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The origins of Chinese medicine

The early development of medical literature in China

by Imre Galambos (1996)

The archeological discoveries of the last few decades reveal that during the two centuries of the Western Han dynasty (206 BC – 23 AD), Chinese medical thought underwent a process of comprehensive standardization and systematization. This newly emerging image is in contrast with the views of the Chinese medical tradition tracing the origins of their primary medical canons to pre-Qin times. The medical manuscripts excavated in 1973 from Tomb #3 at Mawangdui show that the early medical classics, especially the Huangdi neijing (The Yellow Emperor's Inner Classic), which is revered as the oldest writings of its kind, had not only been compiled much later than it is commonly believed in the Chinese tradition but even the views represented in them could not have developed before the Han. Thus the standard view of medical tradition of the last fifteen-seventeen hundred years in China contradicts to the reality manifested in the Mawangdui manuscripts. Based on the manuscript texts, one can determine that at the time of Qin (221 BC – 206 BC) and the beginning of Western Han most of the typical features of the Chinese healing art had not been formed yet. One must also point out here the significance of the Nanjing (Classic of Difficult Issues) and its role in establishing a new direction towards a standardized and systematic body of knowledge.



The tradition

Traditional Chinese medicine has been practically unknown in the West until very recently. The pioneers in this subject were the Jesuit missionaries traveling and living in China starting from the 17th century;[1] this was also the time when Western medicine was introduced to China for the first time. In later centuries, as political and cultural connections between East and West grew stronger and became more frequent, most aspects of Chinese culture, including traditional medicine and pharmacology, came to be an object of increasing curiosity in the Western world.

Despite the growing interest, even in our times, and despite the fact that the major works of ancient European medical science have been translated into Western languages with dependable philological and medical annotations,[2] the ancient Chinese medical writings, with a very few exceptions, are still not available in any of the main European languages.[3] Thus the range of specialists who could make serious and reliable research in comparing medical systems of different cultures, when it comes to Chinese medicine, is limited to those few people who are able to read the original texts.

As is the case with many other aspects of Chinese culture, the authorship of medical classics has been assigned to mythical personages and pushed back to times of remote antiquity. In traditional thought, the beginning of healing art had been associated with Huangdi, the Yellow Emperor or Yellow Sovereign and the knowledge of pharmacology with Shennong, the Divine Husbandman; they hand down their wisdom in the Huangdi neijing,[4] or the Yellow Emperor’s Inner Classic and the Shennong bencao, the Materia Medica of the Divine Husbandry, respectively. Huangdi was the one who taught people the knowledge of raising silk-worms, riding boats and carriages, also he was the one who invented writing, music and medicine. Chinese historical records date the reign period of Huangdi and, consequently, the Huangdi neijing to 2698 B.C., a time which by no means can be regarded historically reliable. The Huangdi neijing is one of the first, and undoubtedly the most important, classic in the history of Chinese medicine, which had an enormous influence on the medical thought in later centuries. The book records the dialogs between the Yellow Emperor and some of his sage physicians on medical issues; the emperor’s questions encompass every possible aspect of diagnostics, pathology, acupuncture, and moxibution, including both theory and practice, and the sage teachers give detailed explanation on each topic.

Another important classic is the Nanjing, or Classic of Difficult Issues which is also referred to as Huangdi bashiyi nanjing, or the Yellow Emperor’s Classic of the Eighty-one Difficult Issues. According to the medical tradition starting from the Shiji (91 BC), this book is a work of Bien Que, a physician who is supposed to have flourished sometime between the sixth and third centuries B.C.[5] Later, the Nanjing was added to the Yellow Emperor tradition and was assigned to the Yellow Emperor himself.[6] Until very recently, the Nanjing was thought to be a commentary to the Huangdi neijing, elaborating on certain obscure passages and issues from it. The difficult issues, however, despite their apparent similarity, cannot be found in the Huangdi neijing; in many cases they in fact do shed light on obscure parts of the Huangdi neijing, but this is due to the fact that the Nanjing explains medical theory and practice in a much more clear and lucid way than the Huangdi neijing.

Regardless of their high esteem in Chinese tradition, almost everything about these classics is uncertain, especially their authorship and date. “It must be taken for granted that our present versions of all important medical classics (including, of course, the Huangdi neijing) are vitiated by interpolations, lacunae, and corruptions ignored by Chinese commentators. The transmission of the principal medical texts (including the Neijing) is submerged in utter darkness from the end of the Han well into the Sui period, that is, for a span of ten generations.”[7]

The homogeneous structure and content of the Nanjing confirms that it is not a collection of thoughts and ideas, as it is often the case with early texts in Chinese literature, but was written by one author and, therefore, belongs to one time period. Most of the Western scholars date the book anywhere from the first to third century AD; in general, their calculations are based on the dating of the Shanghan lun, written by Zhang Ji (142-220?), which has been influenced by the Nanjing.[8] As I mentioned above, the Nanjing is also referred to as Huangdi bashiyi nanjing.  The Shiji quotes a book called Bashiyi nan fourteen times and all of the quotes can be identified in the present version of the Nanjing; therefore, we have a clear evidence that at the time of the compilation of the Shiji, i.e. around 90 B.C., the Nanjing was already extant. On the other hand, the Mawangdui texts, as I will attempt to prove below, demonstrate that the Nanjing was composed after the burial date (168 B.C.).

Unlike the Nanjing, the Huangdi neijing is a text that was put together over a span of several centuries by a number of individuals; one can finds esoteric and self-cultivating cosmology next to Confucian discussions on ethical considerations; there are highly rational and scientific arguments a few pages after appraisal of physiological alchemy; certain parts of the book may go back to pre-Qin times and other parts are from the Tang dynasty. There has been an extensive debate over the last few decades regarding the authorship and dating of this book, yet, to present day, no generally accepted and solidly based theory exists. Since it is a compilation, it is extremely hard to label it with a particular date. The title first appears in the "Yiwenzhi" chapter of the Hanshu, among the bibliography of medical classics. Of course, there is no way of knowing, whether that title referred to the same content and, similarly, other titles could have included parts of the present text. The name Huangdi neijing is generally prefixed to the titles of four books, Suwen, Lingshu, Taisu, and Mingtang. We do not have a Han copy of any of the texts and all of the extant texts have undergone further editing and revision after the Han. There are also two other texts, the Jiayijing  (256 – 282) and the Maijing (ca. 280) which were strongly influenced by the original version of the text. [9] This shows that the Huangdi neijing was already present at least during the Latter Han, however, it is very hard to establish to what extent was this original text damaged by later revisions. A detailed analysis of the various time layers in the Huangdi neijing and the dating of these text fragments is a task far beyond the scope of this paper.

Before the Nanjing and Huangdi neijing, we do not see comprehensive works on medical theory; there are only practical manuals and reference books, entirely focusing on the practical applications of treatment. Even the Nanjing follows this tradition, closely concentrating on medical questions. The Huangdi neijing is probably the first medical book which aims to interweave medical experience with the wider cosmogonic ideology into a coherent system.

Medical theory has always been traced back to the Nanjing and Huangdi neijing which served as an absolute standard for all works after the Han; this kind of continuous authority, produced as a result of the well-known traditionalism of Chinese scholarship, resulted in an unusually homogenous and coherent conceptual structure. On this part of the world, just like in other ancient societies, the idea of evolution worked seemingly backwards, the original settings were the best and ever since the times of antiquity everything has been deteriorating. While in the modern, “scientific” West it is customary to think that the newer a thing is the better, in traditional Chinese thought this appears to be just the opposite; a new thing could be justified and accepted if one could prove that it has been already mentioned and thought of in ancient times.[10] As a result of this traditionalistic approach, medicine in China has been regarded as a body of knowledge which has undergone very little, if any, changes through the span of history.[11]

This conservative attitude was largely shaken by the archeological discovery of medical documents dating back to early Han or pre-Han times.



The Mawangdui documents

In 1973, a large number of silk and a smaller number of bamboo slip documents were excavated from Tomb Three of the Mawangdui site at Changsha, Hunan. The burial is dated to 168 B.C., providing us with an absolute date for the latest time span of all the manuscripts in the tomb. The total of 130,000 characters included the copies of the Yijing, the Laozi, Chunqiu shiyu, as well as other manuscripts on history, geography, military science, philosophy, astronomy, divination, and medicine.[12] The medical texts, representing every aspect of healing art in ancient China, amount to more than 23,000 characters,[13] constituting one sixth of all the writings; the 14 individual medical documents, following the arrangement of the bibliographic catalogue in the Hanshu,[14] can be grouped into four main categories:

A. Classics of Medicine (yijing):[15]

1. Zubi shiyi mai jiu jing (Canon of Cauterization for the Eleven Ducts of the Legs and Arms).

2. Yin-yang shiyi mai jiu jing (Canon of Cauterization for the Eleven Yin and Yang Ducts, ed. 1 and 2).

3. Maifa (Model of the Ducts).

4. Yin-yang mai sihou (Fatal Symptoms of the Yin and Yang Ducts).

B. Collection of Prescriptions (jingfang):

1. Wushier bingfang (Recipes for Fifty-two Ailments).

C. Treatises on the Bedroom (fangzhong):

1. Yangsheng fang (Recipes for Nurturing Life).

2. Za liao fang (Recipes for Various Cures).

3. Shi wen (Ten Questions).

4. Tianxia zhidao tan (Lecture on the Culminant Way in Under Heaven).

5. He Yin-yang (Joining the Yin and Yang).

D. Methods and Prescriptions for Immortality (shenxian)

1. Qugu-shiqi (Rejection of Grains and Consumption of Vapor).

2. Daoyin tu (Illustration of Guiding and Conducting).

3. Taichan shu (Book of the Generation of the Fetus).

4. Za jin fang  (Recipes for Various Charms).[16]

It is fortunate that all of the four categories in the Hanshu are represented among the excavated materials. “The diversity of texts included in the Mawangdui medical corpus gives us an unusually complete picture of the state of medical literature in the Warring States and Qin-Han periods.”[17] Despite the wide variety of documents, the Mawangdui corpus presents us with an essentially consistent ideology; this is an important evidence that the texts are part of a larger tradition and not just individual fragments.

What makes these documents so rare and valuable is that the exact date of the burial and the way name-taboo characters are used or omitted give us a solid chronological basis so unusual in this field. Furthermore, since these manuscripts have been out of circulation during the centuries of changes, they allow us to lift up the veil covering the earliest phase of development of medical thought during the Eastern Han dynasty.

The Mawangdui documents present us an ideology remarkably different from the conventionally accustomed view of medical theory which, in its earliest form, is represented by the Nanjing and Huangdi neijing. The more “primitive” and unstructured doctrines of the excavated material remind us of the grand process of standardization that took place sometime during the Latter Han. If we compare the Mawangdui medical corpus with the classics, a number of striking distinctions confirm the gap in time and ideology.

The manuscripts within group A, categorized under the title “Classics of Medicine,” are the ones immediately concerned with medical theory and ideology and in my study I would like to concentrate on these texts. Below are descriptions of the main distinctions in the Mawangdui medical corpus as opposed to the extant medical classics.

1. Acupuncture points

None of the documents mentions names or even the existence of acupuncture points (xue). The later classics discuss a large number of different types of acu-points, most of which are located along the ducts; the Huangdi neijing states that there are 360 acu-points in the body which corresponds to the number of days in a year. In traditional Chinese medical thought the needling of acu-points has been regarded as definitely the most important kind of treatment along with herbal therapy; consequently, the classics elaborate in detail on the name, location, category, and function of individual points, as well as the technique of piercing, including the depth, angle, body position, time interval, time of the day etc. Evidently, the theory of acu-points was altogether a later development.[18]

2. Metal Needles

Apparently as a direct consequence of the absence of the concept of acupuncture points, none of the texts in the Mawangdui corpus mentions the use of acupuncture needles. Instead, as in B2, we find that stone probes were used to open up boils and abscesses, just as documented in writings from the Warring States period.[19] In Chinese medical tradition acupuncture treatment with metal needles plays an extremely important role and even in the age of the Huangdi neijing there were already nine different needles in use with a specific name assigned to each of them.[20] This is a clear proof that needling technique was unknown before 168 B.C. and that stone probe technique, which completely disappeared in the following one or two centuries, was still in use. In B1 we read, “pierce the side of the buttocks with a stone probe.”[21] While the Nanjing, devoted to new classification, does not speak about stone probes, the Huangdi neijing occasionally refers to them as a treatment against boils and abscesses.[22]

3. System of Ducts

The documents only list eleven ducts none of which is connected to specific organs, as opposed to the usual twelve ducts being ascribed to twelve organs. Although most of the ducts can be identified, their names mostly do not match those of the present model. Some scholars have related the descriptions of ducts in the Mawangdui documents to the Jingmai chapter in the Taisu part of the Huangdi neijing. According to their conclusions, A1 and the two editions of A2 could be regarded as the archetypes for certain chapters of the early Huangdi neijing;[23] although many of the ducts can be identified with each other, in the Huangdi neijing, and consequently in all of the later medical tradition, their names have been altered. Interestingly, the names for the same ducts within the individual documents of the Mawangdui corpus, such as A1 and A2, can be different too, while after the new names took their final form in the Huangdi neijing, they remained unchanged for the next two millennium up to the present day. This is a further evidence that at that time when the excavated Han documents were written, Chinese medical terminology had not become standardized. 

4. Theory of Five Phases

Manuscripts of group A and B1 employ the theory of five phases. A4 lists the qi, blood, bones, flesh, and muscles (tendons) in relation to the symptoms of death; according the five phase theory, the tendons, flesh, blood, and bones can correspond to wood, earth, fire, and water, respectively, but the qi cannot be associated with any of the presently known five elements. This suggests that at the time of the compilation of the text, the theory of five phases, being already fully developed and accepted in Chinese philosophy and literature, had not been fully incorporated into medical theory. On the other hand, D3 lists six phases or elements with the addition of shi (stone) which is not part of the standard classification;[24] the C3 manuscript already mentions the five sounds, five tastes, five voices, confirming the presence of five phase theory at the time, or place, of this manuscript’s compilation.

5. Organs

In the documents we rarely find the names of the zang and fu organs. While in later times these organs play a vitally important role and are related to the ducts, the Mawangdui scripts do not use them in this way. Also, their meaning does not always correspond to the customary ones. For example, in B1 the word shen (kidney) does in fact refer to the testes and in this sense is very different from the concept of kidneys; also in B1 the character fu (hollow organ, palace) means the bladder and not all six of the hollow organs (gall bladder, stomach, large intestine, small intestine, middle burner, and bladder).[25] Furthermore, the organs were not connected physically with the ducts,  nor pathogenetically with the individual diseases. This evidence suggests that the theory of organs had been also in the process of development.

6. Yin and Yang

In B1 Yin and Yang are also mentioned in their more primitive form as mu (male animal) and pin (female animal), a distinction that cannot be found in the classical medical texts. The existence of the theory of Yin and Yang is extensively documented in the philosophic and military literature since the Warring States period and a usage of the mu and pin forms can only mean that medicine was a practical matter which did not always and completely accord with the philosophic ideology and in many cases was using its own terminology. 

7. Mai and Jing

While later tradition, especially the Nanjing, distinguishes between mai and jing,[26] in A1 the ducts are exclusively referred to as mai. The term jing customarily is the term for the twelve main ducts in the body ascribed to the twelve inner organs and mai plays a multiple function naming the eight extra channels, the blood vessels, and the pulse. Besides, A1 uses the character wen (warmth) to write mai, a practice previously unrecorded.

7. Pathologic Names

In the Mawangdui documents we find a large number of previously unrecorded names of diseases,[27] some of which were presumably part of the local dialect around Changsha. In later tradition, the names of ailments, were also standardized and categorized according to their cause and nature.

8. Magic

In the Mawangdui corpus magic plays a considerably larger role than in later tradition. B1 contains thirty-eight recipes including magical formulas which reveal their significance in early Han healing practice. In his research on B1, Harper comes to the conclusion that “the inclusion of magical recipes in the repertoire of medical treatments represented in Fifty-two Ailments is clear evidence of the shamanistic heritage which continued to form part of the medical practice of the physician during the Han period. These recipes, which reveal the precise wording of incantations to be used against demonic forces and detail a variety of excorcistic rituals, constitute yet another body of secret knowledge in Fifty-two Aliments.”[28] We find traces of magical healing even in the early passages of the Huangdi neijing, although in later parts it expresses a much more “modern” attitude towards magical healing, saying that believing in demons cannot be agreeable with medicine.[29] Chapter 50 of the Suwen tells us about a kind of divination called zhuyou which was used in antiquity.

I have heard that in ancient times, when the sages treated, all they had to do was to employ methods to guide and change the emotional and spiritual state of a person and redirect the energy flow. The sages utilized a method called zhuyou, prayer, ceremony, and shamanism, which healed all conditions. Today, however, when doctors treat a patient, they use herbs to treat the internal aspect and acupuncture[30] to treat the exterior.[31]

 

This is a description of the evolution of Chinese medicine. Originally people were treated with exorcism and other ‘primitive’ healing technique, later they treated them with stone blades, metal needles, and herbs. The Nanjing, on the contrary, being a major step in the process of rationalization, does not talk about magic at all.



A new standard: the Nanjing

In the Nanjing we are able to witness a very important moment in the history of Chinese medicine. It is the link between the archaic medicine and the standardized new concept which will dominate the next two millennia. It systematically covers all aspects of medical thought, including diagnosis, needling technique, pathology, and, especially, theory.

The main concern and the aim of the book is classification and standardization. The questions are not the inquires of a person ignorant in the field but questions of an expert on the contradictions, inconstancies, and illogical concepts in contemporary medicine.

With regard to its effort of guide medical thought into new directions, it applies two distinctive methods to convey information to the reader.

1. Descriptive classification

This is a category where the question does not directly refer to any kind of argument or contradiction, it is simply asking for information. An example for this is the Twenty-third issue which details the length and starting and ending point of every conduit.

The twenty-third difficult issue: Can one be instructed on the measurements of the three yin and three yang vessels of the hands and feet?

It is like this. The vessels of the three hand-yang [conduits] extend from the hands to the head. They are five feet long. Five [feet] times six amounts to three zhang.... [32]

The Thirty-fourth issue asks about the correspondence of the five sounds, colors, odors, tastes, and body fluids to the five depots. This is a classification of body organs and functions according to the five phases theory.

The thirty-fourth difficult issue: Each of the five depots has a [specific] sound, complexion, odor, and taste. Can they be known?

It is like this. The ‘Ten Transformations’ states: The color of the liver is virid; its odor is fetid; its taste is sour; its sound is the shout; its liquid is the tears. The color of the heart is red; its smell is burned; its taste is bitter...[33]

2. Clarification of inconstancies

Another approach is revealed when the “disciple” points out an inconstancy within the existent ideology and asks the “teacher” to solve the contradiction. The Twenty-fifth issue inquires why is it that while every conduit is assigned to an organ, there are twelve conduits and only eleven organs (five depots and six palaces).

The twenty-fifth difficult issue: There are twelve conduits, but the [body’s] five depots and six palaces [add up to only] eleven. Of what nature is the missing conduit?[34]

The Thirty-sixth issue asks why all the depots have a single entity, except the kidneys which have a double entity.

 The thirty-sixth difficult issue: Each of the depots is a single [entity], except for the kidneys which represent a twin [entity]. Why is that so?

It is like this. The two kidneys are not both kidneys. The one on the left is the kidney; the one on the right is the gate of life. The gate of life is the place where the spirit-essence (jing) lodges; it is the place to which the original influences are tied. Hence, in males it stores the essence; in females it holds the womb. Hence, one knows that there is only one kidney.[35]

The examples quoted above indicate that, at the time the text was written, there was a difficult conflict present between different medical ideas and schools and the Nanjing was intended to establish, through its clear and categorical definitions, a new standardization of ideology and terminology.

The didactic tone and concise definitions of the text, as well as the complete absence of references to magic, magical spells, and incantations suggests that the goal of the Nanjing’s author, or authors, was to guide medical thought towards a rational and “scientific” approach. Unschuld writes in his Nanjing monograph that the “Nanjing should once again (as was the case until early this millennium), be regarded as a significant and innovative work that marks the apex, and also the conclusion, of the developmental phase of the conceptual system known as the medicine of systematic correspondence. The contents of the Neijing texts, in contrast, should be appreciated as a collection of extremely valuable transitory stages in this developmental phase — valuable because they reflect various historical steps as well as a wide range of diverging (and even contradictory) theoretical arguments.[36]

 

By talking about the consolidation and rationalization of medicine I am by no means suggesting that medical theory stagnated and did not evolve anymore after the standardization of the Han; indeed, there were other major changes in later ages too. A significant development was the introduction of the concept of phase energetics, the “transformation of the energy” (yunqi). Although the Suwen part of the Huangdi neijing corpus, which was edited and annotated in AD 762 by Wang Bing, contains a large number of passages related to phase energetics, the other parts of the book, do not include any of these sections; therefore, phase energetics appears to be Wang Bing’s interpolation and a much later invention. Porkert says, “The thesis that phase energetics constitutes a relatively late innovation is corroborated by the fact that secondary literature on this subject does not appear before the middle of the Song period (1099) and in notable quantity only in the Ming.[37]



Standardization of Chinese thought during the Western Han

The standardization of terminology, theory, and practical technique during the early Han was by no means limited to the medical world; it was a much broader process, involving many aspects of contemporary culture, including philosophy and literature. “In sharp contrast with the Qin the Han dynasty, while continuing the political heritage of the former, combined in its world-conception the idea of the absolute power of the Emperor with the recognition of the necessity of the metaphysical norms of love and duty, thus realizing, perhaps for the first time in Chinese history, Confucius’ ancient ideal of the Sovereign who, mandated by Heaven, carried out its will: to govern the people by spiritual power which by its very nature is beneficent and stimulating.[38]

The period of early Han is the time of general standardization in Chinese culture; it is the time of classification and standardization of the classics. The study of the classics was a central issue and was promoted by the emperor himself; in 191 B.C. emperor Hui abolished the law proscribing the possession of books, promulgated by the Qin in 213 B.C.; in 136 B.C. emperor Wu established, advised by the leading scholar Dong Zhongshu, the institution of the wujing boshi (erudities for the five classics), raising Confucianism to be the only officially recognized doctrine. The reign of emperor Wu of the Han is known in Chinese literature as the period of tongyi sixiang, or the ideological unification; despite his affinity towards occult and esoteric teachings, through promoting Confucianism and the study of classics, he made a big step towards the unification and rationalization of Chinese thought. The need for such reforms was present in the political and intellectual world, the changes did not merely represent the literary interest or attraction of the emperor; “the fact that two councils for the discussions of the discrepancies in the Classics were held within comparatively so short a time, the first in the Shiquguo in 51 B.C., the second in the Baihuguan in 79 A.D., points out the unsettled state of affairs in the world of Classical studies during the Western and Eastern Han Dynasties;”[39] even the fierce conflict between the  New Text and Old Text schools shows us how important it was considered to have a united and consistent approach to intellectual thought.

During the Han dynasty, Confucian thought became a great synthetic religion which, despite all the superstition and mysticism fused into it, was a highly rationalized body of thought. This rationalistic system, until the first decades of the Western Han, was counter-balanced by “other, rival, doctrines, in particular Taoism and the School of Law;”[40] later on, these schools lost from their influence and attraction and Confucian rationalism became the dominant force in politics and culture. This is what Needham calls a “Naturalist-Confucian synthesis during the Han.“[41] The study of the classics was further emphasized in the years of the reign of emperor Xuan (73-49 B.C.), twelve scholars representing twelve different schools of interpretation taught the Five Classics at the Grand School in the New Text tradition; the Old Text versions were not recognized officially until a little later, although many scholars of the first century knew and had studied them.[42]

The process of ideological and intellectual consolidation was present in all aspects of contemporary Chinese thought; the grand scale unification also involved the standardization of terminology and technical vocabulary. John S. Major presents a clear and detailed analysis on the evolution of the nomenclature of winds and directions in this period, reaching the conclusion that “the nomenclature of winds and directions in the early Han was still somewhat confused, but also that the confusion was rapidly diminishing as the manifold correlations of Han cosmology were becoming standardized.”[43] Major also points out the cosmological significance of Gao You’s (c. 168-212) commentary that gives a correlation to the eight musical instruments as well. “This may seem a trivial correlation to make until one remembers how seriously music was taken in ancient China for its symbolic and numerological qualities. Thus introducing musical instruments in this context opens the door for further cosmological integration, so that the system will embrace not only time and space, yin and yang, the Five Phases, and the eight triagrams, but the numerology of the pentatonic and duodecatonic scales. Thus the system approaches the all-embracing syncretic organic cosmology, containing an appropriately detailed set of prescriptions for human conduct, that was to have its full flowering in the works of Dong Zhongshu within a few decades of the writing of the Huainanzi.”[44]

One of the spectacular manifestations of this standardization process in this period is the compilation of Dong Zhongshu’s Chunqiu fanlu, a work in the New Text tradition which, despite its later interpolations,[45] remains to be one of the greatest examples of correlative thinking and the system of correspondences. It is a work extends the theories of Yin-Yang and five phases to virtually every aspect of human existence, including arts, music, food, politics, philosophy etc., creating a consistently integrated system very much in the tradition seen in medical literature starting from the Nanjing, Huangdi neijing, Shanghanlun and other texts during and after the Han dynasty.



Conclusions

As the examples above suggest, the sophisticated system of correspondences constituting the main characteristics of Chinese medical science could emerge only after the first century B.C., possibly even later. It was certainly far from that stage in 168 B.C., at the time of the Mawangdui burial and, considering the phase of development revealed by the excavated documents, it might have taken several centuries to reach the stage manifested in classics like the Nanjing. Despite the gen%ral view of seeing the system as part of the Zhou or early Han Jprosperity of Chinese philosophical thought, the materials found in the Mawangdui tombs confirm that even during the early Han, Chinese medicine was still far from that comprehensive and subtle universality which became its main characteristics during the next millennium. The Mawangdui documents reveal a pragmatic clinical healing practice primarily based on pharmaceutical knowledge; routine, philosophical ideology and theoretical considerations play a much smaller role  in the texts.

During the Western Han dynasty, in the time period between the Mawangdui medical corpus and the text of earliest traditional medical classics, especially the Nanjing, that is during the several decades between 168 B.C. and  the first century B.C., as part of a more general process in Chinese thought, we can recognize a grand scale standardization and systematization of Chinese medical thought and terminology; the medical knowledge and experience of the preceding centuries was revised and shaped into a new integrated model.

In the process of standardization the Nanjing played a pioneering role, outlining the new principles and eliminating the contradictions and peculiar interpretations; with its scientifically concise style it is a conscious effort to guide the contemporary medical thought towards integration. Unlike the Huangdi neijing,  it was a work of one person with a revolutionary attempt to influence and guide medicine into a new direction. Taking into consideration the questions raised regarding the unsettled aspects of various concepts and the intentionally methodical answers, at the time when the Nanjing was written, there was a great deal of confusion and uncertainty in the medical world and the old teachings were still very much present.



[1] J.P.Du Halde, “The art of medicine among the Chinese,” in A Description of the Empire of China and Chinese-Tartary, together with the kingdoms of Korea and Tibet (London: E.Cave, 1738-41).

[2] The works of Hippocrates and Galen have been available to modern readers for several decades in all European languages. In fact, the study of ancient medical history has always been mostly concentrated on that of the Hellenistic and Roman tradition.

[3] Most of the modern translations of these works are medically oriented and follow the traditional interpretation of these works, completely disregarding the historical development and philological background. Instead of a precise translation of passages, the translator “reads in” modern, Chinese or Western, ideologies into the original text, destroying the creditability of the translation and depriving the Western reader from an unbiased and authentic reading of the text.

[4] Although the Huangdi neijing is a collective title that includes the Suwen, Lingshu, Taisu, and Mingtang-jing, for the sake of simplicity, I will treat it as a single work.

[5] Donald John Harper, , Do#toral Dissertation, University of California, Berkeley, 1982, p. 59. Harper (p. 133, n. 262) discusses the historical identity of Bian Que who became a patron saint of medicine in later times.

[6] On the medical texts in the Huangdi tradition see David J. Keegan, The Huang-ti Nei-ching: The Structure of the Compilation; The Significance of the Structure, Doctoral dissertation, University of California, Berkeley, 1988. Keegan believes that the Nanjing originally belonged to the so-called Bian Que tradition and later on came to be part of the Huangdi tradition.

[7] Manfred Porkert, The Theoretical Foundations of Chinese Medicine: Systems of Correspondence, Cambridge, Massachusetts and London: MIT Press, 1974, p. 4.

[8] For a detailed analysis of this matter, see Unschuld, Nan-Ching, pp. 29-34. Unschuld gives a valuable summary of different attempts to date these two texts, followed by his own. “Earlier in these prolegomena, I have referred to the Nanjing as a work of the first or early second century A.D.; it may even have been written a few decades before the first century A.D. I concur with the opinion that the Shanhanlun was influenced by the Nanjing, and I agree with those commentators who saw a significant gap between the language and the concepts used by the Nanjing and those found in the Neijing — a gap that signals development as well as difference. I am convinced that the Nanjing was compiled to overcome the heterogeneity and unsystematic nature of the Huangdi neijing anthology of medical schools and concepts — and especially to draw the conceptual and clinical consequences from the ‘discovery’ of the circulation of vapor-influences in the organism. In my opinion, the Neijing texts on needling and diagnosis reveal a stage of development that is not only later than that indicated by the texts unearthed from the Mawangdui tombs (168 B.C.) but also later than that indicated in the biography of Shunyu Yi (216-150?) in the Shiji (compiled in 90 B.C.) Thus the Neijing texts cannot have been compiled before the late second or first century B.C. (although some parts of the Neijing — for instance, those on wind divination — appear to be older, and some are much younger.) The Nanjing, then, could have been written after the appearance of the Neijing texts on needling and vessel diagnosis, and before the appearance of the Shanghanlun in the second century and of Huangfu Mi’s Diwang shiji in the third century A.D.” I do not fully agree with this conception and I believe, following Keegan, that the two texts are unrelated and are coming from a different tradition of texts. Keegan distinguishes a Huangdi and a Bian Que tradition in early Chinese medicine and classifies the Nanjing under the latter one; he writes on the relation between these texts, “the more we examine the Nanjing, the less it looks like an explication of the Neijing. ”Keegan, The Huang-ti, p. 32.

[9] Nathan Sivin, “Huangdi neijing,” in Early Chinese Texts: A Bibliographical Guide,  ed. Michael Loewe (Berkeley: IEAS, 1993), p. 196.

[10] In relation to Chinese medicine, Porkert gives an illustrative example, “The American doctor who at some medical meeting happens to quote Hippocrates, does not do it so directly. Instead, more likely than not, he will quote his former teacher at medical school, who in turn had quoted a specialist on the history of medicine, who in turn had quoted a philologist who died 110 years ago without the slightest inkling of what Western medicine would develop into in the mid-twentieth century. Still, the American doctor’s fourth-hand quotation of Hippocrates is of but slight concern, since nobody in today’s medical world will pretend that constant and direct reference to the works of Hippocrates is indispensable to the advancement of research. Yet this — with reference to the Chinese medical classics — is precisely what would be required of anyone who seriously meant to amalgamate Chinese and Western medicines.” Manfred Porkert, “The dilemma of present-day interpretations of Chinese medicine,” in Medicine in Chinese Cultures: Comparative Studies of Health Care in Chinese and Other Societies, eds. A. Kleinman, P.Kunstadter, E.R. Alexander, J.L.Gale (Washington, D.C.: Geographic Health Studies, 1975), 61-75.

[11] This is the conventional approach of Chinese medical scholarship which somehow denies the idea of development and evolution; in reality, however, medicine has undergone some fundamental changes through the span of its evolution.

[12] For the account of medical writings found in the tomb, see D. J. Harper, “Mawangdui tomb three: documents, I. The medical texts,” Early China 2 (1976), p. 68-69.

[13] Ma Jixing, “Mawangdui gu yishu kaoshi”, Changsha: Hunan kexue jishu, 1992, p. 1.

[14] “Originally compiled by Liu Xiang (79-8 B.C.) and Liu Xin (d. AD 23), this catalogue served as the basis for the Hanshu bibliographic catalogue. For the section on medical literature see Hanshu 30.78b-82.” Harper, The Wu Shih Erh, p.111, n. 25.

[15] The translation of the Hanshu categories is from Pierre Huard and Ming Wong, Chinese Medicine, New York, Toronto: McGraw-Hill Book Company, 1968, p. 13.

[16] The translation of the names of individual documents in from Harper, The Wu Shih Erh, pp.8-9. On the description of all medical documents found at the Mawangdui site, see ibid., pp. 7-14.

[17] Harper, The Wu Shih Erh,  p. 9.

[18] As a reference to this and the following points, it would be appropriate to say a few words about the way the Nanjing presents medical theory and practice. According to its content, it can be divided into six part:

1. Pulse

2. Ducts

3. Organs

4. Diseases

5. Acupuncture points

6. Needling

Each of these subjects are discussed in detail, aiming to provide the reader with a clear understanding. It also elaborates on the Yin and Yang and the five phases theories. Consequently, all of the topics I list below as different in the Mawangdui medical corpus, are already present in the Nanjing. 

[19] Showing the presence of stone probes in pre-Qin times, Ma Jixing quotes several passages from the Guanzi, the Hanfeizi, and the Heguanzi where stone probes are used for medical treatment. Ma Jixing, Mawangdui, p. 19.

[20] See Xie Guan, Zhonghua yixue da cidian, Shenyang: Liaoning kexue jishu, 1994, p. 38.

[21] Harper, The Wu Shih Erh, p. 392.

[22] In the Huangdi neijing the use of stone probes and metal acupuncture needles is explained in one place with reference to geographical conditions. “The east is the direction of the birth of heaven and earth. The weather there is mild, and it is close to the water. Many varieties of fish and salts can be found, so the local people eat many kinds of fish and like salty flavor... The commonly suffered illnesses are boils and carbuncles. The treatment of this disease often utilizes needles made of stone, which are thicker, and bleeding which releases the heat. Thus, the method of stone needles comes from the east... In the southern regions the weather is hot, and the Yang qi is at its utmost... Conditions common in these areas are spasms, numbness, paralysis, bi/arthralgia syndrome, and wei/flaccidity syndrome. The correct treatment employs very fine needles. Thus, the art of the nine types of needles comes from the south. These are metal needles.” Ni Maohsing, The Yellow Emperor’s Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, Boston and London: Shambhala, 1995, p. 48.

[23] For the complete account of this argument see Yamada Keiji, “The Formation of the Huang-ti Nei-ching,” Acta asiatica 36 (1979): 67-89.  “What we have at hand as facts almost established are that the four medical articles written on silk were compiled in the early Qin period and that they form the archetypes of at least three articles in the Huangdi neijing.” p. 78. For a detailed and extensive description see Akahori Akira, “Onyo juichi myaku kyukei no kenkyu,” Toho gakuho 53 (1981), pp. 299-339.

[24] Ma Jixing, Mawangdui guyi shu kaoshi, Changsha: Hunan kexue jishu, 1992, p.13-14.

[25] For a fascinating account on the relation between the ducts and organs, see Porkert, The Theoretical Foundations, p. 107-162.

[26] In standard Chinese medical thought, the word jing exclusively refers to the twelve main ducts associated with twelve body organs. The mai, unlike in the Mawangdui documents, is never used to indicate these main channels; there are eight so-called “extraordinary” or “peculiar” (qi) meridians that are not related to any individual organ but are running symmetrically along the body. Beside this meaning, the word mai, both in the Mawangdui and traditional texts, has been used to indicate the pulse.

[27] See Ma Jixing, Mawangdui, p. 16-17.

[28] Harper, The Wu Shih Erh, p. 67. Harper sees the magical recipes reflecting the shamanistic traditions of the South.

[29] The historically heterogeneous nature of Huangdi neijing has been emphasized  by Yamada Keiji. See Yamada, “The Formation.”

The translation is not complete at this point, since the original texts speaks of treating with metal needles (zhen) and stone [blades] (shi). The term acupuncture could be only applied to the needles; stone blades or probes (bianshi) are known to be used at the early stage of medical practice, even during the Zhou dynasty.

[31] Ni, The Yellow Emperor’s Classic, p. 50.

[32] Paul U. Unschuld, Nan-ching: The Classic of Difficult issues, Berkeley, L.A., London: University of California Press, 1986, p. 285.

[33] Unschuld, Nan-ching, p. 367.

[34] Unschuld, Nan-ching, p. 310.

[35] Unschuld, Nan-ching, p. 382.

[36] Unschuld, Nan-ching, p. 3.

[37] Manfred Porkert, The Theoretical Foundations, p. 58. Porkert gives a convincing account on the late origins of the theory of phase energetics.

[38] Som, Po Hu T’ung: The Comprehensive Discussion in the White Tiger Hall, Westport, Connecticut: Hyperion Press, 1949, p. 85.

[39] Ibid., p. 82.

[40] Ibid., p. 96.

[41] Joseph Needham, Science and Civilization in China, Cambridge: University Press, 1956, vol 2. p. 247.

[42] Michele Pirazzoli-t’Serstevens, The Han Dynasty, New York : Rizzoli, 1982, p. 128.

[43] John S. Major, “Nomenclature of winds and directions in the early Han,” T’oung Pao 65.1-3 (1979), pp. 66-80.  Major points out that while the names of winds and directions become fixed and unchanging during the Western Han, they do not have this permanent nomenclature in the Huainanzi and works prior to that. In fact, the Huainanzi is a work that witnesses the process of this evolution, since it mentions both the standard names and the variants of an earlier, more inconsistent tradition.

[44] Ibid. p. 79.

[45] On the account of uncertainties regarding the date and authorship of certain passages in the Chunqiu fanlu, see Steve Davidson and Michael Loewe, “Ch’un ch’iu fan lu,” in Loewe, Early Chinese, pp. 80-85.


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