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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)):
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.
Kuriyama, Shigehisa. The Expressiveness of the Body and the Divergence
of Greek and Chinese Medicine. New York: Zone Books, 1999.
Porter, Roy, ed. The Cambridge Illustrated History of Medicine.
Cambridge, UK: Cambridge University Press, 1996.
Unschuld, Paul. Introductory Readings in Classical Chinese Medicine.
Dordrecht, Holland: Kluwer Academic Publishers, 1988.
Unschuld, Paul. Medicine in China: Historical Artifacts and Images.
Munich: Prestel Verlag, 2000.
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].