Red swelling on the skin was a danger sign to Chinese people in the Han dynasty because they knew it could be a sign of one of the most dreaded diseases known during this period, o ping or li. This illness is described by the Chinese surgeon Hua TÕo around 150 C.E.: "The skin is first numb without sensation, gradually red spots appear on it, when it is swollen and ulcerated without any pus. And later the disease develops to such an extent that the eyebrows fall, the eyes may become blind, the lips deformed and the voice hoarse. The patient may also experience ringing in his ears and the soles of his feet developed rotted holes; his finger joints may become dislocated and the bridge of his nose flattened" (1).

If a patient began to develop these symptoms, a doctor would recommend either acupuncture or a set of therapeutics designed to force the illness out. Initial attempts might be made with diaphoretics and purgatives, along with salt and poisons such as arsenic. Many believed that scorpions and snakes made an effective treatment. The Chao Ya Chien Tsai examines the basis of this belief with the following story. "A certain man living in the city of Shang Chow suffered from [li]. The people, loathing him, built a cottage for him on the hills. It happened that a black snake fell into the wine barrel. Not knowing this the [patient] drank the wine and gradually became better. It was only when the bones of the snake were discovered at the bottom of the cask that the reason of the cure was clear" (2). If the patient were not cured by the treatment, they might be ostracized from the community and forced to live separately.

A more extensive description of the illness and its causes was recorded in a later text: "What is fierce and violent during all four annual seasons, that is the destroyer-evil wind. It causes an illness that is most harmful and extremely distressing. In ancient times the people called it li, and they considered it as the worst of all illnesses. To suffer from this (illness means that one's) physical appearance and disposition undergo destruction and change. It is an obstinate (illness), and one does not know where it will turn. It fills and blocks the interior of the vessels and network (conduits), and it spreads into the flesh below the skin. The constructive and the protective influences can no longer pass freely. The flesh and the armpits swell; the influences accumulate and do not pass through (the body any longer). That causes the blood (stream) to silt up, and stop flowing. The sinews and the bones relax and shrink, the skin and the body rot. Pus and foul (liquids) drip out (of these lesions). The eyebrows and the hair fall out; the hands and the feet are paralyzed. The toes and the fingers break and fall off; one feels spells of cold and heat, numbness and itching. Deformations through shriveling occur as well as swellings; oneÕs limbs ache; bitterness and poison (seem to penetrate the body; externally it is covered with) knots. All possible evils come together." (3)

This passage is particularly effective for illustrating how the Chinese cultural understanding of medicine influenced the understanding of this illness. The middle of this passage focuses on the blocked flow of the vessels which prevents the ch'i from moving and causes the illness. For the Chinese, it was the trapped ch'i, not the blood (which has stopped flowing in this example without causing death) that is most central to understanding and treating the illness.

Notes

1. Quote translated by Skinses, Olaf K in "Notes from the History of Leprosy." International Journal of Leprosy 41: 220-37, 1973.

2. Chao Ya Chien Tsai, as translated by K. Chimin Wong and Wu Lien-the in Wong and Lien-the, 1973, 211.

3. Chieh wei yüan sou, ch. 1, as translated by Paul Unschuld in Unschuld, 1988, 124.