugs function in organism could be explained.
TABLE: 4-FOLD CATEGORIZATION OF DRUG QUALITIES
The 6-fold Categorization of Drug Qualities: A more important function of drugs was supplying individual palaces and depots, in cases of depletions, with necessary influences, or when state of repletion, to dissipate them. So needed demonstration of theoretical connection between drugs and location of their effects and conduits leading to these locations. To do this develop 6-fold classification of yin/yang phases already used in Nei-ching to indicate correspondence between depots and palaces and conduits. Added idea that drug properties could be transported over conduits (as were stimuli triggered by needles, heat, or pressure). Also change drugs so work differently in different parts of body.
TABLE: 6-FOLD CATEGORIZATION OF DRUG QUALITIES
The 5-fold Categorization of Drug Qualities: Third system. Arranged the primary properties first in accordance with the 5 categories of the five elements (phases). Since these were also correlated with the depots and palaces, as well as with the 5 circulatory phases and 6 climatic influences, result was additional method for differentiating properties of medical substances. .
TABLE: 5-FOLD CATEGORIZATION OF DRUG QUALITIES
Main problem was determining primary qualities of drugs. Had information on old drugs, but incomplete, so try to compare expected results with actual results. Also had to show how the flavor and thermo-influence of a drug could be determined. No objective way, so much disagreement. Easier when expected result not same as theoretical result. Eliminate by idea that each yin phases already contained nascent yang phase. Others rationalized that each drug had several primary qualities. Expand range of correct uses. Ultimately failed in developed of pharmacology based on our criterion, but perhaps not by their criterion.
Ming and Ching Medical Thought
Ming: (1368-1636) End of 14th. cent. Yuan (Mongols) face uprising of Chinese. Mongols couldn't comprehend intellectual culture or civil service system, which led to uprisings. Chu Yuan-chang (1328-1398), son of impoverished peasant family, rise to become rebel leader then first Ming emperor through concentration of institutional power in imperial offices. Peace brought prosperity, but rise of absolutism sow seed for dynastic decline. Decline of civil service system. Eunuchs again rise to power, caused conflict with Confucian officials, who also had internal conflicts. Early Ming saw continued rise of Neo-Confucian ideas of Zhu Xi (Chu Hsi) to orthodoxy. In addition, the civil service system was democratized , opened to broader groups of people. State exams standardized and abilities more important than literary education. Exams based on memorization of orthodox writings on Neo-Confucian texts. Blue distinctions between scholar, peasants, and merchants. Rise of standard of living and huge increase in numbers of books. Literary works reach lower strata, fringe ideas rise to upper strata. Led to dramatic diversity of ideas, and pursuits of individual ideas. Also, although Confucian ideas had triumphed over Buddhist and Taoist thought, these ideas effectively carried even greater influence than before in their incorporation into Neo-Confucianism. Late 16th. cent, early 17th cent., widespread mismanagement, natural catastrophe, bad harvest, led to uprisings. Manchu's invade, led to Ching dynasty.
Ching Dynasty: (1632-1912) Marked by continuity of ideology, structures, and institutions. New government adopt absolution and Song Neo-Confucianism. Unlike Mongols, Manchu mad effort to understand Confucian values. Achieve economic, cultural, and political significance, under direction of 3 far-sighed emperors, represent pinnacle of Chinese Civilization. 1796 last of the 3, Ch'ien-lung, voluntarily resigned, sow seeds of decline. Ultimately unable to cope with foreign influences and internal burdens. Conservative forces held Song ideas responsible for decline of empire, which led to successive invasions by Mongols and Manchus. Believed it was time to return to true Confucian values from Neo-Confucian thought. One of first to offer these ideas, Ku Yen-wu (1613-1682) proposed using as many literary sources as possible to dilute impact of Neo-Confucian ideas. Others advocated return to past. Despite attempt to find foundation to resolve internal conflict and growing external threat from the West, events starting at end of 18th cent. led to demise of state and imperial rule, and of the Confucian tradition. These include secret societies, huge growth in population (400 million by early 1800's), insufficient food, introduction by West of opium, ensuing trade balance and Opium wars. Secret societies continue activities and grew as result of internal distress and humiliation caused by West. Taiping rebellion from 1850-1866 claimed millions of victims. This was followed by Sino-Japanese war, Boxer rebellion directed against imperial forces and Manchus, which was crushed by foreign forces. Republic formed in 1912.
Trends in medicine parallel thought in Ming and Ching eras. Continue reductionist approach of Song-Yuan medicine, but attempt to incorporate drugs into systematic correspondence didn't evolve much. Maybe work of Chu Chen-heng provide satisfactory explanation to practitioners. Important authors of this era try to incorporate demonology (which existed outside of Confucian tradition) into systematic correspondence. In Ming individual search for reality, lead to multiple approaches and new interpretations of ancient texts. Continued in Ching but believe inadequacy of traditional healing techniques caused some to reject all post-Sung changes. In mid 19th cent., influx of Western ideas of anatomy, minor surgery and Western Scientific techniques cause number to lose beliefs in own system.
In Song period, motto was "investigate things and affairs and extend knowledge to utmost" - (ko-wu-chih-chih). Individual could find own view of world, and with "correct" interpretation of old text, could criticize past role. In Ming period, a moral resolve evolved to bring out the knowledge that exist in man (liang-chih) that would lead to moral action in world.
Wang Yang-ming, introduced concept of liang-chih, and extent Zhu Xi (Chu Hsi) views. Stated that reality of environmental phenomena preexisted in mind. Therefore unity between of human spirit and universe. Realize your own knowledge produce faultless conduct that leads to physical and mental health. Therefore personal health and health of environment depend on right conduct.
The climate persisting from Ming to end of Ching, was a stimulating fruitful time in Chinese medical history, but it led to a fruitlessness of even greater diverging opinions. No single theory emerged as leader, even temporarily. Individual schools developed independently. Solution to the problem came with collapse of Confucian system that had prevailed for centuries...
Spectrum of Approaches
Searching the Interior: Some believed exclusively in an idea of Sung era. One was yang yin school, based on notion that deficiency of yin influences cause of disease. Supply yin to treat. Also theories of Li Kao, with wen pu course of treatment - supply body with substances that radiate heat. Hsueh Chi, thought spleen and stomach associated with soil, all which must get nourishment to function. If ill, cant get nourishing influences, so supply drugs to restore spleen and stomach, then with drug to supply yin influences to kidney. Chang Chieh-pin, using military analogy, viewed illness as enemy. Considered yang influences as most important, so replenish yang influences. Influence are yang, while body he considered yin. Bodily structure requires influence to come into existence, and influences require this structure as supporting medium. All living beings brought into existence by yang, and given physical structure by yin. Function of kidneys plays significant role in 16-17th century discussions on whether is was "Gate of Life". Hence great concern with physiological function.
Searching the Exterior: Kung T'ing-hsien considered wind most important cause of disease, far more important than knowledge of processes in affected people. Wu Yu-hsing (1644) system of healing based on causation. School of Attack or Purgation, since felt primary therapy to be suppression of evil influences that had penetrated body. Described epidemic that hit in 1641-1644, which caused pain, deafness, vomiting, alternating hot and cold fits. Achieved success through salt peeter and other drugs. Epidemic caused by seasonal imbalance.
Ch'en Shih-to (1637) wrote text with 136 different therapeutic techniques. Social status of patient help determine treatment. Use logic of 5 Phases. Adopt axiom that runs through medicine of systematic correspondences: Attack of evil influences from outside often result of deficiency of vital influences within the body, brought about by victim themselves.
Searching the Past :Ku Yen-wu and Yen Yuan question merits of Sung Neo-Confucianism. So must determine true nature of Confucian teachings. Tai Chen (1724-1777) one of originators of this effort. Result -Han-hsueh movement- return to teachings of Han, also reflected in medical literature. Went late into Ching period. Most interest went not to Nei-ching but to Pen-ts'ao ching of Shen-nung, Classic of Pharmaceutics. Hsu ta-ch'un one in one of brilliant thinkers. Argue that every medical practitioner must know ancient literature and combine classical theories with experience. Try to refute one of keys of Sung-Chin- Yuan medicine, that drugs reach locations through specific transportation channels.
Searching the Down Below: Chao Hsueh-min (1730-1805) start new perspective (not within medicine of systematic correspondences). Interested in new approaches. Wrote Ch'uan-ya (1789), based on recollections of itinerant country doctor. More than 1000 drug prescriptions, but also almost complete absence of yin yang theories and 5 element (phases). Drugs classified into those that ascend body, those that descend, or just interrupt an illness.
Searching the Far Ahead: Wang Ch'ing-jen (1768-1831) in part broke in part tradition of systematic correspondence. Studied anatomy of corpses of children who died from an epidemic and whose bodies were unearthed. Saw difference between reality and medical literature. Examined bodies after executions. Wrote I-lin kai-ts'o (Correction of Errors from Medical Literature) in 1831. "...the people in former times in compiling medical books were mistaken when they wrote about the depots and the palaces, and later people then respectfully followed and built their theories on them. They missed the basis of the illness.....they contradicted one another again and again."
Emotion problems treated within systematic correspondences. Question whether psychic problems treated with science (like Freud) or humanities (like Jaspers) never arose in China. Link emotional and somatic with correspondences in a whole. Emotions anchored in body and could influence. Excessive anger hurt the liver; fear strain kidney. Likewise somatic effects can cause psychic disorders. Treatment directed to correcting deficiencies or excess in depots or palaces, using acupuncture and drugs. Also reduced psychic problems to imbalance in yin and yang.
Until modern times, demonic medicine and other approaches also used. Demonic medicine most influential. Belief in evil spirits not restricted in uneducated people. Li T'ing, author of I-hsueh ju-men (Introduction to Medicine) adopted demonology in etiology and treatment. To treat tsu-chung o-wu ("sudden attack by evil or hostile agents", try to expel demons through noise making, burning, and fumigation. Drugs used included peach branches and leaves, which symbolized archery weapons.
Ch'en Shih-to (1687) argue that madness was result of too much mucus produced in heart . (Character for mucus - 2 elements, burning flame and sickbed). Since too dangerous to dissipate the flame, so strengthen the soil region of the body (spleen and stomach). In 5 element (phases) fire creates earth (like wood reduced to ashes), so this therapy reduces from fire its function, and thus reduces itself. Sun Te-jun (1826) included classical demonological guidelines and concepts in his literature.
Until beginning of 20th century, concepts of systematic correspondence dominated Chinese medical literature, at least among upper strata of society. But interpretation of classics, and experience, gave rise to contradictions, fragmenting professional medical practitioners into countless traditions. Westerns often present systematic correspondences as the single Chinese medicine, but this is misleading since its was not well defined, and there were many alternative therapies. Experience, as well as religious, demonological and magical practices for treatment of disease and maintenance of health shape lives of most Chinese. Literature describing these actions are less available. These traditions often passed down orally.
A Brief Review of Medicine in China in the 1900's - the present
Systematic correspondences dominated medical practice in China through the beginning of this century. Given the multiplicity of interpretations available, the theoretical underpinnings became weakened, especially with the arrival of Western medicine. After the founding of the Republic of China in 1911, science was viewed by some as a universal doctrine that could apply to natural and social realms, not unlike the systematic correspondences. Dialectical materialism served as a replacement for Confucian ideology and science for Yin/Yang and Five Element Theory. Western medicine seems to be build on a system which would ensure future progress in contrast to systematic correspondences.
When Communists took control of China and established the PRC, reevaluation of the role of modern science, medicine, and TCM occurred periodically. In 1940, TCM was described as "collected garbage of several thousand years", but as anti-Western propaganda grew, Mao declared that "Chinese Medicine is a great treasure". Rationales for this change include the observation that few Western practitioners were available to practice a more expensive medicine, and that Mao found parts of TCM closer to the ideology of Chinese dialectical materialism. In the 70's, Western diagnosis and treatment based on specific organ function and disease was considered not holistic. Western treatment was condemned when external measures were directed at a passive patient not involved in their own recovery. Mao wanted a new foundation for medicine consistent with Marxist ideology. Different schools within TCM combined to present a single paradigm for the new Chinese medicine, which hid the fact that TCM is not a monolithic, singular tradition. The traditional philosophies of Yin/Yang and Five Elements were considered incomplete and metaphysical. The new reinterpretation in Marxist's terms sanctioned it for a modern era. Much as in TCM external evil influences would facilitate disease if internal influences were not optimal, in dialectical theory, pathogens (external) are necessary but internal effects cause illness (change) in TCM. Illness and therapy became struggles with forces that oppose disease and those that promote it. This reinterpretation of TCM required personal responsibility and was holistic. TCM drug therapy was relegitimized not in terms of Taoist magic or system correspondence, but on the practical experience of over a thousand years of experience.
The information for the time line and descriptions come directly from a variety of sources. Foremost for the written documentation on the history of Chinese medicine above is the first reference below. This document literally an online reduction in his text, which I have used instead of placing Chapters or sections on reserve.
Unschuld, P. Medicine in China: A History of Ideas. University of California Press, 1985.
Ronan & Needham, The Shorter Science and Civilization in China: 1. Cambridge University Press, 1988.
Advanced Textbook of Traditional Chinese Medicine and Pharmacology, Volume 1. New World Press, Beijing, China. 1995
Last Update: April 29, 2004