The Territory Between Life and Death

Medical History, 2003, 47: 250-258 Essay Review The Territory between Life and Death

VIVIENNE LO MhWiS*

Li Jianmin, A RG Sisheng zhi yu N LA (The Territory between Life and Death), Taibei, Academia Sinica, 2000, revised in 2001, 435 pages incl. illustrations (fine binding edition, ISBN 957-671-703-5; ordinary edition 957-671-704-3). Li Jianmin's richly illustrated book is the "Immortals" in a section of the first monograph wholly devoted to mai R-R, bibliographical treatise of A (History of which he identifies as the most fundamental the Former Han) that catalogues an eclectic unit of the body for early Chinese medical selection of technical and medical arts, theorists, and a primary measure for its known asfangji )tAIk (remedies and skills).' health. Questions concerning how the The relevant sentence reads: "protect the concept of mai emerge in historical and genuine in life and roam around searching technical literature have important for what is outside of it ... equalize the implications for our understanding of the territory between life and death" (emphasis development of classical Chinese theories of mine).2 Here are books on the physiology of health and acupuncture theory and practice. the body, its xue &i (blood) and mai )L, Sisheng zhi yu R L A is a seminal which are also aimed at clarifying work which draws together some 1,500 distinctions between life and death and the primary and secondary sources that bear roots of all illness. upon our understanding of mai at a critical The underlying argument of Li's book is phase in the late Warring States and early that the mai themselves are the technical imperial period (irca fourth to second ground that form that "territory between century BCE); for the first time Li Jianmin life and death", and through which gives a three-dimensional account of the immortality might seem a tangible goal. The complex arts and technical culture within pursuit of immortality in early China took which the concept first developed, and with many forms, some of which are documented which it is inseparably intertwined. Thus the in the Hanshu bibliography: from massage task of this review article is to summarize and therapeutic movement to alchemy, sex his findings for those who do not have and drug-taking, all in varying degrees access to new trends in Chinese scholarship. constituted paths to long life, and the His title is taken from the entry for avoidance of decay.

* Vivienne Lo, The Wellcome Trust Centre for the History of Medicine at University College London. 'Hanshu iM (History of the Former Han, compiled 58-76 CE) juan 30, Ban Gu *EIRI I am very grateful to Lois Reynolds for her (32-92), Beijing, Zhonghua, 1996, pp. 1701-1780. editorial expertise. 2Ibid., p. 1779.

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Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 28 Sep 2021 at 21:48:11, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300056751 Review In the last decade, Maixue 1Je (the environments could be judged. What Li study of the mai) has fascinated historians adds to the field is a close examination of of early Chinese medicine. Some translate how, when and where that body was mai as "vessel", others "channel", constructed. He reassesses assumptions sometimes "pulse". But when mai comes about periodicity; finds geographical fused, as it often is, with other Chinese variation in the interpretation of the mai, as terms the problems multiply. Jingmai £NI, well as three different stages of development together with jingluo ., fundamental differentiated by the influence of theories concepts common in the canonical treatises about the movement of heavenly bodies, the of Chinese acupuncture theory, Huangdi priorities of early Chinese forms of self- neijing ** Fs (the Yellow Emperor's cultivation and the development of a Inner Canon), have been translated numerological body with which one could "conduit", "meridian", "circulation tract" calculate physiological movement and and "vessel" as well. Then there are the circulation. dongmai Oft, literally the "moving" mai, Maixue is not a new field, and Li's study not to be too closely associated with the is one of the latest in a long tradition of "pulses" of Western medicine, and finally scholarship, including a substantial pre- xuemai IfiiJ1J (blood mai) or baimai -.)11i modem corpus of critical study. The earliest (one hundred mai), which more simply refer may even date to Nanjing N (Canon of to the "blood vessels". Yet the divisions of Difficulties), an innovative and structure and function differentiated in the systematizing circa second-century Chinese English renderings of mai as "vessel" and work, written to elucidate many of the "6pulse" may be an artefact of problems and inconsistencies that existed in translation-of the inseparable development the Huangdi corpus.4 The latter body of of anatomy and theory of blood circulation writings comprises several compilations of in the Western medical traditions and the small texts dealing with separate topics, challenge has been to give a positive which may reflect the thinking in a distinct account of the mai.3 Li Jianmin has now medical lineage. It is now thought by most gone a long way towards meeting that European and American scholars that the challenge. texts were set down at the earliest in the It is commonplace understanding that the second century BCE, but possibly in the first acupuncture body is a microcosm of the centuries CE. Collectively, they represent the known universe, a metaphor for structures kind of debate through which classical that early Chinese found in Heaven and medical concepts matured. Earth. In Li's words the mai are "a field of Scholars working in the last century have temporal spaces" that act as a pivot of tended to imagine a collective accumulation many different worlds; at once analogous to of knowledge about the body developing the rivers of China, to astronomical into an empirically-based medical system. movements, to rivers of blood and channels For example, in Celestial lancets Lu and of communication, patterns against which Needham imagine a golden age of human disharmony with different "empirical" medical activity at the

3Shigehisa Kuriyama, 'Varieties of haptic Huangdi neijing suwen * IsW.irI and experience: a comparative study of Greek and Huangdi neijing taisu *tPi;k* are Chinese pulse diagnosis', PhD diss., Harvard generally considered to contain the core theory University, 1986, pp. 58-100. of traditional Chinese medicine. Nathan Sivin, 'Paul Unschuld, Nan-Ching: the classic of 'Huang ti nei ching', in Michael Loewe (ed.), difficult issues, Berkeley, University of Early Chinese texts: a bibliographical guide, California Press, 1986. The combined treatises Berkeley, SSEC and IEAS, University of of the Huangdi neiing lingshu **AJg,949, California, 1993, pp. 196-215. 251

Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 28 Sep 2021 at 21:48:11, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300056751 Essay Review foundation of classical theory, a scientific wuxing HIT (five phases), the "turtle and spirit that was ultimately stifled after the milfoil", physiognomy, the determination of Tang period (618-907) when "abstraction auspicious times and places, as well as types trampled over empiricism" in the hands of of exorcism, omenology, etc.7 Once those more learned in astrological associated with the numerological sequences calculation than practical medicine.' A of shushu calculation, the routes and cherished view was that the replacement of channels around the body defined as mai bian E (stone lancets) and other crude open out into Li's "field of temporal stone implements with finely drawn metal spaces": each of the mai has designations needles was the catalyst that stimulated a relating Yin and Yang (Great Yin mai, new age of medical sophistication.6 Li Great Yang mai, Lesser Yin mai, etc.), Jianmin and others represent a growing terms that can refer to the dark and sunny number of scholars who prefer not to aspects of a mountain, but equally describe emphasize continuities in Chinese the phases of the sun and moon-thus technological culture and favour a creating the essential spatio-temporal differentiation of the historical layering of framework for the body to become a vessel medical knowledge and experience. There is for circulating qi and blood. now considerable doubt about the narrative Where Lu and Needham refer to a of "trial and error" in the discovery of "characteristic noise or redundance", which acupuncture channels and loci, and it has always accompanies the growth of become a matter of academic rigour to find systematic classifications in all cultures, new ways of re-framing the essential more recently historians tend to concentrate questions. their attention on the elements of medical The core of Li's thesis is that the practice that did not succeed in becoming development of mai was motivated by the part of a canonized tradition. Li Jianmin is pervasive culture of shushu OM (literally, at the forefront of research into lost numbers techniques), the art of traditions of the late Warring States and "calculation". Shushu is a peculiarly Chinese early imperial medical cultures and the notion of "numbers" used in the doctors and diviners that worked with their computation of "celestial patterns" at the theories. He is well known for his work on foundation of the astro-calendrical the early literature on remedies, on human traditions. Different forms of shushu culture dissection as spectacle, and the history of pervade all aspects of life in early China, the occult arts, such as seduction, or ideas and in Han times embrace types of of contagion through demonic influences.8 divination using Yinyang MM and the His work follows in the wake of those

5Lu Gwei-Djen and Joseph Needham, (Demonic Illnesses and 'Place': One Celestial lancets, Cambridge University Press, Explanation of Family Medical Attitudes to 1980, p. 141. Demonic Illness), in Hanxue yanjiu *YWf5ft, 6Lu Shouyan 9 , Lu Shouyan Zhenjiu lun 1994, 12 (1); 'Furen meidao kao-chuantong zhu yian xuan VAi+*- R*i! (Lu jiating de chongtu yu huajie fangshu' Shouyan's Selection of Acupuncture Cases), kM}A): e {bIT#1 (The Beijing, Renmin weisheng, 1984, p. 1. Art of Charming for Women: Traditional Family 'See Michael Loewe, Divination, mythology Conflict and Magical Techniques), in and monarchy in Han China, Cambridge Xinshixue VT*, 1996, 7 (4); 'Zhongguo gudai I Iniversity Press, 1994, and Marc Kalinowski, "jinfang" kaolun' +RP &ftWt;VA 'Les Instruments astro-calenderiques des Han et (Examination of ancient Chinese 'restricted la methode liu ren', Bulletin de l'Ecole FranVaise remedies'), in Zhongyang yanjiu yuan lishi yuyan de l'ExtrtCme Orient, 1983, 72: 309-419. yanjiu suo jikan AiJEliJ, 8 Li Jianmin, 'Suibing yu changsuo: chuantong 1997, 68 (1); 'Wang Mang yu Wang Sunqing ji yixue dui suibing de yi zhong jieshi' gongyuan yi shiji de renti kubo shiyan' zE#043EIAX;W.E9t§JJS-

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Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 28 Sep 2021 at 21:48:11, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300056751 Essay Review scholars such as Li Ling, Sakade Yoshinobu tianguan )it (Bureau of the Heavens), and Donald Harper who have pioneered thought to be responsible for imperial research into all those elements of medicine ceremony, and idealized in Zhouli MR M considered superstitious, and therefore (Ceremonies of Zhou: second century BCE?). irrelevant, by the last generation of If the ruler does not carry out the imperial scholars.9 Recent debate has centred on rites according to the changes of season, the how, where and when philosophy and the people will become ill with liji , technical arts came to be based upon these seasonal epidemics (li sometimes refers to a systems of astrological calculation. In a leprosy-type illness) or ulcerous swellings. well-known reference to Yi He R1IiI, the More reliable records relating to the actual Physician He, we have a recurring theme of administration of Han ritual affairs refer to Heaven above, represented by the number an Office of the Grand Astrologer, Tai shi six, and by Earth below five, "the six qi I ling ; responsible for generating the [Yin, Yang, Wind, Rain, Obscurity and shushu categories in the bibliographical Brightness] which descending generate five treatises of Hanshu." Li points out that the flavours, emit as the five colours, and find fang/i }ftA (remedies and skills) category is fulfilment in the five sounds".'0 The modelled on the observances of a Bureau of numbers are restated in Guoyu gLRr Heaven, linking iatromantic skills of the (Dialogues of the State: fifth to fourth physician (prognosis and prediction of the centuries BCE), i/X1i3i,ttPJ course of an illness) with the numerological (Heaven being six and Earth being five is sequences thought immanent in the natural the rule in calculation). Here are the initial world. If it were possible to establish rules seeds of many numerological correlations about the movement of the sun and moon, concerning qi and Yin and Yang which are and the courses of rivers and waterways, the ultimately integrated into different systems rules would also apply to physiology, and in at the foundation of this concept of mai. the case of the mai navigating routes Eventually the same sequence can be found around the body through which blood and in the linking of bowels and viscera to the qi flowed. channels through the wuzang The 'Jingmai' 00 treatise of the liufu afI AJt (five viscera and six Huangdi neijing lingshu is the locus classicus bowels) system. for the twelve channels of acupuncture that On the face of it, the shushu calculations remain in the modem repertoire of may look like a numbers game, but as Li traditional Chinese medicine (TCM), and explains, they are at once both functional in link to the viscera and bowels. Different daily medical practice and inherently treatises follow which focus on separate powerful, in that they contain a way of constructions of the body channels such as ordering the mysteries of the universe. He "Jingshui" .W*k linking body channels to places the focus for this medical innovation the waterways of China."2 Adding to the firmly in the anachronistic concept of a transmitted canons, newly excavated

(Wang Mang and Wang Sunqing Recording a Kansai Daigaku shuppan bu, 1999; and Donald First-Century Experiment in Human Harper, Early Chinese medical literature: the Dissection) W*5 Xin Shixue, 1999, 10 (4). Mawangdui medical manuscripts, London, Kegan 'Li Ling 2, Zhongguo fangshu Paul International, 1998. kao rPN5V- (An Examination of Chinese Translated in Angus Graham, Disputers of Technical Arts), Beijing, Renmin Zhongguo, the Tao, La Salle, IL, Open Court, 1989, p. 325. 1993; Sakade Yoshinobu, Chiigoku shiso " See Goh Thean Chye, The history of the kenkya iyaku yoseilkagaku shiso hen Chinese Astronomical Bureau, MA thesis, Kuala + P9 1381,K f5L t- k* ~t - ,4*,%V (Study Lumpur, University of Malaya, 1967. Microfilm: of Chinese Philosophy: Volume of Medicinal Rochester, Eastman Kodak Co, 1969. Regimen/Scientific Thoughts), Osaka, 12 See note 4 above.

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Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 28 Sep 2021 at 21:48:11, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300056751 Essay Review manuscripts, as well as images and the Han.'I But we must be cautious of artefacts, have changed the nature of dating the excavated manuscripts in their research into the history of Chinese relationship to an unconfirmed dating of the medicine in both early and medieval Huangdi corpus. Li sets out four critical periods. Four manuscripts excavated at questions: first, he asks why the tomb Mawangdui tomb 3 (buried 168 BCE) and owners should collect antique texts; second, Zhangjiashan tomb 247 (c. 186 BCE) in he makes the point that it is inappropriate Hunan and Hubei respectively (the former to confuse popular and scholarly works on kingdom of Chu M), describe eleven mai the mai, when it is clear that texts of "channels" that chart the course of diverse varying sophistication were simultaneously physical phenomena.'3 These channels have in circulation; third, he emphasizes the been related to blood vessels, muscular danger in trying to trace lineal somatography, various types of illness, as developments when there is evidence of well as sensory experiences of the body, many systems of mai; and finally he argues including pain, passion and pleasure.'4 that the relative sophistication of the Modern scholars, both in China and diagnosis seen in Sima Qian's 1J;I abroad, were excited to find in the (?145-?86 BCE) biography of the Han manuscripts what appeared to be early physician Chunyu Yi 4iTs, co-exists in versions of the jingmai channels of the the Western Han period with a cruder Huangdi neijing lineage. Indeed, the practice exemplified in household medical Zhangjiashan manuscript, Maishu Ji* books excavated from the Chu graves-thus (Book of mai c. 186 BCE) is the earliest emphasizing medical pluralism.'6 treatise to set out both principles and Li provides a labyrinth of charts and practice of acupuncture, if we assume that references laying out the many different the art involved piercing the body to constructions of channel theory which vary normalize a flow of qi. But the excavated in the number of channels, their titles and texts do not link the channels to the viscera routes. In his analysis, for example, are the and bowels, and have no mention of ten lines drawn on a small wooden acupoints or formal circulation of qi. lacquered figurine (c. 118 BCE) excavated Until recently, a pervasive assumption from a late Western Han tomb near was that the three Huangdi neijing Mianyang in Sichuan. One line which compilations that make up the Huangdi traverses the head laterally is unique, with corpus (suwen, lingshu, taisu) date to the no known analogue in any other source.'7 Warring States and form part of the Li describes a sudden breakthrough testimony to a critical transformation of around the time of transition between the medical ideas due to the work of Zhou and Qin periods (late third century distinctive medical lineages, rather than BCE), concurrent with the establishing of the evidence of further and separately first empire. It is certainly at this time that distinctive medical developments through we find the emergence of a new technical

"For a description and translation of all '5Yamada Keiji di , 'The formation of the manuscripts, see Harper, op. cit., note 9 the Huang-ti Nei-ching', Acta Asiatica, 1979, 36: above. 67-89. 14 See MVvienne Lo, 'The influence of nurturing 16 Shiji ZA (Historical Record) Beijing, life culture on early Chinese medical theory', in Zhonghua shuju, 1996, 105 ed., pp. 2751-83. For Elisabeth Hsu (ed.), Innovation in Chinese a discussion of Chunyu Yi's pulse diagnostics, see medicine, Cambridge University Press, 2001, pp. Elisabeth Hsu, 'Pulse diagnostics in the Western 19-50, idem, 'Crossing the Neiguan MJN "Inner Han', in Hsu (ed.), op. cit., note 14 above, pp. 51-91. Pass"-A neilwai d9 * "Inner/Outer" distinction 7Vivienne Lo, 'Spirit of stone: technical in early Chinese medicine?' in EASTM, 2000, 17: considerations in the treatment of the jade body', 15-65. Bull. SOAS, 2002, 64 (3): 124-6.

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Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 28 Sep 2021 at 21:48:11, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0025727300056751 Essay Review of pain, as well as other phenomenological in the Huangdi neijing compilation, perceptions of the body, played an amounts to little more than petty surgery, important role in laying out the pathways blood-letting and massage. Only the of the mai.2' To emphasize the contrast with haozhen ]i+, the chanzhen *i+ and Chinese ways of knowing the body, the yuanlizhen 0*Ji± "round sharp Kuriyama describes how each culture needle" of the "nine needles" were used privileges different styles of seeing. He to pierce the body to influence conditions argues that complexion diagnosis, the art of of qi pathology.23 seeing disharmony in the aura of the face, For Li Jianmin the significance of the was rooted in botanical metaphors long Nine Needles treatise is that it shows how established in the language and culture of the priorities of "the arts of calculation" are early China. Like the blossom of a flower, worked out in the minute details of the complexion was the visible expression of practice. Each of the nine needles the strength or weakness of the underlying corresponds to numerological sequences organism. Kuriyama distinguishes between attributed also to parts of the body: the first haptic knowledge in the different traditions. resonates with the skin, the second with the Contrasting palpation of the mai and the flesh, the third with the mai, the fourth with knowledge of the pulse that begun in the the sinews, etc. The more subtle needles can Greek medical tradition, he emphasizes how move the spirit. the most immediate experience of the body Li Jianmin starts with the framework for is constantly subject to a relationship with a metaphorical body that was determined theoretical preconceptions distinctive to a by the ceremonial priorities of governance, particular culture.22 the mai were enlivened and invigorated by Li Jianmin takes a fresh look at the the practice of circulating qi in self- development of new tools, such as those cultivation, and calculated by the described in 'jiu zhen lun' Af+0 (Nine "gentleman of remedies" working in the Needles treatise) of the Huangdi neijing technical arts. If the idea of channels arose lingshu. It has been thought that the in an accumulation of knowledge about the emergence of drawn metal needles such as pulse, in theorizing about the experience of the hao zhen, fashioned to be "as thin as pain, pleasure, and emotion, the an autumn hair", ushered in a new age of systematizing of numerical priorities came medicine where treatment at finely located with the pervasive influence of shushu acupuncture points replaced the cruder culture. The number of pulses, routes of lancing stones. Li, characteristically, mai, viscera and bowels, orifices, the provides us with a more complex picture circulation of qi, and medical equipment, in which many forms of body piercing every nook and cranny of the human body and tools appropriate to different practical and its physiological processes were contexts co-existed, and were permeated calculated down to the very last digit. With with priorities based in the arts of the combination of observation and calculation. Much of the therapy detailed experience of the body and a numerological certainty legitimized by the movements of 21Vivienne Lo, 'Tracking the pain: Jue and the Despeux, 'From prognosis to diagnosis of illness formation of a theory of circulating qi through in Tang China', in Vivienne Lo and Christopher the channels', in Sudhoffs Archiv, 1999, Bd 83: Cullen (eds), Mediaeval Chinese medicine 191-211. (forthcoming). 2 Shigehisa Kuriyama, The expressiveness of 23Yamada Keiji, The origins of acupuncture, the body and the divergence of Greek and Chinese moxibustion and decoction, Kyoto, Nichibunken: medicine, New York, Zone Books, 1999; see also International Research Centre for Japanese Sarah Allan, The way of water and sprouts of Studies, 1998. virtue, Albany, SUNY Press, 1997, and Catherine

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