Medicine: China

"Classical Chinese medicine" refers to the cumulative practices and abstract doctrines passed down by a small literate minority in China beginning in the first century b.c.e. As in any traditional society, this elite knowledge has made up only a small part of China's health care practices, which include self-therapy, family therapy, and ritual and religious curing. Since 1949, as these elements have changed and their balance has shifted, state-regulated medical practice has come gradually to be divided between biomedicine and a greatly modernized form of the classical art generally called traditional Chinese medicine, or TCM, and hybrids of the two.

Literature

More than ten thousand medical books survive from imperial China (221 b.c.e.–1911 c.e.). These include a small number of doctrinal works with a large accumulation of commentaries and scholarly studies; works on nosology and diagnosis; a great many formularies, most of which systematically set out therapeutic methods; collections of materia medica, which over the last millennium tended to incorporate compound drug formulas; collections of the medical case records of physicians; as well as more or less distinct genres for gynecology, pediatrics, and external medicine. Since the 1950s, scholars in China have edited, annotated, and reprinted many significant early works, and have translated some of the most important into the modern vernacular. Scholars in Asia and elsewhere have used this literature to throw light on a wide range of Chinese ideas, ranging from ethics to gender.

Doctrines

In most of early medieval Europe, only a few classical medical treatises survived, primarily in the libraries of monastic institutions, and most medical practitioners had little education. The outcome was a split between theory and practice. In China there was no such split. Almost all of the literature, including works on doctrinal foundations, was written by practitioners.

Excavated writings on medical divination (from c. 316 b.c.e.) and on medicine (from c. 205 b.c.e.) show traces of a gradual separation of both from popular ritual healing, which had a strong occult component. The first collection of mature classical writings is the Yellow Emperor's Inner Canon (Huangdi nei jing, c. first century b.c.e.). It was one of a number of foundational works but the others of the same period have been lost. Although physicians through history considered the Inner Canon a coherent two-part treatise, David Keegan has shown that it incorporates many separate texts from different sources, some of which comment on, elaborate on, or disagree with others. The various understandings of the body, health, illness, and therapy contained in the work are inconsistent in many respects. Still, all its component text understand the body to be an ensemble of processes that, in health, remain in harmony with those of the cosmos. Reconciling the discrepancies in this most authoritative of classics in order to present a single picture was the goal of several doctrinal works over the next two centuries.

The Inner Canon defined what remained the chief characteristics of medicine: It was process-oriented and relational. Medicine treated a complex ensemble of life processes. Diagnosis was generally a matter of identifying abnormal states of the body as a whole (although, given the diversity of practitioners, the training of many allowed no more than proceeding from a list of symptoms to the name of a disorder). Even physicians who treated particular local symptoms did so from the viewpoint of the whole. Wounds were disorders in the same sense as fevers; they affected not only the lesion but all body processes. Body and mind, complementary aspects of a single organism, were bound to affect each other. Because a disease was a process, doctors had to determine its stage and anticipate its evolution. Medical thinkers defined concepts in relation to others; yang was never an absolute property, but implied a relationship to something else that, in the particular pair, was yin. A young woman might be yin in a discussion of gender relations that compares her with a male, but yang in comparison with an aged man who lacks her vitality.

The conviction that both the state and the body are microcosms that partake in the dynamic order of the universe emerged in political theory, moral philosophy, and medical thought over the last three centuries b.c.e. Intellectuals built these doctrines on the concept of qi, which was both the basic material that filled the universe and formed individual things, and the vitality that maintained body states and brought about change. The Inner Canon integrated this notion with that of yin and yang and the five phases (wuxing ). It interpreted the former as paired, opposed, but complementary aspects of qi, and the latter as five aspects of it, permitting a finer analysis of interaction in cyclic change. This synthesis became ubiquitous in the history of Chinese ideas. Within medicine, additional analytic categories, especially threefold and sixfold ones, made possible a sophisticated organization of knowledge.

Authors built up a model of fivefold and sixfold systems of vital function that stored and circulated qi throughout the body. The supply of qi was partly inborn and partly metabolized from air (i.e., ambient qi ) and food. These systems were named for the main viscera. Unlike in the European understanding, organs were not considered processing stations, but rather bureaucratic offices responsible for order and control of spontaneous processes.

The main principle of health was the unimpeded circulation of qi ; blockages and stases led to pain and dysfunction. The normal body's relation to its environment was equally important; it had to be open to air and food, but closed to pathogens, and it had to excrete what it could not assimilate without allowing leakage of the body's own qi. Medicine from the earliest times also incorporated the value of moderation, not only in conduct but in thought. Just as sensual indulgence could open the way to invasion by pathogens, jealousy or longing could generate medical disorders.

Therapy

Physicians largely depended on opposition therapy, but could modulate it in sophisticated ways. Once the practitioner knew the character of the disorder, he chose therapies to oppose and overcome the imbalance by strengthening the body's functions or attacking the pathogenic agent. The physician's tools included modifications of diet and exercise, massage and manipulation, and a great variety of drugs (over eighteen hundred, mineral and animal as well as botanical, in the great Bencao gangmu [1596; Systematic materia medica ]), as well as acupuncture (inserting needles at certain locations on the circulation pathways to adjust the movement of qi ) and moxibustion (burning cones of leaf pulp to stimulate these locations more intensely).

Modernization

Biomedicine had little influence on health care in China until after 1949. At that point there were too few qualified personnel to provide basic medical care for the whole population. The government of the People's Republic organized a network of schools to train doctors of traditional Chinese medicine (Zhongyi ) and a system of modern medical schools. Both trained secondary-school graduates. The Cultural Revolution, from the mid-1960s to the mid-1970s, brought the two closer as those in power demanded that physicians in each sector be trained more than negligibly in the other. This demand also incorporated in the curricula of the TCM schools modern subjects such as anatomy and biochemistry. The government's policy of pushing for synthesis led to textbook interpretations of the old functional discourse in new frameworks close to Western anatomical, lesion-centered views.

The basic education of physicians in imperial China was a matter of memorizing, and learning to apply the methods of reasoning and treatment in classical writings. But by 1980, few secondary-school graduates learned to read classical Chinese. The classics necessarily played a small part in their medical courses, and their confidence in the use of such traditional concepts as qi, yin and yang, and the five phases lessened. By 1980 symptom-based diagnosis that drew on biomedical concepts had become common among young practitioners. Therapy increasingly added to traditional remedies both standard packaged formulas and biomedical drugs. By 2000, medical-school teachers and their pupils were using many styles of synthesis involving traditional and modern medicine—recapitulating the diversity of medical reasoning and practice in previous centuries.

See also Medicine: India ; Science: East Asia ; Yin and Yang .

bibliography

Furth, Charlotte. A Flourishing Yin: Gender in China's Medical History, 960–1665. Berkeley: University of California Press, 1999. On medical care for women and childbirth, with a chapter on women as healers.

Keegan, David. "Huang-ti nei-ching: The Structure of the Compilation, the Significance of the Structure." Ph.D. diss., University of California, Berkeley, 1988.

Lloyd, Geoffrey, and Nathan Sivin. The Way and the Word: Science and Medicine in Early China and Greece. New Haven, Conn.: Yale University Press, 2002.

Scheid, Volker. Chinese Medicine in Contemporary China: Plurality and Synthesis. Durham, N.C.: Duke University Press, 2002. Important, well-informed study.

Sivin, Nathan. Traditional Medicine in Contemporary China: A Partial Translation of Revised Outline of Chinese Medicine (1972); with an Introductory Study on Change in Present-day and Early Medicine. Ann Arbor: University of Michigan, Center for Chinese Studies, 1987.

Nathan Sivin