Traditional Chinese Medicine

Heritage and Adaptation

Paul U. Unschuld, Bridie Andrews

• Publisher: Columbia University Press
• Year: 2018
• eBook ISBN:
  9780231546263
• Topic: Medicine
• Subtopic: Chinese History

A leading authority explains the ideas and practice of Chinese medicine from its beginnings in antiquity to today. Paul U. Unschuld describes medicine's close connection with culture and politics throughout Chinese history. He brings together texts, techniques, and worldviews to understand changing Chinese attitudes toward healing and the significance of traditional Chinese medicine in both China and the Western world.

Unschuld reveals the emergence of a Chinese medical tradition built around a new understanding of the human being, considering beliefs in the influence of cosmology, numerology, and the supernatural on the health of the living. He describes the variety of therapeutic approaches in Chinese culture, the history of pharmacology and techniques such as acupuncture, and the global exchange of medical knowledge. Insights are offered into the twentieth-century decline of traditional medicine, as military defeats caused reformers and revolutionaries to import medical knowledge as part of the construction of a new China. Unschuld also recounts the reception of traditional Chinese medicine in the West since the 1970s, where it is often considered an alternative to Western medicine at the same time as China seeks to incorporate elements of its medical traditions into a scientific framework. This concise and compelling introduction to medical thought and history suggests that Chinese medicine is also a guide to Chinese civilization.

I

THE HISTORICAL FOUNDATIONS

1

ORIGINS AND CHARACTERISTICS OF CHINESE MEDICINE

In 221 B.C.E., Ying Zheng, the king of Qin, brought a centuries-long period of warfare among multiple smaller states (an era known to history as the Warring States period) to an end. After long years of successful military campaigns, he was able to consolidate power and declare himself “First Emperor of Qin.”1 Qin Shi Huang Di, as he is known in Chinese, became in that moment the architect of the political structure of imperial China, a structure that has lasted longer than any other in world history. Not until 2,133 years later did a Manchu ruler by the name of Aisin-Gioro Pu Yi became the last of Qin Shi Huang Di’s successors by abdicating in January 1912. A few weeks earlier, in October 1911, the new Republic of China had been declared.

The success of the First Emperor in eliminating, with great ruthlessness, the last six states that were competing with Qin for supremacy earned Qin Shi Huang Di an outstanding position in Chinese historiography. His tomb, where he had himself buried along with thousands of individually fashioned, life-size terracotta warriors, has made him famous throughout the modern world since its discovery and opening to tourism in the 1970s.

Qin Shi Huang Di is unlikely to have wasted much thought on the development of Chinese medicine. However, the new political structures that he created and left behind (after less than two decades at the helm of the newly united Chinese state) became so deeply imprinted in the consciousness of many of the intellectual elites of the time that they even influenced their interpretation of the structures of the human body—the body was modeled on the state. Efforts to keep the body healthy and to combat disease were expected to follow the same principles as the pacification of society. Observers of the state and of the human body at this time saw no difference in approach to these two realms: indeed, the same word, zhi 治, which has a general meaning of “to put in order,” was used to indicate both ruling (the state) and treating (a person).

By the third century B.C.E., China had already achieved a high degree of cultural civilization. The writing system had been perfected and was designed to express highly sophisticated political, philosophical, and military concepts and ideas. The thousands of characters gave educated authors the ability to fully express themselves in writing. A network of educated readers, dispersed over great geographical distances, created a need for these manuscripts, which were repeatedly copied as they made their way to their recipients. The First Emperor retained the most talented advisors to help create, in short order, an integrated economic and cultural organism out of the final seven territories. As a result of his standardization of weights, measures, written characters, and road and axle widths, along with other initiatives, it became possible to establish large cities, which had in turn to be supplied from distant hinterlands. The unimpeded circulation of people and goods was the precondition for the maintenance of the new political order.

At that time, people were still living under the trauma of the previous centuries. Contemporary observers complained that all moral sensibility had been lost in the years of indiscriminate conflict. The unification of the country had been achieved by using weapons to end the wars between individual states, but the trauma of internecine conflict remained; it can still be found today in the Chinese collective mentality. The lesson of the preceding centuries was that it is not the good but the cunning who survive. This encouragement to deploy whatever crafty strategies might give an advantage in the ongoing struggle for survival can still be found in the cultural heritage of modern China.2

2

THE LACK OF EXISTENTIAL AUTONOMY

In those days, survival was clearly not only a matter of avoiding the human enemies who came to take one’s land, property, and more. A person’s life was also threatened by invisible forces that, like human enemies, were lurking everywhere and had to be warded off. The conclusion for people of the time—and for the majority of the Chinese people until very recent times—was that it was almost impossible to be in control of your own life. The length and quality of one’s earthly existence depended on forces over which humans had only uncertain influence. Whether and when you might become ill or even die of illness was out of your own hands. The forces that controlled such matters could, at best, be beseeched or placated with offerings.

In this period, when the king of Qin was declaring himself the divinely appointed First Emperor of China, people who wondered about the causes of ill health and early death knew who exercised power over this earthly life. They had identified various forces to which they could ascribe the sufferings that haunted them. Ancestors had particular significance in the causation of disease. As early as about 1000 B.C.E., ox scapulae and tortoise plastrons (the underparts of tortoise shells) were used as divination devices by the living to ask the dead about the cause of the wrath of an ancestor and hence the illness of a descendant, and whether an offering, in the form of a sacrifice, would appease it.

Concepts of the relationship between the living and the dead became increasingly sophisticated. The idea that ancestors would punish their living descendants for their sins evolved in the course of the centuries into the idea that living descendants would have to bear the punishments for the past sins of their ancestors as well as for their own transgressions. Certainly by the time of the Han dynasty, and possibly as early as the Shang, it was agreed there were nine generations of ancestors still active in the afterlife. They were held to account for all the offenses they had committed while alive, and every indictment in the underworld led to an illness among their living descendants.

From this perspective, the efforts of the living to protect their own health became insignificant. People lived with the feeling of complete inability to influence the conditions of their existence. On the many bronze vessels found buried in Shang-dynasty tombs, we often find inscriptions that effusively praise the individuals they accompanied into the afterlife. It is possible that these glorifications were intended as testimony to be placed before the judge of the underworld, to be weighed against the crimes of the deceased, not least out of the self-interest of the survivors, who would otherwise bear the brunt of any punishment.

The ancestors were not the only spirits who could make things difficult for the living. Beginning in the Warring States period, the ancestors had competition in the form of demons. Demons were not identified by their family connections to the living, but rather, having died an unnatural or violent death, bore a grudge against all of humanity. They expressed this resentment by causing all kinds of malicious damage. The only thing the people of the Warring States knew to use against such spirits was violence, of the form they had learned to use against their human enemies. Resistance could be initiated through an alliance with a powerful deity, such as the sun, the moon, or the stars, or through the invocation of particularly powerful spirits who were known to specialize in devouring lower-ranked demonic beings.

The creativity the early Chinese brought to devising words, gestures, objects, and substances to reflect the increasing diversity of concepts, such as how evil spirits caused harm and how most effectively to protect oneself from them, has continued largely unabated into the present. These ideas are clearly further evidence of their underlying sense of existential uncertainty: the knowledge that the quality and length of human life largely depended on forces that the living could only imperfectly resist, and then only with great effort.

“Heaven,” regarded as an abstract being, was also considered responsible for human fate. Long before the title di 帝, divine ruler, was secularized and applied to a human, the label “Heaven” referred to a deity who was conceptually far less anthropomorphic than anything in the Judeo-Christian West. That is why we find in the Confucian Analects the saying “Life and death are governed by fate, wealth and honor are determined by Heaven.”1 Humans had no influence over Heaven, so the existential uncertainty not only applied to the influence of ancestors, ghosts, and demons but also extended to such abstract forces.

The many initiatives that people in ancient times took to protect their lives by appeasing the ancestors, demons, and Heaven seemed to be effective often enough to consolidate belief in these forms of existence. The Book of Songs 詩經, a text most probably compiled in the late Zhou dynasty, records many instances of using specific modes of communication with the spirit world to good effect. Ultimately, ghosts were still (faded) persons, even if some of them were particularly malevolent:

Their spirits happily enjoy the offerings of food and drink, and in return, will cause you to live long.2

When the forms and rituals are according to rule, and smiles and speaking are appropriate, the spirits come and reciprocate with great blessings. Ten thousand years are the reward.3

Even today, when unprovable kinds of faith healing seem to yield the desired results, many people evaluate them with the sentence “Whatever works is right.” The exact same logic has been at work across the entire period from more than two thousand years ago until today: those who were able to demonstrate success with their incantations and exorcisms felt vindicated by the results. Their demonstrations of success provided justification not only for their methods but also, above all, for the theories that undergirded them. The belief system of antiquity was coherent but not comforting, because the forces that negatively influenced human life were arbitrary and unpredictable. This arbitrariness, referred to in modern theological circles as “God’s inscrutability,” was already described in the Book of Songs. We see it in the still powerful lament of a desperate man who had tried all possible means to procure relief: “The drought is endless, the shimmering heat is agonizing. I have offered up pure sacrifices without ceasing.… There is no spirit I have not honored.”4 No reaction occurred, and nobody was able to explain why.

3

THE LONGING FOR EXISTENTIAL AUTONOMY

It is necessary to retain an acute awareness of this basic sense that life was dependent on scarcely controllable forces to truly appreciate how disorienting was the revolution in thinking expressed in the new and completely oppositional worldview that accompanied the unification of the state. We find the rationale for the change expressed only much later by various authors, such as Ge Hong, ca. 280–340 C.E., and Tao Hongjing, 456–536 C.E., who declared: “My fate lies in my own hands, not in Heaven!” (Wo ming zi wo bu zai tian 我命在我不在天). With this, they were uttering the same longing for existential autonomy that had already been expressed several centuries earlier in a much more formal sense in the new medicine, as they were well aware.

As always, when a fundamental theoretical innovation is introduced into the history of medicine, we must ask when considering its origins, why did it occur in this way, and why at that particular time? So we will first consider the characteristics of the new medicine.

Underlying the new perspective on the human organism in conditions of health and sickness was a concerted effort to reject the superior power of the spirits, including Heaven. One could have simply negated them: they don’t exist! But that would have been a mistake. Our own recent history shows that when one wants to erase a concept from people’s consciousness, one should not avoid the word that expresses the concept. On the contrary, one should retain the word and redefine it with completely new and opposing content. This was the case with the early Marxists, who had no use for the word “freedom” in its conventional sense, so they redefined it—“freedom is the recognition of necessity”—thereby turning it into its opposite. Necessity was to be determined by the Communist Party.1

A similar procedure occurred when the small band of philosophers known as the Yin-Yang School sought to free themselves from the power of the spirits. They retained the word for spirits or deities, shen 神, and redefined it in two different ways. First, the spirits were newly identified, no longer as invisible beings in the human environment but rather as the concrete substances, blood and qi, that were necessary for human life: “Blood and qi are the spirits within humans. One must nourish them carefully!”2 The literal translation of the character qi is “steam rising from rice.” The original meaning included both the breath and the gases that escape as a result of digestion, as well as the supposed currents of vapors that, like the blood, flowed throughout the organism and whose obstruction, counterflow, or excessive discharge could lead to disease. In the following centuries, the word qi was invested with various new meanings, so that it is not possible to translate it one-to-one with any single appropriate word in a European language.

A second reinterpretation of the spirits was to prove substantially more effective. From now on, the spirits would no longer have power over humans. On the contrary: humans had power over the spirits. The new medicine provided an explanation for this: within the human organism, attached to one or more organs, is a spirit. The Chinese character for such organs is zang 藏, which means long-term depot, or in this context, long-term storage organs. In other words, long-term depots are where important goods are protected for extended periods. There is another category of organ in the body, the fu 府 or short-term repositories. There are no spirits trapped in these organs. They take in goods one day and release them again the next day, if not before. The spirits are retained securely within the body as long as the long-term storage organs have sufficient reserves of qi. Each organ has a natural endowment of healthy qi, but if this is carelessly overspent, it may become insufficient to retain the organ spirit. In that case, the spirit frees itself, with all kinds of negative consequences for the human host.

It is therefore within each person’s power to control these spirits within the body or to let them escape. Control operates through the emot...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Preface to the English Edition
• Introduction
• Part I: The Historical Foundations
• Part II: Modern and Contemporary Times
• Epilogue
• Notes
• Index