EASTM 18 (2001): 75-11 I

Changing Standards: Tracing Changes in Acu­ moxa Therapy During the Transition from the Tang to the Song Dynasties 1

Asaf Goldschmidt

[Asaf Goldschmidt is a lecturer at Tel Aviv University, Israel. He received his Ph.D. in History and Sociology of Science from the University of Pennsylvania in I 999. His dissertation was on "The transformations of Chinese medicine dur­ ing the Northern (920-1127)." The dissertation analysed how by the end of the three past medical approaches converged into one comprehensive medical system. He is currently working on a history of the first imperially sponsored pharmacy in and on the influence of the Song emperor Huizang on medicine.]

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Acupuncture is probably one of the most renowned topics when traditional Chi­ nese medicine is discussed. Indeed, more often than not, when people discuss traditional Chinese medicine one of the first issues they discuss is acu-moxa therapy (see definition below). Acu-moxa therapy is certainly one of the most intriguing and unintuitive therapeutic skills in the arsenal of traditional Chinese medicine. However in spite of this, little research has been conducted on the history of this topic. Existing works mostly concentrate on either the question of the origin of acu-moxa therapy or provide a general overview of its history.2 This paper offers a different approach - it compares the contents of six surviving texts of acu-moxa therapy dating to the late Tang and early Song dynasties. By com­ paring the contents of these works, I attempt to examine changes in the manu­ scripts available to practitioners of that era. Despite the fact that the comparison relies on only six extant texts, it offers some interesting inferences regarding the development of acu-moxa therapy. The most interesting conclusion of this com-

I I thank Nathan Sivin and two anonymous reviewers for their helpful comments on earlier versions of this paper. All errors or omissions are my responsibility alone. 2 Epler (1980) and Kuriyama (1995b) discuss the topic of the origin of acu-moxa therapy. Lu & Needham (1980), Lin Zhaogeng and Liang (1995), and Weikang ( 1991) provide a more general overview and history of acu-moxa therapy. 75

Downloaded from Brill.com09/24/2021 10:22:25AM via free access 76 EASTM 18 (2001) parison is that acu-moxa texts during the Song became more systematic and stressed the standard location of acu-points and circulation tracts. The transition from the (618-907) to the Song dynasty (960- 1276) was more than just a dynastic succession; it was a period of major trans­ formations in all aspects of state, thought, culture, and society. Some scholars refer to this period as shift from the Chinese middle ages to "renaissance" or even "pre-modern" China. Others claim that this transition marks an economic revolu­ tion that was somewhat comparable to the industrial revolution in Europe.3 Medicine was no exception. Much like other aspects of life, medicine and medi­ cal practice experienced major transitions and transformations. The changes included the establishment of a public pharmacy, a medical university, and an imperial bureau dedicated to revising medical texts. In addition, during this pe­ riod three major past medical approaches were integrated into one comprehen­ sive medical system resembling, to a certain degree, present-day traditional Chi­ nese medicine.4 The objective of this paper is to expose some changes in one specific facet of Chinese medicine, transformations that otherwise may go unnoticed. More spe­ cifically, this paper, drawing on several surviving acu-moxa texts from this era, will trace changes in acu-moxa therapy during the transition from the late Tang dynasty to the Northern Song dynasty (960-1127). A number of historians of Chinese medicine have found evidence of change during the Song dynasty by analyzing predominantly either prefaces to medical books or commentaries ap­ pearing in various historical sources.5 This approach provides a somewhat biased perspective since it does not focus on the most important aspect of medical litera­ ture - the content of the medical text. In this paper I attempt to show how we can detect changes in medicine by analyzing and comparing the technical contents of a certain genre of medical writing - namely acu-moxa therapy. My hypothesis is that by comparing the contents of acu-moxa manuals, which reflect to a certain extent issues and topics most highly regarded by their physician-authors, we can offer a unique perspective on the state of knowledge in the field and how it changed over time. The term "acu-moxa therapy" refers to a group of traditional Chinese clinical techniques designed to stimulate specific loci on the human body in order to obtain a desired therapeutic effect. and moxibustion are the most

3 See Gernet 1985: 298-300; Shiba 1970: 1-3; Hartwell 1962; and Elvin 1973 (espe­ cially pp. 111-199). 4 For a comprehensive analysis of the changes in medicine during the Northern Song dynasty including the integration of the three past medical approaches, see Goldschmidt 1999. 5 For example, see Zheng Jinsheng 1982 and 1988; Unschuld 1985: 154-186; and Wan Fang 1982.

Downloaded from Brill.com09/24/2021 10:22:25AM via free access Asa/ Goldschmidt: Changing Standards 77 popular, but not the only, techniques in this therapeutic approach.6 In discussing changes in acu-moxa therapy, my concern is not the stimulation technique or its effects. Rather, I focus on the process in which acu-moxa transformed from a mere symptom-based treatment into the last stage of the clinical process of clas­ sical Chinese medicine, following detection of symptoms and determination of manifestation types.7 Detecting changes in acu-moxa therapy during this period is not trivial. Only a limited number of medical works dating to the Northern Song dynasty has dis­ cussed acu-moxa therapy. In spite of this limitation this paper concentrates on comparing the contents of six extant acu-moxa texts dating to the late Tang and Northern Song dynasties. Of these only one was devoted solely to acu-moxa therapy. The others are chapters discussing acu-moxa therapy included in general medical manuals, or formularies, concentrating mainly on drug therapy.8 The six texts are included in the following five books: Arcane Essentials from the Imperial library (752), Prescriptions at the Heart of Medicine (984), Impe­ rial Grace Formulary of the Taiping [ Reign-period] (992), Illustrated Canon of Acu-moxa Therapy [Depicting] the Acu-points of the Bronze Figure (1026), and Medical Encyclopedia: A Sagely Benefaction of the Zhenghe [Reign-period] (1122).9 Of these five books, one was compiled during the Tang dynasty, three

6 Acupuncture is based on inserting needles of various gauges and lengths into the skin at specific loci. Moxibustion is based on burning tinder made of Chinese Mugwort (Artemisia Argyi or Artemisia Vulgaris) next to a locus or on it. The Chinese term for moxibustion is ai 3t. For a comprehensive discussion of acu-moxa techniques and doc­ trines, see Lu and Needham 1980: 69-153, 170-184, and Sivin 1987: 258-264. 7 'Manifestation types' are schematic representations of disorders in traditional Chi­ nese medicine. The determination of manifestation types is the stage in the clinical inter­ action between physician and patient in which the physician groups the symptoms he observed into categories or types and accordingly draws conclusions regarding the desired treatment approach. I use this term following Hans Agren's definition (Agren 1975: 39). For further discussion see Sivin 1987: I 09-111, 329-347, and Farquhar 1994: 55-59. 8 I did not include other Tang dynasty formularies, such as the Essential Prescriptions Worth a Thousand, for Urgent Need (Beiji qianjin yaofang {11/i ~- -f- ~ ~ 1J), since they do not have a specific section systematically discussing acu-points, their location, and effects. These formularies provide only the therapeutic application of acu-points accord­ ing to symptoms. 9 Waitai biyao 5'} ~ fii ~ (Arcane Essentials from the Imperial Library), Yixinfang (in Japanese: /shimpo) ~ ,C,, 1J (Prescriptions at the Heart of Medicine), Taiping sheng­ hui fang -Jr. 5¥ ~ ~ 1J (Imperial Grace Formulary of the Tai ping [Reign-period]), Tong­ ren shuxue zhenjiu tujing ~ A ffifii '/'i.. jt ~ Ill ~ (Illustrated Canon of Acu-moxa Ther­ apy [Depicting] the Acu-points of the Bronze Figure), Zhenghe shengji zonglu i&: f □ ~ i1'f ff,!. j-J< (Medical Encyclopedia: A Sagely Benefaction of the Zhenghe [Reign-period]).

Downloaded from Brill.com09/24/2021 10:22:25AM via free access 78 EASTM 18 (2001) were compiled during the Northern Song dynasty, and one is a Japanese contem­ porary to the Northern Song dynasty. Despite the dates of compilation, the con­ tents of the first three books ( one dating to the Tang dynasty and two dating to the early Song dynasty) represent the state of the acu-moxa therapy during the Tang dynasty.lo The latter two books represent its state during the Northern Song dynasty. Using these six texts, I will attempt to show how acu-moxa therapy trans­ formed from a mere clinical technique, similar in approach and application to the eclectic drug therapy during the Tang dynasty, to the end stage of the process of classical diagnosis and differentiation during the Northern Song dynasty. In other words, the analysis of the changes in the contents of the six texts suggests a shift in focus towards the integration of classical medical doctrines underlying the acu­ points' application and towards the role of the circulation tracts. This paper is composed of two parts. In the first part, I provide a short de­ scription of the contents of the six extant acu-moxa texts under consideration. I concentrate mainly on the organization of the material and the information the authors provided regarding the acu-points and the circulation tracts. In the second part, I compare the contents of the texts. Accordingly, I suggest certain conclu­ sions regarding how the practice and theory of acu-moxa therapy changed during the late Tang and the Song eras.

It should be noted that the third book, the Imperial Grace Formulary of the Taiping [Reign-period], includes two distinct acu-moxa texts in two separate chapters - the Nee­ dling Canon (Zhen jing ~ ~ ), chapter 99, and the Hall of Enlightened Rule (Ming tang l:l}J ~ ), chapter I 00. 10 To reach this conclusion I rely on several scholars who performed textual and con­ textual analysis of the texts. Each analyzed the language and the use of characters to conclude which era they represent and sometimes even suggesting a probable compilation date of the text. See Gao Wenzhu et. al. 1996: 663-672 and 678; Huang Longxiang 1996: 216-219 and 224-225; Lin Shucai and Feng Hechang 1996: 18-19; and Feng Hechang 1997.

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Part I: Description of the Acu-moxa Texts

Arcane Essentials from the Imperial Library

The Arcane Essentials from the Imperial Library (Waitai biyao j} if fk'i ~. in short, Arcane Essentials) was compiled by Tao I 1f/J: (670-755) in 752. This Tang dynasty work consists of forty chapters (Juan fl;), of which chapter thirty-nine, titled "Moxibustion Methods of the Hall of Enlightened Rule" (Ming­ tang jiufa B)3 ¥: ~ r.t), is devoted to acu-moxa therapy. This chapter consists of two parts, an introduction and a main body describing the acu-points. Unlike some other surviving acu-moxa texts of the early Tang dynasty, this one dis­ cusses each acu-point and does not simply list them in formulas prescribed for various disorders. The introduction begins with a preface discussing the origin of acu-moxa therapy and provides some basic dimensions of the body. In the preface, the author includes a stern and intriguing warning, "The Canon said: Acupuncture can kill living people, but cannot revive those who are dying. If one desires to record this [technique], I am afraid he will harm life. [Therefore] in this present compilation, I do not record [both techniques presented by] the Needling Canon (Zhen jing H ~:fil: ), I only record moxibustion." 11 This warning may suggest the existence of a certain clinical reality of the late Tang dynasty. Wang's warning suggests that during his era needling was considered, at least by some physicians, as undesirable, possibly due to ambiguity regarding the exact location of the acu­ points. Thus, it could have been that practitioners shunned needling patients due to the possible risks of internal injuries resulting from inserting needles into in­ correct loci. The rest of the introduction to the text briefly discusses the pathology of common disorders treatable with moxibustion, some general contraindications to acu-moxa therapy, and some divinatory aspects of this type of treatment. The introduction does not provide any information regarding the circulation tracts nor regarding their functions or relation to pathologies. The main body of the chapter lists 665 acu-points which are arranged accord­ ing to the twelve regular circulation tracts. By doing so the author, Wang Tao, deviates from an earlier order of presentation put forth by the 'A-B' Canon of the (Huangdi jia yi jing N %' 4J Z, ti, third century AD), which associated the acu-points with fourteen tracts - twelve regular and the two ex­ traordinary.12 Wang embedded the acu-points of the two extraordinary tracts

11 Waitai biyao: 1077. The first sentence of the quotation is drawn from the Lingshu ~ Wi l;i;J /i_fil !i m60: 173. 12 There are actually eight extraordinary tracts but only two have independent acu­ points. The other six traverse along a course that passes through acu-points, which are

Downloaded from Brill.com09/24/2021 10:22:25AM via free access 80 EASTM 18 (2001) within the list of the regular tracts of the 'leg immature yin tract' (zu shaoyin JE 1J; ~. or the kidney tract) and the 'leg mature yang tract' (zu taiyang JE -A ~. or the urinary bladder tract). The fact that the acu-points of the extraordinary tracts are listed under two of the twelve regular tracts may indicate that the usage of the extraordinary tracts, originating from the Yellow Emperor's Inner Canon: Basic Questions (Huangdi neijing suwen N "'ii pg f~ * Foi, first century BC) and from the Canon of Eighty-one Problems of the Yellow Emperor (Huangdi bashiyi w %' )\ + - ft ~, first century AD, in short, Canon of Problems), had fallen out of use and was not known to the author. For each circulation tract, the author provides a sketchy description of its course along the body based on a group of selected acu-points.13 After introduc­ ing a circulation tract, though almost without any anatomical information regard­ ing its course, the author describes the acu-points located on its course. For each acu-point he details its location and its effects or the main symptoms it treats. The author concentrates on the symptoms treatable by the acu-points but does not include the doctrinal explanations underlying the functions and effects of the acu-points as they appeared in the medical canons of the . The text does not include any organizational means, a fact that may indicate that the au­ thor compiled the text aiming to an audience of practitioners familiar with the topic.

Prescriptions at the Heart of Medicine

The Prescriptions at the Heart of Medicine (Yixin fang U ,C,, 15) is a formulary compiled by a Japanese scholar, Tamba Yasuyori :H ~ /lJt ti, between the years 982-984. The work of thirty chapters was based entirely on imported Chinese medical books, all of which date to the Sui and Tang dynasties.14 Therefore, this formulary reflects the state of acu-moxa during the Tang dynasty. The author of the book devoted one chapter, chapter two, to acu-moxa therapy. This chapter consists of two parts: The first lists the acu-points, while the second quotes an­ cient sources on various topics relating to acu-moxa therapy. The first part of the chapter opens with a short introductory paragraph stress­ ing the importance of the Yellow Emperor's Canon of Hall of Enlightened Rule (Huangdi mingtang Jing w ~ 8)3 :i: *l).15 Following the introduction, the au- primarily associated with the twelve regular tracts. For further discussion about the ex­ traordinary tracts, see Sivin 1987: 249-250; Porkert 1974: 213-214; and Lu and Needham 1980: 48-52. 13 A sample translation of one tract is provided in the Appendix. 14 MaJixing 1990: 207. 15 This book, which did not survive to the present, is recorded under several titles in various sources (Hunagdi neijing mingtang ' % P'.] /tfil tljj ¥'., Ming tang tljj ¥'., Ming-

Downloaded from Brill.com09/24/2021 10:22:25AM via free access Asa/Goldschmidt: Changing Standards 81 thor presents a total of 660 acu-points, of which 649 he claims to quote from the Hall of Enlightened Rule and eleven from other sources. The loci are arranged according to regions of the body, such as the head, chest, arms, etc., not accord­ ing to the circulation tracts. Each description of an acu-point provides informa­ tion regarding its location, instructions on needling, moxibustion techniques, and the symptoms treatable by stimulating each acu-point. The text does not include any discussion of the circulation tracts, their importance, or the relationship be­ tween the acu-points and the tracts. The second part of the chapter consists of a selection of quotations originating from various Tang dynasty acu-moxa books. These excerpts, which are grouped under sub topics, discuss issues relating to acu-moxa such as the total number of acu-points, the number of vertebrae in the body, and various contraindications. The text concentrates on the acu-points and the symptoms they treat while ignoring the circulation tracts. Moxibustion is, once again, the preferred method of treatment, although needling techniques are also mentioned. Moxibustion is also mentioned in other chapters of the book as the preferred treatment technique for various disorders. 16 Unlike the Arcane Essentials, this text includes excerpts from many sources, some of which discuss classical doctrines. However, the discussion is not systematic and cannot help a novice understand the doctrinal basis of acu-moxa or how to apply these doctrines in clinical practice.

Imperial Grace Formulary of the Taiping [Reign-period]

One of the most important and comprehensive medical works of the early Song dynasty was the Imperial Grace Formulary of the Taiping [Reign-period] (Tai­ ping shenghui fang -ft,.:, -if ~ !( 1J, in short, Imperial Grace Formulary), com­ pleted in the year 992 by a group of scholars headed by Wang Huaiyin I 't~ ~i. Wang, a medical official from the and the Chief Steward of the Palace Medical Service (shangyao fengyu rc5 ~ :$ fij), headed a group of four scholars appointed to collect medicinal formulas and compile this enormous work.17 The Imperial Grace Formulary consists of one hundred chapters and includes 16,834 different formulas. Two of its chapters that are devoted to acu­ moxa therapy - the Needling Canon and the Hall of Enlightened Rule - are dis­ cussed below according to their respective titles. tang jing l!jj '.M: ~1 ). I follow Ma Jixing who refers to these sources as records of one text and classifies them under one name, the Yellow Emperor's Canon of the Hall of Enlight­ ened Rule or the Huangdi ming tang jing. For additional information, see Ma Jixing 1990: 295-299, and Sivin 1993. Okanishi (1969: 238-239) refers to this canon using a slightly different title - Huangdi neijing ming tang leicheng Jr ~; I};] ~ l!jj ~ ~ fJ)i:. 16 Gao Wenzhu 1996: 771. 17 Emperor Taizong appointed Wang in 976 to the position of Chief Steward of the Palace Medical Service (Songshi, 461: 13507).

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The Needling Canon

The Needling Canon (Zhen jing it ~ ), chapter ninety-nine of the Imperial Grace Formulary, was the main acupuncture text in use during the first decades of the Song dynasty.IS Its preface does not specify the origin of the text. After criticizing their predecessors, the authors expound their compilation process:

In this instance we have gathered earlier classics and studied their perfect principles, in order to point out what our prede­ cessors have not made clear, attempting to reveal the subtle words of the ancient sages. Having reviewed the best [sources], we have written this work in one chapter.19

It seems that this chapter was an aggregate of excerpts from various Tang dynasty compilations. The most prominent influence on the authors of this text probably came from the famous Tang dynasty acupuncturist, Zhen Quan !ffi ti (540-643), who authored a book entitled the Excerpts from the Needling Canon (Zhen jing chao H ~ tJ>).20 The Needling Canon concentrates mainly on describing indi­ vidual acu-points while providing little information about the circulation tracts or the process of differentiating symptoms into disease patterns. The text consists of two parts - a brief introduction and the main body de­ scribing the acu-points. The introduction begins with a short preface discussing the state of acu-moxa therapy and the reasons for compiling the text. The preface includes a very brief description of the twelve regular circulation tracts without a mention of the extraordinary tracts. The tracts' courses are delineated according to a specific group of loci along each tract. The introduction ends with a few short quotations, some originating from the Inner Canon. The quotations provide a limited doctrinal background to the de­ scription of the loci that follows. Some clinical aspects are also covered by these quotations, such as the application of the nine-needle technique (jiu zhen ) Lit )21 or the different needling techniques suitable for each of the four sea-

18 See Huang Longxiang 1996: 224-225. 19 Taiping shenghuifang (1958 edition): 3169. 20 See Huang Longxiang 1996: 225. The Zhen jing chao text did not survive to the present. 21 This technique is based on the application of certain types of needles belonging to a category originally recorded in the Yellow Emperor's Inner Canon. The nine types of needles are: Sheer needle, round-point needle, spoon needle, lance needle, stiletto needle, round-sharp needle, filiform needle, long needle, and big needle. The shape and applica­ tion of each needle are discussed in detail in the Yellow Emperor's Inner Canon: Divine Pivot (Huangdi neijing lingshu 'iif f?j r-1 ~ e ~ ). This definition of the nine-needle technique is taken from Shi Xuemin and Zhang Mengchen 1998: 221-222.

Downloaded from Brill.com09/24/2021 10:22:25AM via free access Asaf Goldschmidt: Changing Standards 83 sons. The last quotation delineates some basic treatment approaches such as replenishing and draining. The Needling Canon includes twelve drawings of the human body (four front­ view, four rear-view, and four side-view) depicting a total of 290 acu-points. An example of two such drawing, depicting front and rear views of the body, is pro­ vided in Figure 1. The acu-points' descriptions are arranged according to their order of appearance in the drawings rather than according to the circulation tracts or regions of the body. The description of each acu-point provides its location both by using crude anatomical details and the distance from adjacent loci. For each acu-point the authors list the circulation tract it belongs to and give a brief description of the symptoms it treats. Finally, the authors discuss techniques of applying either acupuncture or moxibustion to the specific locus indicating how deep the needle should be inserted, for what duration of time, and which manipu­ lation technique should be applied. If moxibustion was relevant for the treatment, the number of cones to be burned on the acu-point and their size is specified. The organization of the acu-points in the Needling Canon is not straightfor­ ward. When a reader is looking for information regarding the application of a specific locus, he has to guess where the description is located in the text since the loci are organized according to the twelve drawings. It is unclear why the authors chose to use the twelve drawings as an organizational tool since it is a crude and cumbersome method.

Hall of Enlightened Rule

The Hall of Enlightened Rule (Mingtang Bjj '.)i), chapter one hundred of the Imperial Grace Formulary, borrows its name from the lost Tang dynasty canon discussing acu-moxa therapy, the Yellow Emperor's Canon of the Hall of Enlightened Rule. The chapter consists of two parts, each apparently originating from a different source. The first part, which is organized in a fashion similar to the Needling Canon, discusses acu-points.22 The second part, which is much shorter, concentrates on pediatric acu-moxa. The text opens with a brief cosmological discussion about how the body's ter­ rain is analogous to the world we live in. Next, the authors briefly present some measurements of the body. In order to do so, he defines the inch (cun --;j- ), the basic length unit used to locate acu-points on the body. The introduction ends in

22 The Chinese used a basic unit for measurement of the body, the cun or inch. They realized, however, that using a standard length for the cun - in a similar way to the mod­ em measurements of centimeter or inch - would prove futile when measuring acu-points on the body due to differences of body sizes among people. Therefore, they instituted a relative cun defined as the distance between the upper end of the distal and middle inter­ phalangeal folds formed by flexing the patient's middle finger. For further discussion, see Lu and Needham 1980: 122-125.

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Figure 1. Drawings from the Needling Canon

,_ ;,.I! t-' ~4=1-' !.., 4=,.! ""~1.., ~(.... «-· ~(..,

<.,

. --='--- ...... , ......

SOURCE: Taiping shenghui fang ( 1958 edition): 3186, 3194. NOTE: These drawings are virtually identical to the ones in a more recent reprint of the Imperial Grace Formulary (1980 edition), vol. 16: 9958, 9978. a discussion of various techniques of moxibustion and miscellaneous contraindi­ cations when needling a specific acu-point. The main body of the first part lists 302 acu-points accompanied by thirty-six drawings. Unlike the Needling Canon, the acu-points here are not organized according to the drawing and are listed without any apparent order. Similar to the Needling Canon, the drawings depict only acu-points but not the circulation tracts. The recommended therapeutic technique here is moxibustion, differing from the equal stress on both needling and moxibustion in the Needling Canon. It is interesting to note that there is a bias toward the application of moxibustion over acupuncture in three of the four texts dating to the Tang dynasty, as dis­ cussed above. The second part of the text concentrates on the application of moxibustion to children. For this purpose, the authors provide nine additional drawings depicting

Downloaded from Brill.com09/24/2021 10:22:25AM via free access Asaf Goldschmidt: Changing Standards 85 the location of relevant acu-points on a child's figure. This part of the text is organized according to a set of forty-seven syndromes. For each syndrome the authors recommend one or more moxibustion loci. To sum up, the two acu-moxa texts included in the Imperial Grace Formu­ lary, the Needling Canon and the Hall of Enlightened Rule, concentrate on acu­ points and devote little attention to underlying medical doctrines. The authors ignore almost completely the circulation tracts as a basis for diagnosis and treat­ ment. Furthermore, they do not discuss the classical manifestation types and limit themselves to providing information about relief of symptoms. Although both texts include drawings depicting the acu-points, these drawings provide limited help to the reader in retrieving information about acu-points.

Illustrated Canon of Acu-moxa Therapy [Depicting] the Acu-points of the Bronze Figure

In 1023, emperor Renzong ordered I. 1t - (c. 987-1067), the Chief Steward of the Palace Medical Service, to compile a systematic work on acu-moxa therapy in order to replace the lost Tang works and to serve as a stan­ dard manual for locating acu-points.23 The book was titled the Yellow Emperor's Canon of the Hall of Enlightened Rule. The project lasted almost four years concluding with the publication of the Illustrated Canon of Acu-moxa Therapy [Depicting] the A cu-points of the Bronze Figure (Tongren shuxue zhenjiu tujing ~ A ~f,J ;\ it ~ Ill ~1., in short, Illustrated Canon of Acu-moxa) in the year l026.24 One year later, Wang supervised the casting of two identical human life-

23 For reference regarding the edict see Junzhai dushu zhi 38: 298; Xu zizhi tongjian changbian 105: 17b. Some historical records disagree about the full name of Wang. In some records it appears as Wang Weiyi and in other as Wang Weide .:E 1i f# (see Huang Longxiang 1996: 216-217). I use the former following the convention used in most his­ torical works. The specific dates of Wang's life are also not clear. It is unknown where he is from and his dates of birth and death are approximations. The dates provided above are suggested by various secondary sources such as Fu Weikang et al. 199 I: I 33 and Li Jingwei et al. 1995: 163. In contrast, Li Yun (1988: 68) offers other dates, namely 981- 1067. 24 The edition of the Illustrated Canon of Acu-moxa I use is the one appearing in Huang Longxiang 1996. This version reflects, according to the convincing exposition by the compiler, an authentic reconstruction of the original. Huang reconstructed this version according to parts of the text that survived on the stone steles (as discussed in the footnote below) and according to sections that were copied to other texts during the Northern Song, especially the Medical Encyclopedia: A Sagely Benefaction of the Zheng he [Reign­ period]. Huang's newly reconstructed version differs from the more widely available Illustrated Canon of Acu-moxa Therapy [Depicting] the Acu-points of the Bronze Figure,

Downloaded from Brill.com09/24/2021 10:22:25AM via free access 86 EASTM I 8 (200 I) size bronze models mapping both the acu-points and the circulation tracts dis­ cussed in the book.25 Wang's book was regarded so highly that in the year 1029 the emperor ordered that it be carved on stone tablets in an attempt to immortal­ ize its contents.26 The bronze model served as the standard for the location of acu-points on the body and for the courses of the circulation tracts. By depicting both the loci and the tracts, Wang Weiyi emphasized the connection between them. The model's exact measurements, aside from the statement 'life-size,' are not specified in the records. A similar Ming dynasty model, though not as elaborate as the Song one, is recorded to be approximately 1.6 meter (four chi R.) tall (see Figure 2).27 According to surviving records, the Song model was made of a few detachable pieces. Inside were representations of internal viscera and on the outer shell the channels were carved with all the corresponding acu-points.28 The metal walls were pierced with small holes corresponding to the acu-points listed in the Illus­ trated Canon ofAcu-moxa. The model, apparently, was the basis for a new hands-on method of examin­ ing medical students.29 During the exam, students were asked to assess cases of patients presented by the examiners and, accordingly, to perform the acupuncture on the bronze model needling the acu-points that should treat the disease condi­ tion they diagnosed. The model may also have contributed to the standardization of the locations of acu-points in an additional way, as can be inferred from Zhou Mi's ml W testimony:

Newly Published with Added Comments (Xinkan buzhu tongren shuxue zhenjiu tujing Ir j'fj ;J

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Figure 2. Bronze model dating to the fifteenth century

SOURCE: The figure is taken from Lu and Needham 1980: 130. NOTE: This bronze life-size human model dates to the Ming dynasty, more specifically, to the fifteenth century. Acu-points indicated by small holes and marked with their name are engraved on the model. The original one cast by Wang Weiyi did not survive.

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Once I heard my maternal uncle, Zhang Shugong ~ ,J& ~ , say that formerly, when he was a Sub-Prefect in Xiangzhou, he got hold of a bronze figure for testing [skill at] acu-moxa therapy. The figure was made of fine bronze, and the viscera were complete. The names of the acu-points were inlaid in gold beside each locus. The figure was made in two halves, front and back, which could be fitted together to make a whole body. It seems that in old times this was used to examine medical practitioners, the body was covered with yellow wax and the inside filled up with mercury,31 so that they could learn how to find the location by measure and try inserting the needle at the [correct] locus. When a needle was put in exactly at the acu-point, the mercury poured out. If there was even a slight mistake, the needle could not penetrate. This was indeed an ingenious instrument. Afterwards Zhao Nanzhong Mi jfj t:j.J returned the figure to the Palace. My uncle, Zhang Shugong, made two diagrams, and had them carved on wood blocks so that they might be reproduced by printing. Therefore I mention the matter here.32

The last paragraph in Zhou's story is important if we assume that the testimony is credible. From the above we can infer that one of the bronze models traveled to localities and was used to make master copies for reproduction, similar to Zhou's uncle making the wood blocks depicting the locations of the acu-points for fur­ ther reproduction. If indeed this was a prevalent practice in localities, as the quo­ tation suggests, it can be considered as an early system for standardizing the locations of the acu-points and promulgating these standards throughout the em­ pire. The Illustrated Canon of Acu-moxa was the first Song dynasty medical work fully devoted to acu-moxa therapy. The book originally consisted of three chap­ ters each beginning with a quotation from the Inner Canon. The first chapter opens with a quotation from the Inner Canon describing the body's circulation tracts. Following the quotation, the author provides three drawings of the human body, in a front, back, and side view, depicting the circulation tracts as well as

30 For references regarding the usage of a bronze model in examinations, see Yuhai 63: 33; Xu zizhi tongjian changbian 105: 17; Junzhai dushu zhi 38: 298-299; and the preface to the Illustrated Canon of Acu-moxa. 31 Lu and Needham ( 1980: 133) claim that water, not mercury, was used. They point out that although the text has the character gong ff<, mercury, "that would surely have been impossible as an amalgam would have formed, and weakened the walls." 32 The quotation is taken from Qidong yeyu (Rustic Talks in Eastern , compiled in 1290) 14: 175. A translation appears in Lu and Needham 1980: 131. I changed the names into romanization for consistency.

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some crude anatomical details of the skeleton and internal viscera. This was the first time that a medical compilation included such descriptive drawings of the body. In earlier works, drawings attached to acu-moxa texts depicted only the acu-points by ignoring the circulation tracts and anatomical details.33 The main body of the first chapter of the Illustrated Canon of Acu-moxa concentrates on the twelve regular circulation tracts. First, the courses of the tracts and their major branches are described. Then, the discussion is supple­ mented by details on the functions of the viscera and the direction of flow of qi ~ and xue Ifll. (blood) in each tract. The author also lists treatable disorders and symptoms associated with each tract.34 Lastly, the acu-points located on each tract are presented, including their location. The first tract, the 'hand mature yin' (shou taiyin + --A ~ or the lung tract), includes additional information such as the basic treatment strategies. Following the twelve regular tracts, the text de­ scribes two extraordinary tracts, which include independent points, the 'concep­ tion tract' (ren mai {:I DJ.lO and the 'superintendent tract' (du mai g DJ[). The second chapter also opens with a quotation from the Yellow Emperor's Inner Canon discussing the times of year when acu-moxa therapy should be ap­ plied and when to avoid it based on the doctrines of yinyang and Five Phases. The text includes a circular diagram that depicts acu-points and times of the year listed in four concentric layers. This diagram is designed to assist the practitioner in deciding which acu-points to avoid needling based on the season, the month, and the day of treatment. The main body of the second chapter describes acu-points located on the head and the trunk. The loci are grouped according to specific bodily regions rather than according to the tracts. A list of acu-points precedes each group of loci fa­ cilitating quick reference for specific locus. The description of each acu-point was copied almost verbatim from the 'A-B' Canon of the Yellow Emperor but differs in the symptoms each locus treats. The third chapter, similar to the previous two, opens with a quotation from the Yellow Emperor's Inner Canon discussing the twelve circulation tracts, fol­ lowed by a table presenting the most potent acu-points or the five transport (shu !Jii~) points, which are listed according to the order of the Five Phases.JS The main body of this chapter describes the acu-points on the limbs. The author groups the

33 It is unclear why Wang Weiyi included such details in his drawings of the body. It is clear, though, that these drawing are connected to the bronze model since they include representation of the visceral organs. We do not find any drawing depicting acu-points since these became obsolete once the bronze model was cast. 34 This description of the tracts is identical to the one appearing in the Yellow Em­ peror's Inner Canon: Divine Pivot and the 'A-B' Canon of the Yellow Emperor, and was probably copied from these earlier texts. 35 These are points located below the knee or elbow, designated according to their position on the limb. For further discussion see O'Connor and Bensky 1984: 126.

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Figure 3. Drawings from the Illustrated Canon of Acu-moxa

~- ·f- ,,, -f- * f· iJ ;t: 1,,- -f- i•l• :.V ii: R:l ~ ;,j, J.l 1C ~ ,,, -·-'\ *~R 1c IIJl ~ -= ~Hi ~ Rifi ~ .C.· f AA\ 1' (!! .,. ~ 'f t2 tP~ ·~· 115 -x:~ f I iii IIJr!!iu.g /ff ;g It! .g ,'\ .~ 1C .f ,"( f- 1( 'f l' tj,- f- i•ft ,y i'( ilfj ~ ,(: ' ~ 1/,t'f -ia }j!it!l ii: f If, :l. illi.li iii1/\ PR rii 1,,- ~J'l i\ ~Jj 'f~ ~ 'l!f :ii.: !Ii 'f t.i tft 4!l ~11 ta !(J if, i( 'f /, r

SOURCE: Tongren shuxue zhenjiu tujing: 171.

acu-points according to their order of appearance on the twelve regular circula­ tion tracts. Here, as in the former chapter, a list of the acu-points precedes each tract to facilitate quick search. The Jllustrated Canon of Acu-moxa signals a turning point in acu-moxa dis­ cussion. It is the first government sponsored acu-moxa text; thus, its contents and organization differs from its predecessors. The author of the text discusses exten­ sively, over a whole chapter, the topic of the viscera, the circulation tracts and their connection with medical disorders. Another innovative feature is the inclu­ sion of unique drawings of the body depicting crude anatomical details. The text also includes indices and tables of contents to facilitate access to the various acu­ points and the information attached to them. Finally, the text was compiled as part of a larger project that included the casting of the bronze model. The text and the model provided a unique set of both educational instruments and means to standardize the location of the acu-points and the courses of the circulation tracts on the body.

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Being an imperial medical official and officially appointed to compile the text and cast the bronze model, it seems that Wang Weiyi designed his projects to meet wider goals than simply making an up-to-date record of acu-moxa knowl­ edge. The organization of the information in the text, especially the abundance of indices, suggests that it may have been designed as some sort of educational text intended for the use of both practitioners and novices. Additionally, it seems that both the text and the model were designed to establish a standard regarding the location of the acu-points and the tracts. Lastly, discussing classical doctrines, such as the viscera and the circulation tracts, may indicate a change in medical environment. Wang Weiyi, in addition to compiling the Illustrated Canon of Acu-moxa, also revised, edited, and brought to printing official versions of two canons - the Yellow Emperor's Inner Canon and the Canon of Eighty-one Prob­ lems of the Yellow Emperor. The publication of these canons made classical doctrines more readily available to a wider audience for the first time in centu­ ries. It is only natural that he included doctrines derived from these texts in his acu-moxa manual.

Medical Encyclopedia: A Sagely Benefaction of the Zhenghe [Reign-period]

The Medical Encyclopedia: A Sagely Benefaction of the Zheng he [Reign-period] (Zhenghe shengji zonglu i& fD ~ iff *-~ n_, in short, Medical Encyclopedia) was compiled during the latter years of the Northern Song dynasty. This was the most voluminous medical compilation up to that time. It includes two hundred chapters and over twenty thousand formulas. The authors of this formulary devoted four chapters to acu-moxa therapy, chapters 191 to 194. Chapter 191 begins with a short introduction, which includes a discussion about anatomy. The authors claim that without knowing basic gross anatomy, one cannot accurately locate the acu-points when attempting to apply acupuncture:

All those who use acupuncture should first clearly understand the bones and the joints. Once their knowledge of this topic is definite, they can determine the location of the jing ff:<] and Luo *3 circulation tracts.36 [When applying acu-moxa, they need to] determine the [location of a specific] acu-point by by means of the standard inch of the [patient's] body (shen cun J;j- -f),37

36 The combination of the two characters, jingluo, is the general Chinese term for the system of circulation tracts. Jing denotes the main lines of flow of qi and blood in the body, or cardinal tracts. Luo denotes the branch lines which are called reticular tracts. See Sivin 1987: 213, 249-250. 37 Zhenghe shengji zonglu 19 l: 3123.

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The text lists a total of 365 bones38 in the body providing spatial measurements for each one. The authors also provide additional details such as whether the bone is "with" or "without" marrow (sui ~). Following the introduction to the text, the authors describe the circulation tracts and their acu-points. Unlike the Illustrated Canon of Acu-moxa, which lists the acu-points according to both body regions and circulation tracts, the Medical Encyclopedia lists the acu-points exclusively according to the fourteen circula­ tion tracts. For each tract, the authors provide extensive introductory discussion, which delineates its course, the courses of its branches, and common symptoms as well as specific manifestation types associated with it. The last category is of special interest, since prior to this work, the Tang dynasty acu-moxa texts did not associate circulation tracts with either symptoms or manifestation types. Preced­ ing the description of each tract, the authors of the Medical Encyclopedia adjoin a list of its acu-points, serving as an index. The descriptions of the acu-points are copied verbatim from the earlier Song work, the Illustrated Canon of Acu-moxa. Chapter 192 begins with a discussion of the eight extraordinary tracts. In the latter half of the chapter the authors discuss the differentiation and treatment of various pathologies. Prior to this text, Tang acu-moxa compilations did not con­ centrate on the differentiation of disorders and their treatments; they only listed the acu-points and the symptoms they treat. In other words, the authors of the Song acu-moxa works, unlike their Tang dynasty counterparts, equally devoted space to the medical doctrines underlying the therapeutic techniques and to the symptoms they treat. The latter part of chapter 192 and all of chapters 193 and 194 provide broad categories of pathologies, breaking them into various manifestation types accord­ ing to symptoms. For each manifestation type, the text lists several acu-points recommended for use in treatment. The preferred technique in most cases is still moxibustion rather than needling. The discussion here also includes mention of several techniques of needle manipulation and contraindications to acu-moxa therapy. By including both acu-point descriptions and information about the treatment of pathologies and manifestation types, the Medical Encyclopedia provided the reader a much more versatile acu-moxa manual than previously available during the Tang dynasty. All the information the reader needs regarding determining the manifestation type and treatment is included in the four chapters discussing acu­ moxa therapy in the Medical Encyclopedia.

38 This number coincides with the days of the year and probably has to do with the author's general inclination to deal with the wuyun liuqi doctrine.

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Part II: Comparison of the Contents of the Texts

Each of the six acu-moxa texts outlined above has its unique features; however, when we compare their contents we find some common patterns that enable us to reach certain conclusions. When we take into account the eras which the texts represent, the findings of the comparison become striking. The latter two texts, which represent the state of acu-moxa during the Song dynasty, have a few com­ mon features that differ from those in the former four texts, which represent the Tang dynasty.39 Below I will delineate the most important differences between the two sets of texts. I will also attempt to show that these differences reflect changes in medicine between these eras. An overview of the comparison is pro­ vided in Table 1. Broadly speaking, we can group the changes under three main categories: (I) Changes in the organization of the acu-points and the rising prominence of the circulation tracts and classical doctrines, (2) inclusion of technical aids to facilitate reader accessibility to the contents and to enhance clinicai use, and (3) additional issues. It seems that these changes are a result of two separate processes that influenced medicine during the Song. One is the revision and re­ printing of ancient medical canons that in turn facilitated the revival of classical doctrines and their integration with clinical practices.40 The second is the broadening of the intended readership of medical books from practitioners to a more general and sometimes lay audience.

39 The four texts representing the Tang dynasty are: the Arcane Essentials, the Pre­ scriptions at the Heart of Medicine, and the two chapters of Imperial Grace Formulary - the Needling Canon and the Hall of Enlightened Rule. The Illustrated Canon of Acu­ moxa and the Medical Encyclopedia represent that of the Northern Song dynasty. 40 For further discussion of the topic, see Goldschmidt 1999, chap. 4.

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Changes in the Organization of the Acu-points

The core of almost any acu-moxa text, and the part most important to both the author and the reader, was, and still is, the section introducing and discussing the acu-points. Traditionally, the location of each locus and the effects of stimulating it, either by needle or heat, were essentially the reason that motivated physicians to compile acu-moxa manuals and readers to consult them. Accordingly, when we observe a change in the contents of these works, such as the order in which the authors discuss the acu-points, it may reflect certain transformations in the field. In the four Tang texts we find an eclectic organization of acu-points ac­ cording to either the twelve circulation tracts, regions of the body, or drawings of the body. This eclectic organization reflects, probably, the order in which the author had learned and memorized the acu-points in the process of learning from his master. It seems that this eclectic organization of the acu-points represents a predominantly clinical perception of acu-moxa, transmitted along various master­ disciple lines. The authors of the two Song texts organized the acu-points predominantly ac­ cording to the circulation tracts. This organization enabled uninitiated readers to easily retrieve information. It seems that these texts were designed to be used by a wider audience that probably included officials and medical students and was not limited to initiated practitioners. Due to the publication and promulgation of revised editions of medical classics by the government, the authors of the Song acu-moxa texts could have assumed that their audience was familiar to a larger extent with the concepts of circulation tracts and the classical doctrines. It is important to note that from the Song dynasty on the organization of acu-points according to the circulation tracts became the preferred convention.

Changes in the Extent of Discussion Regarding Circulation Tracts

The circulation tracts are important to the discussion here since they represent a wider change in acu-moxa therapy as well as in Song medicine, namely the re­ newed interest in classical medical doctrines. Indeed, a comparison of the six acu-moxa texts shows a marked change. In the four Tang texts, we see that the authors concentrated on the acu-points and on the symptoms they treat. The cir­ culation tracts are mentioned only briefly. The authors did not discuss patholo­ gies related to the tracts, the tracts' courses, and the courses of their various branches along the body. In other words, it seems that the authors of the four Tang texts regard acu-points and drug formulas as parallel clinical measures - both focusing on alleviating symptoms and often disregarding the causes and the pathology of the disorder. In the two Song texts, the authors emphasized the importance of the circula­ tion tracts by organizing the acu-points according to the tracts and by re­ introducing the role of the circulating tracts as the doctrinal basis for acu-moxa

Downloaded from Brill.com09/24/2021 10:22:25AM via free access Asa/Goldschmidt: Changing Standards 97 treatment. In addition, they discussed symptoms and pathologies related to each circulation tract. In order to demonstrate the change in the role of the circulation tracts in the six acu-moxa texts, I provide in the Appendix the descriptions of one tract, the 'hand immature yin' tract (shou shaoyin + 1J; ~. or the heart tract), as it appears in each text.41 These descriptions provide evidence to the increased emphasis on the circulation tracts.

Technical Aids

The two Song texts include innovative structural features that did not appear in the Tang texts. It seems that this development resulted from a change in the in­ tended audience of the texts. This change may also suggest an emergence of a new genre of acu-moxa literature, namely texts for general audience and text­ books. The authors of the Song texts incorporated various technical aids not included in the Tang texts - predominantly lists of acu-points serving as tables of contents or indices and the life-size bronze figure. These technical aids were intended to facilitate the readers' accessibility to the acu-points discussed in the book. The addition of such technical aids suggests that the authors of the texts either at­ tempted to expand their audience beyond experts and practitioners or had to comply with government requirements to produce textbooks for the growing medical education system.42 Consequently, the authors organized the contents of the texts in such a way that even someone with only a limited command of medi­ cal knowledge would be able to use them. Drawings of the human body depicting acu-points already appear in the Impe­ rial Grace Formulary. Nonetheless, these drawings are merely rough sketches of the body inaccurately depicting the location of acu-points. Although the authors listed the acu-points according to their order of appearance in the drawings, lo­ cating a specific desired locus was cumbersome. The three drawings included in the Illustrated Canon of Acu-moxa are highly innovative and were not repro­ duced in later compilations.43 These drawings depict human figures with crude

41 I provide only four translated descriptions since the Prescriptions at the Heart of Medicine and the Hall of Enlightened Rule do not include such description. 42 For more details on the establishment and expansion of the medical education sys­ tem, see Zhang Ruixian 1989, 1990, 1993, and Zhang Ruixian and Yuan Xiurong 1993. 43 The drawings of the original text, which were preserved on the stone tablets, were not reproduced in a later editions of the Illustrated Canon of Acu-moxa dating to the twelfth century and bearing the same or similar title (see 1987 reprint under the same title and a 1980 reprint of the revised edition of the book titled Xinkan buzhu tongren shuxue zhenjiu tujing iji J'lj fr if I: ffl A ff~ ;\. H ~ Iii ~ (Illustrated Canon of Acu-moxa

Downloaded from Brill.com09/24/2021 10:22:25AM via free access 98 EASTM 18 (2001) representation of some internal organs as well as some skeletal bones (see Figure 3 ). The drawings depict the courses of the circulation tracts but they do not depict any acu-point. It seems that the authors designed the drawings to complement the bronze figure as a teaching tool. The Medical Encyclopedia does not include any drawings. As mentioned above, the Song texts include an innovative tool for organizing the acu-points, namely lists of acu-points either at the head of each section or at the end of the book. The Jllustrated Canon of Acu-moxa includes two levels of such lists. One appears ahead of every group of acu-points. When the text was carved onto stone tablets in 1029, the carvers added two chapters, one of which consisted of a list of all the acu-points discussed in the book according to their order of appearance. This is an early form of what we would term a table of con­ tents or an index for the whole compilation. The second Song text, the Medical Encyclopedia, included only one type of organizing list. At the beginning of the discussion of each of the fourteen tracts the authors provide a list of the acu­ points associated with the tract. A general index was redundant since the authors organized the acu-points uniformly according to the circulation tracts and not in a dual system as was the case in the Jllustrated Canon of Acu-moxa.

Standardization

Governments often implement standardizing measures to enhance communication and interaction between different regions of a large empire. In medicine the need for standards is much more significant, since lives are at stake. During the Song dynasty, similar to earlier eras when the Chinese empire was re-unified, the gov­ ernment imposed new as well as old standards.44 The Song government even attempted to impose some standardization on medical practice. Such was the case when following a statewide survey of available medicinal materials a standard was imposed on the drugs sold at the Imperial Pharmacy.45 Another form of standardization was imposed on the field of acu-moxa. When historians discuss standardization in acu-moxa therapy, they usually concentrate on the casting of the life-size bronze human model and the publication of the lllustrated Canon of Acu-moxa.46 However, the standardization was more comprehensive as is evident from the comparison of the content of the acu-moxa texts. The casting of the life-size bronze model set a universal standard for the loca­ tion of acu-points and the courses of the circulation tracts on the body. This was

Therapy [Depicting] the Acu-points of the Bronze Figure, Newly Published with Added Comments). 44 Wu Chengluo 1937: 169-175. 45 See Ma Jixing 1993: 8-9; Zhen Tuixi, Chen Zifu, and Li Libin 1986; and Wei Jia 1982. 46 For such discussion see Huang Longxiang 1996: 223.

Downloaded from Brill.com09/24/2021 10:22:25AM via free access Asaf Goldschmidt: Changing Standards 99 not the first time a life-size human model depicting acu-points was cast, but it was by far the most detailed and sophisticated one.47 As mentioned earlier, each acu-point was represented by a small hole through which a needle could have penetrated. This unique feature set apart this model from previous ones; it was used for examining medical students, thus enabling the government to enforce the standard location of the acu-points in an effective manner.48 Furthermore, ac­ cording to surviving records quoted earlier a second identical model was cast and circulated among the localities, enabling local officials to prepare maps locating the acu-points. Therefore, more and more practitioners, those who graduated the medical education system and local physicians using officially-prepared drawings depicting the location of the acu-points, knew the official standardized locations of the acu-points to be used in clinical practice. Analyzing the contents of the six texts reveals a few additional aspects of standardization. First, we find that during the Song dynasty the number of points per circulation tract was set. As mentioned earlier, the Tang texts did not stress the role of the circulation tracts. Consequently, the number of acu-points per tract varies among the texts. Starting with the Illustrated Canon of Acu-moxa, the courses of the tracts on the body were officially defined. Accordingly, the num­ ber of the acu-points associated with each tract was also determined. Second, the two Song texts set a standard for the number of circulation tracts. In the Tang texts we see variation in the number of tracts, and one of the texts even ignores them altogether. The Song texts not only set the number of tracts, they also pro­ vided a detailed description of the tracts' courses on the body.

The Penetration of Anatomy into Acu-moxa Therapy

One of the striking new features in the Song acu-moxa texts is the appearance of discussion concerning the anatomy of the human body. Prior to the Song, when discussing the body, the majority of the classical medical canons, including early acu-moxa texts, focused mainly on the functions of the internal organs largely ignoring their shape, size, or internal location.49 Early medical texts provided

47 See Lin Zhaogeng and Yan Liang 1995: 202-204. 48 For comprehensive discussion about the history of medical examinations, see Sivin 2000, chap. 4. 49 There are exceptions to this generalization. For example, both the Yellow Em­ peror's Inner Canon and the Canon of Problems offer some remarkably detailed numbers about the weight, size, and volume of certain visceral organs. See Huangdi neijing ling­ shu, chap. 31 and 32, and Huangdi baishiyi nanjing, chap. 42 and 43. Kuriyama (1995a: 224) and Unschuld (1986: 416-418, 425) provide a sample translation of these measure­ ments. Nevertheless, even when anatomical information was provided in Chinese texts it lacked the detailed and systematic character that we find in Greek and other traditional Western anatomical descriptions.

Downloaded from Brill.com09/24/2021 10:22:25AM via free access JOO EASTM 18 (2001) only limited information about gross anatomy or spatial measurements of the body and their relevance to acu-moxa therapy. The casting of the bronze model and the drawings included in the Jllustrated Canon of Acu-moxa signaled a change. Although Wang Weiyi's life-size human bronze model did not survive to the present, based on the available historical evidence it seems that it included de­ tailed representations of the internal organs that were placed inside it.SO The outer cover of the model was detachable thus enabling students to study the in­ ternal organs. The three extant drawings of the Jllustrated Canon of Acu-moxa, which were preserved on stone tablets, support the historical records about the structure and contents of the model. Two of the three drawings, the front and the back view, depict the internal organs. They also roughly indicate the bones of the limbs and the chest (see Figure 3). These drawings and the bronze model are unique in the history of Chinese medicine and were not reproduced in later dy­ nasties. The acu-moxa chapters of the Medical Encyclopedia also include an interest­ ing reference to anatomy. The authors of the text claim that students who desire to study acu-moxa must first study the location and size of the bones of the body before proceeding to learn acu-moxa therapy.SI The authors then list the bones in the body and provide some additional information about them. References to the skeleton existed in a few earlier works but none was as detailed, or claimed that this type of knowledge was essential to the practice of acu-moxa as was done in the Medical Encyclopedia. The increasing interest in anatomy was not limited to acu-moxa texts. Accord­ ing to extant bibliographical records, two separate Northern Song medical works included charts depicting internal organs, namely, Ou Xifan 's Charts of the Five 'Zang Organs (Ou Xifan wuzang tu ~ mie li /}j llJ, compiled in 1045) and Charts of Internal Organs and Tracts (Cun zhen huan zhong tu ff~ ffl cp Ill, compiled in 1113). Neither of these books has survived to the present.52 It is unclear why during the Song we find such interest in gross anatomy. It is plausible that the need to standardize acu-moxa therapy and to disseminate this knowledge led to an increasing interest in anatomical knowledge. Further re­ search may reveal a shift in focus, from a solely functional perception of the body to a more balanced conception drawing equally from the functions of the internal organs and from the physical form of the body.

50 See Qidong yeyu 14: 175 and the preface to the Illustrated Canon of Acu-moxa. For further discussion, see Ma Jixing 1993: 11-14, and Lin Zhaogeng and Yan Liang I 995: 204-206. 51 See p. 91 above. 52 For information on the two compilations, see Hervouet 1978: 258. For further dis­ cussion on the interest in anatomy and visceral organs in Chinese medicine including surviving charts and illustrations of the body, see Jin Shiying 1994 and Yan Xin 1992.

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Conclusions

The comparison of the six acu-moxa texts reveals some disparities between the Song and the Tang texts. These disparities can be placed at two different tiers - the organization of the texts and the characteristics of their contents. The first tier of change lies within the organization of the information. The Song texts are more systematically organized and they incorporate various methodological tools, such as indices and tables of contents to facilitate the readers' accessibility to the contents of the text. The second tier of change lies in the content of the discussion and the scope of the general doctrinal medical knowledge included in the texts. The authors of the Tang texts did not devote much attention to doctrinal issues such as circulation tracts or manifestation types. Instead, they concentrated on the clinical application of acu-moxa therapy. The Song texts devoted more space to these topics and provided an elaborate presentation of the classical doc­ trines. Furthermore, the Song texts also provided standardized locations for both the acu-points and the courses of the circulation tracts. The changes in the contents of the acu-moxa texts may reflect a transforma­ tion in the environment in which these texts were composed. The Tang texts do not follow any specific organizational format and their contents frequently vary according to the author's knowledge and education. This suggests that the Tang texts reflect the knowledge of specific practitioners or their lineage and presuma­ bly their target audience was limited. During the Northern Song dynasty, printing became widespread and the imperial government played an active role by spon­ soring the publication of medical texts. The government's role in publishing medical books was probably a result of the increasing importance of medical education. Consequently, government officials in charge of compiling acu-moxa texts, as well as individual authors, compiled their works to fit the changing medical knowledge, which by now included the newly revised and published ancient medical canons. To sum up, the changes in the contents of the acu-moxa texts suggest that these texts transformed from being practitioners' manuals to becoming more widely circulated medical texts covering a broader scope of medical knowledge. Accordingly, they stressed both medical doctrines and clinical application of the techniques.

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APPENDIX

Description of the Hand Immature Yin Tract- the Heart Tract- Translatedfrom the Analyzed Acu-moxa Texts

Arcane Essentials (p. 1 100)

The heart [tract] originates at Shaochong j; f;j [locus, HT9]; Shaochong is wood. From there it flows to the Shaofu 1_!;- !ff [locus, HT8]; Shaofu is fire. Then, it pours into the Shenmen :j:Ejl Fi [locus, HTI]; Shenmen is earth. Then it passes to the Tongli 3.m .lI! [locus, HTS]. From there it travels to the Lingdao ii ~ [locus, HT4]; Lingdao is metal. Then it enters Shaohai 'Y mi [locus, HT3]; Shaohai is water.

Prescriptions at the Heart of Medicine

[Does not include a description of the tracts.]

Needling Canon (Chapter 99 of the Imperial Grace Formulary, p. 3169)

The heart tract originates from the Shaochong, which is a well # [locus]. It is the hand immature yin (shaoyin 1_!;- ~) tract. [From the Shaochong locus] it flows to the Shaofu, which is a construct or spring (ying ~ = m) [locus]. Then it pours into the Shenmen, which is a transport (shu @J) [locus]. It then passes by the Tongli, a source (yuan /Jl'O [locus]. From there it travels to the Lingdao, a warp (Jing*~) [locus]. Finally it enters into the Shaohai, a union (he -g-) [locus].

Hall of Enlightened Rule (Chapter 100 of the Imperial Grace Formu­ lary)

[Does not include a description of the tracts.]

Illustrated Canon of Acu-moxa (p. 172)

The hand immature yin [i.e. the heart] tract originates in the heart. When it emerges, it follows the heart complex down to the diaphragm and connects to the small intestine. Its branch segment (zhi "St) follows the heart complex along both sides of the pharynx, and connects to the eye.

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Its [i.e. the heart's] direct segment (zhi @) also follows the heart complex, but goes up to the lung [system]. It [then] comes out under the axilla, and follows downwards along the inner back side of the upper arm (nao Im), passes behind [medially] to the Tai yin [i.e. the lung] and the heart master (xinzhu {,, I) [tracts]. arriving [down to] the inner sides of the elbow. [From there,] it follows the inner-back side of the lower arm, reaches the palm behind the end of the ulna [dui ~ = ffl], enters the palm on the inner side, follows the inner little finger and comes out at its end. If [the tract's qi] is disturbed, the disorders are dry throat (yi ~ ), heart pain, thirst with desire to drink. This is called forearm cold sensation disorder (bijue ~ ~). This [tract] is responsible for [treating] illness generated in the heart [system]. [Its symptoms include] yellowness in the eyes, pain in the lateral costal regions (xie ~ ), pain and cold feeling at the medial back side of the upper and lower arm, hot [feeling] in the palms of the hand.53

Medical Encyclopedia (p. 3143)

The hand Shaoyin heart tract originates in the heart. When it emerges it follows the heart complex down to the diaphragm and connects to the small intestine. Its branch segment (zhi 3t) follows the heart complex along both sides of the pharynx, and connects to the eye complex. Its [i.e. the heart's] direct segment (zhi [la) also follows the heart complex, but goes up to the lung [system]. It [then] comes out under the axilla, and follows downwards along the inner back side of the upper arm (nao Hi), passes behind [medially] to the Tai yin [i.e. the lung] and the heart master (xinzhu {,,I) [tracts]. arriving [down to] the inner [sides of the] elbow. [From there,] it follows the inner-back side of the lower arm, reaches the palm behind the end of the ulna [dui ~ = ffl ], enters the palm on the inner back side, follows the inner little fin­ ger and comes out at its end. If [the tract's qi] is disturbed, the disorders are dry throat (yi ~ ), heart pain,

53 This section is quoted with minor changes from the Huangdi neijing lingshu 10: 234. In a different edition of the Illustrated Canon of Acu-moxa (Beijing: Zhongguo shudian, I 987), another paragraph is added at the end of the discussion of the heart tract. This paragraph is translated below in the heart tract section from the Medical Encyclope­ dia. The I 987 reprint differs from the edition I use in this study in a number of respects. It is actually a reprint of the Xinkan buzhu tongren shuxue zhenjiu tujing $Jr flj fffi i_i ilnJ A ijjf,j ;\ H 0i: Ill t

Downloaded from Brill.com09/24/2021 10:22:25AM via free access 104 EASTM 18 (2001) thirst with desire to drink. This is called forearm cold sensation disorder (bijue ~~). This [tract] is responsible for [treating] illness generated in the heart [system]. [Its symptoms include] yellowness in the eyes, pain in the lateral costal regions (xie ~ ), pain and cold feeling at the medial back side of the upper and lower arm, hot [feeling] and pain in the palms of the hand. When [the qi level is abnormally] high, the [pulse] at the Qikou ~ P locus feels twice as large as at the Renying A ;!] locus. When [the qi is abnormally] low, the [pulse] at the Qikou locus is smaller than at the Renying locus.54

The collateral tract (bie 7.ltl )55 of the hand Shaoyin [tract] originates at what is called the Tongli [locus, HTS]. At one cun [inch] from the wrist, it crosses col­ laterally and moves upwards, following the [heart] tract to enter the heart. It collects to the base of the tongue and joins the eye complex. In repletion, it [gives rise to the uncomfortable feeling of] propping up in the diaphragm; in depletion, [the patient] cannot speak. Perform acupuncture one inch behind the palm, [be­ cause the tract] crosses the Taiyang [i.e. the small intestine] tract.56

The [cardinal] sinew [tract] of the hand Shaoyin [tract] originates at the palmar side of the little finger [and continues to] join the ulna. It goes up to bind with the medial side of the elbow. It continues upward and enters the armpit, intersecting with the hand Taiyin [tract]. It goes along both sides of the nipple and joins the chest. It proceeds through the diaphragm down to the navel. The diseases [of the cardinal sinew of the hand Shaoyin tract] are internal [feelings of] urgency (oppressive feeling,ji ~J. The heart [tract] is susceptible to accumulation disorder (ff:~). Downward [along the tract, i.e. arm] symptoms are inability to bend or stretch the elbow Cf~ ij,j m). When this [tract] is dis­ eased, there are [the symptoms of] propped and twisted sinews as well as pain in the sinews along the course [of the tract]. To treat this [disorder] apply heat nee­ dling and rapid pricking techniques. Use knowledge [about the effect] to decide about the frequency of needling [i.e. stop when the treatment begins to take ef­ fect], use [acu-points around the] painful region as [the choice of] acu-points. When [the heart tract] has accumulation disorder, then the patient spits blood, and has pus. In this case death is inevitable and there is no cure. The diseases of the [cardinal] sinew of the [heart] tract: At times when it is cold, then [the patient experiences] arching backward [of waist and back] and muscular contractures [i.e. muscle spasms and inability to flex and extend]. At times when it is hot, then [the patient's] muscles are slack and relaxed and he

54 This section is quoted with minor changes from the Huangdi neijing lingshu 10: 234. 55 It seems that the character bie >;~ should be replaced here by the character Luo *a. 56 This section is quoted with minor changes from the Huangdi neijing lingshu I 0: 269.

Downloaded from Brill.com09/24/2021 10:22:25AM via free access Asa/Goldschmidt: Changing Standards 105 cannot hold anything [in his hand]. His sexual organ is flaccid and useless. When there is a feeling of urgency in the yang [aspect], then the patient experiences arching backward. When there is urgency in the yin aspect, then the patient can bend but not stretch. Use red-hot needling technique [inserting red-hot needle to the locus] to treat [feelings of] cold and urgency. In case of heat the muscles are relaxed and the patient cannot hold objects. [In this case,] do not use heat nee­ dling. 57 This is called bi f¼ syndrome of the last winter month. In diseases of the heart tract the symptoms are: Pain in the chest, fullness and swelling of the hypochondriom [i.e. the lateral costal area], pain below the sides of the hypochondrium, the area between the breast, back, shoulder, and shoulder blade is painful, and the two upper arms have internal pain. If deficiency exists, then the chest and abdomen are extended. The areas below the hypochondrium and the waist pull each other and cause pain. For treatment choose either the Shaoyin or the Taiyang tracts. When there is blood on the underside of the tongue, then this is a symptom of transformation of the disorder. Lance into the cleft (xi ffl~) [acu-point HT6] until blood comes out.SB Heat diseases of the heart: First the patient is unhappy. Then after few days he has hot sensations. When the heat struggles [with the patient's own qi], this leads to sudden heart pains. The patient then has tendency to vomit, his head hurts, his face is red, and there is no perspiration. On ren 3:: and gui ~ [days]S9 the condi­ tion is serious, on bing )1g and ding T [days]60 the patient experi~nces heavy perspiration. If there is a back-flow of qi, then on a ren or gui day the patient will die. Needle the hand Shaoyin and Taiyang tract [i.e. the heart and small intestine tracts]. The Shaoyin tract of the hand is the heart tract. It travels from the abdomen to the arm. Its length is three chi [Chinese foot61] and five cun. Right to left all together seven chi. It includes a total of eighteen acu-points.

57 This section is quoted with minor changes from the Huangdi neijing lingshu 13: 321-322. 58 This section is quoted with minor changes from the Huangdi neijing suwen 22: 322. 59 The cyclic characters ren and gui are associated with water (kidneys) and water de­ feats fire (heart). 60 The cyclic characters bing and ding are associated with fire (heart), therefore the disease can get better. 61 The Chinese foot is equivalent to ten Chinese inches (cun). For a definition of the cun see above note 22.

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