Friday, September 20, 2013

Early Views on Systematic Correspondence in Chinese Medicine

If you read Volume I of Fung Yu-Lan’s A History of Chinese Thought, which I mentioned in my last post, you will find that much of Chinese philosophy developed during the end of the Zhou Dynasty in the Spring-Autumn Period (770-476 BCE) and the Warring States Period (476-221 BCE). Another spurt of philosophical development came during the Han Dynasty (206 BCE-220 CE). During these times, Chinese philosophers developed the Yin-Yang Theory, which I discussed in earlier posts with respect to its influence on gender roles and women. They also developed the Five Elements or Five Phases Theory (五行,wu xing) that categorizes natural phenomenon into the five elements of wood, fire, earth, metal, and water. These five elements or phases move according to the cycle of the seasons. Paul Unschuld’s Medicine in China shows how these theories gave rise to the theories of systematic correspondence that form the basis for TCM today. Unschuld prefers the term Five Phases for wu xing because the Chinese term implies process or motion. These five notions are not static materials as the word “element” might suggest.

Unschuld also traces the development of the concept of meridians along which the qi or vapor of life flows. In medical texts found in the Ma-huang-dui, there are eleven disconnected meridians, and it seems that acupuncture and moxibustion are recommended for aiding the flow of qi. Later, in the Huang-di-nei-jing (Yellow Emperor’s Inner Classic), the eleven meridians have been augmented into a system of twelve meridians which connect the various organs of the body. These organs are divided into two groups, the depots and the palaces, and it seems that the entire economy of a healthy body is characterized by the metaphor of a healthy united empire with canals and roads for transporting food, with storage depots for holding supplies, and with factories for processing metals and making salt. There is a hierarchy among the organs, similar to the hierarchy of officials in the empire. The heart is considered to be the ruler or jun. Grains are eaten and are processed in the stomach to become qi. This qi nourishes the blood, which circulates, and the qi itself also circulates to all parts of the body. The various parts of the body absorb whatever elements of the qi they need for their functions, and the dregs are moved to the lower parts of the body from which they are eliminated. The qi going up to supply the body is called pure qi, and the depleted qi going down for elimination is called turbid qi. Herbs, food, life-style, acupuncture, and moxibustion are all recommended to help maintain the proper balance and functioning of the organism.

In addition to these theories, Unschuld describes how the religious Daoists contributed greatly to the knowledge of herbal properties, as they conducted alchemical experiments in their pursuit of immortality. They, too, became a school of medical practice in Chinese antiquity.

The following are three of the early Chinese medical texts with Paul Unschuld’s translations from his Chinese Life Sciences: Introductory Readings in Classical Chinese Medicine (Paradigm Publishers, 2005). I have chosen three that I think give a basic overview without getting into too much detail. They are a few of my favorite texts in the book.


從陰陽則生。逆之則死。從之則治。逆之則亂。反順為逆。是謂內格。是故聖人不治以病治未病。不治已亂治未亂。此之謂也。夫病以成而後藥之。譬如渴而穿井。鬪而鑄錐。不亦晚乎。 (Unschuld 2005, p. 10)

Huang Di Nei Jing, Su Wen  2
Comprehensive Treatise on the Regulation of the Spirit in Accord with the Four Seasons

If one follows yin and yang, then life results; if one opposes them, then death results. If one follows them, then order results; if one opposes them, then disorder results. To act contrary to what is appropriate, this is opposition. This is called inner obstruction. Hence, [when it was said] “the sages did not treat those already ill, but treated those not yet ill; they did not regulate what was already in disorder, but regulated what was not yet in disorder,” then this expresses the meaning of that [what was said above]. Now, when drugs are employed for therapy only after disease has become fully developed, when [attempts at] restoring order are initiated only after disorder has fully developed, this is as if a well were dug when one is thirsty, and as if weapons were cast when the fight is on. Would this not be too late, too? (Unschuld 2005, p. 12)


聖人之治病也。必知天地陰陽。四時經紀。五藏六府。雌雄表裏。刺灸砭石,毒藥所主。從容人事。以明經道。貴賤貧富。各異品理。問年少長勇怯之理。審於分部。知病本始。八正九候。診必副矣。(Unschuld 2005, p. 16)

Huang Di Nei Jing, Su Wen 77
On the Five Errors

When the sages treated a disease, they certainly knew the yin and yang [qi] of heaven and earth and the invariable rules followed by the four seasons; the five depots and six palaces (1), female and male, exterior and interior, [as well as] piercing, cauterization, pointed stones, and toxic drugs with all [the diseases] they master. Their approach to the human affairs was natural, thereby understanding the Way laid down in the classics. The noble and the common, the poor and the wealthy, they all [represent] a structure of different ranks, [and the sages] inquired [from the parents] whether they [belonged to] the order of youth or adulthood, of courage or timidity. They investigated [all the] parts and sections [of the human body] and they knew the root and the beginning of the diseases [to be treated]. As for the eight cardinal [turning points] (2) and the nine indicators, in their examinations they were of definite help [too].

(1) The acknowledgement of the yinyang dualism as one of the pervasive structuring principles of all existence required the identification of two types of organs. The designations chosen were metaphors borrowed from the realm of social institutions, i.e. fu in the sense of a storage unit where items are kept only temporarily before being emitted again, and zang in the sense of an inner-most storage unit where items are kept for a long time, if not forever. The former, including small and large intestines, urinary bladder, gallbladder, stomach, and heart enclosure (pericardium), were identified as yang, signifying notions such as “outer” and “passage”; the latter, including lung, heart, spleen, liver, and kidneys, were identified as yin, signifying notions such as “interior” and “tranquility”. However, a second metaphorical usage of fu identified small and large intestines, urinary bladder, gallbladder, stomach, and heart enclosure (pericardium) as “palaces” housing the zhu  , “rulers”, lung, heart, spleen, liver, and kidneys, respectively. Thus, in ancient Chinese medical literature, the term fu is encountered in two different kinds of social metaphorical contents. In my translations of the terms zang and fu , I render the former as “depot”, thereby referring to the storage unit metaphor, and the latter as “palace”, thereby referring to the ruler-palace metaphor. A clear identification of each usage of the term fu as either “palace” or “short-term storage unit” appears impracticable.

(2) A reference to the qi at “the eight seasonal turning points”, i.e. the two solstices, the two equinoxes, and the four first days of the four seasons. These are critical terms in the course of each year. (Unschuld 2005, pp. 18-19)

黃帝內經,太素 2

黃帝曰: 願聞穀氣有五味。其入五藏。分別奈何。伯高曰。胃者。五藏六府之海也。水穀皆入於胃。五藏六府皆高於胃。胃受水穀。變化以滋五藏六府。五味各走其所喜。穀味酸。先走肝。穀味苦。先走心。穀味甘。先走脾。穀味辛。先走肺。穀味鹹。先走腎。穀氣津液已行。營衛大通。乃化糟粕。以次傳下。(水穀化為津液。清氣猶如霧露。名營衛。行脈內外。無所滯礙。故曰大通。其沉濁者。名為糟粕。泌別汁入於膀胱。故曰以次傳下也。) 黃帝曰。營衛之行奈何。伯高曰。穀始入於胃。其精微者。先出於胃之兩焦。以即五藏。別出兩行於營衛之道。(精微。津液也。津液資五藏已。衛氣出胃上口。營氣出於中焦之後。故曰兩行道也。) 其大氣之搏而不行者。積於胸中。命曰氣海。出於肺。循喉嚨。故呼則出。吸則入。(搏。聚也。穀化為氣。計有四道。精微營衛。以為二道。化為糟粕及濁氣并尿。其於精下傳。復為一道。搏而不行。積於胸中。名氣海。以為呼吸。復為一道。合為四道也。) (Unschuld 2005, p. 55)

Huang Di Nei Jing, Tai Su 2
To Balance Nourishment

Huang Di: I should like to hear [about the following]. The qi of the grains have five flavors. When they enter the five depots—according to what [kind of criteria] are they separated?
Bo Gao: The stomach is the sea for the five depots and six palaces. All the water and grains [that man consumes] enter the stomach. The five depots and six palaces receive all their supplies from the stomach. (The stomach receives the water and the grains; it transforms them to nourish the five depots and six palaces.) The five flavors move each to [the one depot] which they prefer. The sour flavor of the grains moves first into the liver. The bitter flavor of the grains moves first into the heart. The sweet flavor of the grains moves first into the spleen. The acrid flavor of the grains moves first into the lungs. The salty flavor of the grains moves first into the kidneys. As soon as the qi of the grains and all the liquids have begun their passage [through the organism], and when the camp and guardian [qi] penetrate the entire body, dregs result from transformation and are transmitted downward step by step. (The water and the grains are transformed into liquids. There are clear qi resembling mist and dew; they are called camp and guardian [qi], and they proceed inside and outside the vessels. There is nothing that could obstruct [their flow]. Hence, [the text] states “penetrate the entire [body].” Those that sink down and are turbid are called dregs. They gush, as separate juices, into the urinary bladder. Hence, [the text] states: “are transmitted downward step by step.”)

Huang Di: How do the camp and guardian [qi] move [through the body]?

Bo Gao: The grains first enter the stomach. Their essential and subtle components leave the stomach first through two of its burners [before] they nourish the five depots. They leave [the stomach through two] separate [openings], and proceed through the two paths of the camp and guardian [qi, respectively]. (The essential and subtle [components] are the liquids. After the liquids have nourished the five depots, the guardian qi leave through the upper opening of the stomach; the camp qi leave from behind the central burner. Hence, the text states “proceed through two paths.”) Those major [portions of] the qi which are seized and do not move on, they are collected in the chest, and this is called the “sea of qi”; its outlet is through the lungs, via the windpipe. Hence, to exhale [causes the qi] to leave; to inhale [causes them] to enter [the body]. (“Are seized” stands for “are accumulated.” The grains are transformed into qi. Altogether there are four paths [for the qi to enter and leave the body, and pass through it]. The essential and subtle [components, i.e. the] camp and guardian [qi] occupy two paths. The transformation into dregs and turbid qi, and also urine, and the passage downward together with the semen, that constitutes yet another path. [Those qi that are] seized and do not move on, and which accumulate in the chest, they are called the “sea of qi”. From this originates inhalation and exhalation, which constitutes yet another path. Together these are four paths.) (Unschuld 2005, pp. 58-59)

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