Korean Anatomical Charts in the Context of the East Asian Medical Tradition

Asian Medicine 5 (2009) 186–207 brill.nl/asme

Shin Dongwon 신 동원 translated by Yuseok Kim

Abstract This paper examines the characteristics of the illustrations in Heo Jun’s Dong’ui’bo’gam 許浚東醫寶鑑 (Treasured Collections of an Eastern Physician), which are the sole distinctively Korean pictorial representations in the history of Korean medical texts. Those anatomical images differ from earlier East Asian anatomical charts in three important ways. First, they embody the view that Daoist practices for preserving health and vitality (yangsheng) are closer to the essence of life than is medicine. Second, unlike existing medical texts, which mainly focused on the organs inside the body and the channels on the surface of the body, they emphasise building up systematic outer ‘bodily form’. Third, they reflect Heo Jun’s regard for the anatomical content of the earlier Inner Canon and the Classic of Difficulties rather than the contributions of positivistic anatomy from and after the Song and Yuan Dynasties, and the diagrams of the five zang-organs are devised in accord with such a view. In my view, these three points in Treasured Collections of an Eastern Physician (hereafter Treasured Collection), the most influential medical book since its publication, provides clues to understanding the very conservative character of traditional Korean medicine in the seventeenth century and thereafter.

Keywords Treasured Collections of an Eastern Physician, Heo Jun, Korean medicine, medical illustration, dissection, organs, viscera

To the best of current knowledge, traditional Korean medical literature contains only three sets of images showing the internal organs of the human body. All three are highly significant in various ways for our understanding of East Asian traditions of anatomical representation. The earliest set, inUi’bang’ryuchui 醫方類聚 (Classified Collection of Med- ical Remedies, 1477 CE), reflects a Daoist vision of the internal landscape of the human body. It comprises six separate images illustrating the five zang- organs (heart, spleen, liver, lungs and kidney) and the gall bladder, one of the six fu-organs (the others are the stomach, large intestine, small intestine, urinary bladder and ‘triple burner’). They are in fact integral reproductions of the

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Fig. 1. 肺臟圖 Image of the lung1 images from Hu Yin 胡愔’s Huangting neijing wuzang-liufu tu 黃庭內景五臟六腑圖 (Yellow Court Atlas of the Inner View of the Five Zang Organs and the Six Fu-Organs), a Chinese Daoist work dating from the Tang Dynasty (ca. 848 CE) (Fig. 1). These images are no longer extant in China, although the text that originally accompanied them is included in the Ming Daoist Canon of 1445 (Zhengtong Daozang 正統道藏). By transmitting the images together with the text, the Classiﬁed Collection of Medical Remedies sheds a unique light on ninth-century East Asian anatomy. The second set, in Chi’mkuyokyel 鍼灸要訣 (Essential Formulas for Acu- puncture and Moxibustion 1600 CE) by the Confucian scholar-physician Yu Seongnyong 柳成龍, consists of one illustration of the zang and fu-organs, and two channel charts (Fig. 2). They are reproductions of the identically named illustrations in Yixue rumen 醫學入門 (An Introduction to Medicine 1575 CE) by the Ming dynasty physician Li Chan 李梴.

1 Yu Seongnyong 柳成龍 1600, Ui’bang’ryuchui 醫方類聚 vol. 5. modern edn. (Beijing: gongneiting shulingbu, 1998. Copy held in the National Library, Korea).

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Fig. 2. 臟腑內觀圖 Image of the organs in the body2

The third set, in Heo Jun’s Dong’ui’bo’gam (Treasured Collections of an Eastern Physician 1613 CE, hereafter Treasured Collections), comprises sinhyeng jangbudo 身形臟腑圖 ‘image of the form of the body and the zang- and fu- organs’ and illustrations of five of the internal organs’. (Fig. 3). At first sight, ‘Image of the Form of the Body and the zang- and fu-Organs’ appears almost identical to an image of the body in Wanbing huichun 萬病回春 (Recovery from Ten Thousand Diseases, 1585 CE) by the Ming-Dynasty physician Gong Tingxian 龔廷賢, while the illustrations of the organs seem to differ but little from Chinese illustrations of the Song and Ming Dynasties (Fig. 4). On closer scrutiny however, significant differences become apparent.

2 Yu Seongnyong 1600, modern edn. 1994, p. 340.

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Fig. 3. 身形臟腑圖 Image of the Form of the Body and the zang- and fu-Organs’3

Fig. 4. 側身人圖 Lateral view of the body4

3 Heo Jun 1630, modern edn. 1994, p. 227. 4 Gong Tingxian (Ming), modern edn. 1999, p. 43.

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The illustrations inTreasured Collections are the sole pictorial representations we possess that reflect the approach and sensibility specific to Korean physicians of the Joseon Dynasty (1392–1910 CE). Studying the text over the years, I have been constantly intrigued by these images.5 Similar to anatomical charts in early Ming-dynasty Chinese medical texts, yet in some ways strik- ingly different from them, what do they actually represent? And what function do they perform within the medical text Treasured Collections? Where do they come from? What place do they occupy in the East Asian tradition of anatomical charts? The present paper is an attempt to answer these questions. In my view, in the process it also provides clues to understanding the unique character of traditional Korean medicine in the seventeenth century and thereafter.

A Short Biography of Heo Jun

Heo Jun remains the most famous physician in Korean history. A royal doctor by his early thirties, he served the Royal Hospital for more than forty years and wrote at least seven medical treatises, including the internationally-known Treasured Collections. After its ﬁrst publication in 1613, the book saw more than ten reprints in Korea, more than thirty in China, and at least two in Japan. Heo Jun’s mother was a concubine, though his father was a county gover- nor. Because the children of concubines were legally barred from taking oﬃce in the civil service or military, the only professions open to a boy of Heo Jun’s birth were astronomy, the law, the interpretation of Chinese and Japanese texts, and medicine. Nothing is known about Heo Jun’s medical training. In 1581, while working at the Royal Hospital, King Seonjo 宣祖 (r.1567–1608) ordered him to revise an important book on diagnosis, which medical students had been using as a basic text for at least a century. Heo Jun became famous in 1590 for curing thousands of smallpox patients, among them the Crown Prince, Goang’haegun 光海君. At that time he was the only royal physician to ignore the religious prohibition against treating people for the disease. He refused to accept the contemporary belief that the god who brought smallpox would kill any patient who sought medical treatment. This success encouraged him to write a medical text aimed

5 Shin 2001, pp. 172–90.

Downloaded from Brill.com09/23/2021 05:17:32PM via free access D. W. Shin / Asian Medicine 5 (2009) 186–207 191 at putting an end to the practice of not treating smallpox patients, Oenhaedu’chang’jip’yo 諺解痘瘡集要 (Essentials of Smallpox with Korean Translation). Treasured Collections, completed in 1610, brought Heo Jun long-lasting fame. After the first Japanese invasion of Korea in 1592, King Seonjo ordered him to compile a medical book to expose the effect of war upon medicine. Work began with a team of six doctors, five of them Royal doctors, but after the second Japanese invasion in 1597, his colleagues scattered and he had to finish the treatise alone. It took Heo Jun ten years to complete this twenty- five-volume work. Meanwhile, as the first Royal doctor, he was impeached for King Seonjo’s death and exiled between 1608 and 1609 to Uiju, at the north- ern frontier of Korea. Although the exile was painful, it gave Heo Jun the time that he needed to complete most of the book, which was finally published in 1613. Treasured Collections consists of five sections: inner body physiology and symptoms, outer body symptoms, common diseases, pharmacology, and acupuncture and moxibustion. This book had three distinctive features. First, it attached more importance to cultivation of the mind and body than to external medical treatment. The popularity of Neo-Confucian and Daoist self- cultivation techniques among the ruling yangban 兩班 class in Korea was influential in this trend. Secondly, it made an attempt to resolve apparent contradictions in traditional East Asian medical discourse such as those of knowledge and practice highlighted between the four great doctors of Jin and Yuan. Between the Han and Ming dynasties Chinese medical texts and rem- edy collections were widely disseminated throughout the territory equivalent to modern day Korea. Thirdly, it emphasised the benefits of using locally pro- duced drugs, according to Korean tradition. During 1601, while working on Treasured Collections, Heo Jun also wrote manuals on obstetrics, emergency treatments, and smallpox. All of these books, originally written in Chinese script, as was conventional in Korean literature, were also translated into vernacular Korean to allow easy access for a popular audience. Heo Jun spent his last days studying the prevention of typhus and scarlet fever. As the leading doctor in Korea he championed pre- ventive health, writing two short books on infectious diseases. His book on scarlet fever, Byuk’yeok’sinbang 辟疫神方, [Divine Remedies for Treating Con- tagious Illness] attracted serious attention from medical historians for his unique and original observations unprecedented either in China or Korea. The Japanese medical historian, Sakae Miki, insists that Heo Jun was the first person to study the disease in East Asian countries. His descriptions of the symptomatology including fever, headache, sore throat, dropsy, rash, and

Downloaded from Brill.com09/23/2021 05:17:32PM via free access 192 D. W. Shin / Asian Medicine 5 (2009) 186–207 desquamation seem so accurate that they have been compared to Daniel Sennert’s 1627 European treatise on fever. Heo Jun died in 1615. In an honour unprecedented in Korean history the king conferred upon him posthumously the highest court rank.

The nature of ‘Form’ in ‘image of the form of the body and thezang - and fu-organs’

To return to Treasured Collections, under the rubric, ‘image of the form of the body and the zang- and fu-organs’, we find the anatomical chart in question and two passages of textual commentary relating to it. To understand the nature of the image, we need to begin with the material data afforded by the text: the title; the chart itself; the commentary; and the physical position of the chart within the text. To begin with, the title itself brings together two conceptually distinct categories: the outward form of the body (形, Chinese xing) and its inward sub- stance (臟腑, Chinese zangfu). It announces the author’s intention to represent the body both externally and internally; to convey both observational knowledge of the body and the experience and imagination of its inner workings. The image itself consists of an outline of the body, shown laterally from the right, with the internal organs as well as various external features drawn and labeled. The external contour of the body is confined to the head and the trunk, with the limbs entirely omitted. The eyebrows, eyes, ears, nose, mouth and chin are drawn on the head; the neck, chest, waist and abdomen are indicated on the trunk; and the navel is drawn protruding. The names of external bodily landmarks all appear outside the outline. As regards the internal organs: the brain and the spine are shown running continuously down the full length of the body, the pharynx and the larynx begin at the same height as the mouth, the larynx connects with the lungs, directly below which sits the heart. The diaphragm—the frontier between the organs of the upper and lower body—is clearly marked and labeled. The downward passage from the pharynx divides into three. One branch leads to the diaphragm, the second branch leads to the kidneys, and the middle branch continues on, to bifurcate further down with one path leading to the spleen and stomach, and the other to the liver and the gall bladder. Underneath the stomach is the small intestine, and underneath that is the large intestine, shown with many folds. Depicted below the small and large intestines is the urinary bladder. Below the gall bladder and to the left of the intestines, we see the rectum and urethra, the paths through which food waste and urine make

Downloaded from Brill.com09/23/2021 05:17:32PM via free access D. W. Shin / Asian Medicine 5 (2009) 186–207 193 their way to the exterior. Although there is no textual explanation of the rela- tions between the internal organs, the image compellingly suggests how they are organically connected with one another. The organs drawn inside the body all have distinctive and evocative visual forms. The brain resembles the bough of a tree, the spine is a long chain of interlinked bones, the pharynx and the larynx look like holes, the lungs are depicted like many layers of leaves, the spleen and the stomach resemble drooping sacks, the liver looks like a long ﬂower bud, the kidneys resemble beans, and the urinary bladder is like an inverted heart.

Heo Jun’s explication of ‘image of the form of the body and the zang- and fu-organs’

The text accompanying this image is particularly detailed and provides a clear guide to the way in which the author, Heo Jun, intended the image to be read. It consists of two parts, which begin, ‘Sun Zhenren 孫眞人)6 says . . .’ and ‘Zhu Danxi 朱丹溪7 says . . .’ respectively. The first part is as follows: Sun Zhenren states: the human head is round in emulation of the roundness of heaven, and the human foot is square in emulation of the square shape of the earth. Just as heaven has the four seasons, man possesses the four limbs. Just as heaven has the five agents [also translated as elements or phases], man possesses the five organs; just as heaven has the six directions, man possesses the six viscera. Because there are winds from the eight directions in heaven, man possesses the eight joints; and just as there are the nine stars in heaven, humans have the nine orifices. The twelve human channels emulate the twelve hours of heaven; and the twenty-five human points emulate the twenty-four solar terms of heaven. In addition, because there are 365 degrees in heaven, man likewise possesses 365 joints. Just as there are the sun and the moon in heaven, man possesses the eyes and the ears. Just as there are day and night in heaven, man sleeps and awakes. Just as there are thunder and lightning in heaven, man feels joy and anger. Just as there are rain and dew in heaven, man possesses tears and nasal mucus. Just as there are yin and yang in heaven, man possesses cold and body heat. Just as there are fountains on earth, man possesses blood vessels; and just as trees and grass grow on earth, man possesses hair both on the body and on the head. Just as there are metals and rocks in earth, man possesses teeth. Everything takes form through the four great agents and the five agents.8

6 Sun Zhenren, or Sun Simiao, 孫思邈 (581–682 CE). 7 Zhu Danxi, or Zhu Zhenheng 朱震亨 (1281–1358 CE). 8 Heo 1994, p. 278.

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This passage gives us a sense of the range of constituents (body parts, physio- logical phenomena, affects) that are regarded as making up human bodily form. With detailed examples, it presents the human body as a homologue of heaven and earth, or the cosmos and natural phenomena, structured according to universal numerological schemes. It asserts the belief that the various parts and aspects of the body are formed not coincidentally and independently of one another but in accordance with cosmic patterns. In essence, all parts of the body are formed according to the order of the four great agents of earth, water, fire and wind, a Buddhist concept, and the five agents, an idea from Chinese natural philosophy. The second part states: Zhu Danxi says: when human form is examined, the tallness and shortness of height are unequal, the largeness and smallness of build are unequal, and the fat- ness and thinness of flesh are unequal. The fairness and darkness of skin tone are unequal, lightness and bluishness are unequal, and thinness and thickness are unequal. Those who are fat abound in the wet vital breath, those who are thin abound in the fiery vital breath, those who are fair are deficient in the vital breath in the lungs, and those who are dark are sufficient in vital breath in the kidneys. Because shapes, colors, the organs, and the viscera thus differ, treatment methods vastly differ even when the outward symptoms are similar.9 Whereas the first passage, from Sun Simiao, describes characteristics universal to human bodies, the quotation from Zhu Danxi discusses individual differences in height, build and skin tone. These differences in bodily form are the outward manifestation of disparities in vital breath in the internal organs. In light of this, Zhu Danxi establishes the principle that even where the present- ing symptoms are identical, medical treatment must be differentiated and per- sonalised on the basis of the disparities among individual bodies. By citing this passage, Heo Jun sought to demonstrate that a discussion of bodily form is germane to the correct treatment of diseases.

The view of the human body ofTreasured Collections of an Eastern Physician as seen in ‘image of the form of the body and the zang- and fu-organs’

What ‘image of the form of the body and the zang- and fu-organs’ represents

‘Image of the form of the body and the zang- and fu-organs’ is placed close to the beginning of Treasured Collections. Because this position in the material

9 Heo 1994, p. 278.

Downloaded from Brill.com09/23/2021 05:17:32PM via free access D. W. Shin / Asian Medicine 5 (2009) 186–207 195 text is important in relation to our overall understanding of the image, it needs to be examined more closely: ‘Preface’ ‘General catalogue’ (2 fascicles) ‘Chapter on internal view’ (4 fascicles): ‘collection of cases’; ‘successive medical formula examinations’; ‘image of the form of the body and the zang- and fu- organs’; 26 categories including ‘bodily form’ ‘Chapter on outward form’ (4 fascicles): 26 categories including ‘head’ ‘Chapter on miscellaneous diseases’ (11 fascicles): 38 categories including ‘celes- tially and terrestrially determined fate’ ‘Chapter on brews and decoctions’ (3 fascicles): 17 categories including ‘prefatory material to brews and decoctions’ ‘Chapter on acupuncture and moxibustion’ (1 fascicle): ‘acupuncture and moxibustion’ Although ‘image of the form of the body and the zang- and fu-organs’ is included in ‘chapter on the internal view’, on examination it differs from the other individual categories in this chapter, with their discrete contents. Appar- ently, it belongs to the level of general summaries like ‘collection of cases’ and ‘examination of successive medical formulae’. ‘Collection of cases’ is the section in which Heo Jun discusses the structure, organisation, noteworthy features, and title of the book, while in ‘examination of successive medical formulae’ he enumerates works deemed to have made an important contribu- tion to the medical tradition in both China and Korea during successive eras. What then is the role of the illustration? In conjunction with ‘examination of successive medical formulae’, which provides a diachronic dimension, this section gives a general account of the body, the object of medicine. The diverse elements that we have examined so far reveal the view of the body held by the author of Treasured Collections. The contents of ‘image of the form of the body and the zang- and fu-organs’ correspond, point to point, to the principles set out in ‘collection of cases’: As I respectfully observe, the body has the five organs and the six viscera inside and muscles and bones, blood vessels, and skin outside, thus completing its form. In addition, essential matter (jing 精), vital breath (qi 氣), and spirit (shen 神) lead the organs, the viscera, and diverse body parts. Consequently, the three joys of Daoism and the four great agents of Shakyamuni Buddha all indicate this. The Classic of the Yellow Court includes the section ‘internal view’, and the medical text also includes mirror images. The basis of Daoism lies in clear and peaceful self- cultivation, and medicine cures with medication, food, acupuncture, and moxibustion, which is how Daoism has acquired its finesse and medicine, has acquired its roughness. Now, this book first presents ‘Inner Chapter’, including in it essential matter, vital breath, spirit, organs, and viscera in the internal view, then

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presents ‘Outer Chapter’, including in it the head, face, hands, feet, muscles, pulse, bones, and ﬂesh of the external realm. . .10 As can be seen in the above passage, Treasured Collection of an Eastern Physi- cian distinguishes three aspects of the body—the organs inside the body; the outward form of the body; and essential matter, vital breath and spirit, which animate the body. ‘Image of the form of the body and the zang- and fu- organs’ is an attempt to incorporate all three of these aspects into an anatomical chart.

The addition of the concept of ‘bodily form’ to anatomical charts

The concept of ‘bodily form’ that emerges elsewhere in Treasured Collections is more inclusive than this image shows us. The ‘chapter on outward form’ includes the locations and lengths of the head, face, eyes, mouth and lips, teeth, neck, back, chest, breasts, abdomen, waist, sides, armpits, and legs (which are not separately indicated on the drawing). This chapter also discusses the characteristics of superficial and deeper structures of the body with reference to the skin, flesh, pulse, muscles, and bones. At the same organisa- tional level, there is a separate account of hair. The ordering of the categories in ‘chapter on outward form’, or ‘bodily form’ broadly follows three criteria. The first criterion hinges on the concept that ‘heaven is round and earth is square’. By starting out with the statement that: ‘the human head is round in emulation of the roundness of heaven, and the human foot is square in emulation of the square shape of the earth’, the author sets up a primary distinction between the head and the trunk. Based on this distinction, ‘chapter on outward form’ begins with the head and the face and then proceeds to the trunk, concluding with the waist and sides. The second criterion is one of depth. Starting with the skin, it moves deeper, progressing to the flesh, pulse, muscles, and bones. Thus, a three-dimensional understanding of the outward form becomes possible. The third criterion is the concept of centre and periphery. The limbs, genitalia, anus, and head, all of which are attached to the trunk, together with the hair on the head, the moustache and beard, and the bodily hair, all of which protrude from the skin, are classified as peripheral. Never before Heo Jun, in the history of East Asian medicine, has the surface of the body been so systematically organised. This is because other medical texts organised their material with regard to the symptoms or nature of diseases. For instance, it is instructive to compare Treasured Collections with Li

10 Heo 1994, pp. 265–6.

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Chan’s Yixue rumen 醫學入門 (An Introduction to Medicine), which exer- cised a considerable influence on Heo Jun’s work.11 In that text, material corresponding to ‘chapter on outward form’ in Treasured Collections is partially included in ‘external medicine’, and is classified into the categories of ‘neck’, ‘hands’, ‘chest and abdomen’, ‘hips’, ‘legs’, and ‘girth of the body’ only. Gong Tingxian’s 龔廷賢 Wanbing huichun 萬病回春 (Recovery from Ten Thousand Diseases, 1585 CE), which is more detailed, conflates body parts with diseases under such categories as ‘stomach-ache’, ‘lumbago’, ‘waist pain’, ‘side pain’, ‘hip pain’, ‘shoulder pain’, ‘headache’, ‘hair on the head’, ‘face diseases’, ‘ear diseases’, ‘nose diseases’, ‘mouth and tongue’, ‘lips’, ‘teeth’, ‘eyes’, and ‘pharynx and larynx’.12 Unlike other, earlier medical texts, Treasured Collections does not combine sections on the body with sections on diseases but, instead, brings the former together under the overarching category of ‘bodily form’. In other words, the concept of disease is consistently subordinated to that of the body.

An emphasis on Daoist physiology for the preservation of health

‘Image of the form of the body and the zang- and fu-organs’ indicates specific bodily organs and parts by means of both images and captions. From top to bottom, these named sites are: Mud Pill Palace, suihainao, Jade Pillow Gate, larynx, pharynx, lungs, heart, diaphragm, Well Pulley gate, spleen, stomach, liver, gall bladder, kidneys, small intestine, large intestine, navel, urinary bladder, Tailbone Gate, large intestine and anus, and urethra. The fact that only these parts were selected from a plethora of possibilities demonstrates that Heo Jun, attached a particular significance to them. However, ‘image of the form of the body and the zang- and fu-organs’ includes no explanation of why it depicts the human body in the way it does or why it draws attention to certain parts. The relevant categories in ‘chapter on the internal view’ and ‘chapter on outward form’ provide detailed accounts of the locations or shapes of each of the organs or body parts, and it is illuminating to read ‘Image of the form of the body and the zang- and fu-organs’ against these accounts. In particular, the separate ‘image of the five zang-organs’ explicates in greater detail the forms of the liver, heart, spleen, lungs, and kidneys, as well as the gall bladder and the stomach (two of the six fu-organs). Simple and economical in its visual language, ‘image of the form of the body and the zang- and fu-organs’ neither attempts to represent the entire compass of Treasured Collections, nor reflects the detail of the text in a straightforward

11 Shin 2001, p. 213. 12 Gong 1999, pp. 236–7.

Downloaded from Brill.com09/23/2021 05:17:32PM via free access 198 D. W. Shin / Asian Medicine 5 (2009) 186–207 manner. Let us examine the location of the liver as an example. According to the main text of ‘diagram of the liver’, the liver ‘is attached from below the diaphragm to the right ribs, and penetrates the diaphragm upward, to enter the lungs and connect with the diaphragm’. However, in ‘image of the form of the body and the zang- and fu-organs’, the liver, though shown below the diaphragm, is not depicted as penetrating the latter or as being connected to the lungs. There is no suggestion of a connection with the right ribs, which are not represented at all. Likewise, there are notable omissions in the depiction of the heart. The main text of ‘a diagram of the heart’ states explicitly that ‘the systems of the five organs are linked to the heart, and the heart is linked to the systems of the five organs so that the systems of the heart and the five organs are linked to one another’. It goes on to explain in detail: The system of the heart is linked upward to the lungs. The other system that branches out begins in the middle of the two leaves on either side of the lungs, penetrates the spine toward the back, and reaches the kidneys. It then proceeds from the kidneys to the urinary bladder and, together with the content of the urinary bladder, reaches to where urine is voided outside. This is the lowest place. However, ‘image of the form of the body and the zang- and fu-organs’, does not depict the heart as being connected to the systems of the five organs. Nor, for that matter, does it depict the systems leading to the lungs and the kidneys. Moreover, this incongruity between explanations and diagrams applies to all the remaining organs. In fact, this textual information on the positions of the organs inside the body is derived from Li Chan’s 李梴 An Introduction to Medicine, a Ming medical text published in 1575, 28 years earlier than Treasured Collections. An Introduction to Medicine also includes an anatomical chart with the title ‘image of the zang- and fu-organs’, in which the various internal organs are represented in accord with the text. But ‘image of the zang- and fu-organs’ was not an original creation of Li Chan. In fact, it goes back to Jinlan xunjing 金蘭循經 (Book Beside the Golden Orchid) by Hut Bilic 忽泰必烈, a master of acupuncture and moxibustion of the Yuan (Mongol) dynasty. Because Hut Bilic’s original chart was extremely large, it was subsequently simplified and reduced. Reduced versions are found in Wu Kun’s 吳崑 Zhenjiu liu ji 鍼灸六集 (Six Volumes of Acupuncture and Moxibustion) and Lou Ying’s 樓英Yixue gangmu 醫學綱目 (Outline of Medicine), both from the early Ming dynasty, and it is to this tradition that Li Chan’s An Introduction to Medicine belongs. Currently, the oldest known extant exemplar is the one in Lou Ying’s (undated)

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Outline of Medicine.13 While Treasured Collections cites An Outline of Medicine as a source, it is uncertain whether the version of the image that Heo Jun con- sulted was one of those accompanied by ‘image of the Illuminated Hall and the zang- and fu-organs’ as an addendum. Hut Bilic’s anatomical chart aimed at demonstrating that ‘man’s five organs and six viscera, entire body, nine orifices, and meridians and collaterals, pen- etrate the body and are connected to every nook and cranny without discon- tinuity’. The ‘Illuminated Hall’ images in Lou Ying’s work consist of three drawings: ‘Illuminated Hall image’, showing the internal organs, and two channel charts, showing front and back views of the body.14 Through these three diagrams, Hut Bilic sought to represent visually the connections between the inside and outside of the human body, the internal organs, and various body parts. Where the internal organs are concerned, noteworthy here is his endeavour to establish an anatomical basis for the connections among the five zang- organs and six fu-organs. Because traditional Chinese medicine is characterised by a physiology of the zang- and fu-organs and the six viscera according to the mutual generation and restriction of the five agents (also translated the five phases or elements: wood, fire, earth, metal and water), it was necessary to demonstrate the anatomical interconnectedness of the internal organs. The ‘Illuminated Hall image’ and ‘image of thezang - and fu-organs’ elaborate and represent visually four organic systems with the heart at the centre, and thereby lend support to the idea that ‘the heart is the sovereign organ’. ‘Image of the form of the body and the zang- and fu-organs’ both adds to and subtracts from the content of the earlier ‘Illuminated Hall image’ and ‘image of the zang- and fu-organs’, revealing very different priorities. It does not portray the systematic connections of the five zang- and six fu-viscera. Instead, it names and thus emphasises a series of places between the brain and the base of the spine, i.e. Suihainao, Mud Pill Palace, Jade Pillow Gate, Well Pulley gate, and Tailbone Gate. Drawn directly from the vocabulary of Dao- ism, these terms reflect a Daoist understanding of the human body. Suihainao, which the Hermit Sutra (仙經) identifies as the ‘upper elixir field’, is here described as the ‘storehouse of vital breath’. Mud Pill Palace (also known as the Yellow Court, Kunlun Mountains, and Heavenly Valley) is, according to Dao- ism, one of the nine palaces of the brain, where the Original Spirit resides. In addition, it is through this orifice that the soul and vital force enter and exit. According to the Hermit Sutra there are three gates at the back of the body: the Jade Pillow Gate at the rear of the brain; the Well Pulley Gate on the back; and

13 Huang 2003, pp. 67–8. 14 Huang 2003, p. 70.

Downloaded from Brill.com09/23/2021 05:17:32PM via free access 200 D. W. Shin / Asian Medicine 5 (2009) 186–207 the Tailbone Gate at the base of the spine. In Heo Jun’s ‘Image of the form of the body and the zang- and fu-organs’, these three gates are identified as pathways for essential matter and vital breath: ‘If the three gates circulate well like the pivotal part of the Big Dipper, essential matter will circulate up and down just as the Milky Way flows and circulates’.15 By focusing on these parts in this way, Heo Jun presumably wishes to emphasize the activities of essential matter, vital breath, and spirit, which are the three constituent elements of the human body. In ‘collection of cases’ in Treasured Collections, Heo Jun sets out the principle that the ‘basis of Daoism lies in clear and peaceful self-cultivation, and medicine cures with medication, food, acupuncture, and moxibustion, which is how Daoism has acquired its finesse and medicine has acquired its roughness’, and the same principle is reflected, as a matter of course, in the anatomical chart called ‘image of the form of the body and the zang- and fu-organs’. By making the Daoist context explicit and suppressing the medical context, which centres on the intrinsic and extrinsic relationships among the zang- and fu-organs, Heo Jun reveals the nature of his work, which foregrounds the Daoist principle of the preservation of health.

The images of the ﬁve organs inTreasured Collections of an Eastern Physician are created according to the teachings of older texts

‘Chapter on the internal view’ in Treasured Collections includes five images of the five zang-organs: ‘image of the heart’, ‘image of the spleen’, ‘image of the lungs’, and ‘image of the kidneys’ (Fig. 5). Judging from the fact that only these five drawings were created or included, we can conclude that Heo Jun regarded these five organs as the most important of all the bodily organs. The liver, heart, spleen, lungs, and kidneys each occupy one of the 108 categories in Treasured Collections, and the images are placed at the beginning of their respective categories. Because each image is provided with an explanatory text, what Heo Jun sought to communicate through the images is unmistakable. For example, his explanation of the image of the liver goes as follows: The liver is shaped like two large leaves and one small leaf, like gaping bark. At the centre of each, channels and collaterals emit harmonious yang vital breath (Nei- jingzhu 內經註 [Annotations on the [the Yellow Emperor’s] Inner Canon]). The liver is shaped like two large leaves and one small leaf. It is divided into three leaves on the left and four leaves on the right, and is like bark split and gaping in many pieces (An Introduction to Medicine). The liver weighs four catties and four

15 Heo 1994, pp. 285–6.

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Fig. 5. Five images of the ﬁve zang-organs 五臟圖. Source: Shin, 2001, pp. 184–5

taels. There are seven leaves altogether, three on the left and four on the right and it holds the soul (Classic of Difficulties).16 It can be seen from this that the subjects that Heo Jun found it necessary to discuss in conjunction with ‘image of the liver’ were the form, weight, and function of this organ. Following ‘image of the liver’, the category ‘liver’ treats the location of the liver, pulse diagnosis of liver diseases, liver diseases them- selves, and the treatment of liver diseases. Thus ‘image of the liver’ serves to provide the anatomical grounds for the various considerations that follow. In other words, the liver is not an abstract entity but a physical thing with form, weight, and specific functions. The same concreteness and physicality hold true of other organs. These diagrams of the five organs differ considerably from earlier drawings of the zang and fu organs. In Chinese medical history, there are two traditions of separate representations of the internal organs.17 One of these is inspired by Daoist ideas and techniques of internal visualization. This tradition is exempli- fied by the drawings of the five zang- and six fu- organs by Hu Yin of the Tang Dynasty, the oldest form of which has been transmitted through A Collection of Medical Formulas, a Korean medical text. As outlined earlier, this work contains six illustrations showing the liver, heart, spleen, lungs, kidneys (the five zang- organs), and the gall bladder (one of the fu-organs). Each illustration presents the shape of the organ in question as well as the hexagrams corresponding to it in the I jing 易經 The Book of Changes and the gods and animals associated with

16 Heo 1994, p. 541. 17 Huang 2003, p. 30.

Downloaded from Brill.com09/23/2021 05:17:32PM via free access 202 D. W. Shin / Asian Medicine 5 (2009) 186–207 it in Daoism. These six images seek to express the cosmic symbolism of the organs as well as the marvel of each organ’s function. The other tradition is represented byZhenjiu juying 鍼灸聚英 (A Glorious Anthology of Acupuncture and Moxibustion), an early Ming medical text. The illustrations in this work depict ten of the elevenzang - and fu-organs (excluding the Triple Burner due to its ambiguous location). The hexagrams from the Classic of Changes and the corresponding animals are omitted, with only the organs represented pictorially. This subsequently became the most widespread model in East Asian medical texts. Treasured Collections depicts the five organs only, without the deities and symbolic creatures found in A Collec- tion of Medical Formulas. Judging from this, it is possible to surmise that the author of Treasured Collections confined himself to the Daoist preservation of health and did not accept Daoist religious symbolism. Treasured Collections differs from both the traditions described above. Its images of the five organs evidently follow neither ‘image of the zang- and fu- organs’ nor A Glorious Anthology of Acupuncture and Moxibustion. This becomes more obvious when these anatomical charts are examined in detail. In the case of ‘image of the liver’, Treasured Collections shows two large leaves on either side and one large leaf in the centre. In total, there are three leaves on the left side (hidden in the centre is the gall bladder) and four on the right side. As for A Collection of Medical Formulas, the liver resembles boughs in clusters, whereas in A Glorious Anthology of Acupuncture and Moxibustion, there are patterns on an image that likewise resembles boughs in clusters. In the case of ‘image of the heart’, in Treasured Collections the heart is shaped like a flower bud, with seven holes and three strands of hair at the top, sur- rounded by the pericardium. In contrast, A Collection of Medical Formulas presents a simple image of an upside-down lotus blossom. In A Glorious Anthology of Acupuncture and Moxibustion, a tube at the top connects the heart with the lungs, and three tubes connect the heart with the liver, spleen, and kidneys. In the case of ‘image of the spleen’, in Treasured Collections the spleen is shaped like a horseshoe, whereas A Collection of Medical Formulas depicts this organ like an upside-down flower pot, and A Glorious Anthology of Acupunc- ture and Moxibustion presents a knife-like image. In the case of ‘image of the lungs’, Treasured Collections depicts the lungs like two broad-shouldered ears of grain, with six leaves underneath and twenty-four points in eight rows and three columns at the bottom. In contrast, the lungs in A Collection of Medical Formulas have three leaves on the left side and four leaves on the right side, with all the leaves displaying a pattern. The lungs in A Glorious Anthology of Acupuncture and Moxibustion have six leaves, with each leaf showing a pattern (the muscles).

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In the case of ‘image of the kidneys’, Treasured Collections depicts the kidneys like two red beans touching each other, their surface lined with scale-like markings. In contrast, the kidneys in A Collection of Medical Formulas resemble two beans touching each other while those in A Glorious Anthology of Acu- puncture and Moxibustion look like two beans separated by the spine in the centre, and neither of the latter two drawings shows scale-like lines. Of these illustrations, those closest to actual dissections are the ones in A Glorious Anthology of Acupuncture and Moxibustion. The images inImage of the Five Zang-Organs and Six Fu-Organs and Treasured Collections are the furthest removed from anatomy. In fact, the images of the five organs in Treasured Col- lections are not anatomical illustrations in a literal sense at all. Rather, they are pictorial representations of the contents of older texts such as the Neijing 內經 (Inner Canon), Wang Bing’s 王氷 Neijingzhu 內經註 (Annotations on the Inner Canon), and Nanjing 難經 (Classic of Difficulties), attributed to Bian Que, as well as the recent ones like the Yixue zhengchuan 醫學正傳 (True Lineage of Medicine) and Yixue rumen 醫學入門 (An Introduction to Medicine).18 ‘Image of the liver’ pictorially represents the contents of An Intro- duction to Medicine, which in turn combines the teaching of Annotations on the Inner Canon that ‘it [the liver] is shaped like two large leaves and one small leaf, like gaping bark’ and of the Classic of Difficulties that ‘there are seven leaves altogether, three on the left and four on the right’. ‘Image of the heart’ represents the teachings of Annotations on the Inner Canon that ‘it [the heart] is shaped like an as yet unopened lotus blossom and has nine holes’, of An Introduction to Medi- cine that ‘there are seven holes and three strands of hair in the centre’, and of the True Lineage of Medicine that ‘the membrane surrounding the heart is the pericardium’. The holes and the hairs of the heart are renderings of the following passage in An Introduction to Medicine, citing from the old Daoist compilation, Yunji qiquan 雲笈七籤 (Seven Sticks from the Cloudy Basket). The heart resembles a lotus flower that is yet to bloom; it has seven holes in the middle and three strands of hair. The wisest ones have nine holes and three strands of hair; wise ones have seven holes and two strands of hair; less wise ones have five holes and one strand of hair; ordinary people have two holes and no hair; and unwise ones have nothing but one hole. These holes and strands of hair are the channels of communication with qi from Mother Nature 본성 (本性).19 ‘Image of the lungs’ illustrates the statements in Annotations on the Inner Canon that ‘they [the lungs] are like broad shoulders, and there are twenty- four points in the middle’, and in the Classic of Difficulties that ‘there are a total of eight leaves, which consist of six leaves and two ears’. ‘Image of the spleen’

18 Yi 1957, p. 263. 19 Heo 1994, p. 549.

Downloaded from Brill.com09/23/2021 05:17:32PM via free access 204 D. W. Shin / Asian Medicine 5 (2009) 186–207 illustrates the opinion of Annotations on the Inner Canon that ‘it [the spleen] resembles a horseshoe and embraces within it the gastric cavity’. ‘Image of the kidneys’ illustrates the view of the Inner Canon that ‘there are two kidneys, and their shape is like that of two red beans facing each other, and they are attached diagonally to the muscles of the back. They are coated with oil on the surface, and they are white inside and black outside, and their role is to hold essential matter’. The Ming Glorious Anthology of Acupuncture and Moxibustion and later diagrams of the five organs tend to represent the organs in a way that echoes the actual experience of dissection; in contrast, the anatomical images in Treasured Collections hark back to more ancient traditions. The same approach runs through those sections of Treasured Collections that explicate body parts other than the six viscera. In the section on the stomach, the Numinous Pivot, Plain Questions, and An Introduction to Medicine are cited as authorities for the length, shape, and diameter of this organ. In the case of the small intestine, the Numinous Pivot is cited with reference to its length, circumference, diameter, weight, and number of folds and capacity. In the case of the large intestine, the Classic of Difficulties is cited on its length, circumference, weight, number of folds, and capacity. In the case of the urinary bladder, the Classic of Difficulties is cited on the circumference of the upper orifice of the bladder, the circumference of the centre of the organ, and the capacity and weight of the entire bladder. This emphasis on older texts coincides with the author’s declared motive for composing Treasured Collections: ‘because recent years have seen far too many heterodox opinions and divergent formulas, which has led to the loss of the spirit of the Numinous Pivot of old, it [the composition of the text] is to correct this’. The argument that the orifices and tiny hairs of the heart are indicators of a person’s degree of wisdom likewise reveals that Treasured Collec- tions sought to pay homage to ancient knowledge rather than moving toward anatomical empiricism, as does the explanation that, because the heart corre- sponds to the Three Terrace Stars삼태성 (三台星), the utmost sincerity can move even heaven. This is why Heo Jun felt no need for dissection, and devised ‘imaginary’ anatomical charts that correspond to statements in older medical texts.

Conclusion

In sum, the anatomical images in Treasured Collections diﬀer from earlier East Asian anatomical charts in three important ways. First, they embody the view that Daoist practices for preserving health and vitality (yangsheng) are closer to

Downloaded from Brill.com09/23/2021 05:17:32PM via free access D. W. Shin / Asian Medicine 5 (2009) 186–207 205 the essence of life than is medicine. Consequently, while based on anatomical charts from the medical tradition, they supplement their sources with key content for Daoist concepts of the preservation of life. In particular, the three gates of the spine, which are the channels for essential matter, vital breath, and spirit, and the Mud Pill Palace (brain) have been introduced into ‘image of the form of the body and the zang- and fu-organs’. Second, unlike existing medical texts, which mainly focused on the organs inside the body and the channels on the surface of the body, Treasured Collec- tions seeks to incorporate other elements of the body into ‘bodily form’. Bodily constituents other than zang- and fu-organs and the channels, including the head, face, eyes, mouth and lips, teeth, neck, back, chest, breasts, abdomen, waist, sides, armpits, arms, legs, skin, flesh, pulse, muscles, and bones are seen in this work as main components of ‘bodily form’. However, rather than rep- resenting all of these explicitly by visual means, the author alludes to his intention through the title ‘image of the form of the body and the zang- and fu-organs’. Third, Treasured Collections aims to establish a medical standard faithful to the spirit of older texts, an enterprise that is especially noticeable in the diagrams of the five organs. In doing so, this work pays more regard to the anatomical content of the earlier Inner Canon and the Classic of Difficulties than to the contributions of positivistic anatomy from and after the Song and Yuan Dynasties, and the diagrams of the five zang-organs are devised in accord with such a view. This approach and set of priorities subsequently became a salient character- istic of Korean medicine. Indeed, medicine in Korea during the late Joseon Dynasty was strongly characterised by Daoist ideas of the preservation of health, which in turn resonated with the spirit of Confucian scholar-officials, who attached great importance to the pursuit of physical and mental cultivation. In addition, Heo Jun’s successors repeatedly condensed and rearranged Treasured Collections, and used it as a model; and in this process, the section of the text entitled ‘treatise on bodily form’ acquired the status of a standard for classifying the body and diseases. Above all, dissection was subject to powerful taboos in Joseon society. This was not so much a consequence of the publication of Treasured Collections, as part of the general ethos of which Heo Jun’s text partook. In fact, there exists only one record of an actual dissection conducted in Korea before the introduction of Western ideas and techniques, and it dates from the same period as Treasured Collections. According to the record, the medical skills of one Jeon Yuhyeong 全有亨 became even more refined following his dissection of three corpses during the Japanese Invasions of 1592–1598. However, this record is

Downloaded from Brill.com09/23/2021 05:17:32PM via free access 206 D. W. Shin / Asian Medicine 5 (2009) 186–207 found in the context of emphasising the taboo against dissecting human bodies: precisely because he conducted this dissection, Jeon Yuhyeong was unjustly charged with treason and later put to death.20 The passage below illustrates the attitude towards dissection of Korean physicians after Heo Jun. It consists of a dialogue between Nam Dumin 南斗旻, a physician who visited Japan in 1763 as a member of a Korean delegation, and a Japanese Confucian scholar-physician. Kitayama Arawatsu 北山彰: So here is my question. In my country, it was heard that a doctor who likes strange things (Miwaki Toyo) dissected the dead body of an executed prisoner, drew the shapes and locations of the internal organs in different colours and published a book entitled ‘Theory of Organs’. He said that while Neijing claimed there were 12 organs, he dissected the body, discovered there were only nine of them, and could see the large intestine but not the small one. He tried to prove this quoting Shang Shu (Book of Documents), Zhouli (Rites of Zhou) and other books from miscellaneous schools. If the so-called arrangement of the human organs and the theory of Five Agent correspondences, described in the Inner Canon, were to be dismissed because of this, all of us in the medical profession are destined to fail miserably, it is said. Is there any such theory in your country, too? What is your opinion about this? Nam Doo-min 南斗旻: Scholars in your country like to present strange theories; I am not sure if it is because they have a predilection for this. In my country, we all follow the principles of Huangdi 黃帝 (the Yellow Emperor) and his teacher, Qi Bo 岐白, and we do not seek any new theories. One who learns only after doing dissection is unwise, while knowing without doing dissection is the ability of a sage. Please do not be carried away [by such theories].21 The general attitude of Korean physicians including Heo Jun was that one should remain faithful to the medicine bequeathed by sages instead of devel- oping new medicine through dissection, and this holds true also of their views on anatomy.

References

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20 An, Jeong-bok, Seongho saseol yuseon 星湖僿說類選 1929, p. 445. 21 Kitayama Shō 北山彰 1764, Keydan waumei 鷄壇嚶鳴 (http://jisik.kiom.re.kr/, 鷄壇嚶鳴, 席上賦一律呈).

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