Basic Perspectives

The Ma-wang-tui manuscripts, the Huang-ti nei-ching, the Nan-ching, and the Shen-nung pen-ts'ao ching are the main sources for our current understanding of the early developmental phase of Chinese medicine, even though the last three may have undergone considerable revisions in later centuries and cannot be considered genuine Han dynasty sources in their entirety. Still, the picture emerging from studies of these sources so far reveals the formation of several complex and multifaceted approaches to health care, all of which were associated with basic social, economic, and ideological changes preceding and following the unification of the Chinese Empire in 221 B.C.

Central to Chinese medicine is its perception of the human organism. Corresponding to the socioeconomic structure of the unified empire, the human organism was described in Han sources as a system of individual functional units that stored, distributed, and processed resources, which were brought into the organism from the outside or were devel oped within. The individual units were linked through a system of channels, thought to transport resources from one place to another and join the units to the outside world. The terminology used to describe the structure and workings of the organism is largely metaphoric and is based on images from the geographic, economic, and social environment of the Ch'in and Han dynasties in China.

The resources or goods to be passed through the organism were given the name ch'i in the Huang-ti nei-ching. This term denotes essential vapors thought to be the carriers of life. Similar to the development of ancient European concepts of pneuma and spiritus, the concept of ch'i may have originated from observations of such phenomena as suffocation and "empty vessels" (arteries = aer tereo = "carriers of air") in a corpse. The Huang-ti nei-ching described a continuous circulation of these vapors through the organism, ascribing greater importance to them than to blood. Illness occurred in an individual organism in the same way that crisis emerged in a complex state economy. This might be because one or more of the functional units failed to fulfill their duties, or were inadequately equipped with ch'i, or did not pass ch'i on. Also, the transportation system might be blocked, thereby preventing the circulation of resources. All of these problems could be caused by the person concerned — for example, through an unhealthy life-style - or by environmental conditions to which the person was unable to adapt.

The purpose of Chinese medicine, like that of all medicine, is to protect individuals from an untimely loss of health, one of their most essential possessions. According to the Huang-ti nei-ching, a life span of 100 years should be considered normal, and as the unknown author concluded, it is only because civilized people are unable to lead healthy lives that they must resort to medicine for help. The prevention and treatment of illness were attempted in Chinese medicine through the two basic approaches of localistic-ontological and holistic-functional reasoning.

An ontological approach views diseases either as abstract hostile entities themselves or as the result of an intrusion of some normally innocuous environmental agent into the human organism. One of the Ma-wung-tui texts suggests the existence of a tangible ontological perspective by relating the notion of small animals (such as worms or insects) entering the body to cause destruction at well-defined locations. This internal destruction was thought to become visible in the failure of bodily functions or in the destruction of external parts of the body that were associated with the internal functional units affected first. The history of leprosy in Chinese medicine, traceable from Ch'in sources written between 252 and 221 B.C., is one example of the persistence of such ontological thoughts through two millennia of Chinese medical history. It is also a good example of the early ontological notions in China that paved the way for an understanding and acceptance of Western bacteriology, morphological pathology, and, finally, chemotherapy in the nineteenth and twentieth centuries.

In addition to such tangible agents as worms and insects, the ontological perspective views the environment as filled with agents (such as heat, cold, humidity, dryness, and wind) that are essential components of nature and that may turn into "evils" that harm humans upon entering their bodies either in undue quantities or at inappropriate times. "Wind" in particular has remained a central etio-logic category in Chinese medicine through the ages, and it is this very concept of wind that demonstrates the continuation and transformation of basic de-monological tenets in the history of Chinese medicine. Originally conceived of as a spirit entity, the wind was believed to live in caves and cause harm to humans when it left its residence. Yet in the Huang-ti nei-ching there is a shift to the concept of wind as a natural phenomenon active as a result of the movement, through heaven, of a superior spirit named T'ai-i. Harm was caused by wind now only if it blew from what were considered inappropriate cardinal directions in the course of the year (as might be expected in an agricultural society) or if it met humans with constitutions susceptible to harm. Then, beginning with the works of Chang Chi in the second to third century A.D., the wind came to be seen solely as an environmental agent, albeit one that could strike humanity and cause a host of illnesses.

In addition to identifiable environmental influences that could change from "normal" (cheng) to "evil" (hsieh), abstract "evil" or "malicious" (o) entities could enter the organism and cause illness. These assaults were thought of not only as invasions of the natural environment into the human body, but also as flare-ups between various functional units within the body itself. If, for instance, ch'i normally filling the spleen was exhausted beyond some acceptable degree, agents from the liver might turn evil and invade the spleen to take over its territory. The language used to describe these processes, beginning with Han dynasty sources and throughout the history of Chinese medicine, reflects the experience of the long period of "Warring States" that preceded the unification of the Chinese Empire. Furthermore, in the same way that troops move through a country from one place to another, the ontological perspective of Chinese medicine assumed that evil intruders could be transmitted from one location in the body to another. Transmission was thought to occur in accordance with clearly defined mutual relationships between the various upper and lower, inner and outer regions of the body. An early example of this thought can be found in the biography of Pien Ch'io compiled by Ssu-ma Ch'ien in 90 B.C.

Closely linked to the ontological perspective of Chinese medicine is a functional view that is recorded in medical literature beginning with Han dynasty sources. This approach to identifying and curing illness is concerned mainly with diagnosing functional disturbances in the human organism, which is considered to be a complex structure consisting of various mutually interrelated functional units. The functional view focuses on processes and on functional relationships among the subsystems constituting the organism, and it assumes that the same illness may affect several functions at the same time.

For example, a specific functional unit may be harmed by wind. There result various pathological conditions, such as aversion to wind or fever, headache, and sweating without external reason. Or the "liver" (seen here not as a tangible organ but as a set of functions) may be marked by a depletion of ch'i, which is accompanied by the growth of a shade in one's eyes. Treatment may be directed at the ailment in the liver, or it may be focused solely on the secondary problem in the eyes. Although the first example reminds one of Western categories such as "disease" and "symptoms," the second demonstrates that the terms illness, disease, and symptom do not entirely overlap in Chinese and Western medicine and should be used only with great care in a comparative context.

The perspectives outlined here did not preclude the realization that one individual organism might be affected at one time by two or more mutually independent illnesses, each of which had to be named and treated separately. To make matters more complicated, one identical cause could result in two simultaneous, yet separate, illnesses. Conversely, two separate causes could bring about one single illness, with each of these situations requiring, theoretically at least, different therapeutic treatments.

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