The
Medical Worldview of Han Dynasty China
This web site examines Chinese medicine at the time of the Han dynasty,
from roughly the second century B.C.E. through the second century C.E.
At this time, a relatively coherent set of beliefs and practices came
together that strongly influenced the development of Chinese medicine
for the next two millennia. The most significant text of the period is
the Huang-ti nei-ching (the inner classic of the Yellow Emperor).
The Huang-ti nei-ching claims that if people follow its teachings,
they will live to the natural age of one hundred years.
The central conception of Chinese medicine during the Han dynasty was
the idea of systematic correspondence, which held that everything in nature
was intended to be in harmony. This belief--related to the dominant Confucian
ethics--extended to everything including the state. The health of the
state flourished when everything maintained its proper harmony. Similarly,
the health of the individual flourished when everything was in balance.
Illness, then, was a result of the body losing its proper harmony. This
could happen several ways: an individual's actions--such as excessive
desire, gluttony, or moral sin--might disturb the balance, the body might
be invaded by evil influences, and exposure to changes in temperature
and environment could trigger an imbalance.
For the human body, the most important factor was maintaining the proper
flow (xun) of ch'i, which was believed to carry vital resources
and goods through the body. Xun was based on a balance of yin
and yang, and the five phases. Yin and yang correspond
to opposing forces that combine to create a unity, such as day and night
or winter and summer. Yin is associated with female, earth, winter,
and passive, while yang is associated with male, heaven, summer,
and dominating. The five phases are the five essential environmental elements:
metal, wood, water, fire and soil. Imbalances in any of these elements
could affect the proper flow of ch'i through the body, creating
sickness.
Two
particularly powerful approaches were central in diagnosing illness: pulse-feeling
and gazing. The Huang-ti nei-ching specified 12 interconnected
vessels, or conduits. By feeling "pulses" (mo) at various
points throughout the body, specific information could be discerned about
the location of illness and its likely development. With the publication
of the Nan-ching around C.E. 150, physicians had identified up to 28 different
qualities of mo that could be detected from feeling different points on
the wrist, with the most important distinctions being floating (fu)
versus sunken (chen) and slippery (hua) versus rough (se).
It should be noted that physicians were not feeling for the strength or
regularity of blood flow through arteries; instead, they were feeling
the nature of the illness by its influence on the 12 conduits. Vision
(se) also played a crucial role in Chinese medicine by contemplating
colors (wangse), which could reveal the nature and progression
of illness. Tints of various colors on a person's skin provided further
information for the diagnosis. Se was an accompaniment to feeling
mo, and it was by combining these approaches that a physician achieved
the best results: "The physician who can combine the mo and
se achieves perfection" (1).
The therapy most strongly associated with systematic correspondence is
acupuncture. Because illness was based on imbalance within the body, the
solution was to restore the proper flow of ch'i. This could be
accomplished by inserting needles into strategic points in the body where
blockages were likely to occur. Acupuncture cured illness by restoring
the bodyÕs natural harmony. Other therapeutic options included massage,
which restored the flow of chÕi in the same manner as acupuncture.
Approaches used less often include changes in diet and moxa cauterization,
which involved burning pieces of flesh with plant material to create a
blister that would serve as a counter-irritant.
In addition to ideas about systematic correspondence, there was also
a flourishing pharmaceutical tradition in China at this time. The first
major text detailing known treatments was Wu-shih-erh ping fang
(Prescriptions Against 52 Ailments) written during the third century B.C.E.
To treat common ailments such as burns, hemorrhoids, skin diseases, fevers,
and dysuria, pharmacists used plants (peaches, dates, coltsfoot), animal
preparations (hare brain, hare skin, dried silkworms), human elements
(head hair, sweat, urine of newborn boys, breast milk, sperm), and minerals
(cinnabar, mercury, iron), all of which were used in European pharmacology
into the eighteenth century. Elements from every day life were also believed
to be effective, although much of their diagnostic power was believed
to come through magical means. This includes items like worn-out hemp
clothing, tattered straw mats, a womanÕs first menstrual cloth, or jacket
collars. Such treatments could either be prepared at home or at specialized
pharmacies.
Medical training was mostly informal, and the state was not very active
in the support or training of physicians. According to Confucianism, medical
knowledge was considered to be common knowledge accessible to anyone.
As a result, there were several types of medical practitioners, and on
the whole, their social status was relatively minor. The most elite were
court-appointed physicians who served the emperor. Beneath this group
was a collection of practitioners such as dietary physicians (shiyi),
physicians for illness (jiyi), physicians for ulcers (Yangyi)
and veterinarians (shouyi). The lowest doctors were the traveling
medicine sellers who often peddled their own drugs. In addition to self-proclaimed
physicians, there were pharmacists, local healers, family members, and
magic workers involved in diagnosing and treating illnesses.
When a person became ill, they might choose any number of treatment
options. A family member would likely be consulted first, and a home treatment
prepared. If the illness persisted, a doctor might be called if one was
available and the family had money. In rural areas, the services of a
traveling doctor might be used. Whether a doctor was summoned and how
high their status was depended upon the wealth of the family. In addition
to attempts to re-establish the flow of ch'i and balance of yin
and yang in the body through treatments like acupuncture, a person
would often take medications developed by pharmacists.
Illness took on strong moral overtones within the worldview of Confucian
ethics and systematic correspondence, because it was understood to be
the result of personal actions. If health was maintained when the body
was kept in balance, a person only fell ill if they allowed their body
to fall out of harmony. Thus, it was not uncommon for illness to be associated
with social stigma.
We can see many of the elements of Chinese medicine (especially the
focus on se and mo) in the following passage from the Huang-ti
nei-ching titled Se mai ch'ih chen (The Examination of (a Patient's)
Complexion, (Movement in the) Vessels, and (skin Condition in His Arm's)
Foot (Section)):
The Yellow Emperor asked Ch'i Po: "I have heard him (saying) that
someone who looks at the complexion (of a patient) and recognizes his
illness may be called brilliant, that someone who touches the (patientÕs)
vessels and recognizes his illness may be called a spirit, and that
someone who asks the patient and then knows the location of the (illness),
may be called (merely) a practitioner. I should like to know from him
now how it can be done that one takes a look (at the complexion) and
recognizes the (illness), that one touches the (vessels) and gets a
(correct diagnosis), and that one asks (the patient) and reaches the
final (conclusion concerning the location of the illness)."
Ch'i Po answered: "The mutual correspondence among one's complexion,
the (movement in one's) vessels, and the (condition of the skin at one's)
foot-section (of the lower arm) is comparable to the mutual correspondence
among the beating of a drum and the sound produced, and also to (that
among an item and its) shadow (or a sound and its) echo. They cannot
be separated from each other! (As a further analogy, one might point
out the correspondences in) the appearances of beginning and end, of
root and leafs. That is to say, when a root has died, the leafs will
wither. (Similarly,) the complexion, the (movement in the) vessels,
and the (condition of the) flesh of oneÕs physical body cannot be separated
from each other. Now, if someone knows one (of these three diagnostic
variables), he is (merely) a practitioner; if he knows two, he is a
spirit; and if he knows all three of them, he is a spirit and brilliant!"
The Yellow Emperor asked: "I should like to hear about this in
all detail!"
Ch'i Po answered: "In case a complexion is blue the respective
(movement in the) vessels is stringy; in case a complexion is red, the
respective (movement in the) vessels is hood-like; in case a complexion
is yellow, the respective (movement in the) vessels is intermittent;
in case a complexion is white, the respective (movement in the) vessels
is hair-like; in case a complexion is black, the respective (movement
in the) vessels is stone-like. If one sees a particular complexion,
but does not get the respective (movement in the) vessels, and on the
contrary, gets a (movement in the) vessels (associated with a superior
phase in the order of) mutual destruction, that means death (to the
patient). If, however, one gets a (movement in the) vessels (that is
associated with a mother phase in the order of) mutual generation, the
illness can be cured."
The Yellow Emperor asked Ch'i Po: "How is it possible (to distinguish
among) the varying illnesses, and (their various) physical manifestations,
generated by the five viscera?"
Ch'i Po replied: "First of all one has to determine whether the
five (kinds of) complexion and the five (kinds of movement in the) vessels
correspond to each other, and then one can distinguish what illnesses
are present."
The Yellow Emperor asked: "How can the (illnesses) be distinguished,
once complexion and (movement in the) vessels have been determined?"
Ch'i Po answered:
"One investigates whether the (movement in the) vessels is relaxed
or tense, minor or strong, smooth or rough, and then the changes (in
the physical appearance caused by an) illness can be determined."
The Yellow Emperor
asked: "How can this be investigated?"
Ch'i Po answered:
"If the (movement in the) vessels is tense, the skin at the foot-section
should be tense too. If the (movement in the) vessels is minor, the
skin at the foot-section should be reduced too, and its influences should
be few. If the (movement in the) vessels is strong, the skin at the
foot-section should be vigorous too, and rise. If the (movement in the)
vessels is relaxed, the skin at the foot-section should be smooth too.
If the (movement in the) vessels is rough, the skin at the foot-section
should be rough too. All these six changes (in the physical appearance
resulting from an illness) may be but slight or extreme. Hence, someone
who knows very well how to investigate (the condition of the skin at)
the foot-section, will not have to depend on (an examination of his
patient's) inch-opening, and someone who knows very well how to investigate
the (movement in the) vessels (at the inch-opening) will not have to
depend on (an examination of the patient's) complexion. Those who are
able to take all three (diagnostic techniques) into consideration, and
apply them in practice, they are superior practitioners; a superior
practitioner cures nine out of ten (cases). Those who apply two (of
these techniques in practice), are mediocre practitioners; a mediocre
practitioner cures seven out of ten (cases). Those who apply one (of
these techniques in practice) are inferior practitioners; an inferior
practitioner cures six out of ten (cases)" (2).
Notes
1. Huang-ti nei-ching, sewen 10, as translated by Shigehisa Kuriyama
in Kuriyama, 1999, 170.
2. Huang-ti nei-ching, TÕai-su, ch. 15 (as translated by Paul
Unschuld in Unschuld, 1988, 162-4).
Bibliography for Further Reading
Kiple, Kenneth, ed. The Cambridge World History of Human Disease.
Cambridge, UK: Cambridge University Press, 1993.
This is an encyclopedic survey of the history of human disease across
the globe. For particularly good information on Chinese medicine, see
the following sections: Unschuld, Paul. "History of Chinese Medicine."
Shigehisa, Kuriyama. "Concepts of Disease in East Asia." Gwei-Djen,
Lu, and Needham, Joseph. "Diseases of Antiquity in China."
Kuriyama, Shigehisa. The Expressiveness of the Body and the Divergence
of Greek and Chinese Medicine. New York: Zone Books, 1999.
Kuriyama explores the different medical understandings of classical China
and ancient Greece. He makes a compelling argument that each culture understood
the body in extremely different ways.
Porter, Roy, ed. The Cambridge Illustrated History of Medicine.
Cambridge, UK: Cambridge University Press, 1996.
This survey of the history of medicine provides helpful background on
changes in medicine over time.
Unschuld, Paul. Introductory Readings in Classical Chinese Medicine.
Dordrecht, Holland: Kluwer Academic Publishers, 1988.
This book makes 60 translations of passages from classical Chinese medicine
texts. Many of these translations are helpful in understanding particular
aspects of Chinese medicine.
Unschuld, Paul. Medicine in China: Historical Artifacts and Images.
Munich: Prestel Verlag, 2000.
This book includes an overview of Chinese medicine as well as images of
many of the instruments used by physicians to make pharmaceuticals and
deliver treatment.
Wong, K. Chimin, and Lien-the, Wu. History of Chinese Medicine: Being
a Chronicle of Medical Happenings in China from Ancient Times to the Present
Period. New York: AMS Press, 1973 [originally published 1932].
This survey of Chinese medicine provides a helpful background to central
ideas about medicine in the Han Dynasty.