Copyright © 2004 by MJM MJM 2004 8: 79-84 79 CROSSROADS: WHERE MEDICINE AND THE HUMANITIES MEET History of Medicine in China When Medicine Took an Alternative Path Francis F. Hong* INTRODUCTION shamans to communicate with the spiritual world [Felt]. Chinese legend has it that in the dawn of human It was a time when man believed that the dead civilization, Heaven sent sage-kings to the midst of influenced the living, and the supernatural world men, teaching them how to survive in the hostile world. controlled harvests, wars, and illnesses. Shamans The beginning of medicine was associated with one or offered prayers to the ancestors and God to gain their another of these sage-kings. Shen Nong, for example, favor. Some rudimentary medications, in the forms of learned the properties of each plant by tasting them, soup or wine, as well as primitive surgeries with stone thus discovering the use of herbs as drugs. Since then, needles and knives supplemented what propitiation medicine flourished. could not do (6). The development of medicine took a different path in Recorded Chinese history started around 722 BC China as it did elsewhere in the world. It devised a during the Zhou dynasty (11th century - 256 BC). system in which circulation of qi is paramount, and Medicine started to break away from religion and changes of yin yang dictate the health of the individual evolve into an independent field. Official archives from (6). It was not until the 18th century that Chinese that period recorded medicine as a profession apart gradually adopted modern medicine. While it is not from diviners, even dividing it into four kinds: within the scope of this paper to examine the reasons physicians, surgeons, dietitians, and veterinarians (2). for these changes, it intends to summarize the This was one of the most dynamic periods in Chinese evolvement of medicine throughout Chinese history. history (771 - 221 BC). Numerous schools of philosophies, including the most prominent THE BEGINNING OF MEDICINE Confucianism, Moism, Daoism, and Legalism, drew on It is impossible to decipher when medicine started ancient concepts to convey their ideas about nature, taking shape, but ancient myths seem to trace its human society and political system. Words such as dao, beginning to the Stone Age when Chinese converted qi, yin yang, and wu xin took on new meanings and from hunter-gatherers to farmers. By then, they had formed the basis of philosophical thinking. This trend accumulated enough knowledge to use nature to their inevitably affected medicine, as the same terms also advantage. Shen Nong's story of "tasting herbs", for found their way into medical theories. example, reflected how "man gradually learned to Qi, for example, which meant air or breath, came to recognize the properties of plants" after innumerable denote energy vital for human life. Yin and yang, which experimentation (4). originally described different exposures to sunlight, The first archeological evidence comes from the time of became opposite forces whose equilibrium in human Shang during the Bronze Age (16th - 11th century BC). body was vital for good health. Wu xin (five elements) In Shang era ruins, scholars found particles of seeds still became properties assigned to five solid organs (wu used extensively in Chinese medicine and stone-crafted zang); liver was associated with wood, heart with fire, instruments resembling surgical tools (4). They also spleen with earth, lungs with metal and kidneys with found the first medical records on oracle bones, used by water (12). These terms illustrated the belief that each part in the human body was intricately related to and To whom correspondence should be addressed: Francis Hong affected by one another. At the same time, email: [email protected] 80 McGill Journal of Medicine 2004 indiscriminative usage of such concepts for both human Texts dated from 2nd century BC warned against binge physiology and natural sciences underlined an ancient eating or drinking, spicy diet, overexertion, excessive Chinese belief that human and the universe were emotions, and extremes of temperature. At the same connected in mysterious ways (6). time, physicians also realized the importance of People had gained some elementary understanding hygiene. Governments constructed sewage systems in about human anatomy, and assigned physiological larger cities; people were advised to do regular house functions to these structures. Liver controlled blood cleaning and avoid drinking contaminated water (6). composition; heart controlled blood circulation and With the development of medicine, professional thinking; spleen controlled digestion; lungs controlled ethics also took shape. One text notes, "to make breathing; kidneys control water balance and sperm diagnosis without an adequate knowledge of Yin and production. Hollow organs such as stomach, gallbladder, Yang... is the first fault on the part of physician", "... to intestines, bladder as well as an imaginary "triple burner" advertise one's medical skills falsely, to apply needles or san jiao were grouped into liu fu, primarily responsible indiscriminately, to cause suffering to the patient for digestion, delivering nutrient or transmitting waste. unnecessarily, is to commit the second fault in There was also documentation of brain, pericardium, treatment" (8). uterus and their respective functions [Nei Jing]. Possibly during the 3rd century BC, medical The meridian or jing luo system was formed during professionals made a comprehensive review of the this period as well. The concept of meridians in the predominant theories and practices, by compiling the beginning referred to blood vessels but by 2nd century oldest Chinese medical text still in existence, Huang Di BC, it had separated from "blood pulse" or xie mai, Nei Jing or "Yellow Emporer's Classic of Internal indicating imaginary channels that transmitted qi and Medicine", which formed the basis of medicine for connected the organs [Jia 1979]. It was believed that qi Chinese physicians in the coming ages (13). In the and blood were transformed from nutrients (by the thousands of years that followed, Chinese medicine spleen) and air (by the lungs), then circulate in jing luo never deviated significantly from the basic framework xie mai around the body as dictated by the heart [Nei created during this period. Jing]. Acupuncture points were identified and placed along these meridians. THE DEVELOPMENT OF MEDICINE Diagnosis relied on four standard steps - inspection, The establishment of a unified Chinese empire in 206 listening, questioning, and palpation of pulses [Nei BC marked the end of five centuries of warfare amongst Jing]. Among these, the art of pulse palpation would Chinese states as well as the defeat of the Huns in the later on become much refined, requiring the physician west. Chinese intellectuals were finally able to focus on to distinguish between twenty-four different kinds of collecting and collating writings from the past wrist pulses. When combined with a detailed history, centuries, hoping to rediscover ancient wisdom that inspection of general appearance, especially that of the would serve them as guidance in every aspect of society eyes, the tongue and the hands, as well as listening of and individual life. Many of ancient compositions were patients' voice, Chinese medical practitioners were elevated to the level of reverence. Huang Di Nei Jing expected to find the diseased meridian (13). similarly gained this status and became the supreme Methods of treatment at the time included simple authority in the medical community. surgical procedures, acupuncture, moxibustion, drugs, Although the framework laid out by Huang Di Nei Jing as well as acupressure, physical exercises, was unchallenged, medical practitioners sought to hydrotherapy, even simple psychotherapy that uses incorporate new experiences as they put old wisdom to emotional adjustment to alleviate illnesses. practice. Nan Jing (Classic of Difficult Problems) of 1st Acupuncture as the core therapy, was quite refined by century BC reflected this development, as it sought to the end of 2nd century BC, involving nine different clarify old concepts and perfect the classical theories by needles and many techniques. Although the role of explaining and expanding on eight one passages herbal drugs was less significant, physicians had at their selected from Huang Di Nei Jing (12). Compared to disposal at least 50 regiments for oral ingestion, and Huang Di Nei Jing, the descriptions and treatments of more than 90 for external application (6). ailments were more detailed in this book, with most Physicians attributed causes of illness to seasons, known entities characterized and named, then sorted weather, diet, human activities and emotions, all of into more than thirty different categories (6). which disturb the balance between yin and yang, Due to its transmissible nature, one disease category, thereby affecting the flow of qi. They put preventative Shang Han Re Bing, which included mostly infectious medicine on the foremost position, stressing that diseases causing fever, was extensively studied, with diseases are better treated before their manifestation (7). their symptomatology, natural history and treatment Vol. 8 No. 1 History of Medicine in China 81 principles documented in Shang Han Za Bing Lun of these books recorded the progress of Chinese medicine the 2nd century AD. The value of this book, however, and represented some of the most sophisticated medical goes beyond