History of TCM

Huangshan

China is a vast country in eastern Asia, totaling some 5.9 million square kilometers, second only to Canada and Russia in terms of landmass. The Chinese call their country Zhong guo, which means Middle Country, perhaps because the ancient Chinese thought of their country as both the geographical center of the world and the only cultured civilization. Like India, China is a diverse land, including some of the world’s driest deserts, the highest mountains, fertile farmlands, and humid tropical coasts. Among the most important regions of China is that traversed by one of world’s longest rivers, the Yellow River, or Huang He. As the Huang He makes its way north from Tibet, it passes though an area of inner Mongolia that is rich with loess, a fertile, yellowish topsoil deposited by the wind, which imparts a yellowish color to the river. The good fortune with which the Chinese perceive the color yellow is perhaps reflected in the origins of their culture, which as we will see, evolved along the banks of the Yellow River.

Ancient Chinese civilization

Humans have lived in what is now China since long before the beginning of written history. Prehistoric humans referred to as the Peking people lived between about 500,000 and 250,000 years ago in what is now northern China. The Neolithic period began in China about 12,000 B.C.E., although definitive archeological information exists from only about 4,000 B.C.E. The Neolithic is defined by the spread of settled agricultural communities, although hunting and gathering was still practiced. The largest concentration of agriculture was below the southern bend of the Yellow River, with millet being the main crop. Unlike its rather cold climate today, northern China during the Neolithic was considerably warmer and moister, with dense forests, and many lakes and marshes. It is in this area that the Yangshao and Lungshan civilizations evolved, and from these peoples, we can trace the beginnings of Chinese civilization.
The Yangshao culture reached the peak of its development about 3000 B.C.E. The Yangshao created painted pottery that had geometric designs on it, and fashioned axes and arrowheads from polished stone. The cultivation of millet was supplemented by the domestication of the pig and dog. The Yangshao also developed the production of silk, probably already in development by the early Neolithic, obtained by feeding the silkworms mulberry leaves, and after molting, boiling the cocoons to produce the raw silk, which was then spun into cloth.

The Lungshan culture developed slightly later than the Yangshao, also located near the Huang River, but further east. The Lungshan are noted for their exquisite unpainted black pottery, which may have been a direct predecessor to later Chinese pottery. Over time, the Lungshan eventually displaced the Yangshao, and gave rise to the Xia civilization. Like the Lungshan before them, the Xia were agriculturalists, but had begun to produce bronze weapons, and had begun to cultivate rice, and raise sheep and oxen as well as pigs and dogs. Radiocarbon dating of Xia archeological sites indicate that they existed from 2100 to 1800 B.C.E.

According to Chinese tradition, the legendary Shen Nung lived during this period, inventing agriculture and the domestication of animals, as well as identifying several medicinal plants. No record from this period suggests his existence however, and the earliest mention of his great accomplishments occur in a text written by Tao Hung-ching in the 5th century C.E. Similarly, Chinese historians suggest that the legendary emperor Huang-ti, the Yellow Emperor, is also from this period. Thus, the famous work of Chinese medicine, the Huang Ti Nein Ching Su Wen (Yellow Emperor’s Classic of Internal medicine), or at least the philosophies and methodologies described therein, is said to be some 4000 years old. Corroborating archeological evidence however is non-existent, with the earliest mention of the Nei Ching occurring more recently in the Han Dynasty.

The Shang Dynasty

By about the 17th century B.C.E., the Shang Dynasty evolved, growing out of the earlier civilizations of the Huang River Valley. The Shang Dynasty is thought of as the first true dynasty because it was the first indication of successive, hereditary rule in China. Of their many innovations the Shang are noted for the invention of writing, most commonly seen on the oracle bones used for divination. To ascertain the answer to some pressing issue, the diviner would write a question on a bone and then fire it in a kiln. Under the extreme heat the bone would crack, and after it was removed and cooled, the diviner would interpret the cracks, and the answer would be inscribed on the bone. The Shang people also advanced the technique of casting bronze, using it to forge bronze weapons, bronze fittings for chariots and harnesses, and bronze vessels used in religious ceremonies.

From what can be pieced together from the archeological evidence, the Shang king had considerable power over his subjects, using them as a labor pool to build various monuments, buildings, roads, and fortifications. The Shang capital at Zhengzhou is a good example of this, displaying a wall of stamped earth that encircled the city that was more than six kilometers long and as high as eight meters. The Shang built these walls by repeatedly pounding thin layers of earth into removable wooden frames. The result was a building material that was as strong as concrete.

Shang culture revolved around the worship of “Ti,” a supreme god who ruled over lesser gods, the sun, the moon, the wind, the rain, and other natural forces and places. The Shang also ritualized ancestor worship, which would later become a major part of the Shang religion. Sacrifice to the gods and the ancestors were apparently quite common, and when a king died hundreds of slaves and prisoners might be sacrificed and buried with him. Such people might also be sacrificed when important events occurred, such as the founding of a palace or temple. The king’s role in Shang society was obviously more important than its common denizens, something that can be easily seen when we contrast the comparatively luxurious accommodations of the king with the otherwise stone age conditions under which the vast majority of people lived. This was because the king served not only a ruler, but performed the primary function of appeasing the various deities and ancestors with offerings to ensure a bountiful harvest. The king performed this function partly through divination, with the answers received providing much of the basis of his rule.

Shang Medical Practices

To fully understand Shang medical practices we have to understand the function of Shang society. While the various symptoms of disease, such as a toothache or a miscarriage, were identified and treated with various remedies including medicinal herbs, these symptoms were not viewed in isolation. All illness, besides that which could be definitively ascribed to some human activity, such as a wound or injury, was perceived as a crisis between the living and a departed ancestor. The oracle would be consulted to determine which ancestor was offended and how he or she might be placated:

Question: Severe tooth illness. Should a dog be offered to the departed father Keng, and a sheep be ritually slaughtered? (Unschuld 1985, 21)

Preventative measures however, were also an important part of Shang society, and great expense and care was taken to appease the departed ancestors, from smaller offerings conducted on a regular basis, to the occasionally extensive offering of hundreds of livestock. Shang religion dictated that society’s resources were to be distributed equally between the living and the dead. As unhappy ancestors caused the majority of illness in Shang culture, diseased individuals indicated a state of disharmony between the living and the dead. Ultimately, Shang medicine was a kind of social therapy, and whether crop failures or epidemics, the king functioned not only as ruler, but as a kind of social healer (Unschuld 1985, 26).

Concurrent with their belief in the role of ancestor in health and disease, the Shang also believed that certain natural forces, wind in particular, could bring disease, as well as poor weather, the latter of which could greatly impact the health of an agrarian society. Such natural phenomena was controlled by Ti, the Divine Ancestor, and Shang culture evolved a class of healer-shamans called “wu” that specialized in conducting certain rites to prevent or pacify an “evil” wind, as well as bring rain (Unschuld 1985, 25). The Shang pictograph for the wu-shaman suggests a dancer, and harnessing the homeopathic doctrine of similars so prevalent in early agrarian cultures across the world, the shaman would perform his ritual dance until the sweat poured off his body, symbolic of the rain falling from heaven (Unschuld 1985, 35, 54).

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The Zhou Dynasty

In about the 12th century B.C.E., a group of semi-nomadic Chinese peoples from west of the Shang empire called the Zhou (Chou), settled in the Wei River valley, where they became vassals of the Shang Empire. Over time their strength grew, and in about 1040 B.C.E. the Zhou fashioned a coalition of disaffected city-states and overthrew the Shang. The Zhou then established their own dynasty, building their capital near the modern city of Xi’an, heralding the beginning of what is called the Western Zhou Dynasty.

Traditional Chinese history states that the Zhou were able to overthrow the Shang because the latter had become morally corrupt, a perspective that was in all likelihood promulgated by the Zhou conquerers. Nonetheless, the Zhou introduced several reforms, including the prohibition of human sacrifice, as well as their religion, which emphasized the worship of the sun and stars, and the division of Heaven and Earth. The Zhou also fashioned a kind of feudal system in which land was given to loyal families in elaborate ceremonies. In large part however, the Zhou fashioned their rule after the Shang Dynasty, using the same system of writing system and many of the same administration techniques.

Like the Shang, the Zhou utilized divinatory methods to direct governmental policy and to ascertain the cause of illness. Although the earliest archeological evidence suggests that the Shang used bones as instruments of divination, it is known that they also interpreted the cracks on fired turtle shells. The excavated Shang capital at Anyang was formerly a marshy area, with many tortoises. A gradual shift towards aridity however dried out these marshy areas, and the practice of using tortoise shells declined. It was during this period that the Zhou gradually replaced the use of fired bones or tortoise shells with the 64 hexagrams of I Ching, one of the oldest and most important texts in Chinese culture. To enquire of the oracle, the Zhou evolved the practice of dividing and counting Yarrow stalks (Achillea millefolium) to form the different hexagrams during a consultation.

The entire concept of the I Ching rests on the dual principles of yin and yang: yang represented by a solid line, and yin by a broken line. The varying arrangement of these yin and yang lines into six parts forms the 64 hexagrams. The concept of yin and yang, the basic division of all phenomena into two opposite, but interdependent. qualities is also an important concept in Chinese medicine, and even though the actual mention of these terms only appears during the One Hundred Schools period of the later Zhou Dynasty, the theoretical underpinnings of Chinese medicine appear to be secure in the antiquity of the I Ching.

Soon after they established their rule in Xi’an, the Zhou Dynasty came under increasing pressure from invading non-Chinese nomadic tribes to the north. In about 770 B.C.E. the Zhou rulers were finally forced eastward, founding a new capital at Louyang, initiating the beginning of the Eastern Zhou Dynasty. Despite these new beginnings the Zhou Dynasty steadily lost ground after this period. This was due, in part, to the realization by the various feudal lords that the Zhou had become weak, as evidenced by their defeat in the west, as well as internal struggles within the Zhou rulership. The latter period of the Eastern Zhou Dynasty is referred to as the Warring States Period, marked by constant feuding and struggles for power, not only between families, but within them as well. The empire was eventually broken into hundreds of smaller kingdoms and fiefdoms, which in latter years was reversed by a series of annexations and alliances, but leaving no power strong enough to unite the people. Lasting from 475 to 221 B.C.E., this period is among the bloodiest in Chinese history. Despite the instability of the period however, it was during this time that some of the most important developments in Chinese culture occurred, often referred to as the One Hundred Schools period. Confucianism, Taoism, and Legalism all developed during this time. Other advances included the formation of textual legal code and a currency-based economy. The development of iron, and tools made of iron, greatly enhanced agricultural production, and thus the population exploded.

Zhou Medical Practices

While the Zhou more or less continued the Shang practice of ancestor worship and appeasement, the role that the ancestors could play in disaster and disease was greatly diminished (Unschuld 1985, 35). Rather, the Zhou emphasized the idea that such events were the direct result of malicious lesser deities, or demons. Dispensing with the wu-shaman of Shang society, the Zhou relied upon their priests, under the authority and with the help of their primary deity, T’ien, to control the demons as well as perform exorcisms. While both Shang and Zhou cultures believed in the influence of the supernatural, the Zhou perspective was that illness and misfortune were no longer an expression of a personal relationship of the living with a departed ancestor. Instead, demons were conceptualized simply as unattached souls, randomly afflicting a person or community. The observance of certain social customs, such as burying the departed with treasure or ritual sacrifice to the ancestors, so important to the Shang, were no longer helpful to protect against malicious demons (Unschuld 1985, 36).

The Zhou evolved a diverse range of customs to protect themselves against the demons. Several times a year, or on the occasion of some event such as the death of the King, groups of exorcists would race through the streets, screaming and shouting, thrusting their spears in the air, all in an attempt to scare off the demons. The importance of exorcising demons appears to have had a significant impact upon the development of medicine during the Zhou dynasty. A medical and alchemical text written by Sun Ssu-miao in the 6th century B.C.E. suggests the location of thirteen points on the body, variously entitled with such names as “demon hearts,” “demon path,” and “demon bed” (Unschuld 1985, 45). In this text, Sun Ssu-miao details that it was the practice of a physician named Pien Ch’io to puncture these points with needles to treat demonic illness. Besides this account of the possible origins of Chinese acupuncture however, Sun Ssu-miao mentions numerous spells and incantations to prevent and treat various diseases. These could be chanted by the afflicted to ward off the demons that caused the disease. In the case of fever, Sun Ssu-miao mentions the “Interdiction of Intermittent Fever,” the “yao” illness:

“I ascend a high mountain. I look down into the water of the sea. A dragon with three heads and nine tails lives in the water. He subsists on nothing but yao demons. In the morning he devours 3000 of them; at night 800. If his hunger is not yet stilled, he dispatches emissaries to drag in more demons. Amulets and drugs penetrate the five granaries of the body; the yao demons should retreat. Those that do not submit will be put in chains and delivered to the Lord of the river. Quickly, quickly, this is an order” (Unschuld 1985, 45)

Treatment, however, was not limited to incantations, and several physical agents were also used, as talismans, incense, or taken internally. Many of these remedies, when burned as incense, had strong odors, such as orchid and musk, or were even toxic, such as the sulfurous fumes of arsenic trisufide. Tree resins, which were thought of as the coagulated blood of the plant, were also considered helpful. When taken internally, the blood of the tree, which contained its vital spirit, could effectively battle the demons and treat the disease (Unschuld 1985, 42).

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The Qin dynasty and beyond

In 221 B.C.E., after the tumult and terror of the Warring States period, the Qin (Ch’in) utilized their military superiority to conquer the other states and unify all of the China for the first time. Their leader was Shi Huang-ti, who perhaps named himself after the ancient Yellow Emperor of traditional Chinese history to solidify his reputation among the people. Shi-Huang-ti initiated his rule based on Legalism, which saw old social customs replaced by a codified system of law under which everyone, including the various heads of the warring states, were accountable. This absolute control of the state was enforced by a system of rewards, and more importantly punishments, so severe they were previously unknown in Chinese society (Unschuld 1985, 32). In order to control any challenge to his authority, Huang-ti transplanted the nobility to his state capital, where they were grouped in units of five to ten families, which had a shared responsibility for the wrongdoings of any individual within the group. Huang-ti also divided his empire into 36 commanderies, which in turn, were divided into individual counties. The appointed administrator for each commandery was then responsible for reporting back directly to the emperor.

While Huang-ti was probably no better than any despot, his government made several reforms, including the standardization of the language and writing of China, which had varied widely from region to region during the previous centuries. This was done, in part, out of a need to have a consistent way to communicate across the country. At the same time, the currency was standardized as a circular copper coin with a square hole in the middle. To accommodate the ruts that cartwheels made in the road, axle lengths were standardized, enabling the efficient transport of goods across the empire. Huang-ti also initiated several public works, such as irrigation canals and road building, as well as the Great Wall, which would be added to in later years by the Han and Ming Dynasties.

Despite all of these accomplishments, Shi Huang-ti was an unpopular leader, and his aggressive pursuit of various public works and the taxes needed to support them were too great a burden. Huang-ti was especially despised by the nobility, who, after being transplanted from their homelands, saw all their power and most of their privileges taken away. In what is largely perceived as the last straw, Huang-ti ordered the burning of all books throughout the empire, a strategy suggested by some historians to keep the common people ignorant, but in all probability, to standardize education, encouraging the people to rely upon an official class of scholars (Yu-Lan 1952, 15). While many of the works of the One Hundred Schools were lost forever, which included works of poetry, politics, and philosophy, Huang-ti’s proclamation was not complete: those texts that related to agriculture, divination, and medicine, were spared.

With the death of Shi Huang-ti in 210 B.C.E., a scant eleven years as supreme ruler of China, the empire was thrown into turmoil. His son, as Second Emperor, had neither Shi Huang-ti’s skill nor experience to rule, and faced the opposition of several disaffected groups: on one hand, the nobles whom Huang-ti had chastened, and on the other hand, a popular uprising led by a Liu Pang, a former soldier. In 206 B.C.E. Liu Pang emerged victorious and was crowned Emperor Kao-tsu, founder of the Han Dynasty. While the Han Dynasty would experience a few starts and stumbles on its path to glory, it established a system of government, based initially upon the Legalist style of the Qin Dynasty, that would dominate Chinese society for the next 2000 years. The Han Dynasty was far more accommodating than was Shi Huang-ti to new developments in political thought however, and in particular, embraced the socio-political perspective of Confucius. As we will see, the innovations in metaphysical and socio-political thinking that occurred during the Warring States period, including Confucianism and Taoism, would have a profound effect upon the development of medicine.

The principle of systematic correspondence

During the Zhou dynasty, medical theories on the origin of disease were in large part based in the religious conception of demon spirits, unattached souls of the departed that would randomly attack the living. Thus, medical treatment often consisted of various rituals, incantations and the use of talismans to ward off these influences. It is clear however, that while demonology was important to Zhou medicine, a conception of homeopathic medicine was also important, especially in treatment.

Homeopathic medicine is based on the principle that two apparently unrelated phenomena are conjoined because they share some feature in common. For example, one Chinese text suggests that a plant which bears no fruit will promote infertility, whereas another recommends giving a potion prepared from the ash of crossbow strings to hasten labor (Unschuld 1985, 53). Such practices however are not unique to Chinese medicine: all cultures all over the world at some point in their history have practiced homeopathic medicine. In western herbal medicine this homeopathic idea is represented by the Doctrine of Signatures, which states for example, that Skullcap (Scutellaria lateriflora) is useful to treat afflictions of the head and nervous system because its flowers resemble a skull when you look down upon them. More recently, the German-born Samuel Hahnemann developed a homeopathic system in which a specific, highly diluted substance is used to treat unrelated symptoms that resemble an overdose of that substance.

In the latter Zhou, and in particular the One Hundred Schools period, a number of developments occurred in Chinese thought that led to marked changes in the practice of medicine, as well as the function of Chinese society generally. Among the most important of these was the development of homeopathic notions into a broader theory in which all phenomena was incorporated into a single system of correspondence. The most prominent of these systems are the yingyang doctrine and the Five Element theory.

The Yinyang Doctrine

In about the 4th century C.E., one school of Chinese philosophy began to promulgate the idea that all phenomena are dualistic in nature. This applied not only to natural cycles and the functioning of the human body, but to matters of the state and society at large. This dualist principle is called the yinyang doctrine. The origin of this dualistic concept is obscure: we have evidence from the venerable I Ching that the various solid and broken lines in the 64 hexagrams are founded upon the concept of yin and yang. There are also references to yin and yang that date back to the first millennium B.C.E. in a collection of ancient folk songs (Unschuld 1985, 55-56). But the dualism that yin and yang represent was well understood centuries before, for example, in the division between the living and the dead in Shang culture. In many ways the 4th century yinyang school was building upon concepts that were already extant, and fairly well understood.

Although not their earliest expression, the theory of yin and yang is perhaps best represented by the teachings of Lao Tzu, a mystical personality dating back, according to traditional Chinese history, to the 6th century B.C.E. In his History of Chinese Philosophy however, Fung Yu-lan states that Lao Tzu was a mythical personage, most probably based on the life of Li Erh who is said to have lived sometime during the Warring Period (1952, 171). In his biography of Li Erh, the old historian Ssu-ma Chien states that Li Erh was a recluse, practicing the doctrine of “self-effacement and namelessness” (Yu-lan 1952, 171). Historian Yu-lan suggests that Li Erh allowed his teachings to become confused with an older literary figure named Lao Tan, releasing him from any obligation to identify himself with his teachings. Instead these were fused with a personage from antiquity, which intentionally or not, enhanced the reputation of the teaching. We do not know however, whether the book of poems called Lao Tzu, or the Tao Te Ching, was written by Li Erh or compiled later by his disciples.

In the Tao Te Ching, the terms yin and yang are used to describe the primary dynamics of a ceaseless cycle of change that forms the Tao, the sum total of all the functions of life, both seen and unseen. While not applied specifically to medicine, the role of the Tao was believed to be the most formative factor in the health of a patient, especially among those that practiced the teachings of Lao Tzu. These Taoists believed that one’s attitude towards the Tao reflected upon one’s state of health to such a degree that the realization of Tao was considered the prerequisite of good health, longevity, and ultimately, immortality. The two principle units of the Tao, yin and yang, are the dual powers that are the instigators of all change. The third stanza of the first poem of the Tao Te Ching describes the significance of these dual principles:

These two come paired but distinct
By their names.
Of all things profound,
Say that their pairing is deepest,
The gate to the root of the world
(Blakney 1983, 53)

A literal translation of yin is the “shady side of the hill,” whilst yang can be translated as the “sunny side of the hill.” As penultimate characteristics of the dualistc nature of the Tao however, these terms represented a relative basis for the classification of all phenomena. In a social sphere, the qualities of yin and yang were considered analogous to the traditional familial roles of female and male respectively; yin being compliant, weaker and downward moving, and yang being adamant, stronger and upward moving.

Yet while representing spheres of function, no one object or thing could be considered purely yang or yin. This is for two reasons: one, all states of being are subject to change, and even if something could be classified as purely yin or yang it cannot remain so indefinitely; and two, because yin and yang are purely relative terms. One cannot designate a particular food for example, such as a carrot, as yang or yin, unless this classification is referenced in concert with how it is prepared, what other dietary articles are consumed along side it, the yinyang status of the person consuming it, and the yin or yang affect of the weather. Even yin and yang were considered subject to yin and yang. Thus within the yin phase there is a greater yin (yin-yin) and a lesser yang (yin-yang) subphase. Similarly, within the yang phase, there is a greater yang (yang-yang) and a lesser yin (yang-yin) subphase. Mapping this subdivision with a view to the different seasons, winter is a manifestation of the greater yin (yin-yin) force, spring is lesser yang (yin-yang), summer is greater yang (yang-yang), and autumn is lesser yin (yang-yin).

In the realm of medicine, the cosmic relationship of yin and yang as darkness and light was carried over into the function and structure of the human body. The earliest reference to the inclusion of Taoist ideas occurs in the Huang Ti Nei Ching Su Wen, which states:

Yin is active within and acts as the guardian of Yang;
Yang is active on the outside and acts as the regulator of Yin
(Veith 1966, 17)

Thus, yin corresponds to the interior of the body (dark, unseen) and yang corresponds to the exterior of the body (light, the observable); moreover, this concept was applied to individual subsystems, such as hollow and solid organs.

Five Phase Theory

Besides the yinyang theory, the other system of correspondence that would influence the practice of Chinese medicine for centuries to come was the Five Phase Theory. According to traditional Chinese history, this system was founded by a philosopher named Tsou Yen in the 4th century B.C.E., during the One Hundred Schools period. Unlike the dualism postulated by the yinyang theory however, Tsou Yen used the number five as the basis of his theory of association, arranging phenomena along five lines of correspondence (Unschuld 1985, 58). The reason for five lines of correspondence, as opposed to the more intuitive duality of the yinyang school, is somewhat of a mystery. The ancient Chinese, however, considered five to be a sacred and special number, used in religious ceremonies and alchemical practices; a number of archaic importance, resonating in the five fingers, the five senses, and the five tastes. Some historians have speculated that the five phase theory was in fact an import from India, as it bears resemblance to the earlier Vedic panchabuthas, but this is unlikely.

In a further break from the abstract concepts like yin and yang, Tsou Yen chose to use tangible phenomena like wood, water, fire, soil and metal as the foundation of these five components. In traditional Chinese medicine, these phases came to be associated with specific physiological functions, for example, wood governs Liver, water governs the Kidneys, fire governs the Heart, soil governs the Spleen, and metal governs the Lungs. While representing five lines of correspondence however, the Five Phase theory is also a model for the various interactions between each of the phases, relationships that can be characterized as either destructive or nutritive in nature. Thus, while water destroys fire, it simultaneously nurtures wood.

Despite the incongruity between them, and the early disagreements between the yinyang and Five Phase schools during the 4th century B.C.E., both concepts would gradually be integrated into the fabric of Chinese medicine. Their mutual existence and conflicting basis would only be occasionally resolved, for example, by designating one of the five phases as neutral, and the others as either yin or yang (Unschuld 1985, 58). But such rationalizations would only be used to resolve a specific argument, and weren’t learned as doctrine. Throughout its history, China has maintained the heterogenous origin of its various philosophies, ideas and practices to a remarkable degree. This is largely the result of a deeply ingrained ability to build bridges between ideas and concepts, unlike the paradigms more familiar in the West, in which old ideas are formed into new ideas by a process of dialectics, or some new idea comes in and completely uproots an older idea (Unschuld 1985, 57). In China, all ideas have some intrinsic importance, and any new idea is solidly built upon the past. This reverent regard for tradition which marked Chinese culture all the way up to the Communist revolution, was in large part fostered, as we will see, by the most influential of Chinese philosophers.

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Confucius, Confucianism and Chinese medicine

Confucius was born in Lu province, in what is now Shandong Province, in 551 B.C.E. His real name is Kong Qiu: the name Confucius is a Latin form of the title Kongfuzi, which means “Great Master Kong.” Although Confucius lived just prior to the bloodiness of the Warring States period, the political infighting and social chaos of the latter Eastern Zhou provoked him to formulate his ideas on political and social harmony. Confucius believed that the reason for social unrest was based in the discrepancy between the apparent role that a person played in society, and how this person actually behaved. For Confucius, the greater a person’s responsibility the greater the need for him to act according to the rules of propriety and conduct that befits such a role: the king, as the appointed ruler of Heaven, should thus think and act in a way that sets the standard for the rest of society. The King displayed his Heaven-conferred nature by observing customary rituals, symbolizing the orderly intercourse between Man and God. This is not to say however, that this heaven-conferred nature was a privilege of birth; rather, it was only through the cultivation of time-honored moral standards as an individual rather than communal ethic that opened up that path to Heaven. Thus, Confucius believed that any man could attain any position in society, provided he follows the path of the “superior man.”

Confucius was wholly concerned with the socio-political sphere of life, believing that Heaven was only made manifest in the cultivation of one’s character. He refused, similar to the Buddha, to speculate on metaphysical questions, encouraging his disciples to look to the sphere of human activity for answers to existential questions. With this empirical outlook, Confucian thinking would set the stage for the innovative spirit of the One Hundred Schools period. And yet while Confucius rejected certain aspects of the Zhou religion, such as demonology, he nonetheless modeled his social theory upon the basis of Zhou feudal practices.

Confucius was for the most part ignored during his lifetime however, despite his innovative thinking. His initial attempts to gain positions of authority, to influence the practice of government, were unsuccessful. Later on in his life Confucius left these aspirations behind, and contented himself with being a teacher, like the Greek Sophist Socrates, perhaps the first of his kind in China. It is not known whether Confucius ever committed his ideas to text, but they were preserved by his disciples in a book called the Analects. Among the more important promulgators of Confucian socio-political theory was Hsun-tzu (c. 3rd cent. B.C.E.), whose affectionate biography and exposition of the principles of Confucius would have an enormous impact upon the advisors of Han emperor Wu Ti (147 — 87 B.C.E.). Wu Ti’s style of government was so successful that his rule would influence every successive Chinese dynasty up until Communist Mao Tse-tung (1893-1976 C.E.).

With the enormous impact of Confucian social theory on Chinese philosophy, it is perhaps no surprise that medicine would be similarly influenced. Over the centuries Zhou concepts of demonology were gradually replaced with the Confucian ideal that harmony was largely a function of personal responsibility. To Confucius, success in life was largely dependent upon fulfilling private, societal and religious obligations with absolute impeccability. Disharmony occurs when these obligations are not fulfilled, and men turn their attention from the observance of morality. Thus, in the sphere of medicine, sickness and disease occurs only when health is not actively maintained:

“Nowadays people are not like this, they use wine as beverage and they adopt recklessness as usual behavior. They enter the chamber (of love) in an intoxicated condition; their passions exhaust their vital forces; their cravings dissipate their true (essence); they do not know how to find contentment within themselves; they are not skilled in the control of their spirits. They devote all their attention to the amusement of their minds, thus cutting themselves off from the joys of long (life). Their rising and retiring is without regularity. For this reason they reach only one half the hundred years and then they degenerate.”
• Yellow Emperor’s Inner Classic (Huang Ti Nei Ching Su Wen) (Veith, 98)

Despite the Confucian emphasis upon preventative medicine and morality, the demonological concepts ingrained in the practice of Zhou medicine continued to evolve, particularly in the understanding of wind as pathology. As early as the Shang Dynasty, and perhaps even earlier, the people of China considered wind to be an influential force in nature, if for no other reason than it is wind that brings the weather that affects the crops, and thus the health of an agrarian society. Gradually stripped of its demonological orientation, wind was increasingly viewed as a natural phenomenon that could have inherently bad effects, effects that could be predicted according to lunar and seasonal cycles. Thus, the superior man lived according to the season and the signs, cultivating a lifestyle and diet that mediated the negative effects of otherwise natural occurrences. Wind as pathology eventually gave rise a theory of environmental medicine, called the Six Evils, of which wind was a component, along with cold, summer heat, dampness, dryness and fire.

The Nei Ching

According to tradition, the practice of Chinese medicine originates with the dissemination of the Yellow Emperor’s Inner Classic (Huang Ti Nei Ching Su Wen), known simply as the Nei Ching. Many Chinese believe that this text originates some 4000 years ago, during the legendary reign of the ancient Yellow Emperor (Huang Ti), the first ruler of China, and founder of Chinese civilization. Archeological evidence for this claim however is weak, as no medical inscriptions have ever been found on anything dating back to this period. The Nei Jing is thought to have been compiled sometime between 200 and 100 C.E., and beyond a series of texts recently excavated that contain reference to the practice of Zhou in the 3rd century B.C.E., it is the oldest extant text on the practice of Chinese medicine.

The Nei Ching takes the form of a dialogue between the Yellow Emperor and his minister, Ch’i Po, in which the Emperor asks questions regarding the practice of medicine, and Ch’i Po responds with long discourses. Despite historical claims, the Nei Ching clearly reflects the heterogenous origin of Chinese medicine, and rather then being thought of as written by one person, it is the compilation of several texts written by different authors with different perspectives. The Nei Ching nonetheless effectively outlines the basic ideas in Chinese medicine, principles that have remained unchanged in almost 2000 years. In the Nei Ching, health and wellness are a manifestation of the Tao, or more specifically, the interaction of yin and yang within the body. Confucian-influenced ideas on morality are also discussed in the Nei Ching, and later, the text details the five phase theory, the associated functional systems (sometimes translated as “organs”), and their corresponding meridians. It should be little wonder that the Nei Ching was, and remains to this day, so highly respected by Chinese physicians and philosophers alike, considering the completeness by which it integrates the philosophies of Confucius, and the yinyang and five phase schools, into a functional conception of health and healing.

Epilogue

Although fully formed in the Nei Ching, traditional Chinese medicine would continue to undergo development over the following centuries, although nothing would significantly alter its basic practices or theoretical structure. Once again, the Chinese tendency for syncretism dominates, with various physicians over the ages refining techniques such as acupuncture or pulse diagnosis, contributing new plants and remedies to the Chinese materia medica, or adding commentaries to older works. And despite the growing influence of Buddhism in China during the later Han dynasty (c. 25 — 220 C.E.), the Six Dynasties period (c. 222 — 589 C.E.) and Tang Dynasty (c. 618 — 907), which in India had supported a growing network of hospitals and clinics to serve the poor and indigent, China continued to adhere to the cultural values of Confucius, who warned against state-funded welfare programs. Thus, unsupported by the authorities, Indian medicine, in guise of Buddhism, never made much of an impact upon China.

With the evolution of the Ming Dynasty in the 14th century C.E., after centuries of invasion and rule by foreign Mongols, China closed its borders to foreign influence, and renewed itself in the distinctly Chinese Confucian social theory. The Ming rulers however weren’t so opposed to foreigners that they didn’t mind getting rich from them. By the 16th and 17th centuries the Chinese had developed a one sided-traded advantage with the West, who in recent centuries had become greatly desirous of Chinese-produced tea and silk. To undermine the Chinese economic advantage, European traders began to smuggle goods into China, the most important of which became opium. The effect of this drug in Chinese society however, was disastrous, and hailed by Chinese authorities as the cause of increasingly financial hardship and social decay. In 1839, in a demonstration of their renewed sense of autonomy, Chinese officials confiscated 20,000 chests of opium from British merchants in Guangzhou. The Chinese however, had little notion of the trap that had been laid by the British, and with the seizure of the opium, Britain declared war with China, and within a relatively short period of time, had defeated the Chinese and firmly established European interests in China. European missionaries soon took up the task, impossible in previous centuries, to spread the Christian gospel across China. In a similar fashion, Western ideas and culture began to make inroads into China, and the Chinese were actively encouraged to dispose of their traditions and customs, which the Europeans saw as barbaric and unintelligible nonsense.

Despite hardcore resistance by some segments of Chinese society to oust the Europeans, the spirit of Chinese society was irreparably changed by Western culture. In medicine, the old theories of yin and yang were displaced by the emerging dominance of Western medicine. Soon, Western medicine became the dominant form of health care, at least for those who could afford it, or were willing to obtain service through the medically-trained Christian missionaries. With the Communist revolution in 1953 however, Western medicine was increasingly viewed as inherently “bourgeois,” and the rediscovery of Chinese medicine followed on Mao Tse-tung’s call to “uncover the treasure house and raise its standards” (Unschuld 1985, 252). It is in the second part of the paraphrased statement by Mao however, that the Communist agenda is fully elaborated, and by “raising its standards,” Chinese medicine was subjected to the socio-political theory of Marxism, stripped of much of its religious and spiritual content, and interpolated with Western medical practices. Although this “new medicine” was widely disseminated by the Communists, for example, in the legion of “barefoot” doctors who practiced a hodge-podge of Chinese and Western medical practices, it was recognized by the early 1980’s that this approach was in danger of causing irreparable harm to Chinese medicine. Since then, the Chinese government has legitimized the practice of Chinese medicine, which although sanitized of any kind of truly spiritual or religious perspective, is granted legitamacy as one of the “Three Roads” of medicine, along with Western medicine, and a rapidly developing Chinese-Western medicine hybrid (Unschuld 1985, 261). Today, a patient China may choose to receive either Chinese or Western medical therapies, and in many cases, a combination of both. And now, in the West, certain aspects of Chinese medicine, especially acupuncture, are undergoing intensive study in becoming integrated into standard patient care. Acupuncture has also fostered the development of an entirely new system of healing in the West called energetic psychology, represented by the work of practitioners such as Roger Callahan and Fred Gallo.